have been able to make it
available. As I have already said, I am now more fearful that it will be
misused, or used where it is not needed, than that it will not be used;
and, with this word of caution, I leave it again to the judgment of time
and my profession.

CHAPTER X.

THE TREATMENT OF LOCOMOTOR ATAXIA, ATAXIC PARAPLEGIA, SPASTIC PARALYSIS,
AND PARALYSIS AGITANS.

In my earliest publication on the treatment of diseases by rest, etc.,
locomotor ataxia was alluded to as one of the troubles in which
remarkable results had been obtained. Rest alone will do much to
diminish pain and promote sleep in tabes, rest with massage and
electricity will do more. It is not necessary to order complete
seclusion for such cases, but some special measures will be needed in
addition to those already described as of use in various disorders, and
these will be discussed in this chapter.

While this is not a treatise on diagnosis, some brief
symptom-description is needed to enable one to define clearly the
methods of treatment at different stages.

In the middle or late stages there need be little uncertainty in
uncomplicated cases; in the earlier periods diagnosis is by no means
easy. A history may usually be elicited of important heralding
symptoms, such as former or present troubles with the muscles of the
eyes, the occurrence of vague but sharp and recurring pains, vertigo, an
impairment of balance, unnoticed perhaps, except when walking in the
dark or when stooping to wash the face, or especially when going down
stairs. Attacks of 'dyspepsia,' as unrecognized visceral crises are
often called, should render one suspicious. If, on examination, loss or
impairment of knee-jerk be shown, contraction of the pupil with
Argyll-Robertson phenomenon and defective station, but little doubt can
exist. The discovery by the ophthalmoscope of some degree of beginning
optic neuritis would make assurance more sure, and this can often be
detected in a very early stage of the disease.

Much controversy has been spent on the question of the share of syphilis
in producing tabes, and out of the battle but two facts emerge fairly
certain, the one that syphilis often precedes the disease, the other
that anti-syphilitic medication is commonly of no service. But syphilis
is so frequently antecedent that a history of that infection may make
certain the diagnosis when doubt exists. This may be an important
point, for some of the cardinal sympt