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Considering these results collectively there are several points which may bear individual comment: (1) a tendency toward a low total nitrogen; (2) the undetermined rest is high and this is in part explainable by the fact that all urines excepting that of the first case (R. N. H.) showed traces of albumin with trichloracetic acid and that in these a few granular casts were to be made out with the microscope; (3) the neutral sulphur is in the majority of instances high, while the ethereal is low. The ratios show some interesting changes, although these are in any case very slight in amount. And particularly does this apply to the ratio of the total nitrogen to the total sulphur. As mentioned earlier in this paper, Folin, at the conclusion of a long series of experiments investigating the metabolism in a number of cases of mental disease, indicated that one of the most tangible points brought out was that in general paralysis there is a distinct though slight lowering of the N, SO, ratio. This was not the case in every instance of paresis, but occurred with such frequency that it seemed somewhat more than mere accident. In view of the figures given by Folin' for this particular ratio, those obtained with the five cases here observed assume a more definite interest, because in every instance the tendency is rather toward too high than too low a quotient. The average ratio for the period is in only one instance below 20, and in only two instances of 19 was it below 19. This ratio seems to be higher on some days when hyoscin-morphin had been given, but the relation does not seem to be constant enough to attribute the increase to the effect of the drug, and further, in the case of H. S. W., no drug was given, and here the ratio is still higher than normal in some instances although not much. One cannot help noticing the parallel in the increase in the ratio and the duration of the disease. In the first two cases, where the ratio is the highest, we find that the disease is not only farther advanced in time, but decidedly so clinically. The third case, on the other hand, is quite early and here the ratio remains well within normal limits. The last two cases occupy an intermediate position. This apparent parallelism may be but a mere coincidence, because when this point is looked up in the cases published by Folin it is not possible to find such close relations in the different cases, although
'Folin: The American Journal of Insanity, 1904, LXI, p. 317.
in one or two experiments this feature was evident. Whatever the explanation may be, it is shown by these cases that a high nitrogensulphur ratio often occurs in cases of general paresis and that the reverse of this cannot be considered peculiarly indicative of this disease.
In this disease it would appear that there are wide daily variations in the amounts of the urinary constituents excreted which are not entirely explained by the action of the drugs given during these experiments, although a certain amount of the variation must be attributed to this source. Further, it would seem that this deviation from the normal tends to be more extensive in proportion to the advancement of the disease, both as regards time and symptoms.
The cytologic examination of the blood did not offer any points of additional value over those which have been indicated by a great many previous papers, so that the details will not be given. It may be mentioned, however, that in the more advanced cases there seems to be a more definite tendency toward an increase in the total number of cells and also particularly in the number of polymorphonuclears. Also, in the more advanced cases of this series degenerative forms of leucocytes are much more common, so that fragmented and poorly stained cells are very frequently encountered.
Notes and Comment.
GERMAN TRANSLATION OF DR. PANDY'S BOOK.-In the issue for July, 1906, the work of Dr. Kalman Pandy, "Gondoskodás Az Elemebetegekröl Mis Allambokman Es Nálunk " (The Care of the Insane in Foreign Countries and in our Own) was reviewed. In this book he showed a very complete knowledge of the subject from personal observation and a remarkable familiarity with the encyclopedic works of Tucker ("Lunacy in Many Lands") and of Letchworth ("The Insane in Foreign Countries"), whose authors had visited the same institutions. Unfortunately Pandy's work was published in Hungarian and consequently inaccessible to nearly all readers outside of Hungary. We are glad to be able to announce a second edition of the work revised and much enlarged by Dr. Pandy and translated into German by Dr. Engelken, Jun., of Alt-Scherbitz and published in a handsome volume of six hundred pages with fifty illustrations by Reimer of Berlin. It is practically a new work and deserves to be better known by all who are interested in the care of the insane in other countries. It is entitled "Die Irrenfürsorge in Europa" and gives a very full and carefully considered account of the care of the insane in Denmark, Sweden, Norway, Scotland, Ireland, England, Holland, Belgium, France, Germany, Austria, Hungary, Switzerland, Spain, Portugal, Italy, Greece, Roumania, Turkey, Russia, and Finland. There is also a final chapter on the Family Care of the Insane Throughout Europe." It is very interesting to observe how closely his conclusions confirm the painstaking accounts given by our own countryman, William Pryor Letchworth, who did so much by his admirable work to bring the methods of foreign hospitals for the insane to the knowledge of alienists in this and other English-speaking countries. It can but be most gratifying to him in reviewing the incidents of a life devoted to the betterment of the care of all sorts and conditions of men to feel that his self-denying labors in behalf of the insane are so widely known and appreciated both at home and abroad.