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OUP CORRECTED AUTOPAGE PROOFS – FINAL, 11/12/2021, SPi
State Laughter
State Laughter
Stalinism, Populism, and Origins
of Soviet Culture
EVGENY DOBRENKO
and
NATALIA JONSSON-SKRADOL
1
3
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Evgeny Dobrenko and Natalia Jonsson-Skradol 2022
The moral rights of the authors have been asserted
First Edition published in 2022
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2021944925
ISBN 978–0–19–884041–1
DOI: 10.1093/oso/9780198840411.001.0001
Printed and bound by
CPI Group (UK) Ltd, Croydon, CR0 4YY
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
For Liudmila Nedialkova.
ED.
For Olga Skradol and Nick Jonsson.
NJS.
Mankind, which in Homer’s time was an object of amusement for the

Olympian gods, now is one for itself. Its self-alienation has reached
such a degree that it can experience its own destruction as an aesthetic
pleasure of the first order.
Walter Benjamin, The Work of Art in the
Age of Mechanical Reproduction
Table of Contents
List of Illustrations xi
Introduction 1
1. The Stalinist World of Laughter: The Fate of the Comic
in a Tragic Age 18
2. A Killer Wit: Laughter in Stalinist Official Discourse 68
3. The Funny War: Laughing at the Front in World War Two 115
4. “One Might Think It Is a Ward in a Madhouse”: Late Stalinism,
the Early Cold War, and Caricature 152
5. The Gogols and the Shchedrins: Lessons in “Positive Satire” 211
6. The Soviet Bestiary: Genealogy of the Stalinist Fable 250
7. The Merry Adventures of Stalin’s Peasants: Kolkhoz Commedia
dell’arte 285
8. “A Total Racket”: Vaudeville for the New People 325
9. Metalaughter: Populism and the Stalinist Musical Comedy 361
Bibliography 399
Index 417
List of Illustrations
Fig. 1. Caricature by Boris Efimov, text by Boris Laskin. Literaturnaia gazeta,

May 1, 1951. 154
Fig. 2. Caricature by Boris Efimov. Literaturnaia gazeta, January 30, 1951. 155
Fig. 3. Caricature by Boris Efimov. Literaturnaia gazeta, August 4, 1951. 156
Fig. 4. Caricature by Boris Efimov. Literaturnaia gazeta, April 5, 1950. 157
Fig. 5. Caricature by Boris Efimov. Literaturnaia gazeta, December 4, 1948. 158
Fig. 6. Montage cartoon by A. Zhitomirskii. © Vladimir Zhitomirskii.
Literaturnaia gazeta, November 30, 1949. 159
Fig. 7. Caricature by B. Efimov. Literaturnaia gazeta, November 26, 1947. 160
Fig. 8. Montage cartoon by A. Zhitomirskii. © Vladimir Zhitomirskii. Izvestiia,
March 27, 1952. 161
Literaturnaia gazeta, October 1, 1947. 162
Fig. 10. Cartoon reprinted from the Czech newspaper Rude Pravo. Literaturnaia
gazeta, February 23, 1952. 163
Fig. 11. Caricature by Boris Efimov. Literaturnaia gazeta, November 4, 1950. 166
Fig. 12. Caricature by the Kukryniksy, Pravda, October 1, 1947. 171
Literaturnaia gazeta, March 24, 1948. 172
Fig. 14. Boris Efimov. Illustration to the satirical piece by D. Zaslavskii “The Trial
of Lynch-Medina” in the collection Cavemen in America (Moscow, 1951). 184
Fig. 15. Boris Efimov. Illustration to the satirical piece by D. Zaslavskii
“How Mr. Acheson Flogged Himself” in the collection Cavemen in
America (Moscow, 1951). 186
Fig. 16. Boris Efimov. Illustration to the satirical piece by D. Zaslavskii
“Acheson overthrows . . . Karl Marx” in the collection Cavemen in America
(Moscow, 1951). 188
Introduction
In 1989, in the heyday of perestroika, the American publisher Andrews & McMeel
published a book about Soviet humor that included caricatures from the principal
Soviet satirical magazine, Krokodil. The book had two introductions. One was by
Krokodil’s editor-in-chief, Aleksei P0 ianov, and the second was penned by the
famous historian of animation and caricature, Charles Solomon. Solomon’s text
opened with a short overview of how the Soviet Union was perceived in the West,
through Cold War films from Hollywood:
That anyone could compile an anthology of Soviet cartoons will surprise many
Americans. In the United States, the USSR is usually depicted as either a bleak,
grey land where gloomy peasant women sweep the sidewalks, or a sinister
conspiracy of a country bristling with missiles, spies, and aging generals in
medal-encrusted uniforms. In both scenarios, the graphic arts are restricted to
garish, “heroic” murals on the walls of tractor factories.¹
What kind of laughter could there be in a country like that?

