A system of practical medicine. By American authors. Vol. 5

by Unknown

The tremors of sclerotic affections, particularly those accompanying the disseminated forms, are from their distressing character prominent objects of special treatment. The bromides have been given with alleged good effect which I am unable to confirm. Curare has caused the tremor to disappear for two days in one of Erlenmeyer's patients. I have seen good results from the descending galvanic current applied in long sittings to the head and neck, sliding in to the point of tolerance, and sliding out before discontinuing. The mydriatics, atropine, and particularly hyoscyamin, often remove tremor radically for the time being; unfortunately, it is necessary to give them in almost toxic doses to obtain this effect. Recently, Feris recommended veratrum in doses of half a milligram repeated every four to five hours. It acted very well in every case in which I tried it, but, as it became necessary to increase the dose, the same objection was encountered as in the case of hyoscyamin. All these measures should be used as emergency remedies only; they cannot, in the nature of the case, prove curative, while their continued use produces a physiological indifference to their effect, and to that extent decreases their value as the case progresses.

MANAGEMENT OF SPECIAL SYMPTOMS AND COMPLICATIONS.—Among the most distressing features of many sclerotic affections is pain, which is usually associated with sleeplessness. The fulminating variety may be often relieved by the use of the actual cautery applied over the affected level of the cord and along the course of the nerve involved. But in the majority of cases morphine will have to be resorted to. Erb cautions against the use of this anodyne in cases where there is much reflex irritability of the cord, as morphine is said to increase this irritability when administered in small doses, and to reduce it again only when larger ones are administered. It is the latter alone which are serviceable with pain, and I have not yet seen any bad effects in the direction apprehended by Erb from such doses as it is necessary to give. That the physician administering it should be always on guard against the possible formation of a drug habit it is unnecessary to add. But it is also unnecessary to add what alternative he shall adopt when his choice lies between the lesser evil of the opium or morphine habit and the terrible martyrdom which some patients would be compelled to submit to if not allowed to indulge in it.¹⁷⁶ The evil effect of opium and its preparations on the visceral functions is to be neutralized, as far as possible, by the administration of laxatives and bitter tonics.

¹⁷⁶ Few sufferers from spinal disease use anodynes habitually; opium and its preparations are not fascinating to the majority of persons. On the other hand, there are two cases of tabes dorsalis now under my observation in which the patients have been compelled to use hypodermic injections of Magendie's solution for two and three years without any materially bad effect.

The deep-seated diffuse pains, such as are found in disseminated and diffuse sclerosis, are not as markedly relieved by opium as the terebrating and lightning-like variety. Frequently spastic or other signs of increased reflex excitability are associated with them; and as both are favorably influenced by the bromides, the latter are doubly indicated in such conditions.

With pains of a rheumatic character static electricity has been recommended. It undoubtedly relieves such pains, as skilfully-applied galvanism would. Its chief effects, it seemed to me from a six months' trial with it, are on the imagination and hopes of the patient.¹⁷⁷

¹⁷⁷ A large apparatus of the new and improved make was at my disposal at the nervous department of the Metropolitan Throat Hospital. It was very popular with sufferers from rheumatism, who had been allowed to accumulate in the class before I took charge, and with a paretic dement who suffered with the rheumatoid pains often found with diseases such as his.

The bromides and camphor¹⁷⁸ are recommended for the obstinate priapism found in some cases of early tabes and transverse myelitis. I have seen better results from warm hip-baths and general baths in this condition than from any drug. As a general rule, the exercise of the sexual function, where not already forbidden by the results of the disease, should be limited as much as possible. The frequency of normal seminal emissions in a given case is a guide to the amount of indulgence in this direction which may be permitted. Where there is the slightest indication of irritative or destructive lesions in the upper lumbar cord sexual acts should be entirely prohibited, for under these circumstances no greater injury could be done the weakened centres than to permit them. This is particularly noticed in those cases of tabes dorsalis which are marked by satyriasis in the early period.

¹⁷⁸ Particularly the monobromate of camphor.

The treatment of the bladder trouble and of bed-sores is carried out in the manner described in the section on Acute Myelitis. For bed-sores Hammond recommends the application of a stabile galvanic element consisting of a plate of silver and one of zinc, the two being united by a wire isolated in the usual way. The silver plate is laid on the bed-sore; the zinc plate, covered by a piece of moistened cloth, is laid on the unbroken skin somewhere in the neighborhood. The result is a weak current under whose stimulant effect the healing process takes place very rapidly. I have seen excellent results that had been obtained by this means in indolent ulcers of the leg. It does not, however, seem to have been tested with the malignant variety of bed-sore.