where very meagre. If tested electrically, the muscles exhibit to perfection the reaction of degeneration. If the knee reflex be tested in the usual way, after the first week of the disease there will be no response whatever; nor can any clonus be elicited. As a rule, all the deep reflexes are lost; but the superficial reflexes, unless in extreme conditions of paresis and muscular atrophy, are usually present and more or less active. If, in severe cases, the patient is set to button his jacket or to pick up a pin, possibly he has a difficulty about it, or perhaps he cannot; he may bungle and fumble like an advanced ataxic.
There is more than ataxia, however; for the hand grasp is so enfeebled that the patient may have a difficulty in holding his rice bowl as well as in feeding himself. There is no tremor of the hands; and never or very rarely is there any paresis of the ocular muscles, or of the muscles of the face, of mastication, of the tongue, or of the pharynx. The sphincters and bladder operate satisfactorily, and the functions of the alimentary canal are carried on fairly well, although there is often some dyspeptic distension and oppression after food. On the patient being got out of bed and started to walk, if he is able to progress at all, his gait will be markedly ataxic; but he is not ataxic merely, for, just as with the hands, it will "be seen that, in addition to want of co-ordinating power, there is great muscular weakness. If he is laid on the bed and asked to raise his legs, he is perhaps hardly able to get them off the mat, to cross them, or to place them one foot on top of the other. Very probably he is the subject of marked ankle-drop, so that he drags his toes when he attempts in walking to advance the foot; he has therefore to raise the foot very high, letting it fall on the ground with a flop when he brings it down again. His ataxia and his muscular weakness, as well as the partial anæsthesia from which he suffers, force him to adopt a variety of devices to assist him in progression (Fig. 75). Manifestly these patients are suffering from some form of peripheral neuritis.
The general health is good for the most part;
