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A Review of Seven Years' Malarial Therapy in General Paralysis^*

Horton Mental Hospital, Epsom

^* Accepted for publication, June, 1932.

ABSTRACT

The percentage of good remissions in our female cases at Horton is low compared with the results of other observers. There is little to be found in the literature concerning the disease as seen in the female. Leroy and Médakovitch, in a communication on the female paralytic, write that the disease is less severe, and tends to follow a more insidious course. They also report that the disease in women is more advanced before they become certified. This may explain the high percentage of dementing forms in our series. They quote reports from other workers, which agree with their results in finding a less favourable outcome in the treatment of women. The predominance of the dementing form in women is probably responsible for the lower rate of remissions following treatment.

The material we have to work on is mixed; the age-incidence and duration of disease vary within wide limits; the proportion of the different clinical types is unequal. From the point of view of prognosis I would lay most stress firstly on the clinical type assumed, and secondly on the duration of disease before treatment. Our experience is that remissions are obtained by the first course of fever, and that subsequent courses of malaria exert no influence on the mental or physical progress. Benign tertian malaria is the most convenient species, but access should be available to quartan malaria for those patients who are immune to benign tertian, or who are in a poor state of health which might be endangered by the more severe type of fever.

Whether second and further courses of malaria are necessary to maintain the latency or suppression of the syphilitic process cannot yet be decided. If it is desirable, we have an ample source of treatment methods in the different species of malaria, including malignant tertian, provided the patient can be assured of skilled and trained supervision.

One can only conclude that the application of malaria to medicine has opened up a new field of research, not only in malaria itself, but in the disease to which it is applied.