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unusual interest in matters which have hitherto received little or no attention, and in which he is not really concerned, while the duties and occupations which have been followed for years receive only a fitful and irregular interest. The person intimates to his companions, or to the members of his family, that he is about to accomplish something of vastly greater importance than he has ever done before, and at the same time he is utterly careless as to the necessary means by which it is to be done. At other times he boasts of his physical strength and of his ability to cover long distances in an incredibly short time; again, of his importance and position in society, and becomes unduly familiar with persons whom he knows little of; he becomes easily excited, irritable, and uncertain in his mental states, with inability to apply the mind long at a time to any task.
When work is undertaken it is done in a slovenly and imperfect manner, without apparently any appreciation of the failure by the patient himself. He goes from one thing to another, is changeful and irresolute, his mental state at any point of time is quite in contrast with what it may be the next hour. The irritability may at times become so exaggerated as to lead to abuse of wife and children, and to acts which border on violence. Unusual explosions of temper may appear at intervals for years prior to the pronounced symptoms, all of which indicates that a change in character has occurred, though at the time it is little thought of by the friends.
In other cases there may appear an unusual mental acumen and facility of expression ; they converse with greater fluency, and use language with more ease in expression than ever before; are readily pleased, or quickly take offense when none was intended, and for such trivial causes as would formerly have received no attention. At other times the mind gives evidence of increased ability to accomplish work; mental operations are quickened, and the imagination is more than usually active and brilliant, but only for limited periods, which are quickly followed by weakness and lassitude.
Other patients during this period become more or less careless as to dress and as to the claims and needs of their friends or families, thoughtless as to the future, more lavish in the expenditure of money for articles of little value and objects of small importance, and are over confident as to matters of uncertain issue.
In case the change at first assumes the form of depression, which is generally the case, it is of a mild character, and partakes more of hypochondria than of melancholia. Patients have periods of being unusually silent, often shed tears without apparent cause, and are not easily roused to take interest in their ordinary occupations, or in anything else. Sometimes there exists, at least in some degree, a realization that they are not well, and that they have lost their power of mental application, and their interest in and love of friends. They speak of this change freely, acknowledge that they feel badly, regret it, and thus excuse their neglect to attend to duties and their exhibition of irritable feelings and frequent explosions of bad temper. The memory gives indication of slight impairment; the person is forgetful of appointments and careless as to personal appearance and dress. Such cases not unfrequently consult the physician and explain in some measure their changed condition, though more often this is not realized or appreciated.
In addition to the above somewhat obscure mental symptoms, which are rather suggestive than pathognomonic,
there may exist certain physical ones, which will tend to assist and confirm the diagnosis. One of these is a pain, not of a severe character, affecting the frontal and sometimes the parietal regions of the head. This is not usually so acute as to greatly annoy the patient, or at first to prevent his attending to business. Indeed, he rarely complains or speaks of it unless questioned, and then will admit that he has experienced it at times for months or for a long period. Two patients, which I have recently seen with other symptoms of general paresis, say that they have experienced such pains in the head at frequent periods, one of them during several months and the other for two or three years.
The wife of a general paretic, who is in the Retreat at the time of this writing, in detailing a history of the case said that for several months prior to the marked indications of mental derangement he had been unable to attend to business, and had exhibited so much restlessness that the family physician was consulted, who said that he had "malaria," and prescribed large doses of quinine. She afterward went with him to the South, where they remained traveling about nearly three months. She often noticed at that time "a difficulty or hesitation" in pronouncing some words, but attributed no importance to it. This patient soon after his return home, one night suddenly became greatly excited and maniacal, which led to an examination by an expert, who at once explained the character of the disease to his family.
All these indications of disease, however, often vanish in the presence of any excitement, and not infrequently in that attending the first visit to the physician. Besides, it will prove quite impossible to obtain such a medical history in the large majority of those cases which occur in the lower ranks of life. These initial changes, especially the physical ones, are so obscure that they have not been noticed, and in consequence of the character of occupations, could not be by non-professional observers. Only the more pronounced and easily recognizable ones which occur later on in the progress of the disorder can be recalled by friends and physician. It will be in those cases which occur among professional men, and those engaged in large business enterprises, that such a medical history as has been described may be observed, while in the larger majority of cases the friends will declare that nothing whatever unusual has been noticed in the mental or physical condition of the patient until within a very short period. When, however, inquiries are made, not infrequently it will be remembered that some of these obscure symptoms have appeared at times, for months or years, in the history of the individual.
The recuperation of brain energy which ordinarily occurs during the periods of rest, diversion, and sleep is in partial abeyance; the vaso-motor system is disturbed in its functions, causing a more or less irregular circulation in the brain cortex, and hence the mental functions common to it become irregular and in some degree abnormal.
GENERAL PARESIS. (ContinuED.) Symptoms Become More Pronounced in Character-Increase of Irritability and
Excitability — Egotism-Self-confidence Extravagance of Projects— Sexual Excitement - Change in Moral Character— Failure in MemoryMental Obtuseness—Insomnia- Depression not Cnfrequently Present – Physical Symptoms – Vertigo - Incoördination of Gait—TongueArticulation-Spinal Symptoms—Disturbances of Circulation-Importance of Recognizing Early Symptoms-Symptoms of Pronounced Period -Excitement - Impairment of Judgment— Dementia—Memory-Attention-Inability to Combine Concepts — Delusions of Great Wealth and Importance-Hallucinations—Emotional States.
We now approach another stage in the development of what are usually described as the prodromatous symptoms of general paresis. In this period a process of evolution in the changed conditions of mind and body which have been hitherto obscure appears to have taken place; they all become more or less pronounced in character, and others arise in connection with them.
While it is difficult to present a description or picture of the symptoms which will hold true as to the patient from day to day, for the reason that they are constantly changing in degree of intensity, and, in some measure, in character, yet certain characteristics may be indicated which will be found existing more or less in all cases if not at all times. The tendency to increase of irritability and excita