Tabes dorsalis

“ The spontaneous ameliorations in the course of tabes dorsalis and the less marked ones of diffuse sclerosis, coupled with temporarily improved sensation in the former and improved motion in the latter disease, show that retrogressions of this character are possible and do occur. How is the physician to imitate the action of nature? how to intensify it so as to secure the permanent improvement which nature unaided does not grant? The first factor to be considered is the removal of the cause of the disease. A number of cases are due to exposure to wet and cold and to over-exertion. ”

“ I remember the night-watches, when we used to relieve each other in attendance on those unfortunate beings who had fallen a prey to tetanus, and whose life had to be prolonged by inhalations of chloroform. In the long, silent halls of [148] the infirmaries I still see the pitiable look of those suffering from tabes dorsalis or paralysis agitans, who could not stand steadily, nor indeed erect themselves at all, as though a curse were agitating the muscles, over which the will had lost all control, and which at last became so rigid that even the bones of the skeleton were bent and deformed. ”

“ Neuro-Arthropathies.—Charcot's disease is usually met with in men over thirty who suffer from tabes dorsalis. One or both hip-joints may be affected. Sometimes the first manifestation is a hydrops and a fluctuating swelling in the upper part of Scarpa's triangle. In many of the recorded cases, however, attention has first been directed to the disease by the deformity and limp associated with disappearance of the head of the femur, or by the occurrence of pathological dislocation. The absence of pain and tenderness is characteristic. ”

“ Of course, the recoil from such pessimism with the onset of salvarsan treatment led various enthusiasts to an undue optimism.
Another great group distinguished by the existence of spinal cord disease is the group we have termed tabetic neurosyphilis, which group contains the classical tabes dorsalis or locomotor ataxia and its congeners.
The question of therapeutic optimism comes up most forcibly in the field of tabes. It is hard, however, at this time to give a proper and scientifically founded estimate of the therapeutic outcome in tabetic neurosyphilis with modern methods. ”

“ The prognosis of tabes dorsalis is relatively good so far as life is concerned, and it might even be possible for Sullivan by training to remain capable of being a waiter. The manual incoördination was not marked, and possibly the manual tremor was in part due to alcohol. Accordingly, the mental symptoms, such as emotional lability and memory defect, were in the foreground of attention. In point of fact, the laboratory examinations showed positive W. R. in the serum and the spinal fluid, which latter also contained 60 cells per cmm., positive globulin, and an excess of albumin. ”

“ First, tabes dorsalis. This variety commences with paralyses of the eye-muscles and amblyopia. The pupils are not contracted. The amblyopia progresses. Cramp-like disturbances of innervation are always present, with a want of co-ordination of movements and anæsthesia of the upper extremities, while mental disturbances are often demonstrable. Second, tabes cervicalis. ”

“ Myosis, with intense boring pains in the extremities and impotence, are its chief characteristics. Ataxia is rare, and disturbances of vision develop only late in the course of the disease. Third, a class which he considers the true form of tabes dorsalis, in which there are marked anæsthesia, formication, bladder and rectal symptoms, associated with motor disturbances which often end in paralysis. In such cases there are no eye symptoms except occasional dilatation of the pupil. ”

“ So much can be said: namely, that the alleviation of pain and the palliation of other symptoms can be successfully claimed as a result of the renewed interest in the treatment of this affection. What was said above concerning the 435finality of the death process in a dead neurone is very strikingly true, of course, of some of the neurones of the posterior columns in tabes dorsalis. Still only portions of these neurones (namely, those which run an intradural course) are strikingly altered in a great many cases. ”

“ Therefore the name T. dorsalis postremus Smith (1942) is resurrected for the population [Pg 116] in the Tepalcatepec Valley. T. dorsalis cyclides and T. dorsalis postremus differ in color pattern (Fig. 10) and in scutellation (Table 6) . Specimens from the Mexican Plateau and mountain ranges have a distinct light stripe on the second and third scale rows, a dark brown dorsum having squarish black spots, and a row of dark spots on the first row of dorsal scales. ”

