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Page 44
In the debate before the British Medical Association the question of the
permanence of cures by this method was the subject of discussion. I have
lately been at some pains to learn the fate of many of my earlier cases,
and can say with certainty that every case then treated was selected
because all else had failed, and that I find relapses into the state
they were in when brought to me to have been very uncommon. A vast
proportion have remained in useful health, and a small number have lost
a part of their gains. I now make it a rule to keep up some relation
with patients after discharge, by occasional visits or by letter, and
believe that in this way many small troubles are hindered from becoming
large enough to cause relapses.
I said in my first edition that I did not doubt that the statements I
made would give rise in some minds to that distrust which the relation
of remarkable cures so naturally excites; and this I cannot blame. Every
physician can recall in his own practice such cases as I have
described, and every medical man of large experience knows that many of
these women are to him sources of anxiety or of therapeutic despair so
deep that after a time he gets to think of them as destined irredeemably
to a life of imperfect health, and finds it hard to believe that any
method of treatment can possibly achieve a rescue.
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 inco�rdination, 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.
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