Three cases of ataxic arthropathy in one of bleb the disease of the joint was one of the first symptoms of tabes. KrUgh's (Finska Lakiire-sall. IIiind., vol. xxxv, '93).
Case of pronounced gonitis tabetica. As the diseased leg was a great hindrance in IN alking, it was amputated at the thigh. R. Rasmus (lnaug. Dissert., '94).
Attacks of (Edema in the extremities or elsewhere, usually transient and of a tvpe similar to angioneurotic cedema, have been noted. Bed-sores on the sacrum, over the trochanters, or at other points exposed to prolonged. pressure are ordinarily late symptoms and belong to the bed-ridden stage. In this connec tion, an emphatic protest might be troduced against the custom, sometimes practiced for the relief of pain in the legs, of tightly binding a cord or liga ture around the limb. It may, and times does, effectually relieve the pains, but at great risk of inducing far more serious trophic disturbances.
Vesical, Rectal, and Sexual Symptoms.
—Slight incontinence or slowness in rnicturition may first attract attention to the possibility of tabes. This may vary from time to time, and is rarely extreme or particularly annoying. In the late stage of the disease there may be partial or total anmsthesia of the bladder, with either absolute incontinence or the op posite condition of retention. The urine may be retained without discomfort for many hours, and. unless withdrawn by catheter, a cystitis may develop. Cath eterization should be practiced very care fully in such patients.
Tabetics are almost invariably consti pated, although in the advanced disease incontinence of keces may be present.
The rectal region may be the site of sharp, stabbing pains in neuralgic cases.
Sexual desire and power, while ably impaired or abolished in the ad vanced disease, is sometimes, in the ginning of tabes, quite distinctly exag gerated, the patient being led into the grossest excesses in sexual intercourse. Such paroxysmal satyriasis may give way to total temporary abolition of sexual function, the paroxysms recurring at varying intervals.
Peculiar localization of the crises in females affected with locomotor ataxia —first mentioned by Charcot. They ap
pear early in the disease and are asso ciated with the usual lancinating pain in the limbs. The spasms of the clitoris occur at frequent intervals and may bc accompanied by ejaculations of mucus or by spasms of the constrictor eunni without pleasurable sensations. Koster 011inchener med. Wochen., No. 5, 1901).
Special Senses.—In addition to vision, hearing, taste, and smell are each or all of them sometimes impaired. Hearing is affected in about 25 per cent. of all cases. Deafness is sometimes, though rarely, due to atrophy of the auditory nerve, sometimes to a trophosclerotic condition of the middle ear through in volvement of the fifth nerve.
In 20 cases of tabes auditory disturb ances found in only 5; of these, 10 per cent. had nervous deafness. Tabes not infrequently causes trophic changes in the middle ear (a, sclerotic process), which may lead to disturbances of hear ing. Treitel (Arch. of Otol., Oct., '90).
Series of 40 cases of tabes, 7 of which had normal hearing; 29 had some affec tion of the auditory apparatus. of which 4 had middle-ear disease, and 15 had positive internal-ear disease, which was also suspected in the remaining eases.
symptoms were not found in any case. Marini (Archly f. Psych. u. Nervenk., B. 21, H. 1, '90).
Tabetic lesions of the auditory nerve are usually only present in the preataxic stage, notably in cases of so-called tabes descendens. Cozzolino (Revista Clinica e Terap., Feb., '94).
Only four cases of tabes have been met with up to the present in which atrophy of the acoustic nerve was discovered at autopsy. In the great majority of eases there is a sclerotic affection of the middle ear, which may be considered as a trophic disturbance following a diseased condi tion of the trigeminus nerve. Usually there is a more or less pronounced deaf ness, which is generally very quickly de veloped, often in a few months. In more than half of the cases a subjective noise precedes the deafness, the sound being of varied nature (musical, whistling, buzz ing, etc.) and also of varying intensity, sometimes excessively loud. Collet (La Presse Med., Jan. 12, '95).