{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T21:13:59Z","timestamp":1770412439107,"version":"3.49.0"},"reference-count":226,"publisher":"Royal College of Psychiatrists","issue":"440","license":[{"start":{"date-parts":[[2018,2,8]],"date-time":"2018-02-08T00:00:00Z","timestamp":1518048000000},"content-version":"unspecified","delay-in-days":21407,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. ment. sci"],"published-print":{"date-parts":[[1959,7]]},"abstract":"<jats:p>Dementia paralytica is a declining disease. Deaths due to it in England and Wales were first recorded by the Registrar General in 1901 and since that year, when the number was 2,272, the annual figure has fallen steadily until in 1957 it was only 68. Moreover, there is evidence (adduced below) that not more than a small part of this decline can be attributed to improvements in medical treatment. The fear that there might be a recrudescence of dementia paralytica as a result of the spread of syphilis during the second world war has not so far been realized and it seems likely that what is now, in Great Britain at all events, an obsolescent disease will soon become a rarity. Yet there are many unsolved problems in its history. We do not know, for example, why the alleged references to this striking disease were so few and so inadequate until the third decade of the nineteenth century. We do not know why its recognition in many countries was so tardy in spite of the clear description given by the French alienists. Nor do we know why the disease, which at the start of the nineteenth century seems to have been predominantly one of males, has gradually\u2014and at different rates in different countries\u2014become much more evenly distributed between the sexes.<\/jats:p>","DOI":"10.1192\/bjp.105.440.594","type":"journal-article","created":{"date-parts":[[2008,8,6]],"date-time":"2008-08-06T14:02:31Z","timestamp":1218031351000},"page":"594-626","source":"Crossref","is-referenced-by-count":52,"title":["The Origin and Spread of Dementia Paralytica"],"prefix":"10.1192","volume":"105","author":[{"given":"E. H.","family":"Hare","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"170","published-online":{"date-parts":[[2018,2,8]]},"reference":[{"key":"S0368315X00158967_ref195","unstructured":"All the vessels of the Dura and Pia Mater were loaded with blood. The surface of the latter membrane was copiously moistened with a serous Effusion. The arachnoid coat was thick and opake over the convexities of the cerebral hemispheres, and the Texture of the Pia Mater generally distended with fluid. The lateral Ventricles were considerably larger than usual and contained an increased quantity of fluid; but they were not distended."},{"key":"S0368315X00158967_ref136","first-page":"1","article-title":"\u201cPathological Notes\u201d","volume":"15","author":"Workman","year":"1858","journal-title":"Amer. J. Insan."},{"key":"S0368315X00158967_ref192","unstructured":"Dec. Troubled with a Dyarrhoea about this Period."},{"key":"S0368315X00158967_ref108","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.3445.87"},{"key":"S0368315X00158967_ref191","unstructured":"Nov. A very miserable object, decidedly liable to attacks of Paralysis. Stammers in his speech and is extremely confused in his ideas. Very zealous in defence of his master."},{"key":"S0368315X00158967_ref99","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1936.00170150138009"},{"key":"S0368315X00158967_ref185","unstructured":"(signed E. T. Monro).\u201d"},{"key":"S0368315X00158967_ref52","volume":"Vol. 2","author":"Hirsch","year":"1885","journal-title":"Handbook of Geographical and Historical Pathology"},{"key":"S0368315X00158967_ref43","unstructured":"Garrison F. H. , An Introduction to the History of Medicine, 1929. 4th edition. London."},{"key":"S0368315X00158967_ref184","unstructured":"May. It appearing that this patient was altogether paralytick, and that his malady arose solely from this cause, no prospect appearing of rendering him any advantage, he was this day (Discharged as an Improper Object."},{"key":"S0368315X00158967_ref198","unstructured":"The term general as applied to paralysis was also a source of confusion. See an inconclusive discussion in the Journal of Mental Science (1896)."},{"key":"S0368315X00158967_ref178","unstructured":"(2) Male, age 26, admitted 20.11.1817."},{"key":"S0368315X00158967_ref218","unstructured":"Nineteenth century ideas on the aetiology of dementia paralytica provide material for a historical study which might illustrate our contemporary views on a disease such as schizophrenia where the aetiology is still obscure. Not only do many of these ideas seem very strange to us now, but they led to the advocation of \u201crational\u201d methods of treatment and prevention which might seem even more strange were it not that the history of medicine is full of such things. For example, the hypothesis that dementia paralytica was caused by sexual excess led to the prophylactic advice that wives should be \u201ccautioned against being too loving to their lords\u201d (Journal of Menial Science, 1873). Of course, not everyone agreed with such a view; Mickle (1880, p. 105) was contemptuous of it, on the grounds that married women were not lascivious bacchantes and stood in no need of such advice."},{"key":"S0368315X00158967_ref168","unstructured":"Of the nineteen cases stated to be paralytic, the three which seem to me the most suggestive of dementia paralytica are as follows:"},{"key":"S0368315X00158967_ref60","first-page":"154","volume":"53","year":"1907","journal-title":"Ibid"},{"key":"S0368315X00158967_ref163","unstructured":"She was sent out in a considerably increased state of violence than when she came in?\u2014 Yes, which Mr. Haslam attributed to paralytic (sic.)."},{"key":"S0368315X00158967_ref75","first-page":"21","article-title":"\u201cWhy is Neurosyphilis uncommon in the Tropics?\u201d","volume":"99","author":"McCartney","year":"1946","journal-title":"Mil. Surgeon"},{"key":"S0368315X00158967_ref151","unstructured":"\u201c\u2014I remember a woman who was discharged as paralytic, who came from Hoxton; the nurses said at the time that she was the strongest patient in the house; she was returned to Miles's."},{"key":"S0368315X00158967_ref150","unstructured":"There was a rule at Bethlem that patients who developed fits or became paralytic could be discharged immediately as incurable. In the Minutes of Evidence of the Committee appointed by Parliament in 1815 to consider the better regulation of madhouses in England there occur the following curious exchanges, which suggest that a diagnosis of \u201cparalysis\u201d might be no more than a mere administrative convenience. The Committee were questioning Wallet, at that time steward of Bethlem Hospital, concerning the early discharge of patients subject to fits or paralysis. Wallet replied (p. 64):"},{"key":"S0368315X00158967_ref148","unstructured":"Bucknill and Tuke (1858, p. 17) also refer to this passage from the Corpus Hippocraticum: \u201cWe might recognize here\u201d (they say) \u201cthe syemptoms of incipient general paralysis.\u201d"},{"key":"S0368315X00158967_ref145","unstructured":"Mickle (1880, p. 2) assigns the chief merit of the discovery of general paralysis to \u201cWillis, Haslam, Bayle and Calmeil, especially the first three\u201d. I doubt whether any Frenchman would agree."},{"key":"S0368315X00158967_ref28","unstructured":"Chase R. H. , General Paresis, 1902. London."},{"key":"S0368315X00158967_ref142","unstructured":"The life, character and works of Bayle and of other eminent French psychiatrists have been described by Ren\u00e9 Semelaigne (1894, 1930). The relevant parts of Bayle's inaugural thesis of 1822 on which rests his claim to have given the first clear description of dementia paralytica have been translated into English by Moore and Solomon (1934)."