P0 ianov’s introduction, a showcase of perestroika rhetoric (glasnost0 , cooper-
ation, trust), was, in a way, an answer to that question. Soviet people, it says, are
full of optimism, as attested by the astronomical print-runs of the country’s
principal satirical magazine. Make laughter, not war, P0 ianov urged his American
reader.
As we shall see, the external, almost cartoonish projection of Soviet laughter did
not, alas, stray far from the perspective usually adopted within the country itself.
Of all aesthetic categories, the comic has the least obvious connection with
Stalinism. It is much easier to associate the Stalinist aesthetic with the heroic,
the monumental, the sublime, even the tragic. For most of those familiar with
Socialist Realism as the official Soviet art, there is nothing more boring, more
helplessly gloomy, and further removed from laughter and merriment. The very
words “Soviet laughter” usually made one think of the same old anti-Soviet jokes
and Aesopian language, the same old Soviet (read: anti-Soviet) satire, intellectuals
giving someone the finger on the sly—the Sovietologists’ favorite subjects. The
names that came to mind would be those of Mikhail Bulgakov, Mikhail
¹ Soviet Humor, p. 3.
State Laughter: Stalinism, Populism, and Origins of Soviet Culture. Evgeny Dobrenko and Natalia Jonsson-Skradol,
Oxford University Press. © Evgeny Dobrenko and Natalia Jonsson-Skradol 2022.
DOI: 10.1093/oso/9780198840411.003.0001
2  
Zoshchenko, Nikolai Erdman, Il0 ia Il0 f and Evgenii Petrov—satirists of the first
Soviet decades, whose names are well known and whose works are still much
loved today. Some readers might think of examples of the more radical humor of
the absurd, for example Daniil Kharms. Yet others might be more familiar with
the names associated with the late Soviet decades: Vladimir Voinovich, Venichka
Erofeev—all dissidents, all printed in tamizdat and read at home, behind closed
doors and drawn curtains.
There is no shortage of works on Soviet satire and satirists, humor and
humorists. In this book, we approach the topic from a completely different
perspective. Rather than turning our attention to the dissident and the original,
the talented and the disruptive authors, texts and styles, we will be talking about
what constituted the fabric of state-sanctioned humor, where individual voices
were lost in the multitude of constantly recycled patterns. Here, we are interested
in the transformations that the comic underwent in the unique political and
aesthetic context of Stalinism, the role it played, and the genres in which it was
manifest. The names of the authors and artists who interest us here are next to
unknown to anyone except a very narrow circle of experts. But back in the day, the
satirical features and sketches [ fel0 etony] by Leonid Lench, Semen Narin0 iani,
Grigorii Ryklin, and Ivan Riabov were devoured by millions of Soviet readers.
Those same readers also went to theaters to see the vaudevilles of Valentin Kataev,
Anatolii Sofronov, Vladimir Dykhovichnyi, and Moris Slobodskoi, and to the
movies—to laugh at the comedies of Ivan Pyr0 ev and Konstantin Iudin. In their
daily newspapers they sought out the cartoons of Boris Efimov, Mikhail
Cheremnykh, Boris Prorokov, and the Kukryniksy trio. These cartoons, film and
theater comedies, satirical features and sketches filled the pages of the popular
press and the screens and stages of the vast country. The comic genres were
favored by a mass audience looking for light reading and enjoyable performances.
The print runs for Krokodil peaked at 7 million copies (by way of comparison,
Pravda, the country’s principal newspaper, held the record at 10 million).
Here, the comic is to be understood as an aesthetic dimension of the things that
were supposed to be considered funny.
It seems appropriate to preface an analysis of this phenomenon with a kind of
meta-joke. A boss is telling his subordinates a joke. Everyone cracks up, except for
one person who does not laugh at all. The boss asks, “Why aren’t you laughing?”
Whereupon the employee responds, “Because I’m quitting tomorrow.” One might
say that the non-laugher in this story is the only one really laughing, because,
being no longer afraid of the boss, this person can laugh not at the silly joke, but at
the boss. This non-laugher has been the object of a huge body of works (both in
the USSR/Russia and in the West) about the liberating and anti-establishment
power of Soviet laughter and satire. In order to break out of the endless rhetorical
circle of, and about, subversive laughter, we suggest a complete change of per-
spective and focus our attention, first of all, on the boss’s joke, and second, on the
 3
laughter of all the other employees, less fortunate than the non-laugher because
they will not be quitting the next day.
The boss’s laughter is the laughter sanctioned by the state, and this is exactly
what we call here “state laughter.” It is in all senses a phenomenon that is yet to be
fully explored. It lacked sophistication, relying as it did on the masses’ tastes and
an undeveloped sense of humor. It was associated less with the great satirists and
humorists mentioned above, and much more with characters like Grandfather
Shchukar0 , a hapless peasant in Mikhail Sholokhov’s Virgin Soil Upturned
(Podniataia tselina, 1932, 1959), and satirists like Sergei Mikhalkov. It violates
all possible stereotypes of the comic.
First of all, it is not funny, as it relies on endless repetitions of the same
templates.
Second, it does not conform to the stereotypical (Bakhtinian) perception of the
social function of collective laughter—as always anti-totalitarian, always demo-
cratic, a tool for a destruction of hierarchies and fear—but instead decidedly
contradicts this perception. The phenomenon of state laughter shows that laugh-
ter can be a most efficient instrument of intimidation, a way to anchor the
hierarchy, a powerful tool of totalitarian normalization and control. We are
interested in the nature and functions of the comic in Stalinism that made it
into such an efficient tool. If we want to understand the Stalinist subject, we can
only do so if we understand the mental profile of the person who laughs at
Grandfather Shchukar0 , who is captivated by the merriment in Ivan Pyr0 ev’s
kolkhoz comedy The Swineherd and the Shepherd (Svinarka i pastukh, 1941),
who is filled with the sense of Soviet national pride when looking at the
Kukryniksy’s caricatures, and who is moved to tears by the “warm humor” of
Fedor Reshetnikov’s paintings.
The ideal Stalinist subject was only partly a product of social engineering. To a
much larger extent this figure was the result of efforts to make the utopian Marxist
project correspond to the “human material” at hand—with the state of the
“human material” being the defining factor. The Bolsheviks, guided by the ideol-
ogy of Marxism, were not known for “kowtowing to the people” (narodopok-
lonstvo), to use their own words. But Lenin knew very well that there were lines
that could not be crossed. He defined the link between populism and authority
very clearly: “We can only rule when we correctly express what the people are
conscious of. Without this the communist party will not be able to lead
the proletariat, and the proletariat will not be able to lead the masses, and the
whole machinery will fall apart.”² In other words, if the authorities do not express
the consciousness of the masses, the “machinery” stops working, which is why
the authorities must function as a “machinery for encoding the flow of the masses’
² Lenin, “Politicheskii otchet,” p. 112.

4  
desires.”³ Seen from this perspective, Stalinist culture must be understood as a

meeting point between the sublime and the mass-oriented, the sacral and the
profane, the high and the low. It is a true “carnival of power.”
The oxymoronic nature of Socialist Realism was a derivative of the political
functions of Stalinist art, wherein the authorities created an image of themselves
that intended to legitimize them in the eyes of the masses. This image was created
concomitantly with the image of the masses themselves, who were now supposed
to self-identify in accordance with the image created “from above,” just as the
concept of “the Soviet people” was a political and ideological construct. This self-
identification could only be achieved if the desired product, the image of the
masses as they should be, was produced by Soviet art. Laughter as a foundation of
“popular culture” was one of the key instruments in the production of “the
people.” Only when seeing their own reflection in the mirror could “the masses”
materialize as “the people,” a supreme sovereign that legitimizes the regime.
Because of this, the reflected image of the masses could not be allowed to arise
spontaneously, but had to be the object of the “incessant care of the party.” The
Soviet mirror was not a single, simple mirror, but rather more like a maze of
mirrors. If there were just one mirror, it would be possible to turn away from it,
which is why the system of Socialist Realism did not leave any escape routes and
reflected into all possible autonomous niches, including “folk culture.” Because the
image of the people was an obligatory component of the image of power, it was a
constructed image of themselves that the Soviet subjects saw in the mirrors of
Socialist Realism.
After the revolution, the creation of this image was part of the “civilizing
mission” assumed by the intelligentsia. Revolutionary culture had looked at its
object “from the outside” and found it to be quite comical. Hence the wealth of
satirical characters created in the 1920s. Stalinism was much more preoccupied
with retaining power than with the construction of a utopia, as it replaced the
communist project with a nation-building one. In the national construction,
popular culture took priority. Consequently, national aspects acquired increasing
importance, and appeals to national traditions and sacralized conventions of style
and genre became more and more demonstrative. The object of laughter turned
into a subject. Socialist Realism internalized the position of the laughing masses.
As it stopped laughing at them, it now laughed with them, until it ultimately
replaced them completely and started laughing instead of them. This is how
populism (and popular spirit—narodnost0 ) became the modus operandi of the
Stalinist culture.
As a result, Stalinist state laughter acquired a completely new nature. Il0 ia
Kalinin suggested that in discussing Soviet cultural and political practices,
³ Nadtochii, “Drug,” p. 115.

