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2 THINKING LIKE AN ECONOMIST
W HA T ’S N E W IN T HE E IG HT H E DI T IO N :
There is a new Ask the Experts feature on "Ticket Resale."
LEARNING OBJECTIVES:
By the end of this chapter, students should understand:
how economists apply the methods of science.
how assumptions and models can shed light on the world.
two simple models—the circular flow and the production possibilities frontier.
the difference between microeconomics and macroeconomics.
the difference between positive and normative statements.
the role of economists in making policy.
why economists sometimes disagree with one another.
CONTEXT AND PURPOSE:

Chapter 2 is the second chapter in a three-chapter section that serves as the introduction of the text.
Chapter 1 introduced ten principles of economics that will be revisited throughout the text. Chapter 2
develops how economists approach problems while Chapter 3 will explain how individuals and countries
gain from trade.
The purpose of Chapter 2 is to familiarize students with how economists approach economic
problems. With practice, they will learn how to approach similar problems in this dispassionate systematic
way. They will see how economists employ the scientific method, the role of assumptions in model
building, and the application of two specific economic models. Students will also learn the important
distinction between two roles economists can play: as scientists when we try to explain the economic
world and as policymakers when we try to improve it.
13
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system for classroom use.
14 ❖ Chapter 2/Thinking Like an Economist
KEY POINTS:
 Economists try to address their subject with a scientist’s objectivity. Like all scientists, they make
appropriate assumptions and build simplified models to understand the world around them. Two
simple economic models are the circular-flow diagram and the production possibilities frontier.
 The field of economics is divided into two subfields: microeconomics and macroeconomics.
Microeconomists study decision making by households and firms and the interactions among
households and firms in the marketplace. Macroeconomists study the forces and trends that affect
the economy as a whole.
 A positive statement is an assertion about how the world is. A normative statement is an assertion
about how the world ought to be. When economists make normative statements, they are acting
more as policy advisers than as scientists.
 Economists who advise policymakers sometimes offer conflicting advice either because of differences
in scientific judgments or because of differences in values. At other times, economists are united in
the advice they offer, but policymakers may choose to ignore the advice because of the many forces
and constraints imposed by the political process.
CHAPTER OUTLINE:
I. The Economist as Scientist
A. Economists Follow the Scientific Method.
1. Observations help us to develop theory.
2. Data can be collected and analyzed to evaluate theories.
3. Using data to evaluate theories is more difficult in economics than in physical science
because economists are unable to generate their own data and must make do with whatever
data are available.
4. Thus, economists pay close attention to the natural experiments offered by history.
B. Assumptions Make the World Easier to Understand.
1. Example: to understand international trade, it may be helpful to start out assuming that there
are only two countries in the world producing only two goods. Once we understand how
trade would work between these two countries, we can extend our analysis to a greater
number of countries and goods.
2. One important role of a scientist is to understand which assumptions one should make.
3. Economists often use assumptions that are somewhat unrealistic but will have small effects
on the actual outcome of the answer.
C. Economists Use Economic Models to Explain the World around Us.
Chapter 2/Thinking Like an Economist ❖ 15
To illustrate to the class how simple but unrealistic models can be useful, bring a
road map to class. Point out how unrealistic it is. For example, it does not show
where all of the stop signs, gas stations, or restaurants are located. It assumes that
the earth is flat and two-dimensional. But, despite these simplifications, a map
usually helps travelers get from one place to another. Thus, it is a good model.
1. Most economic models are composed of diagrams and equations.
2. The goal of a model is to simplify reality to increase our understanding. Assumptions help to
simplify reality.
D. Our First Model: The Circular Flow Diagram
Figure 1
1. Definition of circular-flow diagram: a visual model of the economy that shows how
dollars flow through markets among households and firms.
2. This diagram is a very simple model of the economy. Note that it ignores the roles of
government and international trade.
a. There are two decision makers in the model: households and firms.
b. There are two markets: the market for goods and services and the market for factors of
production.
c. Firms are sellers in the market for goods and services and buyers in the market for
factors of production.
d. Households are buyers in the market for goods and services and sellers in the market for
factors of production.
e. The inner loop represents the flows of inputs and outputs between households and firms.
f. The outer loop represents the flows of dollars between households and firms.
E. Our Second Model: The Production Possibilities Frontier
1. Definition of production possibilities frontier: a graph that shows the combinations

of output that the economy can possibly produce given the available factors of
production and the available production technology.
Spend more time with this model than you think is necessary. Be aware that students
need to feel confident with this first graphical and mathematical model. Be deliberate
with every point. If you lose them with this model, they may be gone for the rest of
the course.
2. Example: an economy that produces two goods, cars and computers.
a. If all resources are devoted to producing cars, the economy would produce 1,000 cars
and zero computers.
b. If all resources are devoted to producing computers, the economy would produce 3,000
computers and zero cars.
c. More likely, the resources will be divided between the two industries, producing some
cars and some computers. The feasible combinations of output are shown on the
production possibilities frontier.
Figure 2
You may want to include time dimensions for variables. This will help students to
realize that a new production possibilities frontier occurs for each period. The axes
show the levels of output per period.
ALTERNATIVE CLASSROOM EXAMPLE:

A small country produces two goods: mp3 players and music downloads. Points on a
production possibilities frontier can be shown in a table or a graph:
A B C D E
mp3 Players 0 100 200 300 400
Music Downloads 70,000 60,000 45,000 25,000 0
The production possibilities frontier should be drawn from the numbers above.
Students should be asked to calculate the opportunity cost of increasing the number of mp3
players produced by 100:
 between 0 and 100
3. Because resources are scarce, not every combination of computers and cars is possible.
Production at a point outside of the curve (such as C) is not possible given the economy’s
current level of resources and technology.
It is useful to point out that the production possibilities frontier depends on two
things: the availability of resources and the level of technology.
4. Production is efficient at points on the curve (such as A and B). This implies that the
economy is getting all it can from the scarce resources it has available. There is no way to
produce more of one good without producing less of another.
5. Production at a point inside the curve (such as D) is inefficient.
a. This means that the economy is producing less than it can from the resources it has
available.
b. If the source of the inefficiency is eliminated, the economy can increase its production of
both goods.
6. The production possibilities frontier reveals Principle #1: People face trade-offs.
a. Suppose the economy is currently producing 600 cars and 2,200 computers.
b. To increase the production of cars to 700, the production of computers must fall to
2,000.
7. Principle #2 is also shown on the production possibilities frontier: The cost of something is
what you give up to get it (opportunity cost).
a. The opportunity cost of increasing the production of cars from 600 to 700 is 200
computers.
b. Thus, the opportunity cost of each car is two computers.
8. The opportunity cost of a car depends on the number of cars and computers currently
produced by the economy.
a. The opportunity cost of a car is high when the economy is producing many cars and few
computers.
b. The opportunity cost of a car is low when the economy is producing few cars and many
computers.
9. Economists generally believe that production possibilities frontiers often have this bowed-out
shape because some resources are better suited to the production of cars than computers
(and vice versa).
Be aware that students often have trouble understanding why opportunity costs rise
as the production of a good increases. You may want to use several specific
examples of resources that are more suited to producing cars than computers
(e.g., an experienced mechanic) as well as examples of resources that are more
suited to producing computers than cars (e.g., an experienced computer
programmer).
10. The production possibilities frontier can shift if resource availability or technology changes.
Economic growth can be illustrated by an outward shift of the production possibilities
frontier.
Figure 3
You may also want to teach students about budget constraints at this time (call them
“consumption possibilities frontiers”). This reinforces the idea of opportunity cost,
and allows them to see how opportunity cost can be measured by the slope. Also, it
will introduce students to the use of straight-line production possibilities frontiers
(which appear in Chapter 3). However, be careful if you choose to do this as students
often find the difference between straight-line and concave production possibilities
frontiers challenging.
ALTERNATIVE CLASSROOM EXAMPLE:

