Ulnar symptom normal in four per cent. of cases, weak in forty per cent., lacking in fifty-six per cent. In nonparalytics it was normal in thirty-three per cent., weak in fifty-two per cent. and absent in fifteen per cent.

Besides this Snell gives in a table the results obtained by him in the various diseases examined:

From these results we may conclude with Cramer that, compared with other forms of mental alienation, ulnar analgesia is most frequent in progressive paralysis.

Orschansky (4) has published a published a series of researches carried out by him in Mendel's polyclinic, on sane individuals, on twenty cases of tabes, and on many individuals with other diseases. He arrives at the following conclusions: "Analgesia of the ulnar nerve is not at all characteristic of tabes, as in many diseases which are not nervous in origin the pain reaction is altogether absent, while, on the contrary, in a certain number of cases of tabes it is neither lessened nor absent."

Boedeker and Falkenberg, (5) from results arrived at by them very different from those reached by Cramer and Snell, conclude that the ulnar reaction is not typical of progressive paralysis nor can it be adopted as a means of differential diagnosis. In fact they obtained this analgesia, in the investigation of one hundred paralytic men and twenty-five women, in respectively fifty-eight per cent. and fifty-six per cent. of the cases while in two hundred psychopathic men and one hundred women there were respectively thirty-nine per cent. and thirty-three per cent.

Hillenberg (6) attaches great importance to this symptom as a criterion of differential diagnosis, and obtained from sixty paralytics the following results: Forty-three had complete unilateral analgesia, seven had diminished

dolorific reaction and five had unilateral analgesia with diminished reaction on the other side, in all fifty-five or 91.6 per cent. On the other hand in the psychopathic patients 83.4 per cent. of the cases presented a normal ulnar ⚫ reaction. In epileptics on whom he made separate researches he found the analgesia in 76.9 per cent. of the cases in men and 70.07 per cent. in women or an average of 75.4 per cent. of all cases.

The researches of Göbel (7) give the following results: In fifty-four cases, forty-seven presented total analgesia or 87.3 per cent., two had analgesia on one side, i. e., 3.5 per cent. and five reacted normally or 9.2 per cent.; in women also affected with paralytic dementia, 81.9 per cent. gave the pain reaction, in 13.6 per cent. there was total analgesia and in 4.5 per cent. unilateral analgesia, a result altogether opposed to those previously obtained.

Obregia (8) observes that analgesia is very frequent in progressive paralysis (88 per cent.).

Hess (9) brings statistics to prove that "analgesia of the ulnar nerve is one essential peculiarity of paralysis particularly of men"; in thirty cases, he found total analgesia in twenty-two, unilateral in one; in all, twenty-three had analgesia of the nerve; of the remaining seven, five felt pain and two had doubtful sensation, hence we have these proportions, 76.6 per cent. with analgesia and 16.6 per cent. without.

In women the following results were obtained in twelve paralytics: disappearance on both sides in five cases, on one side only in one (50 per cent.), normal in four and weak in two (50 per cent.).

Taking together these two sets of statistics we find that analgesia was present in 69 per cent. of the cases.

Hey has compiled a summary of all the cases hitherto studied and taken the average, and finds that in four hundred and seventeen cases of tabes and paralysis, 66.9 per cent. had analgesia; in three hundred and fifty-four paralytics it was present in 70 per cent.

According to sex, the ulnar symptom was absent in 73.7 per cent. of two hundred and thirty-two men, and in

43.7 per cent. of seventy-one women.

Amongst those who were neither paralytics nor epileptics he found that the ulnar reaction was absent in 16 per cent., uncertain in 82 per cent. and normal in 82 per cent. In women these percentages were respectively 9 per cent., 2 per cent. and 89 per cent.

From such facts the author concludes that the symptom to which Biernacki has called our attention has a certain value; but it would possess a great diagnostic importance. if we knew to what to attribute the analgesia of non-paralytics.

In male epileptics Hess found this analgesia in 8.69 per cent. of the cases, while in women he could not find it at all. He discovered besides that the pain reaction was absent for six to twelve hours after a convulsive attack; after this time the reaction appeared again and only in the case of one woman did the analgesia remain for about thirty-six hours, the normal reaction returning after fortyeight hours. Hess attaches great importance to this in the diagnosis of the epileptic psychosis.

