GROUP IV. PSYCHOSES DUE TO MI CROSCOPIC STRUCTURAL ALTERATIONS IN THE BRAIN (PRIMARILY PROBABLY NUTRITIONAL OR Toxic).
General Paresis.
Definition. — General paresis is a chronic, progressive, diffuse, structural alteration of the cerebral tissue, with in volvement of the cortical and meningeal blood- and lymph- vessels, attended by characteristic psychical and motor dis turbances. The disease is incurable and leads to death usually within three years.
Symptoms and Course.—No single symptom can be regarded as diagnostic of general paresis, even in the advanced stages. The diagnosis must be made from a study of certain concomitant symptoms, partly psychical and partly physical. Of the latter, the motor dis turbances are, as the various names given to the disease indicate. the most char acteristic.
Among the early psychical symptoms are irritability and especially an in stability of the moral and mental char acter. The subject is easily disturbed, emotional, of variable moods. His mem ory, especially for recent occurrences, be comes defective. He forgets dates, ap pointments, mislays valuable documents or other articles. The moral sense is often perverted. He loses that delicate sense of propriety by which his previous life has been guided. He becomes un conventional, consorts with drunkards and lewd females, makes indecent pro posals to respectable women of his ac quaintance, indulges in a latitude of speech and action not tolerated by the conventions of the social stratum to which he belongs; all this without recog nizing any impropriety in it. He may make a public merit of his sociological study of the nude in brothels, and of his compounding with liars and perjurers. He may violate public decency by ex posure of his genitals in the street, or show a coarse disregard for his own household by defecating in bed or uri nating on the carpet in his room.
There is progressive inability to con centrate the attention. With the failure in memory, incidents, real or imaginary, are embellished with fanciful details, the truth of which is asserted and maintained with vigor, and all doubts are actively and often angrily combated.
The prevailing character of the psy chical manifestations is one of exaltation. Cases occur not infrequently, however, in which the key-note throughout the whole course of the disease is depression. In some instances the diagnosis of melan cholia would be justified if the psychical symptoms alone are taken into consider ation. Delusions of persecution may also be present, but are generally attended by expansive delusions.
Delusions of grandeur are present in most cases of general paresis, although they cannot be regarded as essential or pathognomonic. Many cases of general paresis run their entire course without manifesting exaltation or expansive de lusions at any time.
The delusions of grandeur are not only unreasonable, but the patient's reasons for his extravagant beliefs are either in adequate or he does not give any reasons. While his imagination seems to be vivid, as shown in his delusions, it is, in fact, decreased. His delusions are so unre stricted that the most modest healthy imagination at once recognizes their ab surdity.
[There are no limits to the wealth, the power, or the accomplishments of the general paretic during the height of his delusions. One patient was going to build a railroad from Home to Chicago for the sole purpose of bringing the Pope to see the World's Fair; another had such acute vision that he could see a thousand miles without any difficulty; another owned the entire United States, France, and Spain, with outlying prov inces in China, India, and South America. He could have England, also, but didn't want it so long as the queen lived. GEORGE H. Itcm.E.1 These delusions are rarely fixed; that is to say, they do not possess the perma nent character of the delusions of para noia. While there is a general sameness of the main feature,—the expansiveness of the delusion,—the individual delu sions constantly vary.