Dr. de Montyel gives the results of his investigations on the sixth of the reflexes which he undertook to study in general paralysis. The discrepancies noticed in the conclusions of many other observers are attributed to their studying patients in various stages; in all researches of this nature it is indispensable to follow the only method susceptible of furnishing data which may be compared with one another,—that is, following up and examining the same patients from the onset to the termination of the disease. Out of 104 cases of general paralysis this method was satisfactorily carried out in the case of thirty only, the others having succumbed either in the first or second stage; 680 satisfactory observations were made, and the results of these are carefully tabulated. The following are some of the author's general conclusions:—Accommodation is more often abnormal than normal in general paralysis; exaggeration of the reflex is rare; diminution is twenty-four times more frequent—abolition being slightly more common than simple diminution. The reaction is nearly always equal on the two sides; in a few rare cases one finds normal accommodation on one side and abolition on the other. In the early stage only does one find normal accommodation more frequent than abnormal; but in the second, and more so in the third stage, abnormality is the rule. Abolition is commoner in the late stage. In more than a third of the remissions there was abnormality. Certain differences in the accommodation reflex are found in the various forms of the disease; it is more often and more profoundly altered with conditions of excitement. As regards the ætiology the reflex was always found abnormal in traumatic general paralysis; next in frequency (i. e. after abnormality of reflex) comes the alcoholic form. Alteration of the reflex is common with cases at the extreme ages of incidence of the disease (after fifty and below thirty). Accommodation was more often and more profoundly affected in the first two stages of general paralysis in proportion to the impairment of motor power. The investigation of the accommodation reflex on account of its frequent and early alterations may be helpful in the diagnosis of doubtful cases, but it affords no indication as to the slow or rapid evolution of the disease. H. J. Macevoy.
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