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Multiple Choice
1. definitions of delinquency hold that only those who have been officially labeled by the
courts are offenders.
A. Behavioral
B. Legal
C. Standard
D. Federal
Ans: B
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Knowledge
Answer Location: Legal Definitions
Difficulty Level: Easy
2. definitions of delinquency hold that those whose behavior violates statutes applicable
to them are offenders whether or not they are officially labeled.
A. Behavioral
B. Legal
C. Standard
D. Federal
Ans: A
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Knowledge
Answer Location: Legal Definitions
Difficulty Level: Easy
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
3. One of the most persistent roadblocks to juvenile justice reform across the country is .
A. media reports of youth violence
B. societal belief in a punitive approach
C. definitions of delinquency
D. resistance to change
Ans: D
Learning Objective: 2-1: Understand and discuss the importance of accurately defining and
measuring delinquency.
Cognitive Domain: Comprehension
Answer Location: Legal Definitions
Difficulty Level: Medium
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
4. With respect to the minimum age at which children should be afforded court protection
changed with the emergence of and _, both of which may have serious prenatal
effects.
A. crack, methamphetamine
B. heroin, prescription pills
C. controlled substances, case law
D. case law, runaway children
Ans: A
Learning Objective: 2-1: Understand and discuss the importance of accurately defining and
measuring delinquency.
Cognitive Domain: Knowledge
Answer Location: Age Ambiguity
Difficulty Level: Easy
6. definitions focus on juveniles who offend or are victimized even if they are not
officially adjudicated.
A. Legal
B. Standard
C. Behavioral
D. Federal
Ans: C
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Knowledge
Answer Location: Behavioral Definitions
Difficulty Level: Easy
7. A problem with legal definitions has been the ambiguity reflected with respect to:
A. gender.
B. age.
C. crime definition.
D. behavior.
Ans: B
Learning Objective: 2-2: Understand the impact of differences in definitions of delinquency.
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
10. Because the definition of delinquency includes many juveniles who do not become
part of official statistics, we need to rely on unofficial, and sometimes questionable, methods for
assessing the extent and nature of unofficial or “hidden” delinquency and abuse.
A. behavioral
B. standard
C. legal
D. statutory
Ans: A
Learning Objective: 2-2: Understand the impact of differences in definitions of delinquency.
Cognitive Domain: Comprehension
Answer Location: Behavioral Definitions
Difficulty Level: Hard
11. Numbers of children suffering from abuse and neglect remain in the United States.
A. low
B. moderately low
C. high
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
D. unchanged
Ans: C
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Delinquency Statistics
Difficulty Level: Medium
12. The , as a source of crime data, are based upon reports to law enforcement agencies.
A. NCVS
B. UCR
C. self-reports
D. metadata
Ans: B
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Delinquency Statistics
Difficulty Level: Easy
13. Black and Reiss (1970) found that in urban areas, only about of police encounters
with juveniles involved alleged felonies.
A. 25%
B. 2%
C. 6%
D. 5%
Ans: D
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Delinquency Statistics
Difficulty Level: Medium
15. The , as a source of crime data, are collected from victims instead of law enforcement
agencies.
A. NIBRS
B. NCVS
C. self-reports
D. metadata
Ans: B
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: National Crime Victimization Survey
Difficulty Level: Easy
17. Which of the following are reasons why crimes are not reported to the police?
A. fear of reprisal
B. too inconvenient
C. lack of proof
D. all of these
Ans: D
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: National Crime Victimization Survey
Difficulty Level: Medium
19. studies, however, are subject to criticism on the basis that respondents may
underreport or overreport delinquency or abuse as a result of either poor recall or deliberate
deception.
A. NIBRS
B. NCVS
C. Police observational
D. Self-report
Ans: D
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Comprehension
Answer Location: Self-Report Studies
Difficulty Level: Medium
20. , as a source of crime data, are gathered by trained observers who ride with police
officers.
A. NIBRS
B. NCVS
C. Self-reports
D. Police observational studies
Ans: D
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Police Observational Studies
Difficulty Level: Medium
21. Nearly 60% of child victims suffered from , the most common form of child
maltreatment.
A. physical abuse
B. neglect
C. sexual abuse
D. bullying
Ans: B
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Comprehension
Answer Location: Official Statistics on Abuse and Neglect
Difficulty Level: Medium
22. A source of statistical information on children missing due to criminal behaviors, parental
kidnapping, and juvenile gang crimes would be found in the .
