From the beginning of the year 1889 to the end of 1899, 128 cases of progressive paralysis came under observation in the German Tirol; out of this number there were 104 men and 24 women. The amount of insane patients during these eleven years came to 5·4 per cent.; out-patients as well as in-patients were included in this calculation. The age at which the disease made its appearance varied between thirty and sixty-four.

This thoughtful paper treats of the different characters of nervous diseases manifested in women from those in man. It groups the mental alienations of women into six classes, distinguished by temperament, and profound alterations of constitution brought about by disease. In the mental derangements of the female, observes the professor, there is a more pervading change in the whole temperament, not only mental perversions, but a multiplicity of organic sensations which act upon the entire personality, inducing states of exaltation and depression, emotions of joy and grief, of fear and anger. These complex changes sometimes culminate in the reeling of altered personality. The structural differences between the male and female render the latter less able to react upon external nature. Her frame is adapted to maternity, conception, gestation, labour, lactation; then the renewal of the periods induces profound changes in her organism. These functions affect even the disposition of the bones and ligaments, the increase and diminution of the unstriped muscular fibres, the activity of the sympathetic ganglia, the vascularisation of organs, and the augmented cellular secretion and enlargement of the glands. The totality of changes, so diverse and profound, subject the feminine constitution to grave fluctuations, which alter its relations to the outer world and affect the psychical manifestations.

Dr. Henneberg has read deeply in the extensive literature of spiritualism and occultism. He treats of table turning and spirit rapping, and what he calls psychographs, in which the subject, believed to be in a trance, writes to the dictation of the spirits of the dead. He mentions cases in which the mental derangement resulted from being hypnotised. Persons who practise these so-called communings with spirits have fallen into hysterical conditions. Some of these were previously disposed to neurosis, so that the tendency was merely aggravated. In other instances hysteria appeared as the result of these practices in persons previously healthy. Dr. Henneberg gives in detail the description of eight cases in which insanity was the result of concentration on spiritualistic experiments. He observes that it is the duty of the physician to warn persons disposed to nervous diseases against any dealings with mediums, magnetisers, and faith healers, who work on the imagination.

The subject of this paper who records her own experiences was a Miss L. S—, described as a highly gifted and well-educated lady. She was admitted to the asylum at Zürich, December 21st, 1882, being then thirty-two years of age. There was a record of insanity in her family. As a child, she was intelligent, imaginative, and impressionable, unpractical, not good at arithmetic, but fond of drawing. As she grew up, she had religious scruples and doubts, especially about the time of confirmation. She was affected by listlessness and melancholy. At her own request, she was sent to a parsonage in the Pays de Vaud, where the cloud soon passed away. When twenty-one years of age, L. S— visited Italy. Amongst her Italian studies she read the Decameron. This book did not affect or excite her at the time, but left much that was impure in her memory, which had an evil effect in later days. She never read any other books of an indelicate character. She fell in love with a man with whom she used to study, who was nine years younger than herself. Apparently they were engaged to be married. He became insane, which deeply affected her. Before her own mental derangement she had a lasting dull headache, especially at the occiput, and sometimes pains and peculiar feelings in the head, but the attack of mania came on quite suddenly. When admitted to the asylum, she was very much excited, and seems to have been put under restraint and treated with the Deckelbad (the warm bath), the head remaining uncovered through a lid. She describes her terrors, the chain of ideas which rushed through her mind. She recalls that she used many words to which she gave quite a different meaning to that they usually bear; some of them were of provincial or of foreign origin. She did not think she was insane nor recognise her excitement, and was surprised that people were afraid of her. She could, however, appreciate the mental alienation of her fellow-patients. She took great pleasure in feeding birds; she had many hallucinations and dreams which passed into her memory as illusions. She heard voices though she denied it. Her hallucinations or delusions were of various kinds and degrees, rising from mere suppositions to convictions; sometimes when spectral figures appeared to her she would guess who they were, try to identify them with real persons; for example, she saw an elderly woman of commanding aspect, very pale, and dressed in white robes, whom she supposed might be Queen Elizabeth of England. In honour of this personage she thought she saw a young horse sporting about in the sea. Looking out at the window of her cell, she saw the figure of a little grey monkey, of almost human expression, rising from the ground, and making signs for her to come away with it. This she felt willing to do, and thought that there was a kind of understanding between them. Another time, she thought that she was in purgatory, and that her companions in the asylum were going through penance there. She believed that she saw Pope Leo XIII, Dante, St. Catherine of Siena, and Francis of Assisi, and nourished the delusion that her grandmother was the original of Gretchen in Faust, and that her family were connected with Goethe. She thought that the currents of air which passed through the gratings were intended as signals from persons who wished to help her, and she stuck little things in the wire to keep up the correspondence. The birds who flew about the windows she took as messengers of freedom. She heard a tumult outside which she believed to be caused by anarchists, and a hollow voice as if preaching, but so quietly that she could not follow the words. She also heard noises like that of machinery. She thought that her teeth had been so calcified that they were all grown together, and expected them to be forcibly separated. A large number of hallucinations and delusions are tabulated in a brief form. After thirteen months' detention in the asylum she was discharged cured, and although nearly twenty years have now elapsed, she has had no return of mental derangement.

