Thinking About Women 10th Edition Andersen Test

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Key: Answer, Page, Type, Learning Objective, Level

Type
A=Applied
C=Conceptual
F=Factual
Level
(1)=Easy; (2)=Moderate; (3)=Difficult

LO=Learning Objective
SG=Used in Study Guide
p=page

Multiple Choice Single Select

M/C Question 1
The household as the main form of economic growth meant that all members and kin participated in a
a) family-based economy.
b) fictive kin economy.
Consider This: Economic and domestic life often intersect.
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
c) structural functionalist economy.
Consider This: Economic and domestic life often intersect.
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
d) patriarchal structure economy.
Consider This: Economic and domestic life often intersect.
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
ANS: a
Skill=Understand the Concepts, Objective=LO 5.1: Recognize that understanding historic
patterns of gender and work is important in understanding the current work pattern,
Topic=Women†™s Work: History Matters, Difficulty=Easy

M/C Question 2
The _________________ led to women being expected to not only complete the work of a housewife but to also
contribute financially to the family.
a) family-wage economy
b) dual-earning household
 Consider This: Eventually, families found work outside of their homes.
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
c) women’s movement
Consider This: Eventually, families found work outside of their homes.
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
d) second shift
Consider This: Eventually, families found work outside of their homes.
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
ANS: a
Skill=Understand the Concepts, Objective=LO 5.1: Recognize that understanding historic
patterns of gender and work is important in understanding the current work pattern,
Topic=Women†™s Work: History Matters, Difficulty=Easy

M/C Question 3
Schools taking over the education of children is a result of the
a) family-consumer economy.
b) family-wage economy.
Consider This: How has work done in the home decreased in value?
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
c) family-based economy.
Consider This: How has work done in the home decreased in value?
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
d) family-structure economy.
Consider This: How has work done in the home decreased in value?
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
ANS: a
Skill=Understand the Concepts, Objective=LO 5.1: Recognize that understanding historic
patterns of gender and work is important in understanding the current work pattern,
Topic=Women†™s Work: History Matters, Difficulty=Easy

M/C Question 4
Statements like “Women can have it all!” and “Women can have a career and be mothers!” are entangled by the
social class, race, and gendered assumptions about women and employment. This is called the
a) social structure of work.
b) social construction of gender.
Consider This: How does economic transition relate to social inequality?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
c) social norms of labor.
Consider This: How does economic transition relate to social inequality?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
d) social function of gender.
 Consider This: How does economic transition relate to social inequality?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
ANS: a
Skill=Understand the Concepts, Objective=LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce,
Topic=What Counts as Work? The Lingering Role of Ideology, Difficulty=Easy

M/C Question 5
When women participate in the economic structure of a society but are denied social resources this refers to the
________________ present in a civilization.
a) gender stratification
b) gender norms
Consider This: How does women’s work sustain an economy?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
c) gender rules
Consider This: How does women’s work sustain an economy?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
d) gender organization
Consider This: How does women’s work sustain an economy?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
ANS: a
Skill=Understand the Concepts, Objective=LO 5.3: Review the intersectional theory to link
race, class, and gender stratification, Topic=Race, Class, and Gender Stratification,
Difficulty=Easy

M/C Question 6
Fields which are dominantly staffed by women are often work that is lower in pay, physically demanding and
have high turnover rates. These jobs are considered a means of ___________________ in the labor force.
a) gender segregation
b) structural functionalism
Consider This: How is service work gendered?
LO 5.4: Analyze the glass ceiling to highlight the changing status of women in the workplace
c) cultural norms
Consider This: How is service work gendered?
LO 5.4: Analyze the glass ceiling to highlight the changing status of women in the workplace
d) feminine status
Consider This: How is service work gendered?
LO 5.4: Analyze the glass ceiling to highlight the changing status of women in the workplace
ANS: a
Skill=Understand the Concepts, Objective=LO 5.4: Analyze the glass ceiling to highlight the
changing status of women in the workplace, Topic=Gender in the Workplace,
Difficulty=Easy

M/C Question 7
Invisible mechanisms that are built into the social structure of organizations and keep women from advancing in
the labor force are called
a) glass ceilings.
b) second shift
 Consider This: Promotions for women are often lateral. LO 5.4: Analyze the glass ceiling to
highlight the changing status of women in the workplace
c) pay discrimination.
Consider This: Promotions for women are often lateral. LO 5.4: Analyze the glass ceiling to
highlight the changing status of women in the workplace
d) work gaps.
Consider This: Promotions for women are often lateral. LO 5.4: Analyze the glass ceiling to
highlight the changing status of women in the workplace
ANS: a
Skill=Understand the Concepts, Objective=LO 5.4: Analyze the glass ceiling to highlight the
changing status of women in the workplace, Topic=Gender in the Workplace,
Difficulty=Easy

M/C Question 8
Women in contemporary society are more likely to be financially responsible for children. This has contributed
to the
a) feminization of poverty.
b) feminist approach to poverty.
Consider This: How does the family structure relate to gender roles?
LO 5.5: Analyze the concept of the feminization of poverty
c) sociological theory of poverty.
Consider This: How does the family structure relate to gender roles?
LO 5.5: Analyze the concept of the feminization of poverty
d) social categorization of poverty.
Consider This: How does the family structure relate to gender roles?
LO 5.5: Analyze the concept of the feminization of poverty
ANS: a
Skill=Understand the Concepts, Objective=LO 5.5: Analyze the concept of the feminization
of poverty, Topic=Poverty and the Declining Safety Net, Difficulty=Easy

M/C Question 9
A woman goes to work for eight hours and then comes home to make dinner, put children to bed, and clean the
house. This is called the
a) second shift.
b) care work.
Consider This: How has the change in gendered labor impacted family life?
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
c) glass ceiling.
Consider This: How has the change in gendered labor impacted family life?
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
d) gender structure.
Consider This: How has the change in gendered labor impacted family life?
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
ANS: a
Skill=Understand the Concepts, Objective=LO 5.6: Examine how work and family are
strongly linked to evolving roles and expectations, Topic=Who Cares? The Intersection of
Family and Work, Difficulty=Easy
M/C Question 10
In high school sports, girls teams and boys teams must receive the same treatment and funding due to the
passage of the
a) Title IX.
b) Equal Rights Amendment.
Consider This: Federal funding impacts sports programs in schools.
LO 5.7: Report some of the laws that were enacted to ensure gender equality
c) Women’s Pay Act
Consider This: Federal funding impacts sports programs in schools.
LO 5.7: Report some of the laws that were enacted to ensure gender equality
d) Bill of Rights.
Consider This: Federal funding impacts sports programs in schools.
LO 5.7: Report some of the laws that were enacted to ensure gender equality
ANS: a
Objective=LO 5.7: Report some of the laws that were enacted to ensure gender equality,
Topic=Policies for Gender Equity, Skill=Understand the Concepts, Difficulty=Easy

M/C Question 11
Which of the following describes intersectionality?
a) Oppression based on gender, race, class, and/or sexuality is overlapping and connected.
b) Oppression based on gender, race, class, and/or sexuality exists in isolation.
Consider This: Power seeks oppression through many systems.
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
c) Oppression based on gender, race, class, and/or sexuality must be studied separately.
Consider This: Power seeks oppression through many systems.
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
d) Oppression based on gender, race, class, and/or sexuality is based in theory not research.
Consider This: Power seeks oppression through many systems.
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
ANS: a
Difficulty=Moderate, Skill=Apply What You Know, Objective=LO 5.3: Review the
intersectional theory to link race, class, and gender stratification, Topic=Race, Class, and
Gender Stratification

