ALL over the civilized world nervous diseases are on the increase -a addition at once explicable by and sequential upon the vast demands upon the central, the vital force. In the changing battle for life, in the hurry and irregularity of the daily routine, in the growing necessity for varying types of distraction, it is inevitable that nervous exhaustion must more and more obtain.
Transmission of disease from generation to generation, the mild form begetting the severe, tends also toward the emphasis and establishment of these conditions, until in this deteriorated soil the rank growth, syphilis, strikes firm root, and upon the central nerve trunk growth, syphilis, strikes firm root, and upon the central nerve trunk are grafted the various forms of disease. Such an effect from such a cause is tabes, and if Homoeopathy will render an account to itself and to us of its accomplishment in this trouble, we shall find a touchstone of comparison between our own work in this behalf and that of our colleagues of the alien persuasion. In a historical resume of this subject, the testimony of our older literature is only valuable theoretically.
It is not available as statistic and comparative material, for its erudition and deduction have waned in the fuller light of a later day, a day whose classification of other as well as nervous derangements is more promisingly rational, definitive, pathological, and anatomical. It may be here opposed that classification of any day or description can have no Homoeopathic weight because Homoeopathy challenges treatment which bases on disease names; but to such opposition I cite hahnemann’s reply to Dr. Jahr, where he expressly asserts that independent diseases may exist “by which the robust may be attacked without internal cause, as in is gripe, whooping cough, scarlet fever, erysipelas, inflammatory pleurisy, and other individual diseases where names represent disease and not symptoms of disease, as is the usual case”.
And among these independent types one may, in absolute accuracy, rate tabes, so positive and individual is its character. I need not here enter into detailed enumeration of tabes’ varying forms; suffice it that I deal with the more intrinsic features of the pathology of the disease. Our modern designation of tabes is not complicated with the archaisms of earlier medical literature, which confuses with its multifold distinction and explanation. However, from the early chaos of diseases of the spinal narrow, Horn, in 1827, Romberg, in 1851, and Duchenne, in 1858, had already crystallized a oneness of existence for that acute, destructive form which we to-day know as tabes dorsalis, progressive locomotor ataxia.
Its patho- anatomical character is indicated in the atrophy of the posterior ligaments and of the posterior nerve roots, especially noticeable in the hip segment of the spinal marrow. The uniformity of the pathological showing testified to the limitation of the range of symptomatology. There, are, to be sure, other affection of the spinal narrow which manifest certain of the symptoms of tabes, vide, disseminating sclerosis; in which the sclerotic changes are apparent in the posterior ligaments; but it is in specific tabes, and only in tabes, that all the essential symptoms, and only the essential symptoms, appear.
Concerning the aetiology of tabes, I stand committed free and entire on the side of those who, following the precedent of Fournier and Erb, account syphilis the most important aetiological period. All other aetiological periods which may be cited are, in my opinion, subordinate.
Neither mental nor sexual excesses, nor oft-responsible colds, can ever engender tabes in themselves. However, it is interesting to mark the influence of a cold upon the incipient and course of some special symptoms, and encouraging to be able to fasten at once upon one effective remedy in the treatment. I refer to Rhus tox indispensable factor in the management of tabes. In the atrophy of the posterior ligaments Secale corn. is one of our most opportune remedies.
Although tabes is more frequent with men than with women, its course in the two sexes is not marked by any difference, and in either it is named incurable. Improvement is possible; skilful treatment may control and abort many an outward manifestation, but the developed disease itself is only manageable-ineradicable; and this for the reason that we have only cure agents-not creative agents-within our range of medicine. We cannot recreate tissue; we can only mitigate the processes which, without our aid, tend to utter destruction. We are, of necessity, effective against disease processes, not products. These last mark the ne plus ultra of our abilities.
When the symptoms of tabes begin to marshal in double rank it behoves us to distinguish clearly between them, because the one array indicates the change in the spinal marrow which precedes atrophy, the other the developed atrophic condition of the marrow. The first condition is manageable, the latter is hopeless. To the first class below the skin eruptions, the feeling of fatigue and of muscular stiffness. To the other class belong the various forms of ataxia, muscular lameness of eyes, limbs, intestines and bladder. The deterioration of sexual power belongs to the first class, the utter loss thereof to the second class.
To deduce now for practice: we can cure incipient tabes, we can allay the irritative symptoms of the developed forms, we cannot materially modify the accomplished results of the developed forms. Even with the admission, however, we are in better plight than our confreres of the Old School, for they cannot check the progress of the incipient symptoms.
