There is, however, one mental disease depending upon a preceding infectious disease which overshadows all others in importance. This is general paralysis or "general paresis," "paresis" or "paralytic dementia" as it is variously known. Almost invariably fatal within a few years after its onset, often a danger to the reputation or to the happiness of whole families in its earlier stages and distressing in its final phases, this disease occupies a place of its own in the interest of physicians and of others who chance to become familiar with it. Six hundred and sixty-four patients, or 12 per cent, of all the 5,301 new cases admitted to the New York state hospitals last year, had general paralysis. Some comparisons with the prevalence of other more familiar diseases may make the significance of this number clearer. Last year there were 1,368 deaths from typhoid fever in New York. Half as many persons died of general paralysis. Cancer of the breast is a relatively common and a much-dreaded disease, yet there were more deaths from general paralysis than from cancer of the breast. Angina pectoris is another frequent cause of death, but more people die of general paralysis. More people died in 1908 in New York from general paralysis than died from smallpox in the whole registration area of the United States in that year and the three preceding it.
The fact about general paralysis which is of the greatest importance is that it depends upon previous infection with syphilis. To just what extent it is not possible to say, but, whatever other causes may combine to produce general paralysis, testimony is increasing that syphilis is essential. In other words, if these 664 men and women had not had syphilis, very few of them would have had general paralysis.
Whatever is to be accomplished in the prevention of disease by the medical profession and an enlightened public will be brought about by concerted action. Without authoritative information and skilled leadership, popular movements in this field will be unlikely to succeed and may even result in harm, and, without popular support, the efforts of doctors will end in academic discussion and in plans incapable of execution. In this alliance frankness is essential; there must be no secrets or half-hidden truths between allies in the battles which are to be fought together for the public health. So the prevalent belief that syphilis is a menace only in an underworld of criminals, prostitutes and the utterly depraved must be abandoned, and the truth realized that it is a peril from which no class of society is exempt and to which the thoughtless, the innocent and the immoral are equally exposed. Three fourths of the 664 cases of general paralysis were married and 69 per cent, of them were in comfortable or affluent circumstances. The most unfortunate feature of general paralysis is that it occurs most often in the third and fourth decades of life; frequently in those who have long since abandoned the immoral or heedless mode of life
