At the annual meeting of the German Association for Psychiatry, held on March 23rd and 24th, at Cologne and Bonn, the principal subject for discussion was the question of the connection between syphilis and general paralysis. The speakers were Plaut (Munich) and Fischer (Prague). Dr. Plaut came to the following conclusions: (1) Without syphilis no paralysis. (2) It is not improbable that during paralysis active virus still exists in the body, and spirochætæ are present. (3) There are not sufficient reasons for presuming there is a syphilis à virus nerveux. (4) The fact that, in those who afterwards became paralytics, the early symptoms of syphilis were singularly mild, suggests an abnormal predisposition. (5) The attempts to establish a connection between heredity, degeneration and temperament, or constitution and general paralysis, have had no definite results, and it would appear doubtful if there are sufficient grounds for accepting a peculiar predisposition of brain. (6) The exogenous influences (alcoholism, trauma, cerebral fatigue) have probably no essential effect, but act only as associated factors, diminishing the somatic and psychic resistance. (7) The variability of the syphilitic changes in the different stages of the disease does not appear to be caused by differences in the character of the spirochæte, but by a gradual change in the way the patient reacts, because this change of reaction leads to tertiary manifestations in only a small percentage of syphilitics, and a further change may lead to paralysis; it is not astonishing that only a small number of syphilitics become paralytics. (8) A number of considerations makes it probable that paralysis is preceded by preparatory syphilitic processes of a chronic kind; it is impossible to say if these are localised in the central nervous system or in any other part. The elapse of a long period of time between syphilitic infection and the onset of paralysis is perhaps explained by this circumstance. (9) The uselessness of mercury in paralysis does not disprove a connection between syphilis and paralysis, because of our ignorance of the pharmacology of mercury. (10) The decision whether the histological changes in paralysis are of a syphilitic character must be, and is, left to the anatomist. (11) The result of serum diagnosis points to a very close connection between syphilis and paralysis. Regarding this we have no clear idea as to the biological position of the reacting substances at present, but some day a definite answer will be forthcoming.
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