},{"key":"S0368315X00158967_ref113","first-page":"81","article-title":"\u201cDie paralytische Geistesst\u00f6rung beim weiblichen Geschlecht\u201d","volume":"7","author":"Sander","year":"1870","journal-title":"Berlin Klin. Woch."},{"key":"S0368315X00158967_ref205","unstructured":"Conolly confirms Bayle's observation that many patients dying of consumption show \u201cspehsthisica\u201d. The reference is not, of course, to the pathologist Gaspard Laurent Bayle, who wrote the famous Recherches sur la phtisie puitnonaire, but to Gaspard's nephew Antoine and his Maladies du Cerveau (p. 551)."},{"key":"S0368315X00158967_ref155","unstructured":"By whose order was she sent to Hoxton?\u2014She was discharged by the medical gentlemen as paralytic."},{"key":"S0368315X00158967_ref134","unstructured":"Wilson S. A. K. , Neurology, 1941. 2nd edition, 1954, edited by A. N. Bruce, London."},{"key":"S0368315X00158967_ref45","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-191411000-00003"},{"key":"S0368315X00158967_ref152","unstructured":"Do you know Sarah Payne?\u2014Yes."},{"key":"S0368315X00158967_ref197","unstructured":"The terms palsy and paralysis have given rise to some confusion in the history of medicine. They have been used to cover: (a) general enfeeblement of movement arising from any cause (e.g. Willis's \u201cbeing long fixed in bed\u201d); (b) all degrees of muscular weakness attributable to special disease rather than to general debility (e.g. Parkinson's \u201cshaking palsy\u201d); and (c) complete or nearly complete loss of voluntary power (e.g. Salomon's usage, where the term paresis is reserved for partial loss of power). The Parisian physicians who described dementia paralytica were well aware of the semantic difficulty: Delaye in 1824 used the term \u201cparalysie g\u00e9n\u00e9rale incomplete\u201d and Calmeil (1826, p. 9) adopted the shorter term \u201cparalysie g\u00e9n\u00e9rale\u201d only with reluctance and perhaps because (as Baillarger suggested) it was already in common use."},{"key":"S0368315X00158967_ref133","unstructured":"Wilson J. H. , on \u201cGeneral Paralysis of the Insane\u201d, Liverpool Med.-Chir. J., 1857, p. 231."},{"key":"S0368315X00158967_ref129","unstructured":"Walshe F. M. R. , Diseases of the Nervous System, 1947. 5th edition. Edinburgh."},{"key":"S0368315X00158967_ref125","unstructured":"Sudhoff K. , Essays in the History of Medicine, 1926. New York, Ch. 22, p. 259."},{"key":"S0368315X00158967_ref146","unstructured":"Most writers quote in the origmal Latin, but for the benefit of those whose Latin is as rusty as my own, I give the translation made by Samuel Pordage in 1684. The \u201cstreaked body\u201d is, of course, the corpus striatum. Willis's explanation of paralysis is based on the theory that normal functioning of the nervous system depends on the unimpeded flow of vital spirits from the brain down through supposed channels in the nerve tracts. A \u201cmorbific\u201d process manifested itself by the generation of \u201cstopping\u201d particles (or \u201coppilative\u201d particles, from the Latin, oppilare, to stop up) in the brain, and these, carried down into the narrower nerve channels, tended to clog them and so impede or prevent the flow of vital spirits."},{"key":"S0368315X00158967_ref116","unstructured":"Semelaigne R. , Les Grands Ali\u00e9nistes Fran\u00e7ais, 1894. Paris."},{"key":"S0368315X00158967_ref177","unstructured":"(No further notes.)"},{"key":"S0368315X00158967_ref115","unstructured":"Idem , Lectures on Mental Diseases, 1866. London."},{"key":"S0368315X00158967_ref193","unstructured":"Jan 11. Died of Apoplexy."},{"key":"S0368315X00158967_ref157","unstructured":"Had she, in your opinion, the appearance of a person who suffered under paralysis?\u2014I do not know that she had; I saw the difficulty they had in taking her away, in putting on a strait waistcoat; she was very strong.\u201d"},{"key":"S0368315X00158967_ref162","unstructured":"No want of articulation?\u2014No, not at all; but she was always kept handcuffed lately, and chained."},{"key":"S0368315X00158967_ref56","first-page":"175","article-title":"\u201cThe Economic Cost of Paresis in the United States\u201d","volume":"26","author":"Iskrant","year":"1945","journal-title":"J. ven. Dis. Inf."},{"key":"S0368315X00158967_ref137","first-page":"357","article-title":"\u201cOn Paresis\u201d","volume":"10","year":"1878","journal-title":"Canada Lancet"},{"key":"S0368315X00158967_ref112","first-page":"411","article-title":"\u201cGeneral Paralysis of the Insane in the Federated Malay States\u201d","volume":"62","author":"Samuels","year":"1916","journal-title":"ibid."},{"key":"S0368315X00158967_ref164","unstructured":"Was she very strong?\u2014Very strong; it required three or four people to move her; she was brought to the side-room every day, but there was great difficulty in moving her, she wanted her liberty I believe.\u201d"},{"key":"S0368315X00158967_ref175","unstructured":"November. Evident symptoms of Paralysis exist in this case and the grand line of operation appears to be the prevention of any fresh accession of similar attacks. His health is pretty good at this time."},{"key":"S0368315X00158967_ref111","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.8.43.365"},{"key":"S0368315X00158967_ref110","unstructured":"Rosanoff A. J. , Manual of Psychiatry, 1938. 7th edition. New York, p. 341."},{"key":"S0368315X00158967_ref106","first-page":"604","article-title":"\u201cAsylum Reports for 1890\u201d","volume":"37","author":"Richardson","year":"1891","journal-title":"J. Ment. Sci."},{"key":"S0368315X00158967_ref122","first-page":"760","article-title":"\u201cThe Increase of General Paralysis in England and Wales; its Causation and Significance\u201d","volume":"42","author":"Stewart","year":"1896","journal-title":"ibid."},{"key":"S0368315X00158967_ref105","unstructured":"Report together with the Minutes of Evidence and an Appendix of Papers from the Committee appointed to consider of Provision being made for the better Regulation of Madhouses in England (1815). London."},{"key":"S0368315X00158967_ref114","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.9.48.467"},{"key":"S0368315X00158967_ref156","unstructured":"Had she any paralytic attack during the time she was in the Hospital?\u2014I never heard of any attack."},{"key":"S0368315X00158967_ref74","unstructured":"Lunier M. L. , \u201cRecherches sur la paralysie g\u00e9n\u00e9rale progressive\u201d, Annal. M\u00e9d.-Psychol., 1849, p. 183."},{"key":"S0368315X00158967_ref101","unstructured":"Idem , Trait\u00e9 M\u00e9dico-philosophique sur l'Ali\u00e9nation Mentale, 1809. 2nd edition. Paris."},{"key":"S0368315X00158967_ref181","unstructured":"Jan. There can be no doubt that some slight degree of paralysis has occurred in this case. The stammering tongue, staring eyes, great incoherence of speech and general demeanour evince this plainly."},{"key":"S0368315X00158967_ref173","unstructured":"Sept. 10th. Remains in the same condition and is a hopeless case, I fear. 26th. Becomes. worse\u2014trembles much and stammers in his speech sometimes\u2014is very much lost in his mind. Has very grand ideas\u2014considers according to Dowie's account that he has four millions of money."},{"key":"S0368315X00158967_ref95","first-page":"10","article-title":"\u201cRecent developments in our knowledge of Syphilis in relation to Diseases of the Nervous System\u201d","volume":"i","year":"1908","journal-title":"Brit. med. J."},{"key":"S0368315X00158967_ref221","unstructured":"A more recent example of the \u201clegend\u201d theory is provided by two studies made in Bosnia and Herzegovina. In 1888, Gluck and others had reported that although syphilis was wide spread in these \u201cremote provinces\u201d, only 0.65 per cent. of native-born syphilitics developed dementia paralytica, compared with 9 per cent. of the foreign-born (Kraepelin, 1927, p. 1149). The investigation was repeated by Kojog (1939) who found that the proportion of paretics to syphilitics was the same as in Europe (5\u201310 per cent.). Kojog drew the conclusion that Gluck's work was entirely inaccurate; but the different findings might alternatively reflect the fact that the first world war and the general development of communication had made this part of Yugoslavia a much less remote place."