Taste and smell are believed to be rarely affected, though Klippel (Archiv de Neur., 3, p. 257, '97) does not agree with this statement, believing that these two senses are much more frequently in volved than is indicated in the literature. They are, moreover, among the earliest symptoms in tabes, according to this au thor, who describes the findings in a case of tabes presenting these symptoms, which came to autopsy, consisting of ' marked degenerative disease of the olfac 1 tory, glosso-pharyngeal, and trigeminus nerves and their ganglia.
Watchfulness necessary to avoid over looking incipient or atypical forms. Five cases cited in which there were practically no objective symptoms. The subjective disturbances were of the slightest: obscure lancinating pains, slight disturbances of sensation, lassi tude, diminished sexual vigor, headache, etc. Pupillary sluggishness or inaction was, however, noted in several instances. In doubtful cases the presence or absence of a syphilitic history is of great impor tance; when preceded by a specific in fection, symptoms whiell otherwise would be negligible assume the gravest signifi cance. Erb (Miinchener med. Woch., July 17, 1900).
Diagnosis.—The chief and most im portant problem in diagnosis is with re gard to the prompt recognition of the incipient or preataxic stage. No single symptom is pathognomonic, although the Argyll-Robertson pupil is considered by 1416bius and others as invariably in dicative of either locomotor ataxia or general paresis. The conjoint associa tion of any two of the four most con stant symptoms—abolished knee-jerks, Argyll-Robertson pupil, lightning pains, and ocular palsies—is quite suggestive, if not diagnostic in importance. The simultaneous existence of these four symptoms occurs in no other disease, and is positively diagnostic. The subsequent development of ataxia completes a clin ical picture 1-vhich is unique and is not even simulated by any other disease.
It is always well to think of tabes in diagnosticating abdominal affections ac companied by repeated attacks of pain, even in the absence of other sensory afTec tions, motor or oeulo-pupillary phenom ena, or the preservation of the knee-jerks. Laget (La Semaine MM., Sept. 23, '91).
The symptom described by Pitres haphalgesia (sensation of pain upon deli cate touching with certain substances) is not a pathognornonie symptom of hys teria, but may also occur in tabetic pa tients. Iannois (La Sem. MM., Aug. 31, '92).
The patellar reflex is never absent in healthy persons, but only when there is structural disease of the musculo-nervous system. Cowers (Clin. Jour., Oct. 4, '93).
Symptoms of tabes dorsalis may be partially simulated hy a peripheral neu ritis, even without a diseased condition of the spinal cord. In eases in NI hich peripheral neuritis is rapidly developed the following symptoms furnish the dif ferential diag,nosis psemlotalies; very rapid progress of the disease; pain in the inuscles proper and in the nerve-trunks; - t. r.q ri action. 1Mjerine , tx, 21t, '93,.
In %%I jeli a IN IlA .0 111 ell the 11111111i:4, ill the 11.1. 10 It• ,T • the there NA as MA •• I.! I iiii lt latet 11 tillle$ ihah . • • ...I !-1. ilt• gide Con4idered pairoot 'put oin of tithes. Bier -. Lir., No. 2, '91).
Ni.o0 lei 1011 Of the li`g flt. tile I./ la it ling it at the knee, .• ..nal III la 110.y sub:eets, m bile in • • 4 t le II during the first stages of 1• •.t. it cal's( s no pain. Putnam PI st.,t M, 1 and Stag Jour., Aug., '95). T Ara stlasia tlie reg,ion of the .1 g .• inns si,mated as "Butchinson's '' a fi (ding as of ft spider-web t_e skin of the face, may he met - 1.1 in the early stages of tabes, and is of d••-4,--•-••••ti • value. MOldus (Neurol. Beit., \ 3, '03..
1,,sny early cases of tahes there is t.s , day to lain on pressure and on 00 V, the i opliteal nerve, this symp t 14 more commonly present than I - sign of aniesthesia of the Ir. ti Becht'. rew (Neurol. Con . r• r. 140, 'DS .
1 . r- is no pathog,nornonie symptom f s. but tAN 0 symptoms are con • h-r 1 f value in making an early di _-, • The first is the remarkable in . r. the abdominal-wall reflex.
A.-. -1- inal rr other cutaneous and ,1, r.11- x•-• are antagonistic phenom •1 1 this antagonism may serve, in -1.,f,11 u•scs. as a means of diagnosis.
I nts during the first period of loco r •t..xi.t ith los= of the patellar r o. 111%e an unusually-marked ab • r 11.x, ehile the lack of the r. al .1 g ith increased patellar re ', s itolitative of a cerebral lesion, t. reuses no irritation in the neigh t rli,a_d of the affected spot. The second • tr i• ti e b•havior of the patient when ? 4 to rise on his toes, with his eyes and remain standing. Those in the first Terirel of tabes, with only soghtest ,-ymptoms of museulo-tonic tr.,,,Pes. and ithout any sensible alter 41i,,n, are net able to execute this aet. O. Rf.er.1 ach Brit. "led. Jour., Oct. 1, A Filth:1r brilliant appearance of the eye, NA 1110)1, nevertheless, is expressionlesa, is a valuable early sign of the disease.