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ENDOCRINOLOGY
The BULLETIN of the ASSOCIATION for the STUDY of INTERNAL SECRETIONS
Volume Three
Published by the Association 1919
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TABLE OF CONTENTS Corpus LUTEUM IN NEUROLOGICAL PRACTICE. By H. Climenko, NIGEE DOs SSeS Ss old GaSb SIcis Cee EIST emir Sie Ieee THE TESTICULAR HORMONE. By Homer Wheelon, St. Louis......
PAROXYSMAL NASAL HyYDRORRHEA DUE TO DYSTHYROIDISM OF SYPHILITIC ORIGIN. By Mariano R. Castex, Buenos Aires
EDITORIALS: PPA SP MAI TS, ope isius siete es ssi sts/s dis'ois s eisrs ooalerasla e's sess PURDON SUN PERI SEVAR GET 85 ede ge rchs ios 6. siaie = \tie)'e.0c 5 Sw ejele\ ee 0 sey e e's Book REVIEW:
LE GOITRE EXOPHTHALMIQUE SYPHILITIQUE. By E. Schul- SLEUTS | LETESS Oe e
THE LITERATURE ON THE INTERNAL SECRETIONS............e00%
THE FUNCTION OF THE CHROMAPHIL TISSUES. By I. Pearlman PM Swale WANGENt. WaNNIPCS .<.. 005 .-,cc0is eos ote eciee oles
DEATH PRODUCED BY TYING THE ADRENAL VEINS. By F. A. Hart- Manual Wells ilabe. LOTONLO sas sa .nc ce avec eee ee vee
THE SIGNIFICANCE OF EPINEPHRIN IN MUSCULAR ACTIVITY. By Gharles M. (Graber, Bouldér, (Colo... 2.2.0... 5-1. ee eee
ACTION OF SOME OVARIAN AND CorRPUS LUTEUM EXTRACTS ON THE PUPIL OF THE FrRoG’s Eye. By D. I. Macht and S. Mat- SURES SINE TERT g 5. fans cicjaha 2 tre = Sia eihe = we Seie(ere oes owes ee
THE PHYSIOLOGIC ACTION OF THYROXIN. By E. C. Kendall, Epeacabeerpeet anv TRAIN fore teny ohare a1e = sank oieyci bieiss cides Gere «isieicie wreiie’s'* «
CLINICAL StuDy. A NEW POINT OF VIEW IN APPROACHING THE DIAGNOSIS AND TREATMENT OF A PATIENT. By George Drapigie. INDIA Mod isthe 38 ii Re ieee See eee
Book REVIEW:
LA ACTION FISIOLOGICA DE Los EXTRACTOS HYPOFISIARIOS. By Bernardo A. Houssay, Buenos Aires.................4.
THE LITERATURE ON THE INTERNAL SECRETIONS...............4.
REMARKS ON THE FUNCTIONS OF THE SUPRARENAL GLANDS AS RE- VEALED BY CLINICAL PATHOLOGICAL STUDIES OF HUMAN BE- INGS AND BY EXPERIMENTS ON ANIMALS. By Lewellys F. OREM MEL TRTIEN ED 8 eye eee ets to. 'u: 5 asada si'eserabers) e's e-'ale 0 «
FETAL AND MATERNAL ATHyYRosIS. II. By G. Ennis Smith, NSS URN AA TY ee eo Tc aTacln. )cl elspa v mye. b: ete bie vv eee oe gee
DIABETES IN INFANCY AND CHILDHOOD. By Isaac A. Abt, Chicago :‘
THE FUNCTION OF THE THYMUS GLAND. By Eduard Uhlenhuth, Nae eet re ee cial. wie c.g oslo pid sewveaccs sees
THE EFFECT OF SPLENECTOMY ON THE THYMuS. By F. C. Mann, USucieshen. linia RAS Say eto =o Cen
THE FUNCTIONS OF THE INTERNAL SECRETION OF THE PLACENTA. By Frederick S. Hammett, Philadelphia..................
THE INFLUENCE OF THE THYROID GLAND ON THE FORMATION OF ANTIBODIES. By J. Koopman, The Hague...............
16
aos
THE ACTION OF ADRENALIN ON THE KIDNEY. By Frank A. Hart- man and Ross S. Lang, Toronto.........
eee eee o o+e (e816 16
ENDOCRINOPATHIC CONSTITUTIONS AND PATHOLOGY OF WAR. By IN; Pende; Palermo litalliys)-cterctonterhelere errs
Book REVIEW:
THE INTERNAL SECRETIONS AND THE NERVOUS SYSTEM. By M. Laignel-Lavastine, Paris..... Bo OOH
THE LITERATURE ON THE INTERNAL SECRETIONS........
es
THE ROLE OF THE PINEAL IN Pepratrics. By Murray B. Gordon, Brooklyn sis cteiers tener enertereere aictere
©1000) 0 (ele CeO. eeee
CO-OPERATION OF INTERNIST AND SURGEON IN THE TREATMENT OF GRAVES’ DISEASE. By H. Lisser, San Francisco..........
EARLY SYNOSTOSIS OF THE EPIPHYSES WITH DWARFISM IN PUBER- TAS Precox. By Knud H. Krabbe, Copenhagen
THE RATIONAL THERAPEUSIS OF EXOPHTHALMIC GOITRE. By Israel Brame ehiladelpiiawryect-rerasiieerisns slap tvayeuete: seks wate ee oes
HyYpoPHYSEAL DIABETES. By J. Koopman, The Hague Book REVIEWS:
SYMPTOMS OF VISCERAL DISEASE, A STUDY OF THE VEGETATIVE NERVOUS SYSTEM IN ITS RELATIONSHIP TO CLINICAL MEDI- CINE. By Francis M. Pottenger, Los Angeles.............
La EpAD CrITICA (THE CRITICAL AGE). By G. Maranon.... THE LITERATURE ON THE INTERNAL SECRETIONS INDEX FOR VOLUME III
Be) 6) eo) =| \0 jal \e) .e lele lelve\(s) «lens
321
329
342
343
437
493 493 495
ENDOCRINOLOGY
The BULLETIN of the ASSOCIATION for the SHODDY of.
MotB RNAL SECRETIONS
JANUARY-MARCH, 1919
CORPUS LUTEUM IN NEUROLOGICAL PRACTICE*
H. Climenko, M.D., New York
Adjunct Attending Neurologist, Montefiore Hospital; Chief of Neuro- logical Clinic, O.P.D., Mt. Sinai Hospital; Attending Neu- rologist, Central Neurological Hospital
“MODERN MEDICINE IS AT THE PERIOD OF HORMONES”* (1)
With the last decade our knowledge of the internal secre- tions has assumed gigantic proportions. Endocrinology has long passed from the realms of academic speculation into the land of practical knowledge. It has been shown that there is hardly a vital function in the living organism that does not depend upon the secretions of one or another gland or, more often, upon the proper relation in the confederacy of glands of internal secre- tion. Attempts have been made to explain even psychic pro- cesses (2) such as emotions (3) and states of mind through the increase or diminution or alteration of secretions of this or that gland. When, however, we come to the therapeutic applications of the organic extracts of these glands we are confronted with a number of serious questions. Robin (4) has pointed out the fact that glands which do not have excretory ducts can be studied only from the physiological point of view. Although subse- quent physiologists, Brown-Séquard and Schafer (5) and a
*Read before the New York Physicians’ Association at the Acad- emy of Medicine, December 26, 1918.
2 ; CORPUS LUTEUM
great many others, have shown the value of some of these ex- tracts in diseased conditions as well as their effect on the normal organism, we are still far from having a scientific basis for the therapeutic use of organ substances. We do not yet know whether by giving dead animal extract we are administering the same substance that the gland produces in vivo, for only two substances, secretin and adrenalin, have so far been demon- strated in the blood and proven to be the products of the secre- tion of these glands. We are in the dark as to the modus oper- andi of the organic extract. Does it have the same action as the product of secretion in life, 1. e., that of a hormone, or does the dead tissue have its own specific action? The answer to this and similar questions belongs mainly within the province of the laboratory. The clinician, however, can assist by confirming the findings of the laboratory at the bedside as well as help observe the effect in so-called normal individuals.
With this object in view, the writer has studied the effect of these extracts on various groups of symptoms and also where possible noted the changes in physiological functions produced by these drugs. In this paper the therapeutic use of corpus luteum will be considered.
The corpus luteum was first described by Volcherus Coiter in 1573. (6) Bischoff in 1844 and subsequently Dalton (7) in 1851- observed that in the impregnated animal the corpus luteum increased in size after the orifice of the follicle was closed. They also pointed out the high degree of development of that corpus luteum where the ovum was impregnated and especially where it was followed by gestation. It was, however. Fraenkel (8) who at the suggestion of Born made a scientific study of the physiology of the corpus luteum. It is to Fraenkel that we are indebted principally for our knowledge of the func- tion of this part of the ovary.
Our present-day knowledge of the physiology of the corpus luteum can be summarized in the following manner: Sack (9) has shown that through its use there is a tendency in the body to retain nitrogen and put on flesh. It has been stated by sev- eral writers that corpus luteum has a marked vasodilator effect ; that was disputed by Gley, (10) but experimental tests carried out by Frank and Rosenbloom (11) show that corpus luteum is a vasodilator. This was also confirmed clinically by Burnam, (12) Dannreuther, (13) Osborne, (14) the writer and many others. O’Donoghue (15) showed experimentally that the development
CLIMENKO
OO
of the mammary gland depends upon the formation of the cor- pus luteum. Ott and Scott (16) have definitely shown that hypodermic injections of a solution of corpus luteum macerated in sterile water causes hypertrophy of the mammary glands of virgin rabbits to twice their size as compared with control ani- mals. The increase was in parenchymatous tissue with a dimi- nution of connective tissue. The breasts of the experimental animals also contained milk. Fraenkel (17) proved experi- mentally that the fixation of the embryo, the formation of the decidua, as well as menstruation, depend upon the secretion of the corpus luteum. In this connection it may be mentioned that De Lee (18) reports negative results in two cases where corpus luteum was transplanted into the broad ligaments in the hope of continuing pregnancy in gravid women whose ovaries were removed for severe pathological conditions. Both aborted. It should also be emphasized that in this respect extracts of corpus Inteum do not replace the functions of the normal gland. (19)
Injections of the extract into the veins produce a marked hyperemia of the pelvic organs. It is a significant fact that corpora lutea are never found in the fetus, in the new-born child, in girls before puberty, nor in women who have ceased to -menstruate. (20) It can thus be seen that in the sense of Steinach (21) corpus luteum is a true puberty gland. Rebaudi (22) has shown that removal of corpora lutea in rabbits is fol- lowed by proliferation in the islands of Langerhans. Giorgi (23) demonstrated hyperactivity of the hypophysis after destruction of the corpora lutea.
Below (24) demonstrated experimentally that the corpus luteum had a different function from that of the ovary proper. He came to the conclusion that ovarian extract, taken from ovaries where all the follicles were removed by cauterization, injected into the blood of animals, showed (1) increase of blood pressure, (2) increase of pulse frequency, (3) increase of the intake of oxygen and (4) increase in the output of carbon diox- ide. Extract of corpus luteum, on the other hand, causes diminution of nitrogen excretion in the urine, diminution of oxygen absorption, unstable output of carbon dioxide, increased activity of sweat glands, and a marked fall in blood pressure.
The chemical nature of the active principle of the gland has not as yet been determined. Iscovesco (25) believes it to be a lipoid; others think it a protein. Frank (26) showed that the gland substance extracted with fat solvents is inert. He, how- ever, does not believe it to be a lipoid, but thinks that the sub- stance is washed away with the lipoids in the process of ex- traction.
+ CORPUS LUTEUM
With these physiological data at hand, extract of corpus luteum has been used by clinicians in syndromes believed to be caused by disturbed sexual gland activity. In this paper, only the so-called ‘‘nervous syndromes’’ associated with disturbed sexual gland activity will be considered. Type cases where therapeutic results have been obtained will be cited. Mention will also be made of instances where corpus luteum gave no re- sults. I shall attempt to establish the contraindications to its use, as well as to show where it can be used with advantage in combination with other gland extracts.
Case l. S. G., fifteen years of age, a school girl born in the United States of Jewish parentage. Family history negative. The patient had pneumonia and mumps in early childhood. Menstruation began at thirteen, was always irregular, tardy, painful, and scanty; one-two day type. On March 30, 1918, the patient first came to see me with her mother, who gave a history covering the previous six months. For a week preced- ing menstruation, she became depressed, lost all initiative, was listless and took food only when urged. - At times she threatened to commit suicide, complaining that she was tired of life. This lasted until menstruation began when a normal state of mental- ity was reestablished. The rather frequent attacks stopped her attendance at high school. She was a well-built, stocky girl, with a pale complexion. There was some acne on the face and back. All reflexes were lively. Pulse 80 and of good quality. Blood pressure 125/80. Urine negative. Hemoglobin 70 per cent. The patient was put on corpus luteum extract gr. ii three times a day. She was instructed to return during the week of expected depression and did so, when there were noted psychic signs of depression but to a far less degree than previously de- scribed. The menstruation that followed was not painful and lasted the usual two days. The next month the depression did not appear. The dosage was gradually diminished and at pres- ent she takes two grains once in two days. She has resumed her studies at high school. There was a fall in the blood pressure from 5 to 10 points during the time she took two grains of extract three times a day.
Case II. B. W., 22 years of age, single, dressmaker. The family history is neurotic; father is suffering from asthma, mother is rheumatic, and a sister suffered from Pott’s disease. The patient began to menstruate at fifteen, was always regular, but menses were painful and scanty. She came to me on Feb- ruary 5, 1916, complaining that for two or three days preceding menstruation she became nervous and excitable, so that she could
CLIMENKO D
not attend to her work, but that the nervousness subsided with the establishment of the full flow. She stated that to control her ‘‘nervousness’’ hypodermic injections, probably morphine, had to be used. The patient was well built. Her teeth were in poor condition with beginning signs of pyorrhea. She was anemic, Hgb. 70 per cent. Urine negative. Blood pressure 115/85. There were some somatic signs of hysteria. The corneal and pharyageal reflexes were absent. I requested to be called during the next ‘‘nervous attack,’’ at which time I found the patient in a state of mania; screaming at the top of her voice, some flight of ideas, and attempts at exposure were pronounced. Hyocine and chloral were immediately administered and later, ‘after menstruation stopped, corpus luteum was given in doses of two to five grains three to five times a day. Corpus luteum in this patient only partially relieved the symptoms. Subsequent attacks were milder, but did not disappear completely. Soon after her marriage it was found that she had marked uterine anteflexion for which she underwent operation. She subse- quently became pregnant and during the gravid state and that of lactation she did not manifest any mental disturbance. The reestablished menses were uneventful. The effect.of corpus luteum in this case was doubtful, because the real cure came only after marriage followed by a correction of malposition of the uterus.
Case III. A.§., a girl seventeen years old, first seen March 8, 1916. Mother died of some acute disease. Brothers and sisters are neurotic. Patient had some of the usual diseases of child- hood, including whopping cough, but no scarlet fever. She he- gan to menstruate at the age of fifteen; menses were regular, but always scanty and never lasted more than two days, often only one day. Three months prior to her coming to me she became depressed without any definite reason. She had not menstru- ated in four months. She was rather plump and her chin some- what protruding. The hair distribution was rather of the male type. Roentgenological examination showed a small sella turcica. The patient was at first put on pituitary extract of the entire gland without any results. We then decided to give her three grain doses of corpus luteum with a small amount of pituitary extract. Within a week she began to improve, and at the end of two weeks menstruation appeared. After the menstruation she became hypomaniacal, which condition, however, disappeared after four weeks. At present she holds a rather responsible position and is in an absolutely normal state.
Analyzing these three cases we see that Case I can be safely diagnosed as a menstruation insanity so well described by Kraft-
6 CORPUS LUTEUM
Ebing (27) and by Powers. (28) Of these I had a number of cases which I hope some day to describe in a separate paper. Kraft-Ebing peinted out the advisability of organotherapy in these cases, but he recommends bromides. Powers, however, showed that the use of bromides did not influence the prognosis in these cases. In my case, corpus luteum had a decidedly cura- tive effect. Case III can best be classed as one of a mild type of manic depressive insanity. It may be argued that the im- provement which followed organotherapy might have come by -itself. It is, however, a not insignificant fact that the patient began to improve soon after the administration of glandular, extracts, and that the improvement coincided with improved menstruation. Case II is probably one of hysteria with mechan- ical obstruction in the uterus. Here the effect of the administra- tion of corpus luteum was probably very questionable. The slight improvement might, however, be suggestive. The real cure followed marriage and pregnancy. In menstrual disturb- ances due to obstruction, opotherapy is of no value and the curative results of any system of treatment in hysteria beginning with the ‘‘application of ill-smelling salts to the nostrils, per- fumes to the vulva, to attract a wandering womb,’’ and ending with psychanalysis of Freud to replace a wandering libido, must be regarded with suspicion. Suggestion is always the under- lying factor in hysteria.
Case IV. R. F., thirty-eight years of age, came to the Mount Sinai clinic of June 13, 1918. Her family history is negative. She began to menstruate at fourteen. Menses were scanty but always regular. The patient was excitable, irritable and suffered from insomnia during menstruation. For the pre- vious ten months she had suffered from hot flashes, could not attend to her housework, and complained of itching all over the body. Physical examination showed nothing abnormal save for an acneform eruption on her legs. Blood pressure was 120/80. The skin condition was diagnosed in the dermatological depart- ment as a drug eruption of bromide origin. She was put on “‘hormotone’’ and her symptoms were somewhat relieved, but not enough to consider the condition improved. On September 17, 1918, corpus luteum extract was ordered in two-grain doses. On September 21 patient returned stating that she felt well. Ovarian extract in five grain doses three times a day was then prescribed and the symptoms returned, but were not so severe as originally. Corpus luteum was again administered and ever
CLIMENKO
~]
since the patient has felt well. Her last visit was on November 5, 1918, when she stated that she felt well whenever she took the pills. She was advised to take two grains once in two days. The amount of her menses did not increase.
This is one of the milder forms of menstruation psychosis, complicated probably by the beginning of involutionary symp- toms. In connection with this case it is well to point out that Kraepelin (29) calls attention to the fact that even in normal women the physiological process of menstruation is accompanied by an increased nervous and psychic irritability and in some women this excitement may even become pathological. Havelock Ellis (30) says: ‘‘ Whenever a woman commits a deed of crimi- nal violence, it is extremely probable that she is at her monthly period.’’ Jn this case the improvement was directly due to corpus luteum extract only. All other drugs were ineffectual.
In well-defined cases of menopause, corpus luteum is not effective. In surgical menopause my results were absolutely nil in all these cases. Hence my results were entirely different from those obtained by Burnam, (31) who says: ‘“‘It affords a valu- able means of controlling the nervous symptoms which occur at the time of the natural and artificial menopause, giving relief to most sufferers.’’ I can partly subscribe to the first part of this statement, but I had no results whatever with corpus luteum in surgical menopause, contrary also to the results obtained by Dannreuther (32) who states that he cured surgical menopause with corpus luteum. This writer also states that in one of his cases menstruation was established after the extirpation of all the ovarian tissue. MeDonald’s conviction, (33) however, agrees with mine on the uselessness of corpus lutem in surgical menopause.
Case V. D. B., 30 years of age, married, came to me on August 17, 1918. Her mother died of cancer of the stomach ; otherwise the family history was negative. She began to men- struate at sixteen years of age, was always irregular; intervals were five, six, eight and ten weeks. It lasted from five to six days but was scanty in amount. She was never pregnant al- though her husband had a normal seminal fluid. Leading gyne- ecologists could not detect any organic malposition. She com- plained of insomnia, irritability, slight dull headaches, constipa- tion and cold extremities. She was plump, her skin was dry and the mucous membranes pale. There were a few hairs on the
8 CORPUS LUTEUM
chin. Tongue was coated. Pulse 70, blood pressure 125/80. Reflexes were increased. A hemie apical murmur could be dis- tinguished. She was given corpus luteum in two-grain doses, with extract of thyroid, one-fourth grain. Her improvement was rapid as to the subjective symptoms, including the head- aches. Menstruation, while more frequent than before, is still not fully nor periodically established.
Southier, Pashon and Gaulstein (34) have shown that the thyroid and ovaries seem to be antagonistic in action. If we remember that Below showed that the corpus luteum is also antagonistic in action to the secretion of ovarian substance proper, the rationale becomes apparent of giving thyroid in cases of deficient menstruation where there are symptoms of hvypo- thyroidism. This is well borne out by clinicians, notably Levi (35) in the case of a lady aged thirty who after puberty men- struated only four or five times a year and who exhibited bald- ness of the masculine type. She was treated with thyroid, and soon after treatment began to menstruate regularly. The same author reports another case of a young girl fourteen years of age whose menstruation was constantly retarded or absent but which became regular after thyroid opotherapy.
Cessation of menstruation with symptoms of acromegaly due to a pituitary tumor is well illustrated in the following ease, now at the Montefiore Hospital.
Case VI. Mrs. R. H. (Fig. I) 21 years old, came to me in February, 1916, complaining that for six months she had not menstruated and that she had been suffering from severe front] and general headaches which at times kept her awake at night and occasionally were accompanied by vomiting. Physical ex- amination, including that of the optic nerves, was negative at the time. Corpus luteum, given in doses of various amounts, had no effect. Her headaches had to be controlled by the coal- tar products. After two months’ treatment, I did not see her until November, 1916, at which time there were outspoken signs of acromegaly. At Mt. Sinai Hospital X-ray examination showed a very large sella turcica, protruding lower jaw, and entirely obliterated frontal sinuses. Wassermann was negative, the urine negative, hemoglobin 75 per cent and blood count was within normal limits. The dises were still normal. For removal of the tumor, operation was suggested, which the patient took under consideration. Meanwhile she was discharged from the hospital and I treated her at the Mt. Sinai clinic. During the time she Was visiting the clinic her menses appeared only once, in a few
CLIMENKO 9
drops, in six months after she received pituitary extract of the entire lobe: Her headaches improved to such an extent that she gave up the idea of an operation. At present she is in the Monte- fiiore Hospital, where she is being treated by pituitary extract only, and a full report of this patient will probably be pub- lished in the future.
Fig. 1. Case of acromegaly.
Casz VII. A. L. (Fig. II), 33 years of age, married, came to me on August 11, 1918. Her father is ‘‘nervous,’’ otherwise her family history is negative. Personal history shows that she began to menstruate at fourteen; menses were regular in type and normal in amount. She suffered from frequent colds. She
10 CORPUS LUTEUM
had never been pregnant. About seven years before I saw her she had undergone some gynecological operation and soon after this the menses became scanty. She still was regular but men- struated only for a fraction of a day. She came complaining of being depressed most of the time, worrying a great deal over every detail, mostly because of her operation, since which she had put on about forty pounds in weight but felt weak. Her
Fig. 2. Case of pluriglandular deficiency with marked spacings of teeth.
chief complaint, however, was insomnia with its accompanying syndrome. Many nights she suffered from frequent urination. There were occasional headaches and dizziness. Physical ex- amination showed a woman of good physique with masculine
CLIMENKO ial
distribution of hair. The skin was dry, the chin somewhat pro- truded and the spaces between the teeth were wide, particularly the upper incisors. Urine was of rather low specific gravity, 1012, but otherwise free from pathological changes. Hemoglobin 80 per cent. Blood pressure 125/90. Pulse 68. After trying several forms of opotherapy it was finally found that she began to improve rapidly under the following combination:
Extract of thyroid, Gr. 1/6
Extract of pituitary, Gr. 11
Extract of corpus luteum, Gr. i De “d:
Her menstruation improved in amount, her mental state assumed a more cheerful character and her insomnia disappeared. While there was a distinct improvement in her frequent urina- tion, her weight remained rather stationary.
The relation of the pituitary body to the sexual glands is
today well established. Case VI illustrates the fact that amenor- rhea must not always be attributed to the changes in the sexual glands but, barring the systemic diseases, inquiry should also be made as to the condition of the other glands. It is evident that the primary cause for the amenorrhea in this case was the dis- turbed function of the hypophysis. No amount of curetting would have helped the condition and opotherapy directed to the sexual glands was of no avail. Her headaches also were not improved by operation on her nose, although she underwent excision of her turbinate bones on being assured that this would cure her headaches.
Case VII shows a marked disturbance of the polyglandular type where the thyroid, pituitary and ovaries are mainly in- volved. It was difficult to say which of the glands was primarily responsible for the clinical picture. The fact that the addition of small doses of thyroid to corpus luteum extract finally cured the patient does not necessarily mean that the thyroid gland was the chief one to be considered. It is a well-known fact that small doses of thyroid are an excellent adjuvant to the other extracts. The reason for this, I do not believe has so far been given.
Case VIIT, 20 years of age, single, seamstress, came to me on September 30, 1918. Her family history could not be obtained. She did not remember having ever previously been sick. She began to menstruate at the age of thirteen, regularly but some- times with pain, though never to such an extent as to interfere
12 CORPUS LUTEUM
with her work. For six months previous to her visit to me her menstruation had become irregular, delayed, more painful and irregular in amount. She complained that for three months she had suffered from a choking sensation, depression and pain like the pricking of pins and needles all over the body, loss of appe- tite, sense of heaviness in the epigastrium, and dull headaches on top of the head. Hemoglobin was 80 per cent. She had a marked phosphaturia. Stomach contents showed total acidity of 40, free acid 10. Physical examination, save for lively reflexes and a mild acneform eruption on the face, was negative. Blood pressure 110/80. She was put on corpus luteum, two grains three times a day at mealtime, and some drops of hydrochloric acid after meals. The improvement was almost marvelous. The pa- tient began to feel better almost on the next day, the symptoms cleared up and her subsequent menstruation was no longer pain- ful. In two weeks the hydrochloric acid was discontinued, but the corpus luteum was kept up for another month. At present she is taking two-grain doses of corpus luteum once in two days.
Case IX. S. R., eighteen years of age, single, hbrarian, came to me on October 15, 1918. Family history was negative. Menstruation began at thirteen years of age, was always pain- ful, rather regular but at times a delay of a few days would occur. Otherwise the personal history was negative. Her chief complaint was that of headaches for the previous two years, occurring almost daily and at almost any time of the day, chiefly in the morning. She also had suffered from dizziness for the previous six months, a feeling as if the buildings were coming down and the street was rising, but things around her did not turn to right or left. She suffered from belching and sour taste after meals. Blood pressure was 130/80. Thyroid was enlarged, there was marked dermographia, and a hemic murmur at the base. The skin was moist and the mucous membranes were pale. She was put on corpus luteum, two grains three times a day, and instructed to call again a month later. On her next visit she stated that all her symptoms had disappeared and that menstruation was no longer painful. She was so improved that she was able to work during the time of menstruation, which she had never been able to do before. :
Cases VIII and IX are the type that is most frequently and
most promptly benefited by corpus luteum. A few words might be said here as to some of the symptoms. Headache that occurs with menstrual disturbance is often relieved by corpus luteum. Tt should, however, be remembered that this does not apply to the headache of migraine type, not even when this headache coincides with the menstruation. In other words, periodic head-
CLIMENKO 13
ache, or migraine, is not influenced by corpus luteum. I found a diminution of hydrochloric acid in many of the cases of this type. The gastric secretion improves with the general condition.
As a control I used corpus luteum in some male neuras- thenic cases. It was also administered to patients suffering from organic nervous diseases, such as multiple sclerosis, and also in the early stages of dementia precox. In all of these the drug was inert. Corpus luteum has no effect on the blood pressure of arteriosclerosis, neither in the male nor in the female. The best results were obtained in young females, poorer results in natural menopause and no results in surgical menopause or in women who had long passed the menopause. The hypodermic preparations did not give me as good results as the drug given by mouth. I discontinued hypodermic use of the extract long before I knew that the extracted substance in Frank’s experi- ments proved inert. The preparation I used is put up by a well- known firm of dispensers of such drugs, and from the chemist of that firm I learned that their product comes from a mixed group of 80 per cent of pregnant animals both sows and cows. Contrary to the statement of Sajous, (36) corpus luteum when- ever efficient gives prompt results and large doses need not be employed. I found that two grains is as large a dose as one needs to use.
Bouin and Aneel, (37) after a series of experiments on the relation of the corpus luteum to the mammary glands, came to the conclusion that the secretion of the corpus luteum is a hor- mone.
If we now take into consideration the following clinical data: (1) Corpus luteum extract is effective only in the female; (2) that it acts best when there is every reason to believe that the native corpus luteum is still present ; (3) that, as shown above, the administration of the extract cannot replace the function of the native corpus luteum in pregnancy and probably also not in menstruation; (4) that when menstruation is discontinued by virtue of disturbance in the secretion of another gland, such as the pituitary, corpus luteum will not produce menstruation as is shown in type case No. VI; (5) that its action is more or less prompt; (6) that corpus luteum extract when effective produces almost always the same chain of phenomena; it is reasonable to
14
CORPUS LUTEUM
conclude that (a) corpus luteum has a specific action; (b) the administered extracts probably do not act as the native hormone ; and (¢c) that the extract, in all probability, stimulates the native corpus luteum to function. The two contraindications to the use of corpus luteum are an abnormally low blood pressure and profuse and frequent menstruation. ~
BIBLIOGRAPHY
Bauer (J.) Neuere Untersuchungen tiber die Beziehungen einiger Blutdrusse zu Erksaukungen der Nervensystem. Zeitsch. f.d. Gesamte. Neurol. und Psych. 1910, 3, 193.
Frankel-Hochwart (L. V.) Med. Klinik, 1912, 8, 2nd part, 1953.
Cannon (W. B.) Am. Jour. Physiol., 1914, 33, 354.
Quoted from ‘‘ Internal Secretions’’ by E. Gley, translated by M. Fishberg, 1917, p. 44.
Schafer (E. A.) Ibid p. 57.
Quoted from Burnam (C. F.) J. Am. Med. Assn., 59, 690.
Dalton (J. Ll.) Tr. Am. Med. Assn., 1851, p. 547.
Fraenkel (L.) Arch. f. Gynak., 1903, 68, 483.
Quoted from E. A. Schafer, ‘‘The Endocrine Organs.’’ London, 1916, p. 145.
Gley (E.) Loe. cit. (4), p. 124.
Frank (R. T.) and Rosenbloom (J.) Surg., Gyn. and Obst. 1915, 21, 646.
Burnam (C. F.) Loe. eit.
Dannreuther (W. T.) J..Am. Med. Assn,. 1914, 62, 359.
Osborne (O. T.) N. Y. Med. J., 1918, 108, 449.
O’Donoghue (C. H.) Proce. The Physiological Society, Feb. 15, 1918, in Jour. of Physiol., 66, 6.
Ott (I.) and Seott (J. C.) Am. Practitioner 1914, 48, 568-570. ;'
Fraenkel (F.) Loe. eit.
De Lee (J. D.) Surg. Gyn. and Obst., 1916, 22, 80.
Sehafer (KE. A.) Loe. eit.
Hermann (E. T.) Minnesota Med., 1918, 1, 181.
Quoted from Lipsechiitz, Jour. of Physiol., Vol. LI, p. 283.
Quoted from Biedl, ‘‘ Innere Sekretion,’’ Vol. II, p. 336.
Giorgi (L. N.) Ibid, p. 336.
Below (N. A.) Monatschr. f. Geburtsh u. Gyn., 1912, 36, 679.
Quoted from Sajous, N. Y., Med. J., 1916, 103, 227.
Frank (R. T.) Loe. cit.
Krafft-Ebing. Psychoses Menstruales. Stuttgart, 1902.
CLIMENKO 15
Powers (Ellen F.) Beitrag z. Kent. der menst. Psychosen. Dissertation, Zurich, 1883.
Kraeplin. Psychiatrie, Vol. 1, 7 ed. Auflage, p. 77. Leipsig, 1903.
Ellis (H.) Manand Woman. London, 1894, p. 10.
Burnam (C. F.) Loe. eit.
Dannreuther (W. T.) Loe. eit.
McDonald (E. J.) Am. Med. Assn., 1910, 55, 205.
Quoted from André Crotti, ‘‘Thyroid and Thymus,’’ Lea & Febiger, 1918, p. 217.
Levi. Ibid, 218.
Sajous. Loe. cit.
THE TESTICULAR HORMONE Homer Wheelon, M.D.
(From the Department of Physiology of the St. Louis University School of Medicine, St. Louis, Mo.)
That the testes are organs of internal secretion has not been proven beyond controversy. As pointed out by Gley (1), in order to prove that an organ has the power of elaborating and discharging a hormone into the blood stream, it is necessary to obtain the products of that organ’s activity from the venous blood and to demonstrate that these products possess the power or property of producing physiological effects similar to those brought about by the normal functioning of the organ. It must be confessed that practically nothing is known concerning the metabole processes related to the functioning of the testes. The statements of Kendall (2) concerning the thyroid gland may well be applied to the gonads: ‘‘Quantitative studies have been directed to anatomic changes and not to physiological proc- esses. A change in the physiologic function is being interpreted in terms of the end results produced by the change.’’ How- ° ever, if changes occur in the bodily structures it is good evidence that functional alterations have taken place or are occurring. If proper means of investigation demonstrate that such end results do not appear in the absence of a certain organ, it may be assumed that that organ does in some way influence the activities of the various tissues. The manner in which the gonads exert their influence upon cellular structures remains to be demon- strated. Nevertheless the elimination of the gonads from the lst of endocrine glands is not justified.
That a hormone is produced by the testes and elaborated in the interstitial cells of Leydig is generally conceded. (38) These cells and the germ cells proper appear to have nothing in com- mon save their anatomical association.
Isolation of the germplasm and specialization of the somato- plasm in order that the second law of biology may be fulfilled, necessitate the development of specialized physical mechanisms in order to insure fertilization. Such demands have been met by the development of the genital canal or secondary sex organs.
16
WHEELON 17
Developmental relationship between the germplasm and somato- plasm may be divided into four stages as follows: (4) [L. Pri- mary undifferentiated stage. II. Secondary undifferentiated. stage. III. Primary differentiated stage. IV. Secondary dif- ferentiated stage. The various changes in the developing fetus and the forces acting upon the two plasms are graphically shown in the accompanying chart.
RELATICS OF THE INTERNAL SECRETION OF THE GONADS TO THE DEVELOPMENT OF SEX CHARACTERS
UNDIFFERENTIATED STAGE DIFFERENTIATED STAGE ee ee sEcomuat
2d sex characters
2d sex organs
Sexually established
indifferent
Active Leydig celle
Active germ and Leydig celis
Up to 14 mm,
14 mz. to 24 ox. Adolescence
PRIMARY UNDIFFERENTIATED STAGE. Potentially the fertil- ized egg carries sexual qualities. The presence of the germplasm, however, manifests itself only after marked development of the somatoplasm. In the primary undifferentiated stage of develop- ment sex cells are forming and may or may not be recognized histologically, hence sex can not be determined. Such a condition obtains in the developing human embryo until it has attained a length of 14 mm.
SECONDARY UNDIFFERENTIATED STAGE. In human embryos 14 to 24 mm. in length sex cells may be definitely recognized. Dur- ing this period organs are forming which later may develop into either male or female secondary sex organs, viz., the Wolffian
18 TESTICULAR HORMONE
and Miillerian ducts. Hence, the embryo is somatically sexually neutral although germ cells of one sex are well established. Therefore, the developmental history of the sexual apparatus shows that the primordia of the genital organs are independent of that of the generative glands, and that the somatoplasm is primarily indifferent (bisexual) in character.
The prevalent use of the word “‘bisexual’’ is unfortunate in as much as it implies that the organs of both sexes are present in the individual embryo or adult. As a matter of fact, sex organs are not present in the embryo until differentiation has taken place and the somatoplasm has assumed male or female characters. Sex cannot be attributed to the soma of an embryo until sex organs are evolved. The mere fact that certain tissues laid down by the embryo continue to grow and differentiate under the influence of determining stimuli does not warrant the assumption of a ‘‘bisexual’’ beginning. It simply means that certain cells laid down in the embryo continue to grow and dif- ferentiate because they receive proper stimuli while other cells cease their development because of the absence of stimulating factors or the presence of inhibiting factors.
Such a conclusion seems justified by the fact that the primordia of two lungs are laid down in the snake embryo, while the adult possesses but a single lung . (6) Again, in the chick there are laid down both Mullerian and Wolffian ducts but, during the development of the hen continued differentiation and growth of both Wolffian ducts and one oviduct is inhibited. Ce) The cock however develops a bilateral genital system. In such cases somatie retrogression undoubtedly begins after the appear- ance of sex-determining factors. Differentiation of somatic struc- tures into sexual characters occurs because of intrinsic factors acting upon structures laid down in an indifferent somatoplasm. If this is true, the presence of two determining stimuli should result in the continued development of those structures which give rise to sexual characters of both sexes. Under such eircum- stances bisexuality or true hermaphroditism would be estab- lished. The condition of hermaphroditismus biglandularis indi- cates that the sex of the individual is not determined until a late stage of development and that the differentiation of the sex
WHEELON 19
organs does not take place until after development of the undif- ferentiated cells.
PrimaRy DIFFERERNTIATED STAGE. Immediately following the secondary undifferentiated stage vascularization of the sex glands occurs. Synchronous with the development of a blood supply to the germ cells there occurs a marked growth and dif- ferentiation of either the Miillerian or Wolffian ducts. The sex- ually indifferent character of the embryo is lost and secondary sex organs become established. This stage begins in the 24 mm. human embryo and continues throughout the adolescent period. Therefore, the differences that exist between tissues of male and female embryos do not make their appearance until the begin- ning of the period of primary differentiation or the time at which vascularization of the genital glands takes place.
SECONDARY DIFFERENTIATED STAGE. At birth the secondary organs of sex are completely formed and continue to grow until the period of puberty. At this time, in the male, the germplasm becomes mature and active formation of spermatozoa begins. Modifications of bodily structure also occur which result in the establishment of the secondary sexual characters. Hair appears on the face, osseous changes occur, the voice becomes heavier and new nervous reactions develop. Sex and sex characters are com- pletely established and sexual life begins. At puberty, as in the primary differentiated stage, the somatoplasm is modified accord- ing to the type of interstitial cell activity.
The question now arises: Why does vascularization during the primary differentiated stage result, in the subsequent male, in a marked and continued development of the structures de- rived from the Wolffian tissues and a suppression of further growth or development of the Miillerian ducts? To answer this question it becomes necessary either to assume that a “‘ principle”’ is liberated from the germ cells at the reception of a blood sup- ply or that a third factor arises from tissues closely associated histologically with the germ cells. If the former possibility is accepted, how are the secondary differentiated changes that occur at puberty to be accounted for? Moreover, the cells of Leydig appear in the embryo before differentiation of the primordial sex cells have taken place or before they have assumed their distinctive cytological character. Their structure also is indicative
20 TESTICULAR HORMONE
of an exceptional degree of activity during embryonal life. From birth to about the beginning of puberty the interstitial glands manifest a minimum relative development. The changes of pu- berty are ushered in by an enormous development of the cells of Leydig and, in species with well-marked rutting periods, this phenomenon invariably precedes spermatogenesis. On the other hand, there is no evidence that the germ cells are active until the advent of puberty. Moreover, if it is assumed that the sex cells act as factors determining sexual characteristics it must be fur- ther assumed that the sex cells are determined by factors other than themselves before they in turn can act in a manner to bring about primary differentiation of the sexually indifferent somato- plasm. Indeed, Bouin and Ancel thought it entirely possible that the interstitial cells, by means of their specific internal se- cretion, determined the sex of the generative cells. This does not appear tenable; however, the acceptance of a third factor or determiner of sexual characters offers a ready explanation.
During vascularization of the gonads the interstitial cells or sex character determiners probably yield to the blood stream materials which cause rudimentary organs to develop into well- defined secondary sex organs of the male. That is, the secre- tions formed by the cellular activity of the interstitial glands when thrown into the circulating bleod foster the development and specialization of male structures from sexually undifferen- tiated tissues. There occurs at the same time a depression of certain primitive structures, viz., the Miillerian ducts. That such a determining factor exists in the adult can hardly be de- nied. It is known that the production of spermatozoa is not essential to virility. On the other hand, loss of the interstitial cells of the gonads is followed by loss of virility and sexual char- acteristics; therefore, it appears probable that the germ cells de not act as determiners of the somatic stigmata of sex.
Along with the phylogenetic specialization of tissues and the relative isolation of each are developed regulatory systems whereby the entire organism is made to function as a harmonious unit. The most highly developed regulator of physical activities is the nervous system. Chemical regulators or hormones also are known which correlate various structures. These in all probability antedate and make nervous coordination possible. Ap-
WHEELON 21
plying this principle to the relations existing between the pri- mary reproductive tissues and the remainder of the body, it be- comes evident that under the influence of the sex hormone bodily structures are modified to meet the requirements of the activity of the germinal tissue. These modified structures later are brought under nervous control. Whether or not the generative tissues are under nervous regulation remains a mooted question. If the interstitial cells are lost the secondary sex character- istics do not develop, but development of the primary differen- tiated type continues. Therefore, it is only by the assumption of an undifferentiated primitive genital primordium together with the dependence of the somatic and psychic sexual characters upon the internal secretory activity of the interstitial tissue that those cases can be explained in which complete alterations of single sex characters occur, or changes of the entire sexual character takes place during the life of the individual. During the period of puberty marked alterations occur throughout the body and active spermatogenesis begins. Hence, the sex determiner must be acting forcibly upon the germinal tissue and to a lesser de- gree upon bodily structure. All secondary sex organs, osseous, muscular and nervous structures were previously present. The individual was anatomically but not functionally a male. Henee, puberty may be considered a time of differentiation as opposed to the period of growth or development during adolescence. The anatomical structures present are simply altered; the chest as- sumes the pyramidal shape; the vocal chords become lengthened, the musculature more massive and the male hirsuties appears.
Associated with alterations in body form and the appear- ance of new functions are manifestations of new emotional, psy- chie and nervous activity. The adolescent becomes the well- known, awkward, boisterous and mischievous youth.
The work of William James, Lange, Darwin (8) and others indicates that impulses arising from the viscera and the periph- ery of the body are interpreted in the form of emotions. The disposition of an individual represents his characteristic mode of response to his own afferent impulses: Accordingly, any alter- ation in the nature of impulses reaching the brain from the vis- cera or the periphery will be manifested as modifications of emo- tional and dispositional states. An organ that has not fune-
22 TESTICULAR HORMONE
tioned cannot be considered as actively affecting the nervous sys- tem, neither can an organ deprived of function cause character- istic responses of nervous apparatus.
The adolescent individual reacts according to the functions of his anatomical structures and the type of impulses reaching the nervous centers. In other words, a habit of acceptance has been formed towards the functions of the body. At puberty marked alterations occur throughout the body. With such alter- ations of structure and the development of new functions by certain cells new types of impulses are transmitted to the nerv- ous centers. These new impulses must be considered foreign to the old habit of acceptance, hence their appearance brings about a condition of psychic unrest. The individual is forced to inter- pret and adopt the changes and form new habits of acceptance. Especially is this true in relation to the nervous mechanisms con- cerned in the performance of the sexual act. At puberty imactive and dormant nerve centers acquire a specific sensibility. The appearance of sexual desires and the various psychie alterations accompanying the ‘‘storm and stress’’ period, indicate that the function of the cerebral cortex is also affected. With new nerv- ous reactions developing, new emotions are experienced and are shown outwardly by dispositional manifestations.
Removal of the reproductive glands is followed by atrophy of the secondary sex organs and ultimately by loss of sexual desire. Sterility, on the other hand, need not necessarily be associated with a loss of virility. X-ray workers have been found perfectly sterile but leading sexually active lives and entirely unaware of their condition. Again cryptorchids are found which show all the secondary signs of sex, possess masculine habits and desires and at the same time are perfectly sterile. The histo- logical examination of the testes of such persons demonstrates the absence of sperm-producing tissue and an increase of inter- stitial cells. In these cases some factor other than the germ cells proper are responsible for the development and main- tenance of masculinity. The reported beneficial results of testic- ular transplants must also be explained on the assumption of interstitial cell activity. The same must hold true for the effects of ligation of the vas deferens in which case there is ultimate destruction of germ cells without alterations of masculinity.
WHEELON 23
Hence the interstitial cells maintain the activity of the processes related to sex and the nature of this activity determines to a great extent the nervous reactivity of the individual.
Such a conclusion is justified by the results of experimental work. Steinach (9) transplanted ovarian tissue into adolescent castrated male rats and found that the matured ‘‘ feminized males’’ were characterized by a slight bony development, growth of fine hair peculiar to the female, development of mammae and nipples, the tail-erect-reflex, and the pecuhar kicking, guarding reflex to repel the male before the appearance of oestrus. Such rats were sought and followed by males as if they were true females. In these animals somatic characters and nervous reac- tions developed not according to the changes that had previously appeared during the primary differentiated stage by reason of the influence of the male sex determiner then present but as determined by the influence of the determiners of the opposite sex. The structure and functions of the somatoplasm were, therefore, governed by the ovarian influence ; that is, the somato- plasm simply acted as an indicator of sex-determining stimuli.
In the frog the thumb pads and certain of the muscles of the forearm undergo hypertrophy during the spawning season. Nussbaum (10) found that castration prior to the rutting season prevented such changes ; however, transplants of testicular tissue into the dorsal lymph spaces of castrated frogs resulted in hyper- trophy of the arm portions at the next rutting periods. It was also found that section of the nerve to one forearm prevented seasonal changes of its form, while the uninjured arm showed hypertrophy as usual. From such findings it was concluded that the testicular secretion stimulated only certain nervous centers and groups of ganglia. The nerves were considered responsible for the changes in form and metabolism of the parts innervated by them. Biedl, (5) however, strongly objects to such conclu- sions. It is true that the arrest of motility and sensibility of the nerves produced by section is sufficient to account for the absence of hypertrophy at the rutting season. However, the ex- periment is of value as indicating that the development of such seasonal changes in form are dependent upon two factors, viz., (1) the elaboration of an internal secretion by the testes, and (2) the presence of a functional nervous apparatus.
24 TESTICULAR HORMONE
On the other hand a successfully transplanted mammary gland will develop turgescence during pregnancy and secrete milk after the period of parturition. (11) In this case the se- cretion of milk seems to be independent of nerves—at least of specific nerves. The presence of a chemically active stimulant from the primary sex organs is sufficient to affect the secretory power of the gland. Further, Goltz and Ewald (12) demon- strated that the mammae undergo enlargement during preg- nancy and that lactation in the bitch is established after parturi- tion, following extirpation of the entire lumbo-sacral portion of the spinal cord. .
Goltz (13) has shown that during the spawning season the male frog responds with the “‘embracing reflex’’ to every touch. upon the skin of the chest. This reflex persists for a short period after decapitation. Such reactions are not obtained by all types of stimuli but only by touching the skin. Moreover, this reflex is restricted to a small group of muscles, and is not accompanied by an increase in general: reflex sensibility.
From the foregoing it is apparent that the influence of the generative glands is not confined to organs functionally related to them. Further data of the same general trend were recorded by the writer (14). It was found in adult dogs that blood pressure reactions to a constant dose of nicotin were constantly and consistently lowered as a result of castration. Reactions to adrenalin remain unchanged. Therefore gonadectomy affects the sympathetic nervous system proper. In some of the dogs marked dispositional changes occurred. The lowered irritability of the sympathetic system may have at least in part accounted for these latter changes. On the other hand, as shown by Hos- kins and Wheelon, (15) marked augmentation of the activity of the nervous system results from spaying female dogs. Such results, in conformity with clinical evidence, indicate that the operation causes a heightened irritability in the sympathetic system.
Hatai (16) has shown that as a result of castration there is a small but constant diminution in the weight of the central nervous system. Further, it is known that atrophy occurs in the secondary sex organs if castration follows the advent of
WHEELON 29
puberty and that a lack of development of the same structure 1s apparent if gonadectomy occurs prior to the establishment of masculinity. In the latter case the individual never attains sexual differentiation either morphologically, physiologically or psychically. The nervous and psychic characters peculiar to the male fail to develop because of the absence of tissue changes which normally occur under the influence of the interstitial cells and development does not continue beyond the stage attained at the period of vascularization of .ae gonads. On the other hand, two individuals of the same species but of opposite sex, deprived of the primary genital glands at the earliest possible date, will not show complete identity of habit or form either directly following the operation or later. Certain character- istics, such as the beard and mammae will develop to a slight de- gree in accordance with the original sex. This may indicate that sexual differentiation of the somatoplasm takes place during fetal life through the agency of the already differentiated genital determiner and that after castration a certain imperfect degree of development occurs. Such a condition represents a continued adolescent stage of growth.
If such a theory is tenable, the introduction of interstitial cells into castrated animals should result in the renewed activity of the depressed organs. The work of Steinach, previously re- ferred to, offers sufficient proof that this is true. The bene- ficial results of therapeutic testicular and ovarian transplants may also be cited. In such cases germ cell activity is not re- stored but the patient benefits physically and psychically because of the presence of the interstitial cells. No competent surgeon would remove the testes of a eryptorchid merely because they do not produce sperm. Such an operation would result in a de- pression of the sex characteristics as pronounced as that of gonadectomy in a normal individual.
Wheelon and Shipley (17) found that the depressed activ- ity of the nervous system following gonadectomy was materially augmented by testicular grafts. Castration resulted in a de- crease of 50 per cent in the sympathetic irritability. Ten days after testicular implants were made there was an increase of irritability of 55 per cent, or a return to 77 per cent of the normal reaction. Berthold, (18) the pioneer student of internal
26 TESTICULAR HORMONE
secretions, in 1849 studied the effects of castration and subse- quent transplantation of gonad material in young cockerels and demonstrated the dependence of development of secondary sex characters upon the testes. Lespinasse (19) reports a case of successful transplantation of testicular tissue in a eunuch. The patient completely regained his lost sexual proclivities. Nor did he lose either desire or power to perform coitus during a period of over two years. lLichtenstern (20) also cites a case of suc- cessful transplantation of testicular material following which within six days after the operation erection and libido returned. Lydston (21) also reports beneficial results from the therapeutic use of gonad transplants. Such findings indicate that a direct interrelationship does exist between the interstitial cells of the gonads and the nervous system.
Simpson and Marshall (22) have found that stimulation of the nervi eregentes in normal adult dogs causes erection and ejaculation. Similar stimulation in castrates, on the other hand, resulted in but slight congestion.
It may therefore be concluded that the proper develop- ment and functioning of the various organs of the body are de- pendent upon the correlating action of the internal secretion of the interstitial cells. Its presence makes possible normal somatic differentiation. Structural and functional changes of tissues re- sult in alterations of nervous activity, such alterations occurring partly because of somatic alterations and their attended func- tional changes and partly because of a direct influence upon the nervous structure proper.
The above arguments might lead one to assume that the internal secretion of the gonads alone is sufficient to establish and maintain sexual characters, but the influence of the adrenals, thyroid, hypophysis and thymus upon the development and maintenance of sex and sex characters can not be ignored. How- ever, these glands are found well developed in the two sexes while but a single specific primary genital gland is found in each sex. The action of the gonad hormone in the presence of normal endocrine glands and somatoplasm is necessary, there- fore, to the development of true sex types.
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WHEELON
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BIBLIOGRAPHY
Gley (E.) The Internal Seeretions. Paul B. Hoeber, New werk. F917.
Kendall (E. C.) The Thyroid Hormone and Its Relation to the Other Ductless Glands. Endocrin., 1918, 2, 81. Wheelon (H.) The Internal Section of the Testes. Inter-
state Med. J., 1917, 24, 1089.
Pohlman (A. G.) Dr. Pohlman of the St. Louis University School of Medicine, St. Louis, Mo., has used this classi- fication for several years in presenting the subject of development of the sex organs to his classes in embry- ology.
Biedl (A.) The Internal Secretory Organs. William Wood & Co., New York, 1913, 358.
Wiedersheim. Comparative Anatomy of Vertebrates. 3d Edition. MacMillan & Co. Ltd., London, 1907. 380.
Lillie (F. R.) The Development of the Chick. Henry Holt & Co., New York, 1908, 401.
James (W.) The Principles of Psychology. Henry Holt & Co., New York, 1905. American Science Series. Ref- erences made to the works of Lange and Darwin.
Steinach (E.) Willkiirliche Umwandlung von Satigetier- Minnchen in Tiere mit ausgeprigt weiblichen Ge- schlechtscharakteren und weiblichen Psyche. Eine Un- tersuchung iiber die Funktion und Bedeutung der Puber-
Nussbaum. Innere Sekretion und Nerveneinfiuss. Merkel tiitsdriisen. Pfliiger’s Arch., 1912, 144, 71.
u. Bonnet, Ergeb. der Anat. u. Entwick, 1905, 15.
Ribbert. Uber Transplantation von Ovarium, Hoden und Mamma. Arch. f. entwick., Mechanik., 1898, 7.
Goltz (F.) and Ewald (J. R.) Der Hund mit verkiirtztem Riickenmark. Pfliiger’s Arch., 1896, 63, 362.
Goltz (F.) Cited by Marshall (F. H. A.) The Physiology of Reproduction. Longmans, Green & Co., London, 1910, 22.
Wheelon (H.) Extirpation of the Testes and Vasomotor Irritability. Am. J. Physiol., 1914, 35, 283.
Hoskins and Wheelon. Ovarian Extirpation and Vaso- motor Irritability. Ibid, 119.
Hatai (S.) The Effect of Castration, Spaying or Semi- spaying on the Weight of the Central Nervous System and of the Hypophysis of the Albino Rat; also the effect of Semispaying on the Remaining Ovary. J. Exp. Zool., 1913, 15, 279. Also,
bo w
TESTICULAR HORMONE
Donaldson and Hatai. Note on the Influence of Castra- tion on the Weight of the Brain and Central Nervous System in the Albino Rat and on the Percentage of Water in them. J. Comp. Neurol., 1911, 21, 155.
Wheelon and Shipley. The Effect of Testicular Trans- plants upon Vasomotor Irritability. Am. J. Physiol., 1916, 29, 394.
Berthold. Miuiller’s Arch. f. Anta., Physiol. u. Wissensch. Med., 1849, 42. (Cited by Gley (E.) The Internal Se- eretions. Paul B. Hoeber, New York, 1917, 30.)
Lespinasse (V. D.) Transplantation of the Testicle. J. A. MAS 1913) 615 1869:
Lichtenstern. Successful Transplantation of a Testicle. Cited in Med. Rec., 1916, 89, 612.
Lydston (G. F.) Implantation of the Generative Glands and its Therapeutic Possibilities. N. Y. Med. Jour., 1914, 100, 745, 812, 862 and 913.
Simpson and Marshall. On the Effect of Stimulating the Nervi Erigentes in Castrated Animals. Quart. J. Exper. Phis,,- 1908; 45s25i:
PAROXYSMAL NASAL HYDRORRHEA DUE TO DYS- THYROIDISM OF SYPHILITIC ORIGIN
Dr. Mariano R. Castex
Professor of Clinical Medicine of the Faculty of Buenos Aires, South America
The most frequent cause among us of disturbances of thy- roid function is syphilitic infection, either acquired or inherited. Among the extremely varied clinical spectacles which functional insufficiency or perversion of the thyroid may engender, exists the form described in this paper. This form has been little studied. No similar case has been found in the literature.
A woman of forty was married at twenty. Her father died of Parkinson’s disease. Her mother is alive and healthy. Two brothers died in adult life, one of general paralysis, the other of chronic nephritis. Five sisters are living, one of whom is fifty years old, operated three times for relapsed breast carcinoma. This patient was perfectly healthy until her marriage. She has had nine pregnancies, all well borne, with birth at term, except the first which occurred at eight months, the child dying two or three hours after birth. Except slight passing indispositions, has always been healthy.
Her present trouble began when she was twenty-eight years old, with an outbreak of rhinorrhea in paroxysmal form. The attacks occurred at relatively long intervals in the first years, ° but slowly and progressively became more frequent and acute. The patient is seized at any hour of the day or night, although there is a predilection for the morning and the evening.
The attack begins with a sensation as of a sudden cold, with sneezing, and forthwith an abundant flow of albuminous liquid occurs which lasts between half an hour and an hour.
She was examined by a great number of rhinologists and internists in Buenos Aires and in France and Germany, where every treatment was tried that has been recommended for “‘nasal discharges’’ of a similar nature. Topical applications, general treatments, dietetic and climatic therapeutics gave not the slight- est relief. the attacks on the contrary becoming progressively more acute and frequent, until from one daily they reached in
29
30 NASAL HYDRORRHEA
the last two years two or three crises per day lasting progress- ively longer, up to two and three hours each time.
The intensity of the flow also increased and necessitated during the past year (1916-17) an average of fifty men’s hand- kerchiefs for each attack.
The first ray of hight on the pathogeny of the case was ob- tained from a statement by Pende (Endocrinologia, p. 707) that ‘‘Nasal hydrorrhea also is not unusual in conditions of dys- thyroidism.’’
Exploration by Maranon’s manoeuver then disclosed that she had goitre, distinct, soft, scarcely perceptible to the touch at the level of the isthmus and left lobe, evident at the level of the right lobe, and still more evident throughout the gland. *
We could not detect any other symptom either of hypo- or hyper-thyroidism other than the goitre and the hydrorrhea.
Treatment was begun with thyroid preparations, and within a few days a favorable effect on the paroxysms of hydrorrhea was apparent. Thereafter the thyroid treatment was intensi- fied. The hydrorrheic attacks became much less, but at the same time the phenomena of hyperthyroidism made their appearance, and their exacerbation was such that the treatment had to be interrupted.
These results led to the conviction that the episode of the hydrorrheic paroxysms had really a thyroid origin, and that we were dealing, not with a hypo- or a hyper-thyroidism, but with a condition of dysthyroidism.
Close examination of the patient disclosed a slight aniso- dischorea and a soft systolic bruit in the aorta. These two ele- ments, to which we attach a value far above biological tests, inclined us to admit the probability of the syphilitic origin of the dysthyroidism—especially since the husband of the patient had formerly had syphilis, treated deficiently, and most of the chil- dren showed a taint of hereditary dystrophic syphilis.
A mixed antisyphilitie treatment was started, having re- course to the administration of iodine through the alimentary canal, and mercury, through intramuscular injections of 0.02 centigrams of biniodide per day for a month.
The effect was remarkable, although it took more than a fortnight to manifest itself. At the end of a month’s treat-
CASTEX 31
ment, the attacks had almost entirely vanished, threatening only from time to time.
The patient was allowed a rest from treatment for three months. The attacks were renewed during the third month. The mercurial treatment, alone, without iodine, of mean intensity was resumed and kept up for three months. At the end of the first month the crises vanished and did not return either during the last two months of mercurial treatment or during the two months’ rest which have since elapsed.
We do not believe, however, that this means a radical cure, and shall persevere, periodically and faithfully, for several months, with the mercurial treatment.
TISSUE TRANSPLANTS
It has been said that the last great problem to be solved by the surgeon is that of organ transplantation. The therapeutic possibilities of such procedure have figured in the day dreams of many an investigator. The ability to augment the hormone pro- duction in an animal by similar procedure would be of great aid in the solution of many problems in endocrine physiology and pathology. The utility of the method has hitherto been very limited because of the brief life of the engrafted tissues. The erux of the problem les in the reaction between the transplanted cells and those of the host. If in any way an adequate tolerance could be developed between them the problem would probably be solved.
In the meanwhile more information is needed as to the spe- cific behavior of tissue grafts, and especially of those from one animal to another. Two recent papers on this subject have been published by Prof, Loeb of the Washington University Medical School. (1, 2)
In the first the donors of the tissue were closely related to the host. Thyroids were transferred from mother to offspring and vice versa as well as between members of the same litters, guinea pigs being used as the experimental animals. It was found that the results were intermediate between those obtained when tissues are transferred from one part of an animal to another and those when the animals are of the same species but - not closely related.
The usual destructive effects upon the graft were seen. This destruction is due to two processes: a development of con- nective tissue throughout the graft and a consequent ‘‘strangu- lation’’ of it and an invasion of lymphocytes. Leucocytie in- vasion plays a minor role. A close study of the engrafted tissue showed that the lymphocytes acted as primary destructive agents and not merely as scavengers. Acini were observed which had the appearance of prospering autotransplants. They were over- whelmed at places by lymphocytic masses. The line of demareca- tion between the invaded and destroyed areas was sharp; there was no transitional zone of degenerating thyroid cells such as
32
TISSUE TRANSPLANTS 733
would have been found if the lymphocyte invasion was secondary. Thyroid tissue is especially favorable for the determination of this point since the stigmata of cell degeneration are definite.
Loeb ascribes both the lymphocyte infiltration and the con- nective tissue cell proliferation which occurs in the graft as due ‘primarily to changes in the metabolism of the invading cells rather than to any hostile reaction of the host. The altered metabolism gives rise to toxins which attract lymphocytes and change the activity of the connective tissue cells. The more closely host and donor are related the less active is the formation of these toxins. As a secondary reaction the proteins of the invading cells may act as antigens and stimulate the formation of antibodies upon the part of the host. These antibodies may then serve to accelerate the metabolic changes in the invading cells and thus contribute to the final destruction of the graft.
As a further investigation of the relative parts played by invading and host cells another series of experiments was per- formed in which multiple grafts from different animals were made in a single host. In this series also guinea pig thyroids were used. In some eases the multiple grafts were made simul- taneously and in others in two stages.
Considerable differences were noted in some cases in the behavior of the grafts from different donors. In other cases the differences were not marked. The lymphocytic reaction in the second transplant was not materially accelerated or intensified over control transplants, even in cases in which the first trans- plantations had been multiple.
It would appear from these experiments that a solution of the problem of successful tissue grafting must await a much better understanding and control of the processes of immunity. Possibly the lymphocytic reaction which, according to Loeb, plays an important part in the destruction of the graft, could be favorably influenced by Roentgen radiation to which lympho- cytes are especially susceptible.
1. Syngenesioplastic transplantation of the thyroid in the ouinea pig. Loeb (L.) J. Med. Res. (Boston) 1918, 39, 39-57.
2. Multiple transplantations of the thyroid and the lymphoeytie reaction. Ibid, pp. 71-91. RG: Hi:
ENDOCRINE RESEARCH
This field is attracting a large number of individuals be- cause of its newness and on account of its wonderful possibili- ties. These individuals are by no means ail trained physiol- ogists. Indeed, judging from the great variation in papers which are being published, an interest in the subject seems to be sufficient ‘‘training’’ for investigation in some instances. Perhaps no field is attracting a more diversely trained set of in- vestigators at the present time. Physiologists, pathologists, zoologists, biochemists, physicians, psychologists and dentists are all taking their turn.
It is gratifying to know that the subject is of such general interest, but it is somewhat disconcerting to find that many who are untrained in physiology are attempting the solution of the physiological problems. Each may do very well in his own field, but he should be exceedingly careful about making interpreta- tions in an unfamiliar field.
When one attempts to study a subject about which he knows little he is often led into fantastic speculation. As he learns more and more, cold facts serve him as ballast and tend to check speculation. It is true that judicious speculation may lead to new ideas and to new researches and thus to new dis- coveries. Yet so much speculation is useless or fallacious that unless tested by the ordeal of rigid experiment it should certainly not be published.
It seems that no field in physiology is filled with a greater amount of published speculation. This is undoubtedly due in part to our limited knowledge. But it is also due to a certain inaction on the part of some who prefer to take a chance on a lucky guess rather than to try out their assumptions. This is unfortunate, for it fogs the field. It is by tedious experiment that endocrinology or any science will be advanced, and not by briliant guessing.
Study of the internal secretions is unusually difficult be- cause these are mingled with the blood stream instead of being conducted through special ducts. Moreover it appears that only small amounts of the secretion are elaborated at any one moment.
34
ENDOCRINE RESEARCH 35
To isolate such a substance requires great patience and labor. And then to prove that one has the normal substance and not a modification presents even greater difficulty. But it will be necessary to isolate these secretions before we get at the funda- mentals of endocrine physiology. Until that is done we shall be skimming on the surface of things. However it seems that much ean be learned before this stage is reached.
If one studies the endocrine literature he is struck by the contradictions among different investigators. If we stop to analyze the researches to account for this, we find that one or more of three causes may be present, viz., faulty technique, in- sufficient observations and incorrect interpretation of results.
It is fundamental in any science that the technique be un- questionable, but in a science so undeveloped as endocrinclogy it is especially requisite that this be true. Where a field is so new there are fewer facts available to correct mistaken methods. The result is that a faulty method may carry investigation far _astray and wrong ideas gain prevalence. Therefore the methods in technique must be tested by carefully planned controls.
A second source of error, as mentioned earler, hes in in- sufficient observation. By this we mean a paucity of experi- ments. Of course the requirements here vary with the nature of the problem. We must continually keep in mind that there may be not only considerable individual variation in the be- havior of animals due to inherent differences, but that unfore- seen modifications in the experimental conditions may give rise to disagreement. Multiplication of the observations as well as as increase in the number of animals used will tend to eliminate this factor. Better a dozen experiments too many than one too few.
Perhaps the biggest factor for error is the personal one. However conscientious one may be this is bound to creep in, par- ticularly in the interpretation of results. The greatest safeguard against this is to test the problem in every conceivable way. If you do not, some one else eventually will.
If these considerations were put into practice there would be far less confusion and contradiction and endocrinology would advance more rapidly. We believe that the time has come for the adoption of a more rigorous standard in endocrine research. HAL Eee
BOOK REVIEW
LE GOITRE EXOPHTHALMIQUE SYPHILITIQUE. Schul- mann, E. Paris, 1919, pp. 107.
In this mongraph Schulmann presents a study of the rela- tion of syphilitic infection to the development of exophthalmic goitre. It opens with a section of speculative endocrinology which impresses the reviewer as somewhat futile. This is fol- lowed by an interesting discussion of the relation of infections in general to the malady in question. Schulmann believes that the association of tuberculosis, typhoid, influenza and other acute infections witht Graves’ disease is too frequent to be regarded as mere coincidence.
The thesis proper begins with a discussion of specific (luetic) thyroiditis and dysthyroidism . These may be mani- festations of either secondary or tertiary syphilis. A section is devoted to acquired syphilis and exophthalmie goitre. Two varieties of this may be recognized, one appearing early and readily amendable to treatment and one which is singularly rebellious, appearing later. Tachycardia is the most character- istic symptom. A section on conjugal exophthalmie goitre and syphilis follows. No very convincing reason is adduced for making this an independent entity. The next section, on goitre and hereditary syphilis, is brief and not particularly signifi- cant. Some interesting cases from the literature on consan- guineous exophthalmie goitre and syphilis are discussed. The next section is devoted to the association of various morbid conditions with exophthalmie goitre. The book concludes with discussions of diagnosis and treatment.
The monograph will serve to direct attention to a subject that has been relatively little studied.
36
ABSTRACTS
ADRENAL crises (Das Krankheitsbild der Nebennierenapo- plexie). Lowenthal (K.) Berl. klin. Wehnsehr., 1918, _.., .... (No. 47).
A ease report. After pleurisy and pneumonia the patient suddenly developed attacks of severe abdominal pain, constipa- tion and slow pulse. Spasms and coma such as have been de- seribed in other similar cases were absent. Autopsy showed hemorrhages (?) of both adrenals.—J. K.
ADRENAL deficiency. Asthenia and intoxication. (La in- suficiencia suprarrenal. Astenia e intoxicaciOn.) Soler (F. L.) and Quesada Pacheco (R.). Actar Jer Congr. Nae. de Med. (Bs. Aires), 1916, 4, 55.
In dogs deprived of their adrenals the fatigue curve was normal even up to the last moment of life. The irritability of the nerves was normal but that of the motor cortex of the brain was diminished. Accordingly the author believes that the symptoms of adrenal deficiency are due to a morphin-like( ?) toxin acting on the brain.—B. A. H.
ADRENAL glands, The. Cobb (I. G.) Med. Press & Cire. (Lond.), 1916, 102, 186-190.
After a review of the chief data on the morphology and pharmacology of the adrenals the author discusses the thera- peutic use of adrenal products. The latter part of the article is based upon an assumption that ‘‘hypoadrenia’’ plays a sig- nificant role in conditions of asthenia. Recent careful studies in the laboratories of Stewart and of Gley cast much doubt upon the validity of the hypothesis.—R. G. H.
ADRENAL, Heteroplastic bone and bone-marrow formation as- sociated with tuberculosis in the—. Wooley (P. G.) J. Lab. & Clin. Med. (St. Louis) 1916, 1, 502-508.
37
38 ABSTRACTS
A rare condition in the adrenal is described and illus- trated. Myeloid osteomyelitis was associated with tubereu- losis. Wooley believes that the reaction of the adrenal tissue was secondary to irritation produced by the bacilli. This led to hyperplasia of the supporting tissue with slowly progress- ing necrosis and deposition of lime salts, a combination sup- plying proper conditions for functional change of the connec- tive tissue cells—R. G. H.
(ADRENAL) L’hypocrine surrenalienne aux armées. Etude particulicre de ses’ rapports avec l’immunisation anti- typhique (Hypo-adrenalism in the army. Special study of its relation to immunization against typhoid). Satre (A.) Arch de Méd. et de Pharmacie Milit. 1918, 69, 789.
The author finds frequently during typhoid and partyphoid vaccination arterial hypotension and other manifestations of suprarenal insufficiency. These are to be counterbalanced by suprarenal injections and by rest previous to the immuniza-
iron —A:. Lacs
(ADRENAL) On the relations of the adrenal medulla to the normal blood-pressure in animals. Austmann (K. J.), Halli- day (C. W.) and Vineent (S.) Trans. Roy. Soc. Canada (Ot- tawa)1917; 14; 123: ‘
After extirpation of both adrenal glands from dogs, con- tinuous records of blood pressure were made for from twelve to forty hours, the animals being kept under ether anesthesia for the whole period. With a few exceptions the curves were very similar to those obtained from normal, control animals. The experiments do not lend support to the theory that the normal blood-pressure is dependent upon adrenal secretion.
| Wiles € acd
ADRENAL, The alleged exhaustion of the epinephrin store in
the—by emotional disturbance. Stewart (G. N.) and Rogoff (J. M.) Proce. Soc. Exp. Biol. & Med. (N. Y.), 1916, 18, 184- 186.
Data published elsewhere. Abstraected Endoecrin. 1917, 1, 60.
(ADRENAL) The question of the relative importance to life of cortex and medulla of the adrenal bodies. Wheeler (T. D.)
ABSTRACTS 39
and Vincent (S.) Trans. Roy. Soe. Canada (Ottawa), 1917, 1 Ase 7.
After the extirpation of one adrenal gland the destruction of.the medulla of the remaining gland by ecauterization was at- tempted in a large number of animals. In several cases the animal survived complete destruction of the medullary tissue, as shown by post-mortem microscopic examination. The ex- periments therefore support the view that the cortex and not the medulla is essential to life—hL. G. K.
(ADRENALS) Acute Addison’s disease (Morbus Addisoni mit hochst akutem Verlauf). Hann (G.) Wiener klin. Wehnschr., iis, —-.,.--'(No. 41).
A ease report. There were no characteristic symptoms. Only severe pain in the abdomen and spine was noted. Death resulted in four weeks. At autopsy tuberculosis of both ad- renals and a persistent thymus were found.—J. K.
(ADRENALS) ADDISON’S DISEASE, Treatment of (Thera- pie des Morbus Addisoni). Leitner (G.) Wiener Med. Wehn- seha, 1913. ....,... (No. 36).
Report of a case successfully treated with fresh adrenals of calves and pigs.—J. K.
(ADRENALS) Fatal superficial burns and the suprarenals. Weiskotten (H. G.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 776.
More or less characteristic alterations are found in the su- prarenals at necropsy in cases of uncomplicated superficial burns. These changes are due not to hemorrhagic infarctions as formerly believed but to a specifie toxin originating in the burned areas.—H. W.
(ADRENALS) La répercussion glandulaire et humorale des commotions. Loeper (M.) and Verpy (G.) Progrés Méd. (Paris) 1916, 30, 203-205.
Trauma may result in a prolonged asthenia and low blood pressure which the authors regard as due to secondary depres- sion resulting from over-stimulation of the nervous system. The digestive organs and especially the adrenals may be notably affected, giving rise to ‘‘insuffisance surrénale.’’
—R. G. H.
40 ABSTRACTS
(ADRENALS) Observations on surgical shock: A preliminary report. Henderson (Y.), Prince (A. L.) and Haggard (H. W.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 965.
Experimental studies upon dogs and eats justify the con- clusion that the prolonged and excessive secretion of epinephrin (if it occurs under pain) is not a critically important factor in the production of shock. Therefore it is improbable that surgi- cal shock is a result of excessive secretion of the suprarenals secondary to sensory stimulation.—H. W.
(ADRENALS) Sur |’ éberthémie. (Adrenal-typhoid syndrome). Eseudor Nunez (P.) An. Fae. de Med. (Montevidio), 1918, —, —, (Sept. and Oct.)
The author attributes to ‘‘hypoadrenalism’’ following typhoid the following symptoms: hyposthenia, hypotension, hypo-cholestrinemia, dicrotism of the pulse and sphygmothermie dissociation. Modern studies upon the adrenals do not support these views. There is no appreciable quantity of adrenin even in normal blood; if it were present it would be only in hypo- tensive concentration ; the adrenal has not been proved to play any essential role in regulating cholestrin metabolism.
—B. A. H.
(ADRENALS) The effects of thyroidectomy and thyroid feed- ing upon the adrenalin content of the suprarenals. Herring (P. T.) Quart. J. Exp. Physiol (Lond.) 1916, 9, 391-401.
Complete thyroidectomy has little effect upon the adrenin content of the glands in rabbits. In eats thyroparathyroid- ectomy results in a diminution of the adrenin proportional to the severity of the symptoms produced. The adrenin content of the glands per kil. of body weight averaged 0.400 mg. for normal rabbits and 0.229 mg. for normal eats. Feeding raw ox-thyroid resulted in raising the amount to 0.347 mg. in eats. Both physiological and colorometric methods of assaying were employed. The results were concordant. For later experiments see Abstract, Endoerin., 1917, 1, 496.—R. G. H.
(ADRENALS) The epinephric content of the blood in condi- tions of low blood pressure and shock. Bedford (E. A.) and Jackson (H. C.) Proc. Soe. Exp. Biol. & Med. (N. Y.) 1916, 13, 85-87.
Data published elsewhere. See Endoerin., 1917, 1, 351.
(ADRENALS) The influence of certain conditions on the rate at which epinephrin is liberated from the adrenals into the
ABSTRACTS 41
blood. Stewart (G. N.) and Rogoff (J. M.) Proe. Soc. Exp. Biol. & Med. (N. Y.) 1917, 14, 77-79.
Data published elsewhere. See Abstracts, Endocrin. 1917, 1, 508; 1918, 2, 310.
ADRENALS, The liberation of epinephrin from the. Stewart (G. N.) and Rogoff (J. M.) Proc. Soc. Exp. Biol. & Med. (N. Y.), 1916, 13, 186-189.
Preliminary publication of some of the fundamental data of the authors’ well known researches on adrenin discharge. Blood from the adrenals was collected in:a pocket fashioned from the vena cava and its adrenin content judged by the mydriasis produced when it was liberated and allowed to reach the irises of the eyes, one of which had been previously **sensi- tized’’ by being denervated. The technique is described. Blood pressure changes were also used as criteria. Cutting the splanchnic nerves greatly diminished or abolished the discharge
58, 60, 341, 343, 348, 486, 508; 1918, 2, 51, 54, 157-8.
ADRENALS, The presence of epinephrin in human fetal. Lewis (J. H.) Jour. Biol. Chem. (Balt.) 1916, 24, 249-254.
Blood pressure and chemical tests failed to disclose ad- renin in human fetal adrenals. In two eases of full term glands, inconclusive positive tests were obtained by use of strips of uterus and intestine. A six months fetus gave definitely negative results. The Folin-Dennis test can not be used to assay adrenin in fetal tissues because of their high uric acid content.—R. G. H.
(ADRENALS) Uber die Funktion der Nebenniere. Bauer (E.) Virchow’s Archiv., 1918, 225, 1-15.
When adrenin increases, so does uric acid; both fall to- gether. In Addison’s disease, and in severe kidney diseases when uric acid accumulates, there is a compensatory hyper- function of the interrenal system. The urie acid accumulates in the skin and is the source of the pigment in Addison’s dis- case.—Physiol. Abst, 3, 526.
(ADRENALS, WHITE LINE) La linea bianca di Sergent nell’insufficienza surrenale (Sergent’s white line in adrenal insufficiency). Ciuti (G.) Riv. Clin. med., 1918, -..., 453.
The author reports observations of Massalongo, that in 400
patients he found the white line only in thirty. Of these 22
42 ABSTRACTS
were typhoid eases. He does not believe this line has any great diagnostic importance since many eases of adrenal lesions did not give it in life. He claims that it has prognostic importance, however, because the patients who showed the white line all died. In none of these patients was adrenalin effective.—G. V.
(ADRENIN) Accion de la adrenalina sobre corazon aislado de Leptodactylus ocellatus (L.) gir. y Bufo marinus. (Action of adrenin on the isolated heart of L. 0. and B. m.) Flores C. F., Rev. Asoe. Méd. Argentina, 1918, 39, 207.
The heart of the frog was more sensitive to adrenin than that of the toad. (Guglielmetti has demonstrated a similar difference in the striated muscle. )—B. A. H.
(ADRENIN) Apothesine and adrenalin anesthesia in the re- moval of tonsils. Coleman (J.) Med. Rev. (N. Y.) 1918, 94, 413-14.
Of technical surgical interest.—R. G. H.
(ADRENIN, ASTHMA) Sulla eziclogia e pathogenesis della neurosi asmatica infantile (Etiology and pathogenesis of in- fantile asthmatic neurosis). Spolverini (lL. M.) Pediatria, 1918 32.250909:
All the author’s cases exhibited extreme peripheral irrita- bility of the cerebrospinal and sympathetic nervous systems. All presented more or less evident status lymphaticus. Adrenin treatment gave excellent results, a fact which is interpreted as supporting Marfori’s theory that the lymphatic glands secrete a hormone antagonistic to adrenin. Further research is ad- vised. The article includes a considerable amount of endocrine theorizing of a type fortunately become obsolete-——G. V., RenG. El.
(ADRENIN) A study of low blocd pressure not associated with trauma or hemorrhage. Simonds (J. P.) Areh. Int. Med., 1916, 18, 848-855.
In most types of low blood pressure the subject reacts sharply to adrenin. In that due to anaphylactic shock and peptone poisoning the reaction is much diminished or entirely absent. Paralysis of the vascular musculature would appear to account for this finding—R. G. H.
(ADRENIN.) Experimentelle Untersuchungen tiber den hem- menden Einflusz von Adrenalin auf die Nierentatigkeit. (Ex-
ABSTRACTS 43
perimental studies on the inhibitory action of adrenin on the kidneys. Wels (G.) Inaugural Dissertation, Kiel, 1917.
The author injected adrenalin (1 mgr.) in patients with healthy kidneys. He regularly observed a diminution of diure- sis; very often this was preceded by a short period of polyuria. The excretion of sodium chloride was independent of the diuresis, but was always diminished after the injection of adrenalin. The excretion of phosphates, nitrogen and uric acid in some experiments paralleled the excretion of sodium chlo- ride; in other experiments it went parallel with the excretion of water. The same changes were observed in the rabbit. Wels tried to determine where the sodium chloride was retained. In rabbits one kidney was removed and after recovery adrenalin was injected. After some hours the animal was killed and the quantity of chlorides in the kidney was determined. This quantity was not increased. However after injection of adren- alin the osmotic tension of the blood serum was much increased. At first the author thought that this might be caused by an in- erease of the chlorides of the blood, but it was found that the quantity of chlorides (and nitrogen) after injection of adrena- lin was unaltered. The rise of osmotic tension is due to hyper- glycemia. Where the sodium chloride is retained is still un-
known. (Compare also Endocrinol. 1918, 2, 160 (No. 89). 4 fee ce
(ADRENIN) Is dilatation of the pupil following gangliectomy due to vaso-dilatation? Githens (T. 8S.) and Meltzer (S. J.) Jour. Pharm. and Exp. Ther. (Balt.) 1916, 8, 133-34.
The authors showed that frequent prolonged instillation of adrenalin into the conjunctiva causes dilatation even of the normal pupil. The vasodilatation produced by section of the cervical sympathetic nerve or removal of the ganglion has noth- ing to do with this dilatation. The prolonged maximal dilata- tion of the pupil previously observed by the Meltzers after a single instillation of a few drops or a subcutaneous injection of adrenalin after 24 or 48 hours occurring exclusively after the removal of the superior cervical ganglion, has nothing in com- mon with the dilatation of the pupil following the prolonged saturation of a normal iris with adrenalin. This is contrary to the conclusions of Strauf, who believed that the dilatation of the pupil produced by adrenalin after section of the cervical sympathetic is a result of vasodilatation and consequently a greater absorption of adrenalin.—L. G. K.
(ADRENIN) On the action of drugs on the ureter. Macht (D. I.) J. Pharm. Exp. Therap. (Balt.) 1916, 8, 111.
44 ABSTRACTS
A ring of pig’s or human ureter suspended in oxygenated Locke’s solution at 37°C. begins to contract and relax spon- taneously and these rhythmic movements may continue for hours. Adrenin was found to inerease the rate of contraction and the tonicity of the ureter. A quiescent ureter can be re- vived and started to beat by the addition of minute doses of epinephrin (one drop 1:10,000 in 50 e.c. of Locke’s solution). The action of other drugs of no endocrine interest was also studied.—L. G. K.
(ADRENIN) Location of the adrenalin vasodilator mechanisms. Hartman (F. A.) J. Pharm. Exp. Therap. (Balt.) 1918, 44, 186.
See Endocrin., 1918, 2, 160, 163 (Nos. 91, 101).—lL. G. K.
(ADRENIN) On the nature of the blood-pressure curve pro- duced by stimulation of the peripheral end of the splanchnic nerve. Parsons (J. P.) and Vineent (S.) Trans. Roy. Soe. Canada (Ottawa), 1917, 11, 129-131.
The authors conclude provisionally that the greater part of the ‘‘dip’’ and the whole of the previous ‘‘step,’’ in the blood-pressure curve produced by stimulation of the peripheral end of the splanchnic nerve, as well as the augmentation of the heart are due to adrenin poured into the circulation as a result of the stimulation, but that a part of the fall or “‘dip”’ is a true vaso-motor reaction. Ligation of the veins of one gland or thorough cauterization of the medulla often does not affect the shape of the curve. Extirpation of both glands abolishes the ‘‘step’’ and the augmentation of the heart, but leaves a ‘‘dip’’ in the tracing. Injection of nicotine into the medulla abolishes the ‘‘step’’ and the greater part of the ‘‘dip,’’ as well as the augmentation of the heart.—L. G. K.
(ADRENIN) On the pharmacology of the ureter. I. Action of epinephrin, ergotoxin and of nicotine. Macht (D. I.) J. Pharm. & Exper. Ther. (Balt.), 1916, 8, 155-166.
Abstracted, Endocrin., 1917, 1, 501. Not previously in- dexed.
(ADRENIN-PITUITRIN) Action antagoniste de 1’adrénaline et des extraits hypophysaires sur les bronches (The antagon- ism between adrenin and pituitrin acting on the bronchi). Houssay (B. A.) La Presse Méd. (Paris) 1918, -..., 513.
ABSTRACTS 45
By means of the pulmonary plethysmograph, with artifi- cial respiration (in the anesthetized dog) Houssay finds a dim- inution of lung volume after an injection of pituitrin. Also in the curarized guinea pig, under artificial respiration, an injec- tion of pituitrin almost completely prevents the access of air to the lungs. Adrenin and atropine have an opposite and an- tagonistic action to that produced by pituitrin on the bronchial muscle. Pituitrin also produces acute exacerbations in certain susceptible individuals with asthmatic diathesis. Attention was ealled to this by Lanari (Argentina Mediea, 1913, 710), who de- seribed the precipitation of asthmatic attacks by use of hypo- physeal extracts. In consequence, Houssay is opposed to the use of adrenin-pituitrin mixtures, or pituitrin alone in the re- lief of asthma. On local application, on the other hand, the two preparations act somewhat synergistically as hemostatics. Pituitrin probably acts directly on the smooth muscle.—A. L. T.
(ADRENIN-PITUITRIN, ASTHMA) La medicazione adreno- ipofisaria nella cura dell’asma (Adrenin-pituitrin treatment of asthma). Bufalini, Rév. Clin. Med., 1918, ..., 371.
Although excellent results have often been obtained, the author has had also some complete failures. In small doses the remedy is harmless even in conditions of marked vascular hy- pertension. The author, unaware apparently that investiga- tions of recent years have proved adrenin to be a hypotensive agent, theorizes to the effect that his observations indicate pul- monary stasis as possibly the cause of asthma.—G. V., R. G. H.
(ADRENIN-PITUITRIN, ASTHMA) La pathologia dell’asma e la medicazione surreno-ipofisaria (Pathology and adrenin- pituitrin treatment of asthma). Massalongo (R.) Rev. Clin. Med., 1918, ...., 469.
Asthma (and hay fever) are regarded as neurogenic rather than of anaphylactic origin, the respiratory center being par- ticularly affected. Marked success with adrenin-pituitrin ther- apy leads the author to conclude that the neurosis has an endo- erine basis. The formula employed in treatment is adrenalin, 0.8 mg. and pituitrin, 0.4 mg. in 1 ¢.e. of vehicle. This has proven invariably successful and harmless no matter how long continued.—G. V.
(ADRENIN, PITUITRIN) The effects of various agents on superficial hemorrhage and the efficiency of local hemostatics. Hanzlik (P. J.) J. Pharm. and Exp. Therap. (Balt.) 1918, 12, 71-117.
46 ABSTRACTS
The most efficient and desirable hemostatic tested was ad- renalin. However its action is temporary and therefore should not be relied upon to produce permanent hemostasis. Pituitary acts similarly, although not so effectively. The effect of the hemostaties on the flow of blood from the incised foot-pad of anesthetized dogs was studied. The relative amount of blood was estimated by the determination of the urea-nitrogen. Sixty- two different agents were tested, adrenalin and _ pituitrin amongst them. Adrenalin in concentrations ranging from 1:1,000,000 to 1:1,000 promptly and effectively lessens the flow. The maximal effect appeared within an average of 234 min- utes, the duration of the action depended on the period of irri- gation and concentration of adrenalin. The action begins al- most immediately with the application. The hemorrhage is al- most invariably increased after the hemostatic effect disappears, perhaps due to low concentrations of the drug in the wound. Concentrations of 1:10,000,000 or more dilute, increased the bleeding. Accordingly adrenalin is not a dependable hemo- static. Pituitary extract produced a momentary increase in the bleeding, followed by a more or less prolonged decrease.
F. A. H.
(ADRENIN, PITUITRIN) The effects of various systemic agents on superficial hemorrhage. Hanzlik (P. J.) J. Pharm. and Exp. Therap. (Balt.) 1918, 12, 119-128.
The most effective hemostatic in superficial bleeding, by intravenous administration, was adrenalin; pituitary extract was variable. The methods are described in the preceding ab- stract.—F. A. H.
(ADRENIN, PITUITRIN) The pharmacology of the vas def- erens. Waddell (J. A.) J. Pharm. and Exp. Therap. (Balt.) SIG. 8, 551-559:
Suspended longitudinal sections of vas deferens of freshly killed animals in oxygenated Tyrode’s or Ringer’s solution showed normally no contractions (dog, guinea-pig, sheep) ex- eept in rat and rabbit where a slow rhythmic contraction was exhibited. Addition of adrenalin (1:1,500,000—1 :500,000) to the immersion fluid caused increased contractions or produced contractions in the quiescent organ. The latent period is short. Both tone and rhythm are affected; the tone is affected prior to rhythmicity. The effect lasted only while the adrenin was present. There is no injury to the organ; repeated tests were equally active as the first: the effect is quantitative with ref- erence to tone effect. The results seem to show the presence of
ABSTRACTS 47
motor-sympathtie fibres. Pituitary extract had no effect on the quiescent organ—W. E. B.
(ADRENIN) Prolonged constriction of the blood vessels by subcutaneous injection of adrenalin into the ear of a rabbit. A demonstration. Auer (J.) and Meltzer (S. J.) Proce. Soe. Exp. Biol. & Med. (N. Y.), 1916, 14, 54-55.
The vasoconstrictor effect of adrenin injected at the base of the ear persists several hours.—R. G. H.
(ADRENIN) Prolonged constriction of the blood vessels by subcutaneous injection of adrenalin into the ear of a rabbit. Auer (J.) and Meltzer (S. J.) Jour. Pharm. and Exp. Ther. (Balt.) 1917, 9, 358-9.
See abstract in Endocrin. 1918, 2 ,479.—L. G. K.
(ADRENIN) The action of epinephrin on vasomotors and heart- beats studied separately by the artificial control of blood pressure by means of the compensator. Brooks (C.), McePeek (C.) and Seymour (R. J.) J. Pharm. and Exp. Therap. (Balt.) 1918, 11, 168-69 and 183-84.
The artificial control of the blood pressure described by Brooks and Heard was introduced into the circulation. In ad- dition a vasomotor balance was used so that when the vessels constricted blood passed from the animal-into the reservoir bot- tle and when vaso-dilatation occurred liquid flowed from the bottle into the animal. Changes in weight of the bottle were graphically recorded by the balance.. The blood pressure and temperature of the animal was thus under artificial control. It was shown that adrenin caused some slowing and an increase in the amplitude of the heart beat apart from its vasomotor effects. Artificially raising the blood pressure also caused slow- ing of the heart and an increase in amplitude, while artificially lowering it had the opposite effect. Within limits, also, arti- ficially forcing the pressure up to a high level tended to ‘‘edu- cate’’ the animal’s own pressure towards a high level.—L. G. K.
(ADRENIN) The action of adrenalin in inhibiting the fiow of pancreatic secretion. Mann (F. C.) and McLachlin (L. C.) J. Pharm. and Exp. Therap. (Balt.) 1917, 10, 251-258.
Adrenalin always caused a decrease in the flow of pan- creatic secretion when it produced any effect on the latter, even with doses producing a fall in blood pressure. The authors con-
48 ABSTRACTS
clude that the action is due to a decrease in blood flow verona the gland.—F. A. H.
(ADRENIN) The blood-pressure curve following an intra- spinal injection of adrenalin. Auer (J.) and Meltzer (S. J.) Am. J. Physiol. (Balt.) 1918, 47, 286-292.
Intraspinal injections of adrenalin (1 ¢.c. or 1.5 ¢.e.) in the lumber region of monkeys cause a rise of blood pressure dis- tinetly different in character from the curve obtained after the intravenous injection of adrenalin. It is characterized by a slow rise to the maximum height, by a plateau-like duration of the maximum and by a slow fall to normal. The duration of the effect is greater than that from an intravenous injection. In some instances the rise was preceded by a fall in pressure. As a rule the pressure at the end of the pressor effect did not fall below the original level.—L. G. K.
(ADRENIN) The activity of different sorts of adrenaline (Over het verschel in werkzaamheid tusschen bij nierprepa- raten van verschillende herkomst). Storm van Leeuwen (W.) and van der Hade (H.) Nederl. Tijdschr. v. Geneesk. (Haar- lem), 1918, 62, (11), 1961.
Comparative results of assays of four brands of adrenin. The necessity of pharmacologic tests is emphasized.—J. K.
ADRENIN, The effect of, on the surviving blood vessels of the rabbit’s ear (Untersuchungen zur Dynamik der Adrenalin- wirkung auf die Gefasse des tiberlebenden Kaninchenohres). del Campo. Ztschr. f. Biol. (Munich), 1918, 69, 111.
The vessels are very sensitive to adrenin, the effect per- sisting for two or three days. Even the smallest trace of ad- renin causes a constriction if the vessels are immersed in Ty- rode’s solution. If instead of this solution caleium free sodium chloride solution is used the effect is diminished or lost.—J. K.
ADRENIN, The effect of, on the pigment migration in the melanophores of the skin and in the pigment cells of the retina of the frog. Bigney (A. J.) J. Exp. Zool. (Phila.) 19D ZT, 391-397.
Adrenin, 1:10,000, caused a strong contraction of the cu- taneous pigment cells that had been greatly expanded by sun- light. The same result was obtained with animals kept in the dark. Adrenin 1:50,000 produced only a slight effect, keeping
ABSTRACTS 49
the melanophores contracted for about two hours, the influ- ence passing off in four to five hours. Adrenin caused the ret- inal pigment cells to expand. This effect could be detected in dilution of 1:5,000,000.—E. R. H.
(ADRENIN) Procaine for dental operations. Mallett (S. P.) Dental Cosmos, 1918, 60, 966-72.
A diseussion of the requisite properties of a local anes- thetic, and of the manner in which a mixture of procaine and adrenaline satisfies these requirements. Chem. Abst., 13, 143.
(ADRENIN) The infiuence of adrenalin in the contraction of skeletal muscle. Takaysu (S.) Quart. J. Exp. Physiol. (Lond.) 1916, 9, 347-353.
Different observers have reported that adrenin has a bene- ficial effect on contracting muscle. Takaysu investigated the effect of adding this substance to Ringer’s solution in which active frog muscle was immersed. It was found that solutions of 1:1,000,000 showed no distinct effect. In stronger solutions the contractions were shorter and briefer than normal. Strong solutions acted as a distinct poison somewhat hke potassium.
—R. G. H.
(ADRENIN) The infiuence of the adrenals on the kidney. Mar- shall (KE. K.) and Davis (D. M.) J. Pharm. and Exp. Therap. (Balt.) 1916, 8, 11-12.
See Endocrin., 1917, 1, 59.—L. G. K.
(ADRENIN) The mutually antagonistic actions of adrenalin and physostigmin upon the spinchter muscle of the iris. ene (D. R.) Jour. Pharm. and Exp. Ther. (Balt.) 1917,
, 308.
Most of the experiments were performed upon the bovine iris. The results were as follows: (a) the primary maximal adrenalin-relaxation can be promptly overcome by eserin, i.e., the spinchter is again brought into a state of contraction by eserin. (b) The primary maximal eserin contraction can be promptly overcome by adrenalin, hence the antagonism is mutual. (¢) Under favorable conditions these effects may be reversed two or more times by the alternate applications. (d) After repeated alternate applications, however, the effective- ness of both diminishes, but eserin usually loses its effectiveness earlier and in a greater degree than adrenalin. (e) In some cases a State was finally reached in which no change in spinch-
50 ABSTRACTS
ter length could be produced by either, although the muscle still reacted well to cold.—lL. G. K.
(ADRENIN) The pharmacology of the vagina. Waddell (J. A.) J. Pharm. and Exp. Therap. (Balt.) 1917, 9, 411-426.
The author found that the application of drugs affects similarly the spontaneous rhythmie contractions exhibited by the circular and by the longitudinal museculatures of the ex- cised vaginae of dogs, cats, rats, rabbits, guinea pigs, sheep, hogs and cows, when suspended in oxygenated Tyrode’s solu- tion at body temperature. The excised vaginae of rabbits, dogs, hogs and sheep are stimulated by epinephrine, while those of cats, rats, guinea pigs and cows are depressed. Therefore, the motor sympathetic innervation is the more powerful in the former species, and the inhibitory in the latter. After ergo- toxine, the excised vagina of the rabbit is depressed, not stimu- lated, by epinephrine, so that the organ in this animal pos- sesses an inhibitory sympathetic innervation as well as a motor. Pituitary extract stimulates the excised vagina. Many other drugs were also tested, but the results are not of endocrine in- terest.—lL. G. K.
(ADRENIN) The primary depression and secondary rise in blood pressure caused by epinephrine. _McGuigan (H.) and Hyatt (E. G.) J. Pharm. and Exp. Therap. (Balt.) 1918, 12, 59-69.
An attempt to explain the secondary rise in blood pressure following pressor doses of adrenalin. This rise is believed to be due to a central action of adrenalin acting through the sym- pathetic ganglia. The basis for this belief is that pithing of the brain prevents it, as also does nicotin.—F. A. H.
(ADRENIN) The proportion in which adrenalin distributes it- self between corpuscles and serum in relation to the tech- nique of testing for epinephrin in blood. Stewart (G. N.) and Rogoff (J. M.) Proce. Soc. Exp. Biol. & Med., 1917, 14, 79-80.
Data published elsewhere. See Abstract, Endocrin. 1917, 1, 348.
(ADRENIN) I. Tonus waves from the sino-auricular muscle preparation of the terrapin as affected by adrenalin. Gruber (C. M.) and Markel (C.) J. Pharm. and Exp. Therap. (Balt.) 1918, 12, 48-51.
ABSTRACTS 51
Adrenalin diluted from 1 :150,000 to 1:174,000,000 caused a disappearance of the tonus waves in sino-auricular muscle preparations of the terrapin. It increased simultaneously the force and the amplitude of the contraction. In some cases ad- renalin increased the contraction rate.—F. A. H.
(ADRENIN) II. Tonus waves in the terrapin auricles as af- fected by pilocarpine, atropine, and adrenalin. Gruber (C. M.) and Markel (C.) J. Pharm. and Exp. Therap. (Balt.) 1918, 12, 53-57
Adrenalin caused a disappearance of the tonus waves in the atropinized heart as it did in the normal heart.—F. A. H.
(ADRENIN) Vaste gangréne cutanée, consécutive d une anes- thésia régionale a la novocaine-adrénaline en solution faible (Extensive gangrene of the skin following regional anesthesia with weak novocaine-adrenalin solution). Chaput and Schek- ter. Bull. et mem. Soe. de chir. de Par., 1918, 44, 808. Abst. Surg. Gyn. & Obst. 1918, 27, 294.
In performing a hernia operation local anesthesia was pro- duced by a 1:400 novoecaine solution to which 20 drops of 1:1000 adrenalin per 100 ¢.c. was added. A week later there was a rise In temperature; a cutaneous area of about five finger widths became infected; this suppurated abundantly and par- tially sloughed. Complete recovery was not made until 244 months later. It is stated that although rare, similar cases have been reported. A depleted general state and arteriosclerosis supposedly favor the development of gangrene. The authors propose to discontinue the use of adrenalin solutions for local anesthesia. In the discussion Legueu said he had been ac- customed in prostatic operations to use local anesthesia includ- ing 20 drops of adrenalin. Having observed gangrene of the cellular tissue following its use he reduced the proportion to 5 drops per hundred c.ec. and had had no further difficulty of this sort.—R. G. H.
A large OVARIAN CYST. O’Day (G. P.) Med. J. Australia (Sydney), 1916, 2, 410.
A brief case report. A multilocular cystadenoma in a woman of 20 contained 16 gallons and weighed 119 pounds. ‘‘It had interfered very slightly with the patient’s vital fune- tions.’’—R. G. H.
52 ABSTRACTS
The older conception was that sex is an absolute attribute. An organism was supposed to be either a male or a female ex- cept in rare cases of hermaphroditism. Researches of recent years have shown, however, that the blending of ‘‘maleness’’ and ‘‘femaleness’’ in a single individual is not uncommon.
Banta studied a race of Cladocera which for 130 genera- tions had been breeding parthenogenetically, none but females appearing. In the 131st generation males and sex-intergrades of many sorts appeared. In the species studied eight morph- ologie secondary sex characters are recognized. Practically every possible combination of male and female characters was seen. The gradation ran from normal females, females with a few male characteristics through hermaphrodites with various combinations of sex characters to male intergrades and finally complete males.
Various anomalous individuals seen by clinicians are prob- ably true sex intergrades.—R. G. H.
CAROTID BODY, Tumors of the. Lund (F. B.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 348
Of technical interest.
CAROTID BODY, Tumors of the. Winslow (R.) Ann. of Sure., 1916, 64, 257.
Two cases are reported and prévious eases briefly dis- eussed. Of no particular endoerine interest—C. MeP.
CORPUS LUTEUM, Data on the relation of the, to primary and secondary sex characters. Pearl (R.) Urol. & Cut. Rev. (Tech. Suppl.) (St. Louis) 1916, 4, 29-37.
An interesting review of some of the recent literature.
DIABETES, Absolute, with return of function: Report of case. Christe (C. D.) Jour. Am. M. Assn. (Chgo.), 1917, 68, 170.
Of clinical interest.
(DIABETES) A case of diabetic conjunctivitis. Hogg (G. H.) Med. J. Australia (Sydney), 1916, 2, 387.
A conjunctivitis of five weeks’ duration in a woman of 80 failed to benefit by local treatment. When the woman was placed upon a diabetic régime the conjunctivitis promptly ceased. A second case was reported by letter by Dr. L. Dey, same journal, p. 464.—R. G. H.
ABSTRACTS D3
(DIABETES) A case of xanthoma diabeticorum. Paul (N.) Med. J. Australia (Sydney), 1916, 2, 320.
A brief report. No specific evidence of the diabetic eti- ology of the condition is offered.—R. G. H.
DIABETES, Acetone substances of blood in. Kennaway (E. L.), Biochem. J., 1918, 12, 120-30.
The concentration of acetone substance in the blood in diabetic coma may be equivalent when reckoned as acetoacetic acid, to that of 0.03 N solution. The method for acetone sub- stances used was a combination of the Schaffer and Seot-Wil- son method. While satisfactory for urine this was not found to be so for blood. Chem. Abst., 1918, 12, 2909.
DIABETES, Acidosis in—. Woodyatt (R. T.) Tr. Ass. Am. Physicians, 1916, 31, 12-21.
““The state of every normal individual becomes diabetic when the rate of glucose supply to the cells is high enough, and every case of human diabetes passes into the non-diabetic state when it is possible to make the rate of glucose supply to the cells low enough. The difference between a ‘total’ diabetic and a healthy person is purely quantitative. When- ever the rate at which glucose is utilized by the body cells falls below a certain minimum relative to the rate of fat and protein catabolism, acidosis results. Whenever the mixture of metabo- lites being oxidized in the body comprises more than three fatty acid radicals to one of glucose, combustion is interfered with, hence acidosis results when, in starvation, body fat is being consumed. For details of application of these principles the original should be consulted.—R. G. H.
(DIABETES) A method for the determination of the diastatic activity of the blood with some observations obtained in diabetes and other conditions. Killian (J. A.) and Myers (V.C.) Proc. Soe. Exp. Biol. & Med. (N. Y.), 1916, 14, 32.
Diabetie blood was found to have two or three times as great ability to digest soluble starch as had normal blood. R. G. H.
(DIABETES) BLOOD SUGAR, Glycolysis in diabetic blood with a method for the estimation of—. Maclean (H.) J. Physiol. (Lond.) 1916, 50, 168-181.
‘“A new method for the estimation of sugar in blood is deseribed.
D4 ABSTRACTS
‘““There is no decrease of glycolytic power in diabetic blood; if the mechanism of sugar oxidation in the blood is sim- ilar to that in the tissues, it must be inferred that the diabetic tissues also possess the power to destroy. sugar.’
(DIABETES, BLOOD SUGAR) Blutzuckeruntersuchungen bei Diabetes mellitus. Hirsch (E.) Arch. Verdauungskrank. 1918, 24, 441.
In man glycosuria may occur with or without an increase in the blood sugar. When the blood sugar is increased and there is glycosuria we have simple diabetes. When the blood sugar is increased and there is no glycosuria we have a latent diabetes. Probably in these cases there is a combination of a disease of the pancreas and a diminished power of excretion of sugar by the kidney caused by a chronic adrenalin influence on this organ. In cases where the excretion of sugar is in- creased without rise of the blood sugar there is ‘‘renal dia- betes.’’ Here also an influence of the adrenal is probable. (This article is rather full of unproved theories and must be read critically.
(DIABETES) Chemical evidence for the presence of glycogen- like polysaccharids in: the liver blood of diabetic animals. Macleod (J. J. R.) Proe. Soe. Exp. Biol. & Med. (N. Y.), 1917, 14, 124-125.
Blood was taken from the vena cava at the mouth of the hepatic veins of dogs rendered hyperglycemic by adrenin or by stimulation of the splanchnic nerves or from the carotid artery of piqure rabbits. A precipitate was thrown down by alcohol and Na Cl. This when purified gave various of the glycogen reactions. Further study is intended.—R. G. H
DIABETES, Cutaneous manifestations of. Their treatment. Anon. Monde Méd. (Paris) (Eng. Edition) 1917, 27, 280-282.
‘‘No disease gives rise to such a large and varied number of skin manifestations as does diabetes.’’ An early recognition of their etiology is important to successful treatment. Certain mycoses sometimes acquire an exuberant development such as balanitis due to oidium, erythrasma, and sporotrichosis. Eezema and pruritis are common. Lichen and circumscribed dermatitis are often met with, as is xanthoma. Even gangrene of the skin from slight trauma is not uncommon. For xanthoma, chemical or galvanic cauterization is preferable to eutting operations. For balanitis, frequent applications of 1 to 1000 permanganate
ABSTRACTS Di
~
-
fe solution are advised. The underlying diabetes should, of course, also receive attention.—R. G. H.
(DIABETES) Diabetic dietetics. Glucose formation from pro- tein foods. Janney (N. W.) and Csona (F. A.) Proe. Soe. Exp. Biol. & Med. (N. Y.), 1916, 13, 78.
It was found that protein foods ordinarily given to dia- betics form considerable quantities of glucose when fed to dogs rendered completely diabetic by phlorizin. .For example, 350 grams of beefsteak yielded as much glucose as 100 grams of bread. In formulating diabetic dietaries, glucose formation from protein as well as carbohydrate should be considered.
—R. G. H.
(DIABETES) Diffuse diabetic ulceration of the pharynx and larynx. Arrowsmith (H.) Laryngoscope (St. Louis), 1916, 26, 1177-78.
A brief description of this rare condition in a woman of 66. So far as the author could determine this is the sixth or seventh case recorded in the literature. —R. G. H.
(DIABETES, HYPERTHYROIDISM) The value of modern blocd chemistry to the clinician. Getiler (A. O.) and St. George (A. V.) J. Am. M. Ass. (Chgo.) 1918, 71, 2033-36.
A report on 15,000 blood examinations made in 1915-17 at the Bellevue Hospital, New York. Among several other dis- eases diabetes mellitus and ‘‘hyperthyroidism”’ were included.
‘‘An increased sugar content of the blood has invariably been found in the untreated cases of diabetes mellitus even without glycosuria. The onset of this condition can be detected in the blood a long time before sugar appears in the urine. It is now well known that because of the variability shown by many kidneys as to their sugar permeability, it is of greater importance to have a blood sugar determination than a deter- mination of the urinary sugar content. The alkali reserve in these cases is also of inestimable importance in diagnosing the degree of acidosis.
‘“The range of values of sugar in diabetes, taken from 800 determinations, has been from 105 to 1,010 mg. in 100 ¢.c. of blood; the alkali reserve, from 60 down to as low as 7 per cent. Similarly, there have been isolated reports of slightly increased amounts of sugar in furuncles, carbuncles, ete. In our experi- ence, covering some fifty cases of carbuncles and furunculosis, all of severe grade not presenting the symptoms of diabetes
56 ABSTRACTS
mellitus (that is, polyphagia, polyuria, loss o& weight and glycosuria), there invariably has been a hyperglycemia, some only of a slight degree, but nevertheless quite definite. It was surprising to see how rapidly these patients improved when they were placed on a carbohydrate-poor diet, in addition to local surgical treatment.
‘“Cases of ‘hyperthyroidism’ almost always show an in- creased sugar content of the blood. We believe, however, that this is of little pathologie significance, except that it indicates that the patient’s metabolism is on a higher level than in a normal person, and that his reserve carbohydrate is being burnt up; hence the rapid loss of weight so frequently seen in these individuals.’’—R. G. H.
(DIABETES) HYPERTHYROIDISM, Carbohydrate tolerance in.- O’Day (J. ‘C.). Sure. Gyn-&. Obst. (Cheo:) one: 2 206-209.
A report and enthusiastic discussion of two cases of hyper- thyroidism in which glycosuria was a prominent symptom. The author believes that surgical attention to the thyroid will prove an important feature in the treatment of diabetes——R. G. H.
DIABETES insipida sifilitica. Rev. méd. d. Rosario, 1918, 8, 197. Abst. Surg. Gyn. & Obst., 1918, 27, 464.
Syphilitic diabetes insipidus was known to Fourier in 1871 and he considered it dependent on a syphilitic cerebral condi- tion which injured region of the fourth ventricle. The subject has since been frequently mentioned in the literature. The author thinks all forms of diabetes insipidus have a common origin due to functional or organic disturbance of the hypo- physis or ‘‘cerebral polyuric centres.’’ Polyuria might be due to spirochetal attack on the hypophysis or to a meningitis of the base of the brain. A case in a man of 25 is reported. The symptoms yielded to mereurie injections —R. G. H.
(DIABETES INSIPIDUS) Sulla patogenesi del diabete insipido (The pathogenesis of diabetes insipidus). Moreschi (C.) Poli- clin. (Rome) 1918, 25, sez. med., 99. Abst. Surg. Gyn. & Obst. 1918, 27, 328.
Moreschi studied a case of diabetes insipidus in a girl of nineteen with the history of a tranmatism which caused tempo- rary paralysis seven years before. The patient was treated by hypophyseal extracts and the various results obtained are given in a series of tables. From a study of this case and the
ABSTRACTS 57
literature Moreschi thinks that there are multiple pathogenetic factors involved in the production of diabetes insipidus. Such multiplicity is a direct corollary of Heidenhain’s conception that diuresis is the first index of the circulating activity of the kidney. Hence in the presence of a polyuric syndrome it is necessary to take clinical cognizance of all the factors which regulate the renal circulation. Considering polyuria as inti- mately associated with direct alterations of the vessels and renal parenchyma, or of the circulation center, and confining the finding to so-ealled idiopathic polyuria, the etiologic factors involved may be thus summarized:
1. Alterations resulting in hypofunction of the pars inter- media of the hypophysis, 1. e., tumors, lesions, chronic inflam- mations such as tuberculosis.
2. Alterations of the endocrine glands and consecutive functional modifications of the vegetative nervous system (en- doerine-sympathetie dystrophia).
3. Alterations in the mid-brain especially involving the floor of the third ventricle and hence with great probability the center of origin of the fibers of the vagus and sympathetie.
4. Alterations involving the fibers of the vegetative system in the thoracie tract, i. e., aneurisms of the aorta, tumors of the mediastinum with compression of the vagus and sympa- thetic, or alterations involving the coeliae plexus.
In his elinieal study Moreschi reserves his judgment con- cerning the question of any clinical pathogenetic signs which polyuria may offer which would enable the particular factor or factors to which it was due to be differentiated. Certain cases which he mentions offer the possibility of differentiation, inasmuch as hypophyseal medication caused a reduction of diuresis without any alteration in the urinary concentration, while in the cases of other authors this is raised proportionate to the fall in diuresis. Moreschi says that the hypophyseal hormone of the posterior lobe is at the present time of great value in the symptomatic treatment of diabetes insipidus.
—Quoted.
DIABETES MELLITUS. A few simple methods of treatment. Katzoff (S. L.) Natl. Eclect. Med. Assn. Quart. (Cincinnati) 1918, 10, 153-157.
An interesting review of some of the more important data. Ineludes a somewhat extensive list of ‘‘permissible’’ and of ‘*forbidden’’ foods. Some unusual drugs are mentioned as valuable but no specific evidence of their efficacy is included.
RB. Go.
58 ABSTRACTS
DIABETES MELLITUS, Permeability vs. tolerance of the kid- neys for sugar in—Epstein (A. A.) Proc. Soe. a Biol. & Med. (N. Y.), 1916, 13, 150-152.
From a considerable body of technical data (summarized) it is concluded that renal permeability is constituted of two phases: (1) Negative or diminished permeability due to impair- ments of renal function; and (2) a positive phase due to in- creased tolerance of the kidney for sugar.—R. G. H.
DIABETES, Metabolism and treatment in. Allen (F. M.) and Du Bois (E. F.) Arch. Int. Med. (Chgo.) 1916, 17, 1010-1059.
Three patients with severe diabetes and three with mod- erate or mild diabetes were studied in the respiration calori- meter. The effects of oatmeal treatment and the fasting treat- ment were followed in detail. The authors summarize their work as follows: No special influence of oatmeal in diabetes or special readiness of oxidation of this form of carbohydrate was demonstrable. The respiratory exchange fails to account for all the carbohydrate that disappears. The behavior of the respiratory quotient showed no important difference on the first day and on the third day of the oatmeal treatment. The occurrence of ‘‘total’’ diabetes in human patients, with dex- trose-nitrogen ratios approximating 3.65 to 1 and correspond- ing respiratory quotients, 1s shown. Notwithstanding the ex- treme severity, neither the sugar excretion nor the gaseous ex- change gives ground for assuming the formation of sugar from fat In any instance.
Even in the severest type of diabetes the active symptoms may be eliminated by prolonged fasting. The observations in the respiration calorimeter prove that patients as a result of the fasting acquire the power of oxidizing sugar derived first from their own body protein and later from the protein and earbohydrate of a carefully regulated diet.
The respiratory quotients during fasting and after the gly- cosuria had ceased were in some instances higher than can be easily explained by the oxidation of the materials supposedly available. Also the ingestion of alcohol was sometimes fol- lowed by respiratory quotients higher than would theoretically be expected. The specific dynamic action of food, especially fat, was apparently normal in a patient with moderately se- vere diabetes. The results of two respiration experiments in a severely diabetic patient have shown that mild exercise slightly raises the quotient, and this suggests the possibility that exer- cise may Improve carbohydrate utilization.
ABSTRACTS D9
According to comparisons of the surface area as calculated by the linear formula, increase of the basal metabolism above the true normal level in severe diabetes is generally absent or slight. The metabolism was shown to fall during fasting, to 20 per cent below normal. The level of metabolism in diabetes is the resultant of a number of forces: for example, increased destruction of protein and perhaps other processes tending to increase metabolism, and undernutrition, muscular relaxation (as in prolonged confinement in bed) and other possible con- ditions tending to diminish metabolism. According as one or the other of these groups of forces predominate, a higher or lower metabolism may be expected in any individual case of diabetes.—L. G. K.
DIABETES, Mortality statistics of— among wage earners. Dubim (ir .), Med. Rec. (N. Y.), 1918, 94, 631-32.
An interesting statistical study based upon the data aceu- mulated by a large insurance company. An increase in the death rate since 1900 is reported.—R. G. H.
(DIABETES, MYXEDEMA, HYPOPITUITARISM) Studies in alimentary hyperglycemia and glycosuria. Bailey (C. V.) Proc. Soc. Exp. Biol. & Med. (N. Y.), 1916, 13, 153-155.
The effect of administering 30-90 ems. of glucose on an empty stomach was tested in various sorts of patients.
(a) Normal subject: The blood sugar increased rapidly for an hour, returned to normal in 214 hours, fell below normal and regained the normal level in 6 hours. Glycosuria at first paralleled hyperglycemia, then rose more rapidly to a concen- tration of 0.9 per cent then fell, reaching normal in 6 hours.
(b) Karly diabetes: Hyperglycemia was rapid, the high- est point being reached in one-half hour and the initial level being regained in 2 hours. The urine sugar was abnormally high and the return to normal, sluggish.
(ec) Diabetes with nephritis: Initial high blood sugar and low urine sugar were noted. The hyperglycemia appeared at a normal rate, but the return to the initial level was delayed to 414 to 6 hours. The urine sugar remained low.
(d) Myxedema and hypopituitarism: The initial blood and urine sugar values were normal. Alimentary hypergly- cemia was delayed and prolonged as in nephritis; kidney per- meability was greatly decreased.—R. G. H.
DIABETES, Observations on the starvation treatment of—. Martin (C. F.) and Mason (E. H.) Tr. Ass. Am. Physicians, 1916, 31, 444-453.
60 ABSTRACTS
Data published elsewhere. See Abst. Endoerin., 1917, 1, 529.
DIABETES of maximum severity with marked improvement. Geyelin (H. R.) Proc. Soc. Exp. Biol. & Med. (N. Y.), 1916, 13, 110.
A brief report of the case of a man of 19 with diabetes of six weeks’ duration, loss of weight, 50 pounds, and impending coma. The blood sugar was 0.312 per cent. Five days. fasting and three weeks alternating fasting and protein feeding caused disappearance of the glycosuria, but nitrogen loss varied from 25 to 38 gm. daily. For three consecutive days the D:N ration was over 3.65. Rapid recovery followed. In four months the patient tolerated a 2500-3000 calorie mixed diet, containing 100 ems. carbohydrate. The blood sugar fell below 0.10 per cent. During an infection (peritonsillar abcess) tolerance markedly dropped, but returned after subsidence of the infection.
—R. G. H.
(DIABETES) PANCREAS, The effect of coagulation of the— in situ. Auer (J.) and Kleiner (I. 8.) Proce. Soe. Exp. Biol. & Med. (N. Y.) 1917, 14, 251-253.
Experiments are recorded on 19 dogs. Strong alcohol (85-95 per cent) usually with 0.7 per cent acetic acid, was in- jected into the pancreatic duct, immediately destroying at least 95 per cent of the gland and abolishing the external secretion. A mixed diet was fed. In most cases neither glycosuria nor hyper-glycemia appeared. Six of the dogs lived four weeks or longer. Two developed diabetes, one, with pancreatitis, dying and one recovering. None of the dogs showed polyuria and acetone was seen only exceptionally. The experiments were to be continued.—R. G. H.
(DIABETES PANCREAS) Erganzungsnahrstoffen. II. ther specifische antidiabetische Stoffe (Anti-diabetic substance). Boruttau (H.) Biochem. Ztschr., 1918, 88, 420-31.
The glycogen consumption in the perfused isolated heart and the glycogen disappearance post-mortem is greater in car- nivora than in herbivora. In the latter the addition of pan- creatic extract or of extracts of yeast or oats to the perfusion fluid (Locke’s) depresses the consumption of glycogen. An extract from the outer portion of oat grains diminishes the sugar excretion in cases of human diabetes and pancreatic dia- betes (dogs) and is therefore regarded as containing ‘‘a spe- cific antiglycosuric substanece.’’—Physiol. Abst., 3, 435.
ABSTRACTS 61
DIABETES, Remarks on the Allen treatment of—. Nesbitt (G. E.), Med. Press & Cire. (Lond.), 1916, 102, 580-82.
No new data are offered —R. G. H.
DIABETES, Starvation and diet in. Wilkinson (J. F.) Med. J. Australia (Sydney), 1916, 2, 335-341.
The author favors the Allen method of treatment, imitiated by purgation. A dietary for 15 days and a classification of vegetables as to carbohydrate content is included.—R. G. H.
(DIABETES) SYPHILIS of the PANCREAS, with reference to the coincidence of syphilitic pancreatitis and diabetes. Warthin (A. S.) Tr. Ass. Am. Physicians, 1916, 31, 387-393. (Preliminary report.)
Contrary to the usual text-book statement, syphilis of the pancreas is very common. Warthin found the pancreas more or less affected in every one of 150 cases of latent syphilis. De- tailed study was made of the pancreas in six cases of syphilitic diabetes. There were found, in all instances, atrophy with fatty infiltration, increase of inter- and intra-lobular stroma, inflamatory infiltrations, marked diminution of the islands of Langerhans, they being replaced by irregular masses of fibrous tissue, and changes in the acini. Usually these were larger than normal. Structures looking like newly formed island of Langerhans were often seen, but these proved to be newly formed acini arising from the ducts. Similar changes were observed in syphilities who did not have diabetes. The author suggests that associated changes in the liver, adrenals, hypo- physis, ete., may be necessary to produce the diabetic phenom-
ena.—kh. G. H.
(DIABETES) The effect of exercise on the blood sugar of de- pancreatized dogs. Mackenzie (G. M.) Proce. Soe. Exp. Biol. & Med. (N. Y.), 1916, 13, 130.
Blood sugar curves of dogs made to run on the treadmill one to four days after extirpation of the pancreas showed:
1. After 20-30 minutes exereise, dogs having been fed 200 ems. bread and meat daily, a marked fall in blood sugar oc- eurred. 2. In starved animals similar exercise caused a rise in the sugar. It was concluded that even after complete loss of the pancreas some power of consuming sugar remains and that there is a difference in the utilization of sugar depending upon whether it is derived from tissue proteins or directly from
food.—R. G. H.
62 ABSTRACTS
(DIABETES) The control of acidosis and its relation to im- paired sugar metabolism in human diabetes. Underhill (F. P.) Proc. Soc. Exp. Biol. & Med. (N. Y.), 1916, 13, 111-113:
Various studies indicate that acidosis as such is an impor- tant factor in causing loss of sugar in diabetes mellitus. Un- derhill undertook, therefore, to keep a diabetic continuously supplied with enough sodium bicarbonate to neutralize all exo- genous and endogenous acid.
A man of 26 was excreting 151 gms. of dextrose daily. After a year of stringently restricted diet the sugar was re- duced to 25-30 gms., but considerable quantities of acetone and diacetie acid remained. The sugar output suddenly rose to 70-80 gms. daily. Under gradually increasing doses of soda to 120 gms. a day the urine became sugar free. The soda was then gradually reduced to 42 gms. and continued at that level. During the next 17 days no sugar was exereted, although the earbohydrate was gradually raised to 10 gms. more than that of the previous diet.—R. G. H.
(DIABETES) The influence of alkali upon the glycosuria, hyperglycemia and carbon dixode combining power in hu- man diabetes. Murlin (J. R.), Craver (lL. F.) et al., Proe. Soc. Exp. Biol. & Med. (N. Y.), 1916, 14, 8-9.
A brief report. A critical study of several cases kept un- der perfect dietary control in the metabolism ward of the Sage Institute of Pathology in Bellevue Hospital, New York, showed that 1 per cent sodium bicarbonate administered by duodenal tube often very materially reduces the glycosuria and may likewise affect the hyperglycemia.—R. G. H.
(DIABETES) Traitment dietetique du diabete sucre. Juilly (G) Clinique (Montreal) 1916, 6, 212-216.
A brief discussion of some of the practical aspects of the dietary treatment of diabetes.—R. G. H.
DIABETES, War diet and. Klemperer (G.) Therap. d Gegenw. (Berlin u. Wien) 1918, N. F., 80, 81-6. Richter (P. F.) Ibid., 113-16.
Further observations appear to show that benefit, when noticeable, is seen in mild eases only. Richter notes that gouty cases were aggravated, and that obese cases did well. The good influence of the diet is attributed to decomposition of the war bread, the products of which are more easily utilized than glu- cose, and to increased alkalinity of the body fluids due to ex- cess of vegetables——Physiol. Abst., 1918, 3, 379.
ABSTRACTS 63
(DIGESTIVE ORGANS) The internal secretions of digestion. Cobb (I. G.), Med. Press & Cire. (Lond.), 1916, 102, 360-363.
.A brief review of the physiology of gastrin and secretin together with some dubious data on the value of liver extracts and ‘‘neo-hormonal.’’—R. G. H.
(ENDOCRINE GLANDS, BLOOD SUGAR) Alimentary hyper- glycemia and glucosuria as a test of sugar tolerance. Ham- man (L.) and Hirschman (I. I.) Tr. Ass. Am. Physicians, 1916, 31, 355-364.
Well informed students now are aware that changes in the blood sugar afford a much better criterion of the progress of diabetes and possibly of some other endocrine diseases than do degrees of glycosuria. Hamman and Hirschman summarize the results of sugar tests in ten patients having diabetes, six having nephritis, five, ‘‘hyperthyroidism’’ and two with overfunction of the hypophysis. It was found that there are in general two types of reaction to the injection of glucose: (a) normal, in which there is a slight or moderate hyperglycémia that rapidly subsides; (b) the diabetic reaction in which the hyperglycemia is higher and more prolonged. The occurrence and extent of glycosuria depends upon two factors: the degree of hyper- glycemia and of renal permeability. The normal renal threshold is between 0.17 and 0.18 per cent of blood sugar concentration. In some normal persons and. commonly in diabetics the threshold is low. In many eases of nephritis and frequently in diabetics the threshold is high. In general, the disturbance of glucose utilization was found essentially the same in diabetes and in other conditions with low sugar tolerance, such as de- ranged thyroid and hypophyseal function and with nephritis.
Ry G. H.
(ENDOCR. GLANDS) Endocrincpathic inheritance. Timme (W) J. Am. M. Assn. (Chgo.), 1916, 67, 65.
A defense of a previous paper, abstracted Endocrin. 1917, ii.
(ENDOCRINE GLANDS) Glandes endocrines et dystrophies osseuses (Endocrine glands and osseous dystrophy). Hutinel, Archiv. de Méd. des Enfants (Paris) 1918, 21, 505, 561.
The author lays stress on the probability of bone marrow being, like all other active tissues, under the influence if not actual control of the endocrine congeries. He argues that the period of life in which osteogenesis is most readily influenced
64 ABSTRACTS
is in the first two years of life and also at the period of ado- lescence, and that the pediatrician should always bear in mind the probable close relationship of disturbances of growth, nu- trition, and mental development to uni- or pluri-glandular’ ab- normality.—A. L. T.
(ENDOCRINE GLANDS) Obesity of glandular origin. Anon. Monde Méd. (Eng. Edition) (Paris) 1918, 28, 83-86.
A general discussion of the etiology and manifestations of genital, thyroid, pituitary, pineal and adrenal obesity. Not amenable to abstracting.—R. G. H.
(ENDOCRINE GLANDS) Total absence of eyebrows and eye- lashes. Shoemaker (J. F.) Am. J. Ophth., 1916, 33, 97-104.
Reports a patient who lost his eyebrows and eyelashes at the age of six, following an attack of measles. The author. be- lieves the condition due to a deficiency of the internal secre- tions.—L. F. W.
(ENDOCRINE ORGANS) The eye and the endocrine organs. Zentmayer (W.) Jour, Am. M. Assn. (Chgo.), 1917, 69, 1.
A paper of clinical interest relative to endocrine organs and diseases of the eye.—H. W.
(GONADS) A description of a case of false hermaphroditism. Jordan (H. E.) Anat. Ree. (Phila.) 1918, 15, 27-37.
The subject had well-developed mammary glands, vestigial scrotum and hands, hips, thighs, and legs of female configura- tion. The penis was about two-thirds the average length, the greater part being internal. Two undescended testicles were found, external to the internal ring. The ease is apparently one of arrested male development with female secondary sexual characters superimposed upon a male structure. Other anom- alies (polydactylism, clubbed feet, feeble-mindedness) were present. Sexual desire was absent. The glands microscopically were atrophic. In many regions the seminiferous tubules were solidified into cords, and where tubules were still distinguish- able their walls had undergone degenerative changes, No typical stages of spermatogenesis were found, merely a few cells, supposedly abnormal spermatogonia. The interstitial cells were few and abnormal in appearance, to which condition the author attributes the absence of libido. The conclusion that it is the degeneration of the interstitial cells, rather than
ABSTRACTS 65
of the spermatogenic tissue, that causes the absence of sexual desire is supported by the evidence from infertile hybrids and eryptorchid individuals. In these, spermatogenesis is incom- plete, but the interstitial cells of the testes are normal and sexual desire is present.—M. M. H.
(GONADS) Etude sperimentali sulla castrazione. La respira- ' gione dei tessuti in rapporto alla castrazione (Experimental studies on castration and tissue respiration). Agnoletti (G.) La elinica veterinaria (Milan) 1916, reprint, pp. 8.
The tissues of castrated animals produce considerably less CO, than normal. The difference is more marked in the liver than in the muscles, and is considered to be connected with the adiposity of castrated animals. A detailed paper is promised.— Physiol. Abst., 1918, 3, 375.
(GONADS) Le conditionment physiologique des caracters sexules secondaires chez les oiseaux. Pézard (A.) Thése de Pas 1918, pp. 176.
Castration, cross grafting and injection experiments with testicular extracts were made upon Orpington fowls and golden and silver pheasants. Castration in the young male prevented the development of the comb and other erectile tissues as well as the sex instincts and the tendency to crow. The plumage and the growth of the spurs were not affected. The same operation in adults had no effect upon plumage or spurs; the erectile tissues, however, began at once to regress and a few days later the sex instincts and crowing tendency disappeared. The transplantation of viable testicular tissue caused a reversal of these effects. The results appeared only after several weeks. Partial effects were not seen; if a sub- minimal quantity of tissue was introduced no results were ob- tained ; if more than this quantity, (about 0.5 gm.) the reversal was complete. Similar results were obtained by the injection of aqueous extracts of pig testes.
The internal secretion was recognized histologically in some cases by the appearance in the testes of cells laden with lipoids and pigments. These were found particularly abundant in the interstitial cells of young golden pheasants. In adult Orpingtons, as well as golden pheasants, however, interstitial cells were not demonstrable even during the period of greatest sexual activity, hence it was concluded that the endocrine fune- tion is shared by other testicular cells. (For extensive diseus- sion of the literature on this subject see Rasmussen, this jour- nal, 1918, 2, 353-404.
66 ABSTRACTS
Castration in the female caused an immediate development of spurs and, after a few months, a transformation of the plumage to the male type. Spurs and male plumage are there- fore potential attributes of both sexes, the development of which is inhibited by ovarian hormones. Castration followed by cross grafting such as has been reported by Steimach, was only partially successful in reversing sex stigmata. Pézard succeeded by this means, however, in preventing a growth of spurs in the male and in causing a rapid growth of the comb in the female, results amounting in effect to gynandromorph- ism. (See Goldschmidt (R.), this journal, 1917, 1, 433-456.)
The exaggerated development of adipose tissue after cas- tration was also investigated. The glycogen of the muscle was diminished while that of the liver was at least normal in quan- tity. A theory is offered that the fat accumulates because in the absence of a testicular hormone, its ‘‘mobilization’’ cannot take place. In this connection the hormone is thought to act on the liver.
The conception is developed that the growth processes represent an approach to a complex of stable equalibria and that the reactions involved are catalyzed by hormones—par- ticularly that of the testis.
A bibliography of 80.titles is included.—R. G. H.
(GONADS) Loi numérique de la régression des organes érect- iles, consécutive a la castration postpubérale, chez les Galli- nacés, Pézard (A.) C. r. Soe. d. Biol. (Paris) 1917, 164, 734- 736.
A mathematical formula is deduced to express the rate of regression of the comb of the cock after castration. The “‘law’’
is based apparently upon three cases.—R. G. H.
(GONADS). On abnormal sexual characters in twin goats. Rickards (E.) and Jones (F. W.) Jour. Anat. (London) 1918, 52, 265-276.
A brief deseription of the genital organs of two hema- phroditic kids with secondary sex characters of both the male and female types. The authors claim to have disproven Lillie’s theory of the cause of free-martin production, but the latter used the term free-martin with a meaning somewhat different from that of the present writers.—E. R. H.
(GONADS) The morphology of the mammalian seminiferous tubule. Curtis (G. M.), Am. Jour. Anat. (Phila.), 1918, 24, 339-394.
ABSTRACTS 67
Tubules were isolated by teasing and by reconstruction methods from testes of the mouse, rabbit, and dog. They showed no blind ends or ampullae. Each tubule is in the form of a single or linked arch. Branchings and anastomoses are found, especially in the dog and rabbit. The spermatogenie waves were studied in detail. They vary in length, continuity, and direction. They may reverse in their course, or show regions of single phases out of order. The general course of the waves in the mouse is descending from the rete; in the rabbit it is irregular. The study is reported in great detail.
—M. M. H.
(GONADS) The reproductive organs of Cetacea. Meek (A.) Jour. Anat. (London) 1918, 52, 186-211.
A description of the anatomy of the genital organs of the whale, dolphin and porpoise, both adult and foetal.—E. R. H.
(GONADS) The sexual organs and their internal secretions. Cobb (1. G.) Med. Press & Cire. (Lond.) 1916, 102, 295-298.
A brief review.
(HORMONES) Cancer, a disease of deficiency. Round (,.) Med. Ree. (N. Y.), 1918, 94, 184-191.
The author believes that hormone and vitamine deficiency are important factors in the etiology of cancer. Thyroid medi- cation is stated to be valuable as a palliative measure. Much specific evidence would be required to substantiate the conclu- sions reported.—R. G. H.
HORMONES, The therapeutic application of—. Cobb (I. G.) Med. Press & Cire. (Lond.), 1916, 102, 488-91.
An attempt to present briefly the indications for the use of a variety of gland products, several of which, in the opinion of most therapeutists, are useless.—R. G. H.
(HORMONES) The treatment of mental defectives through physical and medical measures. McCready (KE. B.) Med. Ree. (N. Y.) 1918, 94, 809-11.
A general discussion. The author uses a mixture of pitu- itary, thymus, thyroid, adrenal and either ovarian and mam- mary or testicular substance as general physiological stimu- lants. No definite evidence as to their value is offered.
—R. G. H.
68 ABSTRACTS
(HYPOPHYSIS) A case of unilateral optic atrophy, the sole symptom of a pituitary growth. Kraus (F.) Ophth. Ree. (Chgo.) 1916, 25, 68-76.
This report is especially interesting in that the perimeter and retinoscope findings are recorded for a period of eight months. <A sellar decompression operation was performed, the patient dying of a secondary purulent meningitis.—R. G. H.
(HYPOPHYSIS) ACROMEGALY of the larynx. Jackson (C.) Jour. Am. M. Assn. (Chgo.) 1918, 71, 1787-89.
The author ealls attention to the fact which has hitherto received little attention that the cartilages of the larynx may share in the overgrowth of head structures in acromegaly. The anatomical changes may produce stenosis sufficient to require tracheotomy to prevent asphyxia. Four cases are reported with illustrations. In three of these the laryngeal mucosa was nor- mal and the chronic laryngitis present in the fourth was prob- ably a coincidence merely. In all cases, Jackson believes, hy- perplasia of the larynx should lead to careful examination for other stigmata of acromegaly. Also to insure accumulation of data laryngeal examinations should become a regular part of the routine examination in acromegaly.—R. G. H.
(HYPOPHYSIS) ACROMEGALY, A case of, with mediastinal tumor. Inglis (J.) Colorado Med. (Denver) 1916, 13, 92.
A very brief report. Atrophy of the testes was noted. —R. G. H.
(HYPOPHYSIS) A study of the lipin-content of the liver in two cases of pituitary dystrophy. (Preliminary report.) Warthin (A. 8.) Proc. Soe. Exp. Biol. & Med. (N. Y.), 1916, 14, 42-44.
An interesting morphological and micro-chemical study of the distribution and character of the ‘‘fat’’ in pituitary dys- trophy. Evidence was seen not only in the liver but also in the adrenals, panniculi, aorta, spleen, ete., that in this disease there is an abnormal lipin metabolism. Cholestrin infiltration or retention occurs similar to that obtained by overfeeding with cholesterol and to the lpoidosis of diabetes and of Gaucher’s disease.
The liver showed also a peculiar intraperipheral zonal necrosis associated with fibroblastic proliferation, giving a pic- ture of an early intralobular cirrhosis.—R. G. H.
ABSTRACTS 69
(HYPOPHYSIS) A study of one hundred selected cases of pituitary diseases. Abrahamson (I.) and Climenko (H.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 281.
The authors conclude that the secretion of the pituitary gland does not influence sugar metabolism but does control the salt content and hence the electrical conductivity of the blood. Diseases of the posterior or intermediate portions of the gland disturb the fixed ratio of the salt content of the blood and lead to polyuria, if there is renal sufficiency, or to a waterlogging of the tissues, if there is renal insufficiency. Sugar tolerance is regarded as not affording a valid criterion of pituitary dis- ease —H. W.
HYPOPHYSIS afwijkingen bij huisdieren. (Diseases of the hypophysis in domestic animals.) Vermeulen (H. A.) Nederl. Tijdschr. v. Geneesk (Haarlem), 1918, 62, (11), 1130.
Description of a horse which was extremely somnolent, but with no other symptoms. At post mortem a tumor consisting of eosinophil cells of the pituitary was found. A tumor of the hypophysis was also found by the author in a goat with herma- phroditismus verus bilateralis.—J. K.
Hypophysis cerebri and its morphological influence. Lewis (F. P.) Laryngoscope, 1918, 28, 604. Abst. Surg. Gyn. & Obst., 1918, 27, 464.
The author formulates the principle that the hypophysis normally exercises a control over skeletal and muscular strue- tures—in fact, of all tissues having an epiblastic or mesoblastic origin. The effect of hypo- and hyper-pituitarism on bony structures is traced. One portion of the pituitary may show signs of increased activity and another part diminished fune- tioning. These effects should be noted in the eye as well as other organs. Two cases are cited.—R. G. H.
HYPOPHYSIS cerebri, Case of subsidence through radiother- apy of a neoplasm in the region of the. Williams (T .A.) Wash. Med. Assn. 1916, 15, 103-4.
A very brief case report. HYPOPHYSIS cerebri, The development of the—of the rabbit.
(Doctorate thesis) Atwell (W. J.) Am. Jour. Anat. (Phila.), 1918, 24, 271-337.
A report of a detailed study throughout embryonic and fetal life. An elaborate series of wax reconstructions was
70 ABSTRACTS
made. For numerous technical details the original should be consulted. It was found that the recently described pars tuberalis constitutes a portion embryologically and _ histolog- ically distinct from the rest of the hypophysis. See also ab- stracts of other papers by Atwell in Endocrin. 1918, 2, 174, and in current number.—R. G. H.
(HYPOPHYSIS) Contribucion a la cirugia de la hipdfisis. (Surgery of the h.) Actas Jer Congr. Nac. de Med., (Bs. Aires), 1916, 3, 299.
Of technical interest.
(HYPOPHYSIS) Contribucion clinica y experimental al estudio de la accién de la hipofisis sobre la diuresis. (Clinical and experimental study of the relation of the hypophysis to diuresis). Marafion (G.) and Rosique (A.) Treb. de la Soe. Biol. (Barcelona), 1917, 19, 126.
The clinical record is of great interest. A boy who re- ceived an accidental bullet wound in the mid-frontal region showed no nervous or psychic changes. Later he showed all the signs of Fréhlich’s syndrome—dystrophia adiposo-genitalis —together with profuse diabetes insipidus. No treatment af- fected the diabetes, except injections of pituitrin, which were brilliantly suecessful, the urine being reduced from 9 litres to less than 1 litre per diem. An attempt to remove the bullet from the interior of the skull proved fatal. Post mortem the bullet was found in the region of the infundibulum, the stalk of the pituitary body being interrupted by the cicatricial tissue formed around the bullet. The pituitary body itself was quite unharmed. The authors maintain that this occurrence of dia- betes insipidus, as the result of blocking of the canal in the stalk of the infundibulum, and its relief by injection of pitu- itary (post-lobe) extract, shows that the true funetion of the pituitary hormone is to restrain the tendeney of the kidney to excessive elimination of water; and that, as Cushing supposed, the hormone is largely secreted by way of the infundibulum. They discuss Schafer’s demonstration of the diuretic action of pituitary extract. Their attempt to explain it away is not com- pletely successful.—Physiol. Abst, 3, 527.
HYPOPHYSIS, Development of the—in anura. Atwell (W. J.) “Anat. Rec. (Phila.), 1918, 15, 73-92.
Recent studies have shown that in addition to the anterior lobe proper and the pars intermedia of the hypophysis which are commonly recognized, a third entity of epithelial nature,
ABSTRACTS 71
the pars tuberalis, occurs in mammals and birds. Atwell has found that this latter structure occurs in amphibia also (toads and frogs). It is characterized by its paired origin, its laminar structure and by its adult location in the pia mater covering the tuber cinereum of the brain floor.—R. G. H.
(HYPOPHYSIS) DYSTROPHY ADIPOSOGENITALIS, Fat redistribution in the hypophyseal type of—. Beck (H. G.) Am. J. Med. Se. (Phila.) 1918, 156, 711-720.
““The function of the pituitary, like that of the thyroid, presides largely over growth, development and metabolism. The gonads also have an important influence over growth and development, but perhaps somewhat less over metabolism. There is a close reciprocal function between these three glands as observed clinically and demonstrated experimentally. True hypophyseal fat dystrophies are rather rare. Mixed or pluri- glandular types are quite common. Hypothyroidism, hypo- pituitarism and hypogonadism are all sometimes found in the same individual, but the character of the dystrophy varies, de- pending upon the relative insufficiency of the respective glands. Primary genital dystrophy is relatively infrequent, and when present usually early becomes a mixed type, in which hypo- physeal symptoms predominate.”’
In a large series of cases of -hypothyroidism studied by Beck, fully twenty per cent showed evidence of hypophyseal fat dystrophy and practically all the female patients, nearly the whole group, gave evidence of ovarian deficiency. The fat dystrophies of pituitary origin are supposedly due to hypo- secretion of the posterior lobe. The most usual type is dys- trophy adiposogenitalis, Frélich. The pathogenesis of adiposis dolorosa has not been definitely established, although it is prob- ably a pluriglandular defect in which the posterior lobe in a large measure shares. The adiposity frequently associated with acromegaly is thought to be due to secondary involvement of the posterior lobe. Four cases of hypophyseal dystrophy are described.
CASEI. A woman aged 41 years, height 5 feet 3 inches. weight 125 pounds; good health until eighteen months pre- viously, when menstruation became irregular and diminished to complete cessation. During ten months preceding examina- tion weight had increased about twenty pounds. The distribu- tion of the increased tissue was peculiar. The circumference of the hips, upper thighs, and abdomen was remarkably in- creased, while that of the upper part of the body and feet and legs had the appearance of under-nourishment. The result was a striking abnormality in the configuration of the body. In
12 ABSTRACTS
addition apathy, impaired memory, sluggish mental functions, and trophic disturbances of the skin and hair were noted. The patient was a confirmed invalid. Beck recognizes three symp- tom groups in this case; those referable to ovarian insufficiency, sterility and amenorrhea; those referable to pituitary insuf- ficiency, that is, the distribution of fat; and those referable to thyroid insufficiency. Hormotone, which contains the sub- stance of the three glands involved was prescribed, four tablets daily, and in addition two grains of thyroid. The results were strikingly successful, the symptoms in general being alleviated, and the peculiar distribution of the fat was rapidly changed.
March 1, two weeks before treatment, waist measure 30 inches, hips 43 inches ;
May 8, after eight weeks treatment, waist 26 inches, hips 3614 inches;
May 31, after eleven weeks treatment, waist 25 inches, hips 35 inches.
The hormotone treatment was continued until July 15. During two years since there has been no return of symptoms and the normal figure is retained.
CASE II. A woman 49 years old, married, weighs 148 pounds; health was good until one year previous to examina- tion. Pains in the back, polyuria, headaches, emotional dis- turbances, mental depression, ete., appeared. Menstrual his- tory normal, but never pregnant. Her figure was strikingly abnormal, the body from the waist down being relatively twice as large as from the waist up—the measurements of the waist and hip being 6914 em. and 113 em. respectively. After treat- ment with hormotone and anterior lobe pituitary, 244 pounds was lost, and the patient had to have her skirts reduced around the hips three times; her general condition was much improved.
CASE ITI. Woman, age 42 years, weight 118 pounds, had during the previous year developed symptoms of hypothyroid- ism—mental dullness, loss of memory, somnolence, sub-normal temperature, profound exhaustion, ete. Recently noticed fat accumulation about hips and upper thighs and lower abdomen so that the typical picture of dystrophy adiposogenitalis was presented. Thyroid and anterior lobe pituitary were admin- istered. The redistribution of the fat followed as in the pre- vious case, although the patient gained six pounds in weight.
CASE IV. A woman, aged 24 years, when married, three and a half years ago, weighed 145 pounds. Since the birth of her child, two and half years ago, her weight had increased rapidly until she weighed 206 pounds. There is no obesity in the family. She had well-marked symptoms of hypothyroidism such as mental dullness, neuromuscular pains, Murray’s hal-
ABSTRACTS 73
jucination, crunching joints, vesical irritability, ete., although the adiposity was not characteristic and the hair was oily, the skin moist and the fingers tapering. There was a relative in- erease in the deposition of fat on the left side, which could be readily discerned by inspection. There were cushions of fat over the upper dorsal region, extending over the shoulders ; the breasts were large and pendulous, the left one larger than the right. There was a transverse cushion at the sulcus, formed by the umbilicus, and another at the ilium, which formed an apron, and still another between the umbilicus and the groin. Mensuration showed a hemidystrophy of fat, the left side being the larger. Unfortunately this patient did not follow out any treatment. However, another patient of this type, treated since, showed a definite tendency of the two sides to equalize. At the same time the umbilical and hip measurements decreased and the waist and axillary increased.
These cases strikingly demonstrate the fact that in hypo- physeal dystrophy the fat may be actually redistributed and the only exact means of determining the effect of treatment is by systematically recording measurements of different parts of the body rather than depending upon changes in weight.
—R. G. H.
(HYPOPHYSIS) DISPITUITARISM(?) The ‘‘pudding face’’ type of—Fearnsides (E. G.), Proce. Roy. Soc. Med. (Lond.) Neurol. See., 1916, 9, 69-71.
The ease is one of precocious obesity and marked hirsutes in a girl of 18. The absence of the classic stigmata of dyspitu- itarism and the hirsutes suggest the presence of hyperne-
phroma.—R. G. H.
(HYPOPHYSIS) Distocia anular y extracto hypofisiario. (An- nular dystocia and hypophyseal extract). Colistro (C. P.) and Platero (H. F.), Rev. Méd. d. Uruguay, Dic. 1917, 20, 753.
Hypophyseal extract may aggravate or initiate hourglass contraction of the uterus. The authors protest against the abuse of this substance and its use by mid-wives.—B. A. I.
(HYPOPHYSIS) Hypophyse y poliuria. Houssay (1B. A.) and Romafia (L.) Actas ler Congr. Nac. de Med. (Bs. Aires), 1916, 4, 69.
So-called hypophyseal polyuria has a cerebral origin. See Endocrin. 1918, 2, 94-97.—B. A. H.
74 ABSTRACTS
(HYPOPHYSIS) Hypophyseal disorder in mammary cancer and its relation to diabetes insipidus. Sekiguchi (S.) Ann. of Surg., 1916, 63, 297.
Sekiguchi reports in detail the clinical and autopsy find- ings in 35 cases of mammary cancer associated with polyuria. Two cases showed definite pathologie changes in the hypo- physis, consisting of dilated acini in the pars intermedia which were filled with collodal masses and a cancer metastasis of the pars posterior. There were no changes reported in the pars anterior, pancreas or kidney. Sekiguchi suggested that the metastatic tumor mass in the pars posterior compressed the pars intermedia leading to a hypersecretory function which in turn stimulated the epithelium of the kidneys to overproduc- tion of urme.—C. MeP.
(HYPOPHYSIS) Hypopituitarism, dystrophia adiposo-geni- talis, polyuria and polydipsia, etc. Fearnsides (E. G.), Proe. Roy. Soe. Med. (Lond.), Neurol. See., 1916, 9, 50-54.
A detailed description of a case. Other outstanding fea- tures were bilateral cortico-spinal interference, optic neuritis and ptosis on the left side, normal sella tureica and positive Wasserman reaction.—R. G. H.
(HYPOPHYSIS) La poliuria hipofisiria. Houssay (B. A.), Rev. Asoc. Med. Argent. (Bs. Aires), 1916, 23, 510-512.
see Endocrin. 1917, 1, 393; 1918, 2, 94-97.
(HYPOPHYSIS) Lesioni sperimentali dell’ ipofisi (Experi-
mental hypophyseal lesions). Chiasserini (A.) Policlin. (Rome) 1918, 25, sez. chir., 97. Abst. Surg. Gyn. & Obst. 1918, 27, 298.
The author found that the injection of sporotrichia and tubercle bacilli into the sella turcica or into the hypophysis re- sulted in variable modifications in the structure of the different parts of the hypophysis. Complete sclerosis or hyperplastic changes usually involving the pars intermedia might occur, but in one case this was seen in the pars anterior. The first were observed when the inoculation was made directly fol- lowing mechanical injury of the hypophysis; the second type resulted from inoculation without previous lesion. The ana- tomic lesions limited to reduction or total replacement of the glandular tissues resulted in a syndrome of cachexia, or hypo- physeal asthenia. Similar results were obtained when the glandular secretion was prevented from reaching the cireula-
ABSTRACTS | 75
tion by detachment of the pedicle or by pressure. This syn- drome begins after some days and progresses rapidly. When the glandular deficit is acute death oceurs rather suddenly in two to six days.
Hyperplastice changes in the pars intermedia result in poly- uria which is sometimes very notable. Thickening of the skin and bony changes resembling those of acromegalia correspond to changes in the pars anterior. Swelling of the gland with mechanical pressure of medium grade did not itself cause any
special symptoms except, in some eases, disturbances of vision. eG med
(HYPOPHYSIS) L’ipofisi in rapporto all’ aumentata diuresi ed al cosidetto diabeto insipido della gravidanza. (The rela- tions of the hypophysis to increased diuresis and to the so- called diabetes insipidus of pregnancy.) Gentili (A.) Ann. di ostet. e ginec., (Milan) 1917, 41, 173. Abst. Surg. Gyn. & Obst. 1918, 27, 328.
The author deseribes the case of a para-V aged forty years who was in good health in spite of having had attacks of ma- laria and pneumonia. The gynecological history showed one febrile puerperium and two others with delayed recovery. In her last pregnancy from the sixth month there was marked polyuria (5,000 to 6,000 gm. of urine in twenty-four hours) of low density but not containing abnormal constituents; alse polydipsia, weariness, insomnia, and abundant metrorrhagia. From the seventh month there were signs of osteomalacia with a beginning skeletal deformation. The general state steadily declined, with loss of weight, persistence of the polyuria, and accompanying phenomena notwithstanding attempts at treat- ment with hypophyseal extract which only effected a tem- porary improvement. Labor was induced at the end of the eighth month by the Krause method, a slight inertia during the expulsive period being overcome by pituitrin injection. The foetus was alive and the postpartum period normal. The poly- uria gradually diminished to about one liter of urine in the twenty-four hours, being normal in density. The osteomalacia also gradually diminished.
The author discusses the case at length, quoting opinions expressed by various authors on the subject. He concludes that the syndrome described, especially the form of the so- called diabetes insipidus of pregnancy, has its origin in fune- tional disturbances principally in the hypophysis. As it has been clinically demonstrated there is a direct or indirect rela- tion between the phenomena of diabetes insipidus, apart from pregnancy, and alterations of the hypophysis, it is reasonable
76 ABSTRACTS
to regard the forms of diabetes insipidus manifested during pregnaney and ceasing with parturition as due to an exaggera- tion of the well known anatomie and functional alterations of the gland in maternity. During pregnancy the hypophysis, owing to great functional adaptability, transforms cells of the anterior lobe into well differentiated elements. This answers perhaps to the call for new hormones to meet changed condi- tions in the organism. The differentiated cells disappear or become reduced when sueh new needs have ceased. But by such action the endocrine relations of the anterior lobe with other parts of the hypophysis and other glands of the same group are probably changed. The relative insufficiency of the posterior hypophyseal lobe is almost normal in pregnancy; it causes urinary modifications during this period and it is more marked in the last period of gestation and in multiparae. If this insufficiency is accentuated by pre-existing modifications in the hypophysis, by preceding alterations in the endocrine inter- relationship, there may oceur during pregnancy a true diabetes insipidus which will cease after birth, though perhaps giving phenomena at recurrent menstrual periods. In the same way may be explained the accentuation of pre-existing polyuria dur- ing pregnancy and the return to normal condition in the puer- perium. :
The cause of this polyuria being known and the accom- panying polydipsia arising during pregnancy and ceasing after- ward, it should be removed from the group of idiopathic forms and classed under the name of polyuria diabetes insipidus of pregnancy.—Quoted.
(HYPOPHYSIS) On the nature of the pigmentation changes following hypophysectomy in the frog larva. Atwell (W. J.) Science (N. Y.) 1919, n. s., 49, 48-50.
It has been shown by other investigators that removal of the hypophysis fundament from the young larval frog is fol- lowed by a marked change in pigmentation. Within ten days after the operation the color of the tadpole changes from black to silvery. This has been attributed to a loss of pigment gran- ules by one authority, while another thinks it is caused by con- traction of pigment cells. Atwell removed the hypophysis at a stage just preceding the appearance of muscular activity. These silvery tadpoles were immersed in a dilute extract of pars intermedia of beef pituitary. As a result they became dark in eolor closely resembling the normal tadpoles. When re- turned to fresh water the silvery color again appeared. It was concluded that the change in color due to hypophysectomy was due primarily to contraction of melanophors.—F. A. H.
ABSTRACTS 17
HYPOPHYSIS, On the role of the, in Graves’ disease (Ueber die Rolle der Hypophyse beim Morbus Bosedowii). Hof- statter (R.) Mitt. a. d. Grenzgeb. d. Med. u. Chir. (Jena), 1918, 31, 102.
Nothing new. A good example of how to write a long article when you have nothing to tell.—J. K.
HYPOPHYSIS, Optic nerve atrophy, and Roentgen rays. Darier (A.) Am. J. Ophth. (St. Louis) 1916, 33, 144-152. (Clingue Ophthalmologique, March, 1916.)
Three eases are deseribed in which symptoms due _ to hypophyseal neoplasms were materially benefited by X-ray treatment. Darter believes that after the exclusion of syphilis as a cause, this method should always be resorted to before surgery. Early diagnosis and treatment are important; if the disease has reached the destructive stage further destructive measures are useless. The application is best made over the temporal bone using a 1 mm. aluminum filter.—R. G. H.
(HYPOPHYSIS) Pituitary body and polyuria. Houssay (B. A.) Endocrin. 1918, 2, 94-97.
Errata: P. 94, 1. 27—For ‘‘metalic salts’’ read methyl aleohol. P. 95,1. 30. Omit ‘‘the diuretic action and not even.”’
(HYPOPHYSIS, POLYURIA) Le sindromi ipofisarie larvate (Hypophyseal syndromes). Pincherle (M.) Riv. Clin. pediat. (Firenze) 1918, ...., 281, 337.
Three cases of diabetes insipidus with enormous polydipsia and polyuria treated with pituitrin are reported.
A. Sella turcica 6x4.5x6.5 mm.; urine reduced from 11 to 4 liters; bodily development augmented.
B. Sella 3x9.5x7 mm.; urine reduced from 9-11 to 6 Liters; marked physical and mental improvement.
C. Sella 1.5x4x3.5 mm. The polyuria began during a con- valescence, with paralysis of leg. The patient drank about 15 liters daily. The treatment reduced the polyuria from 7-11 to 2.5 liters.
In a fourth case with normal sella turcica, pituitrin treat- ment gave entire relief from polydipsia and polyuria. Forced lordosis caused albuminuria in each case. In each instance a favorable influence was shown by the pituitrin on temperature as well as physical and mental conditions.—G. V.
78 ABSTRACTS
HYPOPHYSIS, Relation between the — and cholestrinemia. (Relacion entre la hip6fisis y la colesterina.) Gonalons (G. P.) Actas Ier Congr. Nac. de Med. (Bs. Aires), 1916, 4, 50.
The gland contains a considerable amount of cholestrin, chiefly in the posterior lobe. In dogs an increase in circulating cholestrin results from hypophysectomy.—B. A. H.
(HYPOPHYSIS). The early appearance of the anlagen of the pars tuberalis in the hypophysis of the chick. Atwell (W. J.) and Sitler (Ida). Anat. Ree. (Phila.) 1918, 15, 181-189.
In the chick the pars tuberalis forms from the lateral lobes of the hypophysis which have previously formed secondarily from the early hypophyseal enlage.—E. R. H.
(HYPOPHYSIS) The effect of alcohol on pituitary extract. Hamilton (H. C.) Jour. Am. Pharm. Ass. (Easton, Pa.), 1918, 4030:
_ Hamilton shows that the uterine contracting active prin- ciple of the posterior lobe of the pituitary body is insoluble in 95% ethyl aleohol. The addition, however, of equal parts of ethyl aleohol to the commercial liquid pituitary extract does not lower the physiological activity of the extract. This amount of alcohol is very much in exeess of the possible alco- holic content from washing the syringe or the site of injection.
—F. F.
(HYPOPHYSIS) The effect of alcohol on the activity of liquor hypophysis. Pittenger (P. S8.), Jour. Am. Pharm. Ass. (Haston; Pa) 918.07. 285i:
It has been suggested that small amounts of alcohol left in the syringe after sterilization destroy the physiological action of liquor hypophysis. Pittenger’s investigation shows that his assumption is incorrect. Identical results were obtained both by the isolated uterus and the blood pressure methods when pituitary extract was tested alone and with small admix- tures of aleohol.—F. F.
(HYPOPHYSIS) The pituitary body. Cobb (1. G.) Med. Press & Cire. (Lond.), 1916, 102, 145-149.
A review of the literature devoted mostly to the diagnosis and treatment of pituitary disorders.
(HYPOPHYSIS) Tumor quistico de la glandula pineal. Morquio (L.) Rev. Med. del Uruguay, 1916, 19, 736.
ABSTRACTS a9
The caption is misapplied to a cystic tumor in the region of the hypophysis.—B. A. H.
HYPOPHYSIS, Variations in the blood of animals deprived of the —. (Variaciones de la sangre en los animales privados de hip6fisis.) Gofialons (G. P.) Actas ler Congr. Nae. de Med. (Bs. Aires), 1916, 4, 52.
The blood of young hypophysectomised dogs retained an infantile character, i.e., a reduced number of red corpuscles and an increased number of polymorphonuclear and eosinophile leucocytes.—B. A. H.
HYPOPITUITARISM, A case of. Boston (li. N.) N. Y. Med. J., 1916, 104, 490.
An Italian male, age 49, showed the general earmarks of hypopituitarism. The skin was soft, velvet like and feminine in appearance. The hair distribution was feminine. He was a sexual pervert, although married. The fingers were greatly shortened, with deep cutaneous furrows surrounding each digit. The nails were brittle, showing a few longitudinal stria- tions indicating malnutrition. The skin presented a peculiar appearance which the writer had noticed in two other cases of hypopituitarism and diabetes, namely, an extreme wrinkling, especially on the forearm and chest, resembling that of old age except that it did not show any longitudinal folds. The sugar tolerance was high. X-ray examination showed an enlarged sella turcica.—M. B. G.
(INTERNAL SECRETIONS) Connecting links between endo- crinology and oto-rhinology. Harrower (H. R.) Laryngo- scope (St. Louis) 1916, 26, 1105-1110.
A general discussion. The importance of hypothyroidism in causing generalized tissue edéma, and hence Eustachean in- filtration leading to deafness is emphasized. Adenoids are fre- quently associated with hypothyroidism and naso-pharyngeal infections may cause thyroid dyscrasias.—R. G. H.
INTERNAL SECRETIONS and metabolism in growing animals (Innere Sekretion und Gesamtstoffumsatz des wachsenden Organismus). Hirsch (E.) and Blumenfeld (E.) Ztschr. f. Exper. Path. u. Therap. (Berlin), 1918, 19, 494.
Experiments on young dogs showed that thyroid extract causes diminished metabolism whereas in adults it has the oppo-
80 ABSTRACTS
site effect. Spermin and pituitrin act similarily to thyroid but ovarian extract has the reverse effect.—J. K.
INTERNAL SECRETIONS, The relation of the,—to neuras- thenia in women. Harrower (H. R.) Am. J. Obstet. (N. Y.) 1916, 73, 630-637.
In Harrower’s experience the administration of thyroid, corpus luteum and pituitary gland preparations, smgly or in combination, has often given excellent results in neurasthenia.
~ —R. G. H.
INTERNAL SECRETIONS. Hypertrichosis, variations in fe- male secondary sexual characteristics and. McAuliff (G .R.) Jour. Am. M. Assn. (Chgo.), 1916, 66, 15.
The author believes that changes of sex characteristics are due to a disturbed pluriglandular equilibrium.—H. W.
INTERNAL SECRETIONS, Relation of—and faulty metab- olism to mental perversions. Keister (B. C.) Med. Ree. (N. Y.) 1918, 94, 4-7. -
A general discussion of some of the more pertinent liter- ature. The lack of specifie information on many endocrine topics and the need for much more study are emphasized.
—R. G. H.
(INTERNAL SECRETIONS) The diagnosis of the internal secretory disorders. Harrower (H. R.) So. Calif. Pract. (Los Angeles), 1916, 30, 558, 31, 93, 115, 215. Texas M. J. (Austin) 1916, 32, 95-99, ete.
See Endoerin., 1918 2, 327.
INTERNAL SECRETIONS with special reference to the treat- ment of disease. Harrower (H. R.) Western Med. Times (Denver) 1916, 35, 468-72.
A general discussion emphasizing the statement that the endocrine glands play a part in the pathogenesis of many dis- eases and that opotherapy is correspondingly valuable.
—R. G. H.
(LYMPHATIC GLAND) Action antagoniste entre l’extrait de ganglions lymphatiques et 1’adrénaline sur les organes a fibres musculaires lisses (Antagonistic action of the extract
ABSTRACTS 81
ef lymph glands and adrenalin on smooth muscle fibres). Chistoni (A.) Arch. Ital. de Biol. (Pisa) 1918, 68, 128.
Extracts of the mesenteric, inguinal, bronchial and cervical lymph glands of the calf, ox, horse, dog, cat and man were all active, those of young animals having the greatest effect. Smooth muscle from the following organs was inhibited in ac- tivity by these extracts: esophagus of toad and of the young chick ; small intestine of the dog, cat and rabbit ; uterus of rab- bit; rings of aorta and carotid arteries; on the contrary the coronary arteries were excited. For critique on this subject see Vineent (S.) Endoerin. 1918, 2, 420.—F. A. H.
LYMPH GLAND extract. Its preparation and therapeutic action. Hadden (D.) Tr. Am. Ass. Obst. & Gyn., 1916, 29, 67-73:
Published elsewhere. See Abst., Endocrin., 1917, 1, 392.
(LYMPHATIC GLAND) Sur la fonction hormonique des gang- lions lymphatiques (On the hormonic function of lymphatic glands). Marfori (P.) Arch. Ital. de Biol. (Pisa) 1918, 68, 113.
The author extracted the mesenteric lymph glands with physiological saline. He has shown that this extract contains one or more active substances which are not destroyed by a temperature as high as 110° C. In the dog and rabbit, injec- tion -of the above extract caused a transitory fall in blood pressure and an increase in heart rate. It was shown to cause dilatation of the vessels through peripheral action by injection into a perfused limb. If atropine is given, the extract causes a slowing of the heart instead of acceleration. The isolated coronary artery is constricted by the extract as is the pupil of the enucleated frog’s eye. The author has found that this ex- tract antagonizes the action of adrenalin in the heart, blood vessels and iris and even states that it antagonizes adrenalin glycosuria.—F.. A. H.
MAMMARY GLAND, The cyclic changes in the—of the guinea pig. Hesselberg (Cora) and Loeb (L.) Proce. Soe. Exp. Biol. & Med. (N. Y.), 1916, 13, 164-166.
Data reported elsewhere. See Endocrin. 1917, 1, 239. MENSTRUATION, Compensatory (vicarious, ectopic): Xeno-
menia; memmes devii. Condit (W. H.) Am. J. Obstet. (N. Y.) 1916, 73, 238-250.
oe) bo
ABSTRACTS
A report of a ease in which for several years following bilateral extirpation of the ovaries and uterus, periodie sub- cutaneous hemorrhages occurred. <A first series was in a nevus and a second, into a mamma. An interesting review of the lt- erature and a discussion of the hormone control of menstru- ation are included.—R. G. H.
(MENSTRUATION) Variaciones de la colesterina durante el ciclo menstrual. (Variations in cholestrinemia during the menstrual cycle.) Gonalons (G. P.) Actas Jer. Congr. Nae. Med. (Bs. Aires) 1916, 4, 30.
See Endocrin. 1917, 1, 533.
MYASTHENIA GRAVIS and epileptiform attacks observed over a period of eleven years. Kearnsides (E. G.), Proc. Roy. Soc. Med. (Lond.) Neurol. See., 1916, 9, 47-49.
A case report. No evidence of specific endocrine abnor- malities was discovered. Neither the thyroid nor thymus was demonstrably enlarged.—R. G. H.
ORGANOTHERAPY. Harvey (T. W.) J. Med. Soe. N. Jer. (Orange) 1916, 18, 452-461.
An interesting general discussion with illustrations from personal experience. The desirability of early diagnosis of endocrine deficiencies is emphasized because of the greater amenability to treatment in that stage.—R. G. H.
ORGANOTHERAPY, A new phase of. Bell (R.) Med. Times (Lond.) 1916, 44, 64-5.
The author believes that depressed endocrine funetions can be stimulated by extract of solar plexus and other autonomic nervous tissue.—R. G. H.
OVARIES, Cystic. Ritchie (W.) Med. J. Australia (Sydney) 1916, 1, 447-448.
The author believes that the distressing symptoms of eystie ovaries are due to thickening of the tunica albuginea. Much relief is afforded by partial denudation of the organs. Two cases are described illustrating the condition and the excellent results of the denuding operation.—R. G. H.
ORGANOTHERAPY in gynecology. (Opoterapie en gineco- logia.) Castano (C. A.) Actas Ier. Congr. Nae. de Med. (Bs. Aires), 1916, 3, 635.
ABSTRACTS 83
A general discussion of several problems.—B. A. H.
OVARIES, Malignant diseases of the. Porter (M. F.) Jour. Am. M. Assn. (Chgo.), 1916, 66, 806.
The author contends that the alleged bilateral tendency of malignant growths is not good ground for removing the healthy ovary.—H. W.
(OVARIES) Ovarian organotherapy: A preliminary report. Graves (W. P.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 718.
Clinieal experience shows that preparations of corpus lu- teum alone are less efficacious therapeutically than are those of the whole ovary. Ovarian therapy should include at least the product of the interstitial cells. Preparations made from cor- pora lutea of pregnancy are too toxic for practical use. Prepa- rations made from the ovaries of pregnant animals, with ex- clusion of the corpora lutea, prove superior therapeutically to preparations of whole ovaries of nonpregnant animals that in- elude the corpus luteum. The superiority of the follicular prod- ucts of pregnancy is explained by the fact that during preg- naney follicle atresia is especially marked and is accompanied by a corresponding increase in the activity of the interstitial
cells —H. W.
(OVARIES) Recent results in the X-ray treatment of menor- rhagia, dysmenorrhea and uterine myoma. Lange (S.) Am. J. Roentgenol. (N. Y.) 1916, 3, 72-83. —
“Tf the proper technique is employed the effect of Cool- idge tube. radiation upon the ovaries is the most certain of medical phenomena. If sufficient radiation be absorbed by the ovaries they will cease to functionate in their fullest physio- logic aspect and a cessation of menstruation will result. We have found no exception.’’ Before applying this treatment malignant neoplasms as a cause should be excluded. In fifty cases upon which this paper is based, no failures occurred, an artificial menopause resulting in every instance in which de- sired. For practical technical details the original should be consulted. The cases mentioned are all deseribed.—R. G. H.
OVARY, A case of a third (Fall von dritten Ovarium). Monch. Berl. klin. Wehnsch., 1918, __., _... (No. 36).
Of anatomical interest. The structure is described.—J. K.
84 ABSTRACTS
(OVARY) Anemia bij lijden der vrouwelijke gesehlacts-deelen en haar verband tot de chlorose. Polak Daniels (L.) Nederl. Tijdschr. v. Keneesk. (Haarlem) 1918, 62, (11), 1146.
Description of some cases of chlorotic women who were suffering from severe menorrhagias. Jron and arsenic gave no improvement; the effect of ovary, however, was splendid.
Jae
(OVARY) Contribucion al estudis de la inevacion ovarica (In- nervation of ovary). Ramon. Aragon medico, 1918, -..., .... (May).
An aceount of the cerebrospinal and sympathetie nerve supply of the ovary, and of its termination there in a ganglion- ated plexus, with suggestions as to the integrating effect of such supply on funetion.—Physiol. Abst., 3, 528.
