After an introduction and historical sketch of this rare and interesting disease, the authors give a detailed analysis of the recorded fifty-seven cases as to aetiology, symptomatology, prognosis, diagnosis, and treatment. The aetiology rests largely upon a family predisposition of degeneration, plus a transient and slight excitant of the character of a toxic or autotoxic agent In the development of the disease epilepsy appears first a few weeks to several years in one half the cases; in rare cases the epilepsy ceases in later life. The epileptic attacks are usually grand mal in character, preceded by myoclonic spasms. For a greater or longer period of time after the fits the patient is free from his myoclonus. The myoclonus is often atypical in degree and character. There is usually much mental impairment attending the development and end of the disease. The prognosis is poor, yet life is often prolonged for years, the patient dying finally of inanition, pulmonary congestion, and premature senility. The children begotten of myoclonic epileptics usually die early of an intercurrent affection, yet they in turn may live to develop the disease. The disease has been found in many cases indirectly as well as directly transmissible. The disease is largely one of the family type of neurosis. The authors place emphasis upon the fact that faulty diagnosis is the result of laying too much stress on single symptoms of the disease. The treatment, while largely palliative, must be undertaken with great care in the proper use of large doses of sedatives. Bromides rank in first place. The hypochlorisation adjuvant principle is highly recommended. Cases not benefited by bromides are decidedly in the minority. Chloral in connection with bromides is recommended in stubborn cases. Care of the diet, general hygiene, and a non-stimulative country existence are found to give best results. The authors present three new cases, which, in addition to one previously reported by Clark, constitute the only cases of the association disease at present in the English language. A study of the cortex in one case under ideal conditions of methods was made, and lesions found were in the second and third layer of cells, those of sensory and motor type. The changes in the second or sensory type are those which the authors have previously urged as the characteristic lesion of epilepsy, while those in the third or large pyramid cell are charged to the myoclonus. The lesions as demonstrated by camera lucida drawings were a destruction of the intra-nuclear network and its replacement by a granular substance. As a consequence of this change in the cell, body abstraction of the nucleolus occurred easily and frequently in making the sections. The exhaustive lesion of chromatolysis was shown over the entire cortex. The pathogenesis of the association disease appears to be an intoxication or auto-intoxication of motor and sensory cortical cells, probably brought about by a faulty chemotaxis of such because of their inherent cellular anomaly.

This subject was chosen by Professor Cunningham for the third Huxley Memorial Lecture of the Anthropological Institute. He deals with it in a thorough manner and with wide knowledge of the extensive literature. He regards right-handedness as an organic acquirement of early man, due to natural selection. There is no good reason to show that monkeys are right-handed, and evidence obtained from Dr. Taylor, at the Darenth Asylum, showed that microcephalic idiots tend to be ambidextrous (five right-handed, four ambidextrous, one left-handed) The functional pre-eminence of the brain is the cause, and not the result, of right-handedness. Left-handedness may be regarded as due “probably to a transposition of the two cerebral hemispheres in the same way that transposition, either partial or complete, of the thoracic and abdominal viscera occurs.” It is noteworthy that there is a large proportion of left-handedness in those showing transposition of the viscera.

Autoscopy is an abnormal power of observing and representing the anatomical and functional state of the subjects own internal organs. If the representation is external, in a hallucinatory form, it is termed external autoscopy; if the observation is direct, it is termed internal autoscopy. The phenomenon, which occurs most clearly in the hypnotic state, is analogous, Sollier suggests, to the power shown in premonitory dreams, by which the disturbance of internal organs becomes definitely clear to sleeping consciousness before it is perceived by waking consciousness. Autoscopy was vaguely known to the ancient magnetisers; more recently attention was called to it by Féré; it has been most thoroughly studied by Sollier and Comar.

This is a report with full anthropometric details, and illustrated by two photographs, of a somewhat uncommon case of sexual abnormality with arrest of mental development.