 5
laughter as labor and laughter as commodity should be distinguished from each

other. In the West, laughter and merriment are commodities in the marketplace of
entertainment, a means to extract revenues. Consequently, those who are involved
in the production of laughter are alienated from their labor and the final product.
“In contradistinction to this bourgeois industry,” Kalinin writes, “Soviet laughter
was not a commodity, and it functioned exactly like Soviet (collective) labor. This
means that laughter was not part of the marketplace where it was produced,
bought and sold. Instead, as collective labor, it was not so much a product as a
process in the course of which the collective was produced.”⁴ It was not by chance
that the venue where Stalin pronounced his words about how “life has become
merrier” was his speech at a congress of shock workers, glorifying their enthusi-
astic labor.⁵
These efforts directed towards the creation of a nation-building canon and the
celebration of new labor relations should not mislead us into thinking that the
society was approaching a period of stabilization. Stalinism is nothing but civil war
frozen in political institutions, ideological postulates, and multiple artifacts, and
each of its gestures is charged with violence.
Only after the Soviet era had ended did its place in history become clearer, as a
special (catch-up) version of modernity and a society in transition from a patri-
archal to an industrial order. In the wake of the revolution, famine, the civil war,
and political repressions, the thin layer of Russian urban culture was almost
completely destroyed. The urban centers were not able to resist the powerful
archaization coming from the erstwhile peasants who were flooding cities in the
course of accelerated industrialization and urbanization. Soviet society was becom-
ing more and more archaic just as it was becoming more and more modern. This is
why the Soviet person became a transitional figure—half urban, half rural. The
related crisis of identity reached epidemic proportions. Even though this process
was made more complex by the need for a collective correction of behavior and a
(re)construction of one’s own biography for many people,⁶ it was still grounded in a
psychology of marginalized individuals who, in the words of the poet Osip
Mandelstam, had been “knocked out of their own biographies like balls from billiard
pockets.”⁷
A marginalized personality is an ideal comic figure. It creates comic situations
and expresses itself through them. There is a huge body of works of comedy that
center on characters marginalized by the Soviet order (the better-known authors
include Zoshchenko and Bulgakov, Platonov and Mayakovsky, Kataev and
Olesha, Erdman and the co-authors Il0 f and Petrov, but there are many more).
However, in these works the comically liminal characters were shown as if from
the outside, critically; they were laughed at. The perspective of Socialist Realist
⁴ Kalinin, “Nam smekh,” p. 120. ⁵ Stalin, I. “Rech0 17 noiabria,” p. 89.

⁶ See Fitzpatrick, Tear off the Masks! ⁷ Mandelstam, Slovo, pp. 74–5.
6  
culture was quite different. Not only was it very sensitive to the mass taste of
semi-urbanized peasants; essentially, it became simultaneously a product and an
expression of this taste, a real mirror of the Soviet people’s consciousness, a mirror
that reflected, among other things, their laughter. It is well known that how people
laugh and what they laugh at reflects their level of cultural awareness, their
sensitivity, the depth of their perception, the level of their intellectual develop-
ment, and their type of wit. This is where an exploration of state laughter is
helpful, as it allows us to analyze this phenomenon from the inside (the side of the
people who were laughing together), rather than from the outside (the side of those
who were laughing at these people).
Our starting point is the conviction that, as a social phenomenon, laughter
cannot be understood except in the context of social, historical, and, if necessary,
political parameters. This is especially true of periods of national construction,
which is exactly what Stalinism was—the era when the Soviet nation was born. To
quote the prominent Russian philologist and cultural historian of Ancient Rus,
Dmitrii Likhachev,
laughter is defined by one’s environment, by the views and opinions that are
prevalent in this environment. Laughter demands the company of like-minded
people. This is why the type of laughter, its character, cannot be changed easily. It
is as bound to tradition as folklore is, and it is ruled by inertia to the same extent.
It strives towards a fixed pattern in the representation of the world. Then it is
easier to understand laughter, and it is easier to laugh. Laughing people are akin
to “conspirators” who know the code of laughter. This is why laughter is subject
to an immense power of inertia. This power of inertia creates whole “epochs of
laughter,” its own anti-worlds, its traditional culture of laughter.⁸
As we will see, contrary to the common perception of Stalinist culture as “numb-

ingly serious,” it was, in fact, an “epoch of laughter” that produced its own (anti-)
world. If we gain an understanding of what was supposed to be laughed at in this
world, and what was not, we will come close to understanding the “code” of
Stalinist laughter—and the Stalinist subject. For this to happen, we need to re-
examine critically some stereotypes that have been widely accepted both in the
USSR/Russia and in the West and that for decades shaped research on the topic.
The first stereotypical belief is that because it is a natural expression of a
spontaneous emotion, laughter cannot be controlled and is thus “a moment of
awakening of the ”natural“ behavior, spontaneous and uncalculated, that other-
wise remains repressed in the process of socialization.”⁹ As the history of the
twentieth century shows, not only is direct control of laughter possible, but so are
⁸ Likhachev et al., Smekhovoi mir, p. 204. ⁹ Vershina and Mikhailiuk, “Smekh,” p. 128.
 7
the practices of manipulation that replaced such direct control. These practices
proved highly effective in overcoming people’s “ ‘natural’ behavior, spontaneous
and uncalculated.”
Second, there is the erroneous assumption that laughter by its nature defies
coercion, that it “cannot be prescribed, as it is the breaking of a prohibition.”¹⁰ In
fact, as we will show, laughter can work perfectly as an instrument of prohibition,
and a much more efficient one, too, than purely repressive measures.
Then there is the oft-repeated claim that laughter by its very nature is anti-
totalitarian. This belief is often supported by references to the favorite genre of
most authors writing about Soviet laughter: political jokes. According to the
proponents of this view, the Soviet “laughing culture” was the “reverse side of
the totalitarian era,” laughter was “corroding the totalitarian ideology, affirming
the superior value of individuality over the collective idiocy,” and the “epic scope
of the political jokes shows that totalitarianism was not only ugly and terrifying,
but also ridiculous.”¹¹ It is still all too often assumed that laughter is “in its essence
nothing other than a sign of rebellious behavior; it cannot be anything else.”¹² But
in fact the Soviet culture of laughter was not at all a reverse side of the totalitarian
era. The opposite is true: the façade of that era was Aleksandrov’s and Pyr0 ev’s
comedies, Dunaevskii’s merry songs and marches, and the jubilant crowds at mass
sports parades. In Stalinism the main function of laughter was to consolidate
behavioral norms and to train individuals in state-sanctioned behavioral and
social roles.
This last point links with the more general myth of the democratic and revolu-
tionary nature of laughter, wherein it is seen as a natural force undermining
the social hierarchy. This, essentially, was the basis of Bakhtin’s theory of the
carnival. Before Bakhtin the same thought was formulated by Alexander Herzen:
“It is true that laughter has something revolutionary about it . . . One never laughs
in a church and in a palace—at least not openly. Serfs are deprived of the right
to smile in the presence of landowners. Only equals laugh in each other’s
company.”¹³ If this were true, then a world in which there was a shortage of
“equals” would die of boredom. The carnival is not the norm but an exception
from the regular routine of the social order, to the extent that Giorgio Agamben
suggested that it be seen as an instance of the state of exception.¹⁴ If so, then we
should acknowledge that even though laughter and the comic continue to reside in
the normalized social order, this order is inevitably based on inequality. The most
common form of the comic is a clever person laughing at someone they consider
stupid, while two “equally” clever people understand each other as they laugh with
each other, preferring irony to direct jokes and laughter. In a semi-urbanized
¹⁰ Vladimir Mikushevich cited in Stolovich, p. 261. ¹¹ Stolovich, Filosofiia, pp. 290, 128.
¹² Kozintsev, “Smekh i antipovedenie,” p. 168. ¹³ Herzen, <O pis0 me>, p. 190.
¹⁴ Agamben, State of Exception.
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material and to have the room well warmed. If bed-sores are already
formed, they are to be treated according to ordinary surgical
principles. Antiseptic means should be in the foreground in the case
of the malignant bed-sore. It is to be remembered that the latter is a
gangrenous process, and, in so far as the formation of a line of
demarcation between the necrotic and the conserved tissue is
concerned, the ordinary expectant rules of surgery govern the case:
the water-bath appears to yield the best results. Ordinary bed-sores
yield readily to mechanical protection and stimulating ointments or
the balsam of Peru. Iodoform is recommended, but it produces
granulations of an indolent character as compared with those
obtained through the use of resinous ointments.
The warm bath is probably the most useful measure in acute

