Demented Type General Paresis Varieties

CHAPTER VIII. VARIETIES {continued). General Paresis with Simple Progressive Dementia. — Some cases exhibit simple weak-mindedness throughout the whole course of the disease, without any intermediate stages of excitement or depression. This may follow in cases beginning with convulsions, or it may develop without any appreciable cause. There is considerable variation in the manifestations. It may show itself in simple loss of memory, in an inability on the part of the patient to adjust himself to his surroundings, or in a childish or emotional disturbance. Some cases are querulous or nervous, others are boyishly frolicsome. The physical symptoms take the usual course. GENERAL PARESIS OF THE DEMENTED TYPE. G. C, aged 50, a quiet-living man. First showed irresolution, want of keen interest, and forgetfulness; he could not realize necessity for working in order to live, and became irritable when pressed to work. Then his mind showed clear signs of enfeeblement and facility. He would believe silly stories; could not converse connectedly, had few likes or dislikes. His speech was thick, and lips quivered when he began to speak. His walk was not firm; in trying to turn around sharply he did so uncertainly, and could not walk on a chalk line, or stand steadily on one leg. Nearly all his symptoms are negative. He had a gentle kleptomania; he would automatically fill his pockets with acorns, rags, etc., and did not seem to care when they were taken from him. He died in six years of pure exhaustion, absolutely paralyzed, not having made an articulate sound for a year, and not having voluntarily used a voluntary muscle, lying on a water bed and leading a merely vegetative life. Such cases are apt to live a long time; they are not usually caused by a dissipated or excited life, and are of a calm, phlegmatic temperament. (Abstract, Clouston, Mental Diseases, p. 391.) A CASE OF GENERAL PARESIS OF THE DEMENTED TYPE WITH EPILEPTIFORM CONVULSIONS. A traveling salesman was regarded in good health, until his return home on one occasion, when he appeared dazed and unable to give an account of himself, except that he had been robbed in a sleeping car in New York. It was then found that he could not tell an occurrence ten minutes after it was past. On admission, he was good-natured, facile and satisfied. He did not mind remaining as long as we should choose, though he left a sick wife and little daughter dependent on friends for support. No impairment of gait; never had been excited, was eminently quiet, good-natured and satisfied. He had epileptiform convulsions, defective articulation, placid expression of face, impaired memory and weakening mind and entire satisfaction; muscular twitching of face and tongue, but hands and legs were firm and he walked without difficulty. He had a convulsion once a month and finally died from the effects of one, having never been excited, depressed or emotional. (Abstract, Stearns, Mental Diseases, p. 489.) A CASE OF GENERAL PARESIS OF THE DEMENTED TYPE WITH HEMIPLEGIA. W. B., aged 32, father has had apoplexy; patient had left hemiplegia of which a faint trace remains in the left leg; fairly good personal history. The attack of hemiplegia came on when he was at work in a coal pit, but he was able to walk home though his leg was somewhat stiff. His speech became slow and thick; he became weak and childish, this mental change being noticed before the onset of the hemiplegia. The pupils were at an early stage unequal and the reactions impaired. There is slight facial deficiency, tremor of tongue, slight tremor of lips and <Callout type=