Study of the cerebral cortex, cere bellum, medulla, and spinal column. In the latter both antero-lateral and pos terior tracts are affected. The neuroglia is found proliferated, especially in those parts of the nervous system which are normally rich in neuroglia. These re gions are in contact with the cerebro spinal fluid or the blood. It is this dis tribution of the neurogliar hyperplasia, early in the disease, that points to the existence of a toxin carried in the fluids of the organism as its cause. The writer believes that the nerve-cells are affected just as early as the neuroglia, but, as we have as yet no means of staining the primitive fibrils of the nerve-cells, this cannot be shown. L. Marchand (Presse Medical°, Aug. 14, 1901).
"Pathologists are not yet agreed whether the essential morbid condition in general paresis is inflammatory or de generative; whether the changes occur first in the nerve-elements, the stroma, or the lymph- and blood- vascular systems. Berkley, one of the most recent observers, found degenerative changes, and then, when the nerve-elements begin to atrophy and disorganize, an overgrowth of the spider-cells, with other fixed cell proliferation among the degenerating tissues; then follow the serous and sanguineous apoplexies and other inci dental symptoms occasionally found." Whether general paralysis is a disease sui peneris or not, it is certain that the pathological appearances point to irrita tive (probably inflammatory) processes in the upper layers of the convolutions in the earlier stages, and to pressure signs from the presence of fluid in the later. T. Claye Shaw (Brit. Med. Jour., Nov. 16, '89).
The whole process of paresis starts in the vessels, and from these inflammatory changes take place in the neuroglia, which leads to destruction of nerve fibres and changes in the ganglion-cells. General paralysis defined as an intersti tial diffuse encephalitis. Mendel (Neurol. Centralb., Sept. 1, '90).
Attempts made to solve the much-dis cussed question, whether the degenera tion of nerves in the progressive paraly sis of the insane is dependent upon a primary degeneration of the vessels, by examining, from the same parts of the brain of paralytics, the capillaries for their condition and sections for degener ation of fibres. The results were, that in every spot where degeneration of capil laries were found degeneration of fibres could also be ascertained. Seven brains were examined, and it was found that the capillaries in the frontal convolutions were always degenerated. In the cere bellar cortex they were degenerated 4 times in 5 cases. In the occipital lobes
the capillaries in 7 cases were healthy thrice, and those of the central convolu tions, although only examined twice in either case, were found diseased. The cortex of the temporal lobe showed healthy capillaries once, diseased ones twice; that of the parietal lobe, diseased ones once and healthy ones twice. Pau] Kronthal (Neural. Centralb., Nov. 15, '90).
Wasting of the fibres with axis-cylin ders in the gray substance of general paralytics (confirming the previous ob servations of Tuczet). Delicate fibres in middle layer of gray matter first to dis appear. A. Meyer (Allgemeine Zeitseh.
f. Psychiatric, etc., B. 51, H. 4, '95).
It is probable that these primary nutritional disturbances are due to toxic influences.
In the depressive delirium which often precedes general paralysis, the sum of the waste-products eliminated in the urine descends below the physiological proportion. In the anxious delirium one observes, on the contrary, an increased amount of solids in the urine, in spite of the insufficient nutrition of the pa tients. In the last period, but not in the beginning, the carbonate of am monium is found in the urine. Laillier (Le Bull. Med., Aug. 15, '90).
Series of experiments to determine whether the blood-serum of patients suf fering from paretic dementia possessed any bactericidal qualities. The results were as follow: (1) in normal and non paralytic individuals a bactericidal action was obtained and was most pronounced between the second and third hours; (2) this frequently fails completely in the blood of paralytics, or, if present, is very slight; (3) in those cases to which from 1 to 1 '/, grammes of chloral-hydrate had been administered on the previous day the blood-serum sometimes exhibited a distinct bactericidal action, and the author ascribes this to the slowly ex creted chlo•al-hydrate that remained in the system; (4) the blood-serum of tabetics exhibited a bactericidal action; (5) the absence of a bactericidal action is a specific quality of the blood-serum of paralytics. It cannot be explained by disturbances in general nutrition or by alterations in the blood, but may pos sibly be accounted for by assuming an alteration in the alkalinity, by a decrease in the amount of NaC1, or perhaps by an alteration in the leucocytes, and in the alexins produced by them. No bacteria are found in the blood of paralytics. Idelsohn (Phila. Med. Jour., from Archiv f. Psychiatrie, B. 31, H. 3, '99).