It has not always been an easy task—this preparation of the American section of the epitome on psychiatric work. Year after year the writer has paused before that word “Progress'’ with a big “P,” obsessed by the limitations which it places on the subject-matter, perplexed at his inability to sift the wheat from the chaff, and to delineate clearly in all the activity called psychiatric only those features which surely made for progress.

The asylums for the insane, since their transformation, have become veritable hospitals; and the medical work, especially as regards the curable and improvable cases, approaches that of the ordinary hospital. The result is that the insane in all modern asylums are cared for and observed day and night, as in a hospital, and assiduous nursing is given alike to the excited, agitated, degraded, paralytic, turbulent, destructive, suicidal, etc.

During the year 1909 the scientific output has been highly satisfactory. Its peaceful termination was in marked contrast to the discomforts we have already experienced during the present year owing to the floods in Paris. The members of the Société Medico-Psychologique were not able to meet in January, and the Maison de Santé d'Ivry, founded by Esquirol, was suddenly inundated, an event which entailed the hurried removal of the patients to another establishment.

At the annual meeting of the German Association for Psychiatry, held on March 23rd and 24th, at Cologne and Bonn, the principal subject for discussion was the question of the connection between syphilis and general paralysis. The speakers were Plaut (Munich) and Fischer (Prague). Dr. Plaut came to the following conclusions: (1) Without syphilis no paralysis. (2) It is not improbable that during paralysis active virus still exists in the body, and spirochætæ are present. (3) There are not sufficient reasons for presuming there is a syphilis à virus nerveux. (4) The fact that, in those who afterwards became paralytics, the early symptoms of syphilis were singularly mild, suggests an abnormal predisposition. (5) The attempts to establish a connection between heredity, degeneration and temperament, or constitution and general paralysis, have had no definite results, and it would appear doubtful if there are sufficient grounds for accepting a peculiar predisposition of brain. (6) The exogenous influences (alcoholism, trauma, cerebral fatigue) have probably no essential effect, but act only as associated factors, diminishing the somatic and psychic resistance. (7) The variability of the syphilitic changes in the different stages of the disease does not appear to be caused by differences in the character of the spirochæte, but by a gradual change in the way the patient reacts, because this change of reaction leads to tertiary manifestations in only a small percentage of syphilitics, and a further change may lead to paralysis; it is not astonishing that only a small number of syphilitics become paralytics. (8) A number of considerations makes it probable that paralysis is preceded by preparatory syphilitic processes of a chronic kind; it is impossible to say if these are localised in the central nervous system or in any other part. The elapse of a long period of time between syphilitic infection and the onset of paralysis is perhaps explained by this circumstance. (9) The uselessness of mercury in paralysis does not disprove a connection between syphilis and paralysis, because of our ignorance of the pharmacology of mercury. (10) The decision whether the histological changes in paralysis are of a syphilitic character must be, and is, left to the anatomist. (11) The result of serum diagnosis points to a very close connection between syphilis and paralysis. Regarding this we have no clear idea as to the biological position of the reacting substances at present, but some day a definite answer will be forthcoming.