166 FKANCIS M. POTTENGEB 



Sweating is* also found in conditions which are accompanied by the 

 above group of symptoms, as well as those belonging to the sympathetic 

 syndrome. 



Variability of Autonomic Symptomatology as Clinically Seen. It 

 must be evident to the most casual observer that the action of a given stim- 

 ulus would differ, according to the irritability of the nerve cells acted 

 upon ; but when we consider that internal secretions are more or less selec- 

 tive in their action, affecting one division of the vegetative system at times 

 to the exclusion of the other, it is further evident that the resultant action 

 would differ greatly, according to whether the patient is a sympathico- 

 tonic or a vagotonic. With this conception grasped, one very important 

 fact in explaining the variability of symptoms in the same .disease in differ- 

 ent individuals is established. 



Hyperirritability may be general or confined to certain structures. 

 Symptoms will often be confined to certain structures, because the nerve 

 cells in these structures only are discharged to a significant extent. If the 

 exciting stimulus were stronger, the symptoms would be more widespread, 

 involving other neurons. 



Intimate Relation Between the Endocrin Organs and Autonomic 

 Nervous System. There is an intimate relationship between the glands 

 of internal secretion and the vegetative nerves. Stimulation of the sym- 

 pathetic nerves, as before mentioned, increases the secretion from some of 

 these glands, particularly the medulla of the suprarenals, the thyroid, and, 

 possibly, the pituitary. Stimulation of the parasympathetics activates 

 others. There is evidence also that the secretion from the various endo- 

 crin glands, on the other hand, activates the vegetative nervous system, 

 some secretions, like that from the suprarenals, hypophysis, and thyroid, 

 acting upon the sympathetics, and others, such as that of the parathyroid, 

 ovary, and pancreas, acting upon the parasympathetics. 2 



The intimate relationship between the autonomic system and the endo- 

 crin organs has been especially emphasized by the Italian school. Pende 

 (1916) has developed at length the conception of such relationship. In- 

 deed, so close does he regard the functional connection that he consistently 

 treats of the two as constituting, for practical purposes, a single mechan- 

 ism. 



It is assumed, says von Fiirth, that the suprarenals, thyroid, and hypo- 

 physis, activated by the sympathetics, have an accelerating influence upon 

 metabolism, stimulating protein destruction, carbohydrate mobilization, 

 and likewise the metabolism of fats, while they also control the water and 

 salt output and the galvanic irritability of nerves. 



Clinical Significance of the Autonomic-Endocrin Relationship. The 

 importance of these facts is evident to the clinician who appreciates them, 



2 In case of the thyroid and suprarenal secretions only is the evidence at all 

 convincing. R. G. H. 