M/C Question 12
Economic restructuring is the result of an economy whose focus shifts to primarily address the rapid growth and
impact of
a) globalization.
b) wage-based labor.
Consider This: What is the result of economic changes from manufacturing to service?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
c) downturn market.
Consider This: What is the result of economic changes from manufacturing to service?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
d) global reduction.
Consider This: What is the result of economic changes from manufacturing to service?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
ANS: a
Difficulty=Moderate, Skill=Apply What You Know, Objective=LO 5.3: Review the
intersectional theory to link race, class, and gender stratification, Topic=Race, Class, and
Gender Stratification

M/C Question 13
How is a family’s poverty line determined in U.S. society?
a) By the cost of providing healthy meals to all family members
b) By determining the amount of people working for minimum wage
Consider This: What is the connection between income, basic needs and families?
LO 5.5: Analyze the concept of the feminization of poverty
c) By the number of workers in service jobs
Consider This: What is the connection between income, basic needs and families?
LO 5.5: Analyze the concept of the feminization of poverty
d) By the average amount of rent a family of four pays
Consider This: What is the connection between income, basic needs and families?
LO 5.5: Analyze the concept of the feminization of poverty
ANS: a
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.5: Analyze the concept of the
feminization of poverty, Topic=Poverty and the Declining Safety Net

M/C Question 14
Applying our sociological imaginations to evaluate the rise of women who do care work we see a growth in
available jobs in these fields. This can be described as
a) more women are in need of jobs and are regulated to lower-paying positions that are often gender-
based.
b) women will take on jobs where they can use their emotions.
Consider This: Employers use social construction of gender stereotypes in hiring.
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
c) care work requires less physical work but more feeling and sentiment.
Consider This: Employers use social construction of gender stereotypes in hiring.
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
d) less positions are available for men because women have had to take on full time work.
Consider This: Employers use social construction of gender stereotypes in hiring.
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
ANS: a
Difficulty=Difficult, Skill=Evaluate It, Objective=LO 5.6: Examine how work and family are
strongly linked to evolving roles and expectations, Topic=Who Cares? The Intersection of
Family and Work

M/C Question 15
One of the stipulations of affirmative action is that an employer not impose an arbitrary rule on hiring based on
his or her own predispositions. An example of this would be a Human Resource manager
a) who likes to talk with younger applicants and interviews them before older applicants.
b) with a shift at night to fill, interviews people who check the “night shift” box before those who checked
“day shift.”
Consider This: What rules have been developed to make hiring policies clear?
LO 5.7: Report some of the laws that were enacted to ensure gender equality
c) who interviews only women to fill the position of a women’s lingerie sales person.
 Consider This: What rules have been developed to make hiring policies clear?
LO 5.7: Report some of the laws that were enacted to ensure gender equality
d) automatically removes applicants who do not have the required college credits.
Consider This: What rules have been developed to make hiring policies clear?
LO 5.7: Report some of the laws that were enacted to ensure gender equality
ANS: a
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.7: Report some of the laws that were
enacted to ensure gender equality, Topic=Policies for Gender Equity

M/C Question 16
In a cash-based economy
a) men are expected to become the primary source of income.
b) women are expected to become the primary source of income.
Consider This: How did the family, historically, gather goods and services?
LO 5.8: Summarize the relationship between gender, work, and the economy
c) men and women share income equally.
Consider This: How did the family, historically, gather goods and services?
LO 5.8: Summarize the relationship between gender, work, and the economy
d) gender does not dictate who earns the primary income.
Consider This: How did the family, historically, gather goods and services?
LO 5.8: Summarize the relationship between gender, work, and the economy
ANS: a
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.8: Summarize the relationship
between gender, work, and the economy, Topic=Chapter Summary: Gender, Work, and the
Economy

M/C Question 17
Which of the following describes human capital theory?
a) A woman leaves work to take care of a sick relative and is paid less for her work as a result.
b) A woman leaves work to have a baby and returns to the same job at the same pay.
Consider This: What worker characteristics equal higher wages?
LO 5.4: Analyze the glass ceiling to highlight the changing status of women in the workplace
c) A woman chooses to not have children thus making her more of an ideal candidate for employers.
Consider This: What worker characteristics equal higher wages?
LO 5.4: Analyze the glass ceiling to highlight the changing status of women in the workplace
d) A woman chooses to stay at home with her children thus making her husband more of an ideal
candidate for jobs.
Consider This: What worker characteristics equal higher wages?
LO 5.4: Analyze the glass ceiling to highlight the changing status of women in the workplace
ANS: a
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.4: Analyze the glass ceiling to
highlight the changing status of women in the workplace., Topic=Gender in the Workplace

M/C Question 18
A family runs their own farm and produces enough crops to sustain themselves each year. They also sell
products made from the crops they grow. Because the family sustains themselves on what they produce they are
a
a) family-based economy.
b) kin-structured economy.
 Consider This: How can the family unit serve as its own manufacturer?
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
c) labor-built economy.
Consider This: How can the family unit serve as its own manufacturer?
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
d) household-created economy.
Consider This: How can the family unit serve as its own manufacturer?
LO 5.1: Recognize that understanding historic patterns of gender and work is important in
understanding the current work pattern
ANS: a
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.1: Recognize that understanding
historic patterns of gender and work is important in understanding the current work pattern,
Topic=Women†™s Work: History Matters

M/C Question 19
While the amount of time spent on housework has decreased, the amount of time spent _________________
through practices like _______________ has increased due to a rise in parental individualism.
a) cultivating childhood; intensive mothering
b) transporting children; home daycare
Consider This: Housework has changed with the rise in industry.
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
c) pampering mothers; hired nannies
Consider This: Housework has changed with the rise in industry.
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
d) raising children; helicopter parenting
Consider This: Housework has changed with the rise in industry.
LO 5.6: Examine how work and family are strongly linked to evolving roles and expectations
ANS: a
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.6: Examine how work and family are
strongly linked to evolving roles and expectations, Topic=Who Cares? The Intersection of
Family and Work

M/C Question 20
Why is evaluating the labor used in household work difficult?
a) Because household labor is a combination of physical and emotional labor
b) Because household labor is done mainly in isolation
Consider This: How have feminist categorized work? LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce
c) Because household labor is has undergone much change over time
Consider This: How have feminist categorized work? LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce
d) Because household labor is not paid and cannot hold a monetary value
Consider This: How have feminist categorized work? LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce
ANS: a
Difficulty=Difficult, Skill=Evaluate It, Objective=LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce,
Topic=What Counts as Work? The Lingering Role of Ideology
M/C Question 21
A Latina woman works as a nurse. She works extra shifts to pay her bills and take care of her children but is
concerned about how she will send her kids to college. Which theory would require that many social factors
present in the nurse’s identity contribute to the economic struggle she faces?
a) Intersectionality theory
Consider This: Why is making a generalization about women’s lives problematic?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
b) Feminist theory
Consider This: Why is making a generalization about women’s lives problematic?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
c) Conflict theory
Consider This: Why is making a generalization about women’s lives problematic?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
d) Functionalist theory
Consider This: Why is making a generalization about women’s lives problematic?
LO 5.3: Review the intersectional theory to link race, class, and gender stratification
ANS: a
Skill=Analyze It, Objective=LO 5.3: Review the intersectional theory to link race, class, and
gender stratification, Topic=Race, Class, and Gender Stratification, Difficulty=Moderate

