Many symptoms, though not constant are, however, frequent and important. This group comprises:
(A) Mental disorders;
(B) Motor disorders;
(C) Disorders of the reflexes;
(D) Disorders of sensation;
1 Klippel et Serveaux. Contribution a Vetude de I'urine dans la paralysie generate. Congres des medicins alienistes et neurologistes, 1895.
2 American Journ. of the Med. Sc, 1896, No. 290.
(E) Trophic disorders;
(F) Visceral disorders;
(G) Epileptiform and apoplectiform seizures.
The principal are delusions and hallucinations.
(a) The delusions of the general paralytic are of the demented type; that is to say, they are absurd, mobile, multiple, and contradictory.
They assume all forms;
(α) Ideas of grandeur: the patient is immensely rich; millions are not adequate, the general paralytic counts his riches by trillions; he governs the forces of nature, resuscitates the dead, is the incarnation of all the great men of the present and of the future, destroys and reconstructs the universe by a single gesture, etc.
(β) Melancholy ideas: ideas of culpability: one patient accused himself of having hastened the end of the world by ten thousand centuries; hypochondriacal ideas: another patient refused to eat because he had "a bicycle manufactory in the throat"; ideas of negation: the organs are liquefied or replaced by air, the body is nothing but a putrefied corpse; ideas of ruin analogous to those of melancholia.
(γ) Persecutory ideas: they are either primary or secondary to ideas of grandeur. In the latter case the patients complain that they have been robbed of their immense fortune, that they are not treated with the respect to which they are entitled, that they are unjustly detained in the institution, etc. Occasionally at the beginning persecutory ideas become systematized,1 but always imperfectly. A close examination always reveals certain flagrant contradictions by which the mental deterioration manifests itself.
(b) The frequency of hallucinations in general paralysis is a much disputed question. Some authors believe that they are almost constant (Christian and Ritti), or at least frequent (Wernicke); others claim that they are rare (Magnan, Dagonet, Krafft-Ebing). The latter opinion is the more widely accepted and I believe the more correct one.
1 Magnan. Legons cliniques.
The hallucinations may affect any of the senses, including the muscular sense.
Illusions are much more frequent than hallucinations.
The systematized persecutory delusions which are occasionally met with are apt to be associated with auditory hallucinations.
As in all cases of pronounced dementia, the reactions and the emotional tone do not always harmonize with the delusions. A general paralytic who believes himself to be dead may eat heartily and remain otherwise unaffected.
The following case illustrates the type of delusions in general paralysis:
Marie B., thirty-two years old, cafe singer. - Family history unknown. - Patient occasionally drinks to excess. Syphilis very probable, as patient has lived for some years with a man who had syphilis. She had two still-births. - She was arrested for creating a disturbance on a public thoroughfare and was sent to the Clermont Asylum. On the way to the asylum she was greatly excited, spoke of her immense fortune, distributing millions among those about her, made indecent signs to all the men she met, but submitted readily to being taken to the asylum.
Two days after her arrival at the asylum, at the time that this record was made, the patient showed marked excitement. Her face was red, her eyes sparkling. She was very voluble, yet quite tractable. Her orientation was very imperfect, delusions extremely active. She said that she was in a town called Clermont, and that she had been there three months; that it was the spring of 1894 (in reality March, 1904); that the institution she was in was a hospital for wounded soldiers. It was pointed out to her that there were no soldiers there. "That is true," she said, "they are in Nice. I take good care of them. I do not put them in a dungeon, but in a beautiful room." She knew at once that there were insane patients in the asylum, but there are no longer to be any there, as to-morrow she is going to cure them all with a good cathartic. She had already cured her husband "of a filthy disease by cleaning out his bowels." This husband of hers married the daughter of a colonel who left him two days after the wedding. The patient states that she herself had also been sick; she was operated on by Duchess de C, then went for six months without making water or moving her bowels, but she was never sick enough to go to bed, neither were her horses.
She has ten thousand race horses that can make twelve hundred miles an hour without getting out of breath. The proof is that they went from Paris to Marseilles in four and a half hours. She is very wealthy, she has a million francs. When it was pointed out to her that a million is not so much, she said she had made a mistake she should have said thirty million francs. At any rate it is going to be increased to one hundred and fifty million this week. All this fortune came to her by inheritance. She also has several hundred mansions which she will convert into hospitals. Everybody around her shall be happy. The nurse who is taking care of her shall receive a hospital, a mansion, three broughams, a landau, two thoroughbred horses, male and female, so that they may have young ones, a race track, an angora cat, and an estate with cultivated grounds. Another patient struck her without provocation; "That's nothing! She shall have her little million like everybody else, just the same, also a suit of man's clothes in which she can follow the regiments." - She has two boys, "each twenty years old "; she herself is twenty-five years old. She had her first child at the age of twelve. She states that she drinks a good deal.
In all the towns through which she passed the station-masters and those in charge of provisions gave her the key to their wine cellar in order that she might help herself at her pleasure. When asked whether she could drink ten quarts of wine a day, she exclaimed: "Ten quarts! a good deal more, at least a barrelful, for I drink a quart with every meal." Her memory is greatly impaired; what little correct information the patient gives is lost in the multitude of disconnected pseudo-reminiscences. - Physical signs: Distinct Speech defect shown in her spontaneous utterances as well as by test words. The pupils show scarcely any reaction to light; they react to accommodation readily. Marked hyperesthesia over entire surface of the skin; the slightest pricking with a pin causes marked pain. For several minutes during the examination simple contact brought forth piercing cries. Considerable loss of flesh.