178 FKANCIS M. POTTENGEK 



constipation, hyperchlorhydria, colicky pains, low pulse tension, and some- 

 times slow pulse. Again we must repeat that these symptoms are varia- 

 ble, because they are very complex in their causation, being a resultant of 

 nervous, psychic, and endocrin reactions. 



Another very important clinical observation, which has been dwelt 

 upon by Bell, is that patients pass the menstrual cycle, the beginning of 

 pregnancy, or the menopause, either normal or artificial, differently, 

 according to whether they have large, small, or medium amounts of ovarian 

 secretion. A woman classed as hypo-ovariac has very different premen- 

 strual symptoms from one who is hyperovariac. In fact, she may have 

 vagotonic symptoms instead of sympathicotonic. The hypo-ovariac also 

 is likely to enter upon pregnancy or the menopause with .comparative com- 

 fort, for the withdrawal of the ovarian secretion makes a comparatively 

 slight impression. The hyperovariac, on the other hand, suffers the loss 

 of a very dominant secretion, apparently sympathicotropic as far as the 

 menstrual cycle is concerned, and consequently suffers from excessive 

 parasympathetic irritability (vagotonic) on the part of many structures. 

 The withdrawal also profoundly affects the patient psychically, disturbing 

 the equilibrium in those structures that are particularly prone to show 

 endocrin and nervous imbalance. Laignel-Levastine has described many 

 of these nervous, psychic, and endocrin relationships as they appear clini- 

 cally. 



The Parathyroids and the Autonomic System 



Little can be found in literature regarding the relationship between 

 the parathyroids and vegetative nerves. The principal nerves to these 

 glands seem to be those branches of the sympathetics which supply the 

 blood vessels, yet I find no recorded experiments which purport to estab- 

 lish the secretory nature of these nerves. 



While the internal secretion of the parathyroids seems to act chiefly 

 upon the central nervous system and produces the disease known as tetany, 

 the vegetative nerves also come in for a disturbance in equilibrium. 



MacCallnm and his coworkers have shown that the symptoms of tetany 

 which result from ablation of the parathyroids may be produced by perfu- 

 sion of blood from which the calcium has been removed by dialysis, and 

 believe that the symptoms of this disease are due to a lack of calcium in 

 the blood, which results from the failure of the secretion from the para- 

 thyroid gland. 



An analysis of the symptoms in the vegetative structures fails to show 

 a preference for either the sympathetic or parasympathetic nerves. On 

 the other hand, there seems to be a general heightening of excitability on 

 the part of both divisions. There seems to be a pronounced excitability of 

 the nerves supplying the blood vessels (Falta (c) ), as is shown by localized 