Ivan receives an allowance from his parents of $20 each week. He spends his entire
allowance on two goods: ice cream cones (which cost $2 each) and tickets to the movies
(which cost $10 each).
Students should be asked to calculate the opportunity cost of one movie and the opportunity
cost of one ice cream cone.
Ivan’s consumption possibilities frontier (budget constraint) can be drawn. It should be noted
that the slope is equal to the opportunity cost and is constant because the opportunity cost is
constant.
Ask students what would happen to the consumption possibilities frontier if Ivan’s allowance
changes or if the price of ice cream cones or movies changes.
F. Microeconomics and Macroeconomics
1. Economics is studied on various levels.
a. Definition of microeconomics: the study of how households and firms make

decisions and how they interact in markets.
b. Definition of macroeconomics: the study of economy-wide phenomena,

including inflation, unemployment, and economic growth.
2. Microeconomics and macroeconomics are closely intertwined because changes in the overall
economy arise from the decisions of individual households and firms.
3. Because microeconomics and macroeconomics address different questions, each field has its
own set of models which are often taught in separate courses.
II. The Economist as Policy Adviser
A. Positive versus Normative Analysis
1. Example of a discussion of minimum-wage laws: Portia says, “Minimum-wage laws cause

unemployment.” Noah says, “The government should raise the minimum wage.”
2. Definition of positive statements: claims that attempt to describe the world as it is.
3. Definition of normative statements: claims that attempt to prescribe how the world
should be.
4. Positive statements can be evaluated by examining data, while normative statements involve
personal viewpoints.
5. Positive views about how the world works affect normative views about which policies are
desirable.
Use several examples to illustrate the differences between positive and normative
statements and stimulate classroom discussion. Possible examples include the
minimum wage, budget deficits, tobacco taxes, legalization of marijuana, and seat-
belt laws.
Have students bring in newspaper articles and in groups, identify each statement in
an editorial paragraph as being a positive or normative statement. Discuss the
differences among news stories, editorials, and blogs and the analogy to economists
as scientists and as policy advisers.
6. Much of economics is positive; it tries to explain how the economy works. But those who use
economics often have goals that are normative. They want to understand how to improve
the economy.
B. Economists in Washington
1. Economists are aware that trade-offs are involved in most policy decisions.
2. The president receives advice from the Council of Economic Advisers (created in 1946).
3. Economists are also employed by administrative departments within the various federal
agencies such as the Office of Management and Budget, the Department of Treasury, the
Department of Labor, the Congressional Budget Office, and the Federal Reserve.
4. The research and writings of economists can also indirectly affect public policy.
C. Why Economists’ Advice Is Not Always Followed
1. The process by which economic policy is made differs from the idealized policy process
assumed in textbooks.
2. Economists offer crucial input into the policy process, but their advice is only part of the
advice received by policymakers.
III. Why Economists Disagree
A. Differences in Scientific Judgments
1. Economists may disagree about the validity of alternative positive theories or about the size
of the effects of changes in the economy on the behavior of households and firms.
2. Example: some economists feel that a change in the tax code that would eliminate a tax on
income and create a tax on consumption would increase saving in this country. However,
other economists feel that the change in the tax system would have little effect on saving
behavior and therefore do not support the change.
B. Differences in Values
C. Perception versus Reality
1. While it seems as if economists do not agree on much, this is in fact not true. Table 1
contains 20 propositions that are endorsed by a majority of economists.
Table 1
2. Almost all economists believe that rent control adversely affects the availability and quality of
housing.
3. Most economists also oppose barriers to trade.
D. Ask the Experts: Ticket Resale
1. The first “Ask the Experts” box shows that 80% of economic experts agree that laws that
limit resale of tickets make potential audience members worse off.
Use the “Ask the Expert” questions and responses from economists throughout the
text to spark discussions. In this case, ask students their opinion on ticket scalping
laws. Discuss the opportunity for potential audience members to pay a price higher
than the stated ticket price to be able to attend the event rather than be excluded
from the event because there are no more tickets available at the stated ticket price.
IV. In the News: Why You Should Study Economics
1. Training in economics helps us to understand fallacies and to anticipate unintended

consequences.
2. This excerpt from a commencement address by Robert D. McTeer, Jr., the former President
of the Federal Reserve Bank of Dallas describes why students should study economics.
V. Appendix—Graphing: A Brief Review
Many instructors may be unaware of how much trouble beginning students have
grasping the most basic graphs. It is important for instructors to make sure that
students are comfortable with these techniques.
A. Graphs of a Single Variable
Figure A-1
1. Pie Chart
2. Bar Graph
3. Time-Series Graph
B. Graphs of Two Variables: The Coordinate System
Figure A-2
1. Economists are often concerned with relationships between two or more variables.
2. Ordered pairs of numbers can be graphed on a two-dimensional grid.
a. The first number in the ordered pair is the x-coordinate and tells us the horizontal
location of the point.
b. The second number in the ordered pair is the y-coordinate and tells us the vertical
location of the point.
3. The point with both an x-coordinate and y-coordinate of zero is called the origin.
4. Two variables that increase or decrease together have a positive correlation.
5. Two variables that move in opposite directions (one increases when the other decreases)
have a negative correlation.
C. Curves in the Coordinate System
1. Often, economists want to show how one variable affects another, holding all other variables
constant.
Table A-1
Figure A-3
a. An example of this is a demand curve.
b. The demand curve shows how the quantity of a good a consumer wants to purchase
varies as its price varies, holding everything else (such as income) constant.
c. If income does change, this will alter the amount of a good that the consumer wants to
purchase at any given price. Thus, the relationship between price and quantity desired
has changed and must be represented as a new demand curve.
Figure A-4
d. A simple way to tell if it is necessary to shift the curve is to look at the axes. When a
variable that is not named on either axis changes, the curve shifts.
D. Slope
Figure A-5
1. We may want to ask how strongly a consumer reacts if the price of a product changes.
a. If the demand curve is very steep, the quantity desired does not change much in
response to a change in price.
b. If the demand curve is very flat, the quantity desired changes a great deal when the
price changes.
2. The slope of a line is the ratio of the vertical distance covered to the horizontal distance
covered as we move along the line (“rise over run”).
slope =
y
x
3. A small slope (in absolute value) means that the demand curve is relatively flat; a large slope
(in absolute value) means that the demand curve is relatively steep.
E. Cause and Effect
1. Economists often make statements suggesting that a change in Variable A causes a change
in Variable B.
2. Ideally, we would like to see how changes in Variable A affect Variable B, holding all other
variables constant.
3. This is not always possible and could lead to a problem caused by omitted variables.
Figure A-6
a. If Variables A and B both change at the same time, we may conclude that the change in
Variable A caused the change in Variable B.
b. But, if Variable C has also changed, it is entirely possible that Variable C is responsible for
the change in Variable B.
4. Another problem is reverse causality.
Figure A-7
a. If Variable A and Variable B both change at the same time, we may believe that the
change in Variable A led to the change in Variable B.
b. However, it is entirely possible that the change in Variable B led to the change in Variable
A.
c. It is not always as simple as determining which variable changed first because individuals
often change their behavior in response to a change in their expectations about the
future. This means that Variable A may change before Variable B but only because of the
expected change in Variable B.
There are two very good examples in the text that you should use in class. To
discuss the omitted variable problem, point out to students that a rise in the sales of
cigarette lighters is positively related to the number of individuals diagnosed with
lung cancer. To discuss reverse causality, show that an increase in minivan sales is
followed by an increase in birth rates.
SOLUTIONS TO TEXT PROBLEMS:

Quick Quizzes
1. Economics is like a science because economists devise theories, collect data, and analyze the data in
an attempt to verify or refute their theories. In other words, economics is based on the scientific
method.
Figure 1 shows the production possibilities frontier for a society that produces food and clothing.
Point A is an efficient point (on the frontier), point B is an inefficient point (inside the frontier), and
point C is an infeasible point (outside the frontier).
Figure 1
The effects of a drought are shown in Figure 2. The drought reduces the amount of food that can be
produced, shifting the production possibilities frontier inward. (If a drought also reduced the amount
of cotton available for the production of clothing, the intercept on the vertical axis would also
decrease.)
Figure 2
Microeconomics is the study of how households and firms make decisions and how they interact in
markets. Macroeconomics is the study of economy-wide phenomena, including inflation,
unemployment, and economic growth.
2. An example of a positive statement is “a higher price of coffee causes me to buy more tea.” It is a
positive statement because it is a claim that describes the world as it is. An example of a normative
statement is “the government should restrain coffee prices.” It is a normative statement because it is
a claim that prescribes how the world should be. Many other examples are possible.
Parts of the government that regularly rely on advice from economists are the Department of the
Treasury in designing tax policy, the Department of Labor in analyzing data on the employment
situation, the Department of Justice in enforcing the nation’s antitrust laws, the Congressional Budget
Office in evaluating policy proposals, and the Federal Reserve in analyzing economic developments.
Many other answers are possible.
3. Economic advisers to the president might disagree about a question of policy because of differences
in scientific judgments or differences in values.
Chapter Quick Quiz
1. c
2. a
3. b
4. c
5. d
6. a
Questions for Review
1. Economics is a science because economists use the scientific method. They devise theories, collect
data, and then analyze these data in an attempt to verify or refute their theories about how the world
works. Economists use theory and observation like other scientists, but they are limited in their ability
to run controlled experiments. Instead, they must rely on natural experiments.
2. Economists make assumptions to simplify problems without substantially affecting the answer.
Assumptions can make the world easier to understand.
3. An economic model cannot describe reality exactly because it would be too complicated to
understand. A model is a simplification that allows the economist to see what is truly important.
4. There are many possible answers.
5. There are many possible answers, including interactions involving government or international trade.
6. Figure 3 shows a production possibilities frontier between milk and cookies (PPF1). If a disease kills
half of the economy's cow population, less milk production is possible, so the PPF shifts inward
(PPF2). Note that if the economy produces all cookies, it does not need any cows and production is
unaffected. But if the economy produces any milk at all, then there will be less production possible
after the disease hits.
Figure 3
7. An outcome is efficient if the economy is getting all it can from the scarce resources it has available.
In terms of the production possibilities frontier, an efficient point is a point on the frontier, such as
point A in Figure 4. When the economy is using its resources efficiently, it cannot increase the
production of one good without reducing the production of the other. A point inside the frontier, such
as point B, is inefficient since more of one good could be produced without reducing the production
of another good.
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disturbances of bladder function have been described as vesical
crises, and recent French observers have observed so-called crises
clitoridiennes in female tabic patients which were characterized by
voluptuous sensations. All of these symptoms have these in
common: that they last but a short time, that their disappearance is
as rapid as their advent, and that they depend for their distribution on
the attitude of the disease in the cord. The vesical crises are more
apt to occur early than late in the disease and where the belt
sensation is in the hypogastric region. The gastric and enteric crises
are usually found when the belt is in the epigastric level, and the
bronchial, cardiac, and laryngeal crises when it is in the thorax and
neck. Some connection has been observed between the occurrence
of the lightning-like pains and these crises. Thus, a sudden cessation
of the former is sometimes the forerunner of the latter. It is also
found that one variety of these crises disappears to give way to
another: this is particularly noticed with the bronchial crises, which
often cease suddenly, to be followed by vomiting.
22 Krause, in a paper read before the Society of Neurologists at Berlin
(Neurologisches Centralblatt, 1885, p. 543), found either laryngeal crises or other
laryngeal symptoms, such as demonstrable ataxia of movement of the vocal cords, in
13 out of 38 cases. This proportion would be far too high for tabes in general; his
cases were probably advanced ones. He established the interesting fact that the
laryngeal crisis may sometimes be provoked by pressure with a probe on the superior
laryngeal nerve at its laryngeal entry-point. Jastrowitz claims to have determined the
existence of actual paralysis of the vocal cords with the crises, but Krause concludes
from the experimental inductibility of the crisis that it cannot be due to a posticus
paralysis. In a discussion on the subject Remak affirms that a unilateral paralysis of
the crico-arytenoideus posticus may be an early or the earliest symptom of tabes. It
seems, however, that in all cases where he determined such paralysis there had been
disturbances of function of other cranial nerves in unusual severity at about the same
time.
23 They must be extremely rare: they have not occurred in a single one of my 81
private cases, nor do I recall one in clinic or dispensary experience.
There is some analogy between the exceptionally-occurring mental
disturbance of tabic patients and the crises. Like them, it resembles
a disturbance of innervation, in this instance the centres regulating
the cerebral circulation appearing to be at fault. It also seems as if in
cases of this character the direction of the mental disturbance were
determined in some sense by the emotional relations of the
oblongata, for the insane outbreak usually consists in a brief but
extreme outburst either of a depressed and melancholiac or an
expansive maniacal or delirious outburst. It is a very rare occurrence,
and usually limited to the latest stages. Much more common is the
development of paretic dementia, but this is to be regarded rather as
a complication than an integral feature of tabes. Most tabic patients
retain their mental equilibrium to the last moment; some develop
truly heroic resignation to their terrible sufferings and gloomy
prospects; and a few, becoming irritable, petulant, and abnormally
selfish, show the effect of invalidism manifested equally with other
chronic diseases.
In addition to the visceral crises there are other disturbances of

