ommon in men than women (ten to one).
Sometimes children suffering from hereditary syphilis have it. The chief
predisposing cause is syphilis which precedes it in from seventy to
eighty-five of the cases according to various authorities. Exposure to
cold and wet, sexual and alcoholic excesses, mineral poisoning, and great
physical exertion also exciting causes.

Symptoms.--These are numerous. They appear in succession and with the same
regularity.

Stages.--Stages of pain; the stage of ataxia, peculiar gait; and the state
of paralysis.

1. Prodromal or forerunning; the stage of pain.--This consists of
lightning-like pains in the lower extremities, numbness, formication
(feeling of ants, etc., crawling), sensation of dead extremities; pins and
needles in the soles of the feet and fingers, coldness, itching of arms
and scrotum or other parts, a sensation of constriction around the chest,
headache, pain in the small of the back and loins of an aching character
may occur. These symptoms may constitute the only evidence of locomotor
ataxia and last for years; but sooner or later there are added absence of
knee cap bone reflex (knee jerk), and immobility of the pupil. The loss of
the knee jerk is always observed in time. The pupil fails to respond to
light while it still accommodates for distance, called Argyll Roberston
pupil. There may be imperfect control of the bladder with slow, dripping
or hasty urination. Later the control is not imperfect, but it may be
painful. Inflammation of the bladder may occur which is dangerous. There
is usually obstinate constipation and loss of sexual power. These symptoms
may last for several months and years, and then the second stage symptoms
appear.

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2. Stage of Ataxia (Disturbance of motion).--The disturbance of motion
(ataxia) is very marked, especially in the lower extremities; the walking
becomes difficult and uncertain; there is difficulty in rising or rapid
turning; the legs are wide apart; feet lifted too high and come down too
forcibly; the length of the steps is irregular, and the body is
imperfectly balanced. If the patient stands with his feet together and
eyes closed he begins to sway, (Romberg's symptom), which is due to a
defect in controlling the muscles from impairment of sensation. There may
be imperfect use of the hands in dressing, writing, etc.; lancinating
pains are marked in all cases and come on in paroxysms. The pains are
mostly in th