164 I am now employing the same treatment in some cases showing no syphilitic history. If any medicinal measures can act upon connective-tissue proliferation, it is these very ones.
In cases of sclerosis due to other causes than syphilis a number of medicinal agents have been recommended as calculated to affect the central disease directly. Ergot is recommended in sclerotic troubles, particularly tabes, by a large number of writers. It is admitted that this substance can produce tabes itself, so that its administration in the large doses recommended by some is not without its possible dangers. I have seen a patient well advanced in the disease who had received the drug for three weeks consecutively in such quantities165 that on estimates made I came to the conclusion that he had received more than some of the persons in whom Tuczek discovered the development of ergotin tabes. Favorable results are reported ensuing after its use in the early stages, particularly where signs of irritation preponderated, such as lightning-like pains, hyperæsthesia, and frequent erections; and it has been suggested that the beneficial action is due to an effect on the blood-vessels, which are supposed to be congested in the beginning of the disease. Proof of such congestion has not been furnished: the vessels are usually sclerosed and their lumen narrowed. In view of the undeniable danger which attends the administration of ergot in tabes, it may be properly insisted that its indications be more precisely formulated than has yet been done. It is commonly noticed in the natural progress of tabes that the lightning-like pains disappear, usually about the time the anæsthesia becomes greater. The anatomical parallel is supposed to be the destruction of the nerve-tubes whose previous irritation caused these pains. If, as is claimed—and it seems to be substantiated—ergotin does produce amelioration of the lightning-like pains, it would prove a damaging revelation which showed that it did so in imitation of the natural process; that is, by increasing the sclerosis.
165 An expert ophthalmoscopist found that the retinal vessels, which were somewhat dilated in this patient, were not influenced by the treatment.
The first drug to which an influence was assigned upon the sclerotic processes, and which has maintained its reputation longest, is nitrate of silver.166 Its claim to being regarded as a remedy may be best characterized by the fact that an author who is far from being prejudiced against it, and who recognizes the claims of Wunderlich, its advocate, speaks of it as a valuable placebo.167 I have never obtained any effects from this drug in the scleroses, or from the chloride of gold, which has been also recommended for these affections, nor have I seen any in cases where either or both had been faithfully tried by others for years. The same is to be said of the chloride of barium, which has been warmly extolled on the basis of a very limited trial in disseminated and diffuse sclerosis.
166 One of the first patients on whom Wunderlich tried this drug died while I studied at Leipzig. He had extensive argyria and sclerosis of the posterior columns.
167 Leyden, op. cit., vol. ii. p. 359.
The direct application of the galvanic current to the spine is recommended, more particularly by Erb and Neftel.168 I am unable to state anything regarding currents derived from as many as twenty of Siemens cells and applied in the ascending direction, as the latter recommends beyond an experience which occurred in the practice of a colleague, who, alarmed by the event to be related, referred the patient subjected to this treatment to me. The patient suffered from tabes dorsalis, the symptoms being limited to the lower extremities, the ulnar distribution, and the pupils. The belt was in the lower thoracic region; the ataxia and lightning-like pains were not great. After a single application of an ascending current from twenty-two cells, continued for ten minutes, the patient suddenly felt a severe dull pain in the occiput and terrible lancinating pains in the distribution of the occipital nerves. With this there occurred scintillation before the eyes, and at the subsequent examination I found that the belt sensation had moved into the neck. The coincidence was so close, and sudden changes in the distributional area of tabic symptoms are otherwise so uncommon, that I attributed the observed change to the treatment.
168 In describing a case in which this measure not only ameliorated lancinating pains and vesical symptoms, but also, applied to the head, relieved the diplopia—usually a spontaneous occurrence, according to both American and European writers—this writer takes occasion to state that in the year 1869 tabes dorsalis was practically unknown to American physicians (Archiv für Psychiatrie, xii. p. 619). Duchenne described progressive locomotor ataxia in that and the preceding year; the necessity of referring to the unfamiliarity of American physicians with a disease not at the time recognized on either side of the Atlantic is hence not apparent. Leyden (op. cit., vol. ii. p. 325) candidly admits that the German medical profession was at first averse to recognizing Duchenne's limitation: this reproach cannot be laid at the door of American physicians, as I can distinctly recollect the demonstration of several well-marked cases exhibiting the characteristic symptoms then known, in the year 1870. The disease obtained recognition in American textbooks and journals as early as in those of any other land.
Erb does not recommend such powerful applications. But the most sanguine electro-therapeutist must admit that the action of galvanic currents on the spinal cord is an exceedingly uncertain one. It is questionable whether weak ones deflect sufficient current-loops to reach the cord and to exert any material effect. As to currents powerful enough to produce an effect, it is not known, except in the loosest and most empirical way, what that effect is. The procedure followed by Erb is to use large electrodes, the cathodal one being a little smaller than the anodal, the former being placed stabile, over the upper cervical sympathetic ganglion of one side, the latter labile, on the opposite side of the vertebral spines, moving gradually downward, the session not exceeding three minutes. This is repeated daily or every alternate day.169 It would prove a strong proof that this treatment really affected the morbid process in a remedial direction if any of the exact signs of the disease were to be modified by it, be it ever so slightly. If, after galvanization of the cervical cord and the sympathetic nerve, the initial myosis of tabes were temporarily lessened or the reflex contraction to light restored for ever so short a time, a brighter future would dawn for electro-therapeutics than seems now to be in store for it.170
169 Why, if the procedure be really remedial or efficiently palliative and devoid of evil consequences, it is not recommended to be repeated oftener I am at a loss to explain or understand. There are some factors involved in practical electro-therapeutic which it is scarcely possible to discuss without encroaching on delicate ground.