Prognosis.—The general experience is that general paresis is incurable. The prognosis is, therefore, unqualifiedly bad. While the progress of the disease can be interrupted by appropriate man agement, no method of treatment is known by which it can be permanently cured.
Apparent recovery from general paresis after a residence in the asylum of six and one-half years. At the present time, nineteen years after the beginning of the disease, the patient is engaged in prac tice as a physician. It is admitted that there may be some traces of mental weakness remaining. Wendt (Schmidt's Jahrbticher, July, '89).
Acute confusional insanity is the only mental disease besides general paralysis which may cause death. The prognosis is worse than in mania or melancholia.
The more complicated and changing the form, the worse the prognosis. J. Seglas (Archives Gen. de Med., May, June, '94).
Treatment.—Obviously not much can be said about the treatment of a disease which, according to all observations, uni formly tends to a fatal ending. It is possible that an early recognition of the disease may lead to measures to arrest its progress. It must be confessed that at present our notions of such measures arc extremely vague.
Complete rest from business and re moval from all sources of irritation is the first object to be striven for. Dissipa tion, intemperance and venereal excesses must be abandoned. Removal to a prop erly managed institution as early as practicable is, therefore, to be urged. When the patient is at liberty and in con trol of money or possessed of credit, his expansive delusions will often lead him to the commission of acts which, while not dangerous, may be decidedly embar rassing to himself or others.
Antisyphilitic treatment may be of benefit even in those cases where there is no evident syphilitic taint. Mercury and the iodides, the latter in large doses, may cause arrest of the connective-tissue pro liferation, and the absorption of the new formation in the brain and spinal cord.
From '/, to 1 ounce of iodide should be given daily.
To combat the sleeplessness, chloral, bromides, sulphonal, and paraldehyde are indicated. In some cases, however, even excessive doses of these drugs fail to pro duce their beneficial effects. Opium
may be cautiously tried, and will some times be effectual.
Marked success in checking the con vulsive seizures of general paralysis by hypodermic injections of ergotinine, grain in solution. One or two injections are sufficient to check the convulsions. Christian (La Trib. Mkt., Dec. 13, '39).
In general paralysis treatment must be guided not by the unfavorable prog nosis, but by a conscientious endeavor to rescue the ease. Many neurasthenics carefully treated are but general paretics in the earliest stages, saved before the fatal disease has a fixed hold. In cases of suspected paresis, the continuous ice cap, ergot, and, in maniacal cases, injec tions of ergotine, the wet pack, sodium bromide, and, in proper cases, local blood letting recommended. The iodides should be persistently tried, even in cases where a syphilitic history is not clear. Mey nert (Zeitsch. f. Therapie, Aug. 1, '90).
Primarily, the patient suffering from paresis must be removed from his usual field of activity and strict quiet enjoined. Abundant, but easily-digested, food is to be prescribed. Iodide of potassium or sodium will be found useful, and, in cer tain cases, ergot. If a specific history is obtained, active antisyphilitic treatment is to be pursued.
For those eases that unfortunately get beyond the first stage the treatment is of necessity adapted to the symptoms. Krafft-Ebing (Wiener med. Presse, Nov. 17, '90).
Encouraging results obtained in the treatment of paretic dementia by cold wet packs, always accompanied by cold to the head in the form of an ice-bag or wet towel. The duration of the pack is from one to three hours. The pack is followed by massage and sometimes by a brief douche. This treatment need not interfere with special treatment, such as iodide or mercurial inunctions.
The details of a cold or wet pack, as used in this treatment, are as follows: As many blankets are used as are con sidered necessary to produce a good re action in the patient, placing one blanket above another smoothly spread out upon the bed; over all is placed a linen sheet wet, in cold water and the patient is laid on that.