“ It may be regarded as a rule in neuro-pathology that wherever reflex iridoplegia is at any time accompanied by other oculo-motor disturbance, it is either of spinal origin or in exceptional cases due to disease of the pons varolii. The peculiar character of the pupillary disturbance of tabes furnishes us with a criterion for distinguishing it from one affection which in common with it exhibits loss of the knee-jerk—diphtheria. In diphtheria there is also a reflex disturbance of the pupil, but it is the reverse of that of early tabes. ”

“ On her applying to them, reassured by this resemblance, for a direction to Miss Dorrit, they made way for her to enter a dark hall—it was more like a great grim lamp gone out than anything else—where she could hear the distant playing of music and the sound of dancing feet. A man so much in want of airing that he had a blue mould upon him, sat watching this dark place from a hole in a corner, like a spider; and he told her that he would send a message up to Miss Dorrit by the first lady or gentleman who went through. ”

“ CAPTAIN EDWARD DORLAND of the liner Centarus was not ready to believe himself an old man. Trimly erect was the spare figure in the uniform of blue, decisive the commands spoken from the lofty bridge. His mustache was white and the wrinkles of the thin, kindly face were graven deeper than those of exposure to wind and sun. ”

“ Social people in other gondolas began to ask each other who the little solitary girl was whom they passed, sitting in her boat with folded hands, looking so pensively and wonderingly about her. Never thinking that it would be worth anybody’s while to notice her or her doings, Little Dorrit, in her quiet, scared, lost manner, went about the city none the less. ”

“ Mr Merdle turned his tongue in his closed mouth—it seemed rather a stiff and unmanageable tongue—moistened his lips, passed his hand over his forehead again, and looked all round the room again, principally under the chairs.
‘But,’ he said, looking Mr Dorrit in the face for the first time, and immediately afterwards dropping his eyes to the buttons of Mr Dorrit’s waistcoat; ‘if we speak of attractions, your daughter ought to be the subject of our conversation. She is extremely beautiful. Both in face and figure, she is quite uncommon. ”

“ So I drove to a large hotel near Charing Cross—I avoid mentioning its name for reasons which will presently be understood—sent in my bag, and dined.
I had not the smallest doubt but that I was still under the observation of the man or the men who had so far pursued me; I had, indeed, no hope of eluding them, except by the contrivance of Dorrington's expert brain. So as I had no desire to hear that shuffling footstep again—indeed it had seemed, at Warwick, to have a physically painful effect on my nerves—I stayed within and got to bed early. ”

“ Neither was it rendered more favourable to sanity by Flora’s dashing into a rapid analysis of Mr Flintwinch’s cravat, and describing him, without the lightest boundary line of separation between his identity and Mrs Clennam’s, as a rusty screw in gaiters. Which compound of man and woman, no limbs, wheels, rusty screw, grimness, and gaiters, so completely stupefied Mr Dorrit, that he was a spectacle to be pitied. ”

“ Little Dorrit took the packet from the still outstretched hand, and broke the seal. Mrs Clennam then gave her the inner packet that was addressed to herself, and held the other. The shadow of the wall and of the prison buildings, which made the room sombre at noon, made it too dark to read there, with the dusk deepening apace, save in the window. In the window, where a little of the bright summer evening sky could shine upon her, Little Dorrit stood, and read. After a broken exclamation or so of wonder and of terror, she read in silence. ”

“ He tried to drink some, but could not bear the odour of it: so he crept back to his chair by the open window, and put the flowers on the little round table of old.
When the first faintness consequent on having moved about had left him, he subsided into his former state. One of the night-tunes was playing in the wind, when the door of his room seemed to open to a light touch, and, after a moment’s pause, a quiet figure seemed to stand there, with a black mantle on it. It seemed to draw the mantle off and drop it on the ground, and then it seemed to be his Little Dorrit in her old, worn dress. ”

