desired, the reason given being that the iodide elinminates the mercury before its full effects are obtained.

Many methods of administering mercury have been used, but inunctions and by the mouth have proven the best for all around work. In certain cases other methods may be tried, perhaps with advantage, such as the hypodermic, fumigations, etc. Baths are not to be forgotten in the treatment of this condition, and waters of a sulphurous nature are especially advantageous in assisting in the elimination.

Tabes Dorsalis as described today is undoubtedly of syphilitic origin in the great majority of cases. It is so conceded by the most eminent observers. We have three distinct varieties to deal with, namely:

Junior, Infantile, or Hereditary Tabes, this being the result of inherited syphilis.

Pseudo Tabes Syphilitica, the early product of an acquired syphilis and

True Tabes Dorsalis, also described as Locomotor Ataxia and Posterior Sclerosis, the latter being one of the two representatives of the para-syphilitic condition, General Paresis being the other. Much time could be spent in discussing each of the three varieties mentioned, in fact volumes have been written on the latter alone, but we will confine the present paper to a hasty resume of the symptomology of each and then under the head of treatment consider the entire subject.

Cases of Juvenile or Infantile Tabes have been reported by Babinski, Erb, Souques, Nome and many others, who conclude it undoubtedly is due to inherited syphilis. Oppenheim, while inclined to agree with the statement, says he has found some cases in which he has failed to find grounds for this assumption. These cases all occur in early life, from 3 to 20 years of age is the rule. The characteristic symptoms found in these cases are loss or inequality of knee jerk, ataxia, lightning pains, sphincter disturbance and optic atrophy and often Argyll Robertson pupil or inequality of the pupils; generally there is found present also the Hutchinson teeth and other evidences of congenital syphilis. In a few of these cases there may be present mental changes, an evidence of juvenile paralysis, just as the two diseases are found combined often in the patient of middle life.

Pseudo Tabes Syphilitica (Mott) was first reported by Oppenheim and Eisenlohr simultaneously about 25 years ago and was described as a disease occuring in syphilitics which pre

sented certain symptoms that resembled tabes dorsalis in at least one stage of the disease and which disappeared or improved under antisyphilitic treatment. Upon post mortem examination in those cases which proved fatal, it was found there existed a syphilitic meningitis involving the posterior roots with a secondary degeneration of the posterior columns. The main symptoms were absent and variable knee jerk, ataxia, lightning pains and bladder troubles, also there were found ocular paralysis, transient or permanent pupilary rigidity, often to both light and accommodation, the Argyll Robertson phenomenon being rare, strabismus more frequent, laryngeal paralysis, deafness and sensory alterations in the distribution of the fifth cranial nerve; attacks of gastric vomiting have also been recorded in these cases similar to true tabes, as well as transient diplopia.

The point of greatest importance is to remember that not every case presenting tabetic symptoms is necessarily parasyphilitic, but may be due to active syphilis, and can be benefitted by antisphilitic treatment. To sum up the essential points in the diagnosis as mentioned by Mott, they are:

First-Sudden onset or comparatively sudden onset and rapid progress of symptoms.

Second-Early appearance of the affection after primary infection, these symptoms making their appearance on the average from 18 months to two years after infection and rarely after four years.

Third-A variability of the deep reflexes; at one time they may be absent, at another present, or increased even, or may be unequal on the two sides.

Fourth-Optic lesions, optic neuritis and post-neuritic atrophy not uncommon with unilateral scotoma.

Fifth-Definite improvement under treatment as well as disappearance of the previous marked lymphocytic reaction of the spinal fluid.

True Tabes Dorsalis or parasyphilitic tabes remains to be considered, and is a disease essentially of the sensory portion of the cord, involving primarily the afferent neuron, and occurs on an average of about ten years after the primary infection. This is one of the most frequently encountered cord diseases, in fact at one time nearly all cord diseases were included under this name which was first given by Hippocrates. In 1824 Ollivier followed by Hutin and Horn three years later, Todd in 1847 and about the same date Romberg, all did much to bring order out of the condition of chaos, and in 1855 Ruscell Reynolds, and

Duchenne in 1858 both emphasized the findings of the previous authors of the disease was established beyond question as a distinct and definite entity. It has, however, been only in more recent times that syphilis as the great etiological factor has been recognized. Many neurologists have made observations along this line and all agree that syphilis is the prevailing factor in the production of the disease, some going so far as to scarcely admit any other, and alcoholism, sexual excesses, exposure and trauma being considered only as contributing factors.

