portion of one leg with the heel of the other. In the incipiency of the ataxia these tests may fail to bring out the ataxic condition, but by having the person turn sharply around a few times then try to execute the movements they will be very evident. This ataxia causes most patients more annoyance than any other and until a comparatively recent date it was thought no help could be rendered it, but fortunately such is not now the case. It should be borne in mind that this is simply a failure to co-ordinate in the muscular action and in no sense a paralysis except rarely at a very late stage of the disease. Crises There are various manifestations of distress or pain occurring in various portions of the body to which the name crises has been given. When the pain is referred the gastric region it is called gastric crises or to the renal region nephritic crises and so on. A very distressing form is the laryngeal crises when the distress in breathing may be very great. Deafness due to atrophy of the auditory nerve occasionally occurs. The so-called Roenberg symptom or swaying of the body when standing with feet close together and with the eyes closed is usually quite prominent. Sensory symptoms aside from pain constitute an interesting manifestation of the disease. The patients will describe the condition as feeling like something was crawling over the skin or again. as if a string was drawn around the parts. Again we may have incoordination of painful perception if I may so express it, for instance a pinch on the skin may be referred to some other portion of the body than where the hurt is made. Sensation may be delayed or at times absent. An interval of two, three or more seconds may intervene between the time of pinching and the perception of the pain by the person. Anaesthetic zones is the name given to the areas where sensation is absent. Not specially pertinent to the subject but interesting from a clinical standpoint was a case I saw in which these anaesthetic zones were very marked from the excessive use of the bromides given for the relief of epilepsy. Vesical and rectal symptoms in which there is difficulty in emptying the bladder and bowels are at times troublesome. The vesical trouble may occur early in the disease and be the first which prompts the patient to seek the services of the physician. Finally from such profound affection of the cord we may find trophic disturbances. These specially are apt to effect the osseous system, particularly the larger joints. Fractures are easily produced. The soft parts are not exempt as witness the perforating ulcer of the foot, a form of trophic disturbance probably occuring nowhere else. Morbid anatomy. I have never had an opportunity to examine post mortem a case of this disease and will therefore be brief. These remarks are abstracted from Strumpell. The change in the cord. consists in a degeneration of the nerve fibres of, mainly the posterior columns of the cord and a corresponding increase in the connective tissue elements This degeneration is most intense in the lumbar cord, where it affects chiefly the middle and posterior portions of the posterior columns, while the most anterior remain intact. In the dorsal cord the posterior columns are almost completely degenerated. There are usually small areas still preserved in the posterior external and the most anterior portions. In the cervical cord the so-called columns of Goll are chiefly involved, together with the prolongation of the fibers from the root zones of the lumbar cord and also the lateral root areas, that is those portions of the columns of Burdock where fibers enter directly from the posterior nerve roots, and from which fibers may be traced farther into the gray matter of the posterior column; but the so-called posterior external areas and also two little antero-lateral areas remain entirely or at least for a long time, free from disease. A system of very fine fibers entering through the posterior roots is also frequently affected even very early. They branch outward immediately after the entrance of the roots and here occupy a small but very sharply defined territory at the point of the posterior cornu, between the posterior and lateral columns (Lissauers Column) also the medullated fibers of Clark's column seem reduced in numbers. These fibers are direct processes of the posterior root fibers. The cells of Clark's column remain normal. On the other hand the peripheral processes of the posterior root fibers are not wholly spared. At any rate in advanced Tabes we can also make out in the larger nerve trunks such as the sciatica, and probably still more in the fine branches of the sensory nerves a number of degenerated fibers. Stumpell thinks this degeneration of the peripheral nerves in Tabes occupies an independent position since besides the changes in the peripheral sensory nerves pronounced degeneration conditions, sometimes occur in the trunks of certain cranial nerves notably the optic and oculo-motor nerves and more rarely in the accoustic" (I might state parenthetically that Morris in his recent work on anatomy says these minute subdivisions of the cord can only be made out in diseased conditions and not in the heathy cord). TREATMENT.