myelitis. In cases due to exposure I do not believe it can be applied
too soon. Its temperature should, in the beginning at least, not be
higher than about 88° F., and the duration about seven minutes. The
continued administration will depend on the immediate effect on the
patient, and the sittings can be ultimately prolonged to half an hour
or even longer. It should be administered once daily, and, when the
patient is not disturbed by the manipulation connected with its use,
even oftener. Cold baths are recommended by the Germans, but it
seems rather in the passive period of the disease than during its
active phase.
The management of the bladder trouble is one of the most critical

points in the treatment of most cases. The results of retention of
urine are more frequently the cause of a fatal issue than any other
single complication. Where there is complete retention continuous
catheterization is to be employed, as recommended by Strümpell.106
In other cases the bladder should be emptied thrice in the twenty-
four hours. The catheter is to be thoroughly disinfected, and if the
slightest sign of cystitis is noted the bladder should be washed out
with astringent and disinfectant solutions. The continuous irrigation
with a solution of corrosive sublimate, 1:2000, appears to give the
best results.
106 A. Nelaton's catheter is introduced into the bladder, and kept in place by strips of
adhesive plaster fixed to the inner aspect of the thighs. A perforated condom fixed to
the catheter, and then fastened to the inguinal region, is in my opinion a better
measure, especially in patients who have some motor power left. The catheter is
connected with a rubber tube, which should run on a decline in order to effect
complete drainage.
If there be a syphilitic taint present—and more particularly is this true

of cases where no other cause can be assigned—large doses of
iodide of potassium107 should be administered, and mercurial
ointment energetically applied, even to the point of salivation.
107 Here, if anywhere, the so-called heroic doses are applicable.
I am unable to say anything with regard to the local use of electricity

in the active period of the disease. Ascending currents are
recommended by Erb, weak currents of about five minutes' duration
being employed over the part supposed to be affected. In order to
secure sufficiently deep deflection of the current large electrodes are
applied. The use of galvanism and faradism on the affected
periphery, the former being preferred where atrophic, the latter
where anæsthetic conditions preponderate, is to be instituted early
and continued through the duration of the disease. The rules stated
in the section devoted to electro-therapeutics are to be followed. In
cases where the bladder or rectum are paralytic, these organs
should have galvanism applied to them by means of electrodes
shaped like catheters or sounds.
After the acute phase of myelitis is passed, the secondary period is

to be managed according to the principles laid down in the section
on the Treatment of the Sclerotic Processes.
THE CHRONIC INFLAMMATORY AND
DEGENERATIVE AFFECTIONS OF THE SPINAL
CORD.
BY E. C. SPITZKA, M.D.
The intimate dovetailing of parenchymatous and connective

substance in the spinal cord renders the determination of the precise
origin of a morbid process often difficult if not impossible. Whatever
the mode of origin, the typical termination of inflammatory and
degenerative spinal disorders is sclerosis—a condition in which the
essential nervous elements suffer diminution or destruction, while
the connective substance is either absolutely or relatively in
preponderance. The clinical result is nearly the same in all cases,
and with few exceptions depends less upon the histological
character than on the topographical distribution of the lesion. It is for
this reason that we shall follow rather the topographical than the
morbid histological principle in classification.
The chronic disorders of the spinal cord here considered have as a

common character the slow and progressive displacement of the
normal conducting nerve-tubes by a grayish, reddish, or otherwise
discolored tissue, which is firmer in texture than normal nerve-
substance. Minute examination shows that it is above all the myelin
of the nerve-tubes that is wasted or destroyed, while the axis-
cylinders may share in this dissolution, or, as in one form of
sclerosis, they may persist and even continue in their conducting
function. This increased consistency is found to be due to the
increase of connective-tissue trabeculæ and of the neuroglia. In
some cases this increase is active and absolute, like the increase in
certain phases of hepatic cirrhosis; in others it is rather relative and
passive, being merely a condensation of the connective framework
after the intervening elements have wasted away, just as the texture
of a compressed sponge is more compact than that of an expanded
one.
Crudely, the affections of the cord characterized by this change may

be divided into two great groups—the regular and the irregular. The
former are characterized by their limitation to special nerve-tracts.
Thus, in primary lateral sclerosis we find a special tract in the
posterior part of the lateral columns occupied by the lesion. A
number of spinal diseases with well-defined symptoms are due to
active morbid processes which similarly follow the normal distribution
of the great nerve-tracts of the cord, with the same, almost
mathematical, regularity with which the medullary white develops in
the fœtal and infantile cord. In another class of cases we find that the
same tracts are involved in like manner—not in the way of primary
disease, but through the interruption of the physiological continuity of
the nerve-tract by some other disease, to which the sclerosis is
therefore secondary. These are the so-called secondary
degenerations.
The irregular affections of the cord comprise cases in which the

sclerotic foci are either disseminated through the cerebro-spinal axis
in numerous foci, or diffusely involve a greater or lesser length and
thickness of the medullary cylinder, or, finally, extend in the
transverse plane completely or nearly so across the section area of
the cord at a definite level.
As the symptoms of the regular affections of the cord are by far the
most readily recognizable, and a preliminary knowledge of them will
facilitate the better understanding of the irregular forms, we shall
consider the former first. They may be subdivided into two groups.
The largest, longest known, and best studied consists of acquired,
the other, containing less numerous cases and varieties, and
rendered familiar to the profession only within the last decade,
comprises the spinal disorders due to defective development of the
cerebro-spinal and spinal-fibro systems.
Tabes Dorsalis.
SYNONYMS.—Locomotor ataxia and ataxy, Posterior spinal sclerosis;

Graue degeneration der Hinterstränge (Leyden), Rückenmarksdarre
(popular), Rückenmarksschwindsucht; Tabes dorsualis (Romberg);
Ataxie locomotrice progressive (Duchenne).
HISTORY.—Undoubtedly, this disease must have been observed by

the ancient masters of medicine, but their descriptions group
together so many symptoms of other organic as well as functional
diseases of the cord that it is impossible to obtain a clear idea as to
what special form they had in view when they spoke of tabes
dorsualis. This term was adopted by the German writers of the last
and the earlier part of this century as designating all wasting
affections of the cord; and it was not till Romberg in 1853 and
Duchenne in 1858 differentiated the characteristic clinical signs, and
Cruveilhier and Todd (1847) determined the distribution of the lesion
in the posterior columns, that the medical profession began to
recognize the distinctness of this the most common form of organic
spinal ailment.
At this time, when tabes dorsalis became recognized as a clinical

entity depending on sclerotic degeneration of the posterior segment
of the cord, the inco-ordination or ataxia manifested in the peculiar
gait of the patient was regarded as the most characteristic, essential,
and constant symptom of the disease. It was regarded as an axiom
in physiology that the posterior segment of the cord was subservient
to centripetal and sensory conduction, and nothing appeared to
follow more naturally than the conclusion that the patient exhibited
inco-ordination because, his sensory conduction being interrupted or
destroyed, he had lost the necessary gauge for judging of the
required extent and force of a given movement. Since then both
spinal physiology and pathology have undergone a profound
revolution. So far are we to-day from regarding anterior and motor or
posterior and sensory as convertible terms that we locate the most
important centrifugal tract of the cord behind the plane which divides
it into anterior and posterior halves, while the most recently
differentiated centripetal tract is represented by Gowers as lying in
front of it. It has been determined, through Türck, Bouchard, and
Flechsig and his pupils, that the posterior white columns of the cord
contain several systems of fibres, whose functions—where
determinable—are of an exceedingly complex nature. The elaborate
investigations of Charcot, Schultze, and Strümpell, made during the
past decade, have shown that the distribution of the diseased field in
the posterior segment is not uniform, but is most intense in special
areas. These were found to be affected with a remarkable constancy
and regularity. Almost coeval with this discovery came the
recognition of symptoms found in the earliest phases of the disorder
by Westphal, which, attributable as they were found to be to the
involvement of the special reflex mechanisms of the cord, enable us
to demonstrate the existence and extent of the disease at periods
which previously were not within the ken of the clinician. The
reproach which Leyden was justified in making, that most tabic
patients pass through the pre-ataxic phase of their disorder under
the diagnosis of rheumatism or some similar affection, can now no
longer be made. Our ability to recognize the advent of this disease
has reached such a degree of refinement that the question arises
whether we are always justified in alarming a patient who has a
prospect of remaining free from invalidating complications for many
years with the announcement of a disease which, above all other
spinal affections, is looked upon with dread as equally hopeless,
insidious, and distressing.
CLINICAL HISTORY.—The development of tabes dorsalis is typically