},{"key":"S0368315X00158967_ref98","unstructured":"Nonne M. , Syphilis und Nervensystem, 1902. Berlin, p. 543. Quoted by Zilboorg and Henry, 1941."},{"key":"S0368315X00158967_ref30","unstructured":"Idem , ibid., 1904. 6th edition. London."},{"key":"S0368315X00158967_ref46","doi-asserted-by":"crossref","unstructured":"Griesinger W. , Mental Pathology and Therapeutics, 1861. Translated in 1867 by Robertson, C. L., and Rutherford, J., London.","DOI":"10.1037\/12213-000"},{"key":"S0368315X00158967_ref160","unstructured":"Had she a fit?\u2014I never knew her to have a fit."},{"key":"S0368315X00158967_ref55","first-page":"382","article-title":"\u201cDe la Paralysie G\u00e9n\u00e9rale chez la femme\u201d","volume":"19","author":"Idanoff","year":"1894","journal-title":"Annal. M\u00e9d.-Psychol."},{"key":"S0368315X00158967_ref26","first-page":"vii","volume-title":"Lead Poisoning","author":"Cantarow","year":"1944"},{"key":"S0368315X00158967_ref39","unstructured":"Esquirol E. , Article on \u201cDementia\u201d in the Dictionnaire des Sciences M\u00e9dicales, 1814."},{"key":"S0368315X00158967_ref97","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1192\/bjp.89.376-377.381","article-title":"\u201cMalaria in Neurosyphilis, 1923\u20131943\u201d","volume":"89","author":"Nicole","year":"1943","journal-title":"J. Ment. Sci."},{"key":"S0368315X00158967_ref36","first-page":"744","article-title":"\u201cThe Etiology of Dementia Paralytica\u201d","volume":"ii","author":"Diefendorf","year":"1906","journal-title":"Brit. med. J."},{"key":"S0368315X00158967_ref123","first-page":"41","article-title":"\u201cDecrease of General Paralysis of the Insane in England and Wales\u201d","volume":"47","year":"1901","journal-title":"ibid."},{"key":"S0368315X00158967_ref22","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.39.165.185"},{"key":"S0368315X00158967_ref135","first-page":"75","article-title":"\u201cGeneral Paralysis of the Insane\u201d","volume":"4","author":"Wise","year":"1869","journal-title":"Indian med. Gaz."},{"key":"S0368315X00158967_ref196","unstructured":"(signed Wm. Lawrence, E. T. Monro).\u201c"},{"key":"S0368315X00158967_ref41","unstructured":"Falret J. , Recherches sur la Folie Paralytique, 1853. Paris."},{"key":"S0368315X00158967_ref27","unstructured":"Castiglioni A. , A History of Medicine, 1947. 2nd edition. Translated by Krumbhaar, E. B. New York."},{"key":"S0368315X00158967_ref120","unstructured":"Spitzka E. C. , Insanity, its Classification, Diagnosis and Treatment, 1883. New York."},{"key":"S0368315X00158967_ref201","unstructured":"Between January, 1815 and July, 1823, Bayle (1826, p. 568) collected 189 cases of \u201cchronic meningitis\u201d (i.e. dementia paralytica) among 847 male admissions, and 25 among 606 female admissions to Charenton. His excellent case histories are monotonously similar in their clinical features and no series like them had ever been described before. His patients govern the universe, have 40 million tons of gold, own marble palaces, or build a new paradise. It was, as Bayle says (p. 547), \u201ctoujours le m\u2256me, d'id\u00e9edsominantes de richesse, de grandeur, de puissance\u201c."},{"key":"S0368315X00158967_ref128","first-page":"587","article-title":"\u201cThe Comparative Frequency of General Paresis\u201d","volume":"58","author":"Wagner","year":"1902","journal-title":"Amer. J. Insan."},{"key":"S0368315X00158967_ref119","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1926.tb05656.x"},{"key":"S0368315X00158967_ref126","first-page":"11","volume":"Vol. 2","author":"Toulouse","year":"1922","journal-title":"La Paralysie G\u00e9n\u00e9rale, Centenaire de la Th\u00e8se de Bayle"},{"key":"S0368315X00158967_ref174","unstructured":"Oct. 30th. He continues to exhibit symptoms of some Paralytick attack which has deprived him of his intellect. He continually harps on his wealth and musical abilities. The use of Calomel keeps him in an equable state."},{"key":"S0368315X00158967_ref102","doi-asserted-by":"crossref","unstructured":"Plaut F. , Paralysestudien bei Negern und Indianern, 1926. Berlin, p. 25.","DOI":"10.1007\/978-3-642-50751-9"},{"key":"S0368315X00158967_ref76","first-page":"451","article-title":"\u201cGeneral Paresis\u201d","volume":"33","author":"MacDonald","year":"1877","journal-title":"Amer. J. Insan."},{"key":"S0368315X00158967_ref54","first-page":"303","article-title":"\u201cPseudo-General Paralysis\u201d","volume":"42","author":"Hyslop","year":"1896","journal-title":"ibid."},{"key":"S0368315X00158967_ref24","unstructured":"Calmeil L. F. , De la Paralysie consid\u00e9r\u00e9e chez les Ali\u00e9n\u00e9s, 1826. Paris."},{"key":"S0368315X00158967_ref85","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.105.438.116"},{"key":"S0368315X00158967_ref7","first-page":"509","article-title":"\u201cDe la d\u00e9couverte de la paralysie g\u00e9n\u00e9rale, I\u201d","volume":"5","year":"1859","journal-title":"Ann. M\u00e9d.-Psychol."},{"key":"S0368315X00158967_ref124","unstructured":"Stoddart W. H. B. , Mind and its Disorders, 1921. 4th edition. London."},{"key":"S0368315X00158967_ref66","volume":"Vol. 2","year":"1927","journal-title":"Psychiatrie"},{"key":"S0368315X00158967_ref1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.101.5.585"},{"key":"S0368315X00158967_ref78","first-page":"450","article-title":"\u201cMental Disease in Negroes in New York State, 1939\u201341\u201d","volume":"37","author":"Malzberg","year":"1953","journal-title":"Ment. Hyg."},{"key":"S0368315X00158967_ref12","first-page":"94","article-title":"\u201cDementia Paralytica in the Negro\u201d","volume":"4","author":"Berkley","year":"1893","journal-title":"Johns Hopkins Hosp. Bull."},{"key":"S0368315X00158967_ref40","unstructured":"Idem , Des Maladies Mentales, 1838. Paris."},{"key":"S0368315X00158967_ref171","unstructured":"July 20th. A Tremor observable in this case with great incoherence of discourse. 23rd. From the evident tremor of his limbs and lips it is to be feared that Paralytick symptoms may come on in this case."},{"key":"S0368315X00158967_ref9","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.51.214.581"},{"key":"S0368315X00158967_ref48","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)72679-7"},{"key":"S0368315X00158967_ref130","doi-asserted-by":"publisher","DOI":"10.1192\/S0368315X00232167"},{"key":"S0368315X00158967_ref18","first-page":"198","article-title":"\u201cNew Cerebro-psychical Diseases\u201d","volume":"32","author":"Browne","year":"1875","journal-title":"Amer. J. Insan."},{"key":"S0368315X00158967_ref15","first-page":"165","volume":"Vol. 8","author":"Bostroem","year":"1930","journal-title":"Handbuch der Geisteskrankheiten"},{"key":"S0368315X00158967_ref20","unstructured":"Idem and Tuke D. H. , A Manual of Psychological Medicine, 1858, p. 17. London."},{"key":"S0368315X00158967_ref19","first-page":"141","article-title":"\u201cThe Diagnosis of Insanity\u201d","volume":"3","author":"Bucknill","year":"1857","journal-title":"J. Ment. Sci."},{"key":"S0368315X00158967_ref182","unstructured":"Feb. This patient shows repeated proofs of his having suffer'd from some attack of paralytick tendency. His spirits are ever good."},{"key":"S0368315X00158967_ref200","unstructured":"Browne (1875) says, \u201cIt would be difficult to rest satisfied with the belief that, whatever may be the cause, general paralysis did not exist until about 50 years ago, or that it had entirely escaped the cognizance of physicians, general and special; yet it is certain that on examining the works left by Pinel and his predecessors it is impossible to discover any mono graphic description of this frightful affliction, now so readily detected and diagnosed, although these distinguished men had, for long periods, access to all the experience afforded in Asylums for the Insane.