Symptoms greatly resembling those of tabes belong to many forms of hysteria. Multiphased as this latter disease is, it is not surprising that it should also cloak itself in some of the guises of tabes. The genus of the misleading symptoms becomes apparent under careful consideration of the duration of the individual play of the toms, which had deceived several experienced specialists, came under my observation in a persons 43 years of age.
Basing wholly on the symptomatological indications, I chose a remedy which bettered one class of symptoms. Then I set to work to beguile the spiritless patient into a belief that her trouble was hysteria, and not tabes. In a short time my course was justified by the passing of the psychical condition of despair and inertia, leaving me firm in my conviction of the mild and hysterical incipiency of the case.
Since in the treatment of disease we are in Homoeopathy concerned with our knowledge of the immutable workings of drugs, not at all upon the shifting values of symptoms, it is immaterial, in the treatment of tabic symptoms, whether these are intrinsically of the disease, or whether, suggesting other nerve disorders, of the same class of indication. Such being the case, it is not worth while for me to longer discriminate between symptoms tabic and pseudo-tabic.
Jendrassik has recently asserted that tabes is not an affection of the spinal marrow, but primarily of the gray matter of the brain, from which source the destruction-processes fasten upon the posterior ligaments. This theory, which rests exclusively upon the frequent appearance of cerebral symptoms in the incipient stage and course of tabes, has little of probability in itself, but serves, rather, to show what a fruitless labor it is to found a treatment of this disease upon the accepted knowledge of its source, and in indicate the superiority of our Homoeopathic position, since we act upon our frank admission that we can only recognize certain external symptoms in the aggregate of cases, and can but approximate the origin of the disease so long as the origin of life is a scaled chapter to us.
It is a simple truth, and one universally intelligible, that we cannot place and classify abnormalities- departures from the rule-so long as we are limited in our knowledge of the normal, so long as we cannot resolve the rule; and where is the man bold enough to assert that he bath read alright the riddle of life?.
The course of the disease divides itself, during the long years of its duration, into three periods; the first, or of invasion; the second, or stage of development; and the third, or stage of complication. The length of the single periods varies, while the entire time consumed in the course of the disease ranges from six to twenty years. The stage of innovation is always the longest and presents the more promising possibilities of recovery. It is that tide in the affairs of men which can be taken at the stem, and a great percentage of cases then treated will permit of a check in the disease’s course and of prolonging of the life at stake, and of a maximum decrease of suffering, which, for all practical purposes, may count for recovery.
In the second stage, that of completed development, all the symptoms which figure in the pathological schema of tabes stand out pronouncedly and the treatment becomes more difficult. In the third and final stage, the stage of complication, the devastations of the spinal marrow begin to result upon the various organs, and from that point on the question is no longer of recovery, but of mitigation of suffering. The devastating changes which the picture of the disease now localizes in the central organs are radical and unsusceptible of substantial betterment. The destroyed or vitiated nerve-cells cannot be recreated in such case we have run again upon the bleak wall of our limitation. Disease-processes, let me repeat, are curable; disease-products are only modifiable when engaging nerves of reflex capability.
In the first and third stages of tabes the treatment must in all cases be purely Homoeopathic, that is, based wholly upon the complexus of symptoms which the individual case presents. In the second stage, the symptoms are so characteristic, that any individuality of case coloring recedes, and we, like our Allopathic colleagues, can refer directly, and in all cases, to the name of the remedy pathological indicated.
Neither opportunity not time just now presents for a review of the whole detail of tabes, but it seems fitting that I should here enter somewhat into the treatment of the promontory conditions, because those are the conditions, and then the time, where treatment is most effective.
Year in and year out, long before the patient experience any actual hindrance or any noticeable pain, he complains of “that tired feeling,” often the only urge which precipitates him upon a timely treatment. This promontory feeling of fatigue is peculiar to al chronic diseases of then spinal marrow, and is as essential an element in the constituency of that at-present reigning disease, neurasthenia. In the valuation of this symptom we must carefully discriminate between two offering possibilities: the one a condition of neurasthenic weakness, the other pointing to a more onerous complication of the nervous system, tabes.
