LOCOMOTOR ATAXIA.
The demonstration of active Spirochceta pallida in the central nervous system in parasyphilitic cases has opened up a field for the activity of physicians where formerly all such cases were regarded as hopeless. The trypanosomes entrench themselves in the cerebrospinal fluid, where they cannot be reached by specific agents such as salvarsan or mercury because the cells covering the choroid plexus do not permit these substances to pass out into the spinal fluid. Hence their failure formerly to make any change in the clinical symptoms of this type of parenchymatous syphilis. But by the administration of the specific drugs through a lumbar puncture the therapeutic results are greatly intensified, and various plans have been devised for carrying this out. Thus it is established that if we wish to get the best result from Salvarsan it should he given both by the spine and by the veins, and this is true also of Mercury. Salvarsan, however, cannot be injected into the spinal canal without certain precautions being taken. The patient receives intravenously 0.45 grm. neosalvarsan. One hour later blood is allowed to flow out of a vein and 15 c.c. of the serum of this blood is injected in the lumbar region. The serum may be injected undiluted or mixed with half its bulk of saline solution; it has been demonstrated to be powerfully spirocheticidal, and may be repeated weekly for six or more times. The injection of salvarsan direct into the spinal subarachnoid has been followed by grave symptoms, hence the substitution of it by auto-salvarsanised serum. Ogilvie simplifies the method by mixing the salvarsan in vitro with human blood-serum before injecting.
Mercury is used in the same way; the serum of the mercurialised patient is injected into the spinal subarachnoid alone or with the addition of gr. mercuric chloride. Good results have also followed the spinal injection of Benzoate of Mercury mixed with human serum. Under this treatment in many cases all the symptoms have improved, lightning pains have disappeared, ataxia rapidly improved and anxsthesia diminished. The injection of the salvarsanised serum may be carried out whilst mercury is being administered by the veins, mouth or skin. Early cases have been reported in which not merely arrest but cure of the disease has been achieved. Suspension treatment is now abandoned.
Whilst spinal and oral treatment is being carried out the older methods of procedure should be persisted in; improved hygiene, sexual excess, abstinence from alcohol, business worries and high pressure of all kinds and as much muscular rest as possible should be duly considered.
Of drugs employed with the view of diminishing the tendency towards the sclerotic changes in the cord, alteratives like Arsenic, Chloride of Aluminium or of Barium, Phosphorus, Chloride of Gold and Sodium and Nitrate of Silver have been from time to time extolled. The latest addition to the list is Fibrolysin administered hypodermically.
Gowers recommended arsenic and aluminium chloride; the latter drug may be given in 3-gr. doses alone or in combination with Fowler's solution, but alternating courses of about a month each are preferable. The dis coloration of the skin liable to follow nitrate of silver administration is a serious drawback, and if the drug is employed at all it should only be for short courses in doses of not more than gr.
Strychnine is a commonly prescribed drug; any beneficial action which it possesses is probably due to its general tonic action. In full doses it is liable to aggravate the crises and lightning pains, but it certainly is useful when bladder troubles are present. Erb's tonic pill contains r gr. Lactate of Iron, II grs. Extract of Cinchona and gr. Ext. Iodides to be of value should be given in full doses and in courses not exceeding a month at a time.
Symptomatic T main hope in helping the tabetic patient must lie in the skilful use of agents and drugs to be employed upon generally accepted principles for the relief of the various symptoms present in each individual case, thus: Ataxia can be greatly improved by the method introduced by Fraenkel in which by a careful education or retraining of the muscles the inco ordination may be greatly lessened. The first step in this plan of treat ment is to teach the patient to ignore or forget the old movement memories of his former healthy state and to turn to advantage a new series of memories which he can only learn by means of exercising his muscle groups with patient and persevering efforts at first guided by his eyes. Many afferent neurons have already perished, and the impressions which he receives through the surviving ones convey to him wrong sensations causing. incoordination. He begins to practise standing between two nurses with his feet apart, and gradually narrowing his base he soon learns to maintain himself in the erect posture with his feet close together, after which he learns to stand upon one foot, and practises the placing of the suspended foot slowly and accurately down till he becomes able to stand upon his toes while his eyes are shut.