\u201d But the Scottish Commissioner in Lunacy cannot have it both ways; either the disease did not exist or it existed but was not recognized."},{"key":"S0368315X00158967_ref38","first-page":"20","article-title":"\u201cSyphilis und Geistesst\u00f6ring\u201d","volume":"14","author":"Esmarch","year":"1857","journal-title":"Allg. Ztschr. f. Psychiat."},{"key":"S0368315X00158967_ref23","unstructured":"Burrows G. M. , Commentaries on the Causes, etc. of Insanity, 1829. London."},{"key":"S0368315X00158967_ref117","unstructured":"Idem , Les Pionniers de la Psychiatrie Fran\u00e7aise, 1930. Paris."},{"key":"S0368315X00158967_ref31","doi-asserted-by":"crossref","unstructured":"Conolly J. , An Inquiry concerning the Indications of Insanity, 1830. London.","DOI":"10.1016\/S0140-6736(02)96289-6"},{"key":"S0368315X00158967_ref33","unstructured":"Cullen W. , Synopsis Nosologiae Methodicae, 1769. Edinburgh."},{"key":"S0368315X00158967_ref29","doi-asserted-by":"crossref","unstructured":"Clouston T. S. , Clinical Lectures on Mental Diseases, 1883. London.","DOI":"10.1037\/12742-000"},{"key":"S0368315X00158967_ref35","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.25.109.8"},{"key":"S0368315X00158967_ref188","unstructured":"Aug. 22. This man has one of the most remarkable craniums Dr. Monro ever saw. There still remains a great propensity to suicide and he appears to be partially paralytick."},{"key":"S0368315X00158967_ref37","unstructured":"Ellis W. C. , A Treatise on the Nature, etc. of Insanity, 1838. London."},{"key":"S0368315X00158967_ref81","unstructured":"Idem , The Pathology of Mind, 1879. London."},{"key":"S0368315X00158967_ref147","unstructured":"Griesinger (1861, p. 172) wrote: \u201cIn lead poisoning the excitement passes frequently into stupor; besides, there are often cramps and paralysis: the prior existence of lead colic\u2026 may assist in forming the diagnosis\u201d. Meryon (1864), discussing a case of plumbism, says: \u201cfor nearly two years the characteristic colic of lead-poisoning preceded the paralysis; and such is the invariable course of the disease.\u201d In the seventeenth and eighteenth centuries, not only was industrial plumbism common but \u201coutbreaks of lead poisoning occurred throughout Western Europe as the result of the addition of lead to wine to promote fermentation and because of its employment in the manufacture and storage of cider and in materials for cooking vessels and other household articles\u201d (Cantarow and Trumper, 1944)."},{"key":"S0368315X00158967_ref172","unstructured":"Aug. 3rd. He imagines that he is the greatest of singers and that he performs at Covent Garden Theatre every night at the present time. 15th. Remains as heretofore. 20th. Either he has already suffered some slight Paralytick attack or the probability is that he will suffer it ere long."},{"key":"S0368315X00158967_ref88","unstructured":"Millingen , J. G., Aphorisms on the Treatment and Management of the Insane, 1840. London, p. 46."},{"key":"S0368315X00158967_ref8","first-page":"1","article-title":"\u201cDe la d\u00e9couverte de la paralysie g\u00e9n\u00e9rale, II\u201d","volume":"6","year":"1860","journal-title":"ibid."},{"key":"S0368315X00158967_ref90","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1934.02250100126011"},{"key":"S0368315X00158967_ref71","first-page":"17","article-title":"\u201cJohn Haslam, M.D., 1764\u20131844, Apothecary to Bethlem\u201d","volume":"10","author":"Leigh","year":"1955","journal-title":"J. Hist. Med."},{"key":"S0368315X00158967_ref167","unstructured":"She was discharged as paralytic?\u2014She was in a general state of tremor. We apprehended she would soon die; she was incurable. Patients becoming sick and weak, and not being able to undergo the discipline of the house, are immediately discharged.\u201d"},{"key":"S0368315X00158967_ref16","first-page":"169","article-title":"\u201cRecherches sur l'anatomie pathologique et la nature de la paralysie g\u00e9n\u00e9rale\u201d","volume":"12","author":"Bonnet","year":"1868","journal-title":"Annal. M\u00e9d.-Psychol."},{"key":"S0368315X00158967_ref3","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.22.97.82"},{"key":"S0368315X00158967_ref149","unstructured":"That a single case may be sufficient is illustrated by another of Willis's case histories in the same chapter \u201cOn Palsie\u201d of the De Anima (p. 167). The \u201cprudent and honest Woman\u201d with the \u201cspurios Palsie\u201d who, when she spoke too long or too eagerly, became as mute as a fish for an hour or two, must surely, as Guthrie (1903) pointed out, have suffered from myasthenia gravis."},{"key":"S0368315X00158967_ref80","doi-asserted-by":"crossref","unstructured":"Maudsley H. , The Physiology and Pathology of Mind, 1867. London.","DOI":"10.1037\/12216-000"},{"key":"S0368315X00158967_ref68","unstructured":"Idem , Die Progressive Allgemeine Paralyse, 1894. Vienna."},{"key":"S0368315X00158967_ref10","unstructured":"Bayle A. L. J. , Recherches sur l'arachnitis chronique, la gastrite et la gastro-ent\u00e9rite chroniques, et la goutte, consider\u00e9es comme les causes de l'ali\u00e9nation mentale, 1822. Paris."},{"key":"S0368315X00158967_ref17","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.10.52.491"},{"key":"S0368315X00158967_ref103","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.76.314.524"},{"key":"S0368315X00158967_ref186","unstructured":"(3) Male, aged 40, admitted 2.7.1818."},{"key":"S0368315X00158967_ref11","unstructured":"Idem , Trait\u00e9 des Maladies du Cerveau, 1826. Paris."},{"key":"S0368315X00158967_ref34","doi-asserted-by":"crossref","unstructured":"Dayton N. A. , New Facts on Mental Disorders, 1940. Illinois.","DOI":"10.1097\/00007611-194004000-00030"},{"key":"S0368315X00158967_ref42","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1956.tb04719.x"},{"key":"S0368315X00158967_ref159","unstructured":"\u201cWhile she was with you, had she any paralytic attack?\u2014She was much worse when she went back than when she came; she was mote violent and unhappy and distressed, always asking if she was going to be murdered and such things; Mr. Haslam thought she was paralytic."},{"key":"S0368315X00158967_ref217","unstructured":"One of the strongest objections to the Theory of Evolution was that, as no one could see evolution taking place, the theory was merely a hypothetical explanation of events long past and incapable of proof or disproof; and a recent demonstration that the evolutionary process can actually be observed today in certain species of seabirds has been claimed as valuable additional evidence. In the same way, many nineteenth century psychiatrists found it hard to believe that the prevalence of dementia paralytica in different countries could have changed significantly during the century; but its rapid increase among American negroes, a phenomenon that took place under the very eyes (so to speak) of Kraepelin, was a practical and almost irrefutable demonstration that such changes could occur."},{"key":"S0368315X00158967_ref21","unstructured":"Idem , ibid., 1874, 3rd edition. London."},{"key":"S0368315X00158967_ref189","unstructured":"Sept. He has an idea that his food and everything else he takes is poisoned. He is a truly deplorable object in every respect."},{"key":"S0368315X00158967_ref131","unstructured":"Whitwell J. R. , Syphilis in Earlier Days, 1940. London."