24 THE INTERNAL SECRETIONS—1920 
an upset of one or the other brought about by an infec- 
tious or toxic origin. So often this is manifest with 
the cardiovascular system, evincing the symptom-com- 
plex, and yet to direct one’s energies towards that 
alone, and not seek for other disturbances, undoubtedly 
gives cause for the feeling that future permanent heart 
or blood-vessel disease may be the outcome of this indi- 
cator. The frequent attacks of cardiovascular insta- 
bility, of neurogenic origin, may be the primary factors 
at play in the future, determining an arteriosclerosis of 
what we now call “idiopathic” origin. It also may be 
possible that the disturbance termed latent myocarditis 
is a smooth muscle neurosis, indicating a future path- 
ology of the myocardium. Such conditions as inter- 
mittent claudication, the acute vasomotor paralysis 
described by Halley,'® and Nothnagel,'’ as well as Ray- 
naud’s disease, may have as their fundamental disturb- 
ance a primary vascular neurosis. These toxic factors 
may produce transitory upsets in the nervous mechan- 
ism or glandular activity, resulting in distinct changes 
in the biochemistry of the blood and in the tissue meta- 
bolism. For instance: A young woman of 24 years, 
three weeks before her confinement, complained of fre- 
quent lapses of consciousness. She went her full time, 
however, and gave birth to an apparently normal child. 
The child died in convulsions on the eighth day. Dur- 
ing these eight days, and for several weeks following, 
the mother had frequent attacks of loss of conscious- 
ness, “rolling of the eyes,” and other epileptoid attacks. 
Approximately two months after her confinement she 
presented a systolic blow at the apex of the heart, a 
rapid arrhythmic pulse, peripheral vasomotor instabil- 
ity. She complained of headache, wept a great deal, 
had “shivering fits,” hot flashes and sweats. Her blood 
examination showed the blood sugar 95 mg., urea nitro- 
gen 18 mg., and kreatinin .4 mg. This disturbance in 
metabolism in conjunction with prepartum and post- 
