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TREATMENT OF GENERAL PARALYSIS Results in 197 Cases Treated from 1923-1926
Leland E. Hinsie; Joseph R. Blalock
Am J Psychiatry 1931;88:541-557.
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The actual treatment of the patients reported in this communication was carried out by the clinicians who were on the services of the Psychiatric Institute during the period from 1923-1926. Those directly connected with the research work during this period were Dr. Henry A. Bunker, Jr., Dr. Carl O. Fiertz, and Dr. Leland E. Hinsie.

Without the assistance of Miss Charlotte Arnold, a member of the staff of psychiatric social workers of the Psychiatric Institute and Hospital, the report would not be as complete as it is. She made comprehensive studies of all patients out of the hospital. Her investigations were of great assistance in the evaluation of the social and economic status of the patients.

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Abstract

The communication comprises a report, from the clinical and laboratory standpoints, of the 1930 status of 197 patients with general paralysis treated from July, 1923, to July, 1926. The report covers three separate methods of treatment, namely, (1) malaria, (2) tryparsamide, and (3) combined malaria and tryparsamide.There were 125 male patients and 72 female patients.A. The findings common to both male and female patients irrespective of the type of treatment were as follows:1. The remission rate was 22.3 per cent, having been 18.3 per cent among the male patients and 29.1 per cent among the female patients.2. The deaths amounted to 40.2 per cent. Forty-three per cent of the male patients, and almost 35 per cent of the female patients were dead.3. In 1930 almost 18 per cent of the original group were considered improved. Nineteen per cent of the men and 15 per cent of the women were called improved.4. Almost 20 per cent were considered unimproved. Nineteen per cent of the men and 21 per cent of the women were unimproved.5. Of all the patients living in 1930 almost 57 per cent were at home and 43 per cent were in hospitals for the care of the mentally sick.6. The clinical outcome in the female patients in this series was more favorable than the clinical outcome in the male patients.B. As regards types of treatment:1. The highest remission rate was in the group treated by tryparsamide (and mercury) alone, viz., 28.4 per cent. The remission rate in those treated by malaria alone was 21 per cent. The remission rate of those treated by tryparsamide, after malaria had failed to produce any substantial gain, was 15.6 per cent.2. The percentage of deaths in those treated by malaria alone and by tryparsamide alone was about the same, viz., 43.8 per cent and 45 per cent, respectively.C. Longevity.Following all types of therapy outlined in this communication, the female patients live longer than the male patients.Although the duration of the psychosis before any treatment was administered was longer in the women (30.2 months) than it was in the men (25 months), the women live longer after treatment.The tryparsamide-treated patients have thus far lived longer 53·9 months) than the malarial-treated patients (40.2 months). Those who received both malaria and tryparsamide have thus far lived for an average of 63 months.D. Clinical outcome and reaction types.Those patients classified as "expansive" experienced the highest remission rate. Those with a schizophrenic coloring had the lowest remission rate. The greatest number of deaths occurred in the group classified as "manic." With time many of the "simple dementing" form advanced from the "improved" to the " remission" column.E. Causes and rate of death.The greatest number of deaths occurred during the first six months following therapy; the deaths during this period amounted to 53.3 per cent of all the deaths.Of the known causes of death the greatest cause is general paralysis (73 per cent). Fewer women than men die in convulsive seizures.F. Laboratory results.1. With time laboratory luetic findings tend to become negative.2. In 1930 the blood Wassermann reaction was negative in 77.7 per cent of the patients; the spinal fluid Wassermann was negative in 83.1 per cent; the colloidal gold curve was negative in 93.7 per cent.3. The greatest incidence of negativity occurred among those patients who received tryparsamide.4. There seems to be no close parallelism between the clinical and the laboratory status.5. The greatest incidence of negativity occurred in the patients classified as "simple dementing."

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