M/C Question 22
Persistent arguments that women’s work is in the home or that men should be responsible for earning the family
salary are reflective of an _______________ used to justify a status quo.
a) ideology
b) intersectionality
Consider This: How are beliefs socially constructed? LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce
c) opportunity
Consider This: How are beliefs socially constructed? LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce
d) approval
Consider This: How are beliefs socially constructed? LO 5.2: Recount how evolving ideologies
defining women and work have justified their standing in the economy and workforce
ANS: a
Skill=Analyze It, Objective=LO 5.2: Recount how evolving ideologies defining women and
work have justified their standing in the economy and workforce, Topic=What Counts as
Work? The Lingering Role of Ideology, Difficulty=Moderate

M/C Question 23
Women of color who worked in factory’s or as domestic help were viewed as lacking traditional femininity. The
_________________ viewed women’s worth as the care giver of the family, even though women of color were
often taking care of their children and homes.
a) cult of true womanhood
b) cult of domesticity
Consider This: How is motherhood tied to politics of race and class?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
c) cult of modern women
 Consider This: How is motherhood tied to politics of race and class?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
d) cult of good mothers
Consider This: How is motherhood tied to politics of race and class?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
ANS: a
Skill=Analyze It, Objective=LO 5.2: Recount how evolving ideologies defining women and
work have justified their standing in the economy and workforce, Topic=What Counts as
Work? The Lingering Role of Ideology, Difficulty=Moderate

M/C Question 24
Both historical and contemporary advertisements demonstrate that a clean house and happy children is not just
an example of the ideal life but it is an expression of _____________ from the mother.
a) love
b) adorationa
Consider This: How is housework connected to ideology?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
c) weakness
Consider This: How is housework connected to ideology?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
d) kindness
Consider This: How is housework connected to ideology?
LO 5.2: Recount how evolving ideologies defining women and work have justified their standing
in the economy and workforce
ANS: a
Skill=Analyze It, Objective=LO 5.2: Recount how evolving ideologies defining women and
work have justified their standing in the economy and workforce, Topic=What Counts as
Work? The Lingering Role of Ideology, Difficulty=Moderate

M/C Question 25
__________________ attempts to help people out of poverty but faces many challenges rooted in social class
stereotypes.
a) Welfare reform
b) Affirmative action
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
c) Feminism
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
d) Social institutions
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
ANS: a
Skill=Analyze It, Objective=LO 5.8: Summarize the relationship between gender, work, and
the economy, Topic=Chapter Summary: Gender, Work, and the Economy,
Difficulty=Moderate
Essay

SA Question 26
How has what is described as “women’s work” changed over time? What new problems have arisen from this
change?
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Apply What You Know, Objective=LO 5.1: Recognize that
understanding historic patterns of gender and work is important in understanding the current
work pattern, Topic=Women†™s Work: History Matters

SA Question 27
What is the difference between the family-based economy and the family-wage economy? How are each
categorized based on gender?
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Apply What You Know, Objective=LO 5.1: Recognize that
understanding historic patterns of gender and work is important in understanding the current
work pattern, Topic=Women†™s Work: History Matters

SA Question 28
Explain the gender pay gap. What contributes to pay inequality?
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.4: Analyze the glass ceiling to
highlight the changing status of women in the workplace, Topic=Gender in the Workplace

SA Question 29
What factors contribute to the feminization of poverty? What makes women more likely to be in poverty than
men?
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.5: Analyze the concept of the
feminization of poverty, Topic=Poverty and the Declining Safety Net

SA Question 30
How is care work related to the second shift? What do each have in common?
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Apply What You Know, Objective=LO 5.6: Examine how work
and family are strongly linked to evolving roles and expectations, Topic=Who Cares? The
Intersection of Family and Work

Essay Question 31
Even though the Equal Pay Act has passed there is a still a pay gap between men and women. Why is this?
Describe what social factors lead to pay discrimination and how social institutions bypass legal orders for equal
pay.
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Difficult, Skill=Evaluate It, Objective=LO 5.4: Analyze the glass ceiling to
highlight the changing status of women in the workplace, Topic=Gender in the Workplace

Essay Question 32
How is Title IX exemplified in the concept of comparable worth? Even if there is no monetary gain to be made,
how are the worth of men and women determined? Discuss how these determinations translate to the labor force
and how they are reflective of a patriarchal society.
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Difficult, Skill=Evaluate It, Objective=LO 5.7: Report some of the laws that were
enacted to ensure gender equality, Topic=Policies for Gender Equity

Essay Question 33
While women have made strides in the workforce, there is still evidence of a glass ceiling. What are some
examples of a contemporary glass ceiling? How does this apply to intersectionality theory, particularly when
looking at the advancement of women of color and the rate women are promoted? Be sure to define the glass
ceiling in your answer and discuss the concept of “leaning in.”
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.4: Analyze the glass ceiling to
highlight the changing status of women in the workplace, Topic=Gender in the Workplace

Essay Question 34
What social factors are present in the stereotypes of welfare programs? How are these factors gender-specific?
Describe how the feminization of poverty connects to welfare reform and include a discussion of the working
poor in your answer.
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.5: Analyze the concept of the
feminization of poverty, Topic=Poverty and the Declining Safety Net

