308 DISEASES OF THE SPINAL MARROW AND ITS MEMBRANES. 



tremities much later than in the lower. Then, when eating or drink- 

 ing, the patients shake out the contents of the spoon or glass, they 

 can no longer dress without aid, especially the buttons trouble them ; 

 finally, they cannot write, knit, or do any other work. The enuresis 

 now often attswns such a grade that the patient voids his urine in bed. 

 If, in consequence of this, a constant moisture of the parts be added to 

 the patient's indistinct perception of the irregularities of the bed and 

 his helplessness in changing his position, we may readily have bed-sores. 



The course of the disease is always tedious. We see most patients 

 drag on for years in a miserable state, the objects of pity, which is not 

 unfrequently pharisaical. Occasionally the disease remains stationary ; 

 in other cases it appears to improve temporarily. Perfect cures are 

 certainly very rare. 



Nutrition is frequently not impaired till late ; the lower extremities, 

 the nates, and muscles of the back emaciate first, so that the spinous 

 processes project. It is not till toward the end of the disease that the 

 emaciation extends to the rest of the body. Death generally results 

 at last from the increase of the bed-sores, from severe cystitis, from 

 pulmonary consumption, or from intercurrent diseases. 8 



TREATMENT. Romberg's assertion, that there is no hope of cure 

 for a tabes patient, that they are all doomed, contrasts strongly with 

 the views of Memak, as published by Cyon, according to which the 

 former is said to claim that his treatment was successful in the ma- 

 jority of cases, and that, therefore, he cannot be reproached for not 

 having autopsies on his cases. The truth probably lies between the 

 two. Of late, few authorities regard the treatment of tabes so hope- 

 less as Romberg. But very few would agree with Remdk, Benedikt, 

 and others, in saying that tabes is a disease where very favorable re- 

 sults can be attained by treatment. 



We may hope for the best results when there is a suspicion that 

 the disease is of syphilitic origin. In such cases an antisyphilitic treat- 

 ment should be instituted, on the plan to be described hereafter. 



The more probable it is that the disease has resulted from taking 

 cold, the more acute its occurrence, the more severe the pains in the 

 lower extremities which preceded the symptoms of disturbance of coor- 

 dination and diminished sensibility, the more probable is it that the 

 disease is of inflammatory or congestive origin, and the stronger the 

 indications to begin the treatment with the local abstraction of blood 

 by leeches, and derivation to the skin by blisters along the spine. 

 Subsequently we may order for such patients the waters of Wildbad, 

 Gastein, Ragaz, Pf&ffers, TOpntz, etc. There is no doubt that tabes 

 patients have been decidedly benefited by the treatment at these 

 olaces. On the other hand, I must warn against the careless emplov 



