Nerve-stretching in the 19th century

Operative nerve-stretching was first described in 1872 to relieve incurable pain from sciatica and tabes dorsalis. It became popular for 20 years and numerous articles were published on the subject. It had many complications but relief was only transient and, consequently, it fell into disuse. This paper analyses the literature, contemporary views on the benefits of nerve stretching and its influence on more recent neurological practice.

The Romberg sign and early instruments for measuring postural sway

In the first half of the 19th century, European physicians-including Marshall Hall, Moritz Romberg, and Bernardus Brach-described loss of postural control in darkness of patients with severely compromised proprioception. Romberg and Brach emphasized the relationship between this sign and tabes dorsalis. Later, other neurologists evaluated the phenomenon, which is now known as Romberg's sign, in a broader range of neurologic disorders using a variety of simple but increasingly precise and sensitive clinical tests. In the late 19th century, neurologists also developed instruments to measure and record postural sway in patients with neurologic disease. Principal contributors included Philadelphia neurologist Silas Weir Mitchell and his trainees Morris Lewis and Guy Hinsdale. The efforts of these neurologists anticipated later physiologic studies and ultimately the development of computerized dynamic platform posturography.

James Joyce: steps towards a diagnosis

Authors whose scholarship is in the golden realm of English literature have not hesitated to make pronouncements on James Joyce's health. A publication in this genre claims he had tabes dorsalis. One feels that an authoritative comment, accepting or rejecting a diagnosis of neurosyphilis, should be provided by the Journal of the History of the Neurosciences.

The history of tabes dorsalis and the impact of observational studies in neurology

It is common for a particular aspect of scientific knowledge to undergo a great advance in a brief period of time after the discovery of new investigational procedures that broaden research horizons. Knowledge of neurosyphilis increased markedly during the second half of the 19th century. As revealed by the example of tabes dorsalis, this progress was not related to new research methods but instead to the impetus of careful clinical observations.

Neurosyphilis, or chronic heavy metal poisoning: Karen Blixen's lifelong disease

BACKGROUND

Since the 1490s, the treatment of syphilis has consisted of heavy metals--first mercurial and later arsenic and bismuth preparations. Tabes dorsalis, as described by Duchenne in the 1850s, is made up of various characteristic neurologic symptoms. "Gastric crises," sudden stabbing pains followed by vomiting and diarrhea, was originally included by Duchenne, but later, syphilologists disputed its relevance to syphilis. Poisoning by heavy metals, including mercury, may produce similar pain reactions and tabes-like neurologic symptoms.

METHODS

According to an earlier published pathography, the Danish author Karen Blixen (1885-1962), also known under the pseudonym Isak Dinesen, suffered from a lifelong disease described as tabes dorsalis. She got syphilis in 1914 and took mercury pills for a year, after which she experienced a severe mercurial intoxication. The Wassermann reaction (WR) in peripheral blood was positive only once, in 1915, before treatment with arsphenamine (Salvarsan), which she received during hospitalization in Copenhagen in 1915 to 1916. Her spinal fluid was examined several times from 1915 to 1956. Apart from an increased number of cells in 1915, the fluid remained unremarkable and the WR was always negative.

RESULTS AND CONCLUSIONS

It was postulated that her illness, ending with a cachectic state, was the result of heavy metal poisoning from the various treatments and not a monosymptomatic tabes dorsalis with negative serology.

The suspension therapy for tabes dorsalis. A case history of a therapeutic fad

The suspension therapy of tabes dorsalis was introduced by Motschutkovsky in 1883, popularized by Charcot and Gilles de la Tourette in 1889, and subsequently rapidly and widely disseminated on the basis of enthusiastic case series. Dissemination was facilitated by endorsements of eminent neurologists, widespread publicity in professional journals and lay press, and the apparent simplicity and safety of the procedure. However, increasingly critical reports appeared, indicating much lower success rates, frequent postprocedure deterioration, and occasional serious complications. The disparity between early and later studies resulted from a placebo effect, from disregard of the natural history of the condition, from misdiagnosis, and from biased observation and reporting. By the end of 1890, the procedure was largely abandoned, despite proponents' attempts to modify the technique or to identify a more responsive subgroup of patients.

Venery, the spinal cord, and tabes dorsalis before Romberg: the contribution of Ernst Horn

Usually Heinrich Romberg is credited with having established tabes dorsalis as a clinicopathological entity in the 1840s. But Romberg's teacher, Ernst Horn (1774 to 1848), had inspired five different students to write their doctoral dissertations on the same subject. These five theses, published between 1817 and 1827, as well as M. Steinthal's most comprehensive later description, were triggered by Horn's observation of the lower spinal cord atrophy which he found in one of his tabetic patients at autopsy. The dissertations are analyzed together with the prior literature reflected in them as it deals with the spinal cord. Discussions of the putative influence of the spinal cord on the vagaries of male sexual function, and vice versa, began with "consumption of the backbone", referred to in the Hippocratic corpus. "Venery"--if not veneral disease as we understand it--was thought throughout the centuries to be the prime cause of tabes. One may presume that the rising concern with public health and with national aims--a kind of "moral rearmament"--caused the subject to be so vigorously pursued by members of the young medical generation in early 19th-century Germany.