On General Paralysis

In attempting to describe the rise and progress of the paralysis, that forms one of the most remarkable symptoms of ‘paralytic insanity,’ I propose to notice first the affection of the muscles of the tongue, which is generally that which most strongly arrests the attention of the physician, who sees a patient in the second or fully-developed stage of the malady. In the last stage, the power of articulation is entirely gone; in both of these the paralysis is so marked, and the evidence of mental disease so clear, that the nature of the case can hardly be mistaken. It is in the very onset of the malady, that the peculiar lisp or failure of utterance, indicating disorder of the nervous centres, at or near the orifice of the nerves supply in the tongue muscles, is of paramount importance in the diagnosis, because if this symptom be superadded to eccentricity of conduct, or distinct delusion, there can remain but little doubt as to the existence of this special and almost invariably fatal form of disease. The alienist physician accustomed to watch the progress of general paralysis, and to recognize its slightest indication, cannot mistake the faulty pronounciation in question, for that of any other form of malady; but inasmuch as there are several affections of the speech that might mislead an unskilled practitioner, it may be useful to describe some of these derangements of the apparatus of articulation, and specify their points of difference. In the first place, an affection of the speech, very much resembling the embarassed articulation of incipient paralytic insanity, may be the result of temporary local congestion at the base of the brain, or may be produced by sudden fright, or by the action of poisons, particularly aconite; the indistinct utterance attending intoxication, is a familiar instance of poisoning of this kind: and all these are easily distinguished by the suddenness of their occurrence, and by their history, from the stutter of general paralysis. The articulation of the habitual stammerer is sometimes not unlike that which is the result of serious organic mischief; and still more striking in its resemblance, is the hesitation of speech, that may be observed in some cases of poisoning by lead. The ordinary signs of saturnine poisoning, the blue gum-line, the dropping of the wrist, &c., will mark this latter malady—the history of the case will prevent any mistake in the former. I may mention here, that I believe it to be an exceptional occurrence to find a person of unsound mind who stammers; such a case at least must be very uncommon, a fact which I can only account for on the supposition that the greater disease prevents any manifestation of the minor nervous derangement.