e difficulty of
micturition is treated by drugs, and the slightly impaired balance
unnoticed or unconsidered.

When such a patient comes into our hands the history, and especially the
history of predisposing causes, needs the most careful examination. It
is well established that syphilis is a common precedent of ataxia,
occurring in at least two-thirds of the cases; it is even more firmly
settled that iodide and mercury in large doses do no good in advanced
ataxia. I say in advanced ataxia, because a few cases are seen in which
the syphilis has been of recent occurrence, or where the spinal symptoms
are of decidedly acute character, and in these anti-syphilitic
medication is needed and useful; but such cases should be described as
acute or subacute spinal syphilis, not as ataxia. When nerve
degeneration has once begun, iodide will do little good and mercury may
do positive harm, if used in large doses. The other common predisposing
causes, exposure to cold, over-exertion, sexual excess, need concern us
only as they suggest warnings to be given, especially when the patient
is improving. Until he does improve not much need be said about them; he
cannot indulge in venery, as sexual power is usually (though not always)
lost early in the disease; and the incooerdination lessens his
opportunities of exposure or over-exertion.

During this stage some patients complain most of the numbness,
girdle-sense, and incooerdination; others of the stabbing pains or the
bladder weakness. The general treatment must be much the same, however,
in all, with special attention besides to the special needs of each
individual.

Fatigue makes all the symptoms worse, increases pain, and impairs still
more the muscular incooerdination; it is, therefore, of the first
importance in every instance to forbid all over-exertion. Walking, more
than any other form of exercise, hurts these cases. The patient should
not walk beyond his absolute necessities. To get the needed fresh air,
let him, according to his situation in life, drive out or use the
street-cars. In some cases the use of a tricycle on a level floor or on
good roads is not so harmful as walking, for obvious reasons; this
tricycle exercise may at first be made a passive or mild exercise by
having the machine pushed by an attendant. To replace the effects upon
the circulation and bowels of physical activity massage may be used, and
the masseur must have directions as to gentle handling of th