innervation of a nutritive or trophic character which are characteristic
of tabes. There is scarcely one of the eruptions or other changes
which are attributable to central nervous disease which may not
occur at some one or other period of this disease. Thus, herpetic
eruptions may occur independently or in conjunction with lancinating
pains, in one case even corresponding to the area of the belt
sensation. Discoloration of the skin or hair, the latter turning gray or
white in circular24 or in irregular patches, spontaneous falling of the
nails, spontaneous hemorrhages in the matrix of the nail,
ichthyosis,25 purpura, diffuse œdemas, localized perspiration
sometimes associated with sudamina and accompanied by
ecchymoses, muscular atrophies, bullæ, and pemphigus-like
eruptions, have been noted by various observers. As yet, they are to
be regarded rather as clinical curiosities than as constant features,
as diagnostic criteria, or as presenting special indications for
treatment. The trophic disturbances affecting the bones and joints
and a peculiar ulcerative process known as the perforating ulcer of
the foot are better studied, and, ranking among the most formidable
and striking manifestations of tabes, merit special consideration. The
tabic joint affection, first described by Charcot as a trophic
manifestation of tabes, is usually located in the hip or knee, but
almost any joint, including the temporo-maxillary articulation, may be
its seat. The earlier or lighter forms consist in serous exudations with
or without active local manifestations resembling those of synovitis;
but the commoner and graver form consists in actual deformity of the
articular surfaces, such as enlargement or atrophy, sometimes
supplemented by the formation of osteophytes. In addition,
spontaneous dislocations occur in a manner which is often quite
surprising.26 As a type of such an occurrence the following may
serve: A tabic patient presented a synovial swelling of the left knee
of truly enormous dimensions; as soon as this became reduced a
distinct crepitus was elicited, and both the femoral and tibial articular
surfaces found enlarged. The whole process occupied only a few
days; the lateral ligaments were then found so relaxed that the leg
could be freely moved in every direction.
24 Rossolymmo, Archiv für Psychiatrie, xv. p. 727. I have never observed this
symptom as beautifully developed as in a case of spinal irritation, in which the
possibility of the existence of any organic disease could be positively excluded.
Bulkley has observed albinism.
25 In three cases by Ballet et Dutil, Progrès médicale, May 19, 1882.
26 Boyer (Revue de Médecine, 1884, p. 487) records a case where the hip became
luxated spontaneously as an early symptom.
The connection between the morbid process in the spinal cord and
these remarkable arthropathies is as yet unexplained; and as
Charcot's original proposition, that they can be always referred to
lesions in the anterior horns of the gray matter, has not been
sustained, some of the German clinicians, notably Strümpell, are
inclined to attribute them, in part at least, to ordinary results and
accidents due to the anæsthesia and its disturbing effect on
voluntary and automatic joint protection. A controversy arose which
was participated in by the Clinical Society of London,27 and evoked
opinions from nearly all the eminent neurologists of Europe. The
result of this thorough discussion has been to establish the joint
affection as a true tabic symptom due to the same morbid process
which underlies the less enigmatical symptoms of the disease. One
of the best reasons for regarding these joint lesions as of trophic
origin is the fact that they are associated with textural bone-changes
by which they become either unduly soft or brittle, and therefore
exposed to apparently spontaneous fracture. Cases of fracture of
almost every long and some of the short bones are recorded, among
the most remarkable being one by Dutil,28 where fracture of the
radius occurred without adequate cause in the initial period of tabes;
and one by Krönig,29 in which the patient, who had been tabic for
eight years, broke a lumbar vertebra while catching himself in the act
of falling down stairs.
27 The question was formally raised by Morrant Baker at the December meeting in
1884, and the discussion participated in by Charcot himself. Among the opponents of
Charcot's theory were Jonathan Hutchinson and Moxon, the latter of whom
administered a sound and well-merited criticism regarding some of the premature, if
not sensational, announcements of the distinguished French neurologist. He
compared the joint lesions of tabes to decubitus: just as the latter can be avoided by a
proper protection of the exposed parts, so the former would not occur if the joints
could be kept in a, surgically speaking, normal state. Moxon seems to have forgotten,
in suggesting this comparison, that there is a form of decubitus which will occur
independently of the greatest care and in spite of every measure taken to arrest it,
and which can be attributed only to an obscure but active perversion of nervous
nutritive control. Barwell, Paget, Herbert Page, Broadbent, and McNamara agreed
that the joint lesions are not of surgical or rheumatic origin, but essentially signs of the
nervous affection. Although Barwell's claim, that the rheumatic and tabic joint
diseases are essentially different, because the former is hyperplastic and the latter is
atrophic, is not borne out by all cases of tabic joint disease, some of which are
certainly hyperplastic, yet the other reasons advanced for regarding these affections
as distinct, and considering the joint affection of Charcot as a trophic disorder, far
outweighed those advanced by the opponents of this view. In fact, the only ground the
latter had to stand on was the fact that Charcot's asserted anatomical foundation was
found to be chimerical.
28 Gazette médicale de Paris, 1885, No. 25.

29 Zeitschrift für klinische Medizin, 1884, vii., Suppl. H.
Another reason for considering the arthropathies as of central origin

is their chronological association with other signs whose trophic
origin cannot be disputed, such as unilateral sweats and œdemas
and visceral crises. They are also found to correspond in many
cases to the lancinating pains both in location and time.
The feet of an advanced tabic patient usually appear deformed; the

extremities of the bones, particularly at the metacarpo-phalangeal
articulation, are thickened, and the axis of the foot as a whole is
bent. It is a question how far this deformity may be due to persistent
faulty innervation of the muscles going to the foot and to ensuing
mechanical influences. A most pronounced deformity found in a few
cases has been designated by Féré as the tabic foot.30 It consists in
the thickening of the tissues on the inner side of the foot, obliterating
its arch in such a manner that in standing the plantar surface is
everywhere in contact with the floor. With this the tarso-metatarsal
and the metacarpo-phalangeal joints of the great toes appear greatly
swollen.
30 Pied tabétique—Revue de Médecine, 1884, p. 473.
There is less dispute concerning the nature of the so-called

perforating ulcer of the foot. This lesion occurs only in cases where
the central or peripheral nervous apparatus is diseased; thus, it may
occur with neuritis, and it is therefore unanimously regarded as due
to morbid nervous influences. In tabes it may follow an exacerbation
of the fulminating pains. It consists in a swelling of the tissues of the
foot; the skin becomes firm and thickened; deep sinuous ulcers are
then developed, showing but slight if any tendency to granulate, and
which extend down to the bone, the latter usually remaining
unaffected.31 In a few cases more remarkable accidents due to
disturbed nutrition have been noted. Thus, J. Hoffmann records a
subcutaneous rupture of the Achilles tendon, and in another case the
spontaneous discharge of all the teeth of the upper jaw within about
a week's time.32
31 Like most of the manifestations of advanced tabes, the perforating ulcer may occur
exceptionally as a pre-ataxic symptom. Thus, Suckling (British Medical Journal, 1885,
April 4, p. 693) mentions its preceding the development of tabes proper by one year.
32 Berliner klinische Wochenschrift, 1885, No. 12. In this unique case the loosening
and falling out of the teeth preceded the tabes by a year. Demange, who observed the
same phenomenon in two cases, found that the ascending root of the fifth pair was
involved. The only analogous observation in my experience relates, like the bleaching
of the hair in circular patches, to a case of spinal irritation: here the gums and alveolar
borders underwent atrophy, exposing the roots of the teeth to beyond the normal
alveolar border: first the right upper row, then the right lower row, and finally the teeth
on the left side in the same order, showed this condition; only the most posterior fell
out.
COURSE.—Tabes dorsalis is to be regarded as an extremely chronic

