General paresis is increasing in fre quency, males being still more often affected than females. The disease ap pears to be more common in married men; thus, of 89 male patients, 64 were married, 17 single, 6 widowed, and 2 divorced. The disease apparently occurs almost exclusively among married women. Steinach (Mcd. Record, Dec. 17, '98).
General paralysis is a disease directly due to poisoning by the toxins of bac teria whose point of attack is through the gastric and intestinal mucous mem brane. The poisoning is probably a mixed poisoning, but bacillus coli is ap parently one of the noxious organisms. The result of treatment with serum taken from a case of general paralysis in a condition of remission and injected subcutaneously into an early progressive case points strongly to the fact that some form of serum-treatment is the proper treatment for this as yet incur able disease. L. C. Bruce (Brit. Med. Jour., June 29, 1901).
It is more frequent in cities than in country-districts. Men are attacked from three to five times as often as women. The latter appear to be becoming more subject to the disease, as a few years ago the proportion in the two sexes was stated as one to seven. Clergymen are almost exempt, while actors and "men about town" are the most frequent victims.
Pathological Anatomy.—In general paresis we have a psychosis based upon recognizable structural alterations in the brain. These alterations are so dissemi nated that the entire brain undergoes a gradual loss of functioning power as a whole. The structural changes in the brain are found everywhere. The vas cular sheaths arc filled with white and red blood-corpuscles, the vascular walls thickened, and the calibre of the vessels diminished. In the substance of the brain there is an increase of the connect ive-tissue elements which, we have reason to believe, produce atrophy of the brain cells by pressure. There is also fre quently close adhesion between the arachno-pia and the surface of the brain. There is pretty constantly a disappear ance of medullary nerve-fibres. At times there are minute hemorrhages into the substance of the brain.
The arachno-pia is generally cloudy and thickened. The convolutions are
diminished in volume and the fissures wider than normal. The cortical sub stance is decreased. The average dim inution in weight of the brain amounts to 100 to 200 grammes (3 to G ounces).
Arachnoid and pia mater examined in a series of patients with general paraly sis, pellagra, acute delirium, and other psychoses, particularly in the region of the central convolutions, where the me ninges in general are first subject to alter ations. In general paralysis the well known vascular changes found; they were even noticed at the beginning of the disease, before there was any trace of sclerosis or atrophy of the cerebral substance. Chronic hypermmia of the encephalon and the consecutive changes considered as primary anatomo-patho logical symptoms of paralytic insanity. In the pellagrous lunatic the pia mater presents diffuse opaque alterations, a slight augmentation of the connective tissue elements, and occasionally an in filtration of leucocytes, collected around the vessels or isolated in the meninges. In the other forms of insanity a slight thickening of the pia mater was usually noticed; the tortuous vessels had rigid walls, as in the case of very old people or in those dying of marasmus. The thickening of the pia mater usually be gan at the level of the central convolu tions. Francesco del Greco ("Revista Sperimentale di Freniatria e di Med. Legale in Relazione con 1'Antropologia e le Scienze Giuridiche e Sociali," Reggio Emilia, '93).
There is a widely - pervading cell degeneration of a granular, probably fatty type; overgrowth of the connect ive-tissue structure within the cerebral substance, and a diffuse, inflammatory change around the sheaths of the blood vessels, with slighter alterations in the sheaths themselves. It is regarded as very probable that the beginning of the disease is to be found in some alteration of the blood-supply, followed by a peri arterial lymphoid growth, disturbance of the lymph-currents, consequent malnu trition of the nerve-structures. The skull is at times markedly thickened. In the medulla oblongata and the spinal cord structural alterations similar to those in the brain are found.