Department of Neuromuscular diseases and Department of Anatomy, CHRU Besançon, University of Franche-Comté, Besançon, France.
Center for Brain and Nervous System Disorders, Genolier Swiss Medical Network and department of neurology and neurorehabilitation Clinique Valmont, Glion, Switzerland.
Rev Neurol (Paris). 2021 Apr;177(4):376-384. doi: 10.1016/j.neurol.2020.10.006. Epub 2021 Jan 15.
Tabes dorsalis, a late neurological complication of syphilis, is nowadays almost extinct. The path to understanding this disease and its pathophysiology was long and winding, spanning multiple centuries. The 19 century was a crucial period for understanding it. In the first third of the century, German and French physicians defined the semiology of tabes dorsalis, renamed in France "ataxie locomotrice progressive [progressive locomotor ataxia]." Nevertheless, the multiplicity of ancient and recent terms and the description of sometimes unclear nosological concepts (tabes nervosa, tabes spasmodic, nervo-tabes, etc.) were a hindrance to understanding it. Tabes dorsalis was a fertile ground for the description of many clinical signs that have become classics in medicine. No real treatment was available and various unusual therapies were performed. For a long time, the etiology of this disease remained unknown. The link between syphilis and tabes dorsalis was slowly established in the second part of the 19 century from epidemiologic observations. We present an overview of the concept of tabes dorsalis in the medical context of the 19 century and discuss the medical observations of some famous patients suffering from the disease such as Édouard Manet (1832-1883) and Alphonse Daudet (1840-1897).
脊髓痨,梅毒的一种晚期神经并发症,如今已几乎绝迹。对这种疾病及其病理生理学的认识过程漫长而曲折,跨越了数个世纪。19 世纪是理解它的关键时期。在该世纪的前三分之一,德国和法国的医生定义了脊髓痨的症状,在法国将其重新命名为“进行性运动性共济失调[progressive locomotor ataxia]”。然而,众多古老和现代的术语以及有时不明确的分类概念的描述(神经梅毒、痉挛性脊髓痨、神经-脊髓痨等)阻碍了对它的理解。脊髓痨为许多成为医学经典的临床体征的描述提供了肥沃的土壤。当时没有真正有效的治疗方法,因此采用了各种不同寻常的疗法。很长一段时间以来,这种疾病的病因都不为人知。梅毒与脊髓痨之间的联系在 19 世纪后半叶通过流行病学观察逐渐建立起来。我们在 19 世纪的医学背景下概述了脊髓痨的概念,并讨论了一些患有这种疾病的著名患者的医学观察,如爱德华·马奈(1832-1883 年)和阿尔封斯·都德(1840-1897 年)。