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4. That syphilis in its advanced stages produces chronic proliferation of connective tissue, with sclerosis in various organs, and that it further provokes specific arterio-sclerosis, and that these two factors acting together would cause degeneration when attacking the posterior root at its weakest point.
In addition to the first statement it is admitted that a direct history of syphilis will be found in the large proportion of tabetic subjects. But when it is remembered that the great majority of tabetic patients are men from thirty to forty years of age, strong, powerful, and otherwise healthy, and denying themselves nothing that their sexual appetites demand, and to that added alcohol and tobacco to fire their already perverted passions, and knowing that such men must necessarily be more exposed, may we not reasonably account in this way for the large per cent. of syphilitic histories occurring in tabetic subjects? It is again true that many symptoms known to be syphilitic also occur in locomotor ataxia, and we confess that we can hardly understand why it should not be so when it is known that there is not a single organ, or constituent part thereof, that is exempt from the ravages of syphilis.
The other statement that many of the symptoms of locomotorataxia are relieved, or even ameliorated in any sense whatever, by anti-syphilitic treatment we desire to question, and would suggest that out of one hundred capable observers belonging to the rank of the majority, there would not be ten per cent. who would agree, or concur in that assertion.
And as to the fourth statement, that advanced syphilis does produce chronic proliferation of connective tissue, with sclerosis in various organs, and further provoking specific arterio-slerosis we most assuredly admit, but would invite investigation and suggest that there are other causes which would account for this condition, namely, arterio-sclerosis.
Be it remembered that of all diseases with which we are familiar, there is not one that is more amenable to treatment, upon the whole, than syphilis, and such being the clinical facts which present themselves is it not, to say the least of it, to be marvelled at that a disease being produced, 'or measurably produced by syphilis has not, in the cycle of years, ever as yet been arrested in its progress for more than a day, figuratively speaking,?
It is admitted that syphilis of the spinal cord and brain, are not only amenable to treatment, but in certain instances are actually cured so far as we are able to ascertain. The tendency of tabetic diseases is to-day progressive, and ever has been so far as we have been informed. It may be truthfully said, however, that when degeneration has once set about that it may continue regardless of what the original cause may be, or may have been, but when we remember, again, that many of these cases of tabes have fallen early under the observation of the most capable practitioners and skilled diagnosticians, who have subjected these self-same patients to most vigorous anti-syphilitic treatmens, practically without results we say, "truly this is the riddle of the Sphynx."
It is believed that few women, comparatively speaking, enjoy the sexual act to that extent which is characteristic of men, and from hints given above as to alcohol, tobacco and sexual excess may we not measurably reconcile the difference in the proportion of male and female subjects attacked with tabetic disease?
In Japan, where syphilis is known to be wide-spread, tabetic disease is rarely to be seen, and in our own country, our native "Southland," among the negroes where syphilis is so frequently encountered, we do not recall the fact in our experience of twelve years in the practice of our profession of ever having seen a single case of tabetic disease in the negro. We are assured that it does occur but those who give such assurance reassure us that the condition is rare. Now, if syphilis were the great factor in the production of tabetic diseases why, in the races which we have referred to above where syphilis is known to be so common, do we seldom meet tabetic disease? This, and other questions which naturally arise from the preceding paragraghs, are worthy of note and entitled to consideration.
It has not been our desire to formulate a theory in the discussion of this subject, but rather to question some of the ideas that are so strongly held by those who believe in syphilis as the great underlying condition in the production of this disease. But at the present time we cannot resist the temptation to suggest that, in our opinion, we have one other cause which enters as a possible factor in producing this disease, namely, the long
continued and uninterrupted administration of large, or even measurably large, doses of iodide of potash, which is so commonly given at the present day in the treatment of syphilis. When we recall the fact that the pathological changes found in every case of locomotor-ataxia primarily are those of sclerosis in the posterior spinal artery, and its lesser branches, and understanding that any agent which is devitalizing, irritative and destructive in its nature, which is constantly left circulating in the blood and destroying the red blood corpuscles, that such agent, or agents, must, necessarily, produce irritation in the delicate walls of the blood-vessels just the same as poison from syphilis, or gout, whatever that, or their, poison may be, and in consequence thereof we might naturally expect just such pathological changes as are found in locomotor-ataxia.
