312 DISEASES OF THE SPINAL MARROW AND ITS MEMBRANES. 



usually so combined that these regional forms cannot be distin- 

 guished. 



Although one of the most tedious of diseases, tabes usually 

 shortens life. It may continue five or ten years, or longer ; but the 

 symptoms, especially the motor disturbances, may progress rapidly 

 and death occur early. As the disease advances, the patient may 

 attain a pitiable condition ; the nutrition of the body, which has 

 been good, may suffer, the legs emaciate, the feet become oedema- 

 tous ; the previous irritable weakness of the sexual function gives 

 way to entire impotence ; urination and defecation are impaired, 

 sensibility blunted, and vision lost ; more especially the power of 

 motion is lost from ataxia and paraplegia. Death is rarely directly 

 due to paralysis of respiratory muscles, and not so often to bed-sores 

 and purulent cystitis as it is in spinal paralysis ; but more frequent- 

 ly it is due to consumption, pneumonia, bronchitis, etc. 



In well-developed typical cases diagnosis is easy. The periodi- 

 cal lancinating pains in the legs or arms, quick fatigue, gastralgia, 

 paralysis of ocular muscles, disturbance of vision, and ophthalmo- 

 scopic appearances, and especially the ataxia of motion, give the 

 disease a decided character. Diseases of the cerebellum also induce 

 an uncertain tottering gait when the eyes are closed, and dizziness ; 

 but there are usually other symptoms, occipital pain, occasional 

 vomiting, epileptic or tonic spasms, hemiplegia, etc. ; while the lan- 

 cinating pains, ready fatigue, girdle feeling, and anaesthesia are ab- 

 sent. Amblyopia and amaurosis occur from tumors of the brain 

 as well as from tabes ; but the ophthalmoscope may show whether 

 the papilla indicates tabes or the optic neuritis and choked disk due 

 to tumors. Electro-muscular contractility gives no certainty to 

 diagnosis, as the excitability of the muscles may be increased, nor- 

 mal, or lessened ; although in the first stages it is generally in- 

 creased, while in other spinal diseases it is apt to be lessened very 

 early. When incompletely developed, tabes may be mistaken for 

 neuralgic, rheumatic, hypochondriac, hysterical, or syphilitic affec- 

 tions. Errors may also occur where the posterior columns are im- 

 plicated in diseases of other parts of the spinal cord. 



