The opinion that syphilis is the usual cause of tabes is now almost universally accepted. Yet there still remains a certain percentage of cases for which the proof of this etiology is lacking, and students of the subject still seek for other influences, which may claim to share with syphilis the right to be considered as real causes or to represent agencies without the concurrent action of which the disease would not have occurred. The most prominent of these rivals of syphilis to the claim of being real or virtual causes of tabes is fatigue, in Edinger's sense; that is, not necessarily fatigue which is felt, but physiologic overstrain of special portions of the nervous system, carried to the point of seriously damaging the power of nutritive repair of the parts concerned.
I have myself seen, as we all have, cases in which, under the influence of severe exertion tabetic
PUTNAM JJ. A SIDE-LIGHT ON THE ORIGIN OF TABESDRAWN FROM A COMPARISON OF TABES WITH DIFFUSE SPINAL DEGENERATION AS SEEN IN CERTAIN ANEMIAS AND KINDRED DISORDERS OF NUTRITION. JAMA. 1909;LIII(13):996–998. doi:10.1001/jama.1909.92550130001001c
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