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Another fact is of importance in this connection. In the defective, a traumatism involving the brain, in our experience, may serve as the starting point for the process of dementia; and, if there is no resulting irritative lesion, the progress of the dementia may be unaccompanied by any manifestation of active mental aberration. However, if the nature of the injury or the anatomical relations of the injured area afterward are of such a nature as to cause pressure or hypostatic congestion, there is a marked aberration, usually in the form of extreme irritability, restlessness, or explosive outbreaks of violence. Again, these same manifestations follow a chronic pachymeningitis, and the occlusion of the pial veins in the frontal area.

In the absence of limited cerebral potentiality, we have not seen these manifestations, even in cerebral traumatism, pachymeningitis, or in connection with degenerative or destructive syphilitic lesions of the brain, although the motor and sensory functions may be seriously interfered with. The same is true with regard to the exigencies of the period of adolescence, and the strain of adult life; even where this is extreme and unusual on account of the incidence of disease, overwork or privation. These conditions are always present, and their somatic effects are apparent in every-day experience. They commonly, too, involve the general nervous system, affecting its sensory and motor functions; but they do not produce mental aberration or reduction in the individual in whom there is no evidence of instability or defect.

So far as the psychogeny of insanity is concerned, the laws of development and degeneration apply as definitely. When development is incomplete, that which is highest and most complex will be lacking, and the process of degeneration will begin with that which is imperfect or incomplete. And, as conduct represents our response to the influence of the conditions in the environment, it also indicates the extent of our ability to adapt ourselves to them. Mental processes do not arise de novo, any more than do the activities that result from them. Therefore, no matter how incongruous the conduct of the individual with relation to his surroundings, or how distorted his ideas, they must represent preexisting experiences and impressions which are wrongly related to the conditions in the immediate environment. By com

parison of the conduct of the insane with the conduct of the sane, it will be found that, within the same limits, it does not differ in kind or quantity; and that in both cases it is directed toward the same general objects. From the standpoint of the individual, his conduct is the expression of his attitude toward his environment, in accordance with his understanding of his relation with it, and it is the reflex of the content of his consciousness concerning that relation. In the insane, just in proportion with the loss of power of attention, and of the ability to relate and coordinate impressions coming from the environment, will be the aberration of response to these impressions, and the domination of the intellectual processes by pre-existing impressions. The confusion that results is the measure of the strain resulting from the imperfect relation and incoordination; while the degree of reversion shown by the conduct will indicate the amount of defect present. The extremity of the alternations in emotion, and the extent of the loss of control of the activities that are manifested in conduct will determine the reduction in mental capacity.

PARESIS: A RESEARCH CONTRIBUTION TO ITS

BACTERIOLOGY.*

(From the Clinical Laboratory of the Cincinnati Sanitarium.)
By F. W. LANGDON, M. D.,

Medical Director.

Paresis, paretic dementia, or as most British authors still prefer to call it-general paralysis of the insane-stands alone amongst the insanities as a disease presenting an unmistakable clinical history, a definite pathology as regards the brain cortex, a constant morbid anatomy and an invariably fatal outcome within a fairly fixed period of time. Not only is it unique, considered purely as a psychosis-but, in addition to its characteristic mental features, its extensive symptomatology eventually embraces the entire nervous system. Thus it is manifested by sensory, motor, reflex visceral, vaso-motor and trophic impairment; and by reason of this widespread abolition of function, the entire organism suffers; hence the older term "general paralysis." general paralysis." In fact, as is wellknown to all of us, it is a general disease, its psychic features being incidental;-local expressions of the action of a widely distributed cause or causes. It is an important disease, by reason of its frequency as well as because of its fatality. Thus: Robert

states its frequency at leading British institutions for the Insane at ten to sixteen per cent; and in Naples he states that it constitutes thirty per cent of the admissions.

Notwithstanding the great practical importance of the subject, the actual cause of the disease has remained a profound mystery. The alleged causes which find place in our current text-books may be summed up as "Civilization and Syphilization," or "Wine, Women, and Worry," which to the thoughtful alienist are merely convenient alliterations which serve to occupy, but can never fill, the hiatus in our knowledge of the actual causation of the dis

ease.

