THE HOMOEOPATHIC TREATMENT OF TABES AND PSEUDO-TABES



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.

Alexander Villers