28 THE INTERNAL SECRETIONS—1920 
chemistry in relation to carbohydrate metabolism, and 
that this factor should be recognized as being fully as 
important as the patient’s appearance and general feel- 
ing, if future mishaps are to be avoided. 
Mention might be made at this point of a case in 
which the cardinal complaints were connected with the 
cardiovascular system. 
The patient is a young man, 27 years of age and sin- 
gle. From the age of eight, until twenty-one, he was 
subject to convulsions, occurring only at night. In ap- 
pearance he was slight and not overweight. At 21 
years a distinct change took place; his seizures stopped 
temporarily; he grew stout; hair appeared all over his 
body ; he became hyper-sexual, vigorous and overactive. 
When seen, eight months ago, his weight was 170 
pounds; he had a heavy growth of hair upon the chest 
and abdomen; he sweat profusely; his blood pressure 
was 168 mm., and his pulse 130, irregular and skipping; 
he had a systolic blow at the apex; he was nervous, 
restless and overactive. By toning the vascular system 
his pulse rate dropped to 88, the blood pressure to 136 
mm., and his general nervousness subsided greatly. He 
then had a period of sexual impotency, during which 
time ideas of reference and feelings of being under 
suspicion developed. He felt the opposite sex looked at 
him and he was self-conscious, fearing that they might 
know he had had convulsions. This psychical impo- 
tency and the accompanying defensive mental state of 
a mild paranoid type became adjusted within a few 
weeks. 
This case is not unlike the pluriglandular syndrome 
as seen in the adrenal-pituitary group, and yet the ad- 
justment has taken place largely through the balancing 
of the neurogenic mechanism of the vascular system, 
apparently. 
THE VEGETATIVE NERVOUS SYSTEM 
The next system to be considered briefly is the 
autonomic or vegetative nervous system. 
Eppinger’® has called that system which supplies the 
smooth muscles, cardiac muscle, and glandular tissues 