* Read before the American Medico-Psychological Association, Boston, June 14, 1906.

"The Pathology of General Paralysis of the Insane," by W. Ford Robertson, M. D. Rev. Neur. and Psychiatry, Feb., Mar., April, 1906.

Any investigation, therefore, which may cast light upon the origin of such a disease is of prime importance, since it is in this direction that we must look for its prevention, if preventable, or its cure, if curable.

Of all the numerous attempts to solve the problem of the actual cause of Paresis, none have seemed to the writer so important as regards completeness of technique, fruitfulness in actual results attained, and promise of future usefulness, as those of Dr. W. Ford Robertson, Pathologist to the Scottish Asylums, and by him recently incorporated in a series of three papers which constitute "The Morrison Lecture for 1906.""

A brief synopsis of his investigations, which extend over a period of four years, and are of a most painstaking character, is as follows:

(1) Paresis is caused by a widespread infection of the organism by a specific bacillus-the Bacillus paralyticans. This bacillus possesses morphological characters and staining affinities which have led him (Robertson) to apply to it the term " diphtheroid." Nevertheless he is inclined to the view at present, that it is distinct from the Klebs-Loeffler bacillus of diphtheria. The Bacillus paralyticans is observed in two forms: (a) as single individuals grouped irregularly, (b) as a filamentous or thread-like form supposed to be due to rapid proliferation and non-separation of the individual organisms. This filamentous form is also supposed by Robertson to represent a "terminal" invasion of the victim.

(2) The Bacillus paralyticans gains access to the system by way of the respiratory tract and the alimentary canal chiefly.

(3) Syphilis, alcoholism, dissipation and the "strenuous life" generally are merely factors in "breaking down the general defences" against bacterial invasion.

(4) The invasion of the blood, lymph, and tissues by the Ba

2 Vide Review of Neurology and Psychiatry, Vol. IV, Jan., Feb., Mar., 1906.

Dr. Robertson gives full credit to several associates in his work; namely, Dr. Douglas M'Rae, Dr. John Jeffrey, Dr. A. Ainslee, Dr. Chalmers Watson, Dr. Shennan and others; also to Dr. Lewis C. Bruce, who has made independent investigations along the same lines (British Med. Jour., June 29, 1901).

cillus paralyticans gives rise to the production of "toxines" to which the various trophic, degenerative, convulsive, and paralytic phenomena of the disease are due.

(5) The Bacillus paralyticans has been found (by Robertson) in the bronchial, alimentary, and genito-urinary mucous membranes; in the cerebro-spinal fluid, in the brain; in the walls of the cerebral blood-vessels; in the blood, the urine; and in other tissues, organs, and secretions when properly investigated.

(6) The living blood (especially the polymorphonuclear leucocytes) possesses the property of destroying the Bacillus paralyticans to a marked degree. To this fact is due the "remissions " so characteristic of the disease.

(7) As regards the frequency with which the Bacillus paralyticans is found in subjects of general paresis, Robertson, M'Rae, and Jeffrey, working with cultures of post-mortem material, found it in seventeen cases out of twenty; and in the remaining three cases it was found on making sections of the alimentary canal. In a series of twenty cases it was found constantly in the catarrhal exudations of the respiratory and alimentary tracts. In five of these cases the filamentous or thread-like form was found.

(8) "In seven consecutive cases of tabes dorsalis we have found the centrifuge deposit from the urine to contain abundant unaltered diptheroid bacilli" (Robertson).

(9) As regards the effects of the bacillus on lower animals: "It was ascertained that the organism was non-pathogenic to guinea pigs." Three rats were fed for several weeks upon bread mixed with unsterilized broth cultures of the bacillus. After three or four weeks they began to show morbid symptoms which gradually increased in severity until the animals became acutely ill. At first they showed, especially, slowness and uncertainty of gait and drowsiness. Later they manifested distinct motor weakness, marked inco-ordination of movement, dyspnoea and great drowsiness. One rat was killed with chloroform when it appeared to be moribund. In the other two, the disease was allowed to go on to a fatal termination, which occurred about two months from the time of commencement of the feeding with cultures. Control animals remained healthy."

"Microscopical examination revealed in each animal a similar series of morbid changes. There was well-marked catarrh of

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