Essay Question 35
Discuss economic restructuring and gender stratification. What effect does one have on the other? How do each
relate to the pay gap for women? How does having an increase in public sector jobs, which will be mostly filled
by women, influence women’s position as wage-earners?
Consider This: What role does the government play in the feminization of poverty? LO 5.8:
Summarize the relationship between gender, work, and the economy
Difficulty=Moderate, Skill=Analyze It, Objective=LO 5.8: Summarize the relationship
between gender, work, and the economy, Topic=Chapter Summary: Gender, Work, and the
Economy
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physiology. It is to be borne in mind that ataxia is a collective term
designating any inco-ordination of movement which is independent
of motor paralysis. It may be due to abolition or impairment of tactile
perception; it may be due to loss of the muscular sense; it may be
due to hampered motor co-ordination; and, finally, it may be due to a
disturbance of the space-sense. In my opinion it is only in
exceptional cases that any one of these factors can be positively
excluded. Occasionally, one has been noted when the ataxia was
grave but the tactile sense was unimpaired, or where the muscular
sense was perfect but ataxia was well developed. The difficulty with
most such records is that no discrimination is made as to the kind of
ataxia present. That loss of skill which the patient shows when he
shuts his eyes and attempts to perform certain movements without
their aid is undoubtedly due to diminished sensation, either tactile or
muscular, and usually both. The inability to stand with the eyes
closed is probably a cerebellar phenomenon, and in this respect we
are on the way to return to Duchenne's opinion. It is true that the
cerebellar organ is healthy in most tabic subjects, but its centripetal
informer, the direct cerebellar tract, is either itself involved or affected
in its origin in the columns of Clarke. But, besides the static ataxia
and that motor ataxia which can be neutralized by the use of the eye,
there is another disturbance, which, as Erb and his followers hold,
cannot be accounted for on the strength of any sensory disturbance.
It consists in an interference with the proper succession and rhythm
of movement. It seems as if that automatic mechanism by which the
individual or grouped muscular contractions engaged in locomotion
follow each other with the smoothness of the action of perfectly-
fitting cog-wheels were disturbed; the correct after-movement is
hesitated over or skipped, or even takes place at the wrong moment,
neutralizing some other step in the co-ordination required. The
tendency of physiologists and pathologists is to attribute this form of
ataxia to the disease of the intrinsic co-ordinating apparatus of the
cord itself. The experiments of Tarchanoff on a headless duck, and
the determination of the existence of cursorial co-ordinating tracts
uniting the brachial and lumbar nuclei in mammals, as well as the
observations made on automatic co-ordinate movement in
decapitated criminals, demonstrate the existence in the cord of such
an apparatus. The combination of the ganglionic centres which
underlies this co-ordination is affected by the so-called short tracts of
the cord,48 and it is precisely a portion of these which are involved in
the lesion of the column of Burdach. A number of arguments have
been advanced against regarding the lesion of this column, or
indeed any of the lesions of the posterior column, as explaining the
ataxia-producing effect of tabes. Westphal has interposed some
potent objections. He holds that lesion of these columns will be
found more frequently when examinations shall no longer be limited
to those cases where disease is suspected because ataxia was
observed during life. He found extensive disease of the posterior
columns in sufferers from paretic dementia who did not exhibit the
characteristic ataxic gait of tabes. I believe this objection can be met
by the very cases cited by Westphal in its support. Where the spinal
disorder preceded the cerebral—that is, where paretic dementia
occurred as a complication of tabes dorsalis—true locomotor and
static ataxia had been present before the insanity exploded. On the
other hand, where the spinal disease followed the cerebral, typical
ataxia did not ensue. This would seem to indicate that the
destruction of cortical control is inimical to the development of typical
tabes. Leyden has made a suggestion in the same direction when he
attributes the lesser manifestness of locomotor ataxia in tabic
females to their inferior cerebral organization.49 A more convincing
proof of the correctness of this conclusion is furnished by the fact
that if the pathological process, after destroying the posterior
columns and producing ataxia, invades the voluntary motor tract, the
ataxic symptom becomes less palpable.50 This antagonism between
lateral-column and posterior-column lesion is frequently exemplified
in the combined forms of sclerosis. It would seem, then, that where
the brain is healthy and the controlling voluntary tracts are
unimpaired, the ataxia is aggravated, supporting the beautiful theory
of Adamkiewicz, which assumes that the locomotor ataxia is due to a
disturbance of the balance normally existing between the psycho-
motor centres and those controlling the muscular tone as well as
those mediating reflex excitability.51
48 Intersegmental tracts.

49 In one out of three female eases I found the active disturbance of gait as severe as
in males, but Leyden's observation is supported by all who have seen a sufficiently
large number of female cases.

50 Not because of paresis altogether, for it diminishes materially out of proportion to

the paresis.

51 Archiv für Psychiatrie, x. p. 545. There is another observation which bears in this
direction: James of Boston observed that absolute deaf-mutes in a large percentage
of cases are insusceptible to vertigo or to the allied phenomenon of sea-sickness.
Certainly, the auditory nerve is a space-sense nerve; its physiological elimination is,
however, accompanied by an immunity against a symptom which may be an evidence
of disturbed space-sense transmission. In like manner, the destruction of the central
perceptive and voluntary centres in the paretic dement inhibits the legitimate results of
posterior spinal sclerosis.

The degeneration of the crossed-pyramid tracts in typical tabes seem to be strictly an

atrophy from disuse, perhaps facilitated by the general malnutrition of the cord. It is
limited to that part supplying the most or solely affected extremities. Thus, where the
lower extremities are alone grossly involved it is totally degenerated in the lumbar
area, and only in its outer parts in higher levels. As if to fortify this comparison by
analogous observations from every great segment of the nervous axis, a similar
inhibiting influence of pyramid lesion on co-ordinating disturbance (muscular sense) is
noted in secondary degeneration of the interolivary layer; when uncomplicated with
 pyramid lesion (Meyer and my own case,) ataxia is present; when so complicated
(Schrader, Homén) it is not observed, even if determinable.

Lissauer52 has recently determined the existence of a degeneration

of certain fine nerve-fibres, apparently derived from the outermost of
the radicles into which the posterior nerve-roots divide on entry. They
are situated on that border of the apex of the posterior horn which is
in contact with the lateral column, and were found degenerated in all
cases except such as were in the initial period. No symptomatic
relation has been claimed for this lesion.
52 Neurologisches Centralblatt, 1885, No. 11.

One of the most important questions which have grown out of the
pathological studies of tabes is the relationship between the lesions
and the not infrequently observed restoration of functions which had
been more or less seriously impaired in an earlier period of the
disease. Even those symptoms which ordinarily comprise the
continuous and essential clinical background of tabes may exhibit
remarkable changes in this direction. I have two well-established
observations—one of tabes of eight years' standing, the other of
more recent date—in which that symptom which, once established,
is the most constant, the reflex iridoplegia, disappeared, to reappear
in two months in one case where it had been associated with
myosis, and to reappear in eight months in the other, repeating this
oscillation the following year. I have now under observation a tabic
patient in the sixth year of his illness who two years ago had a return
of both knee-phenomena to a nearly normal extent, to lose them in
two months, and to regain the reflex on the left side four months ago,
retaining it up to the present. These three cases were of syphilitic
subjects. In a fourth advanced non-syphilitic tabic patient, whose
ataxia had reached a maximal degree, I found a return of both knee-
phenomena for three days after its absence had been established by
medical examiners for over a year, and had probably been a feature
for a much longer period. Hammond the younger and Eulenburg
have reported similar cases. Nothing is more surprising to those
unfamiliar with the progress of this disease than to find gross ataxia
or the electrical pains and anæsthesia to disappear or nearly so; and
the alleged success of more than one remedial measure is based on
the fallacious attributing to the remedy what was really due to the
natural remittence of the disease-process or of its manifestations.
The financial success of quacks and the temporary but rapidly
evanescent popularity of static electricity, Wilsonia belts, and like
contrivances are owing to the hopefulness inspired in the credulous
patient by the mere coincidence of spontaneous improvement and
the administration of a new remedy, supplemented, it may be, by the
influence of mind on body in his sanguine condition. It is to be
assumed that the influences which are at work in provoking the
trophic and visceral episodes of tabes are of an impalpable
character, and that all theorizing regarding the reason of their
preponderance in one and their absence in another case are as
premature as would be any speculation regarding their rapid
development and subsidence in the history of one and the same
case. But we have better grounds for explaining the remissions of
the ataxia and anæsthesia.

