Paralyses, cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian.

  • Bastian, H. Charlton.
Date:
1886
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Licence: Public Domain Mark

Credit: Paralyses, cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    easily to be separated from that presented by all other affections of the spinal cord : especially if we are duly impressed by the negative symptoms, namely, the absence of sensory impairment, of bladder- troubles, and of bed-sores. 26. LOCOMOTOR ATAXY. This is a disease which occurs most frequently between the twentieth and the fiftieth year. It is much more common in males than in females. It is often called ‘tabes dorsalis* or ‘posterior spinal sclerosis.’ It is a disease concerning which much might be said both in re- gard to etiology, and also in regard to the excessively wide range of symptoms that may at times be included under it, in one or other patient; but we cannot pretend to enter into these discussions or descriptions here. We shall limit ourselves to such a brief outline of the symptomatology of the disease as may be needful for the proper understanding of the points upon which its diagnosis depends. The patients in whom locomotor ataxy develops have often a dis- tinctly neurotic history. The exciting causes are generally extremely obscure. Marked sexual excesses seem occasionally to be connected with its development. Syphilis is, in my opinion, greatly over- rated as a cause of this disease. I have seen numbers of cases in which the most careful examination and enquiry have failed to reveal any evidence of pre-existing syphilis. I believe that it has not existed in one-fourth of the numerous cases of locomotor ataxy that have come under my observation and treatment. The disease is dependent, in the main, upon a sclerosis of the posterior columns of the cord in the lumbar region, whence the pro- cess extends upwards so as to involve the same parts in the dorsal and in the cervical regions. It has been shown by Pierret that it is the implication of the posterior root-zones in this process which seems to give rise to the symptoms of the disease. Strumpell, however, has recorded two or three cases which seem opposed to this view ; so that it cannot be considered to be, as yet, definitely settled. It is true that the process of sclerosis often extends so as to involve the whole or the greater portion of the posterior columns of the cord. As Lockhart Clarke pointed out, it also occasionally extends so as to involve the posterior cornua of the cord. TT