67 Coitus reservatus, the real crime of the Onan of Scripture.
68 Leyden states that coitus in the upright position has been accused of producing tabes, without mentioning his authority. I have no observation on this subject touching tabes, but am prepared to credit its bad effect from the account of a masturbator, who during the orgasm produced while standing felt a distinct shock, like that from a battery, shooting from the lumbar region into his lower limbs, and causing him to fall as if knocked down. He consulted me in great alarm—was scarcely able to walk from motor weakness, and had no knee-phenomenon; in a few weeks it returned, and no further morbid sign appeared. Masturbators of the worst type occasionally manifest ataxia, and in three cases I have been able to establish the return of the knee-jerk, together with other improvements in the spinal exhaustion of these subjects. The loss and diminution of the patellar jerk, and the frequently associated urinary incontinence, as well as certain of the peripheral pains found in masturbators, certainly prove that undue repetition of the sexual act (be it natural or artificial) is competent to affect the cord in a way that cannot but be injurious in case of a predisposition to tabes, if not without the latter.
Of single causes, none exerts so direct and indisputable an influence on the production of tabes as the action of cold and wet upon the lower segment of the body. It is usually the case that such exposure is frequently repeated and combined with over-exertion before the disease is produced, but it is occasionally possible to trace the very first symptom of the disease directly to a single exposure. A soldier who stands up to his knees in a rifle-pit half full of water finds his limbs numb or tingling; develops slight motor weakness, then lightning-like pains, and ultimately a typical tabes. In the case of a peddler who presented an advanced form of the disease, the first symptoms had developed after a single wetting of his feet: while walking along one of our watering-places with his wares the swell of a steamer inundated the beach. He had been subject to perspiring feet before that, and the perspiration remained checked from that time on.69 The influence of surface chilling was remarkably manifest in all three of my female cases. In one of them it was due to frequent wetting of the feet; in the second, a midwife, the first symptoms began immediately after standing on a cold hearthstone while preparing some article needed in a lying-in case. In the third case, a lady who contracted and safely passed through a scarlatina in her twenty-eighth year was taken out driving while desquamation was going on. She became thoroughly chilled, experienced numbness in the fingers and toes, and from that day on developed a slowly progressing tabes involving all extremities alike.70
69 Checking of habitual perspiration by violent measures is mentioned by the German textbook writers as a frequent cause, but occurs quite rarely in the modern tables.
70 In view of the absence of spinal—or, in fact, any nervous—symptoms prior to the exposure referred to, it does not seem necessary to insist that this was not an instance of a true post-scarlatinal tabes; and possibly the case thus designated by Tuczek (Archiv für Psychiatrie, xiii. p. 147) may have been really due to chilling of the delicate body-surface after desquamation or during that process. The typical form of myelitis and sclerosis after exanthematous fevers is rather of the disseminated type.
Spinal concussion has been mentioned by a number of authorities as a possible cause for tabes, as for other forms of sclerotic spinal disease. In 1 of 81 cases in my own observation the development of the disorder could be distinctly traced to a railway injury; in 2 a sudden aggravation was as distinctly referable to a similar cause.71 To what extent railroad travelling, with its attendant continual jarring of the body, may predispose to the development of tabes or of other spinal diseases is as yet a matter of mere conjecture. That railroad travelling exerts a bad influence in some cases of the established disease is evident; but in others the patients rather like the motion, and claim to feel benefited by it.
71 A fall from a chair, striking on the back of the latter, while endeavoring to keep a row of books from coming down in one case, and the shock of the Ashtabula disaster in the other. The latter patient, the same one who is referred to as describing the electric-storm sensation in an earlier part of this article, had his foot amputated in consequence of that disaster; but, like one of the characters in Jacob Faithful, who felt his toes when the weather changed, though he left both legs at Aboukir, he felt the terrific pains of the disease in the absent foot as distinctly as in the other. Dumenil and Petit (Archives de Névrologie, ix. Nos. 25 and 26) relate cases in which a spinal concussion was the only ascertainable cause.
A number of toxic agents have been charged with producing tabes: thus, Bourdon maintains this of absinthe; Oppenheim attributes one case to poisoning by illuminating gas, the exposure to its influence being immediately followed by a gastric crisis, and this by a regulation tabes.72 It is supposed that most of the poisons acting on the cord in this or a similar way, such as arsenic, cyanogen,73 barium, and chloral,74 do not produce a spinal lesion directly, but through the medium of a secondary cachexia. Of no agent is the effect in producing tabes so well studied as ergot of rye. It had long been known that ergot-poisoning provoked certain co-ordinating, motor, and sensory disturbances, but it was left for Tuczek75 to show that this vegetable parasite produces a lesion of the spinal cord which in its character and distribution apes typical posterior sclerosis so closely as to justify the designation of a tabes ergotica. Possibly, pellagra, which is sometimes manifested in a similar way,76 may yet be shown to have a like influence.
72 Archiv für Psychiatrie, xv. p. 861.
73 Bunge, Archiv für experimentelle Pathologie, xii.