Page images
PDF
EPUB

cases, regard hydrotherapy as the first among therapeutic measures in this disease.

Electricity occupies an important position, overpraised by some, sneered at by other critics; the most stringent opinions being passed by those who have never studied or used it. I place at the head of the currents static electricity.

I use the heaviest sparks to spine, extremities, epigastrium, and bladder, this to be followed by head shower or insulation. The sparks should be the heaviest possible and up to the patient's full toleration. Especial care should be devoted to anesthetic regions such as hips, feet, soles, etc. Of late I have been substituting the currents of high tension for the insulation and head shower, and have satisfied myself that it exercises a marked influence in improving the general nutrition, relieving the lightning pains and promoting a feeling of well-being. The next current I prefer is the galvanic. I generally apply same in two ways. (a) The cathode pole a pan in which the feet are placed; anode nape of neck or labile to spine for three to five minutes, using from ten to thirty milliamperes; then large pad over lumbar region for five minutes, using twenty to fifty milliamperes. (b) Cathode indifferent, electrode twelve by twenty inches on abdomen; anode nape of neck ten to twenty milliamperes five minutes; large pad six by eight lumbar region twenty to forty milliamperes five minutes. With this may be combined

the faradic.

The rationale of the action of electricity in this disease is still unexplained and more or less empirical, but it has always seemed to me that, reasoning by analogy, if its action in other affections stimulates nerve nutrition, increases the circulation in the part, enhances elimination and promotes normal function, it is likewise true and applicable in this disease, and the pathological fact that degenerating nerve tissue must precede sclerosis may explain this action. In any event, speaking clinically, that it removes anesthesia, improves muscular tone, increases the circulation peripherically, relieves pain, strengthens the bladder action, and promotes well-being is true, and the daily observation of those who use it much in this affection. I am constrained to believe where used alone the results are not permanent, but when it is merely the part of a general system of treatment its action is enhanced and made permanent.

Massage and Suspension. For twelve years I have used massage in tabes and can speak highly of its merits, but to secure lasting benefit the patient must persist in its use for a long time. I personally much prefer

the mechanical variety and have supplanted the manual by its use. I know of no one agent of which patients speak so highly as this, and my observation has been that general weakness, lassitude, asthenia, knee weakness, leg tire, cold extremities, muscular hypotonia and digestive disorders, especially constipation, disappear under its use. I have seen the pains disappear during its application. At the start the treatment is made light, and gradually the time at the different machines is increased until thirty to forty minutes of active treatment is given, the machines being run at a rather high rate of speed and the vibration being marked. I am satisfied that massage is a remedy that will materially increase sensation and assist in relieving anesthesia, and such removal has been noted by Fuller, Schreiber, Türk, Langenbach, Graham, Granville, Erb, and Ziemssen. The rationale of massage has been entered into by me thoroughly before (Mechano-Therapy, Louisville Journal of Medicine and Surgery), but a short résumé here may not be amiss. In these cases, where the blood and secretions are thick, the circulation sluggish, the nerve centers torpid, sensibility deficient, the special senses blunted, massage is invaluable. Tissue metabolism and elimination being impaired, the effect of massage is to stimulate the cell changes and nutrition and to improve the lymphatic and venous circulations, leading directly to improved excretion.

Massage stimulates the medulla and exercises a beneficial influence over all the vital functions. It is particularly helpful. in diseases of degeneration and devitalized conditions.

Suspension no longer creates the same furor that marked its advent some fifteen years ago. The writer recalls, while studying in Paris, the claims then made for it by Prof. Charcot and the French school, and the hopes it held out. That it has more or less fallen into desuetude is true, but in about ten to fifteen per cent of selected cases it certainly helps the pains and seems to improve the gait. It is only to be considered an adjunct of other systematic treatment.

The main difficulty, handicap, and burden of the ataxic's life is the question of locomotion. Allow him the use of his extremities and he may lead a useful and ordinarily active life, but when he reaches the stage of canes, crutches, and a constant attendant with an invalid's chair life holds little that is bright and rosy, and just at this time he becomes most despondent, hopeless, introspective; his strength of will, fortitude, and hope deserts him and he resigns himself as patiently as he can to the inevitable, and awaits the release the grim monster of hour-glass and

scythe brings. The essential basic element of exercises and gymnastics is the directing of them purposely by brain action. That is to say, these movements are performed with definite purpose and intent, the attention concentrated upon them, and by so doing the sensori-motor cortex becomes reëducated so that the movements become easier and easier and are finally performed without conscious attention and conscious will power. Fraenkel truly called them "cerebral gymnastics." These movements do not require force and power, but aim at acquiring dexterity and skill, and each endeavor must be marked by methodical and exact execution. The patient usually commences with the simplest of movements, and as soon as these can be done well and accurately moves on to more complicated ones. Interest, snap, and closely concentrated attention should mark their performance. I have seen patients who could only walk with canes and crutches much benefited and able to lay them aside after several months' exercises in combination with the treatment above outlined. These exercises are not curative of locomotor ataxia, as many seem to believe, but serve to overcome the ataxia. Contraindications are the acute cases with much pain and crises; in severe athropathy and fragile bones; in markedly run down and anemic patients. Successful use of these exercises demand much time on the physician's part, a careful study of the patient's capacity, the ability to enthuse active coöperation, and a thoroughly trained assistant and gymnasium. They should be practiced once or twice daily, but never until fatigued. As ataxia of the lower extremities is much more marked, so it is much more difficult to overcome, because of the supported body weight and the more difficulty in overcoming the upset and disordered equilibrium. I have selected and use the following exercises, which my experience has taught me to be valuable and which have been taken from the plans of Fraenkel, Goldscheider, Leyden, Hirschberg, Dana, and others, and besides a few of my own added.