slow and its precise commencement usually not determinable. In
some cases this or that one of the characteristic symptoms of the
disease preponderates from the beginning, and continues
throughout the illness as a prominent feature; in others distinct
stages can be recognized, each marked by one or several symptoms
which were absent or slight in the other stages. In some cases the
progress of the affection is marked by episodes which are absent or
rare in other cases. As a rule, however, it may be stated that tabes is
a progressive affection, marked by pronounced temporary changes
for better or worse, which are often developed with astonishing
rapidity, and subside as quickly, terminating fatally unless its
progress be arrested by treatment or interrupted by some other fatal
affection. The latter is by far the more frequent termination in the
well-to-do class of sufferers.
For purposes of convenience we may consider the symptoms of the

earlier period of the illness as pre-ataxic, and those of the later as
the ataxic. It is to be remembered, however, that in the strictest
sense of the term there is usually some disturbance of co-ordination
even in the early period, while the symptoms of the pre-ataxic period
continue over the ataxic period, and may even become aggravated
with it. Often the patient does not himself suspect a spinal, or indeed
any nervous, disorder, and consults the physician either on account
of rheumatic pains, double sciatic neuralgia, bladder disturbance,
diminished sexual power, amaurosis, diplopia, or even gastric
symptoms, which on closer examination are revealed to be
evidences of tabes. The determination of the initial symptoms is
retrospective as a rule.
Of the subjective signs, one of the commonest, if indeed it be ever

entirely absent, is a tired feeling, particularly noted in the knees and
ankles. This sensation is compared to ordinary muscle-tire, but is
provoked by slight exertion, and not as easily remedied by rest.
Often a numb feeling is associated with it, although no objective
diminution of cutaneous sensation be determinable. This combined
feeling of tire and numbness, described as a going-to-sleep feeling in
the ankle, has indeed been claimed by one observer1 to be
pathognomonic of early tabes. Next in frequency, and almost as
universal, are peculiar pains: these are manifold in character and
distribution, but so distinctive as to alone suggest the existence of
the disease from the manner in which the patient describes them.
One variety, the lightning-like, is compared to a sudden twinge of
great intensity shooting through the limb. The sciatic and anterior
crural branches are the lines usually followed by this pain, but there
are cases where perineal and abdominal regions are affected. Often
the pain is so severe that the patient cries out or the limb is violently
contracted under its influence. It differs from rheumatic pain in the
fact that it is distinctly paroxysmal and that the intermissions are
complete; that it is not greatly aggravated by motion nor relieved by
rest, while the rheumatic pain is; that tabic pain is usually relieved,
and rheumatic pain aggravated, by pressure, while hyperæsthesia is
present with the former, and either absent or barely indicated with
the latter. The lightning-like pains are sometimes combined with
another form, which is even more distinctive in character. This form
does not affect the distribution of special nerves, but is found limited
to a small area which the patient is able to localize definitely: it may
not exceed a centimeter or two in diameter, and within this area the
pain is excruciating. It is either of a burning character or compared to
the firm pressure of a vise or heavy weight, or to the tearing, boring,
and jumping of a violent toothache.
1 Canfield, Lancet, 1885, vol. ii. p. 110.
While some patients escape these pains almost entirely,2 others are
tormented with them at intervals for years, their intensity usually
diminishing when the ataxic period is reached. There is little question
among those who have watched patients in this condition that their
pains are probably the most agonizing which the human frame is
ever compelled to endure. That some of the greatest sufferers
survive their martyrdom appears almost miraculous to themselves.
Thus, in one case the patient, who had experienced initial symptoms
for a year, woke up at night with a fulminating pain in the heels which
recurred with the intensity of a hot spear-thrust and the rapidity of a
flash every seven minutes; then it jumped to other spots, none of
which seemed larger than a pin's head, till the patient, driven to the
verge of despair and utterly beside himself with agony, was in one
continued convulsion of pain, and repeatedly—against his conviction
—felt for the heated needles that were piercing him. In another case
the patient, with the pathetic picturesqueness of invalid misery,
compared his fulminating pains to strokes of lightning, “but not,” he
added, “as they used to appear, like lightning out of a clear sky, but
with the background of a general electrical storm flashing and
playing through the limbs.”
2 I have at present under observation two intelligent patients (one of whom had been
hypochondriacally observant of himself for years) who experienced not a single pain,
as far as they could remember, and who have developed none while under
observation. Seguin mentioned a case at a meeting of the Neurological Society with a
record of but a single paroxysm of the fulgurating variety. Bramwell (Brit. Med. Journ.,
Jan. 2, 1886) relates another in which the pains were entirely absent.
Either while the pains are first noticed or somewhat later other signs
of disturbed sensation are noted. Certain parts of the extremities feel
numb or are the site of perverted feelings. The soles of the feet, the
extremities of the toes, the region about the knee-pan, and the
peroneal distribution, and, more rarely, the perineum and gluteal
region, are the localities usually affected.3 In a considerable
percentage of cases the numbness and tingling are noted in the little
finger and the ulnar side of the ring finger; that is, in the digital
distribution of the ulnar nerve. The early appearance of this symptom
indicates an early involvement of the cord at a high level. Some
parallelism is usually observable between the distribution of the
lightning-like pains when present and the anæsthesia and
paræsthesia if they follow them. With these signs there is almost
invariably found a form of illusive sensation known as the belt
sensation. The patient feels as if a tight band were drawn around his
body or as if a pressure were exerted on it at a definite point. This
sensation is found in various situations, according as the level of the
diseased part of the cord be a low or high one. Thus, when the lower
limbs are exclusively affected or nearly so the belt will be in the
hypogastric or umbilical region; if the upper limbs be much involved,
in the thoracic region; and if occipital pain, anæsthesia of the
trigeminus, and laryngeal crises are present, it may even be in the
neck. Correspondingly, it is found in the history of one and the same
patient: if there be a marked ascent—that is, a successive
involvement of higher levels in the cord—the belt will move up with
the progressing disease. This occurrence, however, is less
frequently witnessed than described. In the majority of cases of
tabes disturbances of the bladder function occur very early in the
disease. Hammond indeed claims that in the shape of incontinence it
may be the only prodromal symptom for a long period.4
3 In the exceptional cases where the initial sensory disturbance is marked in the
perineal and scrotal region I have found that the antecedent fulminating pains had
been attributed to the penis, rectum, and anal region; and in one case the subjective
sense of a large body being forcibly pressed through the rectum was a marked early
sign.
4 New England Medical Monthly, 1883.
I have under observation a patient who has been compelled to use