OVARY, Further investigations on the cyclic changes in the mammalian. Loeb (l.) Proce. Soe. Exp. Biol. & Med. (N. Y.), 1916, 18, 162-164.
Of technical interest. OVARY, Hematogenous infection of the—. Wiener (S.) Surg. Gyn. & Obst. (Chgo.) 1918, 27, 622-623. A ease report. Not of endocrine interest.—R. G. H. (OVARY) L’evolucio del follicul de Graaf (Evolution of
Graafian follicle). Nubiola (P.) Treb. de la soe. biol. (Baree- lona) 1917, 19, 227-32. Largely a review of previous publications on the morphol-
ogy and functions of the different tissue elements in the ovary. Physiol, Abst., 3, 528.
(OVARY) Nota sobre les cellules anoménades paraluteiniques. Nubiola (P.) and Domingo (P.) Treb. de la soe. biol. (Barce- lona) 1917, 19, 349-52.
Histological details, with plates——Physiol. Abst., 3, 528. (OVARY) Ovario y Colesterina. Gonalons (G. P.) Actas ler Congr. Nac. Med. (Bs. Aires), 1916, 4, 22.
A study of the cholestrin content of the organs of various animals. See Endocrin. 1917, 1, 533.—B. A. H.
ABSTRACTS 85
(OVARY) Reaccioén de Abderhalden en algunos estados demen- ciales. (Abderhalden reaction in certain dementias.) Jacob (C.) and Zabala Ortiz (E.) Actas Jer Congr. Nac. de Med. (Bs. Aires), 1916, 4, 85.
In 40 eases of dementia precox an ovarian substrata gave a positive reaction.—B. A. H.
(OVARY) Some observations on the growing oocytes of the stone fly, Perla imarginata Say, with special regard to the origin and function of the nuclear structures. Nakahara (W.) Anat. Ree. (Phila.) 1918, 15, 203-217.
Not of endocrine interest.
OVARY, The behavior of the mammalian—and especially of the atretic follicle toward vital stains of the acid azo group. Evans (H. M.) Proe. Soc. Exp. Biol. & Med. (N. Y.) 1916, 13, 80-81.
Acid azo dyes are selectively taken up in the living ovary by the granulosa cells destined to undergo atresia. By intra vitain staining it is thus possible to identify such cells before any morphologic signs of degeneration appear.—R. G. H.
(OVARY) The preservation of the menstrual function in double suppurative diseases of the tubes and chronic metritis. Polak (O) Jour. Am. M. Assn. (Chgo.), 1917, 69, 1938.
Hysterectomy in chronie pelvie inflammatory diseases may effect a cure. However the conserved ovary quickly loses its function, as the circulation is frequently impaired, and even its internal secretion is short lasting. The gynecologist, there- fore, should aim to preserve both ovulation and menstruation. A method for such preservation is given.—H. W.
OVARY, The relation of the endometrium and—to hemorrhage from myomatous uteri. Geist (S. H.) Surg. Gyn. & Obst. (Chgo.) 1916, 23, 68-74.
In most cases of fibroid uteri associated with pathological bleeding there is a hypertrophic condition of the mucosa. The ovaries are abnormal, containing most often a large corpus luteum, occasionally cystic. Ovarian influences play a large part in regulating normal menstrual flow and Geist’s findings suggest that the same is true of atypical (hemorrhagic) flow.
—R. G..H.
Dm
6 ABSTRACTS
(OVARY) Three cases of an acute abdominal affection due to hemorrhage from a ruptured corpus luteum. Lipscomb (T. W.), Dansey (St. J. W.) and Browne (H) Med. J. Australia, 1916, 2, 57-58.
The cases are briefly reported.
OVARY, Unilateral solid primary ADEMOMA of the—Briggs (H.) Proe. Roy. Soc. Med. (Lond.) See. Obstet and Gyn., 1916, 9, 73-84.
z
Illustrated descriptions of four cases of this rare condi- tion —R. G. H.
(PANCREAS) Acute suppurative pancreatitis. Miller (R. T.) Ann. of Surg., 1916, 64, 329.
Miller reports the laboratory findings in a man who three years previously had suffered with acute pancreatitis accom- panied by a sloughing of the major portion of the gland and a fibrosis of most of the remainder. A carbohydrate tolerance test demonstrated that sugar metabolism was being maintained at a lower limit than normal. The opinion that digestion and sugar metabolism are being maintained by glands other than the pancreas is offered, but without proof—C. McP.
PANCREAS, On the reaction of the—and other organs. Long (J. H.) and Fenger (F.) Science, 1916, n. s. 44, 217. Not of endocrine interest.—R. G. H. (PANCREAS) Parotitis und pancreatitis. Zimmerli. Corre- spondenzbl. f. Schw. Aerzte (Basel), 1918, 48, _..__.. (No. 37). Of no endocrine interest.—J. K. PANCREAS, Shell wounds of, cause pancreatic pseudocyst. Moreley (J.) Brit. M. J. (London) 1918, 1, 341.
A case report; not of endocrine interest.
PANCREAS, The. Cobb (I. G.) Med. Press. & Cire. (Lond.) 1916, 102, 211-214.
A brief review of the literature on pancreas physiology, together with a section discussing with unusual favor the use . of pancreas preparations in diabetes.—R. G. H.
ABSTRACTS 87
(PANCREAS) The use of pancreatic vitamine in cases of in- fant malnutrition. Eddy (W. H.) and Roper (J. C.) Proe. Soe. Exp. Biol. & Med. (N. Y.), 1916, 14, 52-53.
Not of endocrine interest.
(‘‘PARAGLANDULAR”’ SYSTEM) O systema dos organs para-glandulares. Castro (A. de) An. Fac. de Med. (Monte- video), 1918, —, 270.
The author develops a theory that the various bits of ac- cessory tissue usually regarded as displaced rests of the endo- erine organs constitute an independent ‘‘paraglandular’’ sys- tem. The parasympathetic glands are the most prominent components of the system. They are believed to have functions supplementary to those of the endocrine glands proper and to be able to some extent to compensate for deficiencies of these.
—B. A. H.
(PARATHYROIDS) Tetania enurética. (Incontinence of urine and tetanie). Busco (J.) Actas Jer. Congr. Nac. de Med. (Bs. Aires) 1916, 4, 538.
Three infants, two of them brothers, had incontinence as well as neuromuscular hyperexeitability to galvanic and me- chanical stimuli. The author ascribes the incontinence to tonic convulsions of tetanic origin.—B. A. H.
PINEAL body, Hyperplasia of the. Bell (iH. H.) J. Missouri S. Med. Assn. (St. Louis) 1916, 13, 239.
Two brief case reports. Nothing new.—R. G. H.
PITUITARY extract, The value of,—in obstetrics and gyne- cology. Bandler (S. W.) Am. J. Obstet. (N. Y.), 1916, 73, 77-88.
With proper regard to contraindications the use of pitu- itary extract is favored in a variety of conditions in which stronger uterine contractions are desired. A slow first stage of labor may profitably be accelerated by the cautious use of small doses.
The literature since 1916 has tended strongly toward con- servatism in the use of this drug.—R. G. H.
PITUITARY EXTRACT, The abuse of. Mosher (G. C.) Surg. tyn. & Obst. (Chgo.), 1916, 22, 108-109.
88 ABSTRACTS
A brief article protesting against the careless use of so potent an agent. Instances of a ruptured uterus and other un- favorable results are cited.—R. G. H.
(PITUITRIN, ADRENIN) The influence of pituitrin and ad- renin on the pupil of normal and ganglionectomized rabbits. Githens (T. S.) and Meltzer (S. J.) Jour. Pharm. and Exp. Therap. (Balt.), 1917, 9, 360.
The authors show that the effect of adrenalin upon the nor- mal pupil is dilatation, while that of pituitrin is constriction. On the ganghonectomized pupil, pituitrin counteracts to a de- gree, the dilating effect of adrenalin.—lh. G. K.
PITUITRIN and ADRENALIN, The effects of—on the urea- excreting function of the kidney. Addis (T.) and Barnett (G. D.) Proe. Soc. Exp. Biol. & Med. (N. Y.), 1916, 14, 49.
Data published elsewhere. See Endocrin. 1918, 2, 161, 162, 189, 316.
PITUITRIN and ADRENALIN, Infiuence of—on the pupil of normal and ganglionectomized rabbits. A demonstration. Githens (T. 8S.) and Meltzer (S. J.) Proce. Soe. Exp. Biol. & Med. (N. Y.) 1916, 14, 53-54.
A reiteration of the well known fact that pituitrin causes contraction of smooth muscle whereas adrenin in some eases causes dilation. This principle is of practical importance in case of the bronchi in that the two substances are sometimes used in combination in the treatment of asthma. The pituitrin in such eases tends to counteract the dilating effect of the adrenin and thus to defeat the primary purpose of its use.
lia G pals l
(PITUITRIN) Coincident pregnancy and tabes dorsalis. Allen (E. M.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 979.
A echnical report of a case in which the outstanding features were the spontaneous onset of an indolent labor, the absence of pain until the head was upon the perineum, and the prompt- ness and efficacy of the action of pituitary solution.—H. W.
(PITUITRIN) Concerning a new method for the biological standardization of pituitary extract and other drugs. Spaeth (R. A.) J. Pharm. and Exp. Therap. (Balt.) 1918, 11, 209-219.
ABSTRACTS 89
A description of a new method for the standardization of pituitary extract. The contraction time of the melanopheres of Fundulus heteroclitus produced by the pituitary extract as compared to the time required to produce contrac- tion by means of a standard KCl, NaCl solution, is the method followed. The technique is said to eliminate the individual vari- ation in the test animals.—F. A. H.
PITUITRIN in labor. Mundell (J. J.) Am. J. Obstet. (N. Y.), 1916, 73, 306-314.
Mundell reports the untoward results from the use of pituitrin noted in all available records, 3952 cases being con- sidered. ‘These were:
Maternal deaths, 7.
Fetal deaths, 27.
Asphyxia of child with recovery, 7 definite; several indef- initely reported.
Tetanus uteri, 5. (Simulated tetanus frequent. )
Postpartum hemorrhage, 40 definite; various indefinitely reported.
Rupture with recovery, 1.
Foreeps applied, Premature separation of placenta and Failures—data too heterogeneous for specific summary. <A bibliography of some 50 titles is included.—R. G. H.
PITUITRIN in post-abortion curettment. Furniss (H. D.) Surg. Gyn. & Obst. 1916, 23, 365.
One cubic centimeter of pituitrin hypodermatiecally is urged as a routine measure before post-abortion curettment. It renders the procedure almost bloodless and the contracted uterine walls resulting facilitates the operation as well as les- sens the danger of perforation. The injection should precede the curettment by 15 minutes; a longer interval is not so favor-
ale te. G. H.
(PITUITRIN) L’extrait pituitaire dans le traitement des incon- tinences d’urine. Mikhailoff, Russky Vrach., 1917, —, —. (June 17).
Four injections are stated to be enough to cure the con- dition (19 cases, all successful.) The treatment was under- taken as pituitrin has a specific action on involuntary muscle, and was therefore to be expected to act on sphincters.—Physiol.
Abst. 3, 455.
90 ABSTRACTS
(PITUITRIN) Sobre el abuso de la pituitrina en San José. Castro (V.) Gaceta Med. de Costa Rica (San José) 1916, 19, 313-310;
Two cases are deseribed in which injections of pituitrin led to unfortunate results in child-birth. In one ease the child had finally to be delivered by a difficult high forceps operation and it was born dead. In the second a precipitate expulsion with ruptured perineum resulted.—R. G. H.
(PITUITRIN) Spontaneous rupture of the uterus following ad- ministration of pituitary solution. Wertenbaker (W.) Jour. Am. M. Assn. (Chgo.), 1917, 68, 1612.
Report of two cases of rupture of the uterus following a single injection of one ampule (1 ¢.c.) of pituitary solution. ES We
PITUITRIN, Use of, in uterine inertia and post-partum hemor- rhages. Holman (J. E.) Natl. Eelect. Med. Assn. Quart. (Cincinnati), 1918, 10, 163-165.
The author emphasizes the desirability of using small doses but regards pituitrin as a valuable agent. A case is described . in which a woman was kept for several days under the infin- ence of pituitrin with, the author is convineed, life-saving re- sults. Small doses have been found valuable in the treatment of incontinence of urine due to reduced tonus of the vessical sphincter.—R. G. H.
(SECRETION) Du nole de la contractilité dans le méchanisme fonctionnel des glandes a sécrétion externe et a sécrétion interne. Dubois (R.) Soc. Linnéenne de Lyon, 9 Juillet, 1917. Reprint, pp. 9.
Dubois maintains that the mechanism of secretion in all sorts of glands depends upon the activation of the contractile elements of the same and that contrary to classic opinion the nervous system has no direct influence upon the cells supplying glandular secretions.—R. G. H.
(SECRETIN-LIVER) Nota sobre la manera d’actuar la se- cretina (Mechanism of secretin action). Dalman (M.) Treb. de la soc. biol. (Barcelona) 1917, 19, 327.
The mesenteric vein and vena cava by means of a Crile cannula’ permitted sending the blood through the liver or di- rectly to the vena cava as desired (p. 325). Utilizing this tech-
ABSTRACTS 91
nique, Dalman was not able to detect any influence exerted by the liver upon the reaction of the pancreas to secretin.—R. G. H. (Physiol. Abst.)
(SECRETIN) Meétode per a obtenir comodament secretina en pols (Method of obtaining secretin as a powder). Dalman (M.) Treb. de la soe. biol. (Barcelona) 1917, 19, 235.
A potent secretin of low toxicity is obtained by precipita- tion with 9 parts of acetone, filtering and drying the precipi- tate. If the filtrate is evaporated, the residue, when freed from lipoids with ether and taken up in water is also active —Physiol. Abst., 3, 527.
(SECRETIN) Remarqgues sur la sécrétin (Observations on se- cretin). Arthus (M.) C. R. Soe. de Biol. (Paris) 1918, 81, 953.
‘The author has attempted to discover whether the in- creased secretion of pancreatic juice resulting from the injee- tion of secretin is due to the toxic action of a protein. He does this by studying the effect of the injection of toxie substances upon pancreatic secretion. Crotalus venom caused a temporary decrease in pancreatic flow. Injection of horse serum into a rabbit previously sensitized produced the anaphylactic reac- tion, but the pancreatic secretion was not increased. Venom of the scorpion on the other hand produced an increase in the pancreatic flow. It was concluded that the effect of secretin was not due to toxic action.—F. A. H.
(SECRETIN) The infiuence of secretin on the number of red and white corpuscles and the ferments and sugar content of the blood. Fujimoto (B.) Am. J. Physiol. (Balt.) 1918, 47, 342-350.
When injected subcutaneously in rabbits secretin was found to increase the number of red and white corpuscles in the blood as previously demonstrated by Downs and Eddy. (See Endocrin., 1917, 1, 492, and 1918, 2,191.) The hypodermic injection of 1 ¢.c. of secretin was found to cause an increase in the cataylse content of the blood, but no change in the dias- tase, glycolytic ferment or blood sugar content.—h. G. K.
(SECRETIN) IV. The numbers of red and white corpuscles in the circulating blood during digestion. Downs (A. W.) and Eddy (M. B.) Am. J. Physiol. (Balt.), 1918, 47, 399-403.
During digestion there occurs an increase in the number both of the red and the white corpuscles per unit volume ot
92 ABSTRACTS
blood in the rabbit, the changes being comparable with the effects produced by the experimental administration of se- eretin. (Endoerin., 1918, 2, 333.) The authors believe that the increased corpuscle content of the blood is due to the direct stimulating action of secretin on the bone morrow. The similar- ity between the differential leucocyte counts in digestion and after the administration of secretin is additional evidence of secretin being the cause of the increase in the number of cor- puscles during digestion.—L. G. K.
SEX, The determination of. Apert (E.) Monde Méd. (Eng. Edition) (Paris) 1918, 28, 65-72.
In connection with a general discussion, Apert reviews a previous article on the relation of the adrenals to secondary sex characters. In 31 women it was noted that suprarenal hypertrophy resulted in arrest of menstrual flow, deepening of the voice and the appearance of hair on the face and down on the rest of the body. Bodily strength increased and, in short, a general ‘‘masculinization’’ occurred. In case the hypertrophy occurs during fetal life, pseudo-hermaphroditism may result and the woman may even believe herself to be a male.
Such results suggest that a course of whole gland adrenal therapy might prove useful in case of overdevelopment of femi- nine characteristics, as mammary hypertrophy or hyperlacta-
on— ls GEL.
(SPASMOPHILIA) Sulle sindromi spasmofili che familiari nell’ infanzia (Familial spasmophilia in infancy). Pincherle and Polidori. Riv. clin. pediat:, 1918, _..., .... (Apr..18). (Pedi- Avia, 1913, 2 660. )
The authors regard functional disturbances of the endo- erine glands as important factors in spasmophilia. Heredity seems also to play an important role.—G. V.
(SPLEEN) A critisue of Banti’s disease. Moschcowitz (E.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 1045.
Not of endocrine interest.—H. W.
SPLEEN in relation to the secretory function of the stomach.
(El bazo en la function secretora del estomago.) Soler (F. L.) and Madero (L. F.) Actas Jer Congr. Nac. de Med., (Bs. Aires), 1916, 4, 105.
Extracts of spleen, lymphatic ganglia, leucocytes and red blood corpuscles produced a leucoeytosis and augmented gas-
ABSTRACTS 93
tric secretion m a Pavloff small stomach dog. The authors theorize to the effect that the spleen sends into the blood stream lymphocytes charged with gastro-excitatory hormone.
—B. A. H.
(SPLEEN) Metabolism studies before and after splenectomy. Pepper (O. H. P.) and Austin (J. H.) Arch. Int. Med. (Chgo.) 1916, 18, 132-135.
Not of endocrine interest.
(SPLEEN) Splenectomy in the anemias and other blood states associated with enlargement of the spleen and liver. Hag- gard (W. D.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 79.
Not of endocrine interest.—H. W.
(SPLEEN) Splenectomy in pernicious anemia: Studies on bone marrow stimulation. Lee (R. I.) and Minot (G. R.) Jour: Am. M. Assn. (Chgo.), 1916, 67, 719.
Not of endocrine interest.
(SPLEEN) Late results of splenectomy in pernicious anemia: A statistical and critical review. Krumbhaar (E. B.) Jour. Am. Med. Assn. (Chgo.), 1916, 67, 723.
‘Not of enoderine interest.
(SPLEEN) Splenectomy in splenic anemia, hemolytic icterus and Hano’s cirrhosis. Miller (J. L.) Jour. Am. M. Assn. (Chgo.), 1916, 67, 727.
Not of endocrine interest.
(SPLEEN) Splenectomy for hemolytic jaundice. Peck (C. H.) Jour. Am. M. Assn. (Chgo.), 1916, 67, 788.
Not of endocrine interest.
(SPLEEN) Studies of urobilin elimination in the normal and anemic dog. Dubin (H.) Jour. Exp. Med. (Balt.), 1918, 28, 313.
Following splenectomy in the normal dog an increase in the urobilin elimination of varying degree occurred. The sig- nificance of this is not clear. Splenectomy during the period of anemia did not cause a decrease in the urobilin elimina-
tion.—H. W.
94. ABSTRACTS
SPLEEN, The. Its association with the liver and its relation to certain conditions of the blood. Mayo (W. J.) Jour. Am. M. Assn. (Chgo.), 1916, 66, 716.
Not of endocrine interest.
(SPLENOMEGALY) Over een weinig voorkomend familiair lijden (waarschijnlijk splenomegalie type Gaucher) (Famil- ial splenomegaly). de Lange (C.) and Schippers (J. C.) Nederl. Tijdschr. v. Geneesk. (Amst.), 1917, 53, (1) 890-904.
Data published elsewhere. See Endoerin. 1918, 2, 192-3, Abst. No. 181.
SYMPATHETIC SYSTEM in GOITRE, The pathologic changes in the—. Wilson (L. B.) Tr. Ass. Am. Phys. 1916, 31, 146-161.
Cervical ganglia of 12 patients dying during the course of exophthalmie goitre were studied with the best known cytolog: ical technique. Those of cases of progressive hyperplastic toxie gvoitre showed very marked hyperpigmentation with extensive granular degeneration and; in some eases, atrophy of the gan- elion cells. In eases in which marked regression or absence of toxic symptoms was shown only a relatively small proportion of the ganglion cells were hyperpigmented or degenerated. In a large proportion of the cases, however, there was a marked diminution in the total number of cells in the individual ganglia.
Later studies have since been reported.—R. G. H.
(TESTES) CRYPTORCHIDISM, The operative treatment of. Keyes (EK. L.) and MacKenzie (D. W.) Jour. Am. M. Assn. (Chgo.), 1917, 68, 349.
A retained testicle which is otherwise normal is not hkely to atrophy before the period of puberty. Hence there is every reason to operate at about the time of puberty in order to fore- stall atrophy of the spermatogenetie tissues.—H. W.
TESTES, Histological study of the—of guinea pigs showing lead blastophthoria. Preliminary report. Weller (C. V.) Proce. Soc. Exp. Biol. & Med. (N. Y.), 1916, 14, 14.
In most eases the testes appeared normal. In a few sterile animals aspermatogenesis and degeneration of the sex eells were seen.—R. G. H.
ABSTRACTS | 95
(TESTES) Note on the present condition of patient in case of implantation of testes, previously reported. Lydston (G. F.) Jour. Am. M. Assn. (Chgo.), 1916, 67, 898.
Slight atrophy of the testes had occurred one year and 15 days after implantation. Sexual function normal. General condition much better—H. W.
TESTES, One man with five: Report of case. Day (G. H.) J. Am. Med. Ass. (Chgo.) 1918, 71, 2055-56.
The subject, age 19, possessed two serota with two normal testes in each and a fifth one in certain redundant tissue pos- terior to the second pair. Aside from an overabundant sexual desire the patient was not aware of any other than the ana- tomie sex abnormality.—R. G. H.
TESTICLE. Impotency; its treatment by transplantation of. Lespinasse (V. D.) Surg. Clin. Chicago. 1918, 2, 281. Abst. Surg. Gyn. & Obst. 1918, 27, 262.
The author insists that an accurate diagnosis of the type of impoteney should be made in each case. Cases should be classified according to the following table:
1. Loss of testicles, (a) by accident; (b) by disease.
2. Psychic changes.
3. Structural changes in the central nervous system, par- ticularly injuries and diseases of the spinal cord.
4. Hypoplasia of the testicle, (a) congenital; (b) ae- quired (internal secretion cases).
Congenital and acquired hypoplasia of the testicle are the only types of impotency that should be treated by transplanta- tion of the organ. The psychie and the structural type of case should have appropriate treatment directed toward their etio- logical factor or factors. The etiological factor in hypoplasia ‘is the absence of the internal secretion. This can be corrected by feeding large amounts of desiccated animal testicle or by transplantation of the human testicle. The two techniques used to transplant human testicles are en masse or by morcellation. In the author’s work he has used the morcellation method en- tirely. Transplantation with blood-vessel anastomosis is of in- terest only from a scientific and experimental standpoint and has not proved practical clinically. The changes occurring in the transplanted testicle are well shown by two photomicro- graphs showing the interstitial cells of Leydig together with their granules. The results in some of these cases of trans- plantation are little short of marvelous; in others the results are not so good.—Quoted.
96 ABSTRACTS
(TESTIS) On the interstitial cells of the testicles in Didelphys. Duesberg (J.) Biol. Bul. (Woods Hole), 1918, 35, 175-197.
The interstitial cells in the testis of the opossum are very numerous. Most of these cells are mononuclear, but some have two nuclei. Near the nucleus there is a zone of differentiation of the cytoplasm, or idiosome, in which the centrioles are lo- cated. The cytoplasm contains fat droplets, and erystalloids. The chondriosomes are numerous. The cytoplasm also contains granules believed by the author to be secretory.
The intercellular spaces are filled with a substance some- times granular, sometimes amorphie and varying in amount. From these spaces, processes containing granular material penetrate the cells. The author believes he has thus demon- strated microscopically an internal secretion —E. R. H.
THYMUS death. Falls (F. H.) Surg. Gyn. & Obst. (Chgo.), 1916, 22, 712-719.
An interesting review of the hterature and a post-mortem report of a case. An interesting finding was an anomalous innominate vein ventral to the thymus. The surgical import- ance of the possibility of such an anomaly is obvious.—R. G. H.
THYMUS gland, Collapse under anesthesia due to an enlarged. Coriat (1. H.) Dental Cosmos, 1918, _..., ..... (Reprint, p. 2.)
The patient in this case was the first to collapse in 2140 operations under anesthesia at the Forsyth Dental Infirmary. The case fits in well with the theory of the thymogenie etiology of rhachitis. Marked bone changes were present such as era- nial bosses, a ‘“‘rosary,’’ ete. There had been attacks of asthma and there was evidence by skiagraphy and percussion of an enlarged thymus.—R. G. H.
(THYMUS) Grave osteoporosi infantile associata a sclerosi del timo. Lanzarini (F.) Riv. di clin. pediat. (Firenze), 1916, 14, 393-418.
See Endocrin., 1917, 1, 540.
(THYMUS) On the (so-called) thymus: IV, and the ultimo- branchial body of the cat (Felis domestica). Stewart (F. W.) Am. Jour. Anat. (Phila.), 1918, 24, 191-225.
Numerous investigators have considered the internal thymic lobule of the thyroid to be a branchiomerie organ de- rived from the ventral diverticulum of the 4th pharyngeal pouch. From the results of this study (based on over 70 em-
ABSTRACTS 97
bryos) it appears that the ultimobranchial body also con- tributes to the formation of this lobule. The ultimobranchial body is formed as an expression of continued growth tendeney or pouch-forming potentialities in the caudal pharyngeal region, but not homologized with a definite pouch in lower forms. Both the ultimobranechial body and the ventral diverti- culum of the fourth pouch are regressive structures. Stages of cellular degeneration and lymphocyte infiltration may be traced in them. Hassel’s corpuscles are also regarded as re- eressive structures, formed from epithelium.—M. M. H.
(THYMUS) Status lymphaticus. Culbert (W. L.) N. Y. Med. de L9G, 104,-739.
Two case reports. Nothing unusual.—M. B. G.
(THYMUS) Status-thymus lymphaticus—Case report. Gar- raghan (EK. F.) Ill. Med. J., 1918, 34, 189-92.
The author briefly reviews the literature. He reports a ease in a girl of twelve who died while undergoing an opera- tion on the frontal sinus. The post mortem showed an en- larged thymus.—L. F. W.
The THYROID and internal secretion. (Romance in Medicine I.) Vereo (J. C.) Med. J. Australia (Sydney), 1916, 2, 465- 470.
A picturesque lecture on the clinical aspects of hyper-and hypo-thyroidism.—R. G. H.
The THYROID mechanism and its relation to endemic and thyrotoxic goitre. Pern (S.) Med. J. Australia (Sydney), 1916, 2, 409-410.
Pern contrasts the low thyroid iodin content and calcium retention of endemic goitre with the high iodin content and calcium depletion of thyrotoxie goitre. A theory is offered that the control of thyroid discharge is mediated through a ealcium-iodin balance. Administration of calcium in thyro- toxic goitre is advocated as a method of ‘‘increasing the rigid- ity of the colloid’’ and hence delaying its absorption.—R. G. H.
(THYROID) A clinical study of fifty-five cases of hypothy- roidism in children. Gordon (M. B.) Arch. Ped., 1918, 35, 577-597.
98 ABSTRACTS"
Neither sex predominated. Precedence in birth and nature of delivery were apparently of no etiological significance. Breast feeding had no tendency to prevent the condition. The incidence of syphilis was only 10 per cent and its importance as an exciting cause is probably small. Familial tendency towards hypothyroidism was but 10 per cent. Delayed develop- ment was most marked in the powers of talking, walking, and teething in the order named. The treatment of hypothyroidism employed is a preliminary catharsis by calomel followed by a saline. The next day, thyroid extract 1/10 grain is given three times a day; this is administered for 10 days and then discon- tinued. Elixir Glycerophosphates of Lime and Soda, 1 dram three times a day is then prescribed for one week, then thyroid is resumed in 1/8 grain doses three times a day. This alterna- tion is adhered to, gradually increasing the amount of the thy- roid, until one grain three times a day is taken. The thyroid is not preseribed in conjunction with any other remedy; any other medicine used is given in place of the phosphates. Minor defects are curable with thyroid. Mental retardation is not as amenable to treatment as physical. The prognosis depends upon the age at which treatment is instituted and upon the reg- ularity and length of treatment. Early and long continued treatment is advised.—M. B. G.
(THYROID-ADRENIN) Nota sobre el mechanisme de correla- cio functional de tiroides é capsula superararenal (Mechanism of functional correlation between the thyroid and adrenal). Dalman (M.) Treb. de la soe. biol. (Barcelona), 1917, -.., 233.
The author refers to current work on the exaggeration of the pressor effect of adrenin as a sequel to stimulation of the thyroid or injection of Kendall’s Thyroxin. He has himself noted an accentuation of the pressor action of adrenin as the result of injecting physiological saline and suggests that the effect of thyroid stimulation, ete., is to cause a better filling of the vaseular system, by causing absorption of fluid from the lymph spaces.—Physiol. Abst., 3, 526.
THYROID and THYMUS, The eye, ear, nose and throat in dis- eases of the—Lisser (H.) Ophth. Ree. (Chgo.), 1916, 25, 433- 440.
A general summary.
(a) Endemic cretinism: The eyes are far apart; conjune- tivitis and consequent eczema of the hd margins are not un- common. Retarded dentition, thick tongue and deaf-mutism are common. The latter may be due to anomalies in develop-
ABSTRACTS 99
ment of the hammer or stapes, and to inadequate development of the epithelial cells of the ductus cochlearis. Central anoma- lies also probably play a part. In these conditions thyroid therapy is generally of little use.
(b) Sporadic eretinism: Myxedema of the eye-lids is common. Homatropin mydriasis persists-unusually long. En- larged tonsils and adenoids are common. Disturbances of hear- ing also occur and may yield spectacularly to thyroid mediea- tion.
(ec) Myxedema: The eyelids are swollen and the eye- brows thin. Homatropin mydnosis persists 36 to 48 hours. Im- paired hearing may occur. It is often amenable to thyroid treatment. Carious teeth and swollen mucosa of the nose and throat is common. Oceasional cases of malignant uvitis or interstitial keratitis are seen which improve strikingly under thyroid medication. Graves’ disease and the relation of the thymus to the condition are also discussed.—R. G. H.
(THYROID) An experimental study of quinin and urea injec- tions in hyperthyroidism. Watson (L. F.) Southern Med. J. 1916, 9, 394.
Illustrates by photomicrographs the necrosis that follows the injection of concentrated quinin and urea solution into the human and dogs’ thyroid.—h. F. W.
(THYROID) A study of exophthalmic goiter from the point of view of the basal metabolism. Means (J. H.) and Aub (J. C.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 33.
In hyperthyroidism the general metabolism shows a char- acteristic increase. This rise may be used as a functional test of thyroid activity or as an index of intensity of thyroid intoxi- eation. Studies of the metabolism in various types of toxie goiter show that rest alone usually causes a marked decrease in toxicity; drugs do not materially accelerate this decrease ; Roentgen rays may or may not produce improvement; the usual immediate effect of.surgery is a marked decrease in tox- icity, followed by a very definite tendency toward subsequent recurrence.—H. W.
(THYROID) Attempts to produce a substance with thyroid- like activity by the artificial iodization of proteins. Rogoff (J. M.) and Marine (D.) J. Pharm. and Exp. Therap. (Balt.) Lots, 10, 321-325.
Artificially iodized blood serum, especially the globulin portion, causes acceleration of metamorphosis when fed to tad-
100 ABSTRACTS
poles. Its action resembles that shown by thyroid feeding, but not so marked. Alkaline hydrolysis of iodized proteins apparently destroys their activity, therein differing from the thyroid. This suggests that the thyroid adds something to the iodine complex in the blood to complete the stable iodine con- taining thyroid hormone.—F. A. H.
(THYROID HYPOPHYSIS) Atrophy of the thyroid gland with hypertrophy of the pituitary gland. Sharp (J. G.) Chin. Jour. (Lond.), 1916, 45, 290.
Report of a ease.
(THYROID) Bocio lingual. (Lingual goitre). Jorge (J. M.) and Layera (J.) Rev. Asoc. Méd. Argentina, 1918, 40, 246.
Two cases were operated upon by the authors. In one a graft was unsuccessfully attempted.—B. A. H.
(THYROID) Cerebral nerve disturbance in exophthalmic goi- ter. Heuer (G. J.) Am. J. Med. Se. (Phila), 1916, 151, 339-51.
Heuer states that only eighty cases of this type of goiter have been reported in the literature. He reports a case in detail, and advises early operation on the thyroid, with the hope of arresting the palsy.—L. F. W.
(THYROID) CRETINISM, The blood picture in (Blutbefunde bei endemische Kretinismus). Kind (E.) (Mitt. a. d. Grenz- geb. Med. u. Chir. (Jena.), 1918, 30, 285.
In most eases an absolute as well as relative lymphocytosis combined with neutrophile leucopenia is found.—J. K.
(THYROID) CRETIN, The energy metabolism of a. Talbot (F. B.) Am. J. Dis. Child. (Chgo.) 1916, 12, 145-148.
Data published elsewhere. See Endoerin. 1917, 1, 84.
THYROID, Conservation of the—— in HYPERTHYROIDISM. Rogers (J.) Ann. of Surg., 1918, 67, 497.
Of general interest. Rogers reports results of a conserva- tive operative technique in a series of 296 cases of hyperthy- roidism. The treatment was ligation of two or more thyroid vessels and the administration of either thyroid or adrenal extract. The mortality was 3%; 70% were cured, 14% im- proved, 8% unimproved.
ABSTRACTS 101
The symptoms indicative of hypo- or hyper-thyroidism are traceable to disturbances in the involuntary nervous system either ‘‘vagotonic’’ or ‘‘sympatheticotonic.’’ Aqueous, saline and aleoholice solution of pigs thyroid were injected in dogs. The aqueous solution proved inert, but the other two active. No tachyeardia was obtained, the action being ‘‘vagotonic.’’ With extract of human hyperthyroid tissue no reactions were obtained. The conclusions drawn are that in the early stage of this disease a superabundance of normal quality thyroid secretion activates the autonomic system. Since thyroid secre- tion accelerates metabolism, tachycardia may be the response of the heart to systemic need for blood. The compensatory hypertrophy of the thyroid probably results in fatigue, giving an impaired quality of secretion. As the impulses causing the thyroid to enlarge and overact come through the blood stream, it is logical to cut off part of the thyroid blood supply and sup- plement by thyroid feeding. This gives the fatigued tissue <¢ rest.
In case of unilobar enlargements Rogers favors excision. If bilobar enlargement occurs partial excision leaves the re- mainder less efficient and quite as toxic. Tying the arteries involves local anesthesia only. The after treatment is impor- tant and consists of rest and organotherapy for several months.
—C. MeP.
(THYROID) Corps thyroides et appareil cardio-modérateur (The thyroid and the cardio-inhibitory apparatus). Arthus (M.) (C. R. Soe. de Biol. (Paris) 1918, 81, 955.
Neither thyroidectomy nor injection of thyroiodine af- fected the sensitiveness of the eardio-inhibitory apparatus. Rabbits were used. Thyroidectomy was performed one to four weeks before the experiment, the external parathyroids being allowed to remain. Cardiae inhibition was produced by as- phyxia, choroform, venom of the scorpion, venom of the rattle- snake, blood serum of the fowl and by direct stimulation of the vagus nerve. Normal animals were employed as controls.
F. A. H.
THYROID deficiency. Cobb (I. G.) Med. Press & Cire. (Lond.) 1916, 102, 9-12, 30-35.
A readable general article on the diagnostic criteria and the art of treating various degrees of thyroid deficiency. It does not lend itself to abstracting. The author especially em- phasizes the desirability of beginning with small doses of thyroid substance (1-10 to 4% grain) and gradually increasing
Los ABSTRACTS
until desired results are secured. The liability of desiccated thyroid to deteriorate and the consequent desirability of ob- taining fresh material are commented upon. The article as a whole is concerned rather with the art than the science of medicine.—R. G. H.
THYROID disease and the present method of operative treat- ment. Benjamin (A. E.) Tr. Western Surg. Assn., 1916, 26, 393-402.
The author summarizes our present knowledge of the fune- tion of the thyroid and deseribes a method of operating. —hL. F. W.
THYROID disorders, Newer Methods in the Diagnosis of— pathological and clinical. Goetsch (E.), N. Y. State J. Med., 1918, 18, 259.
Thyroid adenomata are responsible of themselves for hy- perthyroidism. They are often multiple and should be removed whenever identified. In a small percentage of his series (2%) malignaney occurred. Symptoms of hyperthyroidism disap- pear when an adenoma formerly active degenerates, only to be followed by a second wave of hyperthyroidism, when a new healthy adenoma arises, as is frequently the case. Almost every form of degeneration can occur in these adenomata. The thyroid gland itself associated with an active adenoma pre- sents a simple colloid appearance, contains few or almost no mitochondria and is relatively inactive. The abundance of mitochondria in the thyroid cell forms a good index for judg- ing of the activity of the tissue under consideration, whether this tissue be from active colloid goitre, exopthalmic goitre or from an adenoma; the greater the number of mitochondria in the thyroid cell, the greater the functional activity of the latter. In states of hyperthyroidism, there is a hypersensitive- ness to adrenalin, whether administered hypodermically or in- tradermically, proportional to the degree of hyperthyroidism present. For discussion see Editorial, Endocrin., 1918, 2, 460-465.—M. B. G.
THYROID disturbances, Tonsillar endamebiasis and. Evans (J. S.), Middleton (W.S.) and Smith (A. J.) Am. J. Med. Se. (Phila) 1916, 151, 210222.
The authors examined 362 goitrous individuals and found tonsillar infection in 22.8 per cent, and nasal and _ tonsillar lesions in 90 per cent. Endameba gingivalis (Gros) was found
ABSTRACTS 103
in 97 per cent of 34 cases examined microscopically. Under emetin treatment 81 per cent of this number were freed from endameba and in the majority there was more or less reduction in the size of the goiter—L. F. W.
THYROID enlargements. Bradley (S. C.) Ill. Med. J. (Chgo.), 1916, 29, 262-4.
Nothing new.
THYROID, Exophthalmic goitre: Accessory—. Campbell (W. F.) Med. Times (N. Y.), 1916, 44, 88-90.
Of technical interest.
(THYROID) EXOPHTHALMIC GOITRE, The etiology and treatment of—with special reference to the use of radium. Aikins (W. H. B.), Canada Lancet (Toronto) 1916, 49, 548- 49; Med. Press & Cire. (Lond.) 1916, 102, 271-275.
Published elsewhere. See Endoerin., 1918, 2, 202.
(THYROID) EXOPHTHALMIC GOITER and other forms of pathologic kinetic drive. Crile (G. W.) Jour. Am. M. Assn. (hieo:)) 1917, 69;: 610.
The author believes that exophthalmie goiter is not alone due to thyroid changes but also to altered function of the supra- renals. ‘‘From the clinical data in certain cases of exophthal- mic goiter in which resection of the thyroid was followed by an increased nervous stability and increased body weight, while there remained a flushed face, sweating and an increase of the frequency and force of the heart beat, we may infer that while the thyroid symptoms of the disease were relieved, the supra- renal group persisted. It may be that the excision of part of the suprarenal tissue will supply the complete eure for such cases as these.’’—H. W.
(THYROID) EXOPHTHALMIC GOITRE, Results of opera- tions for—. Judd (E.S.) and Pemberton (J. D.) Med. Press. & Cire. (Lond.), 1916, 102, 125-129.
Data published elsewhere. (Jour. Surg. Gyn. & Obstet., March, 1916.)
(THYROID) EXOPHTHALMIC GOITRE, The medical treat- ment of—. Rice (J. F.) Med. Rec. (N. Y.) 1918, 94, 97-99.
104 ABSTRACTS
Applies Crile’s conception of the ‘‘kinetie drive’’ to the problem of the treatment of Graves’ disease. Discusses treat- ment by diet, hydrotherapy, climate, psychotherapy, rest, exer- cise, massage, heat and cold, light, electricity, radium, roentgen rays, drugs, vaccines, serums and opotherapy. Emphasizes the need of early treatment to protect the myocardium.—R. G. H.
(THYROID) EXOPHTHALMIC GOITRE, The treatment of, by means of the Roentgen rays. Pfahler (G. E.) and Zulich (J. D.) Am. J. Roentgenol. (N. Y.) 1916, 3, 63-72.
The article comprises a review of the literature and a valu- able bibliography of 76 titles as well as the personal findings of the writers. They believe that the Roentgen treatment should be given a trial in all cases because even if success is not achieved nothing is lost and many operations can thereby be avoided. Both the thyroid and the thymus should be treated. — An inerease in weight and rehef of tachycardia are the first and practically invariable signs of improvement, while thy- roid enlargement and exophthalmos are the last and in many cases these show no change. Treatment must not be unduly prolonged because hypothyroidism may thereby result.
—R. G. H.
(THYROID) HYPERTHYROIDISM in the recruit. Brooks (H.) Am. J. Med. Se. (Phila.), 1918, 156, 726-733.
Data published elsewhere. Abstracted Endoerin. 1918, 2, 62 (No. 27).
(THYROID) Experimental hyperthyroidism. Kendall (E. C.) Jour. Am. M. Assn. (Chgo.), 1917, 69, 612.
Thyroid-parathyroideectomized dogs with a high protein in- take invariably go into a state of depression following injec- tions of amino-acids. The administration of thyroid hormone previous to the injections of amino-acids produce the same results. In such eases the organism is unable to convert am- monia into pre-urea compounds fast enough to ward off de- pressant effects. Experimental results indicate that thyroid activity in the absence of a simultaneous suprarenal cortex activity does not produce the usual so-called hyperthyroid symptoms, but instead, a condition of depression. ‘‘In order to obtain a so-called hyperthyroid reaction, hyperactivity of the thyroid is only one result that must be produced; aecom- panying this, increased activity of the suprarenal cortex is just as essential.’’—H. W.
ABSTRACTS 105
THYROID extract in the treatment of uveitis. Bordley (J) Jour. Am. M. Assn. (Chgo.), 1916, 67, 412.
Of technical interest only.
THYROID function, A simple therapeutic test of—. Harrower (H. R.) Med. Ree. (N. Y.) 1918, 94, 196-97.
The test is to administer desiccated thyroid for three days in increasing doses, of one-half, one and two grains respec- tively, four times daily and to note the effect upon the pulse rate. Patients having abnormally active thyroids are abnor- mally reactive, whereas normal individuals are not influenced.
—R. G. H.
(THYROID) GOITRE among the United States Indians. Anon. J. Am. M. Assn. (Chgo.), 1916, 67, 1097.
Editorial comments on article by Hrdlicka previously ab- stracted, Endoerin, 1918, 2, 531.
(THYROID) Goitre and pregnancy. Crotti (A.) Tr. Am. Ass. Obst. & Gyn., 1916, 29, 353-358.
A goitre during parturition generally enlarges. If there is reason to believe dyspnea will be severe, elective Cesarean section should be performed. If labor is advanced, pituitrin should be used to shorten the process. Thyroidectomy in such cases is seldom advisable. Colloid goitres should be treated by thyroid medication to forestall difficulties in delivery. Graves’ disease if discovered early in a pregnancy should receive imme- diate attention, preferably by a dietetic, hygienic régime. In later pregnancy two choices are offered: thyroidectomy or sur- gical delivery. Crotti prefers a timely thyroidectomy. Exoph- thalmiec goitre patients should be guarded against pregnancy.
—R. G. H.
(THYROID) GOITRE operations, preliminary hemostasis in. de Quervain (F.) Surg. Gyn. & Obst. (Chgo.), 1916, 23, 402- 412.
A well illustrated technical diseussion. A systematic plan of ligating the arteries is favored.—R. G. H.
(THYROID GOITRE) Discussion. Todd (J. L.) Bull. Sox Pam, Bx, (Paris.), 1916, 9, 167.
A brief note to the effect that during an expedition in 1911 through British Gambia in only a single locality—on the upper
106 ABSTRACTS
Gambia—was goitre seen. In four villages the incidence was very high.—R. G. H.
(THYROID GOITRE) Répartition des eaux minérales et de l’endémie goitreuse au Yunnan. Jeanselme (E.) Bull. Soe. Path. Exot. (Paris), 1916, 7, 414.
Commenting on Répin’s theory of a relation between the distribution of mineral waters and of endemie goitre, Jeanselme points out that in Yunnan the coincidence does not obtain.
fe Ge Ee
(THYROID, GOITRE) A propos de l’hypothése de la transmis- sion du goitre endémique par un insecte piqueur (The theory of transmission of endemic goitre by a biting insect). Berge- vin (E. de) and Sergent (E.) Bull. Soe. Path. Exot. (Paris.), 1916, 9, 345.
Commenting on Bouilliz’ theory that goitre may be trans- mitted by acanthispis suleipis, the authors point out that the theory is not tenable as regards the goitre region of Algiers.
RAG. oe
(THYROID, GOITRE) A propos de la distribution géograph- igue du goitre en Algérie. Sergent (E.) Bull, Soe. Path. Exot. (Paris) 1916, 9, 344.
A brief article confirming a previous report by Répin that the distribution of mineral waters and of endemic goitre in Algiers coincide.—R. G. H.
THYROID gland, Cancer of the—. Balfour (D. C.), Med. Ree. (N. Y.), 1918, 94, 946-850.
Balfour presents a very interesting discussion of the data on this topic accumulated in the Mayo Clinie from 1910-1916. In 46 per cent of the cases (103 in all) no elinical manifesta- tions were in evidence. The great majority of surgical cures were recorded in this group. In any ease of nodular goitre suddenly exhibiting increased rapidity of growth, therefore, immediate operation should be urged. After the disease has progressed to a point that it is recognizable as such the results of surgical intervention are discouraging. The final emphasis of the article is on the importance of regarding all thyroid adenomata as precancerous and promptly removing them. For many points of technical interest the original should be eon- sulted.—R. G. H.
ABSTRACTS 107
THYROID gland, Conditions affecting the secretions of the— Cannon (W. B.) Tr. Ass. Am. Physicians. (Phila.), 1916, 31, 162-64.
Data published elsewhere. See Abst. Endoecrin. 1917, 1, 55, 72, 243, 362.
(THYROID, GOITRE) Contribution 4 1’étude et 4 la réparti- tion de quelques affections parasitaires au Moyen Chari (Afrique Centrale) (Distribution of certain parasitic diseases in Central Africa). Bouilliez (M.) Bull. Soe. Path. Exot. (Paris), 1916, 9, 143-167. (Goitre, 165-167.)
An interesting study of the geographical distribution of certain parasitic diseases and of various parasites concerned in their transmission. A map is included.
In a certain restricted district the goitre incidence runs as high as 80 per cent. Men, women and children as well as dogs, eats and horses are affected. No relation between age or sea- son of the year and incidence of the disease could be detected. Th goitres are often very large, causing edema of the face and even death from tracheal compression. Some are soft, others rigid. All races in the region are affected. Heredity apparently plays no part in the etiology. There is no apparent relation between the physical or chemical properties of the drinking water and the disease. By exelusion parasitic transmission seems most plausible although specific (microscopic) evidence was not obtainable. Inoculation and feeding experiments gave negative results.
Two observations seem to the author especially significant : (1) A child recently come to the region was taken with a severe fever which lasted more than a month; this was sueceeded by goitre. (2) In this region a certain biting insect, ac ant his- pis sulecipis (Fabr.) is common.—R. G. H.
(THYROID) GOITRE operation, Right laryngohemiplegia fol- lowing a—. Davidson (L. G.) Med. J. Australia (Sydney), 1916, (1) 449.
Not of endocrine interest. THYROID gland, Report of two adenomas of the. Bellin (J. J.) Wisconsin Med. J., 1916, 14, 386-7. Nothing new. THYROID gland, Some functions of the,—and their relation-
ship to goitre. Pern (S.) Med. J. Australia (Sydney) 1916, 1, 482-84.
108 ABSTRACTS
Graves’ disease and lesser degrees of toxie goitre are believed to be due to one or more of three causes: (a) Failure of the thyroid to funetionate properly as a detoxicating mechanism; (b) derangement of sympathetic funectionmeg and (c) interfer- ence with calcium metabolism. Pern has noted that, in Gipps- land, goitre with mild thyrotoxic symptoms is common. This is ascribed to the use of rain water and to slight consumption of milk and vegetables with resulting caleium deficiency. A large proportion of the cases are benefited by calcium medica- tion.—R. G. H.
THYROID glands, Some essential points in the anatomy and surgery of the. Barnhill (J. F.) Am. J. Surg., 1916, 30, 137-43.
Believes that the otolaryngologist should perform the surgery of head and neck, including thyroidectomy.—lL. F. W.
(THYROID) Graves’ disease. Keogh (C. H.) N. Y. Med. J. 1916, 104, 457.
The author describes a case of Graves’ disease in a woman 40 years of age after two operations for this condition. She developed a psychosis, emotional instability, nausea, vomiting, severe headaches and attacks of partial blindness. X-ray ex- aminations of the head were negative. Eye findings were con- tracted fields of vision in both eyes. The cause of the tempo- rary amblyopia was not defintely determined since intestinal toxemia and hysteria were not eliminated.—M. B. G.
(THYROID) Hyperthyroidism. Spence (lL. B.) L. I. Med. J., TOTES 10, 71:
A woman, 50 years old, complained of arthritis deformans symptoms as loss of appetite, loss of weight and pain in fingers and extremities. There was no exophthalmos but there was some enlargement of the neck. Treatment with quinine, thy- roidectine, sodium bromid, ergotole and complete rest in bed proving of no avail, one lobe and the isthmus were removed. Gain in weight and general well being resulted, but some ar- thritis symptoms remained.—M. B. G.
(THYROID) HYPERTHYROIDISM and abnormal growth. (Hypertiroidismo y enfermedad de crecimiento). Busco (J.) Actas Ier. Cong. Nac. de Med. (Bs. Aires), 1916, 4, 540.
A young girl having Graves’ disease, on account of febrile erises and pain in the bones had to remain in bed. When she got up it was evident that in a short time she had inereased in height in a short period to an unusual degree.—B. A. H.
ABSTRACTS 109
(THYROID) HYPERTHYROIDISM, Intrathyroid injection of boiling water in—. O’Day (J. C.) Ann. of Surg., 1917, 65, 279.
Seventeen cases of hyperthyroidism were successfully treated by successive intrathyroid injections of boiling water. These are carried out under local anesthesia; the ‘‘cooking”’ is begun at the upper pole and each succeeding injection car- ried downward. The treatment destroys the secreting tissue apparently better than does arterial ligation —C. MeP.
(THYROID) HYPOTHYROIDISM, Urticaria as a symptom of. (Urticaria als verschijnsel van hypothyreodie.) Bolten (H.) Nederl. Tijdsch. f. Geneesk. (Haarlem), 1918, 62, 1747.
In the Dutch literature are described several cases of urti- caria showing itself after fatigue. Bolton describes four other cases in which signs of diminished thyroid functioning and sympathetic ‘‘hypotonia’’ were noted—4J. K.
(THYROID) Intrathoracic goitre. Lamson (O. F.) Surg. Gyn. & Obst. (Chgo.) 1918, 27, 397-402.
It is stated that 50 per cent of intrathoracic goitres escape detection until discovered at operation. The patients are most likely to manifest respiratory symptoms, and to be treated for asthma, aneurism, etc. Roentgenograms, however, usually give a rather characteristic picture which facilitates diagnosis. The sympomatology is largely that of pressure; it includes respira- tory embarrassment, cyanosis, cardiovascular disturbances, dysphagia and dysphonia. Usually only one lobe of the thyroid is involved. Due to the position of the goitre and its anatom- ical relations its removal usually presents a trying problem. Local anesthesia is advised by Lamson. Hot saline packs in- serted as soon as the gland is delivered are advisable to prevent hemorrhage. Sudden collapse of the trachea necessitating tracheotomy is always to be feared.
The article includes a well illustrated case study.—R. G. H.
(THYROID) Isolated paralysis of the cervical sympathetic ac- companying goiter. Langdon (H. M.) Tr. Am. Ophth. Soce., 1916, 14, 661.
The author reports two cases of paralysis of the cervical sympathetic which he believes due to pressure exerted by a small, hard goiter which was present in each case. He gives in detail the eye findings.—L. F. W.
110 ABSTRACTS
(THYROID) Klimax und Myxodem. (Menopause and myxe- dema.) Curschmann (H.) Ztsch. f. d. ges. Neurol. u. Psych. (Berlin) 1918, 41, 155.
It is well known that increase of thyroid function has a marked influence on the genital functions. It is not so gener- ally known that increase of the function of the ovaries has an influence on the thyroid. The author describes an interesting case of a woman aged forty who developed typical myxoedema after castration for fibromyoma uteri. The disease was cured by thyroid tablets. Four cases are described in which the menopause was followed by myxoedema. In another case myxoedema developed in a woman aged 62 after ovariotomy for a cystoma. In view of the general opinion that after ovar- iotomy the function of the thyroid increases, these cases deserve attention.—J. K.
(THYROID) La pequena insufficiencio tiroidea en ginecologia. Castano (C. A.) Rev. Asoc. Med. Argent. (Bs. Aires), 1916, 23, 856-860.
See Endocrin., 1917, 1, 377.
(THYROID) Les goitres exophthalmiques. Debove. Clinique (Montreal) 1916, 6, 307-316.
A general discussion of the clinical aspects of Graves’ dis-
@ase.——_henGa be
(THYROID) Les tumeurs de la glande thyroide. Cancer thy- roidien ‘‘aberrant’’ chez le cheval. Petit (G.) Ree. Méd. Vét. (Paris) 1916, 92, 326-331.
A brief article classifying thyroid tumors and describing a thyroid cancer in a horse.—R. G. H.
(THYROID) Myxedema and the nervous system. Pitfield (R. Li) Am. J.Med. Sex(Phila.);, 19lesdat, 4092
Pitfield observed that most cases of thyrotoxicosis exhibit the stigmata of neurasthenia. In athyrosis mental disease is often due to deficiency of the thyroid function. The writer reports five interesting cases which were greatly benefited by thyroid extraet.—L. F. W.
(THYROID) Myxedema, The heart in (Myx6demherz). Zondet Miinch. med. Wehnschr., 1918, ..... .... (No. 43).
ABSTRACTS 4
Dilatations of both sides of the heart, bradycardia, normal blood pressure and absent antrium peak in the electrocardia- gram were observed. After the administration of thyroid the dilatation and bradycardia disappeared, blood pressure re- mained at the same height and the cardiogram became nor- mal.—J. K..
(THYROID) On THYROIDECTOMY in amphibia. Hoskins (BE. R.) and Morris (Margaret). Proce. Soc. Exp. Biol. & Med. (N. Y.), 1917, 14, 74-75.
Data published elsewhere. See Endocrin. 1917, 1, 345; 1918, 2, 340.
(THYROID, PARATHYROID) The relationship between thy- roid and parathyroid. Arnasson (J. 8S.) and Vincent (S.) Trans. Roy. Soc. Canada (Ottawa), 1917, 11, 121-122.
The thyroids and internal parathyroids were removed in a numiber of rabbits, and the remaining external parathyroids examined histologically after varying intervals. In all cases the parathyroids were found to be considrably hypertrophied, but in none was any trace of vesicle formation found. The au- thors believe that in those cases in which previous workers re- ported vesicle formation in parathyroids of cats and dogs, there was likely a small amount of thyroid tissue left behind after thyroidectomy.—L. G. K.
(THYROID) Present status of the surgical treatment of goiter. Wathen (J. R.) Ky. Med. J., 1916, 14, 18-21.
Wathen considers the diagnosis and symptoms, of the dif- ferent types of goiter that come to the physician for treatment. He urges early surgical intervention to secure the best re- sults.—L. F. W.
(THYROID) Quinine and urea injections in hyperthyroidism. Watson (L. F.) N. Y. Med. J., 1916, 103, 791.
See Endoerin., 1918, 2, 74 (No. 62).
(THYROID) Rectal anesthesia in thyroidectomy. Lathrop (W.) Penn. Med. J., 1916, 19, 78-82.
Lathrop reports 118 cases operated on under this form of anesthesia. He believes it has several advantages over gen- eral narcosis, especially in lessening the strain on the heart, lungs and kidneys.—L. F. W.
112 ABSTRACTS
(THYROID) Removal of the third lobe of a cystic goitre. Gal- lant (A. E.) N. Y. Med. J., 1916, 104, 778.
A married woman, 48 years old, had had a goitre since the age of 14. The interesting points in the case were: (1) The mother and five sisters had goitre said to have been cured by medicine. (2) Successive enlargement of the right and left lobes after removal of the middle lobe, with intervals of four- teen and four years respectively. (3) Aphonia following the second operation, and restoration of the voice after the third. (4) Very disagreeable effects when thyroid gland or potassium iodide was administered. (5) Almost uninterrupted discharge from the sinus and serious discomfort whenever the sinus closed temporarily, preventing escape of the secretion. (6) Marked diminution of the exophthalmus. (7) Return of a considerable growth of hair at her age.—M. B. G.
(THYROID) Results of operation in exophthalmic goiter. Judd (E. 8S.) L. I. Med. J., 1916, 10, 405.
The author reported in 1916 on 176 cases operated on in 1909. Of these he succeeded in tracing 121. Ligation proved advisable in two types of cases: (1) Patients with disease in mild form. (2) In very severe cases with one or more liga- tions preliminary to resection. The latter were advised to re- turn in three months for removal of part of the gland. In cases showing considerable intoxication, the left superior thy- roid vessels are first hgated under local anesthesia. If there is no reaction, the right lobe is removed in seven days. If there is a reaction, it is best to wait until this subsides before ligating the right. The reaction is increased and more irregular heart action, vomiting, diarrhea and restlessness. After the second ligation, it is advisable to wait about three months before thy- roidectomy. Thyroidectomy should always follow ligation, late recurrences being more common among patients who had been ligated only. Symptoms may return after a number of years. The exophthalmus is one of the last symptoms to disappear. Surgical interference should not be undertaken at the height of an attack of hyperthyroidism. The 121 cases show that about 46 per cent can be absolutely cured, 23 per cent practically cured, with a slight trace of former symptoms remaining, and an additional 4 per cent benefited. About 6 per cent reported no benefit at all—wM. B. G.
(THYROID?) SCLERODERMIA with subcutaneous calcareous concretions. Fearnsides (E. G.) Proce. Roy. Soe. Med. (Lond.) Neurol. Sec., 1916, 9, 73-77.
_ ABSTRACTS 113
A report of a case in which thyroid medication was not efficacious.—R. G. H.
(THYROID SPLEEN) Physiologie der Drisen. L. Asher. XXXVI. Das Verhalten von schilddriisenlosen, milzlosen, und schilddriisen-milzlosen Tieren bei 0, Mangel. (Reaction to oxygen deficiency after extirpation of thyroid, spleen and both combined.) Streuli (H.) Biochem. Ztsch., 1918, 87, 359-417. j
In rats deprived of the thyroid, oxygen want produced but little distress ; in those without a spleen there is more sensi- tiveness to oxygen want than normal, whereas when both or- gans are removed the animal reacts in the normal way. The
bearing of these observations on mountain sickness is discussed. —Physiol. Abst. 3, 453.
(THYROID SPLEEN) Uher die Blutgerinnung, und iiber die Beziehungen zwischen Schilddriise und Knochenmark, sowie Milz und Knochenmark. (Blood coagulation and the rela- tion of thyroid and spleen to bone marrow.) Yamada (M.) Biochem. Ztschr., 1918, 87, 273-330.
The spleen and thyroid are regarded as antagonistic in their remote effects on metabolism, on the strength of the find- ing that after removal of the thyroid, thrombin increases in bone-marrow and in blood-serum, but after removal of the spleen, though the marrow effect is the same, the thrombin in the serum (possibly a complex involving several factors) falls.
—Physiol. Abst. 3, 453.
THYROID, Studies of the active constituent, in crystaline form, of the—. Kendall (E. C.) Tr. Ass. Am. Physicians, 1916, 31, 134-145.
Data published elsewhere. See Endoecrin. 1917, 1, 72, 153- 170. The illustrations in this article are noteworthy.—R. G. H.
THYROID, Studies on the relation of iodin to the. I. The effects of feeding iodin to normal and thyroidectomized tad- poles. Swingle (W. W.) J. Exp. Zool. (Phila.) 1919, 27, 397- 416.
Tadpoles fed with potassium iodide, flour and algae grew more rapidly and developed limb buds more rapidly than other larvae fed with algae only. Later the experimental larvae were observed to be slowly falling behind in growth rate. At all times the experimental larvae were lighter in color than the
114 ABSTRACTS °
controls. Iodine and iodoform fed to tadpoles checked their growth rate and hastened development considerably. Jodin was found to stimulate metamorphosis in a shorter time than fresh thyroid tissue and thus to be more effective. Iodine was found to be very toxic to the larvae. Its toxicity seemed to be decreased if it was mixed with flour. Larvae from which the thyroids have been removed will not undergo metamorphosis on an ordinary diet (Allen, Hoskin) but such larvae were found to develop into frogs if fed on iodine.
The author advances the theory that iodin fed to larvae acts as a hormone itself without the intermediation of the gland (thyroid?). Also the author suggests that the chief function of the thyroid is to remove iodine from the blood and to store it. In regard to the first theory it should be noted that after thyroidectomy in amphibians the hypophysis undergoes a marked hyperplasia and shows microscopically a heightened secretory activity, facts which the author disregarded. It is believed that in all animals the hypophysis and thyroid are able to some extent to function vicariously for each other. Hence in the experiments described by Swingle the hypophysis of the thyroidless larvae may have been able to utilize the iodin fed, and thus bring about metamorphosis although unable to do so upon a normal diet. Therefore, the theory advanced cannot be proven correct, until the possibilty of the utilization of the iodin by the hyperactive hypophysis has been eliminated.
The second theory advanced, namely, that the chief fune- tion of the thyroid is to remove iodine from the blood and store it, is not proven by the experiments described. There would be no point in an animal having an organ with such function unless it were to keep the iodine for future use. If the thyroid were to act merely as a storage place for iodine, the amount of iodine in this gland would inerease steadily with age, but such is not the case. There is great variability in the amount of iodine present in the thyroid at any given age.—H. R. H.
THYROID, Studies on the relation of iodin to the. II. Com- parison of the thyroid glands of iodin-fed and normal frog larvae. Swingle (W. W.) J. Exp. Zool. (Phila.) 1919, 27, 417-427.
The thyroid glands of animals fed with iodin were larger than those of starving animals of the same size, but the thyroids of well-fed (larger) control larvae were the same size as those of ihe iodin-fed larvae. The thyroids of iodin-fed larvae cor. tained more colloid than those of the controls.—E. R. H.
ABSTRACTS 115
THYROID, Surgery of the—. Knott (V. B.) Jour.-Lancet (Minneapolis), 1916, 36, 138-142.
A general discussion, chiefly of technical interest. The author believes that copious administration of water by any of the usual methods should be practiced after thyroidectomy for exophthalmie goitre in order to forestall acute thyroidism.
—R. G. H.
(THYROID) Surgical treatment of goitre. Webb (C. W.), N. Y. State J. Med., 1918, 18, 272.
The great need in the surgical treatment of thyroid condi- tions is to know with what type of goitre we are dealing. The author divides them into three types: (1) Colloid, (2) Ade- noma, (3) Exophthalmic. The adrenalin test is of value in de- termining this. If it is negative in type 1, there is no indica- tion for surgery, other than to remove the deformity or relieve pressure symptoms. It is positive in class 2, when the adenoma is active. It is also positive in cases of type 3. The proper treatment is determined by the type of the disease and the condition of the patient.—M. B. G.
(THYROID) Surgical treatment of goitre. Vaughan (J. W.) N. Y. Med. J., 1916, 104, 1235.
Patients suffering from severe symptoms upon entrance to the hospital are confined to bed with ice bags over thyroid gland and heart. Frequently after 24 hours to one week, the acute symptoms have subsided sufficiently that operation may be safely performed. If the pulse rate and nervous symptoms do not subside, in from seven to ten days the case should be treated by Porter’s method. In relatively severe cases, the writer removes the greater portion of both lobes, together with the isthmus and pyramidal lobe.—M. B. G.
(THYROID) Surgical treatment of goiter. Wilson (J. M.) Am. J. of Surg., 1916, 30, 38-41.
Nothing new.
(THYROID) Surgical treatment of goiter. Bay (R. P.) Mary- land Med. J.,.1916, 59, 31-34.
Nothing new.
(THYROID) Sur le goitre exophthalmique traumatique. Léniez. Progrés Méd. (Paris) 1916, 30, 215-216.
116 ABSTRACTS
The author had previously made a study of exophthalmie goitre due to trauma—particularly of the head. He believes that certain cases of sub-acute goitre seen in soldiers fall into the class of traumatic goitre—R. G. H.
THYROID, Syngenesioplastic transplantation of the,—in the guinea pig. Multiple transplantation of the thyroid and the lymphocytic reaction. Loeb (L.) J. Med. Res. (Boston) 1918, 39, 39-91 - (1-91.
Reviewed elsewhere in this issue under the caption ‘‘ Tissue Transplants.’’ In view of the ‘‘overpretentious terminology”’ of the endocrine literature of which Vincent and others have complained, the author’s nomenclature is unfortunate. Of the superfluous coinages introduced the worst is ‘‘syngenesiotrans- plantation.’’—R. G. H.
(THYROID) Technic of the enucleation thyroidectomy. Gron- nerud (P.) Ill. Med. J., 1916, 29, 259-62.
Describes a method of enucleating the thyroid gland with- out the use of clamps.—L. F. W.
(THYROID) The early morphogenesis of the human thyroid gland. Norris (E. H.) Amer. Jour. Anat. 1918, 24, 443-466.
The article is based on a study of 72 human embryos from 2 to 15.5 mm. crown-rump length. The development is divided into eight stages: 1, pre-anlage, between the formation of the endodermal pharynx and appearance of the thyroid anlage; 2, early anlage, in which the thyroid is‘represented by a shal- low evagination of the pharyngeal floor between the first two gill pouches; 3, early growth stage, in which the thyroid is a single or double bud connected to the pharynx by a solid or hollow stalk; 4, beginning separation stage in which the bud is separating from the pharynx; 5, complete separation stage in which the bud separates from the pharynx; 6, cavity forma- tion stage in which cavities appear in the hitherto solid anlage; 7, plate stage in which these cavities open to the outside, trans- forming the anlage into an irregular plate, and 8, follicular stage in which the plate breaks up into follicles that acquire a himenss ==
Considerable variation was found in the shape of the de- veloping thyroid and in the rate of development. <A thyro- glossal duct may or may not develop and if developed may be either hollow or solid.—E. R. H.
-
ABSTRACTS 117
THYROID, The function of the—normal and abnormal. Plum- mer (H. S.) Tr. Ass. Am. Physicians, 1916, 31, 128-133.
Being in itself an abstract the article cannot well be fur- ther condensed. Plummer’s conception of the’essential role of the thyroid is that metabolism in the body as a whole is largely regulated quantitatively by chemical stimuli derived from the thyroid gland acting directly upon the tissue cells. For further development of the idea see Kendall, Endocrin. 1918, 2, 81-93.—R. G. H.
THYROID, The influence of the, on regeneration (Regenera- tion und Schilddriisenfunktion). Eppinger (H.) and Hofer (G.) Mitt. a. d. grenzgeb. Med. u. Chir. (Jena.), 1918, 31, 12.
In acute yellow atrophy of the liver changes in the thyroid have been described. Ponfick has reported that rabbits will survive extirpation of 24 to 34 of the liver, the latter subse- quently undergoing slow regeneration. The authors repeated the Ponfick experiment on rabbits that had been thyroid- ectomized. No animal survived and no liver regeneration took place. (It is probable that similar results would have been obtained in animals ill from any other cause.)
The effect of thyroid substance on wound healing was also investigated. Oral administration sometimes resulted favor- ably. In eases in which this was not successful the authors claim to have had brilliant results from local application of aqueous extracts.—J. K.
(THYROID) The isolation in crystaline form of the compound containing iodin, which occurs in thyroid; its chemical na- ture and physiological activity. Kendall (E. C.), Tr. Ass. Am. Physicians (Phila.), 1916, 30, 420-449.
For later report of this work see Endocrin., 1917, 1, 153, 169, and 1918, 2, 81.
(THYROID) The management of toxic goiter. Frazier (C. H.), Penn. Med. J., 1916, 19, 231-35. The writer carefully reviews the preliminary and surgical treatment of toxic goiter. He believes partial thyroidectomy the treatment of choice.—L. F. W.
(THYROID) The medical treatment of Graves’ disease, Gor- dinier (H. C.), N. Y. State J. Med., 1918, 18, 267. -
The author makes a plea for the early recognition of the disease, especially the toxic type. He advises the detection and
”
118 ABSTRACTS
treatment of local infection in tonsils, gums, sinuses, middle ear, ete. The ideal treatment is enforced rest. If recognized early, most mild or incipient cases and 50 per cent of advanced cases are curable by rest, hygienic and medical means. All cases that have undergone careful medical treat- ment without improvement or have progressed or present pressure symptoms, should be referred to a surgeon. Cases showing myocardial insufficiency or serious arrythmias should be treated medically. Skigrams of the chest should be taken to discover extraneously placed, accessory or dipped thyroids and to determine the size of the thymus. Suecess in each ease depends upon careful individualization.—M. B. G.
(THYROID) The non-dependence of the protein quotient in the blood-serum upon the rapidity of metabolism with especial reference to the non-effect of antipyretics, sodium cacodylate and thyroid extract. Hanson (S.) and MeQuarrie (I.) J. Pharm. and Exp. Therap. (Balt.) 1917, 10, 261-275.
Thyroid extract produced no change in the relative pro- portions of the serum proteins.—F’. A. H.
THYROID, The nucleoprotein of the (Ueber das Nukleoproteid der Schilddrtise). Grobly (W.) Mitt. a. d. Grenzgeb. Med. u. Chir. (Jena.), 1918, 30, 403.
Puppies show marked changes in the thyroid after admin- istration of iodthyreoglobulin or thyronucleoprotein. These are increase of colloid, atrophy of the epithelial cells and atro- phy of the intervesicular tissue; the vacuoles shrink or totally disappear. In ease of thyreonucleoprotein feeding there is more marked epithelial atrophy and more affinity of the colloid for aleohohe stains than when iodthyreoglobulin is used.
Grobly theorizes to the effect that the nucleoprotein dimin- ishes the solubility of the colloid hence the function of this ma- terial is to retain colloid in the gland; a deficiency of the nucleo- protein would lead, therefore, to increased resorption of the colloid and, hence, hyperthyreosis. In Graves’ disease there 1s not only evidence of hyperthyreosis but also of diminished formation of nucleoproteins in general. This indicates a rela- tionship between the thyroids and phosphorus metabolism. Hence in Graves’ disease phosphorus should be administered. (In view of the lability of the thyroid to react morphologie- ally to such factors as diet, hygiene, toxic influences and, espe- cially, iodin, such experiments to be significant would have to be extensive and rigorously controlled. They should also be confirmed by several investigators.—Ed.)—J. K.
ABSTRACTS EIS
(THYROID) The relationship of the pathological histology and the iodin compounds of the human thyroid. Wilson (L. B.) and Kendall (E. C.) Tr. Ass. Am. Physicians (Phila.),
1916, 30, 458-573. Published elsewhere. See Endocrin., 1917, 1, 90.
(THYROID) The ultimobranchial bodies in postnatal pigs (Sus scrofa). Badertscher (J. A.) Am. J. Anat. (Phila.) 1919, 25, 13-27.
Another contribution by the author to the study of the as- sociaticn of the ultimobranchial bodies with the thyroid. In young and adult pigs it was found that the ultimobranchial bodies embedded in the thyroid form colloid and assume the histological structure of the thyroid. The amount of the thy- roid formed by these bodies was found to vary in different pigs.
(THYROID THYMUS) GOITRE, A complete metabolism study of—with the effect of thyroid and thymus treatment. Hal- verson (J. O.), Bergheim (O.) and Hawk (P. B.) Proc. Am. Soe. Biol. Chemists (Balt.), 1916, 22, 23.
Published elsewhere in full. See Endoerin. 1917, 1, 242.
(THYROID) Thyrotoxicosis. Bogart (A. H.) L. I. Med. J., 1916, 10, 249.
A typical case with recovery after operation.
THYROID treatment of chronic rheumatism. Anon. Monde Méd. (Paris) (Eng. Edition) 1917, 27, 214-217.
In certain cases of ‘‘rheumatism’’ careful search will dis- close slight degrees of the classic signs of hypothyroidism, as dry skin, falling eyebrows, ete. In such eases the joint pain sometimes disappears quickly when thyroid medication is insti- tuted. Caution as to dosage should be observed because such patients are often unusually susceptible to thyroid.—R. G. H.
(THYROID) Uber die Behandlung des Morbus Basedowii und der Struma maligna mit Réntgenstrahlen. (The treatment of Graves’ disease and struma maligna by X-rays.) Ludeck (G.) Deutsche med. Wehnschr. (Berlin) 1918, 44, 1104.
120 ABSTRACTS
X-ray treatment is not to be recommended in eases of Graves’ disease. The results of operation are more certain and much better. When a malignant tumor is growing in the thyroid, the results of surgery are extremely bad, while a bril- hant success may be obtained by X-ray treatment.—QJ. K.
(THYROID) Un caso de acondroplasia con antecedentes famil- iares de hipotiroidismo. (Achondroplasia with family his- tory of hypothyroidism). Mussio Fournier (J. C.) Rev. Méd. d. Uruguay, Dic. 1917, 20, 769.
A typical case reported. <A tentative polyglandular an- alysis is offered.—B. A. H.
(THYROID) Un caso de mixedema. Piaggio Garzon (W.) Rev. Med. del Uruguay, 1916, 19, 736.
A case of sporadic myxedema in an infant of 5 months.
—B. A. H.
(THYROID) War neuroses in women. Boehme Jr. (G. F.) Med. Ree. (N. Y.) 1918, 94, 180-84.
Boehme discusses the importance of various intrinsic fae- tors including incipient Graves’ disease and endocrine or auto- nomic nervous imballance in the causation of war neuroses.
—R. G. H.
(THYROIDECTOMY) Die Milch schilddriisenlosen Ziegen (Milk of thyroidless goats). Grimmer (W.) Biochem. Ztschr. 1918, 88, 13-34.
Thyroidectomy reduced the quantity but not the quality of the milk secreted.—Physiol. Abst., 3, 449.
The abstracts in this number have been prepared by the staff assisted by:
W. E. Blatz, University of Toronto.
Frederic Fenger, Chicago.
Margaret M. Hoskins, Pittsburgh.
L. G. Kilborn, University of Toronto.
C. E. MePeek, University of Ohio.
Homer Wheelon, St. Louis University.
With the permission of the editors, certain abstracts have
been quoted from ‘‘Physiological Abstracts’’ and ‘‘Chemical Abstracts.”’
BRO OCRINOLOGY
THE BULLETIN of the cASSOCIATION for the STUDY of
PGE RINAL SECRETIONS
APRIL-JUNE, 1919
THE FUNCTION OF THE CHROMAPHIL TISSUES
I. Pearlman and Swale Vincent
(From the Physiological Laboratory, University of Manitoba, Winnipeg, Canada)
The theory that the chromaphil tissues (and especially the medulla of thé adrenal bodies) maintain, or help to maintain, the normal tone of the blood-vessels and other sympathetically innervated structures, is now generally abandoned, if we may judge by the attitude adopted by the writers of recent text- books (15). It is also recognized that the medulla of the adrenal body is not essential to life, and that the reduction of the adrenin content of the blood to a minute fraction of the normal amount does not affect the health of an animal (16). Certain phases of this question have been dealt with in a recent article in this Journal (18).
These statements, however, do not exclude the possibility that the chromaphil tissues play a part in certain reactions which are initiated elsewhere, as, for example, in those which result from stimulations of nerves in laboratory experiments.
It has been known for a long time that the rise of blood- pressure brought about by stimulation of the peripheral end of the splanchnic nerve is not simple. The curve obtained sug- gests at once that there is more than one factor concerned in its production. We have not been able to find any reprodue-
122 FUNCTION .CHROMAPHIL TISSUES
tion of tracings obtained previously to the work of Elhott, so that it is difficult to ascertain what was the precise form of curve which was considered to be typical under normal or under different experimental conditions,
Johansson (13) found that in the dog the curve presents two summits, and it has since been found that the same is gen- erally true in other animals also.
Lehndorff (14) also worked with dogs and came to the conclusion that the first rise is due to vaso-constriction in the splanchnic area, the ‘‘step’’ to a temporary dilation of the heart, and the second rise to increased force and frequency of the heart-beat accompanied by vaso-constriction in the somatie area.
Elliott (6), who investigated the subject in cats, stated that in animals recently admitted and still in a frightened con- dition, the typical splanchnic curve cannot be obtained. But he regarded the typical curve as something different from that obtained by previous workers in the case of dogs. According to this author a well marked characteristic of the pressure curve seen when the splanchnics are stimulated under good condi- tions in the cat, is that it rises rapidly for nine or ten seconds; then, without any check in the heart’s rhythm, the curve is sharply cut down nearly to the level from which it came, whence it rises slowly again so long as the stimulus is continued. The drop, according to Elhott, is due to the liberation of adrenin into the blood, and he gives what seems to be very convineing evidence in favor of this view.
VY. Anrep (1, 2) who used dogs for his experiments, réports that stimulation of the splanchnic nerve causes a rise of blood-pressure which occurs in two phases. The second phase is accompanied by constriction of peripheral blood-vessels (even after denervation) and by acceleration and increased tone and augmentation of the heart (also after denervation). The secondary rise and all the concomitant phenomena are due to the discharge of adrenin into the cireulation, and are absent after extirpation of both adrenal bodies. Every rise of blood- pressure, brought about by the ageney of the nervous system, involves the co-operation of the chemical mechanism repre- sented by the adrenal bodies. The constriction of blood-vessels
PEARLMAN AND VINCENT 123
~~
in denervated limbs under splanchnie stimulation, which was regarded by Bayliss (3) as a local reaction to increased pres- sure, is interpreted by V. Anrep as due to the action of adrenin. The rise of blood-pressure in asphyxia is also looked upon by this author as being partly due to constriction of somatic ves- sels as a result of the action of adrenin upon them.
Gley and Quinquaud (7, 8, 9, 10) have recently thrown doubt upon the validity of these experiments. They think that ligature of the vessels of the adrenal bodies or extirpation of the organs in the dog involves damage to some of the splanehnic vaso-constrictor fibres and that this accounts for the alteration in the splanchnic blood-pressure curve. In the eat and the rabbit, according to these authors, such alteration does not occur. In these animals the nerves are not so intimately connected with the adrenal bodies.
These criticisms on the part of Gley and Quinquaud have prompted us to a re-investigation of the subject. We have performed a very large number of experiments upon dogs, cats
and rabbits.
Fig 1. Dog, 12 K. Ether, vagi cut. Left Splanchnic stimulated in thorax. Time tracing in seconds.
At the outset it was found that the conditions under which the experiment is performed makes a very considerable differ-
124 FUNCTION CHROMAPHIL TISSUES
ence in the character of the curve obtained by splanchnic stimulation. There may also be differences characteristic of the different species and of different conditions of the animal. V. Anrep seems never to have obtained in his dogs under normal conditions a form of curve which we now look upon as the typical or normal, namely, a sharp rise (having a ‘‘hump”’
ce
about half-way up) followed by a marked ‘‘dip’’ nearly down to the original level, and succeeded by a rise which lasts as long as stimulation is continued. (See Fig. 1.)
This occurs in dogs under ether with both vagi eut. V. Anrep used A. C. E. mixture and morphia. Chloroform, curare, and morphia sometimes modify the curve in such a way as to abolish the ‘‘dip,’’ leaving only the ‘‘hump’’ on the rise (See Fig. 2.)
Fig. 2. Dog, 10 K. Ether, vagi cut, both splanchnies cut in thorax. a. Stimulation of left splanchnic five minutes after injection of 2 cc. of 1% morphine sulphate. b. Stimulation 15 minutes later. c. Stimulation 15 minutes still later. The effect of the morphine wears off and the normal curve tends to appear again.
In many of our tracings the ‘“‘hump’’ and the subsequent ‘“dip’’ are quite distinet (see Figs. 1, 2, 3) and the augmenta- tion of the heart is very manifest (1, 2, 4, and others).
The curve just deseribed is, we believe, to be regarded as the normal effect of stimulation of the peripheral end of the splanchnic nerve in the dog, as well as in the eat and the rabbit, when these animals are under the influence of ether alone, or under morphine and curare in addition, although under the
ce
influence of the latter drugs the ‘‘dip’’ is much less pronounced
and sometimes altogether abolished.
PEARLMAN AND VINCENT 125
V. Anrep, in discussing Elliott’s results, says ‘‘ Elliott investigated the question in the eat, in which animal the ‘step’ becomes a distinet fall.”” As we have already stated, in our experiments there was no essential difference in this respect between dogs and cats. The ‘‘step’’ referred to by V. Anrep is therefore not what we have called the ‘‘hump,’’ but some- thing which occurs later and which we eall the ‘‘dip.’’ We have not been able to convince ourselves that the nature of the nor- mal curve is dependent on nervous or emotional conditions either in dogs or in eats.
According to Elliott the ‘‘dip’’ of the splanchnic curve in cats does not occur if the adrenal bodies are excised or tied off. V. Anrep reports that the ‘‘step’’ in dogs is in a similar manner abolished by suppression of the adrenal bodies. Gley and Quinquaud, on the contrary, believe that there is an impor- tant difference in the results between dogs and eats. They state that interference with the adrenal bodies does not affect the result in cats, and that it does so in dogs only because of a different anatomical arrangement. In their opinion, extirpa- tion or ligature of the glands in dogs necessitates damage to nerve fibres, while in cats it may not.
According to our experiments there is no such difference in the results obtained in dogs and eats, respectively. Our results, indeed, entirely confirm those of Elhott and apply equally to dogs, cats and rabbits. We have usually obtained quite satisfactory positive results by simply clamping and unclamping the adrenal veins. Moreover, all necéssary dissec- tion in the neighborhood of the gland was earried out before
the control experiment was performed. (See Figs. 3, 4.
Fig. 3, Dog, 10 K. Ether, vagi cut, both splanchnics cut in thorax. a. Stimulation of left splanchnic. b. Do. after clamping adrenal veins. c. Do. after clamps have been released.
126 FUNCTION CHROMAPHIL TISSUES
Fig. 4. Bitch, 10 K. Ether, morphia, vagi cut, both splanchnics cut in thorax. a. Left splanchnic stimulated. b. Left splanchnic stimulated after left adrenal has been tied off. c. Right splanchnic stimulated with right gland intact.
Fig. 5 shows that the results in the cat were similar to those obtained with the dog.
2
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i ; [ 120 100 100
PUiFerve COO UOONNTS FOYTD CET ORNEETD FET COYET CSP TTTUTYITTL POTEET ONT TTT PEPIN TT eee eS eT ee vi
Fig. 5. “Cat, 2K. Ether, vagi cut, both splanchnics cut in thorax. 1. Right splanchnic stimulated. 2. Right splanchnic stimu- lated after the adrenal veins had been clamped on the right side.
During the period of the first rise of blood-pressure under splanchnic stimulation there is marked passive dilation of the denervated limb. This is followed by pronounced -constriction. In experiments on this subject we have always employed ether, morphia, and curare. When the adrenal veins are clamped or tied this constriction does not oceur. Thus, our results are in accord with those of V. Anrep. (See Figs. 6 and 7.)
V. Anrep believes that the constriction of a denervated limb during the pressor response to stimulation of the central end of the sciatic nerve is due to the action of adrenin. He
PEARLMAN AND VINCENT 127
Fig. 6. Dog, 16 K. Ether, morphia, curare, vagi cut. Upper curve, volume of denervated hind limb; lower curve, carotid blood- pressure. Time tracing in seconds. The right splanchnic was cut in the thorax and the peripheral end stimulated.
Litsisititisistisiitisriditirdisietirabs hare Mckee deities Dee ed) to bss
Fig. 7. Same dog as in Fig. 6. In this tracing we see the effect of stimulating the right splanchnic after the adrenal veins had been clamped on both sides.
128 FUNCTION CHROMAPHIL TISSUES
was led to this conclusion by the observation that after removal of the adrenal bodies from the circulation, the limb does not constrict, but follows passively the blood-pressure. Our own results enable us to confirm this observation. (See Figs. 8 and oS)
Fig. 8. Dog, 10 K. Ether, morphia, curare, vagi cut. Upper curve, volume of denervated left hind limb. Lower curve, carotid blood-pressure. The abdominal cavity was open and the adrenal bodies had been cleaned in readiness for tying off.
Although suppression of adrenal function does not appear to affect the alteration in blood-pressure brought about by vaso- motor reflexes, yet it seems exceedingly probable from the above experimental results that, even when the limb is intact, the adrenals must play a considerable part in determining the dis- tribution of blood in the body, when a stimulus is applied to an afferent nerve. It can scarcely be imagined that the presence of a nerve-supply can totally mask the aetion of the chemical
PEARLMAN AND VINCENT 129
agent. But it is difficult to be certain that the adrenal bodies play a part in vaso-motor reactions in the normal state of the animal.
What follows after adrenal suppression when a_ weak stimulation causes a depressor response we have not ascer- tained.
iM arn "140 WME ny
Ann’ 100
Fig 9. Same dog as in Fig. 8. The tracing is taken five min- utes later than in Fig. 8, after the adrenals on both sides had been tied off. Stimulation of central end of right sciatic.
If we investigate the difference between the intact and the denervated limb in regard to their respective responses to injection of small doses of adrenin (0-2 e@.c. to 1 @e. of a 1:100,000 solution) we must bear in mind the results obtained by Hoskins, Gunning and Berry (12). It was found that with
nerves intact adrenin causes active dilatation of the muscles
130 FUNCTION CHROMAPHIL TISSUES
and vaso-constriction in the cutaneous vessels, so that while the entire limb usually constricts, a skinned limb will invariably dilate. This result we have been able to confirm. As further pointed out by Gruber (11), the results just described are obtained only when the nerves to the limb are intact. In the denervated limb, at any rate within a certain period after the denervation, adrenin does not cause active vaso-dilatation in the muscles. These results agree well with what we find, namely, that when the splanchnic nerve is stimulated periphe- rally and the sciatic centrally in such a way as to give pressor responses, the intact limb follows passively the blood-pressure, | while the denervated limb econstricts. It is only reasonable to suppose that this is a natural consequence of the fact that in the denervated limb the muscles do not actively dilate, and therefore fail to produce the masking effect upon the skin con- striction. We have been able to satisfy ourselves on these points by injection of adrenin as well as by stimulation of the nerves just referred to. This is, in our opinion, to be regarded as a provisional answer, to the query above, as to why the presence of intact nerves should interfere with the response to the chemical agent.
In regard to the effects of asphyxia, our results differ from those of V. Anrep. We have been unable to obtain trac- ings showing any significant difference in the behavior of a denervated limb during asphyxia in an animal with adrenals suppressed as compared with one in a normal animal.
It seems impossible to avoid the conclusion that when pow- erful impulses are transmitted along certain afferent or efferent paths, the adrenal bodies (or, more correctly, the masses of chromaphil tissue contained within these bodies) play a part in the total response. Whether, under normal condition of the animal, the impulses which are so transmitted are sufficiently powerful to give rise to results similar to those of the laboratory experiments, or whether they are of such a character as to be adequate for such results, we cannot pretend to say. It is tempting to assume that the impulses may become adequate in
PEARLMAN AND VINCENT 131
physiological emergencies, as was suggested by Cannon and de la Paz (4).
It appears from our own tracings and from those of Elliott that, although the character of the splanchnic curve is seriously modified by elimination of the adrenals, the total rise of blood- pressure may not be affected, or may even be greater than before. It follows that in these cases the effect of the adrenin actually poured out into the circulation is a fall of blood- pressure and not a rise. This corresponds with the fact that small doses of adrenin produce a fall and not a rise. In other cases, however, the total rise is greater in the intact animal.
The question arises as to the nature of the process by which the adrenin is poured out into the circulation in sufficient quantity to produce, in laboratory experiments, the effects detailed above. It is generally assumed that the process is a true secretion, and that the splanchnic nerve is the channel along which the secretory fibres run. This is supposed to apply equally to experiments in which the splanchnic itself is stimu- lated and in those in which changes in the circulation are brought about reflexly by stimulation of different afferent nerves.
Some observers have alleged that the discharge of adrenin is the result of vaso-dilation of the adrenal body as a result of direct or reflex stimulation of its vaso-motor nerves. It would appear very extraordinary if stimulation of the splanchnie caused vaso-dilation in the adrenal bodies, while it caused vaso- constriction in all the other abdominal viscera to which it sends fibres. Moreover, the experimental evidence on this point is not satisfactory. We might even go as far as to assume for the present that stimulation of the splanchnic constricts the vessels of the adrenal body. If this is the case, the constriction of the vessels of the gland might actually be the cause of the discharge of adrenin. For a certain amount of this substance contained in the veins and capillaries of the organ would be almost instantly driven out into the general circulation. This effect
132 FUNCTION CHROMAPHIL TISSUES
could of course be only of the briefest duration, though it might sasily be sufficiently prolonged to produce the temporary effects above referred to. These effects as we have seen, consist prac- tically in a fall of the carotid blood-pressure and a constriction of vessels in certain somatic areas. This theory would account for the fact, observed by Elliott, that it is not possible to com- pletely exhaust the gland by continued splanchnic stimulation. It would also explain the fact that the effects above detailed cannot be repeated until a certain time has elapsed since the first stimulation. If this were found to be the true explanation of what happens, we should then not have to deal with a true secretory activity of the glands, but only a mechanical expul- sion of adrenin as a result of vaso-constriction.
In all such discussions it is important to bear in mind that the medulla of the adrenal body constitutes only a portion of the total chromaphil tissue in the body. In fact, it seems more than likely that there is more chromaphil tissue outside the adrenal bodies than within them. We ean searcely avoid this conclusion when we remember that the tissue in question is distributed widely in the sympathetic ganglia and in masses of various sizes throughout the abdomen. (See Vincent, 17).
This being so, it is remarkable that elimination of the adrenal medulla alone produces such marked and definite results as we have described. In the case of the effects of stimulation of the splanchnic nerve, it may be that the stimu- lation produces greater or more direct effects on the adrenal
‘
medulla than on such structures as the ‘‘abdominal chromaphil body’’ (17), though the innervation of the latter would also be from the splanchnic. There is another possibility. Assum- ing that the glandular theory of adrenal activity is the true one, it might be urged that the adrenal medulla is a chromaphil gland of a more highly-developed type than that of the seat- tered masses of chromaphil cells in other regions.
Cramer (5) has recently come to the conclusion that an increased activity of the thyroid gland leads to an increased liberation of adrenin from the adrenal bodies. He has formu-
PEARLMAN AND VINCENT 133
lated the conception that the thyroid and adrenal bodies form part of a mechanism for the chemical heat regulation of the body. He uses osmic acid vapor as a fixing agent to show the adrenin granules under varying conditions. The method has been applied to the adrenal bodies of mice and rats subjected to the conditions which were expected to produce alteration in the functional activity of the glands; these were thyroid feed- ing, thyroidectomy, injection of B-tetrahydronaphthylamine and other procedures. In all cases, he says, the method gave evidence of distinct changes in the medullary cells. There was evidence of the passage of adrenin granules into the blood- vessels of the medulla after injection of B-tetrahydronaphthyla- mine. The granules disappear if the glands are exhausted, and, in the various conditions demanding increased activity of the glands, fine black granules, similar to the granules of the medulla, appear in the cortex, especially in the layers of cells nearest the medulla. Cramer points out that this is clear evi- dence that the cortex takes part in the functional activity of the medulla and that these two parts of the gland are not two physiologically independent organs.
These observations, if confirmed, have a very important bearing on the question of the relationship between cortex and medulla of the adrenal bodies. Up to the present time there has been no satisfactory evidence that the two portions of the gland have any relation to each other, either embryological or physiological.
Even if it could be shown conclusively that under certain conditions adrenin granules are found in the part of the cortex next to the medulla, this would by no means prove that the cortex normally takes a part in the production of adrenin. It might be supposed that under pathological conditions adrenin might not be able to escape by the usual channels, and so would overflow into the neighboring cortex.
The histological evidence as to a secretory function of the
adrenal medulla seems to us to be far from satisfactory.
134 FUNCTION CHROMAPHIL TISSUES
SUMMARY
1. The typical blood-pressure curve obtained in response to stimulation of the peripheral end of the cut splanchnic nerve has the following characters:
There is first a sharp rise (having a ‘‘hump”’ about half- way up). This is followed by a marked ‘‘dip’’ nearly down to the original level and succeeded by a second rise. The pressure remains high as long as stimulation is continued.
This curve is obtained in dogs, cats, and rabbits, and although it is perhaps most typical of what occurs in animals under simpie ether anesthesia, yet with slight variations it may be expected to represent the usual sequence of events under morphine and also under curare.
2. When the adrenal veins of both sides are clamped or tied, or when both splanchnic nerves are cut and the adrenals clamped or tied off on the side stimulated, stimulation of the splanchnic nerve gives rise to a simple curve without the “‘dip.”’
This is true in dogs, eats, and rabbits, and is not deter- mined by any damage done to nerves in manipulation of the elands, but to an interference with the pouring out of adrenin into the blood-stream.
3. The ‘‘dip’’ in the normal curve is due to the discharge of adrenin in such doses as to produce a depressor effect.
4. When splanechnie (peripheral) and sciatic (central) nerves are stimulated in such a way as to give a pressor re- sponse, the intact limb follows passively the blood-pressure, while the denervated limb becomes constricted. This is due to the fact that in the recently denervated limb the blood-vessels of the muscles do not actively dilate (as they normally do) and therefore fail to mask the skin constriction.
5. After elimination of the adrenal bodies the denervated limb also follows passively the blood-pressure. There is now no constriction on stimulation of the above nerves.
6. It would appear that the general result of a discharge of adrenin into the circulation, over and above the amount which normally passes out into the blood, would be a econstric- tion in the skin area and a vaso-dilatation of skeletal and car- diac muscles. It is obvious that this might be of advantage in certain physiological emergencies.
7. It seems probable that the chromaphil tissue, especially, perhaps, the so-called ‘‘medulla of the adrenal’? may have
PEARLMAN AND VINCENT 135
important functions connected with the distribution of blood in the body, if not under normal conditions, at any rate in times of nervous and muscular strains.
BIBLIOGRAPHY
1. V. Anrep. On the part played by the suprarenals in the normal vascular reactions of the body. J. Physiol., 1912-13, 45, 307.
2. V. Anrep. On local vascular reactions and their interpre- tation. Ibid., 1912-13, 45, 318.
3. Bayliss (W. M.) On the local reactions of the arterial wall to changes of internal pressure. Ibid., 1912, 28, 220.
4. Cannon (W. B.) and de la Paz (D.). The stimulation of
adrenal secretion by emotional excitement. J. Am. Med.
Assn., 1911, 56, 742; also in Am. J. Physiol., 1911, 28, 64.
Cramer (W.) Further observations on the thyroid-adrenal apparatus. A micro-chemical method for the demonstra- tion of adrenalin granules in the suprarenal gland. Proce. Physiol. Soc., Jan. 26th, 1918, in J. Physiol., 1918, 52, Ex:
6. Elhott. The control of the suprarenal glands by the splanchnine nerves. J. Physiol., 1912, 44 374.
Gley (E.) et Quinquaud (A.) Influence de la sécrétion surrénale sur les actions vaso-motrices dépendant du nerf splanchnique, C. r. Acad. d. Sei., 1913, 157, 66.
8. Gley (E.) et Quinquaud (A.) Des rapports entre la séeré- tion surrénale et la fonction vaso-motrice du_ nerf splanchnique. C. r. Acad. d. Sci., 1916, 162, 86.
9. Gley (E.) et Quinquaud (A.) La _ séerétion surrénale d’adrenaline ne tient pas sous sa dépendance l|’effet vaso- constricteur du sang asphyxique. C.r. Soe. d. Biol., 1917, 80, 15.
10. Gley (E.) et Quinquaud (A.) La fonction des surrénales. 1. Du role physiologique supposé de l’adrenaline. J. de Physiol. et de Path. Gén., 1918, 17, 807.
11. Gruber (C. M.) Further studies on the effect of adrenalin upon the blood flow in muscles. Am. J. Physiol., 1918, 45, 302.
12. Hoskins (R. G.), Gunning (R. E. L.) and Berry (E. L.) The effect of adrenin on the distribution of the blood. I. Volume changes and venous discharges in the limb.
Am. J. Physiol., 1916, 41, 513.
ON
~l
136
13.
14.
jd (00)
FUNCTION CHROMAPHIL TISSUES
Johansson (T. E.) Die Reizung d. Vasomotoren nach der Lahumung der cerebrospinalen Herznerven. Arch. f. Anat. u. Physiol. (Physiol. Abt.), 1891, —, 193.
Lehndorft (A.) Uber die Ursachen der typischen Schwank- ungen des allgemeinen Blutdruckes bei Reizung der Vasomotoren. Arch. f. Anat. u. Physiol (Physiol. Abt.), 1908, —, 362. .
MacLeod (J. J. R.) Physiology and Biochemistry in Modern Medicine, St. Louis, 1918.
Stewart (G. N.) Comment on Prof. Vincent’s article (Re- cent views as to the funetion of the adrenal bodies). Endocrin., 1917, 1, 150.
Vineent (S.) The chromaphil tissues and the adrenal me- dulla. Proce. Roy. Soc., London, 1910, 82, B. 502.
Vineent (S.) Recent views as to the function of the adrenal bodies. Endoerin., 1917, 1, 140.
DEATH PRODUCED BY TYING THE ADRENAL VEINS
F. A. Hartman and W. E. Blatz
(From the Department of Physiology of the University of Toronto)
Since the discovery that Addison’s Disease is due to dis- turbance of the adrenal apparatus, many attempts have been made to produce the disease artificially. Adrenal insufficiency is said to be the main cause, and hence epinephrectomy was thought to be the best method of producing the peculiar syn- drome of the disease. This method is, however, too drastic, the animal suecumbing more or less rapidly to the operation. Some method of reducing the adrenal function without completely destroying it, appeared to be required.
Certain infectious diseases impair the function of the ad- renals. Diphtheria (1) produces vacuolization and hemorrhage in the adrenals, and diphtheria toxin (2) is said to lessen the pupil-dilating substance in the adrenal venous blood. In view of this we attempted to destroy a portion of each gland by the injection of sublethal doses of diphtheria toxin into the ex- posed gland. Evidently the toxin was either neutralized, or else washed away by the blood stream before it could cause much destruction of the adrenal tissue, because no symptoms could be noticed, following such injection. Although we ex- perimented with only one cat and one guinea pig, the method was considered unsatisfactory.
The blood flow through the adrenals is relatively very large; therefore by hindering the blood supply we should be able to produce degenerative changes rather easily. If the blood flow could be almost stopped, the changes in the gland might be slow enough to produce merely a condition of hypo- ‘secretion, such as we desired. The arteries break up into such fine branches before entering the capsule, that checking the inflow would be too difficult. On the other hand, the outflow is mainly through a large vein emptying into either the vena cava, or else the renal vein, so that by ligation the flow could easily be stopped. However, a small amount of blood eseapes
137
138 DEATH FROM ADRENAL OCCLUSION
through a rete of vessels connecting the adrenal with the kid- ney (3) so that occlusion of the adrenal vein does not produce complete stasis of blood in the gland. (See accompanying figure. )
Veins to the adrenal of the cat. The rete of vessels connecting the adrenal with the kidney, after the diagram of Cow.
ad., adrenal.
a., common lumbo-adrenal vein.
l., Jambar vein joining the adrenal vein.
Vv. c., vena cava.
xX., position of ligature.
xx., ligature here in some experiments, in addition to position x.
This research is a preliminary study of the effects produced by disturbing the blood supply to the adrenals.
Methods A lumbar vein from the dorsal musculature joins the ad- renal vein as the latter leaves the gland (Fig.) so that their blood is carried by a common trunk into the vena eava. In some cases one adrenal was excised. In all of the experiments the common lumbo-adrenal vein was completely tied off (see X in Fig.) central to the adrenal or adrenals left in the body. Because of the possibility of a back flow through the lum- bar vein, this was also tied in a few animals (XX, Fig.). All
HARTMAN AND BLATZ 139
animals were anesthetized with ether and the operations con- ducted aseptically. Cats were used in a majority of cases, but dogs and rabbits occasionally.
After the operation the animals were studied at first daily, and then at longer intervals to see whether characteristic symp- toms developed. They were examined for changes in rectal temperature, weight, heart rate and muscular weakness. In some cases the animal was killed, in others it was allowed to die following the natural course of events. The adrenals were then fixed and studied.
The glands were placed for twenty-four hours in a mixture of 90 parts of 3.5 per cent K,Cr,O, with 10 parts of 40 per cent formaldehyde (4). They were then washed in running water for an equal time, after which they were immersed in a solution of Gum Arabie for a few hours before sectioning.
Sections 5 micra to 30 micra in thickness were cut with a freezing microtome. After washing in tap water to remove the gum, the sections were stained 5 to 10 minutes with Dela- field’s haemotoxylin, subsequent treatment with water remov- ing the excess stain. They were finally left in a saturated 70 per cent alcoholic solution of Sudan III over night. After again washing with water they were mounted for study in Farrant’s medium. The lipoids were stained red by Sudan III and chromaffin cells yellowish if they contained adrenalin.
Results
Experiment 1. The adrenal veins to both glands in a eat were tied off by ligating the vein coming from the lumbar muscles and the common vein as it entered the vena cava. The only possible outlet from the adrenals was the kidney rete. Forty-eight days later the animal died without developing any noticeable symptoms except muscular weakness just before death. Microscopic examination of the glands showed a slight vacuolization in the zona fasciculata and the presence of adre- nalin in the medulla. Lipoids were plentiful in the cortex.
Experiment 2. The right adrenal was excised and both the lumbar vein and the common Jumbo-adrenal vein tied off on the other side. The cat died two days later with no observed external change. The adrenal which had remained in the ani- mal was much congested with blood. The superficial veins of
140 DEATH FROM ADRENAL OCCLUSION
the kidney on the same side were also congested. The two elands were compared microscopically. The appearance of the left adrenal was very striking. Adrenalin instead of being limited to the medulla was disseminated throughout the gland, being especially concentrated in the cells of the zona glomeru- losa. Adrenalin in the zona fasciculata and zona reticularis was found between the cell columns, but was absent from the cells. The total quantity of adrenalin was much greater in the left adrenal than in the right, as indicated by the staining. There was considerable vacuolization in the zona fasciculata.
Experiment 3. The lumbar and lumbo-adrenal veins were tied on the left side, the right adrenal being left intact. The animal in this ease was a dog. Eighteen days later the animal was killed, and the two adrenals fixed. No great difference was observed between the two glands. There was less lpoid in the ligated gland, there being great numbers of large lipoid bodies in the cortex of the normal gland, while these were largely absent from the ligated gland.
Experiment 4. The lumbo-adrenal vein where it entered the vena cava was tied off on both sides, but the veins to the lumbar muscles were not touched. This animal, a rabbit, gained in weight during the next thirty-two days. It died seventy- five days after the operation. Upon microscopic examination the presence of adrenalin was not found. Lipoids were very secant in amount.
Experiment 5. After removal of the right adrenal the lumbo-adrenal vein from the left gland was tied off, the vein from the lumbar muscles being left intact. The animal (cat) was operated upon at 4p. m.
At nine o’clock the next morning the pupils were still greatly dilated, and constricted much less than did those of a normal cat when exposed to a bright light. The most striking thing, however, was the marked pilomotor effect. The hair was erect all along the dorsal surface, and to a certain extent, on the tail. The heart was beating at the rate of 140 per minute, whereas before the operation the rate was 250. The rectal temperature was 35.7° C.
Forty-one hours after the operation, the pupils had become nearly normal, while the pilomotor effect still persisted, but
HARTMAN AND BLATZ 141
was not quite so marked. The heart rate was 184 beats per minute. The rectal temperature was 37.2° C.
In four days the cat appeared normal except for a sight pilomotor effect. Later certain changes were apparent. The hair on the face was falling out. The hair on the ears had become quite scanty. There was a red coloration on the inner side of both forelegs. The cat began to ery incessantly and lost weight. Eruptions appeared on the skin of the face (46 days after the operation).
Sixty-eight days after the operation, the weight had been reduced from 2.500 kem. to 2.060 kgm., in spite of its eating well. The rectal temperature was 39.1° C. The hair was very scraggy and unkempt. The cat was irritable, but weaker than normal. It was not so active, largely on account of muscular weakness, because it still appeared restless. The heart rate was normal (249). At this time there was considerable difficulty in mictu- rating. It took several minutes to expel the urine.
Ninety-five days after the operation, the heart was still normal in rate, the temperature still high (39.0° C.) and the weight partly regained (2.350 kgm.). It appeared a little stronger, but still walked with a stiff-legged gait. The fur was still in a poor condition, the longer hairs, such as the vibrissae, being broken and scragey.
The cat died 128 days after the operation. It had been gradually losing weight so that it was reduced to two-thirds the original, viz., to 1.750 kgm. The day before death it ap- peared very much as it had for weeks. (Death was hastened the last two or three days by a marked fall in the room tem- perature. )
Upon post mortem everything was found well healed. The lumbar vein to the left adrenal was much enlarged. The adrenal weighed 0.426 gm. Lipoids were fairly plentiful in the gland, but did not seem to be entirely confined to the cortex. Some adrenalin was present, as shown by the yellow stain.
The kidney on the same side had been fixed and stained in the same manner as the adrenal. Many of the blood vessels in the outer zone were stained yellow. Scattered here and there tubules and glomeruli were found similarly stained. It appeared that adrenalin brought to the kidney directly from
142 DEATH FROM ADRENAL OCCLUSION
the adrenal was being excreted in the kidney. However, this observation needs further confirmation.
Experiment 6. A second cat was operated upon in the same way as in the preceding experiment. Within two hours after the operation the pupil had become normal. Eight hours later there was a decided pilomotor reaction along the back. In 13 hours the pilomotor effect had become slight. No other changes appeared. The animal died 18 days later. It had been eating well up to that time.
There were only slight traces of lipoid in the cortex of the adrenal which had been left in the animal. There were also traces of lipoid in the medulla. Adrenalin if present at all was extremely scant.
Experiment 7. The adrenals of a third cat were treated as in the two foregoing eases. Three hours after, there was a marked pilomotor effect, but no dilatation of the pupil.
The pilomotor effect persisted for 38 days. At that time the animal appeared weaker. The temperature and heart rate remained about normal. The animal died 59 days after the operation. It had fallen off slightly in weight, from 1.34 kgm. to 1.22 kgm.
Histologically, the adrenal which had remained in the animal was almost devoid of lipoids, the small amount present being in the cortex. No trace of adrenalin was found.
Experiment 8. A dog was operated upon as in the pre- ceding experiments. It recovered without showing any decided symptoms. The rectal temperature 10 days after the operation was 39.2° C. The animal was killed 83 days after the operation. Its weight had fallen from 5.1 kgm. to 4.6 kgm. Histologi- cally, the adrenal gland which had remained in the animal differed very little from normal.
Experiment 9. In order to determine how much pressure might be produced in the lumbar vein when the lumbo-adrenal vein was tied, we fastened a cannula into the former vein imme- diately after the latter had been tied. A large dog (18 kgm.) was used while under ether anesthesia. The cannula was con- nected with a long vertical glass tube containing a little half- saturated Na.SO, solution.
HARTMAN AND BLATZ 143
The pressure in the tube gradually rose as follows: Total pressure
Increase mm. 1% sat. mm. 1% sat. Time in minutes Na,SO, Sol. Na,SO, Sol. 1 155 155 2 109 264 3 93 aol 4 81 438 5 al 509 6 60 569 i 47 616 8 38 654 9 30 684 10 26 710 11 a9 729 12 19 748 13 12 760 14 9 769 15 6 775
The final pressure attained in the glass tube was 775 mm. or 73.25 mm. in terms of Hg. Arterial pressure at the same time was 77 mm. of Hg.
Discussion
The method which we have used does not produce death nearly so quickly as does the removal of both adrenals. In that case death occurs in a few hours to a few days (5). Six of the seven animals, in which the veins from the adrenals had been tied, died in 2, 18, 48, 59, 75 and 128 days respectively. Experiment No. 3 should not be included because one gland was left intact in the animal. Experiment No. 8, on a dog, was the exception, the animal being killed after 83 days. At the time of death, however, it was losing weight.
Three of the animals which died of their own accord, showed symptoms of weakness some time before death; in the other three, no changes were observed. In regard to the his- tological changes, three of the animals showed no presence of adrenalin, and only a trace of lipoid in the adrenal after death, while three others showed both adrenalin and lipoid in larger amount. Of course, the absence of adrenalin in a gland which
144 DEATH FROM ADRENAL OCCLUSION
is not fixed immediately at death indicates little, for adrenalin disappears very soon. But in any ease, judging from the lpoids, with the exception of experiment No. 5, the adrenal function was much below normal.
Cat No. 5 was very exceptional and may have been a case of hyperactivity of the adrenal. Many of the symptoms tend to indicate that. It is quite possible that in this instance the increased pressure produced by tying the common lumbo- adrenal vein stimulated the cells of the adrenal to greater activity. The increased pressure may also have produced a back-flow of blood through the lumbar vein and thus through anastomoses into the general cireulation. In fact, this was possible in all the animals where the lumbar vein was not tied, beeause the pressure attained is nearly as great as arterial pressure (experiment No. 9).
Summary
1. After having the veins to the adrenal glands tied an animal lives much longer than after double epinephrectomy, but eventually dies.
2. There is evidence that the adrenals function for a con- siderable time after such an operation, the secretion escaping through the rete of vessels leading to the kidney, and possibly by back flow through the lumbar vein, when that is left open.
BIBLIOGRAPHY 1. Thomas: Die Nebenniere und ihre Verindérung bei Infee- tions Krankheiten. Beitrage z. path. Anat. 1911, 50, 283-316. 2. Lukseh: Die Storung die Nebennieren Funktion bei In- fections Krankheiten. Berlin. klin. Wehnsehr. 1909, 46, 1979-80. 3. Cow: The suprarenal bodies and diuresis. Journ, Physiol. (Lond.) 1914, 48, 446 4. Kohn: Archiv. f. mikr. Anat. 1903, 62, 243. 5. Strehl und Weise: Beitrage zur Physiologie der Neben- ' niere. Archiv. f.d.ges. physiol. 1901, 86, 107.
THE SIGNIFICANCE OF EPINEPHRIN IN MUSCULAR ACTIVITY
Charles M. Gruber
(From the Department of Physiology and Pharmacology and the Henry §S. Denison Research Laboratories in the University of Colorado.)
Since 1855 (1), a symptom-complex has been linked with the destruction of the suprarenal glands or the chromaffin system in general. This disease, ‘‘Morbus Addisonii,’’ is char- acterized by muscular and vascular asthenia, irritation of the stomach, pigmentation of the skin and changes in the blood picture.
Abelous, Langlois and Charrin (2) showed that persons suffering from this malady were less capable of doing muscular work, than were individuals suffering from pulmonary tuber- eulosis. According to Langlois this myasthenia ean be mark- edly diminished by organotherapic measures. After six weeks treatment with suprarenal extract, the subject of their investi- gations was able to lift a weight 5.8 times longer and the highest contractions were four times as high as those recorded before the treatment.
Such a marked improvement is not always observed. In fact the results obtained by the different men and by the same men working on different patients vary a great deal. Adams (3) has collected from the literature reports of ninety-seven cases with the following results: seven were made decidedly worse, forty-three derived no benefit, thirty-one showed marked improvement and sixteen cases showed permanent relief after organotherapic treatment.
Daland (4) reports good results with the use of therapeutic doses of epinephrin in a ease of Addison’s disease.
There is a great deal of difference of opinion as to the seat of the lesions. Marakascheff (5), after studying the adrenal glands in cases of Addison’s disease and in certain conditions in which the glands were the seat of marked patho- logical change, concludes that the cortical substance is particu-
145
146 ADRENIN AND MUSCULAR ACTIVITY
larly involved and destruction of this portion of the gland may be followed by the entire symptom-complex. He claims that the medullary substance may be completely destroyed without the presence of the malady. If one adrenal is destroyed, hyper- trophy of the cortex of the other may take place; this hyper- trophy leads to great compression of the medulla. His views are supported by Lowy (6), who claims that complete absence of the specific cellular elements of the cortex of both adrenal glands will produce typical symptoms of Addison’s disease. The adrenal glands he examined were composed of medullary parenchyma only.
Wiesel (7) on the other hand cites six cases in which the chromaffin cells in the medulla of the adrenals and in the sympathetic system were destroyed. The cortex of the adrenals and of the accessory adrenals was found intact or only shghtly affected and he believes Addison’s disease to be a specifie dis- ease of the chromaffin system.
Be that as it may, it is safe to suppose that the function of the cortex of the gland may be different from that of the medulla. Such a possibility is suggested by Hoskins and Wheelon (8). It may be that in those cases in which the cortex as well as the medulla is diseased epinephrin has little or no action, whereas in those eases in which only the medulla is af- fected the epinephrin is of the highest service to the patient in relieving the symptoms caused by its deficiency in the circulation.
Marked betterment in the height of muscular contraction has been reported by Trerotoli (9), who studied the effect of adrenalin in human beings, upon muscles which had been fa- tigued either by voluntary or by electrical excitation. He observed that 1 mg. of adrenalin injected subcutaneously pro- longed the record of contraction.
According to Cannon (10) epinephrin plays a definite role in enabling the individual to meet successfully the emergencies of life. Various major emotions, pain, fear, and rage cause a reflex secretion of epinephrin, which assists in the execution of the physical counterparts of the emotions; combat, flight et cetera. The muscles, which are chiefly concerned in these, are benefited to the greatest extent by the epinephrin discharge.
GRUBER 147
The inhibition of intestinal peristalsis, the constriction of the splanchnic and cutaneous vessels and the dilation of the vessels in the muscles themselves (11) cause a shifting of the blood from the bowel and skin to the muscles to meet the extra strain about to be put upon them. The hyperglycaemia produced furnishes the muscles with an additional food supply and the dilation of the bronchioles (12) assists in supplying more oxygen for the crisis. Furthermore, efficiency of a fatigued muscle is greatly improved by epinephrin, by the means already mentioned, and probably also by some action on the fatigue products (13), and within certain limits the coagulation time of the blood is diminished to meet the emergency of hemorrhage (14). All these conditions function for the superiority of the individual and for the preservation of his life.
That epinephrin is invaluable in rapid recovery from fatigue is borne out on experimental animals. Albanese (15), Boinet (16), Abelous and Langlois (17), Abelous (18), and Hultgren and Andresson (19) and Biedl (20) found that ani- mals in which the suprarenals were removed died shortly after the operation. They also found that the life of the animal could be prolonged slightly by the injection of suprarenal ex- tract. Myasthenia occurred in all cases and Abelous and Langlois and Albanese concluded that the function of the adrenalin was to neutralize or destroy the toxins set free in muscular work. These experiments upon experimental animals support the view that muscular vigor and power is dependent upon the epinephrin set free by the suprarenal glands. It must be remembered, however, that the life of these epinephrecto- mized animals could not be prolonged more than twenty-four hours by the injection of epinephrin. It seems, therefore, that something is lacking in the commercial epinephrin and as has been suggested, is possibly supplied by the cortex of the adrenal glands.
If epinephrin is essential for prolonged muscular efforts, it would be natural to suppose that some change should be noted in the cells proper of the suprarenal glands after such exer- tions. Changes have been observed. Battelli and Boatta (21) and Carl (22) found that the adrenals are exhausted of their
148 ADRENIN AND MUSCULAR ACTIVITY
adrenalin, after prolonged muscular fatigue. Such a change was also noted by Ingier and Sehmor!] (23) in patients suffering from Addison’s disease in which there was marked myasthenia. Not only is there a depletion in the glands of their epinephrin but they also undergo histological changes. Bernard and Bigart (24) and Bardier and Boone (26) observed the cells to contain numerous vacuoles after prolonged muscular activity. Since other glandular cells and also nerve cells develop vacuoles after activity the inference can safely be drawn that these suprarenals are active as well as are the muscles, during the period of exertion. Some interrelation must, therefore, exist between museular work and the chromaffin system.
The results of the experiments which have been performed to determine the effect of epinephrin upon non-fatigued and excised, fatigued muscles are not uniform. Oliver and Schafer (26) and Boruttau (27) claim that adrenal extract increases the height and prolongs the periods of contraction in non- fatigued muscle. These results are contradicted by Kuno (28) Takayasu (29) and by Schafer in his later work (30). Takayasu found adrenalin to have a depressing action similar to that observed by Boruttau (26) in some of his experiments.
Dessy and Grandis (31) report that adrenalin produces a beneficial effeet on fatigued salamander muscles, either when injected subeutaneously or when added to the solution in which an isolated muscle is contracting. Cannon and Nice (32), Hos- kins (p. 185) and also the author (unpublished experiments) after repeated attempts have been unable to confirm Dessy and Grandis’ observations in frog’s muscles similarly exposed to the adrenal extract. The author also demonstrated that the threshold stimulus of a non-fatigued muscle was not affected by adrenalin (33). Panella (34), Radwanska (35), Cannon and Nice (37), and Gruber (36) showed conclusively that adrenalin betters the height of muscular contraction in a muscle under- going fatigue. Cannon and Nice demonstrated that adrenalin injected in small doses or secreted by, the glands during splanehnie stimulation, improved the activity of the fatigued muscles, in some cases by more than 75 per cent. These results were corroborated and extended by me in a series of researches,
GRUBER 149
the results of which were published a few years ago. I showed that adrenalin inereased the height of muscular contraction when injected intravenously in small doses (0.2 to 0.5 mil. of a 1:100,000 solution) and that the same dose administered in the same manner would bring back in five minutes or less the increased threshold stimulus caused by fatigue of the nerve- muscle or muscle as would rest of one to three hours (36).
The question as to how adrenalin produces this beneficial action is still unsettled. Hoskins, Gunning and Berry (11) attempted to explain this as due to a bettered circulation. Epinephrin, however, can produce vaso-dilation in the muscle vessels only when the nerves are intact, or, after nerve section, only when some time (4 to 10 days) has elapsed (36). I have never been able to get vaso-dilation of muscle vessels immedi- ately after cutting the nerves leading to the muscles. More- over in muscle electrically excitated (2 to 4 times per second) there are three factors tending to bring about extreme dilation of the vessels: first, the nerves are severed, and the vasomotor tonicity from the vaso-motor center, therefore, inoperative (37); second, the rate of stimulation is favorable to dilation (38) ; and third, as Kaufmann (39) has shown, active muscles presupposes actively dilated vessels. Under these conditions one would searcely expect adrenalin to produce further dilation. Yet under these circumstances epinephrin does exert a beneficial influence.
Experiments were performed in which the epinephrin was injected into the perfusion fluid of a fatiguing muscle. (See accompanying figure.) It was noted that invariably vasocon- striction resulted with a betterment in the height of muscular contraction. This betterment was dependent upon the strength of the adrenalin injected. In one case a 27-fold betterment was obtained by injecting 0.5 mil. of 1:1,000 solution of epine- phrin (36). This substance is therefore not a depressant, as stated by Takayasu.
From the experiments upon animals, the inference can be drawn that epinephrin betters the height of muscular contrac- tion in two ways; first by its specific effect upon the muscle in eliminating fatigue and in addition, in those animals in which the nerves are intact by bettering the circulation through the
150 ADRENIN AND MUSCULAR ACTIVITY
muscle by its vasodilator qualities. Whether or not the specific action is due to neutralization, or destruction of the fatigue products, the rapid formation of more available energy or due to some toxie action thus increasing the exeitability of the muscle cannot be definitely stated.
Some investigators attempted to throw hght upon this subject by noting the antagonistic action of the so-called fatigue
Upper record, muscular contraction of the anterior tibial muscle of a cat, contracting 120 times per minute pulling against a spring with an initial tension of 75 gms. Below it the time in half minute intervals. The lowest record is the rate of flow of the perfusion fluid from the venous cannula. (x — x) Adjusted muscle lever so that the muscle was after loaded. At the point indicated on the lower middle line 1 mil. of a 1:100,000 solution of epinephrin was injected into the perfusion fluid. There resulted an increase in the height of contraction of 92 per cent, but a decrease in the rate of the perfusion fluid of 91 per cent. products and epinephrin. Carnot and Josserand (41) studied the vasoconstrictor qualities of epinephrin before and after fatigue. They found that 0.05 mg. of epinephrin per kilo body
gS 3 S J J I] 4 weight injected into the femoral artery, with the leg at rest, produced a rise in blood pressure of 10 em. of mereury. After tetanizing the opposite leg for fifteen minutes, 0.055 mg. of epinephrin per kilo body weight was injected into its femoral artery and the systemic blood pressure rose only 1.5 em. of mereury. They claim, rightly, I believe, that the epinephrin
GRUBER 151
was destroyed or neutralized by the fatigue products.
That the reaction of a muscle after fatigue is acid to litmus has been known for more than half a century. Ranke (41) in 1865 proved definitely that paralactic acid, monopotassium phos- phate and carbon dioxide are some of the products given off during the process of fatigue. Lee (42), Burridge (43), and Schenck (44) were able to reproduce the fatigue curve by irri- gating muscles with the above products. Ryffel (45) reported an increase in lactic acid in the urine after severe muscular exer- cise. Gruber and Kretschmer (46) and Gruber (47) were able to corroborate Lee’s and Burridge’s results and they demon- strated that epinephrin possesses the ability to restore almost to normal the height of contraction of muscles artificially fatigued by the injection of lactic acid, sarcolactic acid, monopotassium phosphate and monosodium phosphate.
An acid reaction is also developed in muscles approaching a state of rigor mortis. Here as in fatigue the reaction is the re- sult of the accumulation of lactic acid. Fletcher and Hopkins and Fletcher noted that most of the lactic acid in frog and mam- malian muscles was produced before rigor mortis had been reached. The muscles were still flaccid and irritable. Just as in artificially fatigued muscles, so also here, epinephrin showed a marked ability to restore irritability and contractility to the nerye-muscle. In some of the experiments performed by Gruber and Fellows (48) epinephrin caused a 29-fold increase in the height of the contraction, in others the irritability, which was lost, as shown by electrical excitation of the nerve, was restored by the perfusion of the drug through the muscle. In many in- stances the animals had been dead for from 1 to 3 hours.
Here again epinephrin must have acted either antagonistic- ally to the substances formed during the death of the animal, or it increased the production of available energy for the contrac- tion of the muscles or it affected the tissues directly, producing _ an increased excitability and contractility.
It was noted by Cannon and Gruber (49) that dilute solu- tions of epinephrin increased the rate of the oscillatory varia- tions observed in rhythmically stimulated muscles, providing the quantity was sufficient to cause a betterment in the height of muscular contraction. A strong dose of adrenalin sufficient to
152 ADRENIN AND MUSCULAR ACTIVITY
produce a marked constriction of the arterioles (1 mil. 1:10,000 injected intravenously ) resulted in a lessened height of muscular contraction and a slowing of the waves. If this decreased blood supply persisted for a long time a temporary disappearance of the waves resulted.
In many of the experiments performed upon perfused, ex- cised muscles the betterments were so marked and the vasocon- striction so striking that only one conclusion can be drawn, 7. @., epinephrin exerts some specific action upon fatigued muscle other than that due to mere circulatory changes.
BIBLIOGRAPHY
1. _Addison: Monograph, The Constitutional and Loeal Ef- fects of Diseases of the Suprarenal Capsules, London,
Se
1855.
2. Abelous, Langlois and Charrin: Arch. de Physiol. Norm. et Path., 1892, 24, 269, 465.
3. Adams: The Practitioner, 1903, -...... , 473 (Oct.).
4. Daland: Endocrinology, 1918, 2, 301.
5. Marakascheff: Ziegler’s Beitrige, 1904, 36, 401.
6. Lowy: Deutsche Arch. f. klin. Med., 1913, 110, 373.
7. Wiesel: Ztsehr.f. Heilk., 1903, 24, 257.
8. Hoskins and Wheelon: Am. J. Physiol., 1914, 34, 184.
9. Trerotoli: Reviewed by Beidl, Innere Sekretion, Berlin,
OTS lee 520: 10. Cannon: Bodily Changes in Pain, Hunger, Fear and Rage, New York 1915, Am. J. Physiol., 1914, 33, 356. 11. Hoskins, Gunning and Berry: Am. J. Physiol., 1914, 34, 90. 12. Jackson: J. Pharm. and Exp. Therap., 1912, 4, 59. 13. Gruber: Am. J. Physiol., 1917, 43, 530. 14. Cannon and Mendenhall: Am. J. Physiol., 1914, 34, 225, 232, 243. . 15. Albanese, Arch. ital. de biol., 1892, 17, 239. 16. Boinet: C.r. Soe. de Biol., 1895, 273, 325, 498, 646. 17. Abelous and Langlois; Arch. de physiol., norm. et path., 1892, 24, 269, 465. 18. Abelous: Arch. de Physiol., 1893, 25, 437-454; ibid: 1893, 25, 720; ibid: 1894, 26, 433-4389; ibid: 1897, 29, 1; C. r, Soe. de Biol., 1896, 578. 19. Hultgren and Andresson: Studien zur Physiologie und Anatomie der Nebenniernen, Leipzig, 1899, 9, 73-312. Biedl: Innere Sekretion, Berlin, 1913, I, 366. Batelli and Boatta: C. r. Soe. de Biol., 1902, 54, 1203.
GRUBER 153
Carl: Deutsche med..Wehnsch. (Berlin), 1911, 37, 1827- 1829.
Ingier and Schmorl: Deutsche Arch. f. klin. Med., 1911, 104, 125.
Barnard et Bigart: C. r. Soe. de Biol., 1902, 54, 1400.
Bardier et Boone: C. r. Soe. de Biol., 1903, 355.
Oliver and Schifer: J. Physiol., 1895, 18, 233.
Boruttau: Arch. f. d. ges. Physiol., 1899, 77, 97-128.
Kuno: J. Physiol., 1915, 49, 139.
Takayasu: Quart. J. Exp. Physiol., 1916, 9, 347.
Schafer: The Endocrine Organs, New York, 1916, 65.
Dessy et Grandis: Arch. ital. de biol., 1904, 40, 225.
Cannon and Nice: Am. J. Physiol., 1913, 32, 49.
Gruber: Ibid., 1914, 33, 339.
Panella: Arch. ital. de biol., 1907, 48, 430.
Radwanska: Anzeiger d. Akad., Krakau, 1910, 728. Re- viewed in Zentralbl. f. Biochem. und. Biophysik, 1911, 11, 467.
Gruber: Am. J. Physiol., 1913, 32, 221, 438; ibid: 1914, 33, 335; ibid: 1914, 34, 89; ibid: 1917, 43, 530.
Gruber: Ibid., 1918, 45, 302. Dale and Richards; J. Physiol., 1918, 52, 119.
Bowditch and Warren: J. Physiol., 1886, 7, 416. Brad- ford: Jbid., 1889, 10, 390.
Kaufmann: Arch. de physiol. norm. et path., 1892, 24, 219, 495.
Carnot and Josserand: C. r. Soe. de Biol., 1902, 54, 1472.
Ranke: Arch. f. Physiol., 1863, 422; ibid: 1864, 320; Tetanus, Leipzig, 1865.
Lee: Am. J. Physiol., 1907-08, 20, 170; Centralbl. f. Phys- iol., 1906, 20, 869; J. Am. Med. Assn., 1905, 45, 1776; ibid: 1906, 46, 1492.
Burridge: J. Physiol., 1911, 41, 285.
Schenek: Arch. f. d. ges. Physiol., 1891, 50, 117.
Ryffel:. J. Physiol., 1909, 39, xxix.
Gruber and Kretschmer: Am. J. Physiol., 1918, 47, 178.
Gruber: Ibid., 1918, 47, 185.
Gruber and Fellows: Ibid., 1918, 47, 472.
Cannon and Gruber: Ibid., 1916, 42, 36.
ACTION OF SOME OVARIAN AND CORPUS LUTEUM EX- TRACTS ON THE PUPIL OF THE FROG’S EYE
D. I. Macht and S. Matsumoto
(From the Pharmacological Laboratory, Johns Hopkins University and the James Buchanan Brady Urological Institute, Baltimore. )
The authors have been engaged for some time in studying the pharmacological and physiological properties of various glandular extracts. In connection with these studies, syste- matic observations have been made concerning the effect of such extracts on the pupil of the frog’s eye, inasmuch as it is well known that certain hormones such as epinephrin exert a marked influence on that organ. It is deemed desirable to re- port in the present communication the findings concerning the action of some ovarian and corpus luteum extracts on the frog’s pupil.
The preparations used in this research were the desiccated lutein of the sow prepared by the Hynson, Westcott, and Dun- ning Company without admixture of any preservatives, and the desiccated ovarian substance of the sow, marketed by Armour and Company. Further experiments were also made with fresh corpus luteum substance of the sow and with the fresh ovary of the same animal. The extracts employed were pre- pared by treating the glands with cold physiological saline or with Locke’s solution. In most cases, whether the fresh gland or the desiccated product was employed the concentration of the extract was made to be equivalent to 10 per cent of the fresh gland. This 10 per cent extract when desired could be diluted by adding saline. Occasionally a 20 per cent extract was made.
The results obtained on the pupil of the frog’s eye are interesting and are expressed in the subjoined table. It was found that the corpus luteum extracts whether prepared from the fresh gland or from the desiccated product, produced a distinet dilatation of the pupil in from 30 to 60 minutes, depend- ing upon the concentration employed. Ovarian extracts, on the other hand, were found to produce very little or no change in
154
MACHT AND MATSUMOTO 155
the size of the pupil. Inasmuch as the ovarian preparations which were used contained small quantities of corpus luteum, the slight dilatation noted after the use of such extracts may be ascribed to the lutein content. The difference between the effects of the ovarian and corpus luteum extracts, however, is so great that we are forced to regard the ovary and corpus luteum in so far as the effect on the pupil is concerned as being very different glandular bodies. This of course agrees well with all other data so far known concerning the independent and distinct function of corpus luteum.
TABLE CORPUS LUTEUM i CONTROL a sat sol l | | | DIAMETERS OF | | | DIAMETERS OF PUPIL Strength “Drug PUPIL
Before | After
Before After m.m. m.m. |min. | m.m. | m.m.
| 2.7x1.5 | 3.4x2.2 || 30 | 20% Ovary | 2.7x1.7 | 3.0x1.9 2.3x1.6 | 3.0x2.4 || 15 : = 2.5x2.0 | 2.9x2.6 2.6x1.9 | 3.0x2.3 |140 | “ é | PSSM 2st Xles 2ASKI-O || 3:0X2.0)\| 2D 10%; 3° | 2.8x1.8 | 3.1x2.0 2.3x1.8 | 3.3x2.91 45] “ ¢ | 2.6x2.0 | 3.0x2.8 2.3x1.7 | 3.0x2.6 10] “ OS Gx2 1 192'Sx29 1.8x0.9 | 2.5x1.5 |) 60 | Locke’s | | | Solution | 1.7x0.8 | 1.7x0.9 2.1x1.5 | 2.5x2.0 | 60 | Locke’s | | | Solution 2.5x1.7 | 2.0x1.7 1.9x1.5 | 2.5x1.7 | 40 | 10% Ovary | 2.1x1.5 | 2.3x1.5 2.3X1.7 | 3.0x2.5 || 30 | & “d | 2.5x1.8 | 3:0x2.2 2.8x2.5 | 3.0x2.5 || 60 | . - | 2.8x2.4 | 3.0x2.6 | 2.38x1.7 | 2.6x1.9 || 30 Locke’s | | | Solution Datel5 |) 2221.6 2.9x2.0 | 3.0x2.6 | 20 10% Ovary | 2.5x1.9 | 2.6x2.0 2.5x2.0 | 3.0x2.5 || 10 5 Zine | 2-5x2-0 2.9x2.3 | 3.0x2.6 || 20 & a | 2.9x2.3 | 3.0x2.4 29x21, \3-0x2.3,1 401 5% © 2.9x2.0 | 2.9x2.0 2.5x1.8 | 2.6x2.0 || 60 | f $ | 2.6x1.9 | 2.8x2.1 2.5x1.8 | 3.0x2.0 || 30 -: Py | 8.0x1.5 | 3.0x1.8 2.8x1.6 | 3.0x2.3 || 20 2 e 2.7x1.6 | 2.5x1.3 2.5x1.5 | 2.7x1.8 || 80 £ oe BURL | 20XL.S 2.1x1.3 | 2.8x2.0 || 45 ‘ +5 PRL oe |p aeO RO 20% Fresh 2.1x1.6 | 2.8x2.5 || 25 | 20% “ 2.1x1.8 | 2.7x1.9 10% * Z.OX 1.00 at xe lt 20 Locke’s | Solution 22x10, |y2soxL.7] . . BOX. |pooxleo we. | Locke’s Solution 2.1x1.5 | 2:2x1.6 . a 2.6x1.7 | 3.0x2.5 | 20 | 10% Ovary AGRI | 2208 z ‘ 2.7x2.0 | 3.2x2.6 || 25 | . 2.7x2.0 | 2.8x2.0
THE PHYSIOLOGIC ACTION OF THYROXIN KE. C. Kendall, Ph.D.
Section of Biochemistry, Mayo Clinic, Rochester, Minn.
In 1914 (2) the physiologic action of the 1odin compound occurring in the thyroid was in part deseribed. At this time it was stated that after the administration of this substance to dogs there was in every ease a long delay before any physiologic effects were demonstrable. The action was deseribed as follows:
‘When injected subeutaneously in animals, there is at first no effect on either the pulse-rate or the blood-pressure. After from twenty-four to thirty-six hours the dog appears restless, has a slight increase in temperature, and a decided increase in pulse-rate. If a series of injections is given on successive days, these symptoms are aggravated, and after two or three injec- tions they are accompanied by a distinct tremor, loss of weight, and severe diarrhea. On the fourth or fifth day of injection the pulse-rate is between 200 and 300, and all the other symp- toms continue with increased severity.’
While the problem concerning the physiologic action of thyroxin is not yet completed, certain progress has been made which will be reported at this time. The iodin compound which in 1914 was tentatively named the ‘‘alpha iodin’’ compound in order to differentiate it from the other iodin compounds oceur- ‘ring in the gland which were ealled ‘‘beta,’’? has now been given the name ‘‘thyroxin.’’
Further investigation has confirmed the delay in the action of thyroxin in animals and also in man, both in the normal con- dition and in myxedema. In a long series of patients suffering from myxedema who have been treated by intravenous injec- tion of known amounts of thyroxin, Plummer has found that in all except two there was a very marked delay in the action of thyroxin. In these two patients there was a short-lived im- mediate response, but the prolonged action of thyroxin was noted as usual and the curve of the response after the first few hours was approximately the same as that given by the other patients. |
KENDALL 157
Some of the early observations on the delayed action of thyroxin were obtained on goats. A series of eleven goats was injected daily with 14 mg. of thyroxin. The first goat died after eleven days and the rest followed at short intervals, all dying within thirty days. This shows that the long-continued presence of thyroxin in the animal organism is incompatible with life and it also suggests that death is not caused from the toxie action of the substance itself, but from secondary reac- tions. In order to bring this out more clearly another normal goat was injected with 230 mg. of thyroxin in a single injec- tion. This amount was.one and one-half times as much as was required to kill the first goat of the series, and yet the single injection of this relatively enormous dose produced almost no demonstrable effect, and the goat, even from the second day after the injection was, to all intents, normal.
Massive doses of thyroxin have also been given to dogs. Some were injected with thyroxin while they were receiving intravenous injections of sugar or of amino acids. In a few of these animals it was possible to demonstrate an immediate re- sponse to thyroxin, but this response very rapidly subsided and a long delay period followed before there were definite signs of the functioning of thyroxin.
Since the suecessive daily administration of thyroxin brings about death, and a single injection of enormous doses produces, in most instances, no demonstrable effect, we may conclude that the thyroxin molecule per se is not toxic to the animal organism. Although the intravenous injection of thy- roxin produces no change in blood-pressure, pulse-rate, nervous manifestations, or any of the so-called hyperthyroid symptoms, the long-continued presence of thyroxin within the tissues of the body produces the picture of hyperthyroidism in its en- tirety, terminating in great emaciation and eventually in death. One factor, therefore, which would determine the reactivity of thyroxin would be the speed with which the tissues absorb thyroxin from the blood-stream. Even though thyroxin is cir- culated through the tissues of the body in the blood-stream, if the tissues refuse to absorb it from the blood it obviously could not produce its normal physiologic action. In order to deter- mine whether or not the tissues do remove thyroxin from the
158 PHYSIOLOGIC ACTION OF THYROXIN
blood, 200 mg. were injected at once into the saphenous vein of a dog, and the bile and urine were saved for the next fifty hours. The bile and urine were analyzed for iodin and it was found that 48 per cent of the total 1odin contained in the thy- roxin injected was excreted in the bile within fifty hours, and 13 per cent was excreted in the urine during the same time. This accounts for a large amount injected and, while the thy- roid gland of this animal was not analyzed for iodin, it is highly probable that the remaining amount injected was re- moved from the blood-stream by the thyroid gland and there retained, making practically 100 per cent of the injected thy- roxin unavailable for functioning within the tissues.
Marine (3) and others have shown that the thyroid ab- sorbs iodin when present in the blood and there can be little doubt that the gland absorbs and holds thyroxin, so that be- tween the liver, the kidneys, and the thyroid gland, the excess of thyroxin is adequately cared for, and the tissues from a single injection do not take up enough thyroxin to result in a demonstrable physiologic response.
While po demonstrable physiologic response follows a single injection of thyroxin, there is no doubt that there is a physiologic response even to very small amounts. By the deter- mination of the basal metabolic rate it may be shown that the myxedematous patient responds to exceedingly small amounts of thyroxin given in single injections. By ‘‘demonstrable re- sponse’’ is meant the increase in pulse rate and nervous mani- festations with loss of weight, such as are observed when sevy- eral administrations of thyroxin are given. The difference in the condition in the dog after one injection of thyroxin and after five injections is very striking, even though the weight of thyroxin given in the single injection is as great as the total amount used in the five injections.
Since the absence of thyroxin from the organism results in a lowered level of metabolic rate and the administration of thyroxin determines the basal metabolic rate in the myxede- matous patient, 1t seems highly probable that under normal conditions an equilibrium exists between the thyroxin in the thyroid gland, the amount in the blood-stream, and the amount in the tissues. It is probable that the amount in the tissues flue-
KENDALL 159
tuates according to the energy demands of the body, but that there is always an equilibrium seems highly probable. Under these conditions, if a large amount of thyroxin is injected into the blood-stream and nothing is done ealling for an increased thyroxin content of the tissues, the tissues apparently are unable to absorb more thyroxin than their normal content and the ex- cess is treated as a foreign substance and is promptly excreted in the bile. Some portion, however, is either excreted unchanged in the urine or is broken down and thus excreted. If thyroxin is injected on several successive days the amount in the thyroid gland, the amount in the liver, and the amount in the blood, eventually pass the normal limits for an appreciable period of time, with the result that the tissues are forced to absorb more than their normal content of thyroxin. When this process has started and secondary effects are brought into play the tissues are stimulated to such a height of activity that they, them- selves, demand more thyroxin, and so the physiologic response is slowly built up. The full effect of the stepping-up process, however, is a matter of days, not a few hours. The tissues, once they have absorbed the thyroxin and begin to function at a higher rate of activity, in turn may affect the other duct- less glands, especially the adrenal, as suggested by Cannon (1), and the inereased activity of the adrenal, in turn, produces its train of effects.
Quantitative studies of thyroxin by Plummer (4) have shown that not only is the appearance of physiologie effects of thyroxin delayed in man, but the duration of the effects is sur- prisingly long, and the maximum effect from a single injection of thyroxin in myxedematous patients is not reached until the tenth day. After reaching the maximum effect, thyroxin still continues to function for another eight to ten days, so that the length of time a single administration of thyroxin functions within the body is about three weeks.
What chemical reactions are so stimulated by thyroxin that hfe is incompatible are still unknown; but it is obvious that death is not due, in a strict sense, to the presence of thyroxin itself, but is due to the secondary effects which thyroxin brings into play.
One of the most important findings in connection with the
160 PHYSIOLOGIC ACTION OF THYROXIN
physiologie activity of thyroxin has been the establishing of the quantitative relation between thyroxin and the basal meta- bole rate. Plummer has shown that 1 mg. of thyroxin in an adult weighing approximately 150 pounds increases the meta- bolic rate 2 per cent. The curve of this response has been shown to be approximately a straight line between metabolic rates 30 per cent below normal to 15 to 20 per cent above nor- mal. This finding, coupled with the observation that all myxe- dematous patients tend to approach a uniform metabolic rate which is about 40 per cent below normal, is extremely strong evidence in favor of the hypothesis that without the presence of thyroxin within the animal organism, rapid and large fluc- tuations in energy output would be impossible. Clinically this is substantiated by the great difficulty the myxedematous pa- tient manifests when endeavoring to walk upstairs or carry out any other muscular activity. Their range of fluctuation of energy output is limited. Their normal existence is at a rate in the neighborhood of 40 per cent below normal. However, by the administration of thyroxin this basal metabolic rate ean be raised to any desired figure, and it can be so maintained over periods of time measured in years. These facts suggest that in the normal animal organism thyroxin is not funda- mentally essential to life. The fundamental chemical reactions occur and life is maintained in the complete absence of thy- roxin, but in this condition the flexibility of energy output is limited to a narrow range. The addition of the thyroid appa- ratus to the animal organism establishes not only a higher plane of basal energy output, but it supplies the mechanism which permits the maximum range in flexibility of energy output. The amount of thyroxin within the tissues is undoubtedly a physi- ologic constant, a figure as constant per weight of tissue as the normal number of red cells per cubic millimeter of blood, ete. What determines this normal content of thyroxin is unknown. What maintains the content of thyroxin within the tissues is obviously the blood-stream. Some work has already been com- pleted in this laboratory which has the objective of determin- ing the thyroxin content of the blood and tissues. This may be done by determining the maximum iodin content of the blood and tissues. Whether or not the total iodin in the blood and
KENDALL 161
tissues is 100 per cent in the form of thyroxin or 50 per cent cannot be shown, but the total amount of thyroxin could not be more than the amount indicated by the total iodin present in the tissues. The method for the determination of iodin which was published by the writer in 1914 has recently been further refined and perfected so that now one part of iodin in ten to twenty millions can be determined with a high degree of accuracy. By the use of this method it has been shown that the iodin content of the blood of animals is approximately 1.5 to 2 parts per ten millions; that is, 15 to 20 one-thousandths of 1 mg. per 100 ¢.c. The iodin content of the tissues is slightly higher, averaging 2.5 to 3 parts per ten millions; and the con- tent of the liver is still a little higher, from 3.5 to 4 parts per ten millions. These figures must be amplified and confirmed by still more work, which is now being earried out, but they already indicate that there is an equilibrium existing between the amount of thyroxin in the blood, in the tissues, and in the liver.
If the presence of thyroxin within the tissues determines the metabolic activity of the tissues it is obvious that if there were no mechanism for varying the amount of thyroxin and if the tissues always contained enough thyroxin to permit of their maximum output of energy, the control of the energy output during periods of rest would be, to say the least, difficult. Whether or not the thyroxin content of the tissues diminishes after a period of great exertion, the thyroxin being carried back to the thyroid gland by means of the blood-stream and there held as a reservoir until further demanded, is still un- known.
This mechanism is at least indicated and is in part sub- stantiated by the findings of the seasonal variation of the iodin in the thyroid gland. Seidell and Fenger (5) have shown that during the winter months the thyroid glands of beef, sheep, and hogs all contain much less iodin than during the summer months. It is apparent that during the winter months more energy is required to maintain body temperature, and the low iodin content of the gland could be explained either by the fact that the thyroid gland has given up its supply of thyroxin to the tissues or by an actual wearing out of thyroxin
162 PHYSIOLOGIC ACTION OF THYROXIN
due to the prolonged functioning of the substance in the tis- sues, so that during January, February, and March the amount left in the gland would be at a minimum. During the sum- mer months with less energy production in the animal, the amount of thyroxin demanded in the tissues is less. It reap- pears in the gland, either because its rate of production is greater than its rate of destruction, or because the amount in the tissues is returned to the gland and held there for use at some future time. The seasonal fluctuation of thyroxin in the gland is more satisfactorily explained on this basis than on the basis of varying iodin content of the food, and as it holds for beef, sheep and hogs, it is suggestive that the mechanism of the variation is essentially due to the varied energy output of the animals during the cold and the hot months of the year.
In conclusion, the physiologie action of thyroxin is prob- ably that of a catalyst which bears a quantitative relation to the production of energy within the tissues, and the curve rep- resenting this relation is a straight line; that is, the increase in energy production with an increasing amount of thyroxin is simply an additive one. The substance appears to function within the tissues, and-there is an equilibrium between the amount in the tissues, the amount in the blood-stream, and its source of supply, the thyroid gland. The entire absence of the substance from the body does not produce death, but merely a lowering of the level at which energy can be produced by the animal organism. In administering more than the normal amount of thyroxin to the animal organism there is a distinet lag in the absorption of the compound by the tissues and there is a rapid return to the normal content if the administration of the substance is stopped. The chemical reactions which are brought into play by the administration of thyroxin are prob- ably not different from the fundamental chemical reactions occurring in its absence. As a catalyst it merely increases the rate at which these fundamental reactions are carried out. The thyroid apparatus apparently has been added to the animal organism in order to permit a greater range of flexibility of energy output than would exist without such a mechanism.
ous
KENDALL 16
Oo
BIBLIOGRAPHY
Cannon, W. B., Binger, C. A. L. and Fitz, R.: Experi- mental hyperthyroidism. Am. Jour. Physiol., 1914-15, 36, 363-364.
Kendall, E. C.: The determination of iodine in connec- tion with studies in thyroid activity. Jour. Biol. Chem., 1914, 19, 251-256. :
A method of decomposition of the proteins of the thyroid, with a description of certain constituents. Jour. Biol. Chem., 1915, 20, 501-509.
Marine, D., and Rogoff, J. M.: The absorption of potas- sium iodid by the thyroid gland in vivo, following its intravenous injection in constant amounts. Jour. Pharm- acol. and Exper. Therap., 1916, 8, 439-444.
Plummer, H. S.: Personal communication.
Seidell, A., and Fenger, F.: Seasonal variation in the io- dine content of the thyroid gland. Jour. Biol. Chem., 1912-13, 13, 517-526.
Fenger, F.: On the seasonal variation in the iodine con- tent of the thyroid gland. Endocrin., 1918, 2, 98-100.
CLINICAL STUDY
A NEW POINT OF VIEW IN APPROACHING THE DIAG- NOSIS AND TREATMENT OF A PATIENT
George Draper, M.D., New York
Physicians have been so intensely occupied with the study of disease by methods of precision which have been developed to extend the range of their five senses, that they have for- gotten to a large extent the subject of disease—Man. Physical diagnosis itself, with its capacity for illuminating the abnor- mal condition, was an added technique of the same nature as the present more elaborate method of examination provided by adaptations from laboratories of pure science. Obviously, as new methods made disease processes more approachable to investigation, the interest and attention of observers was drawn even more keenly to the pathological phenomena. The nat- ural outcome of this interest has been to establish the present habit of medical thought which focuses primarily upon the pathological process.
The teaching in all medical schools is designed to develop among medical students the capacity to detect various disease entities. The system of physical examination which has be- come so firmly rooted, has enabled physicians to detect con- solidations of the lung, cardiac murmurs, enlargement of liver and spleen and the presence of masses where masses do not belong. The typical history and description of the phenomena of all the known disease entities have been carefully compiled and the student is practiced in comparing his ‘‘ease’’ with the accepted descriptions of the diseases. If one observes the history and the physical examinations on the charts of any good hospital it becomes at once evident that the primary ob- ject of the record is to establish the presence of a definite dis- ease and give it a name. The whole plan upon which the his- tory is taken and the physical examination executed is designed to demonstrate some pathological lesion. If this lesion is dis- covered, the object of the search has been accomplished. But
164
DRAPER 165
except for the description of the specific lesion of each case, if it should be found, the remainder of the physical examina- tion and history would fit equally well any other patient in the ward.
In the matter of history taking the stereotyped form of inquiry as to the health of the parents is definitely directed toward answering the question, ‘‘Is this disease before us one which has been acquired from parents?’’ In the same way the record of the patient’s past disease experience is designed to narrow the diagnosis to those maladies for which he has not developed an immunity by reason of a previous attack. The physical examination then proceeds to search for the lesions; and when the lesion is found, the most careful and minute de- seription of it entered upon. Histories and physical examina- tions of this character when carefully carried out are pro- ductive of as much knowledge as the purely clinical side of medicine of the moment can be, and from this point the labora- tory has been called upon to amplify our understanding. But here, again, we meet the same point of view, and the laboratory is utilized as were the history and the physical examinations to demonstrate the pathological process.
The question with which this discussion attempts to deal is, whether there may not be some other method of approach to the study of disease more illuminating than the present one. Contemplation of the great epidemic diseases has indicated definitely that there is such a thing as racial susceptibility to infection. The appearance of diabetes and arterio-sclerosis in the Hebrew race points to a tendency of physiological na- ture. One also hears, not infrequently, of family susceptibility ; in the latter instance the word susceptibility is perhaps not so well chosen as would be the word tendeney or character- istic. But at all events, in these two expressions of racial and family differentiation may be found the germ of an approach to the problem of disease which is not carried into the study of the affliction of the individual. In other words, with the individual, cognizance has not been taken of the kind of human material in anticipation of the kind of disease. Obviously, the first step in shifting our point of view from the study of the disease process primarily, to a study of the subject, is to de-
166 DIAGNOSIS AND TREATMENT
velop a method of history and physical examination which will make each individual stand out from the rest of humanity as sharply as the black race does from the white. We must subject the individual who comes for advice and relief from suffering to an analysis that is directed in the first instance toward an understanding of his personality, and by the term personality in this sense is not meant his psyche alone. The study of personality should inelude an analysis of his anatom- ical individuality, as well as his physiological, psychological and immunological characteristics. This method of approach, by these four definite avenues, must not be limited alone to physical examination, but must pervade the taking of the his- tory and the use of whatever specialized and technical forms of examination are at our disposal. And the findings along each of these avenues of study must be correlated and consid- ered with the greatest care.
With our increasing knowledge of the still shaded terri- tory of the endocrine glands it is becoming evident that there is some connection between body conformation, body function, psychie activity and possibly also between immunity forces and these glands. That anatomical features are definitely associ- ated with the action and interaction of the endocrine system is now generally accepted in the condition of acromegaly, myxedema, Graves’ disease and Addison’s disease. The diag- nosis of these maladies up to the present time has depended to a large extent upon the changes in the surface and bony anatomy of the individual. It may further be assumed that the disturb- ances of various body functions found in this group, are analo- gous phenomena in the domain of physiology.
Indeed, in this group there has been made a fairly com- plete correlation between the anatomical and physiological and psychological changes. Thus, in Addison’s disease we associ- ate pigmentation and unusual distribution of hair with the asthenia as forming two important elements in the picture. The usual method of history and physical examination, however, does not include as routine a particular study of the points upon which the diagnosis of this group of maladies is based. And yet, these disturbances produce in a striking measure what is meant in this paper by personality. The acromegalic
DRAPER 167
giant ; the nervous, irritable, ineffectual individual with hyper- thyroidism ; and the subdued, gloomy, tired patient with Addi- son’s disease, are well known characters in hospital wards. Is it possible that by taking these types as yard sticks by which to measure individuals whose personalities are less striking to the casual observer, we may gradually come to an understand- ing of the more subtle differences between individuals, and so to a better knowledge of their success or failure in the face of attack by disease or under the stress of life?
In the plan for the study of patients which follows, it will be found that there is little, as a matter of fact, which has not been included in other schemes of physical examinations, but the arrangement of the material is such that it helps primarily to study the personality of the patient. In the course of this examination any pathological deflection which would have been detected by the routine method will not escape. But instead of occupying the center of the stage and focusing the interest of the study upon itself, the lesion will automatically assume a perfectly logical position in the general plan upon which the individual is designed by nature.
PERSONALITY STUDY
I. ANATOMICAL: History: Family: shapes and sizes. Patient: a. Size at birth. b. Growth and development (before puberty). ce. Age of appearance of secondary sex characters. d. Growth and development after puberty. e. Dentition history.
PuysicaL EXAMINATION: A. Outward, anatomical markings as per Chart I.
CHART I
WEIGHT : HEIGHT : GENERAL CONFORMATION : Heap: Shape: Length: Width: Shape of face: Profile : Eyes: Deep set: Interval: Squint : Exophthalmic: Motions: Oedema: Palpebral fissure: (width:
(direction:
DIAGNOSIS AND TREATMENT
Glabella: Supraorbital Ridges: Nose: Size: Form: Ears: Size: Shape: Lobe: Jaws: Tongue: Teeth: Spacing Color: Quality: Position : Shape: Repair: Neck: Length: Girth: HaAnpbs: Shape: Fingers: Nails: SHOULDERS: Breadth: Form: CHEST: Girth: Sub-costal angle: Waist: Girth: Petvis: Width at crests Trochanters : TRUNK: Length: Upper Extremities: Length: Lower Extremities: Length: Hair: Scalp: Eyebrows: Space: Color: Thickness : Supratemporal recessions: Arch: Outer end: Cycle growth changes: Beard: Chest : Abdomen : Axilla: Back: Suprapubie: Thighs: - Arms: Legs: Forearms: GONADAL SYSTEM: Varicocele : Prostate :
SKIN: Texture:
iby
Pigmentation : Inward Markings as per Chart II
CHART II
ROUTINE EXAMINATION OF:
a. b.
as
Eyes: pupils, and fundi and visual fields: Heart and circulation by usual methods:
1. percussion. ;
2. auscultation.
3. X-ray. Routine examination of lungs; lymphatic system.
. Routine examination of abdomen, liver, spleen.
Routine examination of prostate and female in- ternal genitals when indicated. Reflexes:
. Blood count and differential. . X-ray of sella turcica, epiphyses, ete.
DRAPER 169
Il. PHYSIOLOGICAL:
History: Family: a. Food idiosyncrasies.
b. c.
Bowel habit. Sweat habit.
d. Mother’s menstrual and pregnancy. Patient: a. Food idiosynerasies.
b. . Bowels—constipation.
. Urine, quantity, frequency, influence of emotion. . Reaction to external temperatures.
h.
Digestion.
Sweat : amount. localization. Heart : sensations. rate on exercise and emotion. Respiratory mechanism: sensation of choking. inability to get breath, ete. Physical strength and fatigue. Sex funetions: Females: Menstruation: age at onset, pain, duration, interval. Pregnancies : toxemias, labor. Breasts and lactations. Males: Maturation age, Libido,
Potentia.
FUNCTIONAL EXAMINATION: (see Chart IIT)
€;
CHART IIT Fastrie juice. Stool examination. Kidney function test—Urine examination. Heart and circulation : Blood pressure, Influence of exercise, Arrhythmias, KE. K. G. . Polygraph. Peripheral circulation—Capillary Pulse. Flushing.
ore 99 BO
170 DIAGNOSIS AND TREATMENT
g. Tache. h. Respiratory mechanism : 1. Arrhythmias, 2. Voice and speech (stammering), 3. Gas exchange (basal metabolism). i. Response to glandular extracts: 1. Adrenalin (Goetsch test), 2. Thyroid, 3.- Pituitary, 4. Ovarian, 5. Drugs—pilocarpin. j. Sugar tolerance. k. Skin irritability: Hives.
Ill. PSYCHOLOGICAL:
History: Family: general nervous pattern. Patient: a. Development in childhood—advaneed, backward.
1. Impatient to get on, ete.
2. Frights in childhood.
3. Karly permanent ideas. 4. Difficult or tractable child. 5. Dreams. b. Adult life.
1. Characteristic or average psychic state. sluggish, recessive, alert, projective.
Accomplishments.
Fears.
Ambitions.
Repressions.
Interests.
Talents.
Sleep : Dreams.
EXAMINATION: 1. Binet test, 2. Psycho-analysis, 3. Dream analysis.
IV. IMMUNOLOGICAL:
History: Race: Family: Tendencies to infectious: disease. Patient : a. Infectious disease history Kspecial attention to relationship of age to dis- ease.
DRAPER Ney
b. Tendency to sore throat, quinsy. e. Tendency to small boils. d. Tooth root and gum infections.
EXAMINATION :
a. Serological reactions : 1. Widal, 2. Wasserman—Blood and spinal fluid, 3. Gold reaction—Spinal fluid, 4. Agelutinations.
b. Bacteriological :
. Cultures,
. Smears,
. Dark field examinations,
. Pneumococcus grouping,
. Animal inoculation.
¢. Immunity test: 1. Schick reaction, 2. Tuberculin test, ete.
m Co DDR
Or
It will be seen from a study of these charts that the patient is investigated as completely as the means now at our command permit in each one of the four domains which together determine the personality of an individual. It is necessary to investigate each domain separately with regard to history and methods of examination and then with the four sets of studies, side by side, one can correlate the findings in each. It is interesting to note when a considerable series of individuals has been studied in this way, that through each, one finds the expression of the same forces which seem to determine the extreme forms mentioned above as representing known disturbances of the endocrine sys- tem. Thus, for example, it is striking to find that the individual who wakes very early in the morning, who has a greatly in- creased tremor after drinking coffee, who has hair line on the forehead that grows very high, with recessions over the tem- ples, whose skin is delicate and pink and white, also disclaims having had any infectious disease with the possible exception of typhoid, malaria or tuberculosis. When the total metabolism of this individual is studied it is found to be above the normal. Or, one finds, for example, an individual of extremely dark com- plexion, with unusually deep pigmentation, normally disposed, an excessive growth of hair and low growing scalp line, or with freckles on the eyelids, who is able to work for half a day with
172 DIAGNOSIS AND TREATMENT
considerable success, but who then becomes so fatigued that the latter part of the day finds him good for nothing. The im- munological history and examination of this individual may indi- cate that he has had diphtheria, or that he is the subject of a positive Schick reaction. Physiologically this patient may suffer from hyperacidity. Again, an individual may be met who dis- closes to anatomical study a large, flabby frame, prominent upper jaw with widely spaced teeth, no hair on the chest and a transverse suprapubic arrangement. Physiological study of this individual will reveal that he has an increased tolerance for sugars. The history of his anatomical deveolpment will indicate that he was a large infant and always continued above size. In his immunological history one may find reference to some sort of brain fever or possibly infantile paralysis or mumps.
And so by correlating the histories and the examinations in each of the four panels it is possible to come to a far clearer understanding of the forces which determine the form and fune- tion of mind and body, their strength and weakness and suscep- tibility to infection. The study of the individual dominates and surrounds the study of his affliction and it is amazing how fre- quently the particular pathological disturbance belongs irresist- ibly in the whole fabric of his personality.
“LA ACCION FISIOLOGICA DE LOS EXTRACTOS HIPO. FISIARIOS.”’ By Dr. Bernardo A. Houssay, Professor of Physiology in the University of Buenos Aires, 1918, pp. 281 and bibliography, pp. 75. A. Flaiban, Buenos Aires.
To sundry good reasons for a wider knowledge of the Spanish language another has been added by the appear- ance of this monograph by Prof. Houssay. It is the result of ten years of intensive study and embodies many hundreds of individual experiments.
Whether the term ‘‘physiological’’ is justified in this cap- tion is discussed in a prefatory section. It is used, at any rate, in a somewhat loose sense since one section of the book is ex- plicitly devoted to toxicology. That various of the pharmaco- dynamic effects described are actually physiological remains to the reviewer, at least, somewhat doubtful.
The first chapter is a profusely illustrated account of the comparative morphology of the hypophysis with a brief con- cluding section on its chemical composition in different ani- mals. Its high content in cholestrol is emphasized. Next the literature on the pharmacodynamie effects of various extracts is exhaustively reviewed and the author’s own contributions summarized, with several illustrative graphs. A brief abstract of this chapter has been published in Endocrinology, 1917, 1, 393. <A closing section reviews the methods of assaying pitu- itary extracts.
Chapter 3 takes up the technique of preparing extracts of various parts of the gland and the comparative pharmacology of these. It concludes with a discussion of the commercial preparations, the nomenclature and the preservation of ex- tracts.
The next section exhaustively treats of the toxicology of hypophyseal extracts. This is followed by a ten-page discus- sion of the effects in different organs of the administration of pituitary materials.
Chapter 6, of 30 pages, is devoted to the effects of extracts prepared in various ways on the circulation in different organs. A shorter chapter takes up the effects on the heart. This is illustrated by mechanical and electro-cardiograms.
Succeeding chapters are devoted to the effects on the blood, on respiration and on various sorts of smooth muscle and on
173
174 BOOK REVIEW
skeletal muscle. On p. 164 is reproduced a graph showing a beneficial effect of posterior lobe extracts on an isolated fa- tigued gastronemius which is strikingly similar to those pub- lished by Gruber on the effects of adrenin in the intact animal. The next sections take up the effects on growth, development and metabolism.
Possibly the most noteworthy chapter in the book is the 14th, devoted to the influence of hypophyseal extracts on the various secretions, and particularly that of milk in the human and other species. This comprises 50 pages.
Five brief chapters devoted to effects on the nervous sys- tem, “‘the alleged antitoxie action of hypophyseal extracts,”’ comparative physiology of the active principles of the hypophy- sis, comparative action of adrenin and hypophyseal extracts, and ‘‘the adrenal-hypophysis association,’’ complete the dis- cussion.
A review of a work of this sort is necessarily inadequate since the wealth of details can not be summarized. Some of these have been included in a series of abstracts in Endoerinol- ogy (1917, 41; 359, 372; 393) .533:) 1918, 2.64: 94 162.) Adios. 325, 478 and 497), but on many points the original must be con- sulted.
The book coneludes with an exhaustive bibliography of 75 pages. The greater part of the references have been obtained at first hand. The source of those otherwise derived has been indicated. The utility of the bibliography is unfortunately eurtailed, as the author admits, by the translation of all the titles into Spanish. Most of the titles quoted, however, are fairly comprehensible to one with but a modicum of knowledge of the specific language employed.
At any rate, so thoroughly has the work been done that no one for years to come can safely publish research on any phase of the subject treated without consulting this monograph.
—R. G. H.
ABSTRACTS
ACROMEGALY with intense diabetes and change of hair color (Akromegalie mit intensiven Diabetes und Wechsel der Haar- farbe). Ausch (D.) Med. Klinik (Berl.) 1918, 14, 131-33.
A ease is described in which ante-mortem X-ray examina- tion. showed an enlarged sella turcica. The diagnosis was con- firmed post-mortem. The change of hair color from fair to dark has not previously been deseribed in acromegaly. Physiol. Abst., 3, 267.
ACROMEGALY without hypophyseal tumor and the pathogeny of same (Zur kenntnis der Akromegalie ohne Hypophysen- tumor und die pathogenese derselben). Yamada (S.) Mitt. a. d. med. Fac. d. k. Univ. z. Tokyo, 1918, 8, 411-41.
The case is reported of a young merchant who had had excellent health until the age of 17, when he noticed that his hands and feet were growing larger. This fact he attributed to his sound health. He developed edema, hypoesthesia of the - calves and finally lassitude and fatigue. Marked depression of sexual inclinations was noted. At the time of his death from beriberi at the age of 21 the enlargement of the limbs was very marked. At autopsy the hypophysis was found normal both in gross and microscopic appearance; there was no evidence of augmented secretion granules. The thyroid was hypertrophic and the thymus ‘‘persistent.’’ The testes were atrophie and spermatogenesis depressed. The pineal contained masses of colloid. The adrenal medulla was hypertrophic. The case was therefore, seemingly, polyglandular in origin. The paper is illustrated with 5 rotogravure plates.—R. G. H.
. ADIPOSIS DOLOROSA. Cecikas (J.) Gréce médicale (Ath- ens) 1918, 20, 1-5 (French supplement to Iatriki Proodos).
Cecikas reports a case in a man of 32, married for six months, which, he thinks, throws light on the etiology of the disease. The pressure of the man’s body against his desk ex-
175
176 ABSTRACTS
plained the unusual location of the ipomas, and the immedi- ate effect of an injection of pituitary extract on retention of urine confirmed the influence of the pituitary on the innerva- tion of the bladder, but the primal factor in Dereum’s disease seems to be some abnormal or lacking hormone from the organs of reproduction. This seems to upset the normal balance in the chromaffine system. His patient was clinically eured, even to the retrogression of the lipomas, by systematic treatment with extract of thyroid 1 part, extract of pituitary, 1 part, and of ovary 2 parts, supplemented by a vegetable diet and exercise in the country. Whenever this treatment was interrupted, the whole set of symptoms returned, even including some of the tumors. The patient learned to make his organotherapeutie products himself, making a cold extract of thyroid and testicles, 1:4, from sheep 1 or 2 years old. (Extraction cold; 50 e¢.c¢.; phenol, 0.05.) He took a teaspoonful of this extract morning and evening in warm soup. Cecikas recalls that Dereum in de- seribing his first ease of adiposis dolorosa noted its connection with the thyroid.—J. Am. M. Assn.
ADRENAL insufficiency, Acute. Boyd (W.) J. Lab. and Clin. Med. (St. Louis), 1918, 4, 133.
A soldier upon admittance to the hospital was sinking into coma. The limbs were rigid, reflexes gone, pupils dilated, face and hands ecyanosed, temperature 99° F. The urine was nor- mal, lumbar puncture negative, Wasserman reaction negative. Death occurred in less than six hours. The autopsy showed pulmonary tubereular lesions. The stomach contents showed no trace of poison. The adrenals were almost entirely de- stroyed, and converted into structureless, amorphous, yellow masses. They were firm in texture and were considerably larger than normal. No trace of adrenal tissue could be found on the right side; on the left side a small strip only was pres- ent. This consisted almost entirely of cortex. The remainder of the gland consisted of areas of necrosis surrounded by endo- thelial and giant cells, characteristic of tuberculosis. No trace of medullary substance remained. The case appears effectually to disprove the theory that the medulla of the adrenal is essen- tial to life. The entire medulla must have been completely de- stroyed for a considerable time, and yet the patient possessed sufficient physical vigor to engage in the full duties of a mili- tary camp. The persistence of a small amount of cortical tis- sue on the left side strongly suggests that this 1s the part of the gland which is necessary for the maintenance of hfe and that the destruction of this tissue beyond a degree compatible
ABSTRACTS LE
with life gave rise to symptoms of acute adrenal insufficiency. —H. W.
ADRENAL crises (Nebennierenapoplexie). Loewenthal. Berl. klin. Wehnschr, 1918, 55, 1126.
In ease of acute infections, and from other causes, “‘apo- plexie’’ in both adrenals may occur. The symptoms are abdomi- nal pain; intestinal spasms with constipation; perspiration ; weak, irregular, slow pulse and normal temperature. The dis- ease 1s always fatal. The symptoms may be explained as due to diminution in circulating adrenin.—J. K.
ADRENAL, Focal necrosis of the, with remarks upon acute adrenal insufficiency. Moschowitz (E.) Proce. N. Y. Path. Soe... 1917, 17, 127-129.
Published elsewhere. See Endoerin. 1918, 2, 472.
