PROGNOSIS.—The very few reported cures in so common a disease as general paralysis, and the circumstances under which they have been reported, lead to the suspicion that there was an error in diagnosis or that the mistake was made of supposing a remission to be a cure, as has often happened. The course of the disease is more rapid in men than women, and in young persons than in the older. From the galloping cases of a couple of months to those slowly advancing, with long remissions, over twenty years, the average, including the prodromal period, is probably not far from five (perhaps six) years. Collected from asylum statistics, it is given as from two to three years. When I am sure of the diagnosis, I generally say that the patient may die within twenty-four hours (of paralysis of the heart, from suffocation by an accident in an epileptic attack, from choking, from cerebral hemorrhage or effusion, or suddenly with cerebral symptoms of which the autopsy gives no satisfactory explanation), within a short time of intercurrent disease, especially diarrhœa or pneumonia, or that he may live several years, as he probably will, and possibly have a remission, during which he may lead for a while somewhat the same kind of life as other people.
Persons presenting symptoms which can in no way be positively distinguished from those at the beginning of the prodromal period of general paralysis recover, but not many come under the physician's care so early. We are not yet in a position to say whether they were suffering from a mild, transient illness or from what would otherwise have become serious organic disease.
TREATMENT.—Life may be prolonged in general paralysis, and usually is prolonged, by the use of such measures as contribute to the patient's comfort, and which in a general way have already been considered under the head of treatment of mental disease on a previous page.
In my experience, stimulating tonics, wine, and even coffee, increase the morbid cerebral energy of the early stage of the disease, but are sometimes of use later. Cod-liver oil and the hypophosphites do better, and many of the disagreeable symptoms of the period of loss of control over the involuntary muscles are relieved by strychnia. Ergot and the judicious use of the bromides abate the cerebral congestion. Gastro-intestinal disorders, when not controlled by attention to diet, require the usual treatment.
Iodide of potassium in the large or small dose, and mercury, I have never found to benefit those cases of general paralysis with a previous history of syphilis. On the contrary, they have proved debilitating and harmful.
When furious excitement is not relieved by prolonged warm baths, with cool applications to the head if possible, and quiet, chloral is of use, and sometimes opium and its preparations.
Frequently-repeated violent convulsions, the epileptic state, are usually at once mitigated by chloral given by the rectum; the inhalation of nitrite of amyl is reported also to have been of use.
There are few cases in which I find that morphine does not quiet restlessness, calm delusions, abate distressing hallucinations, and make the patient generally more comfortable; and I give it freely, seldom more than twice a day, often almost daily, for two or three years. In this way it can be used in quite moderate doses. Coca also relieves symptoms.
Rest and quiet are most important in all stages of the disease. This can be best accomplished in a quiet private house in the country, which can be made a virtual hospital, and next in a private asylum. But such care is beyond the reach of the vast majority of the insane, to whom the public asylum becomes a necessity. Wherever they are, an orderly life is best for them, with as little irritating interference with their ways or control of them as is possible.
If the results of treatment are in the highest degree unsatisfactory, and consist chiefly in meeting symptoms as they come up, without hope of permanent recovery, it is not impossible that when we can put the patient under treatment at the very beginning of his disease, as we can now do in pulmonary consumption, the prognosis in the former disease may change as much for the better as it has changed in the latter.