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Charles Ricksher
Am J Psychiatry 1907;64:241-262.
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Danvers State Hospital, Hathorne, Mass.

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1. General paralysis seems to be less frequent in the United States than in the continental countries.2. Males are affected much more frequently than females.3. The greatest number of cases occur after the age of 30 and before the age of 50 years.4. Comparatively few cases last longer than four years, the majority dying in the first two years after admission to a hospital.5. Married men are much more frequently affected than are single men.6. In the United States, Jews are not more frequently affected than other races.7. Brain workers are much more often affected than those who have little mental work.8. Heredity is not an active factor in the causation of the disease, but when joined with other causes it occupies a not unimportant place.9. Syphilis is the fundamental cause with alcohol and sexual excesses and mental stress as determining causes.10. The disease is usually well advanced before a diagnosis is made, due to the indefiniteness of the prodromal symptoms.11. The gait and writing are changed in a large percentage of the cases on admission to the hospital, due to the muscular tremor and weakness, and to the diminished activity of the psychic functions.12. The pupillary disturbances are the most frequent of the ocular disturbances found, and inequality of the two pupils and diminution in the light reflexes are the most important of these.13. The tendon reflexes are frequently exaggerated, but vary in the different stages of the disease, and in the third stage are least often exaggerated.14. The cremasteric reflex is very often irregular on the two sides, and there is no rule for its diminution or exaggeration.15. In a majority of well-marked cases, the sexual power is diminished, being exaggerated only in the early stages.16. The memory and attention are practically always affected in well-marked cases.17. Sensory disturbances are not infrequent and neuritic symptoms are often found in the early stages.18. The cerebro-spinal fluid in practically every case shows an increase in albumin and cellular constituents, the small lymphocytes predominating.19. The grandiose type of the disease predominates, only one-fifth of the cases belonging to the depressed form.20. Convulsive seizures may occur very early in the disease and in about one-half of the cases occur at some period. They may occur regularly for a long time before death appears.21. Death by exhaustion is most frequent. In this hospital, there were no deaths from an intercurrent affection.

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