Licence: Public Domain Mark
Credit: Mental diseases / by Charles F. Folsom. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
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![iodide of potassium, touics, and c4ectricity, are sufficient to establish the diagnosis. Cliroiiic and ])ersistent alcoholism is always attended with some mental imjKiirment, which may so resemble the dementia of general paralysis, with marked moral perversion, mental exaltation, grand delusions, mus- cular tremor, ataxic symptoms, and impaired muscular power, as to make; the diagnosis doubtful for several months, until removal of the cause (alcohol) in the course of time causes the symptoms to so abate as to make the real character of the disease evident. I have once seen chronic interstitial nephritis without its usual ])rom- inent symptoms and with mild urtcmic convulsions mistaken for general paralysis. A tumor of the brain, if not attended with the common symptom of vomiting, may be the cause of convulsions and headache resembling those often seen in general paralysis. Optic neuritis or atrophy is usual in cerebral tumor, but rare in a stage of general paralysis so early that the diagnosis might be doubtful. Hemorrhagic pachymeningitis also now and then simulates an obscure case of general paralysis in the early stage, but a few weeks at most settle any doubts in the matter. Although diffuse cerebral syphilis is more apt to be associated with dis- tinctly localized symptoms than the demented form of general paralysis, and although it is characterized by a mental apathy and physical torpor which follow a more regular course with more definite symptoms, i-esult- ing in a slow decay, yet there may be doubtful cases in which the differ- ential diagnosis is impossible, and in which antisyphilitic treatment does not throw any light on the subject. Syphilitic new growths, endarteritis, and meningitis may so far improve from the use of mercury or the iodide of potassium as to end in an apparent cure, but in those cases the symp- toms are not so marked as to make an exact diagnosis always ])ossible. A distinct syphilitic cacJiexia is presumptive evidence of syphilitic encephalitis when there is doubt Avhether the syphilis is the cause or the diathesis. Profound melancholia is not so often as varying gloom or moderate despondency a symptom of general paralysis. When it is such, there are developed in time the other marks of that disease, and it will only be necessary to hold the diagnosis in reserve for their ajipearance. The melancholia masks the dementia unless it is very carefully sought for, nnd the tremor may be as marked in melancholia as in the early stage of general paralysis, but more universal. Acute mania is not uncommonly mistaken for general ])aralysis, when, as often happens, the delusions are as expansive and the tremor as great in the mania as in general paralysis; and it may be several months before the differential diagnosis can be made with certainty. In the pi-esence of a high degree of maniacal excitement, with great emotional agitation and muscular tremor, it is difficult to establish the fact of the existence or not of dementia in doubtful cases until it is well developed. Acute mania has been known to constitute the prodromal period of general ])aralysis for a number of years. Primary mental deterioration cannot be always differentiated from general paralysis of the demented tyj)e in its early stage. After the](https://iiif.wellcomecollection.org/image/b2119760x_0111.jp2/full/800%2C/0/default.jpg)
