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Page 48
For several years past in all patients with the general lowering of
nervous force and vitality so common in this disease I have habitually
used the testicular elixir of Brown-S�quard. The ridiculous length to
which organic therapeutics have been carried, the extravagant
advertising claims, and an absurd expectation of impossible results have
combined to make the profession shy of those organic preparations which
have not very good evidence in their favor, and for some time I shared
in this prejudice against the Brown-S�quard fluid. A talk with that most
distinguished physician and an examination of some of his cases led me
to a trial for myself, and I am at present very well convinced that,
whether a physiologic basis can reasonably be assumed or not, we have in
the fluid a tonic remedy of great power. While I have used it with good
effect in other conditions, it is in ataxia that I have found it of most
value.
The glycerin extract is freshly prepared from bulls' testicles in exact
accordance with the directions of the discoverer. It is used
hypodermatically every other day, beginning with a diluted ten-minim
dose and increasing by two or three drops up to about forty minims. The
effect is at its height twelve to twenty-four hours after the
administration in most patients, hence the reason for using it only once
in two days. The skin is prepared, the needles and syringe disinfected,
and the tiny puncture sealed afterwards with as minute care as would be
given to a surgical operation. By these precautions the danger of
abscess, always considerable if hypodermics are carelessly given, is
minimized. As the dose is large, a site must be selected for the
injection where the tissue is loose, otherwise the pain will interfere
with the desired frequency of use. The buttocks serve best, or the outer
masses of the pectoral muscles, or the abdominal muscles. If the
administration causes pain (due in part to the large quantity used and
in part to the local effect of glycerin), a fraction of a grain of
cocaine may be added to the solution when measured out for use.
It may at once be said, emphatically, that in some cases remarkable
results have followed the use of this material, while in others no good
has been done; but the same may be said of most plans of treatment in
this disorder. As to possible danger from it, no harm has been done to
any patient known to me, except that abcesses have occurred sometimes,
though very rarely, for in many hundreds of injections it has been my
good fortune to see abscesses form only three or four times, two of
these instances, by curious ill luck, being in physicians. Patients
describe a stimulating effect not unlike that of strong coffee,
following a few hours after use and lasting for a day. The sexual
appetite, if present, is increased; if absent, it is often renewed,
sometimes in elderly men to an inconvenient extent. In one tabetic
subject who had lost desire and ability for more than three years both
returned in sufficient force to allow him to beget a child. This
patient, like most of the others, was ignorant of what drug was being
used and of what effects might be expected, so suggestion played no
part. Apart from this special effect, the solution acts only as a highly
stimulating tonic.
The full dose of forty minims or thereabouts is maintained for a
fortnight or less, and then gradually diminished in the same way that it
was increased. Sometimes, when the effect has been good, a second
"course" may be given after two or three weeks' interval.
During the treatment by hypodermic the masseur should be told to avoid
rubbing where the injections have been given. A few trials with the
fluid internally have produced so little result of any kind that I am
inclined to think the gastric juices must alter it so as to lessen or
wholly destroy its power.
As to other drugs, experience has not given me much confidence in any
of those usually recommended. Strychnia, belladonna, and those
antiseptic drugs which are eliminated chiefly by the kidneys are of use
when cystitis has to be treated and the bladder muscles urged to
activity. Arsenic, the chloride of gold and sodium, and chloride of
aluminium are suggested by various authorities, but they have not been
of any value in my hands. In hopeless cases, where all treatment fails,
as will sometimes happen, or in patients in whom the paralytic stage is
already far advanced, if other measures are unsuccessful, morphia is
left as a forlorn hope, which will at least relieve their pains.
An outline report of several cases of different types and degrees is
appended:
M.P. of North Carolina, �t. thirty-seven, general health excellent until
syphilis in 1894, was admitted to the Infirmary in 1898. He had had for
two years recurrent attacks of paralysis of the external rectus muscle
of the right eye, slight gastric crises, and stabbing pains in the legs;
station very poor, but strength unimpaired, and he was able to walk
after being a few minutes on his feet; when first rising he was very
unsteady. Knee-jerk lost, no reinforcement. No sexual power. Some
difficulty in emptying the bladder. Examination showed slight atrophy of
both optic nerves, Argyll-Robertson pupil, and myosis. He was ordered
two weeks' rest in bed, with massage, cool sponging daily, and
galvanization of the areas of neuralgia. After two weeks he was allowed
to get up gradually, to occupy himself as he pleased, but not to walk.
Lessons in balance and co-ordination were begun in the fourth week of
treatment, and supervised carefully for two weeks more. When his station
and gait were both improved, he was permitted to walk, always with care
not to fatigue himself. At this time, six weeks from commencement of
treatment, his eyes were glassed by Dr. de Schweinitz. He had gained
some pounds in weight, and walked on straight lines without noticeable
inco�rdination, but in turning short or walking sharp curves he was
still unsteady. He found walking much easier than formerly and was less
easily tired. After nine weeks he could stand or walk, even backward,
with closed eyes. He was sent home for the summer, with directions to
continue his co-ordination movements, to walk very little, and take
such exercise as he needed on horseback, riding quietly. He had still
some stabbing pains two or three times daily.
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