It may at once be said, emphatically, that in some cases remarkable results have followed the use of this material, while in others no good has been done; but the same may be said of most plans of treatment in this disorder. As to possible danger from it, no harm has been done to any patient known to me, except that abcesses have occurred sometimes, though very rarely, for in many hundreds of injections it has been my good fortune to see abscesses form only three or four times, two of these instances, by curious ill luck, being in physicians. Patients describe a stimulating effect not unlike that of strong coffee, following a few hours after use and lasting for a day. The sexual appetite, if present, is increased; if absent, it is often renewed, sometimes in elderly men to an inconvenient extent. In one tabetic subject who had lost desire and ability for more than three years both returned in sufficient force to allow him to beget a child. This patient, like most of the others, was ignorant of what drug was being used and of what effects might be expected, so suggestion played no part. Apart from this special effect, the solution acts only as a highly stimulating tonic.
The full dose of forty minims or thereabouts is maintained for a fortnight or less, and then gradually diminished in the same way that it was increased. Sometimes, when the effect has been good, a second "course" may be given after two or three weeks' interval.
During the treatment by hypodermic the masseur should be told to avoid rubbing where the injections have been given. A few trials with the fluid internally have produced so little result of any kind that I am inclined to think the gastric juices must alter it so as to lessen or wholly destroy its power.
As to other drugs, experience has not given me much confidence in any of those usually recommended. Strychnia, belladonna, and those antiseptic drugs which are eliminated chiefly by the kidneys are of use when cystitis has to be treated and the bladder muscles urged to activity. Arsenic, the chloride of gold and sodium, and chloride of aluminium are suggested by various authorities, but they have not been of any value in my hands. In hopeless cases, where all treatment fails, as will sometimes happen, or in patients in whom the paralytic stage is already far advanced, if other measures are unsuccessful, morphia is left as a forlorn hope, which will at least relieve their pains.
An outline report of several cases of different types and degrees is appended:
M.P. of North Carolina, æt. thirty-seven, general health excellent until syphilis in 1894, was admitted to the Infirmary in 1898. He had had for two years recurrent attacks of paralysis of the external rectus muscle of the right eye, slight gastric crises, and stabbing pains in the legs; station very poor, but strength unimpaired, and he was able to walk after being a few minutes on his feet; when first rising he was very unsteady. Knee-jerk lost, no reinforcement. No sexual power. Some difficulty in emptying the bladder. Examination showed slight atrophy of both optic nerves, Argyll-Robertson pupil, and myosis. He was ordered two weeks' rest in bed, with massage, cool sponging daily, and galvanization of the areas of neuralgia. After two weeks he was allowed to get up gradually, to occupy himself as he pleased, but not to walk. Lessons in balance and co-ordination were begun in the fourth week of treatment, and supervised carefully for two weeks more. When his station and gait were both improved, he was permitted to walk, always with care not to fatigue himself. At this time, six weeks from commencement of treatment, his eyes were glassed by Dr. de Schweinitz. He had gained some pounds in weight, and walked on straight lines without noticeable incoördination, but in turning short or walking sharp curves he was still unsteady. He found walking much easier than formerly and was less easily tired. After nine weeks he could stand or walk, even backward, with closed eyes. He was sent home for the summer, with directions to continue his co-ordination movements, to walk very little, and take such exercise as he needed on horseback, riding quietly. He had still some stabbing pains two or three times daily.
He reported in one month, and again in six months, "No improvement in the pains, but I walk well and briskly, can jump on a moving street-car, and have ridden a horse twenty miles in a day without fatigue."
This case was in one way favorable for treatment: the patient, an educated and intelligent man, helped in every way, carrying out minutely all orders, and had the good sense to begin treatment early. But the acuteness and rapidity of onset of the tabetic symptoms were so great that in a little more than two years they had reached a condition which most cases only attain in from five to ten years, and this makes the prognosis somewhat less favorable.
In the instance to be next related there was also antecedent syphilis, and the patient had already been heavily dosed with iodides and repeatedly salivated with mercury. His recovery was and has remained remarkably complete.
H.B., travelling salesman, from New York, æt. forty, single, a large, strongly-made man, a hard worker, given to excesses in sexual indulgence and alcohol for years. Syphilis was contracted fifteen years before the first traceable symptoms of ataxia, which had shown themselves after an attack of grippe, in 1890, in sudden remittent paralysis of the external muscles of the right eye, followed within a few months by gastric crises, general lightning pains appearing a few months later. During the two years succeeding he was drenched with drugs and grew steadily worse. When admitted to the hospital in 1892 he was very ataxic in the legs, suffered greatly from gastric and other pains, difficulties with bladder and rectum, loss of sexual power, various anæsthetic areas, could not stand with eyes open unless he had help, total loss of knee-jerk, paralysis of right rectus, indigestion from the irritation of the stomach from medicines as well as from the disease, and, though muscular and over-fat, was flabby and pallid. He had no ataxia or loss of sensibility in the upper half of the body. He was in bed for two weeks, on milk diet, with warm baths and massage. Systematic movements were begun and massage continued. After the stomach improved he grew better with unusual rapidity. He is now able to work hard again, travels extensively, can walk strongly, but wisely takes his exercise more in the form of massage and systematic gymnastics. He appears to report himself once or twice a year. There has been a partial return of sexual ability.