ADRENAL form of malaria. Fraga (C.) Rev. Ibero-Americana de Ciencias Medicas (Madrid) 1918, 40, 9-20.
Fraga reports from Brazil three cases of a set of symptoms indicating acute insufficiency of the suprarenals, and explained by malarial infection. One of the patients was demonstrated at a meeting of the American Society of Tropical Medicine at New York. Necropsy in one case showed the malaria parasites in the capillaries of the suprarenal cortex. The importance of this suprarenal form of malaria is enhanced by the fact that we have in epinephrin a means to tide the patient past the danger point. In the algid form, artificial serum with epinephrin given by the vein, may complete the triumph of quinin. In the less severe cases opotherapy alone may prove effectual. J. Am.
M. Assn., 71, 1447.
ADRENAL gland, Functional activity of the medulla of the — of the tuberculous (De l’activité fonctionelle de la glande médullaire surrénale des tuberculeux). Porak (R.) Annales de Méd. (Paris) 1918, 5, 404-416.
Extracts were made of the glands of patients dying of tu- berculosis in various forms. The extracts in each case caused a marked increase in arterial pressure when injected intra- venously in rabbits. The hypotension of tuberculosis is due, therefore, to some other cause than adrenal deficiency. A con- siderable amount of theorizing is included, in which no atten-
178 ABSTRACTS
tion is paid to the various pertinent researches of recent years on adrenin pharmacology.—R. G. H.
ADRENAL glands with toxic infections. Manie (A.) Ann. inst. Pasteur, 1918, 32, 97-110.
The subeutaneous administration of adrenin has no pre- ventive action against tetanus intoxication. When the two are injected separately they remain ineffective against each other. Only their mixture exposed at 37° insures innocuousness of the toxin. Experimental evidenee is given of the inactivity of ad- renin administered under these eonditions. Chem. Abst., 12, 1361.
(ADRENAL) Contributo allo studio della malattia di Addison nell’ infanzia (Addison’s disease in a girl aged 10 years). Rutelli (G.) La Pediatria (Napoli), 1916, 24, 274-81. Abstr. Brit. Jour. Child. Dis., 1919, 16, 61.
There was a history of enlarged cervical glands at the age of 10 months, and an affection of one finger which resulted in ankylosis at the age of two years. Pigmentation of the skin commenced at the age of 4 years. The blood pressure was 65-70 mm., and there was marked asthenia. The urine was normal excepting for slight diminution in elimination of urie acid and ereatinin. On a diet rich in earbohydrates, sugar appeared in the urine 20 hours after an injection of one mg. of adrenalin; on ordinary diet, after 18 hours, and on a diet poor in earbo- hydrates, after four hours. Control experiments in a healthy subject gave 12, 8 and 2 hours, respectively.—M. B. G.
ADRENAL insufficiency, Acute—in recurrent fever and ma- laria; pre-existing tuberculosis in the adrenal glands. Porto- ealis (A.) Tr. Soe. Medico-Chir. d’Athénes, 1918, Session Feb. 20. J. de Med. Bordeaux, 1918, 89, 169. Pub. in full, else- where; see Endocrin., 1918, 2, 469.
Cases are described of four soldiers who died, two of re- eurrent fever and two of malaria, having shown symptoms of acute adrenal insufficieney of the choleriform, algid type. Post- mortem examination showed only old pulmonary tubereular lesions and tuberculosis of the gangha and adrenals. Compare with Endocrin. 1918, 2, 471, 473, 476., Absts. Nos. 354, 357, 366.
—R. G. H.
ADRENAL insufficiency in combatants (Insuffisance surrénale chez le combattant). Carles (J.) J. de Méd. d. Bordeaux, 1918, 89, 185-88.
ABSTRACTS Tg
Fifteen cases are utilized as a basis for an exposition of the current French views on adrenal insufficiency. The cases were apparently of the same sort described in English as ‘‘shell- shock.’’ That the adrenals play an essential part in the symp- tomatology has not been satisfactorily demonstrated. The therapeutic test in such cases is not convineing.—R. G. H.
(ADRENAL) La linea blanca suprarenal, su produccion y sig- nificacion diagnostica (Adrenal white line). Sergent (F.) Medicina Moderna (Havana) 1918, 1, 19-21.
Reprinted in Spanish translation from Endocrin., 1917, 1, 18-22.
(ADRENAL) Maladie d’Addison chez un fille de treize ans; mort; autopsy (Addison’s disease in a girl of 13; death; au- topsy). Comby (J.) Arch. de Méd. des Enf. (Paris.), 1917, 20, 28. Abstr. Brit. Jour. Child. Dis., 1919, 16, 62.
The patient had probably been infected by her father, who had died of pulmonary tubereulosis. She presented all the symptoms of Addison’s disease, including bronzing of the skin, profound asthenia, arterial hypotension, vomiting and almost sudden death after about two months’ illness. The only lesions found post mortem were in the adrenals. The right gland was a mere abscess cavity, and the left was studded with caseous nodules.—M. B. G.
(ADRENIN) Observations of the effects of drugs on the ileo- colic sphincter. Kuroda (M.) J. Pharmacol. and Exp. Ther. (Balt.), 1916, 9, 187-195.
Adrenin contracts the ileo-colie sphineter while the small intestine is relaxed. Confirms Elliott: Jour. Physiol., 1904, 31, 157.—F. A. H.
(ADRENIN) On the pharmacology of the ureter. VI. Action of some optic isomers. Macht (I.), J. Pharmacol. and Exp. Ther. (Balt.), 1918, 12, 255-265.
Laevo-rotatory adrenin stimulated the ureteral contrac- tions and raised the ureteral tonus much more than the racemic
variety.—F.. A. H.
(ADRENAL) Sobre la formula leucocitaria en la enfermedad Addison (Leucocytic formula in Addison’s Disease). Mara- non (G.) Boletin-de la Soc. Espafiola de Biol., Session Dee. 17, 1915.
180 ABSTRACTS
The blood picture was studied in 13 eases of Addison’s dis- eases One showed leucopenia (4,200), 5 were normal (5-8,000), 3 showed slight hyperleucoeytosis (9-13,000) and one marked (30,100). In 3 eases the total number of leucocytes was not determined. As to mononuclear cells, three showed 35-40% ; six, 40-50%, and four, 50-60%. There was no apparent rela- tion between the mononueleosis and the severity of the symp- toms. Generally the mononucleosis was at the expense of the lymphocytes, but in certain cases there was an absolute aug- mentation of the large mononuclears. No abnormality in the number of the eosinophiles was detected, nor any abnormal cells in the blood.—R. G. H.
(ADRENALS) Des rapports entre la sécrétion surrénale et la fonction vaso-motrice du nerf splanchnique (Relation be- tween adrenal secretion and the vasomotor function of the splanchnic). Gley (E.) et Quinquaud (A.) C. R. Aead. Se. (Paris.), 1916, 162, 86-88.
The rise of the blood pressure upon stimulation of the splanchnie nerve is a purely neuro-muscular phenomenon and the secretion of the adrenals has no part in it, since excitation of this nerve does not lose its effeet even in the absence of the adrenals. If the veins of both adrenals are ligated and great care is taken not to injure the fibres of the splanchnic nerve—to carry out which is particularly difficult in the dog—the blood pressure will rise upon stimulation of the splanchnic to the same level as before operation. In order to make sure that no adrenalin was escaping into the circulation through the tho- racic duct, the latter also was ligated —KE. U.
ADRENALS, Development of the—in the cat (Sur la develop- ment des capsules surrénales du chat. Notes d’organogenése et de cytogenése). da Costa (A. C.) Bull Soe. portugaise des sel. nat. (Lisbon) 1916, 7, 161-71.
A detailed deseription of the adrenals in cat embryos. From histological evidence it is suggested that adrenin is produeed in the latter half of gestation. Physiol. Abst., 3, 265.
(ADRENALS) Een geval van ziekte van Addisonii (A case of Addison’s Disease). Hekman (J.) Nederl. Tijdschr. v. Ge- neesk. (Amsterdam) 1916, 60, (11) 371-72.
Deseription of a case with pigmentation of the skin, but not of the mucous membrane. Blood sugar and blood pressure were normal. According to the description, the ease is not properly diagnosed.—J. K.
ABSTRACTS 181
ADRENALS, Secretory innervation of the—(Uber die sekretor- ische Innervation der Nebennieren). Popielski (L.) Arch. f dees) Physiol., 1918, 170, 245-59.
The author believes that the existence of secretory fibres to the adrenals has not been proved—that positive results of reported experiments are due to manipulation of the glands or asphyxia of the medullary portion. The splanchnic fibres to the medulla are vasodilator hence their stimulation leads to flush- ing out formed adrenin. In experiments in which the amount of adrenin in the two glands was estimated, and in which the nerve was divided on one side so that the denervated gland could serve as a control retention of adrenin in that side was due to resulting anemia. Anemia, nevertheless, results in lib- eration of adrenin from the complex precursor in which it is present in the gland so that stimulation of the splanchnie re- sults in the passage of large amounts of it into the circulation. The liberation of adrenin in asphyxia is also due to its being set free by the action of CO,. Manipulation of the adrenal lib- erates adrenin, but it does not pass from a denervated gland into the cireulation until the gland is flushed out with blood, as by stimulating the splanehnie. Physiol. Abst., 3, 265.
ADRENALS, Sudden post-operative death and tuberculosis of the—(Mort subite post-opératoire et tuberculose des surré- nales). Brindeau (A.) Arch. mens. d’Obstét. et de Gyn. (Paris) 1917, 6, 159-68.
A woman suddenly died after a short, uneventful operation under general anesthesia. At autopsy the adrenal glands were found tuberculous. The author accounts for the otherwise in- explicable death as due to ‘‘insuffisance surrénale.’’ Unlike most papers on this topic, this one presents some tangible, spe- cific evidence. The author believes that when a pre-operative diagnosis of such insufficiency can be made (as by the ‘‘ white line’’ associated with low blood pressure), local anesthesia should be used or, in case this is impossible, the patient should be fortified by the administration of adrenin.—R. G. H.
(ADRENALS) Sul meccanismo d’azione del cloroformio. II. Azione sulle capsule surrenali. Aloi (V.) Riforma Med. (Na- ples) 1918, 34, 990-91.
Experiments were made on dogs. These were subjected to chloroform inhalation for varying periods and at intervals of two or three days. The adrenin content of the adrenal glands was determined colorometrically. It was found that the in-
182 ABSTRACTS
toxication resulted in a depletion of the glands such as Elliott has described after etherization.—R. G. H.
(ADRENALS) The experimental production of lesions, ero- sions and acute ulcers in rabbits by repeated injections of pilocarpin and adrenalin. Friedman (G. A.) Jour. Med. Re- search (Boston), 1918, 38, 449.
Friedman summarizes his work as follows: The produe- tion of gastric and duodenal uleer will depend upon the syner- getie work of vagotrope and sympathicotrope hormones, as in rabbits after repeated injections of pilocarpin and adrenalin. If hormones act independently, either gastric or duodenal ulcers will develop, as occurred in rabbits which were injected with pilocarpin or thyroid and in dogs with adrenalin injections. Since vagotoniec and sympathicotonic symptoms and signs are found in the majority of patients afflicted with peptic ulcer, there may exist in such individuals minor degrees of hyper- tonicity of vagus and sympathicus—the conditions resembling Graves’ disease, with the difference, however, that in the latter the hypertonicity of the vagus and sympathicus is lhkely to be marked. The work of Adler is cited as indicating that the ad- renals are disturbed in Graves’ disease.—J. P.S.
ADRENALS, The function of the—(La fonction des surré- nales). Gley (K.) et Quinquaud (A.) Archives neerlandaises
de physiologie de l|’>homme et des animaux (The Hague), 1918, rae 1
Data published elsewhere. See Endocrin., 1918, 2, 473.
(ADRENALS) (a) The reactions of the melanophores of the horned toad. (b) The co-ordination of the melanophore re- actions of the horned toad. Redfield (A. C.) Proce. Nat’l Acad. Sei. (Washington), 1917, 3, 202-3; 204-5.
The pigment cells of the horned toad are under reflex and hormone control. That the hormone is adrenin is indieated by the facts that: (1) Adrenin in minute doses causes contraction of the melanophore pigment. (2) The adrenal glands give a substance pharmacologically like adrenin which causes the pig- ment cells to contract. (3) Faradic stimulation of the ad- renals causes a similar reaction. (4) The occurrence of ‘‘emo- tional’’ hyperglycemia in the horned toad indicates adrenin is secreted during nervous excitement. (5) The melanophore pig- ment is contracted under the influence of asphyxia, ether, mor-
ABSTRACTS 183
phia and nicotine. (6) Removing the adrenals blocks the re- action of the melanophores so that (especially in denervated areas) no contraction of the pigment accompanies nervous ex- citement.—R. G. H.
(ADRENIN) Accion de la adrenalina en la fatiga muscular del Leptodactylus ocellatus (L.) Gir. y. del Bufo marinus (Ll. Schneid). (Action of adrenin on muscular fatigue in L. ocellatus and B. marinus.) Guglielmetti (G.) Rev. Assoc. Méd. Argentina (Buenos Aires) 1918, 29, 774.
The observations of Dessy and of Grandis are confirmed and extended. Guglielmetti employed adrenin and not supra- renal extract as did the former authors. In general adrenin did not affect the normal muscle, but restored the fatigued muscle, increasing its contractile powers. The original report should be consulted for numerous details. The frog Leptodac- tylus ocellatus is five times more sensitive than the toad Bufo marinus. (See article by Gruber in this number.)—B. A. H.
ADRENIN, Action of—on the secretion of sweat. Dieden (H.) Ztschr. f. Biol. (Miinechen), 1916, 66, 387-90.
Injection of adrenin into the pad of a cat’s paw causes secre- tion of sweat only after section of the sciatic nerve, unless the animal is deeply anesthetized, in which case section of the nerve is unnecessary. A positive reaction is also obtained six days after division of both sciatics and ten minutes after death. Intravenous injections or subeutaneous injections in other regions are ineffective. The author believes that the seiatie carries inhibitory fibres to the sweat glands which are stimulated refiexly or by adrenin acting on an inhibitory cen- ter in the spinal cord. After cutting the posterior roots (con- taining the inhibitory fibres) in the lower dorsal and lumbar regions, the sciatic remaining intact, adrenin evokes sweating in the hind paws but not the front. Stimulation of the posterior roots now appears to cause the sweat to dry up. Physiol. Abst., 1, 174.
(ADRENIN) A note on the effect of asphyxia and afferent stimulation on adrenal secretion. Cannon (W. B.) Science (N. Y.) 1917, 45, 463.
The ‘‘splanchnie area”’ is isolated by tying off carotids, subelavians and aorta above the inferior mesenteric. Blood pressure readings were taken from the proximal end of the
184 ABSTRACTS
carotid. Any changes in blood pressure were thus due to vaseu- lar changes in this area. Asphyxia for one minute causes marked rise, but no result if the adrenals are removed. If the adrenals are denervated there is a longer latent period.
The heart was completely denervated and used as an ‘‘ad- renalin indicator.’’ Stimulation of central end of a eut sci- atic causes an increase in heart rate (50 per min.). The effect is lost if the adrenals are removed or denervated. The effect of asphyxia is not so marked.
A caution is given regarding the manipulation of abdomi- nal viscera with an attendant secretion of adrenalin, confusing the results.—W. E. B.
(ADRENIN) A respiratory factor in the production of adrenin pulmonary oedema in the rabbit. Gates (F. L.) and Auer (J.) J. Pharm. & Exp. Ther. (Balt.), 1917, 9, 361-2.
Artificial respiration in vagotomized rabbits, with chests intact, greatly reduces the pulmonary oedema produced by adrenin injected intratracheally. Experimentally induced tracheal stenosis, with vagi intact, favors the production of oedema after the intratracheal injection of adrenin. These facts, together with the observation that adrenin causes a definite broncho-constriction in vagotomized rabbits, were ex- plained by the view that the alveoh supplhed by a constricted bronchiole act like miniature dry cups, and since there is also pulmonary congestion, the passage of a transudate into the alveoli is facilitated. Artificial respiration prevents the oedema by setting up a positive pressure in the lung.—L. G. K.
(ADRENIN) Arsphenamin and neoarsphenamin plus epi- nephrin. Beeson (B. B.) Am. J. Syph. (St. Louis), 1919, 3, 129-38.
In a series of 500 intravenous injections of arsphenamin approximately 3 per cent developed nitroid crises. These varied in manifestation from slight flushing of the face and feeling of precordial fullness to extreme flushing and marked air hunger with edema of tongue and lips and injection of the conjunctiva. In three cases marked prostration occurred. Adrenin, 1-2 milligrams, given intramuscularly ten minutes be- fore the injection, proved beneficial in warding off these ill
ABSTRACTS 185
effects. Beeson’s conelusion that the erises are due to adrenal insufficiency is not justified by the evidence presented. Se tte-G. H.
(ADRENIN) Drei Vorschlage zur Namensgebung und schreiben (Three proposed improvements in terminology). Kahn (R. H.) Zentralbl. f. Physiol. (Leipzig) 1917, 32, 285-90.
One of the proposed changes is “‘“sympathikotropine,’’ or sympathizine for adrenin. Physiol. Abst. 3, 307.
ADRENIN in asthma. Trivino (G.) Revista [bero-Americana (Madrid), 1918, 39, 271-77.
Trivino has used epinephrin in twenty-two cases of asthma and, with one exception, the results were highly encouraging. In this one exception, there may have been a complicating emphysema. In other cases the patients were always relieved within twenty minutes. He followed the technic advised by A. Hertz, who has had considerable clinical experience besides his experience with asthma in his own person. He found that injection of 3 drops of the usual 1 per thousand solution of epinephrin gave prompt relief, but the by-effects were disagree- able. Reducing the dose to 2 drops or even 1 drop proved usually efficient without the by-effects. Trivino did not find the relief so immediate as others have reported, but it was always experienced within twenty minutes.—Jour. A. M. A.
(ADRENIN) Mechanism and control of fibrillation in the mam- malian heart. MacWilliam (J. A.) Proe. Roy. Soe. London (1918), 90B, 302-23.
The paper is mainly physiological. The control of ven- tricular fibrillation by means of certain compounds (SrCl., urethan, adrenaline, hirudin, and pilocarpine) is deseribed. Chem. Abst., 13, 34.
(ADRENIN) On certain antagonists of pilocarpine. Ransom (F.), J. Pharm. & Exp. Therap. (Balt.), 1917, 10, 169-184.
The only point of endocrine interest is that adrenin very
effectively antagonizes the action of pilocarpine on the rate and on the systole of the frog’s heart.—L. G. K.
186 ABSTRACTS
(ADRENIN) PURPURA. Johannessen (C.), Norsk Magazin for Laegevidenskaben (Christiania), 1918, 79, 1209-52 (Abst. J. Am. M. Assn., 1919, 72, 318).
In connection with an extensive article on the symptom- atology, etiology and treatment of purpura the author discusses the use of adrenin. It is valuable, he says, to arrest the paralysis of the contractile elements of the sympathetic nerve terminals, which is a feature of anaphylactoid purpura. From 0.1 to 0.83 ¢.c. of the 1 per thousand solution can be injected subcutaneously several times a day. It is ineffectual by the mouth. Administration of epinephrin conforms also to Fried- richsen’s theory of the nature of purpura. With abdominal purpura the colic pains may be agonizing. Dieting does not help and warm applications give little relief. Atropin para- lyzes the irritated terminals of the vagus nerve in the intestines and thus has a sedative action. He gives it by the mouth or subeutaneously in a 1 per thousand solution.—R. G. H.
(ADRENIN) Quantitative experiments on the liberation of epinephrin from the adrenals after section of their nerves, with special reference to the question of the indispensability of epinephrin for the organism. Stewart (G. N.) and Rogoff GML). Jour. Pharm. Exp. hers(Balt,) oie lO ss ae:
See Endoerin. 1917, 1, 341-2.—L. G. K.
ADRENIN, Synthetic —. Nagayoshi Nagai. Brit. 118,298, duly 23, 1917. Adrenin is obtained by the following synthesis: (1)
Diacetylprotocatechuic aldehyde, prepd. by the reaction of AecCl or Ac,O on protoecatechuie aldehyde, is condensed with nitromethane in the presence of weak inorg. or org. bases; (2) the resulting diacetyldihydroxyphenylnitroethanol is reduced in the presence of HCHO by means of Zn dust and HOAe; (3) the diacetyladrenin so formed is hydrolyzed by HCl, giving adrenin hydrochloride. Chem. Abst., 13, 59.
(ADRENIN) Test glycemia. Loeper (M.) and Verpy (G.) Arch. de. méd et de pharm. militaire (Paris) 1917, 67, 817.
Adrenin may be used as a means of determining the power of the liver to transform glycogen into sugar: Normal indi- viduals show a rise of 0.40 gm. of blood-sugar one hour after the injection of 1 mg. of active adrenin. This is taken as a stand- ard. In eases of acute irritation of the liver, the rise of blood-
ABSTRACTS 187
sugar is exaggerated, while, in cases of defective liver action, the reverse is true. Physiol. Abst., 3, 182.
(ADRENIN) The action of some optic isomers on the ureter. Macht (BD, 1). J. Pharm: & Exp. Therap. (Balt.), 1917, 9, 351.
The only point of endocrine interest is that laevo-adrenin is more stimulating than the synthetic adrenin.—L. G. K.
(ADRENIN) The administration of epinephrin by intraspinal injections in acute or subchronic cases, accompanied by a low blood pressure. Auer (J.) and Meltzer (S. J.) J. Am. M. Assn. (Chgo.), 1918, 70, 70.
A former observation was corroborated in case of three monkeys in which intraspinal injections of adrenin caused pro- longed elevation of blood pressure. This effect persists for an hour as contrasted with a few minutes as a maximum when the drug is given intravenously. The suggestion is offered that 3 ¢.e. doses of 1:1,000 solution of adrenin intraspinally might be beneficial in elinical cases of low blood pressure. This dosage is regarded as safe.—R. G. H.
(ADRENIN) The coordination of chromatophores by hormones. Redfield (A. C.) Science (N. Y.) 1916, N. 8. 43, 580-81.
The melanophores of the horned toad become contracted during states of nervous excitement. All attempts to prevent the reaction locally by cutting nerves have failed, hence it seems to be due to a hormone. If the circulation to a leg is blocked the melanophores remain expanded, the skin appearing much darker than that of the rest of the body. Removing the blocking ligature causes contraction of the melanophores. The effects in the ligated leg are not due to asphyxia therein. Blood from a horned toad in a state of nervous excitement injected into a lymph space of a second animal causes local paleness ; blood from a quiet animal does not have this effect. Hence excitement causes the appearance in the blood of some chem- ical substance identical with, or similar to, adrenin. Other experiments, later reported, indicate that it actually is adrenin.
ten Oya ble
(ADRENIN) The influence of asphyxia upon the rate of libera- tion of epinephrin from the adrenals. Stewart (G. N.) and Rogoff (J. M.), Jour. Pharm. & Exp. Ther. (Balt.), 1917, 10, 49-72.
188 ABSTRACTS
No increase was detected in the rate of liberation of epinephrin from the adrenals during asphyxia, as determined by testing adrenal vein blood on rabbit intestine and uterus segments. Therefore such phenomena as hyperglucemia and glycosuria when associated with asphyxia, are not due to in- creased liberation of adrenin from the adrenal glands.
—L. G. K.
(ADRENIN) The influence of ether anaesthesia, of hemorrhage, and of plethora from transfusion on the pressor effect of minute quantities of epinephrine. Rous (P.) and Wilson (G. W.) Jour. Exp. Med. (Balt.), 1919, 29, 173.
Ether anesthesia has a marked influence in diminishing the pressor response to minute amounts of epinephrine injected directly into the circulation. Hemorrhage acts in much the same way. In plethoric animals the response to small doses of epinephrine is lessened in proportion as the blood pressure is increased by the plethora. In the exsanguinated animal an amount of epinephrine three or four times that sufficient to produce a pressure rise of 10 to 15 mm. of mereury under nor- mal conditions, may be entirely without effect. On the other hand, the response to large doses is uninfluenced by ether or hemorrhage. Hence, if epinephrine is to be used to tide over collapse it should be appreciated that the amount of epinephrine which will suffice under normal conditions to bring up the blood pressure may have little or no effect on an etherized individual or one that has lost blood.—H. W.
(ADRENIN) The mechanism of ether hyperglucemia. Keeton (R. W.) and Ross (E. L.), Am. J. Physiol., (Boston) 1919, 48, 146-160.
The authors show that a persistent hyperglucemia occurs in normal dogs under continuous ether insufflation. This reaches a maximum at the end of two hours, with little change in the third hour. A transient hyperglucemia passing off at the end of two hours occurs in animals with splanchnic nerves see- tioned on both sides. Asphyxia was suggested as the cause of this through an altered reaction of the blood. <A persistent hyperglucemia of a lower grade oceurs in animals unilaterally splanchnicotomized. Denervation of the hepatic artery does not affeet the hyperglucemia. Section of all the nerves in the hepatic pedicle with cauterization of the coats of the hepatic artery, portal vein and common duet prevents the sugar rise from reaching as high a point as in normal dogs, but does not
ABSTRACTS
abolish it. Eck fistula retards the appearance of Byperzic- cemia in the systemic vems. Ligation of the hepatic artery in Eck fistula animals causes a termmal hyperglucemia. Reversed Eck fistula does not imffuence the course of ether bypergiz- cemia. The adrenin content of the suprarenal glands of dogs
whose splanchnic nerves had been previously sectioned om one side was found to be unequal m the two glands. although the inequality was not constant (sometimes the denervated gland contamed more adrenin. sometimes the control gland. and m other animals there was little difference). However. the authors believe that adrenin is am essential factor m the pre- duction of ether hypergiucemia. particularly the persistent type lasting for several hours. The adrenin is believed to act by stimulating the endings of the hepatic splanehnie nerves. —i, G. K.
(ADERENIN) The output of epinephrine in shock. Stewart (G. N.) and Rogoff (J. M.) Am. Jour. Physiol (Balt.). 1919. 48, 22-44.
The authors found that the rate of output of epinephrin In dogs and cats, after the blood pressure had been permanently lowered by exposure and manipulation of the intestine. by par- tial occlusion of the inferior vena cava, by hemorrhage and by ““neptone’” injection, was the same as before the lowering of the blood pressure. within the limits of error of the methods (rabbit intestine and rabbit uterus segments) used for assaying the epinephrin. A marked increase in the rate of output of epinephrine was produced by strychnine, probably due to its stimulating action on the epmephrin centre in the lower thoracic cord—L. G. K.
(ADRENIN) Uber die Henlesche Chromreaktion der sogen- annten chromaffinen Zellen und den microchemischen Nachweis des Adrenalins. Ogata (T.) and Ogata (A.) Mitt. a. d. Med. Fak. d. k. Univ., Tokyo, 1917, 17, 173-85.
Published elsewhere. See Endoerin., 1917, 1, 349.
(ADRENIN, THYROID) Glucemia é hiperglucemia adrenal- inica en la paloma (Glucemia and adrenin hyperglucemia in the dove). Maranén (G.) and Rosique (A.) Zoletin Soe. Espanola de Biol. 1916, Session, June 10.
Analysis by Bang’s method gave an average glucose con- tent of the blood in normal doves of 0.080 per cent. Adrenin
190 ABSTRACTS
injections constantly increased the percentage to about 0.09 or 0.10. Treating the doves with thyroid extracts did not aug- ment the adrenin glucemia reaction as it has been reported by several observers to increase the vasomotor effects.—R. G. H.
A SEX—intergrade strain of Cladocera. Banta (A. M.) Proe. Soc. Exp. Biol. & Med. (N. Y.), 1916, 14, 3-4.
The older conception was that sex is an absolute attribute. An organism was supposed to be either a male or a female ex- cept in rare cases of hermaphroditism. Researches of recent years have shown, however, that the blending of ‘‘maleness’’ and ‘‘femaleness’’ in a single individual is not uncommon.
Banta studied a race of Cladocera which for 130 genera- tions had been breeding parthenogenetically, none but females appearing. In the 131st generation males and sex-intergrades of many sorts appeared. In the species studied eight morpho- logic secondary sex characters are recognized. Practically every possible combination of male and female characters was seen. The gradation ran from normal females, females with a few male characteristics through hermaphrodites with various combinations of sex characters to male intergrades and finally complete males.
Various anomalous individuals seen by clinicians are prob- ably true sex intergrades.—R. G. H.
(CARBOHYDRATE METABOLISM) Metabolism of glucose in surviving organs. Lombroso (U.) and Artom (C.), Arch. farm. sper. (Rome) 1917, 24, 215-22, 223-30, 263-7, 268-79.
Cireulation of Ringer’s solution plus glucose through the liver of a dog which had fasted several days does not result in loss of carbohydrate. But the liver from a nourished dog destroys some of the glucose, as do also intestine, spleen and panereas. (See also Endocrin. 1917, 1, 357.) Physiol. Abst. 3, 318.
CATALASE ACCELERATOR, Does the liver secrete a—? Burnett (T. C.) Proc. Soc. Exp. Biol. & Med. (N. Y.), 1918, 15, 80.
Published elsewhere. See Endoerin. 1918, 2, 328. (CORPUS LUTEUM) Les variations de la cholésterinémie du-
rant le cycle menstruel (D’apres des recherches recents) (Variations in cholesterinemia during the menstrual cycle,
ABSTRACTS Ou.
according to recent researches). Chauffard (A.) Presse méd. (Paris), 1917, 25, 329-31.
Recent experiments seem to establish as a fact that the corpus luteum is a gland of internal secretion not only histo- logically, but also in its function, and that at least one of the substances manufactured by this gland is cholesterine. Chauf- fard, in 1911 and 1912 demonstrated the presence of cholester- ine in the corpus luteum of the menstruation period and a cholesterinemia prevailing during pregnancy; the corpus lu- teum is a center for the production of cholesterine. G. P. Gona- lons (Semana Medica No. 51, Buenos Aires, 1916) reports 27 determinations of the cholesterine content of the blood each one comprising a complete period; a periodic hypercholester- inemia exists, beginning several days before and ending 3 to 4 days after menstruation (total duration of 11 to 13 days), and comprising two maxima, one before and one during men- struation. In three eases where menstruation did not take place for pathologic reasons, a periodic cycle of hypercholes- terinemia corresponding to that in normal menstruation, was nevertheless observed; the corpus luteum is not the only center of cholesterine production. C. concludes that the peculiar fre- quency of gall stones (cholesterine concretions) 1n women is due to the presence in the gall bladder of an excess of choles- terine during each menstruation resulting from the hypercho- lesterinemia.—E. U.
CORPUS LUTEUM, Soluble extract of—used in the vomiting of pregnancy. Zimmerman (B. F.) Louisville Monthly J. Med. & Surg., 1916, 23, 129-30.
Reports brilliant results in a stubborn case which had not been benefitted by desiccated corpus luteum, opium and hyo- cyamus or chloral. Five injections only of the soluble extract (1 ¢.c. each) were required.—R. G. H.
(DIABETES) (1) Blutzucker und Rest Kohlenstoff beim Diabetes mellitus des Menschen. (2) Die Vertheilung des Blutzuckers auf Korperchen und Plasma beim menschlichen Diabetes. [ (1) Blood sugar and residual carbon in human diabetes. (2) Distribution of blood sugar between corpuscles and plasma in human diabetes.] Stepp (W.) Deutsch. Arch. f. klin Med. (Leipzig) 1917, 124, 177-98; 199-206.
In some eases hyperglucemia accounts for extra residual carbon in the blood, i.e.: carbon not precipitated by phospho- tungstie acid. But in most diabeties this carbon is less than that
192 ABSTRACTS
expected from the extra sugar, and in some eases it is higher. This suggests that in the majority of cases there are reducing substances in the blood with a lower carbon content~ than glucose, and among those found are glycol aldehyde, glycerie aldehyde and dioxyacetone. In cases where the residual carbon is higher than that calculated from the sugar there must be an increase of non-reducing carbon compounds. In experimental diabetes with phloridzin (1 case) the residual carbon was un- expectedly low; in pancreatic diabetes it is higher. (2) In 12 cases the sugar percentage in the plasma was higher than in the whole blood; in three cases the converse was found; in one case the two were equal. In experimental (phloridzin and pan- creatic) diabetes the plasma sugar percentage was the higher. Physiol. Abst. 3, 248.
DIABETES, Calcium soap deposit in the liver during—. Hagiwara (R.), [ji Shimbun, 1917, 981, 1201-2; Jap. Med. Lit- erature (1918), 3, 62.
At the autopsy of a patient who had shown acetonuria, de- posits of Ca soaps were found in the liver such as occur in fat necrosis as a result of pancreatic lesions. No lesion could be demonstrated in the latter organ, and no explanation could be found for the deposits. Chem. Absts., 18, 475.
DIABETES, Clinical aspects of the fasting treatment of—. Rowe (A. H.) Calif. State J. Med. (San Francisco), 1918, 16, 433-38.
An excellent brief exposition of the practical features of the fasting treatment together with tabular analysis of 40 cases, giving extensive laboratory findings.—R. G. H.
(DIABETES) Hyaline degeneration of the islands of Langer- hans in pancreatic diabetes. Winternitz (M. C.) Johns Hopk. Hosp. Rep.- (Balt.), 1916, 18, 37-48.
A detailed microscopic study of the pancreas of a man who had had mild diabetes mellitus for 18 or more years. Both interacinar fibrosis and marked hyaline degeneration of the islands of Langerhans were seen. The author remarks that the more recent experimental evidence supports the insular theory of pancreatic diabetes, but it must be borne in mind that the pancreas forms only one link in the chain that controls carbo- hydrate metabolism. Diabetes may occur when the pancreas is apparently normal, with lesions of the central nervous system
ABSTRACTS 193
or disturbances in certain endocrine glands. In pancreatic
diabetes the important lesion is in the islands; there may be
a decrease or an actual increase in size and number of these
or-a qualitative change. The remarkable power of the insular
tissue to regenerate as well as subsequent disappearance of
degenerated islands complicates the anatomical interpretation. : —R. G. H.
(DIABETES) Lipoids in one hundred thirty-one diabetic bloods. Gray (H.) Bost. Med. Surg. J., (1917), 178, 16, 50, S120, 156.
In this long series of articles the results and details are given of many determinations of total fats, total fatty acids, glycerides, cholesterol and phosphatides in 131 diabetic bloods. It is impossible to present the content of all the papers in abstract form. Some of the outstanding points are as follows: There is a lipoid threshold, by Bloor’s method, of about 0.7%, analogous to the glucose threshold of 0.1%. Only 7% of dia- betics come inside the threshold of the normal Bloor values. The maximal total lipoid value of this series was 16.3%. The higher the lipoids the more unfavorable the prognosis. With acidosis the lipoids are above the level in diabetes without acidosis. Chem. Abst., 12, 1368.
DIABETES, Metabolism ins nephritis and cholecystitis. Breed (Lorena M.), Calif. State J. Med. (San Francisco), 1918, 16, 327-330.
A general discussion with brief reference to several illus-
trative cases.—R. G. H.
DIABETES, Modern views on—. Poulton (KE. P.), Lancet (London), 1918, (i), 863-6, 895-7; (11), 31-4.
Treatment and acidosis are dealt with chiefly. DIABETES, Renal—. Bailey (C. V.), Am. J. Med. Sci. (Phila.), 1919, 157, 236-52.
Two cases are deseribed in detail with results of glucose tests. An interesting discussion of the differentiation between renal and pancreatic diabetes is included.—R. G. H.
(DIABETES) Respiratory exchange and blood sugar regula- tion. Bernstein (S.) and Falta (W.) Deut. Arch. klin. Med. (1918), 125, 233-83; Physiol. Abstracts 3, 245.
On oral administration of carbohydrates the respiratory
194 ABSTRACTS
quotient rises only when the glycogen reserves of the body are full. On giving sugar intravenously or injecting adrenin, the R. Q. rises whether the glycogen depots are full or not. Injee- tions of pituitrin lessen heat formation and raise the R. Q., the condition of glycogen reserve making little or no differ- ence.—Chem. Abst., 12, 2357.
DIABETES, Theory of—. Jacoby (M.) Deutsch. Med. Wehnschr. (Berl.), 1916, 42, 478-79.
A critical discussion of various views, many of which do not recognize the complex nature of the disordered metabolism which underlies the diabetic state. No new experiments are given, but it is suggested that such questions as the relationship of diabetic muscle to hexose-phosphorie acid and to lae- tacidogen require investigation.—Physiol. Abst., 1, 227.
DIABETES, Serum for—. Parke, Davis & Co. Can., 184,763, June 4, 1918.
A serum which decreases blood pressure and increases sugar metabolism is prepared by administering to horses or other suitable animals an extract of the pituitary body and then deriving the serum.—Chem. Abst., 12, 2411.
DIABETES, The acetone bodies of the blood in—. Kennaway (E. L.) Biochem. J. (Liverpool), 1918, 12, 120-30.
The concentration of acetone bodies in the blood in diabetic coma may be equivalent, when reckoned as aceto-acetice acid, to that of a 0.03 N solution; this amount is sufficient to combine with more than one-third of the sodium of the plasma. The amounts of aceto-acetic acid show less variation in the series of cases than do those of B-hydroxybutyrie acid. Methods for the estimation of acetone and aceto-acetic acid are as a rule tested with acetone only. It is pointed out that this is quite inadequate, as the recovery of aceto-acetie acid is liable to an error which does not occur in the ease of either acetone or B-hydroxybutyrie acid.—Physiol. Abst., 3, 319.
DIABETES, The treatment and laboratory control of—. Lang- stroth (L.) Cal. State J. Med. (San Francisco), 1919, 17, 5-11.
An exposition of the methods used in the Hospital labora- tories of the University of California. Chiefly of technical interest.—R. G. H.
ABSTRACTS 195
DIABETES INSIPIDUS, Uber intramediare Vorgainge beim— (Metabolism in—.). Veill (W.H.) Biochem. Ztschr. (Berlin), 1919, 61, 317.
As regards the symptoms, polyuria, polydipsia and dilute urine, diabetes insipidus is a well defined disease. This latter symptom, contrary to frequent statements, is always present, but its degree is remarkably variable even in a single indi- vidual. Blood analysis discloses two distinct types of the dis- ease. In one the chlorm in the blood is increased and in the other diminished. The first class cannot retain water and would die without a plentiful supply. This class alone responds favorably to treatment with posterior lobe pituitary extracts. The relation between the internal secretions, the nervous system and diabetes insipidus is unknown. Therapeutic success with pituitary extracts does not prove that the corresponding gland is at fault; it merely proves that the extract influences the tissues, causing them to retain water.—J. K.
DIABETES mellitus and the PANCREAS. Heiberg (K. A.) Nord. med. Ark. (Stockholm), 1918, 50, 663-80.
Two forms of pancreatic diabetes are distinguished, those in which the injury is confined to the islets of Langerhans, and those in which the ordinary tissue is also involved. Progress of the disease depends on fresh islet degeneration, whereas im- provement follows on their regeneration and growth. The islands should be examined quantitatively. In an area of 50 mm. in the tail of the pancreas, 6 out of 75 diabetic cases had 76 to 150 islets, the remaining 69 showed less than 75. In 75 non-diabetic pancreases there were 5 with less than 75 islets, but in the remainder the number was not so high as in diabetic cases. The two groups cannot be correlated with the clinical varieties. Rapidly progressing cases especially in the young, are, however, solely due to islet affection—Physiol. Abst., 3, 379.
DIABETES MELLITUS, Dietetic treatment of—. Cammidge (P. J.) Am. Med. (N. Y.) 1918, 13, 388-401.
Discussion of various diets used in diabetes.—Chem. Abst.. 12, 2352.
ENDOCRINE disorder, uric acid diathesis as an—. (La dia- tesis urica como un trastorno de secrecion interna). Pita (A.) Medicina Moderna (Havana), 1918, 1, 31-34.
196 ABSTRACTS
A theoretical discussion. No specifie new evidence is offered.—R. G. H.
(ENDOCRINE GLANDS) An anatomical study of senescence in dogs, with especial reference to the relation of cellular changes of age to tumors. Goodpasture (EK. W.), Jour. Med. Research (Boston), 1918, 38, 127.
This report is based upon a detailed study of 50 dogs. Only that portion dealing with the endocrine glands will be re- ported. The paper embodies a conception that ‘‘ With a con- tinued increase in structural intricacy, incident to ageing, the body cells gradually lose their metabolhe equilibrium, so that the ultimate conclusion of progressive cell differentiation is death. But . . . it is possible for many cells to return to a more simple form in which special function is absent, or sub- ordinate to growth and division. . . . This process of elimi- nation of structural differences, or metaplasm, is called ‘‘de- differentiation.’ ’’ A dedifferentiated cell may differentiate again, reforming structural substances similar to those formerly possessed, and perhaps funetion normally. But when dediffer- entiation has proceeded far enough, under abnormal conditions, a metaplastic transformation may result, the cells producing structural characteristi¢s which they did not formerly have.
There appears to be a greater number of interstitial Ley- dig’s cells in the testicles in old than in middle age. Definite tumors made up of small multinucleated masses of Leydig’s cells were not uncommon in the animals studied. The ovaries were usually small, scarred and fibrous. They commonly con- tained cysts, occasionally corpora lutea, and in two instances macroscopic tumor nodules derived from follicular epithelium which began to proliferate after death of the germinal cells. The adrenals were usually larger than normal and their surface irregular with smooth, more or less spherical protuberances from one to twenty millimeters in diameter, usually multiple and oceurring in both glands. There was usually great irregu- larity in the architecture of the cortex due to combined atrophy and hyperplasia. There were no outspoken degenerative changes in the cells that could be constantly found and fol- lowed, but there were indications of a gradual disappearance and replacement of the parenchyma. Indirect evidence of de- eeneration was the presence to a greater or less extent of phagocytes in the lymph spaces filled with brownish finely granular pigment. Hyperplastic changes of the cortex were found in all three zones. No disintegrative or degenerative changes were found in the medulla.
ABSTRACTS 197
The parathyroids showed little deviation from the normal. In one instance there was a complete conversion of the gland into a thin walled cyst lined by a single layer of cuboidal epithelium. The thyroid glands in very old dogs were smaller than normal. There was a marked irregularity in the distribu- tion of the colloid. Areas of metaplasia may be present. In three glands multiple cysts were found lined usually by three or four layers of epithelium, with the layer nearest the lumen partially or completely differentiated. In the thymus glands of old animals cysts lined by euboidal cells were common. Cysts were also seen in the hypophysis.
As the dog grows old, many eells, by dedifferentiation, free themselves of the more rigid demands of functional speci- ficity and become more capable of growth. In the hypophysis, thyroid, thymus, adrenals, testicles and ovaries, as well as in other organs; this power to grow results in tumors. In propor- tion to the activity of this power of growth, the resultant tumors are benign or malignant.
The tumors found in the endocrine glands of the fifty dogs were:
Tumors Benign and Malignant
= Per Per Tot.Per Malig. Per Organ Male Cent Female Cent Cent nant Cent Adrenal «2.22... 29 78 13 100 84 1 2 Hypophysis —... 1 3 ey — 2 23 C26 * a 6 45 a: ue oo CGE Cl hee 21 63 ru ee 63 4 8 oo ] of pe Es 2 MR yrord: <2... a 12 fi a2 22 os. et as Mees:
(ENDOCRINE GLANDS) Recent progress in gynecology. Mc- Cann. (F.) Practitioner (Lond.), 1918, 101, 194. Abst. Surg. Gyn. & Obst., 28, 160.
A diseussion of the endocrine factors in uterine and ovarian functioning. The ovaries, corpus luteum and post-hypophysis exercise control over the uterus and adnexae. There is a def- inite interaction between ovarian, corpus luteum and menstrual decidua secretions and hypophyseal secretions. Probably dysmenorrhea and pre-menstrual pain are frequently due to excessive activity of the corpus luteum. Menstruation is left in abeyance for the period of pregnancy by the presence in the uterus of the ‘‘placental gland.’’ The normal menopause with ovarian retrogression is usually coincident with alterations in the thyroid and hypophysis. Altered ovarian secretion as evi-
198 ABSTRACTS
denced by menstruation is indicative of altered glandular inter- action. Lactation amenorrhea is due to mammary hormone antagonizing the corpus luteum. <A persistent thymus is asso- ciated with hypoplastic ovaries, while early retrogression of the thymus results in large hyperplastic ovaries. Various other similar statements are made, a conclusive demonstration of which would give scope for many detailed researches.
—R. G. H.
(ENDOCRINE GLANDS) Studies on alimentary hypergly- cemia and glycosuria. Bailey (C. V.), Arch. Int. Med. (Chgo.), 1919, 28, 455.
An interesting paper relative to alimentary glycemia and elycosuria resulting from the ingestion of glucose in weak tea. Following the taking of the glucose, blood and urme specimens were collected at frequent intervals for from six to eight hours. Normal individuals and those suffering from disturbed renal and endocrine function were studied.
Sugar is a constant constituent of normal urine, and, dur- ing a fasting and thirsting state, the concentration in the urine approximates that in the blood. In a normal person the sugar in the urine parallels that in the blood up to the latter’s con- centration of 0.16 to 0.17 per cent. Above this the kidneys actively secrete sugar.. In returning to the normal value the decrease in blood sugar precedes that in the urine. Alimentary hyperglycemia is prolonged in myxedema and hypopituitarism. The concentration of biood sugar at which glycuresis occurs varies in different individuals, and is influenced by disease, be- ing abnormally low in early diabetes, high in diabetes of long standing, in nephritis, and in deficiency of the thyroid and hy- pophysis. Glycuresis is a kidney function and is excessive in diabetes and hyperthyroidism. It is greatly decreased in ne- phritis and in deficiency of the thyroid or hypophysis. Blood sugar estimations from two to three hours after the ingestion of glucose may be the same in diabetes of long standing, in nephritis, myxedema, or in hypopituitarism.—H. W.
(ENDOCRINE GLANDS) The use of X-rays and electricity in exophthalmic goitre and other disorders of the ductless glands. Hernaman-Johnson (F.), Arch. Radiol. & Electro- therap. (Lond.) 1918, 23, 91-99.
The author coneludes that in exophthalmic goitre X-rays are a specific in the sense that the secretion of the thyroid may be diminished to any required extent. Cure cannot be effected
ABSTRACTS 199
in the presence of any persistent irritation, and reduced activity of other endocrine glands may delay cure. Bedside administra- tion of X-rays in acute cases is recommended, but in critical cases operation alone offers hope.
In dysmenorrhea of ovarian origin when drug treatment has failed and when there is no gross surgical lesion, a trial should be given to X-rays. The first period may be worse and the second httle better, but the third should be unmistakably better. Otherwise the treatment should cease. In young women, complete suppression of ovarian function should not be attempted by X-rays. As regards other endocrine glands X-ray treatment is in its infancy, but progress is predicted. In no class of cases is unintelligent routine treatment less condu- cive to results than in those mentioned.—R. G. H.
(ENDOCRINE GLANDS) War neuroses, shell shock and ner- vousness in soldiers. Bailey (P.) J. Am. M. Assn. (Chgo.), 1918, 71, 2148-53.
Many of the neuroses of the neurasthenie or psychasthenie types are associated with symptoms suggestive of endocrine dis- turbances and the thyroid picture, especially in gas cases, is much in evidence. Thus in addition to the symptoms of fatigue, lack of confidence, phobias, compulsions and general hyper- esthesia, are observed rapid pulse, cardial irritability, pain over the heart, vomiting and terrifying dreams.—Excerpt quoted,
p. 2150.
(ENDOCRINE GLANDS) Wirkung von Explosionen auf das menschliche Nervensystem. de Crinis, Arch. f. Psych. (Ber- lin), 1918, 59, 988.
After explosions nervous symptoms may occur. The author finds in such cases destruction of adrenal, and often, of liver and pancreas tissue by ferments (Abderhalden), ‘‘sympatheti- cotonie’’ (mydriasis, vasomotor symptoms) and alimentary gly- cosuria. The intrinsic unreliability of the anamneses and the in- complete clinical descriptions of the cases render the article entirely unconvinel
(ENDOCRINE ORGANS) A therapeutic suggestion concerning endocrines. Bandler (S. W.) Med. Ree. (N. Y.), 1919, 95, 429-32.
A general article analyzing the action of endocrine factors in practical gynecology. The author includes mammary gland
200 ABSTRACTS
and placenta extracts among the valuable opotherapeutie products.—R. G. H.
(ENDOCRINE ORGANS) Epilepsy and ductless glands. Prior (G. P. U.) and Jones (S. E.) J. Ment. Sei. (Lond.), 1918, 64, 30-35.
According to numerous quoted authorities, epileptiform seizures may occur as a result of disease in most of the endo- crine organs. These are considered to be concerned in Ca metabolism, and epilepsy is supposed to be due to an upset of Ca metabolism. Numerous cases are citéd which, the authors consider, support this view. They appear to have adminis- tered extracts of most of the duectless glands without reason and without success and to have performed no original research. —Physiol. Abst., 3, 386.
(ENDOCRINE ORGANS) Some observations on the effects of feeding glands of internal secretion to chicks.. Wintermitz (M. C.) Johns Hopk. Hosp. Rep. (Balt.), 1916, 18, 21-23.
Three groups of experiments are summarized:
I. Twenty-two white Leghorn chicks, 11 experimental, 11 control. Fed small doses of powdered dried hypophysis, five months. The experimental animals developed more rapidly and began egg laying earler than the controls. The differences were striking.
Il. A group, number not specified, fed adrenal, hypophysis, ovary, thyroid and thymus (different individuals for each). The only constant result was delayed growth and a condition suggestive of rickets in the thyroid group.
III. Similar to II, including fresh and three sorts of dried hypophysis. No effect except that thyroid interfered with erowth. The negative results in the latter experiments are ten- tatively ascribed to seasonal or other variations in the hypo- physis material.—R. G. H.
(ENDOCRINE ORGANS—SYMPATHETIC N.S8.) The inter- dependence of the sympathetic and central nervous systems. Orr (D.) and Rows (R. G.) Brain (London), 1918, 41, 1-22.
The thesis is elaborated that certain degenerative changes in the spinal cord and brain associated with visceral cancer, Addison’s disease, severe anemia and experimental infection of
ABSTRACTS 2011
the peritoneal cavity are traceable to disordered influence of the sympathetic system and endocrine organs. The ‘‘protoplasmic neuroglia’’ is involved as a possible intermediary, and Achu- earro’s hypothesis (reviewed Revista di Patologia Nervosa e Mentale, 1917, 22, 321) that that tissue in addition to a nutri- tive role secretes ‘‘emotional’’ hormones. But Lugaro’s eriti- eism (ibid., 323) is also evaluated. Various facts, chiefly em- bryological and physiological, are adduced as a priori support for the author’s views.—Physiol. Abst., 3, 420.
(ENDOCRINE ORGANS) The “‘higher up’’ theory of sterility in women and its relation to the endocrines. Bandler (S. W.), N. Y: Med. J., 1919, 109, 309-13.
A general discussion impossible to abstract satisfactorily. Bandler believes that the inability of formed ova to escape leading to ‘‘eystic ovaries’’ and subsequent pressure on other developing ova is an important factor in causing sterility. Rup- ture of the follicles is also at times prevented by lack of proper hormone stimulation. This is best supplhed by ovarian and thyroid extracts. Other stimulants of the genital function are suprarenal and post-pituitary extracts. The menstrual fune- tion may be depressed by thymus, mammary and placental ex- tracts and in some phases, probably, by thyroid. The best opotherapeutic results have been obtained in threatened abor- tion, in which ovarian and thyroid extract and ‘‘ovarian resi- due’’ with occasional doses of morphine were given.—R. G. H.
(ENDOCRINE ORGANS) The pathogenesis of deficiency dis- ease. McCarrison (R.) Brit. Med. J. (Lond.), 1919, -..., 177-8. (Feb. 15.)
An abstract of a paper to be published in full in the Indian J. Med. Res. The fact that the influence of vitamine defic- iency on the endocrine glands has not been carefully studied is unfortunate. McCarrison studied the problem in pigeons fed solely on polished rice. Of these, 168 developed polyneuritis ; a large proportion had concurrent septicemia. As controls 72 pigeons were used. It was found that this restricted diet led to functional and degenerative changes in every tissue and organ of the body. The resulting symptomatology was ascribed particularly to chronic inanition, derangement of digestion and assimilation, disordered endocrine function, mal-nutrition of the nervous system and to ‘‘hyperadrenalinemia.”’
202 ABSTRACTS
The theory of hyperadrenalinemia is deduced from the facet that the adrenals were markedly enlarged and had a greater adrenin content than normal. That this resulted, however, in increase of actual circulating adrenin, no specific evidence is offered; the hypertrophy might conceivably be a ‘‘detoxica- tion’’ reaction. The pituitary in the males showed slight en- largement and the thymus, testes, spleen, ovaries, pancreas, thyroid, ete., were atrophied. Simple inanition gives rise, ac- cording to the author, to similar results—a finding not entirely in accordance with Jackson’s results in rats. The coneurrent edema is aseribed to increased adrenalin production resulting in increased intra-capillary pressure. This theory is opposed by the results of several recent studies of adrenin pharmacology. Among other effects complete ilens would be produced by adrenin in concentration sufficient to cause such eapillary con- striction.—R. G. H.
ENDOCRINE SYSTEM, Uric acid and the—. Silvestri (T.) Polioclinico (Rome), 1918, 25, 184. J. Am. Med. Assn., 71, 608.
The results of S.’s research apparently support his theory that the endocrine-sympathetic system presides over the metabolism in general:as a regulator, or physiologic stimulus indispensable for its normal rhythm, but is not the chief factor in the metabolism. It merely stimulates or checks the activity of the metabolism in general, including the production and de- struction of uric acid—tChem. Abst., 12, 2360.
ENDOCRINOLOGY and opotherapy of shock. Bate (R. A.) Ky. Med. J. (Bowling Green), 1918, 16, 558.
An article including some speculative endocrinology em- phasizing the usefulness of pituitrin injections in shock.
—R. G. H.
GIGANTISM (acromegalic) associated with bilateral, symmet- rical syndactylism of the second and third toes (Gigantismo acromegalico associato a sindattilia simmetrica bilaterale del secondo e terzo dito del piede). Battistini (F.) Riv. erit. di Clin. Med. (Firenze), 1916, 17, 185-8.
A case is described and theorized upon to the effect that the condition was due to fetal dyspituitarism.—R. G. H.
ABSTRACTS 203
(GONADS) Del’ influence des extraits de glandes génitales sur le métabolisme phosphoré (Influence of gonad extracts on phosphorus metabolism). Jean. C. R. Acad Se. (Paris), 1917, 164, 438-40.
Extracts of the interstitial tissue of the testicle and of the active corpus luteum cause a distinct decrease of phosphoric acid excretion. The interstitial tissue of pig’s testicles and the active corpora lutea of pig’s ovaries were extracted in phys- iological serum and the extracts administered by injection to male and female nurses respectively. The excretion of phos- phorie acid in urine and feces after injection was compared with the excretion before injection, the diet having been the same before and after injection; the amount excreted after in- jection was considerably smaller than that before injection. It was noted also that injection of corpus luteum extract was fol- lowed after from 2 to 3 days, by hypertrophy of the mammary glands.—E. U.
GONADS, Endocrine function of the—and heredity (Over die inwendige afscheiding der geslachtsklieren en de erfely- Kheidsleer). Vermeulen (H. A.) Tijdschr. v. Diergeneesk. (Utrecht), 1917, 44, 681-91.
A general discussion presenting no new data.
J. K.
(GONADS) Eunuchoidismus. Fischer. Deutsche Med. Wehnschr. (Berlin), 1916, 42, 214.
Demonstration of three cases:
(a) Individual was tall with atrophie genitals and skia- gram showed a large sella turcieca.
(b) Individual was very fat with atrophic genitals and a small sella turcica.
(c) A girl of 16, very small, with small sella, atrophic uterus and much fat in the breasts.
In each case .400 gms. of glucose failed to cause glyco- suria.—J. K.
(GONADS). Goodale’s experiments on gonadectomy of fowls. Morgan (T. H.) Science (N. Y.) 1917, 45, 483. [Referring to Gonadectomy in relation to secondary sexual characters of some domestic birds. Goodale, Carnegie Inst., (Wash.), 1918. No. 243.]
Rouen ducks and brown Leghorns were employed. Re- moval of testes showed inconclusive results, although chiefly
204 ABSTRACTS
negative. Removal of ovary was difficult, but when successful the duek and hen assumed male plumage. Ovaries transplanted into a castrated cock prevented the assumption of characteris- tic male plumage. Spurs develop in capons as well as cocks, and in all spayed females (brown Leghorn). The spur develops normally in some females.
Inconelusive data with reference to voice characteristies are offered.
Goodale submits the theory that the internal secretion of the ovary is a ‘‘simple’’ substance inhibitory in action. It prevents the appearance in the female of the male character- istics, which are inherited equally by both sexes, the nature of the reaction simulating an oxidation process.
The discussion 1s closed with an intimation that the process is probably not so simple, but composed of a series of sue- cessive reactions.—W. E. B.
(GONADS) La courbe myo-glycérinique. (Glycerine muscle curve.) Rocha-(A. D’A.) Bull de la Soe. Portug. des Sei. Nat. (Lisbon), 1917, 8, 1-22. Physiol. Abst. 3, 228.
It was noted that the effects of drugs on frog’s muscle curves varies with the sexual cycle of the animals. This indi- cates that sex hormones play a part in controlling muscular - activity. The paper is mostly concerned with the effect of olycerine on muscle.—R. G. H.
GLYCOSURIA, Study of an unusual—. Langstroth (L.), Am. Jd. Med. Sci. (Phila:), 1919)1157,. 201-205.
A ease of glycosuria with apparently lowered renal threshold for glucose is reported with details as to blood and urine findings. The blood sugar curve showed a higher rise than normal and a delayed fall such as has been found assoei- ated with mild diabetes and other endocrine diseases. This is evidence of abnormal carbohydrate metabolism. True diabetes was probably not present.—R. G. H.
(HORMONES) Chemical correlation in the growth of plants. 3aylis (W. M.) Nature (Lond.), 1918, 102, 285-7.
A review of experimental work on the chemical basis of regeneration and geotropism in plants (Botan. Gazette, 1915, 60, 249. 1917, 63, 25; 1918, 65, 150; Science, 1917, 66, 115, 547; Proc. Nat. Acad. Sci., 1918, 4, 117). The greater growth of the apical buds of plants as compared with the lateral buds of the stem is explained on the assumption that when the leaves
ABSTRACTS 205
are first removed inhibitory substances are present everywhere throughout the stem, but that these have a tendency to flow towards the base. Hence the most apical node is the first one to become freed from their presence, and when its buds grow they form anew the inhibitory substance which prevents the growth of the more basal buds. Evidence is offered that the inhibitory effect is proportional to the size of the growing apical bud.—Chem. Abst., 13, 613.
(HYPOPHYSIS) Acromegaly, A case of—in a child (Hen geval van reurengroei bij een kind). de Monchy (L. B.) Nederl. Tijdschr. v. Geneesk. (Amsterdam), 1916, 60 (i) 597.
Deseription of a case in a child of 17 months. There was no goitre or symptoms of hypophyseal tumor. Glycosuria could not be produced either by injections of adrenin or administra- tion of glucose.—J. K.
(HYPOPHYSIS) Acromegaly of long standing without sub- jective symptoms. Williamson (C. 8S.) Med. Clin. Chicago, 1916, 1, 885-893.
Report of a case of acromegaly with typical objective symptoms— marked prognathism, enlargement of the nose and increase in size of the extremities—without any of the usual subjective symptoms. The patient was a man thirty vears old. The precise manner in which the disease began escaped his notice. The present condition of his features and extremities has been almost unchanged for the past twelve years; but dur- ing this time he has grown 5 or 6 inches in height and gained 90 pounds in weight. There was nothing of importance in the family history. A Roentgenogram revealed an enlargement of the sella turcica.—J. P. S.
The HYPCPHYSIS and hypophyseal disease. Schnoor (FE. W.) J. Mich. State Med. Soe. (Grand Rapids) 1919, 18, 87-96. A general review of the more significant literature. No original data.—R. G. H.
(HYPOPHYSIS) Case of dyspituitarism in a girl aet. 15 years. Stephenson (S.) Proe. Roy. Soe. Med. (Sect. Stud. Dis. Child.) (Lond.), 1915-16; 9, 23-26.
Published elsewhere. See Endoerin., 1918, 2, 64. (HYPOPHYSIS) Case of mental imbecility and absence of sella
turcica; improvement by organotherapy. Leiner (J. H.) N. Y. Med. J., 1919, 109, 156-7.
206 ABSTRACTS
An interesting case resembling Lorain hypophyseal infan- tilism in a girl of 12. The cranial skiagram indicated absence of sella turecica. The patient had a mentality of about four vears (Binet-Simon seale). She was timorous and irritable. The shafts of the long bones were elongated; premature ossifi- cation of the epiphyses was apparent in skiagrams and prog- nathism was obvious. Low blood pressure and asthenia were marked. Menstruation had not appeared. The thyroid was not palpable and no evidence of thymus hyperplasia was elic- ited. Sugar assimilation was below normal. Treatment with thyroid and thymus preparations was inefficacious, but persist- ent administration resulted in marked inerease in weight and strength and, within three months, in a mental advancement of three years.—R. G. H.
(HYPOPHYSIS) Congenitalen Akromegalen habitus, Een geval van familaren—. Scheffer (C. W.) Psych. en neurol. 3lad. (Amsterdam) 1917, 21, 211-18.
Description of a ease in a family of which two brothers and a sister had typical acromegaly.—J. K.
(HYPOPHYSIS) Diabete insipido da emorragia nelle neuro- ipofisi e nel peduncolo ipofisario (Diabetes insipidus from hemorrhage in the neurohypophysis and into the pedicle). Luzzatto (A. M.) Lo Sperim. (Firenze) 1918, 71, 405.
In man the syndrome of diabetes insipidus may arise from destructive lesions of the neurohypophysis or its pedicle even though there occurs no apparent injury to the adjacent in- fundibular region. These lestons may be accompanied by se- vere cachexia similar to that produced experimentally by see- tion of the pedicle or by total hypophysectomy. Hemorrhage may occur spontaneously in the neurohypophysis and produce morphological changes like those produced by hemorrhage in any other parts of the central nervous system. Consequently, hemorrhage must be considered as a possible etiological factor in the so-called spontaneous cases of hypophyseal disorder.
—A. L. T.
(HYPOPHYSIS) DIABETES INSIPIDUS, treatment of—with pituitary extract. Rosenfeld (G.) Berlin klin. Wehnschr., 1996, 5S, 553-55.
See Endocrin., 1917, 1, 272.
ABSTRACTS 207
(HYPOPHYSIS) Dyspituitarism; Report of cases of disorder of the pituitary gland, occurring in the pre-adolescent period, and differing widely in clinical manifestations. Moleen (G. 4.) Areh. of Diag. (N. Y.) 1917, 10, 103-122.
Four cases are described, illustrated with photographs.
Case I. Male, age 26: Pre-adolescent dyspituitarism with optic atrophy of right eye and temporal hemianopsia of left; undergrowth, sexual infantilism (Lorain type) delayed ossifi- cation, hypotrichosis, enlargement of sella turcica and probable tumor of hypophysis.
Case II. Female, age 9: Pre-adolescent pituitary insuffi- ciency (dyspituitarism), Froehlich type, probably secondary to cerebral tumor; mental deficiency ; nystagmus; optic atrophy; adiposity ; sexual precocity; progressing paralysis and mental retardation.
Case III. Male, age 18: Pre-adolescent dyspituitarism, acromegalie stigmata; no sexual changes.
Case IV. Acromegaly in adult, with enlargement of sella turcica.—R. G. H.
(HYPOPHYSIS) Drugs to aid delivery. Benestad (G.) Norsk Magazin for Loegevidenskaben (Christiania), 1919, 80, Suppl. 1-171.
Benestad discusses quinin and pituitary extracts, with ten pages of bibliography, giving the details of 111 cases in which one or more of these drugs were applied. The maximal dose of pituitary extract, he reiterates, must never be higher than twice the ordinary therapeutic dose. As a rule, one injection during the dilating phase and one during the phase of expulsion are all that should be used. The therapeutic dose of pituitary extract should correspond to not more than 0.10 gm. of the gland substance. In 71 per cent of his cases delivery proceeded spontaneously after a single injection of the pituitary extract. The failures were due to causes which the drug could not influ- ence, extra large size of the fetus, rigid parts, ete. He advises operative delivery if the birth does not progress during the hour following the injection in the second stage of labor when the labor contractions are growing weaker. The effect seemed the same in primiparas and multiparas. J. Am. M. Assn., 72, 1116.
(HYPOPHYSIS) DYSTROPHY adiposa genitalis in women, A study of—. Schumann (E. A.) Am. J. Obst. (N. Y.), 1918, 78, 428. Abst. Surg. Gyn. and Obst., 28, 150.
The syndrome resulting from the effects of deficient pitui-
208 ABSTRACTS
tary secretion upon the female sexual system may be properly divided into three clinical groups, according to the sex epoch affected. Sueh terms as amenorrhea of obesity, and lactation atrophy or super-involution of the uterus are no longer cor- rect, since it seems reasonably well proven that both conditions are but phases of a primary hypopituitarism. Definite retro- gression of the reproductive tract may follow deficient pitui. tary secretion in parous women of mature age and may and frequently does give rise to erroneous diagnosis of pregnancy. Treatment for all groups consists in general measures and the empirical use of glandular extracts, the systole blood pressure being a fair index of the particular eland substances to be em- ployed—low pressure indicating pituitary and high pressure, thyroid.
The prognosis as to recovery is guarded in all eases, but is favorable in direct ratio to the age of the patient. (Quoted.)
(HYPOPHYSIS) Dystrophie genito-glandulaire. de Souza (O.) et de Castro (A.) Nouv. Icon. de la Salpét. (Paris) 1916-1917, 28, 1.
This article is a presentation of illustrations and clinical history of dystrophia AISRLLORO- gvenitalis as observed in Brazil.
—A. L. T.
(HYPOPHYSIS) Early pituitary syndromes. Pincherle (M.) Riv. di Clin. Pediat., 1918, 16, 281, 337. Abstr. Brit. Jour. Child. Dis., 1919, 16, 62.
The author gives full details of four cases and extensive tabulated results of experimental pituitary lesions, of the action of pituitary extract and clinical symptoms. He says that there exist morbid entities having the clinical course of diabetes in- sipidus, in which other symptoms indicative of disturbed pitu- itary function are found associated with polyuria and polydip- sia. The most important of these are somatic under-develop- ment, excessive tolerance of carbohydrates, Cushing’s thermo- reaction, arterial hypotension, deficient secretion of sweat, as- thenia and somnolence. In some of the author’s cases the size of the sella tureica was markedly reduced and there were cer- tain nervous phenomena indicative of participation of other endocrine glands. Moreover, he was able in some instances to produce a more or less marked, but always transitory, albu- minuria by repeated forced lumbar lordosis. Pituitary organo- therapy, although capable of reducing the polyuria and poly- dipsia, was powerless to effect a lasting cure.—M. B. G.
ABSTRACTS 209
HYPOPHYSIS extract, Effect of—on nephritic processes (Wirkung von Hypophysenextrakt auf nephritische Prozesse). Glaessner (K.) Wiener med. Wehnschr., 1917, 30, 1197-9.
Pituglandol usually acts as a diuretic in nephritis as in health; it also frequently (4 out of 6 cases) lessens the albumin and formed elements and causes blood, if present, to disappear. Whether this is simply due to diuresis or to a specific action on the kidney e¢ells is not yet clear. Physiol. Abst., 3, 331.
-(HYPOPHYSIS) Familiare akromegalieahnliche Erkrankung. Oehme (C.) Deutsche Med. Wehnsehr. (Berl.), 1919, 45, 207.
Description of acromegaly in 5 brothers and one sister.
—J. K.
(HYPOPHYSIS) Growth of normal and hypophysectomized tadpoles as influenced by endocrine diets. Smith (P. E.) Univ. California Pub. Physiology (1918), 5, 11-22.
When the glandular lobe of the hypophysis was fed to normal tadpoles late in their larval cycle, a relative acceleration in growth occurred as the result of the retention of the 2nd growth cycle (period of rapid growth) beyond the normal point. During this late period all other larvae showed an ex- tended period of retardation in growth (a prolonged 3rd growth cycle). When anterior lobe of the hypophysis was fed during this late period, the tadpoles reached a size somewhat above normal. Hypophysectomized tadpoles were retarded in growth on all diets except the glandular lobe of the hypophysis ; the retardation was slight prior to the mid-larval period, but became very pronounced thereafter. While the rate of growth was retarded, the growth span was extended since metamorpho- sis failed to occur, and the hypophysectomized larvae thereby attained a size equal to or in exeess of that of normal larvae. The retardation of growth in hypophysectomized tadpoles was entirely prevented by a diet of anterior lobe; a brief initial period was followed by a constant and accelerated rate of growth, so that these tadpoles exceeded in size (1) normal tad- poles on a control diet and (2) controls fed glandular lobe; they attained the maximum size far more rapidly, and exceeded in maximum size the hypophysectomized controls. Chem. Abst., 12, 2385.
(HYPOPHYSIS) Hydroxybenzene radical in the acceleration of the growth of carcinomata by cholesterol and by tethelin. Robertson (T. B.) and Burnett (T. C.) J. Cancer Res., 1918, @, 15-91.
210 ABSTRACTS
Other hydroxybenzene derivatives such as M-eresol, ben- zyl aleohol, hexahydrophenol, borneol and inositol do not cause any decisive acceleration of tumor growth. The accelerative actions of cholesterol and tethelin are not due to their posses- sion of a hydroxybenzen group, but the accelerative action of cholestrol is in some way rendered possible by its possessing a hydroxyl group. The hydroxyl group may act as an anchoring group, fixing the cholesterol to the tissue, or it may merely facilitate the distribution of cholesterol throughout the tissue fluids by rendering the cholesterol emulsifiable. (Chem. Abst.) Physiol. Abst., 3, 464.
(HYPOPHYSIS) Infantile DWARFISM (Infantiler Zwerg- wuchs). Stursberg. Deut. med. Wehnschr. (Berl.), 1919, 45, 112.
A boy of 16144 years had grown normally up to the age of 10 when development ceased. The sella turcica is flat, and the testes small, but there is no eunuchoidism or evidence of mal- function of the thymus. S. believes that the condition is due to disease of the anterior lobe of the hypophysis.—J. K.
(HYPOPHYSIS) Lactation in an acromegalic patient (Auf- treten von Milksekretion bei einem an Akromegalie leidenden Patienten). Roth (O.), Berlin klin. Wehnschr., 1918, 585, 305-7.
The patient, a man of 28, secreted milk in the course of the disease. Physiol. Abst., 3, 320.
(HYPOPHYSIS) Le rythme de la polyurie hypophysaire (Rhythm of hypophyseal polyuria). Bergé (A.) and Shul- mann (E.) Presse Méd. (Paris) 1918, ...., 618-20.
An interesting history of a case of diabetes insipidus, to- gether with a review of some of the older hterature, mostly Continental. The quantity of urine excreted by this patient was variable, from 2000 to 5000 e.e. daily ; the quantity of urine per hour was greater at night. At times excretion surpassed absorption of fluid, leading to a degree of dehydrating of the body. The chemical composition of the urine presented nothing noteworthy. There was no tendency to glycosuria. Functional tests showed that the kidney was normal. Posterior lobe pitu- itary extract produced a marked diminution in the urine forma- tion and had a surprising tendency to relieve insomnia. At autopsy the anterior lobe of the pituitary was found invaded by gummata, while the posterior lobe was sclerotic —R. G. H.
ABSTRACTS 211
(HYPOPHYSIS) Lesion traumatigue pure de l’hypophyse:. Syndrome adiposo-genital et diabete insipide (Traumatic lesions of the hypophysis. Syndrome of dystrophia adiposo- genitalis and diabetes insipidus). Marandén (G.) et Pintos (G.) Nouv. Icon. de la Salpet. (Paris), 1916, 28, 185.
The authors present in detail the clinical history and sub- sequent autopsy of a boy of 13 years, who had been accidentally shot in the head. The rifle ball lodged in the region of the stalk of the hypophysis. After a few months there appeared a de- velopment of secondary sexual features of the feminine type, together with excessive thirst and polyuria. Injections of ex- tracts of the middle and posterior lobes of hypophysis very quickly caused temporary reduction of both thirst and diuresis. At autopsy, there was found a connective tissue overgrowth al- most but not quite cutting off all nervous connections between the glandular portion of the hypophysis and the brain.
The authors also describe two other cases of diabetes in- sipidus, but without symptoms of dystrophia adiposo-genitalis. In both these instances pituitary extracts reduced the volume of urine and correspondingly increased the concentration of solids.
The authors maintain that diabetes insipidus consequent to hypophyseal injury is due essentially to hypopituitarism which, in turn, is relieved, temporarily, by pituitrin injections, just as definitely and specifically as myxedema is relieved by thy- roid extracts.—A. L. T.
(HYPOPHYSIS) Pathological report on a case of pituitary in- fantilism. Evans (J. J.) and Assinder (E. W.) Birmingham Med. Rev., 1916, 80, 1-6.
A man of 52 had stopped growing at the age of 12 or 14. He had worked comfortably as a lapidary until about 40, when failing vision and headaches developed. Later there were visual hallucinations which were augmented by attempts to relieve the symptoms by X-ray treatment. Thyroid and pitui- tary medication were of little or no benefit. Death occurred at 52. An autopsy showed a tumor in the pituitary fossa about the size of a hen’s egg; this was identified as angioma. The ordinary stigmata of infantilism were present, as absent facial and pubic hirsutes, small genitalia, etc. The thyroid appeared under the microscope as hyperplastic, a finding interpreted by the author as indicating a relationship between the thyroid and pituitary glands.—R. G. H.
212 ABSTRACTS
(HYPOPHYSIS) Pituitary headaches and their cure. Pardee (I. H.) Arch. Int. Med. (Chgo.), 1919, 23, 174.
From a review of the literature and a consideration of seven cases, the author coneludes that pituitary disturbances constitute a fairly common cause of headache. This headache is located between the temples, deep in behind the eyes, and is accompanied by dyspituitary signs. The sella turcica in most cases shows demonstrable abnormalities. In a large percentage of the cases these headaches and the accompanying symptoms disappear upon the administration of whole pituitary gland substance in doses varying from 4, to 2 grains three times a day. Cases of progressive neoplastic growths were not bene- fitted by this treatment.—H. W.
(HYPOPHYSIS) Pituitrin in de verloskundige klinick. Knap- pert (J.) Nederlandsch Haandschrift voor Verloskunde (Lei- den) 1916, 5, 119-141.
A technical discussion of the indications for the use of pituitrin in obstetries.—J. K.
(HYPOPHYSIS) Pituitrin in labor (—inspuitingen bij baring). de Monehy (M. M.) Nederl. Tijdschr. v. Geneesk. (Amster- dam), 1916, 60 (11), 5-17.
de Ke
Reports satisfactory results.
HYPOPHYSIS, Pure traumatic lesion of the—(Lesion trau- matica pura de la hipOfisis, sindrome adiposo-genital y dia- betes insipida). Marafén y Posadillo (G.), Madrid, 1918, pp: 16:
A well illustrated exposition of the subject matter ab- stracted in Endocrin. 1919, 3, 70.—R. G. H.
(HYPOPHYSIS) Un cas de dystrophie hypophysaire. Obregia (A.), Urechia (C.) et Popea (A.) Nouv. Icon. de la Salpet. (Paris) 1914-1915, 27, 317.
The authors deseribe in detail the ease history of a woman of 27 years with some of the symptoms of dystrophia adiposo- venitalis, such as enlargement of the sella turcica, great excess of fat deposit, genu valgum, flat foot, moderate increase in urine output, frequent occurrence of epileptic attacks, inconti- nenee of urine and low mental. capacity. Menstruation was normal without any evident abnormality in sexual develop-
ABSTRACTS 213
ment. They class their case as a ‘‘forme fruste de la dystrophie
adiposo-genitale.’’ In summary, they conelude this to be a
rather typical instance of dystrophy from hypopituitarism. —A. L. T.
HYPOPHYSIS, The anatomy of the—(Over een weinig bekend gedeelte der hypophyse). Woerdeman (M. W.) Nederl. Tijdschr. v. Geneesk. (Amsterdam) 1918, 62 (1), 215-21.
An accessory structure the ‘‘lobus bifurcatus’’ is described as developing embryologically in connection with the anterior lobe of the hypophysis. Later the connection is lost and it lies independent in the sub-arachnoid space. It is of some surgical interest since it occasionally gives rise to cysts. See also Endo- erin. 1918, 2, 174.—J. K.
(HYPOPHYSIS) Tumor of the pituitary gland; technique of operative approach. McArthur (L. lL.) Surg. Clin. Chicago, 1918, 2, 691.
Of technical surgical interest.
(HYPOPHYSIS, ADRENAL) The effect of some food hor- mones and glandular products on the rate of growth of para- mecium caudatum. Chambers (M. H.) Biol. Bull. (Woods Hole), 1919, 36, 82-92.
The author found that small amounts of pituitary extract added to hay infusion used as a diet for paramecia, caused an increase in their rate of division, but had the opposite effect when added to milk. Suprarenal extract caused an‘ increase in the division rate of these protozoa when mixed with their diet of either hay infusion or milk. Shumway has reported an increase in the rate of division of paramecia when thyroid sub- stance was added to their diet.—E. R. H.
INFANTILISM. Valdizan (H.) Revisto de Psyquiatria (Lima, Peru), 1918, 1, 25-36.
Valdizan’s five cases confirm the share of the endocrine system in the morbid tendeney which is manifested by infantil- ism. All were young men, except one man of 56. In most of them the phase of infantilism followed some severe sickness, and under tonics and organotherapy clinically normal condi- tions were restored in time. Two were brothers, and albumin- uria was among the first symptoms. He accepts it as an indica-
tion of the onset of the pluriglandular disorder, initiated in the
214 ABSTRACTS
kidneys and spleen. This assumption is confirmed by the retro- gression of this infantilism under a course of tonics. J. Am. M. Assn., 72, 905.
(INTERNAL SECRETION) Over interne secretie. Vermeulen (H. A.) Tijdschr. v. Diergeneesk. (Utrecht), 1917, 44, 155-64.
No new data presented.—J. K.
INTERNAL SECRETION, The so-called glands of—(Over zoogenaamde klieren met inwendige afscheiding). Lamers (A. J. H.) Nosokomos (Amsterdam), 1916, 14, 224, 236, 280.
Three popular lectures on the internal secretions.—J. K.
INTERNAL SECRETIONS and enzymes, their inter-relation and inter-dependence, their value and application in modern therapy. McNulty (J. J.) J. Am. Inst. Homeopathy (N. Y.) 1918, 11, 531-40:
A review, with special stress on the therapeutic value of polyglandular therapy. Chem. Abst., 18, 47.
(INTERNAL SECRETIONS) Infantilism from ankylostomi- asis. de Andrade (A. D.) Ann. Paul. de med. e chir., 1916, 7, 133. Abstr. Brit. J. Child! Dis 1919) 16758:
The author reports six cases of infantilism in children, aged from 8 to 16 years, in which the condition was due to a pluriglandular syndrome caused by ankylostomiasis.—M. B. G.
INTERNAL SECRETIONS, Shell shock and the—: with sug- gestions as to treatment. Harrower (H. R.) The Prescriber (Edinburgh), 1916, 10, 203-9.
Recent literature, largely French, indicating that the endo- erine glands play an important part in shell shock is reviewed. It is suggested that opotherapy would be correspondingly valu- able.—R. G. H.
INTERNAL SECRETION, The influence of—on the formation of bile. Downs (A. W.) and Eddy (N. B.) Am. J. Physiol. (Balt); 1919, 48, 192-98.
The authors show that the intravenous injection of secretin causes an increase in the amount of bile secreted, while ad- renin, mammary, orchic, ovarian, pancreatic and thymic gland substances cause a decrease. The amount of bile secreted is
C1
ABSTRACTS yA:
not affected in a constant or definite manner by the substances of the spleen and thyroid gland.—lL. G. K.
(LACTATION) Acetonuria hos notkreatur. Eklund (J.) and Engfeldt (N. O.) Svensk. Veterinartidskrift, 1918, 223, 47.
A study of the acetonuria which appears in the cow in certain diseases in connection with lactation. Physiol. Abst., 3, 452.
LACTATION in a calf. Fink (J. W.) Veterin. J. (Lond.), 1916, 72, 28.
A description of a Holstein calf which began lactating at the age of a week and had continued to the time of writing, when a quart a day was being produced. Physiol. Abst., 1, 239.
(MENSTRUATION) Date of fecundation. Razetti (L.) Gaceta Med. de Caracas, 1918, 25, 232.
Razetti discusses the various theories in vogue and rejects all except those which accept the menstrual function as a prepa- ration of the uterus for the embedding of the ovum. The in- ternal secretion of the corpus luteum is what starts this prepara- tion. According to this theory, there is no ripe follicle in the ovary during menstruation, and hence fecundation during this period is impossible. J. Am. M. Assn., 72, 689.
MYASTHENIA gravis, with report of a case. Rosenheck (C.) J. Am. M. Assn. (Chgo.), 1919, 72, 1211-12.
Ineludes no data of direct endocrine interest.—R. G. H.
(ORGANOTHERAPY) Concepto moderno de la opoterapia. Pita (A.) Medicina Moderna (Havana), 1918, 1, 15-22. A general theoretical discussion of the principles of opo- therapy.—R. G. H.
ORGANOTHERAPY in relation to the practice of medicine. Starkey (F. R.) Northwest Med. (Seattle), 1916, 15, 16-19.
A summary, perhaps too enthusiastic, of the use of organ extracts in the treatment of all sorts of diseases from myxe- dema to eclampsia and asthenopia.—J. P. S.
ORGANOTHERAPY, Rational—. Ghedini (G.) Gaz. d. Ospedali ed. Clin. (Milan), 1918, 28, 9-12.
216 ABSTRACTS
Ghedini insists that instead of using the extracts of organs we should use the venous blood issuing from the organ. This contains the true internal secretion, while the cells of the organ cease secreting this product when they are dead. Hence the removal of the organ from the body to make the extract not only arrests production of the internal secretion, but probably modi- fies essentially the delicate secretion already on hand in the tis- sues of the organ. Instead of a living secretion we get only a dead and possibly decomposed product. The efferent blood con- tains the secretion in its maximum vital potency. He published in 1911 research on the thyroid secretion thus obtained in the efferent blood, and in 1913 and 1915 similar research on the venous blood from the suprarenals, pancreas, and _ testicles. Manfredi announced in 1913 that the efferent blood from the pancreas inhibited certain actions of epinephrin. He cites fur- ther research since by Ollini, Masera, Durand and eight others. The difficulty of obtaining the efferent blood or lymph hampers and limits the research in this line, but this should be the goal toward which we strive. J. Am. M. Assn., 72, 833.
OSTEOMALACIA. Selhorst (J. F.) Nederlandsh. Tijd. v. Ge- neesk. (Amsterdam), 1917, 2, 2176.
In the case described the osteomalacia developed during a pregnaney and returned during the next pregnancy. Phos- phorus was tried, but without success. Ovariotomy was fol- lowed by considerable improvement. Physiol. Abst., 3, 228.
OVARIAN influences. West (G. R.) J. Tenn. State Med. Assn. (Nashville), 1918, 11, 300-305.
A general discussion of the subject as related to practical medicine. No new evidence is adduced.—R. G. H.
OVARIES, Transplantation of—(Transplantation der Ovarien). Unterberger. Arch. f. Gynak. (Berlin), 1918, 116, 173.
Homoioplastic grafts, although they sometimes give tem- porary amelioration of symptoms are soon resorbed. Accord- ingly, injections or oral administration of ovarian material is ordinarily preferable. In cases of atrophy of the ovaries, how- ever, such transplants at times give brilliant results. (The atrophic ovaries should not be removed.) Heteroplastic trans- plantation is possible only with the ovaries of monkeys. Auto- plastic transplantation is nearly always successful. Small slices of the organ should be utilized, implanted, preferably, in the rectus abdominis. The two indications for this procedure
ABSTRACTS 217
are benign tumors of both ovaries and purulent inflammation of both—J. K.
OVARY, Cyclic changes in the interstitial cells of the, in the woodchuck (Marmota monax). Rasmussen (A. T.) Anat. Rec. (Phila.), 1918, 14, 48.
See Endoerin. 1918, 2, 353-404.
-
(OVARY) Hydatiform mole with ovarian cyst. Nordentoft (J.) Ugeskrift for Laeger (Copenhagen), 1918, 80, 2139-43.
In Nordentoft’s case the woman of 35 had borne three children. There was an interval of three years since the last pregnancy, but recently there had been no menstruation and a tendency to nausea and vomiting had convinced the woman that she was three months’ pregnant. Then came severe hem- orrhage by the vagina and the uterus seemed to be of a size corresponding to a six months’ pregnancy. A large mole was found and the uterus curetted. A tumor rapidly developed thereafter on each ovary. On the left ovary the cystic tumor was 15 em. long, with a base 8 em. broad; on the right ovary the tumor was smaller, but both were of cystic structure, filled with a fluid, gelatinous mass similar to the contents of the mole. The uterus itself also showed suspicious patches so that supra- vaginal amputation seemed advisable. The patient has been in good health during the months since to date. The ovarian tumors had probably existed at the time of the operation on the mole, but their rapid growth, that could be followed with the eye and palpation, within less than a week, was most strik- ing. In six other cases of mole given operative treatment at the same hospital, the women were from 20 to 46 years old; four of the women had borne several children, one only one child, and one was pregnant for the first time. Four have borne healthy children since; one woman died several months later of a pulmonary lesion which may have been metastasis from the mole, and one succumbed to sepsis consecutive to the op- eration. J. Am. M. Assn., 72, 838.
(OVARY) Notes on superfetation and deferred fertilization among mice. Sumner (F. B.) Biol. Bull. (Woods Hole), 1916, 30, 271-85.
Ovulation may continue during pregnancy. Physiol. Abst., #253 , mt.
218 ABSTRACTS
(OVARY) Studies on the ovary of the spermophile (Spermo philus citellus tridecemlineatus) with special reference to the corpus luteum. Drips (D. G.) Am. Jour. Anat. (Phila.), 1919, 25, 117.
The cycle of changes occurring annually in the ovaries of the spermophile is presented with detailed histologic deserip- tions of the corpus luteum at each stage of its development. Specific stains are used to bring out the nuclear and proto- plasmic characteristics of the luteal cells. Three phases are thus noted in the life ecyele of the corpus luteum: First, a phase characterized by the presence of great numbers of red granules, undoubtedly secretion granules in the protoplasm of the luteal cells. This phase embraces practically all of the period of pregnancy. Second, the lipoid phase, so ealled be- cause of the abundance of lipoid droplets in the protoplasm of the cells. This phase begins some time before parturition and lasts for about six weeks afterward, which is also about the time the normal involution of the uterus becomes complete. Third, the phase of regression. Certain experimental studies are reported, such as the effects of single and double ovariec- tomy on pregnant and non-pregnant animals. Single ovariec- tomy is negative in results. Double ovariectomy in non-preg- nant animals causes a very gradual functional atrophy of the uterus. In pregnant animals this procedure causes abortion ex- cept when it is very late‘in pregnancy. From the results of the histologic and experimental studies it is coneluded that the corpora lutea produce two internal secretions which preside over changes occurring in the uterus incident to pregnancy. The early secretion effects the normal implantation and devel- opment of the embryo and the late lipoid secretion helps to bring about the normal involution of the uterus. Author’s Abst.
(OVARY) The effects of hysterectomy upon ovarian function. Richardson (E. H.) Surg. Gyn. & Obst. (Chgo.), 1919, 28, 146-52.
Published in abstract elsewhere. See Endoerin., 1917, 2, 181.
OVARY, The relation of the supplying—to the causation of sex. Murray (J. G.) Johns Hopk. Hosp. Bull. (Balt.), 1918, 29, 215-8.
This paper is devoted partially to a criticism of the evi- denee submitted by Dawson in a recent book, ‘‘The Causation of Sex in Man,’’ and partially to an analysis of the records of 17,500 deliveries in the Obstetrical Clinie of the Johns Hopkins Hospital as bearing on Dawson’s theories. The theory that.
ABSTRACTS 219
male children are derived from the right ovary and female from the left was tested in the case of 74 pertinent available records. In ease of 47 male babies the corpus luteum was found in the right ovary in 55 per cent and in the left-in 45 per cent of the mothers. In case of 28 female infants the corpus luteum occurred in the right ovary in 47 per cent and in the left, im 57 per cent.
Dawson’s ‘‘rule’’ that ovulation occurs from the ovaries al- ternately and that, having established which ovary was in- volved in any given pregnancy, the prognostication of the sex of the offspring in succeeding pregnancies is possible, was also found to hold true in only half the cases. It is concluded that the supplying ovary has no influence upon the sex of the child and that male and female children result in about equal num- bers from the fertilization of ova from either ovary.—R. G. H.
(OVARY) Tubal and ovarian hemorrhage. Its etiological rela- tion to pelvic hematocele and extra-uterine pregnancy. Bovée (J. W.) Surg. Gyn. & Obst. (Chgo.), 1919, 28, 117-22.
Published in abstract elsewhere. See Endocrin. 1918, 2, 185. Over glandulae PARATHYROIDEA. Vermeulen (H. A.) Tijdsch. v. Diergeneesk. (Utrecht), 1917, 44, 155.
Published elsewhere. See Endoerin., 1917, 1, 333.
J. K.
(PANCREAS) Diastatic activity of the blood in cancer, syphi- lis, and diabetes. De Noird (H. H.) and Schreiner (B. F.) Arch. Int. Med. (Chgo.), 1919, 28, 484.
The diastatie activity of the blood of the ordinary syphi- litie varies within normal limits. In the simple diabetic the diastatie action is extremely high. On the other hand, those diabetics who are syphilitic have a low diastatie activity. Both types have varying degrees of hyperglycemia. Five syphilitic diabetics demonstrated extreme loss of carbohydrate tolerance. This condition was materially checked by the cure of the syph- ilis. If it is possible to have a low diastatie activity and dia- betes, then the disease does not depend solely on glycogen- olysis, but may be due to the failure of the tissues to hold or burn sugar. It appears incredible that the islands of Langer- hans should secrete an activating agent for diastase that some- times activates and sometimes inhibits, but this must be true if one accepts the idea that pancreatic and syphilitic diabetes have the same cause—insufficiency of the secretion of the
220 ABSTRACTS
islands of Langerhans—for in one ease the diastatie activitiy is high and in the other low. Henee, it is suggested that the islands of Langerhans secrete a substance inhibitory to the se- eretion of diastase and thus control its activity. If this is true, then the increased diastatie activity in pancreatic diabetes is due to destruction of the islands to such an extent that there is no inhibiting agent of diastase secreted, and the diastase in the blood is super-active. In syphilitic diabetes, cirrhosis is not confined to the islands of the pancreas, but involves all paren- chymatous tissue. This encroaches on the secretory cells which, in turn, are stimulated to excessive secretion. The diastase is inhibited to a greater degree, with a resultant low diastatie activity. Increased diastatie activity never accompanies hypo- or normal glycemia, but it is not uncommon to find hyper- olycemia associated with a low diastatie activity.
The conclusion is drawn that the hyperglycemia of dia- betes is due to another cause than increased glycogenolysis alone, and that it probably is something affecting the permea- bility of cell membranes to sugar and inhibition of glycogen- olysis so that all or a great part of the sugar remains in the blood to be exereted. Hence, the internal secretion of the pan- ereas is probably inhibitory to the action of diastase in the blood.—H. W.
(PANCREAS) Marche de la glycosurie chez le chien dans les premiéres heures qui suivent l’ablation totale du pancréas (Development of glycosuria in the dog during the first hours following the total ablation of the pancreas). Bierry (H.) C. R. Soc. de Biol. (Paris.), 1919, 82, 305-307.
Glycosuria appeared within five hours after removal of the pancreas. During the first hour after the appearance of sugar in the urine, the amount of sugar rapidly inereases until it reaches 5 to 10 per cent.—F. A. H.
(PANCREAS) Observations concerning the pathology of pan- creatic ferments. Wago (H.) Arch. Int. Med. (Chgo.), 1919, 23, 251.
Not of endocrine interest.
(PANCREAS) The blood supply of the areas of Langerhans, a comparative study from the pancreas of vertebrates (Pre- liminary paper). Flather (M. D.) Anat. Rec. (Phila.), 1919,
UG le
A comparative study was made of the arrangement of cells
ABSTRACTS 221
and blood-vessels in the islet areas of the alligator, opossum, horse, raccoon, badger, skunk, rabbit, and guinea pig. The au- thor coneludes that while the vascular areas are extremely varied even in the same individual, there are certain distinctive features—shape, size, sinusoidal network, ete——which charae- terize the islets in the different species of vertebrates. The pa- per is based upon a rather limited number of data, but more are promised for a later communication.—E. R. H.
PARATHYROID tetany, Studies on—. Wilson (D. W.), Stearns (T.), Janney (J. H., Jr.) and Thurlow (Madge DeG.), Johns Hopk. Hosp. Rep. (Balt.), 1916, 18, 12-20. (Abstract of previ- ous papers. )
The tetany resulting from parathyroid extirpation can be relieved by administration of acids. After the operation alka- losis may develop and be neutralized by the acid products re- sulting from muscular activity incident to tetany; the acidosis is associated with relief of the tetany. Ca salts as well as acid lower the dissociation constant of oxyhemoglobin and the alve- olar CO, pressure. With development of tetany the elimination of acids and ammonia inereases. After acute or chronic tetany acidosis may occur.—R. G. H.
(PARATHYROID) Tetany, Treatment of post-operative—by homoioplastic transplantation (Dauerheilung einer lebenbe- drohenden postoperativen Tetanie durch homioplastische Epi- thelkorpertransplantation). Borcher (K.) Zentralbl. f. Chirur. (Leipsig), 1919, 40, 34.
The only rational treatment of post-operative tetany is homoioplastie transplantation. A single large parathyroid is adequate. The operations upon both donor and recipient ean be carried out under local anesthesia. The best locus of the graft is in the left externis abdominis muscle out of the way of a possible appendicitis incision. The procedure does not always result in complete disappearance of symptoms; psychie irrita- bility and a feeling of weariness at times remain.—J. K.
(PARATHYROID, THYMUS) Parathyroids and calcium met- abolism. Uhlenhuth (E.) J. Gen. Physiol. (Balt.), 1919, 1, 315-322.
Three series each of 6 or 7 larvae of the salamander Ambly- stoma opacum were fed on thymus gland. The first series was otherwise untreated and each individual developed tetanie con-
222 ABSTRACTS
vulsions, which ceased as metamorphosis approached. After metamorphosis all the larvae were free from tetany, although the limbs and feet remained permanently twisted and con- tracted and the muscles were permanently paralyzed. The sec- ond series was kept in a solution of calcium lactate. Tetany was less marked than in series I, but the permanent effects (paralysis and deformity) were quite as marked. Moreover several weeks after metamorphosis tetanic convulsions ap- peared. Series III was kept in a solution of magnesium lactate. These larvae acted similarly to those in Series II, except that the tetany was still less marked during the larval period.
The author believes with Biedl that the tetany toxin acts on the central nervous system to cause tetany and permanently to injure it. The muscular contractions may be prevented by the action of Ca or Mg salts, but no substanee has yet been found which will antagonize the tetany toxin and so prevent its action on the central nervous system. Accordingly the most im- portant function of the parathyroids is to prevent the tetany toxin from coming into contact with the central nervous sys- tem, by neutralizing it.—L. G. K.
PARATHYROIDS and calcium metabolism. Uhlenhuth (E.) Proc. Soc. Exp. Biol. & Med. (N. Y.) 1918, 16, 20-21.
Larvae of a species.of salamanders which have no para- thyroid glands are thrown into tetany by the ingestion of thy- mus gland. It is supposed that this is due to a thymus toxin which is normally neutralized by the parathyroids. The more likely possibility that the tetany is due merely to improper diet is not discussed. Magnesium and calcium salts suppress to some extent the tetany, but can not prevent permanent lesions of the nervous system which result from thymus diet. These lesions result in permanent muscular spasms and paralysis.—R. G. H.
(PARATHYROIDS, THYMUS) The influence of milk upon tetany in Salamander larvae. Uhlenhuth (E.) Ibid., 1919, 16, Dike
Milk has an effect similar to Ca and Mg.—R. G. H.
PARATHYROIDS, Contribution to the normal and pathological
anatomy of the—(Contribucion a la anatomia normal y patho-
logica de las glandulas paratiroideas). Strada (F.) Actas del ler Congress Nac. de Med. (Bs. Aires), 1916, 4, 215.
See Endocrin. 1918, 2, 516.
ABSTRACTS 223
(PARATHYROIDS) CO, combining power of blood plasma in experimental tetany. McCann (W. 8S.) J. Biol. Chem., 1918, 35, 553-63.
After parathyroidectomy in dogs, this rises coincident with the development of tetany. Both these phenomena also follow gastric operations which exclude acid from the duodenum. Tetany is considered to be an alkalosis in which a dispropor- tion between the rates of secretion of acids and alkalis in the digestive tract may be a factor. No reference is made to the views of Paton and his colleagues.) Physiol. Abst., 3, 453.
(PARATHYROIDS) Further studies of the influence of para- thyroidectomy on the gastro-intestinal mucosa of dogs and rabbits. Friedman (G. A.) Jour. Med. Research (Boston), 1918, 38, 69.
Thyroid insufficiency causes in dogs and rabbits acute ul- cers of the stomach and duodenum which do not show a ten- dency to heal, due probably to permanent constitutional anoma- lies. Occasionally appendicular lesions are produced. In man minor degrees of thyroid insufficiency may cause the appear- ance of the initial lesion of peptic ulcer or appendicitis; but since the insufficiency is probably shghter than in thyroid- ectomized animals compensation may occur. Chronicity of the ulcer is due to other factors such as the constant irritation by food and an excessive amount of hydrochloric acid. The pri- mary lesion is probably not due to infection, but to thyroid in- sufficiency. It is only after the initial lesion has been formed that Invasion of bacteria and stagnation of feces help to de- velop the various forms of appendicitis. Diminished thyroid se- eretion in man may be responsible for the association of peptic uleer and appendicitis, in the causation of the primary lesion of which the adrenals and parathyroids probably co-operate. The probable relation between them must be a functional one. The assumption of a disturbance in the endocrinous glands ex- plains possibly the subtonie and hypertonic types of stomachs or peptic uleer.—ZJ. P. S.
(PINEAL?) Sexual precocity (Uber vorzeitige Geschlechts- entwicklung. Obermann (W.) Deutsche med. Wehnscehr. (Berlin), 1916, 42, 196-98.
A boy of 4 is deseribed. At birth he was normal. Soon he developed excessive hunger and was put on a diet of bis- cuits and cow’s milk. At the age of one year there was hair on the genitals. At two years the genital development was that
224 ABSTRACTS
of 18 years and the voice was deep. At 4 years acne appeared on the face and back, but there was no axillary or facial hir- sutes. His physical strength and intelligence were excellent. — The author discusses the possibility of disease of the pineal gland, but offers no specific evidence. No brain tumor was apparent.—J. K.
(PLACENTA) Secrezione interna della placenta e sua azione supra altre ghandole endocrine (Internal secretion of the pla- centa and its action on other endocrine glands). Ercole (C.) Ann. di Ostet. e Gin. (Milan), 1915, 37, 225.
Injections of alcoholic extracts of placenta into guinea pigs and rabbits gave rise to manifestations of hypertrophy of mammary glands, uterus and vagina similar to that of normal pregnancy.
The adrenal cortex increased in size and cells of the thy- roid gland simulated the appearance commonly assumed to represent an active state. The author considers that the corpus luteum of pregnancy differs from the corpus luteum of men- struation owing to the hormonic influence of the placenta. It: is suggested that extracts of placenta may find clinical appli- cation in conditions of hypoplasia of the uterus; also in hemor- rhagie metritis, and in changing ovarian activity towards the gravid type, favoring amenorrhoea.—A. L. T.
SECRETIN, Is vitamine identical with—? Jansen (B. C. P.) Geneesk. Tijdschr. voor Ned. Indié (Amsterdam), 58, 191-7; Chem. Weekblad (Amsterdam), 1918, 15, 1520-1.
Various statements occur in the hterature about the iden- tity of secretin with vitamine. Experiments showed that the vitamine from rice hulls is not identical with secretin. If it were, the fact could be used as the basis for a quantitative method of determining vitamine. An incidental result of the experiments was the observation that K salts injected into the blood vessels are poisonous! Chem. Abst., 13, 466.
(SECRETIN) Chemical stimulation of the intestinal glands. Tomaszewski (Z.) Pfliiger’s Archiv. 170, 260-312; Physiol. Abstracts 3, 252-3.
Experiments were carried out on dogs with gastrie and duodenal fistulas. Psychic influences were excluded as far as possible. Aq. or HCl extracts of stomach, various parts of small and large intestine, and pancreas were made and injected
ABSTRACTS
iw) 1) Ol
intravenously or subcutaneously. Very little effect was ob- tained by intravenous injections, but after subcutaneous injec- tion a flow of juice began in about 15 minutes and lasted 1-2 hours, as much as 350 e.c. of Juice being collected in that time. In some eases the vagi were cut or atropine given, but the re- sult was the same. The volume of juice obtained was propor- tional to the solid content of the extract used. Edkin’s experi- ments were repeated, but in those cases where secretion of juice was observed, T. explains it as due to squeezing out of juice as the result of muscular contractions of the stomach wall. In any case the effect of pyloric extract was no more marked than that of an extract of fundus. The substance responsible for the secretion is an organic compound, stable at 100°, slowly de- composed at 130°, or by the action of pepsin, but not of trypsin. It is not identical with vasodilatin, since Witte peptone does not cause the secretion. The activity of the extracts is in- creased by treatment with 80% alcohol, but is slowly destroyed by absolute alcohol, ethyl or methyl. It is not extracted by Et,O, CHCl, and is not precipitated by colloidal Fe or HgCl, but 34 of the activity is lost by precipitation of the extract with phosphotungstic acid. Chem. Abst., 13, 36.
(SECRETIN) Note sur la répartition de la sécrétine dans le duodénum et dans le jéjunum (Note on the distribution of secretin in the duodenum and in the jejunum). Métivet (G.) C. R. Soe. de Biol. (Paris), 1919, 82, 274-275.
Confirmation of the work of Bayliss and Starling, showing that there is as much secretin in the jejunum as in the duo-
denum.—F. A. H.
(SEX) Contribution a l’histoire des femelles d’oiseaux chez qui se développent les attributs extérieurs du sexe male (Con- tribution to the history of female birds in which secondary male sex characteristics have developed). Larcher (O.) Ree. de Méd. Vét. (Paris), 1916, 92, 173-83.
A valuable annotated bibliography of some sixty papers. —R. G. H.
(SEX) Féminisme post-ourlien (microrchidie et gynécomastie consécutives a une orchite double), presentation du malade (Feminism following double orchitis). Laignel-Lavastine and Courbon (P.) Bull. et Mém. Soe. Méd. d. Hép. de Paris, 1917, 33, 914-15.
226 ABSTRACTS
A young man of 22, previously notably virile, had double orchitis following mumps. His virility disappeared and the external genitalia diminished in size, while the breasts devel- oped marked hypertrophy. In general the patient approached the hermaphroditie type.—R. G. H.
SEX GLAND implantation, Further evidence on—. Lydston (G. F.) J. Am. M. Assn. (Chgo.), 1919, 72, 396-98.
Progress of two cases earlier reported is discussed and four new eases are described. Continued favorable therapeutic results confirm the author’s opinion that the procedure is of marked value in producing virility.—R. G. H.
(SEX) Several ways in which gynandromorphism in insects may arise. Morgan (T. H.) Anat. Ree. (Phila.), 1919, 15, 357 (abstract).
Sex intergrades are very rare, 1:2200, in the fruit fly, Drosophila. They usually start as females. The author ex- plains this gynandromorphism on the basis of loss of sex chro- mosomes. Nothing is said here of hormones.—E. R. H.
(SEX) The extent of the occurrence of sex intergrades in Cla- docera. Banta (A. M.) Anat. Ree. (Phila.), 1919, 15, 355- 356 (abstract ).
Sex intergrades in these small crustaceans are very rare, but when once established they tend to produce sex intergrades indefinitely.—E. R. H.
SPLEEN, The effect of the removal of the—upon the meta- bolism. Berlin (E.) Ztsechr. f. Biol. (Miinchen), 1918, 68, 371- 90; J. Chem. Soe. 114, I, 360.
Extracts of spleen contain, besides choline, a substance which exerts a powerful action on the muscles of the uterus and intestine. The latter substance is not 6-amino-4-ethylglyoxa- line. Both choline and the unknown substance occur also in a commercial extract of spleen, called ‘‘hormonal.’’? Chem. Abst., 12, 2355:
SPLEEN, The effect of the removal of the—upon the meta- bolism in dogs. Preliminary report. King (J. H.) Johns Hopk. Hosp. Rep. (Balt.), 1916, 18, 7-9.
The idea that the spleen may have an obscure endocrine
ABSTRACTS
bo bo ba |
function has not been entirely disproven. The observation that splenic extracts injected intravenously stimulate intestinal peristalsis is one that has been cited as indicating such a fune- tion, King made a careful metabolic study of dogs during a control period and after splenectomy. The metabolic processes were in general little affected, but an increase in the fats and cholestrin in the blood, together with increased absorption of fats and elimination of fatty acids were noted. The elimination of calcium was also increased.—R. G. H.
(SYMPATHETIC N. S.) MYASTHENIA, Studies with the plethysmograph and string galvanometer in—. Athanasiu (J.) and Marineseo (G.) C. r. Soe. Biol. (Paris) 1916, 79, 545-548.
The authors conclude that the sympathetic, but not the cerebro-spinal system, is involved in myasthenia.—Physiol. Abst., 1, 348.
(TESTES) Hypertrophy of the prostate. Mieremet (C. W. G.) Nederl. Tijdschr. v. Geneesk. (Amsterdam) 1918, (ii) 1474-81.
Mieremet presents a number of arguments to sustain the assumption that the hypertrophy of the prostate is due pri- marily to the action of a hormone from the testicles. If the hypertrophy were merely a tumor, then we might expect it to occur at any age, while in fact it affects almost exclusively men at a certain age. The phenomena observed with roentgen ex- posures of testicles and prostate also sustain his assumption. He thinks that not enough attention has been paid to the inter- nal secretion of the testicles as a factor in enlargement of the prostate, and urges research on the testicles in eases of hyper- trophied prostate-——J. Am. M. Assn., 72, 386.
(TESTES) Influence of castration on the larynx of the large domesticated animals. Schreiber (J.) Anat. Anz., 1916, 49, 129-150.
Experiments on horses and eattle show that castration of males in early life causes the larynx to remain in an infantile condition. Physiol. Abst., 1, 249.
(TESTIS) Degeneration in the albino rat testis due to a diet deficient in the water-soluble vitamine, with a comparison of similar degeneration in rats differently treated and a consid- eration of the Sertoli tissue. Allen (E.) Anat. Rec. ( Phila.), 1919, 16, 93.
oe
~
ABSTRACTS
~ io 6)
[ t
Albino rats fed by Osborne and Mendel on a diet deficient in the water-soluble vitamine were sterile. Examination of the testes showed complete degeneration of the germ cells. The Sertoli cells alone persisted in the tubules, though their nuclei were much shrunken. The interstitial tissue was hypertrophied. These conditions are the same as found in X-rayed testes of varlous mammals. Similar degeneration was found also in some rats aleoholized by MacDowell. It was present to a less degree in their non-aleoholized brothers. Under these conditions the Sertoli tissue reveals a syneytial structure which the author be- lieves is the normal state, as shown by well-fixed material.
—Author’s Abstract.
TESTIS, Transplantation of the—in man. Lichtenstern (R.) Miinechner med. Wehnschr., 1916, 63, 673-75.
After loss of both testes, transplantation of a testis from another man restores the previous physical and psychie condi- tion. Experiments on animals are thus confirmed on man, and the hormone theory supported. Physiol. Abst., 1, 249.
THYMUS and carcinoma, The connection between—(Uber Beziehungen zwischen Thymus und Karzinom). Kaminer cae and Morgenstern £0.) Wiener klin. Wehnschr., 1917, 30, 41-5
In animal experiments the addition of thymus to serum in- creases the power of the latter to destroy cancer cells. The administration of thymus lessens cancerous growths. Animals with persistent thymus are very insusceptible to cancer. The internal secretion of the thymus is thus believed to be a natural defence against carcinoma. Physiol. Abst., 3, 330.
THYMUS and GONADS, The influence of feeding with—in tadpoles (Beeinfiussung des Wachtums von Kaulquappen durch Verfiitterung von Thymus und Geschlechtsorganen), Stettner (E.) Jahrbuch f. Kinderheilk (Berlin), 1916, 83, 154.
A repetition of the experiments of Gudernatsch, who found that feeding thyroid hastened while thymus delayed metamor- phosis. S. found that thymus feeding caused delayed meta- morphosis, but not the excessive growth described by Guder- natsch. Inadequate bone formation frequently resulted in crooked tails; the tadpoles also showed abnormal configura- tion suggestive to the author of rickets in children. Feeding with testis or ovarian material caused slight delay of meta-
ABSTRACTS 229
morphosis, but growth was normal and deformed tails not seen. Combined thymus and gonad exerted no apparent influence, a result due, possibly, to technical difficulties in adjusting dosages. Gudernatches results with thyroid were confirmed; the material produced very marked effects and minute doses only could be given without causing death.
See also Endocrin., 1917, 1, 345.—J. K.
THYMUS, Influence cf the—on the regeneration of bone (Beeinfiussung der Regeneration von Knochenverletzungen durch die Thymusdrtise). Glaessner. Berl. klin. Wehnschr., 1918, 55, 1127.
In the rabbit ingestion of thymus hastens the healing of fractured bone. Extension of the experiment to other animals and to man is advised to determine the practical significance of the results —J. K.
THYMUS gland injection, The effect of—on the growth and behavior of the guinea-pig. An experimental investigation. Olkon (D. M.) Arch. Int. Med. (Chgo.), 1918, 22, 815.
Intraperitoneal injections of thymus preparations often re- sulted in muscle spasms, dyspnea and cenvulsions. These spasms appeared more severe and of longer duration than those following the injection of muscle or one-tenth normal sodium chloride solutions. Emaciation, accompanied by dryness and roughness of the fur, and loss of weight followed the continued use of thymus preparations.—H. W.
(THYMUS) Nature of the retarding influence of the thymus upon amphibian metamorphosis. Uhlenhuth (E.) J. Gen. Physiol. (Balt.), 1919, 1, 305-313.
The author found that, although thymus-fed salamander larvae often metamorphose normally, thymus feeding some- times retards and in rare cases completely inhibits metamor- phosis. This action, however, is very inconstant and variable, completely unlike the constant effects of the tetany producing substanee of the thymus and the metamorphosis producing substanee of the thyroid.
When normal food is added to the thymus diet the inhib- itory effect does not appear. Also the addition of a small quantity of Bayer’s iodothyrin rapidly leads to precocious metamorphosis of thymus-fed larvae. The conclusion is there- fore reached that the inhibitory effect of the thymus is not due
230 ABSTRACTS
to a specific inhibiting substance, but to the absence from the diet of the thymus-fed larvae of a substance required to develop the thyroid to the secretory state. Such a substance might occur in the connective tissue of the thymus, and since some of the larvae no doubt obtained more of this tissue than others, the great variability of the results could thus be explained.
—L. G. K.
(THYMUS) Thymectomy after failure of radiotherapy (Un cas de thymectomie sous-capsulaire pour hypertrophie du thymus, apres échec de la radiothérapie). Chaton. Rev. internat. de Méd et de Chis. (Paris), 1917, 28, 105-6.
Of technical surgical interest. The radio-therapy had ap- parently left the thymus tissue normal.—R. G. H.
(THYMUS). Uber die Funktionen der Thymusdrise vom Standpunkte ihrer Ausfallserscheinungen (The function of the thymus considered from the effects of extirpation.) Tangu (Y.), Mitt a. d. Medizin. Fakultét. Tokyo Univ., 1916-17, 16, 539-605.
The first series was extirpation, with autoplastic trans- plantation into the mesentery. The operation was performed on 40 dogs, of various breeds; of these seven lived (three con- trols); all of the others died from causes unavoidable, shock, disease, infection, etc. There was no difference in skeletal measurement, calcium content, or epiphysis. The conclusion is naturally drawn that either extirpation has no effects or that the transplanted organ has functioned.
In order to determine the normal period of involution of the thymus an unusual number of observations was made on the absolute and relative weight of the gland in dogs of the same litters and then reduced to a standard. The author comes to the following conclusion: Involution does not begin until the fourth month (gross weight and microscopically). During the first—second week the ratio of thymus to body weight is the least, 1:189. This observation is important in considering the most opportune time to extirpate to obtain the most marked effects.
A great number of animals was used and exhaustive exam- inations made of fatal eases and of those that were ultimately killed. Both clinical and biological tests were employed.
The results may be tabulated as follows, no observations being included where a proper control was lacking:
I. Body weight—no change after thymus extirpation.
ABSTRACTS 231
Il. Growth—no three stages as reported by Klose and Vogt.
Ill. Nervous, Psychic, ete.—no effect.
IV. Blood corpuscles—no change in number or differen- tial count.
VY. Change in opsonic index—none. The.alexin action of the blood serum is lowered for several weeks and then recovers, probably due to the activity of other alexin producing tissues, bone marrow, spleen, ete.
VI. Blood pressure—results conflicting.
VII. Histological—there were generally small patches of thymus cells in the body, due either to regeneration (?) or accessory thymus-granular structures.
VIII. Skeletal changes—no change in length, cellular structure, calcium content or callus formation after fracture of epiphysis.
IX. Change in other organs—no change macroscopic or microscopic in any of the other internal secretory organs, epi- thelial tissues or lymphoid tissues.
On the whole the evidence convincingly indicates that the thymus is not an organ of internal secretion.—W. E. B.
(THYROID) A discussion of goitres in 583 registrants. Levin (S.) J. Mich. State Med. Soc. (Grand Rapids), 1919, 18, 98-104.
An interesting contribution to the statistics of endemic goitre. Levin, as examining surgeon, collected data on 583 registrants for military service. The locality from which the men came is in the ‘‘goitre belt’’ in the Great Lakes district. The proportion of the men born in the locality was 95 per cent. Of the 583, 177, or 30 per cent, showed demonstrable enlarge- ment of the thyroid. Of these 140, or 24 per cent were classified as simple goitres; 3.9 per cent, toxic goitres and 2.4 per cent were large goitres of the adenomatous, colloid or cystic types. The incidence of goitre in the group studied decreased with age, possibly because more of the older men were born outside the district—R. G. H.
(THYROID ADRENAL) The stimulation and inhibition of the gastric secretion which follows the subcutaneous administra- tion of certain organ extracts. Rogers (J.), Rahe (J. M.), and Ablahadian (E.) Am. Jour. Physiol. (Balt.), 1919, 48, 79-92.
Slightly alkaline extract of the non-coagulable material
232 ABSTRACTS
from the thyroid gland was found to be a vigorous stimulant to gastric secretion, when injected into the subeutaneous tissue of the neck, in dogs. The effect produced was attributed, in part at least, to an intensification of the functions performed by the terminal filaments of the (gastric) vagus. Atropin checked, but did not prevent the increased gastric flow pro- dueed by the thyroid extract. Extracts similarly made from adenomatous or hypertrophied human glands were found to be inert. Extracts of the adrenal gland vigorously inhibit gastric secretion, supposedly by an intensification of the inhibitory function of the sympathetic. Adrenalin is not as active a gas- trie inhibitor as the adrenal nucleo-proteins obtained from ex- tracts of the whole gland. These nucleo-proteins contain only traces of epinephrin. Extracts of the pituitary also inhibit gastric secretion, but only about one-half as vigorously as do extracts of the adrenal.—lL. G. K.
(THYROID) A few facts in regard to modern X-ray therapy. Bellaire (R. F.) Minnesota Med. (St. Paul), 1918, 1, 380.
Among several other conditions mentioned ‘‘hyperthyroid- ism’’ 1s mentioned as amenable to roentgen therapy. Clinical cures of toxie goitres are obtainable in 80 per cent of the cases. The chest in all instances should be rayed from both front and back to include the thymie area.—R. G. H.
(THYROID) A propos d’un syndrome basedowein d’origine émotive survenu chez un addisonien. Etude pathogénique. (Concerning the syndrome of Basedow’s disease of emotional crigin occurring in an individual suffering from Addison’s disease.) Etienne (G.) et Richard (G.) Soc. Méd. des Hop. de Paris, 1918, 42; 1199"
As evidence against the theory that exophthalmic goitre has origin in hyperseeretion of the adrenal glands, which in turn may possibly function as exerting a sympathicotonie influ- ence over all endocrine organs, Etienne and Richard report a ease of frank Addison’s disease, in which psychie trauma eaused the sudden appearance of symptoms of exophthalmie voitre. Here obviously there was a condition of adrenal de- ficiency, yet emotional causes appeared to be immediately responsible for an acute appearance of thyroid abnormality, presumably hyperactivity.
This does not prove the non-existence of a sympathetic origin of this type of goitre, but rather that the intermediation of the adrenal glands does not appear to be a necessary factor.
—A. L. T.
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i) OO (es)
(THYROID) An unusual combination of cardiac arrhythmias of atrial origin occurring in a patient with focal infections and thyroid adenomata. Barker (L. F.) and Richardson (H. B.) Arch. Int. Med. (Chgo.), 1919, 23, 158.
Report of a case in which marked disturbances of cardiac rhythm were encountered in association with peridental, maxil- lary and tonsillar infection and minute adenomata of the thy- roid gland. Marked improvement followed treatment of the infected foci and partial thyroidectomy. Electrocardiographic studies of the case demonstrated at one time or another the following: (1) Physiological rhythm; (2) Dislocation of the pacemaker from the sino-atrial node to points elsewhere in the atrium; (3) Alternate atrial extra-systoles, none of which pro- voked a ventricular response; (4) Alternate atrial extra-sys- toles, many of which provoked a ventricular response ; (5) Paroxysmal tachycardia; (6) Atrial flutter.—H. W.
(THYROID) A report on goitre among draft men from the Northwest. Brendel (F. P.) and Helm (H. M.) Arch. Int. Med. (Chgo.), 1919, 23, 61.
An examination of 8,951 drafted men showed that goitre is more common in young men from the Northwestern States than the experience of the general practitioner would suggest. Apparently there are definite goitre districts existing in Oregon, Montana and probably in Nevada. Locality seems to be of greater etiological importance than heredity. The more toxic eases, in addition to the: classical cardiac symptoms, show a tendency to nephritis.—H. W.
THYROID carcinoma among the salmonoid fishes. McHenry (H. H.) Med. Review of Reviews (N. Y.), 1916, 22, (32-36.
This is a study of the enlargements of the thyroid and the carcinoma found among the salmonoid fishes. The disease occurs rarely in wild fish, but very commonly in those kept in captivity. McHenry concluded that the geologic formation at the source of the water in which the fish were kept had noth- ine to do with the development of the disease. The disease occurred in ponds and troughs of all descriptions. The inci- dence of carcinoma increased with age. In the thyroid glands of some fish nematode worms were found. Scrapings from the inside of the troughs containing fish with thyroid carcinoma were fed to four dogs for six months. All of these developed marked thyroid hyperplasia, and one of them showed a grossly detectable enlarged thyroid. The author thinks that these
ABSTRACTS
te oe
enlargements and changes are the first stages in mammals of the same thyroid disease which occurs among the fish. In the hyperplastic thyroids of three puppies and of one adult dog which were given infected water, minute nematode worms were found immediately beneath the capsule or in the sub- stance of the gland. If these worms have any etiologic signifi- cance it is probably merely as carriers of the causative agent. MeHenry thinks that man would acquire thyroid disease from drinking water occupied by infected fish—J. P. S.
(THYROID) Cretinism. Lattimore (KE. B.) Charlotte Med. J. 1917, 76, 206. Brief description of two cases which reacted favorably to thyroid medication.—R. G. H.
(THYROID) Cretinism, A case of complete—with normal men- tality. Hoag (W. B.) N. York Med. J., 1916, 103, 791. Published elsewhere. See Endoerin., 1918, 2, 337. (THYROID) Diagnosis and treatment of non-toxic goitre.
Scott (C. M.), West Va. Med. J. (Huntington), 1916, 11, 169-70.
No new data.—R. G. H.
(THYROID) Een geval van struma van het paard. Hartog (H. J.) and Loran (G. J.) Tijdsenr. v. Diergeneesk (Utrecht), 1919, 46, 93.
Describes a case of goitre m a horse.
oJ. eK
(THYROID) EXOPHTHALMIC GOITRE in relation to ovarian insufficiency (Des relations de goitre exophthalmigue avec l’insuffisance ovarienne). Tilmant (A.) Presse Méd. (Paris), 1919, —, 164.
A brief presentation of six cases in women of. the same family in whom the appearance of the thyrogenie symptoms coincided with periods of ovarian disorder (as menopause). It appeared that the thyroid disorder was due to a transmitted hereditary tendency.—R. G. H.
(THYROID Exophthalmic goitre, nervous and mental symp- toms in—. Barker (L. F.) Med. Press (Lond.), 1919, 107, 85-87.
ABSTRACTS Dan
Reprinted from J. Am. M. Assn., 1918, 71, 327-29. See Endocrin. 1918, 2, 343.
(THYROID) Exophthalmic goitre, peculiarities in the symp- tomatology of—. Bram (I.) Med. Ree. (N. Y.), 1919, 95, 358-60.
Bram believes that thyroid dysfunction is an important. unrecognized factor in many disorders. By the time the classical ‘‘tetrad’’ of ‘“‘hyperthyroid’’ symptoms is clearly in evidence much harm to the individual may have been done. Even an enlarged thyroid may produce local manifestations, the cause of which is frequently overlooked, such as cyanosis, headache, vertigo, epistaxis, ‘‘vagotonic’’ (irritative) symp- toms, dyspnea, dysphagia and dysphonia. The enlargement may be in an inward direction and thus escape detection. Obseure symptoms due to excess thyroid secretion are very numerous; among these are emotional instability, glycosuria, polyuria, loss of weight and noctural sweating suggestive of tuberculosis. The diagnosis of exophthalmic goitre is accord- ingly beset with pit-falls. In the presence of symptoms which eannot be brought into line otherwise, the thyroid gland should always be taken into account.—R. G. H.
(THYROID) Exophthalmic goitre, Successful therapy of—. Brown (1.) N. Y. Med. J., 1919, 109, 314-21.
The relative virtues of surgical and non-surgical treatment are again debated with the author strongly favoring the latter. The successful treatment of three cases is given in detail. ‘It is insisted that individualization of treatment is essential to success. The importance of maintaining good digestion is espe- elally emphasized.—R. G. H.
(THYROID) Exophthalmic goitre, The aorta in—(L’aorte dans le goitre exophthalmique). Folley (C.) C. r. See. de Biol. (Paris), 1918, 166, 830-31.
Further evidenee of aortie dilatation (abdominal) in exoph-
thalmie goitre. See Endoerin., 1918, 2, 342. Physiol. Abst., 3, 265.
(THYROID) El refiejo oculo-cardiaco en el hipertiroidismo (The oculo-cardiac reflex in Graves’ disease). Maranon (G.) Boletin Soe. Espanola de Biol., 1916. Session, May 26.
It has been reported that pressure on the eye-ball produces
236 ABSTRACTS
a greater slowing of the pulse in exophthalmic goitre of the ‘‘vagotonic’’ than of the ‘‘sympatheticotonic’’ type and that this phenomenon has diagnostic and prognostic value. Maranon tested the theory in 47 eases of all types of ‘‘hyperthyroidism’’ of various degrees of severity. Slowing of the pulse eight or more beats per minute was regarded as ‘“‘positive,’’ less than eight ‘‘negative’’ and acceleration of the pulse ‘‘inversion.”’ In the 47 cases reported the reaction was positive in 61.7%, negative in 34% and inverted in 4.2%. No relation could be established between symptomatology or severity of the disease and the sign or character of the reflex. Maranon regards it, therefore, as useless either for diagnosis, prognosis or as deter- mining treatment.—R. G. H.
(THYROID). Esperimenti di innesti eteroplastici di tiroide Basedowiani. (Heteroplastic transplantation of thyroid glands of exophthalmic goitre). Agata (G. D.) Lo Sperim. (Firenze), 1918, 71, 392.
Small portions of human thyroid glands from true cases of Graves’ disease were transplanted into rabbits and dogs. The grafts rapidly autolysed and became infiltrated by con- nective tissue from the surrounding tissue. The engrafted tissues degenerated equally in normal and in thyroidectomized animals.—A. L. T.
(THYROID) Experimental investigations of ENDEMIC GOITRE. Hirshfeld (l.) and Klinger (R.) Areh. f. Hygiene (Miinchen) 1916, 85, 139-188.
As a result of the authors’ study of the disease, combined with experiments on animals, the essential condition of the change is regarded as of metabohe origin; protein metabolism is specially affected, and the cause is probably specific, though not yet ascertained. The hypothesis that it is due to lack of iodine is rejected. Physiol. Abst., 1, 245.
THYROID Gland, Acute necrosis of the—. Bevan (A. D.) Surg. Clin. Chicago, 1918, 2, 1089. Abst. Surg. Gyn. & Obst. (Chgo.), 28, 300.
An unusual case of subacute infection of the thyroid in a man of 60 is described. A hard, tender, deeply situated mass above the sternoclavicular articulation associated with systemic symptoms suggested septic thrombus of a large vein. Opera- tion disclosed an inflamed thyroid which upon section showed
ABSTRACTS 23
|
round ¢ell infiltration but no pus. The wound was kept open and packed with iodoform gauze. Recovery did not take place and the diagnosis of thrombosis was repeated. Further opera- tion showed a total necrosis of the right lobe of the thyroid, which was removed, leading to prompt recovery. Upon encoun- tering a similar case in the future the author would immedi- ately extirpate the affected lobe—R. G. H.
THYROID gland, A proving of the—. Gillingham (H. P.) Homeopathic Recorder (Lancaster, Pa.), 1918, 33, 481-89.
An interesting series of experiments on thyroid feeding in six young women and in four guinea pigs, reported in the technical terminology of the homeopathie sect. In all, over 900 ‘‘symptoms’’ were produced which, by elimination of those obviously not due to the drug and of repetitions, were reduced to 407. Many of these were subjective, and some due, appar- ently, to an intercurrent rhinitis. Menstruation was delayed in one and hastened in four cases, with increased pain in all but one. An extended report is promised.—R. G. H.
THYROID gland, Brief synopsis of the structural changes occurring in the—when diseased. Vass (T. E.) West Va. Med. J. (Huntington), 1916, 11, 171-2.
No new data.
THYROID gland, Relation between—, metamorphosis and growth. Uhlenhuth (E.) J. Gen. Physiol. (Balt.), 1919, 1, 473-82.
From studies on the growth curve and age of metamor- phosis of Amblystoma opacum the author concluded that two substances are involved in amphibian metamorphosis; first, iodine, which is taken up from the food and stored by the thyroid gland, and second, an exeretor substance, which is evolved during the processes of growth and induces the ex- cretory function of the thyroid. This hypothesis explains why in larvae, whose metamorphosis is inhibited by lack of iodine (by a thymus diet), there is a drop in the growth curve at the time metamorphosis should occur; for at this time the exeretor substance begins to act and this results, since iodine is absent, in the excretion by the thyroid of a toxic substance, (probably the amino-acid tryptophane which is normally used to build up the thyroid hormone), which causes the breakdown of proteins and consequently a decrease in size of the larvae. Larvae
238 ABSTRACTS
whose metamorphosis is inhibited by extirpation of the thyroid or by the hereditary lack of a thyroid (as in the case of Typhlo- molge) show no drop in the growth curve, since in them the action of the excretor substance cannot result in the excretion by the thyroid of a toxie growth-inhibiting substance. At low temperatures less excretor substance is produced than at high temperatures during an equal rate of growth; consequently larvae kept at a low temperature reach a larger size than larvae kept at a high temperature, before they metamorphose. —lL. G. K.
THYROID gland, Syphilis of the—. .Report of a case. Schnei- der (E. H.) Calif. State J. Med. (San Francisco), 1918, 16, 484-85.
The patient, a woman of 48, gave a history indicating adenoma of the thyroid persisting 17 years. Upon the develop- ment of tertiary syphilis in the thyroid, the goitre disappeared. The luetic manifestation began as a slowly growing, painless in- duration involving the thyroid gland and the overlying muscle. The neighboring lymph glands were not enlarged. There ap- peared an area of caseation in the sternothyroid muscle, with general fibrosis of the thyroid and adjacent tissues. The dis- eased portion of the gland was removed and, upon the discovery of a positive Wasserman reaction, anti-luetic treatment was instituted, leading to complete restoration to health. The micro- scopic picture in the thyroid removed confirmed the diagnosis of syphilis. The theory that normal thyroid tissue will not harbor Treponema on account of the iodine present is men- tioned.—R. G. H.
THYROID glands, van Os (D.) Pharm. Weekblad. (Amster- dam) 1918, 55, 1426-31.
Unlike most pharmaceuticals, thyroid preparations are not standardized according to any adequate system. The usual plan of stating strength in terms of the weight of the fresh glands and gauging the dose accordingly, is very unreliable be- eause of wide variations in the amount of fat and H,O in the fresh glands. This is especially true of the glands from sheep. The I content of the dried, fat-free powder is fairly constant in preparations from sheep (ranging in 5 samples from 0.355 to 0.38%), but less so in those from swine (ranging in 7 samples from 0.15 to 0.266%). The Holland Pharmacopeia requirement of 0.4% should be lowered to not more than 0.3%. Experiments failed to show that I takes any part in the action of thyroid
ABSTRACTS 239
preparations. Since neither a chemical nor a physiological method of standardization is practicable, the most reliable basis for expressing the strength and calculating the dose is the weight of the dried, fat-free powder—Chem. Abst., 13, 360.
(THYROID) Goitre, A summary of the surgical treatment of—. Porter (M. F.), Surg. Gyn. & Obst. (Chgo.), 1919, 28, 431-2.
Generally speaking, surgical services are sought by goitre patients because of (1) toxic symptoms, (2) pressure symptoms, (3) deformity, and (4) a combination of these. Porter feels that it is highly important that patients with benign goitres be urged to have them treated, on account of the danger of their becoming toxic. In all patients who are good surgical risks subtotal thyroidectomy is the operation of choice. The general belief that the hyperactive portions of a hypertrophic thyroid are marked by redder color than the remainder of the gland is not borne out by Potter’s observations. The trouble-producing portion, as indicated by microscopic determination, has at times been found lighter and softer than the remainder. Various details of surgical interest are included. Especial emphasis is laid on the importance of foci of infection in goitre patients. Removal of these will at times cause the disappearance of the goitre. To leave such foci after a goitre operation is to invite recrudescence of the goitre and expose an especially vulnerable patient to extension of the infection.—R. G. H.
(THYROID GOITRE) Notes on radium treatment. Turner (D.) Edinburgh Med. Rev., 1919, 22, 79-86.
Turner has treated to date upwards of 50 eases of exoph- thalmie goitre with radium and, with one exception, all have been in some degree benefited. The one exception was a woman of 22, who died within two weeks after the treatment, of toxic thyroidism. The benefit that patients with exophthalmie goitre derive from the expert application of radium is in their general condition and in their general symptoms. They regain strength and weight and the tachycardia, tremor and breathlessness diminish or disappear. The thyroid gland becomes harder, but. usually not smaller, a fact of which it is wise to forewarn the patient, to prevent disappointment. Exophthalmos is little affected. Cosmetic operative measures can later safely be taken if desired. Turner treats each lobe and the isthmus of the thyroid, and the thymus. A dose of 200-400 milligram hours, with proper screening, is given, over each area, and the patient sent home for three months. Then, if necessary, the treatment
240) "ABSTRACTS
may be repeated. The skin in the throat region is very sensi- tive to the rays and must be earefully protected. As compared with X-rays, radium permits more exact dosage, penetrates bet- ter and is not disturbing to a nervous patient.—R. G. H.
(THYROID) GOITRE, Pathology of—, based upon specimens received at the State Institute for the Study of Malignant Disease, Buffalo, New York. Simpson (B. T.), Surg. Gyn. & Obst. (Chgo.), 1919, 28, 153-58.
Thyroid enlargements fall into the following groups: Simple goitre Physiological Toxic Multiple adenomata Cystic Solid Colloid goitre Exophthalmie goitre Neoplasms These differ markedly from each other and should receive correspondingly: differentiated treatment. Multiple adenomata form the commonest type. They begin probably in remnants of embryonic ducts at about the age of puberty; later they tend to the degenerative changes which give this type its numerous names. When very cellular these adenomata may cause intoxi- cation. Exophthalmice goitre is due to excessive secretion, whether normal or not. Five per cent of the specimens showed combinations of the foregoing types.—R. G. H.
(THYROID) Graves’ disease, The treatment of—(Erfahrungen und Studien iiber die Basedowsche Krankheit und ihre opera- tive Behandlung). Hilderbrand, Arch. f. klin. Chir. (Berlin), P9135 .0P st:
In most cases, according to Hilderbrand, surgical treat- ment, and in a few, even repeated operations, are indicated. In his experience 54 per cent were entirely cured and 34.3 per cent improved. Although in many cases a persistent thymus plays an important role, this often is not found. Very frequently symptoms are seen which can best be explained as due to ‘“hyperadrenalinemia.’’—J. K.
(THYROID) Hyperthyroidism. Marshall (H. P.) Northwest Med. (Seattle), 1916, 15, 8-11.
ABSTRACTS 241
This is a brief, systematic discussion. The author empha- sizes the observation that ‘‘most cases of hyperthyroidism be- long to the constitutionally nervous class, and have at some time or other passed through either a severe psychic or a severe physical strain.’’ He divides hyperthyroidism into two types: (1) low grade hyperthyroidism accompanied by non-hyperplas- tic goitre and in which parenchymatous degenerations predom- inate over toxic functional disturbances; and (2) high grade hyperthyroidism, usually accompanied by hyperplastic goitre in which toxie disturbances prevail. He thinks that all cases should be given medical treatment until it is evident that no improvement is to be expected. Then surgical interference is justified.—J. P. S.
(THYROID) Hyperthyroidism, Contribution to the study of— (Contributo allo studio dell’ ipertiroidismo: le variazioni dell’ acqua, dell’ azoto e del glicogene nei principali tesuti degli animali ipertiroidati). Sega (A.), Bull di Se. Med. di Bologna, 1916, 87, 125-42.
A rat, two rabbits and two dogs were fed large quantities of thyroid gland. The tissues were desiccated and analyzed for nitrogen and glycogen. The results are reported at length. No conelusions of general interest were reached, except that hydremia results from such treatment. The paper is chiefly of technical interest.—R. G. H.
(THYROID) Hyperthyroidism, Several cases of—, including three of acute Graves’ disease, in soldiers (Einige Falle von Hyperthyroidismus, darunter drei von akutem Basedow bei KriegsteilInehmern). Rothacker (A.) Miinchner med. Wehnschr., 1916, 63, 99.
Rothacker describes six cases of Graves’ disease which developed after the psychic strain of participating in battle. They were perfectly cured by rest. The cases are regarded by the author as demonstrating that the thyroid condition is not the essential factor in the disease, but that the symptoms, of which hyperthyroidism is one, are purely of psychie origin.
—J. K.
(THYROID) Hypothyroidism, Brown (J. R.) Northwestern Med. (Seattle), 1916, 15, 5-8.
The author states that the function of the thyroid is (1) to act as a stimulus to growth and development; and (2) to cause
242 ABSTRACTS
the oxidation of the waste matter of cell degeneration into end products easily excreted by the lungs, skin and kidneys and (3) to influence menstruation, pregnancy and lactation. True myxedema is rare, but mild thyroid deficiency is very common, especially in the Puget Sound country, as shown by the large number of compensatory goitres one sees daily. <A list is given of twelve objective symptoms suggestive of thyroid deficiency. Seven cases are briefly reported and the difficulty of determin- ing the right dosage in thyroid medication is emphasized. When thyroid medication is followed by loss of weight, a cor- rect diagnosis has been made. This loss of weight continues until the infiltrating mucin has been displaced, after which no further loss occurs no matter what dose is used. The author beheves that the simple enlargement of the thyroid in children and young persons is probably always an expression of hypo- thyroidism and recommends the use of thyroid extract.
—J. P.S.
(THYROID HYPOPHYSIS) Effect of extirpation of the thyroid gland upon the pituitary gland in bufo. Larson (M. E.), Anat. Ree. (Phila.), 1919, 15, 253-254 (abstract).
The anterior lobe and pars intermedia of the hypophysis both increased in size. after removal of the thyroid. The nuclei of the hypophysis of the experimental larvae were more nearly spherical than normal and the gland itself was less compact. The gland normally decreases in size during metamorphosis.
—K. R. H.
(THYROID HYPOPHYSIS) Miscellaneous notes regarding experimental studies upon the endocrine glands of rana and bufo..-Allen (B. M.); “Anat. Ree. -(Pinla.), 19i9lea5. 355 (abstract).
Tadpoles from which removal of the thyroid had been attempted and which metamorphosed later than normal were found to have imperfect thyroids. Three animals from which removal of the hypophysis had been attempted gave the usual pigmentation reaction of larvae without hypophysis, but meta- morphosed and were found to have imperfect hypophyses. Keeping hypophysisless tadpoles in dilute solutions of pituitrin did not stimulate pigment production. Hypophysis of cattle had no effect when fed to thyroidless tadpoles. The parathy- roids (epithelioid bodies) of thyroidless larvae were larger than normal.—kE. R. H.
ABSTRACTS 243
(THYROID HYPOPHYSIS) Results of extirpation of both thyroid and pituitary glands in tadpoles of bufo and rana. Aalenoecs- Mi). “Amat. Ree: (Phila:), 1919, 15, 252-253 (abstract).
The author found that removing both the thyroid and hypophysis fundament gave results similar to removing only the latter, in regard to retarded growth and development and deficiency of pigmentation. The limbs were retarded in growth in the same manner as after extirpation of either the thyroid or hypophysis. The germ glands developed proportionally with the size of the body.—E. R. H.
(THYROID) Infantiel myxoedeem. Scheltema (G.) Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919, 63, 637.
Treatment of infantile myxedema never results in complete normality ; abnormal bone structure always persists.—J. K.
THYROID insufficiency, The frequency of—in general practice. Johnson (R.) Dub. Jour. Med. Se., 1917, 144, 297-309. Abstr. Brit. Jour. Child. Dis., 1919, 16, 60. .
In treating a case it is well to have the eyes tested, since the headaches complained of are often lessened by the use of correct glasses. It is noteworthy that glasses worn before the taking of thyroid gland often have to be altered after a month or more of regular doses. Experience is the only teacher in the administration of the correct dose of thyroid. Small doses should be given at first, and then an increase; if the increase is not well tolerated return to the smaller dose. The weight should be recorded weekly. The author’s routine is to give one-tenth grain three times a day, with liquid paraffin or some other suitable laxative night and morning. A good working knowledge of the symptoms of slight thyroid insufficiency is essential, and it is certain that no drug gives more pleasure to both the patient and his medical advisor than thyroid gland given in the right dose to the right person—M. B. G.
(THYROID) Intensive study of fifty cases of neurocirculatory asthenia. Friedlander (A.) and Freyhof (W.L.) Arch. Int. Med. (Chgo.), 1918, 22, 693.
Of fifty cases of neurocirculatory asthenia studied, twenty per cent demonstrated to a greater or less degree, thyroid tumors. This is not considered unusual among men from the Ohio Valley region. Tremor was present in 96 per cent of the
244 ABSTRACTS
eases. Little importance is attached to these findings as a possible factor in causation of neurocireulatory asthenia. —H. W.
(THYROID) Les petits basedowiens (Minor exophthalmic goitre). Lian (C.) Presse Méd. (Paris) 1918, —, 665-67.
A general discussion tending to the conclusion that the ‘irritable heart of soldiers’’ is often due to minor degrees of exophthalmie goitre. This can be confirmed by the author’s ‘‘hyperesthesia sign.’’ (See ‘‘Le signe de l’hyperesthésie, ete.’’ abstracted in this number of Endocrinology.)—R. G. H.
(THYROID) Le signe de l’hyperesthésie de la region thyroid- ienne et le basedowisme fruste dans les troubles cardiaques des soldats (A sign of hyperesthesia in the region of the thyroid, and suspected exophthalmic goitre in cardiac dis- turbances of soldiers.) Lian (C.) Soc. Méd. des Hop. de Paris, 1918, 42, 1041.
In making systematic examinations of patients complain- ing of palpitation of the heart, Lian found in a certain number of instances, a hypersensitivity of the skin over the thyroid glands. This area of hypersensitivity may closely follow the margins of the glands, or may cover only parts of one or both lobes or the isthmus. Jn some eases the area of hyperirritability corresponds to the hypertrophied portions of the glands, hence the suggestion that the hyperirritability may mark out the loca- tion and extent of the diseased portion of the gland. In sub- jects suffering from circulatory or nervous disturbances simu- lating exophthalmie goitre, this sign of regional cutaneous hyperirritability may be the means of establishing the seat of the trouble directly or indirectly in the thyroid gland. It was noticed, however, that in chronie cases, where an enlargement had been of long standing, there might be no evidence of hyper- irritability, consequently the sign is likely to be elicited only in the initial stages of thyroid abnormality or in its exacerba- tions.—A. L. T.
(THYROID LIVER) Hemophilia: Experimental data bearing on the effect of glycerinized extracts of visceral hemophilic tissue on the coagulation time of blood. Lowenburg (H.) and Rubenstone (A. I.) Arch. Ped., 1918, 35, 757. Abstr. from J. A. M. A. Oct. 12, 1918
The authors noted that normal tissue extracts uniformly accelerate the coagulation time of calcium plasma and that
ABSTRACTS 245
most of the tissues of a hemophilic patient, with the exception of thyroid and liver, seem to exert almost the same influence on coagulation. Thyroid gland and liver not only caused a prolonged coagulation time, amounting to two and one-half times the corresponding normal time, but actually inhibited the action of the calcium added to the plasma, so that the coagulation of the calcium plasma was prolonged almost two minutes. These observations were repeated with uniform re- sults and though admittedly limited to the tissues of one hemo- philic, they are striking. There is a possibility that the thy- roid and even the liver may secrete an antithrombiec substance or enzyme, which may be in part, if not principally, the cause of the deranged coagulative mechanism of hemophilic blood. —M. B. G.
(THYROID). Maladie de basedow et emotions de bombarde- ments. (Basedow’s disease and emotional states from bom- bardments.) Etienne (G.) et Richard (G.), Soe. Méd. des Hop. de Paris, 1918, 42, 1196.
Apropos the theories of Crile and of Cannon, regarding the intermediation of the adrenal glands in the etiology of Base- dow’s disease from psychic trauma, the authors describe two cases in which the views of Crile and Cannon appear to be con- firmed ; on the other hand two eases are reported resulting from comparable external causes, but instead of having an elevation of blood pressure there occurred a diminution. In the former two cases recovery was associated with a gradual fall of blood pressure to normal, while in the latter two cases the blood pressure rose to normal in the process of recovery. Conse- quently the assumption that the adrenal glands respond more readily to sympathetic nerve action than do the other endocrine glands owing to absence of intercalated neurones in the nerves passing to the adrenal glands does not form a safe basis for the generalization that hyper-activity of these glands is a precursor to dystrophy or abnormal functionation of the thyroid appa- ratus.
(It should also be noted that there is no unequivoeal evi- dence that the adrenal glands have anything to do with the maintenance of vasomotor tone or general blood pressure. )—
Ae L.-T.
(THYROID) Neues Verfahren zur Herstellung und Isolieren der inneren Sekretion der Schilddriise, sowie auch der in- neren Sekretion aller lebenden und iiberlebenden Driisen und Organe (New method of isolating hormones). Eiger (MM. Zentr. f. Physiol. (Leipzig), 1917, 32, 64-6, 209.
246 ABSTRACTS
The method is to wash out the blood by saline fluid (Ring- er’s or Locke’s) via the artery and then to continue the per- fusion and collect the issuing fluid from the veins; the fluid will contain the natural secretion. The method has been ap- plied to several endocrine and other organs and tissues, inelud- ing tumors benign and malignant. Details are at present given only for the thyroid; its secretion is water-clear, and contains no protein, iodin, or choline. It keeps for months; it inereases the action of small doses of adrenin and increases the output of phosphorus in metabolism experiments. Thyreo- glandol (Roche) and Burrows and Welcome’s tabloids used as controls have the same action in less degree.—Physiol. Abst., 3, 328.
(THYROID) Note on the preparation of a soluble concentrated product of the thyroid gland. Rogoff (J. M.), Jour. Pharm. Exp. Ther. (Balt.), 1918, 12, 207-9.
The preparation of a concentrated active product of the thyroid gland, which is soluble in water, is briefly described. —L. G. K.
(THYROID) Observaciones experimentales sobre el exoftalmos hipertiroideo (Observations on experimental hyperthyroid exophthalmos). Maranon (G.) Congr. Asoc. Espanola para el Prog. de las Ciencias, Valladolid, Oct. 19, 1915.
Experimentally Maranén has been able to produce in rab- bits the tetrad of symptoms characterizing Graves’ disease, namely, emaciation, tachycardia, nervous exeitability and hght exophthalmos. The exophthalmos in thyroid-treated animals as in clinical Graves’ disease was inconstant. If the animals were previously castrated the exophthalmos appeared more con- stantly and more intensely. Injections of glycerine extracts from a Graves’ patient, herself not having exophthalmos, pro- duced this symptom in a rabbit. This is a remarkable observa- tion since the thyroid glands of such patients are usually de- pleted of active constituents. The symptom of exophthalmos was observed to be accentuated by fear in thyroid treated rab- bits. In one such animal, which was literally frightened to death, the exophthalmos was very pronounced.—R. G. H.
(THYROID) Observations on the blood pressure in cases of dysthyroidism. Swan (J. N.) Interstate Med. J. (Chgo.), 1916, 23, 186-203. :
ABSTRACTS 247
Discusses the varying degree of intensity of the blood pressure findings, in fifty eases of dysthyroidism. The obser- vations were made during the operation of partial thyroidec- tomy, and at intervals for several weeks after operation. It was concluded that the first effect of dysthyroidism on blood pressure is to reduce it in the systolic phase. This is accom- panied by disturbance of pulse pressure, usually, an increase. After a varying period the systolic pressure begins to rise and gradually chronic hypertension develops. Functional myoecar- dial tests indicated that in nearly all cases the heart muscle was affected whether there were clinical symptoms of this or
not.—R. G. H..
(THYROID) Observations on the prevalent types of GOITRE in western Washington. Jones (EK. O.) Northwest Med. (Seattle), 1916, 15, 13-16.
Jones cites the studies of D. C. Hall who found, among the students of the University of Washington coming from the counties on Puget Sound and on both slopes of the Caseade Mountains, goitre in 13 to 33% per cent; while students from the eastern and southern counties of the state showed goitre in a very small per cent. The author accepts Plummer’s classi- fication and contrasts his own records of 150 cases with those of the Mayo Clinie. The chief differences were the relative infrequency of true exophthalmie goitres in Washington (16 per cent), and the proportionately large number of secondary hyperthyroidism (78 per cent). In 117 cases the average length of time between the appearance of the goitre and-the onset of toxic symptoms was 6.3 years.—J. P. S.
(THYROID) Over hypothyreoide (Minor thyroid insufficiency). Bolten (G. C.) Psychiat. en neurol. Bl. (Amsterdam), 1918, Za o-1 To.
In an excellent article B. points out that this condition plays a much more important role than even many endocrinolo- gists believe. The following classification is offered:
A. Direct symptoms.
1. Diminished gastro-intestinal secretions; nervous dyspepsia. . 2. Changes in metabolism; diminished oxidation; di- minished salt exeretion. a. Gout, sciatica, ete. b. Constitutional obesity.
248 ABSTRACTS
c. Dereum’s disease. 3. Symptoms of intoxication due to diminished pro- duction of enzymes. a. Nervous headache (‘‘migraine’’). b. Epilepsy (genuine). ce. Neurasthenia. d. Certain light cases of dementia precox. e. Symptoms of menopause. B. Indirect symptoms due to sympathetic hypotonia. a. Atrophic diseases of skin, nails and subeutane- ous tissue. b. Quincke’s edema. ce. Diminished power of regeneration of skin, bone, ete. C. Mixed forms—myxedema (mixture of B and A, 3, d). The possibility of endocrine factors in symptomatology should always be kept in mind.—J. K.
(THYROID, PARATHYROID) Eye affections following EX- PERIMENTAL THYROIDECTOMY. Edmunds (W.) The Ophthalmoscope (London), 1916, 14, 300-302.
Complete thyro-parathyroidectomy in dogs is frequently followed by cataract. Analysis of the experiments leads the author to conclude that the altered secretion of these organs produced by interference with their nerve supply is more inimi- cal to the nutrition of the cornea than are the toxic effects due to their complete excision. Physiol. Abst., 1, 245.
(THYROID) Postpneumonic strumitis. Zindel (L.) Beitr. z. Chir. (Tiibingen) 1918, 110, 649.
Description of a case of purulent inflammation of a goitre after pneumonia. Pneumococci were found in the pus in pure culture. Such cases are extremely rare. The author could find only 12 others in the literature.—J. K.
(THYROID) Preoperative considerations of exophthalmic goi- tre. Berkman (D. M.) St. Paul Med. J., 1916, 18, 300-303.
A statistical analysis-of the mortality records of the Mayo Clinic, 1914 and 1915. Among other things the data indicate that the duration of the disease prior to operation has httle re- lation to the operative risk. Cardiae deterioration was rela- tively inconspicuous, but was present in some degree in all but 6 of the 24 cases reported. The operative mortality had reached
ABSTRACTS 249
a level of 2.89 and 2.63 per cent, respectively, in the two years, a level which the author believes can not be much lowered without refusing operation to patients who should have the benefit of the doubt.—R. G. H.
THYROID preparations, A method for the standardization of—. Rogoff (J. M.) Jour. Pharm. & Exp. Therap. (Balt.), 1917, 10, 199-208.
A method is deseribed in which the specific action of thy- roid gland (emaciation, angulation of head, ete.) upon tad- poles is used to assay the physiological value of commercial thyroid preparations. It was shown also that the value of thy- roid is in proportion, not to its total iodine, but to the iodine in combination. (See Endoerin., 1917, 1, 55-56.)—L. G. K.
(THYROID) Production of CONGENITAL GOITRE. McCar- rison (R.) Proe. Roy. Soe. (Lond.), 1916, 89B, 322-327 ; Indian J. Med. Res. (Caleutta), 1916, 4, 183.
The experiments recorded were made on goats, and con- firm the author’s view that congenital goitre is due to the action on the fetal thyroid of toxic substances derived from the ma- ternal intestine. These substances are the products of the micro-organisms originating in fecally contaminated soil which are conveyed to man and animals by infected food and water. The prevention (by muzzlng, ete.) of the entry into the ali- mentary canal of anything but clean food and water prevents also the entry of the infecting agent. The goitres themselves were sterile. Physiol. Abst., 1, 312.
THYROID, Report of a case of sarcoma of the—. Vanden Bere (H. J.) J. Michigan M. Soc. (Grand Rapids), 1917, 16, 18-20.
A brief case report illustrated with photograph and two microphotographs. The case terminated fatally.—R. G. H.
(THYROID) Simple goitre. Cameron (M. H. V.) Can Med. Assn. J. (Toronto), 1919, 9, 302-309.
A brief discussion of the classification, symptoms, etiology and treatment of goitre. Contains nothing new.—lL. G. K.
(THYROID) Struma bij een meisje van 16 jaar (Goitre in a girl of 16). Noordenbos (W.) Nederl. Tijdschr. v. Geneesk. (Amsterdam), 1916, 60 (ii), 596.
250 ABSTRACTS
A demonstration of a girl upon whom a goitre operation was performed. Histological examination showed cancer,
—J. K.
(THYROID) The effect of typhoid inoculation on endemic goi- tre at the Lawrence Military Asylum, Sanamar, Punjab. Nicholson (M. A.), Lancet (Lond.), 1916, (ii), 275-77.
This asylum was established in 1848, and after a few years endemic goitre became very common among its inmates. Nich- olson found that inoculation against typhoid had no effect in any way on the course of the endemic goitre.—J. P. §S.
THYROID. The etiology and treatment of exophthalmic goitre with special reference to the use of radium. Aikins (W. H. B.) Canada Lancet (Toronto), 1916, 49, 548-59.
Data published elsewhere. See Endoerin., 1917, 1, 104.
(THYROID) The effort syndrome together with a considera- tion of certain murmurs. Conn (A. E.) J. Am. M. Assn. (Chgo;), 1988, 71, 2132-397:
Symptoms associated with exophthalmie goitre are in some respects lke those found in the effort syndrome. The symptoms in common are nervousness, tremor and tachyeardia. In the effort syndrome, exophthalmos or thyroid enlargement is usually absent. There need be no diarrhea. Tachycardia may be absent. The tremor is really no tremor, but a shake, and it attains degrees of severity never seen in the most ad- vaneed cases of exophthalmie goitre. On the other hand, when tachyeardia in exophthalmie goitre develops to as high a rate as is attained in the effort syndrome, there is usually a certain degree of dyspnea as well, and the size of the heart is definitely increased, whereas there is no reason for believing that this occurs in the effort syndrome. Between the conditions, a strik- ing difference is observed at night. When tachycardia and dyspnea in exophthalmie goitre are sufficiently severe to attract attention, they persist, as a rule. In the effort syndrome, on the other hand, both disappear. The presence of small thyroid tumors or slight symmetrical enlargement of the gland can scarcely be taken as evidence in favor of hyperthyroidism. Such enlargements oceur in large numbers of persons in certain see tions of the United States, as elsewhere. They are not neces- sarily accompanied by symptoms either of developing exoph- thalmic goitre or of the effort syndrome. (Quoted.)
ABSTRACTS 251
(THYROID) The liberation of the internal secretion of the thy- roid gland into the blood. Rogoff (J. M.) Jour. Pharm. Exp. Ther. (Balt.), 1918, 12, 193-206.
An attempt was made to detect in the blood coming from the thyroid glands of three dogs, a physiologically active secre- tion, by feeding the dried blood to tadpoles. One dog, whose thyroid glands were rich in colloid and had a good iodine con- tent, yielded evidence of an active secretion into the blood col- lected from the glands during massage and during stimulation of the cervical sympathetic nerve. This was not taken as evi- dence of the existence of secretory nerves to the thyroid since the slowing of the blood flow due to vasoconstriction during the nerve stimulation may have resulted in-a higher concentration of the hormone in the blood coming from the gland, even though the rate of liberation remained constant. The other two dogs whose glands were hyperplastic and contained no detectable iodine yielded negative results.—L. G. K.
THYROID therapy in ophthalmic practice. Dunn (P.) Med. Press (Lond.), 1919, 107, 200-202.
The author believes that the thyroid plays an important role in various diseases of the eye. Thyroid medication js valuable in ‘‘keratitis punctata’’ and in slowly healing corneal uleers. The paper bears out a well grounded hypothesis that thyroid secretion is a potent general cell stimulant.—R. G. H.
(THYROID) The relative frequency in recruits with and with- out thyroid enlargement of certain signs and symptoms which occur in neurocirculatory asthenia. Addis (T.) and Kerr (W. J.) Arch. Int. Med. (Chgo.), 1919, 23, 316.
From a survey of recruits, the authors found that those ‘signs and symptoms which occur in neurocireulatory asthenia, and which may be present in toxie goitre were not more com- monly seen in recruits with thyroid enlargement than in those who had no enlargement. The enlargement of the gland in such cases is considered incidental and not causative. The conelu- sion is drawn that the development of toxie goitre is not the cause of the syndrome even in men with thyroid enlargement. Hence, there is no reason why cases of thyroid enlargement with the syndrome of neurocireulatory asthenia should be con- sidered as in any essential respect different from those without thyroid enlargement.—H. W.
202 ABSTRACTS
(ULTIMOBRANCHIAL BODY) The origin of the ultimobran- chial body and its relation to the fifth visceral pouch in birds. Johnson (C. E.) Jour. Morph. (Phila.), 1919, 31, 461. ;
Observations on embryos of coot, gallinule, tern, and chick show that the true fifth visceral pouch in birds is a diverticulum distinet from that which gives origin to the ultimobranchial body. The last-named body, contrary to the usually accepted accounts, arises not from the fifth pouch, but from a divertieu- lum developed medially to the fifth pouch. Observations on embryos of the turtle, Chelydra serpentina, and comparisons with accounts based on other reptiles, show that the fifth pouch and the ultimobranchial diverticulum in birds are homologous with those of reptiles—Author’s Abst.
VAGATONIA. Werley (G.) Southwestern Med. (El Paso, Texe), 1918, 2; 125:
A very brief case report with an uncritical exposition of Falta’s well-known theories of autonomic pathology.—R. G. H.
The abstracts in this number have been prepared by the staff assisted by:
W.E. Blatz, University of Toronto.
L. G. Kilborn, University of Toronto.
E. Uhlenhuth, Rockefeller Institute, New York.
With the permission of the editors, certain abstracts have been quoted from ‘‘Physiological Abstracts,’’ ‘‘Chemical Ab- stracts’’ and ‘‘Surgery, Gynecology and Obstretrics.”’
EMmDOCRINOLOGY
THE BULLETIN of the cASSOCIATION for the STUDY of
MNTERNAL ~SECRETIONS
JULY-SEPTEMBER, 1919
REMARKS ON THE FUNCTIONS OF THE SUPRARENAL GLANDS AS REVEALED BY CLINICAL-PATHO- LOGICAL STUDIES OF HUMAN BEINGS AND BY EXPERIMENTS ON ANIMALS.*
Lewellys F. Barker, M.D.
Johns Hopkins Hospital, Baltimore.
The Association for the Study of the Internal Secretions has been organized and its journal, Endocrinology, is being pub- lished in the interests both of the advance of science and of better medical practice. Our objects include not only the further devel- opment of a pure science of endocrinology, but also the evolution of an applied science of endocrinology and the improvement of the medical art as far as it is exercised in endocrine domains. The membership of our Association includes therefore not only investigators and teachers in the pre-clinical medical sciences of anatomy, histology, embryology, physiology, physiological chemistry, pharmacology and experimental pathology, but also many representatives of the clinical sciences of diagnosis and therapy and of the closely allied sciences of pathological anatomy and pathological physiology. Only through the mutual respect, the thorough reciprocal understanding and the closest co-operation in every way of workers in all these sciences can
*Address of the President of the Association for the Study of Internal Secretions, Atlantic City Meeting, June 9th, 1919.
254 FUNCTIONS OF SUPRARENAL GLANDS
progress in knowledge of the internal secretions and utilization of it best be made. It is hoped and believed that the Association and its journal may go far toward stimulating research in clinies as well as in laboratories and toward co-ordinating the interests of the workers in all subdivisions of the endocrine field.
No better example of the value of correlation of the activi- ties of endocrine investigators of different sorts could, perhaps, be given than that offered by a consideration of studies in the functions of the suprarenal glands in health and in disease; and at this meeting, at which it is my privilege to preside, it is to this subject that I desire to refer. From the time of the great clinician Addison to the present, practising physicians have been deeply interested in the normal and abnormal functioning of the suprarenals, and with the rise of laboratory research a goodly number of scientists have busied themselves with researches bearing upon the structure and functions of these mysterious organs. You will recall that the president of this association last year took one phase of the subject into careful consideration, and a glance at the several quarterly issues of our journal shows how widespread throughout the world and among different types of investigators is the interest in, and how painstaking is the research at present going on in attempts to elucidate, the influences of these glands upon other parts of the body under normal conditions and in pathological states. That out of the studies already made and those that will be conducted in the near future, when they are properly co-ordinated, much will emerge that will illuminate an area hitherto dark and obscure, no physician with vision can doubt. Though we know but little as yet in comparison with what there is still to be learned about the suprarenal glands, the contributions that have been made and that are now being made give us every reason to hope that ere long the secrets of these organs will, by a band of earnest work- ers, be wrested from nature.
The advantages for the study of the suprarenals derivable from division of labor in the clinical and preclinical medical sciences he especially in the variety of the backgrounds of the workers in the several sciences, in the differences in the problems they set out to solve, and in the modes of approaching: the solu- tion of these problems by means of practical-technical procedures of different kinds. The anatomical group, the physiological-
BARKER 255
pharmacological group, the experimental pathological group, and the clinical group of workers have different kinds of past experi- ences to draw upon, different materials to occupy themselves with, a different body of principles to guide them, a different set of technical methods to employ, different interests to stimulate them, and different purposes to achieve. In the end, their activ- ities and results, when co-ordinated, converge; for all make use of the general method of science, and each contributes to knowl- edge that can be used by all. Thus the special desires, the special ideas, and the special activities of the single workers can ultimately be fused in the service of the emotions, the ideas and the purposes of endocrinologists in common.
Certain very stimulating ideas regarding the significance of the suprarenal glands have come, as everyone will admit, from observation at the bedside of sick human beings, and in the post- mortem room. Thus, when Addison observed that certain pa- tients manifested profound asthenia, marked disturbances of digestion, and a peculiar bronzing of the skin, and that in their bodies, after death, there was extensive chronic disease and destruction of the suprarenal glands, the first great step toward the recognition of the significance of these structures was made. Clinicians and pathologists since Addison’s time have done much to elaborate the syndrome he first observed and to enlarge our ideas of the pathological changes that may underlie it, and of its etiology. On the clinical side there are many special observa- tions upon the motor asthenia (affecting both the voluntary muscles and the heart muscle), the low blood pressure, the anorexia, nausea, vomiting and diarrhoea, the tendency to faint- ing spells, the pigmentation of the skin and mucous membranes, the white line phenomenon, the anaemia, the oliguria, the slow- ing of the metabolic processes, the hypothermia, and the lowered resistance to infections. In some cases there was obesity, in others emaciation. In addition, clinicians have studied certain syndromes that more or less closely resemble the symptom-com- plex of Addison’s disease, but are not identical with it—syn- dromes that may be met with in infaney and childhood, in ado- lescence, in middle life or in old age, syndromes that sometimes develop slowly, sometimes acutely. On the pathological side many special observations have also been made on the bodies of patients dead of Addison’s disease or of diseases, chronic or
256 FUNCTIONS OF. SUPRARENAL GLANDS
acute, resembling it. The frequency of tuberculous lesions of the suprarenals in such cases was early recognized, and the occa- sional occurrence of cancerous disease and of diffuse fibrosis of these glands was described. In some instances, no changes could be recognized in the suprarenal glands themselves, but lesions involving the nerves that supplied them were discovered. In still other cases, neither the glands nor their nerves showed any recognizable changes, and a functional disorder of the glands secondary to diseases elsewhere in the body had to be assumed to have existed. After the doctrine of internal secretions developed and it was believed that the suprarenal glands belong among the endocrine organs, it was natural for clinicians to advance the hypothesis that the symptoms of Addison’s disease in which the glands were slowly destroyed were due to insufficiency of the internal secretions of these glands—to a hypo-suprarenalism (or hypoadrenia), and that in conditions resembling but not iden- tical with Addison’s disease there was also a greater or less degree of suprarenal insufficiency or hypofunction. <As a result of this conception there has been, on the one hand, much speculation as to the possible causes of the hypofunction in instances in which no organic changes in the suprarenals could be found, and, on the other, an attempt favorably to influence the course of Addison’s disease and of allied conditions by the institution of substitutive organo-therapy of different sorts. Another very important idea that emanated from clinical-pathological observa- tions is that of a connection between the function of the supra- renal glands and the development, and behavior during life, of the secondary sex characters. Thus clinicians and pathologists have observed that in association with certain diseases (especially tumors) of the suprarenal glands, or of aberrant masses of supra- renal tissue in other organs, peculiar disturbances in sex domains may be met with. For example, if the disease be present in the foetus, and the child live, the condition of pseudo-hermaphro- ditism is prone to develop, the individual presenting to a greater or less extent the external habitus and the external genitalia of one sex though the primary sex organs (testes or ovaries) are those of the opposite sex. Or, if the disease be a little later in its development, the external and internal genitalia may be in accord, but the child matures too soon (pubertas praecor), a little girl of 2, 3 or 4 years of age perhaps, presenting the sexual
BARKER 297
appearances of a girl of 14 (pubic and axillary hairs, mammary development, menstrual flow, adolescent psyche), or a boy of 6 or 7 may exhibit the somatic and psychic sexual phenomena of a boy in his teens. Or, again, should the disease develop still later in life, the body may become slowly or quickly covered by an abundant growth of hair (hirsutismus) and in the case of a female, in addition to the hirsutism of the trunk and extremities, and the growth of a beard and moustache upon the face, the patient may present somatic and psychic asthenic features re- sembling those of the male (large clitoris, great muscular power, masculine voice, love of hard labor, ete.), a condition known in clinical papers as virilismus. Since this sthenic condition con- trasts strongly with the asthenia or adynamia that characterizes ‘Addison’s disease, in which the suprarenal glands are, as a whole, slowly destroyed, it was natural for clinicians to think of.viril- ismus (and the allied conditions—hirsutism, premature puberty and pseudo-hermaphroditism)-as examples of overactivity: or hyperfunction of the suprarenal glands, though the terms hyper- suprarenalism and hyperadrenia, when they have been used at all, have been applied in a different way, and perhaps less justi- fiably, namely, to conditions in which the blood pressure is in- ereased. Clinical observations then, controlled by pathological- anatomical examinations made after death or after operations upon the living, have yielded these two great conceptions: (1) the conception of a loss or diminution of the function of the suprarenal glands characterized by the Addisonian syndrome, and (2) the conception of an overactivity of these glands char- acterized, according to the time at which the overactivity appears, by pseudo-hermaphroditism, by precocious puberty or by vir- jlism.