affection. Its development, as previously stated, is insidious,33 and
the symptoms demonstrating the advent of the disease may be so
slight for many years that the patient does not regard himself as ill or
as likely to become so. In this condition he may remain for ten or
more years; and there are cases recorded where the exact signs of
the incipient stage were well marked, and yet no ascertainable
progress was made in a period of such long duration that the
inference naturally follows of a much longer prospective period in
which the patient would not have become ataxic. There may be
distinguished two forms of invasion: the more frequent is marked by
the development of the terebrating, fulgurating, and fulminating
pains, to which, sooner or later, the abolition of the pupillary and
certain other deep reflexes is added. In the vast majority of cases
they are found absent when the physician's attention is directed to
the question of the existence of spinal disease. In about one-fifth of
the cases pain is at no time a prominent feature of the disease, and
may be, as is established by the cases cited, entirely absent. In
these patients the first symptoms noted are muscle-tire on slight
exertion. Usually, the evidences of disturbed sensation and
innervation begin in one extremity or preponderate in it, but
symmetry is soon established. The same is noticed in the extension
of the morbid process: when the ulnar distribution is involved—which
is the first danger-signal on the part of the cervical enlargement of
the cord—usually one side is first involved, but the other soon
follows, and becomes affected in equal or nearly equal degree. In
the overwhelming majority of cases the disease manifests itself in
the lower extremities first, remaining limited to them for a long
period, and if extending to the upper extremities doing so in much
slighter intensity than in the lower. Gull, Leyden, and others have
observed cases where the arms were first and chiefly involved; but
this is extremely rare. Cases of a simultaneous involvement of the
upper and lower extremities are more frequently noted. The
symptoms detailed above are developed in varying order in different
patients, and the line has been already indicated which separates
the progressive from the episodial features of the disease. Even in
the ataxic period the patients may remain in a comparatively
stationary period for many months and years.34 The general bodily
nutrition is usually good, and the muscular strength, as such, rarely
affected to any noteworthy extent until the extreme phase of the
disease is reached. Even the formidable-appearing crises and
trophic disturbances, though occasionally fatal, are not always so.
The direct danger from the disease proper, so far as life is
concerned, is in the possible development of cystitis and pyelitis, of
the malignant bed-sore, and of delirium and coma, the latter of which
is occasionally found to be due to cerebral hemorrhage—a lesion
which some writers regard as possibly due to some impalpable
influence of the spinal disease on the cerebral circulation.35
33 Cases of acute locomotor ataxia have been described. In no instance are they pure
or typical, and the last case of the kind published in America, beginning, as it is
evident from the account, with signs of general myelitis, illustrates the impropriety of
utilizing one or a few symptoms as determining nomenclature.
34 Thirteen patients are now under my observation, or I have been able to obtain
reliable medical information concerning their condition, who have been in the ataxic
period since the date of my first examination, varying from a year to seven years ago.
Not one of these patients is materially much worse than at that time. Two only died,
both being bedridden at the time they came under observation. Of the first group,
three have shown more or less lasting improvement in respect to special symptoms,
as will be detailed in connection with the treatment.
35 In a case of sudden death, with an asthma-like seizure, of a tabic patient under the
charge of T. A. McBride, I found an intense injection of one (the right) vagus nucleus,
the color of the ala cinerea and of the nucleus on section being almost black.
MORBID ANATOMY AND PHYSIOLOGY.—Our knowledge of the structural

disease underlying the symptoms which comprise the clinical picture
of tabes dorsalis is perhaps the clearest in the domain of spinal
pathology. Not alone the commencement of the morbid process and
every stage of its subsequent encroachment on the spinal cord, but
also its relations to special symptoms, have been demonstrated in
numerous cases by some of the most careful German and French
investigators.
In advanced cases of tabes the disease of the spinal cord is so

evident that it was noted even by earlier observers, the region of the
cord lying between the posterior nerve-roots being altered in color,
consistency, and dimensions. It is gray instead of white, hard instead
of soft, and considerably shrunken. The gray discoloration of the
surface appears to be complete in the lumbar and lower dorsal
region; it is less intense in the upper dorsal and cervical part of the
cord; and often shows a division into three streaks, of which one, in
the middle line, occupies both columns of Goll, while on either side
another extends in the inner side of the posterior root-entry. The
posterior roots themselves are frequently atrophied, and exhibit a
firmer consistency and darker color than in health. On making cross-
sections of the spinal cord it is found that the gray discoloration
extends inward, involving more or less of the posterior columns in
well-defined areas. Microscopic examination shows that the myelin
of the nerve-tubes is either destroyed or atrophied, and the axis-
cylinder is found to be affected in the same way, usually presenting
alterations in its refraction and diameter where it is not entirely
destroyed. In the maximum foci of disease the conducting elements
of the cord are nearly destroyed, and their place is occupied by a
firm connective substance made up of wavy bundles, enclosing here
and there a few atrophied axis-cylinders with wasted myelin-sheaths.
The blood-vessels participate in the morbid process, at least as far
as the larger vessels are concerned: these are sclerotic, their lumen
appears contracted, the adventitial sheath is hypertrophied and
occupied by a nucleated, fibrillar connective substance. The
capillaries are sometimes normal, or participate in the morbid
process to the extent of a thickening of the extra-endothelial sheaths
which is either hyaline or fibrillary, and may show inflammatory cell-
proliferation. It is evident that the increase of connective tissue in the
posterior columns is not merely a relative one, due to the
condensation of the normal neuroglia after the disappearance of the
normal nerve-tubes, but is the result of actual proliferation. Opinion is
somewhat divided as to whether this is to be considered as an
inflammatory interstitial proliferation or as a more passive
development of tissue compensating for the destroyed conducting
elements. My own observations incline me to the belief that in
syphilitic tabes the morbid process is essentially interstitial, while in
non-syphilitic tabes it is parenchymatous, the disease beginning in
the nerve-tubes proper. Perhaps the controversies between
pathologists as eminent as Schultze, Tuczek, Rumpf, Zacher,
Kahler-Pick, Rosenstein, and Adamkiewicz—who are rather evenly
divided into opposing camps, one maintaining the parenchymatous,
the other the interstitial, origin of the disease—may be solved when
we learn to distinguish between the non-syphilitic and syphilitic
cases, which is clinically, as yet, impossible. The difficulty of deciding
what is a parenchymatous and what is an interstitial disease of the
cord is considerably enhanced by the fact that the neuroglia, which
by some at least is regarded as an interstitial connective tissue, is
derived, like the nerve-substance proper, from the upper or neuro-
epidermic germ-layer of the embryo, and not from the mesoblast,
which furnishes all other connective substances in the body.
It is regarded as well established that the sclerosis of the areas of

the spinal cord which are affected is preceded by a stage of granular
degeneration.36 This is supported by the facts that the sclerotic areas
are surrounded by a zone in which sclerosis has not yet developed,
but which is in a state of granular degeneration, and that in more
advanced tabes this belt is also found sclerosed. In paretic
dementia, a disease whose complicating cord affection closely
resembles that of locomotor ataxia, a granular degeneration of the
posterior columns is very common in earlier periods, while in later
periods a sclerotic tissue is found in the same locality.
36 Westphal, Archiv für Psychiatrie, ix. p. 725.
I regard these observations as opposed to the assumption of