From the one-view point will be whetted a critical judgment of ourselves and our trade, from the other we will be led to clap spurs to speedy care. In the many remedies indicated in fatigue, the most essential in import are Arnica, Antimony tart., Causticum, Cannabis, Nux vomica, Rhus and Tabacum, while Pulsatilla, which counts the feeling of fatigue among its indications, is not at all effective in the forerunning conditions, for the reason that they lack that eminent characteristic of Pulsatilla, deterioration in repose.
Not so significant as the fatigue, but of equally early appearance and steady duration, is the admitted weakness of the bladder and the sexual organs. Where excess is directly determined upon, and where symptoms of neurasthenia, or of some special affection of the centre of the uro-genital nerves are not peculiarly indicated, the apparent symptoms must immediately direct attention to the possibility of tabes in the prodromal stage. In the premonitory bladder vitiation I have got best service from Clematis and Sulphur, and in sexual impotency, Caladium, Causticum, Graphites and Sulphur, are my preferences.
The prevalent impression that tabes is the result of sexual debauchery, and the moral reproach consequently attaching to the unfortunate patient, is undeserved. When in the aetiological forecast of a case of tabes the responsibility rests with sexual excess, complications early ensue, as is true in multiple sclerosis, which may pass in its incipiency for almost every form of spinal affection, and other immediate and indubitable symptoms index the origin of the trouble.
During the stage of invasion, every possible remedial agent must be cautiously and advisedly employed. Tonic effects upon the body are to be secured through massage and waters, the unloading of the system through special diet and the sparing of the nerve system through change in the habits of life are to be prescribed, and the prescriber must vehemently insist upon a rigid adherence to his side orders as upon the use of his remedies. Baths in thermal springs are helpful in the first stage. We of Europe may have recourse to Gastein, and, further up the line, to Wildbad, Baden, Weiler, and the thermal springs of France.
But, on the one hand, the chosen springs must be Homoeopathically adapted to the individual case, and the required provings of the water are with difficulty and rarely obtained-one of our best, the proving of the Gastein waters, got up by Dr. Proll, I have made public in the first volume of my Annals (International Homoeopathic Annals, Dr. Villers, vol. i., p. 17, English Edition), while, on the other hand, the right bath being carefully selected, the waters must be cautiously employed, lest the very Homoeopathicity of the application lead to a deterioration whose course cannot be checked.
In the stage of perfected development there stands of apex of all bewailed symptoms the lancinating pains through the trunk and in the lower limbs. However the image of the pain may vary as to its burning or boring or sticking character, there always obtains an impression of its sudden, interpenetrating nature. According to provings, the remedies most widely effective for this state of affairs are belladonna, Lycopodium, Sulphur, Colchicum, Graphites, and Stannum.
These especial pains frequently manifest a further individuality in the fact that severe pressure upon the seat of pain gives substantial relief, while light pressure violently augments the trouble. This limits the above-cited number of remedies to those whose pathogenesy presents this idiom; these are Graphites, Sulphur, and Stannum. In accord with this consideration, I have obtained the best results with Graphites in most cases, using Stannum only when the appearance of pain was marked by a steady increase, a not infrequent manifestation in tabes.
Sooner or later to these lancinating pains is allied paraesthesia, the most frequent symptom being the feeling of formication in the lower limbs; then the feeling of being laced across the throat and in the joints, and the sensation of abnormal temperature in particular parts. The formication, in its slightly varying forms, is almost always greatly amenable to Secale.
In a few cases only Nux vomica serves a better turn. This last agent is indicated in the early appearance of sluggishness in the colon, and we at once recall the application of Nux vomica in the frequent cases of titillation of the soles of the feet after the overloading of the stomach, or especially in that stowing in the abdomen which we often see in our daily practice.
The feeling of lacing in both trunk and joints belong to the province of Graphites, Nux vomica, and Stannum; and three other remedies may be hereto appended as worthy of note, as their application is not to be overlooked in the therapeutics of tabes. I refer to Rhus and Alumina, and, in then acute contraction of the abdomen in the spasms of pain, to Plumbum.
The feeling of circumscribed warmth or cold when appearing separately I have never yet been able to subdue without the aid of outside agents like rubbings, massage, fomentation, etc. Moreover, the fact that these symptoms, as well as those of other paraesthesiac showing, appeared in the section of the under arms, has given me in one case with Ruta. In this stage the reflex muscles are either destroyed or materially vitiated. Although this indication, which most clearly presents in the so-called Westiphalian phenomena and also in the destruction of the reflex patella muscles,. blurs somewhat between the above alternatives, yet the appearance of the symptoms is indubitable proof of the existence of genuine tabes, and appeals tour most searching attention in our diagnosis.