“ She walked up into Miss Flora’s sitting-room, as in duty bound, and there found a breakfast-table comfortably laid for two, with a supplementary tray upon it laid for one. The young woman, disappearing for a few moments, returned to say that she was to please to take a chair by the fire, and to take off her bonnet and make herself at home. But Little Dorrit, being bashful, and not used to make herself at home on such occasions, felt at a loss how to do it; so she was still sitting near the door with her bonnet on, when Flora came in in a hurry half an hour afterwards. ”

“ Many combinations did those spikes upon the wall assume, many light shapes did the strong iron weave itself into, many golden touches fell upon the rust, while Little Dorrit sat there musing. New zig-zags sprung into the cruel pattern sometimes, when she saw it through a burst of tears; but beautified or hardened still, always over it and under it and through it, she was fain to look in her solitude, seeing everything with that ineffaceable brand.
A garret, and a Marshalsea garret without compromise, was Little Dorrit’s room. ”

“ Mr Dorrit, seeing the whole Marshalsea and all its testimonials in the pause, instantly flew at him with, ‘How dare you, sir? What do you mean?’
‘I beg your pardon, sir,’ pleaded Mr Tinkler, ‘I was wishful to know——’
‘You wished to know nothing, sir,’ cried Mr Dorrit, highly flushed.
‘Don’t tell me you did. Ha. You didn’t. You are guilty of mockery, sir.’
‘I assure you, sir——’ Mr Tinkler began.
‘Don’t assure me!’ said Mr Dorrit. ‘I will not be assured by a domestic. You are guilty of mockery. You shall leave me—hum—the whole establishment shall leave me. ”

“ Throughout he never took any notice of Little Dorrit, save once or twice when he happened to come close to her and there was no one very near; on which occasions, he said in passing, with a friendly look and a puff of encouragement, ‘Pancks the gipsy—fortune-telling.’
Little Dorrit worked and strove as usual, wondering at all this, but keeping her wonder, as she had from her earliest years kept many heavier loads, in her own breast. A change had stolen, and was stealing yet, over the patient heart. Every day found her something more retiring than the day before. ”

“ Dorrington and I grew more intimate every day of the voyage, till he knew every detail of my uneventful little history, and I knew many of his own most curious experiences. In truth he was a man with an irresistible fascination for a dull home-bird like myself. With all his gaiety he never forgot business, and at most of our stopping places he sent off messages by cable to his partner. As the voyage drew near its end he grew anxious and impatient lest he should not arrive in time to enable him to get to Scotland for grouse-shooting on the twelfth of August. ”

“ Go at once I must, it stands to reason; because I can’t live without breathing freely; and I can’t breathe freely until Arthur is out of this Marshalsea. I am stifled at the present moment, and have scarcely breath enough to say this much, and to carry this precious box down-stairs for you.’
They got into the street as the bell began to ring, Mr Meagles carrying the box. Little Dorrit had no conveyance there: which rather surprised him. He called a coach for her and she got into it, and he placed the box beside her when she was seated. In her joy and gratitude she kissed his hand. ”

“ Her head ached with the idea that she would find the other clever one kissing Little Dorrit next, and then the two clever ones embracing each other and dissolving into tears of tenderness for all mankind. The idea quite stunned her, as she attended the light footsteps down the stairs, that the house door might be safely shut.
On opening it to let Little Dorrit out, she found Mr Pancks, instead of having gone his way, as in any less wonderful place and among less wonderful phenomena he might have been reasonably expected to do, fluttering up and down the court outside the house. ”

“ He seemed a younger, healthier man. The watcher saw him safely off to Birmingham by the ten minutes past ten train, and then gave Dorrington note by telegraph of the guise in which Mr. Mallows was travelling.
Now this train was timed to arrive at Birmingham at one, which was the reason that Dorrington had named it in the anonymous telegram. The entrance to the "Avalanche" works was by a large gate, which was closed, but which was provided with a small door to pass a man. Within was a yard, and at a little before one o'clock Dorrington pushed open the small door, peeped, and entered. ”