Tabetic patient in whom a great many cerebral nerves were diseased, eyen the seldom-affected facial nerve. Asymmetry of breathing was particularly noticeable, the left half of the thorax being much less active than the right. Chvostek (Neurol. Centrelb., Nov. 15, '93).
Multiple Iipontata witnessed in per sonal ease: These may be regarded as a peculiar trophic manifestation in tabes.
The patient suffered from lancinating pains and parasthesia in the lower ex tremities. After two years these symp toms disappeared and instead small lipo mata appeared simultaneously on both forearms, at first growing larger and then remaining stationary. Similar lipomata then appeared on the hips and thighs. The unmistakable symptoms of tabes only presented themselves later on. Tscherkassoff (La Med. Mod., Afar. 25, '95).
Perforating ulcers almost invariably develop on the plantar surfaces of the feet, often beneath the great toe, and may be symmetrical. Such ulcers inay occur quite early in the disease. I recall the case of a patient in whom such ulcers led to the discovery that he was suffering from locomotor ataxia, the discovery overwhelming him with surprise.
Herpes is not an uncommon accom paniment of the severe neuralgic or neu ritic pains sometimes observed. Bald ness or anomalies in pigmentation, espe cially the former, are common. The teeth may all fall out as a result of in volvement of the fifth nerve.
Atrophy of the jaws, with loss of the teeth, frequently occurs in tabetie pa tients. Rosin (Dent. Zeit. f. Nervenh., vol. i, '92).
Case of tabes with bilateral atrophy in the region of the trigeminus, loss of the teeth, paralysis of the soft palate, laryn geal crises. There was found degenera tion of the ascending (spinal) root of the trigeminus, of the ascending glosso pharyngeus root (fasciculus solitarius), and of the substantia feruginea. Pacetti (Trans. Eleventh Inter. Med. Congress, '94).
Spontaneous loss of the teeth most fre quently occurs in the later stages of the disease, and is due to the diseased condi tion of the nervus trigeminus. Lemaire and Bernard (T2Odontologie, Feb., '04).
Case of tabes with perforating ulcer of the mouth and loss of the teeth. No
other Mbar symptoms were present. Letulle (Revue Neurol., Oct. 15, '94).
Onychia is sometimes very trouble some, and wounds or operations upon the extremities, especially the feet, may prove quite obstinate in healing. Mus cular atrophy, if extensive and affecting groups or an entire limb, is a late inci dent in the disease. Extensive atrophy occurring early indicates a probable com plication. Atrophy of single muscles may occur, though not frequently early, as a result of the neuritis.
From 10 to 12 per cent. of all tabetic patients are affected with muscular at rophy. This tabetic muscular atrophy is principally characterized by the great slowness of its development; fibrillary contractions and degeneration reactiona are not present. D6jerine (Ann. de Med. Thermale, '92).
Case of tabes in a. female patient in which there was also increasing paralysis and atrophy of the lower extremities. These symptoms were due to atrophy of the peripheral nerves of the lower ex tremities, as was proved by the post mortem. Goldscheider (Zeit. fiir klin. Afed., vol. xix, '92).
Case of tabes in which there existed a general inuscular atrophy and also marked involuntary movements of the lower extremities and of the face during sleep. Lacaze (Montpellier Med., No. 1, '93).
Case in which the symptoms of pro gressive muscular atrophy first presented themselves, those of tabes only occurring several years later. J. Collins (Jour. of Nerv. and Mental Dis., Feb., '94).
The arthropathies and osteopathies, which are ordinarily associated phenom ena, have been especially studied by Charcot, Dejerine, and others. They occur in from 5 to 10 per cent. of cases. The knees are chiefly affected. The smaller joints usually escape, though Hirtz (La Med. Mod., 9, p. 4S, '93) has recently reported a case with radio graphic illustrations, involving the meta tarso-plialangeal articulations. Tn some cases there exists, withont swelling or dt.forinitY, a remarkable relaxation of the muscles of the knee and other joints, ptrinitting extreme degrees of dexion and hyperextension. This dition has been called "hypotonia" by Frenkel, who considers it an early symp tom.