This disease is characterized by disturbances of sensations and incoordinations of the muscular system. Nutritive changes are also in evidence. There is also found degeneration of the root fibers of the dorsal columns of the cord. The disease means hardening of the posterior columns of the spinal cord. This hardening is on the order of arteriosclerosis. It is really a changing, so to speak, of the spinal cord--a premature aging of the nervous system. The symptoms all point to more or less degeneration of the brain, especially that part related to the cord.

Etiology

This is a very common disease--more common in cities than in the country. Men are more inclined to have the disease than women; the proportion is estimated at ten to one. It is a disease of adult life, the majority of cases developing between forty-five and fifty. Occasionally cases are seen in young men. I think all authorities agree that syphilis is the cause. My experience--which has not been small--is positively contrary to this opinion. The disease is strictly an old-age disease, and so are most of the chronic symptoms attributed to syphilis; but there is good reason for young men thirty-five to fifty years of age being brought down with locomotor ataxia, for the disease is certainly an index to imprudent life from a sex standpoint. The general opinion about the cause is approximately right, yet absolutely wrong. By "approximately right" I mean that it is a disease brought on oftener from sex abuse than from any other cause. However, anything that will use up nerve energy and break down the nervous system is liable to develop locomotor ataxia. But in all cases that I have ever seen there has been a history of early self-abuse, beginning as early as eight years of age and continuing with either the practice of onanism or excessive venery to forty years of age and the full development of incoordination; and in the majority of these cases I have found that there was not a reliable history of any kind of venereal disease. Where the diagnostician starts out with the assumption that syphilis is the cause, he will convert every sort of pimple or blister around the reproductive organs, lips, mouth, or throat, which would hardly be noticed, into a syphilitic infection. Where trouble is sought for it is exceedingly easy to find; this is true in the search after the etiology of locomotor ataxia. In the majority of cases, so far as I have seen, it requires an exceedingly strong imagination to ferret out an excuse for syphilis; but it does not by any means require a sleuth hound to discover sex abuse to such an extent that it is a wonder that some of these people are left to tell the story. To add to this one cause, there are many others, such as deranged digestion, overwork, worry, anxiety, overworked emotions, exposure to cold and wet, the excessive use of alcohol, tobacco, coffee, and tea.

In all subjects of middle age and over, prostatic enlargement with the accompanying symptoms must be kept in mind by the diagnostician. I am satisfied from years of experience that often first-class physicians pay little attention to prostatic enlargement with its varying symptoms, when reckoning up a diagnosis of any kind, and especially in diagnosing ataxia. I never pass up a patient over thirty-five years of age without an examination of the posterior urethra and neck of the bladder, for a possible pathology, caused by enlarged prostate gland. It is almost as common among men over thirty-five years of age as enlarged tonsils in children, but strange to say, it is criminally neglected and overlooked by many clinicians. For years such patients have been coming to me after getting the last word on diagnosis--the clinic not even hinting that there might be such a condition existing.

The symptoms of locomotor ataxia and those accompanying enlarged prostate gland, inflammation of the urethra and urinary bladder, often parallel each other so that sometimes the symptoms would be summed up as locomotor ataxia when they really belong wholly and entirely to prostate gland enlargement and its varying symptomatology; which symptom complex is very much more simple to treat and more amenable to treatment than the complex of locomotor ataxia.

The latter disease is one of a general giving down of the entire nervous system. The patients of the former may be brought back to very good health if they are willing to follow a rigid regimen for life. Men of no self-control will find the cards stacked against them at every turn, with either of these so-called diseases. The straight and narrow path is the only road to travel. The ataxia subject can do much for himself--not by drugging--not by any curing scheme, but by learning how to conserve every bit of nerve energy. "Regular" medicine has nothing to offer that will not hasten the end.

Doctoring always comes to the end of palliation--either death of the patient, or the patient senses that he has been paying for a benefit he never gets, but, instead, a hurry all to eternity. All cures end in premature demise, the contention of medical superstition to the contrary notwithstanding.

Symptoms

There are three stages--namely, incipient, ataxic, and paralytic. Symptoms in the incipient stage, which is sometimes called the pretoxic stage, differ very widely. There will be pains of an indefinite character, which may be treated for rheumatism or neuralgia. Sometimes a very great discomfort will occur in the rectum, which may be treated as hemorrhoids or proctitis, or even stricture, when the irritability is wholly reflex and in reality there is absolutely nothing pathologic about the rectum. Some will complain about an irritability of the urethra. I had a case with one tormenting symptom--namely, a feeling as though there were a hair in the throat.