A. UCR
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
B. NIBRS
C. NCVS
D. self-reports
Ans: B
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Comprehension
Answer Location: Official Statistics: Sources and Problems
Difficulty Level: Medium
23. Victimization surveys do not include interviews with children under the age of .
A. 11
B. 12
C. 13
D. none of these
Ans: B
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: National Crime Victimization Survey
Difficulty Level: Medium
24. In their study using self-reports of delinquent behavior, Short and Nye found .
A. no difference between the extent and nature of delinquent acts committed by non-
institutionalized youth and those committed by institutionalized youth
B. little difference between the extent and nature of delinquent acts committed by non-
institutionalized youth and those committed by institutionalized youth
C. a large difference between the extent and nature of delinquent acts committed by non-
institutionalized youth and those committed by institutionalized youth
D. a major disjunctive between the extent and nature of delinquent acts committed by non-
institutionalized youth and those committed by institutionalized youth
Ans: B
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Comprehension
Answer Location: Self-Report Studies
Difficulty Level: Hard
25. Black juveniles were more likely to receive harsher dispositions in areas where the
proportion of was high.
A. Whites
B. Hispanics
C. Blacks
D. Asians
Ans: A
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Statistics: Sources and Problems
Difficulty Level: Medium
True/False
2. Using the behavioral definition, a juvenile who committed a relatively serious offense but was
not apprehended would not be classified as delinquent.
Ans: F
Learning Objective: 2-1: Understand and discuss the importance of accurately defining and
measuring delinquency.
Cognitive Domain: Comprehension
Answer Location: Legal Definitions
Difficulty Level: Medium
3. There is a dark figure of delinquent activity where a substantial amount of illegal behavior
committed by youth is not detected.
Ans: T
Learning Objective: 2-1: Understand and discuss the importance of accurately defining and
measuring delinquency.
Cognitive Domain: Knowledge
Answer Location: Inaccurate Images of Offenders and Victims
Difficulty Level: Easy
4. A basic difficulty with legal definitions is that they differ from time to time and from place to
place.
Ans: T
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Comprehension
Answer Location: Legal Definitions
Difficulty Level: Medium
5. An act that is delinquent at one time and in one place might not be delinquent at another time
or in another place.
Ans: T
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
6. Estimates of the extent of delinquency and abuse based on a legal definition are far lower than
those based on a behavioral definition.
Ans: F
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Knowledge
Answer Location: Behavioral Definitions
Difficulty Level: Medium
7. If we concentrate on juveniles who are not officially labeled, we get a far different picture
from that if we include all of those who offend or are victimized.
Ans: F
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Comprehension
Answer Location: Behavioral Definitions
Difficulty Level: Medium
8. One of the major problems confronting those interested in learning more about offenses by
and against juveniles involves defining the phenomena.
Ans: T
Learning Objective: 2-2: Understand the impact of differences in definitions of delinquency.
Cognitive Domain: Knowledge
Answer Location: Legal Definitions
Difficulty Level: Easy
9. Despite growth in the juvenile population over the past decade, crime and violence by
juveniles have not declined.
Ans: F
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Delinquency Statistics
Difficulty Level: Medium
10. In an attempt to combat some of the reporting problems found in UCR data since 1987, the
FBI has been implementing an incident-based reporting system, a modification of the original
UCR reporting system, throughout the United States.
Ans: T
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Delinquency Statistics
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
11. A problem with behavioral definitions is the ambiguity reflected with respect to age.
Ans: F
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Comprehension
Answer Location: Legal Definitions
Difficulty Level: Medium
12. Use of behavioral definitions necessitates reliance on unofficial methods to assess the extent
and nature of hidden delinquency and abuse.
Ans: T
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Comprehension
Answer Location: Behavioral Definitions
Difficulty Level: Medium
13. UCR data would be of value if one wanted to know something about the actual extent and
distribution of delinquency, or about police handling of juveniles involved in less serious
offenses.
Ans: F
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Delinquency Statistics
Difficulty Level: Medium
14. Official statistics on abused and neglected children are only available from a limited number
of sources.
Ans: F
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge
Answer Location: Official Delinquency Statistics
Difficulty Level: Medium
15. Poor recall and deliberate deception are both criticisms of the under- or over-reporting of
abuse or delinquency in self-report studies.
Ans: T
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Comprehension
Answer Location: Self-Report Studies
Difficulty Level: Medium
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
Essay
2. Discuss the impact that different definitions of delinquency have on the juvenile justice
system.
Ans: A brief discussion of the different definitions of delinquency and their associated policy
impacts on the juvenile justice system. There should be at least one policy implication discussed
for each definition.
