The author bases his conclusions on cases occurring in his Constantinople practice. These cases are of exceptional interest from the etiological point of view in that (1) the patients comprise representatives of various nations; (2) these nations, owing to differences in religion and mode of life, vary greatly in their liability to syphilis and alcoholism.

After a preliminary description of the social and economic conditions prevailing in Constantinople the author applies the postulates thus gained to his 144 cases, and deduces the following conclusions: General paralysis is invariably preceded by syphilis. Instances where this cannot be proved may usually be accounted for either by the early exaltation of general paralysis, leading the patient to deny the existence of previous disease – the prevalence of pederastia, whereby infection may have taken place without leaving any discernible trace – or, finally, by the existence of hereditary syphilis. Syphilis alone is, however, incapable of producing general paralysis. Other accessory causes are requisite, of which by far the most important are heredity and alcoholism. A possible explanation of these facts is to be sought in the functional failure of the liver, involving loss of its poisoneliminating power. Out of thirty-eight cases examined from this point of view thirty-six had some organic or functional defect of the liver. It has been shown that toxins diminish the amount of glycogen; if the glycogen re-forms, recovery ensues; if not, the organism succumbs. On this theory the part played by alcoholism in the genesis of general paralysis is easily discernible. It is probable that heredity and intellectual overwork act in a similar manner.

General paralysis is, therefore, to be regarded as a result of an ensemble of causes. Its comparative limitation to civilised countries is explained by the fact that the necessary causes, though found singly, do not occur in combination amongst savage nations.

Bernard Hart