A Case of Tabes Dorsalis in an Indian

K. L. A., male, Indian Christian, aged 45, who had never been out of India, was admitted to the ophthalmic ward for drooping of the right upper lid, and was soon transferred to the medical wards. History.?For two years he had suffered from shooting pains in the lower extremities?described by him as ' electric shocks'?the attacks lasting for fifteen to twenty minutes, and recurring at indefinite intervals of fifteen days to four months, and being experienced mainly in the calves. Coincidently he had felt a sensation as of a tight rope round his waist at the level of the tenth and eleventh dorsal vertebra. For a year and a half he had experienced difficulty in balancing himself, noticed most when washing himself in ihe morning, for on closing his eyes he would fall forward into the basin. About six months previously he noticed dimness of vision in the left ej^e, and at the same time found the right eye deviated inwards and experienced diplopia. He was treated for these troubles in the ophthalmic outpatient department by electric massage and antisyphilitic measures, though the Wassermann reaction of his blood was negative, both before and after a provocative dose of neosalvarsan. His squint became much better after three months. One and a half months before admission he noticed partial drooping of the right upper lid. Condition on admission.?A well-built man, who walks with difficulty with a staggering gait, and at once falls on closing his eyes. He complains of frequent pains in his lower limbs, and of the sensation of a continuously present tight band round his waist. Cranial nerves.?The right eye is slightly deviated outwards and the right upper lid droops slightly; the internal movement of the right eye and external movement of the left eye are defective; the pupils are unequal, the right being the larger; the right pupil does not react to light but reacts sluggishly to accommodation; the cilio-spinal pupil reflex, while present in both, is very sluggish in fhe right eye; the consensual light reflex is present in the left eye only; Wernick's hemianopic pupil reflex is not present; vision is 6/6 in both eyes; fundus examination shows no abnormality. Outside the eyes the only cranial nerve abnormality is a weakness of the right facial muscles. Upj>er extremities show no change, motor or sensory. Lower extremities show defective co-ordination, but normal motor power. Sensations of heat, cold, touch, and pinprick are normal, but muscle.sense and vibration sense are absent in legs and feet. The deep reflexes