Thus the course of the disease progresses until, in from two to three years, on the aver age, the paretic is a bedridden dement, who dies of exhaustion or an apoplectic or epilepti form convulsion. Occasionally remissions of the disease occur. These are particularly try? ing to most of the paretic's friends, for hopes of recovery receive a sudden stimulus only to be destroyed after a period of from six months to a year or so. Occasionally the remissions last a number of yeats, but at the present time it is believed that general paresis is a necessarily fatal disease.
The main features of a central type of the disease are here given, but there are countless variations. Acute maniacal states sometimes occur, and the patient dies in a galloping frenzy in from three to six months. Occa sionally a paretic is melancholic or stupor ous throughout. A small proportion, one-half per cent of the cases, show this type. Oc cas'onally—and many modern alienists believe this to be more common at present — a gradu ally progressive dementia without grandiose ideas marks the entire course of the disease. Most cases of paresis have apoplectiform or epileptiform attacks at some period of the dis ease. A few begin in this manner. There are
countless numbers of mixed forms, the details of which may be consulted in textbooks of mental disease. Here also the subdivisions of the disease into stages may be found. Of the treatment little may be added. The most es sential step in relation to this disease is its early recognition. To be able to know what is the matter before the patient has ruined his busi ness, or his family and friends, is the most im portant feature for the layman to grasp. The paretic himself is doomed, but it is not neces sary for those dependent on him to suffer irretrievable loss because of his disease. The proper course to pursue is to place the patient in a sanatorium or asylum at the earliest pos sible moment, the place selected depending largely on the means of his friends or relatives. Consult Maudsley, 'Pathology of Mind' (1895); Chase, 'General Paresis' (1902) Kraepelin, 'General Paresis, Nervous and Mental Dis ease Monograph Series'(the best short dis cussion in English) ; Jelliffe and White, 'Dis eases of the Nervous System' (2d ed., 1917). See DEMENTIA; INSANITY.