General paresis of the insane
Encyclopedia
General paresis, also known as general paralysis of the insane or paralytic dementia, is a neuropsychiatric
disorder affecting the brain and central nervous system, caused by syphilis
infection. It was originally considered a psychiatric disorder when it was first scientifically identified around the nineteenth century, as the patient usually presented with psychotic
symptoms of sudden and often dramatic onset. It is rare in most developed countries.
), and, eventually, the development of muscular reflex abnormalities, seizure
s, memory impairment (dementia
) and other signs of relatively pervasive neurocerebral deterioration.
. General paresis of the insane was first described as a distinct disease in 1822 by Antoine Laurent Jesse Bayle
. General paresis most often struck people (men far more frequently than women) between twenty and forty years of age. By 1877, for example, the superintendent of an asylum for men in New York reported that in his institution this disorder accounted for more than twelve percent of the admissions and more than two percent of the deaths.
Originally, the cause was believed to be an inherent weakness of character or constitution. While Esmarch
and Jessen
had asserted as early as 1857 that syphilis
caused general paresis, progress toward the general acceptance by the medical community of this idea was only accomplished later by the eminent nineteenth-century syphilographer Alfred Fournier (1832–1914). In 1913 all doubt about the syphilitic nature of paresis was finally eliminated when Noguchi
and Moore
demonstrated the syphilitic spirochaete
s in the brains of paretics.
In 1917 Julius Wagner-Jauregg
discovered that infecting paretic patients
with malaria
could halt the progression of general paresis. He won a Nobel Prize
for this discovery in 1927. After World War II
the use of penicillin
to treat syphilis made general paresis a rarity: even patients manifesting early symptoms of actual general paresis were capable of full recovery with a course of penicillin. The disorder is now virtually unknown outside developing countries, and even there the epidemiology is substantially reduced.
In her 1915 novel, "The Song of the Lark", Willa Cather
referred to the insanity of the wife of a main character as having been caused by general paresis but there is no hint that the character had contracted syphilis. In her 1953 novel, Pocketful of Rye, Agatha Christie used paresis as an explanation for the behavior of the victim. She did not mention the syphilitic connection.
Neuropsychiatry
Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training....
disorder affecting the brain and central nervous system, caused by syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
infection. It was originally considered a psychiatric disorder when it was first scientifically identified around the nineteenth century, as the patient usually presented with psychotic
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
symptoms of sudden and often dramatic onset. It is rare in most developed countries.
Diagnosis
The diagnosis could be differentiated from other known psychoses by a characteristic abnormality in eye pupil reflexes (Argyll Robertson pupilArgyll Robertson pupil
Argyll Robertson pupils are bilateral small pupils that constrict when the patient focuses on a near object , but do not constrict when exposed to bright light . They are a highly specific sign of neurosyphilis. In general, pupils that “accommodate but do not react” are said to show light-near...
), and, eventually, the development of muscular reflex abnormalities, seizure
Seizure
An epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness...
s, memory impairment (dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
) and other signs of relatively pervasive neurocerebral deterioration.
Prognosis
Although there were recorded cases of remission of the symptoms, especially if they had not passed beyond the stage of psychosis, these individuals almost invariably suffered relapse within a few months to a few years. Otherwise, the patient was seldom able to return home because of the complexity, severity and unmanageability of the evolving symptom picture. Eventually, the patient would become completely incapacitated, bedfast, and die, the process taking about three to five years on average.History
While retrospective studies have found earlier instances of what may have been the same disorder, the first clearly identified examples of paresis among the insane were described in Paris after the Napoleonic WarsNapoleonic Wars
The Napoleonic Wars were a series of wars declared against Napoleon's French Empire by opposing coalitions that ran from 1803 to 1815. As a continuation of the wars sparked by the French Revolution of 1789, they revolutionised European armies and played out on an unprecedented scale, mainly due to...