Before considering further the bearing of clinical-pathologi- cal observations upon the functions of the suprarenals, let us recount some of the more important contributions of pre-clinical scientists, working in experimental laboratories, to our under- standing of the nature and activities of these organs. First of all, the anatomists and histologists showed us that each human suprarenal gland is divisible into two parts, cortex and medulla, which differ from one another entirely in their morphological appearances, and which, therefore, presumably, have entirely different functions. The cells themselves, as well as the way
258 FUNCTIONS OF SUPRARENAL GLANDS
they are arranged, are wholly different in the cortex from those in the medulla. The medullary cells closely resemble certain cells found along the sympathetic trunks, along the aorta, and in ‘the carotid glands; they show an especial affinity for compounds of chromium, and are accordingly known as chromophile cells. Indeed, it is believed that the medulla of the suprarenal gland is only a part of a much larger anatomical-physiological system of cells, now known as the chromaffine system. So firmly accepted is this conception of the identity of the widely distributed chromophile cells that what is proven to be true of one portion of the chromaffine system is now likely to be assumed to be true of all the other portions of this system, though strange to say many investigators, who should be familar with the total extent of the chromaffine system, seem, when writing of suprarenal function, to forget that there is a considerable body of chromaf- fine tissue outside of, and even far distant from, the suprarenal glands. A second important laboratory contribution that goes far toward confirming the views just mentioned of a totally dif- ferent structure and function for cortex and medulla respecet- ively has been made by the embryologists and comparative anatomists who have demonstrated (1) that in human beings and higher animals generally the medulla of the suprarenal is derived from the Anlage of the sympathetic nervous system, whereas the cortex of the suprarenal has an entirely different genesis, being derived from the germ epithelium, and (2) that what correspond to cortex and medulla of the suprarenal of higher forms are in lower vertebrate forms not even spatially associated, but exist as parts of two anatomically separate and independent series of organs—the one a part of the so-called interrenal system of organs, the other as a part of the chromaffine system. Thus, in the eel, what corresponds to cortex or interrenal system includes the corpuscles of Stannius and Giacomini’s mass in the pronephros. Even in man it has been found that small masses of accessory interrenal cells (‘‘suprarenal rests’’) may be met with in the kidneys and at various sites within the abdomen and pelvis, though by far the majority of cells of interrenal origin in man and higher vertebrates are included in the suprarenal cortex. A third important contribution made by laboratory experiment was the bringing of the proof that the functions of the interrenal system are necessary for life and
BARKER 299
that the death of a higher animal that is due to total extirpation of the adrenals must be the result of removal of the interrenal portion (cortex) rather than of the removal of the chromaf- fine portion (medulla) of these organs; it would seem that though there is enough chromaffine tissue outside of the supra- renal glands to maintain life (if, and we are not yet sure of this, the functions of the chromaffine system are essential to life) there is not enough interrenal tissue outside the supra- renals to maintain life after the suprarenal cortex has been ex- tirpated. A fourth discovery of great significance was that of Schafer, who demonstrated that extracts of the suprarenal glands when injected cause a rise in blood pressure. And a fifth funda- mental laboratory contribution was the demonstration that this blood-pressure-raising substance is derived from the chromaffine part (medulla), not from the interrenal part (cortex), and that it is a well-defined substance (adrenalin of Takamine; epinephrin of Abel) the chemical constitution of which has been determined, and methods for its artificial manufacture worked out. A sixth laboratory discovery that may prove to be of real importance is the isolation by Voegtlin and Macht of a pressor substance, not epinephrin, from the suprarenal cortex; this substance and the abundance of lipoid substances present in the cortex require study.
Coincident with and following upon these several funda- mental findings by laboratory workers began a series of experi- ments further to determine the functions of the medulla of the suprarenal and the epinephrin it produces. A period of intensive experimental research yielded results that served as materials out of which various hypotheses concerning the significance of the suprarenals were constructed. Among the better known of these attempts at generalization are what are known as (1) the fonus theory, which assumes that epinephrin maintains in one way or another constantly a state of tonus in smooth muscle innervated by the sympathetic nervous system; (2) the emergency theory, which regards the suprarenals as an apparatus for discharging epinephrin in emergencies only; (3) the antitoxic theory, ac- cording to which suprarenal products neutralize poisons; or its variation, which assumes that the suprarenal products them- selves are detoxicated substances; and (4) the metabolic theory; which postulates that the presence of minute quantities of
260 FUNCTIONS OF SUPRARENAL GLANDS
epinephrin are necessary for the metabolic activities of the tis- sues, including the oxygenation of the blood. Thus‘the results of experiments led to the formulation of hypotheses, which in turn stimulated further research.
These speculations have really had a heuristic effect, for groups of experimental workers have undertaken investigations in laboratories to corroborate or to refute them, and as results of their studies many important discoveries can be recorded. Thus we now possess valuable information regarding (1) the quantity of epinephrin present in the suprarenals, in other chromaffine tissues, in the various organs, and in the blood, under certain conditions; (2) the circumstances (pain, asphyxia, ex- citement) in which epinephrin is discharged into the suprarenal veins; (3) the influence of epinephrin (a) on the body as a whole, after subcutaneous injection, (b) on perfused organs like the heart, the spleen and the kidney, (ce) on strips of muscle like that of the uterus, the intestine, the iris, the bronchial mus- culature and the bundle of His; (d) on the calibre of, and the blood-flow through, arteries, veins and capillaries in different regions of the body; (e) on the functions of nerves and of neu- ronal synapses; (f) on the content of the blood in its different varieties of white corpuscles; (g) on the discharge of red blood corpuscles from the sinuses of the liver; (h) on the secretion of saliva and other digestive juices, and (i) on the mobilization of sugar and the sugar-content of the blood. Discoveries such as these show the great value of hypotheses as the groundwork of action, for the careful testing of a hypothesis, whether it be true or not, advances knowledge. John Hunter’s ‘“‘ Don’t think; try,’’ really meant, ‘‘Think, but do not stop at thinking; test your thought by trial.’’ Clinicians and pathologists, to-day, are making their observations and their classifications of disease of the suprarenal glands in the light of all this new knowledge. They, too, are speculating regarding the significance of their observations at the bedside and are subjecting their hypotheses to tests by means of experimental methods carried on during the life of patients and by means of histological and chemical studies of the dead. I need refer only to (1) the use of epinephrin in the treatment of asthma, of urticaria, and of angio-neurotic oedema, (2) the administration of suprarenal gland in Addi- son’s disease, and in other states of asthenia, hypotension, and
BARKER 261
hypothermia, (3) the clinical conceptions of the chromaffino- pathies and the interrenopathies and their subdivisions of hyper- function, hypofunction and dysfunction, and (4) the Loewi test and the Goetsch test in clinical diagnosis, to recall to your minds some of the directions in which physicians are speculat- ing and working in the hope of advancing knowledge in the clin- ical sciences of diagnosis and therapy. Real progress is here certainly being made. Though many of the hypotheses now held will later be discarded and some of the classifications will doubtless have to be revised, still these hypotheses and classifica- tions will have served their purpose if they have stimulated closer observation and continuous experimentation, and have been regarded merely as stepping-stones in the path of progress. Clinicians and pathologists, as well as physiologists, have the right to speculate, provided their speculations are based upon the facts that have already been accumulated, and provided also that they persist in subjecting their speculations to rigid tests by further observation and experimentation.
Time will not permit me further to elaborate the topic in this brief address. But enough has perhaps been said to justify the optimism that exists among those who, both in the pre-clinical and the clinical sciences, are absorbingly occupied with the study of the suprarenal glands.
FETAL AND MATERNAL ATHYROSIS. II.
G. Ennis Smith Institute of Public Health, Western University, London, Canada.
INTRODUCTION
The author has described a thyroid disturbance (1) that is prevalent among new-born domestic animals in western sections of this continent. The disease is one which affects swine, sheep, cattle, horses, goats and dogs, and occurs among such a wide range of animals that it appears very probable that if human beings were subjected to the same relative conditions a more or less severe form of a similar thyroid disturbanee would result. A profound influence of pregnancy upon the maternal thyroid, which may develop into a pathologic condition, has to some extent been recognized, but the attention has been confined mainly to the maternal organism. The manifestations of the thyroid dis- turbance among domestic animals show very clearly, however, that the effects are more disastrous to the fetus than to the ma- ternal organism. It is our opinion that when this subject has been thoroughly explored many of the cases of infantile fatality and of arrested development of children which are now vaguely designated as congenital, will be found to arise from a lack of function of the fetal thyroid which may be overcome by a proper diet and conduct of the mother during the gestation period.
REVIEW OF THE THYROID DISTURBANCE OF DOMESTIC ANIMALS
The disturbance is to a large extent endemic to certain see- tions and appears to correspond more or less with the distribu- tion of goitre. Many of the young are born dead, others die in an hour or two and very few live more than 24 to 36 hours. The loss in Montana alone has amounted to about one million young pigs annually. While the loss is heaviest among swine, there are numerous cases among sheep and occasional cases among horses and cattle. The symptoms in the affected animals cor- respond to the symptoms of myxedema and also to the symptoms occurring after extirpation of the thyroid. The most striking feature of typical specimens is the absence of hair. The hoofs are thin-walled, short, brittle, and plainly in an undeveloped
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SMITH 263
condition. The iodine content of the thyroid is extremely low and varies inversely with the severity of the malady. There is a pronounced hyperplasia of the gland with a great multiphea- tion of the cells of the interstitial tissue. The malady is un- doubtedly due to the decreased physiological activity of the fetal thyroid which the author has designated as fetal athyrosis. The evidence eliminates an infective agent as a possible factor and indicates that the cause of the malady is a nutritional deficiency caused by a lack and possibly an uneconomic use of available iodine. Pigs born in Mareh and April are more frequently affected than those born in May and June and even in the badly affected regions the fall litters are usually normal. Diets that tend to produce rapid growth when the amount of available iodine is low appear to make the malady more severe and to exhaust the fetal thyroid of its physiologically active constituent.
Hart and Steenbock (2) have been able to produce hairless pigs experimentally with symptoms that correspond exactly to those described by the author, by feeding the pregnant sows a high protein diet, and they confirmed our conclusions that the malady can be overcome by feeding an abundant supply of iodine. They were also able to demonstrate that the maternal as well as the fetal thyroid was involved, although to a much less degree.
While the shght disturbance of the maternal thyroid does not appear to have a very distressing effect upon the mother, yet its importance must not be underestimated because if the condition is not corrected it has a very pronounced effect upon the fetus when the animal becomes pregnant again. The pri- mary thyroid disturbance that is produced in the maternal organism during pregnancy will be designated in this paper as maternal athyrosis.
DISORDERS OF THE HAIR, NAILS AND TEETH DURING PREGNANCY
With every well-defined thyroid disturbance and after extir- pation of the thyroid, disorders of these specific epidermal appendages are invariably reported. The occurrence of disor- ders of the teeth, nails and hair during pregnancy is widely recognized. DeLee (3) states that during pregnancy the nails are thinner and the teeth are liable to loosen and decay and he described the ultimate effect of this state upon the hair as sim-
264 FETAL AND MATERNAL ATHYROSIS. II.
ilar to that of fever. We believe that it is feasible to attribute the above disorders to a lack of function of the thyroid and assuming the existence of a thyroid disturbance by the manifes- tation of these disorders, it would indicate that there is a very wide occurrence of a more or less severe form of maternal athyrosis.
HIGH PROTEIN METABOLISM DURING PREGNANCY
It has been, pointed out that the diets that produce rapid growth tend to exhaust the fetal thyroid of its active secre- tion (1) and that Hart and Steenbock (2) were able to produce hairless pigs experimentally by feeding a high protein diet. It is also well known that thyroidectomy is more disastrous to carni- vora than to herbivora. The above evidence indicates that any increase in the protein metabolism requires a corresponding in- crease in the thyroid activity. If there is not an abundant supply of iodine the thyroid will eventually become exhausted, and with the low iodine concentration of the blood the thyroid will attempt to accommodate itself to that condition and hyperplasia will take place. This was actually the condition found with the hairless pigs. The iodine content of the fetal thyroid was reduced to a mere trace and the size of the gland was increased tenfold and to a less degree the maternal thyroid was similarly affected.
The proteolytic enzymes of the blood increase two to four- fold during pregnancy (4) indicating a higher protein meta- bolism which would require a corresponding increase in the activity of the thyroid. If there were not the required amount of iodine to meet that increase, then it seems reasonable to as- sume that a pronounced disturbance both of the fetal and inater- nal thyroids would result. Therefore, we contend that the great increase in the proteolytic enzymes in the blood of the pregnant woman tends to produce a condition similar to that under which fetal and maternal athyrosis is produced among domestic ani- mals—not an abnormal condition, but still one that requires an abundant supply of iodine.
ALBUMINURIA AND TOXEMIA DURING PREGNANCY
The experiments of Hunt and Seidell (5) in which they were able to immunize animals against two to tenfold the lethal dose of different toxic substances by feeding desiccated thyroid, tend to prove that detoxication may be one of the functions of the
SMITH 265
thyroid, though, we believe, not its sole function. During preg- nancy the excessive protein metabolism tends to exhaust the fetal and maternal thyroids of their physiologically active secretions if the active constituents are not continually renewed by an abundant supply of iodine. In a more or less exhausted condi: tion its functions as a detoxicating agent would be reduced and there would be a corresponding increase of toxic metabolites in the blood which would set up a condition of general toxemia such as may induce albuminuria. Bowen and Boothby (6) have dem- onstrated that, in subthyroid conditions, albuminuria can be eliminated by thyroid medication. Thus, while albuminuria and toxemia of pregnancy may be produced by other conditions, experimental evidence indicates that a lack of function of the thyroid may be a probable cause of albuminuria and toxemia during pregnancy which may be overcome by an abundant supply of iodine.
When the pregnant woman develops albuminuria some obstetricians recommend eliminating protein as much as _pos- sible from the diet. It is generally recognized, however, that the growing child has a high protein requirement, hence a treatment that tends to produce a protein starvation of the fetus does not appear to be reasonable. We contend that, unless there are sec- ondary complications, if the activity of the thyroid is maintained by an abundant supply of iodine the metabolism of favorable proteins in reasonable amounts will proceed without distressing effects. A milk diet is sometimes recommended. It has been found that a very severe form of fetal athyrosis has been pro- duced when pregnant sows have been given large quantities of skim milk. While a milk diet may assist in the elimination of a general toxemia, yet we wish to point out that it will probably be very disastrous to the fetus unless it be supplemented with an abundant supply of iodine.
UNECONOMIC USE OF IODINE THROUGH A PREVIOUS
THYROID DISTURBANCE
In regions where fetal athyrosis is endemie the ranchmen say that gilts are likely to produce hairless pigs. For this reason it was claimed by some that sows would develop an immunity, but this claim was refuted and it was found on the contrary that sows acquired a susceptibility. That hairless pigs are so largely the product of gilts in these regions is due to the fact
266 FETAL AND MATERNAL ATHYROSIS. II.
that the gilts happen to be natives of the regions and are affected to a greater or less extent with a thyroid derangement.
Hart and Steenbock (2) demonstrated that when pregnant sows were given a high protein diet in close confinement, hairless pigs were produced which had the usual manifestations of the malady and the maternal thyroid was affected to a less degree. With a low protein diet they produced normal pigs. When the sows that had recently produced hairless pigs on a high protein diet were again bred and given a low protein diet, they again produced hairless pigs. The authors state that “‘with these mothers once there had been induced serious derangement, through the use of the first ration . . . the introduction of a lower protein level and larger amount of roughage did not act as a corrective.’’ With sows that had produced hairless pigs three times in succession, the diet was supplemented in the fourth gestation period with a supply of iodine and they produced nor- mal, vigorous and healthy offspring with normal thyroids. The above evidence shows that when a pregnant animal is suffering from a previous thyroid disturbance it cannot make an economic use of the available iodine, and this inability has a most disas- trous effect upon the fetus when the amount of available iodine is near the border line of the amount required by the pregnant animal. This has a very vital significance, for when an indi- vidual who is affected with a thyroid disturbance becomes preg- nant unless that disturbance is counterbalanced by exceptionally favorable conditions or an abundant supply of iodine, there will be a very serious arrested development of the fetus which will be subjected to a more or less severe form of fetal athyrosis and grave disturbances will be produced also in the maternal or- ganism. MceCarrison (7) after extensive observation of endemic eretinism in the Chitral and Gilgit Valleys of India has con- cluded that defective thyroid function in the mother is the essen- tial factor in the production of cretinism.
From available evidence it seems incumbent to discuss here the effect upon the fetus when the parents are suffering from tetany, a disease that is generally associated with the parathy- roids. Some physiologists (8) are inclined to look upon the thyroid and parathyroids as a single physiological apparatus, but for our present initial contention it is immaterial whether we consider the thyroid and parathyroid as separate and distinct
SMITH 267
kinds of tissue with only a functional relationship or whether we look upon the parathyroids as essentially thyroidal in nature engaged in the active secretion of the same substance as the thyroid gland. MecCarrison (9) reports the prevalence in India of endemic tetany, a disease of child-bearing women. There is a marked family tendency to the disease and the children of the women who suffer from tetany are frequently cretinous. The dis- tribution is peculiarly local and appears to correspond more or less with the distribution of goitre. The seasonal prevalence of tetany, its practical lmitation to the spring months, is very striking.
Dr. E. L. Hodgins of this University has called our atten- tion to cases where the father suffered from tetany and the chil- dren have developed signs of cretinism. While the evidence to a certain extent would indicate that the thyroid disturbance of the offspring, in both the above mentioned instances, might be due to a hereditary trait, yet there is such a marked similarity in the manifestations of endemic tetany and fetal athyrosis in that both are pecuharly local and appear to correspond more or less with the distribution of goitre and both are practically confined to the spring months and the gestation period, which would lead us to believe that the influence of parental tetany was very similar to the influence of maternal athyrosis and that the arrested development of the offspring was due to an uneconom- ical use of the available iodine during the gestation period. This would produce an iodine starvation of the fetus resulting in fetal athyrosis. Thus we conclude that when either of the parents is suffering from a disturbance of the thyroid it appears to be imperative that the ordinary diet should be supplemented with an abundant supply of iodine throughout the gestation period and possibly also when they are suffering from a disturbance of the parathyroids. = THE SEASONAL VARIATION OF THE EFFICIENCY OF THE
THYROID
Seidell and Fenger (10) found that there was a great sea- sonal variation in the iodine content of thyroids of sheep, cattle and hogs killed at Chicago. The iodine content was at a maxi- mum in the summer, dropped rapidly during the winter and rose to a maximum again the following summer. Their results were obtained in such a manner that it can be concluded that their
268 FETAL AND MATERNAL ATHYROSIS. ILI.
results hold true for all the thousands of animals killed at Chi- eago. This fact would eliminate the factors of local environment and individual traits and also indicate that the environments of the majority of the domestic animals of this continent tend to induce a thyroid inefficiency at least during the winter months.
It has been pointed out that fetal athyrosis is practically confined to the spring ltters. The results of Seidell and Fenger show that the iodine content of the thyroid of hogs is lowest from December to March, the period of the intra-uterine life of the spring litters. MeCarrison (9) also reports that endemic tetany of child-bearing women, whose offspring are eretinous, is practically confied to the spring months. The corroboration of the decrease of the thyroid function during the winter months from three different, wide aspects is very striking.
What are the factors that caused this wide variation during the winter and summer months? Closer confinement and a diet consisting entirely of dried food are two outstanding winter conditions. If these may be the factors then the question arises: Will an artificial mode of life with increasing closer confinement and a decreasing amount of fresh food tend to produce a greater prevalence of a more or less acute form of fetal and maternal athyrosis? We have no direct evidence that either of the above is the controlling factor, although some investigators claim that close confinement will produce thyroid hyperplasia in cer- tain wild animals (14). Still it appears advisable that the diet should be systematically supplemented with iodine at least under certain conditions during the first three months of the year.
THE IODINE REQUIREMENT DURING PREGNANCY
When we first made the deduction that in certain sections of this continent the available iodine was near the border line of the amount required by the pregnant animal (1) it appeared to us that one or more possible conditions varied in such a manner as to exert the controlling influence on the occurrence of the thyroid disturbance. There is a wide variation in the iodine con- tent of farm crops, even of the same kind. Forbes and others (11) found that the iodine content of a given grain crop varied in the same field. Therefore the amount of iodine in the mother’s food would appear to vary.* Fetal athyrosis is most prevalent when the gestation period is confined to the winter months when the animals are in relatively close confinement and their rations
SMITH 269
are practically devoid of fresh fodder. Is there a variation in
*Hunziker (12) after an extensive study of goitre in Switzer- land, has recently concluded that goitre is prevalent in regions where the vegetation lacks the standard proportion of iodine.
the iodine content of the fresh and dried food with regard to amount and availability? It may be pointed out that the results that have been published (11) (13) which show an entire absence or a low percentage of iodine in the common agricultural prod- ucts, have been obtained practically all by analysis of the dried samples, usually in a water free condition (that is, dried for four or five hours at 100° to 110° C). Further, the desirability of fresh foods, vegetables, etc., is universally accepted. Does that metabolism which is associated with the thyroid require a greater thyroid activity with dried food than with fresh foods and there- fore an increased iodine supply to maintain the increased activity? Bensley (14) claims that close confinement is the cause of thyroid hyperplasia that he observed in opossums in captivity. Does close confinement require an increase in the thyroid secretion and therefore an increase in the iodine supply? Diets that produce rapid growth appear to cause an excessive elimination of the iodine of the thyroid. May not the diets or other conditiions in certain areas produce an excessive elimina- tion of the iodine of the thyroid and necessitate an increase In the iodine supply? Several investigators claim to have produced goitre by administration of the drinking water from certain geological formations. Whatever may be their contentions, at least it would make us suspect that the drinking water might be a possible factor in the available iodine supply, not only in actual amount, but perhaps in availability and economic use. We suspected numerous conditions that might be possible factors controlling to a certain extent the occurrence of the thyroid dis- turbance yet the main controlling influence might at the present time be completely masked and there was not the evidence that would lead to a clear understanding of the relation of the condi- tions which we did suspect, to the occurrence of the disturbance. Therefore it appeared to us to be more concise and more satis-
factory to designate the controlling influences as certain un- known conditions, and, according to whether these were fayor- able or unfavorable, the iodine requirement of the pregnant
animal would be sufficient or insufficient, and as the disturbance
270 FETAL AND MATERNAL ATHYROSIS. II.
could be overcome by an abundant supply of iodine that for prac- tical purposes it was feasible to assume that the cause of the lack of function of the thyroid was a deficiency of iodine.
The human environments may not lead to such a general thyroid inefficiency as has been observed among domestic animals and while we do not wish to underestimate the importance of ascertaining all the factors that may contribute to the final con- dition of a deranged thyroid, yet it appears to us in the interest of public health that during those periods in the hfe history of the individual when the thyroid takes on an increased activity, that is during the fetal growth, pregnancy and probably puberty and menstruation, it is advisable to supplement the ordinary diets with an abundant supply of iodine in order to insure a normal development and to ward off pathological conditions. From one-half to one grain of iodine supplementing the ordi- nary diet approximately daily during pregnancy and menstru- ation and for a period of seven days each month during puberty would be sufficient to meet all the iodine requirement of the thyroid.
When iodine is adminstered as potassium iodide it is quickly detected in the urine and saliva, but in combination with fats it is retained for a relatively long period in the system, therefore it would probably be more efficient to use the iodine derivatives of the higher fatty acids. In the absence of any satisfactory organic iodine compounds any of the non-toxic iodides can be used as the source of the iodine as they would all probably be converted, in the body, into sodium iodide. Potassium iodide can be used or perhaps better still, the ferrous iodide. The bene- ficial results obtained when desiccated sheep thyroid was sup- plied to pregnant sows (1) were only very shght in comparison to those obtained when iodides were given and they appeared to be only in proportion to the iodine content. As we contend that it is essential that iodine concentration of the blood should be maintained we do not recommend desiccated animal thyroid as the source of the iodine supply because of its very low iodine content.
CONCLUSIONS
The occurrence of disorders of the teeth, nails and hair during pregnancy indicates that there is a very wide occurrence of a more or less severe form of maternal athyrosis.
SMITH 271
The increase of the proteolytic enzymes in the blood of the pregnant woman tends to produce a condition similar to that under which fetal and maternal athyrosis is produced among domestic animals—not an abnormal condition, but still one that requires an abundant supply of iodine.
Lack of function of the thyroid is a probable cause of albu- minuria and toxemia of pregnancy which may be overcome by an abundant supply of iodine.
A milk diet for the elimination of toxemia of pregnancy will probably be very disastrous to the fetus unless it be supple- mented with an abundant supply of iodine.
When. either of the parents is suffering from a disturb- ance of the thyroid it is imperative that the ordinary diet should be supplemented with an abundant supply of iodine throughout the gestation period and possibly also when they are suffering from a disturbance of the parathyroids.
To insure the normal function of the thyroid the ordinary diet should be supplemented with one-half to one grain of iodine approximately daily during pregnancy and menstruation and for a period of seven days each month during puberty, especially during the first three months of the year.
BIBLIOGRAPHY
1. Smith, G. Ennis: Fetal athyrosis. J. Biol. Chem. (N. Y.) ToT 29,215,
2. Hart, E. B. and Steenbock, H.: Thyroid hyperplasia and the relation of iodine to the hairless pig problem. J. Biol. Chem. (N. Y.) 1918, 33, 313.
3. DeLee: Principles and practices of obstetries, 1916, 108, 112.
4. Wilson, C.: Metabolism of the pregnant woman. Bull.
Johns Hopkins Hosp. ( Balt.) 1916, 27, 121.
5.- Hunt, R. and Seidell, A.: Studies on thyroid. Bull. Hyg. Lab. U. S. P. H. S., 1909, 47.
6. Bowen, B. D. and Boothby, W. M.: A study of the effect of thyroid medication on the basal metabolism, renal function and nitrogen balance in chronie nephritis and in hypothyroidism. J. Urol. (Balt.) 1917, 1, 469.
MecCarrison, R.: Observations on endemic eretinism in the Chitral and Gilgit Valleys. Proce. Roy. Soc. London, 1908-9, II Med. 1-36.
8. Vincent, 8.: Internal secretion and the ductless glands.
1912, 337-45.
~I
5 10.
dale
12.
13.
14.
FETAL AND MATERNAL ATHYROSIS. II.
McCarrison, R.: Endemic tetany in the Gilgit Valley. Lan- eet (Lond.) 1911, 1575.
Seidell, A. and Fenger, F.: Seasonal variations in the iodine content of the thyroid gland. J. Biol. Chem. (N. Y.) 1912-18, 18, 517. Fenger, F.: On the seasonal varia- tion in the iodine content of the thyroid gland. Endocrin. © 1918, 2, 98-100.
Forbes, E. B. and Beegle, F. M.: The iodine content of foods. Ohio Agric. Exp. Station, 1916, Bull. 299.
Hunziker, H.: Goiter in Switzerland. Cor. BL. f. Schweizer Aerzte (Bern) 1918, 48, 220; J. Am. M. Assn. (Chgo.) 1918, 70, 1196.
Bohn, R. M.: The iodine content of food materials. J. Biol. Chem. (N. Y.) 1916-17, 28, 375.
Bensley, R. R.: The thyroid gland of the opossum. Anat. Ree. (N. Y.) 1914, 8, 437.
DIABETES IN INFANCY AND CHILDHOOD.
Isaac A. Abt, M.D. Chicago.
Diabetes in children is infrequent as compared with its oc- currence in adult life. Van Noorden (1) found of 3000 patients 2.8 per cent were in children under 12 years of age. In scanning the literature one is impressed by the fact that no extensive clinical studies have been made-on the diabetes of infancy and childhood, and consequently no valuable contributions have ema- nated from this source. Many interesting clinical reports have been made, though they tend more to confirm the general knowl- edge of diabetes than to shed any new light on the subject. The literature of diabetes is replete with experimental studies on animals. In candor, however, it should be stated that the experi- mental results fail to explain fully the clinical manifestations in man.
In many instances the conditions produced in experimental studies are not duplicated in clinical diabetes. Lorand (2) says that extirpation of the thyroid suppresses glycosuria in depan- creatized animals. Normally the pancreas exercises an inhibitory influence on the thyroid gland. In a depancreatized animal this influence is lost. In consequence the thyroid secretion is increased in these animals. This increase of thyroid secretion augments the quantity of adrenalin. If the thyroid is removed the secre- tion of adrenalin diminishes, and at the same time the’ hypergly- cemia and glycosuria disappear. Standing out in apparent con- tradiction are these facts: Glycosuria has been observed in thyroidectomized animals, and in cases of myxedema diabetes has been described. How can these statements be reconciled?
From clinical studies we know that glycosuria in children occurs in a variety of conditions. Glycosuria has been observed in the newly born. WHoeniger (3) observed several times that infants delivered with forceps showed sugar in the urine for three or four days, which gradually diminished. In contradis- tinction to this he found children who were born after long labor remained free from sugar. This led him to believe that the trauma inflicted by the application of the forceps was suffi-
273
274 DIABETES IN INFANCY AND CHILDHOOD
cient to induce glycosuria. There are no statistics, however, to indicate the frequency of this occurrence.
In premature babies lactose is sometimes found in the urine. Glycosuria occasionally occurs in alimentary intoxication and shows its presence in the form of lactose and galactose. Where certain foods have been administered other forms of sugar may be observed, such as saccharose, lactose and maltose. Lactosuria and galactosuria are not easily demonstrated by the ordinary copper tests. The presence of considerable ammonia in the urine interferes with the reaction (4). It is advisable to boil the urine before testing it. If the sugar content is small the copper oxide is precipitated after the test tube has been allowed to stand for atime. If one is in doubt as to the nature of reducing substance the osazone test should be applied. Saccharose does not ordinarily reduce the copper solutions. The finding of lactose in the urine is simply an indication of the increased permeability of the in- testinal epithelium, permitting the sugar to pass into the blood. The presence of lactose in the urine may indicate an alimentary lactosuria without any particular illness on the part of the child. An alimentary lactosuria is sometimes observed in those children in whom a rapid change in the sugar content of the food is made.
In addition to the alimentary origin, sugar is found in the urine in organic disorders of the liver, acute infectious diseases of infancy and organic brain diseases. In syphilis, scarlet fever, enteritis, chronic enterocolitis and other infections, a transitory glycosuria has been observed. In chronic illnesses sugar may be present.
Mosenthal (5) describes renal diabetes as glycosuria, the re- sult of increased permeability of the kidney for sugar. These are usually mild cases and have none of the grave manifestations of true diabetes. The glycosuria continues at a fairly constant level and is not markedly affected by the carbohydrate intake. The percentage of blood sugar remains normal, while the urine contains sugar. The occurrence of this condition is not frequent, and owing to the almost universal severity of diabetes in chil- dren we would doubt its frequent occurrence in early life, although Bonninger (6) reports the case of a man of 37 years who suffered from renal diabetes, whose son, age not given, suf- fered from the same disease. Wynhauser and Elzas (7) reported a child of 12 years who apparently suffered from renal diabetes.
ABT 275
Injection of potassium, calcium or normal salt solution hy- podermically not infrequently produces glycosuria in babies.
True diabetes mellitus in children usually assumes a severe and progressive type of disease characterized by constant sugar production in the urine; hyperglycemia, acetone and diacetic acid are frequently present. The patient is profoundly affected, and the course of the disease, as a rule, is brief.
Concerning the age of occurrence Wageli (8), who collected 168 cases, was able to give the age of occurrence in 102, and summarizes as follows:
Not Age Males Females Given ‘Total Winder Try Gar. 2.25.5... 2 i 1 3 U5 0/20 fe 12 8 6 26 MP Wears 1 iby 3 31 1 O-) S72 ir 19 22 if 42 44 47 Jia 102
It is to be noted that boys in the first five years are much more frequently affected. Saundby (9) collected 159 cases in 1886, with about the same results. Notwithstanding Wegeli’s opinion, later tables would indicate that the sexes are equally affected. Among 6496 fatal cases of diabetes occurring in Eng- land and Wales in ten years there were but 8 patients under one year of age (10). A study of statistics would indicate that boys are more frequently affected in the first five years and that both sexes show an equal frequency from five to ten years. The peculiar circumstance has been remarked that in families in which several generations have been so struck the patients are younger the more advanced the generation. My own experi- ence would indicate that the predilection for diabetes is not manifest in Jewish children. It would seem more than coinci- dence that I have seen seven to eight non-Jewish children with diabetes to one Jewish child. Heredity, undoubtedly, has an influence on the occurrence of diabetes in children, though my own observations extending over a period of years would seem to indicate that only an occasional case shows a definite hered- itary influence. Notwithstanding this, Lion and Moreau (11) report 23 out of 100 cases which showed a familial occurrence of the disease. Langaker (12) reports the incidence of the dis-
276 DIABETES IN INFANCY AND CHILDHOOD
ease in four children of a family of eight. These died within four years, and three of them were less than five years old at the time of death. Five years later a fifth child of the same family died at seven years. Juvenile diabetes is relatively frequent, heredity playing an important part. Lion and Moreau collected thirty instances of this type. .
It has been known for some time that some relation seems to exist between trauma and transitory glycosuria. Diabetes in children has followed severe trauma not only to the head, but to the muscles and abdomen as well. In the review of 212 cases of head injuries admitted to the Boston City Hospital, Higgins and Ogden (13) found glycosuria in 20 cases. Five of them were simple scalp wounds, four deeper wounds denuding the bone, five fractures of the vault and five fractures of the base. One case was omitted.
Naunyn collected from his own clinic and the literature 50 cases of traumatic diabetes, half of which were head injuries and half injuries to other parts of the body. Two cases, which were reported by Dr. S. Strouse and myself (14) and were at the time considered mild eases, died about one year after our reporting them. One of these cases of diabetes followed a head injury and one, an abdominal. I have a case in the hospital at the present time, a child of four, whose playmate let a brick fall upon his head from a distance of four feet. This produced no severe injury, not even a scalp wound. The accident occurred seven weeks ago. One week later the patient showed marked polyuria, a voracious appetite and a loss of strength. Urinary examination on entrance showed 2.8 per cent of sugar.
Infectious diseases are recorded as an exciting cause of diabetes. Numerous authors suggest the possibility of the acute infectious diseases as an etiological factor. Von Storek (15) reports a seven-year-old girl who developed diabetes mellitus in the course of whooping cough. He suspects the child developed an infectious pancreatitis. Von Noorden conceives the possi- bility of a lesion of the pancreas in many of the acute infectious diseases, such as angina, influenza, measles and scarlet fever. Connective tissue changes occur in many of these diseases as well as the alimentary disturbances. This view of the cause of diabetes, no matter how attractive it may be, lacks clinical and pathological basis.
ABT 277
The fetus and infant are variously affected by maternal diabetes. The disease in the mother is most frequently disas- trous to the fetus. Naunyn (16) says that conception does not often occur in women who are diabetic, although he reports 16 cases where women became pregnant. Premature labor with dead or macerated fetuses is a common occurrence. Naunyn . reports a woman suffering from diabetes who had three suc- cessive pregnancies each of which resulted in an abortion at the 4th or 5th month. Offergeld (17) reports a series of 57 women who became pregnant. Fifty-one per cent of the chil- dren were still-born, 11 per cent died soon after birth, and 7 per cent died in infancy from hydrocephalus or diabetes, a mortality of over 66 per cent. In 25 cases in which the chil- dren died, 17 mothers died in coma. It is noteworthy to quote Naunyn, who says that there is no well-authenticated case on record where a mother gave birth to a diabetic child. This is not to say, however, that surviving children do not become diabetic in infaney.
There are very few contributions on the pathological anat- omy of the pancreas in the diabetes of children. Heiberg (18) performed autopsies on four diabetic children four and a half and five years, and three and fifteen months old. He examined the pancreas particularly, and the striking pathological findings were moderate atrophy of the pancreas and diminution in the number of the islets of Langerhans. Rarely is there found degeneration of the islets. In this connection it would be well to recall the observations of Weichselbaum and Kyrle (19), who record the histological findings in the pancreas of normal in- fants: They found that shortly after birth the islets tend to diminish in number and do not form such large groups. The islets are not always spherical, but are inclined to be irregular in shape. They vary in size and are lined with only a few rows of cells. In diabetes round cells are sometimes found in the islets and in the immediately surrounding tissue. The obser- vation of Heiberg coincides with the statement frequently en- countered in the literature that pancreatic fibrosis does not commonly occur in the diabetes of children. In J. H. Mason Knox’s ease the panereas was carefully studied. He describes small round cells in the interstitial tissue, which in some places seem to replace the acini. Connective tissue was increased. The
278 DIABETES IN INFANCY AND CHILDHOOD
islets were diminished in size and number, and in one section none were seen. The capsule was thickened, and the trabeculae were visible in the connective tissue. Martins (20) found in a series of 51 cases, including four children of 3, 12, 15, and 16 years, that all showed a histological alteration of the islets of Langerhans, such as sclerosis, hyalin and hydropic degeneration. Not all of the islets, however, are involved. It seems a striking fact that severe and fatal diabetes may occur with slight or insignificant changes in the pancreas. It is also worthy of note that severe lesions of the pancreas may occur without producing glycosuria. There are some who would explain this by saying that death may occur before the symptoms of diabetes come to light or that in severe lesions of the pancreas the uninvolved portions may be sufficient for sugar metabolism. We are assured from the highest pathological authorities that severe diabetes may occur with no demonstrable lesion of the pancreas.
A careful search through the literature reveals that there are apparently no cases reported to establish a relationship be- tween lesions of the hypophysis and diabetes in children. It appears that a true acromegaly does not occur in childhood, although a case is reported of congenital enlargement of the extremities suggesting acromegaly. This baby was brought to the clinic when it was one day old. The extremities were un- usually long. The child died at two and one-half months with bronchopneumonia and a congenital heart lesion. Autopsy re- vealed an enlarged sella turcica and a pear-shaped hypophysis the size of a bean. Histological examination showed no definite pathology. No mention is made of glycosuria.
Lipemia occurs commonly in diabetes. Stoerk (21) reports a case of fatal diabetes in a child of ten years who had large amounts of fat in the blood and had symptoms of status lymphat- icus. He quotes Klemperer, who explains lipemia in diabetics as greater cell destruction and construction, the lipemia signi- fying the preparation of the cell lipoids for construction of new cells.
For the sake of clearness it should be mentioned that there are those who believe that the whole glandular substance oi the pancreas is primarily the cause of diabetes, but the con- sensus of opinion favors the view that the disease is intimately associated with the internal secretory functions residing in the
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islets of Langerhans. As is admitted by every one, the islets play no part in the production of digestive secretion, but prob- ably furnish an internal secretion regulating sugar metabolism.
The symptoms of diabetes in children are almost identical with those in adults, such as loss in weight and strength, fatigue upon slight exertion, increased appetite, polydypsia, and poly- uria. Eneuresis is not an infrequent symptom. Urticaria, pruri- tis and eczema occur as well as furunculosis. The teeth decay early, and stomatitis is not uncommon. Edema about the face and ankles has been observed in advanced cases. Headache, backache and radiating pains in the extremities are sometimes seen. Particularly characteristic are pains in the calf muscles. The urine contains sugar, at times acetone and diacetic acid, and not infrequently albumen and casts. Morse (22) mentions an early and conspicuous symptom is irritation of the external genitalia. He also describes polyuria as the first symptom in five of seventeen patients over two years of age, although eventually it occurred in all.
Diabetes in children may begin in a mild or severe form, though it must be observed that the transition from the mild to the severe form occurs more rapidly than in adults. In some cases the disease has not been recognized until after this transi- tion has occurred. Some children seem to improve after the sugar tolerance has been regulated and the urinary sugar kept low. They attend school and seem to progress favorably in their studies. At times they gain in weight. The temperature is inclined to be subnormal. When the glycosuria has disap- peared none of the children lose their tendency toward it. Sugar returns on the slightest provocation. It reappears following psy- chic disturbances such as disappointment about a journey or a bad school report. Sugar also tends to return following coryza, parotitis, pharyngitis and diarrhea. In most cases the sugar tolerance can be restored, but an accumulation of insults, that is frequent: recrudescences, tends gradually to reduce perma- nently the level of tolerance. In consequence of this fact infec- tions of the upper respiratory tract or other infections have an ominous significance and tend to produce complications in dia- betic children. In three of Kleinschmidt’s (23) cases measles had a decidedly unfavorable effect. In one the disease was first discovered after the measles. In a case reported by Naunyn
280 DIABETES IN INFANCY AND CHILDHOOD
varicella entailed fatal acidosis, and in Starck’s case whooping cough had the same effect. In one of Kleinschmidt’s cases a girl of seven suffered a severe hemorrhagic nephritis without return of the diabetes. This child had a suppurating skin infection besides the diabetes.
There are a few cases of diabetes in children reported in the literature which seem to illustrate the influence of other factors, such as glandular disturbances not pancreatic, injury to the brain and other trauma. Siegmund (24) reports that thy- roid deficiency in children is often accompanied by pathological sugar hunger. Such children are able to take large quantities of sugar for long periods without glycosuria, and the sugar seems to act beneficially upon the effect of the thyroid deficiency. He states that thyroid feeding may cure this sugar hunger within two days. Alfred Gordon (25) reports two cases showing appar- ently a relation between the thyroid and diabetes. The patients were brothers, three and four and one-half years old. The younger gave full evidence of myxedema. His intellect was retarded, and he was quite indifferent to his surroundings. Res- pirations were slow and the pulse was sixty. The hair was coarse, and the skin thick and edematous. The urine had a high specific gravity and a few drops promptly reduced Fehling’s solution. The child had all the symptoms of diabetes, as fre- quent and abundant micturition and increased thirst. The sec- ond child, four and one-half years old, had been sick for two years. There were marked symptoms of eretinism. The hair was scanty, the nails brittle, and the urine contained sugar in abundance. The findings were all more marked than in the younger brother. The children were both given thyroid gland extract. In consequence, their mental dullness, apathy and lan- guor improved. The myxedematous condition of the skin grad- ually disappeared, and the color improved. The sugar dimin- ished, and it appears conspicuous that the glycosuria cleared up more quickly than the myxedema. Eventually the sugar dis- appeared, and the children became more lively and playful. When the thyroid treatment was temporarily stopped the mental hebetude returned, and the sugar increased in quantity. With resumption of treatment the condition again improved promptly, and at the time of writing they were doing well even after a period of non-treatment. The family history is interesting. The
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father is a neuropath, treated for obsessions, and the mother is obese and is treated for diabetes. This case report is extremely interesting and is unique. No similar cases have been observed as far as our researches reveal; and no definite deductions should be drawn as to the relation between thyroid deficiency and glycosuria. Who has not seen his quota of cretins without the slightest glycosuria? Von Noorden states it is almost im- possible to set up glycosuria in animals after extirpation of the thyroid, or in human beings suffering from myxedema, as the pancreatic influence is increased by the absence of the thyroid.
Glycosuria occurs in association with neoplasms, hemorrhage and abscesses of the brain and hydrocephalus. Strauch, Hassin and Levin in a personal communication have given us a brief report of an interesting case of hydrocephalus which they will shortly publish in full. The patient was a fat girl of nine years with diabetes insipidus and such marked hydrocephalus that the cranial sutures gaped. She had long, tapering hands, although her feet were not large. There was paralysis of the eye muscles, bilateral optic neuritis and marked development of the labia majora and pubic hair. The voice was not coarse, and the blood pressure was somewhat increased. Feeding nine ounces of sugar did not produce glycosuria. Autopsy showed no involvement of the hypophysis. There was complete occlusion of the aqueduct of Sylvius, no fourth ventricle, and the lateral ventricles were as large as an ordinary brain. Jeans (26) describes a boy of three years with diabetes who had features suggesting dispituitarism, as spade-like hands, dry skin, fingers of the shape seen in acrome- galics, large hands and feet and stature above normal. Knox (10) quotes several reports of brain involvement with diabetes. Hagen- bach (27) in 1879 reported a case of an eight-months-old child with glycosuria, polyuria and urine of high specific gravity, whose illness lasted thirteen months. The child died with gan- grene of the lungs and chronic hydrocephalus. Orloff (28) de- seribes a case of a five-months-old child with glycosuria, hunger, thirst, polyuria and loss of weight, whose lateral ventricles were found markedly dilated on autopsy. Langstein’s (29) case of a six-months-old child with repeated convulsions and urinary sugar running from 0.1 to 1.0 per cent died in a few months with internal hydrocephalus. He also had a ease of a seven-day- old infant with anencephalus. This child had 0.5 to 1.0 per cent
282 DIABETES IN INFANCY AND CHILDHOOD
of glucose and died nine days later. There was a complete ab- sence of the cerebral hemispheres. Glycosuria is not infrequently associated with brain tumor. The case of Van Ordt, quoted by Falta and Meyer, is of interest in this connection. An eight- year-old girl was free from sugar when she fell ill. With agegra- vation of the brain tumor symptoms, 3.5 per cent of sugar was found in the urine. After restriction of the earbohydrates the urinary sugar disappeared, although it later reappeared. Au- topsy revealed several miliary tubercles on the floor of the fourth ventricle and a large tumor in the region of the posterior corpora quadrigemina, pes cerebri and tegmentum pontis. The mass also involved the floor of the fourth ventricle. The pancreas, according to Van Ordt (30), was normal.
Since the work of Claude Bernard in the early part of the nineteenth century in demonstrating the piqure phenomenon, much interest has attached to the cerebral origin of diabetes mellitus. Whether the altered carbohydrate metabolism is to be explained on the basis of a carbohydrate metabolism center or by the removal of the nervous influence over the chromaffin system is far from being definitely settled. The fact remains that there are many well-authenticated cases of cerebral disease, especially lesions of the floor of the fourth ventricle, which in some unknown way produce permanent glycosuria.
As has already been pointed out, diabetes in children may be mild or severe. It is striking, however, that the vounger the individual the more marked is the tendency for the disease to pass suddenly from the mild to the severe type. In my own experience such cases as I have considered mild and amenable to dietetic treatment nearly always terminated fatally in the course of several months or a few years. Nevertheless, reports of mild diabetes in children are not infrequently found in the literature, in which the authors promulgate the opinion that juvenile diabetes need by no means be considered a mortal dis- ease. Inasmuch as the further course of those patients reported is not available, we remain in the dark as to their final outcome.
In this brief review I have attempted to outline the salient features concerning the diabetes of infaney and childhood. Such case reports were used as would illustrate the pathogenesis, symp- tomatology and course of the disease. Detailed reference to the extensive literature on experimental diabetes has been purposely
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omitted because at the present time it is difficult to coordinate the experimental data with the clinical manifestations in adults
and children.
BIBLIOGRAPHY.
Von Noorden: Hand. der Kinderkrank., Pfaundler u. Schlossman, 2 Auf., 1910, 11, 117.
Lorand: Trans. Path. Soe. London, 1906, Pt. 13, 1-57.
Hoeniger: Deutsch. med. Wehnschr. (Berlin), 1911, 37, 500.
Finkelstein: Sauglings Krank., Berlin, 1912, Pt. IIT, 318.
Mosenthal: Johns Hopk. Hosp. Bull. (Balto.), 1916, 27, 133.
Bonninger: Deutsch. med. Wehnschr. (Berlin), 1908, 34, 780.
Wynnhauser and Elzas: Abs. J. Am. M. Assn., (Chgo.) 1918, 70, 1343.
Wegeli: Arch. f. Kinderheilk. (Stuttgart), 1896, 19, 1.
Saundby: Leet. on diabetes, including the Bradshawe Lect., Bristol and London, 1891; quoted by Wegeli.
Knox: Johns Hopk. Hosp. Bull., (Balt.) 1913, 24, 271.
Lion et Moreau: Arch. de Med. des Enfants, (Paris) 1909, 41, 21.
Langaker: Deutsch. med. Wehnsehr. (Berlin), 1911, 37, 217. ;
Higgins and Ogden: Boston M. and S. J., 1895, 132, 197.
Abt and Strouse: Am. J. Med. Sci., (Phila.) 1911, 141, 338.
Von Storek: Miinch. med. Wehnschr., (Miinich) 1912, 11, 24.
Naunyn: Nothnagel’s System, 1893, 206.
Offergeld: Deutsch. med. Wehnschr. (Berlin), 1909, 35, 1226.
Heiberg: Arch. f. Kinderheilk., (Stuttgart) 1911, 56, 403.
Weischselbaum und Kyrle: Arch. f. mikr. Anat., (Bonn) 1909, Bd. 74 quoted from Heiberg.
Martins: Frankfort Zeitseh. f. Path., 1915, 17, 278.
Stoerck: Wien. med. Wehnschr., 1911 13, 1298.
Morse: Boston M. and S. J., 1913, 168, 533.
Kleinschmidt: Med. Klinik., (Berlin) 1916, 12, 1227.
Siegmund: Deutsch. med. Wehnschr. (Berlin), 1910, 36, 990,
Gordon: Amer. Med., (N. Y.) 1904, 7, 229.
344 DIABETES IN INFANCY AND CHILDHOOD
bo oe
26. Jeans: Am. J. Dis. Child., (Chgo.) 1917, 13, 145.
27. Hagenbach: Jahrb. f. Kinderheilk., (Leipzig) 1879, 18, 421, from Knox.
28. Orloff: Vrach., Mar. 3, 1901; abs., Semaine Med., 1901, 192 (Knox).
29. Langstein: Verhand. d. Cong. f. innere Med., 1909, 26, 209 (Knox).
30. Van Ordt: Deutsch. Ztschr. f. Nervenheilk, (Leipzig), 1900, 18, 126, from Falta and Meyer, p. 554.
THE FUNCTION OF THE THYMUS GLAND* Eduard Uhlenhuth, Ph.D.
Rockefeller Institute of Medical Research, New York
The function of the thymus gland is less Well understood than that of any of the other organs usually enumerated under the terms ‘‘glands of internal secretion.’’ The evidence in favor of the existence of a thymic hormone is extremely meagre, and for the most part is deduced from experiments, the results of which are doubtful in their bearing upon that problem. The warnings which have been raised repeatedly against a premature conception of the thymus as an endocrine gland, therefore, seem to be fully justified.
A warning has but recently been sounded by E. R. Hos- kins (10). In 1918 he reviewed carefully the most important literature and was led to the conclusion that up to that time no experiments were known which deserved the credit of having proved conclusively the existence of an internal thymic secre- tion. Referring to the present writer’s experiments (at that time incomplete) upon feeding thymus to the larvae of sala- manders, he correctly stated that these could not be regarded as demonstrating an influence of the thymus gland upon growth and development. Hoskins correctly estimated the vagueness of our knowledge with regard to the function of the thymus at the time the article was written. Extensive experiments appeared, therefore, to be necessary to clear up the problem. We have now conducted such experiments on a rather large seale for sev- eral years, and have obtained positive evidence in favor of the existence of a thymic secretion. To report some of these experi- ments and to discuss their bearing upon the function of the thymus is the object of this article.
The animals used for these experiments were the larvae and adults of amphibians—water lizards, newts, mudpuppies, or salamanders—the latter being the correct term. These animals present certain important advantages for a study of the prob- lem of internal secretions. First, the phenomenon of metamor- phosis can be used as an indicator in quantitatively determining
*Paper read before the meeting of the Association for the study of the Internal Secretions, at Atlantic City, N. J., June 9, 1919.
285
286 FUNCTION OF THYMUS GLAND
the rate of development under normal and experimental cond.- tions. The stage in question can be observed readily without killing the experimental animals or interfering otherwise with the normal progress of their development. Another most inr portant advantage is that during the larval period amphibia lead a free life, whereas all other vertebrates spend this period of life either in the egg or in the maternal uterus. At present one of the most important requirements is to study the relation which exists between the anomalies of internal secretion in adult life and the development of the endocrine glands in embryonic life. It is during the embryonic period that the glands of in- ternal secretion, like all other tissues, undergo the most active and profound changes, and consequently react to external fac- tors more promptly than during adult life. In salamanders, new endocrine glands are found to develop until the time of meta- morphosis, and it is not until after metamorphosis has taken place that the structures of most of the glands become stable. In these animals, the effects of all the factors suspected to have some influence upon the development of the inner secretory glands can be studied readily during the free embryonic stage, and the influence of the abnormal development of these glands upon the development and physiological condition of the organ- ism as a whole may be observed. This advantage is not offered by any other group of vertebrate animals.
We shall report first such results as bear upon the relation of the thymus gland to development and growth. As is well known to readers of this Journal, extirpation and feeding ex- periments in mammals have been carried out to prove that the thymus regulates the growth of the skeleton and the teeth, the development of the sex glands, ete., but as Hoskins points out, none of these experiments has been conclusive and most of the results have been contradicted by other experimenters.
More interest was aroused by the experiments of Guder- natsch on the tadpoles of frogs and toads than by any performed on mammals. Gudernatsch (6) reported that when tadpoles are fed on thymus, the differentiation of a certain number of these animals is checked completely, while at the same time their growth is stimulated in an extraordinary way, leading to the formation of giant larvae. From these experiments which were repeated by several other investigators who got similar results,
UHLENHUTH 287
the conclusion has been drawn that the thymus gland contains a specific hormone which inhibits development and promotes growth. Lately, however, Swingle found that thymus fed tad- poles grew and developed in a normal manner (12). It was, therefore, necessary to repeat these experiments carefully and under varying conditions.
We will report first our results bearing upon the claim that the thymus secretes a specific growth-promoting hormone. When we started the experiments with feeding calf’s thymus gland to the larvae of salamanders, at first we saw no evidence of a spe- cific growth-promoting influence (16,17). In some thymus fed series we actually observed a greater rate of growth than in the control series, but in others a slower rate was observed. Since such differences can be easily produced by relatively small quan- titative differences in dietary constituents, we concluded that in the thymus fed larvae which grew better than the controls, we were not dealing with the effects of specific qualitative differences, but simply with quantitative differences such as are presented by variations of the amount of proteins in different kinds of food.
In experiments performed at a later date, however, we could not reproduce the growth curve exhibited by our former thymus fed series ; not only did these later series grow less well upon thy- mus feeding, but there were always a few larvae which showed a distinct and marked inhibition of growth accompanied in the later stages of the experiments by cachetic phenomena. This induced us to study carefully the records made during all our investigations and this, together with experiments (to be pub- lished elsewhere) carried out especially with the intention of clearing up this point, has brought out the fact that the re- searches of Gudernatsch and Swingle, together with our own earlier experiments, suffered from inexactness, in that we all overlooked the possible influence of the addition of normal food to the thymus diet. Our later experiments have revealed the fact that if larvae are fed from the beginning on thymus gland, without the addition of normal food at any time, they will show a distinct inhibition of growth; this inhibition is exhibited uni- formly by every individual and even by the larvae of those spe- cies in which at first we had not observed any influence. Larvae which are fed from the beginning daily and throughout the larval period on a certain amount of normal food in addition to
288 FUNCTION OF THYMUS GLAND
the thymus diet, grow at a normal rate or even better than the controls. Larvae which are fed for only a short time (8 to 24 days) after hatching on normal food, are able to grow at a nor- mal rate during a period of exclusively thymus feeding lasting 10 to 15 weeks.
In our first experiments, all series were kept for one to three weeks after hatching on normal diet; the records of the experiments performed by Gudernatsch and also by Swingle show that these authors have used larvae which were caught after hatching from ponds, in which they had fed on norma! food, or were kept in the laboratory on a diet of algae before the begin- ning of the experiment, or were kept even during the experi- ment entirely on normal diet, the thymus being added to the water in powdered form. Obviously these experiments vould not decide the problem in question. It should be mentioned here, however, that Swingle in a number of experiments in which he fed thymus to larvae hatched in the laboratory, does not mention whether or not they were fed from the beginning of the experiment on normal food, although this seems to be the case, since some of them were used a considerable time after hatching and nothing is said to indicate that they were starved animals. If, however, the larvae of these experimental series of Swingle actually were starved before beginning the thymus feeding, it is necessary to assume that the water of the locality in which the experiments were performed contains sufficient micro- organisms to permit growth of the larvae. In the water used in our laboratory, which is filtered, neither the salamander larvae nor the tapoles of Rana sylvatica grew on an exclusively thymus diet, unless fed a normal diet during the first days. following hatching. At any rate, it seems desirable that Swingle should repeat his experiments, in order to clear up this difference.
Our experiments, then, show that the thymus does not con- tain a specific growth-promoting substance but, on the contrary, is deficient in specific substances required for growth; if these substances are introduced into the organism even in small amounts by keeping the larvae only for a short period on normal diet, growth can proceed in a normal way. It is necessary to assume, therefore, that the substances required for growth can be stored up in the organism, or else that they are required to ' develop some special organs which elaborate growth-promoting
UHLENHUTH 289
substances. Which of these two assumptions is correct available data do not determine, but judging from the facts generally known about deficiency phenomena, it is more likely that the organism can store up these substances and that growth can then go on until they are used up.
We may now discuss our results concerning the influence of thymus feeding upon development, as observed in the larvae of salamanders. It should be said at the outset that such an influ- ence, in contradiction to Swingle’s statements, can actually be demonstrated. It is not due, however, as Gudernatsch and his successors thought, to the presence in the thymus of specific de- velopment-inhibiting substances, but on the contrary to the ab- sence from the thymus of a specific substance required for meta- morphosis (23, 25); and furthermore, our experiments show that it is only the process of metamorphosis which is inhibited by thymus feeding, while other developmental phenomena can take place in a normal way (26).
We have found (23) that when normal food is added to the thymus diet, metamorphosis takes place invariably at the same time as in the controls. And, furthermore, larvae which were fed for several days after hatching on normal food, metamor- phosed frequently at the normal time, even if they were later on fed exclusively on thymus gland. It is evident, therefore, that the great variability which may be observed in the results of different authors and even in the experiments of one and the same author—a variability which was observed also by the writer in his first experiments (17, 23)—is due merely to uncontrolled additions of normal food to the thymus diet. In those series in which all larvae were fed from the beginning on thymus exclu- sively, not one individual was able to metamorphose, as will be reported in full elsewhere.
From these experiments it is evident that the feeding of thy- mus gland to the amphibian larvae actually inhibits metamor- phosis and that this effect is due to a deficiency of the thymus in substances which are required for metamorphosis. In a former paper (25) I assumed that the lacking substance is iodine which, as Swingle (13, 14) has shown, is neces- sary for metamorphosis and of which only traces are contained in the thymus gland (Baumann, 3). Of late, however, I have come to doubt the correctness of this explanation because I have
290 FUNCTION OF THYMUS GLAND
observed that the anterior lobe of the hypophysis does not in- hibit metamorphosis in the same species in which metamorpho- sis is inhibited by thymus diet, although Baumann (3) by the same method by which he found traces of iodine in the thymus gland could not find any iodine in the hypophysis—a result which has been confirmed later on by many investigators (4, 7, 11, 27). At present we must defer discussion of what substances necessary for metamorphosis are lacking in the thymus, since our experiments on this point are not complete.
Meanwhile the reader may be referred to a report of certain experiments (25) in which it was demonstrated that besides the thyroid secretion, still another substance, the ‘‘excretor’’ sub- stance, is required to induce the thyroid to excrete its hormone; metamorphosis occurs only if, in addition to the hormone, the excretor substance also is present in a definite amount.
From the foregoing statements it is evident that the belief that the thymus gland forms specific substances effecting growth and development can no longer be based upon the experiments on amphibian larvae. It seems that at present no definite proof exists that the thymus has anything to do with growth and de- velopment, although it must be admitted also that no facts are known which disprove such a function.
Moreover, a conclusion that the thymus does not produce any secretion at all by no means follows. If the larvae of cer- tain species of salamanders (15, 16, 17, 18) are fed on thymus gland, they soon show severe convulsions of all the muscles of the body; later on the power of voluntary contractions becomes greatly impaired, and this finally leads to permanent disablement of the muscles. The appearance of these tetanic attacks resem- bles in every detail the convulsions which develop in mammals after removal of the parathyroids.
That this syndrome is due to the presence of a specific sub- stance in the thymus is indicated by the following facts: Even if the larvae are fed for a considerable initial period on normal food, thymus feeding still results promptly in convulsions observ- able in each single individual, and which now the addition of normal food to the thymus diet does not prevent. We have replaced: more than half the amount of thymus by normal diet, and yet convulsions occurred promptly in every individual. Moreover, the thymus gland is the only one among those so far
UHLENHUTH 29k
tested which produces convulsions. We have tried other nearly related tissue, such as the prescapular lymph gland and the spleen of cattle, but neither gave results. The parathyroid glands also gave negative results. It is evident, therefore, that the phenom- enon in question is a specific effect of the thymus gland, due to the presence of a specific substance in the gland.
The next question is: Are these convulsions identical with those of parathyreoprival tetany, and .does the thymus manufac- ture the toxin which is responsible for tetany? The answer is again in the affirmative (19, 22). The larvae of salamanders do not possess parathyroids, while the larvae of the closely related frogs and toads develop their parathyroids soon after hatching. If the thymus actually contains the substance causing parathy- reoprival tetany, we should expect that only the larvae of. sala- manders would develop tetany upon thymus-feeding. This is true; the frog and toad larvae never have been observed to develop tetany. Moreover, the salamander larvae begin to develop parathyroids at the time of metamorphosis; at the same time the tetanic convulsions are checked and do not return after metamorphosis, even with continued exclusive thymus diet. So far thymus has been fed to several larvae for two years after metamorphosis without the appearance of tetany. This observa- tion supports the assumption that the toxin contathed in the thymus is antagonized by the parathyroids.
Of course the fact that calf’s thymus contains a_ specific toxin which is capable of producing tetany in salamander iarvae and which can be antagonized by the parthyroids does not possess the character of absolute proof that the mammahan thymus would excrete this substance into the blood and in the absence of the parathyroids cause tetany. There are, however, facts at hand which very conclusively show that this is exactly the case in the amphibian organism and this certainly is sufficient reason to assume that we have discovered the most important factor involved in the tetany at least of the amphibians and mam- malians. In the sauropsidae in which this phenomenon has not been studied so far, the occurrence of parathyreoprival tetany is not certain.
We have observed that in the salamander larvae tetany does not occur immediately if they are fed on thymus from an early larval state (18, 22), but begins to appear in all the larvae at a
292 FUNCTION OF THYMUS GLAND
definite developmental stage. It was found that this stage cor- responds with the time at which the thymus of the larvae present for the first time the aspect of functioning possessing all the cellular elements of a fully developed gland. This must be in- terpreted to mean that by means of thymus feeding alone not enough of the toxin can be introduced to produce tetany ; but as soon as the animal’s own thymus glands begin to excrete, an excess amount of the toxin is reached and tetany appears. It seems then that the amphibian thymus produces and excretes a substance of the same character as that contained in the ealf’s thymus, and it is most likely, therefore, that the calf’s thymus not only contains, but also, like the amphibian thymus, execretes this substance. Further discussion of the role of the thymus in parathyreoprivai tetany will not be offered in this article, but more data may be found in several former papers (20, 21, 24).
The relation of our findings to the function of the thymus may now be pointed out. First, it is evident that the thymus may justly be called an endocrine gland, since it exeretes a specific substance, the presence of which can be demonstrated by its effects. Naturally, however, it is impossible to conceive this action as the function of the gland, since by the term function we understand an activity which in some way is required to achieve the normal physiological condition of an organism. But so far we have not been able to show that the substance which, when left in the circulation, produces tetany, exerts any other and useful effects before it is removed from the circulation by the parathyroids. However, it would be unwise to argue that because we have not found such a physiological action of the thymus, it does not exist. The lack of such knowledge should serve as a stimulus to further research.
I have pointed out in a former article (26) that during the development of the amphibian organism six groups of organs can be distinguished, the development of each of which seems to be caused by a separate chemical mechanism; while only one of them is proved to be of an endocrine nature, the same is suspected to be the case in the other five mechanisms though the exact nature of these is unknown.
Our knowledge of the role of internal secretions is only in the beginning of its development and yet it has proved to be of such importance that wherever the slightest suspicion of an inner
UHLENHUTH 293
secretory action appears most extensive and active work should be initiated to bring to lhght facts upon which further studies could be based. It is my opinion that these methods alone will be able to solve the thymus problem. For this reason I think that Hoskins (10), while he was justified in claiming that the exist- ence of a thymic hormone was not proved up to 1918, went too far when he predicted that the thymus gland would turn out to be non-endocrine. Besides, | do not think that his arguments are entirely in accord with the facts. He cites as against an inner secretory function of the thymus its lymphoid nature. The cells which make up the thymus belong to the vascular sys- tem, and their function, he says, is no more likely to be the forma- tion of an internal secretion than is true of cells of similar ap- pearance in other lymphoid tissues. He overlooked, however, the fact that the thymus contains beside lymphoid cells also other types whose possible function cannot well be determined merely from histological examination. Even the spleen, which also belongs to the vascular system and plays an important role in supplying the cellular elements of the blood, is believed by some to form an internal secretion (5, 8, 9).
Furthermore the extirpation experiments of Allen (1) can- not be justly claimed to prove that the thymus is a useless organ. Allen extirpated the thymus from very young frog embryos and found that they went through metamorphosis in the normal way. This is a very important result, but it does not prove by any means that the thymus is not required to maintain a normal physiological condition of an amphibian. For, first, metamor- phosis, as | have shown recently, is only one part of development and that it takes place in a normal way does not prove that other developmental phenomena have also done so. Furthermore it may be possible that the thymus gland, even if it is not necessary during the larval period of amphibians, is performing a very important function during the later periods of life, or that, without the function of the thymus gland, some organs have not developed during the larval period the function of which would have become of importance after metamorphosis. Allen has not extended his experiments over a period long enough to make these points certain, but his statement that all larvae from which the thymus had been extirpated died during metamor- phosis in a most conspicuous manner and in contradistinction
294 FUNCTION OF THYMUS GLAND
to the non-operated controls certainly is far more in favor of the assumption that the thymus plays an important role during the life of an amphibian than it is in favor of the opinion that the thymus is a useless organ.
How important it is to extend experiments concerning the function of endocrine organs over as long periods as possible has become evident from Allen’s own experiments on the thyroid gland. Allen (2) has shown that during the larval period tad- poles from which the thyroid was extirpated were indistinguish- able from normal tadpoles; it would be very wrong, however, to conclude from this that the thyroid is a useless gland. For as soon as the time comes when the larvae should metamorphose, the effect of the absence of the thyroid becomes visible in a failure of that process. This result is of very great general importance, because it shows that endocrine disturbances though they may appear late in life need not have been caused by the action of factors during this period; they may be due to factors which acted during an early embryonic period when the glands were in the state of development, their effect not becoming visible at this time because that particular function which was suppressed or disturbed by the action of these factors was not required for the maintenance of the normal condition of the organism until at a later period. Hence our opinion that the relation of inner secre- tory disturbances to embryonic development needs an extensive study.
It might be well to make brief mention of still another phenomenon which we have regularly observed in thymus fed salamanders. Though the experiments are not complete and an adequate explanation cannot so far be offered, it seems desirable to describe briefly the observations because more careful studies under way now will not be finished for some time.
It has been stated above that larvae which receive normal food for a short time after hatching will grow and metamorphose even if they are fed exclusively on thymus during the rest of the larval period. We were successful in obtaining quite a num- ber of such metamorphosed thymus-fed animals. If these ani- mals, after metamorphosis, are held at a low temperature (15°C) it is possible to keep them alive on exclusive thymus diet; such animals may grow for a considerable time just as well as worm- fed animals at the same temperature; one of them, for instance,
UHLENHUTH 295
was growing for about two years after metamorphosis, though it ‘had been fed on normal food only during the first 14 days after hatching. Finally, however, all of them began to exhibit signs of an edematous condition which progressed until the entire body became greatly swollen. The parotid region, the region of the thymus and of the parathyroids began to develop into large pro- trusions, the tongue became thick and filled up the entire mouth cavity. Everywhere the skin presented an appearance as if it were thinning out over large water-filled cavities. This condi- tion once started progressed until the death of the animal. Weeks before the animals die they exhibit a sort of stupor and increasing debility ; they frequently are found on the back and they hardly move. The heart beat also is slowed down and apparently is less vigorous than normal. During the last week or so long intervals may elapse between successive beats. The most con- spicuous and extraordinary phenomenon, however, is the edema. We have observed this condition so far in the adults of two species (Ambystoma maculatum and A. opacwm) the only ones fed on thymus for so long a time after metamorphosis. Recently, however, we have paid greater attention to this phenomenon and have found that edema may appear even in the larval stage of the species A. opacum if the larvae are fed from the beginning on thymus, but in a more moderate degree. The most peculiar form of this edema, however, was exhibited by the larvae of a third species, A. tigrinum; if no normal food was given before the beginning of the thymus feeding, all larvae developed, at an age of about 70 days, four balloon-lhke protrusions, which were filled with fluid and over which the skin was greatly thinned out. One of these accumulations of fluid was situated in the region of the heart, one on the belly and one on each side immediately back of the gills and extending from the root of the forelimb to the dorsal fin. These protrusions were of enormous size, giving the animal a shape much like a balloon. Shortly after the de- velopment of this edema all animals died.
A number of our oldest metamorphosed animals were dis- sected when they showed the comatous condition and while they were still alive (in order to make sure that the changes to be reported are not post-mortem changes). It was found that many parts, including the skeleton, had assumed a white and _ jelly- like appearance. Upon opening the abdomen large quantities of
296 FUNCTION OF THYMUS GLAND
fluid were seen. These phenomena are so conspicuous and occur so regularly that it might cause wonder that other experimenters have not observed them. Apparently this is due to the fact that no one so far as we are aware, has kept the animals long enough under observation and no one has fed them exclusively on thymus. Though, naturally, many suggestions may be ventured, we cannot yet give any real explanation of the phenomenon, since our studies concerning this point have not been completed.
SUMMARY
The thymus actually does produce an internal secretion, but one which, so far as we know at present, has only a toxic effect in that it is the factor causing the ‘‘tetania parathyreo- priva.’’ There are, however, no facts known at present to war- rant the claim that the thymus gland does not produce an internal secretion which is required to maintain the normal physiological condition of the organism.
BIBLIOGRAPHY 1. Allen, B. M.: Extirpation of the thymus gland in Rana pipiens larvae. Anat. Ree. (N. Y.), 1918, 14, 86. 2. Allen, B. M.: The results of thyroid removal in the larvae of Rana pipiens. J. Exp. Zool. (Balt.), 1918, 24, 499.
3. Baumann, E.: Uber das Thyrojodin, Minch. Med. Wehnschr., 1896, 43, 309.
4. Denis, W.: <A note regarding the presence of iodine in the human pituitary. J. Biol. Chem. (N. Y.), 1911, 9, 363.
5. Gachet, J. and Pachon, V.: Nouvelles expériences sur la
secrétion interne de la rate, a fonetion pancréatogene. Arch. de Phys. norm: et path. (Paris), 1898, 5th Series, 1ON363:
6. Gudernatsch, I. F.: Feeding experiments on tadpoles. I. The influence of specific organs given as food on growth and differentiation. Arch. fiir. Entwick. d. Organ. (Leip- zig), 1912, 35, 457. ;
Halliburton, W. D., Candler, J. P. and Sikes, W. A.: The human pituitary body. Quart. Jour. Exp. Phys. (Lond.), 1909, 2, 229.
Herzen, A.: Uber den Einfluss der Milz auf die Bildung des Trypsins. Arch. f. d. ges. Physiol. (Bonn), 1883, 30, 295.
—~l
[o'a)
10;
11. 12.
13.
14.
16.
17.
18.
fo
UHLENHUTH 297
Herzen, A.: Beitrage zur Physiologie der Verdauung, II. Alteres, Neueres und Zukiinftiges iiber die Rolle der Milz bei der Trypsinbildung. Ibid, 1901, 84, 115.
Hoskins, E. R.: Is there a thymie hormone? Endoerinol- ogy (Los Angeles), 1918, 2, 241.
Simpson, 8. and Hunter, A.: Relation between the thyroid and pituitary glands. Proce. Soc. Exper. Biol. and Med. peeers) 190910. 7,511.
Swingle, W. W.: Experiments with feeding thymus glands to frog larvae. Biol. Bull. (Woods Hole), 1917. do, c016. .
Swingle, W. W.: Studies on the relation of iodine to the thyroid. I. The effects of feeding iodin to normal and thyroidectomized tadpoles. J. Exp. Zool. (Balt.), 1919, 27, 397. |
Swingle, W. W.: Studies on the relation of iodine to the thyroid. II. Comparison of the thyroid glands of iodin- fed and normal frog larvae. Ibid, 1919, 27, 417.
Uhlenhuth, E.: On the role of the thymus in the produe- tion of tetany. Proc. Nat. Acad. Se. (Balt.), 1917, 3, 517.
Uhlenhuth, E.: Does the thymus gland of mammals when given as food to amphibians exert any specific influence upon the organism? Proc. Soc. Exp. Biol. and Med. fie) Poly. 20, 37.
Uhlenhuth, E.: Is the influence of thymus feeding upon development, metamorphosis and growth due to a spe- cific action of that gland? J. Exp. Zool. (Balt.), 1918, 25, 135.
Uhlenhuth, E.: The antagonism between thymus and parathyroid glands. J. Gen. Physiol. (N. Y.), 1918, 1, 23.
Uhlenhuth, E.: Further proof of the existence of a spe- cific tetany-producing substance in the thymus gland. ibids 1918. 1, 33.
Uhlenhuth, E.: Parathyroids and calcium metabolism. Proe. Soe. Exp. Biol. and Med. (N. Y.), 1918, 16, 20.
Uhlenhuth, E.: The influence of milk upon tetany in sala- mander larvae. Ibid, 1919, 16, 51.
Uhlenhuth, E.: Further proof of the antagonism existing between the thymus and parathyroid. Ibid, 1919, 16, 70.
Uhlenhuth, E.: Nature of the retarding influence of the thymus upon amphibian metamorphosis. J. Gen. Physiol. Cn). £999" 4: S05:
bo ~l
FUNCTION OF THYMUS GLAND
Uhlenhuth, E.: Parathyroids and calcium metabolism. | Ibid, 1919, 1, 315.
Uhlenhuth, E.: Relation between thyroid gland, meta- morphosis and growth. Ibid, 1919, 1, 473.
Uhlenhuth, E.: Relation between metamorphosis and other developmental phenomena in amphibians. Ibid, 1919, 41,-525:;
Wells, H. G.: The presence of iodine in the human pitui- tary gland. J. Biol. Chem. (N. Y.), 1909-10, 7, 259.
THE EFFECT OF SPLENECTOMY ON THE THYMUS* F. C."Mann, M.D.
Division of Experimental Surgery and Pathology, Mayo Clinic, Rochester, Minn.
Probably very few glands in the body have been the subject of as much barren research as the spleen and thymus, and but few positive statements can be made with regard to the function of either of the glands. They do not appear to be necessary for hfe and their loss produces little demonstrable change which may be the reason we know so littke about their functions.
Both the glands are lymphoid in character; this is believed from clinical and experimental standpoints to establish a definite relationship between them. A few deaths have been reported which seemed to have some connection with a large thymus and atrophic spleen (Avellis). The investigators of the thymus have been more insistent on a relationship between the two organs than the investigators of the spleen. Friedleben seems to have been the first to hint that such a relationship exists. In Basch’s experiments the removal of the spleen in a thymeectomized animal did not produce any effect. Klose claimed that the spleen is the principal compensatory organ of the thymus. He found that the spleen, at first much enlarged after thymectomy, later seemed to undergo functional atrophy; its removal in some of the thymectomized animals. produced death. Klose and Vogt assumed that the adult spleen undertakes the function of the thymus when the latter regresses and suggested that the thymus compensates for the spleen when the latter is removed. Soli found the weight of the spleen in chickens and rabbits unaffected by thymectomy. Lucien and Parisot also found the weight of the spleen unchanged after thymectomy, but in certain cases they observed an increase in the number and the size of follicles. Perrier found an increase in the lymphatic tissue of the spleen and the presence of very large germinating centers in the fol- licles after thymectomy. Magnini claimed there is a hyper- trophy of the spleen in both young and adult rats after thymec- tomy. Matti found primary hyperplasia followed by atrophy of the spleen after thymectomy; he also reported hyperplasia of
*Submitted for publication July 9, 1919.
299
300 EFFECT OF SPLENECTOMY ON THYMUS
the thymus following splenectomy in the dog. Bayer stated that there is a mutual compensation between the spleen and the thymus. If the spleen is removed the function of the thymus becomes more efficient; if the thymus is removed the spleen becomes more active. Pappenheimer, in his careful study of the effect of early extirpation of the thymus in rats, was not able to detect any alteration in the spleen. Many other studies have been made on the effect of thymectomy or splenectomy in . various species of animals such as guinea pigs (12), rats (17), dogs (16, 8, 13), but little or no mention has been made of the thymus. This brief review of the pertinent literature shows that the so-called pluriglandular theory has been applied to the spleen and thymus with the usual lack of discrimination and substan- tial data.
In my series of experiments on animals from which the spleen had been removed for various purposes the thymus was observed regularly. As nothing definite was determined, although some suggestive material was obtained, a special series of experiments was performed for the specific purpose of deter- mining whether or not splenectomy produces any effect on the thymus. Observations on the thymus after removal of the spleen have been made on both adult and very young animals of several species. Since the thymus regresses and almost disappears early in hfe it would seem that should any effect of removal of the spleen be demonstrable, the splenectomy would have to be per- formed on very young animals. The spleen was therefore re- moved just as early in life as the animals were considered able to withstand the operation successfully. One or more members of the same litter or of the same age were kept as controls. In some instances one of a litter was killed and the thymus removed and weighed at the time of operation and beginning observations of the animal used in the experiment.
All operations were performed under anesthesia, with sterile technic. The young animals were placed in an incubator imme- diately after operation because their temperature controlling mechanisms were not very stable. Many of the animals died from intercurrent disease, but enough data were secured to justify certain conclusions. At necropsy a careful examination for thymic tissue was made and when any was found it was fixed in Zenker’s solution without acetic acid and weighed
MANN 301
twenty-four hours after fixation. Since the tissue removed frequently consisted mainly or wholly of fat it was necessary to make several sections of the specimen in order to estimate the amount of thymie tissue present. The position of the thymus or thymic tissue varies with different species of animals. In instances in which no thymic tissue could be found grossly in the thorax and the neck, a histologic search was seldom made because small amounts of such tissue may usually be found microscopically in the normal adult animals. |
Observations were made on 25 adult dogs from which the spleens had been removed at different periods varying from a few weeks to two years. The thymus of these animals did not differ from that of normal dogs. In a very few animals of the series a small amount of thymie¢ tissue could be found, but in most instances it could not be noted grossly. The same varia- bility in the amount of thymic tissue may be observed in normal adult dogs.
The spleens were removed from 16 puppies ranging in age from three to six weeks. Thirteen puppies belonging to the same litters were kept as controls. As is often the case, distemper killed most of the puppies within a short time after observations were begun, but a few of them lived several weeks and one lived eleven months after splenectomy. No difference in the thymic tissue of the splenectomized puppies and of their controls was noted, although a great variability in the amount was found in the different animals, even of the same litter. One puppy would have a large thymus, while another of the same litter would have only a trace of thymic tissue. No grossly discernible: thymic tissue was found at necropsy in- the splenectomized puppy that lived for eleven months after operation.
A few kittens were used in the investigation ; no conclusions could be drawn. The kittens were found to have practically no thymus by the time they were old enough to be operated on safely.
Observations were made on 75 adult rabbits from which the spleen had been removed at different periods varying from a few days to two years. Very rarely was any thymic tissue found and when found the amount was small. With one exception the splenectomized rabbits did not have more thymic tissue than the controls.
302 EFFECT OF SPLENECTOMY ON THYMUS
Spleens were removed from 21 young rabbits ranging in age from five to nine weeks. ‘Twelve rabbits belonging to the same litters were kept as controls. Great variation in the size of the thymus was found even in the animals of the same litters. Splen- ectomy did not, however, cause an increase in the thymus, nor apparently any earlier regression of the organ.
In observations made on a large series of normal adult goats only a small amount, if any, thymic tissue could be recognized grossly. However, at necropsy of a very old goat (Goat 50), from which the spleen had been removed in another experiment, a large thymus was found. This seems to indicate that the lack of the spleen might be a cause of the enlargement of the thymus, although the experiment was complicated by other factors, such as the administration of cholesterin, and the X-ray. Accordingly several careful experiments were carried out on young goats. Normal data were obtained from goats of various ages that had been used in other experiments, and it was found that the size of the thymus varied greatly.
The spleens were removed from eight kids shghtly less than a month old. Four other kids of the same age were kept as controls. The thymuses of a few other kids that died shortly after birth, were studied for controls. At birth and during the first few: weeks of life the thymus is usually quite large, but even at this age individual variation is marked. Most of the kids withstood splenectomy well, then died or were killed at various periods of time after operation. A careful review of the results does not show any difference in the thymus of the splen- ectomized animals and that of the controls (Table 1 and protocols of goats).
An attempt was made by microscopic study not only to estimate the amount of thymic tissue in relation to the fat, but also to gauge the possible activity of the gland from its general appearance, number of Hassall’s corpuscles, ete. Decided varia- tions were found, but there was no evidence that splenectomy produced any specific change.
Luckhardt has made some suggestive observations with re- gard to splenectomy in very young rabbits and dogs. (8) Tachi- gara and Takagi apparently did not note much difference be- tween the effects of splenectomy in the puppy and in the adult dog. Our results show that some animals from which the spleen
3
« .
30
TABLE I. SALIENT DATA OF THE MOST IMPORTANT EXPERIMENTS PERFORMED ON GOATS.
MANN
Age at Time |Weight at ‘Time Time From | Weight at | Weight of |Estimated Amount
Goat Sex of Operation, | of Operation, | Operation | Operation to Time of | Thymus, | of Thymic Tissue
Days kg. Necropsy, days | Death, kg. gm. in Mass Weighed 77 M 25 5.0 Splenectomy 318 15.5 0.9 20 per cent 78 M 25 5.2 Splenectomy 327 15.9 1.0 50 per cent 79 F 25 5.6 Splenectomy 490, 16.5 0.9 50 per cent 80 r 25 ‘sys Control 483 2° 0.85 35 per cent 81 M 25 4.9 Splenectomy 174 24 1.6 90 per cent 82 iF 25 5.4 Sontrol 490 14.5 1.52 75 per cent 83 M 28 4.9 Splenectomy 9 3.15 3.3 85 per cent 84 M 28 4.8 Control 18 4.0 3.9 85 per cent
304 EFFECT OF SPLENECTOMY ON THYMUS
has been removed quite early in life develop in the same fashion as the unoperated controls; furthermore, no definite specific change in the development due to the loss of the spleen was observed in any of the animals. Most of the splenectomized animals died before the controls died, however, and under the same conditions that the controls were developing normally. While removal of the spleen in the young did not produce any noteworthy change in development, it seemed to make the animal less able to withstand the stress of life. In order to obviate the possibility of false conclusions owing to this individual variability in the thymus it might be of value to perform the experiments on rats as that species has been carefully standardized. It should also be remembered that since rarely some effect of splenectomy has been noted on other tissues, such as the bone marrow and lymph nodes, it is possible that a larger series of experiments might have contained one or more that were positive.
PROTOCOLS
Goat 50. A very old female angora goat weighing 98.8 kg. was admitted to the laboratory Sept. 15, 1916, and was used by Dr. Luden in making cholesterol observations. January 5, 1917 the spleen was removed successfully. Complete healing followed slight infection of the abdominal wound. Beginning February 26 the animal was given cholesterin and a few X-ray treatments. She gave birth to a kid April 17 and died June 17, at which time she weighed 36 kg. At necropsy a large thymus (4 gm.) was found. Histologically the thymic tissue appeared to be very active; approximately 90 per cent of the tissue weighed was thymic.
Goat 79. A female angora goat, one month old, weighing 5.6 kg., was splenectomized March 22, 1918. The weight of the spleen was 20 gm. The animal recovered from the operation and re- mained in excellent condition. It was allowed to run with its mother on pasture, where it seemed to grow and develop normally. At the end of four months the animal did not differ noticeably from the controls. It weighed 18.2 kg. at this time. February, 1919, when the animal was returned to the laboratory, it weighed 22 kg. A series of blood counts, hemoglobin estimations, etc., was made; all counts fell within the normal limits. The animal lost some weight in the laboratory; on May 25 it weighed 21.3 kg., but it remained in good condition until June, by which time its weight had decreased to 16.5 kg. This loss of weight was attributed to the loss of its hair, which had been sheared, and to the confinement in the labora- tory, since the control also lost weight under the same circum- stances. The animal was killed by bleeding under ether, and necropsy (300) was performed immediately after death; except for
MANN 305
the emaciation the animal was normal. The operative wound was healed perfectly; there were no adhesions. A small amount of thymic tissue was found. This was fixed in Zenker’s solution with- out acetic acid and twenty-four hours after fixation it weighed 900 mg. Microscopic examination showed that about 50 per cent of the weighed tissue was thymic. There were many Hassall’s cor- puscles; the hemolymph nodes were undoubtedly greatly increased in this animal.
Goat 82. A female angora goat one month old was splenecto- mized March 22, 1918. The kid was allowed to run with its mother on pasture, where it developed normally. August 1 its weight was 20 kg.; February, 1919, it was returned to the laboratory weighing 24 kg. A series of blood counts, hemoglobin estimations, etec., was made; all counts were normal. The animal lost slightly in weight in the laboratory, but remained in good condition until June 25, when its weight had decreased to 14.5 kg. One month before the animal had weighed 29.5 kg. The loss of weight was attributed to the loss of hair which had been sheared, and to the confinement in the labora- tory. The animal was killed by bleeding under ether. Necropsy (301) was performed immediately. The animal was emaciated, but perfectly normal. A small amount of thymic tissue was found and fixed in Zenker’s solution without acetic acid; twenty-four hours after fixation it weighed 1520 mg. Microscopic examination showed about 75 per cent of the weighed tissue to be thymic. There were but few Hassall’s corpuscles. There were practically no hemolymph nodes; a few, measuring 2 mm. in diameter, were with difficulty found for microscopic study.
BIBLIOGRAPHY
1. Avellis (G.) Epikrise eines Falles von nicht ganz plotz- lichem Thymustod, verursacht dureh (vireariirende) Thymus-Vergrésserung bei rudimentiir kleiner Milzan- lage.. Arch. f. Laryngol. u. Rhinol. (Berlin), 1898, 8, 159-167.
2. Basch, (K.) Uber Ausschaltung der Thymusdriise. Wien. klin. Wehnschr., 1903, 16, 893-896.
3. Bayer (R.) Weitere Untersuchungen iiber die Funktionen der Milz, vornehmlch ihre Rolle im Eisenstoffwechsel, mit besonderer Beriicksichtigunge des Morbus Banti. Mitt. a.d. Grenzgeb. d. Med. u. Chir. (Jena), 1914, 27, 311-339.
4. Friedleben. Quoted by Matti.
5. Klose, (H.) Ueber Thymusexstirpation und ihre Folgen. Arch. f. klin. Chir. (Berlin), 1910, 92, 1125-1141.
6. Klose (H.) and Vogt (H.) Klinik und Biologie der Thy- musdriise. Mit besonderer Beriicksichtigung ihrer Bezie- hungen zu Knochen- und Nervensystem. Beitr. z. klin. Chir. (Tiibing), 1910, 69, 1-200.
306
16.
AT.
EFFECT OF SPLENECTOMY ON THYMUS
Lucien (M.) and Parisot (J.) Contribution a l’étude des fonctions du thymus. Arch. de méd. exper. et d’anat. path. (Paris), 1910, 22, 98-137.
Lueckhardt. Data presented before the American Physio- logical Society, December, 1917.
Magnini (M.) Le funzioni del timo ed i rapporti fra timo e milza. Arch. di fisiol. (Firenze), 1912-1913, 11, 333-354.
Matti (H.) Untersuchungen tiber die Wirkung experi- menteller Ausschaltung der Thymusdriise. Mitt. a.d. Grenzgeb. d. Med. u. Chir. (Jena), 1912, 24, 665-821.
Pappenheimer (A. M.) The effects of early extirpation of the thymus in albino rats. Jour. Exper. Med. (N. Y.), 1914, 19, 318-338.
Park (E. A.) Extirpation of the thymus in the guinea pig. Jour. Exper. Med. (N. Y.), 1917, 25, 129-152.
Pearce (R. M.), Krumbhaar (E. B.) and Frazier (C. H.) The spleen and anemia. Experimental and_ clinical studies. Philadelphia, Lippincott, 1918, 419 pp.
Perrier (C.) Modifications histologiques de l’hypophyse et de la rate consécutives 4 la thymectomie. Rev. med. de la Suisse Rom. (Genéve), 1910, 30, 839-854.
Soh (U.) Comment se comportent les testicules chez les animaux privés de thymus. Arch. ital. di biol., 1907, 47, 115-122. Contribution 4 la connaissance de la fonetion du thymus chez le poulet et chez quelques mammiféres. Arch. ital. de biol. (Rome), 1909-1910, 52, 353-370.
Tachigara (S.) and’ Takagi (T.) Uber die Erythroblastose und die Blutveranderung nach der Milzexstirpation beim neugeborenen Hunde. Mitt. a.d. med. Fak. d. k. Univ. Tokyo, .1917, i 563-595.
Wolferth (C. C.) Blood changes in albino rats following removal of the spleen. Arch. Int. Med. (Chgo.), 1917, 19, 105-116.
THE FUNCTIONS OF THE INTERNAL SECRETION OF THE PLACENTA
Frederick S. Hammett,
Pennsylvania Hospital, Department for Mental and Nervous Diseases, Philadelphia, Pennsylvania
From 1884 on, when Johannes Muller (1), designated the placenta as one of the secretory glands, the amount of investiga- tion devoted to attempts at determining the functions of the elab- oration has been so cumulatively stupendous in its complexity that any presentation in detail of the literature would be out of the question save in a monograph devoted to the subject.
A retrospective analysis of the work undertaken reveals, however, four fairly distinct nuclei of attention, although it must be said that the investigations from the point of view of quantity bear but little relation to the validity of the findings in the re- spective fields of endeavor.
Apparently the most potent nucleus of attention was that around which has gathered the controversy regarding the role played by the placenta in the development of eclampsia. With the discovery by Schmorl (2) of the presence of emboli of pla- cental cells in the blood vessels of eclamptics there originated the idea that this not infrequent accompaniment of pregnancy was due to the placenta. The gradual accumulation of experimental results gave rise to three fundamentally different conceptions. The first of these hypotheses attributed as the cause of eclampsia the giving off from the placenta of protein material foreign to the host, and the inadequate elaboration of an antibody ‘‘syncytioly- sin’’; around this idea of Veit (3) revolved the work of Ascoli (4), Weichardt (5), Shenk (6, 7), Liepmann (8, 9), and others, but the entire series of experiments and conclusions therefrom was repudiated by the work of Licthenstein (10, 11, 12), Dryfuss (13), Freund (14), and Mathes (15, 16). The second idea sup- ported by Hofbauer (17, 18), Dienst (19), Dryfuss (20), and others, attributed the etiology of eclampsia to an escape of the placental enzymes into the maternal blood stream in excess, with subsequent development of toxic products. Not as opposed to the latter hypothesis as a contributing ¢ause, but as considering it inadequate, Lichtenstein (21), proposed the idea that the origin
307
308 INTERNAL SECRETION OF PLACENTA
of eclampsia does not he in the production by the placenta of toxic material per se, but in the possibility that through a per- version or diminution, or both, of placental function the meta- bole by-products are allowed to escape in quantity into the ma- ternal system and there being present in addition to those pro- duced by the maternal organism as the result of its own meta- bolism, put such additional burden upon the excretory and detoxi- cating organs that they can not adequately deal with it, and toxe- mia results. In a monograph by Hofbauer (22), are collected the references and evidence of the metabolic activities of the pla- centa up to 1905, which clearly indicate that the placenta plays a significant part in the preparatory metabolism for both mother and foetus. Quite recently it has been shown that the placenta can readily form urea (23), and it is well known that the forma- tion of urea by the organism is the method by which the body prepares the greater part of its nitrogenous by-products for exere- tion. Moreover, further evidence has been adduced in the fact that placentas from toxic pregnancies contain a much higher urea content than do these from normal pregnancies (24), and it is evident from the work of Marshall and Davis (25), that due to the ready diffusibility of urea this substance must accordingly be present in higher concentration throughout the tissues of eclamp- tics than in the tissues of those in normal pregnancy. In addi- tion, histological studies by Dr. J. L. Bremer, which have not yet been published, strongly indicate that in the placentas of eclamptics there is a markedly increased transformation of the syncytium into a squamous type of cell thinly overlying the foetal placental blood vessels which points to the probability of an in- creased permeability in these cases. It accordingly appears prob- able that the cause of eclampsia does not lie in any inherent pro- duction of a secretion by the placenta, but rather that this dis- order comes from a decrease, or perversion, or both, of the inter- mediary metabolic function of the placenta accompanied by an in- creased permeability of the endothelium covering the villi pro- jecting into the maternal sinuses; the combined effect of this increased permeability and decreased detoxicating activity being a flooding of the maternal organism with the incompletely hydro- lysed by-products of the ‘foetal metabolism, putting such extra
burden upon the liver and kidneys of the mother that these tis-
HAMMETT 309
sues break down, with the characteristic manifestations of an acute toxemia.
In the search for the specific source of the substance causing hyperplasia of the mammary gland during pregnancy it was but natural that the placenta received much experimental attention, since this tissue occurs concomitantly with the marked develop- ment of the mammae immediately preparatory to the taking up of the function of supplying nourishment for the infant. The in- vestigations along this line consisted mainly in administering pla- cental extracts prepared in a variety of ways, either subcuta- neously or intraperitoneally. The apparently conflicting results have given rise to no little controversy, but although Fellner (26), Halban (27), and Cohn (28), seem to have obtained a type of response indicating that the placenta does in part, at least, contribute stimulus to mammary hyperplasia in virgins yet the mass of experimental evidence produced by Biedl (29), Biedl and Konigstein (30), Basch (31), Frank (32), Frank and Unger (33), Foa (34), Lane-Claypon and Starling (35), and others seems to disprove the idea in a satisfactory manner, and more particularly since the work of the latter investigators, which has also been confirmed by Foa (36), and Biedl (37), gives conclu- sive evidence of the stimulating effect of extracts of tissues of the foetus upon mammary hyperplasia. In an experiment carried on at the Boston Lying-in Hospital during the winter of 1917-1918, it was impossible to detect by bedside observation any increased growth of mammary tissue when desiccated placenta was fed post- partum to lactating women, as compared with a series of patients not receiving the placental material (38). It is, of course, obvious that we were here dealing with a condition much different from that ocevrring during pregnancy and that the negative results may mean little or nothing as evidence towards the part played by the placenta in pregnancy hyperplasia, nevertheless, the va- lidity of the interpretation is on a par, until disproved, with that given from the work on virgin animals. From the evidence at hand it is reasonably certain that the placenta has but little if any direct influence upon the mammary hyperplasia of preg- nancy, the source of the stimulus of this development lying in part in the foetus.
The mammary hyperplasia of pregnancy is but the prepara- tion of the glands for the secretory function of producing milk,
310 INTERNAL SECRETION OF PLACENTA
and the question as to the source of the stimulus initiating and maintaining this function throughout the period of lactation has been a subject of much study. A very comprehensive bibliogra- phy on milk secretion compiled by Rothschild (39), contains references to most of the investigations up to 1904. The studies of Goltz (40), Ribbert (41), and Pfister (42), have shown quite conclusively that direct nerve stimulation is a relatively unim- portant factor. This demonstration of the dependence of the secretory function of the mammae upon the elaboration of a hor- . mone led Halban (48), to a series of experiments in which he sue- cessively eliminated the ovaries, uterus, and foetus as the cause, and to the conclusion that the placenta during pregnancy gives off a substance acting as a chalone to milk secretion which, on its removal at term, allows the secretory function to be taken up. This was supported by Hildebrandt (44). Basch (45), Lederer and Pribram (46), and Aschner and Grigoriu (47), Bouchacourt (48), and Niklas (49), claim to have obtained an increased milk secretion on administration of placental extracts and the latter considers that at delivery there is an overflowing of placental hormones into the maternal blood which. after a certain pericd of incubation, brings about the initiation of the secretory activity of the milk producing cells. Yet this idea fails to explain the con- tinued secretion of milk during the period of lactation. On the other hand, Mandl (50), Lane-Claypon and Starling (51), Mac- kenzie (52), Gaines (53), Fieux (54), and others, have been un- able to find any valid evidence of increased milk secretion due to the placenta. More recently Van Hoosen (55), and Cornell (56), have concluded from feeding experiments with desiceated placenta that this tissue acts as a galactagogue, Van Hoosen (57) definitely claiming to have obtained an increased milk secretion and Cor- nell (58) basing his conclusions on an increased growth of the breast-fed infants. However that may be, in a short series of experiments carried on at the Los Angeles County Hospital and reported in two publications, one by McNeiie (59), and one by MeNeile and the author (60), and in a longer series of experi- ments in which over three hundred women were fed 10 grains of desiccated placenta three times a day (61), it was impossible to detect any increased secretion of milk as the result of the inges- tion of this material when compared with the secretory activity of the mammae of patients not receiving the material. No pub-
HAMMETT 311
lished reports having appeared giving results of consecutive analyses of human milk produced under the influence of the in- gestion of desiccated placenta, McNeile and I (62), carried on a research designed to demonstrate whether or not the maternal ingestion of desiccated placenta would alter in any way the chemical composition of the milk produced when compared with that from lactating women under identical conditions of diet and environment but not receiving the desiccated placenta (63). As a result of our investigations it was found that although there was no apparént stimulation leading to an increased supply of milk there was exerted upon the secretory function of the mam- mary gland an influence tending to raise the level of protein and lactose production with a decrease in fat elaboration.
This alteration in composition, however, was not attributable to the food value of the ingested placenta! material since the amount was hardly a grama day. It is therefore possible to con- clude that the evidence at present available does not permit us to assign a galactogogic activity to the placenta, and that its only influence upon milk secretion is slightly to raise the level of pro- tein and lactose production while lowering that of fat. .
The fourth and most recent nucleus of attention in the search for the evidence of the placental production of an internal secre- tion has been the question of the influence of the placenta on growth. A number of direct feeding experiments have been car- ‘ried on, but they give no evidence of a specific growth promoting substance in the placenta since the increased growth may well have been due to the addition to the diet of a supply of amino- acids in sufficient relative quantity to cause the observed effect. Van Hoosen (64), however, noticed increased growth of breast- fed infants when the mothers were fed desiccated placenta, as compared with infants subsisting upon milk from mothers not re- ceiving the placental material. However, the general plan and scope of the work did not allow the drawing of any valid conclu- sions, although taken together with the note by Hammett and Me- Neile (65) ,and the work on the galactagogic action of the placenta by Cornell (66), pointed to the possibility that the feeding of des- iccated placenta to nursing mothers had some effect on the growth of the breast-fed infants. Cornell found that 87 per cent of those infants receiving milk from mothers ingesting desiccated placenta had regained their birth weight by the 4th or 5th day, as com-
312 INTERNAL SECRETION OF PLACENTA
pared with a 67 per cent regain for the infants ingesting milk from mothers not receiving the placental material. He wrongly attributes this favorable effect to a galactogogic activity of the placenta, as it has been shown above that the ingestion of desic- ‘ated placenta fails to increase the secretion of milk, and as it will be later shown, the caloric increase in the milk, due to the action of the placenta ingested upon the secretory functions of the mammae is insufficient to account for the gain in weight ob served.
During the winter of 1917-1918 I carried on a series of experiments at the Boston Lying-in Hospital with the view to determining whether or not the maternal ingestion of desiccated placenta, as prepared according to the earlier report (67), would cause an appreciable difference in the rate of growth of the breast-fed infants when compared with that observed in normal breast-fed infants. The data for the normal growth curves were obtained from the weights of 537 infants born at the Boston Lying-in Hospital, taken on the Ist, 3rd, 5th, 7th, 9th, 11th and 13th days after delivery. Figures were taken only from those infants whose sole nourishment was derived from the maternal breast (68). Having thus obtained a standard based on the meth- ods of weighing, care, and diet in use at that hospital, and which was necessary for any valid investigation of this nature, every patient was given 10 grains of the desiccated placenta in a capsule three times a day for two weeks, until a sufficient number of ob- servations had been made to give valid indications. The condi- tions as to diet, weighing and so forth were the same as obtained with the cases where no placenta was fed. The growth curves of 177 infants were obtained from the weights of the infants on the Ist, 3rd, 5th, 7th, 9th, 11th and 13th days after delivery. Asa result of this investigation it was determined that the effect of the ingestion of desiccated placenta by the mothers on the growth of the breast-fed infants is a lessened post-natal decline in weight, a quickened recovery from the preliminary loss, an increase of over 60 per cent in the rate of growth by the 13th day and an increase in the growth capacity when compared with similar figures ob- tained from infants receiving nourishment from others not ingest- ing the desiccated placenta. In view of these facts, and having, in addition, evidence that the increased food value of the milk preduced during the administration of the dried placenta cannot
HAMMETT 313
of itself compensate for the increased growth, and, moreover, since but 30 grains or less than a gram of the dried material was fed each day, a quantity so small as to be negligible as matter from which new tissue can be built, it is evident that there is pro- duced in the placenta some substance capable of acting as a stimulus to growth, when ingested by the mother and passed on to the infant in the lacteal secretion, and it is not illogical to suppose that the placenta in utero produces a substance acting as a stimulus to the foetal growth.
SUMMARY
The evidence now available concerning the functions of the internal secretion of the placenta eliminates the probability of the participation of such a substance in the production of eclampsia, in the hyperplasia of the mammary glands during pregnancy, or in the secretory function of the mammary glands from a quantity point of view. The feeding of desiccated placenta to nursing mothers does affect slightly the chemical composition of the milk produced, but not significantly. It is, however, certain that there is in the placenta a substance which, when fed to nursing moth- ers, is passed on in the milk to the infants and acts as a stimulus to growth and it is this and this alone that permits the designation of the placenta as an endocrine gland.
BIBLIOGRAPHY
1. Miller, Johannes, Lehrbuch der Physiologie. I. Kloblenz, 1844. e
2. Schmorl, G., Pathologisches-anatomisches Untersuchungen liber puerperale Eklampsie. Leipzig, 1893.
3. Veit. D., Verschleppung der Chorionzotten. Weisbaden, 1905.
4. Ascoli, G., Vorlesungen uber Uraimie. Jena, 1903.
)». Weichardt, W., Zur placentiren Theorie der Eklampsiei- tiologie. Arch. f. Gynaik. (Berlin). 1909, 87, 655.
Shenk, F., Ueber besonderheiten der Giftwirkune des menschlichen Placentasaftes beim Kanninchen. Centbl. f. Gynik. (Leipzig), 1909, 33, 1500.
Shenk, F., Schutzeffekte normaler Sera gegen die Wirkung menschlichen Placentasaftes beim Kanninchen. Centbl. f. Gynak. (Leipzig), 1909, 33, 1353.
8. Liepmann, A., Zur Technik und Kritik der Placentafor-
schung. Centbl. f. Gynak. (Leipzig), 1909, 33, 379. 9. Leipmann, A., Zur Technik und Kritik der Placentafor- schung. Centbl. f. Gynik. (Leipzig), 1909, 33, 138.
a
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Lichtenstein, W., Kritische und experimentelle Studien zur Toxicologie der Placenta, zugleich Beitrag gegen die placentire Theorie der Eklampsieatiologie. Arch. f. Gynak. (Berlin), 1908, 86, 484. (Literature).
Lichtenstein, W., Gegen die placentare Theorie der Eklampsieitiologie. Centbl. f. Gynak. (Leipzig), 1909, 33, 265.
Lichtenstein, W., Im Kampfe gegen die placentare Theorie der Eklampsieitiologie. Centbl. f. Gynak. (Leipzig), 1909; 33,1313;
Dryfuss, J., Chemische Untersuchungen uber die Atiologie der Eklampsie. Biochem. Centbl. (Berlin), 1909, 7, 492.
Freund, R., Zur plazentiren Eklampsieatiologie. Berlin klin. Wochenschr. 1909, 15, 682.
Mathés, P., Zur Theorie der Intoxikation der Mutter durch die Frucht. Centbl. f. Gynak. (Leipzig), 1909, 32, 1548.
Mathés, P., Zur Toxiecologie der Placenta. Centbl. f. Gynak. (Leipzig), 1909, 32, 1548.
Hofbauer, J., Fiir die placentire Theorie der Eklamp- sieditiologie. Zentbl., f. Gynik. (Leipzig), 1908, 32, 1469.
Hofbauer, J., Beitrage zur Aetiologie und zur Klinik der Graviditaitstoxicosen. Ztschr. f. Geburtsech. u. Gynak. (Stuttgart), 1907, 61, 200.
Dienst, A., Die Pathogenese der Eklampsie und ihre Bezie- hung zur normalen Schwangerschaft, zum Hydrops, und zur Schwangerschaftsniere. Arch. f. Gynak. (Berlin), 1908, 86, 314.
Dryfuss, J., loc. cit. 13.
Lichtewstein; loe. eit. 10.
Hofbauer, J., Grundziige einer Biologie der menschlichen Plazenta mit besonderer Berichtsichtigung der Fragen der fotalen Ernahrung. Wein. Leipzig; Wilhelm Braun- miller, 1905.
Hammett, F. S., Urea formation by the placenta. Jour. Biol:;Chem.. CN; ¥:), 1919.37, 105,
Hammett, F. S., The Urea content of placentas from normal and toxemie pregnancies. Jour. Biol. Chem. (N. Y.), STS. 34, 1b.
Marshall, BE. K., Jr., and Davis, D. M., Urea; Its distribu- tion in and elimination from the body. Jour. Biol. Chem. CNe Y¥.), 1914. 185 53:
Fellner, O. O., Experimentelle Untersuchungen iiber die Wirkung von Gewebsextracten aus der Plazenta und den weiblichen Sexualorganen auf das Genitale. Arch. f. Gynak. (Berlin), 1913, 100, 641.
27.
32. 33.
HAMMETT 315
Halban, J., Die innere Secretion von Ovarium und Placenta und ihre Bedeutung fiir die function der Milchdruse. Arch. f. Gynak. (Berlin), 1905, 75, 353.
Cohn, F., Die innere Seeretorischen Beziehungen zwischen Mamma und Ovarium. Monatsch. f. Geburtsch. u. Gynak. (Berlin), 1913, 37, 93. ;
Biedl, A., Internal Secretory Organs. Page 374, New York, 11S:
Biedl, A., and Konigstein, R., Untersuchungen tiber das Brustdriisenhormon der Graviditat. Ztschr. f. exper. Pathol, u. Therap. (Berlin), 1910, 8, 358.
Basch, K., Uber experimentelle ausl6sung der Milchabson- derung. Monatsch. f. Kinderheilkunde (Leipzig), 1909, 9, 8:
Frank, R. T., Zur Frage der experimentellen Milchauslo- sung. Arch. f. Gynak. (Berlin), 1912, 97, 183.
Frank, R. T., and Unger, A., An experimental study of the eauses which produce the growth of the mammary gland. Areh. Int. Med (Chgo.), 1912, 7, 812.
Foa, C., Sui fattori che determinato la funzione della ehiandola mammaria. Archiv. fisiol. (Firenze), 1907, 5, 520.
Lane-Claypon, Janet E. and Starling, E. H., An experimen- tal enquiry into the factors which determine the growth and activity of the mammary glands. Proc. Roy. Soe. (Lond.), Series B, 1906, 77, 505.
Foa; loc. cit. 34.
Bied1; loc. cit. 29.
Hammett, F. S., The effect of the maternal ingestion of desiccated placenta upon the rate of growth of breast-fed infants. Jour. Biol. Chem. (N. Y.), 1918, 36, 569.
Rothschild, H. de, Bibliotheca Lactaria. Paris, 1904.
Goltz, E., Einflusz des Nervensystems auf die Vorginge wahrend der Sehwangerschaft. Pfliiger’s Arehiv. (Bonn), 1874, 9, 552.
~Ribbert; Archiv. f. Entwicklungsmechanik (Leipzig),
1898, 7, —.
Pfister, M., Uber die reflektorischen Beziehungen zwischen Mammae und Genitalia muliebra. Beitriig z. Geburtsch. u. Gynak. (Wein), 1901, 5, 421.
Halban; loe. cit. 27.
Hildebrandt, P., Zur Lehre von der Milechbildung. Beitr. chem. Phys. u. Pathol. (Braunschweig), 1904, 5, 463. 3asch; loe. cit. 31.
Lederer, R., und Pribram, E., Der Einfluss von Plazentiir- extracten auf die Milchsekretion. Deutsch. med. Wehnschr. (Berlin), 1909, 36, 2079.
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47.
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61. 62. 63.
64.
INTERNAL SECRETION OF PLACENTA
Aschner, B., und Grigoriu, Chr., Placenta, Foétus, und Keimdriise in ihrer Wirkung auf die Milchsekretion. Arch. f. Gynak. (Berlin), 1911, 94, 766. souchacourt, M., Nouvelles récherches sur |l’opotherapie placentaire. C. R. Soe. Biol. (Paris), 1902, 54, 133.
Niklas, F., Zur Frage der Plazentahormone und der Ver- mendung von Plazentasubstanzen als Laktagoga. Mo- nats. f. Geburtsch. u. Gynak. (Berlin), 1913, 38, 60.
Mandl; Die klinisehe Bedeutung der Milehsekretion bei bestehenden Sehwangerschaft. Wien. klin. Wehnsehr., 1905, 185 73:
Lane-Claypon and Starling; loe. eit. 35.
Mackenzie, K., An experimental investigation of the mech- anism of milk seeretion with special reference to the action of animal extracts. Quart. J. Exper. Physiol. (Lond.), 1911, 4, 305.
Gaines, W. L., A contribution to the physiology of lacta- tion. Am..J. Physiol. (Balt-), 1915; 38, 285.
Fieux, M. G., Contribution a 1]’étude du sue placentaire dans ses rapports avee la séerétion lactée. Bull. méd. (Parisi 19030 lt 725:
Van Hoosen, B., The new method in obstetrics. Woman’s Med. J. (Toledo), 1915, 25, 269.
Cornell, E. L., Placental tissue as a galactagogue. Surg. Gyn. and Obst. (Chgo.), 1918, 27, 535.
Van Hoosen; loe. eit. 55.
Cornell; loe. eit. 56.
MeNeile, L. G., The effect of the ingestion of desiccated placenta during the first eleven days of lactation. A preliminary report. Am. J. Obst. (N.Y.), 1918, 77, 377.
Hammett, F. S. and MeNeile, L. G., The effect of the inges- tion of desiccated placenta on the variations in the chem- ical composition of human milk during the first eleven days after parturition. ~J. Biol. Chem> GNOYe)] 197 30, 145.
Hammett ; loc. eit. 38.
Hammett and MeNeile; loe. eit. 59.
Hammett, F. S., Variations in the composition of human milk during the first eleven days after parturition. J. 3iol, Chem: (Ne Ye), 1917, 29, 381.
Van Hoosen; loe. eit. 55.
65.
66. oF. 68.
HAMMETT 317
Hammett, F. S. and MeNeile, L. G., The effect of the in- gestion of desiccated placenta on the growth-promoting properties of human milk. Science (N. Y.), 1917, N.S. 44, 345.
Cornell; loc. eit. 56.
Hammett; loc. cit. 60.
Hammett, F. S., The relation between growth capacity and weight at birth. Am. J. Physiol. (Balt.), 1918, 45, 396.
THE INFLUENCE OF THE THYROID GLAND ON THE FORMATION OF ANTIBODIES
J. Koopman The Hague (Holland).
It is a fact, well known to all workers of experience in car- rying out Wassermann tests, that sometimes it is very difficult to get a hemolytic amboceptor with a high titer. There are rabbits which, after three or even after two intravenous or intra-abdominal injections of an emulsion of sheep red blood cells, give a serum with a good or even a high titer. From time to time, however, one may meet with a rabbit, well fed and appar- ently in good health, which may be injected ‘‘ad infinitum”’ without giving a serum with a_ sufficient hemolytic power. Though I have injected many rabbits [ have never been able to tell beforehand whether or not the animal would produce a good amboceptor. I doubt if this is possible. In ordinary times what to do with a rabbit not producing an amboceptor of sufficient titer presents a simple problem. It may be used for all kinds of experimental work, but it is excluded for the Wassermann test.
During the last years of the war, rabbits were rare and expensive, and it is natural that the receipt of such a rafractory rabbit was considered a real calamity. I tried, therefore, to find a way to improve the amboceptor of such an animal. The forma- tion of hemolytic amboceptor may be considered a special case of antibody formation. The formation of antibodies is a regen- erative process. That regeneration is to a great extent under the control of the thyroid gland we know from the work of Hertoghe, Léopold Lévi and de Rothschild, Eppinger and Hofer and others. So the first time I encountered a rabbit which after 15 intravenous injections of 1 ¢.c. of a 5 per cent emulsion of sheep corpuscles gave a serum with a titer of 1:100, it was submitted to thyroid treatment.
At first intra-abdominal injections were made of fluid ex- pressed from the fresh glands of the cow, and later on, as it showed itself more effective, of the pig. The rabbit weighed 3000 grams. In the beginning daily injections of a quantity of
318
KOOPMAN 319
fluid corresponding to a milligram of fresh substance were made and the dose gradually increased to 15 milligrams. Then when the animal began to lose weight and showed a diminished appe- tite, the dose was decreased to 10 milligrams daily. After some weeks the fluid was administered by mouth, using a Nelaton catheter No. 20 as a stomach-tube. After two months of treat- ment the amboceptor showed a remarkable increase of hemolytic power. When 1 ¢.c. of a 5 per cent suspension of sheep corpuscles was added to 1 c¢.c. of fresh serum of a guinea pig in a dilution of 1:20, 0.8 ce. of a dilution 1:1000 of the inactivated serum of the rabbit was enough to produce complete hemolysis. Before beginning the experiments the titer was 1:100; during treatment it increased to 1:1200. Though an amboceptor with a titer of 1:1200 is not ideal it could be used in the hemolytic system of the Wassermann test.
This male rabbit was put in a cage with a female with an amboceptor of 1:6000. Four young rabbits were born. When they were six months old, all were injected three times with sheep corpuscles. Three of them produced an amboceptor of a suffi- cient titer (1:3000; 1:8000; 1:3600). The fourth one, however, gave an amboceptor of only 1:150 which did not rise after 15 injections. Thyroid tabloids from a Dutch firm (Grana) were administered by mouth (one milligram of dried gland daily). After nine weeks of treatment the titer was raised from 1 :150 to 1:2000.
During the administration of thyroid gland the injections of sheep corpuscles were continued. I cannot believe, however, that. these injections were the cause of the formation of an amboceptor with a high titer. Both rabbits had been submitted to 15 injec- tions of sheep corpuscles without any tendency to raise the hemolytic power of the serum. As soon as thyroid was given a gradual increase was seen in both cases. I am inclined to be- lieve, therefore, that thyroid insufficiency had caused the low titer of the amboceptor.
I am quite aware that the last word in this matter has not been spoken. It is very possible that another rabbit would show . the same symptoms, but caused by an insufficiency of another
320 THYROID AND ANTIBODY FORMATION
gland or perhaps by the hyperactivity of an endocrine organ. At any rate it appears that endocrinology may open to serologists and bacteriologists a new field for investigation.
If not only the formation of hemolytic amboceptor, but also of agglutinins, antitoxins, bacteriolysins and other antibodies were included in such investigations an enormous field for re- search would be open. Almost nothing in this direction has as yet been done.
THE ACTION OF ADRENALIN ON THE KIDNEY
Frank A. Hartman and Ross S. Lang.
(From the Department of Physiology, University of Toronto)
Many investigators have studied the action of adrenalin on the kidney, both in regard to circulatory changes and to urine flow, and have found that one or both may be modified by this substance. Inasmuch as Cow (1) has shown that there is direct communication between the adrenal medulla and certain parts of the kidney, it appears that adrenalin might have some important function in the control of the kidney. In the present instance we have made a study of the influence of adrenalin on the kidney volume, both from gangliar and peripheral action. Although it is possible that adrenalin may influence urinary secretion independent of vascular changes, yet we know that if vascular changes occur they will also modify kidney activity. It is assumed that volume changes are due to vascular changes.
METHODS. The methods employed were similar to those used in a pre-
vious study of the spleen (2), the kidney being enclosed in a gutta percha oncometer which was connected with a Brodie bellows recorder.
In the perfusions the vessels were all tied off and warm oxygenated Ringer’s solution forced into the renal artery under a constant pressure. Injections of adrenalin into the perfusion fluid were made at the entrance of the perfusion cannula by means of a hypodermic needle piercing the rubber tubing. Passive effects of the injection were ruled out either by slow injection or else by a simultaneous removal of an equal quantity of perfusion fiuid by another needle inserted farther back in the connecting rubber tube.
All animals were under the influence of ether. Adrenalin solutions were made by diluting Parke, Davis & Co.’s adrenalin chloride solution with distilled water.
RESULTS. In an earlier research (3) we found that small doses of
adrenalin injected into the general circulation caused constric- tion of the kidney, while in some instances larger doses caused 321
322 ADRENIN AND KIDNEY
constriction followed by dilatation. Brief dilatation preceding constriction occurred at times, but appeared to be a passive re- sult from a short rise in blood pressure.
Five more cats and three dogs were studied in this way, with results which agree with the earlier research.
One experiment may be cited. The kidney of a dog weigh- ing 18 kgm. responded by constriction to doses of adrenalin rang- ing from 0.2 ec¢., 1:100,000 to 0.4 ec., 1:10,000. These were all depressor doses of adrenalin. The response to doses ranging from 0.4 ec., 1:10,000 to 3.0 ec., 1:10,000 was constriction followed by dilatation (Fig. 1); 0.6 e¢., 1:10,000 was a depressor dose, while 1.3 cc. of the same dilution was pressor in effect.
Fig. 1. Constriction and dilatation of a normal kidney from adrenalin, 1.3 ¢.c., 1:10,000 injected into the jugular vein. Dog 18 kgm. Although this delayed dilatation occurring in the kidney was similar to that occurring in the intestines (3, p. 313), with large doses of adrenalin it was by no means so prevalent. How- ever, in those individuals in which it was obtained it resulted repeatedly from injections above a certain dose.
es
HARTMAN AND LANG
W a
We next attempted to locate the regions where adrenalin could produce these two effects, 1. e., constriction and dilatation. In order to separate peripheral from gangliar or more central effects, we completely cut off the kidney from the body circula- tion, then perfused it. Nervous connections to the kidney were earefully preserved in the operation. Both kidneys were per- fused alternately in two dogs. The first was an animal (18 kgm.) that gave constriction followed by dilatation of the kidney when its circulation was intact and a large dose of adrenalin was in- jected into the jugular vein. When perfused, the left kidney gave dilatations *from jugular vein injections of doses above 0.2 ee., 1:10,000. Sometimes slight constriction preceded the dilatation (Fig. 2). Injections of adrenalin into the perfusion
— Maney
RI. ne
OR
fs, at jo
Fig. 2. Constriction and dilatation of a perfused kidney, 2 e.c., 1:10,000 adrenalin injected into jugular vein. Dog 18 kgm.
fluid caused a similar effect, i. e., constriction followed by dilata- tion (Fig. 3). Occasionally the dilatation was followed by con- striction. The other kidney responded in a similar manner, both before and after perfusion.
The second dog (15 kgm.) gave dilatation in both perfused kidneys from adrenalin injected into the jugular vein, while injections into the perfusion fluid caused constriction (Fig. 4) Doses as small as 0.2 ece., 1:100,000 gave this result.
Volume changes in perfused kidneys from jugular vein injec- tions of adrenalin, may be due to action on structures in the semi- lunar ganglion, dorsal root ganglia or in some more central loca-
tion. We tried the effect of direct application of adrenalin to these
324 ADRENIN AND KIDNEY
ganglia. The ganglia were usually slt to facilitate absorption.
In the case of the semilunar ganglion, the mesentery was cut and separated from it in such a way that a pocket could be made
Fig 3. Constriction and dilatation of a perfused kidney from the injec- tion of 0.2 c.c., 1:100,000 adrenalin into the perfusion fluid. Dog 18 kgm.
a
a ee es
Ny. a rT whe nad verdes wii asi Hinedinr Vee: PN NAAN AOE
pws Sniny, < la dente: ; ee wh Ne ceeattlapiaciicccaanbinicicns in
a
Fig. 4. Constriction of a perfused kidney from the injection of 1.3 c.c., 1:100,000 adrenalin into the perfusion fluid. Dow 15 kgm.
by engaging the cut surface of the mesentery with haemostats. Adrenalin solutions could then be confined in this pocket without absorption into the general circulation.
HARTMAN AND LANG 325
Adrenalin action on the semilunar ganglion was studied in three cats and one dog. Dilatation of the kidney was obtained in all of these when adrenalin was applied to the ganglion in question. In some animals, concentrations as low as 1:100,000 produced this result ; in others a 1:10,000 solution was necessary (Fig.5). In two of the cats the latter solution sometimes caused
Fig. 5. Dilatation of the kidney caused by the application of 1:10,000 adrenalin to the semilunar ganglion. Cat. 3.1 kgm.
dilatation followed by constriction. This could be explained on the ground that small amounts of absorbed adrenalin affect the dilator mechanism, while larger amounts bring the constrictor mechanism into action. This was confirmed by the pure con- striction which it was possible to obtain with concentrated adren- alin solutions (1:1,000) (Fig. 6).
We concluded from these observations that adrenalin can influence the volume of the kidney by action upon both dilator and constrictor mechanisms located in the semilunar ganglion, the result depending upon the concentration of adrenalin ab- sorbed.
The effect of adrenalin through the dorsal root ganglia was studied in four cats. With the animal lying on its side, an open- ing extending transversely from the midline was made in the abdominal wall above the kidney. The kidney was placed in the oncometer and the apparatus properly adjusted before exposure of the dorsal root ganglia. The twelfth and thirteenth thoracic ganglia were carefully exposed and their connections with the spinal cord severed. After allowing a short time for the bleed- ing to stop, the adrenalin solution was applied to a ganglion. In
326 ADRENIN AND KIDNEY
some cases, to make sure that adrenalin was not escaping into the general circulation, the ganglion was surrounded by rubber dam. The earlier the adrenalin was applied the more sensitive was the ganglion. In fact, if the ganglion had been exposed too long or the blood pressure had become extremely low, there was
Fig. 6. Constriction of the kidney caused by the application of 1:1,000 adrenalin to the semilunar ganglion.
either no response or else only a slight effect. Second and third applications to the same ganglion had no effect unless several minutes intervened and the ganglion was thoroughly washed with isotonic salt solution. The adrenalin solution was warmed to 37° C. because cold solutions of distilled water sometimes pro- duced an effect.
In one animal, constriction of the kidney was produced by 1:10,000 adrenalin applied to the dorsal root ganglia. No dila- tation was obtained. The blood pressure, however, was quite
¢
low (32 mm.).
Dilatation of the kidney was produced in the three remain- ing animals from solutions of 1:10,000. One of these animals gave a similar response with 1:100,000 adrenalin. The response is frequently very slow, due no doubt to the slow absorption by the ganglion (Fig. 7).
HARTMAN AND LANG
sy) bo ca |
Fig. 7. Dilatation of the kidney produced by painting a dorsal root gan- glion with 1:10,100 adrenalin. The ganglion was surrounded by rubber dam. Cat 2.4 kgm.
DISCUSSION.
Our experiments prove that adrenalin frequently causes dilatation of the kidney. This dilatation can be caused by action on the semilunar ganglion, dorsal root ganglia, or, in some cases, on structures in the kidney itself.
Hoskins and Gunning (4) obtained dilatation following con- striction in one dog out of sixteen from intravenous doses. This has been more frequent in our experiments, as five out of nine gave this response. In addition to these experiments, which were upon kidneys with an intact circulation, we have obtained dilatation of the perfused kidneys of two dogs.
Kidney dilatation from small doses of adrenalin may be more common than one might suppose. However, the constrictor mechanism in the kidney tends to predominate in adrenalin responses.
In view of the recent work of Addis, Barnett and Shevky (5) we tried to obtain dilatation of the kidney in a rabbit by the application of adrenalin to the semilunar ganglion. Concentra- tions of adrenalin from 1:100,000 to 1:10,000 caused only con- striction in the kidney. This is confirmatory of recent work from this laboratory (6), which has shown that rodents are exceptional among mammals in that adrenalin vasodilator mech- anisms are either absent or else insignificant in their action.
We also attempted to produce volume changes in the kid- neys of eats by subeutaneous injection of adrenalin. Doses of 0.5 ee., 1:1,000 produced no distinct result. Three animals were tested in this way. Therefore, it seems that even in animals which are known to possess adrenalin vasodilator mechanisms subeutaneous injections have little effect upon the volume of the kidney.
328 ADRENIN AND KIDNEY
In regard to the effect of adrenalin mingled with the per- fusion fluid fed to a kidney, numerous observations have been made by others. Sollmann (7), with relatively large doses of adrenalin, obtained constriction. He says, however, that after several hours’ perfusion, or sometimes earlier, the constrictor action disappears and that at times it is replaced by a dilator action. Pari (8) obtained one case of dilatation from adrenalin in the perfused kidney.
SUMMARY.
1. Adrenalin in moderate amounts produces dilatation of the kidney in some individuals.
2. Dilatation is usually preceded by a brief constriction.
3. Adrenalin can produce dilatation by its action on either the semilunar ganglion, dorsal root ganglia, or on some structure in the kidney.
4. Likewise constriction can be produced by adrenalin acting either in the semilunar ganglion, dorsal root ganglia, or the constrictor structures in the kidney.
BIBLIOGRAPHY. 1. Cow: The suprarenal bodies and diuresis; J. Physiol. (Lond.), 1914, 48, 443. Hartman and Lang: The action of adrenalin on the spleen ; J. Pharm. and Exp. Therap. (Balt.), 1919, 13, 417. 3. Hartman and McPhedran; Further observations on the differential action of adrenalin; Am. J. Physiol. (Balt.), 1917, 43, 319. 4. Hoskins and Gunning: The effects of adrenin on the dis- tribution of the blood; ibid., 1917, 48, 304. 5. Addis, Barnett and Shevky: The regulation of renal activ- ity; ibid., 1918, 46, 39. 6. Hartman, Kilborn and Lang: Vaseular changes produced by adrenalin in vertebrates; Endocrin., 1918, 2, 122. 7. Sollmann: Perfusion experiments in excised kidneys; Am. J. Physiol. (Balt.), 1905, 18, 246. 8. Pari: Action locale de ]’adrenaline sur les parois des vas- seaux et action des doses minimes d’adrenaline sur la pression du sang; Arch. ital. d. biol. (Pisa), 1906, 46, 209.
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ENDOCRINOPATHIC CONSTITUTIONS AND PATHOLOGY OF WAR*
N. Pende From the Institute of Special Medical Pathology of the University of Palermo, Italy
The clinical study of the internal secretions opens a vast field of research, so far little known, notwithstanding its great ‘ value in practical medicine. Particularly important are those states of hormonic imbalance which are at the border line be- tween health and disease, and which represent either latent or mild endocrinopathie conditions, real endocrine diatheses or endocrinopathic temperaments. It is already understood that for each of the best known endocrine glands, in addition to frank malfunctions there must be recognized minor degrees of pertur- bation giving rise to the endocrinopathic habitus.
To the French writers, especially Levi and Rotschild, we owe much of our knowledge of the hypothyroid habitus, and also, though not so thoroughly, the hyperthyroid ; we owe to the Amer- ican investigators, and especially to Cushing, a knowledge of the mild forms of hypo- and hyper-pituitarism ; while the hypo- adrenal constitution has been first studied in Italy (Constitu- tional angihypotony of A. Ferranini and the spurious hyposur- renalism of Castellino), as has also the hypogenital temperament (geroderma genitodystrophica of Rummo and Ferranini). In a way, however, the hypogenital habitus was described by Hip- pocrates, in case of the Seyti, who by being almost all the time on horseback developed signs of mild feminism in the males and of mild masculinism in the females.
The writer has been engaged for several years in the experi- mental and clinical study of the endocrinopathic habitus, and has found it quite as fruitful and interesting, practically, as that of the classic forms. Constitutional hormonie imbalance forms the pathogenetic substratum of a great many diseases, especially in the nervous and mental domain. It is of importance also in pathologic metabolism and growth, and in cardiovascular pathol-
*For an exposition of the theoretical conceptions involved in this paper, the reader is referred to a review of Prof. Pende’s book, “Bndocrinologia,’” published in this Journal, 1918, 2, 42-50.—Ed.
329
330 ENDOCRINE PATHOLOGY OF WAR
ogy. It plays a part in sexual perturbations and may also be a factor in infections, especially tuberculosis.
The War, in my opinion, showed clearly the importance of the constitutional hormonic anomalies in producing many slight disturbances of health, occurring every day, which represent the border line between health and disease. It has shown, further- more, how such anomalies may lead to real disorders in sundry organs. Any endocrinologist who hyed long among the soldiers had many opportunities to observe the close connection between various syndromes common in war life, and the endocrinopathie predisposition of the patients.
In this paper is summarized the results of my clinical obser- vations during four years of war. These will be grouped as follows: (a) war syndromes, the most frequent and impressive, being the emotive-commotive psychoneuroses of the soldier; (b) the cardiovascular syndromes, often referred to under the in- appropriate captions “‘irritable heart of the soldier’’ or ‘‘war heart’’; (c) the relation of endocrine factors to infectious proc- esses, and (d) the pathogenesis of ‘‘congelation’’ (torpor).
I. ENpbocRINE ANOMALIES AND WAR PSYCHOSES.
By studying a great number of patients, suffering from acute psychoneuroses induced either by violent emotions or, oftener, by having been within the zone of explosion of large projectiles. (commotive psychoneuroses), it is easy to recognize a complex of symptoms due to functional imbalance of the vegetative nerv- ous system. These are often very slow to yield to treatment.
The most important of these symptoms, which in some cases constitute a clinical entity of ‘‘diffuse sympathetosis,’’? and in some what we could eall a ‘‘regional sympathetosis,’’ are the following: mydriasis; wide open, anxious, shining eyes; diffuse tremor of the extended hands and Basedowian and Parkinsonian tremor; hyperidrosis, either diffuse or localized; rhythmic tachyeardia (usually about 120 beats a minute) ; sometimes ex- aggerated and arhythmie or paroxysmal tachycardia; seldom a mild, nervous bradyeardia, cured with atropin; pulsations of the superficial arteries; dermographism ; vascular crises in the distal parts of the body (face, hands, feet), suggestive of symmetrical asphyxia of Raynaud; tricographism (Pende) and tricotonia; oculo-cardiae reflex usually absent or inverted, sometimes pres- ent; arterial pressure tending to increase, especially in the dias-
PENDE 331
tolic phase; light hyperthermia or tendency to facile increase of the superficial temperature ; rapid loss of weight ; positive, though weak and dissociated, adrenalin reaction; seldom a shght spon- taneous glycosuria; alimentary glycosuria; very seldom nervous vomiting ; continuous or paroxysmal polyuria; hyper- and hypo- peristalsis ; hypotonia or spasm of the vesical sphincter ; aphony or disphony; hiccough; asthmatic crises; diaphragmatic con- tracture and sudden and exaggerated gastro-intestinal meteor- ism. By analyzing with care these psychoneurotic syndromes the endocrinologist can recognize more or less definite forms of alterated endocrinism, though they are almost always attenuated.
This endocrine symptomatology is so closely connected with sympathetic symptomatology, that in such cases we can really say ‘‘sympathetic-glandular syndromes’’ or, as I have proposed to eall them, ‘‘endocrino-sympathetic syndromes’’; these acute war endocrinopathies show better than any other syndrome the close physiologic and pathologie synergy of these two trophic- regulating systems of our organism.
Chief among these syndromes is the status of Basedowism, which differs from the classical Graves’ syndrome in the usually moderate tachyeardia (90-120 pulsations a minute); the shght thyroid swelling; the almost constant lack of exophtalmos, while the eye is wide open and fixed and shining, and the great preva- lence of tremors and muscular asthenia. It is very characteristic of this acute war Basedowism, of emotive-commotive origin, that it is likely to disappear readily in a few months after removing the patient to more quiet surroundings, or after a few applica- tions of X-rays to the thyroid. I believe that its being mild and curable (at least in the majority of cases) is due to its newrogenic nature.
In this connection it may be stated that, clinically as patho- logically, I divide all the endocrine syndromes into two principal types—one chiefly neurogenic and the other chiefly glandular, according as the glandular dysfunction is a secondary symptom of alterated nervous influences, or is due to primary alterations of the glandular tissue. Thus we have Basedow, Addison or dia- betic syndromes. There may be also pituitary, genital, thymo- lymphatic syndromes of neurogenic type. In these, besides the primary dominating pathogenetic factor of nervous nature (dy- namie or organic alterations of the endocrino-secretory nerves),
332 ENDOCRINE PATHOLOGY OF WAR
the nervous symptomatology (true glandular neurosis) is a chief symptom. The course of the disorder, its oscillations and varia- ° tions and its peculiar way of reacting to therapy show the char- acteristics of a neuropathy.
Any clinician of wide experience must recognize this nervous type of Basedow’s disease. It is interesting in this connection to note that several pathologists (Wilson among the most recent) try to demonstrate a nervous pathogenesis of the disease, the thyroid alterations being regarded only as epiphenomena. Sev- eral observers, including the writer, have demonstrated also the existence of nervous forms of Addison’s disease in which post- mortem examination failed to disclose any gross alteration of the adrenals.
As regards neurogenic diabetes, Von Noorden, more than anyone else, insisted during the war on the peculiar clinical char- acters of this type. This may be ascribed to the exaggerated action of glucomobolizing hormones, resulting from abnormal nervous impulses acting on the liver, pancreas and cromaffin sys- tem. Von Noorden regards this type as quite distinct from chronic pancreatic diabetes.
These neurogenic endocrinopathies often but not in every ease differ from the endocrinopathies due to direct primary lesions of the glands, by their peculiar mildness, the uncompleted syndromes, their temporary character and their ready curability. The war gave rise to many instances of such clinical forms of dyshormonism.
Many observers studied the ‘‘war Basedowism.’’ Among these are Rothacker, Stoney, Barr, Schulzinger, E. Romberg, Aschenheim, Ney, White, Hernaman-Johnson, Boschi and 1212 ehini. The French observers, Sergent, Loeper, Oppenheim, Ramond Francois, Satre and Carles, studied mostly the “‘war Addisonism,’’ and Von Noorden the ‘‘war diabetes.”’
Tt may be added that, besides the Basedowism, Addisonism and hypopancreatism, I saw rather often in soldiers exposed to intense psychic excitement, genital symptoms,—impotency, male chlorosis and gynecomastia,—rapidly developed.
Finally, very interesting are the cases of ‘‘mors thymica’”’ which show at the post-mortem table status thymo-lymphaticus associated with hyperthyroidism. Two such cases have been seen by Pighini in two of our soldiers with ‘“emotive-psychoneurosis’’ ;
PENDE O35
three have been found by Schiboni, also in our soldiers; and all five, according to Pighini, demonstrate how the mental condition, if long lasting and associated with war fatigue, may determine, in predisposed subjects, a revivification of the thymus and of other lymphoid organs already involuted. This in its turn leads to the well-known dysfunctions: vagotonia; cardiac, respiratory and gastric disorders, and even sudden death.
So far we have not any unequivocal observations of hypo- physeal reaction in the psychoneuroses of soldiers, though from some researches (especially the recent ones of Shamoff) there is reason to believe that the hypophysis secretion also is controlled by the sympathetic system, and hence is under psychic influence. Perhaps certain polyurias, suggestive of diabetes insipidus, and which we usually call either ‘‘spastic’’ or ‘‘nervous,’’ might be an expression of alterated hypophyseal function. They are very often found, according to Rothacker, in the periods of the utmost psychic excitement.
There may here be recalled the observations, though few, of certain syndromes which seem to be connected, at least indirectly, with complex alterations of the endocrine system or, better, of the sympathetic-endocrine system. Dercum’s syndrome, for instance, has been found sometimes in soldiers undergoing intense emo- tions. Two such cases have been described in Italy, one by Alzona and the other by Bochi, who found several symptoms of hypophyseal hypofunction. The neurofibromatous syndrome of Reklinghausen has been reported by Roceavilla, Guillain and Barré as developing in some soldiers under the influence of the war.
The frequent occurrence of syndromes of hormoniec imbal- ance due to war emotions is no doubt connected in some instances with a condition of constitutional instability of the endocrine glands, so that these may easily be either excited or inhibited by nervous impulses. The same unsteadiness in the toxi-infective processes of the soldiers will be discussed in a later section.
My researches on the habitus of subjects stricken by these syndromes lead to the conclusion that the most predisposed are the patients with hyperthyroid status, more or less pure, i. e., more or less associated with stigmata of lymphatism or of con- stitutional hypoadrenalism.
In such temperaments ‘‘sympathicotonia’
’ generally prevails
334 ENDOCRINE PATHOLOGY OF WAR
and may be associated or alternated with ‘‘vagotonia’’ whenever the hyperthyroid function is accompanied by status lymphaticus or by hypoadrenalism. I believe that in determining the psy- choses of war a lack of resistance of the endocrine-sympathetie system is the most important pathogenetic factor and the one, besides, that explains the peculiar features of these various syn- dromes (hypersthenic forms when hyperthyroidism predominates and asthenic and depressive when hypoadrenalism prevails).
Recently Buscaino has insisted on the importance of the endocrine-sympathetic habitus (especially hyperthyroid) in a class of neuropathic soldiers which he calls constitutional kines- thopathic. Bratz refers to them as affected by emotive epilepsy and Dana calls them ‘‘psycholeptic.’’ These soldiers are easily subjected to kinesthetic alterations, to outbreaks of furious rage, during which they are apt to commit acts of insubordination or violence, associated or not with a state of semi-consciousness (never with total unconsciousness) or with crises of motor excita- tion. These subjects also, according to my findings, show pre- dominance of hyperthyroid habitus.
Nowadays several psychiatrists especially interested in the study of war psychoneuroses admit that steady and repeated psychic traumata connected with the war have determined, in predisposed individuals, a sort of neuropsychic anaphylaxis, a thesis developed by Boschi and Bennati in Italy and by Roussi and Lhermitte in France. I believe that such neuropsychie hy- persensibility to psychic, physical or chemical stimuli is brought about essentially by the abnormal action of the hormones on the nervous centers. The thyroid hormone (according to Cannon also the cromaffin hormone) may easily be increased through psychic exciting influences, and sensitize the nervous centers, espe- cially those of the vegetative life; other hormones, i. e., the para- thyroid, which under normal conditions are supposed to moderate the neuropsychic excitability, may perhaps undergo a diminution or an inhibition through long lasting and violent psychie influ- ences, Which condition also leads, by another road and in com- bination with hyperthyroidism, to a neuropsychie hypersensi- bility.
We may mention, also, in this connection Léopold Lévi’s opinion that paroxysmal hyperthyroidism and functional insta- bility of the thyroid have great pathogenetic importance in deter-
PENDE : 339
mining the anaphylactic syndromes of ‘‘neuro-arthritism,’’ and in determining paroxysmal endocrine hypersecretory crises. These he calls ‘* Endocrinolepsies.”’
We beheve that hereafter the constitutional imbalance be- tween the thyroid and parathyroids, i. e., hyperthyroidism com- bined with the hypoparathyroidism, must be held as the key to these conditions of ‘‘neuropsychic anaphylaxis.’’ The frequency of spasmophiha, of mechanical and electrical neuromuscular hy- perexcitability, of vascular spasmophilia (vasomotor epilepsy of Bratz) observed in soldiers affected by acute psychoneuroses (Pighini, Buscaino) suggest a status of parathyroid inhibition
which, I believe, is often associated with the thyroid hyper- function.
IJ. ConstituTIoNaL ENDOCRINE ANOMALIES AND ‘‘SOLDIER’S IRRITABLE HEART.’’
Having had a chance to study many soldiers showing nery- ous and functional cardiac weakness, I have been able to dis- tinguish four principal types of ‘‘irritable heart.’’ Such forms are not absolutely distinct from each other; sometimes they can even be associated or alternated in the same patient, but, in the pure cases, they cannot be grouped in a single category, either as to their pathogenesis or their prognosis and therapy.
A first clinical type, which we may eall ‘‘thyroid, sympa- thicotonic or Basedowiform heart,’’ presents the cardiovascular symptoms very much like those of the initial or mild forms of Graves’ disease. As regards such cases we can really admit with White and Hernaman-Johnson that the irritable heart is a ‘‘sort of pre-Graves condition.’’ Quite pronounced in these patients is the thyroid habitus, characterized usually by lean body or tendency rapidly to become thin through psychic causes. They have clean cut features, thick hair, often wavy or curly (Pende’s tricotonia) ; thick and long eyebrows; large eyes, open, lively, shiny, bright, sometimes with nystagmic motions, and well differentiated sexual traits. Often there is hypertricosis of the face and of the whole body; teeth and nails very well developed ; skin rich in pigment, especially in the palpebral region and at the extensor surface of the hands and increased pigmentary re- action to external stimuli. These patients often show also a symptom, which I deseribed in hyperthyroidism, i. e., hyper-
336 ENDOCRINE PATHOLOGY OF WAR
excitability of the muscles arrectores pilorum to mechanical stimulation or tricographism. The thyroid may or may not be slightly enlarged. Their blood shows mononucleosis, especially of the Pappenheim leukoblasts.
Even before the development of their illness, such individu- als usually have shown in some degee the functional character- istics of hyperthyroidism, i. e., a functional juvenilism, a tachy- pragia corresponding to the somatic juvenilism, motor and psy- chic restlessness, agility, tachyphagia, intestinal hyperperistalsis, cardiac acceleration on the least provocation, pulsation of the arteries, crises of hyperidrosis, great emotivity, unusual quick- ness of perception and volition, impulsiveness and peculiarly explosive personality. To these characteristics of the hyper- thyroid temperament correspond rapid and precocious growth. Owing to a marked tendency to catabolism, especially of pro- tein, habitual leanness and crises of muscular and psychic as- thenia are common.
The cardiovascular phenomena induced by the war on this hyperthyroidic substratum are usually sympathicotonic. There is continual tachycardia, almost always moderate (100-120) though of a changing ratio and accompanied by painful pulsat- ing sensations, but very seldom by real paresthesia and pains of the heart. There are at times, however, hyperalgesic zones (Head) to the left of the chest and of the neck.
The tachyeardia is generally rhythmic (sinus type) ; extra- systoles are almost never found. The heart at times has a rounded apex and moderate hypertrophy of the left ventricle. The aorta may be in a condition of temporary atonic dilatation, but functional souffles are very few. The oculo-cardiac reflex is either very moderate or absent or inverted (sympathico- tonic). Tonic reflex contraction of the cardiac cavity under stimulation of the precordial region is easily elicited. There are frequent angiospastic phenomena at the distal parts of the body. Diastolic pressure is slightly increased, due to hyper- tonia of the peripheral arteries. The functional capacity of the heart varies greatly, especially in accordance with the psychic conditions, leading to frequency of sudden and unexpected crises of myocardial exhaustion; these are rapidly transitory most of the time—a sort of functional claudication of the heart.
This clinical form of ‘‘soldier’s heart’’ is found mostly in sol-
PENDE 337
diers exposed to violent and long lasting cannonading, or within the zone of explosion of large projectiles, or with a sight febrile rheumatic infection, which often starts the cardiac disturbance. Very often there is no cardiac trouble in their anamnesis. We may admit that the repeated emotions or a violent physico- psyehie shock (explosion of large projectiles) or the rheumatic virus can easily bring about a frank Basedowism in one of hyper- thyroid constitution, having a thyroid already tending to hyper- secretion. Such Basedowism may be of a type predominantly cardiovascular, predominantly neurogenic, or thyreotoxic; in all these cases, however, cardiovascular sympathicotonic phe- nomena are particularly in evidence.
A second elinical type of ‘‘soldier’s heart,’’ less frequent than the preceding one, shows essentially those heart disorders which Eppinger and Hess described in the vagotonic constitu- tions. In such individuals the stress of war frequently leads to frank yagotonia.
Peculiar to these people are the stigmata of adenopathy and sometimes also signs of organic immaturity and of infantilism. A slight degree of thyroid swelling, of hypertonia and retraction of the upper lid, of shining and protruding eye bulbs, of fine muscular tremors and of nervous and psychic irritability, bring these people near to the true thyroidism (vagotonic hyperthy- roidism or lymphothyroidism).
The cardiovascular reactions of these subjects differ in many ways from those of the first class. There is arhythmia of the extrasystolic, the respiratory or the juvenile types; there is no tachycardia at rest, but, on the contrary, slight bradycardia. This in some cases through the least strain or psychic excitation may turn into an even severe tachycardia, which, however, is temporary and ends in bradycardia. The apex beat is often rather lively and diffuse; the region of the pulmonary artery may appear pulsating; sometimes the heart is very movable. There are very severe cardiac paresthesias, very distressing to the patients. Frequent and sometimes intense and lasting func- tional souffles are heard. The oculo-cardiae reflex is always pres- ent and accentuated. Red dermographism is a constant finding associated with a rather low diastolic and an increased pulse pressure.
This type of ‘‘soldier’s heart,’’ of a vagotonic form, has
338 ENDOCRINE PATHOLOGY OF WAR
been found by other authors (Hirtz, Gouget, Binet, Petzetakis, Braun and Von Dzyembowski). We believe that to this type belong the people with prevailing “‘vagotonic hormones,’’ though they are not yet well known nor chemically differentiated. Ep- pinger and Hess found in these vagotonic patients hyperplasia of the thymus, the same as is found in cases of Basedow’s dis- ease with pronounced symptoms of vagotonia.
In a third clinical type of ‘‘soldier’s heart’’ the syndrome ap- pears like a true myasthenia cordis, while in the two preceding forms one could speak of ‘‘neurasthenia cordis.’’ In this third class there is the well known asthenic constitution of Stiler, or better, asthenic hypoplastic (Bartels), in which, according to my observations, constitutional hypodrenalism dominates. This is very often associated with hypopituitarism and hypogenitalism.
The hearts of these patients are small and hypoplastic (the ‘‘euore a goccia’’—globular heart—of the Italians) ; the cardio- vascular syndrome, which the war makes conspicuous, amounts to a true insufficiency of the heart to any strain, a real cardiac myasthenia associated with symptoms of nervous and psychie irritability and weakness, which characterize their temperament. As well for the vagotonie heart, as for the hypoplastic-asthenie heart, the cardiac anomalies have not been created by the war, but only exaggerated.
There is a fourth group of functional cardiopathies in men who before the strain of military service never showed any in- sufficiency of the heart nor any constitutional anomaly. These oceur in rather elderly soldiers called back to the colors, who, out of fear of the war, even without having been exposed to the exertions and the intense emotions of trench life, show general adynamia and cardiovascular phenomena so severe as to lead us to think of a true myocarditis. They display palor of the face, eyanotie lips, atonic and sunken eyes, livid and cold extremities, sometimes slight edema of the lower limbs, peripheral hypo- thermia, anorexia, dyspnea, absolute physical prostration to the extent of not being able to sit up in bed, severe psychic depres- sion and rapid cachexia. The heart is at times of an increased size with weak and muffled tones associated with moderate brady- cardia and diminished systoli¢ and diastolic pressure. They are not amenable to any treatment, but they recover rapidly as soon as removed from the military life.
PENDE 339
In these cases one is apt to think of hypoadrenalism and we can accept the hypothesis of a functional inhibition of the ad- renals due to the war, followed by a pseudo-myocarditic syn- drome, as seen in some forms of adrenal insufficiency through organic alteration of the glands.
The neuropsychogenic origin of the adrenal insufficiency of these patients, which must obviously come from a certain in- stability of the glands or from an easy exhaustion of their secre- tory nerves, explains the peculiar clinical characters of this form and its easy curability by the removal of its psychic causes. Cases of such form, which we may call ‘‘hypoadrenal types,’’ have been observed by other authors, e. g., by Satre at the French front. He claims that such cases may be taken for neu- rasthenia, or sometimes peritonitis, dyspepsia, tuberculosis, or latent carcinomatosis, according as there is found headache and asthenia, abulic depression or Hippocratic facies with abdominal pains, dyspepsia or cachexia, respectively. But Satre does not mention the peculiar myocarditic syndrome that may be found in some of these patients.
IJ. ConstrruTionaL ENDOCRINE ANOMALIES AND INFECTIONS.
Of ail the endocrine glands the adrenals are the oftenest affected in the course of infections such as epidemic infectious icterus, typhoid and paratyphoid, malaria, dysentery and other infections with: unknown organisms. In this way we can ex- plain the syndrome of hypoadrenalism described in soldiers suf- fering from infectious icterus in Italy by Frugoni, Gardeghi, An- cona, Notari and Monti; from typhoid by Frugoni, Oppenheim and Loeper; from dysentery by Izar, Dujarric, Riviere and Fil- lerval; from malaria (severe) by Paisseau and Lemaire and from indefinite infections by Carles and Satre. , Even anti-typhoid vac- cination evoked in some predisposed subjects signs of acute ad- renal insufficiency (Loeper).
The adrenal symptoms in these infections are no doubt ac- centuated, in their initial stages, by the capsular exhaustion due to the excessive war fatigue (Sergent) and, we may add, the ad- renal exhaustion due to long felt emotions, as demonstrated by Cannon and his collaborators. To explain such adrenal insuffi- ciency of war we must admit a glandular weakness already pre- existing and due to constitutional conditions.
One way in which constitutional imbalance of the endo-
340 ENDOCRINE PATHOLOGY OF WAR
erine glands has, to my knowledge, an important predisposing influence in the infectious pathology of soldiers is in preparing the ground for the so-called war tuberculosis.
During more than a year’s service directing the diagnostic center for the tuberculous soldiers of the XII Corps of the Ital- jan Army, I had a chance of studying thoroughly, from the endocrine point of view, a great many soldiers in the several stages of consumption. Confirming the results of my previous researches on the relation between endocrine glands and tubercu- losis (N. Pende: Organi endocrinici e tuberecolosi. I] Morgagni 1912 No. 45-46), I found that the war tuberculosis is seen espe- cially in those subjects who show constitutional hormonic im- balance; that is, in the first instance, in patients with hyperthy- roid-hypoadrenal habitus; and in the second place in patients with either hypogenital habitus or thymo-lymphatie status. Sig- norelli, confirming my views as to the marked predisposition to tuberculosis in these hyperthyroid-hypoadrenal individuals, has ealled attention to the special facies characteristic of war tuber- culosis. This is to be ascribed to the endocrine condition just mentioned. _
It is probable that the great number of cases of mild tuber- culosis, especially of the lymphatie glands and of the serous membranes, found by me in soldiers back from the front, may be related to the status lymphaticus and status thymo-lymphaticus found in many returned soldiers. Doubtless the adrenal hypo- plasia and thyroid hyperplasia associated with persistent thymus also play a part. To this may be added also a secondary form of hypogenitalism often to be found in the soldiers.
We finally know, through the researches of Von Noorden, how often hyperglycemia occurs in soldiers exposed to the fatigue and stress of war. This is probably due to pancreatic deficiency resulting from infections. This hyperglycemia also predisposes the subject of tuberculosis.
IV. Hormonic ANOMALIES AND TORPOR.
V. Neri, in Italy, found in many soldiers with torpor of the extremities sluggish vasomotor reactions, analogous to those of hypothyroidism; hence he proposes as a preventive treatment thyroid opotherapy.
In such eases I have found associated hyperthyroidism and vagotonia manifested by angioecstatic phenomena (exaggerated
PENDE 41
red dermographism) and by a certain degree of permanent acrocyanosis of the distal parts of the body.
CONCLUSIONS.
The ‘‘war endocrinology,’’ studied from the point of view of the predisposing action of the individual hormonic anomalies towards the various groups of morbid conditions in the soldiers, demonstrates, even better than in time of peace, how great is the importance of the endocrine temperaments not only in the pathogenesis of the endocrine syndromes sensu strictiori, but also of the nervous and mental affections, of the cardiovascular morbid conditions, of some infectious processes, especially tuber- culosis, and of some trophoneurotie and angio-trophoneurotic affections.
Two forms of dyshormonism chiefly are found in the war pathology, one prevalently hyperthyroid and the other hypo- adrenal.
The thyroid and the adrenals are the most easily influenced by psychic factors. The extraordinary influx of psychic disturb- ances on the body life, especially in the field of the vegetative nervous system, is the factor that gives its peculiarity to the morbid syndromes of the soldiers, no matter of what kind they are. Such morbie reaction very likely depends upon a chain of psycho-somatic relations, of which the thyroid and the ad- renals, and possibly other endocrine glands, are indispensable links.
BOOK REVIEW
“THE INTERNAL SECRETIONS AND THE NERVOUS SYSTEM.”’ Dr. M. Laignel-Lavastine. Authorized Trans- lation, Translator’s Preface and Introduction by Dr. F. B. Robeson. Nervous and Mental Disease Publishing Co., New York and Washington, 1919, pp. 57.
Although dated 1919 the book, as a matter of fact was written in 1914, and hence does not inelude any of the work of the past five years, and especially that dealing with war neu- roses. Much of the subject matter is based directly on the observations of the author, but a bibliography, largely French and German, of some 150 titles, is also utilized.
The difficulties of writing acceptably upon a topic of which so little is known are recognized and engagingly emphasized. For the most part only tentative conclusions are reached and the way is pointed for many more researches. While it must be recognized as the author maintains, that there is some sort of reciprocal relationship between the endocrine and nervous systems, ‘‘from a pathological standpoint, much less is known than one would suppose.’’
The first section of the monograph is devoted to a seriatim discussion of ‘‘Nervous disturbances in the endocrine syn- dromes’’ outlining both the ‘“‘uniendoerine’’ and the “‘polyen- doerine syndromes.’’ This is followed by a section on ‘‘ Endo- erine disorders in nervous syndromes.’’ These include sensory- motor, vegetative and psychic syndromes. The last twenty pages are devoted to an ‘‘Endocrine-neurological sketeh’’ in which such topics as Asthenia, Headache, Insomnia, Anxiety, Sweats, Constipation, Arterial Hypertension, Obesity and various ‘‘Kndoecrine-sympathetie syndromes’’ figure. The Psychoneuroses are also treated. It is in the study of such topics as these that the author believes Endocrinology is of greatest aid to the neurologist.
The book is written by and for neurologists who are as- sumed already to have a considerable command of the subject matter. Such readers will find it an interesting attempt to organize in brief scope a large amount of information. The general reader will find it rather too technical and concentrated to be easily followed.—R. G. H.
ce
ABSTRACTS
ADRENAL dyspepsia. (La dyspepsie surrénale.) Loeper, Beuzard and Wagner. Prog. Méd. (Paris), 1917, 32, 241.
Of the group of dyspepsias secondary to endocrine disturb- ance one can isolate a suprarenal dyspepsia due to capsular in- sufficiency, and manifested by atonicity and coprostasis. Su- prarenal insufficiency should be suspected in a large number of gastropathie and constipated conditions observed in fatigued soldiers. Inefficacious medication should be replaced by adrenin injections.—F. 8. H.
(ADRENAL) Adrenopathic hyperchlorhydrias. An endocrine therapeutic study. Kaplan (D. M.) and Greeff (J. G. W.) Neeveiwed: J. (IN Y.), 1919, 108, 61.
A report of three cases of gastric disturbance greatly re- lieved or cured by the use of suprarenal gland extract.—H. W.
(ADRENAL) L’hypertrophy et la teneur en adrénalin des surrénales dans les infections, les intoxications et certains états d’immunité. (The hypertrophy and adrenalin content of the suprarenals in infection, intoxication and certain immune states). Porak (R) J. Physiol. et. Path. Gen. (Paris), 1918, 18, 95-112.
Various animals were infected with rabies, tetanus, polio- myelitis, diphtheria or pneumonia; poisoned with lead, mer- eury, strychnine or chloroform; subjected to the action of the endogenous toxins produced by insomnia or nephritis, or to con- tinued injections of adrenalin. Under these pathological eondi- tions no constant relation was found to exist between the arte- rial pressure and the adrenin content of the suprarenal glands, the latter being determined by injecting extracts into rabbits and dogs and noting the extent of the rise in blood pressure. However, the ratio of the body weight to the weight of the adrenal glands (dried at 56° C.) was frequently found to be modified, especially if the diseased condition had been long continued. The body weight decreased, the glands (particu- larly the cortex) hypertrophied, and the pressor action of the
343
344 ABSTRACTS
extracts was diminished. The author emphasizes the fact that the function of adrenalin is not to maintain the tone of the blood vessels, and that the fall in arterial pressure often seen in pathological conditions is not due to a loss of adrenin from the circulation. The changes occurring in the suprarenal glands in these states are largely in the cortex.—h. G. K.
(ADRENAL) The postnatal development of the suprarenal gland and the effects of inanition upon its growth and struc- ture in the albino rat. Jackson (C. M.), Am. J. Anat. (Phila.) 1919, 25, 221-291.
A volumetric and histological study of the gland in 108 rats, including normal organogenesis and histogenesis ; volumes of cortex and medulla, of parenchyma and vascular stroma, and of cytoplasm and nuclei; occurrence of mitosis; effects of stunt- ing by underfeeding the young and effects of acute and chronic inanition upon the adult. Confluence of the medulla, with ab- sorption of the intermixed cortical strands, occurs during the first week. Expansion of the medulla continues, with absorp- tion of the cortex at the inner zone and regeneration from the outer zone. The cortex in géneral increases in relative volume, with no apparent sexual difference and no marked change dur- ing inanition. The vascularity in general increases from the periphery toward the center, with variable increase during inanition. During inanition there is a variable amount of cellular atrophy, especially in the middle cortical zone, and increased degeneration in the inner zone. The medulla is less affected. Mitosis (in the young) is prevented, but is rapidly reestablished upon refeeding. In stunted young rats the normal differentiation of liposomes continues, especially in the outer cortical zone, with pigment formation in the inner zone. In adult rats the liposomes resist inanition remarkably, especially in the outer zone, where they persist nearly unchanged. In extreme cases they disappear from the remainder of the cortex. The chromaffin reaction is weak in young rats and may be diminished by extreme underfeeding. In adults it is (aside from post-mortem changes) apparently unaffected by inanition.
—Author’s Abstract.
(ADRENAL) The relative volumes of the cortex and medulla of the adrenal gland in the albino rat. Donaldson (JJ. C.) Am. J. Anat. (Phila.), 1919, 25, 291-299.
The measurements for this study were made on the adrenal glands of seventeen albino rats fixed in Bouin’s solution and reconstructed from serial sections. The left adrenal is usually distinctly heavier than the right. The relative volume occupied
ABSTRACTS 345
by medullary tissue decreases from about 12 per cent for the males and 10 per cent for the females at birth to 7.5 per cent and 6.5 per cent, respectively, at about the time of puberty. From this time on there is relatively little change. When com- pared with those of the male, the glands of the female, body weight for body weight, contain relatively less medulla. —Author’s Abstract.
ADRENAL GLAND, Primary tumor of the—. (Neuroblastoma Sympathicum). Wolbach (S. B.) and Morse (J. L.), Am. J. Dis. Child. (Chgo.) 1918, 16, 63..
The authors report a case of a primary tumor of the left adrenal gland in a boy 4 years and three months old. At necropsy metastases were found in the liver, but nowhere else. The symptoms of the overgrowth of the liver overshadowed all other signs. Notes are added on two other cases, one in a boy aged 7 months and another in a girl of two years. Their three eases bring the number of undoubted cases of neuroblastoma sympathicum to twenty-nine thus far reported, twenty of which were primary in the adrenal gland. The others have taken origin in sympathetic ganglia (3), retroperitoneal tissue (3), coecygeal gland, nose and uterus. The literature on the subject is briefly reviewed.—M. B. G.
(ADRENALS) Addison’s disease. Gottheil, J. Cutan. Dis. inelu. Syph., 1916, 34, 224. Society transactions.
A man 40 years old who had suffered a three months’ attack of eczema returned to the hospital for further treat- ment. He showed a slight degree of eezema, a little thickening of the skin and moderate itching. The skin was dark in color. Although no demonstrable pathology could be demonstrated, _ the patient developed general debility and further bronzing of the skin. The pigmentation involved the entire skin, but was most marked on the legs. The eczema cleared up on treatment. Suprarenalin medication did not affect the coloration.—H. W.
(ADRENALS) A opotherapia suprarenal e as suas multiples indicacoes. (Adrenal organotherapy and indications for its use.) Franca Rocha (A.) Archivos de Biologia de San Paulo (Brazil), 1918, 3, 411.
General review of the uses of adrenalin in medical prac- tice and a discussion of dosage. No new data.—G. P. G.
(ADRENALS) Contribution a 1’étude du fonctionnement de la capsule surrenale humaine a 1’état normal, et dans les
546 ABSTRACTS
états infectieux en particulier dans les gangrénes gazeuses. (Function of the human adrenal cortex in normal condition and in infections, particularly gaseous gangrene). Goor- maghtigh (N.) Arch. méd. expérimentale (Paris) 1918, 28, 277.
An extended study of the morphology of normal and path- ological adrenals led to the conclusions that each zone of the cortex has a certain specific function, and that the infections of a gangrenous type accompanied by gas formation cause a liberation of a considerable amount of cholesterol and ehlosterol esters into the blood stream with consequent disturbances of function.—F. S. H.
(ADRENALS) De l’activité fonctionnelle de la gland medul- laire surrénale des tuberculeux. (Functional activity of the adrenal medula in the tuberculous). Porak (R.) Ann. Méd. (Paris), 1918, 5, 404.
In four cases of tuberculosis clinically quite unlike, it was noticed, in trying the functional activity of the suprarenal extract, that there occurred a persistency of the hypertensive effect. The immediate effect gives the determination of the proper dose. The rising of the lowest pressure during a series of injections of suprarenal medullary extract is a very impor- tant symptom showing that the treatment must be stopped.
(ADRENALS) On the functional relations of the suprarenal gland and the retinal pigment. Arey (lL. B.), Anat. Ree. (Phila.), 1919, 16, 138.
The influence of extremes of temperature on the position of the visual cells and retinal pigment of dark-adapted anuras differs both in degree and kind from that exhibited in other vertebrates. In the frog these temperature changes are of max- imal order—such as have been associated chiefly with light adaptation. This unusual response may conceivably depend either upon direct nervous control or on hormone activation.
Controlled experimentation proves that adrenalin is able to induce, for example, maximal pigment expansion in the frog. Extracts of other endocrine glands fail to exert a similar influ- ence. On the contrary, certain other observations are sugges- tive of nervous control.—Author’s Abst.
(ADRENALS) La fonction des surrénales. Gley (E.) et Quin- quaud (A.) Arch. néerl. de physiol., 1918, 3, 1-6.
Data published elsewhere. See Endocrin. 2, 473.
ABSTRACTS 347
(ADRENALS) Influenza and suprarenal glands. von Tiling €(H. M. A.), N. Y. Med. J. (N. Y.), 1918, 108, 895.
Certain influenza patients present almost the classical symptoms of Addison’s disease, extreme muscular weakness, tendency to syncope, insomnia, low diastolic pressure with high pulse pressure and pigmentation of the skin. Jn the author’s experience the administration of repeated injections of epinine and adrenalin chloride solutions in such eases was followed by marked improvement. The severe backaches so often com- plained of usually cleared up on the administration of epinine. Such observations give the impression that the administration of suprarenal substance or epinine sustains the patient during a period of suprarenal gland exhaustion.—H. W.
(ADRENALS) Report of a case of Addison’s disease. Hall (Gi) eosp: Bull. Dept. Pub. Char. (N. Y.), 1917, 1,:39-42.
A complete clinical description of a patient having Addi- son’s disease. Treatment with adrenin gave indeterminate results.—F. S. H.
(ADRENALS) Suprarenal syndrome in paludism. Fraga (C.), Trans. Am. Soc. Trop. Med. (N. Orleans), 1917, 11, 39.
A report of a case diagnosed as suprarenal form of pal- udism showing intense muscular asthenia; deep adynamia; hypothermia; weak, unstable, irregular pulse; disturbances of digestion, ete. The blood showed the presence of Lavaran’s parasites. Opotherapy was beneficial and the patient dis- charged cured.—F. S. H.
(ADRENIN) Action de l’adrénaline sur la motricité et la con- tractilité gastriques. Pron (L.), Bull. gén. Therap. (Paris), 1918, 170, 86.
The administration of adrenaline in atonie conditions of the gastric musculature gives marked relief.—F. S. H.
ADRENIN, Dosage and method of administration of— (Posologie et mode d’administration de l’adrenaline). Ser- gent (E.), J. de med. et chir. prat. (Paris), 1917, 88, 753-760.
Sergent considers that the commonly prescribed dose of adrenin is too small and advocates larger doses varied accord- ing to the case, the desired effect, and the mode of administra- tion. Adrenin is indicated in two general classes of disorders— suprarenal insufficiency and morbid conditions wherein the physiological properties of the drug are of therapeutic value.
348 ABSTRACTS
In acute suprarenal insufficiency 5-6 mg. by injection per 24 hours is not too much; in cases unaccompanied by gastrie dis- turbanees four capsules of 3 mg. desiccated suprarenal sub- stanee a day are preferable. In the chronic types the inges- tion of 3 mg. of the dried material plus the injection of 2 mg. of the extract is beneficial. In asystoliec conditions where digitalis is ineffective and also in tuberculosis of the adrenals, the injection of .5 mg. adrenin per day is indicated. The drug should always be administered in fractional doses at regular intervals throughout the twenty-four hours, with at least two hour intervals, no matter what is the method of administration. The injections should never exceed 0.5 mg. at any one point, though as much as 2 mg. can be given at one time.—F. 8. H.
(ADRENIN) Experimental studies on the anaphylaxoid of salvarsan. Hirano (K.) Proce. Japanese Bacteriol. Soe. (Tokyo), 1918. Abst. of Bacteriology, 2, 324.
Confirming the work of Milian, H. showed that the ana- phylaxoid of salvarsan may be prevented by the injection of adrenaline. The intravenous injection of salvarism and neo- salvarsan reduced the quantity of adrenaline in the suprarenal and in the blood. This reduction is transitory. Chem. Abst., 13, 1229.
(ADRENIN) L’adrénaline dans la prophylaxie et le traitment de la réaction 4 l’injection de collobiose d’or. (Prophylactic use of adrenalin preceding colloidal gold injections). Rosen- thal (G.), Bull. gén. Therap. (Paris), 1918, 170, 80.
The congestion and tremors attending the therapeutic use of colloidal gold are markedly reduced when preceded by the administration of adrenaline—F. S. H.
(ADRENIN) Ingestion d’adrénaline et injection intraveineuse de quinine. Rosenthal (G.) Bull. gén. Therap. (Paris), 1919, 170, 412.
The ingestion of one to two milligrams of adrenaline in solution twenty minutes before the intravenous administration of colliodal quinine prevents the disturbing effects of the latter, observed when it is used alone.—F. 8S. H.
(ADRENIN) L’ingestion d’adrénaline dans la suppression de la réaction 4 l’injection intraveineuse d’or colloidal. (Sup- pression of reaction to colloidal gold by adrenalin ingestion). Rosenthal (G.) Bull. gén. Therap. (Paris), 1919, 170, 414.
R. found that if he fed 1 mgm. of adrenalin in solution twenty minutes before the intravenous injection of the colloidal
ABSTRACTS 349
gold, the subsequent shock was largely averted. When more than 1 ¢.c. of colloidal gold is used 2 mgm. of adrenaline is indi- cated. Under ordinary conditions the adrenal secretion suffices to maintin arterial pressure even during an infection, but on the intravenous administration of the colloidal gold solution it becomes very weak, not as an actual insufficiency but due to a lessened activity, a meilépragia, which is combatted by the pre- liminary ingestion of adrenaline.—F. S. H.
ADRENIN glycosuria, Influence of diet upon—. (Zur Kenntnis der Einflusses der Ernahrung auf die Suprarenin-glykosurie). Biberfeld (J.) Arch. f. experimentelle Path. u. Therap. (Leipsic), 1919, 84, 360.
A meat diet inhibits glycosuria produced by adrenin injec- tions, but augments that caused by inhalation of carbon mon- oxide. Bernard’s piqure glycosuria cannot be explained as due to adrenin discharge because the glands never produce enough to evoke such a reaction.—J. K.
(ADRENIN) Osteomalacia (Uber gehauftes Auftreten von Osteomalazie und eines osteomalazie—ahnlichen Symptomen- komplexes.) Edelmann (A.) Wien. klin. Wehnschr., 1919, 32, 82.
In a short period 19 cases of osteomalasia were seen in non- pregnant women. The changes in the pelvis were relatively less important than those in the ribs, the sternum and the vertebral column. Most probably the condition is to be ascribed to pluriglandular insufficiency combined with poor nutrition. Improved dietaries and injections of 0.1 to 0.5 mg. of adrenalin resulted in improvement.—J. K.
(ADRENIN) Precipitation of epileptic attacks by adrenal extract (Uber die Auslosung von epileptischen Anfallen mit Nebennierenextrakt). Benedek (L.), Wiener klin. Wehnschr., 1918, 31, 1365.
Adrenin was injected in 19 patients subject to epilepsy.
In seven eases this resulted in typical seizures. In other dis-
eases and in normal individuals no similar reaction has ever
been observed. —J. K.
(ADRENIN) The prophylaxis of hay fever. Lane (H. C.), N. Y. Med. J. (N. Y.), 1918, 108, 859.
_ Adrenalin and the various pollen extracts and antigens give some relief and in many cases apparently relieve the pa-
350 ABSTRACTS
tient for years, but, as a rule, eventually the hay fever reeurs. EW;
(ADRENIN) The treatment of influenza with adrenalin (Die Behandlung der Grippe mit Adrenalininhalationen). Wolff- Hisner (A.), Miinch. med. Wehnschr., 1919, 66, 15.
Especially to prevent the occurrence of pneumonia, but also for the treatment of pneumonia as seen in the epidemic of influenza the author recommends the inhalation of adrenalin. He uses a spray and gives 4-6 inhalations a day. He saw only few complications with bronchopneumonia and even eure of some cases of severe bronchopneumonia.—J. K.
(ADRENIN) The use of adrenalin in malaria (Wher die An- wendung des Adrenalins bei Malaria). Abl (R.), Miinch. med. Wehnschr., 1919, 66, 180.
The injection of 1 mgr. adrenalin causes a contraction of the spleen. The latent parasites appear in the blood. After the treatment of malaria by quinin it is necessary to examine the blood following an injection of adrenalin to see whether there are still latent parasites in the body.—J. K.
(ADRENIN) Tyrosinase in human urine (Uber die Ausscheid- ung von Tyrosinasen in menschlichen Harn). Gross (0O.), Deutsche med. Wehnschr. (Berl.), 1919, 45, 488.
The author found in urine of a patient with a melanosar- coma of the liver, tyrosinase. This enzyme may transform adrenaline into a brown substance of unknown chemical prop- erties.—J. K.
ASTHMA considered in its relationship to the vegetative nervous system. Pottenger (F. M.), N. Am. Clim. & Chn. Assn. (Phila.), 1917, 33; 129-41.
Published elsewhere. See Endocrin. 2, 317.
(AUTONOMIC N. §.) So-called irritable heart of soldiers. Lyter (J. C.), Proce. Mo. State M. Assn., J. Am. M. Assn. (Chgo.) 919. 72, 193%
After studying the subject in the military camp at Camp Custer, Mich., Lyter is convinced that this syndrome, which was first deseribed by Da Costa during the Civil War and by the French, English and American physicians during the re- cent war, is not a cardiovascular disturbance primarily, but the disturbance of the autonomic and sympathetic nervous sys-
ABSTRACTS 35]
tem. This syndrome occurs most often in the ‘‘hypoplastic”’ class of patients. The syndrome is a nervous disturbance most probably having its origin in a psychic disturbance result- ing from a conflict of desires. The hypoplastic individual, having an unstable nervous system, manifests the symptoms more pronouncedly than other classes of individuals.—Official Abst.
(BLOOD SUGAR, ADRENIN) The influence of intravenous injection of Witte’s peptone upon the sugar content of the blood and epinephrine hyperglycemia and glycosuria. Kuri- Waman(ss)s J-ebiol: Chem. (N. Y2),-1917, 29, 127-139.
The blood sugar content of rabbits shows a teadency to increase after intravenous injections of Witte’s peptone in doses of 0.5 to 0.75 gms. per kilo of body weight, the hyper- glycemia lasting for a few hours only. No differences were observed when using boiled or unboiled peptones. The intra- venous injection of gelatin or egg albumin has little or no influence upon the sugar content of the blood. Although an intravenous injection of peptone may be without marked infiu- ence upon epinephrin hyperglycemia, glycosuria is distinetly diminished. The same result is obtained with gelatine and egg albumin.—F. S. H.
CHOROID PLEXUS, Artificial stimulation of the—and experi- mental poliomyelitis. Flexner (S.), Amoss (H. L.) and Eberson (F.), J. Exp. Med. (N. Y.), 1918, 27, 679-87.
Dixon and Halliburton have reported that intravenous in- jections of extracts of choroid plexus cause an augmented secre- tion of cerebro-spinal fluid. This observation is confirmed both in dogs and monkeys.—H. W.
CORPUS LUTEUM. Hirst (J. C.), Trans. Obst. Soe. of Phila- delphia. Am. J. Obst. (York, Pa.), 1919, 79, 495.
““T have found it essential to give corpus luteum by deep intramuscular injections, and not subeutaneously or by mouth. By the subcutaneous method there has been: little effect; by the mouth, none whatever.’’—H. W.
CORPUS LUTEUM extracts, A biological test for—in vitro. Macht (D. I.) and Matsumoto (S.) Proce. Soc. Exp. Biol. & Med. (N. Y.), 1919, 16, 86-87.
Aqueous, saline extracts of fresh or desiccated corpus lu- teum were found to exert a powerfully stimulating effect on
302 ABSTRACTS
the vas deferens and seminal vesicles. Only adrenal and or- chitie extracts have a comparably marked action. The vasa deferentia of the dog, cat,-rabbits, guinea pig and rat were all found to react similarly, but that of the rat is most sensi- tive. Contractions occur with extracts as dilute in some cases as 1:2500, and nearly always with 1:1000. Though very sensi- tive to corpus luteum, the vas does not react to ovarian sub- stance proper. The activity of corpus luteum preparations as indicated by vas deferens preparations runs parallel to that indicated by other clinical and experimental tests. This tissue is recommended, therefore, for the physiological assaying of corpus luteum preparations.—R. G. H.
(CORPUS LUTEUM) Sur les roles du Corps Jaune. (Role of corpus luteum). -Mulon (C.) Ann. de Gynec. et d’Obstet. (Paris), 1916-1917, 2me. Series, 12, 545.
Continuation of a discussion of the part played by the corpus luteum in the production of hydatid-mole, extrauterine pregnancy, abortion, growth and secretory function of the mammary gland, arterial pressure, calcium elimination, gaseous exchange, adiposity, chlorosis, eclampsia, and the interglandu- lar reaction. To be continued.—F. 8S. H.
(CORPUS LUTEUM) The control of the nausea and vomiting of pregnancy by intramuscular injections of corpus luteum extract. A report of the final results in one hundred and eleven consecutive cases. Hirst (J. C.), Am. J. Obst. (York, Pas), 1919, 79; 327-32:
Of 111 cases of nausea and vomiting due to pregnancy, 65 were entirely relieved, and 34 improved to the point where further administration of corpus luteum extracts was discon- tinued. Thus 99 of the 111 patients were entirely relieved or made.comfortable. In 8 cases no beneficial results were ob- tained; in 4 nausea was increased. These 4 cases demon- strated large goiters. Hence, 12 were not improved and 4 made worse. Two cases gave anaphylactic reactions. Four of the cases aborted. In 11 cases classed as pernicious, 6 were completely relieved; 5 failed to respond to the treatment; in 2 cases pregnancy was interrupted to control the nausea and vomiting. Hirst uses ampules containing % grain of the sol- uble corpus luteum powder in 16 minims of physiologic salt solution saturated with chlorbutanol for its local anesthetic effect. This amount is equal to 244 grains of the desiccated corpora lutea. All preparations, cow, sheep or pig, have about the same potency. A series of 12 ampules injected intramus- cularly should constitute the treatment in these cases. One or
ABSTRACTS 393
two ampules a ah may be necessary at times to control vom- iting. —H. W.
CORPUS LUTEUM, The use of—in the treatment of the nausea and vomiting of pregnancy. Cummins (E. J.), Southwest. Med. (El Paso.), 1917, 1, 38.
In five out of six cases the intramuscular injection of corpus luteum extract relieved the nausea and vomiting of pregnancy and no untoward effects were observed.—F. 8. H.
(CORPUS LUTEUM) The relation of the corpus luteum to menstruation (Uber die Beziehungen des Corpus Luteum zur Menstruation). Seitz (L.) and Wintz (H.), Monatschr. f. Geburtsh. u. Gynaik. (Berlin), 1919, 1, 49.
In a series of 177 ovariotomies presenting serous or pseudo- mucinous cystomas, parovarian cystomas, dermoids, or com- plicated by peritonitis, and where both unilateral and bilateral excisions were necessary, it was observed that the operative procedure was followed by discharge of blood from the uterus in but three eases. This evidence leads the authors to the con- clusion that uterine hemorrhage, insofar as it is of menstrual type and eannot be attributed to other causes, is connected with the functional condition of the ovaries. Observations made at the time of occurrence of menstrual flow after opera- tion in which the corpus luteum was removed, one series made during the first half of the intermenstrual period, and a sec- ond series during the last half, brought out that the flow oce- eurred usually within three days after the operations when this took place in the last half, and was delayed three weeks or more when the surgical procedure occurred during the first half of the intermenstrual period. As a result of these and other observations the following conclusions were drawn. I. Histological, biochemical, and experimental investigations, as well as results obtained in X-ray castration, show that the menstrual cycle can be differentiated into and allocated to various phases of function of the ovary, as well as to changes in the endometrium. II. The phases of the ovarian cycle are as folfows: 1. Ripening of the follicles. (Lipamin gland.) 2. Corpus proliferativum, the hitherto unobserved intermedi- ary stage between ripened follicles and ripened corpus luteum. 3. The hyperemic stage of the corpus luteum. 4. The re- gressive stage of the corpus luteum. III. The ripening follicle brings about the premenstrual change of the mucosa and per- haps also the proliferative phase of the endometrial cycle. The corpus proliferativum of the corpus luteum brings the pre-
304 ABSTRACTS
menstrual condition to full development and brings about the secretory phase of the endometrium. Both ripening follicles and corpus proliferativum prepare with increasing intensity the fore-conditions of menstrual flow. The hyperemic phase of the corpus luteum underlies the secretion phase of the endo- metrium and inhibits by its hormone the onset of menstrua- tion. When the corpus luteum goes into the regressive phase the inhibiting influence of its hormone declines and the men- strual flow begins.—F. 8. H.
CORPUS LUTEUM, The significance of the—. Epley (C. O.), J. Iowa State M. Soe. (Des Moines), 1917, 7, 215-218.
As a result of studying the literature and the favorable outcome from feeding three cases having menstrual disorders with 5 grains of desiccated corpus luteum, the author con- siders that whenever it can be demonstrated that the patient lacks the internal secretions from the ovary, corpus luteum medication in some form is indicated. The specific indications for its use are: Profuse menstruation at puberty; disturbed artificial or normal menopause; amenorrhea and sometimes dysmenorrhea; nausea of pregnaney; nervous symptoms of pregnancy; infantile uterus; threatened abortion. The prob- able indications are: Acne, eczema, prurigo, acne and chlorosis of puberty and osteomalacia.—F. S. H.
DIABETES, Acetone hodies in the blood in—. Fitz (R.) Tr. Assn. Am. Physicians (Phila.), 1917, 32, 154-58.
By the Van Slyke method the total acetone bodies, acetone, diacetic acid and betahydroxybutyrie acid, were determined and expressed as acetone. The degree of acidosis was deter- mined by measuring the combining power of plasma for COQ,. A series of 100 cases was tabulated, giving simultaneous deter- mination of total acetone in the blood plasma and degree of acidosis. Some of the cases had severe acidosis and others were acid free. No comatose cases or those having had alkali were included. No definite quantitative relationship was discovered between increased concentration of acetone and lowering of blood bicarbonate, but in a general way the acetone rose as bicarbonate fell. The total acetone was increased by large amounts of fat, the maximum occurring several hours after ingestion and after visible lipemia had disappeared. Small amounts of fat depressed blood acetone. Fasting and pure carbohydrate diet diminished high acetone. Sodium _ biear- bonate increased acetone output, but its effect on blood acetone was uncertain. In three fatal cases of coma it was observed that a rapid premortal rise of blood acetone occurred. In one case this was independent of acidosis ——R. G. H.
ABSTRACTS 395
(DIABETES) Acidosis in relation to pancreatic diabetes. Jen- sen (V. W.), J. Biol. Chem. (N.Y.), 1918, 33, vii.
In studying the effect. on the production of glycosuria by introduction of acid into a dog previously rendered glycosuric by removal of six-sevenths of the pancreas, it was found that 600 ce. of 0.1 NHCl given in three lots of 200 ce. each, during twenty-four hours, doubled the sugar excretion, while the same treatment of a dog sensitized by removal of five-sixths of the pancreas did not produce glycosuria. This indicates that acidosis is a result of the glycosurie condition and after it has developed it acts as part of a vicious circle —F. S. H.
(DIABETES) Action of chloroform. Aloi (V.), Riforma med. (Naples), 1918, 34, 890.
Results are reported which appear to confirm the increased excretion of urea, ammonia and total nitrogen after chloroform anesthesia. Diabetes induces lesions analogous to those of chlo- roform. The author was able to determine directly the pres- ence of B-hydroxybutyrie acid in 9 of 11 cases as the immedi- ate result of the inhalation of chloroform.—Physiol. Abst., 4, 143.
(DIABETES, BLOOD SUGAR) De bloedsuiker in de tropen. de Langen (C. D.) and Schut (H.) Geneesk. Tijdsch. ned. Indié, 1916, 56, 490-551.
The blood sugar is 30 to 75 per cent higher in the tropics than in Europe; this is independent of race. This must affect the metabolism and may account for the frequency of diabetes and neuritis in the tropics—Physiol. Abst., 4, 17.
BLOOD SUGAR, Clinical significance of—in nephritis and other diseases (First paper). Williams (J. R.) and Hum- phreys (E.M.) Arch. Int. Med. (Chgo.), 1919, 23, 537.
The average blood sugar level as determined upon a series of 113 normal individuals was 0:107 per cent, the values ranging from 0.07 to 0.14 per cent. In a series of 60 cases of miscel- laneous diseases, gastro-intestinal and pernicious anemia, the average of the blood sugar level was 0.115 per cent, ranging from 0.07 to 0.16 per cent. In 9 cases of carcinoma there was a moderate elevation of blood sugar, 0.12 to 0.16 per cent. In 22 miscellaneous infections the values ranged from 0.07 to 0.15 per cent. with an average of 0.11 per cent. During the early stages of nephritis, when the general metabolism is but little disturbed, blood sugar, as a rule, is normal. In the last stages
356 ABSTRACTS
of nephritis, when the patient is uremic, the blood sugar is found high, often equalling the severe stage of diabetes. Car- diovascular cases, characterized by high blood pressure and little or no evidence of renal disturbance, usually exhibit blood sugar levels higher than normal. Patients may excrete small quantities of sugar in the urine. In such eases the blood sugar level is inappreciably influenced by carbohydrate restriction. Failure in nitrogen metabolism precedes, often by months, the rise in blood sugar.—H. W.
(DIABETES) The clinical significance of blood sugar in dia- betes mellitus (Second paper). Williams (J. R.) and Hum- phreys (E.M.) Arch. Int. Med. (Chgo.), 1919, 23, 546.
The renal threshold should be considered the height of the blood sugar level at which appreciable quantities of sugar are eliminated in the urine. The blood sugar level in various stages of diabetes may be much higher or lower than the renal threshold. No striking relation is found to exist between the height of the renal threshold and the duration of the diabetes. Young diabeties, as a rule, show a low or normal threshold. The threshold appears to rise with advancing years. When the diabetes is mild or quiescent, the point at which the kidneys eliminate sugar is stationary; but when the disease becomes progressive, the threshold tends to rise. Before death the blood sugar renal threshold may reach great heights with little or no sugar appearing in the urine. A high renal threshold for sugar in mild diabetes under proper dietary regulations usually indicates some complication, as arterial hypertension. A high renal threshold for sugar may mean a physiological expedient to conserve food material. A high, persistent blood sugar level promotes exhaustion and rapid decline of function, hence, the higher threshold is simply a safety measure. In severe diabetes, when extremely low diets are necessary to maintian life, the high threshold is essential to compensate for the impaired ecar- bohydrate metabolism. In the treatment of diabetes it is desir- able to maintain the blood sugar level as nearly normal as pos- sible, even though severe restrictions in diet may be necessary for this purpose, notwithstanding the fact that the high threshold will permit of a much more liberal diet without the appearance of sugar in the urine. Patients are apparently safer when the maximal digestion blood sugar level is not higher than 0.13.—H. W.
(DIABETES) Observations on tolerance and rate of utilization of glucose in a series of individuals exhibiting various de- grees of diabetes mellitus. (Third paper). Williams (J. R.),
ABSTRACTS 307
~ and Humphreys (E. M.) Arch. Int. Med. (Chgo.), 1919, 23, 5d9.
The authors highly recommend the Janney modification of the Hamman and Heischman method as a means of measuring the degree of disturbance in carbohydrate metabolism in hyper- thyroidism and other endocrinal disorders, this being much superior to tests depending wholly on the determination of urine sugar. Renal diabetes is considered a definite physiolog- ical disturbance, easily distinguished by the above mentioned process from true diabetes. A number of reports and protocols are included.—H. W.
(DIABETES) Clinical Calorimetry.. Twenty-fourth paper. Metabolism in three unusual cases of diabetes. Gephart (F. C.), Aub (J. C.), Du Bois (E. F.), and Lusk (G.), Arch. Int. Med. (Chgo.), 1917, 19, 908-930.
A paper dealing with the measurement of the respiratory exchange and total heat production of three diabetics under- going the starvation treatment. It was observed that metabol- ism was markedly decreased in all cases and in one some 40 per cent below the normal for the age and weight of the indi- vidual studied. With the increase in sugar tolerance there was a synchronous rise in metabolic level.—F. S. H.
DIABETES, Dietetic helps in—. Donk (Rose R.), J. Am. M. Assn. (Chgo.), 1919, 73, 25-27.
It is with difficulty that the busy practitioner finds time to carry out the exact regulation of diet that the proper treat- ment of diabetes demands. The dietary requirement depends upon the age, weight, condition as regards obesity and habits of exercise. Acidosis must be prevented. The metabolic de- rangement of diabetes involves protein and fat as well as carbohydrate metabolism, hence the beneficial effect of ‘‘fast days.’’ Carbohydrate tolerance is relative as shown by im- provement when protein is kept at a sufficiently low level. <Ac- curate laboratory control is essential. Although the blood urea is low the patient commonly has a high urinary urea output. Like the hyperthyroid or fever patient the diabetic over- excretes and overconcentrates. If in becoming sugar-free and acid-free the patient lowers a high urea index he has scored an extra point. Fat ingestion should be regulated by determi- nations of acetone bodies, acid and ammonia of the urine. Al- veolar air determinations are a reliable guide as regards acid- osis. The Marriott apparatus is simple and sufficiently ac- curate.
358 ABSTRACTS
A case is reported with full laboratory details of a fairly severe diabetes in which the patient ultimately regained an ability to utilize 83 gms. protein, 147, fat and 58, carbohydrate, giving 1887 calories. In order to eliminate as much as possible of the drudgery of regulating the gradual dietary progress of the patient in accordance with the laboratory findings, an elaborate set of tables is given. Starting with fixed quantities of 5 per cent. vegetables, from 200 to 5000 ems., the effect is siven of adding various quantities of potato, bread, broth, fish, egg, cream, butter, lean meat, cheese, bacon and olive oil. This, in effect, gives a progressive chart of augmenting protein, fat, carbohydrate and caloric values the exact degree of which is indicated without laborious ealeulations. The total range is from 40 to 1778 calories.—R. G. H.
(DIABETES) Diffuse diabetic ulceration of the pharynx and larynx. Arrowsmith (H.), Laryngoscope (St. Louis), 1916, se2Ove ai —1 5.
Report of a ease of diabetic ulceration of the uvula, velum and posterior pharyngeal wall, the laryngeal surface of the epiglottis and right arytenoid of 5 months standing in a woman 66 years old. The Wassermann test was negative; there were no tuberculous findings. The Allen treatment brought about a marked improvement of her glucemia, but the local condi- tion remained unaltered.—H. W.
DIABETES, Edema as a danger signal in the starvation treat- ment of. Croftan (A. C.), J. Am. Med. Assn. (Chgo.), 1917, 69, 1962-1963.
The benefit to be derived from the starvation treatment of diabetes is exaggerated since no increased sugar tolerance was found and since there was a marked increase in acetone bodies accompanied by edema. These conditions disappeared when small amounts of carbohdyrate food were ingested. A diuresis followed, but was not accompanied by compensatory elyecosuria. This phenomenon is due to the fact that in hunger the urine output is low and water retention by the tissues causes the appearance of the edema, which is a danger signal. This can be prevented by the use of pancreatized oatmeal- aleohol-glycerin clysmata.—F. S. H.
(DIABETES) Glycosuria complicated with maltosuria and dextrinuria (Glycosurie compliquée de Maltosurie et de dex-
ABSTRACTS 399
trinurie). Gaillard and Fabre, J. Pharm. et Chim. (Paris), LOT, 7; 1292137.
A ease of traumatic diabetes arising from concussion syn- cope followed by vertigo, instability, ete. Analysis of the urine showed the presence of 25-26 gms. glucose, 36-37 gms. dextrine and 35-36 gms. maltose per litre. This is attributed to involve- ment of the central nervous system—F. S. H.
DIABETES in children. Gray (H.) and Joslin (E. P.) Tr. Assn. Am. Physicians (Phila.), 1917, 32, 149-54.
Among the private cases of diabetes of the authors 4.7 per cent fal] within the first decade of life, a proportion mate- rially higher than in well known earlier statistics. The same etiologic factors are found as in adults, but obesity, dietary excesses, heredity and mental over-exertion are most commonly observed. Fatness of undue degree in children is very prone to be followed in later life by diabetes. A child with hereditary history of diabetes has, in the authors’ experience, a more fa- vorable outlook than one free from hereditary taint. Low blood sugar in children is not ground for undue complacency. Repeatedly children of low sugar type have developed pro- gressive diabetes. Children make exceptionally good patients, responding well to proper dietary therepeusis and, as a rule, complaining little. Growth often takes place normally—a fact that is likely to lead to a false conclusion that a cure has been effected. The treatment is precisely the same as in adults, namely, rigorous restriction of eating. Complete fasts are usually well borne. Following the fast, administration of 50 grams of 5 per cent vegetables with broths is effective in relieving hunger, and subsequent weekly strict diet days cause no trouble if broths and 300 grams of 5 per cent vegetables can be allowed. Special pains should be taken in the preparation of the vegetables, for children eat rapidly and diarrhea ocea- sionally results. Constipation, however, is more common. The diet should not be made too simple.—R. G. H.
DIABETES insipidus. Barach (J.H.), Am. J. Med. Se. (Phila.), 1917, 154, 220-225.
A case of.diabetes insipidus with kidneys capable of elimi- nating a normal amount of solids in twenty-four hours. In response to ingestion of added amounts of salt or urea the elimination was prompt and rapid. The ingestion of 100 gms. of glucose was followed by a slight transitory glycosuria and diuresis.—F, S. H.
360 ABSTRACTS
DIABETES INSIPIDUS due to hemorrhage into the neuro- hypophysis (Diabete insipido da enorragia nella neuroipo- fisi). Luzzato, Riforma med. (Napoli), 1918, 34, 94.
See Endocrin., 1918, 2, 32.
(DIABETES) La chirurgie chez les diabétiques (Surgery in diabetics). Labbé (M.), Ann. de méd. (Paris), 1918, 5, 428. Abst. Surg. Gyn. & Obst. (Chgo.), 1918, 28, 407-8.
The danger of operating upon diabeties arises principally from hyperglycemia which favors suppuration, and acidosis leading to post-operative coma. Only absolutely necessary operations should be undertaken. When not urgent the opera- tion should be preceded by a diabetic regimen. Immediately before operation fasting should be suspended and 40 gms. sodium bicarbonate given. Local anesthesia with cocaine or one of its congeners should be utilized if possible, with spinal anesthesia as second choice. If general anesthesia is Impera- tive ethyl chloride should be used. No diabetic patient should be subjected to ether or chloroform. After operation sufficient sodium bicarbonate—up to 100 grams—should be given to pro- duce an alkaline urine. When the patient is able to eat, vege- table broths, oats, dry vegetables and milk should be given, with continuation of the alkaline treatment until acidosis has disappeared.—R. G. H.
DIABETES mellitus, A case of—, with apparent recovery. Colquhoun. New Zealand Med. J. (Wellington), 1917, 16, 5-0.
On a regular diabetic diet an individual previously show- ing a daily glucose elimination of 32.8 grams decreased the sugar output to 26.3 grams during a month’s treatment. A high protein diet following resulted in a decrease of the sugar output to zero within two weeks. The later admission of carbohydrates to the diet did not produce a recurrence of the elycosuria.—F’, 8. H.
DIABETES mellitus, Psychoses associated with. Singer (H. D.) and Clark (S. N.), J. Nerv. & Ment. Dis. (N. Y.), 1917, 46, 421-428.
Toxic hallucinoses often coincide with the diminution of sugar elimination, though not according to any rule and with- out any apparent explanation. Two cases are reported. With the reappearance of the sugar the hallucinations disappeared.
—F.S. H.
ABSTRACTS 361
DIABETES mellitus, Recent studies in—. Williams (J. R.), N. Y. State M. J. (N. Y.), 1916, 16, 412-18.
Young patients do well on the Allen treatment. Diabetes is more amenable to treatment when not complicated with in- fection or arterial degeneration. Syphilis is probably a rare factor in the causation of diabetes. Of the 10 patients who died (82 cases observed), 4 succumbed to exhaustion occa- sioned by severe surgical operations; none of them died in coma. The others would not follow the treatment. Advanced eases should not be subjected to starvation methods too rapidly as fatal results have followed such procedures.—H. W.
DIABETES mellitus, The Allen-Joslin treatment of—. Woldert (A‘), N. Y. Med. J. (N. Y.), 1918, 108, 764-7.
A general statement of the methods used in the treatment of diabetes mellitus.—H. W.
DIABETES MELLITUS, The maintenance diet in—as deter- mined by the nitrogen equilibrium. Mosenthal (H. O.) Tr. Assn. Am. Physicians (Phila.), 1917, 32, 159-71.
Metabolic studies on nine diabetics are reported. It was found that patients could be established in nitrogen balance by a protein-fat diet having a caloric value equal to the stand- ard calorie requirement. In many eases nitrogen equilibrium is possible at a sub-standard caloric level. The factors deter- mining the minimal level at which balance can be maintained are apparently very numerous and partially unknown, but glycosuria and slight infections are two that may necessitate an increased food intake to avoid a nitrogen deficit. It is neces- sary to maintain nitrogen equilibrium if the physical and men- tal efficiency of the patient are to be conserved. On a carbo- hydrate-free regime this amounts roughly to 1500-2000 calories, women and smaller individuals in general requiring less than normal size men. A positive nitrogen balance may be attained in diabetics while on carbohydrate-free diet—R. G. H.
DIABETES, Observations on the starvation treatment of— Martin (C. F.) and Mason (E. H.), Tr. Assn. Am. Physicians (Phila.), 1916, 31, 444-54.
Published elsewhere. Abst. Endocrin., 1, 529. DIABETES, On sudden changes of refraction in—. Zimmer-
man (C.), Wisconsin M. J. (Milwaukee), 1915-1916, 14, 227-31.
Report of a case of sudden development of myopia in a diabetic man 52 years of age. Treatment -of the diabetes
362 ABSTRACTS
brought about marked improvement of vision. The various theories concerning the etiology of refractive changes in diabetes are thoroughly discussed.—H. W.
DIABETES. On xanthosis diabetica (Uber die Genese der Xanthosis diabetica.) Biirger (H.) and Reinhart (A.) Deutsche med. Wehnschr. (Berlin), 1919, 45, 430.
The so-called xanthosis diabetica has nothing to do with diabetes. It may be seen in all patients and is normal in per- sons when they are fed during a long time only on green vege- tables.—J. K.
(DIABETES) Pancreatic diabetes in the dog. I. The influence of alkali and acid upon the glycosuria and hyperglycemia. Murlin (J. R.) and Kramer (B.) J. Biol. Chem. (N. Y.), 1916, 27, 481-498.
Sodium bicarbonate and potassium bicarbonate adminis- tered by stomach tube may be without immediate effect on the glycosuria and hyperglycemia of the depancreatized dog. A bicarbonate given by mouth to a fasting depancreatized dog may even cause the reappearance of glucose in the urine after it has been ‘‘starved’’ out. The normal anhydrous sodium carbonate may, on the contrary, reduce the sugar in the urine materially when given:by mouth, and when given by vein invariably does so, especially when added to Ringer’s solution to the amount of about 1%. The blood sugar does not undergo a compensating increase in percentage even when the dilution of the blood is accounted for. Dilute HCl given by mouth or subcutaneously to the depancreatized dog has just the oppo- site effect of alkali, increasing the sugar in the urine without materially affecting the nitrogen elimination, and without caus- ing any effect on the blood.—F. §8. H.
(DIABETES) Pancreatic diabetes in the dog. II. Is the glu- cose retained when sodium carbonate is administered to de- pancreatized dogs deposited as glycogen? Kramer (B.), Marker (J.) and Murlin (J. R.) J. Biol. Chem. (N. Y.), 1916,
27, 499-515; Proce. Am. Soe. Biol. Chem., 1916, xxiv.
Neither the direct determination of glycogen in liver and muscle of depancreatized dogs to which had been given sodium carbonate with consequent diminution of glycosuria, nor the feeding of glycogenetic material plus sodium carbonate to de- glycogenized dogs with study of the subsequent degree of gly- cosuria under further deglycogenization, sueceed in producing
ABSTRACTS 363
evidence that the glucose retained is held ue as glycogen. —F.S. H.
(DIABETES) Pancreatic diabetes in the dog. III. The influ- ence of alkali on the respiratory metabolism after total and partial pancreatectomy. Murlin (J. R.) and Kramer (B.) a biol Chem (N. Y.), 1916, 27, 517-537.
In completely depancreatized dogs the administration of sodium carbonate by mouth or intravenously is promptly fol- lowed by a retention of considerable amounts of glucose of endogenous or exogenous origin. In partially depancreatized dogs which still have some capacity to oxidize glucose, the administration of sodium carbonate or sodium hydroxide with glucose is followed by a greater oxidation of glucose than when either is given alone. Sodium carbonate itself causes but a slight increase in respiratory quotient, or none, whether administered’ per os or intravenously, to normal or diabetie dogs. The retention is rarely if ever accompanied by any evi- dence of improved oxidation. Thus, while it seems that sodium carbonate or sodium hydroxide alone cannot restore the lost function to an organism completely deprived of its ability to oxidize glucose, either substance can improve the capacity of the organism as a whole to oxidize glucose when this function is more or less crippled but not completely lost.—F. 8S. H.
DIABETES, Salt metabolism in—. Beard (A. H.) and Rown- tree (L. G.) J. Biol. Chem. (Balt.) 1918, 33, xx. See also Arch. Int. Med. (Chgo.), 1918, 21, 716-739, Abst. Endocrin. 2, 320.
If diabetic patients are followed to ingest salt ad libitum they consume very large amounts and in many eases the gain in weight and the development of edema is synchronous with, and in all likelihood dependent upon, retention of salt and water.—F’.. S. H. :
(DIABETES) Studies of acidosis. IV. The blood, urine, and alveolar air in diabetic acidosis. Stillman (E.), Van Slyke (D. D.), Cullen (G.), and Fitz (R.), J. Biol. Chem. (Balt.), 1917, 30, 405-456. ;
The alveolar air carbon dioxide tension in diabetic patients under treatment is often much too low to indicate the true level of the blood bicarbonate. In very severe acidosis the urine index is less accurate than the alveolar air in indicating the alkaline reserve. Of the two indirect measures of alkaline reserve, therefore, the alveolar carbon dioxide appears to be
364 ABSTRACTS
the more accurate in measuring the more severe stages of dia- betic acidosis, such as are encountered in threatened coma, while the index of acid excretion is more accurate in the more common intermediate stages.—F. 8S. H.
DIABETES, The Allen treatment of—. Friedenwald (J.) and Leinbaugh (L.) Interstate M. J. (St. Louis), 1916, 23, 71-79.
Report of 20 cases of diabetes treated by the Allen method. All were rendered sugar free in from one to four days, and, save for one case which would not follow the dietary measures, kept free from sugar. In a very few instances in which sugar reappeared, the condition was overcome by a single day’s fast—H. W.
(DIABETES) The concentration of dextrose in the tissues of normal and diabetic animals. Palmer (W. W.), J. Biol. Chem. (Balt.), 1917, 30, 79-114.
The concentration of dextrose was determined in muscle, liver, heart, kidney, spleen, pancreas, stomach, intestine, skin, lung, and eye tissues of normal and diabetic animals, under varying conditions of procedure. No difference in the amount of dextrose to be found in either normal or diabetic tissues is eaused by variation in the manner of producing the hyper- glycemia. The concentration of dextrose varies directly with the degree of hyperglycemia. The largest amount of sugar was found in the liver, the smallest in the brain, the difference being accounted for by the difference in vascularity. The concentrations of dextrose in the tissues, with the exception of the liver, was invariably lower than that of the blood. Normal animals have a higher concentration of dextrose in striated muscle than have diabetic animals when the levels of blood sugar are comparable. Bleeding of an animal causes a rapid glycogenolysis in the liver. Adrenalin produces no change in tissue sugars different from that found when hyper- glycemia is caused by other means.—F. 8. H.
(DIABETES) The influence of renal function on hypergly- cemia and glycosuria in diabetes mellitus. Epstein (A. A.), Am. J. Med. Se. (Phila.), 1917, 154, 103-121.
Clinical reports of cases of diabetes with and without nephritis comparing the blood and urinary sugar and also renal function using the phenolsulphonpthalein test. From these it is concluded that: 1. A condition simulating renal diabetes, i.e., a glycosuria without hyperglycemia, may occur in diabetes
ABSTRACTS 365
mellitus. This is brought about by an increase in blood volume which reduces the concentration of the blood sugar, and the consequent fall in its percent masks the hyperglycemia. 2. Hyperglycemia without glycosuria is of frequent occurrence in diabetes mellitus. When sugar is absent from the urine a persistent hyperglycemia which remains constant or does not progress, shows an altered state of carbohydrate metabolism in which a balance is established between the supply of sugar to the blood and its ultilization by the tissues on a higher plane than that found normally. This is interpreted as an increased tolerance of the kidneys. A true nephritis need not interfere with the elimination of the sugar. Testing the kidney fune- tion by means of phenolsulphonpthalein in diabetes mellitus is a useful procedure: It aids in understanding the relation of the hyperglycemia to the glycosuria. It is particularly help- ful in those cases in which a fall in the urinary sugar is assoc}- ated with a rise in blood sugar, thus yielding confirmatory evidence of the fact that the elimination of glucose is inter- fered with.—F. S. H.
DIABETES, The role of fat in—. Allen (F. M.), Am. J. Med. Se. (Phila.), 1917, 153, 313-371; see also N. Y. Med. J. (N.Y.), 1916, 104, 1005.
In studies on partially depancreatized dogs it was ob- served that a lipemia could be developed by regulating the diet. The visible blood fat in the lipemic dogs was not in an abnormal form insoluble in ether. The power of the plasma to hold the fat in clear solution was not diminished, and there was a low total fat content of the corpuscles. The condition was due neither to a hyperglycemia, an absence of carbohy- drates, nor to a loss of sugar from the body. It was not due to the presence of acetone bodies, nor to the change in reaction of the blood. It was not due solely to the partial removal of the pancreas. Nor was it due to a breaking down of a hypothetical ‘fat funetion’’ by direct overstrain of that function. It does depend, however, upon the severity of the diabetes, hence the disorder underlying the lipemia is bound up to a considerable extent with the other diabetic disturbances and is not entirely independent, its exact focus being at present undetermined. The production of an acidosis in partially depancreatized dogs on a high fat diet can lead to coma with a terminal low carbon dioxide capacity of the plasma, which can be relieved by bicar- bonate treatment but which does not prevent the death of dogs dying of acidosis. Increased ammonia exeretion and the elim- ination of acetone bodies also oceur. The addition of fat to the diet caused a distinct depression of blood sugar. An attempt
366 ABSTRACTS
at high nutrition with fat produces a spontaneous aggrava- tion of the condition. Accordingly the experiences with dia- betic dogs warns unmistakably against efforts to maintain pa- tients on a luxus level of diet or weight, and the standard of feeding should approximate that of Chittenden rather than that of Voit.—F. 8. H.
(DIABETES) The present outlook of diabetic treatment. Allen (F. M.), Tr. Assn. Am. Physicians (Phila.), 1917, 32, 139-48: Med. Ree. (N. Y.), 1917, 92, 39.
-Three years after the Allen treatment was first instituted, the originator of it sums up accomplishments and future out- look. It appears that the most accurate standard of severity of the disease is not acuteness of onset, rapidity of progress, in- tensity of glycosuria or degree of acidosis. The genuinely difficult cases are those in which the sugar tolerance is prac- tically nil and fails to inerease under prolonged, rigorous treat- ment.
In experimental diabetes in animals specific degeneration of the islands of Langerhans occurs; this is characterized by vacuolation of cytoplasm, pyknosis of nuclei, loss of cells and finally almost complete disappearance of the islands. Partial pancreatectomy does not produce diabetes in animals if these are fed within their tolerance, but overtaxing this tolerance will at any time initiate the degenerative changes in the islands. The clinical progress of the resulting diabetes and the degree of exhaustion and degeneration of the cells run parallel. When extreme exhaustion is reached death is inevitable. Although excellent pathologists have failed to find similar exhaustion and denegeration in the Langerhans cells of some eases of human diabetes, such have been found in all fatal cases at the Rockefeller Institute Hospital. It is emphasized, however, that the tissues for microscopic diagnosis should be secured imme- diately after death.
Allen feels that the death of any patient in which struc- tural defects of the pancreas can not be demonstrated lays the treatment administered under grave suspicion, it being probable that proper conservation of tolerance would have saved the patient. The worst form of treatment is that which permits death from coma or similar avoidable accident. The next worst is that which slowly destroys the Langerhans cells by continuously overtaxing them. The only present hope for diabeties is treatment by functional rest, with conservation of what viable Langerhans cells remain and, possibly, regeneration of others.—R. G. H.
ABSTRACTS . 367
DIABETES, The starvation treatment of—. Marshall (M.), J. Mich. State M. Soc. (Grand Rapids), 1916, 15, 01550 3 Cie hp wea Clin. Soe. Univ. Mich. (Ann Arbor), 7, 48.
M. obtained good results in the treatment of diabetes by the Allen method. Most cases so treated became sugar free in about three days.—H. W.
ENDOCRINE GLANDS and bone dystrophies. Editorial. N. Y. Med. J., 1919, 109, 907.
Whether the subject presents hereditary syphilis, an infee- tion or chronic intoxication, nervous stigmata or circulatory disturbances resulting from improper feeding 2, one will invari- ably find indices of a local or general pertubation of the nutri- tion. Frequently this is due to changes or functional disturb- ances arising in some set of endocrine glands which are the great regulators of metabolic changes. In the majority of cases the osseous dystrophies are due, not to a single given endocrine gland, but to several, so that they belong to a true pluriglandu- lar syndrome.—H. W.
. ENDOCRINE GLANDS and their relation to vaso-motor dis- turbances of the air passages, hay fever and asthma, with the past year’s report. Selfridge (G.), Calif. State J. Med. (San Francisco), 1919, 17, 139.
Among 26 cases of vaso-motor rhinitis 14 were found with signs of slight endocrine gland insufficiency. Signs of more or less marked endocrine disturbances were also noted in 22 eases of bronchial asthma; in 6 thyroid disturbances predom- inated, 15 demonstrated hypo-pituitarism, and one probably status lymphaticus. Observations upon eight cases demon- strated a striking relationship of anaphylaxis to pituitary dis- turbances. This relationship was present in those reacting to hairs, foods, bacteria and to colds which seemed to be anaphy- lactic rather than bacterial in origin. All of these cases showed abnormalities about the sella turcica. Chest radiographs of anaphylactic cases gave normal readings in contradistinction to the peribronchial thickenings commonly found in the elass of so called ‘‘asthmatic bronchitis’? or infective types. Endo- crine therapy apparently relieved some of the cases of vaso- motor disturbances of the air passages, hay fever and asthma. ~ However, time enough has not elapsed to warrant any definite statements or conclusions regarding such therapy.—H. W.
368 ABSTRACTS
(ENDOCRINE GLANDS) On the use of internal glandular extracts in mentally retarded children. Timme (W.) Bull. Dep. Pub. Char. (N. Y.), 1916, 1, 40-47.
The endocrine system comprises groups of glands that fune- tionate during different epochs of life. In early years the pineal and thymus apparently control body growth and met- abolism. These at puberty give way to the ovaries, testes and pituitary. After middle life one or the other of these latter becomes atrophied and a train of symptoms due to endocrine imbalance results. The thyroid and the adrenals act as regu- lators throughout life, controlling to an extent the others and compensating for them. The organ or tissue of the body that does not move harmoniously with the rest during early child. hood becomes a drag upon its co-workers. Should the thymus, the pineal or the thyroid functionate abnormally, disturbance of growth occurs and the individual becomes backward men- tally and bodily. If the pineal atrophies before puberty, pre- cocity appears. If the pineal functionates beyond the normal age, a certain degree of infantilism results. The thymus that does not atrophy as the child advances in years, conditions a state of deficient evolution, especially of the connective tissues; the mentality is on a par with the physique, childish and back: ward. The thymus that ceases to act too early causes a pre- cocious body growth; the muscles and bones, without apparent increase in size, give the appearance of age; the skeleton is abnormally brittle and subject to easy fractures. Three illus- trative cases are described.—E. H.
(ENDOCRINE GLANDS) Phosphatides in the ductless glands, Fenger (F.), J. Biol. Chem. (Balt.), 1916, 27, 303-307.
Chemical analysis of the amounts of phosphatides in the ductless glands of cattle show that the pituitary, the suprare- nals, the pineal, the infant thymus, and the corpus luteum of pregnancy contain considerable amounts of phosphatides in excess of ordinary muscle tissue, indicating that the phospha- tides play some part in the internal chemistry of the ductless glands. The thyroid does not contain any more phosphatides than lean meat, and it may, therefore, be assumed that this gland performs its secretory functions independent of the phosphatides.—F. 8. H.
(ENDOCRINE GLANDS) The early recognition of some endo- crinopathies. Timme (W.) Hosp. Bull. Dep. Pub. Char. CN: ¥.p5 09 Pi xt5 38.
A few general principles should be kept in mind so that
ABSTRACTS 369
the matter of recognition of the various signs and symptoms of internal glandular disorders be not reduced to a memory basis purely, but that associative aids in our interpretation be en- listed in our service. These general principles are, first, the activity of the pineal and thymus glands in infancy and child- hood up to the period of puberty; they control constructive metabolism. At puberty the gonads come into the field; the pineal and thymus atrophy. The thyroid, pituitary and supra- renals are monitors over the others during life. The two series of glands being antagonistic, any invasion of the thymus or pineal in the domain of the gonads, or vice versa, results in changes in the individual as to growth, sexual development or mental precocity. Any change from the normal in any one gland must necessarily have compensating changes in the other glands. If sufficient compensation is lacking, we may have either under-compensation or over-compensation. The impor- tance of interpreting the manifestations of a disturbed glandu- lar system in terms of the proper gland originally at fault is evident. A synopsis is appended, giving the symptoms refer- able to the thyroid, suprarenal (cortex), suprarenal (medulla), pituitary, thymus and pineal glands.—E. H.
(ENDOCRINE GLANDS) Recovery of normal weight in the various organs of albino rats on refeeding after underfeed- ing from birth for various periods. Jackson (C. M.) and Stewart (C. A.) Am. J. Dis. Child. (Chgo.), 1919, 17, 328.
The authors conducted experiments on albino rats, under- feeding the animals from birth to 3, 6 or 10 weeks of age and then refed them amply. The process of recovery on refeeding will vary according to the age at which the preceding inanition period began. This is evident if the results of the present ex- periments (beginning at birth) are compared with those pub- lished earlier by Stewart in 1918, in which the rats were amply refed after maintenance by underfeeding beginning at three weeks of age. In the rats in which the inanition tests began at the later date, most of the organs (excepting the testes, epidid- ymi and suprarenals, which remained subnormal) had recovered approximately their normal relative weight within from two to four weeks of refeeding. The thymus and possibly the spleen and ovaries were apparently above normal (over-compensatory growth?) after from two to four weeks of refeeding. In the present experiments, the authors found different results. In general, inanition at the earlier age seems to have effected more permanent results, as reflected in the more tardy recovery of normal weight in several of the organs. The hypophysis and suprarenals are apparently nearly normal in weight in all groups. The testes, epididymi, brain, thymus, thyroid, and
370 ABSTRACTS
ovaries show more or less retarded recovery in weight on re- feeding. To this list may perhaps be added the pineal gland. This would seem to indicate that early inanition, especially when prolonged, tends to inhibit the later growth of the pineal geland. The testes and spleen show an apparent tendency to over-compensatory growth in the earlier stages of refeeding with later retardation. There is no evidence of over-compen- satory growth in the thymus and ovaries. The results may perhaps indicate the probability of recovery in the various organs of infants after periods of inanition.—M. B. G.
ENDOCRINE ORGANS, Influence of the—on the physiological activity of the bladder (Die physiologishe Tatigkeit der Harnblase und ihre Beeinfliissung durch Produkte der in- neren Sekretion). Abelin (J.), Ztschr. f. Biol. (Munch u. Berl.), 1919, 69, 373.
Intravenous injections of adrenin diminish the contraction of the bladder. Pituitary extract causes a very marked increase of tonus; this is independent of its effects on blood pressure, vascular calibre or respiration. The bladder is, in fact, the best test object for assaying pituitary extract. It can be utilized in situ in the living animal, without anesthesia. Thyroid and thymus extracts have no effect on the bladder.—J. K.
(ENDOCRINE ORGANS) Juvenile endogenous adiposity. (tiber endogene Festtsucht im spateren Kindesalter). Schueany (T.), Jahrbuch f. Kinderheilk. (Berlin), 1919, 69, 30.
Two cases of adiposity in children, the first one caused by hypofuncetion of the thyroid, the second by a diminished fune- tion of the pituitary body. This latter case showed also eunuch- oidism. The skeleton of the first patient was under-developed ; the skeleton of the second showed a remarkable overgrowth. In both patients a good result was obtained by specific organo- therapy.—J. K.
(ENDOCRINE ORGANS) Rare forms of pluriglandular insuf- ficiency (Uber seltene Formen der pluriglandulairen endo- krinen Insufficienz mit Xanthosis, familiarem Ikterus, hypo- thyreogenem Oedem). Curschmann (H.) Ztschr. f. klin. Med. (Berl, ), 1919 380, 19:
Three interesting cases are described. 1. A woman with- out diabetes had a classical xanthosis. Many symptoms of plu- riglandular insufficiency were present, including genital atrophy and enormous hands and feet, but no changes in the
ABSTRACTS 371
sella turcica. After her first pregnancy the symptoms increased rapidly ; menstruation ceased and sex feelings disappeared to- tally. Organotherapy was not successful. 2. A boy at 12 devel- oped glycosuria. At 19 he complained of stomach symptoms. No free HCl was found. He had jaundice, but no bile in the feces. Sexual functions ceased as did growth of hair and beard. 3. A man of 36 a year before his death developed edema of the legs, dry skin, typical pigmentation as in Addi- _son’s disease, testicular atrophy and sexual impotence. Fat appeared in the stools in large quantities. At autopsy the thyroid was found small and hard, but the pancreas and adrenals appeared normal.—J. K.
(ENDOCRINOLOGY) Evolucao da endocrinologia (Evolution of Endocrinology). Brazil (A.) Archivos de Biologia de San Paulo (Brazil); 1918, 3, 439.
Brazil gives a long review to the more significant articles on Endocrinology. No new data are offered.—G. P. G.
(ENDOCRINOLOGY) The dominance of the endocrines. Gar- retson’ (V. P.) N. Y. Med. J., 1919, 109, 839.
An understanding of the physiology relative to the endo- erime and vegetative nervous systems is of paramount impor- tance and proves an incalculable aid in the analysis and treat- ment of so-called functional derangements, as well as organic disease. The internal secretory glands are vegetative organs, and their function is to a degree regulated by the nervous sys- tem, while on the other hand the dominance of these glands over the nervous system is quite beyond dispute; especially is this evident as displayed through psychical or mental functions. In proof of this one has but to note the alterations in character that follow or are associated with disturbed endocrine fune- tion. The psyche is maintained in proper balance through the normal action of the vegetative nervous system. Its responses, in so-called psychic reactions, are dependent upon the endo- crine functions. As a buffer to these vital functions, it responds in varying degrees as influenced by experiences based upon instincts and memory complexes, and the so-called shock reac- tions are accordingly expressed and reflected by symptomatic evidences. That large group of patients generally misunder- stood and frequently classed in civil life as neurasthenies, psy- chasthenies, hysterics, cyclothymics, and hypochondriacs, is now capable of an intelligent analysis and rational therapy, if one will concede these are the victims of an endocrine asthenia. ‘““The life of every individual is dominated by his ductless gland chain. Certain of the glands assume a dominating influ-
372 ABSTRACTS
ence and by reason of this, we are able to designate persons in terms of glandular types. For example, studies clinically have proved that certain physiological and structural markings are constant to certain glandular types, and by the physical ob- jective examination alone, without other information we can make an accurate diagnosis.’’—H. W.
GOITRE from the standpoint of the internist. Anders (J.), Penn. Med. Jour. (Athens), 1917, 21, 483-85.
A general clinical discussion of syndrome. Advocates the feeding of iodine for development in suspected cases.—F. 8. H.
(GONADS) Development of heterosexual symptoms (Auftreten von heterosexulaen Merkmalen). Hermans (L.) Miinch. med. Wehnscehr., 1919, 66, 157.
The author describes a case of a man of 38 years who, with- out known cause, developed atrophy of both testes. At the same time hypertrophy of the mammary glands appeared.
—J. K.
(GONADS) Evidence that the germ cells are subject to selec- tion on the basis of their genetic potentialities. Danforth (C. H.), J. Exp. Zool. (Phila.), 1919, 28, 385-413:
Not of endocrine interest.—M. M. H.
(GONADS) Interstitial cells in the gonads of the domestic fowl. Goodale (H. D.), Anat. Ree. (Phila.), 1919, 16, 247-251.
The author believes that the granular interstitial cells of the ovary of the domestic fowl are eosinophile leucocytes. He has found cells like them among the erythrocytes in the blood vessels, in the active thymus of two moulting drakes, in the connective tissue of testes and epididymus, and rarely in the thyroid, pituitary and pineal glands. He ealls attention to the presence in the ovary of a type of cell which is not demon- strably granular (called ‘‘clear cells’? by some authors and ‘“Juteal cells’’ by Pearl and Boring). These he believes may be shown to be granular by the use of special stains, and may prove to be the true interstitial cells from the physiological standpoint.—M. M. H.
(GONADS) On the physiological properties of the gonads as controllers of somatic and psychical characteristics. Moore (C. R.), J. Exp. Zool. (Phila.), 1919, 28, 137-161.
A study of the conditions following gonadectomy in young
ABSTRACTS 373
rats and the subsequent transplantation of the opposite gonad to each animal (repetition of the experiments of E. Steinach) shows that the apparent effects of such a condition are not so marked as one is led to expect from Steinach’s reports. Somatic changes that are due entirely to the presence of the implanted gland are difficult to demonstrate. From the psychical side the results are more definite. Young male animals have been con- verted into such apparent, typical females that the mother in- stinct to protect and nurse the young is readily noticeable. Also young females have been converted into such apparent, mature males that they react psychically as males and imitate a male, in a very exact way, in the act of copulation. Histolog- ical sections, of the grafts show the ovary to have remained apparently functional, while the testis has undergone marked changes leading to destruction of spermatocytes and sperma- tozoa.—Author’s Abst.
(GONADS) On the physiological properties of the gonads as controllers of somatic and psychical characteristics. II. Growth of gonadectomized male and female rats. Moore (C. R.), J. Exp. Zool. (Phila.), 1919, 28, 409-469.
Gonads were removed from eighteen male and twenty-two female albino rats, at ages from twenty-three to thirty days. The weights of the animals were recorded for a period of 180 days, and from these records the author compiles a growth curve which shows the average weight of castrated males to be greater than that of spayed females. He concludes that there is a potential weight difference between the sexes independent of the secretion of the gonads. This fact must be borne in mind when conclusions are to be drawn regarding the effect on the growth curve of the transplantation of gonads from one sex to the other.—M. M. H.
(GONADS) Relation of the sex glands to metabolism. Murlin (J. R.) and Bailey (H.), Tr. Am. Gynec. Soe. (Phila.), 1917, 42, 247-56.
Published elsewhere. Abst. Endocrin. 1, 473.
(GONADS HYPOPHYSIS) The effects of inanition in the young upon the ultimate size of the body and of the various organs in the albino rat. Jackson (C. M.) and Stewart (C. A.), Anat. Ree. (Phila.), 1919, 16, 153.
Thirty-eight litters were used; 113 rats survived, 35 male and 35 female test rats, 27 male and 16 female controls. Groups were underfed from birth to three, six, and ten weeks of age,
374 ABSTRACTS
and from three weeks to twenty weeks or to nearly one year. Thereupon the test rats were fully refed. They grew variably, but remained permanently stunted, failing to reach the adult size of the controls. Stewart (716) found perfect recovery after underfeeding from three to ten weeks of age. The ultimate effect, therefore, varies according to the age of the animal and the extent of the underfeeding period. This is in agreement with the results of Aron and Briining, but disagrees with Osborne and Mendel. Forty-five of the rats (28 test and 17 controls) were autopsied. Of the individual organs, the brain, spinal cord, hypophysis, and lungs average slightly subnormal ; the ovaries distinctly so. The heart and alimentary tract are slightly, and the testes and epididymides definitely above nor- mal weight. While some abnormalities thus appear, they are usually slight, and in general the organs and parts are nearly normally proportioned in the permanently stunted rats. Thus early starvation apparently retards the later growth process of the body as a whole—Author’s Abst.
(GONADS) Un caso de distophia genito-glandular. Murillo Campos. Archivos de Biologia de San Paulo (Brazil), 1918, 3, 324.
A ease of a boy of 18 years with all the characteristics of a eunuch is described. He was beardless, had testes of almond size, and penis 6.8 ems, in length. The Wassermann reactive was negative. He had juvenile mentality —G. P. G.
(HORMONES, AUTONOMIC N. S.) Neurocirculatory as- thenia (soldier’s heart). Carroll (J. H.), Am. J. M. Se. (Phila.), 1918, 158, 35-46.
From an analysis of the literature and a study of his own eases the author concludes: 1. That some types of hyperthy- roidism are analogous to the entity neurocireulatory asthenia and their pathogenesis is probably identical, the phenomena being attributable to a hyperexcitability of the opposing sets of fibers of the autonomic nervous system. 2. That in both conditions the syndrome develops in individuals in whom there is a hyperirritability of one or other sets of fibers in the autonomic system. Hence, constitutional predisposition due to inherited sympathetic or vagotonic instability is a factor in the causation on a sound basis. 3. That nervous and emotional strain is the immediate cause, precipitating the syndrome in susceptible individuals. 4. That in the cause of susceptibility (acquired instability of the autonomic nervous system) infec- tion plays a predominant role and the susceptibility in such cases may be accepted as indicating a chronicity of the infec-
ABSTRACTS 375
tion with constant or frequent outpourings into the blood of the infective agent. 5. That there is a certain rationale for believing that this instability in the autonomic nervous system lies in the element of anaphylaxis in disease in the predilection of anaphylatoxin for the parasympathetic system. 6. That there is some evidence that deficiencies of calcium in the diet may have played a part in the causation of some of the phe- nomena and that the higher plane of inorganic metabolism in the organism may have shared with adrenin increase the re- sponsibility in causation of the thyroid hyperplasia and hyper- thyroidism among the soldiers.—R. G. H.
(HORMONES) Climacteric hypertension: a study of high blood pressure during and following the menopause. Hopkins (A. H.), Am. J. Med. Sci. (Phila.), 1919, 157, 826-36.
A type of high blood pressure is described which develops in women at the time of the menopause, and possibly as a result of it. There is no evident arteriosclerosis, at least for several years after its onset, no renal involvement and often no symp- toms of any sort for a decade or longer. Little has been writ- ten on this condition. Hopkins’ paper is based on a study of 51 eases. The blood pressure in many instances was very high, reaching 230-310 systolic and 130-150 diastolic. Among the chief symptoms the gastric neurosis group are prominent, with fermentation and constipation. Nervousness and pains in the limbs are common. Headache and evidence of eardiae embar- rassment are next most frequent headache in some degree being present in nearly all cases. Five of the cases are described in some detail and in contrast, two cases of renal sclerotic hyper- tension in men of corresponding age. The high blood pressure resulting ultimately produces a degree of vascular fibrosis. The author suggests as a probable explanation of the climac- teric hypertension that the ovarian influence having diminished an endocrine imbalance ensues allowing the adrenals, hypo- physis and thyroid to overfunction. It is concluded that rou- tine blood pressure studies in all women at the period of the menopause would be of great diagnostic and therapeutic bene- fit for the patient’s future.—R. G. H.
(HORMONES) Os hormonios e o sistema vegetativo. Gallotti (O.) Archivos Brasileiros de Med. (Rio de Janeiro), 1919,
9, 3.
From a review of the literature it is concluded that the endocrine and the vegetative nervous systems mutually influ- ence each other.—G. P. G.
376 ABSTRACTS
(HYPOPHYSIS) A case of hypopituitarism. Melver (J.), J. Nerv. & Ment. Dis. (N. Y.), 1917, 45, 443.
A clinical deseription of a case of hypopituitarism pre- senting increased sugar tolerance, polyuria, and a deep sella turcica.—F.. 8S. H.
(HYPOPHYSIS) Acromegialy illustrating the chief features of the disease. Futcher (T. B.), Med. Clin. N. Am. (Phila.), 1917, 1, 131-143.
A report of a case of acromegaly in a woman 67 years of age. The report gives the history and physical examination of the case, illustrating the chief features of the disease, with the possible association of a myxoedematous factor. There is also a classification of the endocrine glands from an embryologic standpoint and a discussion of the ‘‘accelerator’’ and ‘‘inhib- itory’’ action of the hormones of these glands. The anatomy and histology of both lobes and pars intermedia of the pituitary gland is given, and also the functions of the two lobes. In addi- tion, the pathology found in the pituitary in acromegaly is deseribed. The commonest finding is hyperplasia. Adenoma, fibroma, sarcoma, and eysts are also found. The latter, Futcher thinks, result from degenerative changes in pre-existing tumors. He gives a classification of dyspituitarism and con- eludes the article with the treatment of acromegaly. In the last discussion he thinks that organotherapy should be followed out after hypophysectomy, since life is not compatible with complete removal of the gland. Its administration combats the somnolence and tendeney to adiposity which develops owing to the increased carbohydrate tolerance. In cases where hypopituitarism dominates the picture, posterior lobe prepara- tions should be given. Oral administration does not yield results at times and in these cases recourse may be had to hypo- dermic administrations of the extract.—M. M. P.
(HYPOPHYSIS) A discussion of the lipoids concerned in growth with clinical observations on the action of tethelin. Barney (E. L.), J. Lab. & Clin. Med. (St. Louis), 1917-1918, 3, 480-486.
Following a suggestion received by the work of Robert- son on the effect of tethelin in the healing of wounds in mice, B. studied its effect in the treatment in several types of indo- lent ulcers, all of which, with one exception, had failed to re- spond to the usual medication. No luetic ulcers were included in the study. The tethelin was applied either in solution on gauze or dusted as a powder on the ulcer. The results were
ABSTRACTS 377
favorable and tethelin, a lipoid extracted from the anterior lobe of the pituitary body, is considered efficacious in the treat- ment of chronic ulcers.—F. 8. H.
(HYPOPHYSIS) Distrofia adiposogenital. Schweizer (E.) Prensa Med. Argent. (Bs. Aires), 1917-18, 4, 366.
Published elsewhere. Abst. Endocrin., 1918, 2, 506.
(HYPOPHYSIS) Dwarf growth with atrophy of the anterior lobe of the hypophysis. (Zwergwuchs bei atrophie des hypo- physis-vorderlappens.) Simmonds (H.), Deutsche med. Wehnschr. (Berlin), 1919, 45, 486.
A man of 21 years, 110 em. in height, died of purulent meningitis. His intelligence had been normal. The internal genitals were very small, the testicles being the size of a pea and the prostate the size of that of an infant. A small thymus, minute adrenals and thyroid were found. The pituitary was small, an anterior lobe was not to be found by gross examina- tion, but upon histological examination some cells probably of the anterior lobe occurring in the first days of hfe may produce dwarfism.—J. K.
(HYPOPHYSIS) Emploi de l’extract d’hypophyse en obstét- rique. Schwaab (M.) Presse Méd. (Paris), 1919, 27, 299-300.
A general discussion of the use of pituitary extract in obstetrics. The author’s experience has led him to the con- clusion that it has an important place. With proper attention to limitations of dosage it should be used whenever either pri- mary or secondary uterine inertia develops and when at the same time acceleration of labor is desirable in the interests of either mother or fetus. When inertia coincides with prema- ture rupture of the membranes pituitary extract should be given immediately, especially in multiparas. Its use in post- partum urine retention is also commended. The uselessness of the drug for the induction of labor or for producing abortion is emphasized. The contra-indications for its use are given as: Cardiopathies, hypertension, arteriosclerosis and pronounced albuminuria.—R. G. H.
(HYPOPHYSIS) Experimental Studies on Growth. IX. The influence of tethelin upon the early growth of the white mouse. Robertson (T. B.), and Delprat (M.), J. Biol. Chem. (Balt.), 1917, 31, 567-574.
The effect on growth of white mice of feeding the lipoid,
378 ABSTRACTS
tethelin extracted from the anterior lobe of the pituitary, dur- ing the early growth periods was studied. When the substance was fed to the mothers the suckling mice showed no deviations from the normal growth rate up to the period of weaning. After that time a noticeable acceleration in growth is observed which persists until the culmination of the second and the in- itiation of the third growth eyele, after which a decisive retard- ation sets in.—F. 8. H.
(HYPOPHYSIS) Extract of pituitary gland in labor. Jamie- son (J. P. 8.), N. Zealand M. J. (Wellington), 1915-16, 14, 233-30.
The three outstanding benefits of pituitrin are that labor is shortened, the use of forceps obviated, and hemorrhage diminished. It is also of value in preventing tympanites and retention of urine. As to the disadvantages, Jamieson states that in proper cases, there are none. Cases, however, should be chosen with great care. Patients with flabby, dilated hearts are bad subjects, as are also eclamptics. His own rule is never to inject it until the os is fully dilated, or it is felt to be readily dilatable—E. N.
(HYPOPHYSIS) Hypophyseal dystrophy in hydrocephalus. Strauch (A.), J. Am. M. Assn. (Chgo.), 1919, 72, 1731-34.
The case is described of a nine-year-old girl who, coinci- dent with hydrocephalus, developed various signs of hypo- physeal disorders. With rapid growth appeared mental dete- rioration and an asthenia which compelled the child to stay in bed or in a chair. Polydipsia and polyuria were marked. A considerable degree of obesity developed, the fat being dis- tributed especially in the regions of the pelvic and pectoral girdles. The mons veneris and labia majora were prominent and beginning pubic hirsutes was apparent. The skin was smooth and delicate and without perspiration. Blood pressure was 95/65 and pulse, 100-110. Glucose by mouth in 100, 150 and 210 gm. doses caused no glycosuria. Roentgenograms showed enlarged, shallow sella turcica and reduced clinoid processes. A gain in weight of three pounds in two weeks was noted. The patient died of broncho-pneumonia. At post- mortem there were found in the hypophysis subeapsular hemorrhages, excessive hyperemia and vascularization of the anterior lobe, hyaline or colloidal thrombosis and excessive amounts of colloid in the acini—R. G. H.
(HYPOPHYSIS) Hypophyseal therapy in Basedow’s disease. (Zur hypophysaéren Therapie des Morbus Basedowi). Hof-
ABSTRACTS 379
stutter (R.), Ztschr. f. Geburtsh. u. Gynak. (Stuttgart), 1918. 80, 493.
The author from investigations on a series of fifteen typi- eal cases of Basedow’s disease, the clinical pictures of which are given, found that marked improvement resulted from the use of repeated injections of 1 ce. posterior lobe extract fol- lowed for a time by the oral administration of desiccated pitu- itary substance. From this he concludes that the anatomical changes in the thyroid after hypophyseal therapy speak for an influence of the thyroid in the sense of an inhibition of secre- tion with respect to the pituitary. Contraindications are preg- nancy and arteriosclerosis.—F. 8. H.
(HYPOPHYSIS) On the effects of ablation of the epithelial hypophysis on the other endocrine glands. Smith (P. E.) Proc. Soc. Exp. Biol. & Med. (N. Y.), 1919, 16, 81-82.
When the epithelial hypophysis is ablated in early embry- onie stages in the frog, the resulting larvae suffer in a charac- teristic way from defects in their pigment system. An equally definite set of alterations is produced in the other glands of internal secretion. Both Allen and the writer have reported the underdevelopment of the thyroid gland to which may in turn be attributed the failure of metamorphosis in these larvae. The posterior lobe of the hypophysis in these larvae is always present, though greatly underdeveloped—ample proof appar- ently of the need of coassociation with the epithelial portion of the gland. Most emphatic is the effect produced on the adrenal, whose cortical or interrenal substance is greatly de- ereased. This discovery was greatly faciliated by the employ- ment of those methods which fix and stain the lipoids of the cortical tissue. These changes in the adrenal tissue do not occur in thyroidectomized larvae and are consequently not to be referred to the thyroid reduction which is coincident with them.—Quoted.
(HYPOPHYSIS) Pituitary headaches and their cure. Pardee (I. H.), Arch. Int. Med. (Chgo.), 1919, 23, 174-184.
Pardee reviews the conditions usually accompanied with headache, after which he takes up a special set of symptoms which he calls pituitary headache, due to enlargement of the pituitary gland. This may be physiological, occurring during the menses and pregnancy or may be compensatory, due to de- creased function of other endocrine glands. Various degenera- tions and true tumor formation are also mentioned. The symp- toms are deep-seated frontal headache, localized behind the
380 ABSTRACTS
eyes between the temples, characterized by its duration and per- sistency. These patients apparently have marked craving for sugars, which ultimately aggravate the symptoms. In many eases there is abnormality of the sella turcica. This form of headache, if not due to neoplastic growths, is amenable to treat- ment. Pardee recommends one grain of the whole gland pituitary substance three times daily.—B. T. S.
(HYPOPHYSIS) Pathogenesis and etiology of acromegaly (Sulla patogenesi ed etiologia dell’ acromegalia). Massalongo (R.) and Pizza (C.) Policlin. (Rome), 1916, 23, 42-84. Abst. Lancet (Lond.), 1916, 1, 926.
Massalongo and Piazza publish a case which lends support to the view that acromegaly, which has its origin in hyperfune- tion of the pituitary gland, is often complicated by contem- porary or successive phenomena dependent on functional or organic change in the other glands of internal secretion. Facts noted in the case made it impossible to exclude the presence of symptoms dependent on simultaneous changes in other endoc- rinous glands, especially in the thyroid and gonads. Changes in these glands do not signify their participation in the patho- logical processes of acromegaly, but that the endocrinic sys- tem constitutes an organo-functional whole whose constituent elements are physiologically in such intimate connection that one of them cannot undergo any changes without a reaction taking place in the others.—M. M. P.
(HYPOPHYSIS) Presentation of pathological specimen of a large tumor of the pituitary gland. Lynch (R. C.) Ann. Otol., Rhinol. & Laryngol. (St. Louis), 1917, 26, 1127; Tr. Am. Laryngol. Assn. (N. Y.), 1917, 35, 139-43.
See Endocrin., 1918, 2, 502.
(HYPOPHYSIS) Relaciones entre la hipofisis y la colesterina. Gonalons (G. P.) Primer Congreso Nacional de Medicina. (Bs. Aires), 1916, 4, 51.
Investigation of the cholesterin content of the hypophysis led to the following conclusions: The hypophysis has a con- siderable cholesterin content which presumably is secreted into the blood. The hypercholesterinemia of pregnancy is due not only to corpus luteum and adrenal hyperplasia as Chauffard, Grigaut and Laroche believed, but also to hypophyseal hyper- plasia. The hypophysis cholesterin content was diminished in generalized sarcomatosis (two cases). The posterior lobe of a
ABSTRACTS 381
young bull was found to contain more cholesterin than the anterior lobe. The content is higher in dogs than other ani- mals. It is higher in men than in women. There was found hypercholesterinemia in acromegalies and in dogs after hypo- physis extirpation.—Author’s abstract.
(HYPOPHYSIS) Report of several cases of hypophyseal dis- ease. Blum (H. N.), New Orleans M. and 8S. J., 1917, 70, 583.
A brief clinical report of four cases showing disturbances of vision associated with deformations of the sella turciea. —F.S. H.
(HYPOPHYSIS) Sindroma hipofisiario de origen infundibular (Pituitary Syndrome). Olaechea (M. G.), Anales de la Facultad de Med. de Lima, 1918, 2, 103.
The syndrome described is characterized by disordered heart beat (tachycardia, extra systoles), narcolepsy, polyuria and polydipsia. It is similar to a syndrome produced experi- mentally in dogs by Camus and Roussy. The case described is similar to one reported by Claude and Lhermitte in 1917. The syndrome was due to a tumor in the third ventricle. Olaechea’s case was that of a woman of 35. The first abnormal- ities noted were impaired vision, reduced sensibility in the right side of the face, mucosa of the cheek and teeth and hyper- esthesia of the right side of the tongue and palate. There were deafness and exaggerated tendon reflexes on that side. Bilat- eral choked disk and right deviation of the head and body were noted. In ten months the blindness became total. Con- stipation was marked. Toward the last intense headaches and tachycardia (140 beats per minute) occurred when the patient attempted to sit up. Compression of the infundibulum was regarded as the cause of the pituitary symptoms. Death was by syncope. No autopsy was performed.—G. P. G.
(HYPOPHYSIS) Some problems in obstetrics; caesarean sec- tion, high forceps, pituitary extract. Bandler (S. W.), Am. J. Surg. (N. Y.), 1916, 30, 121-27.
Pituitrin is said to be valuable in stimulating bladder con- tractions and intestinal peristalsis. Bandler, however, says that for the former condition there is little need for pituitrin on account of the ease and safety of cathetrization, if urotropin is used systematically. He lauds the use of pituitrin in post- operative tympanites. It is valuable also in post-operative cases as a stimulant, being in this respect in a class with
382 ABSTRACTS
strychnin, caffein, digitalis and camphor. Bandler has used pituitrin in a number of cases of Caesarean section, giving it in small doses several times a day for several days after opera- tion. As soon as the abdominal incision is made, an injection of pituitrin is given, causing strong contraction of the uterus immediately after extraction of the infant. It also stimulates the secretion of the breast. In the third stage of labor Bandler always gives ergotol, no matter how much pituitrin the patient may have had. In his experience, pituitrin has no marked action in procuring emptying of the uterus in abortion, al- though he uses it in practically every case. Hypodermie use of the extract he considers an excellent ambulatory treatment for menorrhagia or metrorrhagia in young girls in whom examina- tion or local treatment is out of the question. An injection is given every day for weeks and months. Bandler states that only occasionally are patients annoyed by weakness, pallor, trembling of the extremities, etc. To patients who are sensi- tive to the drug, he gives the whole gland in eapsules for long periods of time. During parturition the three factors to be borne in mind in the use of pituitrin are proper doses, proper intervals and proper indications. He gives one-third ampoule every half hour, from three to five minims being given for the first dose to judge its effect. It is used when conditions are normal, and when all that is needed is sufficient uterine force.
—KE. N.
(HYPOPHYSIS) The control of the symptoms of diabetes in- sipidus by subcutaneous injections of extracts of the hypo- physis cerebri (pars posterior and pars intermedia). Barker (L. F.) and Mosenthal (H. O.), Tr. Assn. Am. Physicians (Phila.), 1917; 32, 233-49!
A careful study of a patient of 44 who suffered from marked polydipsia and polyuria (8000 ¢.e. daily). In addition to diabetes insipidus there was evidence of ‘‘dyshypophysism,”’ hyperthyroidism, myoma uteri, oral sepsis, arteriosclerosis and arteriolar nephropathy. The urine was very dilute (1001-1004 sp.g.) Injections of adrenin and of ‘‘tethelin’’ were without effect, as were also pituitary tablets by mouth, even in large doses. Pituitary extract (posterior lobe and pars intermedia), however, resulted in normal thirst and urine output. Two in- jections of 1 ¢.c. each were required daily. A single large dose (4 ¢.c.) was little more efficacious than 1 ¢.c. and doses smaller than 1 ¢.c. were inadequate. The efficiency of the pituitrin was not appreciably diminished during the two months ineluded in the history. A good bibliography is appended.—R. G. H.
)
ABSTRACTS
we) 5 wo
(HYPOPHYSIS) The pigment changes in frog larvae deprived of the epithelial hypophysis. Smith (P. E.), Proc. Soe. Exp. Biol. & Med. (N. Y.), 1919, 16, 74-78.
Tadpoles from which the hypophysis is removed have a characteristic silvery color. This has been aseribed to a con- tracted condition of the melanophore pigment cells. Smith maintains that the major role is played by expansion of another type of cells, the xantholeucophores. The article is chiefly of technical interest.—R. G. H.
HYPOPHYSIS, The relation of the—to certain clinical mani- festations and the therapeutic application of its extracts. Miller (J. L.), Am. J. Med. Se. (Phila.), 1916, 152, 549-60.
The anterior lobe of the hypophysis is essential to life, its complete removal resulting in death and its partial removal in developmental disturbances, resembling closely Fréhlich’s syndrome as observed in man. But it is only extracts of the posterior lobe that have proved therapeutically active. Strictly speaking, the active substance is present in the pars intermedia. When given intravenously or intramuscularly it affects the cardio-vascular system, kidney, uterus, urinary bladder, intes- tine, and the secretion of the mammary glands. In the group of clinical manifestations which may be associated with dis- turbance in the hypophysis and the therapeutie application of its extracts, the author considers acromegaly, dystrophia adiposo-genitalis, or Fréhlich’s syndrome, possibly adiposis dolorosa or Dercum’s disease, diabetes insipidus and glycosuria. These various conditions are fully discussed, especially from the viewpoint of etiology and the application of hypophyseal therapy. The author speaks also of the galactogogue action of the posterior lobe and of the more important effects on uterine musculature and intestinal peristalsis. These results are obtained with extracts of the posterior lobe. They must be given subcutaneously or intravenously to obtain results. 3y mouth they are inactive, like adrenalin. The paper, while not presenting anything especially new, is a well prepared resumé of our present knowledge of this subject.—E. N.
(HYPOPHYSIS) Treatment of nasal and bronchial asthma by local applications of pituitary extract. (Traitment de V’asthme nasal et bronchique par les applications locales d’extrait d’hypophyse.) Bourgeois (H.), Prog. Méd. (Paris) 1917, 32; 37-38.
Nasal asthma is markedly relieved with no untoward effects by the insertion of a cotton pledget soaked with a solu-
384 ABSTRACTS
tion of equal parts of hypophysin and 10% novocain into the nares. In bronchial asthma the combination of hypophysin and adrenalin gives good results, but not as striking. The latter combination is given hypodermically.—F. S. H.
(HYPOPHYSIS) Un caso distrofia adiposogenital. Schweizer. Semana Med. (Bs. Aires), 1917. 24, 54; Prensa Med. (Bs. Aires), 1917, 4, 366.
See Endoerin., 2, 506.
(HYPOPHYSIS) Upon the experimental exchange of skin transplants between normal and albinous larvae. Smith (KE. P.) Proc. Soe. Exp. Biol. & Med. (N. Y.), 1919, 16, 80-81.
Hypophysis-free tadpoles present a silvery appearance due largely to the expanded condition of the xantholeucophores. It is possible by working rapidly to graft skin from these albi- nous to normal larvae. Within 15 minutes the light skin of the eraft begins to assume the darker color of the host, and within four hours the change is complete. This is interpreted as indi- eating that the preceding expansion of the leacophores was due to some hormone.—R. G. H.
(HYPOPHYSIS THYROID) Hypophyseal treatment of Graves’ disease (Hypophysére Therapie des Morbus Basedowi). Hofstiitter (R.), Ztschr. f. Geburtsh. (Stuttgart), 1918, 80, 493.
In 15 cases of Graves’ disease in which ovarian function was disturbed (amenorrhea and dysmenorrhea following ovarian extirpation) hypophysin was given. Although favor- able results in such cases have been reported by others, Hof- staitter saw no effects on the chief symptoms except that some improvement occurred in cases having marked ‘‘sympathico- tonia.’’ Hypophysin has an influence on blood pressure and on the nervous system; it inhibits the function of the thyroid but stimulates the ovaries and the adrenals. This possibly explains the effects in ‘‘sympathicotonia.’’ Hypophysin is contra-indi- cated in pregnancy, arteriosclerosis and Bright’s disease.
—J.K.
(HYPOPHYSIS) Variaciones dela sangre en los animales pri- vados de hipofisis (Blood changes in animals after experi- mental hypophyse extirpation). Gonalons (G. P.) Primer Congreso Nacional de Medicina, 1916, 4, 52.
The investigation was carried out on the animals operated
ABSTRACTS 385
upon by Prof. Houssay. The blood for study was taken from puppies and adult dogs, operated and control. It was found that in animals deprived of the hypophysis the blood acquired all the characteristics of that of a young animal. The number of red corpuscles and percentage of hemoglobin were dimin- ished, but the polyneutrophile and eosinophile cells were in- ereased by 10 per cent.—Author’s Abstract.
(INFANTILISM) Chronic nephritis with infantilism. Hill Ge WwW), Am: J..Dis. Child. (Chgo.), 1919,.17, 274.
In a review of nephritis in children, Hill states that there have been twenty to thirty cases of chronic nephritis with infantilism reported in the literature. This condition may be likened to chronic interstitial nephritis in the adult. It de- velops insidiously and is of unknown etiology. It sometimes occurs in several members of the same family. One interesting point in the symptomatology is that these children usually show infantilism, a child of 10 or 12 years being developed mentally and physically only as much as a normal child of 5 or 6. The patient is subject to headache, the vision is poor and there is often a marked albuminurie retinitis. The blood pres- sure is very high, often over 200, and the heart may show con- siderable hypertrophy. The urine is large in amount and of low specific gravity, containing usually a very small amount of albumin and an occasional cast. The functional tests are low and the kidneys at necropsy are of the usual contracted type seen in the corresponding condition in adults. The prog- nosis is bad.—M. B. G.
(INTERNAL SECRETIONS) Circumscribed edema. Christof- ferson (N. R.) Ugeskrift for Laeger (Copenhagen), 1919, 81, 381-407.
Christofferson discusses the pathogenesis of Quincke’s cir- cumscribed edema, and describes various experiences which, in connection with the ‘‘war edema,’’ seem to indicate that the internal secretions have more to do with it than has been sus- pected hitherto. In a case described in detail the little girl had been having hemorrhagic purpura, and the blood pressure was abnormally high. Transient edema developed in different regions in turn, and a marked tendeney to retention of water and salt was evident although there was nothing in heart or kidneys to explain this tendency to edema. In this and oe cases in his experience, he never found anything to suggest peculiarly unstable nervous system.—J. Am. M. Assu., 72, 1504,
386 ABSTRACTS
(INTERNAL SECRETIONS) Defective development of the blood. Pittaluga (G.) Arch. espafioles de ped. (Madrid), 1918, 2, 513.
The author elassifies a group of blood cases as hemodys- trophies. This represents groups in which the biochemical ab- normalities predominate over the histopathologic, and a neuro- pathie factor is manifest, either directly or through the medi- ation of the endocrine glands. A hereditary influence is ap- parent. The group contains the so-called hemorrhagic diathe- ses, purpuras, scurvy, hemophilia, paroxysmal hemoglobinuria and hemolytic Jaundice.—Physiol. Abst., 4, 43.
INTERNAL SECRETIONS, Glands of—. Crispin (A. M.) Siglo Med. (Madrid), 1918, 64, 908; Rev. Assoc. Med. Argent., 1918, 27, 845.
See Endocrin., 2, 165.
INTERNAL SECRETIONS in obstetrics and gynecology. Bandler (S. W.), Am. J. Surg. (N. Y.), 1917, 31, 156-162.
General discussion of the functions of the ovary, thyroid, hypophysis, ete., as glands of internal secretion and the part they play in medical practice.—F. 8S. H.
INTERNAL SECRETIONS, Relation of—and faulty metabol- ism. Keister (B. C.) Virginia M. Month. (Richmond) 1918, 45, 38-43.
Published elsewhere. Abst. Endocrin., 1919, 3, 80.
(INTERNAL SECRETIONS) Sexual precocity in the male. Strauch (A.), Am. J. Urol. (N. Y.), 1918, 14, 116-20.
Published elsewhere. Abst., Endoerin., 1918, 2, 176.
(INTERNAL SECRETIONS) Sugar tolerance in cancer. Roh- denburg (G. L.), Bernhard (A.) and Krehbiel (O.) J. Am. M. Assn. (Chgo.), 1919, 72, 1524.
The authors incidentally remark that not a few investi- gators have attributed cancer to faulty endocrine functioning, different glands being held responsible. So far positive proof is lacking. There are no specific lesions demonstrable in the endocrine glands of mice with spontaneous tumor nor does ex- tirpation or the feeding of one or more of these glands have any apparent influence on the rate of growth, infectivity, or immunity against animal tumors.—R. G. H.
ABSTRACTS 387
(INTERNAL SECRETIONS) Remarks upon the vegetative nervous system and the internal secretions. Farnell (F. J.), J: Ment. Sei. (Lond.), 1917, 63, 225-237.
A general discussion of the interrelations between the vegetative nervous system, the glands of internal seeretion and mental disturbances.—F. S. H.
INTERNAL SECRETIONS, Some clinical aspects of—. Illus- trated. Bainbridge (W. S.), Hosp. Bull. Dept. Pub. Char. CPN O17, 1,°12-58.
An extensive and comprehensive clinical presentation with many illuminating illustrations of the more striking appear- ances occurring in disorders of the glands of internal seecre- tion. Among the types pictured in the sixty-two illustrations are: dystrophia-adiposa-genitalis, adiposa dolorosa, progressive muscular dystrophy, osteomalacia, hirsuitism, microsomia, acro- megaly, gynecomastia, Addison’s disease, hydrocephalus, mi- erocephalus, hyperthyroidism, and hypothyroidism.—F. S. H.
INTERNAL SECRETIONS, The relationship of the—to gastro- intestinal diseases. Editorial, N. Y. Med. J., 1919, 109, 774.
While enough is not absolutely known with regard to the internal secretions to warrant any dogmatic statement as to the exact part they play in the working of the human mechan- ism, it may be said that they wield a remarkable influence on physical and mental health. It may then be justly inferred that the diseases and disorders of the gastrointestinal tract are owing, at least to some extent, to the impaired or imperfect action of not only the thyroid gland, but of those internal secre- ions which are connected with the alimentary tract. The in- ternal secretions should always be considered in the preven- tion and treatment of gastrointestinal diseases and disorders:
—H. W.
(MONGOLISM) Mongolismo. Meirelles (E.) Archivos Bra- sileiros de Medicina de Rio de Janeiro (Brazil), 1918, 8, 738.
Three cases of mongolism without autopsy. Meirelles states that it is not easy to determine whether this condition is due to endocrine dysfunction or to cerebral injuries.
. —G. P. G.
MAMMARY GLAND, Studies on the—. Myers (J. A.) Am. J. Dis. Child. (Chgo.), 1919, 17, 311.
The experimental animals in this series were rats of both
388 ABSTRACTS
sexes ranging in age from birth to ten weeks. The author ar- rived at the following conclusions: Severe inanition retards the growth of the milk duets of the female rat during the first week, but apparently does not completely stop their growth. The nipple grows very little during inanition. The subeutane- ous fat that appears very early in the neighborhood of the milk duets becomes greatly decreased after the amount of food is reduced to a minimum. In all, the retardation in the develop- ment of the mammary gland is roughly proportional to the retardation in body weight (at least within lmits of normal variability). When the animal is refed, the glands respond slowly. When the body weight during refeeding reaches that of a normal rat at the age of puberty, the milk ducts are far behind those of the normal rat at corresponding body weight. That this stunting is not permanent is shown by the fact that the duets ultimately attain the same stage of development as those of a normal animal, but at a much later date.—M. B. G.
MUSCULAR DYSTROPHY, A case of—. Anon. Guy’s Hosp. Gaz. (Lond.), 1917, 31, 250.
An illustrated clinieal deseription without explanation of etiology, of a case of muscular dystrophy.—-F. 8. H.
NEURASTHENIA, A form of—, due to hypcadrenia. Wil- liams (T. A.) Am. Med. (Burlington, Vt.), 1917, 12, 582-86.
Williams believes that neurasthenia is hypoadrenia, basing this conclusion on the apparent identity of the symptoms in the two conditions. Several cases are reported as illustrative of the results of adrenal therapy in neurasthenia. The author concedes that not all cases do well with this form of treatment.
—KE. N.
(OVARIES) Experimentelle Kastration durch Cholin. Wintz (EE) ‘Areh. t£Gyndak, (Berl). solo alto son
The influence of X-rays on the body cells has been much discussed. Sehwartz has emphasized the statement that in tissues exposed to these rays an increased amount of cholin is found. He thinks this is due to decomposition of lecithin, Werner has reported that rabbits can in effeet be castrated by the administration of cholin. The experiments were extended to the human species—especially in myoma of the uterus and in severe hemorrhages preceding the menopause. Wintz has repeated such experiments in hares and in women. In hares one ovary was removed as a control and then different quanti- ties of cholin (in combination with borie acid) were injected.
ABSTRACTS 389
Some of the animals became sterile, but one gave birth to young several months later. In women injections of borocholin caused atrophy of the ovaries, the degree depending upon the quantity administered. Cholin, it is concluded, has the same action as X-rays, but results are obtainable much less rapidly. —J. K.
OVARIES, Histological examination of the—in mental disease. Forster (Laura), Dementia Precox Stud. (Chgo.), 1918, 1, fo-o1l,
See Endoerin., 1918, 2, 512.
OVARIES, Influence of the—upon the production of artificial deciduomata; confirmatory studies. Corner (G. W.) and Warren (S. L.), Anat. Ree. (Phila.), 1919, 16, 168.
Leo Loeb reported in 1907 and 1908 that at certain stages of the reproductive cycle of the female guinea-pig, injury to the uterine mucosa leads to the formation of a tumor at the site of trauma which closely resembles in cellular structure the maternal portion of the placenta. This reaction can be elicited only during a period of two to nine days after ovulation; it does not occur in the absence of the ovaries, even if these be left in place until after ovulation has occurred. From these facts Loeb believes that the young corpus luteum formed at the time of ovulation develops a hormone which in some way sensi- tizes the uterine mucosa in time to receive the ovum and to participate in placenta formation. The artificial stimulus of his experiment merely imitates the trophic action of the early embryonic ectoblast. Confirming evidence was reported by Robert Frank (711), using rats.
Pregnant animals were allowed to give birth, in order to fix the date of ovulation, which invariably occurs in rats within twenty-four hours after parturition. Six to seven days after ovulation the abdomen was opened under ether anesthesia and the uterus traumatized by the insertion of a small foreign body, such as a fine short piece of glass, into the lumen; by the passage of a silk suture through the uterine wall, or merely by scratching the mucosa with a needle inserted through the wall. In seven animals killed four or five days after opera- tion, the traumatized areas presented large, soft, solid enlarge- ments of dark congested appearance, more than twice as thick as the intervening parts of the uterus. In color and texture the tumors greatly resembled the enlargements of early preg- nancy in the rat. Microscopie sections showed the uterine mu- cosa to have been replaced by a solid mass of cells varying from spindle-shaped to large oval outline. Many nuclei were
390 ABSTRACTS
in mitosis; an occasional cell was polynuclear. In some speci- mens small local areas of degeneration were seen. Even when the traumatizing object had been left in place, the microscope showed not the familiar foreign-body reaction of tissues in gen- eral, but true decidual cells.
Seven other rats were treated in exactly the same way, except that shortly after ovulation the ovaries were removed. On the seventh or eighth day the uteri were traumatized, and four or five days after the second operation the rats were killed. In none did any enlargement at the site of trauma take place. In two animals the ovaries were merely separated from the uterus by cutting between ligatures near the tubal extremities of the uterine horns. In these the placenta-like tumors devel- oped, showing that the influence of the ovaries is exerted through the bloodstream or possibly the nervous system. It is hoped that it might be possible to elicit deciduomata in rats deprived of their ovaries immediately after ovulation if early corpus luteum tissue from another species were provided. The administration of corpus luteum of the sow to a small series of rats, by mouth in the fresh state, by abdominal injection after desiccation, or in alcoholic extract, has so far given negative results—Author’s Abst., abbreviated.
OVARIES, The function of the—after X-ray treatment. (Bei- trag zur Kenntnis des Verhaltens der E1erstockfunktion nach der Rontgentiefentherapie.) Werner, Arch. f. Gynak. (Ber- lin), 1919, 110, 434.
Though in young individuals sterility oceurs after ex- posure to X-rays, there is no reason not to treat them with X-rays when necessary. Nearly always the sterility is tem- porary and in most cases menstruation and even pregnancy returns some months after treatment has been discontinued.
B ae Ee
(OVARIES) The vertigo of the menopause. Sanes (K. I.) Am. Je Obst: (NY) 19197 79.7.
Vertigo is seldom the only prominent symptom of the menopause. Invariably vertigo at this time is accompanied by such disturbances as hot and cold flashes, cold perspiration, blurred vision, flickering before the eyes, headache, nausea and tinnitus. In a study of 102 cases of vertigo occurring at the menopause and not complheated by cardiovascular or renal dis- eases, the author found that 45 or 46 per cent had a systolie blood pressure above 150 mm. Hg. A preparation of ovarian extract was administered, each grain of which represents a grain of the fresh ovarian substance. Five-grain doses two or
ABSTRACTS 391
three times a day were given. Larger doses were of doubtful advantage. Under this treatment 37 per cent showed marked umprovement and 25 per cent were held in control. Referring te Hallion’s law, the author states that ‘‘by the administration of ovarian substance, while the ovaries are still functionating somewhat, we not only supply a substitute for the internal ovarian secretions but stimulate the ovaries to an increased production of it. If this is correct the earlier in the menopause the ovarian substance is given, the better should be the re- sults.”” In some cases an additional dose of thyroid seems to -help in the management of the menopause. This is in accord with the idea of pluriglandular disturbance following dys- ovarism. The author justly laments and criticises the lack of standardization of ovarian extracts.—H. W.
(OVARY) Brain and ovarian function in mammals (I] cervello e la funzione ovarica nei mammiferi). Carlo Ceni, Arch. di fisiol. (Firenze), 1917, 16, 1-20.
A continuation in dogs of earlier work on birds. Extensive lesions of the cerebral cortex were followed by immediate changes in the ovarian parenchyma, analogous to those already deseribed in birds, which are attributed to ‘‘visceral shock.’’ The more advanced Graafian follicles undergo involution. The ova atrophy showing pigmentation of the nucleus and disar- rangement of the chromosomes. Physiol. Abst., 4, 140.
OVARY, Cholesterin and—. (Gonalons (G. P.) Primer Con- greso Nacional de Medicina (Bs. Aires), 1916, 4, 22.
Assays were made by Grigaut’s colorimeter method with certain modifications by the author. It was found that the chol- esterin content of the corpus luteum in the pregnant heifer was high (ranging up to 57 per cent) ; that it was higher than the ovary alone (43 per cent of fresh organ) ; that the blood choles- terin content diminished in castrated animals (rabbits), and that it was increased in women from whom the ovaries were removed three or four years before.—Author’s abstract.
OVARY: CORPUS LUTEUM. General considerations. Os- borne (O. T.), N. Y. Med. J. (N. Y.), 1918, 108, 401.
A general paper dealing with the functions of the ovary.
(OVARY CORPUS LUTEUM) Symptoms caused by adminis-
tration of ovarian and corpus luteum substance. Osborne fer 2), N.Y. Med. f. (IN. ¥_), 1918, 108, 447.
Ovarian feeding may lower a high menopause blood pres-
392 ABSTRACTS
sure; it may awaken to energy a lackadaisical woman; it may cause menstruation in simple amenorrhea, but in this condition it is not as valuable as is corpus luteum. ‘Toxic symptoms are rarely caused by feeding ordinary doses of ovarian extract. Corpus luteum is an active physiological and at times a toxie preparation. It may cause menstruation in amenorrhea, but it probably cannot cause abortion. It readily causes nausea, and even vomiting, when fed in too large doses or for too long a time. It lowers the blood pressure. Corpus luteum extracts may cause a little dizziness or faintness. This is especially true if they are allowed to lower blood pressure too much. The extract may cause loss of weight, but it should not be used for this object; thyroid extracts are safer and better for this purpose. There is probably no great difference between the action of corpora lutea of pregnancy and of those of nonpreg- nant animals. Commercial preparations of corpora lutea are of a mixed variety, and the only correct dose is that sufficient for results. If an ovarian transplant lives and functions, it should be remembered that it periodically swells, and hence, in tense, nondilatable tissue may cause severe pain.—H. W.
OVARY, Hernias of the—of the fallopian tube, and of the ovary and fallopian tube. Heineck (A. P.), Med. Times (N. Y.), 1919, 47, 161-64.
A paper dealing with diagnosis and treatment.—H. W. (OVARY) Melanosarkome der Ovarien. Herzog (T.) Ztschr. f.-Geburtsch. (Stuttgart), 1918, 80, 576.
Not of endocrine interest—J. K.
(OVARY) Mucous colitis (Colica Mucosa). Foges (A.) Wiener klin. Wehnsch., 1918, 31, 1295.
The author argues for a relationship between the ovary and mucous colitis. In a single case attacks of this malady occurred always one week before the beginning of menstrua- tion. The treatment must be the same as for dysmenorrhea.
—J. K.
(OVARY) Osteomalacia. (Uber Osteomalacie, eine innersekre- torische Studie). Scipiades (E.), Ztschr. f. Geburtsh. (Stutt- gart), 1919, 81, 156.
It is possible by total extirpation of the thymus in puppies to get changes in the bone structure as seen in osteomalacia. By theoretical speculation the author tries to prove that the
ABSTRACTS 393
cause of osteomalacia is in the thymus. It is an interesting article —J. K.
(OVARY) Ovarian grafting. Bell (N. B.) Brit. M. J. (Lond.), 1918, 1, 619.
Bell insists that the grafts must be autoplastic, small in size and from the interior follicles. The operation is not indi- cated In women over 42, in women sexually inactive, or in cases where conservation is at all possible. Grafts were stored in the utero-vesical pouch until the later stages of the opera- tion, and were embedded either in the abdominal wound, drain- age wound, or in the fundus of the uterus, according to the variety of case operated on. After-histories in a series of 20 cases were noted as regards (1) absence of menopausal symp- toms, (2) persistence of menstruation, and (3) general health.
—M. M. P.
(OVARY) Ovarian organotherapy. Graves (W. P.), Med. Clin. N. Am. (Phila.), 1918, 2, 935.
Graves has used ovarian substance in three forms: (1) ovarian residue, a dried preparation from the ovaries of preg- nant animals, with the corpus luteum excluded. (Parke, Davis & Co.) This is also put up in ampoule form for hypodermic use. (2) Extract of the whole ovary (Armour’s). (3) Extract of corpus luteum (lutein tablets of Hynson & Westcott). These three preparations have been, so far as his experience goes, the most efficacious. The respective therapeutic value of the three forms has, in general, proved in the order named. ‘‘This con- clusion is not without rational theoretic confirmation. There is scientific evidence to show that the chief source of the ovarian internal secretion is in the so-called interstitial cells. These cells have their origin in the connective tissue envelope of the follicles, and are developed both in the process of follicle atresia and in corpus luteum formation. Therefore prepara- tions from the ovarian stroma alone and from the corpus luteum alone both possess therapeutic value.’’ The use of ovarian residue of pregnant animals was the result of his per- sonal experimentation. He found in eases in which corpus luteum was left in the ovary and those in which it has been enucleated, that the latter gave better results. The cases cited are those of hysterectomy with ablation symptoms, symptoms of menopause, and irregularities of menstruation.—M. M. P.
394 ABSTRACTS
(OVARY) Ovarian salvation vs. ovarian destruction. Bizot (A.-R.), Am. J. Surg. (N. Y.), 1919, 33, 134-40.
From a review of recent literature Bizot coneludes that in all cases of doubt one ovary of women of child-bearing age should be conserved except in the presence of undoubted ma- lhgnanecy. Sterilization can not be effected always by leaving an ovary on one side and a tube on the other. Neither can both tubes be removed, leaving part of an ovary, with assur- anee of sterility. Under no circumstances should both ovaries be removed as a matter of mere prophylaxis.—R. G. H.
(OVARY) Relation of blood lipases to cell metabolism (Die Bedeutung der Blutlipasen fiir die Fettstoffwechsel der Zel- len). Bayer (G.) Ztschr. f. Biol. (Miinch. u. Berl.), 1919, 69, 365.
The hpolytic power of the blood serum was found to be much lower in female frogs than in males. When ovarian ex- tract is administered the lpolytic power is diminished—J. K.
OVARY, Relation to the—to the uterus and mammary gland from the experimental aspect. Loeb (L.) Tr. Am. Gynee. Soe. (Phila.), 1917, 42, 172-207.
Published elsewhere. Abst. Endoerin., 1, 514.
(OVARY) Papillary cystadenoma of the ovary. Corcia (J.) N. Y. Med. J. (N. Y.), 1918, 108, 837-38. 3
Case report of an unmarried woman, 32 years of age, in the peritoneal cavity of whom an operation disclosed about five gallons of fluid and an extraordinary number of cysts of differ- ent sizes. These surrounded with racemose disposition a cen- tral and large cyst containing more than a gallon of fluid. On the external and internal surfaces of these cysts were numerous papillomata which extended also into the peritoneum, intes- tines, bladder, and to the ovary on the other side. After tap- ping the central cyst the whole mass was removed. The eyst originated on the left side, but no trace of the ovary could be found. The right ovary was also removed. It also was studded with papillary growths and a few cysts. The patient made an uneventful recovery. Seven years after the operation the pa: tient was enjoying good health.—H. W.
OVARY Sarcoma of the—in a child twenty-three months old. Hayd (H. E.) Abst. Proc. Am. Assn. Obst. and Gyn., N. Y. Med. J. (N. Y.), 1918, 108, 968-69.
ABSTRACTS 395
Report of a case of small round cell sarcoma of the ovary in a child 23 months old.—H. W.
(OVARY) Theory and treatment of osteomalacia (Zur Theorie und Therapie der Osteomalazie). Cramer, Deutsche med. Wehnsehr. (Berlin), 1919, 45, 475.
The fact that osteomalacia in pregnancy may be cured by castration proves that defective lime metabolism of the foetus is not the cause of this disease. Most probably the cause is an enormous increase of the internal secretion of the ovary caused by the internal secretion of the corpus luteum. Transplanta- tion of an ovary has a much more striking effect when it is transplanted with a corpus luteum than without. A good re- sult is seen in osteomalacia from the administration of milk of castrated goats.—J. K.
(OVARY) The corpus luteum in its relation to amenorrhea, sterility, abortion, and pseudo extra-uterine pregnancy, Ochsner (KH. H.), Illinois M. J. (Chgo.), 1919, 35, 225-26.
y 24
Observations made by veterinarians in the past few years indicate that if a false corpus luteum remains unabsorbed in either ovary of the cow, she remains sterile. This condition corresponds to amenorrhea in women. Expressing this false corpus luteum or allowing it to be absorbed, causes oestrus to reappear. Women who are sterile and have not menstruated should be examined by laparotomy for an unabsorbed corpus luteum. Veterinary surgeons have discovered that in trying to express a false corpus luteum they sometimes rupture a true corpus luteum, causing the death of the cow by hemorrhage or an abortion within twenty-four hours. This observation throws light on some obscure problems in gynecological sur- gery, such as the finding of blood in the peritoneal cavity, ascribed to extra-uterme pregnancy, although no placental tissue is found. Experience has led me to believe that post- operative abortions are due to trauma of the corpus luteum and not of the uterus. By being very gentle with the ovaries during operations on pregnant women I have found it possible to avoid abortion, the women going to full term.—Author’s Abst. (abbreviated).
(OVARY) The formation of the corpus luteum (Untersuch- ungen tber die Bildung des Corpus luteum und die Follikel- atresse). Borell (H.) Beitr. z. pathol. Anat. (Jena), 65, 108.
Jo Kk.
Of no endocrine interest.
396 ABSTRACTS
OVARY, The internal secretion of the—in osteomalacia. (Zur inneren Sekretion der Ovarian bei Osteomalakie). von Franque. Deutsche med. Wehnschr. (Berlin), 1919, 45, 424.
Though it is demonstrated that osteomalacia can be cured by removal of the ovaries, this does not prove that in osteo- malacia there exists an abnormal function of the ovaries. It is as likely that the adrenals functionate too little. Then the ovaries produce too many antagonists. The removal of the ovaries may have the same result as an increase of the adrenal functions. The author promises to publish a long article on this question in the Centralblatt fiir Biologie —J. K.
‘(OVARY) The menopause. An analysis of two hundred cases. Norris (C. C.), Am. J. Obst. (York, Pa.), 1919, 79, 767-78.
Menstruation depends upon an ovarian secretion, hence the menopause is due to alterations in ovarian function. The menopause is established in women of the Eastern United States at 46 to 49 years, and not 42 to 45 as usually stated. The age at which the menopause appears varies within wide limits. Menstrual function is prolonged by child-bearing, marital rela- tions, good nutrition and hygiene, city life and education ; con- verse conditions tend to an earlier menopause. Climate and race probably play but a small part in the age at which the menopause appears. Hereditary influences are marked in some families. In most cases the chief feature of the menopause is not the diminution or cessation of bleeding, but the neuroses. These frequently antedate any change in the menstruation and may continue from 6 to 18 months after the final cessation of flow. The menopause should be established without the loss of blood. In about 90 per cent of absolutely healthy women the menopause occurs normally, but among average women 30 per cent present symptoms which eall for a careful physieal and gynecological examination.—H. W.
OVARY, Transplantation of the—in women and animals (Ovar- ien-transplantationen bei Menchen und Tieren. Cramer, Deutsche med. Wehnschr. (Berlin), 1919, 45, 475.
No new data are brought forward.—J. K.
(OVARY) Types of tubo-ovarian suppuration and their treat- ment. Green (R. M.) Boston Med. and Surg. J., 1919, 180, 179.
A paper of clinical interest dealing with the differentia- tion, classification and treatment of tubo-ovarian suppuration. —H. W.
ABSTRACTS 596
(OVARY) Vertigo of menopause. Sanes (K. I.), Abst. Proc. Am. Assn. Obst. and Gyn., N. Y. Med. J. (N. Y.), 1918, 108, 967-68.
Menopause vertigo is mainly of the objective type, i.e., a sense of rotation of the visible or palpable environment. Some demonstrate subjective vertigo, 1. e., sensations of motion of the body itself. Vertigo is seldom the only prominent menopause symptom; it is almost always accompanied by such disturb- ances as hot and cold flashes, cold perspiration, palpitation, blurred vision, flickering before the eyes, headache, nausea, and tinnitus.—H. W.
(PANCREAS) Agents which accelerate glucolysis (Les agents qui activent glycclyse). Lépine (R.) Arch. Physiol. Path. Gen (eams), 1918, 17, 747-71. Physiol. Abst., 3, 378.
In the absence of bacterial infection and other sources of error, upon warming the sugar disappears from the blood of a depancreatized dog more slowly than from that of a normal animal. Stimulation of the nerves to the pancreas or ligation of its duct produces increased glucolysis in blood withdrawn thereafter; this is due to rise of pressure in the small duets and increased absorption of the internal secretion of the pancreas. The greater portion of this internal secretion goes to the lymphatics. The utilization of sugar depends on two distinet substances which are present in all tissues: (1) an intracellular enzyme which decomposes the sugar molecule and (2) a ther- mostable substance, produced chiefly but not exelusively, by the pancreas, and functioning as activator of the intracellular enzyme. The blood decomposes glucose more easily than other sugars; various products, including lactic acid, are formed: production of glucuronic acid is a special, not a normal type of glucolysis. Chem. Abst., 13, 1224.
(PANCREAS) The effect of pancreatectomy on the catalase content of the tissues. Kennedy (J.) and Burge (W. E.). Arch. Int. Med. (Chgo.), 1917, 20, 892-895.
In dogs it was found that extirpation of the pancreas de- creases the catalase content of the liver by about 75 per cent, which results in decreased output of the catalase into the blood and hence a lessened supply to the tissues. The decreased eata- lase content of the tissues may account for the imperfect or defective oxidation in diabetes, since the amount and intensity of oxidation is so inseparably linked with catalase.—F. S. H.
398 ABSTRACTS
(PARATHYROIDS) Tetania enurética. Busco (J.) Prensa Med. Argent. (Bs. Aires), 1917-18, 4, 366.
Published elsewhere. Abst. Endocrin., 1919, 3, 87.
PARATHYROIDS, Transplantation of—in post-operative tetany (Epithellsérperchenverpfianzung bei postoperativer Tetanie). Thierry (H.), Miinch. med. Wehnschr., 1919, 66, 538.
Two eases are described in which post-operative tetany was eured by homoplastie transplantation of parathyroids into the preperitoneal fat. The author prefers in such cases to use the parathyroids of women operated upon for goitre. Surgical details are given.—J. K.
(PINEAL BODY). Further evidence in support of the glan- dular nature of the pineal body. ‘Tilney (F.), J. Nerv. & Ment. Dis. (N. Y.), 1917, 46, 442.
Comparative histology and ontology of the pineal body furnishes tenable evidence that this structure is a gland.
—F. 8. H.
(PINEAL) Further experiments with pineal gland extract. Goddard (H. H.), J. Am. M. Assn. (Chgo.), 1917, 68, 1340.
Goddard reports the further observations on one of the patients who had been in his original series of feeding experi- ments with this gland. This was a girl, 8 years old, with a mentality of 3 when he began the experiment. At the close of the series, she tested 4 years, which was a gain of one year mentally in four months. Because of the good results in her case, she was selected for further tests. She was observed, weighed, tested under her ordinary institutional environment and then brought to the laboratory to live. Here she was given a special diet and the observations continued. After her nor- mal curve had been established, she was fed pineal gland for six months and then the gland was discontinued and she was observed for another period. At the time of reporting, it was 15 months since the second experiments had ceased and 20 months since the administration of the gland. There was no marked change in her growth curve during the period of admin- istration nor was there any other effect as far as physical con- dition shows. There was no change in the mentality since March, 1912, when she tested 5 years. Goddard feels that the influence of the pineal gland in this case was nil. He also conducted further observations on cases of Mongolian idiocy.
ABSTRACTS 399
Two cases of this type were selected. One was 10 years old with a mentality of 4, the second was 9 years with a mentality of 3. The first was given the gland for 6 months, while the second received it for 12. For the first month, they were both given one capsule once a day, this then being increased to twice a day. The results obtained confirmed those of the first series in demonstrating that this gland had no effect on Mon- golian idiocy.—M. B. G.
(PINEAL) The morphology and evolutional significance of the pineal body. Tilney (F.), and Warren (L. F.), Am. Anat. Memoirs (Phila.), 1919, No. 9, 1-257.
The comparative morphology of the diencephalie roof is carefully reviewed, and the epiphysis studied in detail with special reference to its evolutional significance. The authors point out that, as a whole, the region is fundamentally glan- diferous. The epiphyseal complex (pineal and para-pineal bodies) exhibits a pluripotential tendency. In lower forms the tendency towards the formation of a visual organ is shown, while in higher vertebrates the complex has glandular charaec- ters. The development towards a sensory organ is seen only in the end vesicle, while the proximal portion is always glan- diferous. It is this proximal portion which shows the greater phyletic constancy, and a progressive development from the ophidians up through the mammals. Even in lower forms it is composed of cells which appear to be secretory. This glan- diferous tendency is the fundamental inherent tendency of the complex, as of other parts of the diencephalic roof; while the differentiation towards a visual organ is an adaptive modifica- tion occurring in a few forms.
The gland contributes its secretion to the cerebro-spinal fluid in lower vertebrates, but in the higher forms it is endo- crine. Its histology is considered in detail. In the mammals studied by the authors, the parenchyma consists of large cells with extensive cytoplasm and vesicular nuclei, arranged in acini or cords. Seattered among these are smaller cells, some of which have large, deeply staining nuclei and others pale nuclei and many cytoplasmic granules. In the early stages of differentiation the parenchmya cells have a relatively small amount of cytoplasm, giving the gland the appearance of lymphoid tissue. Later, the cytoplasm increases and the glan- dular nature of the cells is evident.—M. M. H.
(PITUITRIN) De 1’extrait de lobe posterieur de l’hypophyse en obstetrique. Chenerson (M.) Arch. mens. d’Obstet. et de Gynec. (Paris) 1918, 7, 22.
400 ABSTRACTS
The use of that amount of extract representing 0.2 gin. of dried gland is advocated as the optimum dose. In simple uter- ine inertia and in eases of retarded labor with ruptured mem- branes 88 per cent of the cases responded to pituitary treat- ment. Favorable effects were also often obtained in the sup- pression of the hemorrhages of labor. The post-partum urine retention is overcome by the use of extract of the posterior lobe of the hyophysis. The author considers that the extract should not be used to initiate labor, but only for the purpose of hasten- ing delivery.—F. 8. H.
PITUITRIN, Does the administration of—to the mother pro- duce diffuse nervous lesions in the infant? Heard (A. G.) Texas State M. J. (Fort Worth), 1916, 12, 264-66.
Heard quotes Norris, Bandler, Mosher, Mundell and others to emphasize the danger, both to mother and child, which may arise from the obstetrical use of pituitrin. It is recognized by all authorities that birth injuries are etiological factors in the production of infantile cerebral palsies. Any factor producing increased or undue pressure on the foetal head is a strong predisposing cause of cerebral or meningeal hemorrhage. Pituitrin improperly used, either as to dosage or time, pro- duces uterine contractions of such force that rupture or tetanus of the uterus is a not ‘infrequent accident. Such force as this must enormously increase the pressure on the foetal head, particularly when labor is rendered so precipitate that molding cannot take place and gradual dilatation of the birth canal can- not occur. Heard reports three cases of extensive cerebral or meningeal hemorrhage of the new born, undoubtedly due to birth injury. In two of these the striking clinical feature was the occurrence of convulsive attacks. In the third, the child, then thirteen months old, was in almost constant motion, turn- ing and twisting the head from side to side; he had no use of arms or legs, and was fed with great difficulty. He appeared to be entirely blind and the pupils were dilated and unresponsive to light. In no case was the child a first-born; in no case was there constitutional disease in either parent or child; in no case was there any question of prolonged or difficult labor; in each case a precipitate delivery was effected by the exhibition of pituitrin early in labor with the consequent induction of violent uterine contractions. Two additional cases of the same general type are reported by Bubis.
The conelusions are as follows: 1. That the improper use of pituitrin extract in labor is a cause of cerebral or meningeal hemorrhage in the new born. 2. That hemorrhages in the ner- vous system of infants, resulting from the use of pituitrin in
ABSTRACTS 401
labor, are productive of diffuse nervous lesions, so extensive as to result in early death, or, if the child survives, in paralysis, epilepsy or idiocy. 3. That cases representing nervous lesions resulting from birth injuries should be earefully investigated as to the possibility of pituitrin having been effective in their causation.—E. N.
PITUITRIN in labor. Matheson (F.), N. Zealand M. J. (Wel- lington), 1915, 14, 294.
The greatest objection to the use of pituitrin is the difficulty of judging what its action will be in any particular case. Once given it is beyond control. While it hastens the third stage of labor, the rapid detachment of the placenta may result in small pieces being retained. If delivery does not occur in about one hour after pituitrin has been given, there may be uterine relax- ation with postpartum hemorrhage. Matheson believes that forceps delivery is preferable to the use of pituitrin. He re- stricts the use of the latter to multiparous women in whom the perineum has lost its rigidity, and in the third stage of labor to those cases with a tendency to hemorrhage.—E. N.
(PITUITARY) The use of pituitary extract for the induction of labor. Adair (F. L.) Interstate M. J. (St. Louis), 1916. 2, LAT1-15,
Pituitary extract is of value in bringing on labor in prema- ture case in some instances and is worth a trial when it is not necessary to end the pregnancy rapidly. In eases of rup- tured membranes it is of value in initiating uterine contrac- tions. In placenta marginalis or lateralis, when the membranes rupture or are ruptured artificially, pituitrin is of value in starting uterine contractions and may save the necessity of intrauterine manipulations. Pituitrin should be used in cases that have gone over time before any other method of inducing labor is resorted to, except in cases where its use is contra- indicated or it is necessary to terminate pregnancy rapidly.
—H. W.
(PITUITRIN) Milk production and drugs. McCanlish (A. C.) J. Dairy Sei., 1918, 1, 475-86.
Numerous drugs were tried. Individual cows vary greatly
in their responses. No drug was found to be relied upon to
increase milk and butter production. Pituitrin and castor oil decreased the butter fat—Physiol. Abst., 4, 32.
(PITUITRIN) Sieben Jahre Hypophysenmedikation in der praktischen Geburtshilfe (Seven years therapeutic use of
402 ABSTRACTS
hypophysin). Holfauer (J.), Monatsehr. f. Geburtsh. u. Gynak. (Berlin) 1918, 48, 325.
An extended summary of the author’s results from the use of hyophyseal extracts in medical practice. He concludes that the use of this substance has found a permanent place in mediecation.—F. S. H.
POLYGLANDULAR SYNDROME. Goldenberg. J. Cutan. Dis. inclu. Syph. (Chgo.), 1916, 34, 387-88. Society transae- tions.
A man 28 years of age entered the hospital because of gen- eral malaise, headache, enlargement of the hands and feet and tumors of the face, trunk, and extremities. The Wassermann reaction was negative. The tumors were osseous, epidermal, and infiltrations of skin tissue. The thyroid isthmus was palpable. Marked gaping of the lambdoid and coronal sutures existed. The sella turcica was not enlarged, but the anterior and pos- terior clinoid processes were unusually thin. The condition was diagnosed as dyspituitarism and dysthyroidism. The pa- tient was put on thyroid extract and the dosage increased up to 25 grains per day. Upon being discharged the dose was reduced to 1 grain a day. The tumors were reduced by one- half at the time of dismissal —H. W.
SECRETIN, Is Vitamine identick met—? Jansen (B. C. P.), Geneesk. Tijdschr. ned. Indie, 1918, 58, _.......
The anti-beriberi vitamine from rice does not cause pan- ereatic secretion in the dog, hence is not identical with vita- mine, as has been asserted. Physiol. Abst., 4, 29.
SECRETIN, The question of the stability of—. Carlson (A J.), Kanter (A. E.) and Tumpowski (I.), J. Am. M. Assn. (Chgo.), 1918, 70, 115-118.
Physiological tests of Beveridge’s patent preparation of secretin show it to be inactivated by the gastric juice, without effect when given by the mouth, and having no greater stability in‘ keeping qualities than the preparation of Bayliss and Star- ling. It should not be given intravenously since it contains split-protein produets and living bacteria.—F. 8. H.
(SEX) Studies on sex in the hermaphrodite mollusc Crepidula plana. III. Transference of the male-producing stimulus through sea-water. Gould (H. N.) Anat. Ree. (Phila.), 1919, 16, 149.
ABSTRACTS 403
The gastropod molluse Crepidula plana passes through a male phase, a transitional phase, and a female phase during its life. The male phase is unstable and oceurs only as the result of a stimulus furnished by an individual of the same species larger than the one stimulated. Complete isolation of small sexually undeveloped specimens over long periods shows that no development of male characters takes place under such con- ditions further than the formation of a few spermatogonia. In time female characters appear. Small sexually undeveloped individuals confined at fixed distances of from 4 to 7 mm. from large females, where contact is prevented, will in a majority of cases develop male characters to various degrees of matur- ity. Fewer and less well-developed males are produced under such conditions than when the small animals are nearer the source of stimulus. Large individuals of Crepidula fornicata, a species related to C. plana, have not been found to induce male development in small Crepidula plana except in a few doubtful cases. The stimulus to male development acts in such a manner as to indicate that it is a substance given off from the bodies of the large Crepidula plana, diffusible through sea- water, but very unstable-—Author’s Abst.
(SEX) The ineffectiveness of oxygen as a factor in causing male production in hydatina senta. Whitney (D. D.), J. Exp. Zool. (Phila.), 1919, 28, 409-492.
Not of endocrine interest.—M. M. H.
SEX, The determination of—. Apert (E.), Med. Fortnightly (St. Joseph, Mo.), 1918, 1150, 134-38.
Published elsewhere ; abstracted Endoerin., 1919, 3, 92.
(SEX GLANDS) Distrophia genito-glandular. Alves Mau-- ricio (M.) Annaes da Policlinica Geral do Rio de Janeiro (Brazil), 1918, 3, 363.
The author follows Aloysio de Castro and Souza’s elassifi- cation. Three brothers of the same family had all the charac- teristics of adiposo-genital dystrophy. Mauricio believes that the condition is hereditary. In ease of the oldest the condition began at one month of age. The third had several fractures.
—G. P. G.
STERILITY. Gelser (G. M.), N. Y. State J. Med. (N. Y.), 1919, 19, 174.
404 ABSTRACTS
A general review of the causes of sterility. It is concluded that sterility is more frequently attributable to the male than the female—H. W.
(THYROID) An experiment to increase the iodine in the thyroid. (Ein Versuch zur Anreicherung der Schildriise an Jod. Strauss (E.), Ztschr. f. physiol. Chem. (Strassburg), 1919, 104, 133.
It is possible to increase the amount of iodine in the thyroid of a dog when Nal is given. This has also been observed after extirpation of a lobe of the gland.—J. K.
(SYMPATHETIC N. 8.) Acute changes occurring in the cells of the solar plexus in intestinal conditions. Myerson (A.) Boston Med. and Surg. J., 1919, 180, 207.
Report of two cases in which acute intestinal conditions occurred associated with acute changes-in the nerve cells of the solar plexus of the type deseribed as acute Nissl degeneration. Case 1. A woman of middle age suffering suddenly died of volvulus. The cells of the solar plexus demonstrated acute axonal reaction, atrophy of nerve cells, marked pigmentation, complete disappearance of Nissl bodies, and peripheral plac- ing of nuclei. In some eases the nucleus was completely ex- truded from the cell. Similar changes were not found else- where. Case 2. A juvenile paretic dying of pleurisy with effusion of tubercular origin demonstrated at autopsy fecal impaction and congestion of the peritoneal blood vessels. Histo- logical preparations of the solar plexus tissue demonstrated axonal reaction in the sympathetie cells. Beeause of these find- ings the author thinks it likely that part of the collapse and shock noted in such cases as volvulus, intussusception, and acute intestinal obstruction of any type may be related to the changes in the nerve e¢ells of the solar plexus.—H. W.
TESTES, Conservation in the management of trauma and dis- eases of the—. Lydston (G. F.), N. Y. Med. J., 1919, 109, 800.
Before a tuberculous testis is sacrificed by total ablation a eareful examination should be made to determine whether or not any healthy portion of the gland still remains. If so the apparently healthy portion should be resected, cutting as wide as possible of the infected area. Then, instead of replac- ing the gland tissue in the infected scrotum, it should be im- planted in the rectus muscle in the suprapubie region beneath the superficial fascia. Even if very small, such auto-implants
ABSTRACTS 405
preserve virility and, in addition, do their very important share in keeping the nervous functions and general nutrition at or near par.
Epididymotomy should be performed in all cases of epi- didymitis as a prophylactic measure against sterility from vas or epididymal occlusion or, perhaps, from infection. Small abscesses often develop very early in epididymitis, with later disastrous results not ascribed to the true cause, infection. In known or suspected malignant growths of the testicle, the highest degree of conservatism demands early and thorough operation. Hematomas of the testes demand opening and re- moval of the extravasated blood. Pressure is relieved and the testis is protected from subsequent damage by tissue and fluid constriction. The operative incision of the tunica albugina is indicated in orehitis secondary to mumps.—H. W.
TESTES, Cross-racial transplantation of—. Further report of case. Lydston (G. F.) J. Am. M. Assn. (Chgo.), 1919, 72, 1614.
The testes were taken from a negro who had been hanged for murder and implanted in the scrotum of a white moron. After 5 months little atrophy of the organs was apparent and condition of the patient was much improved so that he was able to perform heavy labor.—R. G. H.
(TESTES) War edema and the testicular hormone (Kriegs- oedem und endocrine Hodenfunction). Reach (F.) Wien. klin. Wehnschr, 1918, 31, 1249.
Reach observed that many subjects with edema had atro- phie testes or eryptorchism. In 26 cases in which no success was had with dietary treatment, testicular opotherapy was tried. In 14 cases the results were splendid, the patients being eured. In 12 cases no result whatever was obtained.—J. K.
(TESTIS) The sympathetic innervation of the testis in the dog. Kuntz (A.) Anat. Ree. (Phila.), 1919, 16, 54.
The sympathetic nerve supply to the testis is derived from the third, fourth, fifth, and sixth lumbar segments of the sym- pathetic trunk. These fibers descend along the course of the spermatic artery and vein. The hypogastric nerve supplies some fibers to the pelvic end of the vas deferens; however, these fibers probably do not reach the testes. Sympathetic fibers are supplied to all structures in the spermatic cord and testis which contain smooth muscle. There is no evidence that sym- pathetic fibers terminate in relation either to interstitial cells
406 ABSTRACTS
or spermatogenie elements. Section of the sympathetic nerves to the testis results in degeneration of the seminiferous tubules. —Author’s Abst.
THYMUS, Enlargement of the—treated by the Roentgen ray. Friedlander (A.) Tr. Am. Pediat. Soc. (N. Y.), 1917, 29,
77-85.
Published elsewhere. Abst. Endoer., 1, 519.
(THYMUS ADRENALS) Relation of status thymo-lymphaticus to suicide in soldiers (Die Beziehungen des Status thymico- lymphaticus zum Selbstmord von Soldaten). Neste. Arch. f. Psych. (Berl.), 1919, 60, 43.
Neste frequently found at post-mortem of soldiers who had committed suicide a hyperplasia of the thymus and lymph glands together with atrophy of the adrenals.—J. K.
(THYMUS ADRENALS) Sudden death (Plotzliche Todes- fille). Meyer (O.), Miinch. med. Wehnschr., 1919, 66, 261.
Two eases are described. In the first suffocation resulted from edema of the glottis following am anti-typhoid vaccina- tion. Autopsy showed status thymo-lymphaticus. In the second sudden death occurred during simple faradisation. At post-mortem hypertrophy of the thymus and atrophy of the medulla of the adrenals was found.—J. K.
(THYMUS) Eine neve Funktion der Thymusdrise nebst Bemerkungen uber anderweitige Beziehungen zwischen inneren Sekreten und Nervensystem. Asher (L.), Cor. Bl. f. Schweiz. Aerzt. (Basil), 1916, 46, 1565-67.
The work of Basch and Matti shows that the thymus has an important influence on body growth. Asher states that his own investigation shows that intravenous injections of thymus extracts, if given properly, exert no harmful effect on the heart or circulation. Experiments in his own laboratory have shown that injections of thymus exert a definite counter- acting effect on muscle fatigue. This result is not obtained by using other internal secretory glands, or pure nucleoprotein. It has not been determined whether this effect of the thymus is exerted centrally or peripherally.—E. N.
THYMUS and PARATHYROID, Further proof of the antag- onism existing between the—. Uhlenhuth (E.), Proce. Soe. Exp. Biol. and Med. (N.Y.), 1919, 16, 70.
ABSTRACTS 407
The larvae of Amblystoma opacum have no parathyroids until metamorphosis oceurs. Feeding thymus to them while in the larval state results, as previously reported, in tetanic con- vulsions. It was found, however, that after the development of parathyroids three animals were able to subsist for seven months on thymus gland without the appearance of tetany. —R. G. H.
(THYMUS) The persistent vivescence of the thymic function. Goffin (O. J.), Med. Sentinel (Portland, Ore.), 1918, 26, 275.
The author noticed that in most cases of simple goitres in boys in Portland there were certain peculiarities common to all. They were tall for their age, spare of hair, had pale skin, round limbs, were rather feminine in feature, had hyper- trophied tonsils, a rounding of the chest over the thymus and sometimes a greater than normal area of dullness over the region of the thymus. They were slow in developing. Goffin ascribes these symptoms to persistence of the thymus, and asserts that the deficiency of iodine in the thyroid has an influence on metabolism in the young, superinducing an abnormal persistent vivescence of the thymus. He believes in the old theory that the thymus has an antagonistic action on the gonads in their maturing at puberty. He advises iodized water or thyroid extract in the daily diet of children who show signs of develop- ment of hyperplasia of the thyroid. He does not attempt to prove his case by any detailed histories, X-ray reports or any other exact scientific data. Some would be slow to accept his statement that enlargement of the-thymus would give much of a perceptible bulging of the sternum.—M. B. G.
(THYMUS) The role of the thymus gland in exophthalmic goitre. Eddy (N. B.), Can. M. Assn. J. (Toronto), 1919, 9, 203-212.
In an attempt to determine whether an excess of the prod- uet of thymic activity in the circulating blood could cause exophthalmie goitre, subcutaneous injections of thymus gland substance were made into six rabbits for a period of eight weeks. Three received 5 mgm. per kilogram of body weight and three received 10 mgm. per kilogram for each dose. Forty injections were given to each rabbit. When compared with two control animals no evidence of the production of symptoms characteristic of exophthalmic goitre was discovered, (weight of thyroid glands, body weight, pulse rate, width of palpebral fissure). A review of the literature (largely clinical), however, seems to indicate the existence of some relation between the
408 ABSTRACTS
thymus gland and exophthalmie goitre. The nature of the connection is not clear—lL. G. K.
(THYMUS, THYROID) A propos des corrélations fonction- nelles entre le thymus et le corps thyroide (The functional re- lations between the thymus and the thyroid glands). Dustin (A. P.) and Zune (E.), J. Physiol. et Path. Gen. (Paris), 1918, 17, 905-911.
From a study of the weights of the thymus and thyroid elands in normal men killed in war the authors show that if the weight of the latter is small the weight of the former tends to be great and inversely that a large thyroid accom- panies a small thymus. There is, however, a much greater variation in the weights of the thyroid than in the weights of the thymus in different individuals. Extensively atrophied thymus glands are rare. The authors are of the opinion that atrophy of the thymus is greatly influenced by, or even depends upon, one or more thyroid hormones. This would explain the correspondence of a small thymus with a hyperfunctioning thyroid and also the inverse condition. On the assumption that the thymus regulates the distribution of the nucleoproteins and that those are necessary for cell division the authors suggest an explanation of the role of the thyroid gland in the development of the organism.—L. G. K.
(THYMUS) Two cases of sudden death associated with enlarge- ment of the thymus, occurring in the same family. Brails- ford (A.M.), J. South Carolina M. Assn. (Greenville), 1917, 13, 447-449.
The sudden death of two children of four months is attrib- uted to an enlarged thymus pressing on the trachea, since autopsy of one case showed the thymus completely covering all the structures of the superior and anterior mediastinum, extending from 2 em. above the isthmus of the thyroid to 12 em. below and closely hugging the trachea. The gland was 12 em. long, 5 em. wide and weighed 34 grams. No other abnormalities were found.—F. S. H.
(THYROID) A case of myxedema. Allen (M. B.) Southern Med. J. (Birmingham), 1919, 12, 185-87.
A woman of 52 had slowly developed typical myxedema. Beginning with an attack of puerperal fever at 27, she had gradually lost strength and gained weight, reaching 89.5 Kg. (240 lbs.). She was physically incapacitated for any work and
ABSTRACTS 409
was mentally depressed and irritable. Under thyroid treat- ment she lost 65 lbs. in 25 weeks and was restored to physical and mental normality. After some experimentation, 0.10 gm. thyroid extract t. i. d. was found to be for her case the proper dosage.—R. G. H.
(THYROID) Acute thyroiditis. Beilby (G. E.) Proc. Med. Soe: State N. Y., J. Am. M. Assn. (Chgo.), 1919, 72, 1567.
Tn a series of ninety-one cases of various forms of thyroid lesion, in which an operation was performed, I have met with tliree instances of acute thyroiditis. In two of the cases, in- fection occurred in normal thyroid glands. The third case was an infection of a cystic adenoma of the thyroid. In two of the cases the infection was a direct extension from a laryngeal and tracheal infection. The infecting organism was a staphylo- ecoceus. The third case occurred during an attack of influenza and represented a hematogenous infection. Cultures in this case yielded a hemolytic streptococcus.—Quoted.
(THYROID) Algunas observaciones de bocios exoptalmicos tratados por inyectiones de agua caliente (Boiling water injections in exophthalmic goitre). Olivieri (E. M.) and Ronchi (P.) Prensa Med. Arg. (Bs. Aires), 1917-18, 4, 285.
Published elsewhere. Abst. Endoerin. 2, 207.
(THYROID, ADRENAL) Fatigue disease as exemplified in functional disorders of the stomach and thyroid gland. Rogers (J.) Arch. Int. Med. (Chgo.), 1919, 23, 498.
From a thorough consideration of the physiology of fatigue and from experimental and elinical observations the author is led to believe that functional disturbance of the thyroid gland and the stomach is due to loss of balanced innervation to the parts; this loss results because of fatigue of the nerve end- plates of the nerves supplying the organs. The etiology of hyperfunctionation of the stomach, with or without ulcer, should not be considered a ‘‘neurosis’’ or pathological condi- tion of the vagus, but a defect or failure in functionation on the part of the gastric and possibly other parts of the sympathetic nervous system, including the adrenal glands. The _ ulcer should be considered a secondary or incidental lesion. If the normal action and qwescence of the stomach are dependent upon the integrity of the organ’s double nerve supply in con- junction with the secretions or products of other viscera, then any interference with this relationship, as a fatigue failure of the gastric sympatheties, might be followed by a defect in nu-
+10 ABSTRACTS
trition which would be localized in the region of greatest anemia, or where the muscular contractions are most pro- nouneed. Hence, gastric ulcers may be considered the result of trophie changes. Disturbances of the stomach should, there- fore, be interpreted according to the functions of the involun- tary nerves in relation to the balance found to exist between the vagus and sympatheties.
The functional disorders of the thyroid, like those of the stomach, are apparently of the same character and occur in the same type of ‘‘nervous’’ individuals. The exacerbations and remissions of these disturbances also occur under the same con- ditions of fatigue, and the symptoms and pathologie physiology in both organs are usually traceable to abnormal functionation of the involuntary nerves. The thyroid through its secretion apparently activates, not the inhibitory or sympathetic system, but all the funetions which are dependent upon impulses dis- charged through the vagus or autonomic terminals. Fatigue of the sympathetic would then allow an unopposed action on the part of the vagus, which in turn would result in overactivity of the gland. The functional thyroid diseases apparently begin with a “simple hypertrophy, which is accompanied by evidence of hyperthyroidism. Such conditions differ from the signs of fatigue only by the presence of goitre.
Observations upon thyroid feeding indicate that the pa- tient to be benefited by such treatment must possess a certain minimal amount of functionating thyroid epithelium, otherwise the medication is useless or harmful. If the thyroid epithelium or its vagus nerve supply, or both, fail to functionate, thyroid feeding is useless. The author reports favorable results in the treatment of hyperthyroid cases by the administration of a few minims of an alcoholic or hydrolyzed extract of the thyroid, 1/100 or 1/50 of a grain of the dried nucleoprotein obtained by precipitating with 10 per cent acetic acid from a saline ex- tract of the hashed fresh gland being used. From 1/20 to 1/4 grain doses every 3 or 4 hours of the commercial desiccated thyroid powder is less often satisfactory. In cases of manifest hyperthyroidism, the author concludes it to be reasonable therapeutics to attempt to reinforce the presumably weak or defective inhibitory or sympathetic system by feeding some derivitive of the adrenal gland. Epinephrine is clinically not as beneficial as an alcohol or hydrolyzed extract of the whole gland, as is the nucleoproteid material. That is, treatment is based upon the grounds that the vagus stimulates the thyroid to action while the sympatheties act to inhibit or check the vagus. Adrenal preparations also seem to have been used with good results in the treatment of ‘‘nervous’’ stomachs.—H. W.
ABSTRACTS 411
(THYROID? ADRENIN) Leukocytic studies on soldiers with irritable hearts. Gay (Ll. N.) Arch. Int. Med. (Chgo.), 1919, 23, 603.
A slight degree of leukocytosis is found in the ‘‘unelassi- fied group’’ of soldiers with irritable heart. Patients of the type classed as ‘‘Constitutional Inferior’’ demonstrate a high leukoeytie count; other types show normal counts. Patients with ‘‘irritable heart’’ show a relative lymphocytosis, the limits ranging between 15 and 51 per cent. A marked leukocytosis occurs in both patients and controls after the injection of epinephrin, 0.5 ec. of a 1:1000 solution. The increase is more marked in patients with positive reaction than in controls who did not respond to the drug. No greater variation occurs in the differential formulas after the injection of epinephrin than before. Morphological studies of the blood in cases of ‘‘irri- table heart’’ show nothing of significance that might assist in the diagnosis of such cases.—H. W.
(THYROID) Blood sugar in hyperthyroidism. Dennis (W.) and Aub (J. C.), Arch Int. Med. (Chgo.), 1917, 20, 964-972.
In a series of eighteen patients having hyperthyroidism the blood sugar was determined after a fourteen or fifteen hour fast and compared with that after the feeding of 100 gms. glucose in lemonade or ‘‘postum,’’ 50 gms. bread, and 20 gms. butter. Hourly samples were taken over a period of three or four hours and the sugar content determined. It was found that fasting hyperglycemia is extremely rare, while alimentary hyperglycemia was observed in every case. No relation was observed between the degree of hyperglycemia and the glyco- suria, nor was there any relationship between the severity of the intoxication and the occurrence of the hyperglycemia. After rest or operation the alimentary hyperglycemia was of a lower order. In two eases of hypothyroidism no change in fasting blood sugar level was observed to result from the administra- tion of thyroid extract.—F. S. H.
THYROID, Carcinoma of lateral aberrant—. Wohl (M. G.) Interstate M. J. (St. Louis), 1917, 24, 1044-49.
Clinical report of a case of adeno-carcinoma of an aberrant thyroid. Microscopic sections demonstrated a papillary adeno- earcinoma. An aberrant thyroid may be defined as normal or abnormal thyroid tissue, not connected directly with the thy- roid gland, and occupying any position along the path of em- bryonal development of the gland.—H. W.
412 ABSTRACTS
(THYROID) Causes and prognosis of exophthalmic goitre. Bram (lj. Arch. Diao’ (CN. Y=); 1919e Al
Proper medical attention applied for the required length of time will, with few exceptions, cure every case of exophthal- mie goitre. Pressure or malignancy of the thyroid should be the only indications for operation.—H. W.
THYROID. Clinical experience in 300 operations for goitre (Klinische Erfahungen bei 300 Kropfoperationen). Orth (O.), Deutsche Ztchr. f. Chir. (Leipzig), 1919, 148, 360.
An article of great interest from a surgical point of view. Some eases of endocrine interest are described. A goitre oc- curred after extirpation of the spleen and in another case after operation for a myoma uteri. Some authors have observed an unfavorable result in pulmonary tuberculosis after the opera- tion for goitre. The author did not observe this.—J. K.
(THYROID) Contribution a 1’étude des goitres congénitaux chez les hérédo-syphilitiques. Pellegrini (R.), Arch. de med. exper. et d’anat Pathol. (Paris), 1916-17, 27, 420-29.
A case report of a prematurely delivered foetus of 460 grams, the thyroid of which weighed 10 grams—the usual weight of this gland at birth being about 1.5 grams. The his- tological picture waS parenchymatous goitre with alveolar exfoliation. Correlating this with reports of other investi- gators, and with the fact that both parents were syphilitic but non-goitrous the author concludes that congenital goitre may appear in the child as an effect of parental syphilis.
—F. 8. H.
THYROID, Diet in diseases of the. Amesse (J. W.), Colorado Med. (Denver), 1919, 16, 113-21.
On first examination it would appear that a discussion of the influence of diet in these obscure disorders must be purely theoretical. Intensive bio-chemical studies during the past decade, however, have developed many significant facts bear- ing on this problem. Reid Hunt has reported that there are items in the average ration which build up materials in the thyroid capable of combining with iodine or which increase the iodin receptors of the gland. Since the functions of the thyroid depend, in part, on the iodin content, a knowledge of the relative amounts of this important element in the common foodstuffs is desirable. Hunter and Simpson have ealled at- tention to the seasonal variation of the quantity of iodin found
ABSTRACTS 413
in the thyroids of sheep subsisting at times on sea weed. Dur- ing these periods the iodin content of their thyroids has been enormously increased. The influence of thyroid extract in goi- tre, Graves’ disease, cretinism and myxedema is discussed. —Author’s Abst. (abbreviated).
(THYROID) Disturbances in dental evolution in infantile myxedema (Troubles de l’evolution dentaire dans le myxe- deme infantile. Superposition des deux dentitions). Lere- boullet (M. P.) et Lang Landry, Mme., Rev. neurol. (Paris), 1917, 30, 128.
Discussion with illustration of a case of double dentition in a boy of sixteen presenting a typical syndrome of infantile myxedema.—F. S. H.
(THYROID) Electrocardiographic observations in toxic goitre. Krumbhaar (E. B.) Tr. Assn. Am. Physicians (Phila.), 1917, 32, 368-403.
Electrocardiographiec studies were made of 51 cases of goitre, mostly of toxic type, in as many eases as possible both before and after surgical operation. In the 47 patients who were operated upon (ligation, partial excision, enucleation of adenomata) three deaths occurred, two without recognized premonitory signs; in the third a development of negative T waves might have served as adequate warning. In 43 per cent of the cases the electro-eardiograms were essentially normal. In 22 per cent preponderating hypertrophy of the right ven- tricle (or tendency thereto) was found; similar hypertrophy of the left ventricle in 22 per cent was noted. The former after operation tended to return to normal, but the latter showed either no change or an increased preponderance.
Cardiac arrythmia was found as follows: Sinus, 4 cases; ventricular extrasystoles, 3 cases; auricular fibrillation, 3 and flutter, 1 case; delayed conductivity, 2 cases. The T wave was unusually prominent in most cases, and materially diminished after operation in about half the cases. The pulse pressure was above normal in most cases and diminished after operation. Systolic pressure was high in the cases with left ventricular preponderance, but did not exceed 170 mm. Hg. In the early eases of toxic goitre the characteristic tachycardia was not accompanied by any signs of myocardial change detectable by the string galvanometer used.
Successful treatment, either medical or surgical, it is con- cluded, by removing the intoxication, improves the cardiac condition, as shown by occasional disappearance of arrythmia,
414 ABSTRACTS
diminution in the size of the T wave and in the pulse pressure as well as by the general clinical condition.—R. G. H.
(THYROID) Etiology and Treatment of Exophthalmic Goitre. Bergh (C.) Norsk Magazin for Laegevidenskaben (Chris- tiania), 1919, 80, 217-52.
Bergh is convineed that the tonsils, nose or throat are often the primary source of the infection causing the thyroid derangement responsible for exophthalmie goitre. He has now a record of 11 cases in which treatment was directed to cure the pathologic conditions in nose and throat, and the exophthalmic goitre subsided. He cites further Salling’s report on 97 cases of exophthalmiec goitre in 13 of which the disease had followed immediately on an infectious sore throat, and he has found 42 on record of a similar briefly preceding infectious disease. In three of Salling’s cases an acute infectious disease caused the flaring up of the apparently cured exophthalmie goitre, and in 20 others the exophthalmie goitre became much worse after an intercurrent acute infection. No less than 60 of the 97 displayed a tendency to infectious sore throat. In 62 of the 97 cases the exophthalmic goitre began evidently as a local process in the thyroid. These data sustain Bergh’s asser- ficial, harmless thing, but may spread along the lymphatics to the thyroid. Migraine and ecephalalgia have been frequently traceable to rhinopharyngitis, in his experience, and now he adds exophthalmie goitre to this group, and sustains his asser- tions that chronic catarrh of the nasal mucosa is not a super- tions by the success of treatment of the rhinopharyngitis. As clinically normal conditions are restored in the nasal mucosa, the secondary affections subside. He treats the mucosa with massage, and commends the efficacy of this absolutely harmless treatment. It removes the chronic source of the infection, and the process in the thyroid then dies out. The outcome is better in the case of soft goitre. About thirty-five applications of massage were required in his cases, to never over forty-two.— J.-Am, MM. -Assn.,.72, 1712.
(THYROID) Exaggerated fear of cachexia thyreopriva (de misplaatste vrees voor cachexia thyreopriva). Lanz (O.) Nederl. Tijdschr. v. Geneesk (Haarlem), 1919, 63, 1086.
According to Lanz many physicians have an exaggerated fear of cachexia thyreopriva. Patients with Graves’ disease who could probably be cured by an operation too often do not receive this because the doctors tell them it may result in their becoming idiots.—J. K.
ABSTRACTS 415
(THYROID) Experimental lesions in the cervical sympathetic ganglia in relation to exophthalmic goitre. Wilson (L. B.) Tr. Assn. Am. Physicians (Phila.), 1917, 32, 336-41.
Published elsewhere. See Abst. Endocrin., 1918, 2, 530.
(THYROID) Exophthalmic goitre. MacKenzie (H.), Lancet (London), 1916, (2), 815.
A lengthy discussion of the etiology and symptomatology of exophthalmie goitre is offered. Briefly, his views on therapy are that the X-ray treatment may prove to be far the best means at our command. It must be supplied in no half-hearted way. It must be persevered with and in many cases continued for a long period of time. As for the surgical therapy, he sums up his views as follows: ‘‘If the operation is done at all, it should be performed under local anesthesia. Local anesthesia is especially indicated in younger subjects. Ligature of the thyroid arteries does not appear to have any appreciable effect on the disease and, therefore, if done at all, it should be the forerunner of thyroidectomy. Thyroidectomy does not cure unless a sufficient amount of the gland is removed. If possible, it is better to remove more than an entire lobe at one opera- tion. The author does not think the risk will be appreciably in- creased if this is done. If a whole lobe is left behind, it is prob- able that another operation will be necessary at a later time, unless, by means of other treatment, a sufficient reduction of the remaining lobe can be brought about.’’—M. M. P.
(THYROID) Exophthalmic goitre. McGregor (J. K.), Can. M. Assn. J. (Toronto), 1919, 9, 406-410.
A discussion of the methods of diagnosis and treatment of exophthalmic goitre. Contains no new data.—L. G. K.
(THYROID) Exophthalmic goitre in children. Welt-Kakels (Sarah), Arch. Pediat. (N. Y.), 1917, 34, 529.
The writer reports a case in a boy 14 years of age. The interesting points were the presence of signs which are found in adults but not usually in children, such as tachycardia, Graef’s sign, exophthalmos and tremor. The heart action was normal. The blood pressure was 135 to 140, which was un- usual. The blood examination showed a red blood cell count of 3,300,000, a white cell count of 14,000 and hemoglobin of 58 per cent. This is not the characteristic picture in goitre, as there was a leucocytosis, whereas one would expect a lymph- ocytosis.—M. B. G.
416 ABSTRACTS
(THYROID) Exophthalmic goitre, The surgery of—. Dunhill (T. P.), Laneet (London), 1917, 2, 883-88.
A discussion of the views of various men regarding the surgical and medical treatment of exophthalmic goitre is of- fered. Dunhill sums up his views on the portion removed as follows: ‘‘I have always found that removal of one lobe and the isthmus gives improvement which is readily recognized by both patient and observer. The removal of rather more than half the remaining lobe almost always places a patient on a plane of health which enables her to work and play and to feel well whilst doing so. Occasionally a third operation is necessary. When necessary it is generally because one has not been able to judge how much was left at the second opera- tion. The reason one is not able to judge is because the por- tion to be left is never dislodged.’’ He presents two cases to show the degree of emaciation which may occur (photographs also shown) and how even in these cases an operation can be performed with reasonable safety, and with obvious improve- ment, when a sufficient amount of gland tissue has been re- moved. Two other cases are presented to show that the eyes may recede, if sufficient gland tissue is removed, even when the exophthalmos has been extreme. He reports two cases where a third operation was necessary to remove enough gland- ular tissue. The article is concluded with a brief discussion of the various views on the medical and surgical treatment of Graves’ disease, and closes with the statement, that “‘there is no doubt that the degree of improvement following operation is much greater than that followimg X-ray treatment.
—M. M. P.
THYROID extirpation, Neuroretinitis (choked disk) sequel to—. Sherer (J. W.), Proc. Mo. State M. Assn., J. Am. M. Assn. (Chgo.), 1919, 72, 1936.
A woman, aged 32, suffered severely with exophthalmie goitre. The thyroid gland was removed five years ago with complete recovery from all symptoms. For about five months ’ she has been suffering severe asthenopic symptoms and during the last two months exophthalmos with swelling of the eye- lids has developed. Pain through the left eye and the left side of the head is very severe. The fundus reveals the classic picture of neuroretinitis or choked disk. No hemorrhages oce- eurred. Urinalysis and Wassermann are negative. The pa- tient is nervous and emotional. The left eye has become totally blind during the last five days. The patient was put to bed on a restricted diet with bromids and alteratives. Pilocarpin
ABSTRACTS 417
sweats were given regularly. Complete recovery ensued in two months. Exophthalmos and choked disk disappeared.—Official Abst.
(THYROID) Focal infection as a possible cause of exophthal- mic goitre. Crouse (H.), Southwest Med. (El Paso), 1917, 1, 9-11.
An editorial assigning focal infection as a contributing cause of exophthalmic goitre, based on the clinical care by the author of five cases each presenting the triad of symptoms of Basedow’s disease. The difficulties disappeared after the re- moval of the markedly infected tonsils and the treatment of the patients with autogenous vaccines made therefrom.
—F.S. H.
(THYROID) Forma congestiva del hipotiroidismo. Mussio Fournier (J. C.), Rev. med. d. Uruguay (Montevideo), 1918, 21, 155-63.
Published elsewhere. Abst., Endocrin., 1918, 2, 199.
THYROID gland, Eczema in infants and the—. Ravitch (M L.) and Steinberg (S. A.), J. Cutan. Dis. (Chgo.), 1919, 37, 312- 16.
During an investigation of the cause of eczema in infants the author was impressed by the number of cases which oc- curred in breast-fed children. The great percent of cases were found in babies whose mothers demonstrated thyroid trouble either during pregnancy or lactation. The eczema in these cases was characterized by a dry, rough skin, perhaps moist, but never oily. The author believes that in all proba- bility the milk of goiterous mothers causes a disturbance of thyroid function in the nursling. This disturbed gland in turn is not capable of maintaining a normal fat metabolism and the result is shown by the peculiar type of eczema found upon the child. Iodides should be administered when there is any sign of hypoactivity on the part of the thyroid either in the child or mother. Thyroid gland preparations should be given when the history or symptoms point to a myxedema. The daily dose of iodides should not be over 6 grains for adults. Infants should not receive over one grain a day.—H. W.
The THYROID gland. Its role in development and disease. Simonton (L. J.), N. Y. Med. J. (N. Y.), 1919, 108, 281.
1. Hypothyroidism and hydrocephalus. Two sisters when
418 ABSTRACTS
first seen showed diminished functional activity of the thy- roid. Both had had marked goitre which had disappeared without treatment. The mother had a large goitre. The pa- rents were first cousins. The first girl married a second cousin. She became pregnant and developed toxic vomiting ; however, she carried her child to term. At nine years of age the child, a boy, wore a size 714 hat. Although the lad’s mentality was good, he was diagnosed as a hydrocephalic. The second girl married a non-relative and became pregnant. There was no vomiting, but she developed violent ‘‘heart attacks.’’ Thyro- protein was administered with immediate relief. She was de- livered at term of a child with a very large head. At four years of age the child wore a size 734 hat. His mentality was normal. This case was also diagnosed as hydrocephalic. The history of these sisters bears out the known relationship be- tween thyroid deficiency and consanguinity, and indicates a possible thyroid etiology of hydrocephalus.
2. Thyroid disease and sexual development in the female. The author states that practically half the female and some of the male population of the Cumberland Valley, Pa., suffer from goitre. The condition is due to thyroid dyscrasia, due either to limestone water, consanguinity or both. The inter- action between the thyroid and ovaries has not been normal with a resulting subnormal sexual development. Most cases show frank hypothyroid symptoms: slow heart, irregularity of heart and menses, rough skin and scanty menstruation. Ninety per cent suffer from scanty, irregular menstruation. Correction of the hypothyroidism restored normal menstrua- tion in all cases and also gave great relief from cardiae symp toms. In the sexually undeveloped cases—painful menstrua tion, irregularity, painful coitus, sterility, frigidity, ete.—cor- pus luteum obtained from the pregnant sow gave wonderful results. Lactation was established in several eases by the ad- ministration of thyroprotein (Beebe). Any attempt to dis continue the medication was followed by drying up of the milk.
3. Hyperthyroidism. Such cases were treated with tine- ture of iodine. In each instance (5 cases) the heart action became slower and in three the goitre completely disappeared. One exophthalmic case and one other with continued nervous symptoms were greatly relieved by thyroidectin medication
(THYROID) Goitre a metastases (metastatic goitre). Leclere (G.) et Masson (P.) Bull. et mém. Soe. de Chir. de Paris,
ABSTRACTS 419
1918, 44, 1815. Abst. Surg. Gyn. & Obst. (Chgo.), 1919, 28, 379.
In a man aged 67, a tumor had been noted for two years in the left costo-iliac region. It was removed and the man made a good recovery. From macroscopic appearance it was believed to be a sarcoma, but microscopically proved to be made up of thyroid tissue. The patient was then re-examined and a goitrous tumor found in the left sternomastoid region. It was painless. Some months later intense pain developed in the operated region and in the left thigh. Almost total paraplegia of the legs with incontinence of urine and feces followed and soon after, death. The author confidently ascribes the terminal phenomena to metastasis. Oseous tumors diagnosed sarcoma often prove to be typical colloid thyroid adenomata. The authors regard their case as of this type, histologically benign, but through multiple metastasis causing death. In the tumor in this case mitotic cell division was common, whereas in ordinary thyroid adenomata it is exceptional.—R. G. H.
(THYROID) Goitre and drinking water. (Krop en drink- water.) Kappenburg (B. D. G.) Inaugural Dissertation, Utrecht, 1919.
A large number of experiments on rats is reported. Little difference was found in the size of the thyroids in wild rats (mus decumanus) whether they had lived in places with no goitre or where it is prevalent. In Utrecht goitre is very fre- quently seen; in Sneek, a little town in the north of Holland, it is never observed. Rats in Sneek were given water from Utrecht to drink. No goitre resulted, nor any histological abnormalities. Similar animals kept under a comparable regime at Utrecht developed thyroids twice as large as nor- mal; histologically they showed to greater or less degree the changes characteristic of goitre. Boiling the water did not prevent the thyroid enlargement. The author concludes that the role played by drinking water in the etiology of goitre is still problematic and that, in fact, it is not proved that it plays any part at all.—ZJ. K.
(THYROID) Goitre, Exophthalmic—with special reference to etiology and Roentgen-ray treatment. Cole (W. A.), J. Med. Assn. Georgia (Augusta), 1918, 7, 186-190.
The author considers the glandular and neurogenic the ories of goiterous disturbances complementary. The X-ray treatment of twelve cases gave no absolute failures. The treatment was followed by reduction in pulse-rate, increase in
420 ABSTRACTS
weight, and favorable response in diminution of insomnia, headache, and tremors. The thymus was simultaneously treated. The initial dose is small and followed after an inter- val of two weeks by the regular course of treatment. In all cases the dose was kept below the erythema stage. The doses were given every three or four weeks, lengthening the inter- vals between the treatments as the conditions improved, in this manner inhibiting the development of hypothyroidism, or cachexia strumipriva.—F’. 8. H.
(THYROID) Goitre in children. Peterson (E. W.), Arch. Pediat. (N. Y.), 1919, 34, 526-29.
The writer reported a case in a girl first under observa- tion at the age of five weeks. Her parents were Hungarian and gave a negative family history as to this condition. Labor had been easy and the child normal except for a relatively large tumor on the right side of the neck. The growth lay behind and to the inner side of the sternomastoid, extending from the level of the jaw nearly to the clavicle. It was made up of two masses, the larger situated above, smooth on the surface, of firm consistency and not fluctuating at any point. Below and to the side there was a distinet palpable nodula- tion. There was some difficulty in breathing for the first two hours, after which there was neither dyspnea nor dysphagia. The tumor was removed and found to be an adenoma with colloid degeneration of the thyroid. Nine days after the op- eration, the child had a convulsion, which was followed by fre- quent repetitions. Believing that the entire thyroid had been removed, thyroid extract was given and the tetany stopped. Thyroid administration was kept up for four years and then discontinued. A close wateh on the girl since then has failed to demonstrate any symptom of hypothyroidism. Her physical and mental development has been normal.—M. B. G.
(THYROID) Goitre, use and misuse of treatment. Grimes (E.), J. Iowa State M. Soe. (Des Moines), 1917, 7, 407-409.
The diagnosis of simple hyperplastic goitre must be aec- curate or else treatment will be disappointing or disastrous. It must be known whether or not the condition is cystic, paren- chymatous, or interstitial, and whether accompanied by tuber- culosis, or whether the case is one of hyperthyroidism. The external use of iodine is valueless and the internal administra- tion of this drug is favorable in but a few eases, being dis- tinctly harmful in cystic and parenchymatous types. X-ray
ABSTRACTS 421
treatment is considered dangerous and surgical interference is advocated.—F. S. H.
(THYROID) Goitre, surgical vs. medical treatment. Smith (E. V.) Wisconsin M. J. (Milwaukee), 1918, 16, 388.
Goitres are classified in three groups, i.e., Exophthalmic, toxic adenomata, and colloid. The treatment of exophathalmic goitre is primarily medical. Surgery should be considered only when it becomes absolutely necessary to relieve the patient. The medical treatment should consist of absolute rest, ice bags over the heart and a diet as protein-free as possible. Patients at the height of an attack should always be treated by non- operative measures until the severity of intoxication has begun to subside. There are two types of symptoms in toxic adeno- mata, one indicating chronic poisoning, the other pressure. The latter condition should, of course, be treated surgically. Cases of chronic poisoning should be given medical treatment for three weeks before operating. Patients so treated seem to withstand surgical procedures to a remarkable degree. Goitres of puberty respond well to the internal and external adminis- tration of iodides. Less surgery and more nonoperative care seems highly advisable in the handling of this type of goitre.
—H. W.
(THYROID) Goitre, differential diagnosis of forms of—. Pember (J. F.) and Nuzen (T. W.) Wisconsin M. J. (Mil- waukee), 1918, 16, 392.
A general review of the findings in various types of goitre. The authors consider the pathology found in enlarged thyroids to be more or less secondary to infection or some profound dis- turbance of the central nervous system which calls for an in- creased thyroid output. The latter, in turn, produces changes in the sympathetic nervous system, adrenals, and other organs. The combined effects of all these changes make up the picture of exophthalmie goitre, and the varying degrees of hyperthy- roidism. Differential diagnosis is not considered difficult save in border-line cases of thyrotoxie goitres which are so often confused with enlargement of the thyroid due to the influence of infection, particularly to incipient tuberculosis, and neuras- thenia.—H. W.
THYROID, Hemi-aplasia of the (Hemiaplasie der Schildriise.) Dubs (J.), Zentralbl. f. Chir. (Leipzig), 1918, 45, 401.
Aplasia of one lobe of the thyroid is very rare. The au- thor describes 4 cases, controlled by operation. In these cases
422 ABSTRACTS
the anomaly is congenital. The author describes one case with aplasia of the isthmus. These conditions have a practical sig- nificance in the operation for goitre or Graves’ disease—J. K.
(THYROID) Heredity of Graves’ disease (Uber dominant ge- schlechtsbegenzte Verurbung und die Erblichkeit der Base- dow Diathese). Lenz (F.), Arch. f. Rassen und Gesellschafts Biologie (Leipzig and Berlin), 1919, 13, 1.
A general discussion embodying no new data.—J. K.
THYROID. Hyperthyroidism: A clinical study. Boggess (W. F.), Kentucky Med. J. (Bowling Green), 1919, 17, 157.
There is a rather close relationship between chronically infected tonsils and enlargement of the thyroid gland with thyro-toxicosis. Three cases of well defined Graves’ disease in women between 20 and 30 years of age, with bad tonsils, re- covered completely following removal of the tonsils. In atypi- eal cases of Graves’ disease, cleaning the erypts and relieving the infection of the tonsils and post-nasal spaces often brings about improvement in health with the abatement or ameliora- tion of the cardio-vascular symptoms. The old etiological fac- tors of fright, extreme emotional excitement or psychical trauma, and iodine therapy and iodine retention may suddenly precipitate the syndrome of hyperthyroidism, yet they in them- selves should not be considered causative factors of the dis- ease. The proper treatment of thyro-toxicosis is not the treat- ment of the heart or any one particular symptom, but the treat- ment of the condition in its entirety. The source of infection should be sought and removed. Rest, forced feeding, thorough alkalinization and the free use of iron and arsenic should be encouraged as therapeutic measures. The beneficial result sometimes seen following the use of thyroid extract is due to some favorable action in stimulating antagonistic glands, or in producing antibodies. But three cases, however, are defi- nitely reported in which removal of focal infections brought about a cessation of thyroid symptoms. Nothing is said about possible cases who did not suffer from focal infections.—H. W.
(THYROID) Hyperthyroidism as occurring in sailors. Find- lay (G. M.), J. Roy. Nav. Serv. (Lond.), 1917, 3, 205-209.
Four men who had been subjected to the continuous strain of naval warfare developed typical symptoms of hyperthyroid- ism. They were given 5 gs. thyroid extract three times a day and the reaction compared with four other patients similarly
ABSTRACTS 423
treated, but having shown no tendencies towards hyperthyroid- ism. In the four suspected cases the administration of the thyroid extract caused a marked exacerbation of the symptoms, while the controls were unaffected. Apparently these were cases where the original stimulus was psychological of fear or anger, excessive in character and affecting the most susceptible endocrine gland with subsequent development of character- istic symptoms of hyperthyroidism.—F. S. H.
(THYROID) Intralaryngeal struma. Dorn (J.), Beitr. z. klin. Chir. (Tiibingen), 1919, 115, 101.
A simple goitre without symptoms of malignant degenera- tion was penetrated through the right ligamentum crico-thy- roideum and removed surgically. Later a metastasis appeared in the larynx. The successful removal of this was accom- plished.—J. K.
(THYROID) Hyperthermie thyro-endocrinienne (Thyro-endo- crine hyperthermia). Léopold-Lévi, C. R. Soe. de Biol. (Paris), 1919, 82, 344-346.
Thyroid hyperthermia is classified under the following
groups:
1. The subject is always too hot and sometimes presents a true thermophobia.
2. The sensation of heat is localized and is either con- tinuous or intermittent.
3. It is not uncommon for the subject to have the sensa- tion of fever, either localized or general. But the tem- perature is hardly above 37° C.; sometimes it is below normal.
4. Fever possible in mild endocrine eases.
a. The temperature regularly a few tenths of a degree above normal.
b. It may exist as a mild sub-febrile state, being exag- gerated by any accessory factor (fatigue, emotion, menstruation).
c. Hyperthermia intermittently affects the course of the fever; there may be a periodie migraine accom- panied by a rise of temperature.
d. Prolonged fever with remissions.
Hyperthermia is accompanied by sweating, circulatory
disturbance, thirst and disturbance of sensibility.
The relations between endocrine disturbance and hyper-
thermia are pointed out.
1. Thyroid. The author mentions the work of others in which an increased temperature was produced by giv-
424 ABSTRACTS
ing thyroid. In his own experience he has observed hyperthermia resulting from an overdose of thyroid substance. In eases of hypothermia attending myxoe- dema, thyroid treatment frequently produced hyper- thermia.
2. Ovary. As a result of the relationship of the ovary to the thyroid, during the menopause there is a hyper- thyroid reaction and a consequent hyperthermia.
3. Adrenal. Hyperthermia from adrenal hyperactivity depends upon the concomitant hyperthyroidism.
The stimulation of metabolism plays an unimportant part in the mechanism of hyperthyroid hyperthermia. There is no appreciable modification of the urine in Basedow’s disease. But it is accounted for by hyperactivity of the muscular sys- tem, with the manifest spasms and trembling, also by an over- stimulation of the thermic centers already sensitized.—F. A. H.
(THYROID, HYPOPHYSIS) The relation of the pituitary and thyroid glands of Bufo and Rana to iodine and metamor- phosis. Allen (B. M.), Anat. Ree. (Phila.), 1919, 16, 137.
Administration of iodine mixed with flour brings about precocious metamorphosis in Bufo tadpoles from which the pituitary gland has been removed. This is accompanied by a marked shrinkage of the body. Iodine has no effect upon the changed color produced by the removal of the pituitary gland. In these operated tadpoles, the absence of the pituitary gland normally results in seanty deposition of colloid in the thyroid sland. Jodine feeding does not cause any marked increase in colloid deposition in the thyroid glands of these pituitaryless tadpoles. Great progress toward metamorphosis was produced by feeding iodine to Bufo and Rana tadpoles from which both the pituitary and thyroid glands had been removed. There is every evidence that complete metamorphosis would have been attained if the tadpoles had lived.—Author’s Abst.
THYROID, HYOPHYSIS and PINEAL glands of Rana syl- vatica, Experiments with the—. Hoskins (E. R. and Mar- garet M.), Anat. Rec. (Phila.), 1919, 16, 151.
A. Thyroid. In 105 young larvae the thyroid fundament was eut to pieces but left in situ, and an additional thyroid fundament transplanted into the animal. Some of the larvae developed accessory thyroids, but this had no effect except perhaps in a few larvae that metamorphosed while small. The time of metamorphosis was not hastened. B. Hypophysis. The hypophyseal fundament was removed from 116 young
ABSTRACTS 425
larvae after the method of Smith and of Allen, with the usual results in most cases. A few larvae became black. Some of these black larvae metamorphosed, but one did not, although it grew much larger than normal. Transplantations of the hypophyseal fundament into 62 young larvae gave negative results, although some of the transplants grew. C. Pineal. The pineal was removed from 70 young larvae, but regenerated either partially or completely and the larvae grew normally. 'The fundament of the pineal was transplanted into 19 young Jarvae. It failed to grow. D. Some of the larvae of the thy- roid and hypophysis operations developed small accessory mouth-parts. These were mostly ectodermal outpouchings, but in some of them muscle fibers developed. One of these opened into the oral cavity.—E. R. H.
The THYROID in gynecology. Hayd (H. E.) Tr. Am. Assn. Opst.6c Gyn., 1917, p. 165-171.
See Endocrin., 2, 534.
(THYROID) Instabilité thermique a mécanisme neuro-thyroid- ien. (Thermic instability in the neuro-thyroid mechanism). Léopold-Lévi. C. R. Soe. de Biol. (Paris), 1919, 82, 346-348.
Amongst numerous cases of thermic instability in mild thyro-endoerine states there are some in which both hypo- thermia and hyperthermia existed in the same subject. He separates these into two groups:
1. Hypothermia and hyperthermia sueceed one another. The two phases may be of long or short duration. 2. Hypo- thermia and hyperthermia occur simultaneously. One part of the body may seem cold while another part is hot. It is con- sidered that variations in the thyroid secretion act through the nervous system, causing thermic instability —F. A. H.
(THYROID) La colesterinemia en la insuficiencia tiroidea (The blood content of cholesterin in thyroid insufficiency). Mar- tinez (B. D.), Primer Congreso Nacional de Medicina (Bs. Aires), 1916, 4, 24.
See Endocrin., 1, 357. (THYROID) Medical treatment of Graves’ disease. Therap. Gaz. (Detroit), 1918, 34, 390-96. See Endocrin., 3, 117.
426 ABSTRACTS
(THYROID) Multiple Strumametastasen. Thomsen. Beitr. z. klin Chir. (Tiibingen), 1919, 115, 118.
An interesting case is described in which a goitre at opera- tion showed under the microscope no sign of malignant growth. After operation, however, metastases occurred in bones, skin, mucous membrane and heart.—J. K.
(THYROID) Névroses et opotherapy. Blane (J.), Prog. Méd. (Paris), 1917, 32, 95-98.
In four eases of dysthyroidism resulting in psycho-thyroid disturbances, due to the war, with positive and exaggerated oculo-cardiae reflexes, the administration of powdered thy- roid, iodothyroidin or thyroid extract, in doses of from 0.002 mg. to 1 mg. a day produced a favorable reaction and disap- pearance of the symptoms as evidenced by the diminution of the oculo-cardiae reflex.—F. 8. H.
THYROID. Nervous cretinism. Crookshank (F. G.), Lancet (London), 1917, 2, 604.
Crookshank has had 10 or 12 cases of nervous cretinism (corresponding to the cases that MeCarrison described in The Lancet, 1908, ii, 1278) with various nervous manifestations, particularly spastic diplegia. His conclusions were: “‘In al- most every case that I have seen which appears to deserve the appellation of ‘nervous ecretinism’ there has been evidence of dysthyreosis in the mother or other members of the family. They go through various nervous phenomena, the more severe showing mental defects which are obvious from the earler days, and the early appearance of spasm with nystagmus leads to the confident diagnosis of congenital spastic diplegia. Cases which have fallen in the latter class have responded well to thyroid therapy.—M. M. P.
(THYROID) Non-surgical treatment of exophthalmic goitre. Bram (I.), N. Y. Med. J. (N. Y.), 1918, 108, 942-44; South. Clinie (Richmond), 41, 225-35.
Hyperthyroidism is not a surgical entity, but is a disease which belongs to the internist, for the following reasons. Re- cent researches prove that Graves’ disease is not a loeal con- dition, nor has it a local etiology. Though surgeons report very favorable surgical recoveries, clinical recoveries are rare, and in a vast majority of cases there is a postoperative return, occasionally with augmented vehemence, of all the signs and symptoms of hyperthyroidism. The patient who has been op-
ABSTRACTS 427
erated upon, and who does recover clinically, gets well because of a carefully outlined system of postoperative non-surgical treatment or because of the fact that the case in question is one of those instances of spontaneous recovery and would have terminated favorably in spite of treatment. Internists who specialize in thyroid gland treatment cure more than 75 per cent of their cases of hyperthyroidism by dietetic, hygienic, medical, and electrotherapeutic measures.—H. W.
(THYROID) Observations on thyroidless Rana sylvatica larvae kept through the second season of normal metamorphosis. Hoskins (E. R. and Margaret M.). Anat. Ree. (Phila.), 1919, 16, 152.
The larvae reached nearly their maximum size the first summer (66 mm.), but grew again slightly during the winter and more during the second spring and summer (72 mm.). They became relatively longtailed, the legs grew 14 mm., the head and back flattened, and the eyes became relatively far apart. The brain acquired a shape practically mature, but at a size much larger than normal, and the liver became nearly mature in shape. The hypophysis became relatively very large, especially the inferior lobe, and this lobe showed an increase in the relative number of eosinophilic cells. The anterior and superior lobes showed little structural differentiation. The thymus glands persisted and became relatively and actually large. They retained the larval shape and structure. The epitheloid bodies (parathyroids) became relatively large. The spleen became large, but was roughly proportional to the size of the larva. The kidneys enlarged both actually and rela- tively. The internal gills persisted and the lungs became large and functional. The intestines grew long and remained larval in type. The ovaries became large and large odcytes developed. Maturation was not seen and oviducts did not develop, so the animals were not sexually mature. The testes became mature and formed spermatozoa which escaped into the kidneys. By successive extirpations of the end of its tail, a larva was made to regenerate 38.5 mm. of tail. It regenerated one small hind leg once, but not a second time after the regenerated leg was removed. The amount of time required for regeneration of the tail gradually increased. A thyroidless larva placed in a moist chamber lived two days, its volume decreasing 18 per cent, its tail shrinking 24 per cent in length, and its intestine contract-
ing to about one-half the normal size, but not shortening per- ceptibly.—E. R. H.
