If the trunk muscles are affected by the ataxia, further exercises are ordered for them, bending and twisting movements, picking up objects from the floor, etc.  For the hands and arms, which, except in those very rare cases where the ataxia first shows itself in the upper extremities, seldom exhibit much incooerdination in the primary and middle stages, the movements are the picking up of a series of different-shaped small articles, arranging objects like dominoes, marbles, or the kindergarten sticks in patterns, bringing the fingers of the two hands one after another together, or touching a finger to the ear or the nose, at first with open and then with shut eyes.

With these methods, needing not more than twenty minutes three times a day, the ataxic symptoms sometimes rapidly diminish.  In certain cases no other improvement will be observed, showing that what has taken place is of course not an alteration of the diseased nerve-tissues for the better, as no treatment can restore sclerotic spinal tissue to a normal state, but is merely a substitution of function, in which other and associated nerve-tracts have replaced in control the ones affected.

As to the pains and bowel and bladder disturbances, their handling will be discussed in considering the treatment of the next or middle stage of tabes.  In this period the ataxic symptoms are most prominent; the gait has become so unsteady that the patient needs canes to walk at all and must constantly watch his feet.  He walks a little better when well under way, but at starting or when standing still he sways and totters.  The girdle-sense is severe and constant, various pains assail the body and limbs; the numbness of the feet, often described as a feeling “like walking with a pillow under the foot,” still further incommodes his walking.[30] The bladder control may be so enfeebled as to require daily catheterization, and the bowels move only with enemas or purgatives, and often without the patient’s knowledge, owing to the anaesthesia which affects the rectum and its vicinity.

One of the first things to attend to when patients are in this stage is the bladder, as the retention is the only condition likely to produce serious disorder.  Cystitis is or may be present, and with the retention is a constant threat to the kidneys.  Catheterization and washing out with an antiseptic must be regularly practised while treatment is used to improve the condition.

For these patients rest in bed is a prime necessity in order to remove all excuse for exertion.  The method of application of massage has already been suggested.  Care must be taken that the patient eats well and of the best food.  Except for occasional gastric or intestinal crises of pain, sometimes with vomiting, sometimes with diarrhoea, the digestive functions are usually well performed, unless the stomach has been greatly upset by over-use of iodide.  The most liberal feeding consistent with good digestion