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Page 49
He reported in one month, and again in six months, "No improvement in
the pains, but I walk well and briskly, can jump on a moving street-car,
and have ridden a horse twenty miles in a day without fatigue."
This case was in one way favorable for treatment: the patient, an
educated and intelligent man, helped in every way, carrying out minutely
all orders, and had the good sense to begin treatment early. But the
acuteness and rapidity of onset of the tabetic symptoms were so great
that in a little more than two years they had reached a condition which
most cases only attain in from five to ten years, and this makes the
prognosis somewhat less favorable.
In the instance to be next related there was also antecedent syphilis,
and the patient had already been heavily dosed with iodides and
repeatedly salivated with mercury. His recovery was and has remained
remarkably complete.
H.B., travelling salesman, from New York, �t. forty, single, a large,
strongly-made man, a hard worker, given to excesses in sexual
indulgence and alcohol for years. Syphilis was contracted fifteen years
before the first traceable symptoms of ataxia, which had shown
themselves after an attack of grippe, in 1890, in sudden remittent
paralysis of the external muscles of the right eye, followed within a
few months by gastric crises, general lightning pains appearing a few
months later. During the two years succeeding he was drenched with drugs
and grew steadily worse. When admitted to the hospital in 1892 he was
very ataxic in the legs, suffered greatly from gastric and other pains,
difficulties with bladder and rectum, loss of sexual power, various
an�sthetic areas, could not stand with eyes open unless he had help,
total loss of knee-jerk, paralysis of right rectus, indigestion from the
irritation of the stomach from medicines as well as from the disease,
and, though muscular and over-fat, was flabby and pallid. He had no
ataxia or loss of sensibility in the upper half of the body. He was in
bed for two weeks, on milk diet, with warm baths and massage. Systematic
movements were begun and massage continued. After the stomach improved
he grew better with unusual rapidity. He is now able to work hard again,
travels extensively, can walk strongly, but wisely takes his exercise
more in the form of massage and systematic gymnastics. He appears to
report himself once or twice a year. There has been a partial return of
sexual ability.
The next case has points of interest in the later history, but the first
examinations and early treatment may be passed over briefly. X.Y., �t.
forty-two, a steady, sober merchant, closely confined by his business,
always of excellent habits, with no possible suspicion of syphilis, was
seen first in 1894 in a somewhat advanced stage of tabes, but with no
optic or gastric disturbances. His station was very bad, but when once
erect and started he could walk without a stick. Girdle-pains very
marked; bowels very constipated; some trouble in emptying bladder;
several points of fixed sharp pain; lightning pain occasional and
severe, but not frequent. He was ordered to bed for six weeks.
Galvanism, alternate hot- and cold-water applications to the tender
spots, careful massage, and a two-months' course of Brown-S�quard fluid
after getting up made a new man of him. Massage and systematic exercise
were kept up together for six months. The massage was stopped and the
exercises continued, and improvement went on steadily, though the fixed
pains kept up in only slightly less severity.
In a year the patient was better in general health, looks, and spirits
than he had been for many years before, and remained in good order,
except for the daily recurrences of paroxysms of pain of varying but not
unbearable severity for two years. He then presumed for a month on his
strength, and took much more exercise afoot than was wise, worked late
at night over his books, had some additional nervous strain from
business worries, and came to Dr. J.K. Mitchell in October, 1898, barely
able to crawl with two canes, having lost weight, become sleepless,
suffered great increase of pain, and grown so ataxic that he could
scarcely walk. This change had all occurred in three or four weeks. He
became steadily worse for two or three weeks till he could not stand or
walk at all, had cystitis from retention, violent attacks of rectal
tenesmus, stabbing pains in rectum, perineum, scrotum, and groins, with
almost total an�sthesia of the sacral region, buttocks, scrotum, and
perineum, inability to retain f�ces, while passages from the bowels took
place without his knowledge. He found that an increase in the rectal
and abdominal pain followed lying down. He therefore spent day and night
sitting up. At the end of three weeks there was total paralysis of the
legs, and the outlook seemed most unfavorable.
Massage was begun again, strychnia and salol were administered, and a
short course of full doses of the testicular fluid was given. A rapidly
interrupted faradic current, with an uncovered electrode, to the
neighborhood of the rectum, bladder, and buttocks, greatly relieved the
an�sthesia, upon which galvanism had no effect; and, in brief, from a
state which looked almost as if the last paralytic stage of tabes had
suddenly come upon him, he recovered in two months, and is now (July,
1899) better than he was a year ago, before the relapse, and will
probably remain so, as he has had his warning.
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