Interesting case of tubes with cranial nerve palsies (third, fourth, fifth, and sixth), supposed to be of nuclear origin, and with muscular atrophies in the upper and lower extremities. The case had been reported at an earlier stage by Seguin as one of external and internal ophthalmo plegia, with incipient tabes. Peterson (Jour. of Nerv. and Mental Dis., July, '90).
Case of chronic progressive paralysis of the ocular muscles in a patient suffer ing with tabes and general paralysis of the insane. Boedeker (Centralb. f. Ner venh., etc., June, '91).
Patient in whom the symptom of pa ralysis of the eye-muscles occurred in the first stage of tabes; all the external muscles innervated by the nervi oculomo torius became paralyzed later on. Rendu (Le Bull. Med., Afar. 16, '92).
Transient ptosis, or diplegia, Argyll Robertson pupil, incipient optic-nerve atrophy, associated in an individual past middle life, of inherited neurotic tend ency, are strong presumptive evidence of the first stage of locornotor ataxia. Ilan sell (Jour. Nerv. and Mental Dis., Apr., '93).
Slight paresis of the ocular muscles, particularly in the early stages of tabes, even though of temporary duration, is of very frequent occurrence, though often overlooked. G. Rurnmo (Lezioni di Clin. Med., S94).
Ataxia. — The disease may manifest itself first in an ataxia of gait or station (acute locomotor ataxia). -Usually, how ever, as has been already stated, various sensory and other symptoms prominently precede the ataxia, disturbances of co ordination being essentially dependent upon impaired centripetal or sensory im pressions. Loss or defect of muscular sensibility and particularly of sense is the dominant factor responsible for the ataxic gait and the don of the upper extremities. The phe nomenon known as Romberg's symptom is probably due to the associated involve ment of both tactile and muscular sensi bility. Leyden's experimental induction of this symptom by freezing (amrsthe tizing) the soles of the feet with spray demonstrates at least some ticipation of the tactile sense in the production of this symptom. I-Telpless ness from ataxia should be, it is scarcely necessary to state, carefully distinguished from helplessness due to true motor pa ralysis or paresis.
Romberg's symptom is caused solely by a feeling of dizziness when the eyes are Grasset (Archives de Neurol., vol. xxv. '93).
Case of locomotor ataxia in which, not ithstanding the fact that the patient was perfectly blind, he could stand with his feet close together with but Little swaying. The moment he closed his eyes,
however, lie swayed violently, and would fall over if not supported. F. F. Ward (Med. Rec., Oct. 8, '9S).
Tabetic Crises.—These consist of at tacks., occurring suddenly, without as signable cause and ending quite abruptly, as a rule, which may simulate symptom atically ordinary atta.ck-s of gastric, intes tinal, nephritic, vesical, or hepatic colic. Gastric crises are most common. The patient is suddenly seized with excruciat ing gastric or abdominal pain, which is usually accompanied with violent retch ing and vomiting. The attack may be prolonged for two or three days or it may end after a single paroxysm lasting a few minutes, recurring at varying inter vals from a week to several months. Except from malnutrition, such attacks are not danErerous.
Case of man in the paralytic and atrophic stage of tabes, whose gastro-in testinal crises were accompanied or ush ered in by profuse sialorrhcea, beginning suddenly, often at night, and nearly choking the patient. Gastric crises would follow, then intestinal crises, sometimes accompanied by genito-urinary symp toms. the attacks lasting from three to twelve days. Girode (T_,a France Med., Feb. 19, '89).
Case of tabetic patient in whom, simul taneously with the gastric crises, pro nounced acuteness of the sense of smell is present. Negro (Rev. Clin. de los Hosp., Mar. 8, '94).
Three cases of tabes in which gastric crises were the first symptom, and, later on, remained the dominant one. There NA as a constant lack of hydrochloric acid both during the crises and in the inter vals. L. Wolff (Lakiire. Forhfind., '95).
[It is striking that gastric crises are very frequently combined with laryngeal symptoms and arc seldom absent when arthropathies are present. H. OBER STEINER, Assoc. Ed., Annual, '90.] When, however, the heart's action or the functions of respiration are involved, the danger is much greater, fatal results having been recorded in both cardiac and laryngeal crises. Both varieties, fortu nately, are rare. The symptoms in laryn geal crises arc not unlike those of laryn gismus stridulus: dry, violent cough, with spasmodic inspiration and marked dyspno2a and at times loss of conscious ness. Burning pains in the neck and shoulder-muscles sometimes attend these laryngeal crises.