CHAPTER III. THE SYMPTOMS OF GENERAL PARESIS. (Part 1)

CHAPTER III. THE SYMPTOMS OF GENERAL PARESIS. The Prodromal Stage. (^First Period.) Mental Symptoms. — There is, perhaps, no disease that begins more gradually than general paresis, for the period of inception, although varying within wide limits, may be prolonged over months, or even years. If one has the opportunity to observe closely the life of the pa- retic and at the same time to gather from his friends all of the data obtainable, it need not cause surprise to find that the first changes in the feelings, the intel- lect and the organic functions of the subject, which mark the appreciable beginning of the disease, extend into the past for many months, and sometimes for a number of years, prior to its apparent onset. At first, the patient is conscious of feeling that he is not in his normal condition, but as the disease advances, he loses the power of discrimination, and he then insists that he is entirely well. Savage refers to a physician who correctly diagnosed his own case as that of paresis, but soon forgot his misfortune in the blighting effects of the advancing disease. In another case, the patient pointed to the top of his head, and said that, like Swift, he was " going first at the top." For the moment he appeared emotional, but in the feeling of bien-etre, which was developing, he forgot his troubles, when induced to speak of his fine capabilities. Lewis tells of a talented mathe- matician, in whom the early symptoms were intense despondency and sudden lapse of attention and mem- ory. Often when solving a problem, he would cover 37 28 SYMPTOMS OK GENERAL PARESIS. his face with his hands, and rising from his chair with a pained expression, hurriedly remark, " It's of no use, it's all gone!" He frequentl}' confessed how painful such a state was to him, realizing most fully the sad condition of his mind, before the final disruption occurred. In former years, alienists were disposed to set the limit of the initial stage at a much shorter length than experience teaches us now to do. Formerly, it was placed at two or three 3'ears, or less ; to-day, it is not unusual to see it placed at eight or ten years. There is a preparal3'tic period, analogous to the pre- taxic period of tabes. Generally, the earliest signs observed are those of mild brain failure, indicated by a somewhat enfeebled state of the mind. This mental failure is shown by a change in the disposition and character of the patient, not at the start very pronounced, but soon issuing in habits and conduct at variance with his normal pro- clivities, which become more and more bizarre with the lapse of time. An intelligent merchant, in good social standing, acquired an ambition to become a pugilist, frequented low places of amusement and taverns and became acquainted with several prize- fighters to whom he paid large sums to be allowed to beat them (Spitzka). The change of character may be detected also in some loss of interest by him in his affairs, or in an impaired ability to attend regularly to them. There is some obtundity of the intellectual and volitional vigor of the mind, and the judgment is more or less clouded. He is varyingly absent-minded, indifferent, apathetic, or negligent in both his domestic and business relations. He seems unable to keep his attention for a length of time to any fixed purpose, albeit he can follow out in a fairly correct manner the routine of his daily life, if its duties be not too THE PRODROMAL STAGE. FIRST STAGE. 47 and at times worked very hard. He had lived well^ tak- ing not a little of alcoholic stimulants habitually ; eating much, sleeping little ; exceeding greatly in regard to sexual intercourse. He had not had syphilis, and showed no signs of it. In recent months ** has not been the same " ; he had flying pains in the head ; was a little forgetful ; want- ing in application to his work, and was irritable at home. A month ago he began to express an exaggerated sense of well-being, so that a stranger remarked: ** What a con- ceited fool that man is I " He could not settle down to his daily work. This state went on for some time without awakening suspicion of insanity until one morning he an- nounced that he had purchased several hundred pounds' worth of silver plate, and that he had lots of money, having a scheme through which, in a week, he could be worth hundreds of thousands of pounds. His wife found that he had been buying many useless things, besides the plate ; he had four gold pencil cases, as presents for people whom he did not know. He was sent off to the country; rest- lessness increased ; constant talking ; almost complete sleep- lessness ; his boastfulness became, in three or four days, exaggerated delusions. He said that he could lift i,ooo pounds, that he was the best rider, swimmer and jumper in the world ; he wanted to buy every farmer's horse that he met, never offering less than lOO pounds and would bid another lOO, if his first offer was refused. He wrote to the Q^een and other notables, offering his services to make their fortunes, and asking them to dinner. In writing, he omitted many single words. A few days later, he was so impatient of contradiction that he struck his wife, but he was usually easily managed. He was sent to an asylum, offering to buy it for £100,000 and later, for £1,000,000. On hearing that they could not get along without it, he said he would build another, the most magnificent in the world, endow it with a million a year, make me