Symptoms.—­These are numerous.  They appear in succession and with the same regularity.

Stages.—­Stages of pain; the stage of ataxia, peculiar gait; and the state of paralysis.

1.  Prodromal or forerunning; the stage of pain.—­This consists of lightning-like pains in the lower extremities, numbness, formication (feeling of ants, etc., crawling), sensation of dead extremities; pins and needles in the soles of the feet and fingers, coldness, itching of arms and scrotum or other parts, a sensation of constriction around the chest, headache, pain in the small of the back and loins of an aching character may occur.  These symptoms may constitute the only evidence of locomotor ataxia and last for years; but sooner or later there are added absence of knee cap bone reflex (knee jerk), and immobility of the pupil.  The loss of the knee jerk is always observed in time.  The pupil fails to respond to light while it still accommodates for distance, called Argyll Roberston pupil.  There may be imperfect control of the bladder with slow, dripping or hasty urination.  Later the control is not imperfect, but it may be painful.  Inflammation of the bladder may occur which is dangerous.  There is usually obstinate constipation and loss of sexual power.  These symptoms may last for several months and years, and then the second stage symptoms appear.

[306 Mothers’ remedies]

2.  Stage of Ataxia (Disturbance of motion).—­The disturbance of motion (ataxia) is very marked, especially in the lower extremities; the walking becomes difficult and uncertain; there is difficulty in rising or rapid turning; the legs are wide apart; feet lifted too high and come down too forcibly; the length of the steps is irregular, and the body is imperfectly balanced.  If the patient stands with his feet together and eyes closed he begins to sway, (Romberg’s symptom), which is due to a defect in controlling the muscles from impairment of sensation.  There may be imperfect use of the hands in dressing, writing, etc.; lancinating pains are marked in all cases and come on in paroxysms.  The pains are mostly in the legs, but also occur in the arms, head, loins, back, and trunk.  Then the sense of touch is partially lost.  The prick of a pin may not be felt until a few seconds after being applied.  This stage may last for years and remain at a “standstill;” but it is usually progressive, and advances to the third stage.

3.  The stage of paralysis is marked by a gradual change to the worse, and the patient must remain in bed, because he cannot get out.  The lower and sometimes the upper extremities have lost a great deal of their power of sensation:  The joints, mostly the knee and hip joints show on both sides of the body a painless swelling, owing to the great quantities of watery liquid there.  Dislocations and fractures occur simultaneously.  Bed-sores and peculiar ulcers on the sole of the foot also occur.  The urine dribbles away constantly, for all control of the bladder is lost.  Death occurs from exhaustion; bedsores, inflammation of the bladder, or pneumonia coming on as a complication.