A huge number of male lunatics were admitted to asylums suffering from a condition that was understood in the 19th century as “general paralysis of the insane” (GPI). A very interesting piece on this condition, written by one Dr E Salomon, appeared in the Asylum Journal in 1862, in which the word “syphilis” is not mentioned but a link with a venereal infection is clearly being made; this link would not be fully confirmed by anatomical and microscopic investigation for many years.

As in my previous posting about Dr Henry Maudsley, Dr Salomon pointed out how symptoms of GPI are also the symptoms of other medical conditions. Salomon wrote of the majority of GPI sufferers being in “full manhood” and rarely younger than 30; they have lived “too fast” and have “fallen victim to enervating excesses, particularly those of a sexual character… France is the peculiar focus of the disease… Paris is the headquarters.”

The disease, stated Salomon, runs from some months to three years, but never beyond five. The article insisted on four stages of GPI: mental alteration; mental alienation; dementia; amentia – ie total paralysis of the mind.

Symptoms were both physical and mental, he continued: firstly, an astounded, vacant look; an inability to perform the simplest mental operations; confusion of ideas and sense of environment; “this devastated intelligence is maintained throughout the disease, regardless of other mental changes”; a deteriorating temper; uncharacteristically impetuous acts – “extravagant and dissolute, dishonest and debauched”.

In terms of movement, the first stage included spasms of the face; disturbed speech, including stuttering and stopping mid-sentence; vertigo; a staggering gait, with legs spread wide.

In the second stage, the insanity seen in GPI cases differed from non-GPI insanity, wrote Salomon. In this second stage, grandiosity was ever-increasing and was a progressive delirium not found in other grandiose insanity cases. There was also persistent raving, without lucid intervals.

Salomon thought that GPI insanity was most often confused with alcoholism, muscular atrophy and apoplexy.

“There is also seen in GPI maniacal exaltation and grandeur; melancholia; loquacity without delusion; false ideas and hallucinations.” Those who lived on to the fourth stage, which was rare, would find their sight and hearing annihilated, and the patient would be bed-bound: “The wreck of the unhappy man lies dull and immovable as a sack of flesh… Soon, however, death puts a long wished-for close to this extreme limit of human misery, as the patient is only a burden, a mass of foetid lumber here upon earth.”