Strümpell that tabes is a system-disease of the cord in the sense in
which he employs that term. In his fascinating and suggestive thesis
on the systemic affections he cites the observations of Tuczek made
on the posterior sclerosis ensuing from ergotism as confirming his
view that special systems of nerve-fibres are separately vulnerable
to special morbid influences. The remarkable correspondence
between the topographical distribution of the lesion of ergotin tabes
described by Tuczek and the characteristic areas of sclerosis found
in the column of Burdach in ordinary tabes, seems to justify a very
different conclusion. Ergot exerts its morbid influence through a
disturbance of nutrition. Just as it produces gangrene by constriction
of the nutritive vessels of the fingers and of whole extremities, so it
produces interference with nutrition of those nerve-elements in the
cord which are most liable to suffer from general arterial constriction.
These are presumably those portions which are supplied by the
longest and narrowest arterial stems—a condition obtaining in
precisely those parts of the cord which are affected both in ergotin
tabes and in ordinary tabes.
It has also been supposed that the morbid process began in the
posterior roots and crept in with these, thence extending upward.37
This view is opposed by the fact that there is no constant relationship
between the root lesion and the cord lesion; the sclerosis of the root-
zones within the columns of Burdach I found to be absolute in at
least one case where the outer nerve-roots were not distinctly
affected.38
37 Takacs is the most recent defender of this view.
38 The root lesion may, like that of the column of Goll, according to a minority of the
interpreters, be a secondary process, for in ergotin tabes (Tuczek) both are usually
intact.
In typical tabes the sclerotic process begins in a special triangular

field of the posterior column in the lumbar enlargement of the cord.
The innermost of the posterior rootlets run through this field, which
has been designated by the French school as the posterior root-
zones, and the rootlets become exposed to all the vicissitudes which
the conducting tracts are destined to undergo in consequence.
Throughout the remainder of the cord it is the involvement of the
root-zone which indicates the advance of the affection upward. At a
time when the lesion is comparatively slight in the cervical level,
manifesting itself by a slight grayish or reddish streak to the naked
eye, a faint, pale discoloration in chromic-acid specimens, a deeper
stain in carminized, and a pallor in sections stained by Weigert's
method, the affected part in the lumbar region has undergone great
shrinkage; scarcely a single myelin-tube is preserved to receive
Weigert's stain within the affected area; the latter involves nearly the
entire field between the cornua, and absorbs carmine deeply, so that
it is difficult to differentiate the gray and white substance in
carminized sections. A small part of the posterior column which most
closely adjoins the posterior (gray) commissure remains free in all
cases; so also does a small laurel-leaf-shaped field bisected by the
posterior median septum. Examination with higher magnifying
powers, aided by the modern improved methods of preservation and
staining, reveals that the gray substance of the posterior segment of
the cord is usually more or less diseased. In advanced cases the
gelatinous as well as the spongy part of the posterior gray horn, and
even the posterior gray commissure, undergo such considerable
atrophy that they may occupy but half the normal area. In some
cases the columns of Clarke appear to be involved quite early in the
disease.39
39 Leyden discovered the degeneration in the fibres which in part make up these
columns and correctly traced its origin to the posterior rootlets. Lissaner and Zacher
(Archiv für Psychiatrie, xv. p. 437) confirmed him, the latter finding, as Leyden was the
first to discriminate, that the cells may escape while the fibres are materially
diminished. Krause claims that the columns of Clarke are constantly affected, but not
necessarily in their entire length, the higher levels appearing quite normal at a time
when the lower are severely involved (Neurologisches Centralblatt, 1884, p. 50).
The triangular field in the lumbar part of the posterior column, which
is one of the typical starting-points of the affection, contains those
ascending nerve-bundles which in their cephalic course emancipate
themselves from the column of Burdach and constitute the slender
columns of Goll. The result is that the degenerative process creeps
up these columns at the same time that it ascends in the root-zones
and deep portions of Burdach's columns. Some authorities regard
this as a mere extension by contiguity;40 others incline to consider it
a secondary degeneration. It may extend to the medulla oblongata,
becoming lost in the level where the nucleus of the column of Goll
terminates, and is accompanied, at least in those advanced cases in
which the upper extremities are involved, by a comma-shaped area
of degeneration in the adjoining part of the column of Burdach, which
similarly extends into the oblongata and terminates slightly more
cephalad. In typical advanced tabes, therefore, the cross-section of
the cord exhibits a characteristic distribution of the sclerosis in each
level. As this distribution is associated with certain constant
symptoms, it is permissible to attempt bringing certain features of the
lesion in relation with special features of the disease symptoms. The
posterior gray horns and the posterior white columns, together with
other fibre-systems connected with them, are much more
complicated in structural and physiological relations than the
corresponding anterior structures. The relations of the anterior
rootlets to the gray substance, and those of the motor ganglionic
elements to their controlling tracts, are comparatively simple; those
of the posterior roots are very intricate. They run up, in great part, at
an angle to the longitudinal tracts; a few pass in directly, and still
fewer dip to a lower level. The result is that a section of the cord
made in the longitudinal direction through the root-zones, so as to
pass from the root-entry to the anterior commissure, shows the
column and root-fibres to be woven into each other like a plait.
Trabeculæ of connective tissue, dragged in as it were with the
posterior roots, fill up the interstices of this labyrinth. They are
particularly dense in the lowest part of the lumbar enlargement of the
cord, constituting the so-called posterior processi reticulares. It is
reasonable to suppose that the overlapping of ascending and
descending root-fibres, associated with the presence of an extra
amount of connective tissue, imbedded as this fibre-maze is in that
part of the cord which is most distant from its lymphatic emunctories,
affords a favorable soil for slow inflammatory trouble. This is the
primary field of tabic sclerosis, and in it the disease may remain most
intense for years, extending but slowly and with diminishing intensity
upward, hand over hand, as it were, on the natural ladder which the
intertwined fasciculi and their matrix constitute. The longitudinal
tracts which lie in and near the root-zones belong to the so-called
short fibre systems, uniting the segments of higher and lower levels
of the cord with each other. As the sclerotic process ascends it
involves the caudal ends of these systems: they consequently
undergo secondary degeneration, and, shrinking in their turn, affect
the caudal part of the next system above in the same manner. The
morbid process in the column of Burdach may therefore be
considered as a combination of inflammatory and degenerative
changes, the inflammatory products causing a series of short
ascending degenerations, and the vulnerable path thus established
being followed by a cirrhotic condition in which the connective and
vascular structures participate actively. With regard to the reasons
for regarding the degeneration of the column of Goll and that of the
comma-shaped field near it as a secondary process due to the
cutting off of its apparent nerve-supply at the caudal end, and of the
posterior nerve-roots or their provisional terminations, they may be
stated in this way: When the lesion of the primary field is limited to
the lower lumbar or sacral part of the cord, the degeneration of the
column of Goll is limited to its postero-internal part; when the upper
lumbar and lower dorsal cord is involved, the entire tract is affected;
and when the cervical portion is diseased, the supplementary
comma-shaped area degenerates. In other words, the projection
tract of the sciatic nerve, as far as it is represented in Goll's column,
suffers in the first, that of the crural nerves in the second, and that of
the brachial nerves in the third instance. In all advanced cases of
tabes the affection of the column of Goll is in direct proportion to the
altitude of the lesion in the primary field. Symptomatically, it bears an
equally constant relation to the ataxia.41 No case is on record in
which these columns were totally degenerated without some motor
inco-ordination of the lower extremity having been observed during
life; and no case is recorded in which brachial ataxia had been a
marked and persistent feature in which the comma-shaped area—
area of the column of Burdach—was healthy.
40 It is held by them that the histological character of the change of the columns of
Goll is not different from that in the column of Burdach. Zacher (Archiv für Psychiatrie,
xv. p. 435) urges that it does not resemble true secondary degeneration, beginning in
the vessels and connective substance instead of the nerve-fibres. Schultze (ibid., xiv.
p. 386), on the other hand, recognizes a primary involvement of the nerve-fibres in
both of the areas of fascicular degeneration in tabes. The observation of intact axis-
cylinders by Babinski in the sclerotic fields is in conflict with the latter's claim, and the
various differences of observation and interpretation seem to be reconcilable only on
the assumption that there are two different modes of origin, both leading to nearly the
same results and occasionally combined in one and the same case.
41 Krause's case and others show that the ataxia of movement is not influenced by
lesion of the column of Clarke; but we are not informed as to the static equilibrium of
the patients in whose cords these columns were found intensely affected.
It is scarcely necessary to seriously consider the suggestion of

