38 GENERAL PART 



disturbances are still present. Also in progressive paralysis, in tabes, and in 

 a series of other brain diseases are alterations of the metabolism observed 

 Paghini found in many brain diseases increase of the elimination of endogenous 

 uric and and of the xanthin bases. Lowe found increase in the elimination of 

 phosphorus after epileptic attacks and in definite phases of the paralysis and 

 in delirium tremens. The thought has also been expressed that the appreci- 

 able indicanuria accompanying brain diseases is sometimes of nervous origin. 

 There are also observed in cerebral and mental diseases considerable varia- 

 tions in the salt metabolism. As is known, there is frequently found in 

 neurasthenia considerable increase in the elimination of calcium. The 

 brittleness of the bones that is so often seen in tabes indicates a considerable 

 loss of calcium and phosphorus. Disturbances in the carbohydrate met- 

 abolism (especially appreciable lowering of the assimilation boundary) are 

 frequent phenomena in cerebral and mental disturbances. Disturbances 

 of the regulation of the heart are not at all a rare symptom. In progressive 

 paralysis Kaufmann often found hyperthermia, and in the akinetic diseases as 

 well as after epileptic attacks reduction of temperature. These few examples 

 might suffice. It can well be conceived that these alterations in metabolism 

 come about through a functional influencing of the ductless glandular system. 



Special attention has been devoted in this respect to the behavior of the 

 ductless glands in the neuroses of the vegetative nervous system. Egger 

 saw in the vasomotor psychoneuroses increases of temperature that lasted for 

 months and years. In visceral neuroses, Pollitzer saw positive alimentary 

 galactosuria, while alimentary glycosuria was negative. This reminds one of 

 the alimentary levulosuria described by the author in some cases of Basedow's 

 disease, or in the disturbances in the qualitative decomposition of protein in 

 tetany. Curschmann saw a case of bronchial asthma with intermittent 

 exophthalmus, tremor, and tachycardia. In the vagal neurosis I regularly 

 found appreciable mononucleosis of the blood, and Eppinger and Hess ob- 

 served also hypereosinophilia. In the vasomotor neurosis Roth found in ad- 

 dition to marked lymphocytosis and lability of the pulse, also lability of the 

 temperature. Why rare cases of pentosuria and isolated levulosuria are almost 

 always associated with vasomotor neurosis is as yet unexplained. A short 

 time ago I saw a case of pentosuria with pronounced Herz's vasomotor ataxia. 



In Raynaud's disease is often seen slight rise in temperature, distinct 

 trophic and secretory disturbances, and in the attack often marked rise in 

 blood-pressure; sometimes there is polyuria and in rare cases glycosuria. 



Partially related to the vasomotor neurosis is perhaps that condition which 

 affects the group of diabetics in which the neurogenous factor especially pre- 

 dominates in the glycosuria. Here we usually find marked vasomotor ex- 

 citability, and under circumstances increase of the blood-pressure without 

 nephritis (hypertonic diabetes, see Chapter XIII). 



Among the many symptoms of the vasomotor neuroses are found, accord- 



