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The haemoglobin percentage fell to 26% (3.8 g.%) and the total leucocyte count to 10,600. Death occurred on July 20. Relevant Necropsy Findings.-The skin and all organs were pale, with many petechial haemorrhages. Several tough, pale nodules were present in the scalp, and there was a large haematoma on the extensor surface of the right forearm. The lymph nodes were all enlarged and pale. The spleen was enlarged, weighing 26 oz. (737 g.). On section it was red, soft, and coarsely granular. The liver weighed 92 oz. (2,608 g.), and was pale and firm on section. The right ankle-joint was opened. The synovial membrane, synovial fluid, and articular cartilage looked normal. Report on Histology.-"Sections of liver, spleen, lymph node, scalp nodule, skin haematoma, kidney, and small intestine show, in greater or less degree, infiltration by immature leukaemic cells. A portion of the synovial membrane of the left ankle shows infiltration by leukaemic stem cells. The cells have round or ovoid vesicular nuclei

IN HIS original and classic description of the disease that now bears his name, PARKINSON [l] noted the progressive muscular rigidity, the characteristic pill-rolling tremor, the stooping posture, the shufEing gait and the akinesia that characterize this condition. He did not, however, describe the digital deformities that are the subject of this paper. C~GCESHALL [2] states that "Charcot first pointed out the resemblance between Parkinsonism and rheumatoid arthritis, especially the similar deformities of the hands and feet in the two disorders." PENNECHIETTI [3] also, has pointed out that Parkinsonism occasionally has been misdiagnosed as rheumatoid arthritis because of "the similar deformities of the hands and feet and the muscular rigidity, tremor and shiny appearance of the face which may occur in both." WECHSLER [4] notes that in Parkinsonism "muscular contractures, especially of the hands and feet, develop on the basis of muscular rigidities." CUTLER [5] writes that "the fingers are partly flexed, as in the resting position, and in the late stages cannot be extended. Hyperextension of the terminal phalanges is occasionally seen." SPILLER [61 states that ulnar deviation of the fingers is common in Parkinsonism. This report is an analysis of the hand deformities found to exist in a series of 86 patients with Parkinsonism examined in three large midwestem county medical care facilities-Washtenaw County (Mich.) Hospital, Wayne County (Mich.) Hospital and Cook County (Ill.) Hospital. Consistent with current medical thought [71 the patients have been divided into two diagnostic categories, those with a history of encephalitis lethargica and those of idiopathic etiology. The age, race, and sex characteristics of the patients are shown in Table 1. Because there are some students of Parkinsonism [S] who believe that all cases of the disease are of encephalitic origin, it is worth noting that there are significant age differences in the two groups here described. In race and sex the two groups are comparable. It is notable that all but two of the patients are white, despite the fact that in the county medical care institutions studied, a large proportion of the patients (over 40 per cent) are Negroes.

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