the catheter daily for years, who has gradual disappearance of the
knee-jerk and reflex iridoplegia, but who has presented no other
evidence of tabes during the year and a half he has been watched.
Among the exact signs of tabes, reflex iridoplegia and abolition of the
knee-jerk are probably the earliest to appear. It may be assumed
with safety that in ninety-nine out of a hundred cases both the
inability of the pupil to respond to light and the absence of the knee-
jerk will be found long before ataxia is developed. Cases are
recorded where no other positive signs were found, and no other
signs of the disease developed for a number of years,5 and others
where disappearance of the knee-jerk was the very first indication.
5 Westphal, also Tuczek, Archiv für Psychiatrie, xiii. p. 144.
The opinion of observers as to the frequency of double vision as an

early symptom of tabes is far from being unanimous. The majority of
writers speak of it as rare, but it is probable that this usually transient
symptom is forgotten by the patient, or because of its apparent
triviality escapes notice. The patient while looking at an object sees a
double image of the latter. This may last for a few seconds, minutes,
or hours, and rarely for a day or week.6 A distinct history of this
symptom was given by 58 out of 81 patients in whom I recorded the
oculo-motor signs. By far the most important of the exact prodromal
signs of tabes are two symptoms—one involving a special faculty of
co-ordination, the other the reflex movements of the pupil. One or
both of these must be present to justify the diagnosis of incipient
tabes.7 The disturbance of co-ordination consists in an inability of the
patient to stand steadily when his eyes are closed. The majority of
healthy persons when tested in this way may show a little swaying in
the beginning, but eventually they stand as steadily as they do with
open eyes, and there is no subjective feeling of uncertainty as to
falling. But the tabic patient exhibits oscillations, and makes efforts to
overcome them which, instead of neutralizing, usually aggravate
them and betray the great disturbance of his equilibrium. It is not as
if he swayed merely because he is uncertain of his upright position,
but as if some perverted force were active in throwing him out of it. It
is found to be a pronounced feature even in cases where the patient
with open eyes is able to walk nearly as well as normal persons, and
experiences no trouble in performing intricate evolutions, such as
dancing, walking a line, or even walking in the dark—faculties which
the patient is destined to lose as his disease progresses.8
6 It has been asserted that the severer and more persistent diplopias are found with
tabes dependent on syphilis.
7 Not even the absence of the knee-jerk ranks as high as these two signs. Aside from
the fact that this is a negative symptom, it is not even a constant feature in advanced
tabes.
8 It does not seem as if the disturbance of static equilibrium were due merely to the
removal of the guide afforded by the eyes, for it is noted not alone in patients who are
able to carry out the average amount of locomotion in the dark, but also in those who
have complete amaurosis. Leyden (loc. cit., p. 334) and Westphal (Archiv für
Psychiatrie, xv. p. 733) describe such cases. The act of shutting the eyes alone,
whether through a psychical or some occult automatic influence, seems to be the
main factor.
In most cases of early tabes it is found that the pupil does not
respond to light; it may be contracted or dilated, but it does not
become wider in the dark nor narrower under the influence of light.
At the same time, it does contract under the influence of the
accommodative as well as the converging efforts controlled by the
third pair, and in these respects acts like the normal pupil. It is
paralyzed only in one sense—namely, in regard to the reflex to light;
just as the muscles which extend the leg upon the thigh may be as
powerful as in health, but fail to contract in response to the reflex
stimulus applied when the ligamentum patellæ is struck. For this
reason it is termed reflex iridoplegia.9 It is, when once established,
the most permanent and unvarying evidence of the disease, and is
of great differential diagnostic value, because it is found in
comparatively few other conditions.
9 It is also known as the Argyll-Robertson pupil. Most of the important symptoms of
tabes are known by the names of their discoverers and interpreters. Thus, the
swaying with the eyes closed is the Romberg or Brach-Romberg symptom; the
absence of the knee-phenomenon, Westphal's or the Westphal-Erb symptom; and the
arthropathies are collectively spoken of as Charcot's joint disease.
In a number of cases ptosis of one or both eyelids is noted at an

early stage of the disease. It is usually temporary, and coincides as
to time with the diplopia, if present.
Patients presenting some or all of the subjective and objective

manifestations of tabes mentioned may continue in a condition of
otherwise comparative health, enabling them to attend to their
vocation for from one to twenty years, and it is not improbable that
the pre-ataxic period may extend over nearly a lifetime. In a less
fortunate minority of cases some of the most distressing evidences
usually marking the last stages of the disease are found developed
at the onset. Thus, cases are known where optic nerve-atrophy
preceded the true tabic period by ten or more years; others in which
trophic disturbances, manifested in spontaneous fractures of bones10
or violent gastric crises, or even mental disturbance, inaugurated
tabes dorsalis, instead of closing or accompanying the last chapter
of its history, which is the rule.
10 Berger, Deutsche medizinische Wochenschrift, 1885, 1 and 2.
The disturbance of co-ordination above spoken of as manifested in
the inability of the patient to stand well with his eyes closed is the
first step in the development of the characteristic ataxia which marks
the full-blown affection. The patient finds that he tires more and more
on slight exertion—not because his muscles are weak, but because
he has to make more voluntary effort than a person in health. He
finds that he stumbles easily—is unable to ascend and descend at
the curbstone or to walk over an irregular surface with ease. Going
down stairs is peculiarly irksome. “I would rather,” aptly said one
patient, “troubled as I am in walking, go a mile in the street than walk
up three flights of stairs; but I would rather go up six flights of stairs
than walk down one.” Soon the patient notices that walking in the
dark becomes more a feat of relative skill than the easy, almost
automatic, act it was in health. His vocation, if it was one involving
the use of the feet, becomes irksome, difficult, and finally impossible,
and in a number of cases the upper extremities are also involved.11
Delicate motions, such as those required in needlework, in writing,
and by watchmakers, musicians, opticians, and lapidaries, are
clumsily performed; even coarser movements, such as buttoning the
clothes and carrying a glass filled with water to the mouth, are
performed in an uncertain and clumsy manner. Meanwhile, the
disturbance of motion in the lower limbs progresses. Difficult as it
formerly was for the patient to stand on one foot or with both feet
together while the eyes were closed, he is now unable to do either
with the eyes open. He straddles in his walk, or, in order to overcome
the element of uncertainty involved in moving the knee-joint, keeps
this joint fixed and walks with short, stiff steps. If ordered to halt
suddenly while thus walking, the patient sways violently, and makes
movements with his hands or arms to recover his balance, in some
cases staggering and even falling down. He shows a similar
unsteadiness when told to rise suddenly from a chair or to mount
one, and it becomes impossible for him to walk backward. Later on,
it will be found that his feet interfere in walking. He has lost the
power of gauging the extent and power of his motions to such a
degree that he may actually trip himself up. To neutralize in some
way this element of uncertainty of his steps, the patient is compelled
to exaggerate all his ambulatory movements, and there results that
peculiar gait which was the first symptom directing attention to the
disease to which it is due. The feet are thrown outward, and violently
strike the ground; the heel touches the latter first, and the patient
appears as if he were punishing the ground and stamping along
instead of walking. The reason for his adopting these tactics are
twofold. In the first place, he has a subjective sense of walking in a
yielding substance, as if on a feather bed, air-bladders, cushions, or
innumerable layers of carpet, and he therefore makes efforts to
touch firm bottom. In the second place, his motor inco-ordination, in
so far as it is not the result of anæsthesias, is greatest in those
segments of his limbs which are farthest removed from the trunk,
and which, enjoying the greatest freedom of combined motion, are
also most readily disturbed. His uncertainty is therefore greater in the
toes than in the ankle, greater in the ankle than in the knee, and
greater in the knee than in the thigh: he prefers to touch the ground
with the heel to touching it with the toes, and to move his limb in the
hip than in the knee-joint. As the patient advances in life even this
limited and clumsy form of locomotion becomes impossible: he takes
to his bed, and it is found that he loses all sense of the position of his
lower and occasionally of his upper limbs. He is unable to tell which
limb overlies the other when his leg is crossed—unable to bring one
limb in parallel position with another without the aid of his eyes. If
told to touch one knee or ankle with the toes of the other side, his
limb oscillates around uncertainly, and makes repeated unskilful
dashes at the wrong point, and ultimately all but the very coarsest
muscular co-ordination appears to be lost, even when the
supplementary aid of the eyes is invoked.
11 Cases in which the upper extremities are intensely involved in the beginning are
uncommon, and those in which they are more intensely involved than the lower, or
exclusively involved, may be regarded as pathological curiosities.
Together with this gradual impairment and abolition of co-ordination,