Again, knowing that anemia means lessened resistance of all the vital functions of the body, as well as a weakening of the walls of the blood vessels themselves in consequence thereof, there would be dilatation, passive congestion, or more blood supply, a step necessary to be taken in the production of new connective tissue, and the consequent thickening of the blood vessel walls themselves would be the result. These two factors, in addition to the paralyzing influence upon the nerve centers of large doses of iodide of potash would, and does, in our opinion, produce just such changes as are found in locomotor-ataxia. Might this not again go to show, in connection with the above statement, why the negro so rarely has tabetic disease, since it is a well-known clinical fact that you cannot force him to take the drug after the active symptoms have disappeared? This will also hold good with women since many of them contract syphilis in such a way that they do not know what ails them and they go through the whole course of the disease, taking medicine when active symptoms manifest themselves.
PASSION FLOWER (PASSIFLORA INCARNATA) IN EPILEPSY AND OTHER NEUROSES.
BY 8. D. BULLINGTON, M.D., NASHVILLE, TENN.
It is needless to mention the many causes and horrors of the dreaded malady, epilepsy, and, indeed, in many cases we are unable to find the cause. But inasmuch as we always have serious nervous disturbances, no matter what the cause, we must try to control and tranquilize nervous action, until we shall have found the cause and removed it, if possible. Most physicians know the poor results of the iodides and the bromides and other usual remedies, and having observed the failure of these remedies in so many cases, in the hands of different physicians, and having had most pleasant results from the use of the F. E. passion flower (passiflora incarnata) with nervous disturbances in children and in various neuroses, I concluded to try it in an obstinate case of epilepsy of more than twenty-six years standing.
The case of epilepsy which I shall report is Miss M., age 33 years. Epileptic manifestations appeared at the age of 6 years. She has been treated by many physicians, of whom, I believe, all gave the usual course of bromides, iodides, etc. Patient began to menstruate at about the age of 13. She has been more regular in her menses than the average woman. The epileptic seizures were of nightly occurrence during most all these years of horrible life, but were worse, being more severe and of longer duration, at the time of the catamenia. Many times there would be an experience of as much as a score or more of seizures during one night. In consequence of such a long and horrible nervous strain, the unfortunate is imbecilic, anæmic and irritable. She has always been obstinately constipated, suffered much from headache and had a poor appetite.
On the 8th of July, 1896, I began treatment with F. E. passion flower (passiflora incarnata), and other drugs as needed to assist in the alleviation of some of the symptoms, such as indigestion and constipation. I administered strychnia, iron and phosphoric acid for a few weeks, keeping the bowels open by podophyllin. In conjuncture with the passion flower I have given F. E. cimicifuga. The dose of each employed is one dram (teaspoonful) of the F. E. About a fortnight elapsed before any results from treatment, so far as relieving the "spells," after which time, during the next few weeks, they were diminished in number and severity. After After about five weeks' treatment, several nights passed without a seizure, then an occasional one. There are occasional "fits" now, but not so severe by any means, and of seldom occurrence.
The mother of the patient tells me that the girl's general appearance is better, her appetite better, and her bowels more regular than since the beginning of the trouble. I have no hopes of effecting a cure in a case of so long standing, but think in early cases the possible results might be a cure.
Insomnia has been treated by me in many cases, and from possibly as many causes, being from pain, dissipation, changing sleeping rooms, and so on, with passion flower, and I fail to recall a case where used, in which I did not see beneficial results.
Hysteria and neurasthenia have improved by its use in my hands. I use it extensively in the fretful and nervous condition in children as a substitute for the very unpleasant bromides. A case of night terrors, with somnambulistic manifestations, has been most happily controlled by passion flower alone.
Robert G., age 11 years, has been troubled since 5 years old with night terrors, with some of the peculiar manifestations observed in somnambulism. He is a bright boy, full of energy, ambitious at school, active in the ordinary athletic sports of boys of his age; seems well nourished, having a splendid complexion. Shortly after going to bed he falls into a light sleep, seems a little nervous, and, with a sudden start and scream, either sits up in bed and continues to cry as if frightened, or springs from bed and runs to his parents for protection as if in danger; at other times he seems to have lost something, and proceeds to search the house for it; his eyes are wide open as if awake. He will