DR. F. W. MOTT'S PAPER 391 



paralysis of the insane in the different parishes in 

 London. This disease forms a large proportion of 

 the male cases admitted to the London County 

 Asylums ; although general paralytic men are not 

 very numerous among the male inmates of asylums, 

 yet in about 40 per cent, of the deaths among males 

 the patients have suffered with general paralysis. 

 After admission to the asylums a general paralytic 

 as a rule does not live more than a year or two, 

 generally only months. Other forms of insanity are 

 much less fatal, and so the cases tend to accumulate 

 in the asylums. Not so general paralysis. The 

 death-rate from general paralysis is much higher than 

 the admissions, and yet the male admissions suffering 

 from general paralysis in 1911-12 are 15*6 per cent, 

 of the total cases of certified insanity admitted. It 

 was interesting to observe that West End parishes 

 sent a considerably higher percentage of male general 

 paralytics than East End parishes, although the 

 percentage of females was a little higher from the 

 East End than West End parishes. The highest 

 incidence was St. George's-in-the-West, and the 

 lowest Bethnal Green. The incidence of general 

 paralysis may serve as an index of the incidence 

 of syphilis in the population, and it might therefore 

 be argued that syphilis is more prevalent among 

 males in the West End parishes and slightly more 

 among females in the East End parishes. Although 

 in the upper and middle as in the lower classes 

 general paralysis becomes less and less frequent 

 among females as we rise in the social scale, yet 

 general paralysis in males is as frequent in the upper 

 and middle as in the lower classes, in spite of the 

 fact that treatment is more efficient in the upper 

 and middle classes. The explanation of this may 

 be that the syphilitic organism under the in- 

 fluence of mercurial or arsenical treatment or some 

 other cause has acquired a predilection to attack 



