I am fortunate now in having been able to show that in other hands than my own, both here and abroad, this treatment has so thoroughly justified itself as to need no further defence or apology from its author. It has gratified me also to learn that in many instances country physicians, remote from the resources of great cities, have been able to make it available. As I have already said, I am now more fearful that it will be misused, or used where it is not needed, than that it will not be used; and, with this word of caution, I leave it again to the judgment of time and my profession.
CHAPTER X.
THE TREATMENT OF LOCOMOTOR ATAXIA, ATAXIC PARAPLEGIA, SPASTIC PARALYSIS, AND PARALYSIS AGITANS.
In my earliest publication on the treatment of diseases by rest, etc., locomotor ataxia was alluded to as one of the troubles in which remarkable results had been obtained. Rest alone will do much to diminish pain and promote sleep in tabes, rest with massage and electricity will do more. It is not necessary to order complete seclusion for such cases, but some special measures will be needed in addition to those already described as of use in various disorders, and these will be discussed in this chapter.
While this is not a treatise on diagnosis, some brief symptom-description is needed to enable one to define clearly the methods of treatment at different stages.
In the middle or late stages there need be little uncertainty in uncomplicated cases; in the earlier periods diagnosis is by no means easy. A history may usually be elicited of important heralding symptoms, such as former or present troubles with the muscles of the eyes, the occurrence of vague but sharp and recurring pains, vertigo, an impairment of balance, unnoticed perhaps, except when walking in the dark or when stooping to wash the face, or especially when going down stairs. Attacks of 'dyspepsia,' as unrecognized visceral crises are often called, should render one suspicious. If, on examination, loss or impairment of knee-jerk be shown, contraction of the pupil with Argyll-Robertson phenomenon and defective station, but little doubt can exist. The discovery by the ophthalmoscope of some degree of beginning optic neuritis would make assurance more sure, and this can often be detected in a very early stage of the disease.
Much controversy has been spent on the question of the share of syphilis in producing tabes, and out of the battle but two facts emerge fairly certain, the one that syphilis often precedes the disease, the other that anti-syphilitic medication is commonly of no service. But syphilis is so frequently antecedent that a history of that infection may make certain the diagnosis when doubt exists. This may be an important point, for some of the cardinal symptoms are occasionally absent; cases are seen with no incoördination, sometimes with the station unaffected, even, though rarely, with the knee-jerk preserved.
The diagnosis established, treatment will somewhat depend upon the stage which the disease has reached.