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.
