26 THE TONER LECTURES. 



lowed, there has been an increasing number admitted to the asy- 

 lums until the present biennial period. He believes that the cases 

 will decrease until a fresh financial revulsion occurs. Spitzka^ 

 holds that paretic dementia is primarily a disease of the medulla 

 oblongata, ultimately due to overstrain of the encephalic vaso- 

 motor centre. The same author points out the striking analogies 

 between this disease and posterio spinal sclerosis, of which latter 

 affection my series furnishes three cases in terribly over-worked 

 and greatly worried public men, without histories of syphilis, or 

 of sexual or other excesses. 



Of the nine cases of phthisis three were members of the lower 

 house of Congress, three were teachers, two were physicians, and 

 one was a lawyer. In each case the history of mental over-work 

 Avas clear, and in each to a large amount of real intellectual labor 

 was added more or less emotional strain. Next to the possessors of 

 the neurotic or insane diathesis, men of superior brain power in 

 whose families phthisis is hereditary would seem to be most likely 

 to over-work themselves mentally. 



The four cases of glycosuria furnish additional evidence of the 

 correctness of the now generally conceded opinion that mental over- 

 work and emotional strain are frequent causes of this disease. The 

 influence of the nervous system in the production of saccharine 

 urine has been shown by Bernard, SchifT, Pavy, Cyon and Aladoff", 

 Eckhard, Brunton, and others.^ In the four cases studied the dis- 

 ease came on insidiously, and not as the result of any sudden shock 

 or emotion. 



That either mental over-work or mental anxiety may lead to some 

 forms of Bright's disease, by impairing vaso-motor control, is highly 

 probable. In two of three instances of this disorder the habits 

 of the patient with reference to alcohol and other abuses usu- 



^ Insanity : Its Classifiation, Diagnosis, and Treatment. By E. C. Spitzka, 

 M. D. Xew Tork. 1883. 



2 See Prof. James Tyson's Treatise on Bright's Disease and Diabetes for an 

 admirable resume of these researches. 



