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psychoses, it is thicker and more opaque than normal, the author states that it is difficult to decide just when the membrane is thickened, as there is variability in each individual case. The inner surface of the membrane is usually smooth and glossy, it may be rough, or it may exhibit deposits varying from slight films to thick, pulpy, highly vascularized, newly-formed membrances, lying in layers, and are the seat of hæmorrhage; a hæmatoma is rarely met with. The dura may display no changes or along the middle line it may be adherent to the pia around the pachionian bodies, which are occasionally larger than normal.

With the naked eye also, one may observe that some of the larger vessels when cut across show changes which are seen in senile conditions. A fairly uniform thickening of the inner coat of the vessels can also be observed. The brain substance itself usually appears softer in consistency. The narrowing of the frontal convolutions and diminution in weight is also spoken of.

Going on to a discussion of the microscopic changes observed, the author first reviews the ground covered by early investigations and cites the opinions put forward by them. That the pia-arachnoid is thickened and that connective tissue proliferation is going on is next observed. The cells found in the pia are enumerated and mention is made of the gitterzellen of Juliusberger and Boedecker. The close connection between the pia and the cortex due to the more intimate connection of glia and piaarachnoid because of the increase in adventitia in the pial vessels, and because of glial proliferation is then noted. The changes in the cerebrospinal fluid are next referred to and the value of early lumbar puncture mentioned.

The pathologic alterations in the intracranial vessels, and especially the presence of plasma cells in the vessel walls, is dealt with at some length, and the author reiterates the doctrine: "no general paralysis without plasma cells." Various views as to the origin of the plasma cells are cited, but one is unable to ascertain what the author's own views on the subject are. The distribution of the plasma cells in dense clusters about the vessels is mentioned. They are distributed generally throughout the cortex. The author has never observed them in the lumina of vessels, nor very close to the lumen in the wall of a vessel. Lymphocytes and mastzellen are also occasionally seen. Proliferation of adventitial nuclei in the smaller vessels is sometimes seen. Hyaline degeneration is also seen in certain cases. The fact that newly formed capillaries are formed, and further that, the view has been expressed that glia cells come forward to give support to the newly formed capillaries, their cell bodies being permeated by endothelial cells which circumscribe the lumen of the new capillary, causes the author to express the opinion that the budding cells from the capillaries make their way between, not through, the glia cells.

The author's view regarding the presence or absence of arteriosclerotic changes in vessels in cases of paresis are: the endothelium does not seem to be altered, a newly formed layer is to be found between the elastic layer

and the endothelium. This new layer consists of a fibrillar ground substance and numerous cells. The ground substance is poorly developed and consists of huge bundles of fibres. The fibres, as a rule, do not give the staining reaction of elastic tissue, but occasionally do. The changes in the elastic membrane are chiefly due to the development of a new layer which develops inside the inner lamina of the membrane. Changes sufficient to cause the obliteration of the lumen of a vessel seldom occur. There are not traces of fatty or calcareous degeneration. The muscular coat sometimes shows a narrowing and occasionally a wasting. An increase in the thickness of the adventitia is seen, caused by a connective tissue proliferation and cellular invasion of the adventitia by plasma cells, and lymphocytes occurs also at times. The author concludes his remarks on the vascular changes by saying "nothing definite can be said about the nature of vascular changes until further investigations have been made," etc.

The proliferative glia changes are then dealt with. The glial increase is chiefly seen where the morbid processes are going on afresh. The presence of the stäbchenzellen of Nissl is spoken of, and the author says that it is possible that later it will be found that they are of connective tissue origin. In describing the changes in the nerve cells the writer follows Nissl, describing "cell sclerosis"; fading of the cell and later liquefaction and the diminution in size of the nucleus. Acute cell disease is not infrequently and very occasionally granular decay and cell shrinking are seen. More marked and more widespread changes may occur if the process has gone on for a long time. The destruction of the medullated nerve fibres as described by Exner and Tuczek is then mentioned.

The tissue changes in the cortex in paresis are usually diffuse, the glia proliferation and destruction of medullated nerve fibres are consequences of changes in the nerve cell. But the only characteristic change which could be said to be due to general paralysis the infiltration by plasma cells of the adventitial lymph spaces, and the dense aggregation of plasma cells must be considered as a peculiar inflammatory condition-diffuse in character and this is the point in the anatomical differential diagnosis between paresis and similar changes in arteriosclerotic psychosis, chronic alcoholism and epilepsy and from non-inflammatory forms of cerebral lues where there are widespread changes without adventitial infiltrations.

