The Origin and Spread of Dementia Paralytica

Abstract

Dementia paralytica is a declining disease. Deaths due to it in England and Wales were first recorded by the Registrar General in 1901 and since that year, when the number was 2,272, the annual figure has fallen steadily until in 1957 it was only 68. Moreover, there is evidence (adduced below) that not more than a small part of this decline can be attributed to improvements in medical treatment. The fear that there might be a recrudescence of dementia paralytica as a result of the spread of syphilis during the second world war has not so far been realized and it seems likely that what is now, in Great Britain at all events, an obsolescent disease will soon become a rarity. Yet there are many unsolved problems in its history. We do not know, for example, why the alleged references to this striking disease were so few and so inadequate until the third decade of the nineteenth century. We do not know why its recognition in many countries was so tardy in spite of the clear description given by the French alienists. Nor do we know why the disease, which at the start of the nineteenth century seems to have been predominantly one of males, has gradually—and at different rates in different countries—become much more evenly distributed between the sexes.

The most deadly disease of asylumdom: general paralysis of the insane and Scottish psychiatry, c.1840–1940

“…2,6 A disproportionate amount of attention has, however, J R Coll Physicians Edinb 2012; 42:266-73 http://dx.doi.org/10.4997/JRCPE.2012.316 © 2012 Royal College of Physicians of Edinburgh history 267 been given to malarial therapy, widely regarded as the most successful form of therapy for this disorder, prior to penicillin. 10,11 With particular reference to the alienists and patients of the Royal Edinburgh Asylum, this paper explores the social and medical significance of the 'death sentence' that accompanied the GPI diagnosis.…”

“…Its identification as a distinct disease category has been credited as the achievement of a small group of French psychiatrists, or alienists, as this profession was commonly known during the nineteenth century. 1 The disease was not recognised in Scotland until around 1839, 2 though clinicians on both sides of the English Channel questioned whether this was simply because British alienists had not yet 'learned to see' the disease. 3,4 There was also considerable confusion as to the causation of GPI.…”

Philosophy of Mind in the Clinic: The Relation between Causal and Meaningful Explanation in Psychiatry

“…For instance, clinical changes associated with tertiary syphilis (e.g., personality disturbance, affective disorder, and dementia) were widely thought to stem from an afflicted individual's moral and psychological defects until the twentieth century, when we came to understand that these behavioral changes result from an infection of the person's nervous system by the spirochete Treponema pallidum. 8 The reconceiving of neurosyphilis as an infectious disease was supported by empirical findings that it could be treated effectively, initially with malaria fever therapy and later with penicillin and newer antibiotics. 9,10 The abnormal behaviors associated with the disease were thereby taken out of the realm of purposive and psychologically meaningful acts (Verstehen) and placed squarely in the realm of causal mechanisms (Erklä rung).…”

Clinical Presentation of General Paralysis of the Insane in a Dutch Psychiatric Hospital, 1924-1954

“…Although exact figures are unknown, asylums throughout the world reported, in the first decades of the 20th century, an increase in admission rates up to 20% [2,13] . At the Royal Edinburgh Asylum, Scotland's largest asylum, up to 17% of admissions and 34% of deaths concerned the patients with GPI [6] .…”

“…Given the dramatic decline of the incidence of syphilis after the introduction of antibiotic treatment, general paralysis of the insane (GPI), also termed dementia paralytica, a late complication of untreated syphilis, was expected to become 'something of a neuropsychiatric rarity' [1,2] . However, GPI has not yet disappeared and should, therefore, still be considered in the diagnostic workup of psychiatric and neurological patients [3] .…”