Synonyms

Chronic arachnitis and chronic meningitis (Baylc). Incomplete general paralysis (Delaye). General paralysis of the insane or chronic diffuse periencephalo-meningitis (Calmiel). Paralytic insanity (Parchappe). Progressive general paralysis (Lunier, Sadras). Paralytic dementia (Baillarger). Chronic diffuse interstitial encephalitis (Magnan). In German: Progressive allgemeine Paralyse. In general it is convenient to employ the Latin term dementia paralytica.

The earliest mention of the somatic and psychic disorders corresponding to general paralysis dates back to 1798, when Haslam, pharmacist at the Bethlehem Hospital, described in a few lines and with remarkable precision the principal features of the disease.

It was only in 1822, thanks to the memorable work of Bayle, that general paralysis gained a footing in classical psychiatry. The history of this disease is a subject much too vast for the limits of this work. It has been quite thoroughly treated by Vignaud1 in his inaugural thesis, which contains also a good bibliography.2

1 Histoire de la paralysie generate. Paris. These.

2 Monographs on general paralysis: Lasegue. De la paralysie generate progressive. Th. d'agreg. Paris, 1853; also Lecons sur la paralysie generate, 1883. - Falret. Recherches sur la folie paralytique et les diverses paralysies. Paris, 1853. - Voisin. Traite de la paralysie generate. 1879. - Baillarger. Theorie de la paralysie generate. Ann. med. psych., 1883 - Mendel. Die progressive allgemeine Paralyse der Irren, 1880. - Mairet et Vires. De la paralysie generate. Etiologie. Pathogenic Traitement, 1893. - Magnan et Serieux. La paralysie

Prodromal Period

It is marked (a) by changes of affectivity and character; (b) by neurasthenic and psychasthenic phenomena.

(a) The mood becomes either irritable and changeable, with sudden alternations of joy and sorrow, kindness and anger, discouragement and optimism; or gloomy and marked by pessimism and by a tcedium vitce which may lead the patient to attempts of suicide. Often the patient is conscious of being stricken with a grave disease and has dark presentiments for the future.

(6) The neurasthenic and psychasthenic symptoms are usually very pronounced: a feeling of general lassitude, fatigue, muscular weakness, diffuse neuralgic pains, headache, a sort of grinding sensation felt especially in the head, and other peculiar sensations which the patient is unable to describe clearly: it may seem to him that his head is empty, that his brain is falling to pieces, etc.

These symptoms are, however, not identical with those of true neurasthenia. The following are, according to Ballet, the most important points of difference:

"(1) The stigmata, that is to say, the permanent signs of neurasthenia (helmet sensation, pain in the spine), are usually absent.

"(2) Neuralgic pains occupy a prominent place in the clinical picture. These pains (excluding the lightning or lancinating pains dependent upon spinal lesions) are disseminated, essentially mobile, varying from day to day. The patients often speak of them as ' pains that are peculiar, unusual.1

"(3) From one moment to another sudden changes are produced in the state of the patient. ... It is surprising generate (collection Leaute), 1894. - Coulon. Considerations sur la nature de la paralysie generate. - Klippel. Les paralysies generates. L'oouvre medico-chirurgicale, 1898. - For a bibliography of general paralysis, see G. Ballet and J. Rogues de Fursac. Article Paralyse Generate in Traite de Medecine Charcot-Bouchard-Brissaud. Paris, 1905. - E. Kraepelin. General Paresis. Eng. trans, by J. Moore. Nerv. and Ment. Dis. Monograph Series. New York, 1914.

to see the neurasthenic paretic, who but a short time before complained of severe suffering and ill health, forget his pains under the influence of some incident or conversation in which he is interested and in which he takes an active part. These momentary changes, appearing at the instance of chance occurrences, may manifest themselves in a more lasting manner on instituting some treatment, though insignificant. The patient, hitherto excessively discouraged and gloomy, speaks with joy of his cure; his satisfaction is exuberant and out of proportion, as was his despair shortly before."

Often some transient phenomenon, exceptional or unknown in neurasthenia, alarms the physician: slight seizures, transitory strabismus with diplopia, slightly marked momentary disorders of speech.

The period of prodromata is seldom absent. It is often long, lasting several months or years.