306 DISEASES OF THE SPINAL MARROW AND ITS MEMBRANES. 



tient has a very marked and extensive anaesthesia of the skin and 

 muscles. He is insensible to the severest injuries. He does not know 

 if he bathes in warm or cold water. On loading his extremities with 

 a weight of twenty-five pounds, he perceives no difference of pressure. 

 On being requested to estimate weights, by lifting them, he cannot 

 distinguish between weights of one pound and a hundred pounds. 

 When his eyes are closed, he cannot tell whether his limbs are flexed 

 or straightened to the greatest possible extent by strong electric cur- 

 rents. When standing erect or sitting up, if he closes the eyes he 

 immediately falls. He perceives the resistance of his bed so little 

 that, when the light is extinguished at night, he feels as if he were 

 swimming in the air. But this patient has no marked disturbance of 

 coOrdinative power ; he does not in the least remind us of a tabes pa- 

 tient ; as long as it is light he walks very well, although carefully ; he 

 travels on foot, without a stick, the mile between Wurmlingen and Tu- 

 bingen. A single such case is enough to prove that the disturbance of 

 coordination of the tabes patient does not depend, certainly not solely, 

 on the diminished sensibility, but that it exists along with the latter. 



In many cases the above symptoms are accompanied by disturb- 

 ances of the excretion of urine. Most patients are obliged to attend 

 to the call to urinate as quickly as possible, as they can only stand it 

 a few moments, and hence, when their means allow it, they buy uri- 

 nals, which they wear in their trousers during the day. I think this 

 symptom arises because the patient does not perceive the fulness of 

 the bladder, and the desire to urinate does not occur till a few drops 

 are pressed out of the bladder into the urethra. Far more rarely than 

 this incomplete enuresis we find retention of urine, and it becomes 

 necessary to draw it off with the catheter. In such cases there is 

 probably paralysis of the bladder, from its having been distended too 

 much or too long. 



It is asserted that, at the commencement of the disease, sexual de- 

 sire is usually increased but the energy and duration of the erections 

 lessened, as well as that, in the later stages, the virile power is en- 

 tirely lost. The latter assertion alone is certain. 



We must also mention the paresis of the oculo-motor and ab- 

 ducens, which occasionally occurs in tabes, which is shown by diplopia, 

 more rarely by strabismus and ptosis of the upper lid ; and, lastly, the 

 amaurosis and psychical disturbances which are sometimes met with. 

 There is no doubt that these symptoms are due to the disease advan- 

 cing to the cerebral filaments, but hitherto autopsy has failed to show 

 what course this advance takes. Atrophy of the optic nerve was only 

 "ound in some of the few cases where there was disturbance of vision ; 

 but even here the atrophy only extended to the corpora quadrigemina, 

 and could not be followed further. 