As toSymptoms, they are numerous but they can be briefly grouped under the following heads:

First-Ocular, includiing the loss of the light reflex, diplopia, etc.

Second-Sensory, both subjective and objective.
Third-Absence or diminution of deep reflexes.
Fourth-Sphincter alteration.

Fifth-Lymphocytosis of the spinal fluid and joint changes; and while there are many more than those just enumerated these may be considered cardinal.

The Wasserman reaction has been found in about 50 per cent of all cases, according to Mott, who also states that this reaction is in proportion to the nervous tissue that has undergone decay. This disease is often accompanied by general paralysis, in fact Ferrier, Mott and others hold that it is one and the same, but only a different manifestation, with the same etiological factor.

The Macroscopic appearance of the cord of a patient that has suffered from advanced tabes is characteristic, the cord when exposed is flattened, especially from before backward, the membranes are thickened especially the pia in the posterior portion, the posterior roots normally larger than the anterior, are seen greatly diminished and are grey in appearance instead of white. The cord, if cut transversely shows a definite degeneration of the posterior columns which are shrunken and hardened in comparison with their normal condition, thus throwing the posterior horns closer together. The ganglia on the posterior roots to the unaided eye do not seem altered.

Microscopically, changes are found in the posterior roots and ganglia, the peripheral nerve trunks and cord itself as well as the mebranes. The most important of these changese according to Oppenheim, as well as many others, is the grey degeneration of the posterior columns, while atrophy of the posterior roots is also a constant feature and according to some observers

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***** of wine and he wonsequent may lations is * BAYA, woumidone for damals at the time but a hasty TENIM WAY HUGS. However, to retard the disease or betbat *... *tteet tus propera di tre danse may be ensidered a madurai rutory and reperty may be Woolplished Church come up to question in a few words when he states. The intelligent propene of treatment is:

Kiral To arrest any active syphilitic process that may be present,

Necond To improve the general health.

Third To increase the nutritive condition of the cord. Fourth Maintain as complete muscular control as possible, and to this we would add renew muscular control.

Fifth To meet the host of incidental disturbances as they mrin,

There are many ways of fulfilling the above indications, not only by the use of medicine but by exercise, proper living and the general observance of the condition in its entirety, ever keeping in mind that in true tabes we are dealing with a parasyphilitic condition.

[CONTINORD IN FEBRUARY ISSUE, WITH DISCUSSION.]

CLINICAL REPORTS

Rheumatism Phylacogen

After reading Dr. E. P. Dorsey's report on the treatment of Rheumatism with Rheumatism Phylacogen, I was prompted to report a case of mine treated by the same medicine.

Man, aged 47, married. Early in the month of March this year, he was taken sick with pain and swelling of joints and fever. Having had a bad attack of rheumatism a year ago, he knew what was coming, so he went at once to Excelsior Springs. This was the second week in March. He stayed at the Springs four weeks, but in place of getting better he got worse. was telegraphed for to come and bring him home.

His wife

I was called to see him April 21st; nearly every joint in his body was involved. He had chills, fever 103, pulse 100, respiration 22. He was unable to move in bed. Aspirin had been given him at Excelsior Springs. I also gave him Aspirin 10 gr. every three hours, but it had no effect on the pain or disease, so I had to give him Morphia gr. 14 hypodermically.

On April 23rd I gave him 5 c. c. Rheumatism Phylacogen, April 24th, 5 c. c., and 10 c. c. each following day for five days. After the second day the pain began to let up, and on April 28th patient walked one block, and on April 30th walked up town and had no pain. He was very stiff in his joints, so on May 17th he began to take treatment from an osteopath for the stiffness. He took four treatments in five days. Pain and swelling of joints returned (after the osteopath treatment) so he was compelled to take to bed. Again on May 23rd, 24th and 25th I gave him 10 C. C. Rheumatism Phylacogen each day. He responded promptly to the treatment and after four days was back up town and at his place of business, and has had no more relapses. In all, I gave him 90 C. C. Rheumatism Phylacogen. This is my first experience with this drug and in this particular case the result was excellent. No other medicine was given. I may state that the local reaction of redness and tenderness at place of injection, and the constitutional reaction, chill and fever after each injection, was very severe; also nausea, but no vomiting. E. J. FLEETWOOD, (Wakefield, Neb.)