which has given the name of locomotor ataxia to the disease, but not
always in that strict parallelism with it on which Leyden12 based his
theory of inco-ordination, the sensory functions proper become
perverted and impaired. Usually the determinable anæsthesias are
preceded by subjectively perverted sensations, such as the
numbness already referred to, or even by hyperæsthesia. Usually, all
categories of cutaneous sensation, whether special or pathic, are
impaired in advanced tabes; the points of the æsthesiometer are not
readily differentiated; the patient is unable to correctly designate the
locality which is touched or pinched; the pain-sense is occasionally
so much blunted that a needle may be run through the calf of the leg
without producing pain, and in some cases without being
appreciated in any form. Even if the pain-sense be preserved, it will
be found that its appreciation by the patient is delayed as to time.
Not infrequently bizarre misinterpretations are made of the
impressions acting on the skin. One of these, the feeling as if the
patient were standing on carpet, cushions, or furs, whereas he may
be standing on stone flagging, has already been mentioned as a
factor in the disturbed locomotion of the patient. In the later period,
numerous perversions of this kind are noted: to one of these, already
mentioned by Leyden, Obersteiner has called renewed attention. It
consists in a confusion of sides; the patient when pricked or touched
on one foot or leg correctly indicates the spot touched, but attributes
it to the wrong side.13
12 Klinik der Rückenmarkskrankheiten, Band ii.
13 Allochiria is the term applied by Obersteiner. Hammond has offered an explanation,

which, as it is based on the assumption of altogether hypothetical nerve-tracts, and
not in any sense accords with positively established facts, is more properly a subject
for consideration in a theoretical treatise.
While it may be affirmed, as a general proposition, that the tendency

of the tabic process is to abolish sensation below the level of the
disease, there are noteworthy exceptions, not only in individual
cases, but with regard to certain kinds of sensation; nor do the
different kinds of sensation always suffer together. Thus, the pain-
sense may be blunted and the contact-sense preserved, or, more
commonly, the latter blunted and the former exaggerated, so that the
unfortunate patient, in addition to being debarred of the useful
varieties of sensation, those of pressure and space, has the painful
ones exaggerated, as a hyperalgesia. According to Donath,14 the
temperature-sense is usually blunted in tabes, and a greater degree
of heat or cold can be borne without discomfort than in health; but in
about two-sevenths of the cases studied there was increased
sensitiveness to heat, and in one-seventh to cold. One of the
commonest manifestations is delayed conduction. This interesting
phenomenon has been especially observed in that phase of the
disease where tactile perception is beginning to be blunted. If the
patient be pricked with a pin, he feels the contact of the latter at the
proper moment as a tactile perception, and then after a distinct
interval, varying from one to four seconds, his limb is suddenly
drawn up and his face contorted under the influence of an
exaggerated pain. This fact furnishes one of the chief grounds for the
assumption that there are distinct channels for the transmission of
pain and tactile perception in the cord, and that they may be involved
separately or with different intensity in the disease under
consideration. In some advanced cases it is found that not only the
transmission of pain-appreciation is delayed, but that there are after-
sensations recurring at nearly regular intervals of several seconds,
and accurately imitating the first pain-impression.
14 Archiv für Psychiatrie, xv. p. 707.
To what extent the muscular sense is affected in tabes at various

stages of the disorder is somewhat in doubt. Strümpell15 by
implication, and other writers directly, attribute the inco-ordination
observed on closing the eyes to the loss of the muscular sense. As
this symptom is also observed in patients who when they lie on their
backs are able to execute intricate movements notwithstanding the
exclusion of the visual sense, and as their uncertainty in an early
stage is not always with regard to the position of their limbs nor the
innervation of individual or grouped muscles, it seems inadmissible
to refer the Romberg symptom16 to the loss of muscular sense alone.
15 Lehrbuch der Speciellen Pathologie und Therapie, p. 193, vol. ii.
16 It should be designated as static ataxia, in distinction from locomotor or motor

ataxia, which is manifested in unskilled movements.
The important part played by eye symptoms in the early stages of
tabes has been already referred to. Reflex iridoplegia is one of these
early and persisting features; it is sometimes complicated with
mydriasis, and occasionally with paralysis of accommodation of one
eye. In the majority of my cases there was spinal myosis, often of
maximum intensity; in a large number there was in addition
irregularity of the outline of the pupil; and where there was mydriasis
I found it to be quite symmetrical, in this respect differing from the
experience of Müller17 and Schmeichler.18
17 Centralblatt für die Gesammte Therapie.
18 Loc. cit.
Atrophy of the optic nerve is a common and sometimes, as stated,

the initial symptom of tabes. It is rarely found in its incipient phase in
advanced stages. The patient who escapes involvement of the optic
nerve in the pre-ataxic stage is very apt to escape it altogether. It is
more frequently found either to precede the pre-ataxic period by
months and even years, or to develop during this period, leading to
complete atrophy in the ataxic period, and sometimes before. Erb
calculates that 12 per cent. of tabic patients have optic-nerve
atrophy; he probably includes only such cases in which the atrophy
was marked or led to amblyopia. Including the lesser degrees of
atrophy, it is found in a larger number of patients. Schmeichler
claims as high as 40 per cent.19 If we regard those cases in which
there is noted progressing limitation of the color-field of the retina as
beginning optic-nerve atrophy, the majority of tabic patients may be
said to have some grade of this disorder. The ophthalmoscopic
changes are quite distinctive: at first there is noted a discoloration of
the papilla and apparent diminution of the number of arterial vessels;
the veins then become dilated; and finally the papilla becomes
atrophied, the vessels usually undergoing a narrowing after their
previous dilatation. In the first stages of this process visual power is
not gravely impaired, but as soon as shrinkage has set in visual
power sinks rapidly to a minimum, decreasing till only quantitative
light-perception remains. This limited function usually remains
throughout, but in a few cases complete amaurosis ensues. As the
field of vision becomes diminished, the concentric extinction of
quantitative perception is preceded by concentric extinction of color-
perception, the color-field for green being the first to suffer; red
follows, and blue remains last.
19 Archives of Ophthalmology and Otology, 1883.
In a large number of cases the only symptoms attributable to a

disturbance of the cerebral functions are those connected with the
motor relations of the eyeball and pupil, and the function and
appearance of the optic nerve. The special senses other than those
of sight and touch are rarely affected. Sometimes there is obstinate
tinnitus, exceptionaly followed by deafness, attributed to atrophy of
the auditory nerve. The development of symptoms resembling those
named after Ménière is not referable with certainty to a disturbance
of the same nerve.
The sexual functions become involved in all cases of tabes sooner or