Strümpell, that the lesion of the column of Goll is in relation with the
bladder disturbance.42 Cases are on record by Wolff and others
where this lesion was intense and there was little or no bladder
disturbance.43
42 Archiv für Psychiatrie, xii.
43 The column of Goll is not present in those mammals which, like the porpoise, have
no developed hind limbs, but these animals have urinary bladders.
If the disease of the column of Goll were a primary systemic affection

independent of the disease of the root-field, it would be difficult to
understand why it, as well as the likelihood of finding a
corresponding degeneration of the direct cerebellar tract, increases
with the extent to which this field is involved. This occurrence
becomes quite clear when we remember that both the direct
cerebellar tract and that of Goll, being centripetal, are under the
trophic dominion of the posterior nerve-roots. The opinion is not
distinctly expressed, but implied in some writings, that the column of
Goll degenerates because of a general transverse cord lesion at a
low level; this is not the case in the tabic cord. There is a difference
in appearance between that part of the primary field which
corresponds to the column of Goll in the lumbar cord and the
surrounding sclerosis in early cases: it is more intensely
degenerated, more homogeneous in appearance, and more evenly
stained. The other part of the triangular field presents a more
trabecular appearance. In the specimen represented in the
accompanying figure this is easily recognized: the darker field
corresponds exactly with the ascending degeneration, which follows
compression of the cauda equina,44 and is the sciatic equivalent of
the column of Goll.
FIG. 31.
Trans-section of Upper Lumbar Cord of a Patient moderately advanced in

Tabes: f, ventral or anterior fissure; g, caput gelatinosum; r r′, entry and
deep course of the posterior rootlets; d, degenerated field, including the
origin of the tracts which in higher levels form the columns of Goll; n, field
near the posterior commissure which remains free from degeneration,
both in the lumbar and cervical cord; s, sharply marked leaf-shaped field,
bisected by posterior septum, which, as claimed by Strümpell and shown
in this case, remains free from disease; z, zone of nearly normal
consistency around it; a, diseased field, suspected to be related to the
analgesia, not usually affected in early tabes; v, fibres running up and
down in front of the gelatinous substance; *, region where the tabic
process sometimes begins.
44 I have also found that this field corresponds to the column of Goll in its myelinic
development: the lumbar part of this column—designated as such by Flechsig—is an
entirely different tract, which enjoys a remarkable immunity from disease in tabes.
As illustrating the bearing of the lesion of the column of Goll on the motor ataxia I may
refer to two cases which happen to be related side by side by Strümpell (Archiv für
Psychiatrie, xii. p. 737, Cases 1 and 2). As far as the lumbar segment of the cord is
concerned, the distribution of the lesion is similar; but in the one presenting marked
motor ataxia the triangular field was slightly diseased, and there was no upward
extension of the lesion in the column of Goll. In the other, with marked ataxia, the
triangular field was intensely diseased, and ascending degeneration (?) occurred in
the sciatic fields of the latter.
In support of the view that the comma-shaped area in Burdach's columns is

homologous with the fibres of the column of Goll, it is to be advanced that
degeneration of this field bears the same relation to symptoms in the distribution of
the ulnar nerve that degeneration of the column of Goll bears to sciatic and crural
symptoms. Where the initial pains and subsequent tactile and locomotor disturbance
were severe, this field was found affected, and most so in the side where the
symptoms had been most intense (Friedreich-Schultze's cured cases, Archiv für
Psychiatrie, xii. p. 234). This area has no direct connection with the root-fields.
Secondly, in a primary system disease of the column of Goll, associated with
degeneration of the nucleus of the column of Goll, described by Scoli, an irregular
encroachment of the column of Burdach was noted. Third, the innermost fibres of the
column of Burdach (those belting the nucleus in the oblongata) have the same
relation to the interolivary layer which the column of Goll has through its provisional
nucleus of termination.
While the evidence of high lesion of the cerebral continuation of the column of Goll,
and, what I regard as its homologue, the comma-shaped area of Burdach, together
with the constant association of marked degeneration of these columns with motor
ataxia, is strong positive proof of its relation to this symptom, there is equally strong
evidence negativing its relation to any other of the prominent symptoms of tabes
dorsalis. Thus Babesin (Virchow's Archiv, lxxvi. p. 74) found degeneration of the
posterior columns limited to the column of Goll, and the patellar reflex was not
destroyed; the root-fields at the upper lumbar levels were intact. That the columns of
Goll have been found profoundly affected without bladder disturbance has been
stated previously, and constitutes a stronger argument against Strümpell's view than
the frequent observation of bladder trouble in spinal diseases, along with which these
columns may be entirely free.
Among the various constituents of the posterior columns which

appear to present a relative immunity to the disease, aside from the
area near the posterior commissure and the laurel-leaf-shaped area
of the posterior septum, Strümpell noted one which is situated at the
periphery of the cord, bordering on the entry-line of the posterior
roots and the inner contour of the posterior roots. In the few cases
where it was found destroyed there was, what is a comparatively
rare thing in moderately severe tabes, complete analgesia. It is not,
however, certain that there is a necessary connection between the
pathological and clinical fact here. The nerve-roots themselves are
involved within the diseased area of the root-zones. The lesion is
one of a kind which, affecting a nerve-trunk, would produce first
irritation of, then impediment to, and ultimately destruction of, its
function. The clinical parallel to this is the occurrence of the lightning-
like pains in the earlier phases of the disease, which are followed by
delayed pain-conduction, and finally by loss of sensation. Of the
rootlets or fibres subservient to the various sensory and reflex
functions mediated by the posterior roots, those which convey the
centripetal impression normally evoking the patellar jerk appear to be
the most vulnerable, or, because of their limited number, the earliest
to be destroyed or compressed, with the result of total functional
paralysis.45
45 It is now conceded that, as Westphal claimed, the patellar jerk is always abolished
when the upper lumbar level of the root-zones (bandelettes externes of Charcot) is
involved. Tshirijew has shown that the translation of the knee-jerk reflex occurs in a
single segment of the rabbit's cord at the homologous level. In transverse sections a
distinct fascicle may be seen coursing from the innermost root-fibres toward the
antero-intermediate cell-group of the anterior horn; it furnishes a pictorial substratum,
if not anatomical proof, for the patho-physiological observation, and harmonizes with
the fact that it is the innermost rootlets which usually suffer first. Perhaps the delicacy
of this tract accounts for the frequent disappearance of the jerk in old people as a
result of senile sclerosis.
With regard to the interpretation of the various tactile sensory