. General paresis of the insane was first described as a distinct disease in 1822 by Antoine Laurent Jesse Bayle
Antoine Laurent Bayle
Antoine Laurent Jessé Bayle was a French physician who was born in Le Vernet, Alpes-de-Haute-Provence. He was a nephew to pathologist Gaspard Laurent Bayle ....
. General paresis most often struck people (men far more frequently than women) between twenty and forty years of age. By 1877, for example, the superintendent of an asylum for men in New York reported that in his institution this disorder accounted for more than twelve percent of the admissions and more than two percent of the deaths.
Originally, the cause was believed to be an inherent weakness of character or constitution. While Esmarch
Johannes Friedrich August von Esmarch
Johannes Friedrich August von Esmarch was a German surgeon. He developed the Esmarch bandage and founded the Deutscher Samariter-Verein, the predecessor of the Deutscher Samariter-Bund.- Life :...
and Jessen
Jessen
Jessen may refer to:*Jessen , a town in Saxony-Anhalt, Germany*Jessen , a Danish surname*A typeface created by Rudolf Koch...
had asserted as early as 1857 that syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
caused general paresis, progress toward the general acceptance by the medical community of this idea was only accomplished later by the eminent nineteenth-century syphilographer Alfred Fournier (1832–1914). In 1913 all doubt about the syphilitic nature of paresis was finally eliminated when Noguchi
Hideyo Noguchi
, also known as , was a prominent Japanese bacteriologist who discovered the agent of syphilis as the cause of progressive paralytic disease in 1911.-Early life:...
and Moore
Moore
Moore may refer to:* Moore , a crater on Venus* Moore , lunar impact crater that is located on the far side of the Moon* Moore , a common English-language surname* People with surname Moore...
demonstrated the syphilitic spirochaete
Spirochaete
Spirochaetes belong to a phylum of distinctive Gram-negative bacteria, which have long, helically coiled cells...
s in the brains of paretics.
In 1917 Julius Wagner-Jauregg
Julius Wagner-Jauregg
Julius Wagner-Jauregg was an Austrian physician, Nobel Laureate, and Nazi supporter.-Early life:...
discovered that infecting paretic patients
Pyrotherapy
Pyrotherapy is a method of treatment by raising the body temperature or sustaining an elevated body temperature . In general, the body temperature was maintained at 41° Celsius. Many diseases were treated by this method in the first half of the 20th century...
with malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
could halt the progression of general paresis. He won a Nobel Prize
Nobel Prize
The Nobel Prizes are annual international awards bestowed by Scandinavian committees in recognition of cultural and scientific advances. The will of the Swedish chemist Alfred Nobel, the inventor of dynamite, established the prizes in 1895...
for this discovery in 1927. After World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
the use of penicillin
Penicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
to treat syphilis made general paresis a rarity: even patients manifesting early symptoms of actual general paresis were capable of full recovery with a course of penicillin. The disorder is now virtually unknown outside developing countries, and even there the epidemiology is substantially reduced.
In her 1915 novel, "The Song of the Lark", Willa Cather
Willa Cather
Willa Seibert Cather was an American author who achieved recognition for her novels of frontier life on the Great Plains, in works such as O Pioneers!, My Ántonia, and The Song of the Lark. In 1923 she was awarded the Pulitzer Prize for One of Ours , a novel set during World War I...
referred to the insanity of the wife of a main character as having been caused by general paresis but there is no hint that the character had contracted syphilis. In her 1953 novel, Pocketful of Rye, Agatha Christie used paresis as an explanation for the behavior of the victim. She did not mention the syphilitic connection.
See also
- Tuskegee experiment
- Tabes dorsalisTabes dorsalisTabes dorsalis is a slow degeneration of the sensory neurons that carry afferent information. The degenerating nerves are in the dorsal columns of the spinal cord and carry information that help maintain a person's sense of position , vibration, and discriminative touch.-Cause:Tabes dorsalis is...