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 18 has called that system which supplies the 

 smooth muscles, cardiac muscle, and glandular tissues 



