The author singles out the new edition of Nonne's Syphilis und Nervensystem, and a new book by Wilhelm Gennerich, Die Syphilis des Zentralnervensystems, which he regards as the most important work on neuro-syphilis published to date.

The present article is chiefly concerned with those thyroid abnormalities which have been found associated with the so-called affective psychoses. The author himself has met with many cases of melancholia, hypomania, and anxiety psychosis, which, at the same time, were goitrous. Thus in a case of agitated melancholia presenting thyroid enlargement with signs of hyperthyroidism, complete mental recovery followed the removal of a thyroid cyst. In another case of melancholia with a large goitre the latter was treated by radio-therapy, with the result that the signs of hyperthyroidism diminished and the melancholia disappeared.

The writer's experience shows the need of co-operation between magistrates and alienists. Representations which led to legal investigations were made by the former confederates of an alcoholic woman who was improving rapidly in the sanatorium of Fort-Jaco. The inquiry was conducted in a spirit of antagonism and suspicion which spread discontent among patients. The removal either home or to the asylum was ordered of certain patients well suited to sanatorium care who had not asked to go. These included chronic psychoses without anti-social conduct, paranoias, simple dementias, transitory and curable psychoses, etc. In particular the removal home as mentally fit and wishing to leave was ordered of a blind paraphrenic who made a stereotyped demand for discharge to go to “X, where she had the freedom of the city,” but who remained, though she carried the writer's signed permit, and who refused to depart with her friends. Other cases, unable to exercise volition (e.g., of stupor) were to be certified.

This plea for greater use of the opportunities which hospital control affords for the diagnosis and treatment of syphilis is based on replies to a questionnaire sent to institutions for the insane and mental defectives in U.S.A. and Canada, and on personal experience as superintendent of Dannemora State Hospital. At Dannemora, of syphilitic cases which received adequate treatment (limited by expense to 25 per cent.), with the exception of paretics, all responded by changes in the Wassermann reaction of blood and spinal fluid and by physical improvement, and nearly all by mental improvement, usually preceded by temporary loss of weight and occasionally by transitory mental exacerbations. Reports of four cases are given as examples. Treatment, the details of which are described, consisted in four courses of neo-arsphenamide given intravenously combined with mercury salicylate intramuscularly and sodium iodide by mouth, and with attention to diet and hygiene. Some paretics showed reductions in Wassermann, blood-count and globulin, but not in gold curve, nor has there, as yet, been a cure. General paralysis, however, is simulated by curable forms of neuro-syphilis. Syphilis may be a factor leading to loss of mental balance even without actual cerebral infection. A routine Wassermann test should be made on all inmates, and all serologically or clinically syphilitic should receive intensive treatment.