-When the pathological condition is borne in a degenerative change the most perfect rest is desirable. The diet and reasoning from its effect on other organs of the body in someshould be night and easily digested as indiscretion in eating is frequently an exciter of the various crises. As syphilis is so largely an etiological factor we would hope for benefit from anti-syphilitic treatment. Unfortunately the hope has been largely unfounded, howin bed is clearly indicated. When the cord is actively undergoing may be obtained. During the most acute period of the disease rest ever, it is not wholly so and the iodides should be given a fair and continuous trial for several weeks or months. We have high authority for their occasional efficacy. If iodides disagree with the patient. the mercurial should be used. For the pains acetanilid is fairly reliable, but at times resort must be had to some form of opiate, preferably morphine or codeine. For the laryngeal crises inhalations of amyle nitrite is useful. Silver nitrate is perhaps the one remedy upon which most reliance is placed today. It should be given in 1-6 grain doses three times a day for weeks, carefully watching the skin as to color. Gold chloride has been rather highly recommended mind the most that can be hoped for is a symtomatic cure. This what analogous conditions it is certainly worthy of more extended trial. Extension has been found useful in modifying the pains and for relief of the ataxia but as it has fallen short of the rather extravagant claims made for it it now seems to be too much neglected. Either the remedies used or nature with favorable hygienic surroundings may stop the progress of the disease, but the troublesome ataxia remains. A few years ago Frenkel began the treatment of ataxia by systematic exercise. "Improvement in the ataxia was always obtained" and he says "much more may be expected from this method than is usually believed." His reasoning is that we, as children, do not co-ordinate and that cordination is an acquirment, that while in this disease there is a destruction of the kinaesthetic paths, nature acts in a compensatory way and this function may to a large extent be assumed by other routes. Be that as it may, he reports good results and Kalinin reports great improvement in five cases. Raichne has applied the method in twelve cases with complete success in eight cases-relative success in three, failure in I case (Tr. B. K. 1898).* In conclusion the following from Goldschieder (Inter. Clinics), I think a fair statement: "On the whole we have in this compensatory movement theory a distinct advance in the therapeutics of nervous diseases, which can be of the greatest assistance to our patients and the greatest consolation to us, when in the presence of a hopelessly incurable nervous affection." No. 104 N. Seventh street, St. Joseph, Mo. *The writer then gave verbal description of exercise. SYPHILITIC RETINITIS WITH ALBUMINURIA. P. I. Leonard, M. D., Professor of Otology, Rhinology and Pathology, Ensworth Medical College; Oculist and Aurist, C. There are clinical cases which unite into one brotherhood the entire medical fraternity. This becomes more apparent in a case presenting unusual difficulties in its management. As soon as a case of unquestionable syphilis with vision gravely compromised, presents itself to the majority of opthalmologists a very energetic inercurial treatment is prescribed. If a renal complication of syphilis exists, whether it be due to syphilis or not, most of the syphilographers counsel a very careful treatment lest there be great danger to the life of the patient. following report of a case I believe interesting: The Mrs. H. was advised to consult me in September, 1895. She is thirty years of age, of medium size and apparently in good health. Five years ago she had typhoid fever from which she fully recovered. Has been married ten years and has two children living, aged respectively nine and six years, both healthy. Her father is a very healthy man, while her mother suffers from rheumatic attacks. During the previous year Mrs. H. had two abortions and has been suffering from a very irritable stomach. On examination I found her pupils dilated, the left more than the right. No reaction to light, vision in R. E. 1, in L. E. 1-3. On ophthalmoscopic examination the fundus looked opaque, bluish, there appeared to be delicate opacities, possibly in the vitreous. The optic disks were swollen and in streaks which were less opaque, you could see enlarged veins and the swollen retina. The patient gave no history of syphilis, but said that her husband would call the next day. I requested that he bring a specimen of her urine. Mr. H. told me that he contracted syphilis three years before and that he was under treatment only about two months. He thought his wife was suffering from the same trouble. On examination her urine I found the sp. gr. 10 22 and considerable albumen. Urea in 24 hours 13 gr. No casts. Diagnosis: Syphilitic retinitis with albuminuria. Treatment: Having ordinarily used the ointment of mercury by friction in syphilitic diseases of the eye with the greatest success, |