428 ABSTRACTS
(THYROID, HYPOPHYSIS, ADRENALS) A contribution to the study of vasomotor reflexes. Ogata (O.) and Vincent (S.), J. Comp. Neurol. (Phila.), 1919, 30, 355-394.
This paper contains but a short section on the effect pro- duced on the vasomotor reflexes by the injection of extracts of the ductless glands, or by extirpation of the glands. Injection of pituitrin or thyroidin (Parke, Davis & Co.) and extirpation of both thyroid glands show no significant results. Injection of adrenin (‘‘adrenalin,’’ Parke, Davis & Co.) seems to give a slight decrease of the pressor reflex. Tying off the supra- renals gives no clear results when the nerves of the limb are intact. The results in the denervated limb are discussed in a a paper in Endocrinology, 1919, 3, 121-36. The experiments were made upon dogs.—M. M. H.
(THYROID) Pregnancy in a case of improved sporadic cretin- ism. Welz (W. E.), Am. J. Obst. (York, Pa.), 1919, 79, 655- 56.
Report of a case of contracted pelvis due to sporadic cretinism. The patient carried a fetus to term and was then delivered of a 744-pound child by Caesarean section. The child was placed upon a milk formula the fifth day because of fail- ure of the mother to establish lactation. The mother made an uneventful recovery and left the hospital on the 14th day.
—H. W.
(THYROID) Radium therapy in hyperthyroidism. Aikins (W. H. B.), Internat. J. Surg. (N. Y.), 1918, 31, 217-24; Boston M. & S. J., 1918, 179, 558-64.
Published elsewhere. Abst., Endoerin., 1918, 2, 537.
THYROID, Sarcoma of the (Primare Sarkoma der Schilddriise mit seltenen Metastasen). Kregliger, Arch. f. klin. Chir. (Berlin), 1919, 111, 545.
Description of a case in which the clinical diagnosis was tumor of the stomach or liver. At the post-mortem examina- tion a large sarcoma of the right lobe of the thyroid was found. There were metastases in the left lobe, the skin, the stomach, the peritoneum, both lungs, the heart, the bile ducts and the bladder.—J. K.
(THYROID) Scleroderma and sclerodactyly: report of a case, with Roentgen rays and review of the literature. Atwater (R. M.), Am. J. Med. Se. (Phila.), 1919, 158, 29-35.
ABSTRACTS 499
A striking case is deseribed at length. It is of endocrine interest in that, on a basis of possible thyroid etiology, the patient was given a two months’ course of treatment with thy- roid extract. From 0.065 to 0.13 gms. was taken three times daily ; this dosage was subsequently somewhat reduced. The treatment appeared to be of no use and possibly even aggra- vated the symptoms.—R. G. H.
(THYROID) Some remarks on hyperthyroidism. Kuh (S.), Til. M. J. (Chgo.), 1919, 35, 190-92.
The fact that thyroid disease—particularly the ineon- spicuous forms—is more prevalent than usually recognized is emphasized. Slight degrees of ‘‘hyperthyroidism’’ are seen‘in individuals of splendid physique who are unconscious of any illness. The most important misleading complications are , gastro-intestinal. The thyroid disorders often date back un- recognized to the time of puberty, as can often be determined by the examination of the family photograph collection. In women in whom diagnosis is difficult, advantage should be taken of the fact that the symptoms are often aggravated dur- ing menstruation. The author regards infrequent blinking as one of the most significant symptoms of Graves’ disease; the occurrence of this seems not to be widely recognized. Excel- lent therapeutic results have been obtained in a large number of cases from the use of serum of thyroidectomized animals, fully 90 per cent of the patients reacting favorably. Doses of 50-60 drops three times daily should be used rather than 15 drops as recommended by Moebius.—R. G. H.
THYROID, Surgery of the—. Judd (E.S.), J. Iowa State Med. Soc. (Des Moines), 1917, 7, 405-407; St. Paul M. J., 19, 70-75.
In thyroidectomy Judd advocates leaving a small bit of the gland intact as well as the posterior capsule containing the parathyroids. With this procedure any tetany that may de- velop is of slight degree and easily controlled by the use of calcium lactate. The removal of all goitres presenting toxic Symptoms is indicated.—F. S. H.
(THYROID) Surgical treatment of goitre. Webb (C. W.), Clifton Med. Bull. (Clifton Springs), 1918, ..., 12-18.
Published elsewhere. Abst., Endocrin. 1919, 3, 115. (THYROID) Surgical treatment of Graves’ disease (Operative
Behandlung der Morbus Basedowi). Fabian (E.), Beitr. z. klin. Chir. (Tubingen), 1919, 115, 1.
430 ABSTRACTS
A long, technical diseussion of the subject embodying no new data.—2J. K.
(THYROID SYMPATHETIC N. §.) The pathological changes in the sympathetic system in goitre. Wilson (L. B.), Am. J. Med. Se. (Phila.), 1916, 152, 799-812.
For abstract of a later report on this work, see Endoerin., 1918, 2, 530.
(THYROID) The heart in myxedema (das Myxoedemherz). Ausmann (H.) Miineh. med. Wehnschr., 1919, 66, 9.
- In myxedema dilatation of the heart may be observed. It is not influenced by digitalis, but is promptly cured by thyroid administration. An illustrative case is described.—J. K.
(THYROID) The infiuence of amines on the nitrogen metabo- lism in the dog without a thyroid (Beitrage zur Kenntniss der physiologischen Wirkung der proteinogen Aminewirk- ung auf der Stickstoff-Stoffwechsel schildrtisenloser Hundes). Abelin (J.), Biochem. Ztschr. (Berlin), 1919, 98, 128.
The influence of phenylethylamine and para-oxyphenly- ethylamine on the nitogen metabolism of the dog without a thyroid was examined. The excretion of nitrogen is increased, diuresis occurs and the animal loses weight. These amines derived from protein have the same action as does the admin- istration of the thyroid gland itself. This points to the fact that the amines have a great biological interest. It is prob- able that the active principles of the thyroid are not the pro- teins but the amines derived from them.—J. K.
(THYROID) The medical treatment of Graves’ disease. Gord- inier (H. C.), Dominion M. Monthly (Toronto), 1918, 51, 49-59: Therap. Gaz. (Detroit), 1918, 24, 390-96.
Published elsewhere; abstracted Endocrin., 1919, 3, 117.
(THYROID) The medical treatment of exophthalmic goitre. Rice (J. F.), Med. Press (Lond.), 1918, n. s. 106, 236-38.
Published elsewhere ; abstracted Endocrin., 1919, 3, 103.
(THYROID) The prevention of simple goitre in man. Kimball (O. P.) and Marine (D), Arch. Int. Med. (Chgo.), 1918, 22, 41-44,
Published elsewhere. Abst., Endocrin., 1918, 2, 204.
“ABSTRACTS 431
(THYROID) The value and limitation of radiotherapy in in- ternal medicine. Boggs (R. H.), Med. Fortnightly (St. Joseph), 1918, 50, 55.
Simple goitres are greatly benefited by radiotherapy. Cases of exophthalmiec goiter should be handled carefully be- cause the thyroid may be entering a period of hypofunction while other structures of the body show apparent effects of hyperthyroidism. Radium gives results comparable to those of radiotherapy. One may easily follow the effects of the rays by noting a reduction in pulse rate and an increase in body weight. The patients improve rapidly. An increase in weight was noted in 50 per cent of the cases and a reduction of the goitre in two-thirds. Radiotherapy has proven notably satisty- ing in the management of adolescent goitres.—H. W.
(THYROID) Tratamiento de bocio por injectiones de agua herviendo. (Goitre treated with boiling water). Ceballos (A.) and Bacigalupo (G.) Prensa med. Argent. (Bs. Aires),
1917-18, 4, 285. Published elsewhere. Abst. Endoerin., 1, 536. (THYROID) Treatment of 1000 cases of goitre (1000 Kropf-
kranke aus der Garre’schen Klinik). Naegeli (T). Beitr. z. klin. Chir. (Tiibingen), 1919, 115, 69.
A general discussion of the topic bringing forward no new observations.—J. K.
(THYROID) Two cases of myxedema. Leonard (EK. F.) Inter- state M. J. (St. Louis), 1917, 24, 1171-74.
Case 1. Myxedema which developed the syndrome of exophthalmic goitre while under thyroid medication. With- drawal of the thyroid treatment, rest and tonics resulted in a return nearly to normal.
Case IJ. A patient suffering from myxedema with intoxi-
cation symptoms recovered under thyroid treatment.—H. W.
THYROID. Two cases showing the effect of the incidence of English measles upon pre-existing Graves’ disease. Jennings (H. C.), Laneet (London), 1918 (1), 906.
The writer reports two cases of measles occurring in pa- tients with a pre-existing Graves’ disease. In one, there were rather marked symptoms of Graves’ and the patient died dur- ing the course of measles. In the other, the symptoms of
432 ABSTRACTS
Graves’ were milder, but the attack of measles aggravated the condition so that four weeks later surgical intervention was necessary.—M. M. P.
(THYROID) Tracheomalacia and goitre (Tracheomalazie und Struma). Denk (W.) and Hofer (G.), Arch. f. klin. Chir. (Berlin), 1918, 110, 401.
From 1901 to 1917 in one clinic in Vienna 1967 patients were operated upon for simple goitre. In 8 of these it* was necessary to perform tracheotomy because of asphyxia. Four of these cases showed the classical anatomical picture of trach- eomalacia. The authors record 3 other cases not from this clinic.—J. K.
(THYROID) Thyreoidea und Menstruation. Weidenmann (M.) Ztsehr. f. Geburtsch. u. Gynak. (Stuttgart), 1918, 80, 419.
The author observed that the thyroid increases from one to two em. in size at menstruation, the increase beginning in the premenstrual period one or two days before and reaching its maximum growth on the first day of menstruation. With the cessation of the period the thyroid regains its original size. In the interval between two periods other smaller changes occur which may be attributed to ovulation.—¥. 8. H.
(THYROID) Uber die Ossifikationsstorungen beim endemischen Kretinismus und Kropf. Wegelin (C.), Cor. Bl. f. Schweiz. Aerzt. (Basil), 1915, 46, 609-25.
It is generally accepted that lessened funetion of the thyroid inhibits, while increased function promotes, skeletal growth. The history of the early work on myxedema and other hypothyroid conditions is reviewed by Wegelin. Cases of myxedema occurring spontaneously in children are due either to complete absence or rudimentary development of the thyroid. Complete absence in such eases has been, up. to the present, demonstrated in only eight cases. In other cases of so-called ‘‘athyreosis’’ aberrant thyroid tissue is present in the region of the ductus thyreo-glossus, most frequently at the base of the tongue. Such individuals may develop nor- mally, symptoms of cachexia thyreopriva appearing only after operative removal of the thyroid tissue. In other instances, hypothyreosis is present from the beginning. Individuals with aplasia or hypoplasia of the thyroid exhibit a well marked dwarfism and even when in mature years are short. The
.ABSTRACTS 433
oldest patient of this group—that of Bourneville—was thirty- seven years old, and measured 100 em. Hanan and Steinlin have shown that in the thyroidectomized animal fracture heal- ing is slower than in normal animals. On the contrary, observations have been made indicating that skeletal growth is promoted by hyperthyreosis. The relation between the thyroid function and certain disturbances of growth is not so elear. This is especially true of dwarfism in endemic cretin- ism. Some authors are inclined to believe that the dwarfism is not due to the hypothyroid condition, but rather that it is only a parallel symptom of the same underlying cause. Wegelin made a eareful study of this subject in seventy new born infants who came to autopsy at the Pathological Institute of Bern, which is a centre of endemic eretinism. The strikingly frequent absence of ossification centres in these new born babies he states is apparently an expression of an inhibitory influence which is widely scattered in that region. Only six babies had normal sized thyroids, weighing from one to three grams. The others were enlarged, there being many over ten grams, two weighing twenty grams, while one reached the enormous weight of thirty-nine grams. In the six cases with normal thyroids, there was only one with absent ossification centres. All the cases without ossification centres showed enlarged thyroids, although many showing normal ossification possessed a more or less large struma. Skeletal inhibition and the size of the thyroid, therefore, are not exactly parallel, for the function of the thyroid does not, of course, go hand in hand with its size. Wegelin concludes that in those regions where goitre is endemic it is common to see marked inhibition of bony development during the foetal period and that the prob- able cause of this inhibition is hypothyroidism.—E. N.
(THYROID) The use of electricity in the various forms of goi- tre. Myers (E.) Northwest Med. (Seattle), 1916, 15, 11.
Recommends strongly the treatment of hypothyroidism ac- companied by simple goitre by cataphoresis. Other types are not so amenable to this treatment.—J. P. 8.
(THYROID) Toxic goitre in a girl ten years old. Sawyer (A. W.) Ann. of Surg. (Phila.), 1916, 64, 371.-75. Report of a case which, except as to the age of the patient,
was not unusual.
THYROID, Traumatic lesions of the—and their surgical treat- ment (Lésions traumatiques du corps thyroide et leur traite-
434 ABSTRACTS,
ment chirurgical). Alamartine (H.) Presse Méd. (Paris), 1OL9,+ 2. LOT-8:
Of technical surgical interest. Three cases are discussed. —R. G. H.
(THYROID) Tuberculose et goitre exophthalmique. Creyx, J. de Méd. de Bordeaux, 1918, 89, 314-16.
A ease of exophthalmie goitre concurrent with pulmonary tuberculosis is described briefly, but discussed theoretically at some length.—R. G. H.
(THYROID) Zur Lehre vom Oedem (Theory of Edema). Klem- ensiewiez (R.) Archiv. f. Psych. (Berlin), 1918, 59, 842.
The author has carried out experiments on edema, ligating the blood vessels of the rabbit’s ear. It was found that edema is due not to a swelling of the tissue elements, but to accumula- tion of fluid in the intercellular spaces. Even though the edema has an immediate mechanical cause, the influence of diminished function of the thyroid cannot be denied. The best remedy is thyroid extract.—J. K.
THYROIDECTOMY, The technigue of—. Warnshuis (F. C.) Nurse (Jamestown, N. Y.), 1916, 247-56.
An illustrated account; elementary.—R. G. H.
(TONUS) Sympathetic tonus, vagotonus and hyperthyroidism. Troell (A.) Allmanna Svenska lakaretidningen (Stockholm), 1916, 138, 137-159.
Later published in English. See Endocrin., 1918, 2, 545.
UTERUS, The undeveloped—. Bonfield (C. L.), N. Y. State J. Med. (N.Y.), 1919, 19, 40.
Rudimentary and infantile uteri are rare and are usually found associated with development anomalies of the vagina. On the other hand the pubescent uterus is comparatively com- mon. The size varies from that which is almost infantile in its dimensions to that which is almost normal. The majority are sharply antefiexed, but an occasional one is equally sharply retroflexed. There is frequently a coincident lack of develop- ment of the ovaries which are prone to undergo cystic degener- ation while the woman is still young. Menstruation is late in being established and early in ceasing, making its first appear-
ABSTRACTS 435
ance at about 17 and its last before 40. Although the condition makes itself manifest with the approach of puberty the major- ity of sufferers do not seek medical attention until 19 to 24 years of age. Sufferers from pubescent uterus may be classed in three groups: First, the very small, frail woman almost a dwarf; second, the woman of normal size, possibly taller than normal, but thin, her limbs and body never having assumed the rounded contour which normally occurs at puberty; third, the large robust woman of somewhat masculine build. Hered- ity can play no marked role in the cause of this disturbance, since most marked eases are sterile. Sisters may have normal uteri. Acute infection at puberty seems to be the most likely etiological factor, especially in the second type. The first class are sufferers from faulty functioning of the ductless glands.
Cases should be treated with extracts of the thyroid, pitui- tary and ovarian tissues. Good results are obtained in cases that menstruate infrequently by giving thyroid extract for 2 to 3 weeks, then stopping it and giving ovarian extract for a week. In severe cases the patient should receive two ampules of corpora lutea hypodermically on the day before expected menstruation. If the patient does not menstruate she should be put back on thyroid extract until the following period is expected. After the patient has menstruated a few times the hypodermic injections are withdrawn, but the thyroid and ovarian extracts continued until the habit of menstruation is well established. Dilation, curettage and packing sometimes greatly benefit cases where the lack of development is most evident.—H. W.
Fibroid UTERUS treated by X-rays. Stoney (Florence A.) Brit. Med. J. (Lond.), 1917, 2, 723.
A married woman aged 42 had a bilobed fibroid of the whole wall, causing discomfort from its size, with constant backache and pressure symptoms. During three months she received eight X-ray treatments, each of two to three pastille doses, filtered. The monthly periods were regular before treatment. Under X-rays she had one heavy followed by two ordinary periods, and they stopped entirely after the sixth treatment.
The fundus was 414 inches above the pubes. During treat- ment it was reduced to 234 inches, and three months later was only 2 inches above the pubes. In width the tumor was reduced from over 5 inches to 4 inches during treatment, and since then has become reduced another inch.
£56 ABSTRACTS
The front wall was bulged out so that the distance from pubes to umbilicus was 714 inches at first; this has come down to being flat, and now measures 6 inches. Except during the first monthly period, the woman has not been in bed for a day since treatment was begun; she became well and strong and very pleased with the final result. In three other cases similar results were secured; in one the menopause was brought about, but in the other two the periods were only reduced in quantity.
—R. G. H.
(VAGOTONIA) The cause of Addison’s disease and sclero- dermia (Zur Aetiologie der Addisonschen Krankheit und der Sklerodermie.) Gerson (H.), Berl. Klin. Wehnschr., 1918, 55, 1211.
Gerson reports that people with Addison’s disease and with sclerodermia exhibit *‘Vagotonia.’’ The treatment should be directed toward this condition. Diagnosis is easy. People having “‘vagotonia’’ are egotists——hard, rough and impolite whereas “‘sympathicotonics’’ are sweet in disposition and very polite. (One suspects that this nonsensical article is an inten- tional satire. If so, it is splendid.)—J. K.
The abstracts in ihis number have been prepared by the staff assisted by:
E. Hood, New York.
Margaret M. Hoskins, Minneapolis.
L. G. Kilborn, University of Toronto.
E. Novak, Baltimore.
M. M. Portis, Chicago.
J. P. Simonds, Northwestern University, Chicago. Burton T. Simpson, Buffalo, N. Y.
With the permission of the editors, certain abstracts have been quoted from ‘‘Physiological Abstracts,’’ ‘‘Chemical Ab- stracts’’ and “‘Surgery, Gynecology and Obstretrics.”’
PeoOCRINOLOGY
THE BULLETIN of the ASSOCIATION for the STUDY of
INTERNAL SECRETIONS
OCTOBER-DECEMBER, 1919
A
THE ROLE OF THE PINEAL IN PEDIATRICS REVIEW OF THE LITERATURE
Murray B. Gordon, M.D.
Assistant Clinical Professor of Pediatrics, Long Island College Hospital, Brooklyn, N. Y.
(From the Department of Pediatrics, Long Island College Hospital.)
The pineal body is a small cone shaped organ about 5 mm. in diameter, attached by a short stalk to the posterior boundary of the dorsal surface of the third ventricle. It varies in size, shape and pigmentation and does not stand in any proportional relation to either the size of the brain or of the body. Cytological studies by various investigators support the view that it has lost all the structural characteristics of a sense organ and that it pos- sesses those of a gland, containing secreting cells and probably some nerve cells. Pende claims that it is connected by means of medullated nerve fibres with the diencephalon and the mesen- cephalon.
The greatest post-natal development takes place during the first few years of life, this being followed by physiological invo- lution of the gland. The age at which this retrograde change takes place has not been fully established, Biedl claiming that it is at seven years, while Cushing places it at the time of puberty. This retrogressive process is not considered by McCord or Krabbe to be a complete degeneration, but a change in the nature
438 PINEAL IN PEDIATRICS
of the cells which still permits of some function in the adult, the latter stating that involution signs at 90 are no more pro- nounced than at 14.
The retrograde changes as described by Krabbe are an in- crease in the connective tissue, the formation of concretions, neuroglial plaques, cysts and cells of disintegration. Recent observers have found the presence of small cysts so constant as to make them feel that cyst formation is part of normal invo- lution. Marburg believes that the first sign of involution of the pineal is the appearance of brain sand. This sand or acervulus cerebri has been found as early as 7 years of age by the majority of observers. Uremura found it in a child as young as 4 years. The coneretions are first found in the glia layer, which covers the habenular commissure and are composed of calcium e¢ar- bonate and calcium phosphate. As age increases, the connective tissue increases at the expense of the glandular element. Through apposition and fusion the concretions may assume various shapes and sizes, the latter ranging from the size of a leucocyte to that of one-third of the gland. Calcification occurs in the normal process of involution, increases with age and has no physiological or pathological significance except in the young under 7 years of age... In this case, the concretions may be evidences of an early involution of the gland and give rise to symptoms of insufficiency of the pineal secretion.
EXTIRPATION
The successful extirpation of the pineal is attended with many difficulties due to the changes incident to the severe operative procedure necessary because of the anatomical rela- tions of the gland, producing thereby injury to the brain and hemorrhages from the venous sinuses. There is always a pos- sibility of an incomplete removal of the gland with the pro- duction of inflammatory changes in the remaining portion with a resulting increase in the pineal secretion. The contrary find- ings at the hands of some investigators may perhaps be explained on this basis, as was demonstrated by Sarteschi, who autopsied his animals which had previously been subjected to pinealectomy by himself and found that portions of the gland had been left behind. While portions are undoubtedly left behind in some in- stances and under the whip of inflammatory processes may be-
GORDON 439
come unusually active, still any wide generalization on this basis is unjustified unless supported by more significant facts.
It seems that the pineal in rabbits and guinea pigs cannot be removed in life without rupturing a number of large venous sinuses around and under it and to destroy it completely. the cautery must be used. Horrax feels that some of the symptoms following the operation may be attributed to injuries incident to the pinealectomy.
The difficulties of extirpation are shown in the attempts of the early investigators. Sarteschi in 1911 experimented with the cautery on eleven animals, with unsatisfactory results. Later, by means of the knife and ligation, he succeeded in removing the gland from two puppies and three guinea pigs. One puppy was said to have gained in weight over his control and also to have shown accelerated sexual development. On autopsy, it was found that the testes were larger. The other puppy had no control. In the guinea pigs there was an increase in the body weight and an enlargement of the testes in one animal over the control. No changes were found in any other gland of in- ternal secretion. His findings are similar to those of Foa, who found in his first series that rabbits were unsuited for pinealec- tomy, but later succeeded with chicks in having three cocks and twelve hens live to maturity. No changes occurred in the hens. The cocks showed evidences of hastened maturity in hyper- trophy of the testes and combs as compared with the control. He confirmed these findings two years later, but in his second series did not obtain any symptoms until five months after the operation and no effects on the general development until nine months after. He also obtained similar results in rats.
Horrax found that total pinealectomy was possible in guinea pigs and rats, but not in cats, dogs and rabbits. Pinealectomized male guinea pigs showed a hastened sexual development mani- fested before puberty by a relative increase in size and weight of the sex organs. On microscopic examination, sections of the testes and seminal vesicles showed a more advanced physiological state than the controls before the age of maturity, though this was not as marked as would be expected. Very few differences were noted in animals which were experimented on after they had passed maturity. There was no great variation in the body weights of the subjects and the controls and not much between
440 PINEAL IN‘ PEDIATRICS
the male and female in this respect. Im keeping with the find- ings of other investigators, there were no changes in the size or weight of the sexual organs in the female, either on gross or microscopic examination. The pinealectomized females appeared to show a tendeney to breed earlier than the controls of the same weight and age. He also obtained some evidence of has- tened maturity with rats after the removal of the pineal gland.
Contradictory results with extirpation were obtained by another group of investigators. Boese and Exner, by the cautery method in 1911, did not obtain any results following the removal of the gland in a series of ninety-five rabbits, only six of which survived to maturity and in these nothing could be demonstrated as abnormal. Biedl’s findings in the following year confirmed this.
Dandy, after several attempts at extirpation by the old methods, finally succeeded in a complete removal of the gland by a new method which consists in approaching the field through the section of the corpus callosum, thereby obviating trauma at the site of operation. He proved by sections of the surrounding tissue that no portion of the pineal had been left behind. He did not have any mortality in any of his animals. His results led him to believe that the pineal gland is apparently not essen- tial to life and seems to have no influence on the well being of the animal. Following the removal of the pineal, he observed no sexual precocity, indolence, adiposity, emaciation, somatic or mental precocity, or retardation. He feels that his experiments have yielded nothing to sustain the view that the pineal has any endocrine function of importance in either very young or old dogs. He also examined various ductless glands microscopically and macroscopically after the operation and failed to find any abnormal changes anywhere. In harmony with this, Fenger found that extirpation of the pineal had no influence on the health of cattle, sheep and lambs. Adler claims that the pineal does not exercise in the frog the same functions which were indi-
cated by Foa in the chick. FEEDING EXPERIMENTS
There have been a limited number of feeding experiments with the pineal, but without furnishing any absolute findings as to the real physiological action of the gland. De Cyon, Howell, Boese and Exner, Dana and Berkeley, Fenger and also Cushing
GORDON 44]
obtained negative results on blood pressure and the circulation with intravenous injections of the aquaeous extract. Jordan and Eyster found no action on the pulse or on the excised heart as a result of their work and only a slight fall in the mean arterial pressure due to dilation of the intestinal arteries with a moderate and transitory diuresis and glucosuria. Horrax obtained a rela- tively slight but constant fall in the blood pressure. Intra- venous injection caused no increase in the flow of cerebrospinal fluid. Dixon and Halliburton also found that there was a lower- ing of the blood pressure with large doses, but none with small doses. Ott and Scott reported a vasodilatation in the male geni- talia of cats; there was first a lowering of the arterial pressure, then a rise, causing glycosuria, diuresis and increased kidney volume through vasodilatation, also a slight effect on the con- tractile power of the uterine and intestinal walls.
The effect of feeding pineal on the body weight and men- tality was studied by Dana and Berkeley. These observers, using the glands of young bullocks, noted that intraperitoneal injection of pineal extract produced a marked increase in size and weight in guinea pigs, rabbits and kittens. In the latter animals, there was also a rapid growth in intelligence and re- sistance to intercurrent disease in the subjects over the controls.
Recent work by McCord strengthens their findings and tends to show that the feeding of pineal extract to young animals produces changes which are similar to those which were thought to be due to deficiency of the gland, and are contrary to the belief that the pineal secretion holds in abeyance too rapid somatic, sexual and mental development in early life. McCord observed that the feeding of fresh pineal gland produced a dis- tinct increase in the general distribution of adipose tissue and in the size of the animal, this never going, however, beyond that of the adult. He noted that the effect of the pineal became less as the animal approached adult size, becoming inert after maturity had been reached. There was at no time any tendency to gigantism. There was a perceptible difference in intelligence between the subjects and the controls. The pineal-fed puppies were one month ahead of the controls in their habits; they were the first to learn to lap milk, to respond to call, and the first to be able to find their way back to the kennels. When the experiments were discontinued, the pineal fed puppies were
442 PINEAL IN PEDIATRICS
more in demand than the controls, the purchasers having no knowledge of the investigations. Some of the subjects were autopsied and microscopical examinations made of the testes; these showed maturer and larger tubules than were found in controls of the same age. In these experiments, better results were obtained by using the pineals of cattle which had not yet reached maturity. The response was more definitely manifested in males than in females. McCord concluded that feeding of pineal leads to a more rapid growth than normal and determines an early sexual maturity.
E. R. Hoskins, on the other hand, did not obtain any effeet on growth or body weight by feeding pineal to albino rats.
The only feeding experiments with children are those re- ported by Dana and Berkeley which were undertaken by Cor- nell and Goddard. In the first joint report, the latter recorded the effects of pineal feeding in a series of twenty-five subjects and a like number of controls. All the children were delinquents. It was found that the gland was of benefit in cases of simple retard-
sation without any organic changes, but useless in mongolians,
congenital idiots, or defectives of 15 years of age. The beneficial. results were in ‘inverse proportion to the degree of physical defect present; the greater number of stigmata in the patient, the less the effect, and vice versa. There was an increase in mentality and physical development in the subjects, except in the weight, in which there was a slight reduction below that of the control. The authors felt that they could not be certain of any mental defect in the children which might be ascribed to either deficiency of the pineal secretion or to apinealism.
Berkeley found that when pineal gland was fed to babies, it caused an increase in metabolic activity as evidenced by an increase in nitrogen elimination in the urine.
Goddard in a later communication modified the original conclusions as a result of the further observations on one of the girls in the series. This subject was 8 years old at the onset of the original investigations, with a mentality of 3 years and at the close, she tested 4, a gain of one year in four months. Because of this improvement in mentality, she was selected for further observations. She was studied, weighed and tested under ordi- nary institutional environment and then taken to the laboratory to live under a special diet and care. After her normal curve
GORDON 443
had been established, she was fed pineal for six months; this was then discontinued and she was placed under observation for another six months. At the time of the second report, it was fifteen months since the experiments had ceased and twenty months since the last administration of pineal gland. There were no marked changes in her growth curve during the period of feeding nor was there any after effect noted in the physical condition. Her mentality had reached the level of a 5-year-old child during the course of the second investigation, but had not progressed any further than this for months previous to the time of the report. Goddard therefore felt that the effects of pineal on this case were nil. He also incorporated observations on two cases of Mongolian idiocy, confirming his earlier findings
as to the inefficiency of pineal in this condition. PINEAL NEOPLASMS
There are several varieties of tumor of the pineal which have been found on post-mortem examination. The most frequent type is the pineal cyst which can be subdivided into two groups: (a), involution, formed by the degeneration of areas of pineal substance due to sclerosis of the blood vessels and (b), re- tention, arising from the recessus pinealis and lined by ependyma cells, the latter distinguishing this group from the first.
The next frequent variety of tumor is the teratoma. This type occurs almost exclusively in children under 15 years of age, Neumann’s patient of 27 being the only reported exception. This class is found in the most anterior portion of the gland and has led Askanazy and others to ascribe their origin to the funda- ment homologous with that of the parietal eye of the lower ver-’ tebrates. Marburg confirms this theory by his discovery of the remains of the ‘‘nervus parietalis’’? and ‘‘ganglion parietale’’ in this portion of the gland, in the neighborhood of the teniae habenulae. The elements of this tumor are those generally con- tained in teratomata. Cases of teratoma have been reported by Weigert, Coats, Falkson, Ogle, Gauderer, Gutzeit, Hueter, Frankl-Hochwart and Bailey and Jelliffe.
Among other varieties of tumor reported and classified by Marburg as mixed tumors are glioma (Duffin, Lawrence), sar- coma, carcinoma and psammoma (Friedrich, Blanquinque ).
Ziegler considers that the most frequent and common abnor- malities of the pineal are hyperplasia, cyst formation and
444 PINEAL IN PEDIATRICS
psammoma. Hyperplasia should not be confused with true hypertrophy of the gland in which there is an increase in the size of the cell.
Other diseases than tumor which are mentioned in the ht- erature are hemorrhage (Simon, Ziegler), abscess (Birsch, Hirschfeld quoted by Marburg), syphilis (Lord), tuberculosis, and xanthochromia. The latter are usually associated with an increase in the cellular and protein elements of the spinal fluid, particularly fibrinogen, this producing the so-called ‘‘ massive coagulation’’ consisting of a yellowish fluid with a small number of lymphocytes and a large number of red blood cells.
SYMPTOMS OF PINEAL TUMOR
There are seventy cases in the literature which have been accepted as being those of neoplasms of this gland. Bailey and Jelliffe in 1911 collected all the cases (59), analyzed them in an admirable paper and added one of their own; since then about ten more have been published. Of the sixty studied by these authors, seventeen were in children under the age of 14, thirteen of these being in boys and four in girls, thus disproving the statement of some that this condition is hmited to the male sex. Unfortunately the majority of the cases were reported with inadequate histories, statistics and clinical observations so as to render a restudy of them very difficult, especially in the hght of present day endocrinology.
Neoplasms of the pineal give rise to two groups of symp- toms, according to Bailey and Jelliffe: (1), neurological and (2) metabolic. This classification is the most feasible one and may include Marburg’s latest headings of (a) general symptoms due to pressure and (b) neighborhood symptoms under - the neurological, and his third class of constitutional symptoms under metabolic.
Both groups of neurological and metabolic changes arise from the encroachment of the neoplasm on the intracranial con- tents and are indicative of disturbances in pressure, in plaee- ment and in destruction of tissue. Such changes may occur at any time of life, but when they take place before puberty, they give rise to metabolic symptoms and are referable to disturb- ances of the secretory function of the gland. They may have neurological signs associated. Lesions occurring in adult life
GORDON 445
produce neurological symptoms and never any metabolic, as the pineal probably does not function after puberty.
The neurological symptoms are those usually found as a result of intracranial pressure from any tumor of the mid-brain or of the corpora quadrigemina and are exceedingly difficult to diagnose, per se, as arising from pineal disturbances. The first symptom is usually headache, which varies in location but is generally occipital at the onset, becoming diffuse later. There is neuralgic shooting pain. Vomiting, vertigo and optic neuritis are also present. Drowsiness is noticed, the degree depending upon the amount of hydrocephalus present. Symptoms referable to the eye muscles are lateral or vertical nystagmus, paralysis of individual muscles of the eye and other ocular motor dis- turbances. Ataxia may assume a prominent part in involvement of the cerebellum.
Enlargements of the pineal gland, because of its anatom- ical position, will produce primarily circulatory disturbances with a subsequent formation of various degrees of hydroceph- alus. The development of the hydrops may be very rapid or very slow, being conditioned by at least two independent factors, pressure on the veins of Galen and obstruction to the aquadnet of Sylvius. Cushing feels that any pineal tumor of any con- siderable size must lead to a secondary hydrops ventricularum and to stasis of the posterior lobe secretion. Bailey and Jelliffe think there is reason to believe that growths in this region fur- ther stimulate the production of cerebro-spinal fluid and that this may enter as an additional factor in the development of hydrocephalus.
The metabolic symptoms are: (a) adiposity, (b) sexual changes, (c) cachexia. The adiposity is independent of the character of the tumor and is not confined to teratoma. It is difficult to determine in many cases whether the adiposity is due to disease of the pineal or of the hypophysis, as there is marked hydrocephalus of the third ventricle with both. It has not as yet been determined whether or not pineal tumors alone can produce adiposis apart from a hydrocephalus of the third ven- tricle. The three leading views on the production of the adi- posity are: (1) That put forth by Marburg, that it is an ex- pression of overfunctioning of the pineal gland, (2) that it may be due to a pineal tumor supposedly producing a hypopinealism
446 PINEAL IN PEDIATRICS
and (3) Cushing’s contention that it is due to secondary changes in the hypophysis brought about by pressure exerted by the hydrocephalus. Against Marburg’s idea of a hyperpinealism is Kidde’s statement that ‘‘adiposity occurs in so many other con- ditions and its mode of production is still so obscure, that we must conclude that it is uncertain whether hyperpinealism in man ever causes adiposity per se.”’
As the pituitary body was not examined in the majority of cases of pineal tumor in the literature, it cannot be shown by proper statistics just what relationship this gland holds to the syndrome. In some cases, the hypophysis had been much com- pressed, but in other instances, the structure was normal. Bailey and Jelliffe feel that in a hydrocephalus there is pressure exerted on the infundibulum and therefore on the pituitary. Cushing thinks that as any pineal tumor of any appreciable size leads to a secondary hydrocephalus, it may ultimately be expected to give symptoms of pituitary deficiency. He makes the statement that symptoms of supposed hypopinealism have been observed only in connection with tumors of the gland which have led to an obstructive hydrocephalus, and this, of necessity, to secondary hypophyseal disturbances. While he considers that the adiposity is an expression of hypopituitarism, Cushing concedes that pineal enlargement, whether associated with hyperplasia or hypoplasia, may be provocative of obesity.
Schafer thinks the condition found with pineal tumors sug- gests the probability that the adiposity is due to hyperpinealism and similar to that found with hypopituitarism.
Sexual changes—The sexual syndrome accompanying pineal tumors consists of (1) an early sexual development, evidenced in enlargement of sexual organs, pubic hair, general body hair and change in voice to that of the deep masculine type; (2) pre- cocious mental development manifested by maturity of thought, mind and speech; (3) general body overgrowth to the extent that a child of 5 or 6 years may have the appearance of one of 11 or 12. This syndrome is not limited to boys, but when present in girls, it does not involve any primary sex changes, but does show secondary changes as menstruation, enlarged breasts and pubie hair. Masturbation may be present in both sexes. Bailey and Jelliffe state that the reason for this syndrome may be one of the following: (a) Early sexual development may be anal-
GORDON 447
ogous to acromegaly, in other words, that it is due to hyper- pinealism; (b) Askanazy’s suggestion that teratomas are false conceptions in which one might expect an increase in the pineal secretion; (¢) Precocious sexual development may be an early irritative sign of a purely nervous character acting through the pars nervosa sympathetica, which is very rich, and that later, increase in pressure brings about degeneration or atrophic phe- nomena (Bailey and Jelliffe) ; (d) Due to dyspituitarism which results from lessened pituitary secretion following pressure on the infundibulum (Cushing).
Cacheria—lt has not as yet been determined whether or not this has any relation to the pineal, to the hydrocephalus or to the tumor itself. Marburg thinks that the cachexia is due _ to apinealism, while McCord considers it a secondary symptom.
Pellizi, Schuller, Frankl-Hochwart and others described this syndrome, to which some have given the name of macro-geni- tosomia praecox, as occurring in cases Which, upon autopsy, showed a tumor of the pineal gland. It was the general con- sensus of opinion among the early observers that these symptoms were the clinical manifestations of a destructive lesion of the pineal gland, most usually a tumor, which could be interpreted as the end results of a lessened pineal secretion (hypopinealism ), on the assumption that the function of the gland was to inhibit the overgrowth of the sexual organs and instinct beyond the normal.
Since then McCord, following his repeated experiments of feeding pineal gland to animals, has raised a pertinent question as to the correctness of this interpretation. He makes the asser- tion that the pineal syndrome is due to an increased pineal secretion (hyperpinealism), claiming that the cells of the neo- plasm involving the pineal may retain some of the metabolic and other functional characteristics of the normal gland from which they are derived. He calls attention to the possibility of the pineal tumor leading to an active, constructive, stimulating influence as being suggestive in the cases reported by Marburg, Polavani, Oestreich and Slawyk, and Askenazy. The last three observers also felt that there was an increased activity of the pineal secretion, for Oestreich and Slawyk stated that early sexual maturity could be regarded as being due to a hyperpin- ealism, analagous to the relationship of acromegaly to hyperpitu-
448 PINEAL IN PEDIATRICS
itarism. Askenazy’s idea of teratoma as false conceptions would make one expect, primarily at least, an increase in the secretion of the pineal cells. To strengthen his contention, still further that tumor cells frequently function after the manner of the cells from which they arise, McCord quotes the findings of Weber, Rolleston, Wheeler, Ribbert and others that functional activity of tumor cells are not infrequent. Hinds Williams in 1910 reported three cases of pineal tumor, in which he noted the similarity of these tumor cells in many instances to those of the normal pineal gland.
Morse analyzed the cases in the literature as to the time of the appearance of the first sign of pineal involvement and arrived at the conclusion that there was no general rule governing either the time of onset or the type of symptoms. The symptoms of physical and sexual over-development may precede those of the tumor, as in the case of Oestreich and Slawyk; or the physical signs may appear alone, as in the case of Frankl-Hochwart; or the disturbances due to the tumor may be the first manifestations, as in Raymond Claude’s case. The time of appearance of symp- toms varied from a few years to four weeks (Stanley’s case) from the onset to death.
Timme feels that disturbances of the pineal play an impor- tant part in the pathogeny of progressive muscular dystrophy, basing his opinion upon the shadows of the pineal obtained by X-ray examination of the skull, and by changes produced by the tumor and by diseases of the pineal on muscles and tissues of the body. He sees a marked resemblance in character between these changes and the signs of progressive muscular dystrophy. He could discern shadows in the pineal gland and a crowded pituitary fossa in patients whom he considered to be in the transition stage from the second to the third periods in his new pluriglandular syndrome. Timme thinks that the onset of this syndrome is well before puberty, the symptoms of fatigability appearing and becoming more marked with an increase in weight and a rapid growth in height. in analyzing the symptoms of pineal disorder as found in the literature by Bailey and Jelliffe, Timme considers the following as being due to progressive mus- eular dystrophy: hypotonic condition of upper and lower ex- tremities, great weakness of lower extremities with loss of mus- cular power, marked disturbance.in gait of a waddling char-
GORDON 449
acter, weak general musculature, contractures of extremities and muscular fatigue. He cites cases of Bailey and Jelliffe, Massat, Feilchenfeld, Nothnagel, Zenner, von Hoesslin, Hempel, Jon- kovsky, Marburg, Hart, Raymond, Claude and Howell. Gowers is also of the opinion that progressive muscular dystrophy is a disease which has its inception before the age of 6 years and that the earlier it appears, the more severe it is.
Schuller was the first to demonstrate the identity of shadows in the pineal region by an X-ray examination of the skull with deposits in the gland. These shadows are due to calcification of the pineal gland and are quite frequently found. The charac- teristic appearance is a more or less dense shadow varying in size from a pin point to that of a split pea and situated 4 to 5 cm. behind and slightly above the level of the tip of the posterior clinoid process. In the vast majority of instances, this calcifica- tion is only an exaggeration of the deposit of brain sand nor- mally found in the pineal gland of adults and is accordingly more frequently found with advancing age. It is significant only when present in children, as it then shows a premature calcification of the gland which would be manifested clinically by the syndrome of hypopinealism.
Treatment of the tumor is unsuccessful. Horrax and others have attempted puncturing through the corpus callosum, but without any beneficial results. While the removal of the tumor, according to McCord, may be surgically possible, it is not to be considered in clinical cases as a promising form of treat- ment except under very unusual circumstances.
The relationship of the pineal gland to various types of insanities has been studied by Farrant. The work was based upon an assumption that toxemias play an important role in the insanities and that the endocrine organs suffer as a result of the toxemias. Faulty action of these glands in turn might be expected to add further to the abnormal chemical environment of the brain cells and thus aggravate the mental disorders. [His deductions were based upon a study of sections from 3000 autopsied cases. The pineal gland reacts to certain toxemias by an ultimate fibrosis. In primary and secondary amentia, atrophy of the pineal gland, hypophysis and thyroid were found in three classes of cases. In dementia praecox, an alteration was found which varied with the duration of the disease. Alterations and
450 PINEAL IN PEDIATRICS
degenerations were noticed also in dementia cases. In _ the manias, melancholias, maniac depressions and other insanities, changes, either hypertrophic or atrophic, were found in the thyroid, sexual and pituitary glands.
Chnical examinations were made in 1000 cases to determine from physical signs and symptoms the condition of the endo- erine glands. Manifestations of pineal disorders were noted in children and adolescents. Alterations in the size of the testes were found associated with other endocrine gland changes. The suggestion is made that if the glands are found to be atrophied, they should be compensated for by administration of the cor- responding endocrine gland product ; if hypertrophic, they should be allowed to involute. It is questionable how much benefit
could be derived in pineal eases. FUNCTION
Many hypotheses and theories have been advanced as to the probable function of the pineal gland.
It is generally accepted that the greatest post-natal develop- ment in the gland is in the first few years of life and that if it is at any time functionally active, it is so during that period. One group of investigators believe that the pineal produces a secretion which inhibits the growth of the body and restrains mental and sexual development from exceeding the rate accepted as normal for pre-adult life. This inference arises from the occurrence of the sexual and physical precocity accompanying ihe invasion of the pineal gland by a neoplasm, it being assumed that such a tumor destroys the pineal tissue and that the result- ant metabolic and neurological disturbances occur from lack of pineal secretion. This interpretation is attacked by McCord and by Dana and Berkeley, who found that these same symptoms of supposed hypopinealism were produced by feeding pineal gland io animals; these investigators accordingly are strongly of the impression that the symptoms of sexual and physical precocity are due to a hyperpinealism instead of to a diminished secretion.
De Cyon thought that the gland had a mechanical function of regulating the outflow and inflow of cerebrospinal fluid of the third ventricle. This theory has not been substantiated, although the finding of striped muscle fibres in the pineal of cattle by Nicolas and by Dimitrowa would attach some signifi- cance to this idea of a valve action.
GORDON 451
McCord and Allen demonstrated the presence of an active substance in pineal tissue by their feeding experiments with tadpoles in which they found that the gland produces a sub- stance capable of controlling pigment cell changes, a fact which, they suggest, may be correlated with a primitive visual function of the pineal.
Dana and Berkeley advance the hypothesis, which has not been substantiated, that the pineal furnishes a ferment or catalytic agent, facilitating the exchange of nutrient material in the cells of the brain.
Cushing considers the pineal as a gland of internal secretion having an unquestionable relation with other endocrine glands. He thinks that there is an antagonistic action between the hypo- physis and the pineal on sex and development.
Pende, Constantini, Urechia and Galascercu consider it an endocrine gland because of the granular nature of the pineal cells.
Dandy does not aseribe to the pineal any endocrine qualities. Gley does not include this gland in his book on ‘‘ Internal Secre- tions.’’ Park feels that it may be considered as an organ of internal secretion only on the strength of other organs of doubt- ful significance having been subsequently found to possess in- ternal secretions.
It is exceedingly difficult to arrive at any conclusive opinion as to the functional activity of the pineal. There has been nothing substantial brought forward to show that it possesses an internal secretion. The experimenal work has failed to prove that it possesses a function and no experimental studies are so complete as to allow comparison with the very striking syndrome seen clinically. If the views of Horrax and others that the yineal controls the inhibition of sex growth were true, then pineal feeding should postpone adolescence, but observations by Dana and Berkeley and by MeCord produced the opposite. On the other hand, if the feeding results of McCord are correct, then the extirpations of Dandy and Horrax ought to have brought overwhelming evidence of a pineal function. In the final analysis, it seems justifiable at the present time to state that our knowledge of the function of the pineal is more prob- lematie than accurate.
452 PINEAL IN ' PEDIATRICS
ORGANOTHERAPY
Rational and scientific treatment by means of pineal gland substance or extract is at the present impossible, in the light of our meagre knowledge of the functions of the gland. Any organotherapy with this gland must remain experimental until this uncertainty is removed by future investigations.
Dana and Berkeley used gland substance prepared by tak- ing twelve pineal glands of 2 to 3-year-old bullocks, ground with an equal amount of milk sugar and distributed in 100 capsules. Hach capsule corresponds to 150 pounds of bullock live weight. The physiological dose for a child of twenty-five to fifty pounds was regarded as one to two capsules daily after meals. For children who cannot swallow capsules, they may be opened and spread on bread or given directly.
The use of pineal extract in doses of one-twentieth of a grain two or three times a day is being advocated by some for delinquent children who do not show any deficiency in the thyroid or pituitary hormones, and without any organic changes, to be administered alone or in conjunction with the other gland extracts.
BIBLIOGRAPHY
3ailey (P.) and Jelliffe (S. E.): Tumors of the pineal body. Arch: Int. Med: L9mI 8-35:
Bartlett (IF. K.): A ease of acromegaly with polyglandular syndrome, with special reference to the pineal gland. arch. Int. Med. 1913, 127-201.
Bell (H.): Hyperplasia of the pineal body. J. Nerv. & Ment. Dis., 1916, 44, 481.
Berkeley (W. N.): Use of the pineal gland in the treatment of certain classes of defective children. Med. Ree., 1914, 85, 513.
Boas (E. P.) and Scholz (T.): Calcification in the pineal gland. Arch. Int. Med., 1918, 21, 66.
Cushing (H.): The pituitary body and its disorders. J. B Lippineott, Philadelphia, 1912.
Dana (C. L.) and Berkeley (W. N.): Funetions of the pineal gland: Med. Rec., 1913, 83, 835.
Dandy (W. E.): Extirpation of the pineal gland. J. Exp. Med., 1915, 22, 237.
Farrant (R.): The causation and cure of certain forms of in- sanity. Brit. Med. J., 1916 (1), 882. Quoted in Editorial, Endocrinology, 1918, 2, 452.
GORDON 453
‘Fenger (F.): Composition and physiological activity of the pineal gland. J. Am. M. Assn., 1916, 67, 1836.
Goddard (H. H.): The Vineland experiment with pineal gland extract. J. Am. M. Assn., 1917, 68, 1340.
Horrax (G.): Studies on the pineal gland. Arch. Int. Med.,
1916, 17, 607; 1916, 17, 627.. Endocrinology, 1917, 1, 243.
Hoskins (E. R.): Growth as affected by feeding thyroid, thy- mus, hypophysis and pineal substance. J. Exp. Zool., 1916, 21, 295. Endocrinology, 1917, 1, 69.
Jordan and Eyster: Am. J. Physiol., 1911, 29, 485. Endo-
erinology, 1917, 1, 243.
MeCord (C. P.): The pineal gland in relation to somatic, sex- ual and mental development. J. Am. M. Assn., 1914, 63, Zeal. 65;75 17.
McCord (C: P:): The pineal gland. Interstate Med. J., 1915, 22, 354.
MeCord (C. P.): The pineal gland. Surg. Gyn. &- Obstet., 1917, 25, 250.
McCord (C. P.) and Allen (F. P.): Funetion of the pineal gland in relation to pigmentation. J. Exper. Zool., 1917, 23, 207; Endocrinology, 1917, 1, 69.
Morse (J. L.): Case of abnormal physical and sexual develop- ment in an infant of two years, probably due to a tumor of the pineal gland. Arch. Ped., 1913, 30, 179.
Pende: Endocrinologia-Patologia e Clinica, Milan, Vallardi; Endocrinology, 1918, 2, 42.
Schafer (EK. A.): An introduction to the study of the endo- erine glands and internal secretions. Lane Medical Lec- tures, Stanford University, California, 1914, 79.
Timme (W.): Progressive muscular dystrophy as an endocrine disease. Arch. Int. Med., 1917, 19, 79; Endocrinology, 1917, 1, 246.
Timme (W.): A new pluriglandular compensatory syndrome. Endocrinology, 1918, 2, 209.
Uremura: Die Glandula Pinealis, Frankfurt. Ztsch. f. Path. (Weisbaden), 1917, 20, No. 3. Abst. Endocrinology, 1918, 2, 67.
Vineent (S.): Internal secretions and the duetless glands. Ed- ward Arnold, London, 1912.
Warren (lL. F.) and Tilney (F.): Tumor of the pineal body with invasion of the mid brain, thalamus, hypothalamus and pituitary. J. Nerv. & Ment. Dis., 1916, 45, 74; Endo- crinology, 1917, 1, 146
4402 Twelfth Avenue.
CO-OPERATION BY INTERNIST AND SURGEON IN THE TREATMENT OF GRAVES’ DISEASE
H. Lisser, A.B., M.D.
Instructor in Medicine, University of California Medical School, San Francisco
It is generally recognized that exophthalmie goitre is by no means an uncommon malady. It is likewise known that patients suffering from this hyperthyroid activity are distressed by many disagreeable and disabling symptoms. These are sufficiently un- pleasant even in mild cases, but may progress to a state of such severity that life itself becomes endangered. It is also known that proper treatment is oft attended by brillant cure, and in the majority of instances, at least, by striking amelioration of symptoms. It is the purpose of this article to consider briefly by what method of treatment or combination of methods, this consummation may best be realized.
In a general sort of way, treatment may be divided into:
1. Operative procedures ; 2. Medical measures, including Roentgen radiation ; 3. A judicious combination of 1 and 2.
1. Treatment by Operation: At the outset it must be frankly admitted that the most rapid, permanent and spectacular results are achieved by surgery. There can be no question of such a contention. No medical maneuvers, however skillfully executed, can quite approach the prompt decisiveness of surgery. Consequently and naturally, some surgeons insist that operation should be the only method employed. They would not concede a place for medical procedures. And, indeed, a few internists frankly agree with them, and are sincere in this conviction, to the extent that they make it a rule to transfer their hyperthyroid patient to the surgeon as soon as they have made the diagnosis. No issue could be taken with this viewpoint, if the surgery of Graves’ disease were a comparatively harmless procedure at- tended by a very small, negligible mortality. Terry recently reports 264 cases of hyperthyroidism operated by him with 10 deaths, a mortality of about 4 per cent, and modestly considers
454
LISSER 455
this rate higher than it should be. The Mayos, Crile, Halsted, Kocher of Berne and many others ean probably claim equally excellent results. And in the hands of such experts thyroid surgery is reasonably safe. But it would probably be conserva- tive to estimate the average mortality of the great majority of surgeons as at least 10 per cent, and it is probably much higher. Thyroid surgery is difficult surgery. It demands technical skill, not only, but what is even more important, a ripened judgment as to the best time to operate, and how much to operate; whether merely to ligate one or more thyroid arteries, or remove one or both lobes. By and large, therefore, we have to deal with a mortality of at least 10 per cent, with an item, therefore, of considerable significance. If surgery were our only resort, and no other measures available, we would necessarily have to be con- tent. But certain other procedures are available and not un- worthy of consideration.
2. Medical Measures including Roentgen radiation:
(a) Prolonged Rest:
Physical exertion, mental strain and emotional excitement are all injurious to the hyperthyroid patient; obviously, then, the removal or reduction of these factors by ‘‘rest cure’’ con- stitutes a form of therapy of considerable value. It is beside the point here to elaborate the details of such procedure. It re- quires painstaking attention to ‘‘small things’’ and in their exe- cution demands the services of the unusual nurse, one who com- bines tact with firmness, charm with skill, who finds delight in ministering to the mental and physical comfort of the patient, who radiates cheer and inspires confidence. The catabolism of these patients is excessive. Their metabolic fires burn fever- ishly ; consequently they lose weight. Even though their appe- tite be excellent (which it usually is) and their calorie intake high, their combustion furnaces spare but little for body weight. Consequently they feel warm in rooms where the normal person feels chilly. Absolute rest in its best sense, is therefore an im- portant form of treatment. It helps to slow metabolism, re- duces diarrhoea, diminishes sweating, soothes the nervous emo- tional excitability, quiets the thyroid heart and adds body weight. A real rest cure, skillfully managed—even without medication or X-rays—is often all that a mild case requires for restoration to normal health, and moderately severe cases undergo astonish-
456 TREATMENT OF GRAVES’ DISEASE
ing improvement ofttimes. This medical measure has, however, decided limitations, chiefly social and economic. <A _ stenog- rapher, a clerk, in fact any patient who must work for a living and continue doing so, can afford neither the time nor the ex- pense involved. For it takes much time and some money if it be done properly. Nor can a mother with many domestic cares and responsibilities be permanently benefited by rest cure, if she carry her worries into the rest cure, and if she knows that she must return afterwards to the same physical, mental and emotional strain that contributed to her illness. This form of medical treatment, therefore, though it possesses real merit, must be restricted to selected cases.
(b) The tce bag:
Cold applied to the vascular goitre in the form of a collar ice bag encircling the neck, and an ice bag over the heart, is a simple measure not to be overlooked. Though it is difficult to estimate just how much good it accomplishes, it would seem to be beneficial and is frequently greatly appreciated by the pa- tient. Parenthetically, it may be stated that the ice bag must not be applied continuously for too long a time, or it may pro- duce consequences of its own that are quite unfortunate, such as painful induration. of the skin, neuritis, and even, in extreme instances, sloughing.
(ec) Diet:
A high ealorie diet—2500 to 3500 calories weight and strength, and is an important adjuvant to any form of treatment, even if it be preparatory to operation.
(d) Medicine:
Although numerous medicines have been employed from time to time, the vast majority have been deservedly discarded, and a very few remain for consideration. By far the most im- portant and effective is the Forchheimer combination of quinine hydrobromate 0.30 (gr. v) and ergotin 0.065 (gr. 1), given in gelatin-coated pills, two to four times daily. Many who have given this preparation a fair trial are decidedly impressed by the patient’s improvement both subjectively and objectively. One is readily deceived in drug therapy and must be cautious in draw- ing conclusions, but my limited experience coincides absolutely with the claims of Forchheimer. I have had occasion to employ this drug where, due to several circumstances, the patients were
helps to restore
LISSER 457
unable to rest, to take X-ray treatment, or to undergo opera- tion. The cases were striking examples of Graves’ disease, but not of extreme severity. Quinin hydrobromate and ergotin was therefore the only treatment administered. There was no change in environment:and it seems reasonable to ascribe improvement to the drugs mentioned. A fair degree of benefit can usually be anticipated from the exhibition of this medicine, but cure can rarely be attained by its use alone.
Certain other medicaments such as sodium cacodylate, ad- voeated by Llewellys F. Barker to slow metabolism, digitahs for a weakened myocardium, bromides, ete., aid indirectly, and are not to be neglected, but are not of prime importance.
(e) X-ray applications to the thyroid and thymus:
This form of therapy is a notable contribution. In a fair number of cases it can accomplish cure, and in the majority of instances, perhaps, it produces surprising improvement. Occa- sionally no benefit results. If administered in proper dosage and at proper intervals by a roentgenologist experienced in its application, it will usually prove itself worthy a trial. In most instances radiation of the thyroid gland suffices; sometimes bet- ter results are obtained from radiation of the thymus. The role of the thymus in Graves’ disease is not yet fully understood, but that a relationship exists at least in some cases, can no longer be denied. I have seen diarrhoea cease, the pulse drop from 120 to 80, and a gain of 20 pounds result from 3 to 5 roentgen treat- ments. Under such conditions there can surely be no indication for surgery.
Summary of Medical Treatment:
In a general way, then, it would seem reasonable to con- clude that the medical measures described above—sometimes one or the other alone, more often a combination of all of them—will cure Graves’ disease not infrequently ; and the majority of cases will show an appreciable improvement. Many competent ob- servers and prominent internists will and have corroborated this assertion. It follows at once, and this is important, that some eases of Graves’ disease do not require surgery. Surely, then, in communities where the expert thyroid surgeon is not avail- able, medical treatment deserves and demands a careful and serious trial.
458 TREATMENT OF GRAVES’ DISEASE
3. Treatment by Internst and Surgeon:
Terry writes: ‘‘The treatment of exophthalmie goitre should be carried out by the physician and surgeon co-operating for the good of the patient . . . the surgeon who rushes into the oper- ative treatment of exophthalmic goitre, without a careful study of the individual case, is just as culpable as the physician who permits his goitre patient to acquire a permanently damaged heart and nervous system through fruitless medication.’’ The above quotation is the truth in a nutshell. I may have greater faith in medical treatment than the author just quoted, but however that may be, the best results for the individual patient will be attained most often by early consultation between the internist and surgeon. Just when medical measures should cease and surgery begin is sometimes difficult to determine. This con- stitutes a borderland zone, where there exists legitimate room for difference of opinion. Perhaps the wisest decision at such a time would be as follows: If an experienced, reasonably safe thyroid surgeon is at hand, let him operate; if he is not avail- able, postpone surgery a little longer; 10 to 20 per cent mortal- ity is not to be trifled with, while less dangerous means may still do good.
Conclusions:
1. The treatment of exophthalmic goitre by the experienced thyroid surgeon leads most frequently to rapid and permanent cure.
2. The average non-expert surgery of Graves’ disease is, however, accompanied by a heavy mortality.
3. Rest cure, certain medicines, and X-rays, skillfully ad- ministered, will cure some cases and improve the majority, with- out the help of surgery.
4. The best results are obtained by early consultation in each case between internist and surgeon, and by cordial co-op- eration throughout the course of treatment, whether that be purely medical, purely surgical, or combined.
5. Surgeons should not rush their patients to operation. Internists should not try medical measures too long.
EARLY SYNOSTOSIS OF THE EPIPHYSES WITH DWARFISM IN PUBERTAS PRECOX
Knud H. Krabbe, Copenhagen.
Amongst the many cases (about 150) of precocious puberty which have hitherto been published, only a limited number have been examined with X-rays in regard to the epiphyseal lines. As it has a certain importance in connection with the problem of the influence of the ovarian and testicular hormones on growth, it may possibly be of some interest to publish a his- tory of a case of pubertas precox, in which there was synostosis of the epiphyses at an abnormally early stage, probably already at the age of 7-8 years.
In the literature that is available to me, the following cases have been found in which X-ray examinations of the epiphyses have been reported.
P. Linser mentions a boy, aged 5% years, with pubertas pre- cox and wholly abnormally early development; he was 138 cm. in height. Radiograms showed that the ossification corresponded to the age of 15 years. Hudovernig and Popovits describe also a 5% year old boy; he was 140 ecm. tall, but the proportions were in- fantile. Radiograms showed a far progressed ossification of hand and foot, the metacarpal bones completely ossified and the epi- physeal fissures narrower than normal. On the whole, the ossifi- cation corresponded to the age of 15 years. In a case of Neurath’s, in which the menstruation had begun before the 6th year, the ossification corresponded in the radiograms to that of 10-11 years. J. Lenz describes a case in which the mammary glands had begun to develop at the age of 3 months and the menstruation began at 4 months. In the X-ray plates taken at the age of 6 years is seen, both in the upper and the lower limbs, ossification corresponding to 18 years. B. Wolf mentions that in a girl of 4 years with pre- cocious puberty he has found the radiogram of the hand corre- sponding to an age of 10 years. Her height at the beginning of the development increased at an abnormal rate, but at the age of 12-14 years, the growth in length seemed to begin to stop. Josef- son mentions that in a 12 year old boy with strikingly early bodily development the ossification corresponded to the age.
459
460 EPIPHYSES IN PUBERTAS PRECOX
THE AUTHOR’S CASE O. F., 13% years old, is the daughter of the manager of a fac- tory. There is no history of familial predisposition; the patient has no sisters or brothers. When she was some few months old, bleeding from the vagina appeared and since that time she has had it regularly every fourth week, without interruption; at first it was scanty, but later, normal in amount. During menstruation
| | | | | |
Fig. 1. Patient 13% years of age showing precocious puberty.
there has been headache but no other molimina. Even from early childhood she has had noticeably large breasts; they were largest at the age of 6-7 years, having since decreased somewhat in size. For at least 2-3 years, perhaps longer, the mother has remarked axillary and pubic hairs on the patient. The hips and thighs have always been rather large. The patient increased much in height up to the age of 7 years; she was then strikingly tall and powerful for her age. Since then the growth has wholly stopped. Of late she
KRABBE 461
has not been stouter, but rather more slender. Several times she has had hemoptyses without demonstrable lung disease. The physi- cian of the patient has considered them as a kind of substitute for menstruation.
My examination of the patient (24/1, 1918) showed the fol-
Fig. 2. X-ray photograph showing closure of epiphyseal junctures of humerus, ulna and radius of girl shown in Fig. 1.
lowing: She was 131 cm. in height. The lower limbs were strik- ingly short in relation to the trunk. The head had a normal form. The expression of the face was somewhat older than corresponding to the age. The hair of the head was normal. The axillary and pubic hair was well developed. The breasts were somewhat larger than ordinarily corresponding to the age, not of the pointed puberty type, but rather of the somewhat flaccid type found in virgins of 30-40 years. There was no goitre. The fat on the hips, thighs and, to some extent, on the legs, was abundant, but the patient was otherwise not obese.
462 EPIPHYSES IN PUBERTAS PRECOX
X-ray examination showed a normal sella turcica. All the epiphyseal fissures of the upper and lower limbs were seen to be completely grown together. Examination of the nervous system did not show anything abnormal. There was no Chvostek’s sign. The voice was infantile. Aside from the attributes mentioned, the pa- tient makes an absolutely natural, childlike impression. From in- formation obtained from the mother, the child has in no manner
Fig. 3. X-ray photograph showing closure of epiphyseal junctures of bones of hand and wrist of patient shown in Fig. 1.
showed an early erotic development; she has not been old-fashioned in her ways of thinking. She attends school and progresses well.
There is no doubt as to the symptomatological diagnosis: it is an indisputable case of pubertas precox. The characteristic
KRABBE 463
symptoms are to be found: menstruation even from the first year, early development of mammae and probably pubic hairs. In opposition to many of the previously published cases of pre- cocious puberty there does not appear to have been any pre- cocity in the mental development; this feature shows among other things, however, that in pubertas precox as in infantilism there may be a dissociation between somatic and psychic evo- lution. There are some cases in which they appear parallel, but others where the psychie evolution is normal, while the somatic is either advanced or retarded. Another remarkable feature is the hemoptyses of the patient, which have no ostensible source in a pulmonary disease. It is not improbable that the opinion of the patient’s doctor was correct, that these hemoptyses have amounted to vicarious menstruation. Finally, it may be noted that the patient’s mammae were largest at the age of 6-7 years, but later decreased in size. Lenz reports a similar finding. In that feature may certainly be seen an analogy with what takes place much later in normal persons.
While the symptomatological diagnosis, pubertas precox, is sufficiently certain, it is much more difficult in a case such as this to demonstrate what is the etiology of the disease. It is indeed most probable that the cause of the evolution of preco- cious puberty lies in either the ovary or the interstitial testicn- lar gland. But as is well known, there is a series of cases of pubertas precox in which there were found tumors in the ad- renal gland or in the pineal gland (in some cases tumors in the genital gland itself). Possibly these cases are to be referred to a general abnormal foundation; but many things make it prob- able that substances which are secreted from the tumor stimulate the endocrine sexual gland to augmented secretion. In the cases in which autopsy or operation has been performed there have constantly been found tumors in one of these three localities, excepting only some few cases in which there has been found hydrocephalus.
Some years ago I reported a case of precocious puberty in a boy, aged 1 year. In this patient pineal and _ testicular tumors could be excluded, and I was therefore most inclined to diagnose an adrenal tumor. Since then I have changed my opin- ion somewhat. It must be remembered that just in the cases in which the disease is caused by a tumor, autopsy or operation
464 EPIPHYSES IN PUBERTAS PRECOX
will be performed. But the many who do not die of such a tumor will ordinarily live to be old; and when they die many years after the normal time of puberty, their pubertas precox will rarely be remembered; hence they will not be reported as cases of precocious puberty and appear in the statistics of such cases.
In the case described here a pineal tumor at any rate can be excluded. An ovarian tumor can not absolutely be excluded ; the patient has purposely not been internally examined, since it was desired not to direct her attention too much to her ab- normality, she being psychically infantile. Adrenal tumor is even not absolutely to be excluded. But it can certainly be said that a malignant tumor could not be found either in the ovaries or in the adrenal glands. And large benign tumors can not be demonstrated, external palpation of the abdomen showing nothing abnormal.
A small benign adenomatous tumor of the ovaries or adrenal glands can not be excluded. But, on the other hand, it must be considered as possible that the disease may be caused by an abnormally early function of the internal secretion of the ova- ries, an early function which is net caused by a tumor, but is parallel to the hypersecretion of the thyroid gland in Graves’ disease.
The features which in this case have a special interest are those relating to growth. The patient appeared to have grown abnormally much until the age of 7-8 years, when the growth stopped. In view of the fact that the epiphyseal junctures were found closed, it can safely be concluded that this closure was the cause of the cessation of growth.
This type of dwarfism is in characteristic contrast to that which is found im thyroid and pituitary diseases; in these, the epiphyseal fissures remain barely open, but for an abnormally jong time. The stopping of the growth is therefore to be re- ferred to a diminished proliferative impulse at the epiphyseal lines.
In examination of adult dwarfs, the precocious appearance of puberty may have diagnostic significance in relation to other types of dwarfism (primordial, chondrodystrophie, thyroid, pitui- tary and rachitic). If sufficiently good anamnestic information is afforded, the diagnosis will scarcely be difficult.
KRABBE 465
A ease like this is further characteristically different from eunuchoidism. In the latter condition height will be increased, since the hormone which normally conditions the closure of the epiphyseal lines after puberty is not present. In our patient we find a diminished height, probably because the same hormone has acted too early. The case is thus a further foundation for the opinion that it, among others, is a hormone from the sexual glands which causes cessation of growth after puberty.
The case described has a further interest in regard to ther- apy. The patient was unhappy because she was so little and unfortunately it must be considered as totally excluded that she should grow more, since her epiphyseal fissures are completely shut. It is now a problem whether the growing together of the epiphyseal fissures could have been prevented. Both X-ray treatment of the ovaries and extirpation of one ovary must be considered. However, the operation must be regarded as some- what uncertain and not absolutely without danger. In eases diagnosed as due to true ovarian tumor, operation must be con- sidered as absolutely indicated, just as in cases in which an adrenal or pineal tumor can be demonstrated.
A therapeutic measure which might be interesting to try as an experiment in cases of beginning pubertas precox is adminis- tration of thymus extract. Many consider the thymus as an endocrine gland which has an effect antagonistic to the ovaries and the testicles. On the other hand, there are authors, among others, E. R. Hoskins, who think the thymus has no endocrine function. The problem is, in my opinion, unsolved. But in spite of that it must be admitted that Hoskins is right in many of his contentions. To my mind there is one series of experi- ments, 1. e., that of Vogt and Klose, which is much in favor of an endocrine function of thymus. If it is correct that the thy- mus in part or as a whole is an endocrine gland, it is possible that thymus extract might be effective at the time of thymic involution. Since the extract is rather innocuous, an attempt to treat pubertas precox with it would not be absolutely without interest, although the eventual results would need to be consid- ered with great reserve.
Whatever be the decision as regards. therapy, it is desirable in every case of precocious puberty to follow the changes of the epiphyseal lines by means of frequent radiograms.
466 EPIPHYSES IN PUBERTAS PRECOX
BIBLIOGRAPHY
In Neurath’s monograph: Die vorsitige Geschlechtsent- wickelung, Ergebn. inn. Med. und Kinderheilk., Vol. 9, 1909, and in J. Lenz’s essay, Vorzeitige Menstruation, Geschlechts- reife und Entwickelung, Arch. f. Gynik., Vol. 99, 1913, is found most of the literature on pubertas precox. Other papers re- ferred to are the following:
Hudovernig et Popovits: Gigantisme précoce. Nouvelle Iconographie de la Salpétriére, 1903.
Arnold Josefson: Om endocrina skelett-och utvecklings- rubbningar, Stoekholm, 1915.
Knud H. Krabbe: Pubertas praecox, Hospitalstidende (Copenhagen), 1917.
P. Linser: Ueber die Beziehungen zwischen Nebennieren und Koérperwachstum, Beitr. z. klin. Chir., Vol. 37, 1903.
Neurath: Vorzeitige Geschlechtsentwickelung (Menstru- atio praecox), Wiener med. Wehnschr., 1909.
B. Wolf: Report of society, in Centralbl. f. Gynak., 1911, p. 1543.
E. R. Hoskins: Is there a thymic hormone? Endocrin., 1918, 2 244.
THE RATIONAL THERAPEUSIS OF EXOPHTHALMIC GOITRE
Israel Bram, M. D., Philadelphia, Pa., U. S. A.
Instructor in Clinical Medicine, Jefferson Medical College
The art and science of medicine, as all other arts and sci- ences, is fraught with periods of fads, which latter constitute the comme il faut for the profession at large for a variable length of time. Time was when blood-letting was considered the panacea for almost every disease; this procedure has now, with few ex- ceptional indications, gone into disrepute. Not many decades ago, wounds were considered exactly right when pints of pus would issue.from them; now our patients are looked upon as infected in the presence of pus, and we endeavor to cure trau- matic and surgical wounds by the clean first intention method. Again, the greater the fever in a patient, the more he was de- prived of water and fresh air; modern medicine recognizes that plenty of water and fresh air are the greatest aids in combatting febrile affections. Only recently the profession at large has come to realize the fallacy of the indiscriminate removal of tonsils. The propaganda for reform in this direction is based upon the logical opinion that tonsils have their function just as the thymus and the other lymphatic glands of the body; that enlarged tonsils, provided there is no marked respiratory obstruc- tion, serve the purpose among other functions of compensating for a deficient glandular activity elsewhere; and that their re- moval is not only an unnecessary procedure but physiologically erroneous. The modern nose and throat specialist, then, will judge his case on the score of respiratory obstruction and whether or not these lymphatic tissues are diseased.
And so, as we survey the periods in medicine, we find repeated examples of theories and procedures formerly consid- ered proper, soon giving way to other theories and procedures in accordance with further physiological and clinical observa- tion. Arts and sciences, as well as men, are susceptible to ‘‘ruts’’ into which they will fall and there remain for a much longer period than subsequent developments and conditions justify,
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468 THERAPEUSIS OF EXOPHTHALMIC GOITRE
simply because it is a somewhat painful procedure requiring considerable effort, to come out into the open and accept sud- denly presented views entirely at variance with habitual methods. The most important disease in which a controversy of this sort is now enacted, is exophthalmie goitre. For many years, the majority of medical men have considered this disease as one belonging to the operating table for relief. Many theories, ingenious and otherwise, have been promulgated to suit this therapeutic conclusion, and thousands upon thousands of cases have been so treated—successfully ?—yes. That is, the patient usually recovers from the operation. But what about cure of the disease for which operation was attempted? Ah, there’s the rub! The goal in the treatment of exophthalmic goitre is to secure a cessation of thyroid intoxication, 1.e., the saturation of the blood with thyroid substance for the present and future, and the repair*of whatever damage there has been wrought in the patient’s organs and functions during the entire course of the disease. This surgery sometimes appears to accomplish for a brief few weeks’ duration, but as a general rule, rarely if ever sueceeds permanently in accomplishing. On the contrary, many instances occur in which, far from a diminution of thyroid in- toxication on leaving the operating table, the patient’s system is more than ever saturated with thyroid substance.
Exophthalmie goitre does not fall into the realm of surgery. Surgery has for its purpose the alteration or removal of an offending portion of the anatomy, a portion which has become diseased, and the removal of which will restore health and hap- piness to the sufferer. Appendectomy, herniotomy, tonsillec- tomy, prostatectomy, hysterectomy, and gastro-enterostomy are examples of perfect surgery, and I frankly admit the advis- ability of the surgical removal of simple (nontoxic) goitres of moderate size. In each instance the condition is strictly local and local relief means cure. In each instance the systemic sufferings are but reflexes resulting from Jocal irritation, which quickly disappear on the removal of the local cause. Not so with exophthalmie goitre.
Surgeons who spend their time largely in thyroid work have frequently offered in support of their views the analogy of the hyperactive thyroid gland as urgent a surgical condition as an inflamed appendix. ‘‘Why remove a diseased appendix,’’ they
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argue, ‘‘and hesitate about removing a diseased thyroid?”’ These men fail to observe (1) that appendicitis is a local dis- ease while hyperthyroidism has a widespread etiology, symptom- atology, and physiologic relationship; (2) that the appendix is a vestigeal organ while the thyroid is a vital organ and must not be tampered with; (3) that the appendix, in appendicitis, is the seat of germ activity while the hyperactive thyroid is not infected; (4) that operative removal of the appendix renders the patient well and healthier than ever, while the total removal of the thyroid means a slow death from cachexia strumipriva, and partial removal does not cure the patient, to say the least.
It has been observed by keen clinicians that gastro-intestinal disease, disturbances in the genital organs, tonsillar and nasal affections, disturbances in the function of the suprarenal glands, in brief, a disturbed structural and physiological balance of alniost any organ in the body, is prone to act as a predisposing or exciting cause of hyperthyroidism: Is it consistent, then, to attack the thyroid as a therapeutic measure? Again, many in- stances of established hyperthyroidism, especially the fruste form, are somewhat atypical in manifestations, presenting evi- dences of an alternating hypo- and hyper-thyroidism, or a pecu- liar combination of the two at the same time. In a case of this sort, the most daring surgeon must pause for lack of determina- tion to operate, through the intervention of his conscience.
In the presence of such confusing etiological theories, con- flicting pathological evidence and profound systemic changes especially referable to the circulation, the nervous system, and the metabolic balance, as evidenced by the progressive loss in weight and strength, does it not seem inconsistent to place the entire blame on the thyroid gland and to proceed surgically on the assumption that the removal of this gland spells cure, i.e., a restoration of the utility and happiness of the patient? It is admitted that the Basedow syndrome could be produced in ani- mals and in human beings by the administration of excessive doses of thyroid substance. It is therefore conceded that most of the symptoms met with in exophthalmiec goitre are produced by the presence of an excessive quantity of thyroid substance sur- charging the blood, which is manufactured by the patient’s thyroid gland. But whether the gland is primarily the cause and all the other manifestations are results of thyroid intoxica-
470 THERAPEUSIS OF EXOPHTHALMIC GOITRE
tioli, or on the other hand, whether the thyroid hyperactivity is reaily secondary to some other cause is the question which both surgeons and internists must decide in view of the fact that the knife is far from successful in curing the disease, and also in view of the fact that it is almost universally recognized at present that the thyroid gland seems as one link of a chain of organs, and its aberration of function forms but a small fraction of the series of abnormal events occurring in all the ductless glands. Thus we have a vicious circle of a most malignant sort, engendering a type of autointoxication but little understood today.
Let us for the sake of argument assume that the diseased thyroid gland is responsible for the picture clinically known as Graves’ disease; still surgery does not seem to be the cure. Remove all of a diseased tonsil and your tonsillectomy is com- plete and satisfactory. There will be no further recurrence ; the patient is better off for its absence. Leave a part of said tonsil and usually we are in course of time confronted with the need for another operation, the remaining portion having served as a root for the regeneration of the removed tissue. Remove the thyroid, however, and you ruin or kill your patient through the resulting myxedema. Leave a portion of the diseased thy- roid in order to conserve the life of the patient, and as the lin- gvering portion of diseased tonsil, not only will it continue poi- soning the body with or without a period of apparent improve- ment or even cure, but sooner or later the entire gland is regen- erated, and we have again a full-fledged case of exophthalmic goitre.
As an evidence that surgeons are at sea regarding what method of procedure to employ in exophthalmic goitre,—a tacit implication of their indecision regarding the therapeusis of this disease,—may be mentioned the fact that during the past decade in different parts of the world and during various moments in the career of the same surgeon, surgical procedures differ, and for each method success is acclaimed. The following are a few of the most important procedures adopted:
(a) Complete thyroidectomy. Since this resulted in cachexia strumipriva in every instance, this method was re- jected after some years as unnecessarily radical and gave way to the following procedures:
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(b) Thyroidectomy of one lobe. This usually preceded sub- sequent operations. It was found that here also the operation was not the one of ‘‘choice’’ because recurrences were too fre- quent, so that
(c) Thyroidectomy of both lobes came into vogue. Follow- ing this procedure, many things happened, among which were accidental removal of the parathyroids with fatal tetany, a tem- porary hypothyroidism followed some time later by a regenera- tion of lost thyroid tissue and recurrence of the Basedowian syndrome, and occasionally an acute exacerbation of hyperthy- roidism which resulted fatally. Many surgeons considering the above procedures too radical resorted to
(d) Ligation of one carotid artery or
(e) Ligation of both carotid arteries. Ligation has for its purpose the partial interruption of the blood supply to the thy- roid in order to diminish its functional activity. The collateral circulation in course of time becomes’ great enough to restore the former excess of vascularity, and the patient is as badly off as before. An occasional simultaneous ligation of all four thy- roid arteries has resulted in death. So that many surgeons re- sorted to
(f) Ligation, unilateral or bilateral, followed some time later by thyroidectomy. This subjects the patient to a plurality of operations and a high mortality rate, to say nothing of the therapeutic futility. A period occurred during which
(g) Sympathectomy or resection of the sympathetic nerve was considered the means of cure, because it was followed by prompt relief of the exophthalmos. This was known as a Jaboulay or Jonnesco operation, but soon fell into disuse because it failed to relieve the other symptoms of hyperthyroidism. Noting that many cases of exophthalmic goitre presented a large thymus, the operation of
(h) Thymectomy, with or without thyroidectomy became the fad, but because of the high mortality rate, this procedure has not become universally popular. Local interference with the excessive action of the thyroid gland was attempted by milder procedures, most important among which are
(i) The injection of boiling water into the thyroid substance as advocated by Porter, and
472 THERAPEUSIS OF EXOPHTHALMIC GOITRE
(j) The injection of solutions of quinine and urea hydro- chloride as advocated by Watson. The writer, though not pre- pared to accept the methods of Porter and Watson as based upon logical grounds, must say that since they are not fraught with the dangers of the aforementioned surgical procedures, they may, in severe cases of hyperthyroidism, be attempted as a supple- mentary measure where other therapeutic procedures do not yield results promptly enough.
(k) Resection of the colon in eases of exophthalmic and simple goitre has a firm advocate in Sir Arbuthnot Lane. He reasons rightly when he states that the thyroid enlargement on the one hand and its hyperactivity on the other are merely evi- dences ef an infection elsewhere acting as primary cause, and this infection, according to Lane, occurs in the colon, the removal of which overcomes the cause. He realizes the fallacy of at- tacking the thyroid itself, and his theory sounds plausible, but clinical evidences of cures are too few to warrant the adoption of this procedure in large measure.
With respect to thyroidectomy, the operation most popular with thyroid surgeons, the following may be said:
A happy medium, i.e., the knowledge of how much or how little gland to leave in situ during thyroidectomy, has long been and still is a surgical controversy. For fear that the removal of too much thyroid will result in hypothyroidism and the removal of too little in the need for subsequent removal of thyroid sub- stance, surgeons have begun to employ figures with respect to how much of the gland is to be permitted to remain. Some state that one-sixth of the gland should be left behind, others one-fifth, still others one-third, and occasionally an opinion is advanced stating majestically that ‘‘not more than one-eighth of the gland should be left behind lest there be a recurrence.”’ All claim that some of it must be left behind, thus admitting that the thyroid gland is a vital organ, (thanks to the experience of men who formerly removed the entire gland). Do such con- troversies arise with respect to how much of the tonsils or of the appendix should be left behind ?
It is not the purpose of the author unconditionally to con- demn thyroid surgery. It is frankly admitted that a simple goitre, one which is not a hyperplastic, toxic thyroid but a non- toxic, innocent enlargement of the thyroid gland marked enough
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to be discernible at a distance and one which has resisted local and general non-surgical measures for a reasonable time should be handed over to the surgeon for operation. Marked pressure symptoms where dysphagia and dyspnoea are distressing, are also surgical conditions. In this category is included malignant changes; no matter what type of thyroid enlargement, any sus- picion of malignant degeneration of the gland classifies the case as surgical. And here again we must include the secondary or Basedowified goitre, whether causing mechanical symptoms or not, as presenting surgical indications. In this latter type the thyrotoxicosis is secondary to the presence of that goitre, be it colloid, cystic, or otherwise, and as soon as the goitre is removed, the toxic symptoms disappear. These cases present the most gratifying surgical results. These conditions, however, are not the true, clear-cut cases of Graves’ disease, a condition in which we unreservedly deny the right of surgery to interfere.
That Graves’ disease or exophthalmic goitre is gradually becoming recognized as a disease strictly non-surgical in nature, requiring non-operative remedial measures, is now being con- ceeded everywhere. This condition is no more a subject in the realm of surgery than is pneumonia or typhoid or scarlet fever. In pneumonia the surgeon’s services may be required to correct a complicating empyema; in typhoid a peritonitis resulting from intestinal perforation; in scarlet fever a dangerous mastoiditis consequent upon a suppurative otitis media. Exophthalmic goitre, though not an acute infectious disease, is nevertheless one strictly outside the domain of surgery, unless dangerous pressure symptoms arise or malignant changes set in.
In view of the fact that many recurrences are seen in sur- gical clinics (not to mention the immediate mortality rate which is really higher than commonly stated), and also because of lack of ample proof of permanent cure from surgical procedures, far- sighted surgeons in all parts of the world are now becoming skeptical with regard to their accustomed method of treatment of this disease and are beginning to lag in enthusiasm with re- spect to surgical interference in exophthalmic goitre. A rapid survey of the following opinions, gleaned from various sources, speaks for itself:
‘*As a general principle, in exopthalmic goitre surgery it is better to err in favor of conservatism, and when in doubt, it is
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by far safer to ligate than to thyroidectomize, and to resort to two ligations instead of three, one instead of two. It is better to have an imperfect result than it is to have death, inasmuch as the first alternative may be remedied by a subsequent operation, whereas the latter is beyond one’s reach. . . .’’—Crotti.
“The early mild forms of hyperthyroidism in young indi- viduals should be treated medically. We often see young women in schools and colleges, girls and debutantes react to overwork and undue excitement with a mild form of hyperthyroidism. They complain of nervousness, palpitation, insomnia, loss of ap- petite, muscular asthenia; the cardiac action runs up to 100 or higher ; they have a moderate thyroid hyperplasia. This class of patients should be the triumph of medical treatment. Such patients should be treated with rest in bed for several weeks or months until the condition has subsided. Furthermore, their activities should be stopped and complete relaxation obtained. Here all physical as well as medicinal means which medical treat- _ ment possesses can be appled.’’—Crotti.
‘‘How little is known today of the function of the thyroid even though surgeons have been removing them by the thousand! How many physicians still question the propriety of operating for toxic goitre and assume a skeptical attitude as to the reported results of surgical interference! It is my own belief that the present status of surgical therapy is but a stepping stone to the development of some method of arresting the toxic functional dis- turbances of the gland and that eventually other measures, per- haps non-operative, will be forthcoming, that will deal with the cause rather than the effect of deranged function and by remov- ing the cause, break the vicious circle. . . . No matter how intelligently the surgical management of the case has been executed, satisfactory end results cannot be obtained without quite as inteligent management of the after-treatment. If the latter is not carefully carried out relapses will be more frequent, and the surgeon is dependent on the co-operation of the family physician. It has been our practice, on the patient’s discharge, to send the physician a suggestive outline of after-care. The patients must be protected as far as possible from unnecessary physical or nervous fatigue, and to this Ochsner adds the im- portance of rather rigid dietary regulation on which he lays great emphasis.’’—Frazier.
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‘““Reviewing the whole subject of the operative treatment of exophthalmic goitre, it seems to me that it may reasonably be doubted whether surgical treatment is not on the whole worse than useless. ...
‘“‘None of the operations that have hitherto been practiced upon the gland, the thyroid vessels or the sympathetic are free from risk. Actual proof that any of them really cures the dis- ease is at present wanting. The sympathetic operation, although it may, and probably does to a slight extent, diminish the exophthalmos, does not usually cure it completely, and may be followed by serious results, such as inflammation of the eye and even blindness. . . .
““The larger operations upon the gland itself, such as extir- pation, are attended with so much danger as to make them unde- sirable. .
“With regard to ligature of the thyroid vessels, it still seems to me doubtful whether this proceeding is followed by cure sufficiently often to justify its performance.’’—Berry.
According to Porter there are three sources of dissatisfaction following thyroidectomy, viz.: First, failure to get relief from symptoms although there be no recurrence of goitre. Second, the immediate mortality is too high. Third, too many cases are seen which have gone beyond the point where the question of surgical relief can be entertained with reason.
According to McCarrison, hyperthyroidism is instigated by a toxemia due to intestinal stasis. This author suggests that surgical interference with the thyroid gland itself is usually not justifiable, but that the seat of the evil be attacked non-surgi- cally, i.e., by the administration of laxatives and intestinal anti- septics. Sir Arbuthnot Lane has also held this view for a long time in his work on intestinal stasis. The fact that exophthalmie goitre and intestinal stasis are both most frequent among women may or may not be a mere coincidence, but we cannot help admit- ting the suggestiveness of this combination with regard to etio- logical relationship.
Even Crile, who is a strong advocate of surgery in exoph- thalmic goitre, says: ‘‘These hypersensitive patients may be killed by fear, even by worry; . . . by slight injury or by surgical anesthesia; hence they require anociated treatment in the broadest sense, and in severe cases the operation itself must
476 THERAPEUSIS OF EXOPHTHALMIC GOITRE
be graded.’’ This statement alone serves as sufficient warning against surgical intervention in these patients. The hypersensi- tive, explosive nervous system, continually dreading the knife, is made worse by the very prospect of surgery and often killed by the surgical shock and anesthesia. This termination occurs either while on the operating table or shortly afterwards.
“Tt is . . . impossible at present to give surgical treatment the preference over medical means.’’—Dieulafoy (quoted by Haeberlin. )
‘“We are beginning to realize that all the ductless glands are intimately related and that in cases of ductless gland disar- rangement we are dealing with a pluriglandular syndrome. We can expect ideal results when we can bring about a readjustment of these glands. At present we are not doing this, as would seem to be indicated by the frequency with which some syn- dromes persist even after most successful thyroidectomy.’’— Dean Lewis.
‘‘The opinion of an eminent surgeon that 90 per cent of all goitres can be so improved by medical treatment as to make operation unnecessary was probably based upon observation of the effect of rest, for rest is the common element in all the various forms of treatment that have proved successful. (That opinion, by the way, is Kocher’s, endorsed by Chas. H. Mayo.) ’’—Riee.
Statistics are a great source of error in surgery as elsewhere. The gloating over low mortality figures is a very misleading point to farsighted investigators. We must bear in mind the great truism mentioned by an eminent surgeon of bygone days, who decried the too thorough reliance upon statistics, exclaiming that ‘‘a dead patient is 100 per cent dead.’’ Surgical statistics in the treatment of exophthalmic goitre seem to present infor- mation revealing (a) the operative mortality and (b) the per- centage of cases relieved or cured. Regarding the first item, it may be said to the credit of surgery that the mortality, formerly as high as 20 per cent or 30 per cent, has now dwindled down, in the hands of competent surgeons, to as low as 5 per cent or 4 per cent, thanks to the refinements of technique by men de- voted to thyroid surgery. Concerning the second factor much may be said. Mere improvement is not sufficient reward to the patient for the risk that she has consented to undergo, nor is it sufficient compensation for the sear which she will present
BRAM 477
throughout life. Improvement is usually short-lived in almost every instance, the status merging back to the full-fledged condi- tion with which the patient formerly suffered. Indeed, occasion- ally the symptoms will return with greater vehemence than the occurrence of the original attack.
The word ‘‘recovery’’ as employed by surgical statisticians, does not mean permanent cure; it means surgical recovery, 1.e., recovery from the effects of surgical shock and traumatism, or it means a degree of temporary relief from the Basedowian syn- drome, or both. The surgical statistics do not go beyond the first few months or a year and are incapable of presenting evi- dence leading to conclusive proof of complete surgical cures of exophthalmic govtre.
*“The present low mortality of thyroid surgery in very com- petent hands has been obtained at the cost of many unfortunate victims as a rule.’’—Beebe. This author suggests that it is this _ Improvement in mortality rate that makes the mind of the surgeon reason along surgical lines only, and though some of these men endeavor carefully to follow their patients through the course of months or even years after operation, the responses obtained from these patients through the mails and which con- stitute the basis of statistical figures regarding percentage of cases cured, improved, etc., are not reliable, since the patient himself is incapable of proper clinical judgment. Beebe empha- sizes the fact that the degree of severity of hyperthyroidism may seriously impair the efficiency of its victim without his being aware of it; ‘‘and while the patient may accurately report the state of his mind with respect to himself, he is not the most suitable person to decide with accuracy the state of his thyroid activity.’ The same observer has seen no statistics based upon a eareful physical examination of the operated patients some months or years after the operation by physicians skilled in the surgery of this disease and is convinced that such an examina- tion would not tally with present statistical figures of surgery. Beebe has never observed a complete operative cure in a case of exophthalmie goitre. This has also been my experience.
In the rare instances in which there is no recurrence of the symptoms within a year or two following thyroidectomy, the patient had obtained either (a) a natural cure, i.e., the patient was one of those rare instances which tended toward spontaneous
478 THERAPEUSIS OF EXOPHTHALMIC GOITRE
recovery, treatment or no treatment; a case of this sort gets well not because of but in spite of surgical treatment; or (b) a non- surgical eure. Careful surgeons will see that their patients be given prolonged non-surgical treatment prior to operation, and many still more carefully outline non-surgical treatment for a long time after operation is performed, as a result of which the asserted therapeutic value of the thyroid operation itself is re- duced to a minimum, the credit of the possible relief or cure of necessity reverting to the non-surgical procedures employed be- fore and after the operation. Without the accompanying non- surgical treatment, thyroidectomy is at once a complete failure, not even yielding temporary relief in most instances. In reali- zation of this fact, most careful surgical clinies see to it that a patient discharged after thyroid surgery is given a list of non- surgical directions, without the religious observance of which, it is frankly admitted by the surgeons, the patient has little hope of the relief of symptoms. As an illustration, Crotti states: ‘“When once a patient has been operated on, he becomes again a medical patient. He should be followed medically until cure is assured. The same medical principles which apply prior to the operation find their indication and usefulness after the opera- tion: rest, change of environment, automobiling, sojourn in imountainous regions, are the best adjuvants of the surgical treatment.’’ To further exemplify: in Ochsner’s clinic, the fol- lowing list of printed directions is given to each discharged pa- tient:
“1. You should avoid all excitement or irritation like attend- ing receptions, shopping, church work, or politics.
“2. You should get an abundance of rest by going to bed early and taking a nap after luncheon.
“3. You should have an abundance of fresh air at night, con- sequently you should sleep with wide open windows or on a sleeping- porch.
“4. You should eat and drink nothing that irritates the nerv- ous system like tea, coffee, or alcohol. Of course, you should not use tobacco in any way.
“5. You should eat very little meat. If you are very fond of meat, take a little beef, mutton, or breast of chicken, or fresh fish once or twice a week, or at most three times a week.
“6. You should drink a great deal of milk or eat things that are prepared with milk, such as milk soup, milk toast, etc.; cream and buttermilk are especially good for you.
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“7. You should avoid beef soup or beef tea or any kind of meat broths.
“8. You should eat an abundance of cooked fruits and cooked vegetables or very ripe raw fruits, or drink fruit juices pre- pared out of ripe fruits.
“9 You may eat eggs, bread, butter, toast, rice, cereals.
“10. You should drink an abundance of good drinking water, or if this is not available, you should boil your drinking water for 20 minutes, or drink distilled water.”’
Ochsner states that with the exception of a very small num- ber of cases in which an insufficient amount of the gland had been previously removed or in which the remnant left at the primary operation had increased in size, in practically all of the eases which had recurred, almost invariably it was found that the patients had disregarded the above directions regarding diet, rest, and hygiene, following their operative treatment, or they had been permitted to return to their homes without definite instructions in this direction. Is this not an outspoken confession of the failure of surgery in exophthalmie goitre? Note that the real basis of relief is frankly stated to be the above mentioned non-surgical procedure without which surgery is admittedly a failure. These rules alone, properly carried out (and this can- not be refuted by thyroid surgeons), are capable of curing all cases of exophthalmiec goitre without surgical intervention, all things being equal.
In addition to the futility of surgical interference in exophthalmic goitre, let us enumerate a few of the many other objections which the internist might advance in this regard:
1. The surgical mortality rate is higher than the stated five per cent, while the non-surgical mortality, if treatment be not too greatly postponed, is practically nil.
2. Many patients succumb to immediate, post-operative, acute exacerbations of hyperthyroidism.
3. Recurrences of goitre and symptoms mean multiple operations with the attending dangers.
4. The subject of exophthalmic goitre, hypersensitive to the extreme degree, may die of fear or of worry over the opera- tion, or even by light infection following surgical procedures. Indeed, experienced surgeons, cognizant of these facts, often prefer to do an enucleation or thyroidectomy in several stages.
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5. The frequent presence of sugar in the urine is a contra- indication to surgical procedure.
6. A great danger in these cases is death by status lymphaticus.
7. The occasional removal of the parathyroids during a thyroidectomy with resulting tetany, is by no means a rare occurrence.
8. Injury to the recurrent laryngeal nerve directly through the operation, or subsequently by pressure of scar tissue, is not uncommon, leading to paralysis of the vocal cords.
9. The frequently occurring post-operative myxedema as a result of thyroid enucleation is worse than Graves’ disease. Kocher states that the average life of a case of myxedema is seven years.
10. In many instances, surgery has so devitalized the pa- tient that the prognosis is rendered doubtful even when under the care of a competent internist. The surgical shock, the post- ponement of the proper non-surgical measures during all this time, and frequently the mental attitude of the patient who is so thoroughly disgusted with everything and everybody, inelud- ing the medical profession, that all initiative to get well is lost— all these factors diminish the prospects for complete recovery.
The real difficulty in the treatment of hyperthyroidism has been that both surgeons and internists have looked for immediate results and drawn their deductions and statistics accordingly. The eagerness to generalize hastily instances of apparent relief or apparent failure on the part of the therapeutists—surgical and non-surgical—has been the stumbling block in the way of therapeutic progress in the treatment of this disease. Surgeons have frequently succeeded in giving immediate improvement, but more frequently these patients suffer a relapse which is some- times of greater intensity than the primary shock of hyperthy- roidism. Internists, even when proper measures are instituted, are impatient when results are not immediate, and turn their cases over to the surgeon. So that here, also, we are tending toward a vicious circle in the therapeutics of the disease. The truth of the matter is that the surgeon should show less haste, and the internist more patience, in the treatment of these cases. I base this conclusion upon the lack of statistics proving perma- nent cures in exophthalmic goitre on the part of surgeons, and
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upon the presence of a large number of permanent cures effected by some internists who skillfully and patiently employ the proper non-surgical procedures through the length of time neces- sary to bring about complete recovery. My object is to suggest to the medical profession to avoid haste in resorting to surgery and to be more patient in the use of non-surgical measures, and when a general practitioner feels that his case has been treated non-surgically for a reasonable length of time without satisfac- tory improvement, it is further suggested that, instead of turn- ing the patient over to the surgeon for operation, an internist who has had exceptional experience in thyroid therapy be con- sulted.
Now what has the internist experienced in thyroid therapy to offer in the treatment of Graves’ disease? The answer can be summarized by saying that first, his discharged patients pre- sent no mutilating scars; second, his cases are free from such complications as myxedema, tetany, and the others mentioned under surgical considerations; third, he has no mortality rate in cases brought to him that are not in the moribund state; and fourth, his patients, treated by an endeavor to overcome the exciting causes, are discharged permanently cured, relapses oc- curring rarely, if ever.
To emphasize, the following additional opinions are offered:
““The surgeon is apt to do too much and the physician too little.’’—Musser.
““In Volume LXV (1911) of Guy’s Hospital Reports, Dr. Hale White records the results of an attempt upon his part to trace the history of patients discharged after medical manage- ment during the last twenty years, and he finds that in about 80 per cent the recovery has been permanent. In my own per- sonal and consultation practice I have had the opportunity to observe a number of patients for periods varying from a few months to twenty-five years after apparent recovery under non- surgical treatment. In but one instance has there been relapse, and in no case had death occurred from any condition with which Graves’ disorder could be causatively associated.’’—Solo- mon Solis-Cohen.
“‘The treatment resolves itself into removing the cause. In true goitre, where pressure symptoms are present or sclerotic changes prevent reduction of the mass, surgical measures may
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become necessary; but where the growth is purely hyperplastic, elimination of the causative toxin, whether this be tonsillar, peridental, intestinal, water borne, etc., with thyroid gland to aid the antitoxie process and relieve the gland of excessive work, excellent results may be obtained. In Graves’ disease with the same line of treatment combined with vasoconstrictors and rest, cure may be obtained in all but a very small proportion of eases.’’—Charles E. deM. Sajous.
‘Tn four out of eleven ‘cures’ effected by operation at St. Thomas’ Hospital, there was no evidence of Graves’ disease found on microscopical examination (Mackenzie), so that in 36 per cent of these cases which were classed as ‘cures’ we must admit either an error in diagnosis or conclude that the thyroid gland does not share the usual evidences of Graves’ disease ina very much higher proportion of cases than has hitherto been supposed.
«| . 6the practice of operative interference with the thyroid gland in all cases of Graves’ disease at sight and with- out applying all our resources of our art in the detection of its cause, as is now a very common custom, is one which cannot be too strongly deprecated. I am convinced that . . . . the number of cases in which thyroidectomy is performed will become smaller and smaller and its practice, except in cases which have baffled the most painstaking investigation, will ultimately be aban- doned.’’—MeCarrison.
It would be superfluous to publish the numerous other opinions of like nature, all of which coupled with the afore- mentioned statements of surgeons indicating hesitancy, reveal this conclusion: The profession is about ready to change its views with regard to the therapy of exophthalmic goitre, and this change is decidedly in favor of a rejection of surgery.
Careful non-surgical management, then, is capable of com- pletely and permanently curing the great majority of cases of hyperthyroidism. The occasional exception not responding to non-surgical measures is not an instance of genuine Graves’ dis- ease, but is one of malignant degeneration of the thyroid gland, a case of toxic symptoms superimposed upon a long-standing non-toxic goitre, or a case brought to the clinician’s attention in a moribund condition. The writer, in unison with others inter- ested in thyroid therapy, does not hesitate to conclude that he
BRAM 483
has been able to cure every case of primary Graves’ disease in which a fair degree of co-operation was obtainable; this was accomplished in from six months to two years, depending upon the exigencies of the case treated. Strict individualization of the case in hand is the dominating principle of treatment. The proper medical attendant, the proper social atmosphere, and the right kind of dietetic, hygienic, medicinal, psycho-therapeutiec, electro-therapeutic and other measures properly applied for the required length of time should yield permanent cure.
BIBLIOGRAPHY
Beebe (S. P.): Reeurrence after thyroid operations. Med. Rec. (N. Y.), 1917, 91, 627-630.
Beebe (S. P.): Thyroid disease and the war. Med. Ree. Cie Ye), 1908.93) 23-238. :
Berry: (J.): Diseases of the thyroid gland. (P. Blakis- ton’s Son & Co.)
Bram (I.): Exophthalmic goitre. Arch. Diag. (N. Y.), 1917, 10, 343-361.
Bram (I.): The surgeon and the internist in the treat- ment of exophthalmie goitre. New York M. J., 1919, 109, 21-23.
Bram (I.): The cireulatory system in exophthalmic goitre. Intern. Clinies (Phila.), 1919, 1, 80-89.
Solis-Cohen (S.): The non-surgical treatment of exophthal- mie goitre. Am. J. Med. Se. (Phila.), 1912, 144, 13-30.
Crile (G. W.): Exophthalmie goitre and other forms of pathologie kinetic drive. J. Am. M. Assn. (Chgo.), 1917, 69, 610-612. ;
Crotti (A.): Thyroid and thymus. Lea & Febiger, Phila- delphia, 1918.
Frazier (C. H.): Constitutional disturbances of toxie goitre as influenced by surgical therapy. Penn. M. J. (Athens), 1918, 21, 510-514.
Haeberlin (J. B.): Treatment of hyperthyroidism. New York M. J., 1915, 101, 1109-1111.
Lane (A.): Abstract of discussion. J. Am. M. Assn. (Chgo.), 1918, 71, 719-720.
Lewis (D. D.): Abstract of discussion. J. Am. M. Assn. (Chgo.), 1914, 63, 1149.
McCarrison (R.): The thyroid gland. Bailliere, Tindall & Cox, London, 1917; Wm. Wood & Co., N. Y.
Musser (J. H.): Problem in treatment of exophthalmic goitre. Am. J. Med. Se. (Phila.), 1912, 148, 810-815.
Ochsner (A. J.): Exophthalmic goitre. Ann. Surg.
(Phila.), 1916, 64, 385-394.
484 ite 18.
19.
20.
THERAPEUSIS OF EXOPHTHALMIC GOITRE
Porter (M. F.): Surgical treatment of goitre. New York M. J., 1919, 109, 306.
Rice (J. F.): Medical treatment of exophthalmie goitre. Med. Ree. (N. Y.), 1918, 94, 97-99.
Sajous (C. E. deM.): The internal secretions as related to tuberculosis in civil and military practice. New York M. J. 1917, 106, 389-395.
Watson (L. F.): Quinine and urea injections in hyper- thyroidism. New York M. J., 1916, 103, 791-792.
HYPOPHYSEAL DIABETES
J. Koopman, M. D., The Hague, Holland.
When von Mering and Minkowski had described their ex- periments on dogs, from which the pancreas had been removed, all secrets of diabetes seemed to be solved. Pfliiger’s ‘‘duode- nal diabetes’’ was proved not to exist and the cause of diabetes was for all, and is still for most investigators, situated in the pancreas. Now it is impossible to deny that the pancreas plays a most important role in the etiology of diabetes, but it is un- certain whether it is the only ‘‘diabetogenous’’ organ. The literature on the subject is enormous. A few opinions, only, may be quoted. According to Heiberg (1) every explanation of a case of diabetes, not taking the pancreas as the source of the disease is suspect. Magnus Levy (2) finds it certain that panereas and brain can cause a primary diabetes; whether adrenals, thyroid or hypophysis may cause diabetes he regards as extremely doubtful. Allen (3) does not believe that other olands play an important part in the pathogenis of diabetes. On the other hand, Biedl (4) believes that most endocrine organs may be involved in the origin of diabetes, though there are always secondary changes in the pancreas. Eppinger, Falta and Rudinger (5) (6) have given their polyglandular theory of diabetes.
These are only a few authors. An exhaustive bibliography on the subject would fill at least ten pages.
It is still an open question whether, in all cases of diabetes, changes of the pancreas are found and if so, whether they are always the primary origin of the disease or whether diseases of another organ may cause diabetes and then perhaps see- ondary lesions of the pancreas. I am quite sure it is necessary to accept the polyglandular origin of diabetes. Of adrenal diabetes I have no experience; I have seen some eases of diabetes, which perhaps have to be considered as beginning from the thyroid. As I have not yet enough facts to discuss these cases, I intend to discuss only one rather strange form of diabetes, which I believe must be attributed to the hypo- physis.
485
486 HYPOPHYSEAL DIABETES
The hypophysis plays perhaps an important part in sugar- metabolism. According to Borchardt (7) injections of whole gland extract cause glycosuria in rabbits. And though Fran- ehini (8) could not confirm this, Cushing reported results sim- ilar to those of Borchardt. Removal of the posterior lobe caused a (very often enormous) rise of the tolerance. The anterior lobe has less influence on carbohydrate metabolism.
But not only does the investigation with laboratory methods show us a relation between hypophysis and sugar metabolism; clinical observation demonstrates most clearly the influence of the pituitary on carbohydrate metabolism. The frequent combination of acromegaly and diabetes is too well known to justify here a long and detailed discussion. Some- times acromegaly begins with an increased tolerance which diminishes during the development of the disease. In other cases glycosuria is the first symptom of a beginning acromegaly. Schlesinger (10) describes a remarkable case of glycosuria which disappeared under treatment. Some years later glyco- suria reappeared and this time acromegaly developed. Now there are two important questions to be answered. Is the glycosuria accompanying some 50 per cent of the cases of acromegaly a real diabetes, and is it possible to explain this elycosuria as of pancreatic origin? Neither question can easily be answered. As far as I know, a good definition of diabetes has never yet been given. If we take the definition of Magnus Levy, it is very simple. This writer says that a glycosuria persisting for some time, is diabetes.
But what about the cases of diabetes without glycosuria? And then, in speaking of diabetes, we feel that a relation must exist between the excretion of sugar and the composition of the food. (Of course I exelude here all cases of so-called diabetes innocens and renal diabetes.) On the other hand, there may be, and there often is, a marked tendency of the organism to form acetone bodies. The patient with diabetes, not dying from an intercurrent disease, dies nearly always in coma. Now, if we consider acromegaly and its combination with diabetes, we see a great difference from the ordinary diabetes. First, in many eases the quantity of sugar in urine and blood is independent of the quantity of carbohydrates in the food. At least it is often difficult to find a relation between the com-
KOOPMAN 487
position of the ingested food and the excretion of sugar. Von Noorden (11) has pointed this out and all authors agree with him on the point. Another difference between diabetes with and without acromegaly is the comparatively small tendency toward the formation of acetone bodies, and even when these bodies are formed, coma almost never occurs.
In the Dutch literature there is a remarkable case de- scribed by Stricker (12). The patient had acromegaly and diabetes. There was an enormous degree of lipemia and a large amount of acetone and diacetie acid in the urine. Coma was certainly expected: The patient, however, died of paral- ysis of the heart. As far as I know there are about eight cases known in the literature of acromegaly and diabetes dying in coma diabeticum: Bury (13), Stadelmann (14), Strumpell (15), Hinsdale (16), Ravaut (17), Dallemagne (18) and Umber (19).
Generally the diabetes as it is seen in cases of acromegaly, is not absolutely identical with the diabetes we generally see. Léry (20) thinks it better not to speak of diabetes in these eases, but to eall it glycosuria. The complications frequently seen in diabetes mellitus, as furuneulosis, pseudo-tabes and arthritis occur also in these cases, but not so often.
Now the second question that must be answered _ is, whether these glycosurias are caused by an abnormal function of the pancreas. We should like to know whether this glyco- suria can occur with a perfectly normal pancreas. The rela- tion between hypophysis and pancreas is not so well estab- lished as the relation between some other endocrine glands. The literature on the subject is very small. Cushing quotes experiments of Goetsch, who showed that after partial hypo- physectomy, changes occur in the islets of Langerhans. The changes are not so constant as the loss of granules in the acini, also observed after similar operations.
In 1910 Cushing (21) believed that the disturbances in carbohydrate metabolism, as they are seen in diseases of the pituitary are due to secondary changes in the Langerhans islets. Now this was not only unproved, but clinical evidence spoke against it. Stadelmann (14) reports some very impor- tant cases of acromegaly. One of them never showed a symp- tom of diabetes. At the post-mortem examination, an enor-
488 HYPOPHYSEAL DIABETES
mous sclerosis of the pancreas was found. This case alone does not prove much, but it is important, when considered in con- nection with another of Stadelmann’s cases. The patient with acromegaly died in coma diabeticum. A very exact histolog- ical examination of the pancreas was made. There was not the slightest change. Later on Cushing published another paper (22), in which he coneluded that hypophyseal diabetes was possible without recognizable change in the panereas. He has studied the pancreas in eight cases of hypophyseal disease, and found no characteristic changes. Only infiltration with fat was seen.
These investigations show that in diseases of the hypo- physis, though diabetes (or glycosuria) exists, the pancreas inay be normal and the question arises whether diabetes may be caused by change in the hypophysis without any other disease, such as acromegaly or \dystrophia adiposo-genitalis. With absolute certainty this cannot be discussed without post- mortem examinations, but there is reason to believe that a real hypophyseal diabetes without other signs of disease of the hypophysis exists. There are but few articles on this subject. Brugsch (23) describes certain cases of this sort. Cushing also describes in his book a case of syphilis of the pituitary gland, giving a clinically typical diabetes mellitus.
But in these cases no proof has been given during life of the existence of a disease of the pituitary. Now there is a case in the Dutch literature, in which the diagnosis of hypophyseal diabetes has been made with at least a high degree of prob- ability (Steensma 24). Here a young girl with some inelina- tion to adiposity proved to be diabetic. There were no symp- toms of disease of the hypophysis; a radiogram of the skull showed an enlarged sella turcica. The carbohydrate tolerance test was negative. Tablets of hypophysis were administered with a splendid result. The author concludes that there are cases of diabetes which can be treated successfully with hypo- physis substance.
This is certainly true, as I shall herein show. Whether this effect proves the hypophyseal origin of the disease will not be discussed. At least, however, it proves that the cases have some relation with the hypophysis. I shall try to show that it is possible in some eases to find out whether organotherapy with
KOOPMAN 489
hypophysis is indicated. It is important to know this, for al- though there exists an enormous literature on the treatment of diabetes, with liver, with pancreas, with testicle and ‘‘tutti quanti,’’? we may simply say that the results of organothera- peusis in diabetes are still ‘‘nihil.’’
Two cases may now be described:
Case I. A man of 40 years came under treatment with com- plaints of asthma, thirst and polyuria. The physical examination showed nothing particularly. The patient was not extraordinarily fat; he had not recently increased in weight; libido sexualis was normal. The urine contained no albumen, 5.2% sugar, acetone, but no diacetic acid. Blood pressure was normal. I began to treat the patient in the old-fashioned way as an ordinary diabetic, but upon testing the tolerance for carbohydrates, I found there was no simple relation between the quantity of ingested carbohydrates and the quantity of excreted glucose. On a diet without carbohydrates the patient excreted more or less sugar. On another day 100 grams of bread was taken without the appearance of sugar. Acidosis was very irregular; from time to time acetone and diacetic acid were found in the urine, without apparent cause. Though I did not understand this, the patient was put under Allen treatment.
DIET
Quantity of Sugar Day in 24 hours 1 Cooked beans 300 gm., butter 20 gm., weak tea 600 ce. 0 2 Cooked beans 400 gm., butter 30 gm., weak tea 600 cc. 0
3 Cabbage 300 gm., asparagus 150 gm., butter 40 gm., lL GEE 6 Oe tc ace Ok © NOISIER CRORE CLIO EE REC > ee 0
4 Lettuce 300 gm., asparagus 200 gm., butter 60 gm., [Sie SEaKO| "REET. “5 6 cacao OhoRClGirrico OCR) Ont Cac IBRn chen ttt | cleneno 0
5 Cooked beans 300 gm., asparagus 200 gm., butter 60 gm., RCAC eee pL GEG Aion cus seyviaiel cles lees cele 6 ane oe trace 6 Cooked cabbage 400 gm., butter 60 gm., bread 25 gm... 0 7 Cooked cabbage 400 gm., butter 60 gm., bread 50 gm. 0 8 Asparagus 300 gm., butter 60 gm., bread 75 gm....... 0
9 Asparagus 300 gm., butter 60 gm., bread 75 gm., lean pee TTT MLO eestcle cies letehersheccl ec shale a eels, Jide» « 38.6 gm. 10 Cooked beans 300 gm., butter 60 gm., bread 75 gm., tea trace 11 Cooked beans 300 gm., butter 60 gm., bread 75 gm., tea 0
12 Cabbage 400 gm., beans, butter 80 gm., bread 100 gm., GCA atc MUNN ele hee cu NE The tacmeMemb iehel sts Mela) soviet Wilaie ols! s eves es 0
138 Cabbage 400 gm., butter 80 gm., bread 100 gm., lean raarepey ty MOU ation OU ey: He odcecut-o 6 GUMS RUDE Dela on ae aa ere 69.2 gm.
490 HYPOPHYSEAL DIABETES
14 Cabbage 400 gm., butter 80 gm., bread 50 gm., lean meat, BO eM ECA Ses: c)o.s mayer eufealselete lexeWeue mile tetedoherameeuenerste . 21.8 gm
15 Lettuce 300 gm., butter 80 gm., bread 100 gm., tea... 8.1 gm. 16 Lettuce 300 gm., butter 80 gm., bread 100 gm., tea.... 0
Here we see a great sensitiveness to proteins. One feels inclined to say that in this patient in protein metabolism a poison is formed, giving rise to an abnormal carbohydrate metabolism. When this low protein tolerance was demon- strated, I thought of the irregular glycosuria seen in acrome- galy and of the possible relationship between the hypophysis and diabetes. A radiogram of the skull was made, but with- out showing any evidence of hypophyseal involvement; the Wassermann reaction was negative. However, I tried the effect of hypophysis tablets. Three times daily a tablet cor- responding to 1-10 of the fresh gland of the cow was given. The effect was striking. The third day after the onset of the treatment 200 grams of bread and 50 grams of meat were tol- erated without glycosuria. The fourth day 100 gm. meat and 200 gm. bread gave rise to a glycosuria of 16.4 gm. After a
we
fortnight the ‘‘protein toleranee’’ was 200 grams of meat. It SD oD
has not been possible to increase this, but to do so is not neces- sary. -
Once we tried to stop treatment; this was followed by a relapse. So this patient is going on, taking his hypophysis tablets. Since the beginning of this treatment, acidosis has never been observed.
Case II. A Belgian workman, 36 years of age, was in an ex- tremely bad condition. His doctor had made a diagnosis of dia- betes and treated him in the old way. His breath smelled of ace- tone. The urine contained 4.8% sugar, acetone, diacetic acid and B-oxybutyric acid. After fasting for 5 days, his urine was normal. There was not seen an increase of acidosis during the first days. Here the same sensitiveness to protein was observed and though for special reasons radiograms could not be obtained, hypophysis tablets were given in the same dosage as in foregoing case. After a fortnight 100 gm. meat and 100 gm. bread were easily tolerated. Before the beginning of the treatment he tolerated only 50 gm. of bread and showed glycosuria when 25 gm. of meat without carbo- hydrates were ingested. Afier two months of treatment the pa- tient refused to follow his diet; the regular taking of medicine annoyed him. Some months later he died in coma. The family re- fused post-mortem examination.
KOOPMAN 491
From these cases certain conclusions may be drawn.
I am quite aware that proof is lacking that these two cases are hypophyseal diabetes, but it is probable that the hypo- physis has played an important part in them. In other cases of diabetes I have seen no results from the administration of similar doses of hypophysis.
Leyton (25) in his excellent little book on the Allen treat- ment, cites diseases of the hypophysis as contraindication to this treatment. I believe that it may be possible to detect by such treatment these cases of diabetes (most probably they are not frequently seen) that would benefit from treatment with hypophysis. As far as I know, in cases of acromegaly and gly- cosuria the analysis of the tolerance for protein and carbohy- drates has not been made. Perhaps the irregularity of the glycosuria in these cases could be explained in this way. At any rate, it will be of interest to analyze these cases very care- fully. It may be not only of theoretical, but also of practical interest.
BIBLIOGRAPHY
1. Heiberg: Sammlung zwangloser Behandlungen aus dem Gebiete der Verdauungs—und Stoffwechselkrankheiten, Halle, 1914, Vol. V, No. 4:
2. Magnus Levy in Kraus und Brugsech. Spezielle Patho- logie und Therapie, Berlin & Vienna, 1913.
3. Allen: Glycosuria and Diabetes, Boston, 1913.
4. Biedl: Innere Sekretion. 3d Ed., Vienna and Berlin, LOUG Vol. If, p: 378.
5. Eppinger, Falta and Rudinger: Ztschr. f. klin. Med. (Ber- lin), 1908, 66, 1.
6. Eppinger, Falta and Rudinger: Ibid, 1909, 67, 380.
7. Borchardt. Ibid, 1908, 66, 332.
8. Franchini: Berlin, klin. Wehnschr. 1910, 47, 613, 670, 719.
9. Cushing: The pituitary body. Philadelphia, 1912, p. 17.
0. Sehlesinger quoted by Cammidge: Glycosuria and allied
conditions. London, 1913, p. 234. 11. von Noorden: Die Zueckerkrankheit und ihre Behandlung. Berlin, 1917. 12. Stricker: Nederl. Tijds. v. Geneesk. (Amsterdam), 1909, 53 (II), 1420.
13. Bury: Lancet (London), 1891, 69, 1383.
14. Stadelmann, quoted by Cammidge.
15. Striimpell: Deutsche Ztschr. f. Nervenheilk. (Berlin),
1897, 11, 51.
HYPOPHYSEAL DIABETES
Hinsdale, quoted by Steiger: Ztschr. f. klin. Med. (Ber- lin), 1917, 84, 287.
Ravaut: Gaz, des hép. de Paris, 1900, 78, 359,
Dallemagne: Arch. de méd. expér. (Paris), 1895, 5, 891.
Umber: Ernahrung und Stoffwechselkrankheiten, Berlin and Vienna, 1914, p. 199.
Léry, in Lewandowsky’s Handbuch der Neurologie, 1913, Vol. FY, p. 290.
Cushing: Am. J. Med. Se. (Phila.), 1910, 39, 473.
Cushing, Goetsech and Jacobson: Johns Hopk. Hosp. Bull. (Balt:), 1911, 225 165:
Brugsch: Zischr. f. exper. Path. u. Therap. (Berlin), 18, 269.
Steensma: Nederl. Tijds. v. Geneesk. (Amsterdam), 1914, 5S (1), 2576;
Leyton: The modern treatment of diabetes mellitus, London, 1917.
BOOK REVIEWS
SYMPTOMS OF VISCERAL DISEASE, A STUDY OF THE VEGETATIVE NERVOUS SYSTEM IN ITS RELATION- SHIP TO CLINICAL MEDICINE, by Dr. Francis M. Pot- tenger, Professor of Diseases of the Chest, University of South- ern California, Los Angeles. CC. V. Mosby Company, Pub- lishers, St. Louis, 1919, pp. 328.
While the book is not addressed primarily to the endocrin- ologist, if contains much information that is indirectly involved in his problems, and in the chapters devoted to ‘‘The endocrine glands’’ and the biology of the ‘‘ Vegetative Nervous System’”’ appeals to him directly.
The monograph is arranged in three parts: I. The rela- tionship between the vegetative nervous system and the symp- toms of visceral disease; II. Innervation of important viscera, with a clinical study of the more common viscerogenic reflexes ; Ill. The vegetative nervous system. The central theme of the book is an emphasis of the desirability of closer clinical analysis and the focusing of attention upon ‘‘the patient who has the disease’’ rather than the ‘‘disease which has the patient.’’ In this effort, a clean cut knowledge of his endocrine and autonomic nervous make-up is of obvious importance.
In the section devcted to the anatomy, physiology, pathol- ogy and pharmacology of the vegetative system will be found a very readable and well-illustrated account of our knowledge, brought up to date. Especial attention is paid to the ‘‘viscero- trophic reflex,’’ an important topic that has hitherto received little attention. It explains, for instance, the localized muscular atrophies encountered in pulmonary tuberculosis. In the opin- ion of the reviewer, the adoption of Mackenzie’s term, ‘‘viscero- sensory reflex,’’ is unfortunate, especially since the author does not explain that it is a physiological absurdity introduced merely for its utility in avoiding intricate explanations.
The book as a whole represents a great deal of study of a difficult field of biology and an admirable adaptation of the data to clinical use. In this latter, the extensive bedside experience of the author has been constantly drawn upon. It is to be hoped that the author may be put to the further task of preparing numerous subsequent editions. —R. G. H.
LA EDAD CRiTICA (CRITICAL AGE), by Dr. G. Marafion, Hospital General, Madrid, 1919, pp. 501. Sociedad Espanola de Publicaciones Médicas, Madrid.
493
494 BOOK REVIEWS
In this work which is written with an admirable method and a brilliant and captivating style the author essays an endocrine - explanation of the menopause. In the extensive clinical part of the volume are recorded in majestic fashion and with much detail all the symptoms of this condition, using the term in its larger sense.
The author believes that the ‘‘eritical age’’ involves the endocrine organs in their entirety, the various ones being affected in different degrees and in different combinations in each ease. Hither hyperfunction, dysfunction or hypofunction may be dis- played. To hyperepinephrinism is ascribed the preponderant role in the production of psychic and cardiovascular disorders presented by certain women approaching the menopause. Thyro- ovarian and hypophyseal syndromes are also regarded as im- portant. The importance of the interrelations between emo- tions and internal secretions is discussed at length. From the point of view adopted, cases can be grouped by types as ‘‘supra- renal,’’ ‘‘genital,’’ ‘‘hypophyseal’’ or ‘‘thyroid.”’
Therapeutic measures are discussed at length, the hygienic, dietetic, opotherapeutic and psychologic in turn receiving atten- tion.
A bibliography of 314 titles completes the volume.
The physiologic basis accepted by the author and defended by him with a vivacity seductive to the spirit of the reader has not, in the opinion of the reviewer, the solidity it appears to have. Space does not serve to summarize further the subject matter of the work which the reader will find easy, agreeable and instructive to peruse in the original. Whatever may be the ulti- mate fate of the doctrines put forward, the work represents a laudable effort which should not be ignored by anyone inter- ested in the field of study concerned.
B. A. HOUSSAY.
ABSTRACTS
(ADRENAL) A case of Addison’s disease with rare etiology (Ein Fall von Morbus Addisonii mit seltener Aetiologie). Roth (N.), Wiener klin, Wehnschr. (1917), 30, 372.
After a pneumonia attack a man of 34 years became very weak. The diagnosis, ‘‘Abscessus suphrenicus’’ was made. An exploratory puncture revealed pus. At the same time symp- toms of Addison’s disease developed (low blood pressure, low content of blood sugar, typical pigmentations, apathy and diarrhoea). An operation was performed to evacuate. Three days later the patient died. Post-mortem examination showed much pus between the liver and diaphragm. There were only small rests of the right adrenal, situated in a mass of yellow pus. In the left adrenal five or six small abscesses were pres- ent. From the pus of these pneumococci were cultivated. The author could not find in the literature another case of Addi- son’s disease caused by pneumococci. J. K.
(ADRENAL) A case of congenital neuroblastoma sympaticum combined with Addison’s disease in a child. Hertz (Povl) and Secher (K.), Hospitalstidende (Copenhagen), 1917, 60, 1093-1106.
A boy, aged 2 months, showed an abdomen enormously dilated, probably caused by a liver tumor, and anemia; after some time pigmentation of the skin and a tumor in the left side of the abdomen appeared and at the same time the liver tumor decreased. Death occurred at the age of 11 months. At autopsy it was found that the tumor at the left was the adrenal gland, which was dilated and destroyed by a neuroblastoma (Wright). The liver tumor was caused by metastases which had early necrotized and caused partial cirrhosis.—K. H. K.
(ADRENAL) Addison’s disease. Motzfeldt (K.), Norsk Mag. f. laegevid. (Christiania), 1919, 80, 371.
The author describes a typical case of Addison’s disease which proved fatal in two months; the autopsy revealed tu- berculosis of the suprarenals. The carbohydrate tolerance was low, a fact that is in conflict with the generally accepted views.
495
496 ABSTRACTS
Some improvement followed injections with adrenalin, while the oral administration was without any effect. The impor- tance of the suprarenal cortex is emphasized.—Author’s Abst.
(ADRENAL) Addison’s disease of syphilitic origin. Schaffner (P. M.) and Howard (T.), New York M. J. (N. Y.), 1916, 103, 1026-1027.
A ease report. Antisyphilitic treatment and the admin- istration of desiccated suprarenal gland in doses of one to three grains, t.i.d., resulted in marked general improvement and diminution of the bronzing of the skin. The patient demon- strated possible tubercular trouble of the lungs, hence, imas- much as most Addison eases have a tubercular origin, the diagnosis of syphilis of the adrenals is open to suspicion.
—H. W.
(ADRENAL) A histochemical method for the demonstration of adrenalin granules in the suprarenal glands. Cramer (W.), Proce. Physiol. Soe., J. Physiol. (Lond.), 1918, 52, Vi1ll-X.
As full report is promised later, it will suffice to state that Cramer has devised a method of staining the suprarenals with osmie acid, which demonstrates the state of activity of the gland, the adrenalin appearing as black granules which can be differentiated from the lipoid globules.
By his method the author has obtained ‘‘very clear evi- dence of the passage of adrenalin granules into the blood ves- sels of the medulla’’ when the gland has been stimulated to intense activity. The granules disappear if the gland is ex- hausted. In conditions ‘‘demanding increased functional activity of the suprarenals, fine black granules similar to the adrenalin granules of the medulla, appear in the cortex, espe- cially in the layers of cells nearest the medulla’ indicating that the cortex participates in the functional activity of the medulla, and that the two parts of the gland are not physiolog- ically independent.—T. C. B.
(ADRENAL) Altitude sickness and hygiene of aviators (Mal des altitudes et hygiene de 1’ Aviateur). Ferry (G.), Ann. de Med. (Paris), 1919, 6, 124-137.
The author attributes the prolonged asthenia occasionally accompanying the sequelae of altitude flying to a suprarenal insufficiency. —F. S. H. .
ABSTRACTS 497
(ADRENAL) Bilateral suprarenal hemorrhage. Eadie (JJ.), Practitioner (Lond.), 1917, 99, 183-187.
A boy of five years became acutely ill, erying out loudly every ten or fifteen minutes, and vomiting watery, greenish fluid. Nothing was found clinically to account for the symp- toms. The pain was referred to the abdomen, but not localized. He was observed three days, then the appendix was removed, but nothing pathological was found in the abdomen. Death occurred thirteen hours after operation. Autopsy showed nothing pathologie but bilateral suprarenal hemorrhage.
—H. L.
(ADRENAL?) Blood cholestrin index; prognostic value in urinary disease (Indice colesterinémico; valor pronostico en los enfermos urinarios). Surraco (lL. A.), Anales de la Fae. de Méd. de Montevideo, 1917, 2, —. (No. 11).
The author attributes great importance to the cholestrin index, obtaining it by comparison with a graded standard series. A comparison of the cholestrin and blood nitrogen values offers a possibility of interesting conclusions.—H. R.
(ADRENAL) Blood sugar and the treatment of Addison’s disease (Blutzucker und Diadttherapie bei Morbus Addi- sonii). Grote (L. R.), Miinch. med. Wehnschr., 1916, 63, 1614-1616.
In Addison’s disease blood sugar is usually diminished. The author gave his patient who had a classical case of Addi- son’s disease 100 grams of sugar daily. At the same time he administered extract of adrenals, and, as it is proved that carbonic-acid baths cause hyperglycemia, he also gave these. The patient improved rapidly; he gained in weight; the blood- sugar rose from 0.05 per cent to 0.10 per cent; the pigmentation of the skin (but not of the mucous membranes) disappeared. The author has not seen the patient lately, and does not know the subsequent history.—J. K.
(ADRENAL) Demonstration that the spontaneously liberated epinephrin can exert an action upon the heart. Stewart (G. N.) and Rogoff (J. M.), J. Pharm. & Exp. Therap. (Balt.), 1919, 13, 397.
As an outcome of their experiments upon the epinephrin output, the Cleveland investigators conclude that the epineph- rin passing into the blood stream from the adrenals at the ordinary rate can exert a definite action upon the heart when
498 ABSTRACTS
it is under the influence of strophanthin. It was proven by artificial administration of epinephrin that the constituent of the adrenal blood responsible for the observed effects was epinephrin.—F. F.
(ADRENAL) Effect of stimulation of sensory nerves upon the rate of liberation of epinephrin from the adrenals. Stewart (G. N.) and Rogoff (J. M.), J. Exp. M., (N. Y.), 1917, 26, 637.
Experiments were made upon both dogs and eats. Blood was obtained from the adrenals by means of the ‘‘cava pocket”’ method. An attempt was made to determine whether stimula- tion of afferent nerves (sciatic and brachial) produced a de- tectable increase in the rate of liberation of epinephrin from the adrenals, as determined by testing adrenal blood on rab- bit intestine and uterus segments. The results were negative.
—J. P.S.
(ADRENAL) Experiments with cell cultures (Ensayo sobre cultivos celulares). Pico (O. M.), 1917, Thesis of Buenos Aires, No. 3296.
The author has made cultures of several organs, using the Harrison method. Ineluded in the series was adrenal gland. In none of the adrenal cultures could evidence of adrenin be detected.—G. P. G.
ADRENAL ganglioneuroma (Ganglioneurom der Nebenniere). Jaffé (B. H.), Beitr. z. Pathol. Anat. (Jena), 1919, 65, 363.
Description of an ordinary case.—J. K.
ADRENAL hemorrhage in infants. Friderichsen (C.), Ugeskrift for Laeger (Copenhagen), 1917, 79, 1818-1826.
The author describes two cases, a boy aged 6 months and a girl aged 10 months, who showed the following: .Sudden onset of the disease with erying, vomiting, diarrhea, alter- nating cyanosis and paleness, high temperature, weak and ir- regular pulse and, several hours after the beginning of the disease, multiple hemorrhages in the skin. After that death occurred. The autopsy showed large hematomas in the adrenal glands. The author suggests that the cyanosis and the hem- orrhages of the skin are related to the adrenal insufficiency. —K. H. K.
(ADRENAL) Histochemical observations on the functional activity of the suprarenal medulla in different pathological
ABSTRACTS 499
conditions. Cramer (W.), Proc. Physiological Soc., J. Physiol. (Lond.), 1918, 52, xiii-xvi.
When mice are injected with a suitable dose of tetrahy- dronaphthylamine, and the suprarenals examined by the his- tochemical method, it is found that there is, during the first hour a massive secretion of adrenalin granules from the medul- lary cells into the blood vessels; during the second and third hours the cells are almost completely depleted, and during the fourth and fifth hours the cells again become filled with granules of adrenalin. If the animal dies the post-mortem ap- pearanees are similar to death from a toxie dose of adrenalin.
Mice differ markedly in their resistance to cold. Under identical conditions some animals remain well, while in others the temperature falls, and, if prolonged, the animal dies. In the animals that remain well the suprarenals are fully charged with adrenalin granules, while in those that die the medulla is depleted of its adrenalin.
Severe uncomplicated hemorrhage causes an active secre- tion of adrenalin within five minutes, which leads to an exten- sive depletion of the medullary cells. If the hemorrhage is arrested, the active secretion continues, but there is a new formation of adrenalin, se that the granules begin to accumu- late in the medullary cells in about an hour.
The glands of mice that have died from post-operative shock, one-half to two hours after an abdominal operation, present a somewhat different appearance from those after hemorrhage. In shock the medullary cells are vacuolated, but fully charged with adrenalin granules ‘‘and a very active secretion of adrenalin into the blood may be proceeding at the moment when the animal dies.’’ The death of the animal is therefore clearly not due to the exhaustion of the gland or to an inadequate secretion of adrenalin.—T. C. B.
(ADRENAL THYROID) Skin diseases caused by abnormal endocrine functions and their organotherapeutic treatment. (Hautzustande endokriner Voraussetzung und ihre organo- therapeutische Beeinflussung). Nobl (G.), Wiener klin. Wehnschr., 1919, 69, 876.
Four cases of scleroderma are described. One patient had a large goitre, one manifested typical Graves’ disease, another showed marked hypoplasia of the thyroid and the fourth showed cystic degeneration of the right lobe, together with struma of the left lobe of the thyroid.
The skin in scleroderma microscopically resembles that in the thyroid alone is at fault. In another case of scleroderma, myxedema. This, however, does not justify a conclusion that
500 ABSTRACTS
described by Rasch, the only endocrine defect detected at autopsy was total atrophy of one adrenal. Although, as some authors believe, tuberculosis is an important etiologic factor in scleroderma, it also may affect the thyroid and thus cause the scleroderma. It is only in eases in which the sclerodermie manifestations are accompanied by diminished functions of the thyroid that administration of thyroid preparations can be expected to give good results. In the cases deseribed by Nobl neither the dose, the preparation used nor the effect is stated. Four cases of alopecia are also described. The author believes that they are of endocrine origin, but gives no specifie evidence as to the etiology or the results of organotherapy. —J. K.
(ADRENAL) Studies on the nervous control of the kidney in relation to diuresis and urinary secretion. I. The effect of unilateral excision of the adrenal, section of the splanchnic nerve and section of the renal nerves on the secretion of the kidney. Marshall (HK. K.) and Kolls (A. C.), Am. J. Physiol. (Balt.), 1919, 49, 302-316.
The authors are of the opinion that the changes produced in the secretion of one kidney by unilateral excision of the adrenal are due merely to the damage to the splanchnic nerves caused by the operation, since unilateral section of the splanch- nics or the nerves on the renal artery and vein (leaving the adrenal nerve supply intact) produce identical results. Further they contend that the direct vascular connection between the adrenals and the kidney which was demonstrated by Cow in the cat does not function in the dog. This view is supported by the observation that ligation of the lumbar vein of one adrenal causes no change in the urine of the corresponding kidney. This work, however, does not invalidate the conelu- sion that complete removal of the adrenals depresses the fune- tion of the kidneys. (See Endocr., 1917, 1, 59-60.)
It was also observed that following unilateral excision of the adrenal or section of the splanchnic or renal nerves the kidney on the operated side secretes in general a more dilute urine containing a greater percentage of chlorides, but a smaller percentage of urea, creatinine, lactose and phenolsulphoneph- thalein. This is always the feature during diuresis produced by sodium chloride, but during a normal flow the urea per- centage may be higher on the side with the greater amount of urine. The total amount of water, chlorides and urea is greater on the operated side, while but little or no change is noticed in the total amount of creatinine and phthalein eliminated on the two sides. The similarity of these changes to those oceur-
ABSTRACTS 501
ring during diuresis and in the lessened flow of urine produced by partial obstruction of the ureter is discussed.—L. G. K.
(ADRENAL) Subacute insufficiency of the adrenals in amyloid- Osis, and some remarks on Addison’s disease (Subakute Insuffizienz der Nebennieren bei Amyloidose, nebst Bemer- kungen itiber der Morbus Addisonii). Schlesinger (H.), Wiener klin Wehnschr., 1917, 30, 99-101.
Deseription of a patient of 47 years with cachexia, bron- ehitis and chronic nephritis. There were found marked pig- mentation of the skin, no pigmentation of the mucous mem- branes, low blood pressure and apathy. Injection of tuberculin gave no reaction; injections of adrenalin did not produce glycosuria and had no influence on the blood pressure. The diagnosis was: Non-tubereulous degeneration of the adrenal; chronic nephritis.
Autopsy showed ehronie nephritis. Both adrenals showed amyloid degeneration. The author discusses the diagnosis of this ease. Though it was a classical example of Addison’s dis- ease, it was possible to make the diagnosis of amyloidosis, because the injection of tuberculin did not produce a reaction. It is possible to draw a conclusion from the effect of the in- jections of adrenalin. If such an injection has no influence on the blood pressure, death may be very soon expected.—J. K.
(ADRENAL) The action of drugs on the output of epinephrin from the adrenals. Stewart (G. N.) and Rogoff (J. M.). J. Pharm. & Exp. Therap. (Balt.), 1919, 18, 95, 167-182, 183. 242, 361. ;
1, STRYCHNINE
It has been the authors’ experience that spontaneous lib- eration of epinephrin is not easily influenced by experimental conditions. The technique of measuring the epinephrin output is carefully worked out and discussed in detail. The conelu- sions are based primarily on assays of adrenal blood (from dogs and eats) with rabbit intestine and uterine segments. Additional evidence, however, was obtained by studying the effects produced on the blood pressure by adrenal blood, col- lected in cava pockets for a given time, before and after ad- ministration of strychnine.
Stewart and Rogoff find that the administration of strych- nine in therapeutic doses causes a marked and lasting increase (1 to 1144 hours or even longer) in the production and output of epinephrin from the adrenals. The epinephrin content of the glands is not materially diminished even after prolonged action of larger and repeated doses of strychnine. The adren-
502 ABSTRACTS
als evidently are able to maintain their epinephrin equilibrium in spite of the greatly increased output. There is no direct action on the gland, the strychnine effect being produced by intensification of the normal secretory process through the nervous mechanism.
2. CONCENTRATED SALT SOLUTIONS (SODIUM CARBONATE) INJECTED INTO THE CIRCULATION
Intravascular injection of small volumes of concentrated salt solutions (sodium carbonate) causes a temporary increase in the rate of liberation of epinephrin from the adrenals. It is concluded that the increase is due to stimulation of the nervous mechanism which governs the epinephrin output. The authors caution against the use of concentrated solutions of salts in tubes connecting an artery with a mercurial manom- eter.
3. NICOTINE
According to Stewart and Rogoff, nicotine, when admin- istered intravenously or hypodermically, produces first a stage of excitation of the adrenals lasting from a few seconds to not over one minute, during which time the epinephrin output is increased to from two to fifteen times the normal. This tran- ~ sient stage is followed promptly by a prolonged period of de- pression which seems to be the predominating action of the alkaloid upon the suprarenals. The functional paralysis of the glands is so severe that no epinephrin may be detected in the suprarenal vein blood at the time of maximum depression, which is reached shortly after the brief period of increased activity is passed. Normal functioning of the glands is re- stored gradually.
4. STROPHANTHIN
No decided and constant effect of strophanthin upon the epinephrin output of the adrenals could be demonstrated. This leads the authors to believe that statements in the literature to the effect that the drug causes a marked augmentation of the output are based upon the use of inadequate methods.
—F. F.
(ADRENAL) The chrome reaction of the chromaffin tissue as an indicator of adrenin. (Die Chromreaktion des chromaf- finen Gewebes als Adrenalinreaktion). Stoeltzner, Munch. med. Wehnschr., 1919, 66, 584.
The chromaffin tissue derives its name from its property of giving a brown color with salts of chromic acid. But with silver salts it takes a black color, and with gold salts a purple one. A solution of adrenaline gives the same reaction with chromium, silver or gold compounds. Probably these reactions
ABSTRACTS 503
of the chromaffine tissue, therefore, are caused by its content of adrenaline.—J. K.
(ADRENAL) Traumatic Addison’s disease (Wher traumatisch- entstandene Addisonsche Krankheit). Driick (A.), Aerz- tliche Sachverstindigen-Zeitung (Berlin), 1919, 25, 73.
A man was pressed between two railway carriages, sustain- ing fractures of several ribs and shock. Three and a half months later the first symptoms of bronzed skin were observed. The patient complained of pains in arms and legs; his muscles became powerless. Gradually he became weaker. He died eight years after the railway accident. At the post-mortem examination no abnormalities were found except that in the place of the adrenals two masses of fat were seen with no trace of adrenal tissue——J. K.
(ADRENAL) Treatment of inflammations of the organs of respiration with extract of adrenals (Behandlung der Ka- tarrhe der Atmungsorgane mit Nebennierenextract). Die- sing. Deutsche med. Wehnschr. (Berlin), 1919, 45, 602.
The author recommends the use of adrenochrom, made from adrenals of calves, sheep or pigs, by extraction with ether, alcohol and benzine, dissolved in a weak neutral soap solution. This extract is very rich in sulphur. When adreno- chrom is used locally on the mucous membrane of the respira- tory tract it proves to be a good expectorant, good results being seen especially in pulmonary tuberculosis.—J. K.
(ADRENAL) Treatment of influenza with adrenin (Tratami- ento de la grippe por la adrenalina). Ricaldoni (A.), Anales Fae. Med., Montevideo, 1918, 3, 867.
The author believes that in ‘‘exotie grippe’’ as observed during the epidemic of 1918, the infection gave rise to a con- dition of partial adrenal insufficiency. The most prominent clinical manifestations of the condition were physical and psychic asthenia, vagotonie pulse which was slow in spite of the fever, and vascular hypotension. The treatment recom- mended is adrenaline 30-40 drops a day, given, if necessary, hypodermatically.—H. R.
ADRENAL typhoid syndrome (Syndrome surréno-typhique). Escudor Numiez (P.), Anales Fac. Med., Montevideo, 1918, 3, —, (No. 8).
504 ABSTRACTS
The author observed in typhoid the following syndrome: Hyposthenia, hypotension, hypocholestrinemia, dicrotic pulse, and sphygmothermie dissociation. This he attributes to adre- nal insufficiency. He advises the administration of adrenin.
—H. R.
(ADRENAL). Treatment of the major syndromes in paludism. (Traitement des grands syndromes du paludism). Benhamou, Bull. gen. de therap. (Paris), 1919, 12, 536-559.
Since paludism is frequently accompanied by a syndrome resembling that observed in suprarenal insufficiency, the author is of the opinion that in this disease there may occur a lesion of the adrenal bodies.—F. 8. H.
(ADRENAL THYROID) Hemadenology: a new specialty. Sajous (C. E. de M.), N. Y. Med. J. (N. Y.), 1916, 103, 274-5.
The psychoses associated with thyroid disturbances are considered by the author to result because of impairment of the antitoxie function of the thyroid. Normal thyroid secre- tion is necessary to sensitize the cellular phosphorus to the action of oxygen, hence a deficiency of this secretion results in deficient oxidation in the cerebral cells. Adrenal psychoses also are considered the result of deficient oxidation of cortical neurones, a condition made possible because of a diminished supply of adrenoxidase.—H. W.
(ADRENAL THYROID PANCREAS THYMUS) The distribu- tion in the body of spirochaeta icterohaemorrhagiae. Kaneko (R.) and Okuda (K.), J. Exp. M. (N. Y.), 1917, 26, 325.
The material which forms the basis of this paper came from forty-three autopsies on the bodies of persons who died at various stages of illness with Weil’s disease or acute febrile jaundice. The spirochetes which are now believed to be the causative agent, were found in the glands of internal secretion as follows: In the suprarenals, in ten out of twenty-four cases examined, but in only one case were they at all numerous; in the panereas, in eleven out of thirty-three cases examined; in the thyroid, in eleven out of seventeen cases examined; in the thymus in both of the two cases examined.—J. P. 8.
(ADRENIN) Experimental studies of the ureter. Satani (Y.), Am. J. Physiol. (Balt.), 1919, 49, 474-495.
Adrenalin and physostigmin stimulate the movements of the excised ureter in Locke’s solution. Adrenalin affects the
ABSTRACTS 505
upper portion of the ureter more strongly while physostigmin gives a more distinct reaction on the lower portion. Ergo- toxin in large doses antagonizes the action of adrenalin, but has no influence upon the action of physostigmin. Large doses of atropin antagonize the action of physostigmin, but not that of adrenalin. It is therefore concluded that the ureter is innervated by both sympathetic and parasympathetic fibres. Considerable other information of pharmacological but not of endocrine interest is included in the paper.—L. G. K.
(ADRENIN) Experiments on the causation and amelioration of adrenalin pulmonary edema. Auer (J.) and Gates (F. L.), J. Exp. M. (N. Y.), 1917, 26, 201.
Intratracheal injection of a single moderate dose of adre- nin in vagotomized rabbits usually produces a marked edema of the lungs, which may be greatly reduced by the employment of artificial respiration. As adrenin can exert a broncho-con- strictor effect, the authors believe that the aspirating action of the lung alveoli under this condition plays an important part in the production of adrenalin pulmonary edema. This hy- pothesis is supported by the effect of artificial respiration (with a bellows). The intratracheal injection of adrenalin was also found to produce temporary incoordination between the heart ventricles, visible on inspection, so that the left ventricle beat apparently half as fast as the right, causing hyperemia of the lungs and hemorrhages. Atropine injected intratracheally in vagotomized rabbits exerts a protective action against adrenin pulmonary edema.—J. P. 8.
(ADRENIN) Further observations showing that epinephrin from the adrenals is not indispensable. Stewart (G. N.) and Rogoff (J. M.), Am. J. Physiol. (Balt.), 1919, 48, 397-410.
The authors continue the work previously done on cats and rabbits by showing that in dogs and monkeys, also, the liberation of epinephrin from the adrenals is not indispensable for life and health. As in their former experiments they re- moved one adrenal and severed the nerves to the other, and after varying intervals assayed on rabbit intestine (and uterus) segments the adrenin content of the adrenal vein blood. As before, the adrenin output was found to have been very greatly reduced, in some cases to an undetectable quantity, without having affected the health of the animals. Tables of addi- tional results from experiments on cats are also included. (See Endocrin., 1917, 1, 341-2.)—L. G. K.
506 ABSTRACTS
ADRENIN in auriculo-ventricular dissociation (Adrenalina en la disociacion auriculo-ventricular). Arrillaga (F. C.), Rev. Assoc. Méd. Argentina (Bs. Aires), 1919, 30, 171-172, 193.
Six cases of this disorder were studied with the electro- eardiograph. The injection of adrenin produced an accelera- tion of the beats manifested independently in the auricles and ventricles. Recomposition of the normal rhythm was not seen. In one case there was tachycardia of 140 beats. Ordinarily the reaction of the auricles and ventricles occurred simultaneously, but that of the ventricle occasionally appeared first.—B. A. H.
(ADRENIN) L’hyperglycémie adrenalinique. Phocas (A.), C. R. Soe. Biol. (Paris), 1919, 82, 485-486.
Following an injection of adrenalin the amount of com- bined (‘‘virtual’’) sugar in the blood of well nourished rab- bits is not altered, but is diminished in the blood of starving rabbits.—L. G. K.
(ADRENIN) Novocaine-adrenaline stock solution. Elphin- stone (J. H.), Dental Cosmos, 1919, 61, 675.
This solution may be preserved by means of CHCl, con- taining a trace of HCl. The solution is contained in a test tube, which is kept in a glass cylinder with a glass cover; the cover is made tight with vaseline; and the CHCl, is placed on the bottom of the eylinder. Chem. Abst., 18, 1742.
(ADRENIN) The influence of subcutaneous adrenalin injection on the blood of healthy and sick children (Der Einfiuss sub- cutaner Adrenalin-injektionen auf das Blutbild gesunder und kranker Kinder). Grimm (G.), Jahrbuch f. Kinderheilk (Berlin), 1919, 89, 442.
In infants the injection of adrenaline produces the same changes in the blood as in adults (the first half hour lymphocy- tosis followed by a leucocytosis).
In diseases of the lymph gland this reaction is not ob- served. Also in children with lymphatic constitution extirpa- tion of the spleen has no influence on the reaction.—J. K.
(ADRENIN) Treatment of serious lung diseases in infants with adrenin (Adrenalinbehandlung schwerer Lungener- krankungen bei Sauglingen). Vogel, Deutsche med. Wehnschr. (Berlin), 1919, 45, 648.
Good results were reported from the treatment of serious capillary bronchitis with injections of 0.2-0.5ce. of a 1:1000
ABSTRACTS 507
solution of adrenalin. They must be repeated two to eight times daily.—J. K.
(ADRENIN and PITUITRIN). A study in interaction and in- terrelation. Cow (D.), J. Physiol. (Lond.), 1919, 52, 301.
In the rabbit the uterus always responds to adrenalin by contraction; in the rat and guinea pig by inhibition; in the virgin cat by inhibition; in the pregnant cat by contraction. The explanation usually given is the preponderance of motor over inhibitor nerves or vice versa. The occasional ‘‘abnor- mal response’’ of the guinea pig’s uterus and the difficulty of postulating the preponderance of one kind of nerve ending over another as the sole determining cause of the kind of re- action of the uterus to adrenalin, led the author to investigate the subject with the idea of showing whether other factors were involved.
In the guinea pig’s uterus the effects of adrenalin and pituitrin are diametrically opposed to one another, adrenalin jnhibiting and pituitrin causing increased tonus and contrac- tions. If the two drugs are applied together in proper propor- tions, the effect is a combination of the two; the uterus shows large contractions and relaxations which in amplitude ap- proach extreme relaxation and extreme contraction. If the pituitrin is in exeess the response is more like that of the pure pituitrin movements in a high state of tonus, but with the relaxations more distinct. If the uterus is first treated with pituitrin and, after suspension, adrenalin is applied, the effect is comparable to that of pituitrin alone, not a mixture of the two; in other words the adrenalin effect is reversed by this ‘‘sensitizing’’ with pituitrin. The same is not true if the uterus is treated first with adrenalin and then pituitrin applied. In this case there is either the pure pituitrin effect, or the effect of a mixture. The pregnant uterus gives the ‘‘reversed re- sponse’’ to adrenalin more readily than the non-pregnant. The non-pregnant uterus of the cat also gives the ‘‘reversed re- sponse’’ to adrenalin. In the rat it is much more difficult to ‘*sensitize’’ the uterus with pituitrin.
Experiments on the uterus in situ gave similar results. ““Some of the animals which had received preliminary treat- ment with pituitary preparations gave the reversed uterine re- sponse to hypogastric nerve stimulation or to injection. of adrenalin without any further injection of pituitrin.
Feeding posterior lobe, together with injections of pituitrin is sufficient to sensitize the uterus and cause the ‘‘reversed response.’’ It would appear that ‘‘an unwontedly generous supply to the uterus of the active principle of the posterior
50 ABSTRACTS
(oe)
lobe of the pituitary body is sufficient stimulus to change in some way the reaction to adrenalin of the uterus of such species of animals as normally react to adrenalin (or to hypogastric nerve stimulation) by relaxation.’’ This change seems to take place normally in the cat, during pregnancy. The “‘sensitiz- ing’’ action of pituitrin appears to be in the peripheral sympa- thetic mechanism.—T. C. B.
(ADRENIN, SHOCK) Studies in secondary traumatic shock. III. Circulatory failure due to adrenalin. Erlanger (J.) and Gasser (H. S.), Am. J. Physiol. (Balt.), 1919, 49, 345-376.
Continuous injections of large doses of adrenalin (6 to 11 ee. of the 1:1000 solution) were made into the femoral veins of dogs, in the course of 21 to 29 minutes. The carotid pressure was recorded and the peripheral resistance measured by the inflow method.
It was found that after sufficiently large doses the arterial pressure usually falls steadily until the animal dies, unless, as occasionally happens, life is cut short by sudden stoppage of the heart or failure of the respiration. Large doses therefore, as Judged by the arterial pressure, do long-lasting damage to the circulation if they do not actually carry the pressure down to a fatally low level. During the injection a constriction of both the somatie and splanchnie arteries develops. With large doses this constriction may be maximal and may outlast the injection period for as long as two hours. Part of this long- lasting constriction is central in origin as evidenced by the immediate acceleration of relaxation at death. In one experi- ment only did dilation follow the constriction at the close of an injection period.
The jugular pressure shows no constant variations of any significance. The portal pressure, however, is increased, often markedly, during the injection and may remain high subse- quently, but often it soon returns to the normal level. The rise in portal pressure is ascribed to an extreme obstruction in the liver.
The cireulation may fail suddenly through stoppage of the heart due to direct action of adrenalin, or the indirect action of respiratory failure. But more often death occurs after a gradual, steady decline in pressure, the arterial con- striction induced by the adrenalin lasting to the end. A re- duced blood volume, either real or effective, is believed to be the main factor at fault. Apathy, as well as other signs of shock, are present.
Evidence is presented indicating that the accumulation of blood in the portal area as a result of the increased portal-
ABSTRACTS 509
hepatic resistance is not in itself the cause of the failure of the circulation, since obstruction of the hepatic radicles in the liver by the injection of lyecopodium spores does not lead to the shock-like failure seen after adrenalin. The failure of the circulation is attributed rather to the extreme slowing of the blood flow throughout the body caused by the constrict- ing action of the adrenalin on the arteries. It is concluded that the cause of the failure is the same as is operative after tem- porary partial obstruction of the vena cava or of the aorta, especially as the most striking lesion found in animals dying as a result of any of these three procedures is the same, namely, a tremendous engorgement of the capillaries and venules of the villi of the intestines.—L. G. K.
(CAROTID BODY) A case of bilateral tumor of the carotid body. Lund (F. B.), Boston M. &S. J., 1917, 7G 6212623:
Report of a case successfully operated upon. Eighty per eent of carotid tumors are benign for many years, and may often be removed during the early stage without tying the earotid artery.—H. W.
(CORPUS LUTEUM) Action of corpus luteum extracts on the movements of isolated genito-urinary organs. Macht (D. I.) and Matsumoto (S.), Am. J. Physiol. (Balt.), 1919, 49, 149.
The freshly excised vas deferens of the rat in Tyrode’s solution was found to be the most sensitive and the most suit- able preparation for testing corpus luteum extracts. Such preparations, when treated with corpus luteum extracts, may react by contractions in solutions corresponding to 1:2500 of the fresh gland and almost always to concentrations of 1:1000 of the fresh gland. Vas deferens does not react to extracts of the ovarian substanee, proper.—h. G. K.
(CORPUS LUTEUM) Ovarian organotherapy in depressed lactation (La opoterapia ovarica en la hipogalaxia). Romero (O.), 1918, Thesis of Buenos Aires, No. 3397.
Romero presents further studies on the therapeutic effects reported by Gonalons (Endocrin., 1917, 1, 390) from organo- therapy with the corpus luteum of pregnant young cows in nursing women with little milk. He administered powdered ovary and corpus luteum powder with suecess. Eight observa- tions were made.—G. P. G.
DIABETES following head injury. (Diabetes nach Kopf- trauma). Kaess. Med. Klin. (Berlin), 1917, 13, 661-663.
510 ABSTRACTS
Deseription of the case of a workman who, after a blow on the head developed diabetes. The author, as expert in the lawsuit for indemnification, tells in this article why he believed the diabetes to be of traumatic origin. No new data are of- fered.—J. K.
DIABETES, The fasting treatment of—. Spriggs (E. I.), Brit. M. J. (Lond.), 1916, i, 841-845.
The author details the histories of several cases of diabetes treated by Allen’s fasting method. He finds that fasting, up to several days, is well borne by most cases of mild and severe diabetes. The urine is easily rendered sugar-free, the blood sugar is reduced and acidosis greatly diminished. All the patients feel better. In most cases the food can be gradually increased without glycosuria until a more liberal diet is bemg taken than before treatment. However, the opinion is ex- pressed that in some cases as good an effect may be attained, though more slowly, without fasting, with its risk of depression and weakness, provided the patient is willing to keep perma- nently to the diet found suitable to his case.—L. G. K.
DIABETES mellitus, The treatment of—. Joslin (E. P.), Canad. J. Med. & Surg. (Toronto), 1916, 40, 89-102 ; Dominion M. Month. (Toronto), 1916, 46, 37-49.
An interesting discussion of the fasting treatment of dia- betes. The desirability of a preparatory period with a fat- free diet is emphasized. If the urine is not rendered sugar- free by a four-day fast there is a likelihood of some compli- eating infection. If glycosuria persists after a preliminary four-day fast, alternate feeding and fasting is advocated. It is pointed out that a return of sugar demands fasting for twenty-four hours or until the urine is sugar-free—a rule that must be inflexibly followed, especially with children.
—hL. G. K.
DUCTLESS GLANDS, The—and atypical growth. Little (S. W.), New York M. J. (N. Y.), 1916, 103, 208-218.
The secretions of the ductless glands are known to exert a great influence on cell growth, on inhibition of cell growth, on eell differentiation or inhibition of the same, with conse- quent marked peculiarities in size, shape, and development of various organs or even of the entire individual. The ductless glands appear after cell differentiation has begun and continue to develop as this becomes more complete, but their secretions do not bring about specialization; they act only to furnish
ABSTRACTS 511
something essential for the maintenance of specialized cells. Such being true a deficiency of the ductless glands should re- sult in either failure or reduction of cells to a simpler form; the maintenance of specialized function would no longer be possible. If an adult carried embryonic cells and at the same time demonstrated a failing ductless gland essential to main- tain properly the highly specialized cells, one could not expect the embryonic cells to develop when the ductless gland essen- tial even to keep intact the developed cell is detriorating. The embryonic cell, lacking the influence of the appropriate duct- less gland, simply multiplies without development. Atypical growths, therefore, may be considered the result of unin- hibited embryonic cell activity due to ductless gland failure.
If the theory is true then the administration of properly chosen preparations of the ductless glands should be indicated. Such a claim is made by the author.—H. W.
DWARFISM. Ueber evolutive Vegetationsstérungen. Bauer (J.). Wiener klin. Wehnschr., 1917, 32, 739.
A very good article on the different forms of dwarfism and gigantism. No new data—J. K.
‘ENDOCRINOLOGY) Conceptos generales de Endocrinologia. Eseuder Nufiez (P.), Anales de la Facultad de Medicina de Montevideo, 1919, 5, 1.
General review.—H. R.
(ENDOCRINOLOGY) Early therapeutic use of animal ex- tracts. Macpherson (L.), Brit. M. J. (Lond.), 1918, (i), 607- 608.
A brief list of some of the earliest works that describe the use of animal extracts.—L. G. K.
(ENDOCRINOLOGY) Gynecologic evolution. Clinical con- ceptions and their therapeutic usefulness (Evolucion de la Ginecologia. Conceptos clinicos y valores terapeuticos actu- ales). Pandolfo (P.), Thesis of Buenos Aires, No. 3476. 1918.
Pandolfo in the second chapter of his thesis gives an ae- count of the newer points of view of the ovarian hormone functions and the relation of the ovaries to the other ductless glands. No new data are offered—G. P. G.
(ENDOCRINE ORGANS) A case of myasthenia gravis with post-mortem examination (Uber einen Fall von Myasthenia
512 ABSTRACTS
gravis mit Autopsie). Pulay (E.), Neurol. Centralbl. (Leip- zig), 1919, 38, 263.
The cause of this disease is unknown. Some authors con- sider the disease as congenital, others think of an abnormal funetion of the thymus or of the parathyroids. Pulay de- seribes a classical case in a girl of 17 vears, beginning with difficulty in speaking and swallowing; then ptosis was seen. She gradually lost her hair. She became very easily fatigued. There was a marked atrophy of the tongue. She died in dyspnea. At the post-mortem examination were found goitre, status thymicus, narrow blood-vessels, hypoplasia of the ovaries, large spleen and enlarged adrenals.—J. K.
(ENDOCRINE ORGANS) Atrophic myotonia and cataract (Myotonische Dystrophie und Cataract). Hauptmann, Klin. Monatsbl. f. Augenheilk. (Stuttgart), 1918, 60, 576.
A clinical description of this disease. It begins after the © age of 20. The chief symptoms are atrophy of muscles, degen- eration in brain and spinal cord, atrophy of the gonads, loss of hair, depletion of lime from the bones and cataract of both eyes. Most probably the disease is hereditary and is caused by a congenital degeneration of the central nervous system and the endocrine organs.—J. K.
(ENDOCRINE ORGANS) Bilirubin in the blood and the infiu- ence of chemical substances on it (Uber das Bilirubin im Blute und seine pharmakologische Beeinfiussbarkeit). Bauer (J.) and Spiegel (E.), Deutsch. Archiv. f. klin. Med. -(Leip- Ze) MOA OTAZO, 17:
It is now generally accepted that normal blood contains always traces of bilirubin. The quantity is different in dif- ferent individuals but is constant in the same person. It is possible to diminish the content of bilirubin by administration of adrenalin; extract of testicle and extract of pituitary (espe- cially of the anterior lobe) had the same effect. Extract of thyroid had in one ease no effect; in another case the bilirubin was slightly diminished. Injection of thymus extract gave, twice, diminution and, once, increase of the bilirubin. Extract of ovary had no influence.—J. K.
(ENDOCRINE ORGANS) Clinical aspect of the diseases of the ductless glands. Sailer (J.), New York M. J., 1917, 105, 1121- 1125.
Glandular disturbances may be elassified as to their eti- ology as follows: Infectious causes including hereditary infec-
ABSTRACTS 513
tions ; toxemias; disturbanees of nutrition; traumatism, includ- ing surgery; nervous influences; tumors; hereditary and familial types; marked activity of other glands of internal secretion and atavism. Illustrative cases are considered under each class.—H. W.
(ENDOCRINE ORGANS) Contribution to the caption ‘‘Inter- nal secretion’’ (Beitrag zum Kapitel ‘‘Interne Sekretion’’). Hoefimayr, Miinch. med. Wehnschr., 1919, 66, 512.
The author describes four cases of atrophy of the optic nerves. In these cases no cause could be detected but each in- dividual had experienced diminished function of the genera- tive organs. One case was cured by a general treatment (baths, massage, etc.). The other three were cured by treat- ment with ‘‘horminum feminum.’’ The significance of the article is obscure.—J. K.
(ENDOCRINE ORGANS) Fundamental considerations in the treatment of psychoneuroses. Gregg (D.), Boston M. &S. J., hy, 216.) 571-58.
Psychoneuroses may be defined as functional disturbances having an emotional origin. True psychoneuroses include such conditions as neurasthenia, hysteria and possibly psychas- thenia. They do not include true fatigue, exhaustion or or- ganic conditions due to internal glandular disturbances, such as hyperthyroidism and the menopause.—H. W.
(ENDOCRINE ORGANS) Infantilism and disturbances of pu- berty (Ueber Infantilismus und Storungen der Geschlechts- reifung). Lommel, Med. Klin. (Berlin), 1917, 13, 618.
Among 600 individuals between 14 and 17 years of age the author observed fifty-five cases of infantilism. They showed infantilism of the generative organs and were smaller than the others. In one young girl a dystrophia sclerodermica (ceasing of the menstruation, leanness, nutritive disturbance of the skin, senile involution of the uterus) was seen.—J. K.
(ENDOCRINE ORGANS) Metabolism in diseases of the duct- less glands (Grundumsatz bei Storungen innersekretorischer Organe). Léoffler, Ztschr. f. klin. Med. (Berlin), 1919, 87, 280.
In a case of Addison’s disease metabolism was dimin- ished; the quantity of exereted CO, and used oxygen was low; the respiratory quotient was low. Administration of 1 ee. of
514 ABSTRACTS
1:1000 solution of adrenalin raised the quantity of CO, and O, and raised also the respiratory quotient. This increase lasted for more than two hours. In another case of Addison’s dis- ease with symptoms of an increased function of the thyroid, metabolism was normal. It was also normal in a severe case of parathyreoprivie tetany with myasthenia. The quantity of CO, and O, was slightly diminished in a ease of familial obesity.—J. K.
(ENDOCRINE ORGANS) Non-specific effects of organo-thera- peusis (Unspezifische Wirkungen in der Organotherapie). 3orchardt, Deutsche med. Wehnschr. (Berlin), 1919, 45, 813.
The author found that the formation of agglutinins after inoculation against typhoid fever was largely increased when adrenaline was injected. This is a non-specific action. It is not impossible that extracts of other endocrine organs act in the same way. Perhaps these organs act through ‘‘activation of the protoplasm.’’—J. K.
(ENDOCRINE ORGANS) Rachitis tarda. Wenckebach (K.), Deutsche med. Wehnschr. (Berlin), 1919, 45, 784.
A brief note on a ease of rickets in a man of 19. These cases (rather frequent in Holland) were extremely rare in Vi- enna; but since 1918 they are seen frequently. This patient had symptoms of polyglandular insufficiency (pain in the joints, infantilism, tetany and abnormal pigmentation). He was treated with phosphorus and cod-liver oil—J. K.
(ENDOCRINE ORGANS) Significance of war pathology (Be- deutung und Ergebnisse der Kriegs-pathologie). Roszle (R.), Jahreskurse f. Arztliche Fortbildung (Munich), 1919, 10, 23.
In this article (although not primarily on an endecrine topic) there are some notes on the endocrine organs. The au- thor gives the results of his post-mortem examinations of Ger- man soldiers killed in the war. The average weight of the thyroid is 34 grams; soldiers born in mountainous districts have larger thyroids than those born in the level country. The average weight of the adrenals is 14.1 grams. Many authors have reported atrophy of the adrenals in all cases of status thymo-lymphaticus; according to Roszle, however, this associ- ation is very rare. The average weight of the hypophysis is 627 milligrams, and that of the testicle 34 grams. This last weight is usually reached at the age of 19-20, after which there is generally no more increase in weight. Some German authors have written that many young soldiers had sexual infantilism.
ABSTRACTS 515
The author rarely observed this; in most of these cases there was at the same time a tuberculous infection—J. K. ~
(ENDOCRINE ORGANS) The absence of fat-soluble A vita- mine in certain ductless glands. Emmet (A. D.) and Luros (G.), J. Biol. Chem. (N. Y.), 1919, 38, 441-449.
The ether extract of the pancreas, thymus and adrenal does not contain ‘‘fat-soluble A.’’? One of the duetless glands, however, cod’s testicles, does contain this dietary factor.
—V. K. L.
(ENDOCRINE ORGANS) The coagulation of the blood (Bei- trag zur Lehre von der Blutgerinnung). Schilling (K.), Bio- chem. Ztschr. (Berlin), 1919, 95, 220.
The author examined the influence of extracts of liver, lung, heart, kidney, adrenal, thymus, testicle, spleen, pituitary, thyroid and pancreas on the time in which the blood coagu- lates. All these extracts quicken the coagulation of the blood to which they are added. The action is due to the quantity of fat of the extract. If first all fats are removed and the ex- tract, free from fats, is added to the blood, it has no influence on the coagulation time.—J. K.
(ENDOCRINE ORGANS) The frequency and significance of dysfunction of the internal secretory system in the feeble- minded. McCord (C. P.) and Haynes (H. A.), New York M. J., 1917, 105, 583-588.