The subject of this paper who records her own experiences was a Miss L. S—, described as a highly gifted and well-educated lady. She was admitted to the asylum at Zürich, December 21st, 1882, being then thirty-two years of age. There was a record of insanity in her family. As a child, she was intelligent, imaginative, and impressionable, unpractical, not good at arithmetic, but fond of drawing. As she grew up, she had religious scruples and doubts, especially about the time of confirmation. She was affected by listlessness and melancholy. At her own request, she was sent to a parsonage in the Pays de Vaud, where the cloud soon passed away. When twenty-one years of age, L. S— visited Italy. Amongst her Italian studies she read the Decameron. This book did not affect or excite her at the time, but left much that was impure in her memory, which had an evil effect in later days. She never read any other books of an indelicate character. She fell in love with a man with whom she used to study, who was nine years younger than herself. Apparently they were engaged to be married. He became insane, which deeply affected her. Before her own mental derangement she had a lasting dull headache, especially at the occiput, and sometimes pains and peculiar feelings in the head, but the attack of mania came on quite suddenly. When admitted to the asylum, she was very much excited, and seems to have been put under restraint and treated with the Deckelbad (the warm bath), the head remaining uncovered through a lid. She describes her terrors, the chain of ideas which rushed through her mind. She recalls that she used many words to which she gave quite a different meaning to that they usually bear; some of them were of provincial or of foreign origin. She did not think she was insane nor recognise her excitement, and was surprised that people were afraid of her. She could, however, appreciate the mental alienation of her fellow-patients. She took great pleasure in feeding birds; she had many hallucinations and dreams which passed into her memory as illusions. She heard voices though she denied it. Her hallucinations or delusions were of various kinds and degrees, rising from mere suppositions to convictions; sometimes when spectral figures appeared to her she would guess who they were, try to identify them with real persons; for example, she saw an elderly woman of commanding aspect, very pale, and dressed in white robes, whom she supposed might be Queen Elizabeth of England. In honour of this personage she thought she saw a young horse sporting about in the sea. Looking out at the window of her cell, she saw the figure of a little grey monkey, of almost human expression, rising from the ground, and making signs for her to come away with it. This she felt willing to do, and thought that there was a kind of understanding between them. Another time, she thought that she was in purgatory, and that her companions in the asylum were going through penance there. She believed that she saw Pope Leo XIII, Dante, St. Catherine of Siena, and Francis of Assisi, and nourished the delusion that her grandmother was the original of Gretchen in Faust, and that her family were connected with Goethe. She thought that the currents of air which passed through the gratings were intended as signals from persons who wished to help her, and she stuck little things in the wire to keep up the correspondence. The birds who flew about the windows she took as messengers of freedom. She heard a tumult outside which she believed to be caused by anarchists, and a hollow voice as if preaching, but so quietly that she could not follow the words. She also heard noises like that of machinery. She thought that her teeth had been so calcified that they were all grown together, and expected them to be forcibly separated. A large number of hallucinations and delusions are tabulated in a brief form. After thirteen months' detention in the asylum she was discharged cured, and although nearly twenty years have now elapsed, she has had no return of mental derangement.

