PARALYSIS, General, of the Insane.
The close association of this incurable malady with a previous syphilitic invasion leaves no doubt that the preventive measures accepted as operative in syphilis should be maintained as regards general paralysis.
As in tabes, there are good grounds for believing, according to the views of Edinger, that the organic lesions are the ultimate result of over exertion of certain nerve paths in the tertiary stage—hence in the consider ation of preventive measures in a subject who has suffered from syphilis the dangers of high mental pressure and prolonged intellectual strain should not be overlooked. Whilst the treatment of the primary disease by Mercury, Salvarsan and other reliable agents should he prolonged and thorough with the view of effecting the destruction of the spirochxta, the possible advent of general paralysis—especially in those patients whose family histories supply evidence of instability of the nerve centres— should suggest to the physician the desirability of recommending the syphilitic patient to select, when possible, a non-strenuous life.
The early removal of the patient to a properly equipped lunatic asylum is necessary in the majority of cases in order to protect the victim himself and his family from the serious consequences liable to follow from the perpetration of crime or financial disasters caused by his giving way to his grandiose delusions. The quiet and rest which asylum treatment affords have certainly some retarding influence upon the rapidity of the progress of the disease through the diminution of the excitement kept up by his restless delirium.
The experience of all trustworthy observers has proved the futility of Salvarsan and Mercury when employed by the usual methods once the disease has declared itself. But there are good reasons for believing that the failure of salvarsan when given intravenously is due to the fact that owing to its large molecule the drug is unable to reach the nerve cells, hence a new method of treatment has been introduced and it promises to be come a valuable advance in the therapeutics of this hitherto incurable malady. This new method consists in the intraspinal injection of Salvar sanised Serum, and two plans are employed. One—the Swift-Ellis practice—consists in the intravenous administration of a full dose of salvarsan or of neosalvarsan by the veins; one hour afterwards a small quantity of blood is withdrawn from the patient, and after 24 hours 15 c.c.
of the blood-serum mixed with an equal amount of normal saline solution is injected by lumbar puncture, the dose being repeated within a fortnight.
Ogilvie obviates the necessity for repeated intravenous injections by directly mixing mgrm. salvarsan in vitro with 5o c.c. of the patient's blood, which after incubation is introduced into the spinal canal in doses of so c.c. whilst salvarsan is occasionally given by the veins. Upon the same principle Bichloride of Mercury Serum is prepared and administered. Both these serums have been administered by the subdural method, and they have been injected into the cerebral ventricles after a preliminary lumbar puncture which reduces the tension of the cerebro=spinal fluid. Whilst in advanced cases, owing to the destruction of the neurons, nothing can he hoped from this treatment, in early and recent cases the results have beyond doubt been most encouraging.
Symptoms as they arise must be treated on recognised principles; thus insomnia should be relieved by simple hypnotics like Trional; opium or morphia should be used sparingly; Hyoscine is a drug of much value in many cases. The paralytic seizures, accompanied by apoplectiform symptoms, are best met by hydropathy and the use of the ice-cap, and epileptic convulsions should be treated by Bromides alone, or with Chloral when the psychic phenomena are severe.
The type of case recognised as Tabio-paralysis or Cerebral Tabes is best managed upon the lines suitable for the treatment of advanced locomotor ataxia, and bladder symptoms, bedsores and Charcot's joint signs will require attention. The various methods of establishing drainage with the view of maintaining a low degree of intracranial pressure by trephining, whilst often suitable for the immediate relief of serious symptoms, are not justifiable as a routine plan of treating general paralysis.
.\s the victim of this disease passes into the helpless paralytic condition, which in his demented condition deprives him of the possibility of doing harm to himself and his relations, the remainder of his days may be permitted to be spent amongst his friends when careful nursing is within the reach of his means.