tions of the test and also to the laboratory worker and research man who can find a concise technic to follow and the bibliography including all of the important papers which have appeared on the subject renders easy access to explanations and views of different phases of the problem. BARNES. Thirty-eighth Annual Report of the Board of Commissioners of Public Charities of the Commonwealth of Pennsylvania for 1907; with the Report of the General Agent and Secretary, including Statistics of Hospitals, Asylums and Penal Institutions, and also the Report of the Committee on Lunacy. Transmitted to the Legislature, January, 1909. (Harrisburg, Pa.: Harrisburg Publishing Co., State Printer, 1909.) The second part of this volume comprises the 25th annual report of the Committee on Lunacy of the Board of Public Charities of Pennsylvania and occupies 102 pages. From it we learn that on September 30, 1907, there were 11,808 patients under care in Pennsylvania, 7091 being in State hospitals where they were cared for at an average cost of $3.99 per week. Various other statistical matters are briefly tabulated, and then we find brief reports, which are also somewhat descriptive, from the five private hospitals. The remainder of the volume is given over to statistical tables from the various institutions. The volume is well printed and bound. W. R. D. Forty-fifth Annual Report of the Trustees of the Boston City Hospital, with Report of the Superintendent, the Medical and Surgical Statistics, House Rules, with Rules for Admission, Discharge, and Government of Patients, etc. For the forty-fifth year, February 1, 1908, to January 31, 1909, inclusive. (City of Boston, Printing Department, 1909.) The above title fully describes the subject-matter of this well-printed volume of 174 pages. A large view and plans of the hospital and numerous half-tones of the newer buildings and wards illustrate graphically the size and material excellence of this great hospital. The statistics are also illustrated with diagrams which naturally impress them more upon the reader. It is with regret that we learn of the retirement of the superintendent and resident physician, Dr. George H. M. Rowe, on February 1, 1909. Under his wise supervision the hospital has been brought to the high rank which it now occupies. W. R. D. Abstracts and Extracts. A Study of Errors in the Diagnosis of General Paresis. By E. E. SOUTHARD. Journal of Nervous and Mental Diseases, Vol. 37, p. 1, January, 1910. Of 247 cases of insanity which were studied clinically at Danvers State Hospital, and which later were studied in the pathological laboratory from 1904 to 1908 inclusive, the number of paretics was 61, or 25 per cent, and they were tabulated as follows: Unexpectedly found post-mortem (in series of 186)... 2 Histopathological total 61 .2 plus 43 The errors of diagnosis found in the clinically certain group were in six cases, or 15 per cent, and abstracts of histories and protocols are given. The first case was presented in the JOURNAL, Vol. LXII, pp. 48-50, by Prof. A. M. Barrett, as a case of severe progressive arteriosclerotic brain atrophy with tabes-like complications, in his "Study of Mental Disease Associated with Cerebral Arteriosclerosis." These cases are summed up anatomically as: 1. Tabes dorsalis and severe progressive arteriosclerotic brain atrophy. 2. Cysts of softening in both dentate nuclei of cerebellum and diffuse brain atrophy. 3. Cerebral sclerosis. 4. Tabes dorsalis and slight atrophy of frontal, parietal, and temporal gyri. 5. Chronic spinal meningomyelitis, diffuse brain atrophy (especially prefrontal), and focal encephalomalacia. 6. Severe arteriosclerosis confined to dentate nuclei of cerebellum and slight sclerosis of right prefrontal and other frontal gyri and of right optic thalamus. Comment is made on the above cases and the author formulates the following conclusions: 1. An effort has been made to establish the accuracy of diagnosis in general paresis. The method has been to analyze clinically the data of cases in which several experienced workers had agreed upon the diagnosis and to compare their findings with the anatomical and histological data of the autopsies. 2. Thirty-five out of 41 cases unanimously diagnosed general paresis ante-mortem proved to be cases of general paresis (85 per cent accuracy). 3. Six cases of erroneous diagnosis have been especially studied. None of these showed plasma cells in the nerve tissues (Nissl's methylene blue and L. Ehrlich's pyronin methods), but all showed a variety of lesions which warrant placing them in an "organic" group. 