PAPERS ON MEDICINE AND PUBLIC HEALTH 269 



about 5 out of every 100 syphilitics develop loco- 

 motor ataxia or general paralysis of the insane. 

 Obviously the rational way in which to deal with 

 this problem is along the lines of prevention; first, the 

 prevention of infection, and secondly, the prevention of 

 the involvement of the central nervous system. But the 

 prevention of venereal disease is a problem of social 

 hygiene, while the prevention of an involvement of the 

 central nervous system belongs for the most part to the 

 syphilographers. "What the state hospitals must! en- 

 deavor to do is to make what repairs are possible to the 

 damaged human mechanisms committed to our institu- 

 tions for care and treatment. 



By general paralysis of the insane, or paresis, we 

 understand a disease of the central nervous system 

 especially affecting the cortex of the brain itself, as 

 differentiated from other syphilitic conditions involving 

 the meningeal coverings of the brain or the walls of the 

 blood vessels or the production of new growths, gum- 

 mata, in connection with the meninges or blood vessels. 

 Formerly it was thought that while syphilis had some- 

 thing to do with laying the general foundation for par- 

 alysis, other factors such as over work conditioned its 

 development. This opinion, however, has of late years 

 been revised by the discovery of Moore and Xoughchi 

 (in 1911) of the spirochaeta pallida in the brain sub- 

 stance of these patients. There is still, however, con- 

 siderable discussion as to what determines this invasion 

 of the brain. Some, notably Levaditi, contend that there 

 are strains of this organism which are neurotrophic, hav- 

 ing a predelection for nerve tissue, while others, derma- 

 trophic in nature, by preference locate in other parts of 

 the body and produce visceral syphilis. Certain experi- 

 ments of Levaditi would seem to corroborate his views. 

 As a matter of fact, it is quite commonly accepted that 

 patients developing paresis have suffered few if any of 

 the secondary and tertiary lesions common to ordinary 

 syphilitic infection. 



It has been well established by many observers that 

 about 20 per cent of infected patients show early in the 

 course of the disease some changes in the spinal fluid, 