This man had kept first-class specialists in New York, Philadelphia, Baltimore, Pittsburg, Chicago, and Denver in meal tickets before he came into my hands. After having a long talk with him, I told him to return home. He lived in Pittsburg. I told him that if he would forget his trouble he could live a number of years yet. I explained to him that it was simply a nervous irritation, indicating the development of tabes dorsalis. No treatment would be of any avail. So long as he annoyed himself by going from place to place, expecting to be cured, and then being disappointed, he would be annoyed so much that life would not be worth the living; but if he could manage to forget it, and think of something else, his life ought to be made fairly comfortable by living correctly, and he should live for a number of years.

Two years afterward I received a letter from his wife, thanking me for my help to him. She declared that he had overcome his tendency to dig into his throat to such an extent that he would forget it for days at a time; at least he would forget it long enough to attend to a certain amount of business, and would pass days without making any remark about the discomfort or annoyance; for, as he declared himself, it did not amount to a discomfort, but he felt that, if he could just get hold of the hair and pull it out, he would be fully relieved.

The pains that precede this disease are of a sharp, darting character. They may show in almost any part of the body. They do not last long. Their tendency is to appear around the belt region. However, there will be darting pains occasionally in the intestine and in the sensitive spots, and a very wise physician will probably advise that there should be an operation for appendicitis. In some cases there is started up a numbness in the feet--a tingling sensation; and then in others there will be a feeling of constriction about the waist, as though the clothing were too tight. In a small percentage of cases there will be an atrophy of the optic nerve. This causes blindness to come on very early in the disease. This atrophy comes on very gradually, and ultimately leads to total blindness.

There is ptosis of the eyelids. The pupil is sometimes exceedingly small, due to spinal myosis. The Argyll-Robertson pupil indications, with the darting pains and ptosis, are considered diagnostic. The character of the pupil is a contraction, with loss of reflex to light. To show how very specific is the idea that syphilis is the cause of this disease, I will repeat a few lines from a well-known authority: "The time between the syphilitic infection and the occurrence of the symptoms of locomotor ataxia varies within a wide limit. About one-half the cases occur between the sixth and the fifteenth year, but many begin even later than this."

Ataxic Stage

The first symptom that the patient experiences is inability to get around in the dark, or inability to stand with the feet together and the eyes closed. Patients in this condition are wholly incapable of standing on one foot. The walk of the patient suffering from ataxia is very characteristic. There is a decided inability to control the movements. The feet come up with a jerk, and are pushed forward in an irregular way, and while clear of the ground there is more or less of a tendency to fall about either to the right or left. Coordination is almost entirely lost; that is, the power to control the movements is apparently not strong enough to do anything more than lift a projected foot and leg, but where and in what direction the movement will be made is conjectural. The patient evinces strength, but nevertheless there is this lost power of controlling the movements. The push and pull of the legs are strikingly strong, showing that incoordination is choreic rather than paralytic. There is paralysis to just the extent that the joints are more than usually relaxed, so that there can be a hyperextension and a hyperflexion.

Sensory Symptoms

Lightning pains may continue. These pains, however, vary greatly in different patients. Some patients will not complain very greatly. Others will complain a very great deal, and the pain is so persistent in certain localities that it is sometimes mistaken for rheumatism. Tingling sensations, described as pricks of pins and needles, are present in the feet. Sometimes patients have a sensation as though there were something between the feet and the floor--when the naked foot is put on the floor, as if there were cotton between the floor and the foot. These, of course, are symptoms of lost sensation--or perhaps I would better say incoordinate sensations.

Sometimes there is lost power of localizing pain. A prick on one limb may be felt on the other, or a pin prick on one foot may be felt on both. In these cases a time comes when the patient loses power to recognize in what position the leg is. It may be extended far to the side, yet, so far as the consciousness of the patient is concerned, he will not know but that both feet are together and the legs parallel to each other.