It is only in the most advanced stages of tabes that the destruction of

the axis-cylinder becomes absolute or nearly so. Contrary to the
opinion of Leyden,53 who held that the tabic sclerosis differs from
disseminated sclerosis in the fact that the axis-cylinder does not
survive the myelin disappearance, it is now generally admitted that a
certain number of exposed or practically denuded axis-cylinders may
be preserved in the sclerotic fields.54 It is on the theory that these
delicate channels may be oppressed at one time, perhaps by
inflammatory or congestive pressure, and relieved at another by its
subsidence, that we may assume them to be the channels through
which the now limited, now liberated, functions are mediated. It is
also reasonable to suppose that vicarious action may supplement
the impaired function, and to some extent overcome the disturbing
factors. This is illustrated by the controlling influence of the visual
function—yea, even of the unconscious and ineffectual co-operation
of completely amaurotic eyes—in neutralizing both locomotor and
static ataxia. One patient who was well advanced in the initial period
of tabes, and who had been encouraged to consider the medical
opinion to that effect as the result of an exaggerated refinement of
diagnosis, made repeated tests of the Romberg symptom in his own
case, and deluded himself into the belief that the physician was
mistaken because he succeeded in practically overcoming it with an
effort that too plainly told its own story; but still he overcame it.
Certain peripheral influences have the power of stimulating the
dormant activity of potentially vicarious tracts, and perhaps also the
blunted activity of those whose function is impaired. The outside
temperature, certain barometric conditions, all may exert an
influence in this direction for good or evil.
53 Op. cit., p. 328, vol. ii.

54 Babinski (Neurologisches Centralblatt, 1885, p. 324) notes this feature, and,

consistently with the findings of most modern observers, discovers much more
resemblance to disseminated sclerosis than to the systemic sclerosis with which
Strümpell and Westphal (in part) incline to classify tabes. Similar objections to the
system-disease theory are advanced by Zacher (Archiv für Psychiatrie, xv. p. 340). I
may not pass over in silence the fact that Babinski considers his observations to
militate also against regarding any phase of the tabic sclerosis as a secondary
process. But while it may fairly be asked that a sclerosis to be regarded as systemic
must be shown to be total, this is not necessary for a secondary process, unless the
primary involvement be total also; and that is not the case in tabes.

ETIOLOGY.—Authorities are now agreed that no single cause can be

regarded as the sole responsible factor in all cases of tabes, and that
a number of etiological influences are combined in the provocation of
this disease in most instances. When the distinctiveness of the
affection was first recognized it was customary to attribute it to
sexual excesses, and the unfortunate sufferer had frequently to bear
the implied reproach of having brought his misery on himself, in
addition to the hopeless prospect which those who followed
Romberg and other authorities of the day held out to him.55
55 This opinion survives in a large portion of the German laity and in French novels.
About the time that the poet Heine was dying from an organic spinal affection two
other prominent literary characters of Paris were affected with tabes. It so happened
that all three were popularly regarded as libidinous, and one of their leading
 contemporaries, whose name escapes me, took occasion to issue a manifesto
addressed to the jeunesse dorée which closed with the apostrophe, “Gardons à nos
moelles.”

Heredity plays a very slight part in the etiology of tabes. Writers of

ten and fifteen years ago attributed a greater importance to it than is
now done. But this was due to the incorporation with tabes of the so-
called family form of locomotor ataxia—a disease which is now
regarded as a distinct affection.56
56 There is but one record of direct heredity (the father and son being affected nearly
at the same time), to my knowledge. It was observed at the Berlin Hospital by Remak
(Berliner klinische Wochenschrift, 1885, No. 7). Both father and son were syphilitic.

More importance may be attached to individual predisposition, but

thus far no distinct formulation of this factor has been attempted
except by Schmeichler,57 who offers the suggestion that there are
persons with a predisposition to the development of connective-
tissue proliferation in various organs of the body, and that in them
tabes and other sclerotic affections are consequently more frequent
than in others. This suggestion appears plausible, but it is
unconfirmed by positive observations.
57 Op. cit.

Sex appears on a superficial view to be one of the most important

elements. It is generally admitted that at most one female becomes
tabic for every ten males who do so. Of 81 cases in private practice,
I observed but 3 females. Rockwell, Seguin, Birdsall, and Putnam
give similar figures. This comparative immunity is probably due to
the fact that the female is less exposed to over-exertion, to surface
chilling of the feet, to the injurious consequences of sexual excess,
and to syphilis58 than the male. As a rule, the affection in females is
more insidiously developed, progresses more slowly, is less marked
by crises and trophic disturbances, and not accompanied by as
severe pains and profound disturbance of co-ordination as is the
corresponding affection in males.
 58 Whether the shorter vitality of the syphilitic female as compared with that of the
male is a factor in diminishing the accumulation of chronic tertiary sequelæ in that
sex, or whether it be the lesser vulnerability of the inferior nervous system, I am
unable to decide from the facts at my disposal. In private and clinical experience I
have been struck by the fact that women affected with syphilis in the same way and
under similar circumstances with tabic syphilitic males develop symptoms of
functional disorder of the brain and cord, such as spinal and cerebro-spinal irritation.
My cases referred to had in no instance any indication of a syphilitic condition or
history, and a distinct and different cause was found in all three.

The most important element in creating an acquired predisposition to

tabes is undoubtedly the existence of constitutional syphilis. Some
difference of opinion still exists regarding the proportion of syphilitic
tabic patients, chiefly due to the neglect of Erb—when he first
announced the prevailing view, and which is generally attributed to
him—to differentiate between cases of demonstrated constitutional
syphilis and the so-called spurious or soft chancre. But although
there occurred a reaction against his view which went to as great an
extreme in the opposite direction, the careful and critically registered
statistics accumulated in the mean time strengthen the view that
there are more syphilitic subjects among the tabic than among any
class of sufferers from other nervous affections.59 Reumont, a
physician at Aix-la-Chapelle, to which place syphilitic patients in
general resort in large numbers, found that of 3400 cases of syphilis,
290 had nervous affections, 40 being afflicted with tabes. Bernhardt60
took occasion to examine a group of hospital patients who were free
from tabes, and found that not fully 16 per cent. were syphilitic, while
of 125 tabic patients, over 46 per cent. were determined to have had
positive syphilitic manifestations. Several of those observers who
have paid attention to the question of the syphilitic origin of tabes
have admitted that the more searching their inquiry the larger the
proportion of detected syphilitic antecedent histories. Thus, Rumpf's
earlier table shows 66, and his later 80, per cent. of such
antecedents. This latter figure exactly corresponds to the percentage
of syphilis in my private cases. At a discussion held by members of
the American Neurological Association in 1884, Webber gave 54,
Putnam 49, Rockwell 40, Birdsall 43,61 and Seguin 22 per cent.62 as
the proportion in their experiences.
59 Excepting always those having the distinctive and undisputed syphilitic character.

60 Archiv für Psychiatrie, xv. p. 862.

61 Derived from over five hundred cases which had presented themselves at the clinic
of the College of Physicians and Surgeons.

62 In the Archives of Medicine he tabulates 54 (private) cases as follows:

Chancre alone 23
Chancre followed by secondary symptoms 16
Total of those with history of chancre 39
No history of chancre in 15
Total 54

Of European writers, aside from those already mentioned, Berger

claims 43 per cent., and Bernhardt, in commenting on the increasing
percentage obtained by accurate investigation, reports an additional
series of 7 new cases in private practice, all of which were syphilitic.
Fournier, Voigt, Œhnhausen, and George Fisher estimate the
syphilitic tabic patients at respectively 93, 81, and 72 per cent. of the
whole number. The almost monotonous recurrence of a clear
syphilitic history in my more recent records is such that in private
practice I have come to regard a non-syphilitic tabic patient as the
exception. Among the poorer classes the percentage of discoverable
syphilitic antecedents is undoubtedly much less. The direct exciting
causes of tabes, exposure and over-exertion, are more common with
them and more severe in their operation.

