|
Main
- books.jibble.org
My Books
- IRC Hacks
Misc. Articles
- Meaning of Jibble
- M4 Su Doku
- Computer Scrapbooking
- Setting up Java
- Bootable Java
- Cookies in Java
- Dynamic Graphs
- Social Shakespeare
External Links
- Paul Mutton
- Jibble Photo Gallery
- Jibble Forums
- Google Landmarks
- Jibble Shop
- Free Books
- Intershot Ltd
|
books.jibble.org
Previous Page
| Next Page
Page 45
In the pre-ataxic stage, where slight unsteadiness, often not
troublesome except in the dark or with closed eyes, sharp stabbing pains
here and there, numbness of the feet, girdle-sense in the region of
chest, waist, or belly, some recurrent difficulty in emptying the
bladder, a fugitive partial palsy of the external muscles of the eye,
are the chief or, perhaps, the only complaints, it would not be
justifiable to put the patient to bed at complete rest. This early stage
calls for a different plan of treatment, to be presently described.
In the middle or more distinctly ataxic period long rest in bed should
be prescribed, and will be gratefully accepted by a patient whose
sufferings from inco�rdination, pains, and numbness of the extremities
are often so great as to incapacitate him.
The bladder muscles share in the ataxia, and the consequent retention
of urine frequently causes cystitis, and may endanger life by the
involvement of the kidneys.
The bowels cannot be emptied or are moved without the patient's
knowledge, and these annoyances combine with the pain and nervous
apprehension to drive the victim into a melancholic or neurasthenic
state. He suffers, too, from want of occupation, from the absence of
exercise, from the anticipation of worse changes in the near future, and
usually by the time he reaches the specialist has been more or less
poisoned with iodide of potash and mercury, and perhaps with morphia.
In the third, the paralytic stage, which seldom comes on until the
symptoms have lasted for years, there is gradual loss of power and
ataxia, increasing until he is totally unable to walk. If a patient is
not seen until this condition of things has been reached, but little can
be hoped from any treatment, though in a few cases energetic measures
may bring about a marked improvement, which is rarely lasting.
A combination of tabes with lateral sclerosis, or with general paralysis
of the insane, is sometimes seen, but needs no special consideration.
The first or pre-ataxic stage is, to the great detriment of patients,
too seldom recognized. The pains are called rheumatic, the eye symptoms
are lightly passed over or glasses are ordered, the difficulty of
micturition is treated by drugs, and the slightly impaired balance
unnoticed or unconsidered.
When such a patient comes into our hands the history, and especially the
history of predisposing causes, needs the most careful examination. It
is well established that syphilis is a common precedent of ataxia,
occurring in at least two-thirds of the cases; it is even more firmly
settled that iodide and mercury in large doses do no good in advanced
ataxia. I say in advanced ataxia, because a few cases are seen in which
the syphilis has been of recent occurrence, or where the spinal symptoms
are of decidedly acute character, and in these anti-syphilitic
medication is needed and useful; but such cases should be described as
acute or subacute spinal syphilis, not as ataxia. When nerve
degeneration has once begun, iodide will do little good and mercury may
do positive harm, if used in large doses. The other common predisposing
causes, exposure to cold, over-exertion, sexual excess, need concern us
only as they suggest warnings to be given, especially when the patient
is improving. Until he does improve not much need be said about them; he
cannot indulge in venery, as sexual power is usually (though not always)
lost early in the disease; and the inco�rdination lessens his
opportunities of exposure or over-exertion.
During this stage some patients complain most of the numbness,
girdle-sense, and inco�rdination; others of the stabbing pains or the
bladder weakness. The general treatment must be much the same, however,
in all, with special attention besides to the special needs of each
individual.
Fatigue makes all the symptoms worse, increases pain, and impairs still
more the muscular inco�rdination; it is, therefore, of the first
importance in every instance to forbid all over-exertion. Walking, more
than any other form of exercise, hurts these cases. The patient should
not walk beyond his absolute necessities. To get the needed fresh air,
let him, according to his situation in life, drive out or use the
street-cars. In some cases the use of a tricycle on a level floor or on
good roads is not so harmful as walking, for obvious reasons; this
tricycle exercise may at first be made a passive or mild exercise by
having the machine pushed by an attendant. To replace the effects upon
the circulation and bowels of physical activity massage may be used, and
the masseur must have directions as to gentle handling of the tender
places at first. These are usually in fixed positions, and can be
avoided or only lightly touched. The shooting pains may be lessened by
deep, slow massage in the tracks of the nerves affected. If, as
generally happens, there are also regions of defective sensation, these
should receive after the general manipulation active, rapid circular
friction, and, perhaps, experimentally, open-hand slapping. As
constipation is one of the troublesome features, the abdomen should have
particular attention, and an unusual amount of time be given to
manipulations of the colon, as described in the chapter on massage. A
full hour's rest in bed, preferably in a darkened room, must follow the
rubbing.
Previous Page
| Next Page
|
|