},{"key":"S0368315X00158967_ref209","unstructured":"Another statistical sceptic was Spitzka, professor of medical jurisprudence at New York, and originator of the maxim that general paresis was due to the three W's\u2014wine, women and worry. He severely disapproved of \u201cwthiedely circulated error\u201d that general paresis was \u201ctravelling\u201d from east to west of the American continent. His opposition to MacDonald's statistics was based (1883, pp. 183, 208): (1) on the fact that in the German and French asylums, \u201cwhere the diagnostic acumen of the medical officers is unquestionable\u201d, the disease was said to be increasing only very slightly; and (2) on the ad hominem argument that MacDonald had not only attempted to support the ridiculous theory of the Englishman Austin that in general paresis an affection of the left pupil was associated with mania and of the right with depression, but that he had got this association the wrong way round, so that his figures instead of supporting Austin's theory were at complete variance with it\u2014a careless error which, says Spitzka, \u201cconstitutes a significant commentary on the reliability\u201d of the author's work in general. Yet in fact it was not MacDonald but Spitzka who was the careless one, inasmuch as Austin (1859, p. 31) claimed mania to be associated with contraction of the left, MacDonald (1877) with dilatation of the right pupil."},{"key":"S0368315X00158967_ref47","unstructured":"Guthrie D. , A History of Medicine, 1945. London."},{"key":"S0368315X00158967_ref44","unstructured":"Georget E. J. , De la Folie, 1820. Paris."},{"key":"S0368315X00158967_ref50","unstructured":"Idem , Observations on Madness and Melancholy, 1809. London."},{"key":"S0368315X00158967_ref166","unstructured":"\u201cWhat became of her?\u201dI do not know; she was discharged from the Hospital; she was paralytic."},{"key":"S0368315X00158967_ref179","unstructured":"\u201cDisorder'd six months. This is the first attack. He imagines himself a great Commander, being a Jew Lawyer."},{"key":"S0368315X00158967_ref63","doi-asserted-by":"publisher","DOI":"10.1159\/000253735"},{"key":"S0368315X00158967_ref67","first-page":"627","article-title":"\u201cZur Geschichte und Literatur der Dementia Paralytica\u201d","volume":"23","author":"Krafft-Ebing","year":"1866","journal-title":"Zeitschr. f. Psychiat."},{"key":"S0368315X00158967_ref118","first-page":"885","article-title":"\u201cContributions to the Natural History of General Paralysis\u201d","volume":"5","author":"Skae","year":"1860","journal-title":"Edinburgh med. J."},{"key":"S0368315X00158967_ref214","unstructured":"2. The change in sex ratio of deaths from general paralysis of the insane is closely paralleled by that from tabes, the accurate diagnosis of which was probably little influenced by the new techniques (Fig. 1);"},{"key":"S0368315X00158967_ref161","unstructured":"No contraction of limbs?\u2014No."},{"key":"S0368315X00158967_ref220","unstructured":"\u201cIn countries where the social care of the insane is not adequately carried out, only a fraction of the psychotic patients enjoy medical attendance, but it is highly improbable that general paretics will be missing amongst these few, all the more so as their symptoms are usually very disturbing. If accordingly I experienced that, in a hospital containing several hundred native patients, not one case of general paresis could be found by excellently trained medical officers, we must infer that the disorder cannot in any way be as common in those parts as it is at home\u201d (Kraepelin, 1926)."},{"key":"S0368315X00158967_ref59","first-page":"646","volume":"42","year":"1896","journal-title":"Ibid"},{"key":"S0368315X00158967_ref169","unstructured":"(1) Male, age not stated, admitted 18 Jly. 1816."},{"key":"S0368315X00158967_ref153","unstructured":"Was she a strong healthy-looking person?\u2014Very much so."},{"key":"S0368315X00158967_ref79","first-page":"139","volume":"Vol. 2","author":"Marie","year":"1922","journal-title":"La Paralysie G\u00e9n\u00e9rale, Centenaire de la Th\u00e8se de Bayle"},{"key":"S0368315X00158967_ref107","first-page":"1","article-title":"\u201cThe Discovery of General Paralysis\u201d","volume":"69","author":"Robertson","year":"1923","journal-title":"ibid."},{"key":"S0368315X00158967_ref61","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(58)91082-1"},{"key":"S0368315X00158967_ref127","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1192\/bjp.5.30.575","article-title":"\u201cOn General Paralysis\u201d","volume":"5","author":"Tuke","year":"1859","journal-title":"J. Ment. Sci."},{"key":"S0368315X00158967_ref62","volume-title":"3rd Gordon Bell Memorial Lecture","author":"Klotz","year":"1927b"},{"key":"S0368315X00158967_ref132","unstructured":"Willis T. , De Anima Brutorum, 1672. Translated in Dr. Willis' Practice of Physick, by Samuel Pordage, London, 1684. Part II, \u201cConcerning the Soul of the Brutes\u201d, Ch. 9, et seq."},{"key":"S0368315X00158967_ref89","doi-asserted-by":"publisher","DOI":"10.1007\/BF02867077"},{"key":"S0368315X00158967_ref64","unstructured":"Kraepelin E. , \u201cGeneral Paresis\u201d, Nervous and Mental Diseases Monograph No. 14, 1913. New York. Translated by Moore, J. W."},{"key":"#cr-split#-S0368315X00158967_ref140.1","unstructured":"It has been strangely neglected by the historians of medicine. Neither the early history of the disease nor the name of Antoine Bayle (who is universally credited with the principal part in its delineation) are so much as mentioned in the histories of Garrison (1929), Guthrie (1945), Castiglioni (1947) or Major (1954)"},{"key":"#cr-split#-S0368315X00158967_ref140.2","unstructured":"and there is only a passing reference in Mettler (1947). Henry, in his History of Medical Psychology (Zilboorg and Henry, 1941) gives a good account, but the story should have a place in the general history of medicine."},{"key":"S0368315X00158967_ref65","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-192603000-00001"},{"key":"S0368315X00158967_ref69","first-page":"285","article-title":"Lancet","volume":"ii","year":"1957","journal-title":"\u201cA new disease?\u201d"},{"key":"S0368315X00158967_ref70","first-page":"58","article-title":"\u201cSyphilis\u2014a historical and modern problem\u201d","volume":"129","author":"Lees","year":"1950","journal-title":"Trans. Med.-Chir. Soc. Edin."},{"key":"S0368315X00158967_ref187","unstructured":"This man has been disordered only 4 months and married only 6 months. He has been 3 weeks at Mr. Pell's Somers Town. He has lived 8 years with Messrs. Rundell & Bridge. Ludgate Hill. He has attempted suicide and is a native of Scarborough. He has a brother who threw himself over Blackfriars bridge. He had a most excellent character."},{"key":"S0368315X00158967_ref77","unstructured":"Major R. H. , A History of Medicine, 1954. Oxford."},{"key":"S0368315X00158967_ref190","unstructured":"Oct. A little improvement is observable in this case since the last account. He talks less and is not so much agitated in his general demeanour. He is described as cleanly in his person."},{"key":"S0368315X00158967_ref72","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1923.02190190029003"},{"key":"S0368315X00158967_ref4","unstructured":"Austin T. J. , General Paralysis, its Symptoms, Causes and Seat, 1859. London."},{"key":"S0368315X00158967_ref104","unstructured":"Prichard J. C. , A Treatise on Insanity, 1835. London."},{"key":"S0368315X00158967_ref57","first-page":"164","volume":"19","year":"1873","journal-title":"Journal of Mental Science"},{"key":"S0368315X00158967_ref82","unstructured":"Idem , ibid., 1895, 2nd edition. London."},{"key":"S0368315X00158967_ref83","unstructured":"Meryon E. , Practical and Pathological Researches on the Various Forms of Paralysis, 1864. London, p. 153."},{"key":"S0368315X00158967_ref25","unstructured":"Idem , Trait\u00e9 des Maladies Inflammatoires du Cerveau, 1859. Paris."},{"key":"S0368315X00158967_ref84","unstructured":"Mettler C. C. , A History of Medicine, 1947. Philadelphia."},{"key":"S0368315X00158967_ref87","unstructured":"Idem , ibid., 1886. 2nd edition. London."},{"key":"S0368315X00158967_ref5","first-page":"1011","volume":"Vol. 6","author":"Ballet","year":"1894","journal-title":"Trait\u00e9 de Medicine"},{"key":"S0368315X00158967_ref58","first-page":"116","volume":"41","year":"1895","journal-title":"Ibid"},{"key":"S0368315X00158967_ref154","unstructured":"Was she a violent patient?\u2014She was."