nterest in the later history, but the first
examinations and early treatment may be passed over briefly. X.Y., aet.
forty-two, a steady, sober merchant, closely confined by his business,
always of excellent habits, with no possible suspicion of syphilis, was
seen first in 1894 in a somewhat advanced stage of tabes, but with no
optic or gastric disturbances. His station was very bad, but when once
erect and started he could walk without a stick. Girdle-pains very
marked; bowels very constipated; some trouble in emptying bladder;
several points of fixed sharp pain; lightning pain occasional and
severe, but not frequent. He was ordered to bed for six weeks.
Galvanism, alternate hot- and cold-water applications to the tender
spots, careful massage, and a two-months' course of Brown-Sequard fluid
after getting up made a new man of him. Massage and systematic exercise
were kept up together for six months. The massage was stopped and the
exercises continued, and improvement went on steadily, though the fixed
pains kept up in only slightly less severity.

In a year the patient was better in general health, looks, and spirits
than he had been for many years before, and remained in good order,
except for the daily recurrences of paroxysms of pain of varying but not
unbearable severity for two years. He then presumed for a month on his
strength, and took much more exercise afoot than was wise, worked late
at night over his books, had some additional nervous strain from
business worries, and came to Dr. J.K. Mitchell in October, 1898, barely
able to crawl with two canes, having lost weight, become sleepless,
suffered great increase of pain, and grown so ataxic that he could
scarcely walk. This change had all occurred in three or four weeks. He
became steadily worse for two or three weeks till he could not stand or
walk at all, had cystitis from retention, violent attacks of rectal
tenesmus, stabbing pains in rectum, perineum, scrotum, and groins, with
almost total anaesthesia of the sacral region, buttocks, scrotum, and
perineum, inability to retain faeces, while passages from the bowels took
place without his knowledge. He found that an increase in the rectal
and abdominal pain followed lying down. He therefore spent day and night
sitting up. At the end of three weeks there was total paralysis of the
legs, and the outlook seemed most unfavorable.

Massage was begun again, strychnia and salol were administered, and a
short course