The author describes one case of idiocy combined with athetosis, and gives a summary of the contributions which have been made to this subject. The number of autopsies of double athetosis is small. The lesions found in athetosis have been mainly of a hæmorrhagic character, though a few cases of atrophy and asymmetry of the brain, cerebellum, and bulb have been recorded. Athetosis is not infrequently met with in paralytic idiocy, although it often occurs where the intellect is not impaired. It seems needless, therefore, to treat what is merely a symptom of cerebral or nervous irritation as a concomitant of so profound an affection as idiocy.

He has made a careful study of twenty-two cases of this malady. Most of his material is taken from the hospital at Merxhausen, which receives incurable insane females from the province of Hessen and the principality of Waldeck. Out of 700 patients, there were 185 idiots, 22 of whom, i. e., about 12 per cent., were affected with cerebral paralysis. He deals with all the symptoms and pathology of the affection. In such cases the paralysis and idiocy is complicated by a variety of nervous symptoms, especially with epilepsy, which affects at least half the patients, and helps to increase the mental deficiency. Dr. Wachsmuth's paper fills forty-four pages. His experience leads him to confirm the observation of Bourneville, that epilepsy generally disappears between the fortieth and fiftieth years of life. A great part of our cases, he observes, have already passed this age, and they have no more epileptic attacks. In other instances a diminution of the epileptic attacks has been observed. Many of the cases of cerebral paralysis are regarded as being the sequel of encephalitis, sometimes caused by infectious diseases. Wachsmuth does not consider the amount of paralysis is a measure of the mental deficiency. This study of the subject has induced him to divide his cases into four classes.

The author describes two cases, the first, a man, æt. 31, who died after fourteen months' illness, with well-marked symptoms of general paralysis. Ten days before death various groups of muscles of the right side of the body (those supplied by lower branch of facial nerve, those of right side of tongue, external abdominal oblique, serratus magnus, biceps cruris, flexors of forearm) were affected by clonus, irregular, with short but distinct intervals; the clonus ceased with sleep, and had no effect on the movement of the muscles. It continued till his death. In the second case, a man, æt. 39, the muscles of face were first affected, and, after a short interval, the right side of body. The movements were arythmic, irregular, and rapid, diminished by movement, increased by an emotion; they ceased in sleep. The pectorals, the abdominal oblique (120 contractions per min.), the extensors of the forearm, and the adductors of the thigh (150 per min.) were all affected. Athetosis, affecting right hand, on one occasion supervened. The clonus later spread to left side of body. During the later stages of the illness they reappeared for a third time. The author points out the relative infrequency of the condition associated with the psychoses. He compares at considerable length the clonus with the allied muscular tremors in chorea in its various forms, and with the group of misclonus associated with epilepsy with a view to establishing the seat of the lesion. This is concluded to be in all these cases probably cortical.

The notes of three cases are given, preceded by an account of the observations made by others on this subject—Esquirol, Sérieux. Psychomotor hallucinations, verbal and graphic, appear to be rare in general paralysis, although one must not lose sight of the fact that their diagnosis in this condition is difficult, either on account of their transient character, or on account of the dementia of the patient.

The author has studied the condition of the genital sense in 108 general paralytics in relation to age, form of mental disorder, etc., and draws certain interesting conclusions. He finds that, for example, the self-satisfaction of general paralytics and their delusions of great physical strength are not due to genital over-activity. That disorders of the genital sense are not related to alterations of touch sensation or of sensation to pain, as has been held by some observers. In seven cases, especially where delusions concerning the genital organs were prominent and spontaneously related (notes given), it appears clear after reading the account given that the genital delusions have no physical basis, and do not seem to be related in any way with the state of the genital organs. Dr. de Montyel finds no relation either between the condition of the genital sense and the subjective sensations felt in the skin by certain general paralytics. Alcohol, of all causes, apparently is most frequently responsible for alterations in the genital sense, more especially in the direction of increase.