On General Paralysis

Extract

The physical symptoms attending the general paralysis of the insane have been shown to present in their progress three well-defined stages. Some of the earliest physical signs—any one of which associated with a particular form of insanity will almost infallibly indicate the first stage of this special disorder—are the intermittent pulse, the irregular or contracted pupil, the quivering lip or embarrassed articulation. The second stage is marked by loss of power in the upper extremities, by a gait more or less unsteady, by diminished sensation in the cutaneous nerves, or by the loss of some of the special senses. In the third period the disease approaches its climax, in an entire want of motory power, and by an impairment of all the nervous functions so universal, that although organic life may, under careful treatment, be prolonged for a considerable time, the patient may be said to exist rather than to live. Epileptiform attacks may precede or accompany any one of these stages. They sometimes very distinctly mark out their boundaries, or the disorder may run its course without any recognised convulsive seizures.