. A text-book of medicine for students and practitioners . he footwith a marked flattening of the are not yet able to explainfully the occurrence of all thesechanges. It is hard to avoid en-tirely the assumption of trophicnervous disturbances. It has beenclaimed that degenerative changeshave been found in cases of tabeticosteopathy and arthropathy in thenerves leading to the bones andjoints; but it is also possible, on theother hand, that many of the so-called tabetic arthropathies may beof syphilitic origin. It is of thegreatest importance, at any rate,that conditions may exist in tab
. A text-book of medicine for students and practitioners . he footwith a marked flattening of the are not yet able to explainfully the occurrence of all thesechanges. It is hard to avoid en-tirely the assumption of trophicnervous disturbances. It has beenclaimed that degenerative changeshave been found in cases of tabeticosteopathy and arthropathy in thenerves leading to the bones andjoints; but it is also possible, on theother hand, that many of the so-called tabetic arthropathies may beof syphilitic origin. It is of thegreatest importance, at any rate,that conditions may exist in tabeswhich must have a very unfavorableintluence upon any existing bone orjoint affection. The most important of these is analgesia. That is the reasonwhy patients, in spite of a beginning arthropathy, do not spare the affectedjoint, but continue to irritate it still more. We saw a patient, for example,where an affection of the knee joint developed in a comparatively very earlystage of tabes, which up to that time had not been diagnostic^ated at all. As the. Fig. 165.—Genu recurvatum in tabes dorsalis(Personal observation.) TABES DORSALIS 355 patient felt no pain whatever in his knee, he hunted most vjo^oronsly through awhole autumn, until iinally an extremely severe swelling of the knee joint andan actual subluxation of the leg ensued. It is also possible that pronouncedataxic movements may frequently aid in irritating the articular surfaces. The muscles preserve in general their normal state of nutrition, except asthey take part in some joint affection or in general emaciation. Charcot de-scribed a case of a combination of tabes with genuine progressive muscularatrophy, in which the autopsy showed a degeneration of the anterior graycornua in the spinal cord besides the atrophy of the posterior columns. Thefirst report upon a unilateral atrophy of the tongue, which sometimes developsquite early in tabes, is due to the same observer. These and similar atrophiessometimes seen in
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