General paralysis : a critical review of the literature of the subject, to which is appended an analysis of the case of John S. Blackburn, in which insanity was alleged as a means of defense / by D.A. Morse.

Morse, D. A. (David Appleton), 1840-1891

Date:: [1874]

Credit: General paralysis : a critical review of the literature of the subject, to which is appended an analysis of the case of John S. Blackburn, in which insanity was alleged as a means of defense / by D.A. Morse. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$dition, however, is, that wliere there is alteration of the pupils one is contracted more than the other. Total blindness, partial, or only slight defect of vision may be observed, with one eye generally more than the other, yet both may be affected. Baillarger claims that he first pointed out unequal contraction of the pupils as a diagnostic sign of general paralysis; but says: this may be discovered with persons perfectly healthy in mind, and who never subsequently are attacked with general paralysis. This unequal contraction of the pupils obsei'ved, is also observed in simple insanity. We learn that they have had, at a period \'ery remote, some affection of one of the eyes, and that since, the sight is more feeble upon one side. These facts have noth- ing in common with those connected with the onset of general paralysis, or its course. ■ Of one hundred cases we will see, for example, one-half or two-thirds who offer for the first time, without having had any ]irevious affection of one eye, this symptom of unequally con- tracted pupils. It will certainly come into the minds of many to declare that an individual, because he has unequal pupils, is threatened with general paralysis, but if to this symptom be added other indices, very slight, of another nature (greater activity, change of char- acter, irritability, &c.,) then the inequality of the pupils be- comes a sign of sure significance. There is no disease of which the development is preceded by more insidious signs than gen- (!ral paralysis. All signs, however slight, deserve the higliest degree of attention during this prodromic period. Inequality of the pupils is one of these signs. I believe we ought always to seek to determine its existence. Griesinger says Seifert found with twenty-five paralytics seventeen cases of which there was inequality of pupils, but says it must not be regarded as a$