Learning Objective: 2-2: Understand the impact of differences in definitions of delinquency.
Cognitive Domain: Comprehension | Application
Answer Location: Legal Definitions | Behavioral Definitions
Difficulty Level: Hard
3. Discuss legal and behavioral definitions of delinquency. Include specific examples of how a
specific offense might be analyzed under each definition as delinquent or not.
Ans: The two different types of delinquency definitions and include specific examples of
behavior (offenses) that might be delinquent under one definition and not delinquent under
another.
Learning Objective: 2-3: Discuss legal and behavioral definitions of delinquency.
Cognitive Domain: Knowledge | Comprehension
Answer Location: Legal Definitions | Behavioral Definitions
Difficulty Level: Easy
4. Discuss the problems associated with the UCR/NIBRS crime statistic data.
Ans: The evolution of the UCR into the NIBRS and discuss the problems associated with it, such
as underreporting, definitional issues, and so on.
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge | Comprehension
Answer Location: Official Statistics: Sources and Problems
Difficulty Level: Medium
5. Discuss the validity of the NCVS when combined with the UCR/NIBRS as a way to get to the
dark figure of crime.
Ans: A discussion of the shortcomings of the NCVS but when it is combined with other sources
of data, it will uncover more of the dark figure of crime.
Instructor Resource
Cox, Allen, Hanser, and Conrad, Juvenile Justice, 9th edition
SAGE Publishing, 2018
Learning Objective: 2-4: Discuss official and unofficial sources of data on delinquency and
abuse and the problems associated with each.
Cognitive Domain: Knowledge | Comprehension | Application
Answer Location: Official Statistics: Sources and Problems
Difficulty Level: Hard
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entirely upon the statements of their wives, without being able myself
to see any evidence of insanity, but where the clinical history of
general paralysis in its early stage was so accurately given that I was
sure there could be no mistake; and a few days' continuous
observation in the hospital showed the diagnosis to be correct.
Mr. ——, age 52, married, a clergyman: his mother died of apoplexy;
two of his four brothers are insane. He had the usual illnesses of
childhood in mild form, diphtheria of the worst type in 1869, and in
recent years, according to his belief, malaria, as he had lived in a
malarial region eleven years. As a young man he was of robust
frame and vigorous health, brought up on a farm. He overworked,
denied himself, and overtaxed, in getting his education, a brain not
trained from early years to exacting labor. Eight years ago, for the
first time, and at intervals since then, he has had attacks of mental
confusion, dimness in sight, and indistinct articulation lasting from a
few moments to several minutes. Three years ago, after great
emotional strain, people began to notice that his preaching had lost
in animation and force, and they complained that he had suddenly
become more radical in his views. Great mental worries occurred
soon after. There had been no alcoholic or other excess, except of
mental overwork, and there could be no reasonable possibility of
syphilis, unless we adopt Hebra's dogma, “Jeder Mensch kann
syphilitisch sein”—that the means of innocently acquiring that
disease are so widespread that no one can be said to be free from
the danger of it. Nearly two years ago, in the dark, while feeling tired
mentally and physically, but not ill or dizzy, in alighting from a coach
he missed the step and came to the ground on his feet with great
force. He walked to the house of a friend, and was found by one of
the family on their entry floor groaning, but not unconscious. He
could not stand or talk, vomited incessantly, and complained of a
horrible pain in the back and top of his head. Two days later, and
each succeeding Sunday, he preached, obstinately and unlike him
refusing to listen to advice to keep quiet; but he remained in bed
between Sundays for three weeks, when the striking symptoms
disappeared; but he had never felt entirely well since then—never
had the same animation. He was supplying various pulpits, and
found, wherever he had preached before, that people complained
that there was a general lack of vigor in his preaching. Two years
ago he observed that his right leg had less life in it than was natural,
and soon after that both legs seemed heavy—that it was less easy to
run up and down stairs, which his wife also noticed several months
later. He also has had for a year a strange feeling, a sort of
numbness, in his legs. He thought that his handwriting and speech
have continued as good as ever, but has observed that he has had
to change to a stub pen, as he found difficulty in writing with the old
sharper-pointed kind; that his voice had grown less clear; and that he
has rapidly become farsighted. He has never had any dizziness,
pain, ache, or uncomfortable feeling about his head, except during
the attacks already referred to. There have been no thoracic or
abdominal symptoms, no neuralgia or rheumatism. Appetite and
digestion have been faultless. He has lost about ten pounds in flesh.
He has slept soundly, but is often restless, getting in and out of bed.