A coexisting and in many patients even earlier appearing-symptom is the irritation in the region of the sexual centres. Strange to say, women present more striking indications herein than men, for the disease course in the male develops no characteristic similar to the clitoris crises of the female, of which Charcot, Bouchard, and Pierret make mention.
These excitative symptoms in the sexual organism, with the pains of the clitoris and along the nerves directly dependent upon the uterine plexus, manifest in hysterical patients given to masturbation, and more particularly in women whose husbands discontinue the marital relationship to avoid the begetting of children. It becomes, therefore, of prime importance to raise this question with the patient, for if the irritating cause of trouble is unknown it is useless to think of improvement or of healing. But whatever the cause, Nux vomica, Selenium, Camphora, Stannum, and Cantharis are not without good results.
It was left to Duchenne’s imperishable service to prove that, despite the ataxia of the tabes patient, the muscular power does not suffer detriment. The ataxia is indeed but the result of the decrement of the inner muscle matter. The question has been mooted in discussion to be true, but Leyden’s theoretical and Charcot’s and Pierret’s anatomical researches have left small doubt on this score in my opinion. The possibility of proceeding further in our symptomatology here again fells us because our provings do not cover these finer differences. It is an urgent duty of our generation to perfect the provings of drugs with regard to the chemistry of secretions, and to the modern side to research in the nerve province.
In consideration of the circumstance that any infallible knowledge of the right remedy is lacking, and that the actuating cause of disturbance is the completed degeneration of the central nerve system, we are precipitated upon the practical conclusion that in this stage of tabes we can here and there obtain fortuitous results, but not as yet cures, by our present methods and knowledge. In this connection it is well to glance at the results accruing in this behalf to our colleagues of traditional medicine.
They, too, find their position one of helpless incompetency, for the insensibility of narcotics, their cul-de- sac if refuge, is never to be accounted recovery nor improvement. Of their recommended methods of treatment, whose number but the more increases as their efficacy is disproved, only three need attract our attention; suspension, the application of electricity, and baths.
The theory of suspension, which was so enthusiastically preached by Motschutowsky, and given a friendly God-speed by Charcot, has already outlived its practice. After those careful showings of Eulenberg and Mandel no one will quite dare to again recommended it. The application of electricity still flourishes, although its most eager supporters adduce no convincing results in its vindication.
In former days I, too, rather lent myself to the belief that the application of a constant current was advantageous in treatment, since its beneficent result is undeniable in certain pain sensations. But practice, that great and final schoolmistress of us all, has taught me that the application of the intermittent current during and after Homoeopathic treatment jeopardizes and even annuls our results. Moreover, the cautions intermittent current is an agent whose positive effect is incompatible with, and consequently destructive to, the healing of our potencies.
There are yet left certain symptoms of tabes to be touched upon of not so inevitable appearance as those already discussed. I mean the retardation of the functions of the bladder and intestines, the gastric crises and the atrophic changes.
While I am justified in speaking decisively of my victories in subduing the intestinal trouble by lightening the work of the rectum through warm-water injections according to Hegar’s method, yet I have been unable to universally cope with the equally important disorders manifesting in the functions of the bladder, in spite of many happy results in the use of Arsenicum. In order to avert the dangers imminent upon a retention of the urine, I empty the bladder three times daily, and if I cannot myself attend to the same with the catheter, I have it done by manual compression.
The gastric crises, which are so closely allied to the lancinating pains, I have never been able to overcome, and the atrophic changes, with which, however, I have seldom met, I consider unamenable to treatment.
The choice of remedy must be unconditionally Homoeopathic, and I furthermore believe that in the treatment of tabes the best results will accrue to that Homoeopathic physician who adds to a scholarly knowledge of symptomatology the fundamental features of the antipsoric method of cure. For this reason I have contended from the beginning for the use of the highest possible potency of the chosen remedy, and I have come off very well in the attempt, These higher potencies-the 200x suffices for my need-I give at long intervals, and in order to quell the sufferer’s impatience between doses, I give him mock powders.
In a critical review of the results obtained one should not forget that remission often endure for a month and deceptively simulate improvement or recovery. It is, for this reason, advisable to impress the patient from the beginning with the need of long continued treatment, and to picture to him emphatically the difficulty with which any favorable modification of his trouble are attained.