PLAN OF TREATMENT.

First Stage Treatment. Rest in bed late in morning; 9-10, mechanical massage, followed by rest until middle of day, either in bed, on sofa, or in chair; 1-2, hydrotherapy as per forms suggested, followed by rest; 3-4, general faradism and exercise of muscles, or galvanism to spine as suggested; 7-8, static electricity; abundant diet, laxatives as needed, I., Q. & S. tonic.

Second Stage Treatment. Gradually allow the patient to get up, remaining up longer each day-now add the exercises gradually on this plan; rest in bed until after breakfast, massage mechanical, heavy; hydrotherapy at mid-day, exercises in afternoon, static and galvanic at night (one or the other).

Third Stage Treatment. Up going about, attending to business; exercises morning and night, or at sanatorium.

Daily Treatment at Sanatorium. Mechanical massage, followed by static electricity three times weekly; galvanic three times weekly, or mechanical massage followed by static electricity twice weekly; half bath twice weekly, galvanic twice weekly.

GYMNASTICS AND EXERCISES.

For Hands and Arms. (a) Sit in front of a table, place hands on it, elevate fingers separately, raise hand slightly, extend and flex each finger; (6) hands on table, spread fingers, contract them; (c) dozen pennies on table, make a stack, taking one at a time; (d) spread pennies on table, touch each one slowly with forefinger of each hand; (e) board and marbles, put marbles in holes; (ƒ) "peg board," put pegs in holes one after another; (g) swing balls of different sizes, oscillate, and while moving seize large balls first, smaller ones last.

(1) Legs. A. Bed exercises for legs-patient lying on his back in bed: (a) flex leg on abdomen and make stepping movement; (b) raise leg as a whole, flex, then extend fully; (c) ladder climbing, making accurate climbing and stepping movements. B. Chair exercises: Rise slowly from chair without aid (as soon as possible) then sit slowly; sitting in chair, flex legs, and make stepping movement; raise leg as a whole, flex, then extend fully; "pegging," first touch round top short pegs, then flat top taller uprights. C. Parallel bar exercises: Hold to bars and flex legs; hold to bars and walk back and forth and sideways; make various movements, touching spots, drawing circles, etc.; obstacle walking.

(2) Drill. (a) Patients walk heel and toe, body erect, soldierly attitude, a black line twelve inches wide; (b) same, walking line six inches apart; (c) same, walking on line twelve inches wide and placing foot exactly on large white transverse lines, thus giving soldiers' regulation step; (d) same, on line six inches wide; (e) side stepping, placing feet exactly, first on small transverse lines, then on larger; (ƒ) side stepping, placing alternately right and left foot exactly in painted footprints; (g) foot on center dot, drawing circles with alternate limbs, especially toes;

(h) walking zig-zag lines, turning promptly and returning to starting point; (2) "right face" exercise, keeping on footprints; (j) "left face" exercise, keeping on footprints; (k) “setting up" movement (useful and difficult), raise leg as high as possible, flex same, bringing toe down on large transverse white line, using alternate legs and progressing along the line; (7) stand feet wide apart; (m) stand feet together, count twenty, increase until one hundred is reached; (n) advance one foot the length of small transverse white line, bring other up; (0) balance on one foot; (p) obstacle walking (over different things placed on the floor, blocks of wood); (9) stair climbing; (r) stand with feet apart, hands on hips, flex limbs, stoop as low as possible, rise slowly; (s) walk backward along lines; (t) feet apart, raise arms from side until they meet above head, carry them forward and downward, bending the body until the tips of the fingers come near the floor; (u) feet apart, hands on hips, make circle with head.

CONCLUSIONS.

The disease can not be treated by the general practitioner owing to lack of apparatus, time, etc. Cases must not be considered hopeless; even the most severe can be helped. Cases must be treated as above outlined and the treatment persisted in, not for weeks, but for months. The sooner a tabetic becomes a philosopher about his disease and determines to earn relief, benefit, and symptomatic cure, the better for him. Until recovery has taken place the physician must exercise close supervision over the case, and relaxation of treatment is always followed by relapse or retrogression. Even where the ataxia is so great as to require support in walking, or when locomotion is almost impossible, most helpful results may be obtained. I have cases that walk so well that no one could detect anything amiss. A gain in weight, strength, nerve force, blood, together with a relief of the more or less neurasthenia and phobia that accompanies the disease may be counted upon. Patients will also gain hope, courage, and become much more content and happy, to say nothing of the comfort that return to business and work insures. Where patients are put to bed, sufficient food, rest, etc., should be given. until they gain in blood count, flesh, and strength. Improvement under this system is usually felt from the first, and varies in its rapidity depending on the intelligence, patience, and persistence of the patient, the general health, and the stage of the disease. The results of exercise and treatment are permanent if general health remains good. Cases of slow progress toward recovery are the best, as they tend less toward relapse,

« PreviousContinue »