later. In the majority of cases there is a slow, gradual extinction of
virile power; in a large minority this extinction is preceded by irritative
phenomena on the part of the genital apparatus. Some patients
display increased sexual desire and corresponding performing
powers, but mostly they suffer from erections of long duration which
may be painful, and loss of the normal sensations attending the
sexual orgasm. There is no constant relationship between the
intensity of the general affection and the diminution of sexual power.
It is retained to a limited degree by patients who are barely able to
walk, and it may be entirely destroyed in those who have but entered
the initial period.
The bladder disturbance,20 which in some forms is usually found

among the initial symptoms, is always a marked feature in the ataxic
period. Usually, there is a frequent desire for micturition, with more or
less after-dribbling; sometimes there is retention, alternating with
involuntary discharge; complete incontinence may close the scene
through the channel of an ensuing cystitis and pyelitis. With the
incontinence of urine there is usually found obstinate constipation,
which may be varied by occasional spells of incontinence of feces.
The crises of tabes often complicate these visceral symptoms.
20 Contrary to what might be anticipated from the topographical nearness of the
vesical and genital centres in the cord, the disturbances of bladder function and virile
power do not go hand in hand.
The reflex disturbances are among the most continuous evidences

of the disease. Of two of these, the disappearance of the patellar jerk
or knee-phenomenon and the inability of the pupil to react to light,
we have already spoken when discussing the initial period.
Practically, it may be claimed that both are always found in typical
tabes. It has been claimed that the patellar jerk may be exaggerated,
or even that its disappearance is preceded by exaggeration. As this
disappearance usually occurs extremely early in the pre-ataxic
period, it is difficult to follow the deductions of those who claim to
have watched an alleged earlier phase of exaggeration. It is more
than probable that cases of combined sclerosis, in which the lateral
columns were affected together with or earlier than the anterior, have
been mistaken for typical tabes. Here, it is true, the jerk is first
exaggerated through the disease of the lateral column, and later
abolished as the lesion in the posterior reflex arch progresses and
becomes absolute.
Other tendinous reflexes21 suffer with the knee-jerk in the peripheries

corresponding to and below the involved level of the cord. The
cutaneous reflexes are usually abolished, but may be retained in
advanced stages of the disease. The same is true of the cremaster
reflex.
21 Whether the tendon phenomena are true reflexes or not is a question still agitating
physiologists. Opinion inclines in favor of their reflex nature, and, pathologically
considered, it is difficult to regard them in any other light.
Opinion is divided as to the electrical reactions in tabes dorsalis.

That qualitative changes never occur in uncomplicated cases all
authorities are agreed, but while Strümpell and other modern writers
claim there is no change of any kind, a number of careful
investigators have found an increased irritability in the initial period,
particularly marked in the peroneal group of muscles (Erb). In my
own experience this is frequently the case, where lightning-like pains
are the only subjectively distressing symptoms complained of.
While the symptoms thus far considered as marking the origin and
progress of tabes dorsalis are more or less constant, and although
some of them show remarkable remissions and exacerbations, yet
may in their entity be regarded as a continuous condition slowly and
surely increasing in severity, there are others which constitute
episodes of the disease, appearing only to disappear after a brief
duration varying from a few hours to a few days: they have been
termed the crises of tabes dorsalis. These crises consist in
disturbances of the functions of one or several viscera, and are
undoubtedly due to an error in innervation provoked by the
progressing affection of the spinal marrow and oblongata. The most
frequent and important are the gastric crises. In the midst of
apparent somatic health, without any assignable cause, the patient is
seized with a terrible distress in the epigastric region, accompanied
by pain which may rival in severity the fulgurating pains of another
phase of the disease, and by uncontrollable vomiting. Usually, these
symptoms are accompanied by disturbances of some other of the
organs under the influence of the pneumogastric and sympathetic
nerves. The heart is agitated by violent palpitations, a cold sweat
breaks out, and a vertigo may accompany it, which, but for the fact
that it is not relieved by the vomiting and from its other associations,
might mislead the physician into regarding it as a reflex symptom. In
other cases the symptoms of disturbed cardiac innervation or those
of respiration are in the foreground, constituting respectively the
cardiac and bronchial crises. Laryngeal crises are marked by a
tickling and strangling sensation in the throat, and in their severer
form, which is associated with spasm of the glottis, a crowing cough
is added.22 Enteric crises, which sometimes coexist with gastric
crises, at others follow them, and occasionally occur independently,
consist in sudden diarrhœal movements, with or without pain, and
may continue for several days. Renal or nephritic crises are
described23 as resembling an attack of renal colic. The sudden

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State Laughter. Stalinism, Populism, and Origins of Soviet Culture Evgeny Dobrenko full chapter instant download

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State Laughter.

State Laughter. Stalinism, Populism, and Origins of

Stalin’s Secret Weapon: The Origins of Soviet

Football (Soccer) in Africa: Origins, Contributions,

Energy Culture: Work, Power, and Waste in Russia and

The Palgrave Handbook of Malicious Use of AI and

Between Laughter and Satire: Aspects of the Historical

Laughter, Humor, and Comedy in Ancient Philosophy

Laughter and Power in the Twelfth Century Peter J.A.

For Liudmila Nedialkova.

Mankind, which in Homer’s time was an object of amusement for the

Fig. 1. Caricature by Boris Eﬁmov, text by Boris Laskin. Literaturnaia gazeta,

What kind of laughter could there be in a country like that?

² Lenin, “Politicheskii otchet,” p. 112.

desires.”³ Seen from this perspective, Stalinist culture must be understood as a

³ Nadtochii, “Drug,” p. 115.

laughter as labor and laughter as commodity should be distinguished from each

⁴ Kalinin, “Nam smekh,” p. 120. ⁵ Stalin, I. “Rech0 17 noiabria,” p. 89.

As we will see, contrary to the common perception of Stalinist culture as “numb-

The warm bath is probably the most useful measure in acute

The management of the bladder trouble is one of the most critical

If there be a syphilitic taint present—and more particularly is this true

I am unable to say anything with regard to the local use of electricity

After the acute phase of myelitis is passed, the secondary period is

The intimate dovetailing of parenchymatous and connective

The chronic disorders of the spinal cord here considered have as a

Crudely, the affections of the cord characterized by this change may

The irregular affections of the cord comprise cases in which the

SYNONYMS.—Locomotor ataxia and ataxy, Posterior spinal sclerosis;

HISTORY.—Undoubtedly, this disease must have been observed by

At this time, when tabes dorsalis became recognized as a clinical

CLINICAL HISTORY.—The development of tabes dorsalis is typically

For purposes of convenience we may consider the symptoms of the

Of the subjective signs, one of the commonest, if indeed it be ever

4 New England Medical Monthly, 1883.

I have under observation a patient who has been compelled to use

The opinion of observers as to the frequency of double vision as an

In a number of cases ptosis of one or both eyelids is noted at an

Patients presenting some or all of the subjective and objective

Together with this gradual impairment and abolition of co-ordination,

13 Allochiria is the term applied by Obersteiner. Hammond has offered an explanation,

While it may be affirmed, as a general proposition, that the tendency

To what extent the muscular sense is affected in tabes at various

16 It should be designated as static ataxia, in distinction from locomotor or motor

Atrophy of the optic nerve is a common and sometimes, as stated,

In a large number of cases the only symptoms attributable to a

The sexual functions become involved in all cases of tabes sooner or

The bladder disturbance,20 which in some forms is usually found

The reflex disturbances are among the most continuous evidences

Other tendinous reflexes21 suffer with the knee-jerk in the peripheries

Opinion is divided as to the electrical reactions in tabes dorsalis.

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