The proof of a relationship between syphilis and tabes dorsalis does

not rest on statistical evidence alone. A number of observations
show that the syphilitic virus is competent to produce individual
symptoms which demonstrate its profound influence on the very
centres and tracts which are affected in tabes. Thus, Finger63
showed that obliteration of the knee-jerk is a frequent symptom of
the secondary fever of syphilis, and that the relation is so intimate
between cause and effect that after the return of the reflex, if there
be a relapse of the fever, the obliteration of the knee-jerk is repeated.
Both the permanent loss of the knee-jerk (Remak) and the peculiar
pupillary symptoms of tabes are sometimes found in syphilitic
subjects who have no other sign of nervous disorder; and Rieger and
Foster64 regard the syphilitic ocular disturbances, even when they
exist independently, as due, like those of tabes, to the spinal, and not
to a primarily cerebral, disturbance. Another argument in favor of the
syphilitic origin of tabes is derived from the occasional remedial
influence of antisyphilitic treatment. The force of this argument is
somewhat impaired by the fact that the same measures occasionally
appear to be beneficial in tabes where syphilis can be excluded. Still,
the results of the mixed treatment in a few cases of undoubted
syphilitic origin are sometimes unmistakable and brilliant.65 As some
cases, even of long standing, yield to such measures, while others,
apparently of lesser gravity and briefer duration, fail to respond to
them, the question as to whether syphilis is a direct cause or merely
a predisposing factor may be answered in this way: That in the
former class it must have been more or less directly instrumental in
provoking the disease, while in the latter class it is to be regarded as
a remote and predisposing factor, to which other causes, not
reached by antisyphilitic treatment, became added. The claim of Erb,
that “tabes dorsalis is probably a syphilitic disease whose outbreak is
determined by certain accessory provocations,” is not subscribed to
unreservedly by a single writer of eminence.
63 “Ueber eine constante nervöse Störung bei florider Syphilis der Secundärperiode,”
Vierteljahrschrift für Dermatologie und Syphilis, viii., 1882.

64 “Auge und Rückenmark,” Graefe's Archiv für Ophthalmologie, Bd. xxvii. iii.

65 In one case already referred to a return of both knee-phenomena and complete

disappearance of locomotor and static ataxia were effected after a duration of four
years. The treatment was neglected and the knee-jerks disappeared, and one has
now returned under the resumed treatment, but accompanied by lightning-like pains.
 At a meeting of the Société médicale des Hôpitaux, held November 10, 1882,
Desplats reported a case in which even better results were obtained. Reumont
(Syphilis und Tabes nach eigenen Erfahrungen, Aachen, 1881) reports 2 out of 36
carefully observed syphilitic cases cured, and 13 as improved under antisyphilitic
treatment.

The question has been raised whether the influence of syphilis is

sufficiently great to justify a clinical demarcation between syphilitic
and non-syphilitic cases. A number of observers, including Reumont,
Leonard Weber, and Fournier, incline to the belief that there are
more atypical forms of tabes in the syphilitic group. Others, including
Rumpf, Krause, and Berger, are unable to confirm this, but the
former admits, what seems to be a general impression among
neurologists, that an early preponderance of ptosis, diplopia, and
pupillary symptoms is more common with syphilitic than with non-
syphilitic tabes. Fournier66 believes that syphilitic patients show more
mental involvement in the pre-ataxic period; but it is evident that he
has based this belief on a study of impure forms. The advent of
tabes in syphilitic cases does not in this respect differ from the rule.
The most protracted and severe diplopia I have yet encountered in a
tabic patient is one, now under observation, in the initial period of the
disease, syphilis being positively excluded as an etiological factor.
66 L'Éncephale, 1884, No. 6.

It seems to be a prevalent opinion that the cases of syphilis in which

tabes is developed include a large proportion of instances in which
the secondary manifestations were slight and unlike that florid
syphilis with well-marked cutaneous and visceral lesions which is
more apt to be followed by transitory or severe vascular affections of
the cord and brain.

Excesses in alcohol, tobacco, and abuse of the sexual function are

among the factors which frequently aggravate the tendency to tabes,
and one or more of them will usually be found associated with the
constitutional factor in syphilitic tabes. Both alcohol and nicotine
have a deleterious effect on nervous nutrition and on the spinal
functions, as is illustrated in the effect of the former in producing
general neuritis, and of both in provoking optic-nerve atrophy and
general paralysis of the insane, not to speak of the pupillary states
which often follow their abuse, and the undeniable existence of a
true alcoholic ataxia. Sexual excesses were, as stated, at one time
regarded as the chief cause: the reaction that set in against this
belief went to the extreme of questioning its influence altogether. It is
to-day regarded as an important aggravating cause in a large
number of cases, and this irrespective of whether it be the result of a
satyriacal irritation of the initial period or a precedent factor. In a
large number of my patients (18 out of 23 in whom this subject was
inquired into) the habit of withdrawing had been indulged in,67 and,
as the patients admitted, with distinct deleterious effects, such as
fulness and throbbing in the lumbo-sacral region, tremor and rigidity,
with tingling or numbness, in the limbs, blurred vision, and
sometimes severe occipital headache; in one case lightning-like
pains in the region of the anus ensued.68
67 Coitus reservatus, the real crime of the Onan of Scripture.

68 Leyden states that coitus in the upright position has been accused of producing
tabes, without mentioning his authority. I have no observation on this subject touching
tabes, but am prepared to credit its bad effect from the account of a masturbator, who
during the orgasm produced while standing felt a distinct shock, like that from a
battery, shooting from the lumbar region into his lower limbs, and causing him to fall
as if knocked down. He consulted me in great alarm—was scarcely able to walk from
motor weakness, and had no knee-phenomenon; in a few weeks it returned, and no
further morbid sign appeared. Masturbators of the worst type occasionally manifest
ataxia, and in three cases I have been able to establish the return of the knee-jerk,
together with other improvements in the spinal exhaustion of these subjects. The loss
and diminution of the patellar jerk, and the frequently associated urinary incontinence,
as well as certain of the peripheral pains found in masturbators, certainly prove that
undue repetition of the sexual act (be it natural or artificial) is competent to affect the
cord in a way that cannot but be injurious in case of a predisposition to tabes, if not
without the latter.

Of single causes, none exerts so direct and indisputable an influence

on the production of tabes as the action of cold and wet upon the
lower segment of the body. It is usually the case that such exposure
is frequently repeated and combined with over-exertion before the
disease is produced, but it is occasionally possible to trace the very
first symptom of the disease directly to a single exposure. A soldier
who stands up to his knees in a rifle-pit half full of water finds his
limbs numb or tingling; develops slight motor weakness, then
lightning-like pains, and ultimately a typical tabes. In the case of a
peddler who presented an advanced form of the disease, the first
symptoms had developed after a single wetting of his feet: while
walking along one of our watering-places with his wares the swell of
a steamer inundated the beach. He had been subject to perspiring
feet before that, and the perspiration remained checked from that
time on.69 The influence of surface chilling was remarkably manifest
in all three of my female cases. In one of them it was due to frequent
wetting of the feet; in the second, a midwife, the first symptoms
began immediately after standing on a cold hearthstone while
preparing some article needed in a lying-in case. In the third case, a
lady who contracted and safely passed through a scarlatina in her
twenty-eighth year was taken out driving while desquamation was
going on. She became thoroughly chilled, experienced numbness in
the fingers and toes, and from that day on developed a slowly
progressing tabes involving all extremities alike.70
69 Checking of habitual perspiration by violent measures is mentioned by the German
textbook writers as a frequent cause, but occurs quite rarely in the modern tables.

