GENERAL PROGRESSIVE PARALYSIS 273 



We have thus reached one of the two great causes of the in- 

 crease of insanity — alcohoKsm. The second great cause, which 

 we will now consider, is general progressive paralysis. 



As to the symptomatology of this formidable malady the 

 medical world has long been agreed ; as to its etiology opinions 

 are still divided. The majority of specialists hold general pro- 

 gressive paralysis to be invariably the result of syphiHs, whether 

 individual or hereditary.^ But others, while admitting syphilis 

 as an etiological factor in most cases, do not admit it in all. 

 Where specialists difEer, it is, of course, not open to a layman 

 to give an opinion. On the one hand, it is a fact that even those 

 who perhaps do not admit syphiUs as a necessary etiological 

 factor in general, nevertheless admit meeting with it in a great 

 many cases. This fact might make it seem probable that syphilis 

 is an agent in every case, and that failure to discover it is due 

 to failure to search for it among the hereditary, as distinct from 

 the individual, antecedents of the patient. On the other hand, 

 syphilis by itself certainly does not suffice to produce general 

 paralysis. It would appear to be estabhshed that only a dan- 

 gerously neglected syphilis can result in general paralysis, or 

 else syphilis combined with alcohohsm or overwork, or both. 

 Perhaps medical science will eventually arrive at the unanimous 

 conclusion that these three factors — syphilis, alcoholism, and 

 overstrain — each play a role in the determining of general 

 paralysis. 



However this may be, we are not here engaged in a clinical 

 investigation into the etiology of general paralysis, but solely in 

 a, research as to the social effects of this formidable disease of 

 the central nervous system. The iacrease of general paralysis 

 is incontestable ; and whatever may be the determining factors 

 in the etiology of general paralysis itself, it is certain that general 

 paralysis is one of the chief determining factors in the etiology 



* Amongst others, Poumier, Raymond, Comil, Brissaud, Neumann, 

 Hipping, Erb, De Pleury. 



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