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GENERAL PARALYSIS OF THE INSANE (syn....
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See also:GENERAL See also:PARALYSIS OF THE INSANE (syn. General Paralysis, dementia paralytica, progressive dementia) is a disease characterized by symptoms of progressive degeneration of the central See also:nervous See also:system, more particularly of the motor Genera/ Paralysis. centres. The disease is almost invariably fatal. Apparent recoveries do very occasionally occur, though this is denied by the See also:majority of alienists. The disease is in every See also:case associated with gradually advancing See also:mental enfeeblement, and very frequently is complicated by attacks of mental disease. General paralysis, which is a very See also:common disease, was first recognized in See also:France; it was identified by J. E. D. See also:Esquirol, and further described and elaborated by A. L. J. See also:Bayle, Delaye and J. L. Calmeil, the latter giving it the name of paralysie generale See also:des alienaes. As first described by the earlier writers the disease was regarded as being invariably associated with delusions of grandeur. At the See also:present See also:day this description does not apply to the majority of cases admitted into asylums. The See also:change may be explained as being either due to an alteration in the type of the disease, or more probably the disease is better understood and more frequently diagnosed than formerly, the diagnosis being now entirely dependent on the See also:physical and not on the mental symptoms. This latter may also be the explanation why general paralysis is much more common at the present day in See also:British asylums than it was. The See also:total See also:death-See also:rate from this disease in See also:English and Scottish asylums See also:rose from 1321 in 1894 to 1795 in 1904. General paralysis attacks men much more frequently than See also:women, and occurs between the ages of 35 and 50 years. It is essentially a disease of See also:town See also:life. In asylums which draw their patients from See also:country districts in See also:Scotland and See also:Ireland, the disease is rare, whereas in those which draw their See also:population from large cities the disease is extremely common. Considerable diversity of See also:opinion exists at present regarding the See also:causation of general paralysis. Hereditary predisposition admittedly plays a very small See also:part in its causation. There is, however, an almost universal agreement that the disease is essentially the result of toxaemia or poisoning, and that acquired or inherited syphilitic infection is an important predisposing See also:factor. A See also:history of syphilitic infection occurs in from 70 to 9o% of the patients affected. At first it was held that general paralysis was a See also:late syphilitic manifestation, but as it was found that no benefit followed the use of See also:anti-syphilitic remedies the theory was advanced that general paralysis was a secondary auto-See also:intoxication following upon syphilitic infection. The latest view is that the disease is a bacterial invasion, to which syphilis, alcoholism, excessive mental and physical See also:strain, and a too exclusively nitrogenous See also:diet, only See also:act as predisposing causes. This latter theory has been recently advanced and elaborated by See also:Ford See also:Robertson and McRae of See also:Edinburgh. Whatever the cause of general paralysis may be, the disease is essentially progressive in See also:character, marked by frequent re-See also:missions and so typical in its physical symptoms and See also:pathology that we regard the bacterial theory with favour, although we are far from satisfied that the actual causative factor has as yet been discovered. For descriptive purposes the disease is most conveniently divided into three stages,—called respectively the first, second and third,—but it must be understood that no clear See also:line of demarcation divides these stages from one another. The onset of general paralysis is slow and See also:gradual, and the earliest symptoms may be either physical or mental. The disease may commence either in the See also:brain itself or the See also:spinal See also:cord may be primarily the seat of See also:lesion, the brain becoming affected secondarily. When the disease originates in the spinal cord the symptoms are similar to those of locomotor ataxia, and it is now, believed that general paralysis and locomotor ataxia are one and the same disease; in the one case the cord, in the other the brain, being the See also:primary seat of lesion. The See also:early physical symptoms are generally motor. The patient loses See also:energy, readily becomes tired, and the capacity for finely co-ordinated motor acts, such as are required in playing See also:games of skill, is impaired. Transient attacks of partial paralysis of a See also:hand, See also:arm, See also:leg or one See also:side of the See also:body, or of the speech centre are not uncommon. In a few cases the See also:special senses are affected early and the patient may complain of attacks of dimness of See also:vision or impairment of See also:hearing. Or the symptoms may be purely mental and affect the highest and most recently acquired attributes of See also:man, the moral sense and the See also:faculty of self-See