TYPES OF THERAPEUTIC RESPONSE OBSERVED IN THE MALARIA TREATMENT OF GENERAL PARALYSIS
Authors: George H. Kirby, Henry A. Bunker
Journal: American Journal of Psychiatry (1926)

1. It is possible to divide into three major groups our material of 93 cases of general paralysis who were given the malaria treatment between June 15, 1923, and December 15, 1925, and who survived the period of treatment by more than two months: (1) Those in whom the treatment has apparently been without any effect whatever, 13 in number; (2) those in whom the results attributable to treatment have been of a more or less temporary character, 15 in number; and (3) those in whom the therapeutic influence, whatever its degree, has persisted essentially unmodified up to the present time, 65 in number. The last two groups are, of course, further divisible according to the degree of temporary or "permanent" improvement. Provisionally included among the 65 "permanent" results are 18 patients who, though they have exhibited no improvement, have manifested so far, after various periods extending up to three years, no evidence of retrogression. 2. The better the therapeutic result obtained, the more likely it is to be of a more or less enduring character; for the ratio of those who evidenced a subsequent decline to those who have so far preserved the status quo is as 8:2 among the only slightly improved cases, as 6:9 among the considerably improved, and as 1:36 among the full remissions. 3. Of 41 patients followed for more than a year, who received no further anti-syphilitic treatment during that period, a well-marked modification in the strength of the spinal fluid Wassermann took place in 13, or in 32 per cent (in 8 of whom the reaction became completely negative); in 11, or 26 per cent, the Wassermann reaction was definitely modified; in 17, or in 42 per cent, it remained unchanged. No very striking correlation between clinical status and spinal fluid findings was present, save that six of the eight cases to become Wassermann-negative had attained full remissions. In the eleven other full remissions in this group the Wassermann reaction in the spinal fluid was unchanged or only slightly modified. The Wassermann reaction in the blood remained essentially unchanged in 28 of the 36 patients who were positive prior to treatment (or in 78 per cent); in only six cases did the blood become negative with an alcoholic antigen and in only two with a cholesterinized antigen as well. 4. Patients of the "manic" type of general paralysis exhibited by far the greatest tendency to a favorable response to treatment. Of 16 "manic" cases in this series, 13 achieved a "permanent" result and 12 of these a full remission. Of 48 patients of the simple dementing type, 30 achieved a "permanent" result, but 13 of these belong in the stationary and unimproved group, and only seven attained a full remission. 5. The total duration of the various physical and mental symptoms referable to general paralysis averaged, at one extreme, 27 months in the cases upon whom treatment was without influence, and at the other, 16 months in the patients who achieved full remissions. There was little difference in this respect between the "temporary" group and the "permanent" group, as a whole. 6. In the 7 out of 12 patients who did not respond to treatment a more or less progressive loss of weight took place subsequent to treatment; 80 per cent of the "temporary" cases eventually lost much of the weight which they had previously gained; 48 per cent of the "permanent" cases registered a more or less progressive gain in weight without subsequent loss. In the case of temporary gain in weight, all three groups of patients made a gain of equal magnitude, amounting to about 16 per cent of the pre-treatment weight, on the average; but the cases uninfluenced by treatment and the "temporary" cases subsequently lost about 85 per cent of this gain, whereas the "permanent" cases lost only 48 per cent. When this post-treatment gain in weight was sustained without subsequent loss, the amount of this gain was likewise about 17 per cent of the pre-treatment weight, on the average. 7. Among the clinical factors which seem to play a part in the results obtained by the malaria treatment, the so-called clinical type of general paralysis appears to rank first in importance, the behavior of the body weight subsequent to treatment second, and the duration of the symptoms prior to treatment third.