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On the present State of Our Knowledge regarding General Paralysis of the Insane. Part II

Published online by Cambridge University Press:  19 February 2018

C. Westphal*
Affiliation:
University of Berlin

Extract

The theories which have hitherto been advanced regarding the nature of the morbid process in general paralysis of the insane are based essentially on actual or supposed anatomical changes in the brain and its membranes. The spinal cord was, as a rule, very seldom examined. In the many records of post mortem examinations which have been published, it is scarcely ever referred to; and only in a few isolated, carefully-observed, and well-described cases (especially by H. Hoffmann), which remain almost unnoticed, has—if we exclude the uncriticisable cases of “softening”—any palpable disease of the spinal cord been established. Thus it came to pass that in the framing of theories regarding the nature of the paralysis, the spinal cord was either entirely ignored, or the purely cerebral character of the disease was expressly and emphatically inculcated as distinguishing it from other spinal affections.

Type
Part I.—Original Articles
Copyright
Copyright © Royal College of Psychiatrists, 1869 

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References

Zeitechr. der Gesellsch. der Aerzte 24 Wien. 1860. Nr. 5, p. 74.Google Scholar

Virchow, Arch. Bd., 39 u 40. Compare also Allgem. Zeitschr. für Psych, XXIII., p. 709; XX., p. I.e., XXI., p., 361 u 450. More recently Magnam (I.e.) has also recognised affections of the spinal cord.Google Scholar

Perhaps Calmeil, in a few of the eases described by him in which he examined the spinal cord, has also seen the nucleated cells, although, for the forementioned reasons, he could not well form an opinion regarding them.Google Scholar

Amongst fifty-six male patients investigated in one day in May this year, there were fourteen in which, owing to the psychical phenomena alone, or in connection with motory disorders, general paralysis was diagnosed. Of these fourteen so-ealled paralytics, two had atrophy of the papilla of the optic nerve, of the ordinary form occurring in spinal diseases. Sight was, so far as could be judged, only moderately altered; but of course a minute examination could not be made. Neither of these two patients had exhibited, up to the day of the examination, any disturbance of the motory apparatus, of speech, or of muscular movement. One of them died soon afterwards, and by the aid of the microscope nucleated cells (myelitis) were found in a portion of the lateral column of the spinal cord; the optic nerves were, in parts, of a grey translucent appearance. Another patient, who died before this one, with complete amaurosis and bilateral atrophy of the papillae, had only disturbance of speech during the course of the disease, and during the last few days exhibited mere symptoms of slight disorders of innervation in the extremities; in him there was likewise found myelitis (nucleated cells) in the anterior, posterior, and lateral columns; the optic and olfactory nerves were grey, translucent, and atrophied. In about fifty women examined in one day, no case of general paralysis was discovered, and none had atrophy of the papilla. In every case the ophthalmoscopic appearances were confirmed by Dr. Yon Groeffe, who also had the kindness to give complete descriptions of them. In no case were traces of neuritis diagnosed.Google Scholar

Also in regard to the staggering with shut eyes in these patients, I will only here mention that I do not consider this phenomena as yet satisfactorily explained, but nothing essentially new can be adduced. Most probably it is the degree and nature of the loss of sensibility which plays the most important part.Google Scholar

See, besides, the argument between Bouilland and Trousseau concerning congestion cérébrale apopletioforme in its relations to epilepsy. Bullet de Tacad, impér. de méd., 1861, XXVI.Google Scholar

This reminds us that Bürge, from experiments upon rabbits, assumes that the pedunculus cerebri is a central point of excitation for the vasomotor nerves of all the arteries in the body. Centralbl. für die Med. Wissensch, 1864. No. 85.Google Scholar

When, after attacks with unilateral paralytic phenomena a slight degree of hœmorrhagic pachymeningitis is occasionally found, we ought not to refer the paralysis, without further evidence, to the hoemorrage, which is often very trifling and may be quite accidental. Indeed, when limited to one side, its position often does not correspond with the side affected by the paralysis (that is, it is not on the opposite side).Google Scholar

De la cause anatomique de quelques hémiplégies incomplètes. Ann. Méd.- psych, 1858, p. 168.Google Scholar

Baume, De l'inégalité du poids des hémisphèris cérébraus, etc. Ann. Méd.- psych., 1862, p. 540.Google Scholar

Boyd, Wells. “Observations on the measurement of the Head and the weight of the Brain in 696 Cases of Insanity.” Med. Times, Sept 24th, 1864.Google Scholar

Köster, Untersuchungen über den Einfluss des Mondes auf das periodische Irresein. Allgem. Zeitschr. f. Psych., p. 709.Google Scholar

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