the damage is done can scarcely be explained in ordinary terms, but, as in all late syphilis, a certain amount of the damage once done is beyond repair.  Locomotor ataxia begins to affect the lower part of the spinal cord first, so that the earliest symptoms often come from the legs and from the bladder and rectum, whose nerves are injured.  Other parts higher up may be affected, and changes resulting in total blindness and deafness not infrequently occur.  Through the nervous system, various organs, especially the stomach, may be seriously affected, and excruciating attacks of pain with unmanageable attacks of vomiting (gastric crises) are apt to follow.  This does not, of course, mean that all pain in the stomach with vomiting means locomotor ataxia.  All sorts of obscure symptoms may develop in this disease, but the signs in the eyes and elsewhere are such that a decision as to what is the matter can usually be made without considering how the patient feels, and by evidence which is beyond his control.

+Late Syphilis of the Nervous System—­General Paralysis.+—­General paralysis, or paresis, is a progressive mental degeneration, with relapses and periods of improvement which reduce the patient by successive stages to a jibbering idiocy ending invariably in death.  Such patients may, in the course of their decline, have delusions which lead them to acts of violence.  The only place for a paretic is in an asylum, since the changes in judgment, will-power, and moral control which occur early in the disease are such that, before the patient gets unmanageable, he may have pretty effectually wrecked his business and the happiness of his family and associates.  When the condition is recognized, the family must at least be forewarned, so that they can take action when it seems necessary.  Both locomotor ataxia and paresis may develop in the same person, producing a combined form known as taboparesis.

The importance of locomotor ataxia and paresis in persons who carry heavy responsibilities is very great.  In railroad men, for example, the harm that can be done in the early stages of paresis is as great as or even greater than the harm that an epileptic can do.  A surgeon with beginning taboparesis may commit the gravest errors of judgment before his condition is discovered.  Men of high ability, on whom great responsibilities are placed, may bring down with them, in their collapse, great industrial and financial structures dependent on the integrity of their judgment.  The extent of such damage to the welfare of society by syphilis is unknown, though here and there some investigation scratches the surface of it.  It will remain for the future to show us more clearly the cost of syphilis in this direction.