},{"key":"S0368315X00158967_ref2","unstructured":"Arnold T. , Observations on the Nature, etc. of Insanity, 1786. London."},{"key":"S0368315X00158967_ref109","first-page":"205","article-title":"\u201cClinical Variations in Disease from the Historical Point of View\u201d","volume":"ii","year":"1927b","journal-title":"ibid."},{"key":"S0368315X00158967_ref49","unstructured":"Haslam J. , Observations on Insanity, 1798. London."},{"key":"S0368315X00158967_ref73","unstructured":"Lomholt M. , \u201cClinic and Prognosis of Malaria-treated Paralysis\u201d, Acta Psychiat. Neurol. Scand., 1944, Suppl. 30."},{"key":"S0368315X00158967_ref51","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1932.tb02961.x"},{"key":"S0368315X00158967_ref92","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)40744-6"},{"key":"S0368315X00158967_ref6","unstructured":"Baillarger M. , \u201cD\u00e9lire hypocondriaque des d\u00e9ments paralytiques\u201d. Gaz. des H\u00f4pitaux, 1857, pp. 55, 218, 477."},{"key":"S0368315X00158967_ref96","unstructured":"Neumann H. , Lehrbuch der Psychiatrie, 1859. Quoted by Krafft-Ebing, 1894."},{"key":"S0368315X00158967_ref139","unstructured":"The disease which all English-speaking physicians recognize by the term \u201cgeneral paralysis of the insane\u201d or \u201cG.P.I.\u201d has suffered from a plurality of names. Calmeil, in 1826, called it \u201cparalysie g\u00e9n\u00e9rale des ali\u00e9n\u00e9s\u201d, which was no doubt an improvement on Bayle's \u201carachnitis chronique\u201d of 1822, in that it did not assume an unproved pathological cause. But later, when Baillarger and others believed they had discovered cases of general paralysis without insanity, a new name seemed necessary, and Falret in 1853 advocated \u201cfolie paralytique\u201d. However, Calmeil's term was by that time fairly entrenched and remained the favourite in spite of Salomon's quip (1862) that \u201che who is generally paralysed is certainly dead\u201d. Salomon suggested the alternative \u201cgeneral paresis\u201d\u2014a term which has enjoyed a considerable vogue in America. Mickle, in his authoritative English textbook on the subject (1880), gave a list of eight English and nineteen French synonyms, but his book is still entitled General Paralysis of the Insane. Krafft-Ebing and other German writers favoured the name \u201cdementia paralytica\u201d; and in adopting this name, which I believe to be the most satisfactory one, I have had in mind not only that it over-rides the barriers of national language but also that (a) Salomon's criticism of the term \u201cgeneral paralysis\u201d is unanswered, (b) the word \u201cinsane\u201d is a legal rather than a medical term and has since 1930 been largely expunged from English statutes, and (c) the criticism that the initial letters of dementia paralytica may be confused with those of dementia praecox is no longer a valid one. Yet during the period with which this essay is mostly concerned (that is, broadly, the nineteenth century), \u201cgeneral paralysis of the insane\u201d or more simply \u201cgeneral paralysis\u201d was the common English usage."},{"key":"S0368315X00158967_ref199","unstructured":"Why, we may wonder, should Esquirol have credited Haslam with a discovery that Haslam's own countrymen denied him? Were it not out of keeping with the magnanimous character of that great Frenchman, we might be tempted to suppose a wish to attenuate the claims of the upstart Bayle, a young man who did not belong to the school of Pinel and Esquirol but had been trained in pathological anatomy by his uncle Gaspard Laurent Bayle and his uncle's friend Laennec. A more reasonable explanation, however, would be that Esquirol, who always thought of paralysis as only a complication of insanity, would have seen no reason to believe that the cases he saw in Paris and which were later delimited by Bayle and Calmeil differed in any fundamental way from other cases of paralysis in the insane already described by Haslam."},{"key":"S0368315X00158967_ref32","unstructured":"Idem , On Some Forms of Insanity, 1849. London."},{"key":"#cr-split#-S0368315X00158967_ref202.1","unstructured":"This would of course in no way lessen the merit of its first describers. The efflorescence of genius which led to and was evoked by the discovery of dementia paralytica is one of the most astonishing and glorious chapters in psychiatry. Baillarger (1860) considered this dis covery the most important single achievement in the history of mental disease"},{"key":"#cr-split#-S0368315X00158967_ref202.2","unstructured":"Harrington Tuke (1859) wrote of Calmeil's De la Paralysie that it described general paralysis \"with a terseness and success that may be considered as rendering his work unrivalled in medical literature\". Robertson is no less emphatic: referring to the publication in 1826 of Bayle's Maladies Mentales and Calmeil's De la Paralysie, he says-The appearance in the same year of two such books \u2026, both dealing with a newly discovered disease in so masterly a fashion, is unique in the history of medicine. And, although much has been written about general paralysis during a century, the disease is described in these two books so fully, so faithfully and so convincingly that future additions to our knowledge seem little more than details. No other book devoted to this subject alone was written for two generations afterwards, nor was there any needed.\" I wish I could add the commendation of some general physician."},{"key":"S0368315X00158967_ref203","unstructured":"We might even hazard the guess that the honour of being the eponymous discoverer of dementia paralytica went to Bayle because, not being a pupil of Esquirol and having no great experience of mental disease, he saw his patients' behaviour without the preconceptions of instruction or of habit. Bayle was only 19 when he became interne under Royer Collard at Charenton, and only 23 when he submitted his inaugural thesis\u2014\u201cRecherches sur les maladies mentales\u201d (1822). But Georget, Delaye, Falret and Calmeil would be thoroughly familiar with the classification and opinions of their great teacher, Esquirol, and of his great teacher, Pinel; they were for many years unable to conceive that paralysis could be other than a mere epiphenomenon of insanity, as scurvy or phthisis might be; and Esquirol himself never abandoned that view (Baillarger, 1859, 1860). \u201cThere is a suspicion\u201d, says Robertson, \u201cthat antagonism to Bayle existed because he did not belong to the school of Esquirol.\u201d This is too mild. It is obvious that intense passions were aroused. Esquirol's pupils went out of their way to pour scorn on Bayle's ideas and to belittle his achievements. According to Toulouse (1922), even Pinel pronounced his work \u201cpremature and useless\u201d. We read with sorrow but without surprise that after his term of office as interne at Charenton ended in 1823, Bayle \u201cdrifted away\u201d from the study of mental diseases to that of general medicine, anatomy, medical history and (horresco referens) bibliography. He died in 1858, two years before the writings of Baillarger convinced his compatriots that dementia paralytica might properly be called \u201cla maladie de Bayle\u201d."},{"key":"S0368315X00158967_ref204","unstructured":"Meyer (1959) has pointed out that Griesinger, in the first edition of his textbook, 1845, drew attention to the occurrence of \u201cso-called general paralysis\u201d in Germany."},{"key":"S0368315X00158967_ref206","unstructured":"Nevertheless, in some asylums in England and Wales there were whole decades when a quarter or more of all the male admissions were paretic. These cases pursued a slow but relentless course to complete dementia and death, and it is not hard to imagine that the un rewarding and dispiriting task of nursing them was one reason why the high standards of humane care set up by the pioneers of non-restraint and moral management seem gradually to have deteriorated during the latter half of the nineteenth century."