4. The lesions probably responsible for the errors in diagnosis were: (a) Meningomyelitis and subcortical encephalitis (luetic?), case 5; (b) tabes dorsalis and non-paretic cerebral disease, cases 1 and 4; (c) arteriosclerotic brain disease with severe cerebellar involvement (dentate nuclei), cases 2 and 6; (d) cerebral sclerosis (type, perivascular gliosis), case 3 5. Although at first sight a probable error of 15 per cent in the diagnosis of general paresis might suggest difficulties in possible medico-legal cases, it is obvious that, were the diagnosis confined to "incurable insanity" or even to "organic brain disease," the error would disappear. However, two cases proved to be general paresis (on the plasma-cell criterion) in a series of 186 cases similarly examined in which the diagnosis of general paresis was not considered. 6. Improvements in our diagnostic ability could perhaps be introduced by lumbar puncture and cytological examination in a greater proportion of cases. But it is doubtful whether three of the six errors here studied would have been resolved by cyto-diagnosis (meningomyelitis, tabes dorsalis). One other case (6, arteriosclerotic brain disease) actually did show plasma cells in the lumbar-puncture fluid, the source of which was not made out at autopsy. W. R. D. Blutdruckmessungen an Geisteskranken. By W. MORGENTHALER Allgemeine Zeitschrift für Psychiatrie, 1910, Vol. LXVII, p. 1. Morgenthaler could not verify previous work by others, in reference to the relation of the blood pressure on the one hand and atmospheric pressure and temperature on the other, finding no uniformity in observations that might indicate any relation between the two groups of observations. The limits of variation from time to time are far wider in the psychoses as a class than is normal. High pressure is not a constant observation in melancholia and it is also often absent in cases where there is a depressive affect, and especially when with this is associated inhibition. When to a depressive affect is added an attack of irritability or Angst, the blood pressure rises. In maniacal-depressive the results are not uniform-there is not an inverse relation between the blood-pressure curve and the affective state. In epilepsy the pressure is increased during the attack and while gradually returning to normal after this it shows great variability. In general paralysis the author found that with excited and irritable episodes the pressure rose, and further, in this disease the limits within which variations occurred were far outside the normal. In dementia præcox there is nothing characteristic in the blood-pressure curve, and the only feature is that with Angst crises the blood pressure is increased. In post-apoplectic insanity just after a seizure the blood pressure is found to be increased. The Riva-Rocci instrument with a narrow (6 cm.) cuff was used. BARNES. Ricerche di sfigmomanometria e sfigmografia nei dementi precoci. By A. GRAZIANI. Rivista sperimentale di freniatatria, 1909, Vol. XXXV, p. 166. From a study of 21 cases the author concludes as follows: 1. The systolic pressure, though within the normal limits, tends to remain about the upper values. 2. The diastolic pressure varies similarly, but does not quite parallel the systolic. 3. The pulse amplitude remains within normal limits, varying with the systolic pressure and showing fluctuations during the day slightly more marked than normal. 4. Pulse frequency is a little above the physiologic mean and shows rather elevated daily variations. 5. Rhythm is rarely found disturbed. 6. Other pulse qualities in general show nothing characteristic of dementia præcox. 7. Catatonics are more prone to show these slight variations from the normal than are the other types. 8. There were no noteworthy changes in the heart and peripheral vessels. BARNES. Come si comportano, in relazione alle alternative di attività e di riposo, le misure sfigmomanometriche e dinamometriche nei malati di mente applicati at lavoro. By C. NENCI. Giornale di psichiatria clinica e tecnica manicomiale, 1909, Vol. XXXVII, p. 85. Using Riva-Rocci apparatus the author observed the blood pressure with relation to the alternating periods of repose and work. The dynamometric observations were of no particular correlative value. In 45 cases of varied psychoses, 28 showed a noteworthy increase in blood pressure on the work-day following a day of repose, 7 showed a fall, and in 10 no particular coincidence was noted. The blood pressure was found in general within normal limits with perhaps a tendency to remain about the higher normal limits. During work the pressure was maintained at a little higher level and always higher in the morning. The conclusions in part are as follows: 1. Alternating periods of work and rest exert a particular effect on the blood pressure in mental cases. 2. Pressure is lowered by prolonged rest and under the influence of the period of productive activity. 3. Habitual inactivity is accompanied by defects of pressure variation. 4. Pulse and respiratory rate and blood pressure seem to bear no uniform relation to one another. 5. In general, blood pressure in the employed insane tends to a level slightly above the mean normal and in the unoccupied the reverse is found to hold true. BARNES. |