. A manual of diseases of the nervous system. pils are not always small; they may be of a * Its return on the paralysed side in a tabetic patient who became liemiplegic,has bpen recorded (Hughlings Jackson and James Taylor, Brit. Med. Journ.,vol. i, 1894). f Berger says 97 per cent. J LAbundo, La Psych iatria, 1889, vii, p. 286. 456 SPINAL CORD. medium size or still larger, and tlien I have usually found tliat thesldn-reflex can be obtained, although the light-reflex cannot. Theyare often not perfectly circular, and are frequently unequal. Both eyesare usually affected in the same manner ; occ
. A manual of diseases of the nervous system. pils are not always small; they may be of a * Its return on the paralysed side in a tabetic patient who became liemiplegic,has bpen recorded (Hughlings Jackson and James Taylor, Brit. Med. Journ.,vol. i, 1894). f Berger says 97 per cent. J LAbundo, La Psych iatria, 1889, vii, p. 286. 456 SPINAL CORD. medium size or still larger, and tlien I have usually found tliat thesldn-reflex can be obtained, although the light-reflex cannot. Theyare often not perfectly circular, and are frequently unequal. Both eyesare usually affected in the same manner ; occasionally the reflex actionis lost in one and only lessened in the other; this is true also ofaccommodation ; indeed, almost every possible condition is occasionallymet with. On the other hand, the intra-ocular muscles may beunaffected even in advanced cases. According to Berger the ocularte ui IS often lessened. Paralysis of the external ocular muscles is also common in tabes,and occurs in several forms. (1) Transient weakness lasting a few. Fia. 119.—^Unilateral tabetic ptosis, Fig. 120.—Double tabetic ptosis. days or weeks, and then passing away. (2) Permanent paralysis,complete or incomplete, of a single nerve or part of a nerve. Eitherform may occur at any stage, but the first is most common in theearly, and the second in the later stages of the disease. The transientpalsy renders diplopia a common symptom in the early period; anymuscle may be affected, but the external rectus is that which mostfrequently suffers. Transient ptosis may precede an almost completeexternal ophthalmoplegia. The persistent palsy may affect one or moremuscles; often the levator is involved, causing what has been termedtabetic ptosis (Figs. 119 and 120). Sometimes the whole third nerveis paralysed. (3) There may be a combined palsy, suggesting a central * Fi om a Salpetriere photograph, for which I am indebted to M. Charcot. LOCOMOTOE ATAXY. 457 origin—as, for instance, loss of tlie movement
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