The autopsy showed chronic conditions: Emaciation. Brown atrophy of heart. Mitral and aortic valvular sclerosis. Chronic fibrous endocarditis. Aortic sclerosis. Coronary, pulmonary, carotid, and basal cerebral arteriosclerosis. Chronic diffuse nephritis. Chronic gastritis. Chronic adhesive pleuritis. Uterine polypi. Calcified lymph nodes in perirectal tissue. Hemangioma of liver. Chronic fibrous pachmeningitis. Diffuse cerebral atrophy. Acute conditions: Bilateral bronchopneumonia with acute bronchitis and lymphnoditis. Acute splenitis. Acute typhlitis and colitis. No cultures were taken. CASE VII.-D. I. H., 13358, Path. Lab. 1134. Woman, born 1840. Heredity: Unknown. Personal history: Largely unknown. Attack said to have been gradual in onset; 9 months before admission, about one year before death. Alcoholism probable. Disorientation, vagrant tendency, delusions of suspicion, wandering talk. Emaciation. On admission feeble, senile skin, arcus senilis, left eye enucleated, cataract of right eye, enlargement of finger joints. Radial arteriosclerosis. Gait tottering. Slight tremor of hands. Brisk knee-jerks and Achilles jerks, plantar reaction slight, abdominal reflexes absent. Delirium and restlessness, with occasional attempts to walk about. Visual hallucinations probable. Was able to obey a few simple directions. Few relevant replies could be obtained. Amnesia for recent events complete; a few isolated facts from past life were recalled. The patient remained completely disoriented for time, place, and persons; but her attention improved somewhat during the first week after admission. Motor restlessness occasionally appeared during December. Reactions occasionally suggested auditory hallucinations. Carcinoma of pylorus with metastatic nodule in stomach wall, Chronic fibrous endocarditis. Aortic and mitral valvular endocarditis with calcification. Coronary, pulmonary, basal cerebral (including primary branches), splenic, and renal arteriosclerosis. Slight hydropericardium. Scars of left apex. Bilateral chronic adhesive pleuritis. Chronic splenitis. Superficial fibrosis of liver, mesentery, and peritoneal wall. Left eye absent. Thyroid small. Irregularity in thickness of calvarium. Chronic fibrous pachymeningitis. Diffuse cerebral atrophy. Acute conditions: Bronchopneumonia of right lower lobe with lymphnoditis. Culture from cerebrospinal fluid yielded B. coli communis. CASE VIII.-D. I. H., 14099, Path. Lab. 1262. Woman, born 1838. According to patient father died at 72 of asthma. Mother at 50 of pleurisy, Two brothers were still-born; one lived 3 weeks. One sister alive at 65. No insanity or alcoholism in the family. At school till 16. Orthopedic operation at Massachusetts General Hospital in 1854. Occupation, housemaid. Since 1906 at Lynn poor-farm. Noisy and troublesome, singing and screaming at night. On admission emaciation, contractures of legs and right arm, radial sclerosis slight, prominent temporal arteries, pulse small, rapid, of low tension. Sensations adequate with rough tests. Left ankle-jerk and knee-jerk brisk. Plantar reflexes and right ankle-jerks not obtained. Deafness, facial muscles normal. Blind. Incontinence of urine and feces. Stereognosis for many objects good, but patient could not tell a cent from a quarter by touch, Amnesia for both recent and remote events. Memory somewhat better for remote events. Death August 16, 1908. The autopsy showed chronic conditions: Emaciation. Contractures of legs and right arm. Brown atrophy of heart muscle. Chronic valvular endocarditis. Aortic and coronary sclerosis with calcification. Chronic obliterative pleuritis (right) and adhesive pleuritis (left). Healed tuberculosis of apices. Generalized adhesions of peritoneum. Cholelithiasis. Chronic diffuse nephritis. Chronic atrophic hepatitis. Perforation of right tympanum. Slight diploë. 1 Cysts and calcified nodules in both ovaries. Acute conditions: Tuberculosis of lungs. (Tuberculous?) ulceration of transverse colon. Cystitis. Sacral decubitus. GENERAL CLINICAL ANALYSIS. SEX. This series of eight cases happens to be composed throughout of women. This fact is in accord with previous experience in the type of senile case termed by Kahlbaum presbyophrenia. Systematists like Kraepelin, for example, mention the predominance of females in presbyophrenia, but fail to note any sex differentiation in other mental disorders of the senium (senile depressions, deliria, delusional insanities). A peculiar fact looking in the same direction was the statistical point made two years ago by Mitchell and the writer,* viz., that the female brains accruing from a series of insanities developing in the sixth and seventh decades were more often atrophic (8 of 11) than the male brains (5 of 12). As we then pointed out, the average age at onset of the females (58.4 years) was not much different from the male average age (59.5 years). But the females survived after onset on the average 8.8 years, whereas the males survived on the average only 2.8 years. Assuming (what has not yet been proved) that a large series of statistics would yield similar results, we should be confronted with the problem how to explain the remarkable viability of females presenting the clinical features of senile dementia and pari passu undergoing cerebral atrophy. A large series of cases is strictly necessary for the solution of this problem. For the moment it is enough to call attention to the somewhat remarkable fact that of all the cases (42) agreed upon as senile dements at the Danvers State Hospital, 1904-8, there were eight cases which showed a relatively pure brain atrophy, and these eight were all females. HEREDITY AND ANTECEDENT FACTORS. The data concerning heredity are lacking in four cases. Two cases have no heredity of insanity, whereas two more have some |