— The. Re flexes.—One of the earliest—possibly the earliest demonstrable—symptom of loco motor ataxia is a diminution in activity of the patellar-tendon reflex. This dim inution may- be first unequal on the two sides, but, as the disease prog-resses, both knee-jerks are affected and event ually lost (Westphal's symptom). So constant is this symptom as to have been considered pathognomonic by some writers (Buzzard). Absence of the knee jerks may exist in persons who are other wise healthy, although such instances are not at all common. The integrity or abnormality of the knee-reflex may be elicited by various methods, the simplest of which is to have the patient "cross" the leg carelessly, when, with the side of the extended hand or a percussion-ham mer, a sharp tap over the tense patellar tendon will ordinarily demonstrate, in the resultant jerk of the leg, the normal or exaggerated presence of the tendon reflex, or, in the absence of response, the loss of such reflex action. Such a test, however, is crude, and should not be considered final unless practiced in con junction with some one of the methods of sensory or mental reinforcement, the simplest of which is that known as Jendrassik's. This consists in having the patient grasp the hands tightly and look up at the ceiling, or at least away from the field of examination, as the tendon is struck. While abolition of the knee-jerk is exceedingly constant as a part of the symptom-picture, occasional examples of the disease have been noted in which the reflex was preserved and remained intact. Westphal himself, as well as Pick, Krauss, Lehman, and, more recently, Achard and Levi (La Med.
Mod., 9, p. 167, '93) have reported such instances, the explanation being found in the non-involvement, by the process, of the zone of entry (wurzell eintrill) of the corresponding posterior roots. The occurrence of hemiplegia in a tdbetic patient may result in the re turn of the knee-jerk, which may even be exaggerated in such cases.
The studies of Sherrington upon the phenomena connected with the tendon reflex are of especial interest in this connection.
[Mills, following the observations of Babinski (Le Prog. Med., Oct. 29, '98) as to the significance of the tendo-Achillis jerk in tabes, examined 100 eases of nervous disease, 28 of which were tabes, with regard to this point. Of the non-tabetic cases, it is sufficient to state that he found this reflex present and equal in all of the 72 patients. Of the 28 tabetics only 3 exhibited the tendo Achillis jerk and hi all three the knee jerk was also present. In one the phe nomenon was well marked, in another slight and in the third present only on one side. Mills thinks that an investiga tion of the tendo-Achillis jerk may prove of diagnostic importance in removing the element of doubt present in the cases of tabes occasionally encountered in which the patellar-tendon reflex is prescrved, such eases usually showing alteration of the Achilles-tendon jerk. W. B. PRITCH
ARD.] In early tabes the cutaneous and super ficial reflexes are preserved and may be ' exaggerated: a fact of some diagnostic significance, in the opinion of Bechterew (Revue de Psych., No. 8, '97). In the ? late disease these also are lost.
Two early symptoms are: 1. The epi gastric reflex appears more pronounced; the abdominal muscles contract when the 1 finger-nail is passed over the skin of the abdomen; this epigastric reflex is un doubtedly, to a certain degree, antago nistic to the patellar reflex. When in tabes the abdominal retlex is more pro nounced, the patellar reflex is lessened. 2. The second symptom, which is already noticeable at a very early stage, is the in capacity to raise one's self on tiptoes, the eyes being closed. Ott, Rosenbach (Cen tralb. f. Nervenh., etc., Apr., '92).
Twenty-six eases of tabes investigated in which the patellar and ankle reflexes were absent in all the cases, In 11 pa tients in the preataxic stage, the abdomi nal reflexes were strongly increased on both sides in 10 and well inarked in 1; of 10 cases in the ataxic stage the ab dominal reflexes were much increased in 3, well marked in 5, very slow in 1, and not present in 1; of 5 cases in the para lytic stage, the abdominal reflexes were completely absent in 4 and in 1 case were increased. Ostankow (Neural. Centralb., p. 140, '98).
The earliest, most constant, and ob trusive symptoms of loeomotor ataxia in its early stage are: absent knee-jerks, shooting or lightning-like pains, and loss of iritic reflex. J. T. Eskridge (Charlotte Med. Jour., Dee., '9S).
Conclusious to be drawn from obser vations upon the biceps-tendon jerks in twenty-nine eases of tabes: The a.taxia in the arms is, as a rule, more marked when the biceps-tendon jerk is absent. It is also usually marked when the same is found in the legs. In these the biceps tendon jerk is absent. In the presence of the biceps-tendon jerk with slight ataxia in the arms, ataxia, in the legs is invariably well marked. Sensation is usually normal in those eases with normal biceps-tendon jerk. The sensory losses are usually foxind when the biceps tendon jerk is absent. ArthropathicA are only found in the advanced cases. Astcreognosis is only present in the markedly ataxic. The loss of the sense of position is almost constant. in the ad vanced cases of tabes. The shooting pains in the arms do not bear any re lation to the degree of ataxia. The marked ataxics seldom show the loss of weight-sense. The intensity of the symptoms is not dependent on the dura tion of the case, but rather upon the ex tent of the sclerotic process. In those eases in which the biceps-tendon jerks are absent the sclerosis probably ex tends to the cervical region; but this reflex may be absent in normal individ uals. Moses liehrend (Phila. Med. Jour., June 1, 1901).