The Family-History of Cancer-Patients
Authors: W. R. Williams
Journal: BMJ (1884)

two or three minutes.The knee-jerk was absenlt in both sides.There were no other symptoms; and she did not appear to have ever been subject to symptoms of inherited syphilis.The pain resisted the use of nitrate of silver, in doses of one-eighth part of a grain, and the application of the constant current; but yielded completely to the use of ergot, in ten-minim doses of the liquid extract, thrice daily.I have not seen the little patient since, and am therefore unable to say whether the patellar reflex has returned.The next youngest patient with tabes whom I have seen was an omnibus-conductor, aged 22, who came under my care at the hospital in February 1878.He had had small-pox ten years before, and a primary sore when seventeen years of age.HIe appeared to have had no secondary symptoms, but had an attack of hemiplegia of the left side two and a half years ago, being then in his twentieth year.He re- covered from this completely in three weeks.In June 1877, he had an attack of double vision, which was cured at Moorfields.A week before he came to the hospital, he suddenly felt pain at the back of the head and down the neck, and a curious sensation of numbness in his face, which soon afterwards was drawn to the side.When I examined the patient, there were all the symptoms of paralysis of the left portio dura in the first portion of the Fallopian canal, together with para- lysis of the left rectus externus.The knee-jerk was absent in both sides.There could be no doubt that it was a case of commencing tabes; but it was difficult to say when this affection commenced, and whether it was already present when the patient had the stroke of paralysis at nineteen years of age, or whether the attack of double vision at twenty-one was the first symptom of it.An examination of the knee-jerk alone at the earlier period of his illness could have settled this question.Another case in a very young man was that of a lieutenant in the Indian army, who was sent to me by Mr. Erichsen in April 1872.He was then twenty-three years of age, and had contracted syphilis three years ago.He had had an indurated chancre and bubo, and had sub- sequently suffered from severe ulceration in the region of the left shoulder, and from iritis.Symptoms of tabes appeared about twelve months ago, that is, at twenty-two years of age, and were more marked in the left than in the right side of the body.He was much troubled with numbness, particularly in the left foot; had difficulty in standing on the left foot, while he could stand tolerably well on the right ; staggered when he was requested to close his eyes; and had much difficulty in walking slowly, while he could walk fast better.He then, however, had to manoeuvre considerably, and showed the characteristic gait of ataxy in the most unmistakable manner.From the table which I have just given, it appears that tabes is mnost prone to break out between thirty and fifty years of age.The ages of the same patients at the time they came under my care were as follows.At 9 years in 1 case.From 20 to 29 years in 3 cases., , 30,, 39 ,, 12 ,, 40,, 49 ,, 21 ,, ,, 50 ,, 59 ,, 11 ,, ,, 60,, 69 ,, 3 ,, At 72 years in 1 case.