physician-in-chief, and get the Queen to make me a baronet, and give me a uniform made of gold cloth. He has been sleepless, destructive of clothing, unclean, in constant motion, facile in some respects, but violent when his commands were not instantly 48 SYMPTOMS OF GENERAL PARESIS. obeyed. He was not surprised at being brought to the asylum, and felt no resentment towards those who brought him. He walks with a quick step, talks rather fast, and has the least slurring towards the ends of long sentences and in articulating long words with many oft-repeated con- sonants. There is fibrillar twitching in the small muscles of the lips, and around the eyes, especially when he breaks into a smile. His tongue quivers in lines on its surface, single strands of muscles being affected. His pupils are contracted, irregular in outline, right larger than the left, which is insensitive to light. Sometimes the right is small and insensitive to light, or large and insensitive to light. The expression of the eyes is feverish and strange ; skin moist ; temperature 99.6^, rising to over 100^ at night ; pulse full and hard. He cannot sit still ; has an abnormal gene- ration of energy ; common sensation markedly diminished ; sense of smell somewhat weakened ; tastes imperfectly ; he calls blue wool red. His patellar, spinal and skin reflexes are very acute. He is very easily led from one subject to another ; he is very irritable on contradiction. A general paretic will not yield to a show of force. He could walk along a narrow board on the floor all right, but when sud- denly told to turn around, he could not do so sharply, but took a circle and that waveringly. (Abstract, Clouston, Mental Disease, p. 379.) A CASE OF GENERAL PARESIS OF THE MANIACAL FORM, A REMISSION FOLLOWING TREATMENT. B., male, married, aet. 35, admitted after an illness stated to be of only fourteen days' duration. Previous history: Entered army thirteen years ago. Before this he had contracted syphilis and was supposedly cured. He had several attacks of fever, and later unmistakable signs of secondary syphilis ; but recovered, married, be- came an accountant and cashier, he being without the neces- sary education for the position, consequently broke down, due to the mental strain, while his figures were found to be in confusion. On admission, he was maniacal, impulsive, violent and very strong ; he was very loquacious, incoherent FIRST STAGE. 49 and exalted; he said he was second son of God, very wealthy, etc. ; he offered gifts of £20,000, etc. He suffered much from insomnia, pupils normal, no tremor of lips or face ; no elevation of temperature, organs healthy. The first development of the disease occurred at a dinner at his house, where he had been unusually voluble, and when his wife remonstrated with him, he burst into tears. Two weeks after admission he began to wet his bed, his mania frequently flared out, notwithstanding doses of bromide, throwing knives at those near him, even when unprovoked ; exaltation advanced ; recognized and deplored his loss of memory. Under treatment (calabar bean gr. one sixth, iodide of potassium, ammonia-citrate of iron, hydrobromic acid) he improved very much. Ten weeks after com- mencement, the treatment was stopped and he was pre- maturely allowed to visit his friends, but returned in seven days complaining of headache and insomnia. These were relieved by quiet and hydrobromic acid ; he was sent to sea- side house for six weeks and then discharged six months after the development of the disease. In ten weeks, he wrote a letter free from the various peculiarities of style usual in general paretics, but saying that his legs were very unsteady, so that while he could play tennis, the fact of knocking one foot against the other was sufiicient to throw him down. His mental faculties appeared unclouded, though they were not exposed to any strain. He mingled in society and held his own, but before long the disease returned and he died. (Abstract, Fox, B. B., Journal of Mental Sciences, Vol. 73, p. 389.) DELUSIONS OF GRANDEUR. A gentleman said he could easily run six hundred miles in a minute ; that he could fly ; that by cutting out his entrails, he should make himself so light that he could jump a mile, and by constant springing could mount higher and higher ; that he could speak all the languages. He mixed all his food together on a plate, which he called the kosmos that would make him strong, etc. (Abstract, San- key, Lectures on Mental Diseases, p. 26^.) so SYMPTOMS OF GENERAL PARESIS. DELUSIONS OF GRANDEUR. One patient proposes to buy up all the water-power in the United States, and let it out to applicants at high prices. He made a table showing, in his opinion, where the power is, its capacity, the price for which it can be obtained, and an estimate for which it can be leased. The profits amount to over a hundred millions a month. Another patient was going into the shipbuilding business, intending to build vessels capable of carrying ten thousand cabin-passengers each, and of making the voyage to Europe in twenty-four hours. (Abstract, Hammond on Insanity, p. 6oi.) DELUSIONS OF GRANDEUR. G. H. believed he had interviews with the Almighty and the Holy Ghost, that he had £40,000 in bank, that he was king of England and therefore accused every one of not paying him proper respect ; he promised to clothe the other patients in armor of gold and said the buttons in their clothing were made of his gold. (Abstract, Bucknill &Tuke, Manual of Insanity, p. 313.) A WOMAN WITH DELUSIONS OF GRANDEUR. A woman insisted that she was the wife of the Saviour ; also of a certain duke, that she had other husbands, more than a million ; that God gave her many rare jewels ; that she had twenty Koh-i-noors. She exhibited also in these notions a great deal of erotic tendency. (Abstract, San- key, op. cit.