The aim of this paper is to investigate the frequency of suicidal tendency in the insane, and the forms of mental disease in which such tendency is more common, and further to determine how often and under what conditions asylum patients find means to commit suicide.

In this paper, originally communicated to the Congress of French Alienists held at Grenoble in 1902, the authors record the result of an inquiry into the value of cytological examination of the cerebro-spinal fluid in general paralysis.

The patient was a child of 7 years, of good family history, both direct and collateral. No other members of the family suffered from epilepsy, and there was no evidence of syphilis. Somewhat slow in development, she began to walk and speak in her fourth year. About this time she would fall down with loss of consciousness lasting from five to six minutes. Bromide diminished these attacks, but afterwards marked convulsions developed, without aura or cry, with frothing at the mouth, incontinence of urine, marked prostration, and headache. Further symptoms supervened. On examination the patient was found to be well developed and nourished. Each three or four months she suffers from the convulsive attacks previously described. Percussion of the head causes the following phenomena:—A light blow on the scalp or face without warning to the child causes either an immediate fall or sudden and very marked trembling, and movements in the upper limbs are noticed. These bear no relation to the strength of the blow, and any hurt to the body produces no effect. Methodical percussion over the motor areas does not produce any isolated contraction. There is no difference on the two sides of the cranium. Excitement increases the effects. Anæsthesia of a skin area by chloride of ethyl produces no alteration. Electrical stimulation does not influence the condition. After the fall the child arose crying and agitated, the walk was uncertain and hesitating, the arms being used to balance, and she walked zigzag, as if the power of directing herself were lost—almost like a cerebellar gait.

In 1887 Korsakoff described polyneuritic psychosis as a special morbid entity, particularly characterised by amnesic disorders. Another name which he gave to this condition was toxæmic (psychical) cerebropathy. He recognised two varieties—one slight, characterised by amnesia affecting recent events; another severe, with marked amnesia accompanied by false reminiscences and delusions. This view has since been severely criticised by Babinski, Chaslin, Séglas, Ballet, etc., who maintain that practically this psychosis of Korsakoff is only a form of mental confusion, and in the two conditions one finds identical amnesic disorders.

The author observed 104 general paralytics, but only 30 of these passed through the three stages, the others dying either in the first or second stage; 750 successful observations were made altogether, from which the following important conclusions among others are made by the author. The light reflex is more often abnormal than normal, and the alteration is almost invariably in the sense of diminution. Diminution and abolition were about equally frequent, and mostly the same in the two eyes. Abnormality was found in about one fourth of the admissions. Certain differences in the frequency of abnormalities were found according to the form of general paralysis, and according to the apparent aetiology. In the first two stages of the disease the light reflex was more altered in cases exhibiting motor affection. No clear relation seems to have been observed between alterations of the light reflex and sensory affections, except that diminution of tactile sensation was associated generally with some abnormality of the light reflex or its abolition. While examination of the light reflex, by revealing frequent and early alterations, is useful in the diagnosis of doubtful cases of general paralysis, it is of no assistance in prognosis.

B. F—, female, æt. 33, admitted January 18th, 1903. Married in 1896; in January, 1900, miscarried at the third month and developed severe streptococcic infection with fever and delirium, which lasted fourteen days and nearly proved fatal. During her convalescence, one month after the miscarriage, she had a convulsive seizure with temporary paralysis of the tongue and right arm (for a few hours). These attacks recurred at intervals of three days to fourteen days, and were followed by various transitory paralyses. Her speech became difficult, her ideas confused. Later she had auditory hallucinations and delusions of persecution, and was sent to St. Jean Asylum on January 19th, 1902. On October 12th she returned home improved, but weak intellectually. Five days later she lost consciousness, and on the following day became maniacal and incoherent, and dirty in her habits; her legs were contracted; reflexes exaggerated; light reflex feeble. No history and no evidence of syphilis could be obtained on careful inquiry and examination.