Sugar has in a few cases been found in the urine; albumen is not uncommon.
The sexual function is commonly exaggerated in the early stages, then diminished, lost, and finally returns in the stage of absolute loss of self-respect and self-control, although it may be impaired from the beginning or not materially changed at first. There may be temporary or persistent incontinence or retention of urine.
At first there is a marked loss of flesh, then a gain. As the muscles lose in power they increase in size, with an interstitial degeneration. The deposit of fat is sometimes enormous. In the final stage there is emaciation.
The convulsive attacks usually are of the nature of cortical epilepsy, or at least commonly begin as such. They are associated with and followed by a considerable rise in temperature—from two to seven degrees F.—and are immediately succeeded by marked increase in the severity of the symptoms, both mental and physical, especially if the attacks follow each other in rapid succession or last for a number of days. They may be due to hemorrhage, embolism, or effusion, and be marked by any or all of the usual symptoms and sequences of those conditions, permanent or transient. General and aural vertigo are not uncommon.
The muscular tremor before the last stages varies in different muscles—excessive perhaps in the tongue, moderate in the fingers, and so on. It may also seem slight as compared with the other symptoms, or, on the other hand, be enormously exaggerated in certain groups of muscles out of all proportion to all other indications. At the end extreme and constant tremulousness accompanies every voluntary movement.
Spastic paralysis, muscular tension, contractures, rigidity of the most persistent character seem at times to be under the influence of the will, although of cortical origin and in a certain sense automatic, like convulsions.
The knee-jerk is changed in somewhat more than half the cases, a little oftener exaggerated than abolished; but sometimes the reflexes are enormously increased all over the body, so that a strong puff of air in the face even will set the arms and legs going like a jumping-jack. I have twice seen the patellar reflex abolished in one leg, and so marked in the other as to seem to me exaggerated.24 I have also known it to disappear absolutely in both legs two weeks after it had been found to be excessively exaggerated. It also varies under conditions of rest, fatigue, excitement, etc. Intense pain in the joints occurs, and I have found it where the knee-jerk was exaggerated, in one case giving rise in a physician to the delusion that his arms and elbows had been resected. This may disappear in time. Charcot's joint disease has been observed.
24 There was no evidence, and there had been no history, of a hemiplegic attack in either case.
In the final stages the bones are fragile and easily break; hemorrhages under the periosteum or perichondrium arise from trifling force or injury, giving rise to hæmatomata, the most common of which are on parts exposed to pressure, etc., as the ear. The patient is confined to his bed, fed like a small child, demented, hardly able to articulate the extravagant delusions which form such a grotesque contrast to his actual state, until the mind is as incapable of forming or receiving ideas as of expressing thoughts; and the body is simply a filthy, helpless mass of humanity, dying of exhaustion or decay, unless lung gangrene, bed-sores superficial and deep, necrobiosis, exhausting diarrhœa, pneumonia, pulmonary consumption, perhaps asphyxia from an epileptic fit or choking, have followed incontinence of urine and feces to the fatal end, or heart failure or apoplexy have closed the scene.
PATHOLOGY AND MORBID ANATOMY.25—General paralysis of the insane is, according to Mendel, following Rokitansky's idea, a connective-tissue disease, affecting the nerve-cells and tissues secondarily, while Tuczek and Wernicke think that the primary disease is of the nerve-elements (primäre Atrophie der Nervenelemente)—a diffuse interstitial cortical encephalitis on the one hand, or a diffuse parenchymatous cortical encephalitis on the other. There is also, in well-marked cases, atrophy of the white substance, due, according to general opinion of pathologists, to primary interstitial encephalitis ending in sclerosis.