oms are occasionally absent; cases
are seen with no incooerdination, sometimes with the station unaffected,
even, though rarely, with the knee-jerk preserved.

The diagnosis established, treatment will somewhat depend upon the stage
which the disease has reached.

In the pre-ataxic stage, where slight unsteadiness, often not
troublesome except in the dark or with closed eyes, sharp stabbing pains
here and there, numbness of the feet, girdle-sense in the region of
chest, waist, or belly, some recurrent difficulty in emptying the
bladder, a fugitive partial palsy of the external muscles of the eye,
are the chief or, perhaps, the only complaints, it would not be
justifiable to put the patient to bed at complete rest. This early stage
calls for a different plan of treatment, to be presently described.

In the middle or more distinctly ataxic period long rest in bed should
be prescribed, and will be gratefully accepted by a patient whose
sufferings from incooerdination, pains, and numbness of the extremities
are often so great as to incapacitate him.

The bladder muscles share in the ataxia, and the consequent retention
of urine frequently causes cystitis, and may endanger life by the
involvement of the kidneys.

The bowels cannot be emptied or are moved without the patient's
knowledge, and these annoyances combine with the pain and nervous
apprehension to drive the victim into a melancholic or neurasthenic
state. He suffers, too, from want of occupation, from the absence of
exercise, from the anticipation of worse changes in the near future, and
usually by the time he reaches the specialist has been more or less
poisoned with iodide of potash and mercury, and perhaps with morphia.

In the third, the paralytic stage, which seldom comes on until the
symptoms have lasted for years, there is gradual loss of power and
ataxia, increasing until he is totally unable to walk. If a patient is
not seen until this condition of things has been reached, but little can
be hoped from any treatment, though in a few cases energetic measures
may bring about a marked improvement, which is rarely lasting.

A combination of tabes with lateral sclerosis, or with general paralysis
of the insane, is sometimes seen, but needs no special consideration.

The first or pre-ataxic stage is, to the great detriment of patients,
too seldom recognized. The pains are called rheumatic, the eye symptoms
are lightly passed over or glasses are ordered, th