of paresis. The way in which the damage
is done can scarcely be explained in ordinary terms, but, as in all late
syphilis, a certain amount of the damage once done is beyond repair.
Locomotor ataxia begins to affect the lower part of the spinal cord
first, so that the earliest symptoms often come from the legs and from
the bladder and rectum, whose nerves are injured. Other parts higher up
may be affected, and changes resulting in total blindness and deafness
not infrequently occur. Through the nervous system, various organs,
especially the stomach, may be seriously affected, and excruciating
attacks of pain with unmanageable attacks of vomiting (gastric crises)
are apt to follow. This does not, of course, mean that all pain in the
stomach with vomiting means locomotor ataxia. All sorts of obscure
symptoms may develop in this disease, but the signs in the eyes and
elsewhere are such that a decision as to what is the matter can usually
be made without considering how the patient feels, and by evidence which
is beyond his control.

+Late Syphilis of the Nervous System--General Paralysis.+--General
paralysis, or paresis, is a progressive mental degeneration, with
relapses and periods of improvement which reduce the patient by
successive stages to a jibbering idiocy ending invariably in death. Such
patients may, in the course of their decline, have delusions which lead
them to acts of violence. The only place for a paretic is in an asylum,
since the changes in judgment, will-power, and moral control which occur
early in the disease are such that, before the patient gets
unmanageable, he may have pretty effectually wrecked his business and
the happiness of his family and associates. When the condition is
recognized, the family must at least be forewarned, so that they can
take action when it seems necessary. Both locomotor ataxia and paresis
may develop in the same person, producing a combined form known as
taboparesis.

The importance of locomotor ataxia and paresis in persons who carry
heavy responsibilities is very great. In railroad men, for example, the
harm that can be done in the early stages of paresis is as great as or
even greater than the harm that an epileptic can do. A surgeon with
beginning taboparesis may commit the gravest errors of judgment before
his condition is discovered. Men of high ability, on whom great
responsibilities are placed, may bring down with them, in their
collapse, great industrial and f