Finally, there appeared but a short time ago an article by Sambo, (10) who, while investigating analgesia of the peroneal nerve in cases of tabes, found that analgesia of the ulnar was present in eleven out of fifteen cases, without there being any relation between the disappearance of this reaction and the disturbances of sensibility.

As will be seen the results obtained do not agree very Some authors maintain that the disappearance of the ulnar reaction is a point of great diagnostic value, while others deny it any such importance and, like Boedeker, Falkenberg and Orchansky, affirm that ulnar analgesia is not characteristic of either tabes or paralytic dementia. And we find the average in progressive paralysis oscillating between a maximum of 91.6 per cent. (Hillenberg) to one of 56 per cent. (Snell-Boedeker) in regard to analgesia; while in other mental diseases we find the average for non-analgesics to vary between 82 per cent. (Hess) and 53 per cent. (Snell). It must be noted, however, that in his 91.6 per cent. Hillenberg includes, besides the bilateral

cases, those in which the symptom was presented only on one side and those in which the pain reaction was somewhat diminished, which the other authors have not done. They have made an average of itself for this last class or else have included them in the normal (Hess). If we take this fact into consideration and subtract from Hillenberg's figures those cases having a weak reaction, we obtain for this author a percentage of 80 having true analgesia.

My researches on this subject have been chiefly made among the insane, not neglecting, however, any cases of tabes which have occurred this year in the Sante Spirito Hospital, and those met with in the neuro-pathological clinic.

The insane cases which I have studied number two hundred and fifty-seven, thus divided; paralytic dementia forty-seven, of whom thirty-nine were men and eight women; the others were afflicted with various mental disorders but were mainly epileptics, idiots, alcoholics, paranoics and cases of dementia; of these one hundred and seventy-three were men and thirty-seven women.

The method used in the researches did not differ at all from that indicated by Biernacki in his article; the patient was made to flex the fore-arm on the arm, and there the nerve-trunk was pressed on with moderate force by the second finger while the thumb rested on the front of the epicondyle of the humerus. In normal individuals the following symptoms are called forth by this pressure:

1st. A contraction of the muscles innervated by the ulnar.

2d. A pain more or less acute, but very characteristic, and one which can with difficulty be borne without some reaction on the part of the patient.

3d. A manifestation of this pain consisting in a change of countenance, flexion of the arm, or exclamation of pain. Now, of these signs, in my researches, only one has been constant and unmistakable, and that is the contraction of all the muscles supplied by the ulnar nerve, a contraction which cannot escape the finger of the hand which holds flexed the fore-arm of the patient.

On the other hand the external manifestations, such as changes in the face and exclamations are entirely wanting in certain mental states in which the patient succeeds in mastering every sensation reaching him from the outside world, and it has often been my lot to see, especially in paranoics and some idiots, the face remain tranquil and impassive, revealing no trace whatever of suffering while the arm was strongly flexed, and the shoulder quickly drawn upward and backward. And so much the more must we take into consideration this manifestation, in as much as the face changes may be so slight and fleeting as to be almost gone unless the countenance is most attentively watched, especially when the physician has not yet had much practice in such studies.

Another fact to which Boedeker and Falkenberg called attention in their article is the following: often examining patients with intervening spaces of time the ulnar symptom was found to vary. It has also happened to me in more than one case that a person in whom we had perhaps found analgesia at the first examination, on being examined again after some length of time presented the characteristic reaction. The above named authors in order to explain this, have considered it to be due to the strength exerted by the observer, which may vary quantitatively from day to day. But I would add these hypotheses:

1st. Want of practice in research, by means of which, at first, a weak reaction may excape the observer.

2d. The nature of the anatomical lesions of the ulnar nerve, on which I shall dwell briefly before closing.

3d. The condition of the patient, especially that of his nervous system at the time of examination.

Having premised these considerations I shall now give the results of my observations on forty-seven cases of paralytic dementia. In thirty-nine men we found: