CENTRAL NERVOUS SYSTEM AND DUCTLESS GLANDS 41 



and especially the often rigid symmetry, comes to the conclusion that nervous 

 influences are the basis. The individual with xanthelasma shows a series 

 of symptoms on the part of the nervous system and especially on the part 

 of the vegetative nerves. Here also the changes in the ductless glands 

 seem to me to be only of a secondary nature. 



Xot only in trophoneuroses, but also in other diseases of the central 

 nervous system, do we find the most manifold symptoms that point to dis- 

 turbances in the function of the vegetative nervous system. It seems to 

 me that the study of these conditions has been handled rather half-heartedly 

 by neurologists. Myasthenia, paralysis agitans, and myotonia have been 

 brought into etiological connection with the parathyroid glands. As we 

 shall see, however, in Chapter IV, I regard the hypothesis of a primary affec- 

 tion of the parathyroid glands in these diseases as insufficiently supported. 

 Myasthenia, because like scleroderma it is sometimes associated with slight 

 symptoms of Basedow's disease or tetany (Tobias), has been regarded as a 

 polyglandular disease (Markelojf), certainly not with more correctness than 

 has been scleroderma. Finally, I wish to make some remarks in this connec- 

 tion with regard to multiple sclerosis, tabes, and progressive paralysis. In 

 multiple sclerosis, often symptoms on the part of the vegetative nervous 

 system become distinctly prominent. There often exist tachycardia and 

 great lability of the pulse, mostly pronounced dermographism, furthermore, 

 sweats, inclination to hyperthermia, manifestations on the part of the gastro- 

 intestinal canal, polyuria, bladder disturbances, etc. In a series of cases 

 that we investigated we found a great sensitiveness against adrenalin and 

 pilocarpine, often appreciable alimentary glycosuria, strong diuretic action 

 of pituitrinum infundibulare, low degree of tolerance against thyroidin, etc. 

 In some cases even Chvostek's phenomenon was observed. It is further known 

 that in multiple scleroses the activity of the generative glands mostly dis- 

 appears early. I think that most will agree with me that if we speak of 

 pluriglandular disturbances in this disease, we shall have to assume a func- 

 tional and trophic influencing of the ductless glands. The relations in tabes 

 and progressive paralysis seem to me to be very similar. Kraepelin has 

 grouped paralysis with the diseases of metabolism, to which group Raymond 

 has ascribed tabes. This seems to me to be overdrawn. In the same manner 

 we could regard the infectious diseases as metabolic diseases. Indeed it is true 

 that in tabes and paralysis the alterations of metabolism are so prominent that 

 at times they almost dominate the clinical picture. I refer to the losses of 

 weight, to the marked cachexia of tabetics, to the decalcification of the bones, 

 which gives rise to the spontaneous fractures, to the positive alimentary 

 glycosuria that is so marked in this condition; also to the irritative symp- 

 toms on the part of the nervous system that are so fulminant, the tabetic 

 gastric crises, the vesico-intestinal crises, the enormous hypersecretion of 

 gastric juice, moreover the vasomotor disturbances, tachycardia, sweats, 



