In the third, the paralytic stage, which seldom comes on until the symptoms have lasted for years, there is gradual loss of power and ataxia, increasing until he is totally unable to walk.  If a patient is not seen until this condition of things has been reached, but little can be hoped from any treatment, though in a few cases energetic measures may bring about a marked improvement, which is rarely lasting.

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.  When nerve degeneration has once begun, iodide will do little good and mercury may do positive harm, if used in large doses.  The other common predisposing causes, exposure to cold, over-exertion, sexual excess, need concern us only as they suggest warnings to be given, especially when the patient is improving.  Until he does improve not much need be said about them; he cannot indulge in venery, as sexual power is usually (though not always) lost early in the disease; and the incooerdination lessens his opportunities of exposure or over-exertion.

During this stage some patients complain most of the numbness, girdle-sense, and incooerdination; others of the stabbing pains or the bladder weakness.  The general treatment must be much the same, however, in all, with special attention besides to the special needs of each individual.

Fatigue makes all the symptoms worse, increases pain, and impairs still more the muscular incooerdination; it is, therefore, of the first importance in every instance to forbid all over-exertion.  Walking, more than any other form of exercise, hurts these cases.  The patient should not walk beyond his absolute necessities.  To get the needed fresh air, let him, according to his situation in life, drive out or use the street-cars.  In some cases the use of a tricycle on a level floor or on good roads is not so harmful as walking, for obvious reasons;