70 In view of the absence of spinal—or, in fact, any nervous—symptoms prior to the

exposure referred to, it does not seem necessary to insist that this was not an
instance of a true post-scarlatinal tabes; and possibly the case thus designated by
Tuczek (Archiv für Psychiatrie, xiii. p. 147) may have been really due to chilling of the
delicate body-surface after desquamation or during that process. The typical form of
myelitis and sclerosis after exanthematous fevers is rather of the disseminated type.

Spinal concussion has been mentioned by a number of authorities

as a possible cause for tabes, as for other forms of sclerotic spinal
disease. In 1 of 81 cases in my own observation the development of
the disorder could be distinctly traced to a railway injury; in 2 a
sudden aggravation was as distinctly referable to a similar cause.71
To what extent railroad travelling, with its attendant continual jarring
of the body, may predispose to the development of tabes or of other
spinal diseases is as yet a matter of mere conjecture. That railroad
travelling exerts a bad influence in some cases of the established
disease is evident; but in others the patients rather like the motion,
and claim to feel benefited by it.
71 A fall from a chair, striking on the back of the latter, while endeavoring to keep a
row of books from coming down in one case, and the shock of the Ashtabula disaster
in the other. The latter patient, the same one who is referred to as describing the
electric-storm sensation in an earlier part of this article, had his foot amputated in
consequence of that disaster; but, like one of the characters in Jacob Faithful, who felt
his toes when the weather changed, though he left both legs at Aboukir, he felt the
terrific pains of the disease in the absent foot as distinctly as in the other. Dumenil and
Petit (Archives de Névrologie, ix. Nos. 25 and 26) relate cases in which a spinal
concussion was the only ascertainable cause.

A number of toxic agents have been charged with producing tabes:

thus, Bourdon maintains this of absinthe; Oppenheim attributes one
case to poisoning by illuminating gas, the exposure to its influence
being immediately followed by a gastric crisis, and this by a
regulation tabes.72 It is supposed that most of the poisons acting on
the cord in this or a similar way, such as arsenic, cyanogen,73
barium, and chloral,74 do not produce a spinal lesion directly, but
through the medium of a secondary cachexia. Of no agent is the
effect in producing tabes so well studied as ergot of rye. It had long
been known that ergot-poisoning provoked certain co-ordinating,
motor, and sensory disturbances, but it was left for Tuczek75 to show
that this vegetable parasite produces a lesion of the spinal cord
which in its character and distribution apes typical posterior sclerosis
so closely as to justify the designation of a tabes ergotica. Possibly,
pellagra, which is sometimes manifested in a similar way,76 may yet
be shown to have a like influence.
72 Archiv für Psychiatrie, xv. p. 861.

73 Bunge, Archiv für experimentelle Pathologie, xii.

 74 Transactions of the Clinical Society of London, xiii. p. 117, 1880.

75 Archiv für Psychiatrie, xiii. p. 148.

76 Bouchard, “Étude d'Anatomie pathologique sur un Cas de Péllagrie,” Gaz. méd. de

Paris, 1864, No. 39.

Among the occasional and exceptional causes of tabes, Leyden and

Jolly mention the puerperal state; Bouchut, diphtheria; and several
instances are recorded in which psychical shock was responsible for
the outbreak of the disease. In a small number of cases I found that
mental worry and anxiety coincided with the period of presumable
origin of the disease.

Age seems to have no special determining influence. It is true that

most sufferers from this disease are men in the prime of life or in the
period following it. But it is precisely at these periods that the
exposure to the recognized causes of tabes is greatest. It seems as
if there were very little liability to the development of tabes after the
fiftieth and before the twenty-fifth year; still, some cases of infantile
tabes have been recorded.77
77 Excluding the so-called family form of locomotor ataxia: 6 rather imperfectly
described cases are cited by Remak (loc. cit.), and 3 additional ones related by
himself. Of the latter, 2 had hereditary syphilis, and of 1 the father was both syphilitic
and tabic.

In the majority of cases tabes is due to a combination of a number of

the above-mentioned factors. The majority of tabic patients in the
middle and wealthy classes have had syphilis, and of these, in turn,
the majority have been guilty of sexual excesses or perverted sexual
acts, while excesses in tobacco and of alcohol are often superadded.
Among the poorer patients we find syphilis less frequently a factor,
but still present, according to various estimates, in from 20 to 60 per
cent. of the cases. Excesses in tobacco play a lesser, and excesses
in alcohol a larger, part in the supplemental etiology than in the other
class, while exposure to wet and cold and over-exertion are noted in
the majority; indeed, in a fair proportion they are the only assignable
causes.

DIAGNOSIS.—The recognition of advanced tabes dorsalis is one of the

easiest problems of neurological differentiation. The single symptom
which has given one of its names to the disease—locomotor ataxia
—is so manifest in the gait that even the sufferers from the affection
learn to recognize the disease in their fellow-sufferers by the peculiar
walk.78
78 At present I have six tabic patients under treatment, who are acquainted with each
other, and who have made each other's acquaintance in the singular way of
addressing one another on the strength of mutual suffering at Saratoga, at the Hot
Springs of Arkansas, and in New York City.

Although there are other chronic affections of the cord which

manifest ataxia, such as myelitis predominating in the posterior
columns, disseminated sclerosis in a similar distribution, and some
partially recovered cases of acute myelitis, the gait is not exactly like
that of tabes. The uncertainty may be as great, but the peculiarly
stamping and throwing motions are rarely present in these
affections. The clinical picture presented by the ataxic patient, aside
from his gait, is equally characteristic in advanced cases. Absence of
the knee-jerk and other deep reflexes, the bladder paralysis, sensory
disturbance, delayed pain-conduction, trophic disturbances, and
reflex iridoplegia are found in the same combination in no other
chronic disorder of the cord. It is supposable that an imperfect
transverse myelitis in the lumbar part of the cord might produce the
reflex, ataxic, sensory, sexual, and vesical symptoms of ataxia, but
the brachial symptoms found in typical tabes as well as gastric crises
would be absent. The pupillary symptoms would also fail to be
developed, in all probability. It is to be remembered that only
fascicular cord affections can produce a clinical picture exactly like
that of tabes in more than one important respect. In analyzing the
individual symptoms of the early stage the more important differential
features can be most practically surveyed.
The discovery of no single symptom of tabes dorsalis marks so
important an epoch in its study as Westphal's observation that the
knee-phenomenon is usually destroyed in it. Had this symptom not
been detected, so Tuczek admits, ergotin tabes would have eluded
recognition.79 It was claimed by a majority of neurologists at first that
this jerk is always abolished in tabes, but it is now recognized that
there are exceptions, as is shown by cases of Hirt,80 Westphal, and
others, not to mention some well-established cases of its return
during the progress of the disease.
79 It is not to be wondered that, like most new discoveries, that of the pathological
changes of the patellar reflex should have been made the basis of premature
generalizations. The attempt of Shaw (Archives of Medicine) to establish a relation
between disturbances of the speech-faculty and an increased knee-jerk has not met
with any encouragement or confirmation, and has been rebutted by Bettencourt,
Rodrigues (L'Éncephale, 1885, 2), and others.