He says that he was depressed for lack of employment; that he is
not irritable, but that his family would say that he is not as tractable
as he was, not as patient, less easily satisfied; that his son and wife
would say that he is not what he once was—that his memory is not
as clear and vivid as it was. He is conscious that within the last two
years he has had violent, uncontrollable passionate outbreaks from
trivial causes. He preaches his old sermons, because he thinks they
are too good to be lost, and because he takes pleasure in rewriting
them, in doing which he remarks that the handwriting becomes
progressively worse toward the end of each sermon. He says that he
can write still better sermons, but does not like to make the effort.
When he went into the pulpit a week ago he was told not to
announce a second service, but everybody seemed to him so
pleased with his preaching that a week later he gave word that there
would be an evening service, to which, he laughingly said, only one
person came. In standing with his eyes closed and feet together
there was a little unsteadiness. On attempting to turn around or to
stand on one foot with eyes closed there was some, not very great,
ataxia. In these trials the unsteadiness and ataxia soon became very
striking on prolonging the muscular effort a few moments. His hands
had a powerful grasp, each marking 74 with the dynamometer, and
on being stretched to their full extent, with fingers spread,
immediately thereafter the fibrillary tremor could be seen only on
close examination. There was no marked tremor of the muscles of
the lips or face, except in movements which placed them at extreme
tension. The tongue was quite tremulous on being protruded to its
full length and held there. In walking in a rather dark entry the steps
seemed to me shortened and the feet wider apart than in his natural
gait, and he did not raise his feet as much, which he noticed also. In
going up stairs he placed the whole foot, heel and all, on each step
to keep his balance. He turned very deliberately, keeping the feet
near together and not raised from the landing. On coming down he
evidently steadied himself by a muscular effort extending to his head
and shoulders. The knee-jerk was well marked and alike in both
legs, but I could not say that it was exaggerated. There had been no
change in the sexual function.
FIG. 15.
I purposely made no remark to the patient, and he made no inquiry,
about diagnosis or treatment. He would have missed his train,
although there was a clock in my office, had I not reminded him of
the late hour, whereupon he made all his arrangements with care,
good judgment, and accuracy, and reached his home safely. As he
walked briskly down the even sidewalk I doubt whether any one,
even a physician, would have remarked any unsteadiness or
anything abnormal about his gait. If he had been followed a few
blocks, until the idea of catching his train had ceased to stimulate
him, and after he had reached the crowded thoroughfares of the city,
especially as he stepped up and down curbstones or walked slowly
to avoid teams at crossings, a close examination would undoubtedly
have shown the defects in gait already pointed out.
Mr. ——'s wife had noticed that her husband did not raise his feet as
of old in walking—that he walked as if they were heavy, but under
the influence of coca wine or a decided mental stimulus he walked
apparently as well as ever for a short distance. She had noticed a
slight impairment in memory, an increased fractiousness, a
diminished ability to appreciate things in their proper light, a
changeability in his moods and mental state, a scarcely-observed
but noticeable neglect or oversight of little customary duties,
occasional passionate outbreaks from trifling causes, a disposition to
laugh and cry easily; and that often he did and said unwonted foolish
little things, like attributing increased flow of urine to his liver, wearing
two starched shirts, announcing the Sunday evening service; but she
had not considered any of the symptoms as evidence of disease,
especially as he kept accounts, attended to his preaching, etc., and
showed no manifest indications of a disturbed or impaired mind. She
had remarked a decided change in the character of his handwriting,
also an unusual deliberateness in speech, but no indistinctness or
hesitation, although his voice had become less clear. He had had no
delusions, illusions, hallucinations, or unreasonable ideas. It was for
the weakness in his legs that she asked my advice.
I found that the mental and cerebral symptoms in this case had been
overlooked, and that the weakness in the legs had been attributed to
spinal concussion, for which a favorable prognosis had been given.
I examined the patient after he had been away from home nine days,
preaching two Sundays, and making many new acquaintances in the
mean while, besides having travelled nearly two hundred miles by
rail, so that he was fatigued. After three weeks' complete rest I saw
him at his house. The knee-jerk was increased as compared with the
previous examination. Otherwise the symptoms had so ameliorated
that some of them could be brought out only after a long and patient
examination, and the rest had to be accepted as a matter of history
of the case. I had his photograph taken, and by comparing it with
another taken three years previously his family noticed what was
quite obvious in that light, but what had thus far been overlooked—
namely, that the facial muscles had lost very much in expression.
