[Extracted from the American Journal of the Medical Sciences for July, 1873.] 
THE INFLUENCE OF REST IN LOCOMOTOR ATAXIA. 
S. WEIR MITCHELL, M.D. 
Many years ago I attended a gentleman who had locomotor ataxia 
which came on with a terrible suddenness in the form of a neuralgia of the 
lower limbs. It arose, as he believed, from having bathed in the sea when 
chilled. The first attack was described as agonizing. It lasted two days 
only, and was followed, after a few weeks, by a second. Thenceforward 
they grew frequent, and at length no day passed without some hours of such 
torment as I have never seen equalled in ataxic neuralgia. The ataxic 
symptoms were more slowly developed, and did not at any time extend to 
the upper limbs. Ten years after the first attack of pain, he fell when 
getting out of a street car, and ruptured the internal lateral ligaments of 
the right knee. Owing to this accident he was forced to remain in bed 
three months. During this period the pain became less severe and less 
frequent, until it finally ceased. When he got about again the pain did not 
return, and during several years there was no renewal of it, nor, as I have 
since learned, did it ever again annoy him. It was also remarked that 
the ataxic symptoms, which hitherto had advanced slowly, progressed 
no further, and remained unaltered until his death, several years after, 
from acute disease of the lungs. I regarded this case for a time as a curious 
medical incident, and though presuming that the check in its progress 
might have been such an one as we often see in this disorder, I neverthe- 
less kept it in mind. 
Five years ago, a patient set. 41, who had well-developed ataxial troubles 
with continuance throughout of the neuralgia, broke his leg. The long 
enforced rest which followed entirely stopped the pain, which has never come 
back. The ataxial symptoms have increased but very slowly; I am not 
confident that their rate of advance was altered, but I am certain the pain 
was quite abruptly ended. 
The third example did not occur in the person of one of my own patients, 
but all the facts are well known to me. In this case the patient broke his 
thigh, and, soon after getting about, broke his leg. The prolonged rest 
thus necessitated terminated the neuralgia, previously severe, and seems up 
to this date (four years later) to have arrested the march of the disease, 
said to have been before that quite rapid. A fourth instance was related to me recently. Here also the left leg 
was broken, and the neuralgia ceasing did not recur, although, as to the 
ataxial symptoms, I can learn nothing. 
There is now in the infirmary for nervous disease attached to the Ortho- 
pedic Hospital in Philadelphia, a woman, set. 48, who has ataxia with 
frequent, almost daily, spells of very painful neuralgia. A few weeks ago 
she broke her left thigh and, being at once put to bed, has had since then 
but a single attack of pain. 
In one of the male wards of the same hospital is a bad and very pain- 
ful case of ataxia in the early stage. To test the correctness of my belief 
as to the value of absolute rest in relieving ataxial neuralgia, I have kept 
him several weeks in bed, no medicine having been given until very lately. 
The result as to control of the pain has most surely been very remarkable. 
Before going to bed he could not walk without aid, nor could he stand for 
even a moment with closed eyes. The pain was inconstant, but never left 
him two days without extreme torment. Six weeks of almost absolute 
rest enable him to stand a few moments with shut eyes, to walk unaided 
up and down the room, and to assure me of his entire freedom from pain 
since the seventh day in bed. 
I do not think these cases can be looked upon as mere coincidences of 
pain ceasing about the time of the injury; I should rather conclude that 
exercise has power to flush the ganglia used in movement just as thinking 
brings blood to the brain and raises its temperature, and that this afflux of 
blood, or at all events the-mere functional activity, is in some way injurious 
and irritating to the diseased centres. This will seem at least a reasonable 
view if we recall the influence of motion upon certain facial neuralgias. 
Even where there is no tender point, talking or chewing will often cause 
increase of pain, or awaken pain afresh. Thus I have lately seen a case of 
frightful torment in the upper jaw, which was due to acid dyspepsia, and 
was cured when this state was relieved. The stomachal condition had 
created, however, a state of the nerve centres of the fifth nerve of such a 
character that it the patient attempted to talk or laugh it presently re- 
sulted in a severe fit of pain, nor is this a very rare or merely curious ex- 
ample. Considering the spinal posterior ganglia and columns as in ataxia 
ready to pass into the state which gives rise to pain, it seems likely enough 
that exercise may be efficient in bringing it on. Exercise does not only 
mean motion in a physiological view of its totality of results, but it also 
involves the passage ceutripetally of a host of impressions generated in the 
moving tissues, and of necessity passing through the central sensory gan- 
glia, and their related parts. The centres of motion and of sensation are, 
therefore, active during movement, and are then alike excited, so that we 
may with these facts in view see why motion may excite sensory organs. 
It seems, then, that in the painful stage of locomotor ataxia motion is 
probably injurious, and that rest in bed is for like reasons useful. Time alone with future experience can be relied upon to determine how general 
may be the value of some such mode of treatment of ataxia and ataxial 
pain, and how permanent may prove to be the result. lam perfectly well 
assured in my own belief that rest will prove to be the best treatment for 
the early stages of ataxia, but if I were even less secure in my opinion I 
should not hesitate to speak of it as a possible mode of relief, since so little 
of value has been offered in the way of cure, or even of partial relief, in this 
long and distressing malady. 
It naturally occurs to ask why so many ataxies have chanced to break 
limbs, and as to this I should answer first that no people are so awkward 
or fall so much, and next, that in some of the cases, it seemed to me that 
the habitual abruptness of the muscular acts had a share in the calamity, 
and that I have suspected, what has not yet been proved, that the bones in 
ataxies may suffer some impairment of their nutrition, and hence of 
their strength. Such was the ease in Dr. Pennock’s case, reported by Dr. 
C. Morris, wdiere the lesion was sclerosis of the antero-lateral columns of 
the cord. But this is as yet purely speculative, however full of interest, 
and what I want to set forward prominently is that I have seen rest cure 
the neuralgia of posterior spinal sclerosis, and apparently in some cases 
arrest the disease.