80 Berliner klinische Wochenschrift, 1886, 10.

The knee-phenomenon is supposed to be a constant attribute of

physiological man. It is difficult to elicit it in children, and frequently
impossible to obtain it in young infants. It also disappears in old age,
without having any special signification, except that this occurrence
seems to be in direct relation to senile involution. In 2403 boys
between the ages of six and thirteen years, Pelizæus81 found it
absent in one only. It is customarily elicited by having the patient
while sitting in a chair throw one leg over the other; hereupon the
ligamentum patellæ is struck a short, quick blow. Under physiological
circumstances the leg is jerked outward involuntarily after an interval
of about one-fifth of a second—one that is scarcely appreciated by
the eye. But if it be found absent by this mode of examination, the
case is not to be regarded as one of absence of the jerk without
further ado. The patient is made to sit on a table, his legs dangling
down and his body leaning back, while he clenches his fists. By this
means the jerk will often be produced where it appears to be
impossible to evolve it by the ordinary means. It is also well to try
different parts of the ligament, and when comparing both sides to
strike on the corresponding spot and in the same direction. Many
subjects who appear to be irresponsive will respond very well when
a point on the outer edge near the tibial insertion is percussed. The
elbow reflex, which has the same signification for the upper extremity
that the knee-jerk has for the lower, is elicited in the same manner.
81 Archiv für Psychiatrie, xv. p. 206.

The absence of the knee-jerk is usually regarded as a suspicious

circumstance in persons of middle life; and where it can be
demonstrated that it has been present years previously and
subsequently disappeared, it is looked upon as of grave import. I,
however, published three years ago an authentic case of
disappearance of the knee-jerk in a physician now in active practice
in New York City who to this day enjoys excellent health and has
developed no other sign of spinal disease. The knee-jerk is also
abolished in a number of conditions not belonging to the domain of
strictly spinal diseases, such as diphtheria, diabetes, secondary
syphilis, and severe cases of intermittent fever. Of these, diabetes
alone can be possibly confounded with tabes dorsalis. The difficulty
of differentiating early tabes and diabetes is enhanced by the fact
that on the one hand there are often ataxic symptoms with diabetes,
while on the other both glycosuria and diabetes insipidus may
complicate tabes. Senator, Frerichs, Rosenstein, Leval-Piquechef,
Charcot, Raymond, Demange, Féré, Bernard, and T. A. McBride all
recognize the occasional presence of the ataxic gait, paræsthesia,
belt sensation, and even fulgurating pains, besides the abolition of
the jerk, in diabetes mellitus.82 In pure cases of diabetes, however, I
am not aware that spinal myosis or the reflex paralytic pupil has
been found.
82 I have now under observation a case of myelitis with predominating sclerosis of the
posterior columns of five years' standing in a merchant who has been under
antidiabetic treatment for eleven years.

Abolition of the knee-jerk is found in all organic diseases of the

spinal cord which destroy any part of the neural arch at the upper
lumbar level, where the translation of the reflex occurs, whether it be
in the posterior root-zones or in the gray matter of the origin of the
crural nerves. Thus, acute or chronic myelitis, disseminated sclerotic
foci of this level, may cause obliteration of the reflex at any time of
the disease; so may acute or chronic anterior poliomyelitis,
neoplasms, and amyotrophic lateral sclerosis of the anterior cornua
type if the destruction of the anterior cornua be complete enough. It
is also found abolished with all diseases of the peripheral nerves—
traumatic and neuritic—which produce absolute motor paralysis of
such nerves.

Among the sources of error possibly incurred in examining for this

important symptom the presence of rheumatism is one. There is
sometimes a tetanic rigidity of the joints which prevents the reflex
from becoming manifest. It is also sometimes found to be absent
immediately after severe epileptic attacks, according to Moeli.83
83 In three examinations after severe attacks of epilepsy I found it normal.

The condition of the pupil is perhaps a more constant sign of early

tabes than the loss of the knee-jerk; at least it has been found well
marked in cases where the jerk had not yet disappeared. It may be
regarded as a rule in neuro-pathology that wherever reflex
iridoplegia is at any time accompanied by other oculo-motor
disturbance, it is either of spinal origin or in exceptional cases due to
disease of the pons varolii. The peculiar character of the pupillary
disturbance of tabes furnishes us with a criterion for distinguishing it
from one affection which in common with it exhibits loss of the knee-
jerk—diphtheria. In diphtheria there is also a reflex disturbance of the
pupil, but it is the reverse of that of early tabes. In the latter reaction
to light is lost, but the accommodative contraction power is retained;
in diphtheria accommodative contraction power is lost, but reaction
to light is retained.

The bladder disturbance has already been described. It is found as a

marked symptom so prominently in no other systemic affection of the
cord, and in few of the non-systemic forms, of sclerosis. In none of
these is it associated with absence of the patellar jerk, reflex
iridoplegia, and fulminating pains, as in tabes, except there be also
some motor paresis. It is the combination of any two of the important
initial symptoms of tabes without paralysis or atrophy that is
regarded as indicative of the disease by most authorities. Thus the
swaying in closing the eyes, if associated with the Argyll-Robertson
pupil, is considered as sufficient to justify the diagnosis of incipient
tabes, even if the knee-jerk be present and fulminating pains and
bladder trouble absent. Undoubtedly, the tabic symptoms must begin
somewhere. But at what point it is justifiable to give a man the
alarming information that he is tabic is a question. I have a number
of neurasthenic subjects now under treatment who have had reflex
iridoplegia for years; in one the knee-jerk is slowly becoming
extinguished; in two it has been becoming more marked after
becoming less; in all the three mentioned there is slight swaying in
closing the eyes and some difficulty in expelling the last drops of
urine while micturating. I do not believe that such a condition justifies
a positive opinion, although the surmise that they are on the road to
developing tabes may turn out correct for all these and for some of
those who have merely reflex iridoplegia.

Incipient tabes cannot be readily confounded with any other chronic

disease of the spinal cord. Some of the cases produced by sudden
refrigeration resemble a beginning myelitis. But the absence of true
paralysis seems to distinguish it from the latter. In all the cases of so-
called acute locomotor ataxia of myelitic origin that I can find a
record of, paralytic symptoms were marked, if not throughout the
disease, at least in the initial period.

Other forms of sclerosis occasionally limited to the posterior columns

imitate the symptoms of tabes. It is unusual, however, for such
sclerosis to be distributed through so great an extent of the posterior
columns as to produce symptoms consistent with tabes in both the
upper and lower extremities. And even where this condition is
complied with, the typical progress so characteristic of tabes is not
adhered to. As previously stated, the progress is weakened by
variations in certain symptoms. Such variations are found in other
forms of sclerosis, but they are not as great, trophic disturbances not
so common, and visceral crises not so violent, as a rule.