20 THE INTERNAL SECRETIONS—1920 
example, a young man of 36 years, complains of loss of 
weight, excessive sweating, palpitation, and extreme 
nervousness. He has been recognized as a possible 
hyperthyroid case without obvious enlargement of the 
thyroid. Because of a tendency towards vomiting and 
periodic diarrhea he was thought to have had an ulcer 
of the stomach. In this case, without going further 
into detail, the important symptoms, such as excessive 
sweating, vomiting, periodic diarrhea, were looked 
upon as vasomotor in type. The loss of weight might 
be expected and the palpitation with arrythmia was 
undoubtedly neurogenic in origin. The Goetsch reac- 
tion’? was distinctly negative. 
On the other hand, a man of 38 years, weight 170 
pounds, complains of sleepiness, fatigue, and is gener- 
ally “slowed down,” both in thought and action. His 
skin was sweaty and oily; his hair-distribution normal 
but “thinned out;” his pulse was irregular and the ten- 
sion low, and he complained of nocturnal tachycardia. 
He also stated that his sexual desires (mental) had les- 
sened, although he could be readily aroused. This pic- 
ture is not unlike the Rénon and Delille syndrome,” in- 
dicating pituitary insufficiency, and yet the Goetsch 
test exaggerated all symptoms and made the patient 
most uncomfortable. Then, too, liquor hypophysis, 
unless given in very small doses, also exaggerated the 
complaints. Might not these symptoms also be of the 
vasomotor type? It is doubtful that the case was one 
of hyperthyroidism. 
It is not uncommon, in taking the anamnesis of these 
patients, to be told that for a long time, or ever since 
the age of 13 or 14 years, they have been “nervous” 
and suffered more or less from so-called “nervous at- 
tacks,” such as cold hands and sweating, or biliousness 
and constipation, or frequency of urination, even to the 
extreme of bed-wetting, headaches, and so forth. Then, 
in later life, an acute infectious disease, or an abdomi- 
