In examining the circulatory system we must bear in mind the powerful influence of the ductless glands upon the circulation, especially that of the adrenals, thyroid, and pituitary body. As shown by Oliver and Schäfer, the thyroid secretion diminishes blood-pressure, whereas the adrenal secretion increases it. Thus, these two glands are antagonistic and it can easily be understood that if there is not sufficient thyroid secretion to counterbalance that of the adrenals, the blood-pressure will increase. If this lasts for some length of time, very serious effects will follow. Atheroma and arteriosclerosis may ensue, both of which conditions tend to shorten life. The adrenals can be stimulated to such over-secretion by mental emotions, which act upon the sympathetic (splanchnic) nerves. Besides mental emotion they can also be stimulated by various poisons, such as alcohol, tobacco, or infectious diseases (see Chapter III). We must keep these facts in mind when we examine the circulatory system, and we must ascertain the condition of the arteries, whether soft or hard, and of the blood-pressure. Tortuosity of the temporal artery in young persons is also a sign of some value. The condition of the coronary arteries is of the utmost importance. We must also not forget the fact, that even in severe cases of arteriosclerosis the pulse may be found soft. Everything will depend upon the examination of the heart, and special attention must be paid to the second sound at the aortic orifice, and to any accentuation of that sound. In the examination of the digestive organs we must pay special attention to the state of the appetite. Very often with a degenerated thyroid this may be wanting. The appetite, as shown by Pawlow, is under the influence of the mind as we will see. With a sad melancholic disposition, as is often found in persons with a degenerated thyroid, there is insufficient or no secretion of gastric juice. Besides, in myxœdematous conditions all glandular secretions are more or less checked. Thus food passes into a stomach with insufficient gastric juice, remains there in stagnation and causes fermentation. The stomach makes vain efforts to drive the food into the intestine. Slowly an atonic condition of the gastric walls arises, and later dilatation of this organ. The fermenting foodstuffs in the stomach set up a chronic intoxication of the organism.