On the progressive locomotor ataxia : its history, symptomatology, pathology, and treatment / by Roberts Bartholow.

  • Bartholow, Roberts, 1831-1904.
Date:
1866
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Licence: Public Domain Mark

Credit: On the progressive locomotor ataxia : its history, symptomatology, pathology, and treatment / by Roberts Bartholow. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    alterations were* entirely wanting. Topinard, who gives the same case (p. 353), concludes that the preceding observation (case of M. Gubler) tends to demonstrate, 1. That the symptom ataxia is not the imme- diate effect of the gray degeneration of the posterior columns; 2. That it may exist six months be/ore the degeneration of the posterior columns manifests itself that is to say, without anatomical alteration appreciable by our present means of investigation ; 3. That in the evolution, not only of the degeneration,, but of the disease considered in its totality, the visible alteration of the optic nerves is anterior to that of the cord. To obviate the difficulty in accounting for the phenomena observed in Grubler's case not dependent upon anatomical lesions, M. Topinard in- vents the words dynamical alteration (alteration dynamique), which, we may be permitted to observe, express no understood pathological law or doctrine. A variety of clinical facts support the conclusions of morbid anato- my. A certain number of cases of progi*essive locomotor ataxia, treated early, are either cured, arrested, or decidedly ameliorated. We have already alluded to the case of M. Bourguignon (Topinard, p. 208), in which there occurred complete recovery, the case having progressed through its several stages in a period of six months. Topinard also gives a case (p. 305) admitted to the Hotel-Dieu in the service of Pro- fessor Trousseau, in which very decided amelioration took place after one year and nine months of treatment. Dr. Radcliffe, physician to Westminster Hospital, in a recent lecture* on progressive locomotor ataxia, speaks of two cases whieh justify a much more hopeful opinion than is usually prognosticated. D. Meryorrf gives a case for which he advised the twentieth of a grain of strychnia to be taken night and morning, and the employment of very weak cutaneous fara- disation, in which, after five months' perseverance, there is decided improvement. Farther, the great apostle of this disease, Duchenne, affirms that he has cured by faradisation eases in his first stage. We may safely add to this array of testimony our own observation. What is the present state (May 1) of our patient, Kelch? The amelioration in all of his symptoms, described in the first part of this paper, con- tinues, but he has not entirely recovered. A certain degree of ataxia remains, and is especially manifest when he rises from his chair and at- tempts to walk, or when he turns without using his eyes to direct his * London Lancet, January, 1866. f Practical and Pathological Resoarches c-n the various forms of Paralysis. Lon- don, 1864,