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Tabes

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TABES DORSALIS.•A disease of the spinal cord, giving rise to loco motor ataxic!. It usually occurs in middle-aged individuals, and more frequently in men than in women. The name " tabes " (wasting away) refers to the protracted course of the disease, which leads to marked emacia tion, and confines the patient to his bed for a long period. The disease has no connection whatever with tuberculosis of the lungs.

In the majority of cases, syphilitic infection (from which the patient may have recovered many years previously) is of great importance as a cause of dorsal tabes. In some cases the affection is ascribed to colds, drenching, or bodily over-exertion. Locomotor ataxia is never the result of masturbation, as is often believed and feared. Nor does it appear that syphilis alone can cause it, although this disease often seems to prepare the soil for other causative factors.

The onset of tabes dorsalis takes place insidiously, the first symptom being violent pains in the legs. These pains, which are usually regarded as being due to rheumatism or to some form of neuralgia, may be present a year or more before the appearance of any additional symptoms. Some of the more prominent of these later signs are a sensation as of a constricting hand being tied around the body, difficulties in voiding the urine, and (in men) sexual impotence. Many other symptoms gradually appear during the development of the disease, Among these may be mentioned attacks of pain in the abdomen and in the larynx, disturbances of vision, paralyses of various muscles, swelling of joints (especially of the knee-joints), and ulcers on the feet.

The most striking symptom of takes dorsalis is the condition known as locomotor ataxia, which is characterised by lack of co-ordination of the muscles governing locomotion. It is not that the muscles themselves are in any way weakened ; but they cease to act in harmony ; and this, together with a diminution in sensibility, makes the act of walking a conscious process in stead of a mechanical one. The patient is obliged to let his vision aid him in maintaining his equi librium ; and when he takes his eyes off his feet he immediately begins to stagger. The accom panying cut (Fig. 39o) shows the

characteristic attitude assumed by blindfolded patients suffering from locomotor ataxia. The gait of these patients is peculiar. lift their feet excessively high from the ground, spread their legs, and take short and rapid strides. The heel usually reaches the ground before the sole of the foot, and the entire manner of walking is indicative of distress. In ome cases the arms and hands also become affected, and the patient is rendered unable to use his hands with precision. He cannot dress himself, and spills his food when eating, although the muscular power of the hand is not decreased. In many cases the symp toms gradually increase in severity until the patient is helplessly bedridden.

There are, however, possibilities for improvement or arrest of the affection.

The treatment includes various hydrotherapeutic, electric, and dietary measures. In former times, when the nature of tapes was unknown, nothing was done to combat the disease ; hut nowadays expert medical assistance is able to accomplish much for these patients. Even in severe cases, where it is not possible to arrest the disease, the physician may do much to alleviate the distress. Patients suffering from tabes dorsalis should avoid all " cures " that tend to decrease their physical strength, such as steam-baths and hot air baths. All so-called " sweat cures " are detrimental. Mild applications of water and electricity, and nourishing and readily digestible food, are advisable. The patients are often benefited by massage, and by gymnastic exercises consisting of carefully selected co-ordinated movements. Fig. 400 shows such hitting-exercises for the hands, while Fig. 401 illustrates how such patients may be re-educated in walking.

Under any and all circumstances, patients suffering from locomotor ataxia should beware of quacks. By holding out fraudulent promises of cure, these gentry rob the patients, thus in many cases compelling them to end their days in public institutions. If, on the other hand, such patients have been advised wisely, they may be able to husband their resources, take up occupations that are not harmful, and lead comparatively comfortable lives of semi-invalidism.