[Footnote 25: For a detailed statement of the post-mortem appearances in general paralysis compare Spitzka's _Insanity_, pp. 218-243; _Beiträge zur pathologischen Anatomie und zur Pathologie der Dementia Paralytica_, von Dr. Franz Tuczek; _Die Progressive Paralyse der Irren_, von Dr. E. Mendel; _Lehrbuch der Gehirnkrankheiten_, von Dr. C. Wernicke, iii. pp. 536-541. Westphal's classical work is not referred to, as his latest views and others of interest are given in a report of a discussion by the German Association of Alienists in the _Allgemeine Zeitschrift für Psychiatrie_, iv. 1883, pp. 634-638 and 648-654. In the third number of the _Neurol. Centralblatt_, Mendel reports an autopsy of a patient diagnosticated to have melancholia, who died a violent death, where he thought that he found evidence of the early stage of general paralysis in moderate opacity of the pia mater, with nodules as large as a pin's head in both parietal regions, and in slight indications of diffuse interstitial inflammation of the cortex, the blood-vessels in the frontal convolutions being extensively filled with white blood-corpuscles.] In the majority of cases there is pachymeningitis, often extensive and excessive, with hemorrhages, but which may be no more than is quite commonly found in persons dying of phthisis or chronic nephritis. There is also, usually, leptomeningitis, with adhesions to the cortex, especially of the anterior and antero-lateral portions, so firm that the arachnoid cannot be removed without tearing off portions of the brain; but it is sometimes scarcely observed, and may be no more than is found in persons dying simply of old age. The pia may be in places thickened, opaque, and without adhesions. Ependymitis is usual. In the terminal stage of general paralysis there is well-marked atrophy (with compensatory serous effusion), which is, as a rule, most marked in the cortex of the brain, but which is of varying degrees in its different {197} portions. Rarely there is scarcely any atrophy of the cortex. The central portion of the brain may be of leathery consistence, but usually shows marked sclerosis, which also may affect its different portions and the different ganglia very differently. The changes resulting from inflammatory, degenerative, and atrophic processes are general and profound. An opinion is beginning to obtain that general paralysis is primarily a disease of the small cerebral blood-vessels, functional or vaso-motor; and Meynert holds that the transition line between that stage, which he considers curable, and organic disease may be recognized clinically.