Of 1134 feebleminded inmates in the Michigan Home and Training School, 240, or 21.16 per cent., showed characteristics of various glandular syndromes. Heredity stands out as the prominent factor in the etiology of these cases. The demon- stration of glandular syndromes in the feebleminded does not in itself allow any inference that the condition can be attrib- uted to the glandular dysfunction. The glandular defect may determine the increasing defect ; but more often the co-existing feeblemindedness and glandular defect are both the outcome of a common cause. Promiscuous treatment of the feeble- minded with glandular derivatives is unprofitable and unwar- ranted. In borderline eases of glandular disease with trivial mental inadequacy, glandular therapy may prove of especial value. Often in these cases no true mental deficiency exists, and all manifestations of mental inadequacy are referable to the glandular malfunction. In such eases glandular treatment persistently carried out may be the factor deciding between normality and increasing defects.—H. W.
516 ABSTRACTS
(ENDOCRINE ORGANS) The osteomalacia-like diseases in Vienna (Zur Kenntnis der gehauften osteomalazieahnlichen Zustande in Wien). Schlesinger (H.), Wiener kl. . Wehnscehr., 1919, 32, 245.
In Vienna an endemic disease of the bones is observed. Most probably this is due to lime and phosphorus starvation. The activity of the endocrine organs has been diminished by the insufficient feeding. Old women, especially, suffer from it, but the disease is also observed in men. The pelvis is generally normal; the ribs and the sternum are most affected. The con- dition is very painful. Treatment with lime, phosphorus and adrenalin alleviates the pain, but has no effect whatever on the defects of the bones.—J. K.
EUNUCHOIDISM. Climenko (H.) and Strauss (1.), Arch. Neurol. and Psych. (Chgo.), 1919, 1, 726-748.
The authors believe that in the eunuchoid lies the key to a solution of some of the vital questions in endocrinology, and on the fact that the pathology of congenital eunuchoidism has been shown to be due to a disturbed pluriglandular condition he bases the present study. The literature is reviewed at length. In general the division of eunuchoids into two groups by Tandler and Grosz is aecepted: (1) tall, slender individ- uals with abnormally large extremities, and (2) stout, bloated people with accumulations of fat at various points. The author has observed, however, intervening types.
Six cases are deseribed in detail with photographs and roentgenograms of the sella turcica. Five of the cases were men. The one woman had strongly marked acromegalic fea- tures. There was clinical and laboratory evidence of pluri- glandular disturbance in all the cases, the adrenals seemingly being most greatly at fault. In the first four cases, all con- genital eunuchoids, three showed status lymphaticus. One gave clinical symptoms of apoplexy into the cord, a condition hitherto unreported. The third and fourth cases each had a very small sella turcica, which is very rare in eunuchoids and contrary to the accepted opinion that the sella is always en- larged. The author believes this illustrative of the fact that judgment of the function of the pituitary should not be based on the size of its bony envelope. In all the five male cases there was a conspicuous lack of masculine traits and all had high-pitched voices. In the one female case, diagnosed as tumor of the hypophysis, there was a pronounced inversion of secondary sexual characteristics; here nature had created an acquired eunuchoidism for through interference with the pituitary function the sex glands had ceased to act. The see-
ABSTRACTS 517
ond ease, that of giantism, was an imbecile, but the mental status of all the other cases was normal. The sixth case had complete absence of external secretion of the testicles, yet he retained the secondary sexual characteristics and was able to indulge freely in coitus. All except the imbecile stated that they had a desire for the opposite sex. The author, however, believes that these people are without a real libido, and inter- prets their desire as a wish to be like other people.
No form of therapy is of any avail since these cases are finished products.—Authors’ abstract (abbreviated).
(GENERAL) Concerning the dysfunctioning of some endo- crine glands during pregnancy (Ueber die Dysfunction eini- gen endokrinen Drisen in der Schwangerschaft). Mahnert (A.), Arch. f. Gynak. (Berlin), 1919, 110, 743-765.
Mahnert in using the method devised by Abderhalden for the detection of specific proteolytic enzymes, found that the serum of pregnant individuals was different from that of non- pregnant persons in that the majority of cases showed the presence of enzymes specific for ovarian, thyroid, and supra- renal proteins. From this he concludes that durmg pregnancy there occurs a dystunctioning of these glands.—F. 8S. H.
(GONADS) A case of eunuchoidism (Vorstellung eines Falles von Eunuchoidismus). Tachau, Miinch. med. Wehnschr, 1917, 64, 19.
Description of a German sergeant of 22 years with atrophic gonads, a high voice, no beard and no hair over the body ex- cept pubie ecrines. There was no sexual desire. X-ray exami- nation showed a small heart and normal sella turecica. No alimentary glycosuria was produced by 100 grams of glucose.
—J. K.
(GONADS) A case of pseudohermaphroditismus (Kin Fall von—). Schmalfuss, Deutsche med. Wehnschr. (Berlin), 1919, 45, 592.
Of technical anatomical interest.—J. K.
(GONADS) Experimenteller Hermaphroditismus. Sand (K.), Arch. f. d. ges. Physiol. (Berlin), 1918, 178, 1.
Data published elsewhere. See Abst. in this number.
(GONADS) Hermaphroditismus femininus externus. Kolhier (R.), Wiener klin. Wehnsehr., 1917, 30, 1117.
518 ABSTRACTS
An individual of 20 years had an operation for peritonitis. During the operation a uterus and one Fallopian tube were discovered. The exterior genitals consisted of a penis instead of clitoris, with labia majora and minora. The vagina was narrow and of a finger length—J. K.
(GONADS) Libido and hormones (Geslachtelijke potentie en inwendige afscheiding). Posner (C.), Med. Weekblad (Am- sterdam), 1916, 238, 592-596.
Sexual desires are independent of spermatogenesis for they remain when the formatian of spermatozoa. has been destroyed by X-rays. Organotherapy in sexual impotence has sometimes given good results.—J. K.
(GONADS) Masculine type of pseudo-hermaphroditism (Pseu- do hermaphroditism masculin). Girou (T.), Ann. Gyn. et d’Obstet. (Paris.), 1919, 13, 434-436.
Concise description of surgical findings in a case of pseudo- hermaphroditism of the masculine type originally diagnosed as inguinal hernia.—F. 8. H.
(GONADS) Pseudo-hermaphroditism, externally female, with diffuse papillomatosis in a rudimentary urethra. Verning (P.), Ugeskrift for Laeger (Copenhagen) 1918, 80, 1701-1708.
The patient, aged 71 years, had when young been a publie woman. The Wassermann reaction was positive. Menstrua- tion occurred from the 13th to 52nd years. Flow had now again begun. She was of virile habitus. The clitoris was 6 em. long; in the glans of the clitoris was a urethra with a nor- mal orifice. At the base of the clitoris a walnut-sized tumor, microscopically, an epitheloid papillomatous structure was found. The uterus was large and the cervix normal.
(GONADS) Pseudohermaphroditism. Record of a case of bi- sexual external organs of generation, psychic hermaphro- ditism, and gumatous ulceration of the genitals. Gottheil (W. 8S.) and Goldenthal (C.), New York M. J., 1917, 105, 933- 935; Abst. J. Cutan. Dis. incl. Syph. (Boston), 1917, 35, 267.
A negress 15 years of age showed a combination of gen- eral male type of body, very large penis with spongy and cavernous bodies, distinct psychical inclinations to the female sex, a vagina, cervix and occasional menstruation. No testes were present in the scrotal sacks. Besides the malformation
ABSTRACTS. 519
of the generative organs, the individual showed other stigmata of degeneration.—H. W.
(GONADS) Ueber Hermaphroditismus. Baumgarten (A.), Wiener klin. Wehnschr., 1916, 29, 1507-1509. Abst. Miinch. med. Wehnschr., 1916, 68, 1804.
In a man of 22 years a little uterus was found at opera- tion, in the inguinal canal. One tube was present, and at the end of it an organ resembling an ovary. Microscopic examina- tion, however, proved it to be a testicle not now forming spermatozoa. The external genital organs were normal, but the external orifice was situated at the junction of scrotum and penis. Epidydimus or vas deferens was not found. In the scrotum was only one testicle and it was very small. The patient had a beard and pubic and axillary hairs. The voice was of the male type; the pelvis was not of the female form. There was no sexual desire.—J. K.
GYNECOMASTIA and mammary hormones (Zur Kenntnis der Gynakomastie und zur innersekretosischen Theorie der Brustdriise). Novak (J.), Zentralbl. f. Gynak (Leipzig), 1919, 48, 253.
Description of 5 cases.
1. <A perfectly normal man of 37. He has a goitre. The right breast is very large, of the female type and contains colostrum. The left breast is normal. The gonads are normal. Libido sexualis is normal.
2. Anormal man of 19. He complains only of pain in the left breast. The left breast is large and contains colostrum, the right one nothing particular. The gonads are well devel- oped but there is no libido sexualis.
3. A soldier of 19 has no beard and no hairs in the axilla. Both breasts are large, of female type. They contain colostrum. There is no libido sexualis.
4. Ina man of 35 without abnormalities, the right breast is large and painful. The gonads are normal.
5. A man of 20 had female breasts. From time to time they were swollen and painful. Both were removed. Histo- logical examination showed the typical female gland, but with- out signs of activity (no formation of milk). The gonads were normal.
The testicle has (as we know from the transplantation of Steinach) the power to reduce the development of the mam- mary gland. Perhaps in these cases the function of the gonad has been diminished (in some of them there was no libido sexualis), but certainly this is not the only cause of gyneco-
520 ABSTRACTS
mastia. In the first case there was a normal hbido and the patient had normal gonads. The author never observed homo- sexuality in his cases.—J. K.
(THYROID) Graves’ disease and increased height in children. Gram -(H. C.), Hospitalstidende (Copenhagen), 1918, 61, 913-930.
As Holmgren has shown, there is in many eases a coinel- dence of Graves’ disease and augmentation of the height. The author describes 3 eases which confirm this opinion. A girl, aged 1234 years, with goitre, tachyeardia and active vasomotor reflexes, was 164 em. in height. A radiogram of the elbow epiphyses showed ossification corresponding to the age of 17-18 years. Another case, aged 13% years, with goitre, nervousness and tachycardia showed also a considerable and early ossifi- eation. The third patient was 13 years of age, had goitre and tachycardia and was 160.5 em. in height—K. H. K.
(HYPOPHYSIS) A case of diabetes insipidus treated with pituitrin. Norgaard (A.), Hospitalstidende (Copenhagen), 1917, 60, 885-902, 909-927.
A patient with typical diabetes insipidus was examined after dosing with chloride of sodium, water, pituitrin, ete. Chloride of sodium augmented the diuresis much; bicarbonate of potassium did not increase it; consequently the chlorid ion was diuretic. Urea did not increase the diuresis; water was very diuretic, protein food somewhat so. Upon injection of pituitrin all the symptoms disappeared. The effect of each in- jection lasted about 10 hours. The treatment must be dietetic, salt- and protein-poor food, restriction of liquid and further injections of pituitrin 2-3 times a day.—kK. H. K.
(HYPOPHYSIS) A case of pituitary tumor. Hansen (P. N.), Ugeskrift for Laeger (Copenhagen), 1917, 70, 559-570.
A man, aged 48 years, had optie atrophy and bitemporal hemianopsia with enlargement of the sella turcica. There was no acromegaly nor adiposo-genital dystrophy. Operation (through the nose) and extirpation of a sarecomatous tumor was performed. After the operation X-ray treatment was ad- ministered. The subjective symptoms and visual field im- proved, but after the operation a marked polyuria developed.
—K. H. K.
(HYPOPHYSIS) Acromegalia. da Cunha Motta (L.), Weisz- flog, Publisher, Sao Paulo, Brazil, 1919.
ABSTRACTS 521
An anatomical study of a fatal case of acromegaly and of a tumor removed surgically from an acromegalic woman. In the first case there was an eosinophile cell adenoma. In the other a chromophobe cell adenoma was found. In the first case examination disclosed a normal pharyngeal hypophysis. —B. A. H.
(HYPOPHYSIS) A cystic tumor of the hypophysis cerebri, with optic nerve atrophy. Hughes (H. S.), Am. J. Ophth. (St. Louis), 34, 142.
The writer reports a case of tumor of the pituitary, pro- ducing in addition to a bitemporal hemianopsia, symptoms of obesity, polyuria and somnolence. This is a classical case.
—J. H. L.
(HYPOPHYSIS) A new hypophyseal symptom complex (Ein neuer Symptomencomplex der Hypophysis cerebri). Fliess (W.), Med. Klin. (Berlin), 1917, 13, 966-970.
The author describes a new complex of symptoms; they are nearly always observed in women after pregnancy or in women with diseases (cystoma) of the ovary. The symptoms are: ob- stinate neuralgias (sciatica, occipital neuralgia), extreme weari- ness (this weariness is often periodically inereased), psychic disturbances (diminished concentration of thoughts), polydip- sla, poly uria and enuresis. Treatment with hypophysis prepa- rations is always successful.—J. K.
HYPOPHYSIS as regulator of diuresis and the specific gravity of the urine (Die Hypophyse als Regulator der Diurese und des spezifischen Gewichts des Harnes). Bab (H.), Miinch. med. Wehnschr., 1916, 63, 1685, 1721, 1758.
Urine secretion depends upon the circulation in the kid- neys and this circulation is under the control of the endocrine system. Pathological polyuria as it is seen in diabetes insipidus is caused by a diminished secretion of the pars intermedia of the pituitary. Theoretically it is possible that the function of the pars intermedia is normal but that the posterior lobe is not able to assimilate the products of this structure. Subeutane- ous injection of an extract of posterior lobe has a good effect in diabetes insipidus. This effect lasts only for a short time. Oral administration has no effect whatever. The best test ob- ject for assaying preparations of hypophysis is a patient with diabetes insipidus. The effect of this extract is specific. Other glands have no similar action. In normal individuals an injec- tion of extract of the posterior lobe increases the concentration of the urine.
| bo i)
ABSTRACTS
In diabetes insipidus the kidney is normal. It is often said that the kidney has lost its concentrating power, but ac- cording to Bab this is not true, since he observed that when extract of hypophysis was injected the concentration of the urine became normal.
In Addison’s disease no symptoms of diabetes insipidus are observed. This is very remarkable for injection of extracts of adrenals causes also an inerease of the specifie gravity of the urine. Probably the hypophysis in this disease can assume the regulatory functions of the adrenals on the secretion of the kidney. In the diseases of the hypophysis, however, the ad- renals cannot replace the hypophysis.—J. K.
(HYPOPHYSIS) Atypical, secondary hypophyseal adiposity with lunacy (Atypische und sekundare Hypophysenfettsucht mit Geistesstérung). Weygandt, Deutsche med. Wehnschr. (Berlin), 1917, 43, 350.
Hypophyseal adiposity is often seen in porencephaly and epilepsy. A description of two cases is offered.
1. <A patient, age unknown, had epileptic attacks, idiocy, and a weight of 152 kg. At post-mortem examination the weight of the brain was 1055 grams; degeneration of the pars nervosa of the hypophysis, chronic encephalitis, and hypo- plastic thyroids were, found. The testicles were normal.
2. <A girl of 17 had mental deficiency and epilepsy. She was very fat. Autopsy showed hydrocephalus internus, with compression of the brain substance and large sella turciea. Probably the pressure in the skull has had an infiuence on the hypophysis and in this way caused the adiposity.—J. K.-
(HYPOPHYSIS) Case of hyperpituitarism with homonymous hemianopsia (supracellar cyst) completely relieved by gland- ular therapy. Elsberg (C. A.) and Krug (E. F.), Arch. Ophthal. (N. Y.), 1917, 46, 97-103.
This case is of marked interest and instructive in view of the failure of a right sub-temporal decompression to improve a failing vision in an adult female showing evidence of hypo- physeal pressure. The patient in fact became decidedly worse. She. however, began to Improve rapidly under the adminis- tration of hypodermic injections of pituitrin. Eight weeks after treatment was begun her eyanosed extremities improved in color, she gained weight and became stronger. Her visual fields gradually enlarged. What is of additional interest, clin- ically, is that the skiagram showed a small sella and normal clinoid processes.—J. H. L.
ABSTRACTS 523
HYPOPHYSIS, Contribution to the study of the—(Contribu- cién al estudio da la hipofisis). Silva (A. 8.), Thesis, Faculty of Medicine, Santiago de Chile ,1917.
Injections of hypophyseal extracts cause a fall of arterial blood pressure. In Graves’ disease they produce a marked retardation of the pulse, transient polyuria and glycosuria, pallor of the skin and contractions of the intestines and uterus.
—B. A. H.
(HYPOPHYSIS) Demonstration of a man of 19 with a slight hypophyseal dystrophy (Demonstration eines 19 jahrigen Mannes mit hypophysarer Dystrophie leichten Grades). Oehme, Deutsche med. Wehnschr. (Berlin), 1917, 48, 701.
The man weighed 57 kg. His height was 175 em. He had no beard, no pubic crines and no hairs in axilla. The testicles were of normal volume but the pelvis was of female form. The blood picture was that of chlorosis. The hypophysis was en- larged (X-ray photograph). There was a slight degree of bitemporal hemianopsia but no diabetes insipidus. After 200 grams of glucose, no glycosuria resulted. The quantity of ex- ereted endogenous uric acid was 0.295 grams. After the in- jection of 0.5 ce. pituitrin (Parke Davis) this endogenous ex- eretion increased to 0.63 grams. This reaction seems to be typical for hypophyseal dystrophia; in normal individuals and in a patient with acromegaly it was not seen.—J. K.
(HYPOPHYSIS?) Diabetes insipidus. Nicolyasen (L.), Norsk Mag. f. Laegevid. (Christiania), 1917, 78, 1184-1209.
Report of two cases, clinically observed only.
Case 1. A woman of 44 had previously been in good health. The symptoms set in gradually after confinement. There were polyuria (3000-4000 ec.) with increased thirst and anidrosis. She gained considerably in weight and developed a state of general weakness. The concentrating ability of the kidneys was relatively good. Injections with pituitrin lowered the output of urine, but only temporarily.
Case 2. A woman of 34 developed during the last months of pregnancy a state similar to that of Case 1. Pituitrin acted in the same way. Both patients were ‘‘nervous.’’ Discussing these cases, the author infers that it is not justifiable to make a sharp distinction between primary polydipsia and primary polyuria. As there were no signs pointing directly to the pituitary body, it is doubtful whether the cases should be ex- plained by a lesion of the hypophysis or of the nervous centers
524 ABSTRACTS
surrounding the third ventricle. (Compare with Houssay, Endocrin., 2, 94.)—K. M.
(HYPOPHYSIS) Diabetes insipidus; its relation to the hy- pophysis and the tuber cinereum (Diabetes insipidus, seine Beziehungen zu der Hypophyse und dem Zwischenhirn). Lesehke, Ztsehr. f. klin. Med. (Berlin), 1917, 87, 201.
-\ very interesting study on diabetes insipidus. In this condition urine seeretion is inereased but the power of con- centration by the kidneys is lost. This is manifested when an extra amount of sodium chloride or urea is given. They are excreted just as in normal cases but much more water is re- quired. It may happen that in such tests the concentration of sodium chloride or urea rises, but in that case the concen- tration of the other constituents of the urine falls; the total concentration as it is measured by the freezing-point remains unaltered. The polyuria depends only on the quantity of in- gested salts. If great quantities of water are given they are excreted in absolutely the same way as in normal individuals. Potassium iodide, lactose and sodium ferrocyanide are ex- ereted as in normal cases but they give rise to an increased diuresis.
When no water is given to a healthy person the specific eravity of urine may rise to 1030; in diabetes insipidus it never reaches more than 1010. When not enough water is given, uremic symptoms are observed, the freezing point of the serum falls and the concentration of chloride and urea in the serum may reach a very high level. Most probably the thirst in diabetes insipidus is caused by a local stimulation of the cortex of the brain by the increased amount of salt in the blood.
In diabetes insipidus there are two circumstances which may temporarily reduce the quantity of urine. The first one is fever. In the first days of an intercurrent infection, not infrequently the urine quantity becomes quite normal, but this lasts for only a few days. Later the quantity reaches the origi- nal height. The second factor influencing diabetes insipidus is injection of a preparation of the posterior lobe of the hy- pophysis. The anterior lobe has no influence whatever on the secretion of urine.
By fractionate precipitation of an aqueous extract of the posterior lobe with picrie acid and methyl alcohol it is possible to get four different substances. One acts on the blood pressure ‘first increasing, later depressing). A mixture of the second and third fractions acts on the respiration. A mixture of the second and fourth fractions acts on the uterus; the second frac- tion alone acts on the secretion of urine.
ABSTRACTS 525
The substance influencing the secretion of urine is a poly- peptide. Combination with adrenaline does not increase its action. According to Leschke, diabetes insipidus is not of hypophyseal origin, for total extirpation of the gland has no influence on the secretion of urine if care is taken that the tuber cinereum and its neighborhood are not touched. If the gland and no parts of the brain are destroyed by pathological processes, polyuria is never observed. On the other hand, a piqure in the tuber cinereum produces polyuria. Most prob- ably here the center for the secretion of urine is situated in the immediate neighborhood of the centers of the sympathetic nerves of the eye, the center for heat-regulation and the center for metabolism. Most probably diabetes insipidus is produced by a disease of this center. The hypophysis itself has no rela- tion with it and only when, for example, a tumor of the hy- pophysis presses this center or a tuberculous process reaches it, polyuria may occur. Also in basal meningitis with a quite normal gland polyuria may be observed. (See also Endoerin.,
2, 94.)—J. K.
(HYPOPHYSIS) Differential diagnosis between temporal lobe cerebral abscess and hypophysis tumor (Zur Differentialdi- agnose zwischen otogenem Schlafelappenabszess und Hypo- physentumor). Alexander (G.), Wiener klin. Wehnscehr., 1916, 29, 766-768.
A boy of 19 years with a chronic otitis media gradually lost consciousness, but did not develop fever. Except for par- alysis of the right occulomotor nerve, he had no symptoms. A puncture of the lobus temporalis was made. No pus was found. The patient died. The post-mortem examination showed a tumor of the hypophysis. During life no symptoms of disease of the hypophysis were present.—J. K.
HYPOPHYSIS diseases exclusive of acromegaly (Symptomatik von Hypophysiserkrankungen unter Ausschluss der Akro- megalie). Nonne, Deutsche med. Wehnschr. (Berlin), 1916, 42, 1338.
Description (very short) of some cases of diseases of the hypophysis.
1. A teratoma with dystrophia adiposogenitalis.
2. A slowly growing glioma of the nervous part of the hypophysis. The symptoms during life were hemianopsia, dystrophia adiposogenitalis and steadily increasing dementia.
3. A sarcoma of the nervous lobe in a man with dystro- phia adiposogenitalis and feminine bodily configuration.
4. A case with the same symptoms as 2 and 3 caused by
526 ABSTRACTS
syphilis of the hypophysis. In this case the serum of the blood gave a positive Abderhalden reaction with hypophysis.
5. Some eases of dystrophia adiposogenitalis caused by congenital syphilis.
6. A ease of dwarfism with glycosuria and dementia, in which the serum gave a positive Abderhalden reaction with hypophysis.—J. K.
(HYPOPHYSIS) Dwarfism (Zur kenntnis des echten Zwerg- wuchses). Rdoszle, Med. Klin. (Berlin), 1917, 13, 618.
A theater company of nine dwarfs proved to consist of nine cases of hypophyseal dwarfism.—J. K.
(HYPOPHYSIS) Dwarfism and atrophy of the anterior lobe of the hypophysis (Juveniler Zwerkwuchs bei Atrophie des Hypophysisvorderlappens). Simmonds, Miinch. med. Wehn- sehr., 1919, 66, 453.
A man of 21 years, height 110 em., well proportioned, had no beard and no pubic erines. The gonads were infantile. The intelugence was normal. Post-mortem: Atrophy of the an- terior lobe of the hypophysis with posterior lobe quite normal. Other organs showed no abnormalities.—J. K.
(HYPOPHYSIS) Dystrophia adiposogenitalis with basal brain tumor (Degenerativ adiposogenitalis bei Hirnbasistumor). Weygandt, Deutsche med. Wehnschr. (Berlin), 1919, 43, 531.
A girl manifested mental deficiency, paresis of the left leg, very irregular menstruation, exaggerated knee-jerks, optie at- rophy, headaches and other signs of inereased intracranial pressure. The skiagram showed an enlargement of the sella turcica. She was extremely fat. There was pigmentation of the skin, polyuria and alimentary glycosuria. The serum gave a positive Abderhalden reaction with hypophysis. She had all the symptoms of mania. ;
Trepanation and puncture of the ventricles was performed. First this had a distinetly good influence, but was followed by deafness. The adiposity disappeared and the patient died in extreme cachexia. Post-mortem examination showed gliosar- coma of the right thalamus opticus, penetrating the pons cer- ebri, and a cyst between the pons and fourth ventricle. The hypophysis was compressed and only traces of the pars nervosa were found. The other endocrine organs were normal.—J. K.
(HYPOPHYSIS) Dystrophia adiposogenitalis mit Myopathie. von Dziembowski (S.), Deutsche med. Wehnschr. (Berlin), 1917, 48, 654.
ABSTRACTS o27
- Deseription of a case of adiposogenitalis in a man of 26 years. The testicles became smaller. Sexual desires disap- peared. A skiagram showed the characteristic changes in the sella turcica. The muscles were very flabby, but the electrical reactions, though slow, were normal. A little piece of the bi- ceps was taken for microscopical examination. The histologi- cal examination showed few muscular fibres and these, atrophie. There was enormous increase of fatty tissue. The sugar toler- ance was increased. First treatment with thyroid, adrenal and testicle was without success. Then twice daily, injection of an ampule of hypophysis was tried with splendid success. The patient lost in weight; after some days the libido sexualis returned and the muscles became thinned with a higher tonus. The author believes that the hypophysis has an influence on the muscles.—J. K.
(HYPOPHYSIS) Hydrocephalus and hypophyseal adiposity (Hydrocephalus mit hypophysarer Fettsucht). Striussler, Deutsche med. Wehnschr. (Berlin), 1917, 43, 256; Med. Klin. (Berlin), 1917, 18, 321; Wiener klin. Wehnschr., 1917, 30, 252.
Description of a case with a typical X-ray photograph. The description, of only a few lines, is too short and too in- complete for an abstract.—J. K.
(HYPOPHYSIS) Hypophyseal cachexia (Hypophysaire Ka- chexie). Fraenkel, Deutsche med. Wehnschr. (Berlin), 1916, 42, 1369-1372.
Description of a case similar to the cases of Simmonds (Endocrinology, 1, pp. 108 and 264). A woman of 45 years had 11 children. After the last pregnaney, menstruation did not return. She became weaker, lost the axillary and pubic hair and the teeth. She looked older than she really was. She died of cachexia. At the post-mortem examination a destrue- tion of the glandular part of the hypophysis was found; all viscera were normal but extremely small. The other endo- erine organs were quite normal.—J. K.
(HYPOPHYSIS) Hypophyseal cachexia (Hypophysire Ka- chexie). Reye, Deutsche med. Wehnschr. (Berlin), 1919, 45, 703.
A very short note without details. The patient (of whom absolutely nothing is told except what is indicated in the eap- tion) gained in weight. The blood pressure was raised. the hemoglobin increased and the psychical symptoms were eased following the administration of hypophysis tablets. Neither symptoms nor dosage are given.—J. K.
528 ABSTRACTS
(HYPOPHYSIS) Hypophyseal cachexia (Hypophysare Ka- chexie). Reye, Miinch. med. Wehnschr., 1919, 66, 453.
A woman with cachexia without a known cause was treated with fresh pituitary glands. The results were very good. Then fresh glands were no more to be had, because the cattle be- came too scarce. The patient became very cachectic again and began to show symptoms of mental disturbances. There was general edema. She gave the impression of one facing im- pending death. Then hypophysis was injected. In 2 months 58 injections (of how much? J. K.) were given. She was re- stored to perfect health.—J. K.
HYPOPHYSIS, its structure and development. Parker (K. M.), Science Progress (Lond.), 1917-18, 12, 450.
The object of the paper is ‘‘to summarize our knowledge of the hypophysis cerebri and thus render it more accessible to the student of biology in all its branches.’’—T. C. B.
(HYPOPHYSIS) Mental symptoms in acromegaly with pre- sentation of a case. Merriman (W. E.), State Hosp. Q., Utiea, N. ¥o-1907-18>3; 992105.
The writer is making an effort towards the formation of a fixed ‘‘Mental syndrome’’ resulting from pituitary disturb- ance. The case cited and the one presented, while exhibiting mental changes, are of the type that one will observe among cases showing intracranial pressure. The mental symptoms pointed to no organie changes, but were of the constitutional type. While Cushing and other observers mention mental de- viation in some of their eases, there was no trained psychiatrist to correlate and observe them as should be done.—J. H. L.
(HYPOPHYSIS) Nanosomia infantilis pituitaria. Bauer (J.),. Wiener klin. Wehnschr., 1917, 30, 573.
A man of 22 years with a height of 142 em. and a weight of 27 kilograms had an infantile skeleton. The testicles were not to be found (eryptorchism?). Male secondary sexual char- acteristics were lacking; high voice and lymphocytosis were observed. Percussion gave a dullness at the upper part of the sternum (persistent thymus?). The skiagram showed the sella turcica to be extremely small (as a pea). The blood-sugar con- tent was high (0.124%). When 100 grams of glucose were given, alimentary glycosuria occurred. No polyuria nor hemi- anopsia were present. The blood pressure was low. The thy- roid was very small. The patient was an imbecile.—J. K.
ABSTRACTS 529
(HYPOPHYSIS) Operation der Hypophysis-tumoren. Piffi. Deutsche med. Wehnschr. (Berlin), 1919, 45, 648. Schloffer, Ibid., 45, 648.
Of technical surgical interest—J. K.
(HYPOPHYSIS) On the presence of histamine (beta-imin- azolylethylamine) in the hypophysis cerebri and other tissues of the body and its occurrence among the hydrolytic decom- position products of the proteins. Abel (J. J.) and Kubota (S.), J. Pharmacol. & Exp. Ther. (Balt.), 1919, 13, 243.
As a result of extensive investigations covering a period of several years, Abel and Kubota conelude that the plain muscle-stimulating and depressor constituent of the posterior lobe of the pituitary gland is identical with histamine (beta- iminazolyl-ethylamine). Histamine was found to be a widely distributed constituent of animal tissue, organ extracts and enzymatic products, both of animal and vegetable origin. Since histamine occurs to some extent in all tissues, it can not be considered a hormone or substance specifie to the pituitary gland. The authors have no explanation to offer at present for the relatively high concentration in which the base is found in the posterior lobe of the pituitary body.—F. F.
HYPOPHYSIS preparations and their therapeutic use. Sajous Cieiide Me) IN: Y- Med. J. (N: Y.),.1916, 103, 468-9.
A general discussion embodying no new data.—H. W.
(HYPOPHYSIS) Remarks on: ‘‘Seven years of hypophyseal medication in practical obstetrics’’ (Bemerkungen zu: “Sieben Jahre Hypophysen Medikation in der praktischen Geburtshilfe’’—Hofbauer). Porges (A.) and Hofstitter (R.), Monats. Geburtsh. u. Gynik., 1919, 49, 207.
A brief polemical note.—F. S. H.
(HYPOPHYSIS) Retropharyngeal tumor of hypophyseal struc- ture. Leegaard (F.), Norsk mag. f. laegevid. (Christiania), 1917, 78, 829.
A report of a unique ease. A man of 23 had during four years developed increasing difficulties in swallowing. At op- eration a soft tumor the size of an apple was removed from between the pharynx and spinal column. The microscopic structure showed close resemblance to the anterior lobe of the normal hypophysis. The tumor is supposed to have developed from rests of the hypophysis pharyngei.—K. M.
530 ABSTRACTS
(HYPOPHYSIS) Sobre un caso de distrofia adiposo-genital. de Stefano (J.), Semana Méd. (Bs. Aires), 1919, 26, 535.
A subject 50 years of age showed somnolence, asthenia, polydipsia and polyuria, occasionally glycosuria, accentuated adiposity (weight increase from 80 to 125 kilos), impotency and partial loss of body hair. The sella turcica was normal in form but slightly less than normal size. Vision was impaired but this was more or less due to bilateral cataract. The author believes that the patient had a syphilitic lesion at the base of the brain which affected at the same time the hypophysis and the adjacent cerebral zone.—B. A. H.
(HYPOPHYSIS) The action of pituitrin upon the gastrointes- tinal tract of man. Pancoast (H. K.) and Hopkins (A. H.), New York M. J., 1917, 105, 289-292.
By means of Roentgen examinations the effeets of pituitrin upon the gastrointestinal tract were studied in 11 eases. It usually exerted a primary depressing influence upon gastric peristalsis or motility and a secondary augmentation. The pylorus was influenced but slightly. In the small intestines the motility was, as a rule, either not affected or was slightly delayed: No appreciable effects were noted upon the large bowel.—H. W.
(HYPOPHYSIS) The development of the hypophysis (Over de ontwickkelingsverschynselen in het hypophysis gebied). Woerdeman (H. W.), Neder]. Tijdschr. v. Geneesk. (Haar- lem), 1917, 61, (1) 955-963.
A study on the embryology of the hypophysis. Of tech- nical interest.—J. K.
(HYPOPHYSIS) The physiology of the pituitary gland. Me- Peek (C.), Ohio State M. J. (Columbus), 1917, 13, 161-165.
A general review.—C. MeP. (HYPOPHYSIS) Pituitary extract in concealed accidental
hemorrhage. Kidd (W. A.), Brit. Med. Jour. (Lond.), 1917, Gi), 116.
Advocates the use of pituitrin in concealed accidental hemorrhage in pregnancy.—L. G. K.
(HYPOPHYSIS) The uses and abuses of pituitrin. Rawls (JJ. L.), Va. Med. Semi-monthly (Richmond), 1917, 21, 535.
ABSTRACTS 531
Pituitrin is a stimulant of unstriped muscular tissue and finds its chief use on the musculature of the pregnant uterus. It is used to stimulate uterine contractions in cases of inertia when there is no mechanical obstruction to delivery. It pro- duces from one to three prolonged contractions when first ad- ministered. If this does not cause delivery, the uterus settles down into regular rhythmical contractions; its action lasts from forty-five minutes to an hour. It is claimed that it will not induce uterine contractions per se, but I have seen several eases with patients at term in which pituitrin apparently did induce uterine contractions. If delivery does not occur within an hour, our custom is to administer a second dose just after delivery and further fortify this with ergotol hypodermatically or ergot by mouth as a prophylactic against post-partum hem- orrhage. Pituitrin is a valuable adjunct in curettements for incomplete abortion. It is contraindicated in primiparae whose pelvic measurements are not definitely known; in the early stages of labor without a well-dilated cervix, with the present- ing part not engaged; a mal-position or any other form of me- chanical obstruction, or merely to hurry the case. Pituitrin is of value as an intestinal stimulant in those eases of distention following abdominal operation and may be used as a prophy- lactie when a large amount of handling of the abdominal vis- cera is unavoidable. Of course the surgeon should be sure that he is not dealing with a mechanical obstruction. It is of use in eases of retention of urine and should be tried before cath- eterization. It is of value also in the treatment of shock. A third use of pituitrin is in hemorrhage when the bleeding shows a tendency to ooze and is not arterial in nature. Johnson states that it is of benefit when administered by mouth over a long period in those cases of idiopathic epilepsy occurring between the ages of fifteen and thirty-five years.—Author’s abstract, abbreviated.
(HYPOPHYSIS) Treatment of diabetes insipidus (Zur Be- handlung des Diabetes insipidus). John (Gertrude), Med. Klin. (Berlin), 1917, 13, 366.
As pituitrin is made in England, the author tried to make a German preparation. She found that pituitrin was more active than hypophysis (Hoechst). Pituitrin contains chlore- ton; hypophysis does not. Is this chloreton responsible for the greater activity? The author does not believe it, for a com- bination of hypophysis and chloreton has no greater activity than hypophysis alone. Pituitrin is an extract from the whole gland; hypophysis only of the posterior lobe. It is not impos-
532 ABSTRACTS
sible that the anterior lobe has an internal secretion which may influence the kidneys, though this has not yet been proved.
—ZJ. K.
HYPOPHYSIS tumor (Geschwulst der Hypophysis). Heyne- mann, Deutsche med. Wehnschr. (Berlin), 1919, 45, 840.
A very short note. A woman had a tumor of the hypophy- sis with visual disorders, increasing during pregnancy.—J. K.
HYPOPHYSIS, Tumor of the—. Syndrome adiposo-genitalis. Ricaldoni (A.), Anales de la Fae. de Méd. de Montevideo, 1912, =" GNo).
The author presents a case of associated obesity and gen- ital hypofunction caused probably by a neoplasm of the hy- pophysis. There was complete, bilateral optic atrophy and ex- cavation of the sella turcica.—H. R.
HYPOPHYSIS tumors; two cases surgically treated (Zwei operierte Falle von Hypophysistumoren). Singer, Deutsche med. Wehnschr. (Berlin), 1919, 45, 592.
I. A man of 39 years had headache, difficulty in walking, bitemporal hemianopsia, enlarged sella turcica and atrophy of the optic nerves. At operation a hypophyseal tumor was found, and part of it removed. After operation there was at first some improvement; hair began to grow on the chest. After a year, however, loss of hair, loss of sexual function, increase of fat and growth of hands and feet were evident. A combination of acromegaly and dystropia adiposo-genitalis had developed.
II. A woman of 42 years exhibited cessation of menstrua- tion and bad vision. A skiagram showed an abnormal shadow in the place of the sella turcica. Hypophysectomy was per- formed. At first the vision improved a little. Then the patient became blind and very stout. The axillary hirei dropped out and for the most part the pubic hair was lost. She had no men- struation. Here dystrophia adiposo-genitalis developed.—J. K.
(HYPOPHYSIS) Two cases of diseases of the hypophysis (Zwei Falle von Hypophysiserkrankungen). Mann, Miinch. med. Wehnschr. 1919, 66, 493.
I.. A girl of 29 years. Six years ago menstruation ceased; headaches, vomiting, attacks of unconsciousness, bitemporal hemianopsia and fatness were observed. In the skiagram an enlarged sella turcica was indicated. Diagnosis: Dystrophia adiposo-genitalis.
ABSTRACTS 533
IJ. A married woman had three children, all born dead. The Wassermann reaction was negative. After the last confine- ment acromegaly developed; the patient began to see badly, and menstruation ceased. The X-rays showed enlarged sella turcica and enormous sinus frontalis on both sides. Operation disclosed a cyst in the hypophysis. The tumor was emptied. After the operation, marked improvement, better vision and restored menstruation occurred.—J. K.
(HYPOPHYSIS) Un caso de diabetes insipida. Dameno En- rique, Prensa Méd. Argentina, 1919, 5, 345.
The case is reported of an infant, supposedly a hereditary syphilitic, who had visual disturbances, post-neuritic optic atrophy and slight exophoria. The sella turcica was normal in shape but slightly enlarged. The urine amounted to four litres daily. Mercurial treatment brought about temporary amelio- ration of the symptoms, but after a time they returned in ag- gravated form with ocular pain. Death followed. The au- thor reviews the pertinent literature and concludes that, in the case reported, the lesion was near the optic chiasma and prob- ably in the hypophysis.—B. A. H.
(HYPOPHYSIS, ADRENAL) The occurrence of pituitrin and epinephrin in fetal pituitary and suprarenal glands. McCord (C. P.), West. M. Rev. (Omaha), 1917, 22, 412-414. Reprinted from J. Biol. Chem. (N. Y.), 1915, 33, 435-438.
McCord sought to establish the earliest period in fetal life at which it was possible to detect the presence of pituitrin and epinephrin in fetal pituitary and suprarenal glands. Fresh bovine embryos at all stages of development were secured, the pituitary and suprarenal glands dissected out and protein free saline extracts prepared. Physiologie tests to identify epine- phrin and pituitrin were carried out for the graded series of glandular extracts. Characteristic reactions were obtained both for epinephrin, and pituitrin in extracts from bovine fetal glands during all developmental stages in which the macroscopic recognition of the glands was possible. For the pituitary gland, this period is from the eighth week to the full term ; for the suprarenals the period is from the sixth week to full term. The presence of the active principles of these glands at so early a developmental period suggests that the fetus in utero may be under the influence of its own as well as the ma- ternal endocrine glands.—Author’s Abst.
HYPOPHYSIS, ADRENAL and THYROID glands, The bio- chemistry of (Zur chemischen Biologie der Nebenniere, Hy-
534 ABSTRACTS
pophyse und Thyreoidea). Richter (E.), Deutsche med. Wehnschr. (Berlin), 1919, 45, 709.
If to 6-10 ee. distilled water, 0.25 ec. of 1% solution of adrenalin is added and raised to the boiling point, and then 0.25-0.5 ee. of cold 1.1% solution of sodium-gold chloride is added, this salt is reduced and a red solution of colloidal gold is formed. Thus it is proven that adrenalin has reducing properties. The reduction time may vary from 15 minutes to 8 days. Adrenalin solution in acetone or alcohol gives a similar reaction. The author believes that this reduction is precisely the opposite to oxidation in the lungs. He believes also that the pigmentation of the skin in Addison’s disease is due to a failure of reducing power leading to oxidation of the normal pigment.
The author has prepared reducing substances also from the thyroid and hypophysis. Similar material ean be obtained from the cerebrum, ovary and testis and, in traces, from the thymus. Reducing substances ean not be obtained from lymph glands, salivary glands, liver, kidney or cerebellum, it is stated.
(The demonstration that certain gland substances have re- ducing power has little significance in the absence of proof that such are contributed to the blood stream. The author naively adds the information that the reductions reported take place satisfactorily only in acid solutions, free from protein, conditions which are never present in the body.)—J. K.
(HYPOPHYSIS, THYROID) On the functional correlation of the hypophysis and the thyroid. Larson (J. A.), Am. J. Physiol. (Balt.), 1919, 49, 55-89.
An extended survey of the literature on the subject estab- lishes the fact that the removal of either the hypophysis or the thyroid gland causes definite changes in the structure of the other. The consensus of opinion is that following thyroid- ectomy the hypophysis undergoes hypertrophy, probably in the anterior lobe. The author found that the administration of anterior lobe to thyroidectomized rats exerts a very beneficial effect upon maintenance and growth, and also definitely pro- longs life. ;
This beneficial effect might indicate a direct substitution in which the pituitary autacoid takes the place of the thyroid hormone in a compensatory effort to establish normal metabo- lism. or the results might be due to a stimulating effect upon the total metabolic processes. The objections to the former view are twofold: ‘‘the failure to find iodine in the hypophysis after thyroidectomy and the possibility that the hypertrophy indicates pathological processes. On the other hand, there is
ABSTRACTS 583i
or
the possibility that the hypertrophy is physiological and that the iodine might not be a necessary factor.’’ It is held that the chemical structure of the known autacoids of the two glands is sufficiently similar to indicate the possibility of sub- stitution. That similarities in function exist is revealed by the fact that removal of either gland causes disturbances in carbo- hydrate and fat metabolism, as well as sexual activities and general growth of the body. However, before a definite de- cision for or against the idea of a direct functional reciprocity can be reached, more evidence is needed.—L. G. K.
INTERNAL SECRETION and insanity. Borberg (N. C.), Bib- liotek f. Laeger, Copenhagen, 1918, 110, 45-63, 126-130, 187- 194, 231-242, 338-370.
The author has examined anatomo-pathologically 40 cases of insanity (maniac-depressives, schizophrenia, paraphrenia, general paralysis, etc.) ; further he had many other cases as controls. The results of the examinations are the following: In manio-depressive insanity, schizophrenia, paraphrenia and epilepsy he found in some few eases slight changes of the endo- erine glands, specially sclerosis in case of implication with tuberculosis, but no important changes. In ease of delirium there was atrophy of the colloid in the thyroid gland and of the visible lipoid in the adrenal cortex. In general paralysis there were inflammatory phenomena in different organs with fibrosis and infiltration of plasma cells. In senile and arterio- sclerotic dementia, the ordinary senile changes; in climacteric insanity (also virile climacterium) more marked changes in the thyroid and sexual glands. The author concludes that endo- erine changes have some role in some eases of insanity, but it is impossible to draw anatomical parallels to the currently accepted psycho-pathological groupings.—K. H. K.
LIPODYSTROPHY in a girl of 11 (Lypodystrophie bei einem elfjahrigen Midchen). Nobel (E.), Wiener klin. Wehnschr., 1919, 32, 353.
A ease is deseribed in which total atrophy of the fat tis- sue occurred. Possibly this was due to endocrine defects, but the author gives no definite evidence that such was the case. A good clinical description of the ease is offered, but it comprises little of endocrine interest.—J. K.
LIPODYSTROPHIA progressiva, 3 new cases. Neel (A. V.), Hospitalstidende (Copenhagen), 1918, 61, 989-996.
The author suggests that besides the cases of lpodystro-
536 ABSTRACTS
phia of the original Simons type, with extreme emaciation of the face and arms, there exists a type with a considerable adi- posity of the lower extremities but without emaciation of the upper ones. The author describes 3 such cases. (It seems to the abstracter doubtful if these cases really belong to the originally described lipodystrophia.)—K. H. K.
(MENSTRUATION) On the cause of the menstrual hemor- rhage (Sur la cause de l’hémorragie menstruelle). Wallich (V.), C. R. Soe. Biol. (Paris), 1919, 82, 405-407.
Of no endocrine interest.—L. G. K.
MYOPATHIES, Primary—. Naccarati (S.), New York M. J., 1917, 105, 351-353.
Report of a case of seapulo-humeral variety of primary myopathy. X-ray examinations of the head did not show any particular abnormality nor pineal shadow.—H. W.
OSTEOMALACIA, Case of—and infantilism, with horseshoe kidney and interstitial nephritis. Cameron (H. C.), Proe. Roy. Soe. Med., Sect. Dis. Child. (Lond.), 1918, 11, 22.
At autopsy no abnormality was detected in the thyroid or other ductless glands.—h. G. K.
OSTEOMALACIA, Case of—and infantilism, with renal de- ficiency. Cameron (H. C.), Proce. Roy. Soe. Med., Sect. Dis. Child. (Lond.), 1918, 11, 23-25.
Not of endocrine interest.—L. G. K.
(OSTEOMALACIA) Osteogenesis imperfecta and its relation to osteomalacia (Ueber Osteogenesis imperfecta und ihre Beziehung zur genuinen Osteomalacie). LHiken (T.), Beitr. z. pathol. Anat. (Jena), 1919, 65, 285.
Description of a case in which microscopical examination showed a diminished formation of bone tissue and a low con- tent of lime. Probably there is a relation between osteogenesis imperfecta and osteomalacia. This article includes no specific endocrine data.—J. K.
(OSTEOMALACIA) Starvation osteomalacia and its relation to tetany (Zur Klinik der Hunger-osteomalazie und ihrer Beziehungen zur Tetanie). Schlesinger (H.), Wiener klin. Wehnscehr., 1919, 32, 336.
ABSTRACTS 537
In ordinary cases of osteomalacia the bones of the skull are almost never affected. But in eases due to starvation the eranial bones are nearly always extremely painful. There are eases in which the skull is affected without any disease: mani- festation in the pelvic bones. More than 50 per cent of the eases reported had goitre. There is probably an etiologic connection in such eases. But that the parathyroids also play a part is indicated by the fact that latent or even frank tetany was observed. The osteomalacia and tetanic symptoms dis- appeared simultaneously. Occasionally starvation osteomalacia is unilateral in its manifestation. That the ovary plays an un- important part in the development of the disease is indicated by the fact that it is frequently observed in men. It is most probably a pluriglandular condition.—J. K.
(OSTEOMALACIA) The mono- and pluri-glandular symptoms of non-puerperal osteomalacia (Wher den mono- und pluri- glandularen Symptomen Komplex der nichtpuerperalen Osteomalacie). Curschmann (H.), Deutsch. Arch. f. khn. Med. (Leipzig), 1919, 129, 93.
Osteomalacia is not seldom seen after the onset of the menopause. It is frequently combined with diseases of endo- erine glands. Curschmann describes a case of osteomalacia combined with Graves’ disease in a woman of 62, osteomalacia in a woman of 36 with amenorrhoea and Graves’ disease, and seven cases of osteomalacia with symptoms of hyperthyroidism without the classical manifestations of Graves’ disease. Most women were at an age when a hyperfunction of the ovary could not be the cause of the osteomalacia. It is probable therefore that in these cases the thyroid is capable of disturb- ing the calcium metabolism and thereby causing osteomalacia. Though they are rare there exist cases of osteomalacia with diminished function of the thyroid. Curschmann describes a ease of a woman with amenorrhoea and chlorosis who at first exhibited Graves’ disease; later on, myxoedema developed; then osteomalacia and tetany occurred. In another case osteo- malacia and myxoedema were observed at the same time; in a third, the myxoedema was preceded by osteomalacia.
All patients with osteomalacia showed many symptoms of sympathicotonia and showed dilatation of the pupil when adrenalin was dropped into the eye.
It is certain that the parathyroids also may play a role in osteomalacia. The important part they play in calcium metabo- lism is well known. A combination of osteomalacia with tetany is not rare.—J. K.
538 ABSTRACTS
(OVARY) Alternating periodic ovarian swellings. Ries (E.), J. Am. M. Assn. (Chgo.), 1919, 73, 100-108.
The swellings tended to appear on alternate sides, from eight to fourteen days before the onset of menstruation. They were due to corpus luteum eysts. Four cases are described.
—R. G. H.
(OVARY) Further clinical experience with corpus luteum organotherapy, with special reference to the soluble aqueous extract: Dannreuther (W. T.), New York M. J., 1917, 106, Tol-vao:
From a consideration of fifty clinical cases, the author con- eludes that the soluble extract of corpus luteum is a better therapeutie agent than the desiccated preparations. Subjective symptoms, such as vertigo and nausea, so often complained of by patients ingesting desiccated gland are seldom noted fol- lowing injections of the soluble extract. Over-dosing with the soluble extract is usually manifested by headache. Therapeutic results are more rapidly attained and after the influence of the aqueous extract has become apparent, the desiccated ex- tract maintains the improvement. Doses of 15 minims are given at irregular intervals, not oftener than every other day.
—H. W.
(OVARY) Further investigation of the female genital hormones (Weitere Beitrage zur Lehre von der inneren Sekretion der weiblichen Genitalien). Felner (O.). Wien. klin Wehnschr., 1916, 29, 930.
The author discusses the question whether in pregnancy the secretion of the ovary continues. He extracted from the ovary and from the placenta a lipoid. Injection of these lipoids in animals produces the same changes as those of pregnancy (hypertrophy of the uterus and of the mammae; typical changes in the mucous membrane of the uterus; growth of the thyroid, ete.). Extracts of ovaries including corpus luteum show a greater activity than the extract of corpus luteum alone. In the pregnant cow mostly one ovary has no corpus luteum ; extracts of such ovaries have the same action when injected in a rabbit as extracts of an ovary with a corpus luteum. Hence the interstitial cells of the ovary have an internal secretion; this secretion continues, also, during pregnaney as is proved by these experiments.—J. K.
ABSTRACTS 539
OVARY, Insufficiency of the—(Sindrome de insuficiencia ~ ovarica). Valenzuela (R. J.), 1918, Thesis of Buenos Aires, No. 3520.
Valenzuela shows two cases of ovarian insufficiency treated with success by ovary organotherapy. No new data are of- fered.—G. P. G.
(OVARY) The endocrine function of the ovary and mammary secretion (La funcién endocrina del ovario y la secrecion mamaria). Pepe (R.), Thesis of Bs. Aires, 1918.
Pepe gives the results obtained by him and Coni Bazan (Endocrin. 1918, 2, 182) in lactating women with scanty milk secretion. He concludes: 1, That there exists an intimate ‘relation between endocrine functions of the ovary and the mammary secretion, as is demonstrated by animals and clin- ical experiments. 2, That there exist a hypogalactia concur- rent with the syndrome of ovarian insufficiency, in which case the homo-organotherapy by corpus luteum or ovary serves as a regular and efficacious galactogogue. Pepe reports eleven cases treated with success.—G. P. G.
(OVARY) The action of ovaradentriferrin (Ueber die Wirkung des 0.). Koslowsky, Deutsche med. Wehnschr. (Berl.), 1919, 45, 746.
Ovaradentriferrin is a pharmaceutical preparation fre- quently used in Germany. The author reports excellent results from it. No significant data otherwise are included.—J. K.
(OVARY) The corpus luteum in therapeutics. Sajous (lL. T. de M.) New York M. J_(N. Y.), 1916, 103, 227.
The most important pre-requisites to success in the use of corpus luteum are: 1, The selection of a preparation made exclusively from the corpora lutea of pregnant animals and 2, due attention to the fact that the action of the drug is fre- quently slow in asserting itself, and hence should be given up only when thorough trial has demonstrated its lack of effi- ecacy.—H. W.
(OVARY) The influence of sexual intercourse on the ovary. (Der Einfluss des Geschlechtsverkehrs auf den Hierstock). Bondi (J.), Zentralbl. f. Gynik. (Leipzig), 1919, 43, 258.
Sexual intercourse has a remarkable influence on the function of the ovary in healthy and ill women. Often dys-
540 ABSTRACTS
menorrhea disappears, the menstruation becomes regular, the quantity of lost blood becoming normal. Very often chlorosis and nervous complaints disappear after marriage. Therefore the author has examined the influence of copulation in rabbits. To avoid ecompleations with pregnancy he first hgated and eut both tubes. After sexual intercourse the ovaries are much more developed than in virgin control animals. Especially the glandular elements are largely developed. The controls showed very often a eystie degeneration of the ovaries. This corresponds to the well known fact that such degeneration is much more frequently observed in unmarried than in married women.—J. K.
(OVARY) The interrelationship between ovarian secretion and uterus. Floeckinger (F. C.), Texas. State J. M. (Ft. Worth),. 1919, 14, 322.
The importance of the relationship of the internal seere- tions to radical operation on the female generative tract has been strongly emphasized. From the immense literature on the subject, the author extracts the facts which led him to study the relationship between the uterus and ovarian secre- tion. In those cases in which the ovaries in the child-bearing period must be sacrificed, the author comes to the conclusion that when complete ablation has been done, the neurotic symp- toms of artificial menopause have been very hght, and only about 50 per cent show them. If neurotic symptoms appear, they last about six months, whereas when the uterus was pre- served they lasted much longer and were more severe. The psychie factor is very important.
Abbreviated from Author’s abstract, South. M. J. 12, 499.
(OVARY) Ueber die innere Sekretion des Hierstockes. Scipiades (E.), Arch. f. Gynak., 1918, 108, 157-223.
An extensive historical resumé of the influence of various preparations of the ovary on menstruation. Clinical reports are given indicating the favorable effects obtained when such preparations are used in disturbances of menstruation indicat- ing the dependence of a properly regulated functioning upon adequate internal secretion.—F. 8. H.
(OVARY CORPUS LUTEUM) Non-puerperal ovarian abscess and abscess of the corpus luteum (Abcés non puerperaux de l’ovaire et abces du corps jaune). Chomé (H.), Arch. mens. d’obst. et de gyn. (Paris), 1919, 8, 113-167.
ABSTRACTS d41
A historical resume of the literature on ovarian and corpus luteal abscesses. Gross and microscopic studies with plates of the author’s cases, together with the pathology, clinical find- ings, bacteriology, etiology and discussion of the physiological disturbances present with abscesses in ovaries or corpus luteum are given. These abscesses usually cause severe disturbance of the menstrual cycle together with modifications of the uterine mucosa analogous to those found in the pre-menstrual period.
—F.S. H.
(OVARY THYROID) Ovarian tumor of thyroid structure. Platou (E.), Norsk Mag. f. laegevid, 1916, 77, 514.
The tumor was removed from a woman of 54; it showed the structure of thyroid with colloidal masses.. The presence of ascites provoked suspicion of the tumor’s being malignant.
: —K. M.
(PANCREAS) A case of acute diabetes, with comments, espe- cially in regard to acidosis. Smith (W. G.), Lancet (Lond.), 4916, (4), 1115-1119.
Contains criticisms of many of the tests for oxybutyric acid, acetone and acetoacetie acid in urine, and points out various commonly held errors in regard to glycosuria, acidosis, ete.—L. G. K.
(PANCREAS) A lay description of diabetes. Coues (W. P.), Boston M. & S. J., 1917, 176, 536.
Quotation from Bazén’s ‘‘The Swan of Villamorta,’’ de- scribing the sensations of a Spanish statesman suffering from diabetes. (Fiction).—H. W.
(PANCREAS) A new conception of diabetes and its treatment. Heffron (J. L.), N. Y. State J. M. (N. Y.), 1916, 16, 69-71.
A report of very favorable results obtained by the author with the now well known Allen treatment of diabetes.—J. P. S.
(PANCREAS) A note on the simulation of diabetes mellitus. Blumer (G.), Boston M. & S. J., 1916, 174, 48-50.
Report of case. In suspected cases of fraud catheterized specimens of urine should be examined and the patient isolated for close observation.—H. W.
diabetes mellitus in Boston from 1895 to 1913, with special (PANCREAS) A statistical study of the mortality from
542 ABSTRACTS
reference to its occurrence among Jews. Morrison (H.), Boston M. & 8. J., 1916, 175, 54-57.
The total number of deaths occurring between 1895 and 1913 was 229,468. Of this number, 8,775 died from diabetes mellitus. There has been a steady rise in the death rate from diabetes from 7.1 per 100,000 inhabitants in 1895 to 21.3 in 1913. The ratio of the number of deaths from all eauses to those due to diabetes was 0.018 among the Jews and 0.007 among non-Jews, hence, death from diabetes occurred about two and a half times as frequently among the Jews as among their neighbors. The largest number of deaths from diabetes occurred among those of Irish parentage, being 656 out of the 1,770, or more than one-third of the total. This figure is not out of proportion to the population. Only eleven deaths from diabetes mellitus occurred among negroes during the same period. Contrary to usual statements there were 958 females as compared with 817 males. The largest number of deaths occurred in persons of the seventh decade. Diabetes mellitus is more commonly found in large cities among individuals and races who are constantly under physical and nervous tension. This disease is particularly prevalent among Jews, not because of ethnic peculiarities, but because a severe environment during many centuries has developed a nervous type easily thrown out of balance.—H. W.
(PANCREAS) Blood sugar in human diabetes. Stepp (W.), Zentralbl. f. klin med., —, 46, 377; Miinch. med. Wehnschr., 19195566) 771
Data published elsewhere. Abst. Endoerin., 3, 191.
(PANCREAS) Cases of diabetes (Diabetesfalle). Gerhardt, Minch. med. Wehnschr., 1919, 66, 339.
Two very ordinary eases of diabetes. No new data.—J. K.
(PANCREAS) Cataract und Diabetes. Wessely, Miinch. med. Wehnschr., 1919, 66, 281.
Describes the difference between the cataract in old pa- tients with concurrent diabetes and the real diabetic cataract. Chiefly of technical ophthalmological interest.—J. K.
(PANCREAS) Definition and detection of acidosis in diabetes mellitus. Hornor (A. A.), Boston M. & S. J., 1916, 175, 148- 152:
ABSTRACTS 545
The acidosis of diabetes mellitus, aside from its clinical picture of exaggerated respiration, drowsiness and rapid pulse, may be defined as a condition in which the earbon dioxide ten- sion in the blood and, consequently, in the alveolar air is re- duced. When the acetone bodies in the blood and urine are in- creased and associated with this there is a rise in the excretion of ammonia, and glycosuria is marked. The detection of glyco- suria, the demonstration of a positive ferric chloride reaction, and the determination of a diminution in the alveolar carbon dioxide tension are procedures suitable for bedside use-—H. W.
(PANCREAS) Observations on the blood sugar in diabetes mellitus. Rogers (O. F.), Boston M. & S. J., 1916, 175, 152-156.
Diabetics have a higher blood sugar when they are excret- ing sugar in the urine than they do when the urine is ren- dered sugar free. The threshold of sugar varies in different diabetie individuals and apparently in the same individual at different times. Sometimes the blood sugar returns to normal under treatment, especially in the milder cases. A persistently elevated blood sugar may be an indication of the greater severity of the disease, or it may occur in apparently mild eases, especially if there is renal impairment. By keeping the carbohydrate intake well below the limit of tolerance, as shown by the appearance of glycosuria, it has been found that the blood sugar will almost, if not quite, sink to normal. Ex- perimentation leads to the belief that efficient treatment can be carried out in most instances, using the urinary sugar alone as the therapeutic guide.—H. W.
(PANCREAS) Diabetes and surgical diseases (Diabetes und chirurgische Erkrankungen). Werland, Miinch. med. Wehnschr., 1919, 66, 740.
Discusses the question whether diabetes can have a trau- matic origin. Probably a traumatic diabetes exists.
Diabetes is never a contraindication to an absolutely neces- sary operation.
No new data.—J. K.
(PANCREAS) Diabetes and war (D. und Krieg). Gottstein (A.) and Umber (F.), Deutsche. med. Wehnschr. (Leipz. u. Berl.), 1916, 42, 1309-1311.
The first part of this article is concerned with a statistical study of the morbidity of diabetes in Germany, especially in Berlin and Charlottenburg. Accurate statistics of this nature
544 ABSTRACTS
are said not to have been available before the late war. Of the eases collected 57 per cent were males and 59 per cent females. In Charlottenburg the morbidity rate was 2.3 per 1000; in lesser Berlin the rate was 1.2 to 1.3 per 1000. Approximately 75 per cent of the patients were between 40 and 70 years of age. Up to 50 years, the disease was more common among men; between 50 and 70, women predominated. Diabetics among the eivil population appeared to suffer during the war, probably be- cause of the limitations as to diet. Among the soldiers, officers and privates, the fatigue of body and soul (‘‘korperlichen und seelischen Strapazen’’) incident to operations at the front did not appear to have any very marked, deleterious effect upon those suffering from the disease. The authors were convinced that the experiences of men at the front did not have an influ- ence in causing the development of diabetes unless there was a family tendency to it.—J. P. S.
(PANCREAS) Diabetes mellitus, a simple dietetic treatment in—, Williamson (R. T.), Brit: M. J: Cuond:.),; 1917), 154.
A diet of cream, eggs, milk and beef tea is recommended. It is said often to succeed in freeing the urine of sugar when other diets have failed.—L. G. K.
(PANCREAS) Diabetes mellitus and syphilis. Barach (J. H.), Boston M. & 8. J., 1917, 176, 58-60.
Report of three cases in which the spirochaeta pallida was active and in which the elinical symptoms of diabetes mellitus appeared. According to the author syphilitic pancreatitis is a comparatively common condition.—H. W.
(PANCREAS) Diabetes mellitus in children (—im Kindesal- ter). Kleinschmidt (H.), Med. Klin. (Berlin), 1916, 12, 1277- 1279.
The prognosis of diabetes mellitus in children is not bad when they are properly treated. It is not enough to give a diet free from carbohydrates. The proteins and fats must be given in quantities not higher than the tolerance for these substances. Intercurrent diseases (measles, parotitis, ete.), may cause coma.
KK
(PANCREAS) Diabetes Mellitus, The etiology of—, and the diet and condition of life during the war. Williamson (R. T.), Brits M: J. (Lond.), 1918-(i), 139-141;
The histories of 300 cases show the following as predis- posing causes: (1) prolonged great excess of sugar, sweet food
ABSTRACTS 545
or sweet drinks (alone or combined with other predisposing factors) in 31 per cent; (2) prolonged and intense mental anxiety, worry, overstrain or sudden mental shock (alone or combined with other factors) in 40 per cent; (3) family history of diabetes (alone or combined) in 25 per cent. No definite predisposing factor was discovered in 19 per cent. In the author’s opinion war time food restrictions should lessen the number of cases caused by an excessively sweet diet, while worry and shock would become greater predisposing factors. =n Gore
(PANCREAS) The importance of regulating the fat-intake in diabetes mellitus. Cammidge (P. J.), Brit. Med. J. (Lond.), 1918 (i), 393-395.
Regulation of the fat intake is important for three rea- sons. (1) There appears to be a tendency to imperfect utiliza- tion of fat in diabetes which is not dependent upon any other feature of the disease, although its extent corresponds roughly to the severity of the disorder. (2) The complete oxidation of the fats in the tissues is dependent upon the ability of the tissues to utilize carbohydrates, consequently if the tolerance for carbohydrates is slight ketonuria and acidosis occur with even a small amount of fat in the diet. (3) Attempts to induce a high level of nutrition by feeding fat results in an aggrava- tion of the diabetic condition similar to that which follows a like attempt with carbohydrate or protein, although the effects are slower and more insidious. The blood sugar is increased, perhaps by a decrease in permeability of the kidneys for sugar, long before glycosuria occurs, It is evident from these facts that it is just as important to ascertain the fat tolerance of the patient as it is to determine his carbohydrate and protein ca- pacity. Such an estimation is best made by Bloor’s method for determining the lipoid value of the blood. However, if suffi- ecient care be taken, glycosuria can usually be prevented if the fat intake is so adjusted that, while further loss of weight is guarded against, progressive gain 1s prevented. This, quite
contrary to the older teaching, is the ideal to be aimed at in all cases.—hL. G. K.
(PANCREAS) Diabetes mellitus, The modern treatment of—. Leyton (0.), Brit. M. J. (Lond.), 1917, (i), 252-254.
A summary of three lectures published elsewhere giving details of the Allen method of treatment.—bL. G. K.
546 ABSTRACTS
(PANCREAS) Diabetes mellitus, The new dietetic treatment of—. Cammidge (P. G.), Brit. M. J. (Lond.), 1917 Gy), 503-505.
In the observation of over 500 cases of diabetes the author discovered indications of chronic eatarrh of the upper intes- tinal tract in 71 per cent of the patients, and it is his opinion that the alimentary rest involved in Allen’s treatment benefits the intestine rather than the pancreas. His experience is that evidence of advanced cirrhosis of the pancreas in diabetics is comparatively uncommon, but signs of some interference with the digestive functions of the gland are met with in 72 per cent of the cases. In 67 per cent there are also indications that the liver is functioning imperfectly, while in 27 per cent the hepatic ‘disturbance is apparently more pronounced than the panere- atic. He therefore recognizes three types: (1) the panecreatie, (2) the hepatic, (3) the panecreo-hepatic. Patients of the first type are not materially benefited by starvation and with them it is important to secure adequate nourishment rather than worry over the traces of sugar they generally pass.
Strictly speaking, the hepatic type does not come under the heading of diabetes, for although a reducing substance is passed in the urine, it is not a sugar but an alpha-ketonic acid, pseudo-laevulose. This is probably derived from protein. A diet low in protein is best suited to this class. An abundance of green vegetables with dextrinized starches or pure dextrose should be given. Other foods are added later, but proteins should be used sparingly.
The pancreo-hepatie type is probably a development of the intestinal type, and corresponds to what has been termed ‘“eouty’’ glycosuria. A short period of fasting generally benefits such cases.
Starvation followed by a largely vegetable diet should render coma from acidosis extremely rare, but the following three points must be kept in mind: (1) There is more danger of serious acidosis during the starvation of fat than of thin diabetics; (2) when acidosis is present the patient should be prepared for starvation by a fat-free, protein-poor diet for several days; (3) an initial increase in the acidosis is to be expected in most eases, but should not put a stop to the treat- ment unless it assumes threatening proportions. Exercise re- duces the length of the fast period. It is important to see that the patient be kept in nitrogen equilibrium. Also the amount of fat given should be carefully regulated. ,At regu- lar intervals the whole level of the diet should be materially reduced to avoid overtaxing the defective metabolic functions of the patient.—lL. G. K.
ABSTRACTS D4T
(PANCREAS) Diabetic acidosis. Cammidge (P. J.), Am. Med. (Burlington, Vt.), 1916, n. s. 11, 363-373.
In the acidosis of diabetes mellitus there is not only an abnormal formation of acid products arising through defects of metabolism, but also an exhaustion of the tissues in the base- forming, acid-neutralizing elements. Of these elements, po- tassium, sodium, calcium and magnesium have a definite dis- tribution in the body, and their presence in their normal quan- titative relations is necessary to the proper functioning of the different organs. Cammidge estimated the loss of calcium and magnesium from the body in eases of acidosis of diabetes. The acid products giving rise to acidosis have a selective affinity for various bases, butyric acid, for instance, tending to com- bine with the heavy metals, calcium and magnesium. The formation of ammonia appears to be the mechanism specially concerned-with the maintenance of a normal equilibrium be- tween the hydrogen and hydroxyl ions of the blood. But the concentration of these ions in the blood is not necessarily a reliable index to the impoverishment of the tissues in bases. The terminal symptoms of a progressive acidosis will depend upon the relative rate of exhaustion of the tissues in bases and the power of the body to prevent changes in the blood which interfere with the mechanism of respiration. Two main types are therefore possible; one, the classical type, in which death occurs with air hunger and typical coma, in consequence of the blood changes before the effect of the impoverishment of the tissues in bases has given rise to noteworthy symptoms ; the other type in which the blood changes do not develop, and death occurs as a result of functional disturbances in organs essential to life, following their depletion of essential bases below the working level. A vegetable diet is important in the treatment of diabetes first, because vegetable proteins may be expected on theoretical grounds to give rise to less acetone and kindred substances than animal protein, and second, be- cause, normally, the store of metallic bases in the body is chiefly derived from fruits and vegetables.—J. P. S.
(PANCREAS) Diabetic acidosis. Croftan (A. C.), Am. Med. (Burlington, Vt.), 1916, n. s. 11, 417-420.
The fats are probably the chief source of the betaoxybu- tyric and diacetic acids in diabetes. For this.reason the fat tolerance of these patients should be determined just as much as the sugar tolerance, in order to detect fat-sensitive patients. Prevention of acidosis in the milder grades of diabetes is not very difficult. In the more severe grades it is much more difficult, but the end to be attained does not warrant keeping
548
the patient permanently sugar-free by starvation if to do so keeps him thin and undernourished. In the very severe types in childhood and adolescence it is necessary to employ starva- tion. But the effect of fasting on acidosis in these cases varies and the element of idiosynerasy is pronounced, hence this method of treatment should be carried out only under the most accurate control and with all emergency measures at hand. Croftan is of the opinion that some of the highly toxie prod- ucts of protein digestion, which is also deranged in diabetes, may play a part in diabetic coma.—J. P. 8.
(PANCREAS) Diabetic coma. Riely (lL. A.), J. Okla. State M. Assn. (Muskogee), 1919, 12, 43.
The study of diabetes and diabetic coma is essentially a study of the chemistry of the body and its excretions. Diabetic coma occurs only when the urine contains oxybutyrie acid. High grades of acetonuria are often associated with lipemia. Premonitory symptoms of coma are lassitude; epigastric pain; occasionally vomiting; restlessness, speech becoming thick and incoherent, growing dull and then passing into coma, and CO, alveolar tension dropping below 20. Breathing is of the Kuss- maul or aleoholic type. Collapse often results fatally in twenty- four hours. Children are especially liable to coma. Predis- posing factors are constipation, excessive fatigue, ether anes- thesia, acute infections and sudden changes in diet. Coma may come on slowly, rapidly or intermittently. Riesman’s ocular sub-tension may be present. Bladgett says a pathogno- monic sign is soreness on deep pressure over the pancreas. Treatment consists of a bed. Warm cloths allay nervousness and discomfort. Enemas should be used, but not catharties. Liquids, 1000 ec., may be given slowly within six hours. Coffee, tea, broth and water are advisable. If the patient is nauseated, give the fluids per rectum or intravenously. For the heart, digitalis is advisable. Coma never develops in edematous eases. Sudden and severe loss of weight nearly always pre- cedes coma.—From author’s abstract, South. M. J. 12, 453.
PANCREAS, Diseases of the—as a cause of retarded growth in children (Pankreaserkrankungen als Ursache des Nichtgedeihen von Kindern). Passini, Deutsche med. Wehnsechr. (Berlin), 1919, 45, 851.
Of no endocrine interest.—J. K. (PANCREAS) Habitus, and especially that of diabetes (Ueber
Habitus in allgemeines und diabetischen Habitus im Beson- deren). Bondi, Miinch. med. Wehnschr., 1919, 66, 544.
ABSTRACTS 549
Patients with diabetes may show as a characteristic hab- itus: a red face, inclination toward adiposity, hairy chest and a slight degree of protrusion of the eyes.—J. K.
(PANCREAS) Elements of success in the treatment of dia- betes. Safian (J.), New York M. J., 1917, 106, 357-359.
A preliminary report upon the treatment of diabetes. The author uses a modified Allen treatment and insists upon hos- pital care during the beginning of the treatment.—H. W.
(PANCREAS DIABETES) Experiments on the glycogen question. (Untersuchungen zur Glykogenfrage). Fahr, Deut. med. Wehnschr. (Leipz. u. Berl.), 1916, 42, 1337.
Dogs were rendered diabetic by extirpation of the pan- creas and injection of adrenalin. The glycogen content of the blood was not increased; in some instances it was decreased, while the blood sugar was increased. The glycogen of the blood is exclusively in the leucocytes. The occasionally ob- served decrease of glycogen in the blood of diabetic animals is explained by the reduction in the number of leucocytes. The author formulates the hypothesis that glycogen is always bound in eells; if the glycogen leaves the cells and reaches the fluid part of the blood it is promptly changed into sugar; the sugar circulating in the blood is transformed into glycogen and stored in the cells as soon as the amount present exceeds the individual needs of the cells. The glycogen found in the cells of the kidney in diabetes is believed by the author to be formed in this manner.—J. P. 8.
(PANCREAS) Glycosuria in diabetes after exceeding the carbohydrate tolerance limit. (Over de glucosurie van dia- betes lijders na overschrijding der tolerantie). Steensma (F. A.), Nederl. Tijds. v. Geneesk. (Haarlem), 1919, 68, (ii),
* 312.
It is often thought that when the tolerance limit for car- bohydrates is surpassed all carbohydrates above this amount are excreted as glucose. This is not true; there are people who have traces of glucose in the urine when they take 400 grams of carbohydrate daily, but who become sugar free only on a diet absolutely lacking in carbohydrates. There are other people who excrete 10 per cent, others who excrete more or less of the carbohydrates given above the tolerance limit. A part of this sugar which is not excreted is assimilated. The author concludes that in these cases it is better not to be too strict with the diet.—J. K.
550 ABSTRACTS
(PANCREAS) Investigative and scientific phases of the dia- betic question. Allen (F. M.), New York M. J. (N. Y.), 1919, 103, 314-315.
The chief points of similarity between human and artificial canine diabetes are as follows: 1. The manner of onset is the same in man and dog. 2. Sugar ingestion alone is sometimes capable of producing diabetes where other carbohydrates are not. 3. Individual idiosynerasies are observed in both in- stanees. 4. Renal impermeability to sugar may result from the presence of an excess of sugar in the blood. 5. A ‘‘ner- yous’? type of glycosuria can be brought on in dogs of a nervous nature. 6. Traumatic diabetes occasionally arises in predisposed animals. 7. Diabetes decipiens may oceur in both man and dog.
The differences between human diabetes and the condi- tion arising through pancreatectomy in the dog include the following: 1. <A discrepancy exists in the dextrose and nitro- even ratio met with in the two conditions. 2. A great increase in protein metabolism takes place in the totally pancreatecto- mized dog. 3. Changes in the pancreas due to diabetes are observed in the dog.
If the cause of diabetes is pancreatic, it is manifested in diminished power on the part of the organism to utilize glucose. Diabetes is probably a broader condition than this. The diabetic organism does not assimilate normally. To ae- count for this we are driven, owing to the lack of chemical evidence, to hypotheses such as that accumulation of reserve decreases tolerance, while deficient supply increases it, or that ingestion of any food decreases the assimilatory power for other foods, so that after a sufficient period of excessive carbo- hydrate intake, ketonuria appears more readily.
The key note of treatment in diabetes is rest of a weak- ened function. As yet no method of actually strengthening this function has been discovered.—H. W.
(PANCREAS) Investigative and scientific phases of the dia- betic question with their probable relation to practical prob- lems of clinical medicine. Allen (F. M.), Boston M. & 8. J., 1916, 174, 319-320; Med. Ree. (N. Y.), 1916, 89, 453; New York M. J., 1916, 108, 314; J. Am. M. Assn. (Chgo.), 1916, 66, 1525, 1582.
The rapid clinical changes possible in human diabetes seem to indicate functional rather than organic alterations in the panereas. Back of human diabetes might be a disorder of the abdominal nerves, possibly disturbing not only the function of the pancreas, but to some extent that of other organs. The
ABSTRACTS 55]
kidneys are generally anatomically normal, although fune- tional changes are frequent.—H. W.
(PANCREAS) Mild diabetes in children. Riesman (D.), Am. J. M. Sei. (Phila.), 1916, 151, 40-44.
Riesman briefly reports four cases and concludes:
‘‘1. There exists a mild type of diabetes in childhood and adolescence. 2. The disease is peculiar in its tendency to occur in several members of the same family. 3. The glycosuria is usually moderate, although nervous excitement and other dis- turbing factors may augment it. 4. Other diabetic symptoms are often slight and may be wanting. 5. The disease is not progressive and may remain stationary, or end in apparent recovery. 6. In its general features, it corresponds to the so- ealled renal diabetes.’’—H. L.
(PANCREAS) Morphine hyperglycemia in dogs with experi- mental pancreas deficiency. Auer (J.) and Kleiner (I. S.), J. Exp. Med., 1919, 29, 49.
In previously reported experiments Auer and Kleinez found that after largely abolishing the function of the living panereas in dogs, without resecting the gland, there was usu- ally no marked hyperglycemia or glycosuria. Jn rare instances, however, these conditions did oceur, and this occasional hyper- glycemia was looked upon as a sign of weakness in the carbo- hydrate metabolism. They put to experimental test the con- ception that any factor causing hyperglycemia would prob- ably eall forth a greater response in animals with a pancre- atie deficiency than in normal animals. They found that the subeutaneous injection of 1 to 2 mg. of morphine sulphate per kilo. in dogs with a pancreatic deficiency, whose sugar toler- ance was still good, produces a rise in the glycemia about four times. greater than the same amount of morphine ealls forth in normal dogs. Inasmuch as these dogs were in a pre-diabetic state, the inference seemed warranted that the morphine test may be of value in detecting weakened carbohydrate metab- olism in the human subject. The experimental facts described in the paper are believed by the authors to give additional cor- roboration to the view that the response of a normal and of a pathologically altered organism to the same drug in the same dosage may be quantitatively very different.—J. P. S.
(PANCREAS DIABETES) Ration certificates and statistics regarding diabetes (Nahrungsmittelatteste und Statistik). Kohn (H.), Berliner klin. Wehnschr., 1916, 53, 1283.
~ ABSTRACTS
or OU bo
The author points out that statistics as to the frequency of diabetes, based upon the number of medical certificates ask- ing a repletion of the daily ration because of diabetes, are unreliable.—J. K.
(PANCREAS) Remarks on the Allen treatment of diabetes. Nesbitt ( G. E.), Dublin J. M. Se., 1916, 142, 379-385.
Reviews the Allen treatment and reports its successful ap- plication in one ease.-—H. L.
(PANCREAS) Results obtained in the treatment of diabetes. Joslin (E. P.), Boston M. & S. J., 1916, 175, 147-148.
Reports a decrease in mortality of 20 per cent over the previous year. This decrease is attributed to better methods of treatment. In the author’s series of cases 66 per cent of the fatalities occurred because of coma. Eighty-seven per cent who succumbed during the first year of the disease died of coma; and 100 per cent of fatal cases among children resulted from the same cause. Therefore, if the mortality of diabetes is to be reduced, more attention should be paid to the avoid- ance of coma, and careful attention to the patient during the first year following the detection of the disease.—H. W.
(PANCREAS) The age at which trypsinogen appears in the foetal pancreas. Sampson (J. J.), J. Biol. Chem. (N. Y.), 1919, 38, 345-355.
Trypsinogen when measured by refractometrie methods, appears in pig embryos at approximately the 50-53 day of in- trauterine life (length 65-72 mm.) The dendritic duct system is substituted for the primitive anastomotic tubules at the time of appearance of trypsinogen, and the point is made that special glandular functions are apparently coincident with the production of intracellular zymogen granules.—V. K. L.
(PANCREAS) The Allen diet for diabetes—with report of cases. MacNair (R. H.), South. Clinic (Richmond), 1916, 39, 43-49.
The author eulogizes Doctor Frederick Allen of the Rocke- feller Institute for his epoch-making advance in the treatment of diabetes; he briefly describes a few successful cases, calling especial attention to the use of spinach.—H. L.
(PANCREAS) The Allen treatment in diabetes mellitus. A report of five cases. Paley (S. H.), New York M. J. (N. Y.), 1916, 103, 159-161.
553
A patient with sugar as high as 7 per cent may become sugar free within three days when starved and given only whiskey. Beginning with small quantities of carbohydrate in the form of non-starchy vegetables in gradually increasing amounts and later adding protein and fat, a tolerance can be established for the three foodstuffs sufficient to maintain the metabolism of the patient.and yet keep him free from glyco- suria. Apparently an acute infection or chronic disease is no hindrance to this form of treatment.—H. W.
(PANCREAS) The Allen treatment in diabetic gangrene. (Let- ter to the Editor) Baldwin (J. F.), Am. J. Surg. (N. Y.), 1916, 30, 65.
Very brief report of amputation of leg for diabetic gan- grene after preparatory Allen treatment, followed by diabetic coma and death two days after operation.—H. L.
(PANCREAS) The classification of diabetes mellitus. Ringer (A. J.), Penn. M. J. (Athens), 1916, 19, 280-283.
A brief address emphasizing the importance of studying diabetes quantitatively instead of qualitatively.—H. L.
(PANCREAS) The diastatic activity of the blood in diabetes. Meyers (V. C.) and Killian (J. A.), Am. J. Physiol. (Balt.), 1917, 42, 582-583.
The blood was found to have an increased activity in nephritis and diabetes, and the suggestion is made that this may be the important factor in the production of hypergly- cemia in these conditions.—L. G. K.
(PANCREAS) The dietetic management of diabetes mellitus. Ruschhaupt (L. F.), New York M. J. (N. Y.), 1916, 103, 1032- 1033.
Dietetics in diabetes mellitus is rational only when it is based upon the caloric calculation of the diet.—H. W.
(PANCREAS) The recognition of pancreatic insufficiency, with special reference to the Loewi test. Decker (H. R.), Boston M. & S. J., 1917, 176, 867-870.
Of 500 cases upon whom Lowei’s test was performed, 18 gave positive reactions and only two of these were known to have pancreatic lesions. Hence, Loewi’s test is not patho- gnomonic of pancreatic disease. It is further pointed out that
554 ABSTRACTS
no tests at present are pathognomonic of pancreatic disease, or even meet the requirements of reasonable simplicity and rel- ability.—H. W.
(PANCREAS) The relations between glycogen and glucose in the liver cell and its significance in pancreatic diabetes (Die Wechselbeziehung zwischen Glykogen and Traubenzucker in der Leberzelle und ihre Bedeutung fur die Lehre vom Pan- kreasdiabetes). Lesser (KE. J.), Ergebn. inn. Med. u. Kinder- heilk. (Berlin), 1919, 16, 279.
No news. The author considers pancreatic diabetes as caused by a change in the liver. As Claude Bernard has al- ready pointed out, in the liver diastase and glycogen are sep- arated from each other. In pancreatic diabetes this separation ceases; according to Lesser diastase and glycogen come into contact and abnormal hydrolysis results. This continues until the liver is free from glycogen.—J. K.
(PANCREAS) The role of fat in diabetes. Allen (F. M.), New York M. J. (N. Y.), 1916, 104, 1005-1007.
Lipemia is almost a constant finding in human diabetes. The same condition is found also in partially depancreatized dogs. The fat may be present in the plasma of severe cases in either man or dog in,amounts up to 15 per cent or over. In experimental dogs the lipemia varies in degree largely with the digestive power of the animals, hence can be controlled largely by feeding. Animals suffering from diabetes if kept upon a full diet develop true acidosis and diabetic coma ensues which is quite similar to that in man. In both man and experi- mental animals if the diabetes has gone too far the acidosis may be checked by the introduction of a fasting period, but if the diet is restored, the downward progress will continue. In severe cases fasting may at first increase the acidosis, but if the fasting is repeated with periods of return to a properly adjusted diet, it is usually possible to produce an immunity to the fasting acidosis and an ultimate recovery of very marked degree. Alterations in the reaction of the blood can not be considered the cause of death in acidosis of diabetic origin, for the blood may be kept normal in reaction and yet the man
or animal may die in diabetic coma and typical acidosis. —H. W.
(PANCREAS) The saliva in diabetics. Boston (lL. N.) and Kohn (L. W.), New York M. J., 1917, 105, 497-502.
In diabetes the diastatic activity of the saliva varies within wide limits. In some cases the enzymic power was slightly
ABSTRACTS 55)
higher than in normal eases. No definite relationship could be established between the diastatic energy of the saliva and the quantity of sugar in the urine. The saliva is more often acid than neutral or alkaline. Normal specimens of saliva have about the same degree of acidity, ranging from .0146 per cent to .0219 per cent. Excepting one case which was alkaline in reaction, all the others (12 cases) exhibited acidities ranging from .00365 per eent up to .07665 per cent. Therefore, quite a number showed acidities higher than .03 per cent when diastatic activity is supposed to be altered, and yet the dias- tatic activity sustained itself quite well—H. W.
(PANCREAS) The treatment of diabetes mellitus by alimen- tary rest. Leyton (O.), Practitioner Lond.), 1916, 97, 24-43; 401-413.
_ An eminently sane presentation of the Allen treatment for diabetes, with Joslin’s dietetic charts, and formulas of Lewis and Benedict’s method of estimating sugar in the blood. The article includes instructions to nurses and details of the diets employed, and a concise tabulated record of forty-four treated cases. Of these, thirty were discharged sugar free; four cases of diabetes complicated by tuberculosis died and Leyton advises against the Allen treatment in these patients, feeling that the return for the sacrifice of food is small. In all other cases he strongly endorses a fair trial of the starva- tion treatment.—H. L.
(PANCREAS) The treatment of diabetes mellitus by prolonged fasting. Cammidge (P. J.), Practitioner (Lond.), 1916, 97, 414-429.
This paper contains some convenient diet lists arranged in ‘“‘average servings’’ of the various foods to be taken at table. The foods are classified in groups according to the ap- proximate quantity of carbohydrate, protein and fat. The author warns against being misled by the absence of sugar in the urine, when there may still be hyperglucemia, which he considers more important.
Cammidge differs with Allen in his method of arriving at protein tolerance. He does not agree that protein can be raised higher and higher so long as the urine remains sugar free. He believes that diabetic diets should be arranged to maintain nitrogenous equilibrium. He considers that better and more permanent results will be obtained from the fasting treatment if the nitrogen loss in the urine is taken as the chief guide in fixing the amount of nitrogenous food than if atten- tion is confined solely to the appearance of sugar in the urine.
556 ABSTRACTS
It is concluded that the Allen treatment controls the acidosis in most typical cases of diabetes more quickly than any plan previously deseribed, but that it will probably result in a cure only in some eases, while only a temporary respite will be secured in others, the ultimate cause progressing or recurring unchecked. And finally, Cammidge believes that many chronic cases in elderly people will do as well without as with pro- longed fasting if the protein and carbohydrate content of their diet is carefully adjusted to their metabolic capacity, and with much less discomfort to themselves.—H. L.
(PANCREAS) The treatment of diabetes mellitus with special reference to Allen’s method. Stengel (A.), Tonas (L.) and Austin (J. H.), Penn. M. J. (Athens), 1916, 19, 283-287.
The authors briefly refer to the history of advances in diabetic treatment, mentioning the contributions of Rolle -in 1796, Prout in 1820, Cantam in 1880, Rubner in 1901, Stadel- man in 1883, Wilben in 1904, Benedict and Torok in 1906, von Noorden in 1901, and finally Allen in 1914. Following a de- scription of Allen’s method of treatment, the authors refer to their own modifications. They conelude that Allen’s method is the most successful in severe cases, but that the majority of diabetics do not require the preliminary fast.—H. L.
(PANCREAS) The value of starvation in the treatment of diabetes mellitus. Poulton (E. P.), Guy’s Hosp. Gaz. (Lond.), 1916, 30, 222-227 ; 238-244.
Poulton accepts Allen’s viewpoint that the pancreas pro- duces an internal secretion which passes in the blood stream to the tissues and there acts as an amboceptor, linking a food molecule, such as dextrose, to the biogen molecule in the cell. In diabetes there is a deficiency in the amboceptor, hence dextrose molecules cannot be anchored to the cell and utilized. The author calls attention to the experimental production of glycosuria by extirpation of the panceras by von Mering and Minkowski in the latter part of the nineteenth century and the elaboration of this relationship by the recent experiments of Allen, who demonstrated that the severity of the diabetes was directly proportional to the amount of pancreas removed. Fur- thermore, the external secretion of the pancreas has no influ- ence on diabetes; the lack of internal secretion is responsible ; the histological change occurring in the islands of Langerhans are probably the result of the diabetes process rather than associated with the cause of. diabetes. The author then re- views Allen’s starvation treatment, reports some cases and
ABSTRACTS DDT
discusses Joslin’s new policy of avoiding alkalies in acidosis. He closes with a favorable opinion of Allen’s exercise treat- ment.—H. L.
(PANCREAS) Treatment of diabetes. KFremont-Smith (F.), Boston M. & S. J., 1916, 175, 476-479.
Nothing new.—H. W.
(PANCREAS) Speculation regarding the pancreas and metab- olism in diabetes. Greeley (H. P.), Boston M. & S. J., 1916, 175, 753-754.
The remarkable success of the Allen fasting treatment of diabetes, the author believes, is largely due to the element of relatively absolute rest—rest being the raison d’étre for almost all medical treatment of chronic metabolic diseases.—H. W.
(PANCREAS) On the internal secretion of the pancreas (Sur la sécrétion interne du pancréas). Kumagai (T.) and Osato (S.), C. R. Soe. Biol. (Paris), 1919, 82, 425-427.
The authors found that the amylolytic activity of the lymph of the thoracic duct was increased to a much greater extent than that of the blood after an injection of pilocarpine. Other investigators have shown that the increase does not occur after extirpation of the pancreas. Accordingly, the authors conclude that amylase is an internal secretion of the pancreas and that it reaches the blood by way of the thoracic duct. Lymph from the thoracic duct of animals treated with pilocarpine when injected into dogs with pancreatic diabetes causes no effect if the whole of the pancreas has been extir- pated, but decreases the glycosuria if the pancreas has been only partially removed.—tL. G. K.
(PANCREAS ADRENIN) The effect of painting the pancreas with adrenalin upon hyperglycemia and glycosuria. Kleiner (I. S.) and Meltzer (S. J.), J. Exp. Med., 1919, 29, 647.
A difference exists in the effects on blood pressure and sugar production, depending upon the mode of administration of adrenalin. With regard to sugar production a subcutaneous injection has a definitely greater effect than an intravenous injection; with regard to blood pressure, however, the oppo- site is true. Herter had claimed that intraperitoneal injection of adrenalin gave a higher degree of glycosuria than subeu- taneous or intravenous injection, and that the difference was due to the direct effect of the drug upon the pancreas. Kleiner
598 ABSTRACTS
and Meltzer tested this hypothesis and found that painting the pancreas so isolated that no adrenalin could reach the peritoneum gave a glycosuria about one-third, and a rise in blood pressure about two-thirds, that obtamed by painting the un-isolated pancreas. Two facts were deduced: (1) that the painting of the isolated panereas produces only mild glyco- suria and hyperglycemia, and (2) that the greater production of sugar observed after painting the un-isolated pancreas can- not be of pancreatic origin. The authors are unwilling, how- ever, to state whether the: production of sugar is due to the escape of the adrenalin to some definite organ covered by the peritoneum (coeliac ganglion or adrenals), or whether the peritoneum as a whole is responsible—J. P. S.
(PANCREAS HYPOPHYSIS) The relation between diabetes mellitus and diabetes insipidus (Zur Frage des Zusammen- hangs des Diabetes mellitus und Diabetes insipidus). Lewin (C.), Med. Klin. (Berlin), 1919, 15, 133.
It is still an open question whether diabetes mellitus may change into diabetes insipidus or diabetes insipidus into dia- betes mellitus. The author discusses the lterature and de- seribes two cases.
In the first case a woman of 32 with an enormous polyuria and polydipsia contracted diabetes mellitus and lost her polyuria. In the second case a man of 46 had diabetes mellitus. The quantity of excreted sugar, however, did not depend upon the quantity of ingested carbohydrates. After some time sugar disappeared from the urine and blood sugar became normal, but the patient developed polyuria and polydipsia. In this ease the author examined carefully the concentration power of the kidneys. The concentration of the urine rose when little water was given, hence the concentration power was normal. This case we cannot designate diabetes insipidus, but we must eall it simply polyuria. So it is with all cases in the literature. Most of them are not carefully examined, or when they are, prove to be neither diabetes mellitus nor diabetes imsipidus. The author concludes that a case has never been described in which the one diabetes actually changed into the other. He believes that there is no relation between the two diseases.
—J. K.
(PARATHYROID?) A case of tetany in an adult. Kjolstad (S.), Norsk Mag. f. Laegevid (Christiania), 1917, 78, 307-310.
A ease report. A man of 22 was suddenly taken ill after exposure to cold weather. He developed general convulsions, without any apparent cause. He gradually grew worse and
ABSTRACTS 509
the ease proved fatal in two days. Previously he had had four similar attacks with convulsions, at intervals of a year, each time after exposure to cold weather. Autopsy was not per- formed. Discussing the case, the author holds it to be one of ‘“idiopathic’’ tetany.—K. M.
(PARATHYROID) A case of tetany in an adult and some critical observations onthe cause of tetany (Een geval van tetanie bij een volwassene en eenige kritische opmerkingen betreffende de pathogenese der tetanie). [olten (G. C.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1917, 61 (1) 218-236.
Description of a case of tetany in a boy of 17. The boy had all symptoms of latent tetany but no real spasms, except once after a few days constipation. When the action of the bowels was again normal he had no more spasms. The boy was very infantile. Most probably this patient was suffering from a polyglandular insufficiency. Bolten reverts again in this article to the etiology of tetany, as previously set forth in Geneeskundige Bladen, 19, 301. (Abstracted in Endocrin., 1, 523.) —=J . 1.
(PARATHYROID) An observation demonstrating the influ- ence of the parathyroids on tetany strumipriva (Een waar- neming die den invloed der bijschildkliertjes cp strumiprive tetanie aanvallen op duidelijke wijze toelicht). Winkler (C.), Nederl. Tijdschr. voor Geneesk. (Haarlem), 1917, 61 (i), 768-770. -
Demonstration of Stenver’s patient (see Endocrin, 1, 399) before a congress of Dutch physiologists.—J. K.
(PARATHYROID) Infiuence of parathyroid organotherapy on the calcification of bone (Influence de 1’opothérapie parathy- roidienne sur la calcification des os). Boez (L.), C. R. Soe. Biol. (Paris), 1919, 82, 447-448.
The administration of dried parathyroid glands along with calcium phosphate to growing rabbits was found to increase the rate of ealeification in bone, while ealeium phosphate alone did not appear to influence it.—L. G. K.
(PARATHYROID) Tetania parathyreopriva, The guanidin con- tent of muscle in—. Henderson (Pearl S.), J. Physiol. (Lond.), 1918, 52, 1-5.
The investigations of Noél Paton and his collaborators have shown a correlation between the symptoms of tetania
560 ABSTRACTS
parathyreopriva and the action of guanidin on the motor eells of the cord. There is also an increase of guanidin in the blood and urine in tetania parathyreopriva. (See Endocrin., 1917, 1, 476.) This increase in guanidin in blood and urine might be due to an increased liberation from the muscle, or to an in- creased formation of guanidin in the muscle. Henderson finds there is a ‘‘fall in the total and in the free guanidin of muscle, and a rise of the creatin, both absolutely and in relation to the total nitrogen. The fall in the total guanidin is far in excess of the nitrogen‘in free guanidin and in ereatin, and must indi- eate either a liberation of guanidin from the muscle, or a failure in the power of the muscle to take up guanadin formed elsewhere,’’ either of which may account for the increase in blood and urine.—T. C. B.
(PARATHYROID) Tetania parathyreopriva. Laméris (J.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1917, 61 (1), 856- 860.
A description of the patient of Stenvers (see Endocrin. 1, 399) by the surgeon who performed the operation. Since the deseription by Stenvers a fourth parathyroid has been trans- planted. The effect has not been as was thought at first. After some months all symptoms of tetany had reappeared.—J. K.
(PARATHYROID) Tetany and the functions of the parathy- roids. Paton (D. N.) and Findlay (L.), Brit. M. J. (Lond.), OUT (Ge 575-51 1.
Published elsewhere. See Endocrin. 1917, 1, 476-890. —L. G. K.
(PARATHYROID) Tetany and the functions of the parathy- roids.. Forsyth (D.), Brit. M. J. (Lond.), 1917 (i), 632.
Forsyth eriticizes the work of Paton and his coworkers. (See Endocrin., 1917, 1, 476-80.) He contends that, on the whole, the evidence does not support the assumption of Paton ‘‘that the nervous symptoms (of tetany) are due to the re- moval of the parathyroids.’’—L. G. K.
(PARATHYROIDS) The role of parathyroids and calcium metabolism in tetany (Over de beteekenis van de bijschild- kliertjes en de kalkstofwisseling bij tetanie). Arntzenias (A. K. W.), Inaugural Dissertation, Leiden, 1919.
The author examined four patients having tetany. Two of them were suffering from severe diarrhoea. The two others
ABSTRACTS 561
had post-operative tetany. Three of these patients had a nega- tive calcium balanee. These were much benefitted by the ad- ministration of calcium (lactate of ealeium or chloride of eal- cium, 4 grams daily). The symptoms of tetany diminished. In only one patient was the calcium metabolism itself improved by this treatment. The fourth patient had symptoms of latent tetany, only, without abnormal calcium metabolism. She, too, was much benefitted by the administration of calcium.
The author tried to treat his patients with fresh or dried parathyroids (of cow or sheep). His results were absolutely negative. Even in enormous doses (he once gave a patient 100 parathyroids at once) no influence on the disease was seen. The author concludes that the cause of tetany is a hypofune- tion of the parathyroids. This causes a change in calcium metabolism. This change in metabolism is responsible for the tetany. We.can only treat the symptom, negative calcium bal- ance, but we cannot treat by remedies the true cause, the para- thyroid insufficiency.
There are probably two factors operative in the association of diarrhoea and tetany. Patients with chronic diarrhoea show a disturbed absorption of fat. The stools contain more fatty acids and more calcium soaps than normal. The excretion of calcium is increased. Also patients with chronic diarrhoea not infrequently suffer from pluriglandular insufficiency. The author found in his patients brown pigmentation and disturbed function of the pancreas. That the internal secretion of the pancreas may be disturbed in chronic diarrhoea is well known. The brown pigmentation may be the result of adrenal insuffi- ciency (blood sugar was normal). Perhaps parathyroid in- sufficiency may be one of the symptoms of the polyglandular disease.—J. K.
(PITUITARY) A case of pituitary body disease and the re- sults of glandular administration. de Schweinitz (G. E.) and How (H. W.), Arch. Opth. (N. Y.), 1917, 46, 139-146.
The writers report a case of gradual onset of blindness in a woman of 38. She had suffered for years with temporal neuralgia and numbness of her fingers. Her mother had arthri- tis deformans, and her father died of angina pectoris. The skiagram showed an enlarged pituitary fossa, and thinning of the posterior clinoid processes. What the writers wish to point out is that in this and two additional cases quoted they administered thyroid extract in addition to pituitary, together with inunections of mereury. The patients showed a steady and gradual improvement in their vision. There was no history of Ines in any of the eases.—J. H. L.
562 ABSTRACTS
PLURIGLANDULAR INSUFFICIENCY, A case of—. Christ- offersen (N. R.), Nord. med. Arkiv. (Stockholm), 1918, 2, 50. (Article written in French.)
A woman, aged 25 years, was suffering from amenorrhea, asthma, palpitations and pigmentation of the skin; the face was somewhat puffy and dropsical. Blood pressure was low. Blood-sugar showed an enormous increase upon feeding with olucose, but there resulted no glycosuria. The patient died in half a year. The autopsy showed atrophy of the thyroid, adrenals and ovaries. No sign of tuberculosis was detected.
—K. H. K.
POLYGLANDULAR INSUFFICIENCY, A case of—. Fog (J.), Ugeskrift for Laeger (Copenhagen), 1917, 79, 1046- 1052.
A woman, aged 18 years, showed from early childhood signs of slow development. She showed now dwarfism (length, 144 em.), retarded junction of the epiphyses, hypotrichia, slight pigmentation, latent tetany, slight goitre, aplasia of the genital organs, infantile face and intellect, disease of the heart, and a strange disturbance of the carbohydrate metabolism (hyperglycemia without glycosuria). .These symptoms are probably related to disease of all the endocrine glands. Of special interest is the fact that the disease seems to go back to early childhood and the hyperglycemia is without glyco- suria; this last thing makes an interesting contrast to a similar ease of Krabbe that showed glycosuria without hypergly- cemia.—K. H. K. ;
POLYGLANDULAR INSUFFICIENCY, Thyreogenic obesity and diabetes. Heiberg (K. A.), Bibliothek for Laeger (Co- penhagen), 1916, 108,- 339-346.
A woman aged 59 years had syphilis forty years ago. Thirty-five years before she became suddenly very fat. She showed signs of diabetes, the sugar reaction of the urine being very marked. The condition was somewhat improved by thy- reoidine treatment.—kK. H. K.
PUBERTAS PRAECOX. Krabbe (K. H.). Hospitalstidende (Copenhagen), 1917, 60, 1165-1175; Ugeskr. f. Laeger (Co- penhagen), 1917, 79, 1427.
A boy, aged 1 year, showed a slight microcephaly, hyper- trophy of the lower face, very marked development of the penis, scrotum and testicles, and short, dark pubic crines. Fur-
ABSTRACTS 563
ther there were signs of latent tetany, spastic paresis of the lower limbs and imbecility. Certain ‘‘cramps’’ which the child showed seems to have been due to onanism. There was no sign of brain-tumor. The author discusses the probable etiology and suggests that the precocious development of the sexual glands in this case perhaps is related to an adrenal tumor, coincident with aplastic development of the brain. —K. H. K.
SCLERODERMA in an infant (Sklerodermie in Kindesalter). Kraus (A.), Miinch. med. Wehnschr., 1919, 66, 429.
Scleroderma in a child of 11 months. Though he looked for it especially, the author could not detect an abnormal func- tion of any of the endocrine organs.—¥J. K.
SCLERODERMA in infants (Uber Sklerodermie beim Saug- ling). Meyer (lL. F.), Deutsche med. Wehnschr. (Berlin), 1919, 45, 850.
Seleroderma is extremely rare in infants. In literature there are only ten cases known. The author reports two other eases. In adults there are three stages: First, oedema; second, induration; third, atrophy. In infants only induration is seen. It is healed without any therapy. The cause is probably a polyglandular dysfunction.—J. K.
(SECRETIN) A comparison of the influence of secretin and antineuritic vitamine on pancreatic secretion and bile flow. Voegtlin (C.) and Myers (C. N.), Am. J. Physiol. (Balt.), 1919, 49, 124.
Aleoholie extracts of yeast and extracts of the mucosa of the duodenum prepared in the same manner and submitted to Funk’s method for the preparation of the vitamine fraction both cause marked increase in pancreatic secretion and bile flow when injected intravenously, and both relieve the para- lytic symptoms of polyneuritic pigeons. Other experiments have shown that liver, heart muscle and milk, previously shown to contain the antineuritie vitamine, also contain a substance which stimulates pancreatic secretion and increases the flow of bile. It is coneluded that secretin and the antineuritic vitamine are very closely related if not identical—h. G. K.
SECRETIN and the change in the corpuscle content of the blood during digestion. Downs (A. W.) and Eddy (N. B.), J. Florida M. Assn., 1918, 5, 101-106.
564 ABSTRACTS
The administration of secretin subeutaneously even in small doses is promptly followed by a considerable increase in the number of both red and white corpuscles in the cireulat- ing blood. This increase is only transient after a single dose, but repeated doses, daily or three times a week, cause both the red and the white counts to remain elevated. The effect on the white corpuscles appears earlier, is more marked and persists longer than the effeet on the red corpuscles. These changes in the corpusele content of the circulating blood are due to a direct stimulating action of secretin on the blood-forming organs, especially the bone marrow. During digestion the number of both erythroeytes and leucocytes in circulation is increased. This change is comparable with the result of the experimental administration of secretin. In both cases the bone marrow is stimulated and the differential leucocyte counts are similarly modified. It is believed that secretin is the cause of the increase in the blood corpuscles observed during diges- tion.—Author’s Abst., N. B. E.
(SECRETIN PANCREAS) The place of formation of secretin and its importance for the functioning of the pancreas (Ueber Bildungsort und Schicksal des Sekretins und ihre Bedeutung fiir das Pancreas). Djenab (K.), Berl. klin. Wehnschr., 1917, 54, 624; Miinch. med. Wehnschr., 1917, 64, 719.
It is possible with hydrochloric acid to extract secretin from the mucous membrane of the duodenum. In the hterature - much has been written on prosecretin, but its existence has never been proved. Secretin injected into a vein lowers the blood pressure and increases the secretion of the pancreas. If, however, it is injected into the vena porta it has no action. The liver seems to inactivate it.—J. K.
(SEX) Effect of grain rations on growth of chicks. Buckner, Nollan, Wilkins and Kastle, J. Agric. Research, 1919, 16, 305.
The results of feeding experiments with proteins of rice, oats, barley, hominy, and glutin flour indicate a retarding action on the development of the external sexual characteristics and their functions, which accompanies the arrested develop- ment of the chicks.—V. K. L.
SEXUAL characters in mammals, experimentally studied. Sand (K.), Dissertation, Copenhagen, 1918, pp. 256.
The author sets out to study experimentally the influence of the gonads on the secondary sex characteristics produced by the sex hormone. Following Steinach, he performed extirpa-
ABSTRACTS 565
tions and transplantations of ovaries and testicles in guinea pigs, rabbits and rats. The experiments affirmed and extended the results of Steinach. All the observations are described in much more detail than were Steinach’s. For these the original article should be consulted. The experiments showed that the male sexual hormones are produced in the Leydig cells, but the female, probably, in all the different elements of the ovaries. Especially new are experiments on artificial her- maphrodites. The author sueceeded, by simultaneous im- plantation of ovaries and testes in infantile castrated animals, in producing artificial ovo-testes with full spermatogenesis and production of ovarian follicles. The secondary sex character- istics in these animals were partially male, partially female. The author considers pseudohermaphroditism and also homo- sexualism in a new light, regarding ‘the endocrine, not the exocrine, sexual gland as the fundamental sex structure, and he suggests’ that perhaps homosexualism might be ascribed to the production of female hormones from the Leydig cells in the testicles—K. H. K.
(SPLEEN THYROID) Influence of the spleen on the respira- tory quotient (Einfluss der Milz auf den respiratorischen
* Stoffwechsel). Danoff (N.), Biochem. Ztschr. (Berlin), 1919, 93, 44-65.
Experiments were made on rats. After removal of the spleen metabolism was enormously increased. The respiratory quotient remained unaltered, but the quantity of excreted CO, and of used oxygen (examined by the technique of Haldane) was largely increased. The spleen inhibits metabolism. It is the antagonist of the thyroid.—J. K.
(TESTIS) Male climacteric (Orqui-Endocrino-Pausia). Allende Ignacio, Libro de Oro del Profesor Bazterrica, Buenos Aires,
1918.
Considerations relative to the production of neurasthenic symptoms and of sexual aberrations in men toward the end of the period of sexual activity. The author compares this to the menopause in women.—B. A. H.
(TETANY) ‘‘Calciprivic’’ constitution (Calciprive constitutie). Stheeman (H. A.), Neder]. Tijdschr. v. Geneesk. (Haarlem), 1919, 63, (ii), 291.
If a young child has an inereased irritability of the nerve or muscle (symptoms of Erb and Chvostek) we are inclined to eall this tetany. If there are no signs of tetany or spasmo-
566 ABSTRACTS
philia we speak of latent tetany. This is not permissible. The symptoms of Erb and Chvostek are very often seen, but tetany is much less frequently observed. In other children, at the age when tetany is no more observed, the symptoms of Erb and Chvostek are often positive. The author thinks that tetany is one of the many disturbances in which these signs are pres- ent. They are also positive in all kinds of chronic disturb- ances as they are frequently seen in children. Also in neuras- thenia, psychasthenia, vagotonia and lability of the sympa- thetic these symptoms may be observed. The author found that all patients with the sympoms of Erb and Chvostek have a diminished content of caleium in blood and tissues. He ealls these two symptoms together the “‘calcioprive stigma.’’ Among the patients with this stigma the parathyreopriviec tetany is an important group, but there certainly exist other diseases which have no relation to tetany, but which show the same stigma. In these cases we can not properly speak of latent tetany.
de. ke
(TETANY) The blood calcium content in normal children and in tetany (Het bloedkalkgehalte bij normale kinderen en bij kinderen met tetanie). de Vries Robles (I. B.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919, 63 (1), 1663.
The author determined by Wright’s method the content of ealeium in the blood of normal children and of children with tetany. He found no difference. He cannot confirm the results of other Duteh and German authors who found the amount of ealeium in tetany diminished.—J. K.
(TETANY) The vegetative nervous system and nutritive dis- turbances in infantile tetany (Ueber die Beteiligung des vegetativen Nervensystems und iiber trophische Storungen bei der infantilen Tetanie). Aschenheim (E.), Miinch. med. Wehnschr., 1919, 66, 712.
All organs supplied by the vegetative nervous system may be affected in tetany. The author describes the changes that may be observed in the heart, the blood vessels, the lungs (bronchotetany), the intestines and the eyes. Nutritive dis- turbaneces are rather rare, but may be observed in the eye (cataract), the nails, the teeth and the skin.—J. K.
The VEGETATIVE NERVOUS SYSTEM. A discussion of its relation to the internist and surgeon. Orbison (T. J.), New York M. J., 1917, 106, 584-589.
A general discussion of the relation of the autonomic
nervous system to functional and organie disturbances.—H. W.
ABSTRACTS 567
(THYMUS) Thymic dwarfism. Krabbe (K. H). Ugeskrift for Laeger (Copenhagen), 1917, 79, 1329-1337.
A girl, aged 16 years, had increased in growth very slowly since an age of 114 years. At 16 years of age she had a height of 111 em. The lower limbs were short; there was some rachitic deformity of the legs; some of the epiphyses had grown together too early. The hair on the head was very short and sparse. Some pigmentation of the skin was noted. - The face was somewhat pre-senile. The genital organs were aplastic. The intellect was good. The dwarfism probably de- veloped in connection with rachitism because achondroplasia and primordial, myxedematous and pituitary dwarfism can be excluded. On the other hand, the patient shows signs of endocrine disturbance. Rachitic dwarfism is rather rare and it must be considered whether this ease could belong to a spe- cial form of rachitism. Klose and Vogt’s experiments on ani- mals have shown that extirpation of the thymus may produce a combination of dwarfism and rachitism. It must therefore be considered if such cases in human beings which show this combination could be related to a thymie disturbance; of course anatomo-pathological examinations are necessary to prove it.—Author’s abstract.
(THYMUS) Status lymphaticus from the clinical standpoint. Cameron (H. C.), Brit. M. J. (Lond.), 1917, (1), 753-755.
Not of endocrine interest.—bL. G. K.
(THYMUS) Status thymo-lymphaticus in infants (—bei Neu- gebornen). Schirmer (A.), Beitr. z. pathol. Anat. (Jena.), 1919, 65, 270.
In infants a status thymicus may be observed in which hyperplasia of the follicles of the spleen is the chief symptom. Very often the thyroid is enlarged. This abnormality is her- editary.—J. K.
?
(THYMUS) The clinical symptoms and treatment of hyper- trophy of the thymus gland. Cumston (C. G.), Edinburgh M. J., 1917, N. S. 19, 20-23; Med. Press. & Cire. (Lond.), 1917, 104, 140-142.
Cumston notes that the functional symptoms of enlarged thymus are those of respiratory disturbances: permanent dyspnea coupled with inspiratory effort, resulting sometimes in a forward projection of the sternum; decrease in transverse di- ameter of the thorax and spreading of its lower circumfer-
568 ABSTRACTS
enee which may produce a characteristic deformity. Frequent paroxysms of suffocation, mostly nocturnal, accompanied by cyanosis and relieved by the sitting position suggest enlarged thymus. The author believes that one may differentiate be- tween laryngeal stridor and thymie stridor by the presence of serious paroxysms of suffocation in the latter. He mentions eyanosis, distention of the superficial veins of the neck, a for- ward vaulting of the manubrium of the sternum, an area. of dullness at either side of sternum beneath the elavicles, and the retrosternal pressure manoeuvre as helpful diagnostic signs. He briefly considers surgical treatment, exothymopexy, resec- tion of the sternal manubrium and thymectomy. He advises as the best, partial intracapsular enucleation. He mentions radiography, but has not had sufficient experience with this method to render an opinion as to its value. In acute emer- vencies surgery is the only procedure possible. (Intubation and trachetomy rarely suffice, but where haste is not necessary, we believe X-rays should always be tried in the hope of accel- erating thymie involution before resorting to surgery.)—H. Lb.
(THYMUS) The Roentgen ray treatment of epileptic subjects of status lymphaticus. Symmers (D.), J. Am. M. Assn. (Chgo.), 1917, 69, 2204.
Based upon the clinical fact that epileptic seizures often cease at puberty, 1e., at the period when the thymus gland undergoes involution, this writer points out that those epilep- ties that show the stigmata of status lymphaticus, should be subjected to Roentgen radiations. This form of therapy should be directed to the thymus, spleen and the intestines. It has the effect of limiting lymphoid tissue proliferation.
—J. H. Li.
(THYMUS) Sudden death during tonsillectomy (Tonsillec- tomie en thymusdood). Burger (H.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919, 63, (1), 1951.
Turing the removal of the tonsils in a boy of 15 years under chloroform narcosis sudden death occurred. Post-mor- tem examination showed an enormous thymus and enlarged lymphatie glands. No changes in the adrenals were detected. Perhaps it would be of some use to give adrenaline in these eases.—J. K.
(THYMUS PARATHYROIDS) Fragilitas osium congenita. Bolten (G. C.), Nederl. Tijds. v. Geneesk. (Haarlem), 1919, 63 (ii), 284.
ABSTRACTS 569
Description of three children of one family with enormous fragility of the bones and with blue sclerae. All three children had symptoms of latent tetany and showed nutritive troubles of hair, teeth and nails. The blue sclerae are also caused by trophic changes; they are much thinner than a normal sclera. The bones are poor in calcium. Most probably the disease is due to an insufficiency of the thymus. The author discusses his eases in connection with the experiments of Klose and Vogt on dogs. After thymectomy these animals showed also a fragility of the skeleton combined with symptoms of tetany. However, the disturbance in calcium metabolism makes it prob- able that the parathyroids play also an important part in the disease.—J. K.
(THYMUS THYROID) Rare forms of carcinoma (Zur Kennt- nis seltener Krebsformen). Schmidtmann (H.), Virchow’s Archiv, (Berlin), 1919, 226, 100.
Anatomical deseription of some rare forms of cancer of the thymus and the thyroid glands.—J. K.
(THYROID) A case of dyscrasic menorrhagia arrested by the use of hemato-ethyroidine. (Un cas de menorragie dyscra- sigue arrétée par l’hemato-éthyroidine.) Hmile-Weil (P.), 3ull. et mem. soe. HOp. de Paris, 1919, 23, 672-77.
A ease is deseribed of severe menorrhagia in a married woman thirty years of age, without children. She was mark- edly anemic and having menstrual discharge from twenty to twenty-five days in succession. Treatment with thyroid, supra- renal, hypophysis and mammary extract was unavailing. The administration of hemato-éthyroidine gave almost immediate relief and normal periods were soon established. When the treatment was discontinued the menorrhagia reappeared, but ceased finally with renewed treatment. This anti-thyroid medication is given in coffee after meals for a week, and then interrupted for a few days and recontinued. The treatment should be carried on for some time to ensure complete regula- tion.—F. S. H.
(THYROID) A case of familial angioneurotic oedema com- bined with tetany (Een geval van familiair angioneurotisch- cedeem gecombineerd met tetanie). Bolten (G. C.), Medisch. Weekblad (Amsterdam), 1919, 26, 1.
Of twelve members of a family, seven showed now and then a transitory oedema of the face. One of these patients had symptoms of tetany, urticaria, fits of sneezing and vomit-
570 ABSTRACTS
ing. There were symptoms of vagotonia. Bolten believes that these cases are caused by a hypotonia of the sympathie nervous system with a hypofunction of the thyroid gland.—J. K.
(THYROID) A case of sporadic cretinism (Ein Fall von spo- radischem Kretinismus). Weygandt, Deutsche’ med. Wehnsehr. (Berlin), 1917, 48, 1624.
Description of a cretin who in Hamburg was well known to all the boys in the street. The skin was dry. The intelli- gence was very low. She knew only how to write her name. Autopsy showed atrophic brain (weight 965 gram.) and small colloid goitre.—J. K.
(THYROID) A case of sporadic hemophilia accompanying myxedema. Favorable action of thyroid therapy (Un cas d’hémophilie sporadique chez un myxoedémateux. Action fa- vorable de l’opotherapie thyroidienne). Benard (R.), Bull. et mem. soc. med. hop. de Paris, 1919, 24, 702-709.
Clinical picture of a case of myxedema presenting sporadic hemophilia. As the result of the administration of desiccated thyroid the coagulation time of the blood was reduced, and epistaxis arrested without return. The author found in the literature accounts of twenty-three other cases of thyroid in- sufficiency with hemorrhages in which therapeutie success was complete. It is suggested that the thyroid may influence coagulation through its relation to calcium metabolism.
—F. 8. H.
(THYROID) Action of the thyroid body on glucose metab- olism (Action du corps thyroide sur le métabolisme du glu- cose). Labbé (M.) and Vitry (G.), C. R. Soe. Biol. (Paris), 1919, 82, 385-386.
The ability of rabbits to retain glucose in the body after its intravenous injection was found to be decreased by removal of the thyroid gland but unaffected by hypertrophy of the thyroid. These results were obtained by urinary analysis for sugar on the day of and the day following the injection of the glucose, the results from the abnormal animals being compared with those from normal rabbits.—lL. G. K.
(THYROID) A new way to diagnose malignant goitre (Kin weitere diagnostisches Merkmal des malignen Struma). Oehler (J.), Zentralbl. f. Chir. (Leipzig), 1919, 46, 536.
If in an X-ray photograph of a goitre the trachea is invis-
ABSTRACTS o71
ible, the goitre is malignant. This may be explained by the infiltration of the trachea by the tumor.—J. K.
(THYROID) An experimental and clinical study of the isolated thyroid hormone. Janney (N. W.), Med. Ree. (N. Y.), 1917, 91, 1161; Arch. Pediat. (N. Y.), 1917, 34, 530-534.
Janney reports studies with Kendall’s thyroid hormone. Normal individuals reacted with tachycardia and other toxic symptoms with very small amounts. The nitrogen balance began to decrease before clinical symptoms appeared and demonstrated that metabolism was profoundly affected by the hormone. Administration to a cretin resulted in decided elin- ical improvement. Much is to be expected from this prepara- tion when its production attains commercial proportions. It is, however, difficult to isolate. Janney’s investigations promise much for the more exact study of endocrine disorders.—H. L.
(THYROID) Anti-thyroidine treatment. Rahlff (A.), Uge- skrift for Laeger (Copenhagen), 1917, 79, 566-570.
Contrary to Sonne (Ugeskrift for Laeger, 1914) who had found that anti-thyroidine had no effect on Graves’ disease, the author suggests that it may have some effect; as proof he men- tions that he has seen the Loewi’s reaction disappear after the treatment.—K. H. K.
(THYROID) Atrophic myotcnia (Atropische Myotonie). Fleischer (B.), Arch. f. Ophthalmol. (Berlin), 1919, 96, 91.
A long article on atrophie myotonia and cataract. Of en- doerine interest is the fact that the author always found de- generations in the thyroid.—J. K.
(THYROID) Blood changes in Graves’ disease. Solling (H. A.), Nordisk medicinsk Arkiv (Stockholm), 1916, 49, (1), 1-44.
In active cases of Graves’ disease the white and red blood corpuscles are normal in number, but the percentage of lymphocytes is somewhat higher than normal. In absolutely cured Graves’ disease the number of blood corpuscles is nor- mal. For the diagnosis and prognosis the examination of blood has less significance than hitherto supposed; especially it is of no importance as an indication for thymectomy.
—K. H. K.
(THYROID) Carbohydrate metabolism in relation to the thy- roid gland. III. The effect of thyroidectomy in rats on the
572 ABSTRACTS
gaseous metabolism. Cramer (W.), and McCall (R.), Quart. J. Exp. Physiol. (Lond.), 1918, 12, 81-95.
A continuation of earlier work with the idea of testing cer- tain conclusions arrived at at that time. (See Endocrin. 1917, 1, 562, 496.) In rats removal of the thyroids and parathyroids cause no severe disturbance of metabolism. There is at first a diminution of the total metabolism, but this is followed by a compensatory increase. A study of the R. Q. and of the urine shows that the power of the cells to oxidise carbohydrates is not impaired by removal of the thyroids, and the inference is drawn ‘“‘that the condition of the carbohydrate metabolism in experimental hyperthyroidism is not due to a direct stimulat- ing effect of the thyroid hormone on the oxidation of carbohy- drates.’’ The authors take the view that in hyperthyroidism there is a mobilization of the liver glycogen due to the action of the thyroid hormone on the adrenals, increasing the ‘‘load’’ of adrenalin in these glands, and this mobilization of liver glycogen is followed by increased oxidation of carbohydrate by the organism, and not by glycosuria. The absence of these alterations of the glycogenic function of the liver in thyroidee- tomized rats will account for the absence of marked changes in their metabolism.—T. C. B.
(THYROID) Carbohydrate metabolism in relation to the thy- reid gland. IV. The effect of thyroid feeding on the gaseous metabolism of thyrcidectomized rats. Cramer (W.) and MeCall (R.), Quart. J. Exp. Physiol. (Lond.), 1919,.12, 97.
Two stages of experimental hypothyroidism are distin- guished; an early stage in which the metabolism falls, and a later stage in which the metabolism swings back toward the normal. If thyroid is fed in the early stage, the metabolism is brought back to that of a normal animal; if fed at a later stage, the metabolism is similar to that of a normal animal that has been fed thyroid. The early period corresponds to hypothyroidism in man, while in the later period there is an increased metabolism which suggests the operation of a com- pensatory mechanism. This compensatory mechanism may be due to accessory thyroids which hypertrophy, or it may be due to the vicarious functioning of other endocrine glands.
—T. C. B, (THYROID) Cases of cretinism. Cameron (H. C.), Proe. Roy. Soe. Med. Sect. Dis. Child. (Lond.), 1918, 11, 20-22.
In the experience of the author cases of cretinism always show a very marked delay in the development of the epiphyses.
ABSTRACTS 573
He believes this to be the most constant evidence of thyroid insufficiency.—L. G. K.
(THYROID) Constitutional disturbance of toxic goitre as in- fluenced by surgical therapy. Frazier (C. H.), Penn. M. J. (Athens), 1916, 21, 510-514.
Frazier’s experience indicates that toxie goitre is increas- ing, whereas simple goitre, so-called, is no more common than heretofore. He divides toxic goitre into four groups. The first is the toxic adolescent group between 16 and 19 years of age, which he considers the gravest form. The second com- prises the group between 30 and 40 which have had adenoma or simple hyperplasia which become toxic. These respond most favorably to operation. The third group are those that are toxic from the beginning. The fourth group are of long duration, are usually examples of dysthyroidism and are rarely benefited by surgery and must be regarded as hope- lessly invalided. The author is using basal metabolism estima- tion by indirect calorimetry as an index of the operative risk, the degree of toxicity and the ultimate effects of the operation. He calls attention to thymus hypertrophy reported with hyper- thyroidism, but has not been able to confirm this relationship.
He emphasizes the nicety of judgment required im deter- mining when to operate, and how much to operate. Frazier’s mortality in 182 lobectomies and 39 ligations is 3.5 per cent, which compares closely with the results of Ochsner, Judd, Porter, Dand and Dowd, and Terry, but is much lower than the average mortality of the average surgeon.
He finds that the nervous phenomena are most consistently relieved by cperation; next follows improvement in nutrition and last to be relieved is the tachyeardia. Frazier advises double lobectomy rather than the resection of one lobe only. He records a cure in 70 per cent of his cases. He stands un- equivoeally for the surgieal treatment of toxie goitre, and denies any place for non-surgical therapy.
The paper is concise and excellent. The only point on which there might be disagreement is his positive refusal to admit benefit from well managed medical measures including roentgen radiation of the gland.—H. L.
(THYROID) Death after treatment with X-rays in Graves’ disease. Secher (K.), Ugesk. f. Laeger (Copenhagen), 1918, 80, 1613-1618.
The author relates a case of Graves’ disease in a 40-year- old woman, who died six days after the last of eight treat- ments. The autopsy showed unimportant changes of the thy-
o74 ABSTRACTS
roid; in the panereas were found microscopical carcinomatous particles. In a following number of the journal Prof. Fischer contends that the death could not be ascribed to the treatment with X-ray.—K. H. K.
(THYROID) Demineralization of the teeth produced by thy- roid disorders (La desmineralizacion de los dientes producida por afecciones tiroideas). Boyé (HK. A.), La Tribuna Odon- tologica, 1919, 3, —, (No. 6).
In a girl of 16 all the teeth were carious or totally de- stroyed. Little by little the symptoms of Graves’ disease de- veloped (goitre, tachyeardia and tremor). Her general aspect became somewhat senile, the skin being dry and wrinkled; menstruation was irregular and at times abundant, and the lower limbs became extremely fat. Before the appearance of the Graves’ symptoms a diagnosis of myxedematous cachexia was made. The symptoms manifested demonstrated the pos- sibility of the coexistence of myxedema and Graves’ disease.
—B. A. H.
(THYROID) Dosage in the therapeutic administration of thy- roid gland substance. Carver (A. E.), Brit. M. J. (Lond.), NOT {Gi seo 15:
Two sources of possible error in the administration of thyroid gland are pointed out: 1. The fact that in the official preparation (B. P.) the substance is presented in concentrated form, whilst in the products of some of the commercial houses it is presented in approximately the strength of fresh gland. 2. The use of the term ‘‘ext. thyroidei,’’ which indicates neither of the above preparations, specifically, but leaves to the chemist the decision as to which of them shall be supphed.—lL. G. K.
(THYROID) Effects of external temperature upon the toxicity of thyroid. Stoland (O. O.) and Kinney (M.), Am. J. Physiol. (Balt.), 1919, 49, 135-136.
The research was undertaken because the toxie dose of desiccated thyroid, as reported by different investigators, varies greatly. Three series of albino rats were kept at tem- peratures of 32, 25 and 18° C. All except controls received 0.2 gms. of desiccated thyroid per day. The series kept at 39° ©. lived an average of 7.3 days; that at 25° C. 22 days, and that at 18° C. more than 32 days. The toxicity, therefore, varies with the temperature, being greater at higher temper- atures. All the animals fed with thyroid and the controls kept at 32 and 25° C. developed the normal resting type of
ABSTRACTS
On
75 gland with low cuboidal epithelium, but the controls kept at
18° C. developed the active type of gland with small amount of colloid and columnar epithelium.—tL. G. K.
(THYROID) Electrocardiograms in Graves’ disease and the in- fluence of cold mud baths (Uber das Electrocardiogramm bei Morbus Basedowi und seine Beinfiussung durch kihle Moorbader). Leidner (J.), Zeitschrift fiir Balneologie (Ber- lin and Vienna), 1919, 11, 119.
In all cases of Graves’ disease the T-wave was abnormally high. In serious cases the R-wave is also increased. The diastolic interval is shortened. The mud baths have a good influence on this electrocardiogram.—J.-K.
(THYROID) Etiology of endemic goitre. Sinclair (H. H.), Am. Med. (Burlington, Vt.), 1916, N.S. 11, 852-854.
Sinelair has noticed the great prevalence of goitre in Walkerton, Ontario, especially in women, and more particu- larly in those residing along the course of two streams. He has seen goitre in all the domestic animals thereabouts and in fish from one of the streams. He reports several children born with goitre and in every instance the mother was goitrous. He does not attribute the goitre to an excess of lime in the water because goitres are prevalent in northern Ontario where no limestone exists. Sinclair found ameba in the intestinal excretions of all domestic animals and man in the goitrous dis- trict, and also in the drinking water. He makes the interest- ing observation that dark, thick skinned fox hounds and Angus eattle (dark, thick skinned) do not develop goitre, whereas all other dogs and Jersey and Ayrshire eattle do. He believes goitre to be more common in the families of the blonde type. Goitre was very rare with the first settlers, but has increased enormously with each generation and these generations have smaller families and more difficult pregnancies. The author believes amebie infection the cause of the decreasing birth rate and claims to have developed a treatment which eliminates the amebae and this is accompanied by reduction of the en- larged thyroid to normal. The eure is not described! The article is by no means convineing.—H. L.
(THYROID) Exophthalmic goitre. Miller (C. S.), New York M. J., 1917, 106, 1210-1213.
The present indications are that goitre is non-infectious and is not caused by a foreign toxin introduced into the body, either by food, drink or other means. Inasmuch as goitre 1s
576 ABSTRACTS
developed in persons subject to nervous strain, and present normally in pregnancy and menstruation, it 1s reasonable to infer that all cases point to the development of some poison within the body due to faulty metabolism. In turn, this faulty metabolism is influenced by the-habits- and hfe of. the indi- vidual.—H..W.
(THYROID) Exophthalmic goitre; strumectomy with a talk on the surgical pathology of the thyroid gland. Murphy (J..B.),: Surg. Clin. Phila.,.1916,: 5, 1077-1084.
The clinical history of a married woman, aged 49 years, with tachyeardia, tremor, tumor, exophthalmos and certain mental symptoms is recited. The author’s comments and de- scription of the operation include a discussion of a. classifica- tion of goitres. Three main anatomical types are described and briefly illustrated viz., the vascular, the connective tissue, and the hyperplastic types.—J. F.
(THYROID) Exophthaimic goitre. With special reference to the etiology and treatment with radium. Aikins (W. H. B.), New York M. J. (N. Y.), 1916, 104, 49-53.
Whatever part the thyroid and other endocrine glands plays in the setting of exophthalmic goitre, the conclusion seems to be that injury to the nervous system is by far the most important etiological factor. The use of radium in cer- tain refractory cases seems to be of decided effect. From a consideration of seven eases the author concludes that when radium is applied over the thyroid, the more penetrating rays diminish the vascularity and reduce the secretion of the gland.
—H. W.
(THYROID) Exophthalmic goitre and its treatment. Berg (C.), Norsk Mag. f. laegevid. (Christiania), 1919, 80, 218.
Many years’ experience in the conservative treatment of the disease leads the author to emphasize the etiologic impor- tanee of recurrent infections of pharynx and tonsils. Very satisfactory results have been obtained with prolonged massage of the mucous membranes of nose and throat. The author employed this method in eleven cases upon which he reports. In general the treatment was given about thirty-five times in each ease. If amelioration results it appears after the sixth or eighth application. If improvement does not appear after ten or twelve treatments the method gives little hope of sue- cess and should be abandoned.—K. M.
ABSTRACTS 577
(THYROID) Exophthalmic goitre in a girl. Gittens (C. W.), Brit. M. J. (Lond.), 1918. (ii), 465.
A typieal case ina girl of twelve.—h. G. K.
(THYROID) Experimental pathology of goitre. Zueblin (E.), New York’ M. J. ‘(N. *Y.), 1916, 104, 1186-1189; Tr: Am: Therap. Soe. (N. Yi) 1916-17; 78-84.
A short review of the ideas accepted and refuted as to goitre etiology.—H. W.
THYROID, Experimental goitre in rats (Proefondervindelij- konderzoek der schildkliervergrooting bij ratten). Potter (A.), Nederl. Tijdschr. vi Geneesk, (Haarlem), 1919, 63 (1), 2288. De
In Utrécht. goitre is very frequent. In Amsterdam it is rate. The author fed young adult_rats with: 1, raw water of the Utrecht water supply company; 2, the same water, but boiled; 3, mineral water from Amsterdam; 4, mineral water from Utrecht; 5, pasteurized, milk and 6, raw water of the Utrecht water supply company to which 36. milligrams dried sea-salt from den Helded was added. After 3,5, 6 and 9 months feeding, respectively, the animals were killed by chloroform. The animals given boiled or unboiled water from Utrecht and those receiving mineral water from Utrecht had goiter. Those to which water from Amsterdam was administered had no goitre. Those to which pasteurized milk had been given had a goiter but smaller than in the other cases. The largest gvoitres were seen in the animals to which water from Utrecht with salt had been given. (The author had added this to give the water from Utrecht the same quantity of salt as the water in Amsterdam.) In all goitres a marked hyperaemia was ob- served.
In Switzerland and South Germany the water becomes harmless by boiling. In Utrecht this does not happen.—J. K.
(THYROID) Experimental researches on the alteration of the thyroid gland in rats, which drank the deep heather-water of Utrecht and some other waters. Potter (A.), Psyehi- atrische & neurologiseche bladen (Amsterdam), 1918. Feest- bundel Winkler, 523.
The same article (but more detailed and translated into English) as in Ned. Tijdschr. v. Geneesk., 1919, 63, (1), 2238 and abstracted from the Dutch paper.—J. K.
THYROID gland, Carcinomas of the—in dogs. Forman (JJ.), and Reed (C. I.). Ohio J. Sei. (Columbus), 1917, 17, 177.
578 ABSTRACTS
This paper describes fifteen enlargements of the thyroid elands of dogs and attempts to correlate these with the well known types of thyroid carcinoma in man as well as with the general principles of oncology. Among the thyroids of 271 dogs five malignant goitres were encountered. These, together with ten other specimens already at hand, were described. These tumors were divided into four groups similar to those already deseribed in case of human earcinoma:
1. Proliferating struma, two specimens.
2. Spindle celled carcinomas simulating sarcomas, two specimens.
3. Adeno-carcinomas, ten specimens.
4. Cysto-carcinoma papilliferum, one specimen.
The tumors are undoubtedly carcinomas. They are all due to new growths of the glandular epithelium, the cells of which do not present typical differentiation. They have lost their polarity and normal arrangement. In certain instances these losses are so marked that from individual section it can not be ascertained that the tissue is at all related to the thyroid gland. All gradations between this and definite tubules con- taining colloid are observed. The growths have infiltrated more or less the surrounding glandular structure. In the more advanced eases, secondary nodules were found in distant parts, more particularly in the lungs. Because of the source of the material, the exact ages of the dogs could not be determined, except in one instance in which the animal was known to be twelve years old. All the others, however, judging by their activity and the condition of the teeth, were old.—QJ. F.
The THYROID gland, its function and diseases. Herrick (W. J.), Iowa State M. Soc. J. (Des Moines), 1919, 9, 212-218.
The function of the thyroid gland is said to commence in utero, or soon after birth (Wolfler). Horsley considers that. it commences before birth, but it is greatest during the period of growth, lessening as the vital process declines. The influ- ence of the thyroid secretion on the morphology of the organs of generation in both sexes has been demonstrated by many observers. It is ancient tradition that the thyroid enlarges at the first menstruation, in certain women, each period pro- ducing an appreciable enlargement of the gland. A suppres- sion of menstruation often produces a swelling of the gland, which disappears on the reestablishment of the flow. The ef- feet of the thyroid development on puberty is of great impor- tanee, Breea (‘‘Goitre and Cretinism,’’ 1891), states that in the complete cretin puberty is never established. Acute in- flammations of the thyroid were observed in the middle of the
ABSTRACTS 579
seventh century, terminating as suppurative goitres. Libert in 1862 and Bauchet in 1877 wrote monographs on the subject which are classical in France. The thyroid gland is subject to two kinds of lesions in tuberculosis; it may be invaded by the tuberele bacilli with the development of the typical granula- tions, or the toxins formed elsewhere may produce sclerosis of the gland and consequent loss of function. Cancer of the thyroid gland is rare, occurring only nineteen times in 10,000 cases and very rarely except in glands which are goitrous. Sarcoma of the thyroid is rare and, curiously, seems to be more common in men than in women. It usually develops between the ages of fifty and sixty years.—Author’s abstract, abbre- viated. ©
(THYROID) Goitre; an analysis of 125 cases with a note on the treatment. Watson (L. F.), New York M. J., 1917, 106, 549- 550.
Present observations indicate that both non-toxie and toxic goitres oceur later in life in non-goitrous localities than in sections where the disease is prevalent. Most patients no- ticed the development of toxic symptoms as the goitre became more chronic; 18 per cent of the mildly toxie patients became exophthalmic after an average period of eight years. In exophthalmie goitre 45 per cent of the patients cured by quinine and urea injections gave a history of acute onset of symptoms, while 54 per cent had a goitre for some time pre- vious to exophthalmie symptoms, which were first’ noted 2.4 years before examination at an average age of 37. The aver- age time elapsing before disappearance of the goitre was five months. In non-exophthalmic, toxic goitre those patients who were cured by quinine and urea injections noted symptoms of intoxication 1.7 years before examination, at an average age of 33.5 years. In such cases the goitre disappeared within one to twelve months, averaging four months. The number of pa- tients cured is highest in the group of those who came for treatment early in the disease. <A goitre that has onee dis- appeared has never returned. Four pregnant women obtained relief from hyperthyroidism following injections and went to term without recurrence and had normal deliveries. Quinine and urea injections are strongly advised in selected cases of goitre. If the best results are to be secured, hyperthyroidal patients must have at least a year of mental and physical rest after treatment. (Perhaps the year’s rest insisted upon by the author is the major factor in the eure of so-called hyper- thyroidal cases).—H. W.
580 ABSTRACTS
(THYROID) Goitre and drinking water (Krop en drinkwater). Kappenbure (B. D. G.), Geneeskundige Bladen (Haarlem), 1919, 21, 145.
Practically the same article as the author’s inaugural dissertation, previously abstracted in this Journal.—J. K.
(THYROID) Goitre and its treatment (Om struma, strumabe- handling og jodbasedow). Kjolstad (S.), Norsk Mag. f. laegevid. (Christiania), 1918, 79, 265-282.
The author reports his personal experience from a Nor- wegian district where goitre is prevalent. As is usually the case in such districts, toxie goitre is very rare. As to the treat- ment, he has been well satisfied with iodine in small doses; only in one case marked toxic symptoms resulted from the treatment. The treatment is discussed at length with many case reports.—K. M.
(THYROID) Goitre, in-crook ankle, and stunted growth. Oliver (J. O.)) Brit. Medi J. (liond), 19%3:.(1), 203: Nothing new.—lL. G. K. (THYROID) Gcitre operations with the tracheoscope (Struma-
operationen bei eingefiihriem Trachescop). von Hicken (C.), Centralbl. f. Chir. (Leipzig), 1919, 46, 369.
diel SE
Of technical surgical interest.
(THYROID) Goitre surgery with report of twenty-eight cases operated upon with one death. Torrance (G.), Boston M. & Sede 1917, 177,-700-702.-
Of twenty-eight thyroid operations ten were for cystic eoitres; ten exopthalmic; one with a single large cyst reserm- bling a parovarian cyst; one for small calcified growth in the right lobe; six adenomata, three of which were substernal and produced marked symptoms.—H. W.
(THYROID) Graves’ disease; clinical studies of the etiology and treatment. Solling (H. A.), Dissertation, Copenhagen, 1916* pp; 325.
The author considers Graves’ disease as infectious for the following reasons: It may begin in direet connection with infectious diseases. The thyroid gland may hypertrophy in connection with the infection; Basedow patients are much disposed to throat infections. Anatomo-pathologically the
ABSTRACTS d81
thyroid gland shows polymorphism of the follicles, prolifera- tion and desquamation of the epithelium, loss of colloid and infiltration with lymphocytes and plasma cells—a picture that the author explains as inflammatory. Bacteriological studies showed signs pointing toward inflammatory conditions. (The examinations seem very incomplete: Abstractor.) Regarding treatment the author considers the operative therapy the best. It is best to make a resection of the largest lateral lobe and isthmus and a section of the other lateral lobe. The author deseribes technical details and refers to ninety-seven histories of operated patients and about three hundred articles published on the subjeet.—K. H. K.
(THYROID) H'stology of goitre heart (Histclogische Befunde an Kropfherz). Fahr (T.), Centralbl. f. allg. Path. u. path. Anat. (Jena), 1916, 27, 1-5.
Fatty degeneration of the heart muscle appears to have been the only lesion found-by other investigators in ‘‘goitre hearts.’’ Fahr found in his eases areas of round cell infiltra- tion and some fibrosis. The round cells consisted chiefly of lymphoeytes and the collections of these cells were quite local- ized, showing a slight tendency to aceumutate in the neighbor- heod of blood vessels. Fahr considers that the toxin which causes the lesions observed by him and by others acts on the heart muscle directly —J. P.S.
(THYROID) Hyperthyroidism. Snow (W. B.), Am. J. Elec- trotherap. & Radiol. (N. Y.), 1916, 34, 21-33.
The author’s conelusions are quoted below. To some ex- tent they are justified, but we believe they are rather extreme and will not be substantiated in larger series of cases.
‘“*Comparison of reports show that surgery has not given so good results as drug methods of treatment. The only eases that may be properly delegated to the surgeon are cases of simple and eystic goitre. All early cases of Graves’ disease and probably many advanced, ean be cured by the static wave current appled over the thyroid gland and the dorsal and cervical region of the spinal cord. A comparison of results with reports of those who have confined their treatment to the X-ray, and reports of but partial results, with our joint use of the X-ray and static current, indicates the greater value of the combined method. Expereince leads us to believe that exophthalmie goitre is curable in all cases by the method out- lined in this paper.’’—H. L.
582 ABSTRACTS
(THYROID) Hyperthyroidism and acute Graves’ disease fol- lowing thyroiditis typhosa (Wber Hyperthyroidismus und akute Basedowsche Krankheit nach typhoser Schilddrisen- entzindung). Walko (K.), Med. Klin. (Berlin), 1917, 18, 397-361.
In 1 per cent of the cases of typhoid fever an acute in- flammation of the thyroid is seen. Not infrequently this in- flammation gives rise to the formation of an abscess; from the pus typhoid bacilli may be isolated in pure culture. The an- thor observed thirty-nine of these cases. In twenty-one of them symptoms of Graves’ disease were noted.—J. K.
(THYROID) Hyperthyroidism as a cause of irritable heart in soldiers. Thorne (L. T.), Lancet (Lond.), 1916, (1), 153-4.
Thorne did not find the thyroid enlarged in such eases. See Endocrin., 1917, 1, 77.—lL. G. K.
(THYROID) Hypertrophy of the muscle in cretinism (Spierhy- pertrophie bij cretinisme). de Bruin (J.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1917, 61, (1) 1328-1330.
A short deseription of a case of ecretinism in a child of three years with an enormous hypertrophy of all muscles.
This combination is very rare.—J. K.
THYROID hypertrophy in pregnancy. Albeck, Ugeskrift for Laeger (Copenhagen), 1916, 78, 678.
The author has found that there is no vomiting in ease of pregnant women who have large and soft thyroid glands.
—K. H. K.
(THYROID) Influence of thyroid gland upon metabolism, I. Carbohydrates. Sekita (N.), Tokyo Igakukai Zasshi, 1918, 32, 1-49.
The author takes exception to the teachings of the von Noorden school in regard to the influence of the thyroid upon metabolism and presents the following points for considera- tion. He is unable to find any function of the thyroid the absenee of which prevents the production of glycosuria fol- lowing adrenalin injections. Furthermore, the adrenalin with its glycosuria, counteracts the cachexia following thyroid ex- tirpation as well as other forms of high grade weakness. The conelusion drawn is that the influence of this organ upon ear- bohydrate metabolism has not been proven. (Abst. in China Med Jour) 19tess5,.2/0)=L: Gk
ABSTRACTS 583
(THYROID) Influenza and loss of hair (Influenza und Haar- ausfall). Sack, Deutsche med. Wehnschr. (Berlin), 1919, 45, 784.
As in all infectious diseases, in influenza a loss of hair and even baldness may be observed. The author saw an actual epi- demie of baldness after influenza in young girls with symptoms of dysthyreosis and goitre. Further details are not given. J2K,
(THYROID) Intrathoracic goitre. Lahey (F. H.), Boston M. & S. J., 1917, 176, 341-344.
Substernal or intrathoracic goitres are either adenomata or cysts. Such goitres originate from the lower poles and isthmus of the thyroid gland and gradually develop downward into the thorax along the path of least resistance. The sym- toms produced by such growths are as follows: a feeling of pressure beneath the sternum on swallowing; huskiness of voice ; dyspnoea, and intermittent attacks of suffocation. Such tumors demand surgical attention and should be delivered in toto; never by morcellation or piecemeal. Details of surgical procedure are given.—H. W.
(THYROID) Medical treatment of exophthalmic goitre. Crotti (A.), Ohio State M. J. (Columbus), 1917, 13, 8.
Of general interest. A resumé of medicinal agents used in the treatment of exophthalmic goitre.—C. McP.
(THYROID) Medical treatment of goitre. Ryan (G. M.), Proce. Am. Therap. Soc., J. Am. M. Assn. (Chgo.), 1919, 78, 447.
In treatment, the conditions must be clearly indicated. There has been no result as yet from efforts to find a counter- acting agent for the thyroid toxin. Quinin hydrochlorid and salicylates have been used. Tincture of aconite is used to mod- erate the tachyeardia. Attention must be paid to environment and hygienie conditions. Absolute rest, physical and mental. is an essential. An ice bag to the gland and small doses of bromid are indicated in acute exacerbations. The use of quinin and urea sometimes achieves good results. Use of the roentgen ray and removal of the tonsils are indicated in selected cases. The intelligent care of a good trained nurse is the most effica- cious step in treatment, proper home eare of these patients being practically impossible. In some eases the combined ef- forts of the medical man and the surgeon are necessary, the medical eare preceding the operation, and supplementing it until recovery is complete.—Quoted.
o84 ABSTRACTS
(THYROID) Mencpause and myxedema (Klimax und Myxo- dem). Deutsch (G.), Miinech. med. Wehnschr., 1919, 66, 589.
Description of a case. After extirpation of a large myoma of the uterus the body began to swell; the patient began to lose her hair, perspiration ceased and she became stupid and lost her memory. Tablets of ovarium prescribed, but had no influence. She went to a hospital where the diagnosis of myxo- edema was made. The thyroid could not be felt; there was achylia gastrica. Thyroidin, 0.8 gm. daily, was prescribed. She was perfectly cured and the achylia gastrica disappeared. After some time even a hyperchlorhydria was observed.—J. K.
(THYROID) Metropathy of thyroid origin (Metropatia de eticlogia tireogena). Schwarzenberg Lobeck (J.), Thesis, Santiago de Chile, 1917.
No significant data are brought forward. The author proposes a method of treatment that is entirely imadequate. —B. A. H.
(THYROID) Mongclism in a child and myxedema in the mother (Mongolisme bij het kind en myxcedeem bij de meoeder). Coenen (J. F.), Nederl. Haandschr. voor Verlos- kunde (Leiden), 191%, 6, 265-267.
Deseription of a child of three years with mongoloid idioey and myxoedematous symptoms (typical skin, dry hair, and nails). The mother had a classic case of myxedema. A sim- ilar ease has not been deseribed in the hterature. There are only a few cases known of Graves’ disease in the mother with myxedema in the child, and of simple myxedema in mother and ehild.—J. K.
(THYROID) Myasthenia gravis with Graves’ disease (Myas- thenia gravis mit Morbus Basedowi). Bauer (J.), Wiener klin. Wehnschr., 1917, 30, 1408.
Description of a post-mortem examination of a case. The thymus weighed 53 grams (the patient was an adult woman). There was hyperplasia of the lymphatic system and thyroid typical of Graves’ disease. The abdominal part of the aorta was narrow; the adrenals were normal; the ovaries were small.
J.K.
(THYROID) Myxedema caused by military service (Myxce- dem als Kriegsdienstbeschidigung). Alexander (A.), Med. Klin. (Berlin), 1917, 13, 994-996.
ABSTRACTS 585
Description of a soldier who, after an explosion of a shrap- nel shell, developed myxedema. Treatment with thyroid prep- arations had a good effect. This case is a proof of the view of Ewald, that psychical shock may cause myxedema. Patients with vagotonia show an increased predisposition.—J. K.
(THYROID) New ideas on prophylaxis of endemic goitre (Neue Vorschlage zur Prophylaxe des endemischen Kropfes). Klinger (R.), Cor. Bl. f. Schweizer Aerzte (Basel), 1919, 49, 575.
The author has repeatedly pointed out the importance of prophylactic administration of sodium iodide, but his publica- tions have had no practical results. He now gives an abstract of an article by Marine (Arch. Int. Med., Vol. xxii) who utilized this method at Akron, Ohio. ‘‘It is absolutely neces- sary to follow the same method in Switzerland,’’ if endemic goitre is to be successfully combatted.—J. K.
(THYROID) Probable pathogeny of endemic goitre. Action of fluorides in small, repeated doses on growth and body temperature (Probable patogenia del bocio endémico. Accion de los fluoruros en pequenas dosis repetidos sobre el crecimi- ento y temperatura animal). Goldemberg (L.), Semana Méd. (Bs. Aires), 1917, —, 213.
The author really obtained, not goitre, but only a slight augmentation of colloid in rabbits to which he administered fiuorides. Growth was less than in the controls and there was a fall of temperature succeeding the injections.- The work does not bear critical serutiny.—B. A. H.
(THYROID) On the epidemiology of goitre (Zur Epidemio- logie des Kropfes). Cemach (A.), Wiener klin. Wehnschr. 1917, 30, 813.
e if
The author observed 52 fugitives coming from Galicia to Vienna in 1915 and 1916, who developed in Vienna acute goitre. All patients were Jews. They were all poor and lived in most dirty houses. Twenty-eight per cent of the patients were men. None of them had had goitre while they lived in Galicia. This is remarkable for in Vienna goitre is very rare. Treatment was without success in any of the cases.—J. K.
(THYROID) On the influence of fats, lipoids and extracts of thyroid on development and metamorphosis (Versuche iiber den Einfluss von Fett und Lipoidsubstanzen sowie von enter- weissten Extracten der Schildriise auf Entwicklung und
586 ABSTRACTS
Wachstum). Romeis (B.), Arch. f. d. ges. Physiol. (Berlin), 1919, 173, 422.
The author studied the effects of the above substances on tadpoles.
1. The thyroid was extracted with boiling acetone. Upon cooling, the precipitate which forms is separated from the solution. The substances remaining in solution diminish growth and delay metamorphosis. The bodies dissolved from the precipitate by chloroform cause a slight decrease in growth. The rest of the precipitate is inactive. After being treated with toluol and then alcohol, the thyroid residue is extracted with water. The aqueous extract increases growth. The in- soluble residue inhibits growth. Both fractions quicken meta- morphosis.
2. Thyroid gland was also extracted by ether and alcohol. Substanees which inhibit growth and delay metamorphosis were prepared from the ethereal extract. A substance which increases growth was prepared from the aleoholic extract.
«
3. When a fresh aqueous extract of thyroid is mixed with aleohol, the bodies which remain dissolved quicken metamor- phosis and inhibit growth.
4. If all proteins are removed from an aqueous extract ef thyroid by tannie acid, lead oxide and barium oxide, the filtrate inhibits growth and delays metamorphosis.
5. Thyreoglandol slightly quickens metamorphosis when great doses are given over a long period. It also increases growth, which is contrary to the influence of fresh thyroid.
6. The more thoroughly the proteins are removed from aqueous extracts of thyroid the smaller is the influence on metamorphosis. It may even be delayed.
7. If in an aqueous extract of thyroid the proteins are decomposed until the biuret reaction is no longer given, these decomposition products inhibit growth and quicken metamor- phosis.—J. K.
(THYROID) Partial thyroidectomy with local anaesthesia, scopolamine and morphia. Lahey (F. H.), Boston M. &S. J., 1916, 175, 566-568.
Reports good results by this method.—H. W. (THYROID) Physiological action of thyroid hormone. Ken- dall (E. C.), Am. J. Physiol. (Balt.),'1919, 49, 136-7.
Data published elsewhere. See Endoerin., 3, 156. —L. G. K.
ABSTRACTS 587
(THYROID) Pulsus arhythmia in Basedow’s disease (Om Pul- sarytmi ved Morbus Basedowi). Fridericia (lL. S.), Uges- krift for Laeger (Copenhagen), 1916, 78, 1899-1908.
The author has examined six patients with Graves’ disease who all showed an arhythmie action of the heart. Electrocar- diographic examination showed that the arhythmia was caused by auricular fibrillation; in some of these cases the fibrillation had a special character in that, in spite of the irregularity and frequency of the pulse, there was no sign of insufficiency of the heart. Digitalis had no effect on the auricular fibrillation.
—K. H. K.
THYROID sterility (Esterilidad tiroidea). Giacobini (G.), La Semana Méd., 1919, —, 253.
No new data are offered.—B. A. H.
(THYROID) Struma intrathoracica. Mayer (K.), Zentralbl. f. Chir. (Leipzig), 1919, 46, 455.
In Basel intrathorie goitres are seen very frequently. In the ease deseribed here, the right lobe had grown into the lung and was surrounded by pulmonary tissue. The form of the lung was normal and the first impression at the post-mortem examination was ‘‘tumor pulmonalis.’’—J. K.
(THYROID) Surgery of the thyroid gland. Porter (C. A.) Boston M. & S. J., 1916, 175, 551-557; Vermont Med. (Rut- land), 1916, 1, 249-259.
A paper of technical interest dealing with the elassifica- tion and treatment of surgical lesions of the thyroid. Porter advises operation upon toxie goitres in cases in which improve- ment is unsatisfactory under medical treatment.—H. W.
(THYROID) Surgical treatment of exophthalmic goitre (Trata- miento quirurjico del bocio exoftalmico). Bacigalupo (A. R.), Thesis of Buenos Aires, No. 3413.
Bacigalupo utilizes all the observations on Ceballos and Olivieri’s operated eases (Endoerin. 1917, 1, 536 and 1918, 2, 207) for his doctorate thesis. See these abstracts—G. P. G.
(THYROID) Surgical treatment of exophthalmic goitre. Crile (G. W.), Ohio State M. J. (Columbus), 1917, 18, 7.
Of surgical interest. Crile’s discussion is based on a series of 674 cases of exophthalmie goitre. His treatment comprised
588 ABSTRACTS
1, a non-surgical rest period; 2, some surgical measures, such . as Porter’s injection of boiling water or the ligation of one of the arteries, and 3, after a period of readjustment, a lobectomy. This is then followed by a period of rest, hygiene and dietetic treatment.—C. MeP.
(THYROID) The basal metabolism and hyperglycemic tests of hyperthyroidism with special reference to mild and latent cases. MecCaskey (G. W.), J. Am. M. Assn. (Chgo.), 1919, 73, 243-246. . .
The differential diagnosis of many mild, atypical or very early cases of thyrotoxicosis by means of the ordinary clinical signs and symptoms can be made with only varying degrees of probability. The need is, therefore, very great for definite objective data, either decisive or very strongly corroborative, not only to determine diagnosis, but to estimate therapeutic results. The clinical application of basal metabolism and ali- mentary hyperglycemia satisfies these demands in a very scien- tifie, practical and satisfactory manner. Basal metabolism can be quickly and accurately determined by measuring the oxygen consumption with the Benedict portable respiration apparatus. The average normal heat production, which is an accurate index of metabolism,.is about 39.7 calories for men and 36.9 for women by the ‘‘height-weight’’ formula per square meter per hour under the conditions indicated. Physiologie varia- tions of not more than 10 per cent and nearly always much less than this, may occur in either direction. In hyperthyroid- ism there is an increase up to 100 per cent or more, according to the severity of the intoxication, which varies in different eases, and in the same ease at different times. In hyperthy- roidism there is a diminished tolerance of carbohydrates with alimentary hyperglycemia, and also with glycosuria whenever the hyperglycemia exceeds the renal glucose threshold of the individual case. In every ease of hyperthyroidism studied (thirty-one cases) the blood sugar content was increased within two hours from 50 to 200 per cent. In 70 per cent of thirty- one cases the maximal rise occurred at.the end of the first hour, with a more or less sharp decline at the end of the second hour, proving that the crest had been reached and _ passed. The very few cases in which hyperglycemia is highest at the second hour may be explained by gastric hypomotility and slow intestinal absorption. The failure of the hyperglycemia to rise proportionately to the increased metabolism and to bear any direct relationship to the intensity of the thyrotoxicosis suggests that it is an indirect phenomenon due perhaps to overexcitation of other organs, for example, the pancreas,
ABSTRACTS 589
which in exceptional cases fails to respond to the thyroid stimulation.
The appheation.of these tests will probably reveal a much greater incidence of hyperthyroidism than has formerly been recognized, and will especially enable us to make a_ clear diagnosis between toxic and nontoxie goitres. While a final diagnosis is altogether a question of clinical judgment, and should not be made exclusively in the laboratory; and while neither increased metabolism nor alimentary hyperglycemia is pathognomonic of hyperthyroidism, yet, when rationally cor- related with the remaining clinical data, they together make as clear-cut a diagnosis of hyperthyroidism as a positive Was- sermann does of syphilis in a suspected case—Author’s sum- mary.
(THYROID) The cause of endemic goitre (Die Ursache des endemischen Kropfes). Isenschmid (R.), Med. Klin. (Ber- vet O17 = 13,.1122-1125.
A good general survey of the theories on endemic goitre. No new data are offered.—J. K.
(THYROID) The circulatory system in exophthalmic goitre. Bram (J.), Internat. Clinies (Phila.), 1919, 1, 80-90.
The author discusses the signs and symptoms referable to the circulatory system which are commonly observed in hyper- thyroidism. He points out that there is no Graves’ disease without circulatory evidences; the circulatory system suffers most from the thyrotoxicosis; ‘‘it is the heart which ultimately determines the course and prognosis of the disease ; its collapse is usually the direct cause of death from Graves’ disease.’’
A consideration of the symptomatology of the heart, blood- vessels and blood, subjectively and objectively, is then stated in a tabulation; this is followed by a detailed seriatim de- scription. Palpitation, at first mild, may become the most troublesome subjective feature, in course of time occasioning extreme nervousness, insomnia, and even anginoid precordial pains. The severity of subjective precordial distress does not depend on the degree of tachycardia; a mild degree of tachy cardia may coexist with marked palpitation, and a patient with severe tachyeardia may not complain much of palpitation. Dyspnoea from cardiac excitation may engender suspicions of phthisis, and though Graves’ disease is often accompanied by pulmonary tuberculosis, we must guard against ‘an omission of a dominant hyperthyroidism. The tachycardia in exoph- thalmie goitre is characterized by its constancy, occurring even during s!eep, and is little if at all affected by digitalis, even in
590 ABSTRACTS
massive doses. The author points out the necessity of differ- entiating the heart-hurry of exophthalmie goitre from that of other conditions, eminently emotional excitement, hysteria, neurasthenia, biological and chemical toxemias, anemia, par- oxysmal tachyeardia, and acute endocarditis. Incidentally, it is pointed out that many cases of rapid heart in soldiers, erron- eously diagnosed as ‘‘shell shoek,’’ when not due to thyroid hyperactivity are instigated by nicotine poisoning in those un- accustomed to smoking. On physical examination in pro- gressive cases, the heart is found to undergo hypertrophie dila- tation, the extent depending upon the severity and duration of the thyroid toxemia. On percussion, one may find the area of cardiac dullness blending upward with the dullness of an en- larged thymus. An X-ray examination is a useful corrobora tive procedure. Murmurs may at first be hemic, occurring at the base, but later may become most marked at the apex, because of relative insufficiency through myocardial exhaus- tion, the continuation of which process may lead to a general anasarea and heart failure. Sahli’s ‘‘gallop rhythm’’ is men- tioned as an interesting phase of the cardiac physical signs; it is a diastole phenomenon, occurring as a triple rhythm heard over the entire precordium.
The signs and symptoms referable to the blood-vessels are briefly mentioned. The thyroid gland throbs beeause of inereased vascularity. All the other superficial arteries are often seen to throb as in aortic incompetency. Thyroid throb- bing is confirmed by the palpating fingers and systolie thrill and bruit are usually obtainable over the organ and are path- ognomonie. A moderate amount of pressure over the thyroid may elicit tenderness, and by expression of some of the blood contents the size of the organ is reduced. The capillary pulse is commonly observed; also dermographia. Systole blood pressure, though at first increased, gradually becomes lower, and with the advent of material circulatory degeneration, falls considerably below normal.
Aside from the leucopenia with relative lymphocytosis and a diminution of the polymorphoneutrophiles, the blood findings in exophthalmie goitre are not important. In spite of an ap- parent plethora (due to vasomotor instability) there is usually a degree of secondary anemia which may in part explain the patient’s weakness. Hemorrhages from the mucous membranes due to vasomotor paralysis, may give rise to epistaxis, hema- temesis, hemoptysis, melena, and the lke, and may endanger life through the associated diminished coagulability of the blood. Hyperglycemia (probably of alimentary origin), 1s commonly observed, indicating a degree of carbohydrate in- tolerance.
ABSTRACTS 591
Bram concludes his paper by an appeal for more conserva- tism in the treatment of exophthalmie goitre. Because of lack of satisfactory proof of permanent cures by the knife, surgery is not the means of restoring the patient to former health and usefulness in the great majority of cases. On the other hand, the writer maintains that skillful, patient, persevering intern- ists affect permanent cures in at least 75 per cent of their pa- tients.—Author’s Abst.
(THYROID) The distribution and etiology of goitre (Verbrei- tung und Aeticlogie der Struma). Lobenhoffer, Miinch. med. Wehnschr., 1919, 66, 111.
Comparison of the frequeney of goitre in Oberfranken and Wiirzburg. In Oberfranken it is more frequent and accessory thyroids (Nebenschilddriisen) are more frequently seen than in Wirzburg.—J. K.
(THYROID) The heart in goitre (Das Kropfherz). Chvostek (F.), Wiener klin. Wehnschr., 1917, 30, 383, 643-648; Med. Klin. (Berlin), 1917, 18, 464.
There are three forms of thyreogenic heart disturbances:
J. The torpid form (type of Bauer), giving systolic mur- mur over the arteria pulmonalis, with an accentuated pulmonic second sound, and dilatation to the left. Not all these symp- toms need be present. Patients with this form offer but little complaint of the heart. This type is seen not only in goitre, but it may be seen in all abnormal constitutions, even without goitre. On the other hand there exist many patients with goitre without the symptoms of Bauer. The thyreogenic origin has not been proved or made probable.
II. Thyreogenie hypertrophy of the heart (type of Hin- nich). This form is often seen in young goitrous patients. In these eases percussion shows but little change. There are acci- dental murmurs; the rhythm of the pulse is very easily influ- enced. Mostly it is combined with tachycardia (type of Kraus). Chvostek does not believe that this type is of a thyreogenie origin. It is too often seen without symptoms of an abnormal function of the thyroid or of a goitre.
Ill. Thyreotoxie heart. The chief symptom is the tachy- eardia; the heart beat is strong; blood pressure is high and is raised through activity of the muscles. Only in the severe cases is the heart hypertrophic. Administration of iodine has a good influence on these hearts. The author discusses the question whether these heart conditions are the same as seen in Graves’ disease. There are, however, such differences between Graves’
a92 ABSTRACTS
disease and goitre that it is a priori not possible to believe that the heart in this disease would show the same disturb- ances. It would be necessary to examine a large amount of pathological-anatomical material to settle this question def- initely. Chvostek still discusses the so-called mechanical cause of the goitre heart; this is supposed to be caused by pressure on the trachea followed by a disturbance in the cireulation in the lungs. He comes to the conclusion that the existence of the ‘‘mechanisches Kropfherz’’ has never been proved.—J. K.
(THYROID) The heart in myxedema (Das Myxoedemherz). Zondek (H.), Miinech. med. Wehnscehr., 1919, 66, 681.
In myxedema changes in the heart are often observed. Typical is bradyeardia with dilatation of the heart to the right and to the left. Not so seldom these changes in the heart are the first symptoms of a latent myxedema. In diseases of the other endocrine organs these symptoms of the heart are never observed. The electrocardiogram in myxedema has a typieal form, of which the author gives some illustrations. Organo- therapeusis should be continued until the electrocardiogram begins to show the form of that in Graves’ disease. Then it is necessary to discontinue the treatment, immediately.—J. K.
(THYROID) The significance of the nitrogen balance in thyroid disease. Janney (N. W.), Med. Rec. (N. Y.), 1917, 91, 352.
The author considers metabole disturbance the funda- mental factor in thyroid disturbance and the degree of dis- turbanee does not always compare with the severity of the clinical symptoms. He finds the nitrogen balance an accurate means of ascertaining the metabolie state of the patient and a delicate gauge of the effect of treatment. Cretin and exophthal- mic goitre patients were found to be unable to assimilate their food as well as normal individuals.—H. L.
(THYROID) The treatment of hyperthyroidism. Grier (G. W.) Am. J. of Roentgenol., 1917, 4, 300-303.
Grier divides hyperthyroid cases into four groups:
1. Simple Hyperthyroidism—A_ persistent exaggeration of the physiological hyperthyroidism of adolescence or preg- naney. These eases are cured in 100 per cent of cases by med- ical or roentgen treatment. The author sees no indication whatever for surgery in this group.
2. Acute Exophthalmie Goitre—<Aecutely ill eases of Base- dow which become gradually progressively worse and either die or beeome examples of
ABSTRACTS 593
3. Chronie Exophthalmic Goitre—in which the subjective symptoms are less pronounced and the objective signs have be- come fairly stationary.
4. Basedowidized Goitre (hyperthyroidism developing in an old goitre). The hyperthyroidism in these cases is very amenable to X-rays, but the goitre itself usually requires surgi- eal treatment.
Grier claims to have cured 87.5 per cent out of a total of 63 cases. The most favorable results are in the following order: Simple hyperthyroidism, acute exophthalmic goitre, chronic exophthalmie goitre. Cases respond to roentgen treatment ac- cording to the length of time the disease has been present, and not according to the severity of the symptoms. The improve- ment in very severe cases is often miraculous. But the longer the disease has been present and the harder the gland, the less satisfactory the result. Little difference in result is noted between gas tubes and Coolidge tubes. Grier advocates treat- ments at longer intervals and with moderate, but not maximum, doses. In most cases the author would prefer roentgen treat- ment to surgery, believing it more effective. Furthermore the death rate due to roentgen treatment as a procedure is nil.
—H. L.
(THYROID) Thyroidine, effect upon the basal metabolism. Krogh (Marie), Ugeskrift for Laeger (Copenhagen), 1916, 78, 2337-2341.
The basal metabolism in man, i.e., the metabolism in abso- lute rest, fourteen hours after the last preceding meal, was determined by the absorption of the oxygen per minute. A Basedow patient showed an increase of 80 per cent, and a myxedema patient, a diminution of 40 per cent from the nor- mal. It is a problem if thyroidine has an effect through an augmentation of muscular activity or through more active com- bustion. The author took electromyograms from a Basedow patient and a normal person at rest. The myograms showed no difference. But it might possibly be true that the thyroi- dine had an effect on the autonomic nervous system, increasing the muscular tonus and, through that, the metabolism. To test this hypothesis she narecotized frogs with ethyl urethane to the point of absolute loss of reflexes and respiration. The animal was after that placed in Krogh’s apparatus for micro- respiration for several days, after dosing with thyroidine through a stomach tube. In another series of experiments all the nerves to the extremities were cut before placing the frog in the respiration apparatus. It was found that the increase of metabolism was much less in the frogs with the cut nerves.
