A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Science
A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Medicine -- Practice
The ability to recognize his own mental state is sometimes retained by
the patient, at certain times at least, to a quite late stage in the
disease, so that he learns to call his visions hallucinations and his
strange fancies delusions. He may even agree that his illusions are
all nonsense, that the disease is in his brain. The so-called lucid
intervals are not uncommon until the final stage of absolute dementia,
when attention, memory, judgment, conception, connection of ideas,
imagination, desires, the exercise of the senses, general sensibility,
after becoming more and more imperfect are at last completely
suspended. The moral sense and finer feelings had gone long before.
Although the story of the mind's decay in general paralysis is a
comparatively short one, from a few weeks to four or five years for
the prodromal period, and then an average of two or three years for
the rest, but varying from a few weeks to a rare extreme of twenty
years, there may be at any stage of the disease, except at the very
end, a more or less complete remission lasting from a few months to
ten years. It is dangerous to say, therefore, that there is any degree
of dementia which may not be temporarily at least, or in some part,
recovered from. Most of the reported cures of general paralysis have
been at last proved to be simply remissions, which may be partial or
so complete as to leave no trace to the most practised observer. It is
not uncommon to see a remission of six months or a year or two, in
which the patient can lead a quiet life; it is seldom that he
undertakes responsibilities without bringing the remission rapidly to
an end. There are a few cases where active business has been resumed
and followed successfully for several years. But there is apt even
then to be some deterioration in character, which may amount to an
actual moral insanity. An arrest in the downward progress, so that the
symptoms remain for a considerable time without essential change, is
not very uncommon, and may occur at any stage of the disease.
The physical symptoms of general paralysis consist in impaired control
over the muscles, diminished power of co-ordinating them, followed at
once by progressive muscular enfeeblement ending in complete
paralysis.
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