In the middle or late stages there need be little uncertainty in
uncomplicated cases; in the earlier periods diagnosis is by no means
easy. A history may usually be elicited of important heralding
symptoms, such as former or present troubles with the muscles of the
eyes, the occurrence of vague but sharp and recurring pains, vertigo, an
impairment of balance, unnoticed perhaps, except when walking in the
dark or when stooping to wash the face, or especially when going down
stairs. Attacks of 'dyspepsia,' as unrecognized visceral crises are
often called, should render one suspicious. If, on examination, loss or
impairment of knee-jerk be shown, contraction of the pupil with
Argyll-Robertson phenomenon and defective station, but little doubt can
exist. The discovery by the ophthalmoscope of some degree of beginning
optic neuritis would make assurance more sure, and this can often be
detected in a very early stage of the disease.
Much controversy has been spent on the question of the share of syphilis
in producing tabes, and out of the battle but two facts emerge fairly
certain, the one that syphilis often precedes the disease, the other
that anti-syphilitic medication is commonly of no service.
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