The 'Tabes Syphilis Controversy' : A Dispute About the Cause of Tabes Dorsalis and Progressive Paralysis at the End of the 19th Century

Abstract

For some years now, the incidence of syphilis and neuroluetic clinical pictures has been increasing. As a result, tabes dorsalis and progressive paralysis are once again gaining relevance in neurology. In the last two decades of the 19th century, there was a heated debate in German neurology about the understanding of the aetiology of these conditions, the so-called 'tabes syphilis controversy'. In 1879, Wilhelm Erb had called on the German neurological community in a much-noticed lecture to finally tackle the problem to unequivocally identify the cause of tabes dorsalis. Mainly on the basis of disease statistics he himself postulated a previous syphilitic infection as of key importance. Answering this question was urgent, because the proportion of patients in psychiatric institutions suffering from progressive paralysis, to which tabes was seen in close parallel, was rapidly increasing. The Berlin neurologists Carl Westphal, Ernst Julius Remak, Martin Bernhardt and Ernst Victor von Leyden regarded Erb's thesis as a gauntlet. They saw the causes of tabes and progressive paralysis in social impoverishment such as damp and cold living conditions, in physically one-sided work overloads or in the hardships of soldiers in the army. They assumed that traumatic tabes was caused by concussions or bruises. The Leipzig neurologist Paul Julius Möbius was the first to state between 1890 and 1897 that the only cause of tabes and progressive paralysis was a previous syphilitic infection. He consistently ruled out all other aetiological theories. Above all, bacteriological and microbiological research in the following years proved Möbius right. Thus 40 years after Erb's lecture, in addition to diagnostic, specific therapeutic approaches could be developed and applied.