The circulatory apparatus in general paralysis of the insane / by T. Duncan Greenlees.

  • Greenlees, T. Duncan.
Date:
1904
Catalogue details

Licence: In copyright

Credit: The circulatory apparatus in general paralysis of the insane / by T. Duncan Greenlees. Source: Wellcome Collection.

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    exist in 12*94 per cent of all cases of insanity. It is thus evident that heart disease is more common among cases of the insanity of general paralysis than among the other types of insanity. Of the valves most frequently affected it was noted that disease of the aortic cusps exceeded either mitral or tricuspid disease. Degeneration of the cardiac muscle is occasional, and acute fatty degeneration of the muscular fibre has been specially described by Campbell,^ who believes it to be due to changes in the motor end-plates ; and Mott^ ascribes this condition to imperfect metabolism, and is of opinion that it is indirectly caused by auto-intoxication, seeing it occurs most frequently in cases ending in bedsores, gangrene of the lungs, &c. During the past thirteen years autopsies were made in Grahamstown Asylum on 50 men and 4 women who had died from general paralysis. The average age at death was, for men, 41; and for women, 45 years. The average w^eight of the heart was 8*46 oz. for men, and 5*50 oz. for women. The aortic valves were shrivelled and incompetent in 11 cases, and in only 1 was the mitral valve likewise diseased. “ Milk- spots”—evidences of old pericarditis—existed in 4 cases, and the larger arteries were noted as atheromatous in 2.S. Pachy¬ meningitis hsemorrhagica, essentially a vascular disease, was found in 7 cases—12*9 per cent of the total. Thickening and hypertrophy of the walls of the left ventricle were common conditions, even although the actual weight of the heart did not appear to be even, in these cases, normal. The arteries in general paralysis.—When we consider the comparatively early age at which death is common in general paralysis, it is interesting to note the frequency with which thickening of the arterial coats, more especially the muscular, is found. This simple muscular hypertrophy is common in ordinary cases of general paralysis, but in the syphilitic, and perhaps also in the alcoholic, types of the disease actual atheromatous degeneration of the arterial tunics is frequent. Indeed, the condition of the arteries reminds one of that common to old age; this fact lends some force to the theory, advanced by some, that general paralysis, a disease essentially of robust manhood, is simply premature senility. Considered pathologically, we thus have two forms of general paralysis—the first, the syphilitic, and perhaps the alcoholic as well, with atheromatous degeneration of the arterial coats; and the second, the non-syphilitic type, where ^ A. Campbell, Journal of Mental Science, April, 1894. 2 F. W. Mott, Archives of Neurology, vol. i, p. 195.