TREATMENT OF THE ENDOHENOUS DISEASES The treatment of the endogenous diseases is not very hopeful. The inability to give any prophylactic advice is actually depressing, and the physician has to look on hopelessly and see one child after another attacked by a family paralysis. Even Edinger's exhaustive theory has but a limited application endogenous diseases, since it appears that even a minimum of function is enough to exhaust the imperfectly developed portions of the central nervous system. In infantile spinal muscular atrophy and in amaurotic idiocy- treatment of every kind is absolutely useless. In other family affeetions associated with spasms and atrophy advantage may be taken of Edinger's hypothe sis to the extent of guarding the child, as well as its brothers and sisters that have not vet been attacked by the disease, against any bodily overexertion, particularly by forbidding all forms of athletic exercise, including gymnastics, mountain climbing and swimming. It is better to give up the idea of keeping the child "in training," by constant use of the already damaged muscles, and to insist at once on the use of a wheel-chair or other vehicle for any extended walk. Even though the prospect of a cure is hopeless, the psychic treatment of the children should not be neglected. We should keep up the hope of ultimate recovery and not allow them to suffer from the loss of proper schooling nor cut them off from intercourse with other ehildren.
Electric treatment in many cases has but a psychic effect. In slowly progressing muscular atrophy, however, it is not altogether hope less and may perhaps bring about remission or even local improvement. The labile cathode or the faradic current are employed on the paralyzed extremity ancl the spine is subjected to stabile galvanization. In im pending paralysis of the muscles of deglutition an attempt should be made, by conducting an interrupted galvanic eurrent through the throat, to induce movements of deglutition artifically. In myasthenia electric treatment should not be used.
In muscular atrophy, massage and gymnastic exercise are to be recommended; greatest stress being laid on passive movements.
Frankel's exercises for the treatment of ataxia should be tried in hereditary ataxia in the same way as in tabes dorsalis.
Warm baths are of great benefit, especially in spastic palsies, and may be combined with light massage. It is a well known fact that spastic extremities can be more readily moved in warm water than in bed. This phenomenon is attributed by Leyden to the buoyancy of water and consequent diminution of the action of gravity. Hot baths are to be avoided.
The question of sending these patients to watering places depends on the rapidity with which the paralysis progresses, as it is unwise to run the risk of their becoming helpless and unable to move while away from home. Any locality with plenty of woods may be selected; or we may advise indifferent thermal and saline waters, possibly containing a small amount of carbon dioxide. Among the thermal waters may be mentioned: Johannesbad, Neuhaus, Ramerbad, Tuffer, Leplitz, Vaslau (Austria), Schlangenbail, Wildbad, Warmbrunn (Germany) Ilagaz, (Switzerland); the temperature of the spring at Gastein is somewhat too high. For saline baths consult the chapter on serofulosis. For earbonated baths Nauheim, Oeynhausen, Eranzensbad and Soden may be considered.
IIydrotherapeutic measures with cold water are called for in these diseases only in the presence of other indications such as insomnia, excitability, depression and the like.
In comparison with these physiologic methods of treatment, internal medieation is of very minor importance in the endogenous diseases. Experiments with organotherapeutic products such as muscle substance, thyroid gland and thymus have so far proved unsuccessful. It is needless to say that, when there is even a faint hope of a syphilitic etiology, the iodides and bichloride of mercury must be prescribed. As the disease is usually painless in the beginning, there is no occasion for any further symptomatic treatment. Of course, after the patient has been bed ridden for some time, a number of therapeutic measures are called for, which, however, do not belong directly to the subject of neurology.