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 10 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 Renon and Delille syndrome, 11 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- 