It is noted, however, that there are certain acute and sub-acute nonpurulent forms of encephalitis in which the cell infiltration can no longer be made the criterion; then the whole pathologic picture must be observed and the fact that the paretic process is usually diffuse and an encephalitis is local, also aids in differentiation. The diagnosis is difficult in cases of the inflammatory forms of cerebral syphilis, but here again the process is not diffuse. Of the various etiologic factors the author regards syphilis as probably a necessary condition for the onset of paresis, and Kraepelin's view that it is a general disease of metabolism, is quoted. Discussing the bacillus paralyticans of Ford-Robertson the author, although he has

evidently had opportunities of studying the micro-organism in Robertson's laboratory, does not express any positive view in the matter, but hopes the investigations will be carried further and taken up by other pathologists. The author, in the concluding paragraph says, "One thing ought to be considered an established fact, that the pathology of general paralysis can only be established by investigations which are founded on the doctrine that this insanity is a general disease." Five plates in the text and a profuse bibliography are the other features of the article.

FITZGERALD.

Pamphlets Received

Annual Report of the Library Committee of the College of Physicians of Philadelphia for the Year 1905.

Memorias De Los Medicos de la Casa de Orates De Santiago Correspondientes Al Ano 1905.

Movimento De La Casa De Orates de Santiago En El Ano 1905, Officio del Administrador de la Casa al senor Intendente.

Proposed Regulation of the Practice of Medicine and Surgery in Pennsylvania in the Eighteenth Century. Charles Perry Fisher, M. D. Reprinted from Medical Library and Historical Journal, April, 1905.

The Indiana Bulletin of Charities and Correction. Board of State Charities. Extra State Conference Number, August, 1906.

A Case of Narcolepsy, from a Specific Infection Transmitted Through Five Generations. Albert N. Blodgett, M. D. From the American Journal of the Medical Sciences, August, 1906.

Pathology of General Paralysis of the Insane. John D. O'Brien, M. D. Reprinted from American Medicine, Vol. X, No. 13, pages 530-532, September 23, 1905.

Some Further Observations of the Pathology of General Paralysis of the Insane. John D. O'Brien, M. D. Reprint from the Ohio State Medical Journal, September, 1906.

Howe's Handbook of Parliamentary Usage.

Eleventh Annual Report of the Lanark District Asylum, Hartwood, for 1905-1906.

Physical Economics. Erastus Eugene Holt, M. D. Reprinted from The Journal of the American Medical Association, July 21, 1906, Vol. XLVII, Pp. 194-204.

The Bulletin of the University of Nebraska College of Medicine. Published by the University. Vol. 1, No. 4, October, 1906.

Ear Affections and Mental Disturbances. By Emil Amberg, M. D. Reprinted from the Journal of Nervous and Mental Diseases, September, 1906. First Biennial Report State Hospital for Inebriates, Knoxville, Iowa. For period ending June 30, 1906.

The Tragedy of Chicago. A Study in Hypnotism. How an Innocent Young Man was Hypnotized to the Gallows. Denouncements by Savants. J. Sanderson Christison M. D.

Physicians' Visiting List, 1907. P. Blakiston's Son & Co., Medical Publishers.

Education in Sexual Subjects. By Ferdinand C. Valentine, M. D. Reprinted from the New York Medical Journal for February 10, 1906.

The American Urological Association. Fred C. Valentine, M. D. Reprinted from the American Journal of Urology, August, 1906.

The Venereal Peril in Its Relation to the State. Fred. C. Valentine, M. D.

The Prevention of Venereal Diseases. Fred. C. Valentine, M. D., and Terry M. Townsend, M. D. Reprinted from the Ohio Sanitary Bulletin for March 1906.

Urethral Dilatations with Expansible Instruments. By Fred. C. Valentine, M. D., and Terry M. Townsend, M. D. Reprinted from the American Journal of Surgery, January and February, 1906.

Sixty-third Annual Report of the Utica State Hospital, at Utica, N. Y., to the State Commission in Lunacy for the year ending September 30, 1905. Biennial Report of the Board of Trustees of Milwaukee Hospital for Insane for the two years ending September 30, 1904.

Practical Disinfection. Circular Issued by the Illinois State Board of Health, 1906.

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