302 DISEASES OF THE SPINAL MARROW AND ITS MEMBRANES. 



CHAPTER VII. 



CONSUMPTION OF THE SPINAL CORD TABES DORSUALIS ATAXIE LO- 



COMOTRICE PROGRESSIVE (Duchenne) GRAY "DEGENERATION 'OF 



THE POSTERIOR COLUMNS OF THE SPINAL CORD (Leyderi) LOCO- 

 MOTOR ATAXY. 



TABES dorsualis, which was discovered and described by Duchenne 

 as ataxie locomotrice progressive, long after it was generally known in 

 Germany from the classical description of Romberg, has recently ex- 

 cited much discussion. The views regarding the significance of the 

 symptoms especially vary. According to the plan of my book, I can 

 only criticise the views of others, so far as is necessary to support 

 my own. The following description is, in the main, the same as was 

 given in the dissertation of my former assistant, Dr. Ernst Spaeth, 

 which was written under my supervision, and which has not, by any 

 means, received the attention it deserved. (The dissertation of Dr. 

 Spaeth was published under the title of " Beitra'ge Zur Lehre von der 

 Tabes dorsualis," at Tubingen, 1864, by Aug. Ludwig.) 1 



ETIOLOGY. In some few cases of decided tabes dorsualis, on 

 autopsy we find no palpable changes in the spinal medulla. This 

 " negative appearance " does not by any means prove that the spinal 

 medulla is normal, but only that its functions may be impaired by 

 molecular changes that escape observation, just as they are by the 

 coarser changes found in other cases. The latter consist in a peculiar 

 degeneration and atrophy affecting particularly the posterior columns 

 and the posterior roots, but occasionally the gray substance also and 

 other columns. In some cases there is no doubt that the degeneration 

 in question is the result of inflammation of the spinal medulla, but 

 in other cases no inflammatory origin can be made out. 



The predisposition to tabes dorsualis is occasionally hereditary, as 

 is shown by a number of cases, where several brothers and sisters were 

 attacked by the disease. On the other hand, I only know of two 

 cases where it was inherited, that is, where the parents of the patient 

 had tabes dorsualis. Children are not inclined to tabes, persons of 

 mature age are most so, while in the aged the tendency almost disap- 

 pears. Men are far more disposed to it than women. 



The exciting causes are almost always said to be 1. Venereal 

 excess. The great physiologist Johannes Mttller, usually very careful 

 and discreet in his assertions, says directly that tabes dorsualis comes 

 only from venereal excess. Besides then* other sufferings and mis- 

 fortunes, these poor patients are made to bear the accusation which in 

 many cases at least is unjust, that they have themselves to blame for 



