Walking with one foot upon a straight line or with both feet between two lines 12 inches apart chalked on the uncarpeted floor is to be practised several times a day for to 4 hour at a time, stopping before physical or mental fatigue is induced. Afterwards curved lines are employed, and finally complicated figures should be practised with numerous turning points. Before getting up and after retiring to rest various muscular movements may be practised whilst he lies upon his back in bed, such as touching with each toe some object suspended above the bottom of the bed, or slowly and accurately flexing his leg first and next his thigh he steadily extends the elevated foot and leg till his toe touches the object, after which the limb is gradually brought again to the horizontal position. No new exercise should be tried till the former one has been accomplished with accuracy and comparative ease or alacrity. At various times during the day he should practise slowly sitting down and steadily rising up, commencing this exercise in an armchair with long arms. Climbing an easy stair with an attendant upon one side without hauling himself up by means of his arms on the handrail should be daily practised.
Massage and Electricity are always of use when the muscles are wasted and flabby, especially in long-standing cases where exercise has been neglected.
The continuous current is the most satisfactory for all purposes. One pole may be placed upon the upper part of the spine in the cervical region and the other one over the lower lumbar spines, and the current from fifteen to twenty Leclanche elements should be allowed to pass for about 5 minutes twice daily. A current from three to four cells should also be passed through the brain for a few minutes. A very good method is to place the positive pole upon the upper spines, and drop the negative into a warm or tepid foot-bath, in which both lower extremities are immersed for 5 or to minutes. Where the continuous current fails to afford any signs of improvement in the patient's condition, Faradic and static electricity have also been employed.
Radium Emanations applied to the spine have been reported upon by Fabre and Max to have produced remarkable improvement in all the symptoms of the affection, lessening pains, spasticity, &c.
A course of hydropathy is of use in some cases, and may be carried out in conjunction with massage or Fraenkel's method. Cold packs, the combination of douche and massage, or spray and needle baths, with frictions and manipulations applied to the spine and lower extremities, may be employed. Hot baths must he forbidden, though Leyden recommends the free use of baths at to 95' F., and also of brine baths, and Luke recommends the peat and fango baths.
Counter-irritation applied to the spine is only indicated in those cases which exhibit marked spinal tenderness or where the ataxic symptoms have rapidly followed after a fall or concussion.
Bladder Troubles.—These are the most serious of all the symptoms of tabes, since they very often cause death from retention, cystitis and secondary kidney infection. The irritability of the bladder in the early stages of the disease, as evidenced by frequent attempts at micturition, passes at a later period into retention or the constant dribbling from a distended bladder, or ends in a purulent cystitis with a large amount of residual urine. It is the duty of the physician in every case to look closely after the state of the bladder, and if any doubt exists about the patient's ability to completely empty the viscus the catheter should be passed after micturition in order to ascertain the amount of residual urine. As the main source of the mischief lies in the insensibility to stimuli from the distended bladder, preventive treatment is important, and should consist in compelling the patient to make water every couple of hours and to insure that the last drops are voided. Where any amount of residual urine is detected the patient must enter upon catheter life, the most scrupulous care in sterilisation of the instrument being exercised, The plan of waiting till a purulent cystitis develops before resorting to catheterisation is a mistake. When decomposed urine is voided or drawn off, the bladder should be freely irrigated with warm Boric Acid solution, a portion of which should be left behind after each washing. Internal antiseptics are clearly indicated in every such case; 5 mins. Creosote in a capsule twice daily is a valuable method for keeping the urine sterile, or 5 grs. Urotropin may be given in i dr. of Sanmetto. The tone of the bladder may be improved by full doses of Strychnine provided lightning pains arc not present, and it may be further increased by a weak con tinuous current passed from the pubes to the sacrum, but the most efficient means of all to restore lost tone is to prevent dilatation or dis tension by repeated catheterisation.
Lightning Pains.—Rest in bed is essential, and the new analgesics for the relief of pain should be employed in preference to narcotics on account of the danger of establishing a drug habit. Antipyrine 15 grs., Phenacetin 20 grs., Aspirin 20 grs., Methylene Blue 4 grs., Pyramidon ro grs., Antifebrin 5 grs., Salicylate of Soda 3o grs., Exalgin 3 grs., may be accepted as maximum doses. Morphia hypodermically and Cocaine should only be resorted to under most exceptional circumstances. Gowers recommended 3-gr. doses of Chloride of Aluminium thrice daily to prevent recurrence, and Muller has reported permanent relief from Fibrolysin injections. When the pain is superficial it may be relieved sometimes by smart counter-irritation, a spray of Ethyl Chloride or Ether, Chloro form liniment, Menthol or warm packs.