The writer of No. 6 was more advanced in general paralysis, but had
been thought not to be ataxic, from the fact that he had been able to
write a single word pretty well. His few lines are quite characteristic
of a general paralytic. Although he was in my office in Boston, he
dated his statement from his home, and wrote the word Lawrence
not badly for a man not in the habit of writing much. Seeing me for
the first time, he addressed me as Friend Folsom, and he signed his
name by his old army title of nearly twenty years before—corporal.
It very rarely happens that the onset and early progress of general
paralysis are so sudden and rapid that there is no prodromal period
or that it is very short.
The patient may recall many long-past events fairly well when he
cannot find his way to the dinner-table without blundering, when he
does not know morning from afternoon, and after he is unable to
dress and undress himself without constant remindings or even
actual help. Such paralytics wander off and die of exposure, are
picked up by the police as having lost their way or as not knowing
where their home is, or fall into some fatal danger from which they
have not mind enough to extricate themselves. When the mental
impairment has reached this point the lack of mind shows itself in a
lack of facial expression, which is so characteristic of the disease
that with a practised eye it is recognized as far as the countenance
can be distinctly seen; and from this point the progress is commonly
quite rapid to absolute dementia, entire inability to form or express
thoughts, too little intellect to even attend to the daily natural wants,
and a descent to the lowest possible plane of vegetative life, and
then death.
The ataxia first shows itself in the finer muscles—of the eye, of the
fingers, of articulation. There is a little hesitancy or rather
deliberateness of speech, the voice loses its fine quality, the
intonation may be slightly nasal. Instead of contracting smoothly and
evenly as in health, the muscles show a hardly noticeable jerkiness;
an irregular fibrillary tremor is seen when they are exerted to their
utmost and held in a state of extreme tension for several moments.
In attempts to steady the handwriting the patient forms his letters
slowly, makes them larger than usual, or tries to hurry over the
letters, making them smaller. The coarser muscles show ataxic
symptoms much later. It is observed by the patient or his friends that
he does not walk off with his usual rapid gait, and the effort to co-
ordinate his muscles produces an early or unusual fatigue, which
may be associated with general muscular pain. Extreme soreness
and pain, following the course of some one or more of the main
nerve-trunks, may be most persistent and obstinate to treatment,
lasting for several years, limiting the motion of the limb, sometimes
beginning a year or two before other symptoms are observed.
Sooner or later, especially after a little weariness or excitement,
there are observed at times, not constantly, indistinctness or an
occasional trip in enunciating linguals and labials, a tremor in the
handwriting, a slight unsteadiness in the gait. When the tongue is
protruded as far as possible, when the hands and arms are stretched
out, when the muscles of facial expression are exerted, in standing
with feet together with closed eyes, a decided muscular tremor and
unsteadiness are remarked. These muscular symptoms soon
become constant, although they may be so slight as to be well
marked only by some unusual test, such as prolonged use after
excitement or fatigue, and the ataxia may diminish, the gait, speech,
or handwriting may improve, while muscular power is growing
progressively less.
In walking the feet are not raised as usual, the steps are shorter, the
legs are kept wider apart; turning about is accomplished in a very
deliberate way, such as to suggest an insecure feeling; movements
like dancing are impossible. Going up and down stairs is difficult; the
whole foot is rested carefully on each step, and the head and
shoulders are held stiffly, so as to maintain the balance. The
muscular movements are generally uneven and tremulous, and yet
the strength may not be so very much impaired, although perhaps
available only for short periods at a time. Even these symptoms may
so improve by a few days' quiet, or even by a night's rest, as to quite
throw the physician off his guard unless a thorough examination is
made. The patient, too, on an even floor or sidewalk may walk so as
not to attract attention, and yet in a new place, over a rough surface,
or in the attempt to perform difficult or rapid movements, exhibit
striking ataxia and feebleness of gait. In starting off with a definite
purpose he may for a short distance walk quite well, as he may do
under the influence of a glass of wine.
In all stages of the disease, especially the later, there may be almost
any of the symptoms observed which occur in the various functional
and organic diseases of the nervous system. The hyperæsthesia,
local or general, may be most absolute, or the anæsthesia so
complete that acts of self-mutilation ordinarily causing exquisite pain
are performed without apparent suffering. Any motor ganglia, any
nerve, any tissue, may degenerate, giving rise to various degrees of
impairment up to total destruction of function—of the optic nerve,
causing blindness; of the auditory, deafness; of the olfactory, glosso-
pharyngeal, or any of the cranial or spinal nerves.
Sugar has in a few cases been found in the urine; albumen is not
uncommon.