Paresis is what is sometimes called softening of the brain, and it attacks by preference men under thirty-five. The first symptoms of it as a rule are not alarming. A young man's disposition changes, so that an individual heretofore rather stingy becomes extravagant, while occasionally a prodigal becomes very saving and considers that he has already a large sum of money to his credit. The most prominent feature of the early stage of the disease is the occurrence of delusions of grandeur, that is to say, the patients get the idea that they are important personages, or that they have fallen heirs to a large sum of money, or that they have been appointed to high salaried positions. As a consequence of these delusions, they may make expensive presents to their friends. Occasionally there are other changes in disposition. A young {320} man, for instance, who has been of genial character becomes morose and hard to live with. The opposite change to greater liveliness of disposition is not unknown, but is more infrequent. Sometimes there are marked excesses, high living, luxurious habits, and the like, before the existence of disease is recognised. The mental stigmata of the disease at the beginning are not alarming at all. There are slight lapses of memory. A man who has hitherto been known as an accurate mathematician, makes frequent mistakes in adding or multiplying. The physical signs are even slighter. In using long words, syllables are omitted from them. A favourite method of testing the speech of a person suspected of beginning paresis is to ask for the pronunciation of a word like Constantinople. Usually a syllable will be elided, and the reply will be "Constanople," or something similar. There is a slight tremulousness of the hands and usually a rather easily marked tremor of the lips, especially when the tongue is protruded. Often in the very earliest stage of the disease, there are changes in the pupils. They may be unequal, or may fail entirely to react to light. When these signs are positive, that is, when there is a change in disposition and then the physical stigmata that we have gone over appear, the diagnosis of the disease is almost certain. The physician is able to say, with considerable assurance, that the young, strong, healthy-looking patient, who has often had to be tempted to come to see the doctor by some specious reason, because he does not consider himself that he has anything wrong with him, will have to be confined in an asylum within a year, or at most, two, and will die in a state of dementia within five years. This, of course, is an awful picture. This is the course of the disease in nearly 20 per centum of the inmates of our asylums. Almost without exception there is a history of syphilis in these cases, and the medical world is now persuaded that this is the most important factor in the production of paresis.