Reflexes

Lost knee-jerk, or patella reflex, is an early symptom; in fact, this often exists when there are scarcely any other symptoms. But in all such cases I have found chronic, granular inflammation of the urethra. Almost invariably these cases have shown one or more strictures of the urethra, bearing out the belief I have had for a number of years that the disease is brought on from excessive venery and irritation of the reproductive organs, more than from any other one cause. Continuous subacute reflex irritation from stricture of the urethra--or what is sometimes called gleet--is capable of breaking down the nervous system and bringing on tabes dorsalis. This, however, will require a certain amount of toxin poisoning--toxemia--to hasten the development. There is nothing that so breaks down the nervous system and prepares it for taking on tabes dorsalis as venereal shocks and where these shocks are excessively frequent, and continue over a number of years, patients are liable to go down and out with locomotor ataxia before the chronometer has tolled off half the years that should come to man.

Deafness is not uncommon as one of the early symptoms of this disease; yet it cannot be recognized as characteristic, for people who develop ataxia have in all probability been more or less troubled with catarrh all their lives, and the deafness may be wholly catarrhal.

Vertigo is another symptom that does not necessarily belong to this disease, because it may be a symptom of indigestion and liver derangement. The irritations that cause such patients to consult physicians--such as laryngeal, gastric, nephritic, rectal, or urethral irritations, etc.--are what are in ataxia called crisis symptoms; but they belong to arteriosclerosis as well, and are brought on by hyperemia. As stated before, they are purely reflex. The most common, or gastric and laryngeal, both may be found in chronic irritation of the stomach of dyspeptics, tobacco-users, and those given to excessive use of any stimulants; hence such symptoms will be of no importance, unless they are found existing without the usual symptoms of gastric derangement due to improper living.

One of the early symptoms of locomotor ataxia is a retarded, or rather a hesitating or halting, expulsion of the urine, The desire to, urinate will be present, but the patient will experience difficulty in starting the stream. Almost any kind of symptoms of a cerebro-spinal nature, due to degeneration, may be looked for in subjects of this disease.

Paralytic Stage

In time these cases arrive at paralysis, where there is no power to walk. Then, of course, they become bedridden. At this time, or before, such patients are often carried off with some intercurrent affection, or a hyperemia, or apoplexy, of a vulnerable organ, brought on from an indiscretion that in health would scarcely be noticed.

Diagnosis

Lightning pains, inability to stand with the eyes closed, etc., are considered almost diagnostic.

Treatment

There is only one cure, and that is prevention--removing the causes before the disease is developed. The habits of life must be corrected. A very foolish manner of treating such cases is for the physician to permit the patient to continue the use of tobacco, coffee, tea, or other stimulants, and prescribe such so-called remedies as strychnin, tonics, etc. Patients must be kept away from all stimulation, and they should be kept out of the atmosphere of them as much as possible. For instance, they should not be confined to offices where there is tobacco smoke, or in homes where the odor of coffee is in the air two or three times a day. It must be remembered that the farther down the nervous system is driven--enervated--the more easily it is affected, and patients may become so susceptible that the inhaling of tobacco smoke for a few seconds will produce as much irritation as two or three cigars would produce several years before the breakdown came. In this respect patients frequently do themselves great harm. They know what they have been able to do; they are quite willing to believe that they can indulge a little, compared with the old supply; and they treat the subject of overstimulation and bad habits in the same way all along the line; and too frequently physicians concur with the patient in this matter. Such patients should be impressed with the necessity of doing absolutely the right thing all the timethey should be made to see that there is everything to gain and little to lose, and that that little is more easily lost than even average physicians can be made to believe. Thus no one is justified in going on the principle that he has nothing to gain, that everything is lost; for nature is more than willing to meet all patients half-way--yes, nine-tenths of the way. Hence those who wish to get any benefit--continue in life and enjoy much comfort--must pay the price, which means absolute continence, complete abstinence from all stimulation, and a very simple diet, made up of fresh, uncooked fruits for breakfast; salad, cooked, non-starchy vegetables, and wholewheat bread, potatoes, or some one of the decidedly starchy foods, once a day for a second and last meal; and abstinence from strong meats, such as beef, pork, etc. Lamb, chicken, fish, or eggs may be indulged in once or twice a week, dropping the starch; but it is my opinion that those patients will live longer and enjoy better health if they do not indulge in animal albuminoids at all; for decomposition of the protein in the intestine is one source of toxin poisoning in this tragic disease.