},{"key":"S0368315X00158967_ref207","unstructured":"See the 41st Annual Report of the General Board of Commissioners in Lunacy for Scotland (1899, App. A, Tab. X). We may calculate a crude mortality rate for general paralysis in England and Wales and in Scotland, using the figures given in the Board of Control Reports for the year 1876 and the estimated population of the two countries in this year. Expressed as deaths per million of the population, the figure for England and Wales is over 50, for Scotland it is under 20."},{"key":"S0368315X00158967_ref208","unstructured":"Macdonald, Workman and Mickie were Canadians and had all studied at the Toronto School of Medicine. Mickle, who emigrated to England and became Superintendent of Grove Hall Asylum, London, was unimpressed by the American statistics of his two compatriots and dismissed them with the remark that \u201cmany statistics are utterly misleading \u2026 merely an index of the varying capacity of medical men to recognize the disease\u201d. But when we remember that this disease was recognized in America only at a time when every psychiatrist must have been familiar with its textbook description, and that the progress of any infectious disease across that vast and largely unopened continent must have been relatively slow, we may think the Americans had a better opportunity than Europeans of observing the spread of dementia paralytica."},{"key":"S0368315X00158967_ref210","unstructured":"Kraepelin (1927, p. 1137) discusses the unreliability of the nineteenth century statistics on dementia paralytica and gives his opinion that \u201cthey are set about with so many sources of error as not to allow any definite conclusion of the actual alterations in frequency of the disease\u201d. Nevertheless, he in fact permitted himself to draw general conclusions: for example (p. 1145), \u201cfrom these considerations we may take it as very probable that dementia paralytica was formerly uncommon, then underwent a progressively rapid increase from the beginning of last century and for some time now has been gradually diminishing\u201d; and again, discussing the sex incidence (p. 1150), \u201calthough the figures may be considerably influenced by the sources of error mentioned above, yet there can be no doubt of the overall increase in the danger to the female sex from dementia paralytica\u201d."},{"key":"S0368315X00158967_ref211","unstructured":"It is sometimes urged that the present-day diagnosis of schizophrenia is too uncertain for epidemiological studies of this disease to be meaningful. The history of dementia paralytica suggests that we should be unwise to neglect such studies. In 1857, Esmarch and Jessen had drawn attention\u2014rather apologetically\u2014to the statistical relations between syphilis and paresis. Another early piece of evidence for the syphilitic hypothesis was provided by Sankey, who, in 1866, pointed out the close association between the incidence of syphilis and of paresis in different social classes. But this delicate flower was withered by the scorn and authority of Mickle, who, in his textbook (1880, p. 105) dismisses it with the inappropriate remark that \u201ceven if true this does not establish any connection between the syphilis and the general paralysis\u201d. Krafft-Ebing, on the other hand, was so impressed by the statistical evidence that he was emboldened in 1894 to inoculate nine paretic patients with syphilis; but, as Berkley (1900, p. 174) and others observed, this proved nothing, for persons infected with syphilis do not necessarily develop symptoms, patients with longstanding syphilis may acquire the infection anew, and other investigators (see Diefendorf, 1906) repeated Krafft-Ebing's work with contrary results. Yet this doubtful experiment caught hold of the popular fancy, convinced many who had been sceptical of all the patiently accumulated statistics, and is still regularly quoted as one of the landmarks in the history of dementia paralytica."},{"key":"#cr-split#-S0368315X00158967_ref144.1","unstructured":"Maudsley was the weightiest proponent of the theory of sexual excess. In the first edition of his Physiology and Pathology of Mind (1867, p. 360) he takes the very moderate view that the commonest cause of dementia paralytica is intemperance, alcoholic or sexual, and, acknowledging that these are nevertheless not infrequently absent, adds that then \"some sort of hereditary taint is likely enough to be present\". In 1873 his views are more definite and his contribution to an aetiological discussion is reported in the Journal of Mental Science (1873) thus: \"He would by no means venture to say that sexual excess was the sole or entire cause of general paralysis \u2026 but of the efficiency of sexual excesses as an exciting cause he entertained no doubt\" the excesses he had in mind were not sudden outbursts of sexual activity but \"that quiet steady continuance of excesses over months or years, by married people, which was apt to be thought no vice or no harm at all.\" By 1879 (Pathology of Mind, 1st edition, p. 432) his opinion on the most frequent exciting cause is-\"Sexual excess I hold confidently to have that evil pre-eminence\""},{"key":"#cr-split#-S0368315X00158967_ref144.2","unstructured":"and in 1895 (2nd edition, p. 465): \"Were it right to ascribe it to any single cause, I should fix on sexual excess and still hold the opinion despite the dissent of those inquirers who find no evidence of such excess.\" Although, from our later knowledge, these extracts might tempt us to reflect on the puritan strain in Maudsley and on the Victorian attitude to sex, yet, until the weight of evidence associating denlentia paralytica with syphilis became overwhelming, the theory of sexual excess explained the facts as well as any other theory and better than most. At times, however, the attempt to reconcile fact and theory strains even Maudsley's ingenuity: commenting on the rarity of general paralysis in the highlands of Scotland, \"where there is of course no deficiency of women or whisky\", he asserts that an open-air life and \"a great deal of bodily exercise\" make people less likely to be provoked into excesses and more capable of withstanding them."},{"key":"S0368315X00158967_ref212","unstructured":"The difficulties of clinical diagnosis were indicated by the problem of \u201cpseudo-paralysis\u201d (see, for example, Hyslop, 1896). It is likely that these difficulties increased at the end of the nineteenth century on account of the rapid changes in the proportions of the different clinical types of dementia paralytica. However, it seems that the difficulty lay more in the initial than in the final diagnosis: Kraepelin says of the period 1892\u20131907, \u201cat time we had the tendency to diagnose the condition as early as possible from the clinical picture. \u2026 Consequently we made many wrong diagnoses later discovered by regular follow-up\u201d (1927, Vol. 1, p. 958). Objective diagnosis became common after Wassermann's demonstration, in 1906, that his complement-fixation test was given by the cerebrospinal fluid of paretics; and was further refined after 1912 when Lange discovered the specific reaction of the fluid to colloidal gold. With these facts in mind we may note that in England and Wales:"},{"key":"S0368315X00158967_ref216","unstructured":"This reviewer seems to have been particularly unguarded in his assertion. The Annual Report gave a table of deaths, not only from general paralysis but also from \u201capoplexy and paralysis\u201d and the numbers in this latter table did not vary over 30 years and showed no sex difference: clearly the Scottish doctors had been at pains to separate \u201ccerebral softening\u201d and \u201ccerebral paralysis\u201d from general paralysis. As for disseminated sclerosis, the Reports of the Commissioners in Lunacy give the number of deaths in England and Wales from cerebral and spinal sclerosis in 1901 as 8, in 1906 as 18, in 1910 as 9; the number in Scotland would be proportionately less and it seems clear there had been little variation in the statistically negligible number of such cases. Again, a fellow-reviewer writing twelve years earlier on the 36th Annual Report (Journal of Mental Science, 1895) had said, \u201cThere can be no reasonable doubt, even after making due allowance for possible greater certainty in diagnosis, that of late years there has been a steady and by no means inconsiderable increase (in general paralysis), notably in the male sex.