A combination of tabes with lateral sclerosis, or with general paralysis
of the insane, is sometimes seen, but needs no special consideration.
The first or pre-ataxic stage is, to the great detriment of patients,
too seldom recognized. The pains are called rheumatic, the eye symptoms
are lightly passed over or glasses are ordered, the difficulty of
micturition is treated by drugs, and the slightly impaired balance
unnoticed or unconsidered.
When such a patient comes into our hands the history, and especially the
history of predisposing causes, needs the most careful examination. It
is well established that syphilis is a common precedent of ataxia,
occurring in at least two-thirds of the cases; it is even more firmly
settled that iodide and mercury in large doses do no good in advanced
ataxia. I say in advanced ataxia, because a few cases are seen in which
the syphilis has been of recent occurrence, or where the spinal symptoms
are of decidedly acute character, and in these anti-syphilitic
medication is needed and useful; but such cases should be described as
acute or subacute spinal syphilis, not as ataxia.
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