also:control. The patient then becomes irritable, bursts into violent passions over trifles, changes in character and habits, frequently takes See also:alcohol to excess and behaves in anextravagant, foolish manner. See also:Theft is often committed in this See also:stage and the thefts are characterized by an open, purposeless manner of See also:commission. The memory is impaired and the patient is easily influenced by others, that is to say he becomes facile. In other cases a See also:wild attack of sudden excitement, following upon a See also:period of restlessness and sleeplessness may be the first symptom which attracts See also:attention. Whatever the mode of onset the physical symptoms which characterize the disease come on sooner or later. The speech is slurred and the facial muscles lose their See also:tone, giving the See also:face a flattened expression. The See also:muscular See also:power is impaired, the gait is straddling and the patient sways on turning. All the muscles of the body, but particularly those of the See also:tongue, upper See also:lip and hands, which are most highly innervated, present the symptom of See also:fine fibrillary tremors. The pupils become irregular in outline, often unequal in See also:size and either one or both fail to react normally to the stimuli of See also:light, or of See also:accommodation for near or distant vision. As the disease advances there is greater excitability and a tendency to emotionalism. In classical cases the general exaltation of ideas becomes so See also:great as to See also:lead the patient to the commission of insanely extravagant acts, such as purchases of large See also:numbers of useless articles, or of lands and houses far beyond his means, numerous indiscriminate proposals of See also:marriage, the See also:suggestion of utterly absurd commerical schemes, or attempts at feats beyond his physical See also:powers. The mental symptoms, in See also:short, are very similar to those of the elevated stage of manic-depressive See also:insanity. Delusions of the wildest character may also be present. The patient may believe himself to be in See also:possession of millions of See also:money, to be unsurpassed in strength and agility, to be a great and overruling See also:genius, and the recipient of the highest honours. This grandiose See also:condition is by no means present in every case and is not in itself diagnostic of the disease. But mental facility, placid contentment, See also:complete loss of See also:judgment and See also:affection for See also:family and See also:friends, with impaired memory, are symptoms universally present. As the disease advances the motor symptoms become more prominent. The patient has great difficulty in See also:writing, misses letters out of words, words out of sentences, and writes in a large laboured hand. The expression becomes fatuous. The speech is difficult and the facial muscles are thrown into marked tremors whenever any See also:attempt at speech is made. The See also:voice changes in timbre and becomes high-pitched and monotonous. The gait is weak and uncertain and the re-flexes are exaggerated. In the first stage the patient, through restlessness and sleeplessness, becomes thin and See also:haggard. As the second stage approaches See also:sleep returns, the patient See also:lays on flesh and becomes puffy and unhealthy in See also:appearance. The mental symptoms are marked by greater facility and enfeeblement, while the paralysis of all the muscles steadily advances. The patient is now peculiarly liable to what are called congestive seizures or epileptiform attacks. The temperature rises, the face becomes flushed and the skin moist. Twitchings are noticed in a hand or arm. These twitchings gradually spread until they may involve the whole body. The patient is now unconscious, bathed in See also:perspiration, which is offensive. The bowels and See also:bladder empty themselves reflexly or become distended, and bedsores are very liable to See also:form over the heels, elbows and back. Congestive seizures frequently last for days and may prove fatal or, on the other hand, the patient may have recurrent attacks and finally See also:die of exhaustion or some accidental disease, such as See also:pneumonia. In the second stage of the disease the patient eats greedily, and.as the See also:food is frequently swallowed unmasticated, choking is not an uncommon See also:accident. The special senses of See also:taste and See also:smell are also much disordered. We have seen a case of general paralysis, in the second stage drink a See also:glass of See also:quinine and See also:water under the impression that he was drinking See also:whisky. The third stage of the disease is characterized by sleeplessness and rapid loss of body See also:weight. Mentally the patient becomes quite demented. On the physical side the paralysis advances rapidly, so that the patient becomes See also:bed-ridden and speechless. Death may occur as the result of exhaustion, or a congestive seizure, or of some intercurrent illness. The duration of the disease is between eighteen months and I three years, although it has been known to persist for seven. No curative See also:measures have so far proved of any avail in the treatment of general paralysis. Additional information and CommentsThere are no comments yet for this article.
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