\u201d"},{"key":"S0368315X00158967_ref219","unstructured":"For a long time, one of the most unlikely of these speculations was that dementia paralytica was due to syphilis. The statistical and epidemiological evidence in favour of this view, how ever, became increasingly strong at the end of the nineteenth century. But statistical evidence is never proof and as late as 1902 Nonne could state that in his opinion \u201cprogressive paralysis is not a specific syphilitic disease of the brain\u201d. Kraepelin, in 1904 (and this was two years before Wassermann showed that his antigen reaction was given by the spinal fluid of paretics), was bold enough to commit himself absolutely to the syphilitic hypothesis, but for the more cautious or less statistically-minded psychiatrist there was no sure path through the speculative labyrinth until the autumn of 1912, when, in the paretic brain sections sent to Noguchi by Moore, the pale visage of a few spirochaetes sufficed to disinherit chaos."},{"key":"S0368315X00158967_ref94","first-page":"166","volume":"1","author":"Mott","year":"1900","journal-title":"Arch. Neurol."},{"key":"S0368315X00158967_ref222","unstructured":"All authorities have agreed that grandiose delusions were less common in female paretics. According to Stoddart (1921, p. 433) this peculiarity was ascribed by Krafft-Ebing and Regis to the relative poverty of ideation in women."},{"key":"S0368315X00158967_ref223","unstructured":"Walshe (1947, p. 174) says that he \u201ccannot claim ever to have been satisfied that antisyphilitic treatment influences the course of tabes\u201d."},{"key":"S0368315X00158967_ref170","unstructured":"\u201cDisordered about 5 weeks. Was disordered 2 years ago and recovered. Talks incoherently \u2014not mischievous. Comes from the Parish of New Windsor, played the Serpent in the Earl of Dartmouth's Band. Staffordshire Militia 2 or 3 years ago."},{"key":"S0368315X00158967_ref100","unstructured":"Pinel P. , Nosographie Philosophique ou M\u00e9thode de l'Analyse appliqu\u00e9e \u00e0 la M\u00e9decine, 1798. Paris."},{"key":"S0368315X00158967_ref213","unstructured":"1. The Registrar General's figures from 1901 onwards for deaths due to general paralysis of the insane show no change other than a continued downward trend (Fig. 2);"},{"key":"S0368315X00158967_ref158","unstructured":"The matron of Bethlem, Elizabeth Forbes, was also questioned on Sarah Payne (p. 76):"},{"key":"S0368315X00158967_ref53","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.87.366.1"},{"key":"S0368315X00158967_ref141","unstructured":"The view that the fifteenth century outbreak of syphilis was due to a mutant strain of the spirochaete has been succinctly put in the Lancet (1957). See also Hirsch (1885), Mott (1908), Morris (1912), Sudhoff (1926), Whitwell (1940), Lees (1950). Some of the arguments for and against the neurotropic hypothesis of dementia paralytica are summarized by Hutton (1941) and Wilson (1941, Vol. I, Ch. 17). Curiously, however, neither of these writers makes reference to the suggestive (though limited) epidemiological evidence mentioned in support of the hypothesis by Stewart (1924). The present essay is, in one sense, an attempt to add to this epidemiological evidence."},{"key":"S0368315X00158967_ref138","unstructured":"Zilboorg C. , and Henry G. W. , A History of Medical Psychology, 1941. London, Ch. 13."},{"key":"S0368315X00158967_ref91","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.53.223.507"},{"key":"S0368315X00158967_ref165","unstructured":"Later still in the Inquiry, Haslam himself was questioned about Sarah Payne (p. 128):"},{"key":"S0368315X00158967_ref176","unstructured":"December. The imbecility of mind which accompanies or rather succeeds Paralytick symptoms was never more obvious than in this case. His answers to questions will vary every minute. He will call his wife by 3 different names and give the most incoherent account with a stammering and tremulous voice."},{"key":"S0368315X00158967_ref143","unstructured":"What Linnaeus had done for botany and Cuvier for zoology, Cullen of Edinburgh (1769) attempted for general medicine and his pupil, Thomas Arnold, for insanity. Arnold's Observations on Insanity (1786) does not appear to have exercised much influence on his contemporaries and remains a curious relic of the attempts to classify on philosophical grounds \u201cthose disorders of the mind which still resist the discriminatory powers of our scientific age\u201d. Philippe Pinel, a friend of Cuvier, also published a classification of mental diseases, but though his Nosographie philosophique (1798) proved in the end as sterile as Arnold's Observations, these works may serve to indicate one significant point: that during the latter part of the eighteenth century, mental disorders were carefully studied with a view to the classification of syndromes and we may pardonably be astonished that so striking a disease as dementia paralytica, if it had been anywhere near as prevalent as it later became, could have escaped notice."},{"key":"S0368315X00158967_ref14","unstructured":"Blandford G. F. , Insanity and its Treatment, 1871. London."},{"key":"S0368315X00158967_ref13","unstructured":"Idem , A Treatise on Mental Disease, 1900. New York."},{"key":"S0368315X00158967_ref215","unstructured":"3. First admissions to asylums of cases diagnosed as general paralysis of the insane are recorded in the annual reports of the Board of Control. These show a sudden decrease in the numbers in both sexes for 1914, an occurrence which may be attributed to the outbreak of the first world war; otherwise, neither the numbers nor the sex ratio show any sign of short term change between 1900 and 1928."},{"key":"S0368315X00158967_ref93","unstructured":"Morton L. T. , Garrison and Morton's Medical Bibliography, 1954. 2nd edition. London, p. 418."},{"key":"S0368315X00158967_ref183","unstructured":"March. He continued very cheerful during this month altho' evidently shattered in his mind and Paralytick. He has an exceedingly good appetite, and is ready to shake hands with everybody. No coherence of speech."},{"key":"S0368315X00158967_ref121","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.70.288.33"},{"key":"S0368315X00158967_ref180","unstructured":"Dec. At the latter end of this month, he faulter'd very much in his speech and was evidently partially Paralytick."},{"key":"S0368315X00158967_ref86","doi-asserted-by":"crossref","unstructured":"Mickle W. J. , General Paralysis of the Insane, 1880. London.","DOI":"10.1176\/ajp.37.1.103"},{"key":"S0368315X00158967_ref194","unstructured":"Appearance observed on examining the Body, 11th Jan. 1819:"}],"container-title":["Journal of Mental Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0368315X00158967","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T16:04:24Z","timestamp":1559750664000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0368315X00158967\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1959,7]]},"references-count":226,"journal-issue":{"issue":"440","published-print":{"date-parts":[[1959,7]]}},"alternative-id":["S0368315X00158967"],"URL":"https:\/\/doi.org\/10.1192\/bjp.105.440.594","relation":{},"ISSN":["0368-315X","2514-9946"],"issn-type":[{"value":"0368-315X","type":"print"},{"value":"2514-9946","type":"electronic"}],"subject":[],"published":{"date-parts":[[1959,7]]}}}