^ p. 262.) EXTRACTS FROM THE LETTERS OF A PARETIC, THE EROTIC PASSAGES BEING OMITTED. My own darling and adored wife Mary : My heart calls you to come to it. Your dear angel presence only can satisfy its constant longing. I count the hours in fear to your coming ; a thousand doubts besiege me night and day. For me there is no light nor life, nor cheer, while thou remainest away. Thou art ipy Peace, my Hope, my " • ' • • * FIRST STAGE. 5 1 ooly ForttuK and the sfaiobig angel of mj soul. Ob come to me, ior you, alone, are mice and you only can still my doubts and feais. My b!e*->e(3 and lovely sweetheart wife, Mary. Yon most cone to me or my bean will break with grief. Come and we will celebrate our reunion and my perfect health, my iove and aitection, free from care for a week. You are my Queen, all I have is yours, my heart and my purse. I have never destroyed a single letter of yours. 1 have preserved them ail because my love for you has been so deep and tender, so strong and loftj', so ardeni and so sacred that I would have deemed myself guilt].- of a sacnligiaus act to destroy even one of them. I have them all preserved and you and I will read them over together some time. I am sure it will recall happy hours and delightful memories of our lives in the past. Let us keep on being happy togelher, for 1 never was, and never can be, happy when I am away from your easeful and nepenthe presence. In your charming society I often think 1 am the one man who is renowned because I really and truly love and am loved by you. Ever since your dear kind, sweet speaking eyes spoke love into my heart you have been the bright and shining angel of my dreams, as you have been the sole C^ueen of my loving heart and of my delightful and happy home. My darling and revered wife, I so long to see you that I do believe I'n go crazy unless yon come. I am constantly thinking and thinking of you; I never cease to think of you and to bless your dear memory. You are the most blessed wife in all the wide, wide world. I will be, oh so happy when I can get my arms around you. I know of no blissful feeling than to be once again in your sweet, beautiful gentle, tender and blessed presence. 1 very clearly see that you are the gentlest and sweetest and the most sensible lady in the wide world. I love yon and my dear little boy, J. W. W., esquire, with all the love, pas- sion and vehemence of my heart. And I honor. I rh-Hrly love and highly respect the dignified, serene, ^r;ii»l, i(*,l,|/ magnificent and queenly lady, my dear -.nui iu<,ui\ u,,,] blessed grandma, X. Y. M. I hope and li;ivf (.rny^d u, 52 SYMPTOMS OF GENERAL PARESIS. Almighty God to allow and save my dear grandma from death and sickness. I realize that my sweet, darling wife, Mary, will very soon come to see me. There is no such other inspiration as is the inspiration of hope. Hope illumines our pathway through the rough places of earth, etc. I hope to be home very soon. I send to my sweet wife, to my dear little J. W. W., esquire, and to my dear and good grandma, X. Y. M., all the great love of my heart and to you my sweet angel wife, Mary, I send ten thousand kisses. Again he says : I am going home to love my heart's only darling, my sweet, lovely angel wife, Mary, and to enjoy the charming and beautiful society and comradeship of the woman I chose for my bride and wife more than twenty years ago. How well I remember the evening, the hallowed and blessed evening, when I asked you with my arms around you to be my wife and how you then raised your dark, beautiful, speaking eyes timidly up to mine and murmured the blessed **yes" and how then and in a moment our waiting souls met and embraced in one look of recognition and bliss. Oh, that blessed word ** yes " you gave me then ; God has written it upon my heart forever. Never, never, will I forsake the dear lips which spoke that word nor fail in all loving doubt and affection to my sweet Mary to the end of my life. Life is like a bright river when it springs from the fresh fountains of the heart. It flows on beautifully, forever and ever widening until it reaches the ocean of eternity and happiness, etc., etc. A LETTER OF A PARETIC IN THE EXALTED STAGE. ** Countess of Elgin and Durham " (but really to Qjieen Victoria). ** House, Royal National Lunatic Asylum." My dear wife : — I am up to the mark and hope that your system is up to the scratch. Has John Brown undergone any form of cremation? I am glad to him adopting my style of shepherd checked trousers. I hope both queens are well, with Princess Louise, Princess Beatrice, that I will give FIRST STAGE. 53 them all that is necessary in this world and the world to come. Compts. to darling *• Eugene." Your affct. hus- band. (Abstract, Clouston, op. cit.y p. 383.) A PATIENT PRINTED THE PROSPECTUS OF A COMPANY HE WAS ABOUT TO ORGANIZE, TO ACQUIRE FROM THE PRINCIPAL GOVERNMENTS THE EXCLUSIVE RIGHT TO MANUFACTURE INDIA-RUBBER RATTLES. THE FOLLOWING IS THE COPY OF A FEW PARAGRAPHS FROM HIS DOCUMENT. Everybody, from the infant in arms to the decrepit old man, likes to make a noise in the world. The noise that should be made is a gentle, undulating, penetrating, but not irritating jingle. Experiments show that such