THE USES OF TUBERCULIN.
Authors: CHARLES DENISON
Journal: JAMA (1902)

table bladder, various neuroses, unilateral headache, and neuralgic irritations about the gums and teeth, together with dermatoses like angioneurotic edema and hives, dis- ordered rhino-laryngologic conditions, local fleeting pains, etc.The severe types may vary from fecal anemia to conditions simulating chlorosis, neurasthenia of the ordinary type and of types mimicking tabes, transitory frenzy, melancholia, acute confusional insanity, stupor, amnesia, emotionally exalted states, and sometimes epileptiform attacks resembling grave hysteria, but accom- panied with partial or complete loss of consciousness.One unpleasant and frequent mental state in other- wise logical auto-toxemics is nosophobia, or worry over the possibility of disease.This differs from hypochondria in the fact that the subject does not think he has a particular disease, but fears he may have.The irregular action of his organs resulting from auto-toxemia intrudes on his consciousness and causes a fear or uncer- tainty as to his actual state.That paretic dementia and tabes are often due to the toxin of syphilis is now gener- ally admitted.The clinical history of some cases would indicate that auto-toxemia has here played its part more especially, as it has been demonstrated beyond cavil that temporary auto-toxemic neuroses mimic these two great constitutional disorders.The fact is but too often for- gotten that the law of periodicity of the nervous sys- tem fixes a tendency of certain symptoms to recur from a slighter exciting cause.Hence, frequently recurring auto-intoxication causes that breakdown of the vaso- motor balance which constitutes the underlying basis of tabes and paretic dementia.Diagnosis in conditions of auto-intoxication is, there- fore, not so simple as it first seems.Owing to the ten- dency of the neuroses with an underlying vasomotor factor to remit or assume temporary appearances of health, the distinction between the deep forms of auto- intoxication and these neuroses becomes at times difficult.This difficulty is intensified by the fact that auto- intoxication, in a hereditarily defective or acquired neu- ropathic constitution, may cause marked and decided symptoms of less augury than when found in a healthy constitution.Auto-intoxication occurring in puberty often temporarily initiates seemingly serious puberty neuroses and psychoses.The same is true of the climac- teric end of the senile period.In all these cases the con- dition produced by auto-intoxication has the clinical tinge of the period in which it appears.This is why treatment directed to a change of environment and the habits of the individual so often produces favorable ef- fects on seeming senile and climacteric breakdown.The grave auto-intoxication resembling tabes and allied conditions are differentiated as a rule by the state of the reflexes as to absence of stupor, melancholia and acute confusional insanity, as well as amnesia, and differ little from the ordinary types except in their compara- tive quickness of response to treatment.This, however, is only a relative test, since in no case of these affections is auto-intoxication absent as an etiologic factor.The convulsive types of auto-intoxication differ from epilepsy in their inffequency and absence of recurrence.Practically the status of the auto-intoxicated is as brief as that of-the epileptic is prolonged.The therapeutics of auto-intoxication will depend on the type.In irritable weakness, while removal from surroundings is desirable for permanent recovery, much may be attained by regulation of diet, use of the mineral waters, regular, moderate exercise and massage, as well as hydrotherapy.Here, as in all cases of auto-intoxica-