s, which by the way
are less suited for the work than plain boards or parquet floors, a
piece of half-inch wide white tape may be laid in the required pattern,
first in a straight line, later, as proficiency is gained, in curved,
figure-of-eight, or angular patterns. The patient must be made to walk
_on_ the line, putting one foot directly in front of the other, with the
heel of the forward foot touching the toe of the one behind.

Walking over obstacles is tried next. Wooden blocks measuring about six
by twelve inches and two inches thick are stood on edge at intervals of
eighteen inches and the patient walks over them, thus training several
groups of muscles; the blocks are at first set in straight lines, then
in curving patterns. An ordinary octavo book makes a good substitute for
a block.

If the trunk muscles are affected by the ataxia, further exercises are
ordered for them, bending and twisting movements, picking up objects
from the floor, etc. For the hands and arms, which, except in those very
rare cases where the ataxia first shows itself in the upper extremities,
seldom exhibit much incooerdination in the primary and middle stages, the
movements are the picking up of a series of different-shaped small
articles, arranging objects like dominoes, marbles, or the kindergarten
sticks in patterns, bringing the fingers of the two hands one after
another together, or touching a finger to the ear or the nose, at first
with open and then with shut eyes.

With these methods, needing not more than twenty minutes three times a
day, the ataxic symptoms sometimes rapidly diminish. In certain cases no
other improvement will be observed, showing that what has taken place
is of course not an alteration of the diseased nerve-tissues for the
better, as no treatment can restore sclerotic spinal tissue to a normal
state, but is merely a substitution of function, in which other and
associated nerve-tracts have replaced in control the ones affected.

As to the pains and bowel and bladder disturbances, their handling will
be discussed in considering the treatment of the next or middle stage of
tabes. In this period the ataxic symptoms are most prominent; the gait
has become so unsteady that the patient needs canes to walk at all and
must constantly watch his feet. He walks a little better when well under
way, but at starting or when standing still he sways and totters. The
girdle-sense is severe and constant, various pains assail