ADDITIONS TO THE REVISED EDITION OF 1880. 3H 



ing worse and ending in double amaurosis, with gray degeneration 

 of the optic nerve. Other cerebral nerves are more rarely affected, 

 but there may be anaesthesia of the trigeminus, impairment of hear- 

 ing, deglutition, or speech, and periodical rapidity, irregularity, or 

 dicrotism of pulse due to the vagus. Implication of the sympa- 

 thetic is often shown by inequality of the pupils. On the side of 

 the contracted pupil there may be signs of vaso-motor paralysis, 

 such as red cheeks, chemosis, and increased temperature. Among the 

 early symptoms there may be a painless swelling of the joints, most 

 frequently of the knee, then in the shoulder, elbow, etc. Charcot 

 regards this as allied to arthritis deformans, and refers it to impli- 

 cation of the gray anterior horns. In a case recently observed, the 

 anterior horns were intact, but the spinal ganglia were very large 

 and perceptibly changed. 



The neuralgias are due to inflammatory irritation of the poste- 

 rior roots of the nerves ; there may be formication, tearing, con- 

 tracting, and especially shooting pains, which may recur weekly or 

 monthly, and are worse at night ; they are rarely entirely absent. 

 The period of pain varies in duration ; in incomplete cases the latter 

 characteristic symptoms may never occur. As the disease pro- 

 gresses, the pains, which might readily be regarded as rheumatic or 

 neuralgic, spread from the legs to the body, and the sensation of a 

 girdle about the body is noticed ; there may be painful contraction 

 of the rectum or bladder, or incomplete erections and pollutions. 

 Later there is neuralgia of other nerves in upper parts of the body, 

 arms, etc.; but there is rarely spinal pain or tenderness. An occa- 

 sional early symptom is an attack of gastralgia and obstinate vomit- 

 ing, lasting several days ; these attacks often accompany the shoot- 

 ing pains, and seem due to irritation of the sensitive gastric fila- 

 ments of the vagus. 



Perfect cure of tabes is only possible when the sclerosis is but 

 slightly advanced, and even then is probably very rare ; though 

 Benedict asserts the contrary, claiming that mild cases are often 

 mistaken for other diseases. Incomplete cures are more common, 

 the progress of the symptoms being arrested and life made endur- 

 able. But most cases progress, though some symptoms improve 

 temporarily. As the disease advances, the upper limbs may be af- 

 fected ; formication and neuralgic pains in the arms and fingers 

 precede Uncertainty of the grasp in writing, etc., till the patient 

 becomes entirely helpless. Exceptionally, the arms may be first 

 affected ; and when the prominent symptoms indicate the part 

 affected to be high in the spine or in the cerebral nerves, a cer- 

 vical or basilar tabes has been spoken of ; but the symptoms are 

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