disturbances of tabes and the delayed pain-sense conduction little
positive advance has been made. That the lesion of the root-zones
and gray substance is responsible for them seems to be the general
conclusion of French and German observers. Recent researches
have shown that disease of the peripheral nerves (multiple neuritis)
may produce sensory phenomena which it had previously been
customary to regard as pathognomonic of disturbance of their
intraspinal terminations and continuations. At the same time, we are
confounded by the observation of Erb, that even retardation of
conduction of the pain-sense, which the dictum of Schiff taught us to
regard as a sign of disturbed function of the spinal gray matter, is
also produced by peripheral neuritis.
Immediately adjoining the gelatinous apex of the posterior horn there

is a column of vertical fibres which bear a relation to it resembling
that of the ascending root of the fifth pair in the oblongata to the
tuber cinereum of Rolando. Sclerosis of this column, as well as of
the ascending root in question (Demange), has been found in tabes,
and usually in association with pronounced trophic disturbances. In a
number of cases (Oppenheim, Eisenlohr, and others) where
spasmodic laryngeal crises had been a marked feature during life,
lesion of the floor of the fourth ventricle, or atrophy of the
pneumogastric nerve, or even of its nucleus, was found. In one case
with marked gastric crises I found sclerotic changes of the arteries in
the ala cinerea.
With regard to the involvement of the peripheral nerves proper, aside

from the optic, opinion is somewhat divided. The discovery of
multiple neuritis, and the recognition of the fact that it had been
erroneously confounded with tabes, led Dejerine to claim that tabes
might be of peripheral origin. He even proposed to account for the
oculo-motor trouble on the basis of an affection of the oculo-motor
nerves. This explanation has been repudiated by Westphal and
sound authorities generally. That the peripheral nerves are
occasionally involved in tabes was already known to Friedreich in
1863,46 and later Westphal found the cutaneous branches in an
advanced tabic patient to present similar changes to those
discovered by Friedreich: these findings are confirmed by his
Japanese pupil, Sakaky. The nerve-tubes are atrophied, the axis-
cylinder being often preserved, and the interneural connective
substance is proliferated. But there is no constant relation between
these changes and the symptoms of the disease; in one of Sakaky's
cases the nerves of an extremity which had been the seat of severe
sensory symptoms were entirely normal. The findings in the
peripheral nerves of tabic subjects lose much of their value in view of
their recent discovery in marantic persons47 advanced in life, but who
had no nervous disease whatever.
46 Virchow's Archiv, vol. xxvi. pp. 399-452.
47 Krause, Neurologisches Centralblatt, 1885, p. 53.
It has been attempted to bring the tabic process in relation to a

supposed primary meningitis. Tabes is a rather common nervous
affection, and primary spinal meningitis is one of the very rarest. The
leptomeninges are found considerably thickened in one out of ten
tabic cords, and those who defend the meningitic origin of the
disease base their theory on this inconstant finding, and allege that
in the cases where it is absent the meningitis has disappeared while
the cord lesion progressed. It is a fatal objection to this view that the
part of the posterior columns immediately adjoining the pia is often
quite free from disease. A meningitic affection, either as an
etiological or a complicating factor, can be admitted in those cases
only where there is a marginal sclerosis.
The changes in the optic nerve resemble those of the white columns
of the cord in their naked-eye and minute character as well as in the
controversial nature of the various interpretations made. When
affected, the nerve is found to be firmer than normal, and discolored;
later it becomes quite gray, and may eventually shrink to two-thirds,
and even less, of its normal diameter. It is generally believed that, as
in the cord, the myelin undergoes wasting before the axis-cylinder
disappears, and that the latter may survive a long time, thus
explaining why the patient may retain his visual power for a
considerable period after the ophthalmoscope determines the
existence of atrophy. No satisfactory explanation has as yet been
offered for the optic-nerve affection of tabes. There is no direct
continuity of the spinal and optic sclerosis. Two theoretical
possibilities suggest themselves. The first is that the lesion of the
cord exerts a remote effect upon the physiological, and through this

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Solution Manual for Principles of Microeconomics 8th Edition

Mankiw 1305971493 9781305971493

2 THINKING LIKE AN ECONOMIST

how economists apply the methods of science.

how assumptions and models can shed light on the world.

the difference between microeconomics and macroeconomics.

the difference between positive and normative statements.

the role of economists in making policy.

why economists sometimes disagree with one another.

CONTEXT AND PURPOSE:

A. Economists Follow the Scientific Method.

1. Observations help us to develop theory.

2. Data can be collected and analyzed to evaluate theories.

B. Assumptions Make the World Easier to Understand.

C. Economists Use Economic Models to Explain the World around Us.

1. Most economic models are composed of diagrams and equations.

D. Our First Model: The Circular Flow Diagram

E. Our Second Model: The Production Possibilities Frontier

1. Definition of production possibilities frontier: a graph that shows the combinations

2. Example: an economy that produces two goods, cars and computers.

ALTERNATIVE CLASSROOM EXAMPLE:

5. Production at a point inside the curve (such as D) is inefficient.

b. Thus, the opportunity cost of each car is two computers.

ALTERNATIVE CLASSROOM EXAMPLE:

F. Microeconomics and Macroeconomics

1. Economics is studied on various levels.

a. Definition of microeconomics: the study of how households and firms make

b. Definition of macroeconomics: the study of economy-wide phenomena,

II. The Economist as Policy Adviser

A. Positive versus Normative Analysis

1. Example of a discussion of minimum-wage laws: Portia says, “Minimum-wage laws cause

C. Why Economists’ Advice Is Not Always Followed

III. Why Economists Disagree

A. Differences in Scientific Judgments

C. Perception versus Reality

3. Most economists also oppose barriers to trade.

D. Ask the Experts: Ticket Resale

IV. In the News: Why You Should Study Economics

1. Training in economics helps us to understand fallacies and to anticipate unintended

V. Appendix—Graphing: A Brief Review

A. Graphs of a Single Variable

B. Graphs of Two Variables: The Coordinate System

2. Ordered pairs of numbers can be graphed on a two-dimensional grid.

4. Two variables that increase or decrease together have a positive correlation.

C. Curves in the Coordinate System

a. An example of this is a demand curve.

E. Cause and Effect

4. Another problem is reverse causality.

SOLUTIONS TO TEXT PROBLEMS:

Chapter Quick Quiz

Questions for Review

4. There are many possible answers.

In addition to the visceral crises there are other disturbances of

25 In three cases by Ballet et Dutil, Progrès médicale, May 19, 1882.

28 Gazette médicale de Paris, 1885, No. 25.

Another reason for considering the arthropathies as of central origin

The feet of an advanced tabic patient usually appear deformed; the

There is less dispute concerning the nature of the so-called

COURSE.—Tabes dorsalis is to be regarded as an extremely chronic

MORBID ANATOMY AND PHYSIOLOGY.—Our knowledge of the structural

In advanced cases of tabes the disease of the spinal cord is so

It is regarded as well established that the sclerosis of the areas of

I regard these observations as opposed to the assumption of