*  The  seven  notes  above  the  middle  C  of  the  bass  clef  are  designated  by  simple  letters,
those  of  each  higher  and  lower  octave  are  indicated  by  small  figures  placed  above  and  below
the  letter.     Thus  the  middle  C  of  the  treble  clef  is  C2.
*9


298  SPINAL    CORD.
Vasomotor  and  trophic  disturbances  constitute  a  singular  group  of  symp-
toms to  which  much  attention  has  lately  been  drawn.  Transient  oedema  of
the  limbs  may  occur  without  albuminuria,  and  is  sometimes  an  early  symp-
tom. Local  sweating  has  been  noted,  confined,  for  instance,  to  the  palms
and  soles,  or  to  one  side  of  the  head.  The  ecchymoses  and  altered  growth
of  hair,  in  connection  with  attacks  of  pain,  have  been  already  mentioned.
Pigment  may  disappear  from  the  skin  and  hair  in  isolated  spots.  Herpes  of
the  skin  is  not  uncommon,  and  usually  occurs  in  association  with  attacks  of
pain.  I  have  twice  known  the  penis  to  be  the  seat  of  herpetic  eruptions.  The
epidermis  of  the  sole  becomes  thickened ;  blisters  readily  form  beneath  it
and  may  lead  to  indolent  ulcers.  The  curious  affection  known  as  "  perfo-
rating ulcer  of  the  foot  "  has  been  found  to  be  almost  confined  to  cases  of
tabes.  Troublesome  ulceration  of  the  toes,  especially  about  the  nails,  is
also  occasionally  met  with,  and  may  necessitate  amputation.  The  growth
of  the  nails  of  the  feet,  and  sometimes  of  those  of  the  hands,  may  be
changed.      They  may  be  thickened  and  the  surface  furrowed  and  uneven.
Fig.  107.