594 ABSTRACTS
It is therefore probable that the augmentation of metabolism is caused by an increased muscular tonus through irritation of the autonomic nervous system.—K. H. K.
(THYROID) Toxic goitre with melancholia; strumectomy. Murphy (J..B.), Surg. Clin., (Phila.), 1916, 5, 1073-1075.
A ease is presented in which a married man, aged. 26 years, comes to the author on account of depression and ex- treme irritability. The patient is weak and has attacks of vertigo and fainting. There is a shght enlargement of the thyroid gland. A strumectomy is performed and a colloid adenoma found. Six months later the patient is examined and is found to have lost all of his former mental symptoms. He gets on well with his associates, is able to sleep at night, and earry on his work.—J. F.
THYROID, Treatment of Graves’ disease (Die Behandlung des Morbus Basedowi). Salzmann, Ztschr. f. Aertzliche Fort- bildung (Jena.), 1919, 16, 310.
The treatment of Graves’ disease must be in the first place an internal one. Every treatment can show good results, but the best perhaps is the treatment with X-rays. Only cases in which the goitre presses the trachea and cases not benefited by internal treatment should be operated. Contraindications against operation are heart failures, status thymolymphaticus and the acute forms of Graves’ disease.—J. K.
(THYROID) Treatment of Graves’ disease with X-rays. Fischer (J. F.), Ugeskrift for Laeger (Copenhagen), 1916, 18, 1755-717.
The author has treated 94 cases with X-rays; 49 had the classic symptoms, the other 45 only goitre and tachyeardia. In 80 per cent of the cases he obtained good results; 18 became neither better nor worse; 15 of 76 were absolutely cured; the others improved in different degrees. Exophthalmus was the most refractory symptom. The author emphasizes much a good technic. The X-ray treatment does not ever give such brilliant
results as the operative, but it is much less dangerous.
(THYROID) Two cases of thyroidism after X-ray treatment. Verning (P.), Hospitalstidende (Copenhagen), 1917, 60, 741-753.
In two eases of Graves’ disease the patient has died after X-ray treatment. The first patient died after high fever and
ABSTRACTS 595
severe heart-symptoms. In the other there was complication with angina.—K. H. K.
(THYROID ADRENIN) The influence of thyroid preparations on the action of adrenin (Uber den Einfluss einiger Thyreoid- priparate auf die Adrenalinempfindlichkeit). Santesson (C. G.), Skand. Arch. f. Physiol. (Leipzig), 1919, 37, 185.
When small doses of adrenalin are injected in rabbits (0.01—0.03 mg. per Kg. weight) a rise of blood pressure is observed which is followed by a fall below the original. When the same doses are repeatedly injected at short intervals (3 or 4 times every 5—12 minutes) each time the same rise is seen. The author has made emulsions with gum arabie from thyroid preparations. He used the tablets of Buroughs & Wellcome, a fresh extract from the thyroid of the pig, thyreoglobuline (Astra), thyreojodin (Astra), whole gland digested by pepsin and a mixture of thyreoglobuline and thyreoalbumin. Intra- venous injection of one of these emulsions produced a short rise, followed by a marked fall of blood pressure. Sometimes the animals died from weakness of the heart. Another effect was that the blood vessels became more sensitive to adrenalin. When an intravenous injection of adrenalin is preceded by an intravenous injection of thyroid, the rise of blood pressure is much stronger and lasts much longer than without this pre- ceding injection. (See Endoerin., 1, 58; 2, 460.)—J. K.
(THYROID OVARY) Hypertension in women. Riesman (D.), J. Am. M. Assn. (Chgo.), 1919, 73, 330-331.
Most of the surprisingly large number of cases of hyper- tension which Riesman has seen in women can be placed in a definite group having the following features in common: They are stout, overweight and undersized; they have borne many children; they present no evidence of syphilis; they are over 45 years of age, mostly between 50 and 60; practically all are constipated and some suffer from intestinal indigestion; up to a certain point they show an amazing tolerance to high blood pressure ; usually the heart is enlarged, commonly to the left; the arteries are soft, even the retinal vessels seldom showing involvement, and the kidneys appear to be competent. <A sim- ilar hypertension is seen in men, but it is less frequent and less innocent. Worry seems to be an important etiologic factor. The fact that the disease is first manifested during the meno- pause in most of the cases indicates that the ovaries are prob- ably involved in its causation. The pressure is surprisingly high. In the eases studied it averaged: Systolic, 211; diastolic,
596 ABSTRACTS
105 and pulse pressure, 106. The highest seen were 310, sys- tolic, and 160 diastolic.
Another type designated non-goitrous, thyrotoxie hyper- tension is also mentioned. It also occurs with preponderating frequeney in women. The patients are near or past the meno- pause, are not overfat, sometimes spare, often single. They complain chiefly of palpitation and headache; are emotional, and have a tendeney to sweating. The heart is rapid, even to the point of tachyeardia; the hands are tremulous. There is often a von Graefe sign, but no exophthalmus and no goitre or other tangible abnormality of the thyroid gland. The systole pressure ranges from 150 to 210, with a diastolic pressure of from 90 to 120. While there is no positive proof of a thyroid cause, and while the patients are nearly all beyond the age at which hyperthyroidism usually appears, the symptoms never- theless closely resemble those of a thyrotoxicosis. The condi- tion may be pluriglandular in origin. It is apparently not renal or arteriosclerotic. Jodids do not benefit but rather harm these patients. The thyrotoxic form is more incapacitating than the first variety mentioned.
As to treatment, relatively little can be done. The diet should be restricted largely to milk and vegetables with rest in some eases and graduated exercise in others. Vasodilator drugs should not be used. Corpus luteum gave in the more recent cases excellent results, lowering the blood pressure and improving subjective symptoms. In the thyrotoxic cases rest is of the greatest importance. Bromides at times with small doses of tincture of veratrum seemed beneficial. All possible measures should be taken to prevent worry.—R. G. H.
(THYROID OVARY) The relation of the thyroid to confu- sional insanity and melancholia. Wright (J. S.), Kentucky M. J. (Bowling Green), 1919, 17, 271-273.
Wright discusses the thyroid in its relation to mental dis- ease. The endocrine organs are regulators of metabolism and as such the thyroid and ovaries are chiefly concerned in the metabolic instability occurring in pregnancy producing psycho- neuroses and puerperal insanity. After the menopause the mental attitude reverts to a neutral type and manic depressive insanities and melancholias of involutions are seen; mental im- provement has followed administration of thyroid extract alone or in combination with other glandular extracts. So called ‘‘hereditary insanity’’ is regarded as an inherited derangement of the glands of internal secretion, manifested by insanity. Considering ali insanities of toxie origin, Wright directs atten- tion to hormone toxicosis as a cause not to be overlooked.
—Author’s Abstract.
ABSTRACTS 597
(THYROID OVARY) The use of X-rays in hyperactivity of the ductless glands: with special reference to exophthalmic goi- tre, and certain forms of ovarian dysmenorrhea. Hernaman- Johnson (F.), Practitioner (Lond.), 1917, 99, 10-18.
The author advocates in exophthalmie goitre sma!] doses of X-rays, frequently repeated, instead of a considerable treat- ment once in ten days to three weeks, as practiced by many roentgenologists; he urges radiation three times a week, and in severe cases even daily doses. He cites a remarkable example of an extremely ill patient given up to die in a few days, who, after thirty sittings, in two months, was able to return to work and was well and at work two years later. The writer has not followed up any of his eases long enough to justify him in saying that the cure is permanent, but he has seen patients remain in perfect health for two and three years after the termination-of a three months’ course of treatment. Tremor, pulse rate, sweating, sleep and nutrition are rapidly benefited. Exophthalmos and the enlargement of the gland are not mark- edly reduced. The author also believes that any case of dys- menorrhea which has resisted ordinary treatment, and in which no gross surgical lesion is present, is suitable for X-ray therapy. Three courses of treatment are necessary in consecu- tive intermenstrual periods.—H. L.
(THYROID and PARATHYROID) The influence of thyroid and parathyroid on diseases of the skin (Schilddriise und Epithelkérperchen in ihrer Beziehungen zu Erkrankungen der Haut). Pulay (E.), Ergebn. inn. Med. u. Kinderheilk. (Berlin), 1919, 16, 244.
A very long article. The author is convinced that myx- edema and the changes of the skin in myxedema are due to a hypofunetion of the thyroid. The eezemas as they are often seen in myxedema, may be of thyreogenice origin, but this has never been proved. The diseases of the skin as they are often seen in Graves’ disease, have no relation to the thyroid. Urti- earia and scleroderma occurring in Graves’ disease have the same primary etiology as do other manifestations of that con- dition. They are caused by sympathicotonie. In myxedema treatment with thyroid gland is indicated. But though tried by many authors in eases of psoriasis urticaria and scleroderma, these diseases are actually contraindications to this treatment. It is impossible to give, offhand, a prescription for organo- therapeutics in skin diseases. The correlation between the or- gans of internal secretion are so complicated that in each case various combinations must be tried until a suitable one has been discovered.—J. K.
598 ABSTRACTS
(THYROID, PROSTATE) Graves’ disease in men during the war (Zur Kenntnis des Manner und Kriegs-Basedow). Mar- euse (M.), Deutsche med. Wehnschr. (Berlin), 1917, 48, 10-73.
The author discusses the question whether Graves’ disease in men is the same malady as in women. It is remarkable that in men symptoms of Graves’ disease are often observed with- out goitre. The author deseribes three such cases in young men without goitre, but with hypertrophy of the prostate. He believes that in men the prostate can be the cause of this dis- ease.—J. K.
(THYROID, THYMUS) Influence of the thymus on the thyroid and on growth (Beziehungen der Thymus zur Schilddrise und zum Wachstum). Adler (l.), Med. Klinik (Berlin), 1917, 18, 491; Miinchen. med. Wehnschr., 1917, 64, 1051.
Hart has maintained a view that diseases of the thymus are able to produce Graves’ disease without disease of the thy- roid. Adler confirms this view and believes that his experi- ments on frogs prove that the cause of Graves’ disease never is an abnormal function of the thyroid. The goitre is caused by Graves’ disease, and not, as many investigators believe, vice versa. When pregnant guinea pigs are fed with large doses of thymus they abort. When the animals are killed after this abortion, one finds hemorrhage in the adrenals. When smaller doses of thymus are given the development of the embryo, according to Adler, proceeds much faster than normal, and perfectly normal young animals are born much earler than in the controls.—J. K.
The abstracts in this number have been prepared by the staff assisted by:
Frederick Fenger, Chicago
Jonathan Forman, Columbus
L. G. Kilborn, University of Toronto
Victor L. La Mer
Jeo emer, N.Y:
H. Lisser, San Francisco
Clayton MePeek, Columbus
Ketil Motzfeldt, Christiania
With the permission of the editors, certain abstracts have been quoted from ‘‘Physiological Abstracts,’’ ‘‘Chemical Ab- stracts’’ and ‘‘Surgery, Gynecology and Obstretries.’’
INDEX
Abel, J. J. (Kubota): Histamine in hypophysis cerebri........529 Abelin, J.: Effect of amines on metabolism in thyroidless dogs 430 — Endocrine organs, bladder ac-
JINVILUAY Seo Sle Sie 370 Abderhalden reactions in certain MEMMETMELASHES S See She ee 85
—— with hypophysis .........526
Abl, R.: Adrenalin in malaria. ..350 Ablahadian, E. (Rogers and Rahe): Gastric secretion and OTS aM OMGGACES) 205s cs cetcca 5s Pane Abortion, relation of corpus lu- COUIN 60s: 52 <5 Od Sie ee 395 Abortions, pituitrin in curett- AM PS eOlts oars = oss cs bee oe DOL Abrahamson, I. (Climenko): Pi- HEE EVeTOISCASCS! 2b 5c... 6 5 oes, 3's 69
I SCCSTROPE INCA. 5 o> cc sacar cays 444 Abscesses in ovaries and corpus
LDINEL GT coacal Ree ods, Grohe ee een: aE Abt, I. A.: Diabetes in infancy LG HILO MOOG! cs, « 85 .c0s ccs «0-0 ilies Acetone bodies, formation of 486, 487 Acetonuria and lactation....... 215 Achondroplasia with hypothyroid- UTA I ese, cc-shs ok bes eee be es 120 Acid-neutralizing elements, ex- haustion of, producing acidosis PHP CCCS wees, Gs ee DAT Acid reaction of muscle after fa- HES) oe Seo Sie ois er eae hay Acidosis and pancreatic diabetes .355 ——- MEMO ONG. 5 Gy olalacks Sha ce-3 ee 62 —danger from, in _ starvation treatment of diabetics... .546 ATA OULE fara iate tees trees 808 2ece 47 —— MPG ADECLOS. = 2. mc wees JDO LD DA — — —/jif fat in diet.......... 545 — — —mellitus .......:.....542 —of diabetes mellitus, clinical GALS ee 2 eS YP. 4
— relation of, to acute diabetes.541
EERO SPIO ke 6 ss eee shee cc 363 —terminal symptoms of pro- POSSI ER. tocol > vhele Gani SL UWE DES ob cc wenn ee DAL Acromegalic gigantism ........ 202 EOC alye 2 oa. ec ee ce os DOO —and cessation of menstruation 8 —and diabetes death in....... 487 — — — frequent combination of 486 —cases of congenital......... 206 —-— of, in 5 brothers, 1 sister..209 —due to pituitary tumor...... 8 — following pregnancy ........533
Acromegaly, illustrating chief ECALUMES POM Vee oe ee se 376 ECM aICASGIOL. 2. fe fs. 205 — lactation in man having.. e210 Len tal symptoms Im). 2%. 2. | 528
— -— long standing with subjec- LLVEESVIMPCOMSs.. 25... . se 205 NOM UIVINRS oe. 8 ue tlre tues Son tele ls 68 — pathogenesis and etiology of.380 ——_ report of case of fatal... ....520 — with adiposogenitalis .......532
— — diabetes and change of hair COLOMERet ets cts ch ee re ALAS — with mediastinal tumor..... 68
— without hypophyseal tumor.. .175
Adair; (Bs ii. : Pituitary extract and labor
Addis, T. (Barnett): Pituitrin and adrenalin, kidney........ 88
— (Kerr): Neurocirculatory as- thenia and thyroid enlarge- PURO ee ercas eta oeasc ys aioe. yer erred & 251
Addison’s disease ......... 345,513
AUT Cem Ss Ys, pois xe fo, ays tee he 39
— — adrenal insufficiency and. .501
— -— and sclerodermia, cause of 436
—-——and tuberculosis ......... 179
— — blood sugar in treatment of 497
SS STE ie ee eee 180
— — — — in girl of 13....... 179
—— — — traumatic .........503
——=— CAUSE OL 26 cs ce ec oe meals WET 7
—-— caused by pneumococci. ...495
— -— description of case.......501
— — following railway accident.503
—-—hypophysis as regulator of
GIURESISFIMew weet c ck. -- cite
fA Oly Eee ae © ree 495
Sith oh el BeCo) Gan DI) ee ae 178
— — leucocytic formula in..... 179
—-— metabolism in ..........513
—-— muscular activity in...... 145
——no symptoms of diabetes
INSUPLGUS bINee 2. De
— —of syphilitic origin....... 496
—-— pigmentation in, cause of.534
—w—report of case....... 347, 495
—-— syndrome of Basedow’s dis-
CHR SRW iG yay sconoy bats, «facts Zoi
—w— treatment of ........... 3S
— —ttubercular origin of...... 496
Adenoma Of OVALY .. .2<% ««.5- 86
Pn POSINE COLOLOSA <c. 205.2 erie eee aNi7(i5)
PROMO SIVA use wesiel ccc vate clement 53
—a symptom of ial tumor. .445
— case proving to be diabetic. ..488
—caused by hypophysis.......522
Adiposity in children.......... 370 — three leading views on produc-
BLOT MO LG etsy cuore che fevake cm els iene 445
— with basal brain tumor......526
Adiposogenital dystrophy. ..377, 403
SS —— OE) Wlisn bat a oun oo OO dane PAY — — — caused by congenital
SVMUMLISMeiets eee 6 ere 0
— — — hypophyseal type...... eA
SS in IAI oh Gob a ee op oo 208
=== teratoma switle.. . xseeuee solo
—— -— with basal-prain tumors. .02
— -— sarcoma of hypophysis with.525
—-— with glioma of hypophysis.525 2
1
——— YY Oe Vamer neuensieie dette cael 526 NGiIPOSOSEMIvAMIS ei caemeieeclicne=eNon-t t=! 532 === CAS Orr Ol sie uc we Cae arene miehenomeltals eae 530 Sine Man Of iG.) GASCHOLs scene rOreul Adler, L.: Influence thymus on thyroid and growth..........0998 INATENAl asa Fo ssreiehed acon s 31-39),
41, 175-182, 343-347, 495-504
—action of drugs on adrenin OUGDING OR cise ian Ale aL —— adrenin content vob.7... sca. 2.) - 343 ——= ——— SPAMS) Tlayewencn- ne ewe ames tone 496 — advantages to be derived from SEO (Olina Alo Bac do 6 ob ot ob 0 AOS: —and muscular activity....... 145 —-—nervous system.......... 39 — — pigmentation of ene phores of horned toad.. 82 —— —— shell “shockan a care feu cues ae 8 — atrophy of, in case of pluri- glandular insufficiency... ..562
— blood’ flow throwgh:2 2 -. wo. 23 — body, lesion of, in paludism. .5 == (CORTES, WS ks Fhe ee ee Bij PAO! — absence of, producing Ad-
disonssmdisease), =e semen 146 —————fumnetion Ofssc... 46,25 95346 — -— importance of............ 496 =CTISUSM APS oie ao evdne Cae ene sae eee Uae — —report of case............ 37 — MEN CHENICY! |... cee soe eedes oe bee 37 — development of, in cat....... 180 ——@YSDEPSIGg. «<< €. hac acts eaten 343
— effect of thyroid hormone on.572 —exhaustion by emotional dis-
turbaniGeuk.s - 25, sched eee oes 38 — extirpation and blood pressure 38 = iOxtTact seMmect Olea s 2). aie os eres 269 — — ——feeding ........... 213
—extract in treatment of Addi- Soneswaisedsereane se ee as as. 497
—extracts in treatment of in- fiammations of respiratory
ChACTI A eae eae oc le ga DOO —w—in tuberculosis...........503 —— fOCAIENECCROSIS Olsie as. ss. <> UT —— fOrM> OL emialiatiliaieormacuen. tacos as Wee —— FUMEEUOME TOL a eee ene sued tela: ANS —-—two great conceptions of. .257 —— Fan eT ONCULOMIA eens pein. 498 = PIANOS! vce 5 paneer iene Rete 3) — - biochemistry of.......... ByBie:
—-—and chloroform inhalation.1$1
Adrenal glands, chromaffine por- tion (medulla) tr. senteeors — — desiccated, in Addison’s dis-
CASCe shes ee) oe co alerts 496 — —functional activity of..... ITF —— — functions Ofies. taineicu eee P53) ——— = MITE WZ INC seeps en ee euemenomemene 347 —-—interrenal portion (cortex).258 —-—ijin tuberculosis........... IW —-— primary tumor of..... Seeee at) —w—relations to retinal pig-
Ment: cisassaeaoeeee 346 — -—relative volumes of cortex
and. smeduillaip ss eens 344 ——' === LUIMOP 352 sueabenceeyet eee 345, 495 — —-—in precocious puberty. .463 —— with tOxicoimkectiOnes) iis 178 —— hemorrhages pillaterallsesscnw-leme 497 ————— I -IMLAMCSA coc nekone oe reemcnane 498 —— Henle’s (reaction im: . 2.) --. cn. 189 — influence on kidneys........ 49 — influenced by psychic factors. 341 —— iin, paludism: 2] ss.csnc ose 347 — imsufficiency ........ OR ALB. UCT — wand Addison’s disease.....501
—-—brown pigmentation in te- taniy (ule stOr --c on-akeeee 561 —-cause of Addison’s disease. 137
—-— caused by altitude flying. .496 — — following influenza.......503 — — jin fever and malaria...... 178° = /=— In: Soldiers’: edhe ee eee 178 —-— Sergent’s white line in.... 41 —-—with typhoid............ 503 —— iN COXIC ALON as) ae coed ae a7 —liberation of epinephrin
EP OM Ni ise nom ne eee eee 40, 41 == medullatst354 Sa eee teehee Bites, DT — —— function! Of-% ..cls). eee 258 — — functional activity of.....498 — — — — — in tuberculosis. ..346
— -relation to blood pressure. 38
—non-tuberculous degeneration ORME ET ee eet ee ae 501 — normal in case of myasthenia LAVAGE ha a tos See ass Cun Rane Sener RIE <—— (OIA OWNING Ao gaoghoadso oc 345 — post-natal development of....344 — post-operative death and tu- berculosissot2-=a eee ee 181 — presence of adrenin in human fetal 3 pe 2 Seer 41 —relation to hyperthermia.....424 —relative importance of cortex and) amediuillla cacmeee eee 38 — secretion and vasomotor func- tion” of ‘splanchnic=..- 4+. 180 — secretory innervation of..... 181 —=SOMeE MOLES ONE = asec) eels 514 SHOES) Cogeco eae se cogs nos 259 — therapy in secondary sex char- ACCONS wx ertnsiss or od cay oc seer oa oaen ike 92 —thyroid and, functional rela- tion: DetWeeMl.csi acs iene i) — tuberculosis)2. eect 37, 495 —tumor and sexual precocity. .563
Adrenal-typhoid syndrome... .40, 503 —veins,,death produced by tying
OU ete Mises casks ort mess eye EUG WLM Ow ess ciel sash eee eee = oc 179 PGE OMIUTM ie ses 5 Hs ars sce aes 42-51, 179
183-189, 347-350, 504-508, 514
—action of drugs on output of .501-
—-——on kidney............ 321 ——— — SCCrerionsoL sweate.-> Lao — — on flow of pancreatic secre- [EMO D0 tae he gene tas gre 47 ——_ —— —— fjeart of frog and toad... 42 — ——muscle fatigue........ 183 ——-—ureter ............ 43,179 — activity of different sorts of.. 48 —— administration: Of. 2.2224... 3 47 — — — by intraspinal injections.187
——an essential factor in produc-
tion of hyperglucemia..... 188 — and bladder activity........ 370 — — colloidal gold injections. ..348 — — — quinine injections...... 348 —— = PEVSOStEZMINM 0... ce ss 49 —-— lymph gland extract...... 80 —— ——_ pituitrin, antazonism..... 44 — anesthesia in tonsillectomy... 42 — blood pressure changes caused
[ERY > Pape oe Se aca ie aera en 50 —ecausing dilatation of kid-
THEN ic ctl Gta ONC ae eee BL OS — — —— pupil ............. 5ST — chromaffine tissue an indicator
Cie. es es Fcc ie eee B02 — circulatory failure due to. 08 — combined with polypeptide, in-
PM CRECHLOL =. oo. won ss os ere a DS =—+AGOUSTRICEION 2c cice sle cic st in ee 47 — content of adrenals after chlo-
LOLORMy sinhalation:;i. 3s 181 —-——suprarenals .......... 343 — distribution in blood........ 50 EOC alte, Hotta cles a tepic Je, « Slave, (elves 179 — — — painting pancreas with.557 — — — repeated injections.....182 —-——stimulation of sensory
nerves on rate of lib- (EVI Vor a1 (0) to ee ene eR 497 ——on excised vagina......... 50
— — — surviving blood vessels. 48 —-— —tonus waves in auricles OiebeLEA PIM oe pecs Oo
— effect on vasomotor reflexes. .428 — essential for prolonged muscu- RTE EMMONS = oi evas eS ca vole estore 147 —from adrenals not indispen- SADLom es <2 50s be girs eae DOD — granules in adrenals........ 496 — glycosuria and diet.........349 — hyperglycemia ............. 506 EMU ELLITUGD ss (5. sa .th e's leet ldue-ela ole 185 — — auriculo-ventricular dissoci- DP IRITY MERCED fate fe SS, teh bath DOIG —dilatation of pupil following Pane weCuOMy’ cates svete oes 43 — — fetal adrenals............533 —influence in skeletal muscle BOULTACTIONN R900". Biase tne ee 49
Adrenin influence anaesthesia, hemorrhage, etc., on pressor ef- fect of
—— of pituitrin and on pupil of
rife H] ©) OWSS Ry <o) oen Dene ence 88 —-—-— thyroid preparations on TOON Olea ees eee es 55/5090 — in gastric disturbance..... ote ——— NS CUM AGUIGE) S. +s scene ese 347 — inhibiting gastric secretion. ..232 — inhibitory action of, on kid- TIGWSHRACRS chsds lalatels She thnetents 42 — injections, arterial pressure MOUMGIWANNES | Bess eleva ens c bos vce ae 508 — -— effect on blood........... 506 — injections in Addison’s disease.496 ae BST AULEUT Vee. We. cs cus ibel ic, isas.1 ie at ote 350 —-— muscular activity......... 145 — prevention of anaphylaxoid Olt SaliviaGSanis sucks coc) esl sts 348 —— FUP UIE) oo ws ta, of ein ene oe aes, 3 186 — in superficial hemorrhage. .45, 46 —-—tonsillectomy ........... 568 —jintravenous injection of, pre- ceded by one of thyroid, ef- INXS Ee a hteis e.H.b eRe Olbecr onan 595 — in treatment of asthma...... 42 —-—-of case of adiposogeni- CALISS See orate eres “seeks iit ——— Ths HE VADINOUG ees, ner ewtoldsiare eecr sneer 503 — intraspinal injection of...... 48 — liberation from adrenals after SCCLION Of MeLVES. 2. . 6 es sia 186 — necessity of, in organism..... 186 — = OUMppUts IM eSNOCK.) <6 + a.l--s1 6. cet © 189 — plus arsphenamin and neoars- HIVE TNA Pe aa past cick, aoens ehaie 184 —precipitation of epileptic at- (HANG! eft (Aa, ics eee Sp ee 349 — pulmonary edema...........505 — — —in rabbit............. 184 — rate of liberation influenced by PUSAN aby euchekes cece tena. | See 187 — reducing properties of.......534 — relaxation of sphincter muscle OLEUEISR cherie tamer eo scale Deke ie 49 — spontaneously liberated, action OMA ALE seer ochetewe.c.. 2 ce seks 497 —suppression of colloidal gold MEACHLONMNS ere ee a-a2 eee oo Le aS VIG CiCrmrs is sess euenake iced «bio e 186 ——=FESt, Amie hyCeMIa:: . 95 s.. sis ccs es 186 — treatment of influenza. ..350, 503 — —— lung diseases with.....506 —————enOrriarialn < se. 22. 50169 — vasodilator mechanism, loca- (ubouTL. (Osis 5 Asdic Gla. C.5 Oo etee DEPReaeeee 44 — with procain in dental opera- [WIG ONSy id ON aes i 49 — with typhoid inoculation.....514 Adrenin-novocain solution used as anesthesia producing gan-
(SINGIN eee ee ee are rete 51 Adrenin-pituitrin treatment. . — —— of asthma............ “45 Adrenochrom in treatment of in-
flammations of respiratory
tract 5
Adrenochrom, use of, in tubercu- NOSIiSMESP ay, Aas ee OOS Adrenopathie hyperchlorhydrias.343 Agata, G. D.: Transplantation of thy TOldeeelanGss erscke hci ee alo Agnoletti, G.: Castration and tis- SIL SNeSpITAatlONsw.r<e. peeeens eee 65 Aikins, W. H. B.: Exophthalmic goitre, radium treatment.....576 — Radium in exophthalmic goi- ENOY ieee eas See See eS Pee 103 — Radium therapy roidism — Radium treatment of exoph- Ehalmic veoierets ses ee aoe 250 Alamartine, H.: Lesions of thy- roid Albeck: Thyroid hypertrophy in DEC LMANGY eis ees a teala eae meron ee eke 582 Albuminuria during pregnancy Bshel ate 0a) etioa awed ema hy Oe PA AT(Al Alcohol, effect on liquor hypophy-
SUS Tnckins edb oS oes ae 78 — — — pituitary extract....... 78 Alexander, A.: Myxedema caused
by military Service... nt. aav2. ab84
Alexander, G.: Diagnosis tempo- ral lobe cerebral abscess and hypophy Sis tumors ies tse «a. DD
Alimentary glycosuria in case of adiposity
Allen, B. M.: Pituitary and thy- roid glands and metamorpho- STS. hike Se ae cae ea, eee 424
— Studies upon endocrine glands
oLnmgtadpaleseiseeen trace
— Thyroid and pituitary Sea
Lon win: tadpoles cise 243 Allen, E.: Degeneration in testis due to deficient diet......... PaENT |
Allen, E. M.: Pregnancy, pituitrin 88 Allen, F. M.: Diabetic question. .550 — Diabetic question, clinical med- GING Mes. SER oe eee 550 — Diabetic treatment.......... es — Role of fat in diabetes. .365, — (DuBois): Diabetes Tee isn pete. chin se Se ee eee 58 Allen, M. B.: Myxedema........ 408 Allen-Joslin treatment of diabetes TINE MTHEUS sen cade Ss kop cer oe eS 2 361 Allen treatment for control of acidosis in diabetes.........:556 — — for diabetes, report of cases.552 —-—of acidosis.............. 364 — —w-— diabetes .......... 61,510 5446 54:95 Db bi2. Didbs Db 5 — — — diabetes mellitus... .545,5 modifications in..5 2) 5
— -— in diabetic gangrene. ; Allende Ignacio: Male climacteric. Allen’s exercise treatment of dia- betes Aloi, V.: Action of chloroform. .355 Adrenal glands and _ chloro- form inihalationey. sesso. 181 “Alpha iodin’’ now known as thy- roxin
Alopecia, of endocrine origin. .500 Altitude sickness of aviators, ad- renalsming ss .5 sents ae ee 496 Alves Maurico, M.: Adiposo-gen- ital* dystrophy. sacs oe eee 403 Ameba and endemic goitre..... Biio Amenorrhea due to dysfunction Ol hy pophysissereiacaacr eens ik —in case of pluriglandular in- sufiiiciency-. aoe eee ee 562
—relation of corpus luteum to.395 Amesse, J. W.: Diet in diseases
of thy roids: eens ieee cee 412 Amoss, H. L. (Flexner and Eber-
son): Choroid plexus and ex- perimental poliomyelitis...... 351 Amylase an internal secretion of PANCREAS! As cma wre cea, Se Dion Anaesthesia, influence on pressor effect] Of, epinephrine n>. eee 188 — in tonsillectomy, adrenalin... 42 Anatomy of parathyroids....... 222 — -—thyroid gland............ 108 Anders). J.2) wGoitre.. 44. emcee BHT? de Andrade, A. D.: Infantilism from ankylostomiasis........ 214 Animal extracts, early therapeutic USE OLS S28 sce Bete ee ee ee ifal —-— uncertainty of action of... 2
Ankylostomiasis, infantilism from.214
Annular dystocia and hypophy- scail weminact2 -sscka SS See (33 Antibodies, influence of thyroid gland on formation of........ 318 Anti-diabetic substance......... 60 Antineuritic vitamine, influence on pancreatic secretion......563 Anti-thyroid treatment......:..571 Aorta in exophthalmic goitre....235 Apert, (He) SOX. cpr eer enero 92 Sex determination.~ 2325.03. 403 Apinealism and mentally defect- ive. Childmenie sees. css eee ae 442 Arey, L. B.: Suprarenal gland and= retinal pigment. sess cise 346 Arnasson, J. S. (Vincent): Thy- roid and» parathyroidh: 4. see Wall Arntzenias, A. K. W.: Parathy- roids and calcium metabolism
AM “CCEA Yao ay. anes eee Oren 560 Arrillaga, F. C.: Adrenin in au-
riculo-ventricular dissociation. 506 Arrowsmith, H.: Diabetic ulcera-
HON 6s ae een eee iy — Diabetic ulceration of pharynx anid lanyiixa a seer Arsphenamin and neoarsphena- Mini plus) <adiremineeee see ae 184 Arterial pressure following ad- Lenins sin} eetlLOnSs > sent a Arthus, M.: Secretin.....:.... 91 — Thyroid and cardio-inhibitory EDPALTATUSY saan s/s cede, eheee totaal 10i Artom, C. (Lombroso): . Glucose metabolism, <3 Sivmses aoe 190
Aschenheim, E.: Vegetative nerv- ous system in tetany: 2225)... 566
Asher, L.: Thymus influence on
OCs PO Wea areas «sc cherssavene as 406 —— PRYTOIG. SPIECOM.....- 2.05 wees oe ahs} Asphyxia, effect on adrenal secre-
(FNC TIE Sp Aue AOL ne ee ea 183 — influence of, on rate of libera-
tion of adrenin from ad- TECTRONSIME 2 he eat Obert. 3 « Beeeeds 187
Assinder, E. W. (Evans): Pitui- HDs PPE AM GUIS. . cals Scopes 211
Association for Study of Internal
Secretions, purpose of........258 ANSI GHG H, Ble Ge eee Bone 530, 562 —as result of adrenal deficiency 37 — neurocirculatory, study of fifty
PAS OS ena esol crags oi tiaheueion ah ete 243
—symptoms of neurocirculatory HME CEMNUSss erates ta oss oe Dil INSUMMIMOM EEE Heme dore rss, Sok. snk o.cy DOs — and vegetative nervous system.350 —adrenin and pituitrin in..... 45 —-— in treatment of....... 42,185 »)
— 7
— pathology and treatment of. —relation of endocrine elands HOMME SRR S sass Qcere ce tete cee 367 — treatment by pituitary extract.383 Athanasiu, J. (Marinesco): Myas- SHARES ska ions cso "<isi-o soci we Athyrosis, fetal and maternal... .262 Atrophic myotonia and cataract .571 Atwater, R. M.: Scleroderma and SCHETOGACUVIY: cc... 0m speveuscace so 428 Atwell, W. J.: Development of hypophysis cerebri of rabbit... 6°
— Hypophysis in anura........ 70
— Pigmentation changes follow- ing hypophysectomy....... 76
— (Sitler): Pars tuberalis in hy- MOPUPSISmasak. setarcloae <5 78
Aub, J. C. (Dennis): Blood sugar inhy perthyroidism... .. <2... 411
— (Gephart, DuBois and Lusk):
Clinicals calorimetry. .......: 307
— (Means): Exophthalmic goi- LIVES 5S -5 Se aac a ee 99
Auer, J. (Gates): Adrenin pul- monary edema... ... 5). 184, 505
— (Kleiner): Coagulation of pan- RAPS Rhett tat ote hasan Ste ec cS. 6 69
—-— Hyperglycemia in experi-
mental pancreas defi- ELIETA CN tengo ae Be eed say!
— (Meltzer): Adrenalin constric- WLM eer eee eee ae 47
— —Adrenin intraspinal injec- [15016 Sat se eee ee bana 187
—-— Blood pressure, adrenalin. 48 Ausch, D.: Acromegaly with dia-
Gs. a 175 Ausmann, H.: Heart in myx- SGT Se ON ee 430 Austin, J. H. (Pepper): Splenec- BUPIANY 5. cpp te sxe Susie: « lathie cect ome 93 — (Stengel and Tonus): Treat- ment of diabetes mellitus, Allen’s method...........556
Austmann, K. J. (Halliday and Vincent): Adrenals and blood DECSSIN Glerceete hee sb sees eens chee fous 3 8
Autointoxication due to dysfunc- tion of endocrine glands..... 4
Autonomic nervous system.350, 3
—— — — jrritation of, cause of in-
creased metabolism. .594
Aviators, altitude flying due to
adrenal insufficiency......... 496
Bab, H.: Hypophysis and specific FAPANTION? Olt {oP HN SRE e anal, okeiGas Gace at 521 Babies, pineal feeding in....... 442 Badertscher, J. A.: Ultimobran- chial bodies and thyroid..... 119 Bacigalupo, A. R.: Surgical treat- ment of exophthalmic goitre. .587
Bacigalupo, G. (Ceballos): Goi- tre and boiling water........ 431
Bailey, H. (Murlin): Sex glands and =metapolism. 1. . +2. sxe alte
Bailey, C. V.: Alimentary hyper- glycemia and glycosuria...59, 198
—— Wena lvdia betes <-. = <y)<5% sss + see 193 Bailey, P.: Endocrine glands... Bainbridge, W. S.: Clinical as- pects of internal secretions. ..387 Baldwin, J. F.: Allen treatment in) diabetic ganerene.... 2.20.00 Balfour, D. C.: Cancer of thyroid
Fea IEA b SRP Pe hy ee rE OPE eae 106 Bandler, S. W.: ‘“‘Higher up” the- ory of sterility in women..... 201 — Internal secretions in obstet- rics and gynecology....... 386 ——— seit aAryaOXtLaCt.. « soja sce oa 87 — Problems in obstetrics....... SiO — Therapeutic suggestion con- cerning endocrines........ 199 Banta, A. M.: Sex intergrade....190 Sex intergrades in Cladocera. 226
Banti’s disease, a critique...... 92 Barach, J. H.: Diabetes insipidus. 359 Diabetes mellitus and syphilis.544 Barker, L. F.: Exophthalmic goi-
[IG O GeiS ROAR roan OR Eek) annie aes oc 234 — Functions of suprarenal PAIN Savoy eee eee oss ac cueyeen PASI: — (Mosenthal): Diabetes insip- idus, pituitary extract.....382 — (Richardson): Cardiac ar- IDV EMT AS ss: mek, eet sios cuss ec 233 Barnett, G. D. (Addis): Pituitrin and adrenalin, kidney........ 88 Barney, E. L.: Action of tethelin. 376 Barnhill, J. F.: Anatomy and cSIresery eOhebnyroid). =... st 108 Basal metabolism, effect of thy- TOM TTU CMON setae ve he ere. s ss va. vo feuteoie tame 593 — — estimation, toxic goitre....573 —-—test for hyerthyroidism...588 — meningitis, polyuria occurring Ales eRe Soo me a oars Sun oe
Basedow patients and throat in- fections
Basedow’s disease and emotional SUAULES Grier; Re tne hay wue ee nies hens 245
Basedow’s disease, emotional ori-
SUTIN eR ees ate eayctesee Mors fe vate sive ks Doe — — hypophyseal therapy in... .378 Basedowized goitre, X-ray treat-
MENS ee he ae Se ee Oro Basedowitied -2oltresa.-. ...- 2+. 473 “Basedowitorm heart. ..:....- 335 Basedowism duration and treat-
TILOTUU Ee eee ae coe ed cians Reesor Bate, R. A.: Endocrinology and
opotherapy, of shock... . a 5 202 Battistini, F.: Acromegalic gi-
SAMNUCISTS Ce er orenebs « chene ere ees 202 Bauer, E.: Function of adrenals 41 Bauer, dec, OWartism: ets ee lee
Myasthenia gravis with Graves’
Giscase? os th eo ee OOF — Nanosomia infantilis pitui-
CATA Seo ee cs eee eee tone” one 528 — (Spiegel): Bilirubin in blood.512
Bauer’s type of thyreogenic heart.591
Baumgarten, A.:- Hermaphrodit- PSTN 5400s 0s Gitere ns Bk tirenenen tere Deg Bay, R. P.: Surgical treatment OL ZOLLER, che reuters eke te nabs)
Bayer, G.: Blood liposes and met- abolism Baylis, W. M.: Chemical correla-
tion in growth of plants...... 204 Beard, A. H. (Rowntree): Salt metabolism in diabetes....... 363 Beck, H. G.: Dystrophy adiposo- SENTtAlIS Sie hk tore ee ee? tal Bedford, E. A. (Jackson): Epi- nephric content of blood..... 40
Beeson, B. B.: Arsphenamin and neoarsphenamin ....... ee es SA
Beilby, G. E.: Acute thyroiditis. 409
Bell, H. H.: Hyperplasia of pineal
DOGY ters ascites © occas oo ee 87 Bell, R.: New phase of organo- DIMER VAR. aires ee eos oe ee $2
Bell, N. B.: Ovarian grafting. ..393 Bellaire, R. F.: X-ray therapy... .232 Bellin, J. J.: Adenoma of thyroid.107 Benard, R.: Sporadic hemophilia with myxedema, thyroid ther-
DY Ware «es rs pabpeemee eRe OMCO Benedek, L.: Epileptic attacks,
AC REMI BAe esas ais ee ee ne 49 Benestad, G.: Drugs to aid deliv-
(35) GN Qe an 8 Se ted aN eR CN Oe ein ne 207 Benhamon: Paludism.......... 504
Benjamin, A. E.: Thyroid disease.102 Berg, C.: Exophthalmic goitre. ..576 Bergé, A. (Shulman): Rhythm of hypophyseal polyuria........210 de Bergevin E. (Sergent): En- demic goitre transmitted by in- SOCU isc it rane Rete eens Sek che 106 Bergh, C.: Exophthalmic goitre.414 Bergheim, O. (Halverson and Hawk): Thyroid and thymus treatment in’ 2oltnen. ee): ata) Berkman, D. M.: Preoperative consideration of exophthalmic POLLT Crs setae ey eee meee 248
Berlin, E.: Effect of removal of
SPleem:. i en2. bce de one oveuengsl epee oe 226 Bernhard, A. (Rohdenburg and Krehbiel): Sugar tolerance in CANICEM Aes Pie meee hee 386 Bernstein, S. (Falta): Respira- tory exchange, blood sugar reg- WIATION 72%... veheee seats. Coe a ee Beuzard (Loeper and Wagner): Adrenale/Gyspepsiase. neuen ee 343 Bevan, A. D.: Acute necrosis of thy roids elandieees:. ore eee 236 Biberfeld, J.: Adrenin glycosuria anid’ Giet:...6 stetcroicts tome ene 349 Bile flow, stimulation of 7... -.-500 Bilirubin in blood, effect of ani- Mal extracuss Olt sccm. eee Selle, Bizot, A. R.: Ovarian salvation vs. ovarian destruction....... 394 Bierry, H.: Glycosuria following ablation of pancreas> 2.5. 4 220 Bigney, A. J.: Adrenin, pigment MAULTAGCION, vod isch shee ene one Bile, influence of internal secre- tion upon formation of....... 214 Bladder activity, influence of en- docrine organs OM... ..5.:2-.. 56 370
Blanc, J.: Neurasthenia and opo- therapy Blatz, W. E. (Hartman): Death by tying adrenal veins....... Sui Blood, acetone bodies of, in dia- DOUGS) 22 ion. 6s esate ss tol heehee eee ne 194 —-—substances of, in diabetes. 53 — adrenalin distribution in..... 50 Blood calcium content in normal children and in tetany....... 566 — change in corpuscle content of.563
—-— in animals following hy- pophysis removal....... 384 — — in Graves’ disease........ Stl
— chemistry, value of, to clinician 55 — cholesterin index, value in uri-
Mary ‘GiSease\: cs. ces cae themeee cee 497 — coagulability of, in exophthal- IMUCHMOUTCr dai coo eee eee 590 — coagulation and relation of thyroid and spleen to bone MATTOW |. 2 ous o pee eee 1LSLs —-—effect of organ extracts ON: . Gs cea eee 515, 244 —content of cholesterin in thy- Told insufficiency. ..-oelee 425 — defective development of....386
— diastatic activity of ..53, 2119, bos — effect of adrenin injections on.506 —epinephric content of, in low
Dlood” pressures ses eee ce 40 — findings in exophthalmic goi-
ENO ee ee eee eT EOLO — flow throwgh adrenals. 25... 4. 337 — glycogen content of, in experi-
mental diabetes, “35.5.4 45 549 — liberation of epinephrin into.. 40 —lipoids in diabetic.......... 193 —liposes and metabolism...... 394
—of animals deprived of hy- pophysis
Blood picture in Addison’s dis- SEIS Lees Groce ane 179 — — — cretinism — plasma in experimental tetany.223
— pressure, action of hypophy- SealeXETACE OD ese ccusiose SABIE BAe! —— changes caused by adrenin 50
— — during and following meno-
DUNS Cue ecehsce toe as Oo LO
—-— curve and stimulation of splanchnic nerve end... 44
— — —following adrenalin in- OCHO M a ees. ac, aptonsy seas sone 48
— — elevation of, by intraspinal injections of adrenin...187 — - in dysthyroidism......... 246 MM are Stnel chore: Zp cicy er Os ah vv. DIOS
——_—-—epinephric content of POO Gael Meare chan ty rsi a a oe 40
— — relation of adrenal medulla (LO). coat Hae CES Deere 38
— spitting of, vicarious menstru- DIGI - a Basak eRe EA pee eee 463 — — study of low............. 42
—red and white corpuscles in, auring. direstion:... .......... .. 91
— sugar and Addison’s disease. .497 — — —residual carbon in dia- NEES) aa 191 ——————COMECTNL, waits 6 cic% ee saree 3 DZS — — distribution of, in diabetes.191 — — content, influence of secretin 91
— -— —in hyperthyroidism..... 554 — — effect of exercise on, in de- pancreatized dogs...... 61 —-w—in diabetes mellitus. .356, 543 — —— human diabetes........542 — —-— hyperthyroidism ...... 411 —— —nephritis ............355 —-—-—tropics .............. 355 — -—influence of injection of Witte’s peptone on..... oD —-—regulation, respiratory ex- Wane. ANG... +... {eerste «~ 193
— supply of areas of Langerhans.220 Bloor’s method of determining
lipoid value of blood.........543 Blum, H. N.: Hypophyseal dis-
AS ea wreiog Med Aes Len trailed oi«,' wheat os 381 Blumenfield, E. (Hirsch): Inter-
nal secretions and metabolism. 79 Blumer, G.: Diabetes mellitus. ..541 Body weight, effect of thymus ex-
PUD ALON ¥/ Oli occ lat atx ch eel es we lia'ye 230 — — influence of pineal feeding. 441 Boehme, Jr., G. F.: War neu-
TOSESP IN WOMEN. .-. + .)aekis ee os 120 Boez, L.: Parathyroid organother-
apy and calcification of bone. .559 Bogart, A. H.: Thyrotoxicosis. ..119 Boggess, W. F.: Hyperthyroid-
ism Boggs, R. H.: Radiotherapy in
MiGerial MCAICING.c). « ~~ yseicelet 431 Boiling water injections in hyper-
GayTOVGISIM =... .-+ «- 109, 431, 471
Lo SG Bolten, G. C.: Case of familial angioneurotic edema with te- UID GRETA tings ity ce kitce& oo sus 6) a DOO — Congenital fragility of bones.568 — Minor thyroid insufficiency. . .247 — Tetany in adult and observa- tions on cause of tetany...559 Bolten, H.: Urticaria and hypo-
UNIV TORGUSIMMW ett Goscrcessc) see fo cy ce sw: 109 Bombardments producing Base- dow’s disease and emotional SUNS Sr 6 eG Gr Renee eee 245 Bondi: Habitus, and especially PAOD eCLCS))o 6 a. 6 eos s DAS Bondi, J.: Influence of sexual intercourse on ovary.........539
Bone calcification, influence of parathyroid organotherapy on.559
— development, thyroid and... .432 — dystrophies, endocrine glands DINCWE RR cits SMe oes saves 367 —marrow, relation of thyroid and -spleenuitO:04.. 6.4 ss ee PAS — -—stimulated by secretin....563 — — stimulation, studies in.... 93 — regeneration, influence of thy- MUS OM wer esos ait woes noc beastie ae, tei 229 Bones, congenital fragility of...569 —endemic diseases of, in Vi- CUT ep erie Sachin is8 scsi Gea Seed es 516 Bonfield, C. L.: Undeveloped UUGGR Siar setecmctea sas oso cba eae ce 434 Borberg, N. C.: Internal secre- tionwand anSamMity.. 2.06.06... 25385 Borchardt: Non-specific effects of organo-therapeusis .......... 514 Borcher, E.: Treatment of post- Operative: LetAMY:.... .....2+ i. . +. PAPAL Bordley, J.: Thyroid extract in UAEHIDIS) Ss, Shin Bees ee ere 105 Borell, H.: Formation of corpus luteum Re hes Bae cbs wave 395 BRoruttau, H.: Anti-diabetic sub- SLAM COMP cEsia Cheah ereetard, > esd rae 60 Boston, L. N.: Hypopituitarism.. 79
— (Kohn): Saliva in diabetics. .554 Bouilliez, M.: Goitre distribution
IMAC entralwATTICaE.. 2... .22.% 107 Bourgeois, H.: Asthma and pitu-
UAT VA OMET ACC mse ees cr: led a 5s 383 Bovée, J. W.: Tubal and ovarian
hemor. ce mar iki Aisa de. 219
Boyé, E. A.: Demineralization of teeth, thyroid disorders 5
Boyd, W.: Adrenal insufficiency.176
Bradley, S. C.: Thyroid enlarge-
TILE TLS Westra ee esos cis. ies "a atte 103 Bradycardia in myxedema......592 Brailsford, A. M.: Sudden death
and enlargement of thymus. .408 Brain and ovarian function.....391 — atrophic in sporadic cretinism.570 — chronic inflammation of.....522 — substance, compression of....522 ——EUMOr, DASBI a a. 08 ee Eee DO Bram, I.: Causes and prognosis
of exophthalmic goitre....... 412
Bram, I.: Circulatory system in
exophthalmic goitre .........589 Non-surgical treatment of ex- ophthalmic 20ltre. so. 0-1. 426 — Symptomatology of exophthal- TPEAUOR STON EEN Ste G caienguD aioe AIS 235 —Therapeusis of exophthalmic FOUN Cee el cota casey ney hae 467 Brazil, A.: Evolution of Endo- (Gren Oyen, Binly 6 oto Sian Ee Gecuonaionys Bay(al Breed, Lorena M.: Metabolism in GID CUOS tres er en oer ces cxocaerauede 193 Brendel, F. P. (Helm): Goitre ANTON PCG ht eC Tats rs oe omega Dios Briggs, H.: Adenoma of ovary... 86
Brindeau, isles Post-operative death and tuberculosis of ad- WOM Ai Sage oo a ck ween eee since ooh means
Brooks, C. (McPeek and mour): Action of epinephrin on vasomotors and heartbeats.... 47
Brooks, H.: Hyperthyroidism in
TECTULE ne cus oo See aes eee 04 Brown, I.: Successful therapy of exophthalnitcG SOE 2 205
Brown, J. R.: Hypothyroidism. .241 Browne, H. (Lipscombe and Dan-
sey): Hemorrhage from corpus
JOR E11 ok ee a ee ee amet Sie Re aue 86 de Bruin, J.: Hypertrophy of mus-
Cle cIMmye TEENS ap -escas cl remus 582 Bruit im dysthyroidism.... 1-1... -.- 30 Buckner (Nollan, Wilkins and
Kastle): Effect of grain mations
On) ZLOWwon Of CHICKS <2 c cue cee 564 Butalinis) cNStHmMtays con sense okens 45
Burge, W. E. (Kennedy): Pan- createctomy and catalase con- Pet MOl mel SSIS a sewer tatect cure eum 397
Biirger, H.: Sudden death during COnSsillectomyee acres ee LOS
— (Reinhart): Xanthosis diabet-
TCR RPE ceo ae ea See 362
Burnett, T. C.:
= (Robertson): Acetetation of
tumor growth by tethelin. . 209
Burns, fatal superficial and ad- PONAIS F owe «ee eee ae)
Busco, J.: Hyperthyroidism and
= hetaniasemuUGeliGa.. 5 eee 398 abnornial erowibhscn. cents case 108
— Urine incontinence and tetany 87
Gachexiamey-). fae f- 0s ere haere 526 —and- pineal tumor... -....:. 447 —a symptom of pineal tumor...445 — case of hypophyseal.....527, 528 = EMEC ODI wl alee econ ie, ole 414 Caleificationsmepiniealassy.-t2.-.- = 438 “Calciprivic’’ constitution.......565 Calcium, administration of, in tetany’ sas. ee eaten OO — balance, negative, in tetany. .561
— content of blood in normal children and in tetany.....566 — metabolism, disturbance in...569
Calcium metabolism in tetany. ..560 —-—parathyroids and.....221, 222 i eer eee Al Cameron, H. C.: Cases of cretin- TSH 0 0 Ae aR RMU Spe ten yy Maes 15) Tf 7 — Osteomalacia and infantilism .536 — Status lymphaticus from clin- icalsstand Poin, sci 567 Cameron, M. H. V.: Simple goitre.249 Cammidge, P. J.: Diabetic aci-
GOSIS:) 32 Fe oo wae eae — Dietetic treatment of diabetes MUCUS \.- 2: eke ee ee 195
— Fat intake in diabetes mellitus.545 — New dietetic treatment of dia-
betes “mellitus>...-.. = 5 >. o —#+reatment of diabetes by pro- longed) Lasting... - eee Campbell, W. F.: Exophthalmic EOUTE M262 ee eee 103 del Campo: Effect of adrenin.... 48 Cancer, a disease of deficiency.. 67 — diastatic activity of blood in. .219 =——of ‘thyroid }eland! ae 2 eae 106 — sugar tolerance in.......... 386 Cannon, W. B.: Effect of asphyxia on adrenal secretion......... 183 — Secretions of thyroid gland. .107 Carbohydrate metabolism....... 190 —- disturbances in and islets of Langerhans: =2 oor 487
— — jin relation to thyroid gland.572 — tolerance in hyperthyroidism: 56
= Mea Se ee Se 549 Carcinoma: ‘of thynoid: ~2.22 5. 411 — -— gland in dogs....:....577 —rare forms of, of thymus and thyroidads.c6 ai. 2S oD a Ee 228 Cardiac arrhythmias occurring in patient with thyroid adeno- Matas: 48 oes Ben ee ae eee Baia: disturbance of soldiers......244 Cardio-inhibitory apparatus, thy- TOW BNE a ects on ee Sakial Carlo Ceni: Brain and ovarian ELIE. CULO eee eae 391 Carles, J.: Adrenal insufficiency IN ‘SOLGIETSIAS © tt, See ee 178
Carlson, A. J. powski.: Carotid body,
(Kanter and Tum- Stability of secretin.402 case of bilateral tu-
MOor0fs = + SR eee RES PRESS 54 Carroll, J. H.: Soldier’s heart. ..374 Carver, A. E.: Dosage thyroid gland “substamcetern. © ee iee Castration=efiectsvofe +. -- 6 eee 26 — experimental study on....... 65 — ini fowls Aaa eee ee 66 —+== == effects. oe ee 65 — influence on larynx..........227 — produced’ by ‘cholin. 222. .222. 388 de Castro, A.: Paraglandular sys- tem: 2.20 eae Sc A eee eee 87 — (de Souza): Dystrophie genito- Slandulaire ens see 208
Castano, C. A.: Organotherapy in
PRMCCOLOL Yo eva oi Eis bec eld wes 82 — Thyroid insufficiency........ 110 Castex, M. R.: Nasal hydrorrhea 29
Castro Va. BEE ETI Myr ets e230 90
Catalase accelerator, does liver
SCI EINEY TS) C2 na tone On a 190 Gataract and. diabetes. .:3...:....542 Catarrh of intestine in diabetes. .546 Ceballos, A. (Bacigalupo): Goi-
tre: and (hoiines water. sci... ¢-. 431 Cecikas, J.: Adiposis dolorosa...175 Cell cultures, experiments with.498 Cemach, A.: Epidemiology of goi-
PEO ree) hone os Sis O85 Cervical sympathetic, paralysis of accompanying goitre......... 109
Chambers, M. H.: effect of food hormones and glandular prod- REC ESE PAPE ISS oho, Sis syfalle Sas cue a: one 213
Chaput (Schekter): Gangrene following adrenalin anesthesia 51
Characteristics, gonads as con- EEOIVCTKSHOlis. os hags. choo 255 ene Siena: le —of patients to be studied in di- agnosis and treatment..... 166 Chaton: Thymectomy after fail- Le Jef sradiotherapy. .c 150... 230 Chauffard, A.: Cholesterinemia during menstrual cycle...... 191 Chemical stimulation of intestinal Pepe Seen Aa mores es ts oe 224 Chemistry, blood, value of mod- Silt, (AO ABR ONKC Ee 1 eo en 55 Chenerson, M.: Pituitary extract PHONON STED TUES 5.2.0 ehe! cus koko ove as.) 9 Blew 399 Chiasserini, A.: Hypophyseal le- SEG) ofA See 74 CiylGdrenvad posity iN. 6 2% . she 370 — blood calcium content in nor- UU Pees re nog d,s 2 a OG — diabetes in......... WTB Bal) ayal — PP OUCUIS) PN. oo we pe ess DAA —exophthalmic goitre in...... 415 SSS ET 420
— mentally retarded, use of in- ternal glandular extracts in.368
— results of pineal feeding in...442 — retarded growthin..........548 Chistoni, A.: Lymph gland extract 81 Chioroform,-action of.. :52:....355 GHreeosiswery heey. wes eee a 2 2S Choked disk sequel to thyroid CRpLOM APIO. ri) ols bts ira oes 416 Cholecystitis, metabolism in.. 193 Cholesterin and ovary..:......391 ——m COrpus luteum .. . .< cn iw nc 191 —in thyroid insufficiency...... 425 —relation between hypophysis ZEON ane a ee eee, ans 389 Cholestrinemia during menstrual CMMI ON oF) us. Suelo ore: ol dee 82 —relation between, and hypo- ULLAL) age, nae a vii — variations in, during menstrual COVER Rs ctovaeesed as.s:a'3 ee eee ne 190 Cholin, production of castration MIA AOL ..<1s.5 Gtr. ease). eee 88
Chomé, E.: Ovarian and corpus luteum. abscesses............541
Choroid plexus and experimental
DOMOMMEHEIS IMs = eeaiey Scooter a See os 351 Christie, C. D.: Absolute dia-
DETES iin Rast Gasol ecatentpaittens a 52 Christofferson, N. R.: Circum-
SCTIPDEOMCMEMUA Kya he ens ep seid fee is 385 — Pluriglandular insufficiency... .562
Chromaffin tissue, chrome reac- tion indicator of adrenin..... 502
— -—color reaction to salts.
Chromaphil tissues, function of .
Chromatophores, co- -ordination Ol aD Ye WOTINOMCS aecssney eels cess 187 Chvostek, F.: Heart in goitre...591 Circulation, failure due to ad- TOTS Brien oa bye baci aioe DUS Circulatory system in exophthal- MDLCFPOMETC eyo. cease Cp aere eS oekd Ge OOo Ciuti, G.: Sergent’ s white line. 41 Clark, S. N. (Singer): Psychoses with diabetes mellitus....... 360 Climenko, H.: Corpus luteum... 1 — (Abrahamson): Pituitary dis- CAS CS tra ede og soe oye ao areas Sor TNE 69 — (Strauss): Eunuchoidism....516 @hinicaly-ecalorimiettyes. secs. <,-s. Sit
— medicine, relation of diabetic question to practical prob-
LEM SEO te kao ats a Soe DIO — methods in diagnosis of thy- LOMeGiSOnGeES.. faeces. nec 102 — standpoint of status lymphat- TCS Mere rag nc /<) Oe. cy pateke sucy suck IONE —symptoms and treatment of thymus hypertrophy....... 567 Clinoid processes, normal in case OLPHYPeELpItTWItATISM...<-. <=... .Do22
Coagulation of pancreas, effect of 60 Cobb, I. G.: Adrenal glands.... 37 — Internal secretion of digestion 63 — Internal secretions of sex or-
ENS ” SNS ake high he ea eit 67
SSSI RAIGTRERIG es, Coe 2 ee 86
—— eat bat Vau DO Givaews ote. - .cce-cr «ote 78 — Therapeutic application of hor-
MVOMCS Ee 4 pipe OM hoe va lone oc: 67
— Thyroid deficiency.......... 101 Coenen, J. F.: Mongolism in child,
myxedema in mother........584 Cole, W. A.: Exophthalmie goitre,
<X=raye treatment, =. - «sens. . 419 Coleman, J.: Adrenalin anesthe-
Siawin tonsillectomy. ........ 42 Colistro, C. P. (Platero): Annu-
LATER SLOCLAN Seer n a. s leioyava sls os 13
Colitis, mucous, relation between OW UVa cel Care ey pe cs). rd feito 2 392
Colloidal gold injections, admin- istration of adrenin preceding. 348
—-—reaction suppressed by ad- renalin ingestion ...... 348
— quinine injections preceded by administration of adrenin. .348
Colquhoun: Diabetes’ mellitus, case OL apparent recovery....360 Colon, resection of, in goitres. 472
Coma, death and, following op-
eration in diabetic gangrene. .553 — fatalities in diabetic cases re- SUL eE LOM a scare = 2 scree 552 —never develops in edematous CAS CSUeINC ae os are COS TOTES Ce Che tone ec etee cote Prien 548 — predisposing factors of......548 — premonitory symptoms of....548 = = FEFCALIMEIUMO te as Se a ee eo BO Comby, J.: Addison’s disease in fare b (O) bs dS}. cher aes Sue tagrondoloed, 6 Cole ng Compensatory goitres.......... 242 Compensating treatment in endo- Chine aGiSORders ae se es © oats 450 Condit, W. H.: Compensatory MENSERUACION. -sroree cae cistene even 81 Confusional insanity, relation of thyroid tO: <: fee secs ee Oe Congenital fragility of bones... .569 goitre, production Of. -.. 2. =. 249
Conn, A. E.: Effort syndrome. . .250 Connective tissue type of goitre.576 Consanguinity, relation between hypothyroidism and.......... 418 Constitutional endocrine anoma- lies ang ifections--. ---4e---- 33 == = (Soldiers heart). oo Corcia, J.: Papillary cystadenoma OL OVATY 2c ees ee ecto e Stoker 394 Coriat, I. H.: Thymus gland, col- IBY CXS umeecRarec orc iold iqacit: (S-Sacnceteeemyo so Corner, G. W. (Warren): ries and artificial deciduomata. 389 Corpora Mubedee serie eee eee 3 Corpus: uve wmM see ere eeeteree ee ve
SS DICER log ccs ot Go SIE 54 1
— -— abdominal affection due to hemorrhage from...... $6
Corpus luteum, a gland of inter-
nal ssecretion 2S ees. .- eee 191 — action on pupil of frog's
(ENS AER ee oo emer: Ae 154
a AnoerteCund abione ses as Sea — — — ovaries, antagonistic in
ACEION “Neeucde ete eteeeee 8 ——— —— pituitary extract) ther apy in menstrual dis-
LUPDANCES ta: as nies eee 5
= as a ealactozosuen == «sn loe
= CHOLESTELING tees = tee oe 191 —-control of nausea of preg-
TEGAN ON eoencecney Gack ROR ROR: Be oD eo —--——eysts cause - of ~ ovarian
SWEUMMOS! (6. cs ee et DS
== WOSARC Mea: aes oe 11535 aja)
—_ — effective in female only.. 13 ——'—_ |OXETAGCE ee oe ee ene 2 wo oe
——-— from pregnant animals.539
—— ny Orit eit Olas PLCS — TANGA eat) ss. 7 191 === = slow actioniomen. |... 059 — —-— action on genito-urinary Orsans eee | 3 09 =~ —— fOTMALL ON Ol eee cr = 395 =—=-— function >... sooo 3: — general considerations... .391
Corpus luteum, historical...... 2 —-—in dementia precox....... 13 — -—in hypertension in women.596 ——-— its relation to amenor- rhea, sterility, abor- tion, and pseudo ex- tra-uterine pregnancy.395
—-——male neurasthenics...... ie —-—-— menopause ........... ds ——-— multiple sclerosis: ....- iba -~-—— — neurological practices eee — —jin therapeutics... ......s55 539 —.—orzanotherapy. a. see 538 — — physiology... <5 2 stem. eee 2 —-relation of, to sex charac- CCTSoe ss ee ee eee Sy —-—relation to mammary gland 14 —_. ——" removals emect sof s.... ae 3 —_-==Toleok see ite eee eee ee 342 ——-— Secretion Of a hormone. se eee — —significance of........... 354 —— soluble extract of -..... 2. 191 —_ — — — dosage ............ 538 —_ —_ —--— value over desiccated preparations eas — — symptoms caused by admin- istration. ola. ee 391 =——-—— therapy 2S eee ikays tke! —-— -—jn headache of men- strual disturbance... 12 —— —- results ......3...580. 13
— — three phases of life cycle of.218 da Costa, A. C.: Development of adrenals=in- Gat.) ee ee 180 Coues, W. P.: Diabetes........ 541 Courbon, P. (Laignel-Lavastine) : Feminism following double or-
Chitis: =) Ao te eeee eee 225 Cow, D.: Interaction and interre- lation +). 2 os eee eee 507
Cramer: Ovarian transplantation.396 — Theory and treatment of oste- OMalAGIA Ss pos ae ica 395 Cramer, W.: Adrenalin granules in StUpPtarenialShpess ocyed- eee 496 — Functional activity of supra- renaliameduilllat ics ae 498 — (McCall): Effect thyroid feed- ing gaseous metabolism thy- roidectomized) rats... ee — — Thyroidectomy in rats, gas- eous metabolism....... 572 “Cramps” in boy of one due to onanism! i... 2 See ee 563 Craver, L. F. (Murlin): Alkali in diabetes: ...< 5.805222 62 Cretin, clinical improvement fol- lowing administration of thy- Told hormones--5 oe le ee tel: —energy metabolism of....... 100 SEES Noire MNSa 5 Soe Soe s Owe ee Ol: 578 — metabolic disturbances in....592 Cretinism> 4.6 eee eee 234 == CASCSEOL >. ao sie es eee 572 _—and bone development...... 432 — blood “picture n= =<.-)-t2.- 100
Cretinism, case of complete, with
mermal mentality... .-. 2... <. 234 —— (P11 TIN Ome ero oth eee ee 98 ——-—_ in India, cause of........ 266
— influence of thyroid extract in.413
— hypertrophy of muscle in... .582 —— SINCUMOML Sate teehc eiters ft es ou si"sucrelle 426 — pregnancy in sporadic....... 428 = AOE AGUCMa erent, eal eks tottioses 3 99,570 —— BOGAN: PAIN Ove) sic nee hens o ore 8% 267
Crile, G. W.: Exophthalmic goi- TLC MRIMeCCIC OTIVIC.. cc 2 y0 ccs schon. 103
— Surgical treatment of exoph- Divine OlULE.. 2.6452 + 6. ss 587
de Crinis: Endocrine glands, ner- WONUSMSMSUCTM 1s 2). -c6s fren is be ss 199 MOT HELO cCLEN ON nt ce cote wo Ses case eee 493
Croftan, A. C.: Diabetic acidosis .547 — Edema in starvation treatment OmMMOnaDCheS shat oh ae Se 308 Crotti, A.: Goitre and pregnancy.105 — Medical treatment of exoph-
BRAC te OlLTes ....6 «2. > 2 « DIO Creyx: Tuberculosis and exoph- Ter OMIECs cies 5 2 ob cle 6 434 Crispin, A. M.: Glands of internal SBICIPSIETUT Go Aces oe CR Oe eae 386 Crookshank, F. G.: Nervous cre- [Pe TRSTt) Peg ls eee 426 Crouse, H.: Focal infection and exophunaimie goltre........ 417 Cryptorchidism, operative treat- GIT Ci cele, CRC re 94 ———aT MEO eaics oe nc feos ae DLO Csona, F. A. (Janney): Diabetic GUCCCIICSME hates, ol ead ead Spe ve 55 Culbert, W. L.: Status lymphati- EUS otha ko Eat ce nae na on
Cullen, G. (Stillman, Van Slyke and Fitz): Studies of acidosis,
Cummins, E. J.: Corpus luteum MEMES UNCY i). 0s oa 6 Sica clas ews ODO
Cumston, C. G.: Clinical symp- toms and treatment of hyper- trophy of thymus gland......567
da Cunha Motta, L.: Acromegaly.520
Curettment, post-abortion, pitui- (NOT Stak d saa ae ae a er a 89
Curschmann, H.: Menopause and TUS CET Vie eye) on bE ay avon a Sleds Shes di-< 110
— Non-puerperal osteomalacia... .537 Pluriglandular insufficiency... .370 Curtis, G. M.: Morphology mam-
milian seminiferous tubule... 66 Cutaneous manifestations of dia-
BELGE EreaLMent..) sccliccleme ens 5 54 Cyst tormation. in pineal::..... 443 Cystic eoitre: removal: .; <<... 1 —— paIMOr Of pineal gland.-........ . 78 — -— in region of hypophysis... 78 Cyclothymia an endocrine asthe-
UUM sis ors ch SS a dawns cee afl Gystadenoma Of Ovary......-.«. 394 waunan, M.: Secretin...;....... 90 I SCCretin POWGEr.. . «2.5. 2c. > 91
——Dyroid, adrenal. .*...3,22.¢. 98
Dameno Enrique: Diabetes in- , SUPILGUS eee emcls Gc 2s oc ns OOO Danforth, C. H.: Germ cells..... 372 Dannreuther, W. T.: Corpus lu- teum organotherapy ........538 Danoff, N.: Influence of spleen on respiratory quotient.........565 Darier, A.: Hypophysis, Roentgen MEDS tee cteme ele etter eta c cs citeae iso vers 77 Dansey, St. J. W. (Lipscombe and
Browne): Hemorrhage from COLDUS LICE WMI ss See woes ee 86 Davidson, L. G.: Laryngohemi-
plegia following goitre opera- tion Davis, D. M. Henalse WKTAMEY Ss 26. chess. 6 oe 4 Day, G. H., Man with 5 testes.... 9 Death in acidosis of diabetic ori- (6a sr ee ace 3 ch Oy GI BION IE: — -Graves’ disease, heart col- lapse direct cause of....589 —produced by tying adrenal METIVS meen pis) teice ve lathes Saw e sctee outs 1 —rate from diabetes insipidus. .: — sudden, due to status thymo- lymphaticus —-— during tonsillectomy......568 Debove: Exophthalmic goitre....110 Decker, H. R.: Pancreatic insuffi- GIENCY A Oe WAMteSte 22 eee DS Deficiency disease, pathogenesis Ole ton sf ete aakcss, cacuserioneieat see conn Delprat, M. (Robertson): Studies One SRO Witla exe 5 5, ces ce oS eusle Sule Dementia in case of dwarfism. ..526 — with glioma of hypophysis...525 Dementia precox, corpus luteum MITTEN RN kee oon oy Oracle on vou ar ret ils} Denk, W. (Hofer): Tracheomala- ClarManideOlere.., 6. ccs-. «ee ta 432 Dennis, W. (Aub):) Blood sugar inwhyperthyroidism ............- 411 De Noird, H. H. (Schreiner): Dia- StatiGesactivitys Of, DlOOd.... .,.0 «5. 219 Dental operations, adrenin with DROCAIMU INS. ci chee 6 oteh3 we eens « 49 Depancreatized dogs, effect of ex- ercise on blood sugar of...... 61 Deutsch, G.: Menopause and myx- CU eCIN Aer ctrl ss chase St Oe. Development, influence of thyroid
(Marshall): Ad-
PLePATAIONS, wONeen tee oe <3 DSO Dextrinuria, glycosuria compli-
CALCUL NE ewe WneNe cleteee ts. eres a 358 Dextrose, concentration in _ tis-
SUC Sree eres each Soe cls eae 364
Diabetes 52-62, 191-195, 354-366, 510
— absolute, with return of func- tion
— acetone bodies of blood in.... 53,194, 354
— acidosis and its relation to su-
gar metabolism in........ 62 Se ETI 6 eric toons aither che eal a ace aetess 53 — acromegaly with........ 175, 486
— Allen treatment of...61, 364, 556
Diabetes, Allen treatment, report
OISCASCS hy crs nk ois ee saeusie ts pie — — its treatment............ 541 —~ — pancreatectomy, relation be-
WIG GiN «ai OhS Sore eine Ga DOD =I ISI AICAleGISGASCS.. «ene shane 543 SS lig Sted Sao ET oes ese} — anti-diabetic substance ...... 60 = [NN OLOG! GSN Tad S¥6 & G Glo ou OE 3 — — — — human .b42
——=— —and residual carbon in® 197! —ecalcium soap deposit in liver
CUUNTDN eetesecre: Sascossyans: sree 192 =r CASES O fae or aie esis nee eee = COTS City oh bw bos doses cMOUs DOW — caused by change in hypophy-
S1Svaeee Suc Pee SE eg WM cat aye doae me 48 —changes of refraction in....361 — characteristic habitus .......549
— complicated with tuberculosis.555
—cutaneous manifestations of, ELCAUIMEN = cutscene nee erences 54 <= (jaihiinOi So 5 a8 Gogg owen oes 486
—degeneration of islands of Langerhans in pancreatic.192 — diastatie activity of blood
1116 Vie ee eee OSE es rattC 219, 553 —diet and conditions during
Walls. wosctecingit oncus ates dsy arene seins 544 a) fh pe ee OR DINS ote ra or eeene 61 —(retetic: MelMS) iM ammesns ce ctacens IT ——I(ietenie theatmlentt= «war. ace 2 een 62 — differences between human
ANG waAvvielalicns spears DOW — distribution of blood sugar in.191 — edema a danger signal in treat-
IMCNUTOL Sohne eileen 358 — elements of successful treat-
TVG G ee nee che Sere OIL — experimental in dogs........549 —— fasting treatment of....192, 510 — following head injury....... 509 ——PIVCOSUMinhay IM. Sh eeieecee + cue cea ee == OM VenyCOSUTIa. «+ e.s susie sues 487 — human, rapid clinical changes.550 —— hypophyseal “2 5. steers cue eee 485 — in children)... . 8:22.52. SOON oD —-—-symptoms ............ 209 — -—jinfancy and childhood... .273 —in patient with obesity...... 562 —— ANSIPIUG AMSTEL Caer, a1 ere ee 56 — keynote of treatment in.....550 — laboratory control of........ 194 —lay description of.:..:.....-/541 —— lipoidssin DlOOde. = S.-— «ares ise: IS )S5 —low protein tolerance in case
(ON ns O'S GYA aC OU CROAT ae era 490 — metabolism in ......... UNAS Bhs) {i — and treatment in........... 58 — modern views on........... O'S — morbidity in Germany.......543 — mortality statistics among
Wii? CeCarMeEs cies ss cbe.e es 59 — myxedema, hypopituitarism .. 59 —of marked severity......... 60 —of traumatic origin, case re-
DOLE Fe: ceo ee ae eo oe 510 —— DANGECALIC, acai ae peace os 195
Diabetes, pancreatic, in dog.362, 363
— possible cause of human....550 —present outlook of treatment Ob > jets Rsteepe ce ee 366 — reduction of mortality....... 552 —remarks on Allen treatment (0) eae RR Hs lame ein SRR 552 ——- iF CNAL <3. <) swemesedoms oun eile eee 193 — results in treatment of...... ie —— role! Of; Lata iene a emenene 365, 554 ——(Salht metabolism. ini-ts-a. eee 363 —='SCr Um: ‘POP ssisne eeosasc eee ee 194 — similarity between human and ATC CIA ic sees eek Re 550 ——/SEanVatlOn: IN. casio aoa once 61 — — treatment of..59, 361, 367, 547 — statistics regarding ......... 551 =—— (SUEZ CTY a1)» cv. mcacusectcac eon eee eee ais) — syphilis of pancreas with..... 61 — UN COLY, Ole «5 ce cnenstsaswahoun meee 194 — thyreogenic obesity and...... 562 —thyroid treatment of patient With’ \ODESItyi. ices susie eee —— Er avuInatiC OFZ Olean ee eee 543 — treated with hypophysis sub- SCANGCE: gays. 4s io seek Oe 488 ——— Ur eCabmMenic .Oke, cuacderbeneneie 194, 557 — — history of advances in....556 —— War—@ilet—and anise ak ieee 62 —— Wilh Ne DINCIGIS: srs cane aeeeneeees 59 Diabetes! ansipidusvcs-5 eee aya) —-—aa well defined disease..... 195 —-—— cause of polyuria in..... L741 —-—due to hemorrhage ...... 360 — -— following hypophyseal in- VUE: cer sc a east oe 2 — — from hemorrhage in neuro- HyipOP HY SiS ss see 206 — — hypophyseal extracts in...521 — SIM SCHIWN Pe essences ee ee 533 —-its relation to hypophysis and tuber cinerium..... 524 —-—metabolism in .......... 195
—-—not of hypophyseal origin..525 — — not present in case of hypo-
physeal dystrophy ..... 523 —-—of pregnancy, relation of hy,pophysisstosn. oie ie —-— pathogenesis ........... 56 —-— probable center of produc- tion”... eee eee 525 —-relation between diabetes, mellituswandgiees see 558
—-—-of hypophyseal disorder in mammary cancer to. 74
— -—report of two cases....... 523 —-—symptoms controlled by pi- tuitary ‘exthact:e+ os. e. 382 — -— treated with pituitrin. 206, 520 —-—treatment of ........... kil
—-—with polydipsia and poly- uria treated with pitu-
IGTING Bias See cee ene Diabetes mellitus, Allen-Joslin treatment. Ol tock eee 361 —= —=|ACIAOSIS: -IMy cesses Semone 542 — -— Allen treatment ......... 556
@iahetes mellitus, Allen treat-
ment, in five cases..........052 —-—and pancreas ........... Oy ——w— syphilis ............. 544 —-—blood sugar in ...... 356, 543 —-——case of apparent recov- GIP > tv ERROR OEE 360 — — e¢lassification ...........- ae —-—complications ........... 487 —— detection of fraud in..... By Se CE aes Lone a Ole 445 546 — — diatetic management of...553 — — exercise in starvation treat- TINCT OLS mS ouoss;<1chs a seaece oss 546 SS Fit TTT CT en eres 4) = CMNGTeN, ~ ... ss, 275, 544 —-— modern treatment ....... 545 —-— mortality from .......... 541 — -— predisposing causes .....544 —— psychoses with ......... 360 ————. recent, studies.in-.......-.:. 361
— relation between diabetes
BU GLDUGUISE ANG. stern <. cirane ano, OS — — starvation in treatment of.556 —-— sugar tolerance of kidneys i 23 >= eae 58 — —three types of...........546 — — tolerance and utilization of SUNCORGY Shi eee ee 356 — — treatment Dien eOn Ae. OD WDTAD CEC SACTOOSIS oo ins fone, crea inns BOO. OAL — blood, glycolysis in .......... aa} SS (TT TTS OS IE eee ee 554 —-—death following ......... Bic —-— time of occurrence....... 548 — conjunctivitis, case of....... 52° GESTS ea een eee ee 55 — gangrene, Allen treatment in.553 — question, investigative and scientific phases of.......550 —-probable relation to prac- tical problems of clinical PIO OMCTINCH clots 5, oye véaopencWe. ous 550 —ulceration of pharynx and UMTS etek cp oh asces 4D Din .O — treatment, present outlook of.366 DIARSMESarSAUEVia) AN . oes tees cease DD Diagnosis and treatment of pa- tient, new point of view...... 164 Diarrhoea and tetany, two fac- POLSMOPECTALI VG IN cs veccdas caso Ob Diastatie activity of blood in dia- [RGLUGS sy BENG ese ae eee 53 Dieden, H.: Adrenin and secre- Uy * WO OSI AER Ng he 183 Diesing: Adrenin treatment of inflammations of respiratory BUACIE Ie On ore ee a he DUS Diet, adjustment in cases of dia- betes in elderly people.......556 — deficiency in, cause of degen- Sravion in testis’..'... 5.5. 227 — in diabetes -61, 195, 546, 549 —-—diabetes mellitus ....... 361 — —— —in children ........544 — — hyperthyroidism 456 — -—tthvroid diseases ........ 412 — lists for diabetic cases......555
Diet, rest and hygiene in treat- ment of hyperthyroidism. 478, 479 Uh
Dietetic helps in diabetes...... 35 — management of diabetes mel- MUGUSEEeR eek ices ie 6. cine 553 —UreaLment Or diabetes. ...... 62 =~ ————_ — mellitus. ...... 544, 546 Dietetics, diabetic, glucose form- ation from protein foods..... 55 Digestion, changes in blood dur- ing, influence of secretin on. ..563 — internal secretion. of........ 63 Dilatation of pupil following SANSIWVECEOM Ys “— ane «sss ss ses, 43 Diuresis, hypophysis as regulator Oli teh o-3. dipeey SCS eee eee a — relation of hypophysis to. .70, 75 Djenab, K.: Secretin and pan- CROCUS Berar hs seeege Cent. ore teen Ad. Domingo, P. (Nubiola): Ovary.. 84 Donaldson, J. C.: Adrenal gland Nea NN Onna meet hep oe ee 344 Donk, Rose R.: Dietetic helps MeO CLCSSen ne ea aii
Dorn, J.: TIM Ms ttc es Botte cae loo ara ce 423
Downs, A. W. (Eddy): Circulat- ing blood during digestion.... 91 — -— internal secretion and bile. 214
—— == secretin. and change. .in blood during digestion. .563 Drinking water, goitre and..... 419,
OD ke i.
Drips, D. G.: Studies on ovary of
SPS uNTO DM Chapstne rye ca ae 218 Dropsy following pineal enlarge-
JO TIES aT EW ches Pea Ease Os Stee eo 445 Bruck, A.: Traumatic Addison’s
HIS CAS Cha Nes erases o sucess, OD Drug treatment of Graves’ dis-
CAS CM uome ener sh cys) ciret si ohoauae. owe 11 cm once ONL!
Drugs, action on adrenin output.501
Dubin, H.: Urobilin elimination 92
Dublin, L. I.: Diabetes mortality among wage earners......... 59
Du Bois, E. F. (Allen): Dia- betes metabolism ..-: .... 58 — (Gephart, Aub and Lusk): Clinical calorimetry ......357 Dubois, R.: Secretion......... 90 Dubs, J.: Hemiplasia of thy- TOW are tay Sy carded, SEAR Seco, he 421 Ductless gland chain dominating 8 am cha eae ed Pa SE 2? Sec 371 Ductless glands and atypical SLOWU Ne eee Mote l+s... . . haliO ee CUO CCS coce. wie.c. «creed 485 = —— Cli eehoG! hee ee ee OXI —-— metabolism in diseases of .513 —-——phosphatides in ....... 368 Ductless glandular disarrange- ment aé_ pluriglandular’ syn- ROTC. foo in cits onc see AS cee 476 —-diseases, clinical aspects OLS oh Hy Seve ee ee 512 — -— disorder, osteomalacia a..537
Ductless glandular disorder, X-ray and electricity in treatment of .198 —-— syndromes in feeble mind-
SOG rare rsh cenish ey so iohis! ofr Boas 5 i'5 Draper, G.: Diagnosis and treat- MUCNGMOL SP ACLEM Ger. cate couse cen 164
Duesberg, J.: Interstitial cells. 96 Dunhill, T. P.: Surgery of ex- ophthalmic goitre Dunn, P.: Thyroid therapy in Opthalmicopractice: 52.4... caecou Duodenal Duodenum, distribution of secre- (oh eleat nee AP lage Gu echiot Sem AUE oo Te — extraction of secretin from... Dustin, A. P. (Zunc): Functional relation between thymus and thyroid Dwarf growth with atrophy of anterior lobe of hypophysis...37
Diwaniismy Wen. «nce Bld 5216, 2 Sia bio2 —due to thymic disturbance. . .567 —— JmPamMetiles os. eccgcs omexioushoesue! ters 210 — with atrophy of anterior lobe Ore JAVON MSIE Go oo 5 6 oO DA Dyshypophiysismy Vs 7-seus < ere = sees) sn 382 Dysmenorrhea, X-ray treat- MCT. Ae a ihoecaren mere metas ase USS aye irl —-— glycosuria and dementia. .526 Dyspepsias. adnrenialyys cts see 343 Dyspituitarism in girl of 15....205 — pudding facez type Obes sue (3) —— TLEport. Ol, CAaSCSheaacaesioteceieiens 207 ——— Thy Told sexthact wiles eels 402 Dysthyroidism, blood pressure in.246 —— Of Sy philitic Oniginig. ce Pea Ay ——~ thyroid extrack sims erature 402
— with influenza and loss of hair.583 Dystocia and hypophyseal extract 73
== ACID OSOLEIMICALIS metal ais] oe eeeeOeIO —-——a case ........... eaeeomes — — —fat distribution in..... rele — == sinew Brazile oss a sls we 208 —-— in women, a study..... 207 Dystrophia sclerodermica, case Ola ORR. cee he ones Dystrophy, case of genito-glandu- AT» Aik Syke <i-o1 Seema eae mea erereks 374 Dziembowski, S.: Dystrophia adiposogenitalis with myop- ahs oo aise en ei eee es ee!
Eadie, J.: Bilateral suprarenal hemorrhage Ear, case of inflamation of mid- dle with hypophyseal tumor. .525 — in disease of nose and throat. 98 Eberson, F. (Flexner and Amoss): Choroid plexus and experimen- tal poliomyelitis Eclampsia, probable cause of...308
— role of placenta int... 2... 307 Eezema in infants, and thyroid Flandre 2 eee ses 417
EFddy, N. B.: Thymus gland in exophthalmie goitre
Eddy, N. B. (Downs): Circulat- ing blood during digestion.... 91 — — Internal secretion and bile. 214
—w—Secretin and change in blood during digestion. .563
Eddy, W. H. (Roper): Pancre- atic vitamine in malnutrition. 87 Edelmann, A.: Osteomalacia...349
HWdema a danger signal in treat-
MeCHE (OL IADeCTCSmieea eee nee menete 358 —— CITCWMSCHIDC Ceti eaenlemenens 385 —familial angioneurotic, with
CGLANY. >see ne eee een eee 569 —in hypophyseal cachexia..... 528 — non-occurrence of coma in...548 ——tHe6ORY Of ec isis whee vedas 6 eee 434 Edmunds, W.: Eye affections, ex-
perimental thyroidectomy ...248
Effort syndrome considered with exophthalmic goitre
von Hicken, C.: Goitre operations with tracheoscope ...........580
Eiger, M.: New method of isolat-
Ins NORMONCS cesses eee eee 245 Kiken, T.: Osteogenesis and
OsteomialaGia-)s sees 4 eens 536 Eklund, J. (Engfeldt): Aceto-
Nuria ang@delactatiOnn. ease 215 Mlectricity, in secowre. eer 433
—-—ttreatment of exophthalmic goitre and ductless gland-
Ulan disorders arcs 198
— static, in treatment of Graves’ GISCASEH. 358 ance geet omens 81 Flectrocardiogram in myxedema. 592 win (Guraviess GISeCaSC rie mete remen SS
Electrocardiographic observations in, COMIC LOlULe ee ase 413
Elphinstone, J. H.: Novocaine adrenaline stock solution..... 506
Elsberge, C. A. (Krug): Hyper- pituitarism relieved by glandu- larctherapyens cee oe ee Or
rmile-Weil, P.: Menorrhagia ar- rested by hemato-ethyroidine..569
Emmet, A. D. (Luros): Absence of “fat soluble A’’ in certain ductless! ‘lands! -...- eee one
Emotional disturbance, adrenal ExDiauStionm by. ack mie Mera
Fmotions and internal secretions
Encephalitis, chronic 2
Endemic goitre, cause of.......58
— —effect of typhoid inocula-
tion
— -—— experimental investigations.236
— probable pathology of... .585
——|—_— NRO Ph ylaxas) Oh geneween 585
—relation between, and min-
“ eraille waters sac se eee — —-—of thyroid mechanism to 97 ——transmission by biting in- SOCU ciwak easter eee 106 Endocrine and _ vegetative ner- WAOUIS) Khuen 5 soc bevoossooc One —anomalies and infections... .339 ——— — SOLdler Salle atm. tewem mera 2388
Endocrine anomalies and war psy-
choses ===> DSU ETE Ae cOe aM een es eee ai al — diets in growth of tadpoles..
—disorder, uric acid diathesis
AUD 5 aebecnaeop nes aaa ee 195 — disturbances in case of dwarf-
TESTIS -tey-pient gn pa acre MN AER acre 567 ——-— jn war neuroses.......... 199 — dysfunction causing skin dis-
CASCHeE een cate ois ts Sele Sp 499 — explanation of menopause... .494 = TtHuchOM. OF “SOnAdS.%.... 2 o6203 Hndoecrme -elands 5. .2.2%55.. 196, 199 —egland disturbance possible
cause of stomach disorders. 223 —— action on of placental ex-
RAL tere eet coo. fea es 3s he 224 —-and bone dystrophies..... 367 —-—-— diabetes ............. 485 —-——nervous system........ O'S — — -— osseous dystrophy...... 63 — — — senescence in dogs..... 196 ————-lOOd SUPAr sacs os ss ek 63 — changes in following pin-
CAICCEOMY «2 onc22 ccc tee es —_— — — some forms of in-
Samityer ac 5 sss aDiso — — dysfunctioning during preg- iTETECA clei Rao eaesCaneRE OR ROMEO at —— effect of removal of epi- thelial hypophysis on QinlaveTe 5:5. dee GSR e REET OROEE Se,
—-—of tadpoles, studied upon. 242 —-—relation to vasomotor dis-
turbances of air pas- SOUR) 12 oy ct care eu ae 367 ———— FeO Or i INSAanity...: 5.2. .0oD
— glandular feeding to chicks. .200 EMGOETING OPLANS . .oetoic ol letecefe os
199-201, 370, 512-516
16
— —activity diminished ...... 5 —w—and sympathetic nervous SISTA lS As 200 = = (Sh ENC ae 64 —— iP OMNATS AS . 2b ee we we ew ee 16 — -—jin deficiency diseases.....201 —-—no abnormal function of in case of scleroderma... .56%
—— regulators of metabolism. .596 — — relation of sterility in wom- Erno) Sey cee re ieee nn aee 201 — — suffer as result of toxemias.449 —— therapeutic suggestions. ..199
— origin of alopecia..........509 — pathology of war........... 329 OS ANCE oo) 2.2 conan, 0% © 6, suai. e ve foc 3 —sex gland as fundamental sex SOTIECHIIEG: (ccs sic. we one eee LOD — system and uric acid........ 202 — -—jn control of urine secre- ITSO lee oe, ens, +. oc one a Oe — symptoms, types ...........ddl Fndoerines. dominance of...... Sil Sumrdoerinolepsics» “oo Shit... aA PMAUETINOLOLY > 2 va. bee ek Sere 371 and opotherapy of shock.....292
—an oto-rhinology
Endocrinology, early history....511
—IEVOlUtON OF Soe< er. 8s. ee aiff — general conceptions of......511 “Endocrinology, purpose of pub-
MNCaAIONM ass sass eee es Ss. Soe PASSES Endocrinopathic habitus er) INNNEeTItANCC Yaa A ess che coke we 63 Endocrinopathies, early recogni- ONE OlseSOMNCY: si teas fe es os 5s 368 Endocrino-sympathetic syn- COMES Hwee. eo i ee. ers Sion Endometrium and ovary, rela- won. to hemorrhage .. 2. 35..: 85 Engteldt, N. O. (Eklund): Ace- LOnUnia and lactation. ¢.. 55. . «215 Epilepsy and ductless glands... .200 — -—thymus involution .......568 — hypophyseal adiposity in....522 — pituitrin in treatment of idio- DaeMCeee sale 2 Sakon a.s Be eA Epileptic attacks produced by GIO TNIM GS A aicepe youd cuckoeris aA ey Sc 349
Epileptic subjects of status lym- phaticus, X-ray treatment of. .568 Epinephrin, see adrenin.
——ACHLON ON: Welter 7.05 3s 2a 2 44 — liberation from adrenals..... 41 —— of into blood............ 40 _—in muscular activity......... 145
— presence in human fetal adre- nals
Epiphyseal lines, changes in, in
Pubexrtasmeprecox = {a sss. 5. se 465 Epiphyses in pubertas precox...459 — retarded junction of........562 — slow development of in cre-
HELIUES IRI pe eet ees oe ok ete e eOnne
Epistaxis arrested by use of thy-
LOU Mm tee el. ee ee OR Epley, C. O.: Significance of cor-
PALS INTE CUI eee bcieieeedslc sc sien e ete 354 Eppinger, H. (Hofer): Regener-
DeOMean Gath ynOldinn. «5 snes. aha ler;
‘Epstein, A. A.: Influence of re- nal function in diabetes mel- RUGS EEE 26s volerowe aeeoro OF
— Sugar tolerance of kidneys... 58
Freole, C.: Internal secretion of HHI KOCTTNIE Rade ete a ceca ce 6 GBB Zar:
Frgotoxin, action on ureter..... 44
Frlanger, J. (Gasser): Secondary traumatie shock. III. Circula- tory failure, due to adrenalin: .508
Escudor-Nunez, P.: Adrenal-ty-
SO cKONOL! G'S Gees cats o CecrOeMGKALo renoErnS 40 — Adrenal typhoid syndrome...503 ENGOCHINOlOSY) |... .6 cae in wo OLE Btienne, G. (Richard): Basedow’s
GUISGAS CW ie. "et oneeiecsus. steneediadarene 245 —-— Basedow’s disease of emo-
Somis) Gisease. ... ss seca Eunuch, testicular transplianta- tion in runuchoidism — case of
— description of six cases......516
Eunuchoidism, report of cases. ..203 —= THETA Dy) WN wis. eens saete wets ee aia Ly Evans, H. M.: Mammalian ovary 895 Evans, J. J. (Assinder): Pitu- LUATY nba mulls yee cecwcie aru Pain| Evans, J. S. (Middleton and Smith): Tonsils and thyroid GisturLbancesi ye sc ac eeeee Coe 102 Exercise, effect on blood sugar of depancreatized dogs ...... 61 —in starvation treatment of di- ADCEECS) pc ee cs eke Sigs SP echoes 546 Exophthalmic goitre 415 351 55 5116 —— -— ACCESSOLY, LMyLOIG . 4. 22 ee 103 KE ae Gon elon econ bya ae — -—and basal metabolism..... 99 — — other forms of kinetic G€LIVE"< San Heo eee 103 ——— —_ ovarian deficiency 234 —-—— syphilis ............. 36 = AOECA “N. Sey ee eee eee 235 ——-—— Plood. ndings ins seen ao —-—ecauses and prognosis of. .412 ——cerebral nerve disturbance 15 Se eran EES BI as a cl Mi 100 —-—change in views regarding ENCTA DY: Ole pues) = 482 ae CHT OT Coe ie ee = —_ Cire lacOLya SY SUCIe Elta. sea oae 589 __ classification of treatment..454 (INKL eh aon oT ee cue 454 — — discussion of clinical -as- DCCETs eee. “as oe 110 == etiolo sy nO bee ee — —-— and treatment of. . 250, 414 — -—focal infection as possible Cause vol. os 2 ea 417 —— ——in' children’ *... 2.24 si. 2h 415 — —— consideration with ef- fort syndrome .......250 — = Il Of Ae PSS. oe eet — — injury to nervous system as causerot, 25, Soe. Senos
— -—jnternist in treatment of. .591 —-— medical treatment........
103, 430, 583 —-metabolic disturbances in.592 ——— NIN OT) Boyce; 2 snepettems aareee ts 244 —-—nervous and mental symp- LOTISBINY Bi reaeas. foo es eee 234 —-— non-surgical treatment OR re ents LS ore ee 426, 591 —-—not an uncommon malady. 454 — — occurrence of ...........579 —-— operations for .......... 103 — -— operative treatment, recur- rences followin’ =. ...5.2 479
— -— outside realm of surgery. .473 — -— peculiarities in symptoma- tology of — — preoperative considerations.248 — — radium treatment of. .103, 576
— -—rational therapeusis of...467 —— recurrences following oper- ative treatment ....... 478
Exophthalmic goitre, relation of lesions in cervical sympathetic fangilia. COs 2 eccpsks Gus See 415
— —results of operation in....112
— —role of thymus gland in...
— -—successful therapy of..... 235
—-_—surgery of ..... 416, 468, 587
—-—suspected in cardiac dis-
turbances of soldiers....244
— transplantation of thyroid
FlandS OL. cit. oie 236
—-—treatment ..421, 576, 587, 597
— — — by internist and surgeon.458
— -—tuberculosis and ......... 434
— -—with Addison’s disease....
— — X-ray and electricity in...
— —-— treatment of..104, 419, 597
Exophthalmos, experimental hy- DerehyLoids. aoe 3 oe 246 Exposure to cold weather fol-
lowed by ‘‘idiopathic’’ tetany. .558 Extirpation of pineal, difficulties AUT OUI Oks sce. ne 438 Eye affections following thyroid- COLONY pe fg e)c chee ial « ae ee —and endocrine organs....... o4 —in disease of thyroid and thy- MUS. svassiassegae +c ee ee ee 98
Fabian, E.: Surgical treatment o£ ,\Grawes:-Gisease . 2-5 eee 429
Fabre (Gaillard): Glycosuria with maltosuria and dextrinu-
PUSS nics eacnnlaviuks yoeet a eee 358 Mace. .edema Ole. a. eee eee 569 Fahr: Experiments on glycogen
QUWeStION” 2 oan cn ke ee 54 Fahr, T.: Histology of goitre
MCArt 9 ecu FS oes eee eee 581 Falls, F. H.: Thymus death..... 96 Falta, W. (Bernstein): Respira-
tory exchange, blood sugar
Dep NM KON OY woesa a Mae Es OS amS n2 193
AMAT ODCSEUY esos ocean ey eee ele
Tiny ces see eae eee 92
tS DLENOMEZALY s *= ahaa). ys see ee 94 Farnell, F. J.: Vegetative ner- vous system and internal se-
CLEETIONS 3 ous30 cee 387 Hasting, in. Giabetes ss. = sae Fasting treatment of diabetes,
see Allen treatment also star- vation treatment.
SS Se ee oe ee oe eee 510 — — — — clinical aspects of...192 — — — — mellitus 2 pli) — — — — in elderly people, not recommended ....556
Fat intake, regulation of in dia-
betes smieliiGusmers. cede.) cee — role of in diabetes...... 365, 554 — tolerance in diabetes........545
— —of diabetics as important as sugar, tolerance: 2552040
Fats, cause of certain acids in dia- betes: 6) Fuckers eee ee eee Fatigue recovery, adrenin in....147
Fearnsides, E. G.: Dyspituitar- TST) Ste eee re See 73 — hypopituitarism, etc. ....... 74 — myasthenia gravis ......... 82 I SCLELOGECTANTA. <a six 0.0 © sens) « os 112 Hecundatron. “date Of). ... 5... .+ 215 Feeble minded, ductless glandu- Late SVMGTOMe. IN: > <5: c-cne sae a cD Felner, O.: Female genital hor- PUOUMCS a ager een ON 5/3 stn anancen DOO
man Feminism following double orchi- MISE Ped otc ceria ssi ctors! so a lece ese oa 225 Fenger, F.: Phosphatides in duct- ESS MULDINS ti. nas a ie «noose oi0:s 368 — (Long): Reaction of pancreas 86 Ferry, G.: Altitude sickness and hyevencGsot AvVIAtOrS.. «..,..... < 4 Fetal and maternal athyrosis....2 Fever causing a reduction of urine in diabetes insipidus... .524 — recurrent adrenal insufficiency
Tih 2-28 ache eee 178 —not accompanying inflamma- TEOMONMOR CS. Sac xs. oo ns te DOO
Fibrillation in mammalian heart, control of Findlay, G. M.:
PSHM MEeSATUOTS: oss cc eek su. o's « = 422 Findlay, L. (Paton): Tetany and
PAaTnsenyToOrds= —.o 2 ok... - 960 Fink, J. W.: Lactation in a calf.215 Fischer: Eunuchoidism SS ee Fischer, J. F.: Treatment of
Graves’ disease with X-rays. .594 Fitz, R.: Acetone bodies in blood
int! (Chie OS Vee es 354
— (Stillman, Van Slyke and Cul- len): Studies of acidosis, UVM, ee en oe. cca OS
Flather, M. D.: Blood co —
islands of Langerhans. :
Flexner, S. (Amoss and ee
son): Choroid plexus and ex- perimental poliomyelitis Sisal
Fleischer, B.: Atrophic myoto-
TE PER EME Ref LOG uc Scie tor Sieh arene nye oO UL Fliess, W.: New. hypophyseal
SVUMMCOMUCOMPICN «.....0 2. wee E aa Floeckinger, F. C.: Ovarian se-
CETerOn tang Uterus.«..2...%. 0... 540 Flores, C. F.: Action of adrenin. 42 Fluorides, influence on growth...585 Focal infection as possible cause
of exophthalmic goitre....... 417 Fog, J.: Case of polyglandular
PASHMOTCLENCY:) 20. "sues. Decks ee DOL Foges, A.: Mucous colitis...... 392 Folley, C.: Aorta in exophthalmic
PURO MEME ce 3) Sica dh oats ats lee ee 235
Forman, J.: Carcinoma of thy- nota) fland “in dogs... ....2..5 Forster, Laura: Ovaries in men- HAPCINCASE? 6%. 4/5 5 be eRe se TR 389 Forsyth, D.: thyroids
Oo et a |
Fraenkel: Fraga, C.:
Hypophyseal cachexia.527 Adrenal form of ma-
EWEN he esr Sacchi ee ee IL (ly. — Suprarenals in paludism..... 347 Franca Rocha, A.: Adrenal or-
An OLMCEADYs eens eyes ar susk so es 345 von Franqué: Internal secretion
of ovary in osteomalacia..... 396 Frazier, €: H:; Toxic goitre....117
— Toxic goitre, surgical therapy .573 Fremont-Smith, F.: Treatment of diabetes 5 Fridericia, LL. S.: Arhythmic pulse in Basedow’s disease....587 Friderichsen, C.: Adrenal hem- orrhageniny imfants.... .. «...<<- 498 Friedlander, A.: Thymus enlarge- LOOSV AIT CHONG 5.5 gee eens, Gi ae See ae 406 — (Freyhof): Neurocirculatory Girl aero hs aie er oe eee ee 243 Friedenwald, J. (Leinbaugh): Allen treatment of diabetes. ..364 Friedman, G. A.: Adrenalin and pilocarpine injections —Influence of parathyroidec- OTL gs crey stow cies cutee ioe or neoks tayo’ 3 Freyhof, W. L. (Friedlander): Neurocirculatory asthenia ...243 Hoyimoto, Bo: Secretin:.~... .. 91 Furniss, H. D.: Post-abortion cu- rettment Butcher, “T: B:: Acromegaly....347 76 Gaiilard (Fabre): Glycosuria with maltosuria and dextrinu- TAGS A CV ie eS 2 oe 358 Galactogogic activity ANNE ee Meare le homeets oslo: saa Sc Ss ye 311 Gallant, A. E.: tic goitre Gallotti, O.: Endocrine and veg- etative nervous systems Gangrene of skin following anes- thesia with novocaine-adrena- lin solution 51
Garraghan, E. F.: Status-thy- THUS SLY MTP NALECWSM «sce. cee eee 97 Garretson, V. P.: Dominance of INMOCEMICS a sti meee: aces oe hg ieee sari al Gasser, H. S. (Erlanger): Sec- ondary traumatic shock. III. Circulatory failure due _ to AGMEMALLINS StAlcbezak axe te tyol ap tenses DO'S Gastric disturbance, suprarenal PlaAnduextract, ies. .c.1.'-'.-...040 — secretion, inhibited by adren- UNTO bos Oy eRe ae eee een 232 ——_ — — by pituitary extracts. ..232 ——stimulated by thyroid ex- BEACUMES HS ciel tise acu eel Gastrin, physiology of... ..'.2:. 63 Gastrointestinal diseases, relation of internal secretions to.....387 Gates, F. L. (Auer): Adrenin pulmonary oedema ...... 184, 505
Gay, L. N.: Leukocytic studies on soldiers with irritable heart.411
Geist, S. H.: Endometrium and
NEMORrN ALC wane cee ee 85 Gelser2G.7Mis= Sterility. 2.22. - 403 Genital function, stimulants of. .201 ——— IV POLUMCLION, sit... ase Dow ——orgzans, aplasia of... 2....-...502 —-—marked development of in
DOVROMIONEs o 62 cies DO Genito-glandular dystrophy, case OL eee et ne eS cn mos oa ae 374
Gentili, A.: Relation of hypophy- sis to diuresis and diabetes in- sipidus of pregnancy. ty Gephart, F. C. (Aub, Du Bois ‘and
Lusk): Clinical calorimetry. .357 Gerhardt: Cases of diabetes....542 Germ cells subject to selection. .372
Germplasm and somatoplasm, de- velopmental relationship, stages OD ston Mer tcereusts Bae oe IN Gerson, H.: Addison’s disease
and: selerodermia,.- -.. 22-2 oe 436 Gettler, A. O. (St. George): Mod-
ern: blood. chemistry. oe oo. 55 Geyeliny Hi. R:: Diabetes. -— -- 60 Ghedini, G.: Rational organo-
therapy: t See eee ee ees PAS)
Giacobini, G.: Thyroid sterility .587 GigantiSm: \ sccm oe oe ene ela — with syndactylism of toes. 22,02
Gillingham, H. P.: A proving of
thyroid -evand? pean eee eee 237 Githens, T. S. (Meltzer): Dila- tationsotpupls=s os eee eee 43 ituitrin and adrenin..... 88 Giron, T.: Masculine type of hermaphroditism 2. 4. - 222s. eps Gittens, C. W.: Exophthalmic LOUGEE HSI | 2 5. fie ene eee eee Mint Glaessner: Thymus and bone re- generation ze rs) Glaessner, K.: Effect ‘of hy pophy- Sisextracke. 2.45. ee See 209
Glands, internal secretory. .214, 386 — of internal secretion, changes following pinealectomy....439 Glandular extract feeding to Chicks AA eee... oc eee 200 — disturbances classification a a — nature of pineal body....... 398 ——\OFIZIN (OmODESIiy. eo Ae oe 64 — products, effect of feeding... .213 Glandular therapy in feeble mind- CdMESSE Sita weet este oo meth — — — homonymous hemian- ODSIa Feira. Sa cet em ee — type of endocrine symptoms. .331 ais CCE CULO M eaeer meer rans pre Sty eS oe 90 Gley, E. (Quinquaud): Adrenal secretion and splanchnic..... 180 >a — HuNnction Ofadrenalss...... 182 — — Function of suprarenals.. .346 Glioma of hypophysis......... S75 Glucemia and adrenin hyperglu- cemian ined Overs eee ee 189 Glucose formation from protein foods*im- dia betes ian sane 55 Glucose, metabolism of........ 199
Glucose metabolism, action of thyroid Dody Ons. oe pee 570 — and glycogen, relation between in liver cells} ce eee 554 — in diabetes mellitus......... 356 Glycogen and glucose, relation between in liver cell... eee 554
Glycogen content of blood in ex- perimental diabetes Glycolysis, agents which accel-
2 of: dE Pear see Sig, aralai cos as iri Glycemia, adrenin test......... 186 Glycerine muscle curve, and sex
MORMONECS: sfss.4, hxc cee eee 204 GLY. COSUTIE.. nuts sie Ree ee 53% —adrenin, and diet............ 349 ===. MIMENCALY, crc oe kene ce Roe eee 198 — and acromegaly, is it real dia-
DELES et i it ee 486 —effect of painting pancreas With aid Tena. Seno eee Dbl —— €rrors regardime .. ..c.. eae — Sao nine pancreas removal. . .220 REOULY 2 ori eheccicic cosh eet ene 546 — Sy neretveenin and, studies in. 59 — in case of dwarfism.....526, 528 =n “diabetes —..? 24-2 ee ee 549 — influence of alkali and acid TWPON Sage ane ee 362 — — —renal function on...... 364 —— Th. ANNE we ce tg a nee ee 54 —— === NEW: DOL, sick, sarees See ee 273 == MATK EG osc. ia ote, ci e == OL, GIAbetes 2... srcrsue ee eee 487
— produced by hypophyseal ex-
TRACTS oA cbc ee ees
— study of an unusual....).. 3204 —with maltosuria and dextri-
MUTA: = Specie eee ee 358
— without hyperglycemia... . .562 Goddard, H. H.: Pineal gland
CXCT ACH sce olor eet oper eee 398
Goetsch, E.: Thyroid disorders. .102
Goffin, O. J.: Persistent thymus.407
GLOLLT CS Rot et ota en eee ee Ge == (a UUSGMSSTOMG sects tae eve eee 105 — among draft men from north- WEST MSS) sacoctcr bas heme eee 232 — — the United States Indians. .105 —analysis of 125 cases, treat- Ment oc. ee So —and drinking water......... 41:9 575-5 tite ee ————_ pre eilaneyas. et eee 105 —— syphilis scs8: 2. Ae eee 36 — — treatmentas Ao 45l eee — cause of endemic...........589 — caused by Graves’ disease and VICE) “VeESaAs atieacse ee 598 — causes and prognosis of..... 412 — classificabionene se. eee 421 —clear diagnosis between toxie and non-toxice.eee 22589 — clinical experience in 300 oe erations: +.2%).40l5 eee 412 — congenital, study in......... 412 — diagnosis a question of clinical JuUGement “2 ses | eee eS
Goitre, diagnosis of malignant. .570 — differences between Graves’ MHISCASCHAN Ces cud ore seus le) =. oe 5.92 — differential diagnosis of forms OTE ass Ome DEEN eee ee 421 — distribution and etiology of. .591
— affected by parasites in
Gentrall ALTTiCa: ». =: aieesss 107 ——— Sim JIG i So era & 106 — due to poison in body....... 576 a= SS ieee Se ere Ce Pores fie — effect of typhoid inoculation (TEs (ENG CIMT Cees) eae «jo ehalcast 250 —electrocardiographic observa- TPGHIASE TE RP oo, fonce, Si ns ava feild ho.’ 0 413 OLS GETIOTE Via TH tic gence te lee ee ® api 433 — endemic and mineral waters. .106
— — experimental investiga-
FiVeh OS ae SP ae eee earch ete 236 — —relation of thyroid mech- AUSTIN On nore. cbswe, o/« iohs.2iay- 97 —-—transmission by biting in- SEC EW io Rees See Reo eae 106 tT SHMOlOS VOL .. <121-)-- -\exz 9 OOO = HiT CIE 5 Ee a ene Of eae SS = TT eins G oe ——AORperiMmental: IN TAS. .frci.. 2 Dl <= += HATICIOA Oe eee Ome OOM eL — from standpoint of internist. .372 — heart, fatty degeneration.....581 ——— ES LOUORSY TOL sic) s otere v0 2 2 OSL —— mechanical cause of. -592 —jin-crook ankle and stunted DIROA Li BS Seed crcl oe ok —in cases of osteomalacia... ..537 ——— I OINGPEN) oho. lesa slac sys e.5 420 — inflammation of, following PECTIN OWT air, 54 eide he. acarnls afielte 248 — influence of thyroid extract in.413 Sih Care fare) ad Ye eee ae 433 — — ——16............... 249 ce ERE ee ay ks iat BOK AOA A Oe) (ole. fe fe. Jao ee OUD — -— Western Washington .....247 —-— 583 registrants ......... Dol ——IMETALDOTACIC 2.5 o2452.% 109, 583 —w— in Switzerland .......... 587 SES Ce ee 100 — management of toxic........ alia ere ——=ECPASGAGIC: Gl. aieret & <\ cheiSheiecs «6 418 — more common in families of FNOUGG OLY Gis St. fie-cetetare DD --— necessity of accurate diagno- TDS. ote SHR S Aen 421 —— WOM -MITOCTIOUS «.o-< <)2 sche cove DTD — non-toxic, diagnosis and treat- RECT ress: CRANE So Peat A ore 234 —w— puberty, treatment ..... 421 eV abIONS = 5. <<< css sa wae ee 105 —— followed by laryngohemi- PETC es ois coyhise ve, Coes 107 — -— metastases following ..... 426 —-— with tracheoscope .......580 —pparalysis of cervical sympa- CEL Ce VUES bs 20a), sc eases ence 109 ADT LORY: OL es aie. o ote onesie: oho snes 240
— probable pathology of endemic.585
6/7
Goitre, production of congenital. 249 — prophylaxis of endemic...... 585 TAG OUMELAD Ve gles cata. oi =. sis 431 — radium treatment of.239, 250, 431 -—recurrences following opera- TUVSuELe ALIEN, = fe. as. «ec, oe 479
—yelation of some functions of
thyroid to — ———— thyroid mechanism to.. 97 —— removal of third lobe of cystic.112
SS eitnglen “Geis! 2 a6 joNeieno Olga means 249 Sonal ecouoid: 1m Cretin....-. 900 —— surgical treatment of........
a a Da En en Ls ye see 4c Sh)
— surgical vs. medical treatment. 421 — surgery, report of 28 cases... — sympathetic system in... 94, — three main anatomical types.
—thyroid and thymus treatment
430
SSG
Mie a Cac ER OE OO Co CaCI eS = texic-ttreatment, of... .....c. 080 —— tracheomalacia and .........432 ——treated with boiling water...431 =treatment of 1000 cases: ...- 431 ae AEV ICSE ites scene ore eistene oa Rol Th Us: ——use and misuse of treatment. 420 —with influenza and loss of
ING e ES Sls! S Siactaws taoma Slecrcuano 583 Goitrous tumor, CaSe....--:...-- 419
Goldenberg, L.: Endemic goitre.585 Goldenberg: Polyglandular syn-
GLAS ae cece cine o Ona O OO 402 Goldenthal, C. (Gottheil): Pseu- do-hermaphroditism .........518
Gonadectomy of fowls, Goodale’s
GXPELMMEMUS) (2.2 eee te See =< ole 203 Gonad extracts, influence on me- eile iistan, | os hae ee "a Ole neice ec meuctee 202 = Hormone action: OL-=- =~... - 26 Gaiavtls) soo SS aSie oretcnn ieee eon aO es oe 64-67, 203, 204, 372-374, 517-519 —and glycerine muscle curve.. .204 ——as controllers of characteris-
EL CSTE ere ete ance see SD OND —CNGOCKING OLLANS® «2.2. 1 =. 156 =“"endocrine function of....... 203 ——in case of dwarfism.........526 — influence on secondary sex
GHaractels see ae sor DOF Goodale, H. D.: Interstitial cells
UE ELO WV owen sees chan aus chs eke oso. 312 Goodale’s experiments on gonad-
CGLOMY OT OWS ca «cists iso « - 208 Goodpasture, E. W.: Senescence
riraWeta oyaes “S3 G ho ts Ot cence SONaeon CEE 1956 Gonalons, G. P.: Blood changes
after hypophysis extirpation. .384 =~ @holesterin: and OVAary:....< = 4 .- 391 —Cholestrinemia during men-
StU ACY OLS» oF 1-20. sete) ate ae 82 — Hypophysis and cholesterin. ..380
— Hypophysis and cholestrinemia 78
——Qyary, cholesterin..°°:..... 84 Goormaghtigh, N.: Function of human adrenal cortex....345, 346
Gordinier, H. C.: Graves’ disease. 117 — Medical treatment of Graves’ disease Gordon, M. B.: Hypothyroidism. 97 — Role of pineal in pediatrics. .437 Gottheil: Addison’s disease..... 345 Gottheil, W. S. (Goldenthal): Pseudo-hermaphroditism payales) Gottstein, A. (Umber): Diabetes Erb oo lag 72) Gaetaeceicteein nbc Ko comemoachicuctucr: 543 Gould, H. N.: WU Aes Soom re rettids, cMets ts coh cle ott 402 Graafian follicle, evolution of... 84 Grafting, ovarian Gram, H. C.: and increased dren Graves, W. P.: ENCTADYoteie «choker eeee 83, 393 Graves’ disease, see hyperthy- roidism, also exophthalmic goitre. —-— accompanied by tuberculo- STS ch en ar oe eee erat De —_— adrenal disturbance in....182 —and goitre, differences be- tween —_— — — infectious disease —__—_——myxedema, possible co- Caen boos soe otsce OO — — anti-thyroidine treatment Ole ee ee he ee eee Ral ——arhythmic pulse in case of .587 ~~ -— blood changes ink. te ene) 5 Tal CASCIO EIE Oe Merencoaeionenn eter 108 — — contraindications against Operations: 4: 2c) eco ——death following treatment AHO OM<AGE Ve gra Glo Geb c yale, —.——discussion of clinical as- pects —— effect of measles upon... .43 — — — — hypophyseal hi eeenee er ole oS =~ “etiology, and treatment... —— — electrocardiograms in 5 —— — heredity of —-—hypersecretion of thyroid TOW Tay S.CT RAIOR ONE, Ob acon Gas 464 —_-——in case of demineralization (ie [WS Seiedeo swewewn owes SS IMenGunime: walter es OS ——_ —_ — increased height in chil- dren ——_ —— influence of cold mud baths.575 eof thyroiduextractin. 4:13 = — medical treatment Ofs.5.. - The 1 42/5 574:3 —_— myasthenia gravis with...584
disease chil-
Graves’ height in
594
2.“ non-surgical in nature... .473 —— _= oculo-cardiac reflex in... .. DARN — — operative treatment of... ROO! === osteomalacia swithie ert. - 537 —__ —_ pituitary treatment of... .384 —-— produced by thymus ..... 598 = - role of hypophysis:in.. .... 76 = sisin’ GISCASCS Mla eustemer-) oren-ic HO,
—— — surgical treatment of..... 429
Graves’ disease, treatment of.... 119, 240, 454 —— —— — —an internal one..... 594 —-—without goitre, but with hypertrophy of prostate.598 XEray treatment soLasee ee 594 Gray, H.: Lipoids in blood — (Joslin): Diabetes in children.359 Greef, J. W. G. (Kaplan): Adre- nopathic hyperchlorhydrias ..343 Greeley, H. P.: Pancreas and me- tabolism in diabetes......... 557 Green, R. M.: Tubo-ovarian sup-
PULAON vs 202s as beckons 396 Gregg, D.: Treatment of psycho-
NIGUGOSESM... ce naeeo nee ee chee ee On laes Grier, G. W.: Treatment of hy-
PEED YTOLGISIN \ecescss eepeeecncncae 592
Goitre, treatment. ..420 Subcutaneous adren-
Grimes, H.: Grimm, G.:
alin Ine CtlOnSy see eee Rene 506 Grimmer, W.: Milk of thyroid- LESS) SOAS <<<, wees tee OO 120 Grobly, W.: Neucleoprotein of thy Told as kate ee One 118 Gronnerud, P.: Enucleation thy- ROLE CLOMIVA tes ee ke coat 116 Gross, O.: Tyrosinase in human UPINE. cece Sessler kee 350 Grote, L. R.: Blood sugar and MadidisonesadiSeasew a eects 497 Growth, abnormal, hyperthy- FOdISM ands waa eee eee 108
—and endocrine glands in dogs. 196
—as influenced by endocrine
DCTS tae soe eee 209 ——ductless glands ands 5 --eeOne — (iwarka sos a cikdena eh 3 aoe eee Bi —effect of thymus gland injec-
TION UPON accecese wanton 229) — in precocious puberty....... 464 —jnfluence of internal secre-
tiONS: ;OMackeeieeael 2 bien cece 510 —— -—— -—. nlacenta OM .o03..-066- ayibat —— i ——— Va US) OMe so cro ieme cnet 598 —— = HPOlds COnNCEEMEG wills -ieasusra eee 376 — metamorphosis and, relation
between thyroid gland and.237 —of chicks, effect of grain ra-
tions on —retarded in children caused by
pancreatic diseases ....... 548 >—AStUGY. Oflcsnstcee cp siceetehowen Reet meme bwart Gruber, C. M.: Epinephrin in
muscularractivityes-1. cite 145 — (Markel): Tonus waves, adre-
malin... cceh Seteetele cee dees ONN)5 Bil Guanidin content of muscle in te-
tania parathyreopriva .......559
Guglielmetti, G.: Action Oh, adrenin on muscular fatigue. .185
Gynecological evolution
Gynecology, endocrine factors in.199
— internal Secretionsyin - 1. si 386 —— Pitwitany exuraCiaimieren niet 87, 207 —— TECeNt PLOZLESS= LM eerie LOT —‘thy roid ine one ee een 425
Gynecomastia and mammary hor- mones, description of five CERES SS Gig aS PRC S oe
Hadden, D.: Lymph gland ex-
TRNGIE 5 SS SR cee cue ec roe 81 van der Hade, H. (Storm van
Leeuwen): Adrenalic activ-
SES? 6. BRAG Wee need oti amen cee 48 Hair, change of color of in acro-
rade hry it; eS een ie emenecece Aad Cee 175 — disorders of during pregnancy.263
Haggard, H. W. (Henderson and
Prince): Sureical shock... .. 40 Haggard, W. D.: Splenectomy,
THIET cy, bee) Skee AGES Cn ceu cee On 3 Hagiwara, R.: Calcium soap de-
OS ese We WET ec sererceiy + fos = 60% 192
-
Hall, G. R.: Addison’s disease. .347
Halliday, C. W. (Austmann and Vincent): Adrenals and blood DES STINGS, 25 Sa Oe eee 38
Halverson, J. O. (Bergheim and
Hawk): Thyroid and thymus PEGAMHMEME IN FOILTC <i. cec. <- - Tae Hamman, L. (Hirschman): Ali- mentary hyperglycemia and RSUUMEO SEI al Acree: a seals al tey ss ansy's 6” « 63 Hammett, F. S.: Internal secre- POUMGOLUMIACEMbAr. <8. ce e.c a 3 ses 307 Hamilton, H. C.: Effect of alco- hol on pituitary extract...... 78 Hann, G.: Addison’s disease.... 39 Hansen, P. N.: Case of pituitary TL OU aa eG. cued casareia hs 20 Hanson, S. (McQuarrie): MThy- roid extract and serum pro- (GIT) Wel SRS See Oe Ronee eso 118
Hanzlik, J. P.: Harrower, H. R.:
Hemorrhage. .45, 46 Diagnosis in-
ternal secretory disorders.... 80 — Endocrinology and oto-rhinol- GEV £5 5 > icles Oe ee aaa 79 — Internal secretions and _ shell REGU es AP oe ees a te 214 — Neurasthenia in women...... 80 — Thyroid function test....... 105 — Treatment of disease........ 80
Hartman, F. A.: Adrenalin vaso-
aqiulator mechanisms. 4... . 2... 44 — (Blatz): Death by tying adre- Taal Vtech (AY Gece Sec Meen mene aa WY — (Lang): Action of adrenalin LOM C Ys fries © oor uek Slaten. owe Baal Hartog, H. J. (Loran): Goitre in LOT ITS (217 se aie Be enna ey A eae 234
Harvey, T. W.: Organotherapy. 82
Hauptmann: Myotonia and cat- PURPURA Ee eo. oy 0. Shc) Sots oS eaekte ew DLS Hawk, P. B. (Halverson and Bergheim): Thyroid and thy- nus treatment in goitre..... 119 Hayd, H. E.: Sarcoma of ovary.394 — Thyroid in gynecology....... 425 Hay fever, pathology and treat- AETETIGELOL | 014.5) c08 cc aie aa.o.m hole, cuss 45 —-— prophylaxis of ..... FG AE)
Hay fever, relation of endocrine SAIN Sab Oerseawecy sus gereeacscl | sa ees 367 Haynes, H. A. (McCord): Dys- function of internal secretory system ill Headaches, cure of pituitary.212, 37 —in menstrual disturbance.... 1 Head injury followed by diabetes.50 Heard, A. G.: Administration of
OUD ING erates See. as, Se, des se 400 Heart, action of liberated adre- TOIT AOI be 5 SCGkS Bash Ee 497
—collapse of direct cause of death in Graves’ disease. ..589
SI TTEZONDGOw tre a isis tisetens Se ss 591 —in myxedema ...... DO. 43:05 592: — irritable of soldier’s......... 350 Heart-hurry of exophthalmic PAONIEIEEL 9305 GR nee a Seo ee es 590 Heffron, J. L.: Diabetes and its GREAbIIEN ty ree ce opie as ces OED Heiberg, K. A.: Diabetes mellitus AMdeDANCTCASS ..4cccescie Se oee.e 195 — Thyreogenic obesity and dia- WOUCSa cra ah-ceeel ect ket eee Oe
Heineck, A. P.: Hekman, J.: Helm, H. M.
Hernia of ovary.392 Addison’s disease. 180 (Brendel): Goitre AMVOMSGMaAnG MEI. =o -.s ee eee Zio Hemandenology: a new specialty.504 Hemato-ethyroidine treatment of
menonrnhagiay sows: ss oe ee oe DO!
Henmianopsiay sami. ne. oes oe Deb
— bitemporal, in case.........532 —- with hypophyseal dystro-
DIONE.” Sd cca eee achat) 078)
— homonymous, case report... .522 Hemophilia, coagulation time of
DOO CME scp try cer Ro eo ce lene 244
Hemorrhage, adrenal, in infants. 498 —as possible cause of hypophy-
Scalm@ausonrgderes = a4. one shee 206 —)ilateral suprarenal ........ 497 -—— cause of menstrual.........536 -——effect of adrenalin, pituitrin
OS rere cae. se es 45, 46
— following thyroid insufficiency.570 — from ruptured corpus luteum. 8&6 — influence of on pressor effect of epinephrin —in pregnancy, pituitrin in... .530 — of oozing nature, pituitrin in.531
=> CONE PO TIEN lye aa eee 444 —of skin and adrenal insuffi- CICINATY Bicche-Clped Beato CaONe ee 498 — postpartum, use of pituitrin bal 25 Bee oy by lobe Cae eee 90 — tubal and ovarian, relation to extra-uterine pregnancy....219
Hemostasis in goitre operations. .105
Henderson, Pearl S.: Tetania parathyroepreva ............559 Henderson, Y. (Prince and Hag- Sand) mureiGal shock. > 2-1: 44 Hepatic type of diabetes.......546 Henle’s reaction of chromaffin Celismnwadrenals:. ans" cee 189
‘“Heriditary insanity” Hermans, L.: Hetrosexual symp-
CONS Gee ea a amioreeen Seshay = aulsis ane Sila Hermaphrodites, experiments on CATA EMOUGNGA! ag RES lo tans Gee Bes ae arene 565 Hermaphroditism, case of......518 —— description of case of false... 64 — —-SOxual swexXternlals Or- (aN ie BS Bipgiena es Ole oon 518 SS AINA Sawn SE MeO oo amo ce 519 =— Gr qceevonenuieil “Ss 6 sa oa oio ora es 517 — pseudo, case of externally fe- eae GO ee Se Slot co. ceo ON Orolo Ono 518 SS TDAOUNDNE [ADE hole ele ao coats: Hernaman-Johnson,_ F.: X-ray and electricity treatment of en- GOCHINeS GISORGETSay- es ieseneeer 198 X-ray in ductless glandular GISCASCS) ceoc ee Coie ne Onn ONG Hernias Ol) OVA PYscer uncon nonce. Boe Herrick, W. J.: Function and diseases of thymord cc cree 578
Herring, P. T.: Thyroid and adrenin content of adrenals.. 40 Hertz, P. (Secher): Neuroblas- toma with Addison’s disease in child Herzoz, Lo: Ovaly-uanerone) oa- 39'2 Hesselberg, Cora (Loeb): Cyclic changes mammary gland.....
Hetrosexual symptoms, develop- TOK ED ORG (Ol PareeRe Nunc CREO c Ole ee cle 372 Heuer, G. J.: Exophthalmic POMC pee er nic eee aca non 00 Hilderbrand: Treatment of G@raviest w@iSeadse) = eicie acannon 240 Heynemann: Hypophysis tumor.532 Hill, W.; Intantilism......-. 385 Hinnich type of thyreogenic hGalitetads sks o olea cis ousteh scence: ay u)al Hirano, K.: Anaphylaxoid of sal- VATS ATL OREM 5 oos.o eI yp cuchovcaeh meine 348 Hirsch, E.: Diabetes, blood sugar 54 — (Blumenfield): Internal ‘se- cretions and metabolism... 79 Hirschman, I. I. (Hamman): Ali- mentary hyperglycemia and
FAKACORNING)” 3 oS ooo oon atc 63 Hirshfield, L. (Klinger): Ende- emo, FONTS: “qo ato Ss oo ola Soo bac te Hirst, J. C.: Corpus luteum..... OIE — Corpus luteum in pregnancy. .3é Hirsutismus 25 Histamine in hypophysis....... 5 —not a substance specific to hy- DOME Sissel ake = en Oo Histochemical observations on functional activity of supra- renals History examination of patient. .166 Hoag, W. B.: Case of complete
Gieawhouision Vnnled > donde do SS as 234 Hoeflmayr: Internal secretion. a Le Hofer, G. (Denk): Tracheomala-
Cia) andy LOitrey nyrcemeee an on - 432 — (Eppinger): Regeneration and
(HM AKONGIE Bing aid gobastoseoas Waly
Hofstatter, R.: Basedow’s dis- CAS Cm) Sieve eats eee Cones 378
— Hypophysis in Graves’ disease 77
— Treatment of Graves’ disease. 384
— (Porges): Hypophyseal medi- Cations inv ObSteLnics) "acces 52:9 Hogg, G. H Diabetic conjunc- tiVitis’ 2c chee eee 52 Holfauer, J.: Therapeutic use of hy pophy sink = sles Gee eee 401 Holman, J. E.: Pituitrin ....... 90 Homonymous hemianopsia, glan- dular>therapy:in een aera bai Homosexualism, endocrine sex StrUCEUTe MING... eich en eee 565 ——SNOSSIDLEnCAUISC) cleus chen nereae 565 Hopkins, A. H.: High blood pres- sure ‘and smenopause’... ce ee 375 — (Pancoast): Pituitrin and gastro-intestinal tract of TAN Hote ho sp mee cees ie oe 530 Hormone, corpus luteum seere- CIOT a ser eh ees See cae orem mente 13! — deficiency a factor in etiology Of (GaNnCer * os see eee 67
— effect of thyroid on adrenals.572 —elaborating power of organ,
DEOOEOf saeco eae — Of gonads» actionvof a eee 26 — — thymus, toxic in effect....290 — study of isolated thyroid....571 —— ‘testicular its 20. cee sue nee ceemeeee 16 — thyroid, physiological action — Ob. ARs ea ae ee 586 — toxicosis in insanities of toxic OLigin! 0 FA eee OL FVOTMIONES sa .ct sectors lone (ai, a) (lc! —— A CEION: Of os. .2sacasace Scone ere Ve —and modern medicine ...... it — coordination of chromato- DHOKES; bY = Sate tee ee 187 ihn jolene FROME, Soa ne aocsc: 204 —Lemalereeniitaliecen scm nce-acrsnonores 538 mali oni ro lacre a0 We Gechhco Ott See tuo Ss 6.0 duc 518 —new method of isolating..... 245 — therapeutic application of.... 67
Hormonic anomalies and torpor. 340 — imbalance and tuberculosis. .340 Hormotone in menstrual disturb-
ANCES! 0s as anS.S heer Sheen eae 6 Hornor, A. A.: Acidosis in dia- betessmellitust a. ce. ciceecnon ene 542
Horse: cortre.ini aa eee 234 Hoskins, E. R. (Hoskins): periments with thyroid, hypo- physis and pineal glands..... 424
—- Observations on thyroid- lessuWlannviales oan eee 427 Hoskins, KE. R. (Morris): Thy-
roidectomy in amphibia...... walal Hoskins, Margiaret M. (Hoskins): Experiments with thyroid, hy- pophysis and pineal glands...424 — — Observations on thyroidless larvae Houssay, B. A.: Adrenin pituitrin antagonism
Houssay, B. A.: Physiological ac- tion hypophyseal extract..4..1783
— Hypophysis and polyuria..... 74
— Pituitary body, polyuria..... 10H
— (Romana): Hypophyseal poly- UIGHUR veneer ayo et cteaee ss ts sy 13
How, H. W. (de Schweinitz): Pit- uitary body disease and glan-
dular administration ....... 561 Howard, T. (Schaffner): Addi-
son’s disease of syphilitic or-
TSA ly ye wey, igs ema TEL ORC ee 96
Hughes, H. S.: Hypophysis tu- mor with optic nerve atrophy.521
Humphreys, E. M. (Williams):
Blood sugar in diabetes mel- litus — — Blood sugar in nephritis. .355
—-—Glucose in diabetes melli- EG) os. ¢Sordich ea eee See 356
Hutinel: Endocrine glands and Osscous dystrophy ~). sow. 63 Hyatt, E.G. (McGuigan): Epine- phrin and_ blood pressure CHUTES ackis alge aaa us een eee 50 Hydatiform mole with ovarian GABLE, <o RG BSR OREO ie eos Pea Lat Hydrocephalus and hypophyseal OHNO SMV Meron Ceres. cesta sacle. 2 es Ook
— hypophyseal dystrophy in....378 — following pineal enlargement.445
— in precocious puberty ...... 463 — internus in girl of 17.......522 — thyroid etiology of......... 418 ‘“Hyperadrenalinemia” ........ 240 = ii EKOR AY (Cit Seen aeeee ee eee 202 Hyperesthesia in region of thy- RONG, -ScosOe rb Oka eR OL ERD a ae eee 244 Hyperglycemia, alimentary ..... 198 —a predisposing cause of tuber- CAMOSUSte cet nas Se cccle ec. ts. 340 —and glycosuria, studies in.... 59 —effect of painting pancreas WH MMAOGeMi occ... ee DDT — important factor in production DE oso SER eae eee 553 == 10) (GION g gaa ohgh ee RC eee 189 — influence of alkali and acid TEGO newer ee sn afs heise aiein 3 OOS — ——renal function on..... 364 — mechanism of ether......... 188
— morphine, in dogs with experi- mental pancreas deficiency .551
——— WPM OME LV COSULIA, obeys. «0 - «002 Hyperglycemic test for hyperthy- MMU Ue a ay ote. .3, Ghd 1s an enti oie, 1s OOS
Hyperpinealism and precocity. ..450 — — early sexual development. .447
Hyperpituitarism, case of com- pletely relieved by glandular PMA VARE Pet 55, 3. (osh ais alle + shots oiae DES
Hyperplasia of pineal... 87, 443, 444
Hyperplastic type of goitre.....576
Hypertension in women........595
— —-— treatment of .........596
— non-goitrous, thyrotoxic .....596
— ovaries involved in causation. 595 — pluriglandular origin of.....596
Hyperthermia in thyro-endocrine SACS mee Westnet a eters isce sine. sirence wis 425 — thyro-endocrine, (ON chess Bi cee ae ee ee eS ce 423
Hyperthyroid exophthalmos, ex-
DEGUNVEMUAN maa tets csc. cee. ne 246 Hyperthyroidism ..... 108, 240, 434 ——and abnormal growth ....... 108 —and consanguinity ......... 418
— and irritable heart in soldiers.582
—and roentgen therapy ...... Dee eID INO Mars ssc eres eoae.s 2a DOS —— MIOOGE SUA IM ho s).c-606 occ we te 411 —-—w—content in ........... 55 — boiling water injections in...109
— carbohydrate tolerance in.56, 588 — cases of with osteomalacia... .537 — caused by toxemia due to in-
vestinial stasis |... 5.6.0 +. 475 = OMT NCA le steUNC aw: ons, sere strel «dues. (oucs 422 — conservation of thyroid in...100 — contribution to study of...... 241 — differential diagnosis of...... 588 == experimentalls . ah sie .0 se 4 « s 104 —in pregnant women, relief LOM ot askew eee enero. SeateHONLIO. =e CCT on sacredness lelatereher ens ss 104 eI ATLORG UPA rere el aeehe sabe ela wes 422 — -— soldiers, cases .......... 241 ———" war pathology 2.e... 5% ss 341 =—fodine: treatment OL... =... 2 418 — laxatives and intestinal anti- SASS OLS a 25: ctepecoey Bao ot CS Obes Gua S 475 AINE CICA ya it DeCALCOs cle te soe one 47: TOCA DOMSTMN UM eins: = © 2 ot esneite og —mobilization of, liver glyco- OTIS TIL Me Near eiaoh < soy ey ?onee ease as) «ued MIO SILLICAL IOMUMYE Bie. =) 0 0 «0 425 — oculo-cardiac reflex in....... 235 ——predisposing causes ........ 469 — quinine and urea injections THOU, vain Clic c: Geek Coen Rene eer jalal =—AHeyoliphon [elaSiceyony iGdby mae cunnolc 4 428 ~— real difficulty in treatment of. 480 —— serum treatment of......... F29 — simple, non-surgical treatment.592 —some remarks on........... 429 — surgery vs. drug treatment...581 — thymus hypertrophy with....573
—— ETO ALIMOMt, Ol enc csc) c.cyetevete «cscs 108, 240, 426, 454, 592 —two stages — X-ray treatment of......... 593 Hypertrichosis — female secondary sexual char-
ACTCHISUICSTAMIG «2.0. fo. ae ae wre 80 “Hypoadrenal type” of soldier’s LEGO m MCAT Gs) cls 60) cio) sperlonets 309 Hypo-adrenalism as immunization AAS, LY PULOUG.s «cove, ov «) tel op euene 38 —————— 1 ATMY. 2... 6 vie ee nee 38 —=—In «war pathology. .... =~ smate 341
Hypoadrenia, neurasthenia and..388 Hypochondria an endocrine as- thenia
Hypophyseal adiposity.........& 5.22 PAT
—=— 1G FONSY. Wits onc noc Ateneo CA CH ORTAMEE ieee kcny @ choere DIEM gtOIaTS == (IAD CLES pce ee toneueee che eeione a heb 485 - ancreas unchanged in... .488 — disease, hypophysis and..... 205 —-—report of cases.......... 381 — disorder in mammary cancer. 74 S—Ghijeweisiint oP MORI So ae aibe Coan — dystrophy in hydrocephalus. .378 — —-—man of 19............ 523 — extract and annular dystocia. .73 —-/jnijections of, and arterial bloods presumes... ...68.020 —-jin treatment of cachexia.. .528 — — physiological action of....173 —- seven years’ use of. ..401, 402
—- therapeutic application of.383 —fat dystrophy in hypothyroid-
TGSIYN Mata, vc ¥ pct cage Cees ies, ci euonel toutes Gal —-— -— treatment ............ (at ——esiOnsd.a04 | Cee. ee Dias —-—and diabetes in children,
relation between....... 278 —— experimental ............ 74 —-—jin infant causing diabetes
INST PUGIUS ga che seek Diote — origin of diabetes insipidus. .525 — polyuria; rhythmeotey.-s. 2. 219 — preparations, best test for as-
SAVANE: 5. wens ley stoi secin eee wee —symptom complex, a new....521 ——SYNGTOMIES: jaw creosote ee 77 — therapy in Basedow’s disease. 378 ——of adiposogenitalis....... Dida == DUTINO a apiete Rohe ee, coer eh ss aek cee Doe —-— acromegaly without....... DES) ———— operation for. .2).\.. 00. .D29 —-— surgical treatment.. 5 a Wao) —-— technique of operative ap-
DEOACH «5 eee.) See ile Hypophysectomy followed by adi-
DOSOZEniTAliSes.. 6 ee eeeoc enor —in frog larva, pigmentation
chansessfollowini..5.. soe 76
Hypophysin, seven years’ thera- DEUTICRUSE Olen. .<seeeoe 401, 402
Hypophysis, see pituitary.
— 68-79, 205-213 376-393, 520-533
— affected by syphilitic lesion at
DASeHOLsD RAINE wee eS = PIT ATOMLY A Ola yays, « tabeieretorsoucuwoks 6 213 — and cholesterin, relation be-
EWE Th eeepc mc scsi erem acs Hs 380 —-—cholestrinemia .......... 78 — -hypophyseal disease...... 205 — — pancreas, relation between. 487 —— = POLY WEA; an oleic e susis ons one whee 74 —anterior lobe, internal secre-
LION HOME eed ie a ins DO —as regulator of diuresis..... bial — atrophy of anterior lobe..... at
-—— awantismepanesses. 526 —— Diochemistry: Ot eoweeeeaaees 533 —cerebri and its morphological
INT WENCE sro eee eee 69
—— development of, in rabbit. 69
Hypophysis cerebri, study in... .528 — — subsidence of neoplasm in
TreLZion OL! cee ce ceea eee 69 — COMPTESSCGs. =:c) se ome eee ens 526 — contribution to study of..... 523 — degeneration of pars nervosa ORS Saree seethetle ete eee AY? —destruction of glandular por- TION czgic cso ee ee 527 — development of............. 530 — diseases, description of cases.525 — -—of, in domestic animals... 69 — effect of removal of epithelial. 379 = enlarged 6:%.....2 oe eee 523 — experiments with, in frog lar- Vile > Adee oka oe ee Sa 424 — extirpation of, influence on se- Gi(oyal Oye lem, Mo 4 oko co 525 — extract, effect in nephritis....209 —-—in treatment of adiposo- SOIC A Sw aecuce ee ee Dyn — -— of posterior lobe, four dif- ferent substances from. .524 — functional correlation of thy- TOI HANG! 3.05) apes be ee —— Bliomias Of ./p-slonne es Re ee 525 =—— MIESCAMUME) GUM scien ses eine eee eae 529 — hypertrophy following thyroid- GCCONVY 7 Wooo are aes 534 ——influence on muscles........ By ZFl —in sugar metabolism........ 486 — liquor, effect of alcohol on... 78 — medication in obstetrics, seven VATS! VOL cctksicesrchel enon eee 529 —— neoplasm (Of aise aore eee 532 — pars tuberalis in, of chick.... 78 —pharyngei, tumor developed fROMPreSts Ofao.ae ase 529 — powder, dried, feeding to chicks; /efiects Oe wee 200 — preparations and therapeutic USC 22 sisegsacwoet ee Laat BAG)
— preparation of anterior lobe, no influence on secretion of
UWTIM Car apc ceca ai cned er eee OIL —-—-—posterior lobe and re- duction of urine in di-
abetes insipidus..... 524 —relation of, to clinical mani- LeEStation's! 4.0 eee 383 =——'— tO GIUTeSsiS= ae eee eee Oe a ——_——— pineals timorsasses eee 446 — —— so-called diabetes insip- idus of pregnancy... 75 — removal and pigment changes.383 — — effect on thyroid......... 534 —resemblance of tumor to an- ienetopenullO Yer Oligtec 65 58 So bac 529 —role of, in Graves’ disease... 76 ——“SOME: NOLES OME nce cae Le. — structure and development... .528 — study of embryology of...... 530 — substance in treatment of dia- DEteS.....5 seve See ee .488 — SUTZETY HOLL S were weiss oe eree ere GO — syphilisMof.ck .S eee 526 — traumatic lesions of....211, 212
Ely pophysisy tUMOr.< 2. 2... ssasc0 as
—-— causing polyuria......... DZ) — —of, in case of inflammation Onemiddle Car 2..........525 —-—surgically treated........£ 532 — two cases of disease of...... DBS — variations in blood of animals GE PEIVIS MeO leys.s4.d cars, Sgt eet 79 Hypopituitarism, case of....79, 376 —a cause of diabetes.....:...211 — causing dystrophy.......... 212 — dystrophia adiposogenitalis,
polyuria and polydipsia, etc. 74
ea RESTIUID Vite ve, eye Peeatiss ch ss doce je: arxei/e Se 376 == ECMO Gaosts. 4 cee, Sparse soo) ebaus 208 Hypothermia in thyro-endocrine SITES SE Se ene eee ane 425 ELV POCMYTOLOISTM Gots = «csi ss ayelous: 241] —— achondroplasia with......... 120 —— I Cnmedwestiay of 55 cases... .. -97 EEO A BMUOIE, o> 5 «, ckevaceos o ale 0-04 97 ——Weiearia as a. symptom of... ..109 EMO ETICHTA csc yaloe chats ePaper cts) a0, DOD Hysterectomy, effects of, upon CUD Me ETM CGEOM cnc ciara. it » 315" 0a 218 Hysteria an endocrine asthenia. .371
Ice bag in treatment of goitre...583 —— — — — hyperthyroidism .456 Implantation of testes......... 95 — of testicle in impotency...... 95 = SE IRIGY) ATARI ORE MIG vate cal Set esce cabelas sore sale aj 530 === GUTTERS (015 Be ok Ce enon Rae 95 —treatment by transplantation PRESS TICLE ee 5 ote S foe a eae acc acs 95 Inanition, effect of, in young on
EIU CoN ee Bie) sicurauiel sab to Sods 373 Individualizatien the dominating principle’ of treatment of
CoRR Cme IGISGASE).5 ...... . © evsue) ere 483 imtaneye "GiabDetes: iM... 2.6... ows 273 Infant, does pituitrin adminis-
tered to mother affect?...... 400 — malnutrition, pancreatic vita-
Tiel elet NG y Cea: a a 87 FH CLOTOUMORIMNA ! 1M... <6 @ fare 5 0 ond Od Infantile asthmatic neurosis.... 42 SS Ua re | ae er 210 === ier sc Olc ioc: er 243 WOULD UH IG 110) ee 213 —and disturbances of puberty. .513 — chronic nephritis with....... 385 —from ankylostomiasis........ 214 — osteomalacia and...........53 == | SD ee i 211 — skeleton in man of 22... se retss — tetany, nutritive disturbance
HNMR vp Ps ro 268 coises a <a 5 enie. Stee BA EEDIOLO
Infants, adrenal hemorrhage in.498 — eczema in, and thyroid gland.417 — status thymo-lymphaticus in. .567
Infectious diseases, an exciting Cause.of diabetes... oj. 085 sw 276 Influenza, adrenin treatment Clee ns. ete a Ae 350, 503 MT Ge ACTONAIS:. «ete Gescesigs eka BERL
Influenza and loss of hair....... 583 — causing partial adrenal insuf- LEK CED KEN TAA LSS eon eee 503 Inglis, J.: Acromegaly with me- CTAStiMaeIENTOT!,. aie chencts «2.0, 0 © 68 Insanities, changes in endocrine glandssas) result Of. <:.........< 450 Insanity, internal secretion and.535 — case of menstruation........ 5 Internal glandular disorders, rec- OPMUTOM es Ober said. =. «ons ietseeue eis 368 —-—eextracts in mentally re- tarded children........ 368 — medicine, radiotherapy in....43 Internal secretion. ..<...... « 90, 214 ——— and INSAMItYs. <<6.<sc0ec «o- o DOD — contribution to caption......513 —-—of digestion............. 3 ——-— ovaries ..............540 — — — interstitial cells, impor- RAITCE RO lta eee Sees c, anes 26 DANCE CASH ou. SPE ance eo iD DIO — — — — and chronic diarrhea.561 IT ACEMCA ces. chs ¢ ates ccuee 307 —-———thymus gland......... 296 — —-—thyroid, liberation into DIO OGM reek eae aL —~—— so-called glands of........ 214 —-—— thyroid’ and.............. 97 Internallseeretions.. ...-.4.... . . 79-80 ANG: MEMMOLIONS: « «severe «cs cc 1 ——-—enzymes, inter-relation and inter-dependence.21+4 —-— —faulty metabolism..... 386 — — — gastro-intestinal dis- CAS CCB tess. cia. to See 387 —-—-— metabolism in growing bobtiaal: ks} ey peek ee eee TS —-———nervous system........ 342
— — — neurasthenia in women. 80 — — effect on bilirubin in blood.512 — — influence of, on formation
Cie [ont Kees St Soa eee ee eee 214 —-—in obstetrics and gynecol-
OD Va Ee WEP A oi teteusse rn OOO — -— knowledge of, how made. .253 —— Ol OVALS sep. ce Sra « 1 ob 40 —— —— Of sexual organs......... 67
— — relation to living organism 1
—-—— —— operation on Ec, generative tract.
— — — — mental perversions. . ‘ "80
—-—— shell shock and..........214 —-— some clinical aspects...... SSL —-— vegetative nervous system GV ANG |. > che at a a ea 387 —-—with special reference to treatment of disease.... 80 Internal secretory disorders, di-
PM PTIOSIS OL acess asks to kote focus caenots 80 — secretory glands........ 214, 386 — — — vegetative organs...... ott —— organs, gonads........... 16 — ——testes .............0. 16
Internist and surgeon, tion between in Graves’
co-opera- treatment of disease. 2.0. ea eee 454
Interstitial cells, internal secre-
EIGN OPA Ole CUMOb sre sc ciate crenens 26 ——of owls MAA. sco ro age
—-- eee internal secretion during pregnancy .538 — — — ites in Didelphys... 96 ary, cyclic changes in.217 — testicular gland and precocious puberty Intestinal catarrh in diabetes. ..5 — distribution of secretin......225 —glands, chemical stimulation OES ee ee rept Sachs ue ayers 224 —stasis and hyperthyroidism. .475 Intestines, contractions of, caused by hypophyseal extracts...... 523 — X-ray treatment to, in status lyaphiaticus. Ree rec OOS Intracranial pressure........-.-526 Intrathoracie goiltre:..-. =<." 109, 587 Iodine, abundant supply needed im pregnant women... >. ..-.. Poth and previous thyroid disturb- INGE SS OS ee areas ate te 265 —containing compound of thy- roid — feeding
a
— — — tadpoles —— in: “CHV TOLGiie Be ea se cre Gon ee 40-4 — influence of administration of,
on thyreotoxic heart.......591 relation Yok, to the ‘thyxoid
JSS eetaioeetoetete ve ae Habs satalye. — requirement during preg-
nancy Iodization of proteins, artificial. 99 Irritable heart of soldiers. .244, 350 — —— ——- — leucocytic studies on. 411 — — — — thyroid in:.........582 Islands of Langerhans and cor-
424
pus luteum removal......... 3 —-——)lood supply of....... 220 — — — changes in, following hy-
pophysectomy ...... 487 — -— — degeneration of, in pan-
creatic diabetes...... 192 — — — histological change _ in,
result of diabetes... .556 —-— —jn diabetic children....277 Isenschmid, R.: Cause of endemic
SOULS ware ee ee esis DO”, Jaboulaye Operations... ots eas 471
Jackson, C.: Acromegaly of lar- ViEUXS Der eee ee yr ee Jackson, C. M.: Postnatal devel- opment ofeadmenalSins «sen. suet 344 — (Stewart): Inanition in young.373 — — Recovery of normal weight.369
Jackson, H. C. (Bedford): Epi- nephric content of blood..... 4\) Jacob, C. (Zabala Ortiz): Abder-
halden reaction in dementias. 85 Jacoby, M.: Theory of diabetes. .194 Jaffi, B. H.: Adrenal ganglioneu-
TOMA! 4.5 wk boars bees cee 498
Jamieson, J. P. S.: Pituitary ex-
tract<im labors ..0- seer OHS Janney, J. H. Jr. (Wilson, Stearns and Thurlow): Parathyroid tetany te oe sete eee ee eet 221 Janney, N. W.: Nitrogen balance in thyrord diseaser eae - soe 592 — Study of isolated thyroid hor- MONE Lae eee eee te en cero 5 — (Csona): Diabetic dietetics... 55 Jansen, B. C. P.: Secretin...-.-- 402 Secretin identical with vita- Mine? 225 4) Ne ee eee 224 Jaundice, acute febrile: =~ Sse 504 splenectomy for hemolytic... 93 Jean: Influence of gonad extracts on phosphorus metabolism... .203 Jeanselme, E.: Mineral waters and endemic goitre:..:>...2.- 106 Jejunum, distribution of secretin 1 U0 es Ga, Oe eee tees PS 3d 22 Jennings, H. C.: English measles and Graves: disease=.... 54456 431 Jensen, V. W.: Acidosis and pan- creatic? diabetess o. 2-4 serra 3D Johanessen, C.: Purpura....... 186 John, Gertrude: Treatment of di- abetes= MSTpPLGUSs. sek eee 531 Johnson, C. E.: Ultimobranchial DOG? eas whe ieee sees eoren eae 252 Johnson, R.: Frequency of thy- . roid insufficiency in general Practice: sf see sete cel ede aeons 243 Jones, F. W. (Rickards): Abnor- mal ‘sexual characters-]2 4.22 66 Jones, O. E.: Types of goitre in western Washington......... 247 Jones, S. E. (Prior): Epilepsy and -ductless) slands- jm. aa 200 JONNeEsco’ Operationiy. — ee eee 471 Jordan, H. E.: False hermaphro- Gitismn se sso ee ete else ere 64 Jorge, J. M. (Layera): Lingual FOUTS RANE Sree Sen ke oat oe erations Joseph, D. R.: Adrenalin physo- stigmin antagonism.......... 49 Joslin, E. P.: Results in treat- ment, of diabetes. ..5 ase oe
— Treatment of diabetes mellitus.519 — (Gray): Diabetes in children.359 Joslin’s dietetic charts in dia- betes —treatment of acidosis in dia- betes: 2 aS oo SSR Ae eae oul Judd, E. S.: Surgery of thyroid. Operation in exophthalmic goi- tC: Si wk &, eR Ree a i — (Pemberton): Operations for exophthalmic goitre....... 103 Juilly, G.: Dietetic treatment of diabetes ent pee. tee ieee eee 62
Kaess: Diabetes following head injury
Kahn, R. H.: Proposed improve- ments in terminology........ 185
Kaneko, R. (Okuda): Spiro- chaeta icterohaemorrhagiae..
Kanter, A. E. (Carlson and Tum- powsky): Stability of secretin. 402 Kaminer, G. (Morgenstern): Thy- MmuUsmand carcinoma: . ..i<.2...225 Kaplan, D. M. (Greef): Adreno- pathic hyperchlorhydrias..... 343 Kappenburg, B. D. G., Goitre and GRinikane Water. .c..ek so 419, 580 Kastle (Buckner, Nollan and Wil- kins): Effect of grain rations OHSSTOWENWOL-CHiCKS= «2-25 tas.s3 564 Katzoff, S. L.: Diabetes mellitus,
UE CAME Genet? soc is, 5. 5 oie fees thes 57 Keeton, R. W. (Ross): Ether hy- DET PaMCe Mal es Vricas Sco. Se & bon wees 188 Keister, B. C.: Internal secretions and mental perversions...... 80 — Internal secretions and metab- CMI E Sire fed ctrcRa vrei: 3,7 wots 386 Kendall, E. C.: Active constitu- CTO fest MY TOLG sc sc. See Ao Sues 113 — Physiological action of thyroid GMA Caer.) Seats caenalet Sh. Sve = OO
— Experimental hyperthyroidism.104 — lodin containing compound in
TICS TIACIG M88 SS enn ae Sete Cee eee ila by — Physiologie action of thyroxin.156 — (Wilson): Histology and iodin
compounds of thyroid..... g Patty) Kenneway, E. L.: Acetone sub-
Stamees. diabetes. 2. ......-... 53
— Blood in diabetes........... 194
Kennedy, J. (Burge): Pancreat- ectomy and catalase content of tissues
Keogh, C. H.: Graves’ disease...
Kerr, W. J. (Addis): Neurocircu- latory asthenia and thyroid en- KPanetSoivevcis, ty = A Sec eee eee Pe
Keyes, E. L. (MacKenzie): Crypt-
CMGI me acteua se Sts. sels eel doe 94
Kidd, W. A.: Pituitary extract, WETMOTGN YESS ois cocci ee ee 2s DOO Kidney, action of adrenalin on. .321 — in diabetes insipidus........522
—npower of concentration by, WONT 2 5 sents) OR eee PE T-E--
— secretion, effect of unilateral EREISTOMMONS Meeks. 6...) Ms, 2%. oer DOO Kadmeys 1m) diabetes .2.. «1... <551 — influence of adrenals on..... 49
— inhibitory action of adrenin on 42 — permeability and tolerance for sugar in diabetes mellitus.. 58 Killian, J. A. (Myers): Diastatic BeUUvILY 4Oly DIOOG 2. ~ as «as eh 53 Kimball, O. P. (Marine): Simple PROTEC LNG NRL woe. ss ft Ws SF ee ss 430 Paice Bie SOTCLIMISTO:<-oco és ev als 100 Kinetie drive, exophthalmie goitre aaoeotier TOrms Of... . 'ie4-.% 103 Killian, J. A. (Meyers): Diastatic activity of blood in diabetes. ..55 King, J. H.: Effect of removal of spleen on metabolism........226 Kinney, M. (Stoland): Effect ex- ternal temperature upon tox- fey Of thYTOIG « 26.2% 6 st oe 574
ww
Kjolstad, S.: Goitre and its treat-
TINE TUL meee ONE a eehs eco sce wbecieereh cus 580 — Tetany in an adult.......... 558 Kleiner, I. S. (Auer): Coagula-
HON wOmeDaNCECAS 5 ssa 6. oc 60 —- Hyperglycemia in experi-
mental pancreas. defici- TVG Vee menos Seite. Sp 0-5-5 eo, Hou
— (Meltzer): Effect of painting pancreas with adrenalin. ..557 Kleinschmidt, H.: Diabetes mel-
Mtuseant childrens .).:........044 Klemensiewicz, R.: Edema...... 434 Klemperer, G.: War diet and dia-
DGUCS HAIER PR e Cerro sc. stele ae gees 62
Klinger, R.: Prophylaxis of en- GeMICHLOMET OSS Avs 2S Gataceterst ers oe 58h — (Hirshfield): Endemic goitre. 236 Knappert, J.: Pituitrin in obstet- CSUs ashe Ae eeh Sis ape tee eeae © 4 212 Knott, V. B.: Surgery of thyroid.115 Kohler, R.: Hermaphroditism. ..517 Kohn, H.: Ration certificates and statistics regarding diabetes. .551 Kohn, L. W. (Boston): Saliva in
GUADCTIGS!.2Ees het fas eo es so D4 Kolls, A. C. -(Marshall): Effect of unilateral excision on secre- LOMetOls eld Me yarns eee eee ee DOI Koopman, J.: Hypophyseal dia- . DEES eee eae EAN cr Sas 485 — Thyroid gland and antibody HOLIMACLOM Gi ces oso es eee ee 318
Kostowsky: Ovara dentri-ferrin.539 Krabbe, K. H.: Epiphyses in pu-
pertas] PTeECOx.. 6206s cece ns). 459 — Pubertas precox.....-.......562 — Thymic dwarfism...........567 Kramer, B. (Marker and Mur-
lin): Pancreatic diabetes in
COS wMEPleReet eh ee re cis bs < oo ntete 362 — (Murlin): Pancreatic diabetes
LA, GIO S=¢ Saal Lor: Seen, a ae ee 362 —-— Pancreatic diabetes in dog. Uy te ee teeny 2 cic uc. Sy oe 363
Kraus, A.: Scleroderma in an in- 121101 Ae en yee eas ofS ECHO ORG. 6 DEOL DIOR: Kraus, F.: Optic atrophy and pi- Luntanyeverowihes =. 6.05 oe ok 68 Kregliger: Sarcoma of thyroid. .428 Krehbiel, O. (Rohdenburg and Bernhard): Sugar tolerance in
AUG OTe ae = Oat note sl iskajcs os ioc eos. 386 Krumbhaar, E. B.: Electro-cardi- ographic observations in toxic OMG Cg cece Serie tate fe, o)e..00s wisete cs 413 WIPLEME COMI Actas ss <2 8 ales 93 Krough, Marie: Thyroidine, ef- fect on basal metabolism.....593 Krug, E. F. (Elsberg): Hyper- pituitarism relieved by glandu- eDe er ENE TEV Yr, oa 6 widens) ke rake dO et Kubota, S. (Abel): Histamine in hypophysis cerebri.......-....b29 Kuh, S.: Hyperthyroidism...... 429 Kumagai, T. (Osato): Internal secretion of pancreas...«.....557
Kuntz, A.: Innervation of testis
Kuriyama, S.:
PENT ee Ore ee es ee ears Bayi Kuroad, M.: Observations of ef- TEectSyOr GTULSs se wee ee 179
Labbé, M.: Surgery in diabetics. 360
(Vitry): Action thyroid body glucose metabolism....... 570 Labor, pituitrin in.89, 212, 378, 401 = OT TN OIUELTON. OF ecient pete 401 IBEX O RN kolsi e O Ae ee Gees Geo PS
— established by administration Of (LBYiLO DEOLCIN Sys -)-9s-) = sexe 418 Shieh, (CETERA Saat m ooo Geom ioe 215 —-—— acromegalic patient.......210
— ovarian organotherapy in de- PROSSEO ~ so ete One oo ee
Lahey, F. H.: Intrathoraciec goi- CLG? : ees eee ESS
— Partial thyroidectomy with lo- Cal ‘AnCSEHESHA ices oe eben 586
Laignel Lavastine, M.: Internal secretions and nervous system.342
— (Courbon): Feminism follow- ing double orchitis. Pocys| SeneiD
Laméris, J.: Tetania parathyreo-
PPWA, fo. wlteSe os eeO Lamers, A. J. H.: Glands of in- ternal-secrebion’ oo... aoe 214 Lamson, O. S.: Intrathoracic goi- 1 Ff eS Oe are er ee nar 109 Lane, H. C.: Prophylaxis of hay fEVET. 2 cle Se shi oe ee es 349 Lang, R. (Hartman): Action of adrenalin on kidney... .=-sa2 - ay 7511 de Lange, C. (Schippers): Splen- OTR EL avgeten sey tee cake ee Lange, S.: X-ray in menorrhagia, CEG: ae en eae in see ee ale oe 83 de Langen, C. D. (Schut): Blood SUZAP aa eETODICS = Ase sb ek 355 Langdon, H. M.: Paralysis of cer- vical sympathetic.....4.-.9rc ee 109 Lang Landry, Mme. (Lereboul- let): Dental evolution in infan- tile: Gn yXedeCma o> seacwees cere 413 Langstroth, L.: Study of an un- usual SIVECOSUTIA cscs apeacs oie 204 — Treatment and control of dia- DCLOSI eRe aS tial eos Oar ae exaeee 194 Lanz, O.: Cachexia thyreopriva.414 Panzarimnt, fs Ee nyIMus .s. > ches = 96 Larcher, O.: Secondary sex char- acteristics, im Hirds....... .< ..-...220 Larson, J. A.: Hypophysis ‘and thyroid ee eee ee eee ee Larson, M. E.: Effect of thyroid CXLITPALION. see ee ee a eee 242 Larynx, diabetic ulceration of 55, 358 — influence of castration on....227 Laryngeal nerve, recurrent, in- jury Of #26 cae eae ee 480 Lathrop, W.: Rectal anesthesia in thyroidectomyc-o---- =. >= cha bab
Lattimore, E. B.: Cretinism..... 234
Laxatives and intestinal antisep-
tics in hyperthyroidism...... 475 Layera, J. (Jorge): Lingual goi-
LTC” onc 2 ee le ee ee 100 Leclere, G. (Masson): Metastatic
POLE octet Se eens Lee, R. L. (Minot): Splenectomy 93 Leegaard, F.: Retropharyngeal
tumor of hypophyseal ture Leidner, J.: Graves’ disease and cold mud" baths. >... eee SCS, Leinbaugh, L. (Friedenwald): Allen treatment of diabetes. Leiner, J. H.: Mental imbecility
struc-
364
and: orfzanotherapy . .. See 205 Leitner, G.: Treatment of Addi-
son's “disease. 2 = ee eee 39 Léniez: Traumic goitre........ i ie BS
Lenz, F.: Heredity of Graves’ dis- ease
Leonard, E. F.: Myxedema...... 431
Leopold Lévi: Thermic instabil- ity in neuro-thyroid mechan-
ISM o.oo Se ee Oe 425 — Thyro-endocrine hyperthermia.423 Lépine, R.: Glucolysis......... 391 Lereboullet, M. P. (Lang Lan-
dry): Dental evolution in in-
fantile™ myxecdemal. => a...) ae 413 Leschke: Diabetes insipidus, its
relation to hypophysis....... 524 Lespinasse, V. D.: Impotency... 95
Lesser, E. J.: Glycogen and glu- cose in liver cell, pancreatic di- abetes
Leukocytosis in soldiers with ir- ritable “heart: -2 2250-5 eee 411
Lewin, C.: Relation between dia- betes mellitus and diabetes in- Sipidus: 3,4 fcc ee ee eee 558
Lewis, F. P.: Hypophysis cerebri 69
Lewis, J. H.: Adrenin in human fetal adrenals*..o 2 22 eee ee 41
Lewis and Benedict’s methods of
estimating sugar in blood....555 Levin, S.: Goitres in 583 regis- trants ™. >. ..20.. 228 eee 231 Leydig cells, seat of production of male sex hormones.......565 Leyton, O.: Modern treatment di- abetes: mellitus-*: 2+... oe 545 — Treatment of diabetes mel- litus, alimentary rest...... 555 Lian, C.: Minor exophthalmic ZOlLTeC §: =a. So Meee Oe — Sign of hyperesthesia in re- Fion of thyroide =. fe a Libido and hormones... ----- oe 518 Lichtenstern, R.: Testicle trans- plantations: 327 As C Se eee 228 Ligation of carotid arteries..... 471 — unilateral or bilateral, fol- lowed by thyroidectomy...471 Lingual goitré: 22232). a eee 100 Lipemia in diabetes....... 278, 554 Lipodystrophia progressiva, re- port of (3 new casess---- ee 535
Lipodystrophy in girl of 11.....5385 Lipoids extracted from ovary and MACE AN a meecs eS e te soe eats wae 538 Lipscombe, T. W. (Dansey and Browne): Hemorrhage from COLDUSMIMELEWIMS o> <p .'2 2-2 Jae. see © 86 Lisser, H.: Treatment of Graves’ USCS CME a bcmetent a tush coat eS aes ons 54 — Thyroid aS iHanaanists one a cae c 98 Little, S. W. Ductless glands and aty Brea SMO WEE ee eee est LO Liver, calcium soap deposit in, GUIGMMNP SATA CUES jee. 0F ole mciered suse 192 —change in, causing pancreatic PLD ELCSE wits + cok nies = 2 DOS — diastase and glycogen in pan- ereawie IaAWeLESS 2°. .-5 rt. . es 5d4 — does it secrete a catalase ac- ROMERO erty saticemecs) ss la Ls <2 190
— dysfunction of, in diabetes. . .546 — inactivating secretin injected PUNvOM Vela POLRLA).-.--> -F--- 564 — lipin-content of, in pituitary PV SOD IY cisccte tates acess 2 © 68 —tumor caused by metastases. .495
Lobenhoffer: Distribution and eti- OlorsyvarOleZOltT Ctr. 6 2s-8 asin DOL
Loeb, L.: Cyclic changes in mam- PEANUT eet Peal oh oto) ¢ a='s oka Lares atc 84
— Relation ovary, uterus and VAM = SVAN... wees se 394
— Multiple transplantation of (TLESAT‘O NOL as SERGI CA ee eee eae 116
— (Hesselberg): Cyclic changes MIAMUNTATY: SANG: <6... cess os we 81
Loeper (Beuzard and Wagner): NOTA MGYSDEDSIA..<.25.02--o04%0 — (Verpy): Adrenal insufficiency 39 —-— Test glycemia............ 186 Loewenthal: Adrenal crisis..... 177
Loewi test in recognition of pan- Creane, MSMMGIENCY... 9... 65 st 558
Loewi’s reaction, disappearance
following anti-thyroidine ad- ministration in Graves’ dis-
ACNE ont ooh elle vs “eel ws TAL Loffler: Metabolism in diseases of
GieGbIeESS SANS 2. coe cle Sc 13 Lombroso, U. (Artom): Glucose
RE PAO US TN em ey ree soe see Seutlicts s < 190 Lommel: Infantilism and disturb-
Blces (OL PUDELtY..... sce. oe. - D138 Long, J. H. (Fenger): Reaction
Ol Oia a 86 Loran, G. J. (Hartog): Goitre in
QTY eee Rh ies aan a Ae See 234
Low blood pressure (abnormal) contraindication to use of cor- PIRATE OUI cog cous cae Sicko ke 14
— protein tolerance in diabetes.4906
Lowenburg, H. (Rubenstone):
PUCMHOUMUIA =... 5 eee ek ee 244 Lowenthal, K.: Adrenal crises... 37 Ludeck, G.: Treatment of Graves’
disease 1! Lunacy, hypophyseal adiposity in.522 Lund, F. B.: Bilateral tumor of
carotid body.. I Ee Oe) cea NI)
Lund, F. B.: Tumor carotid body 52 Lung diseases, treatment with UGE CINE Ns ree ed eee ne) ta cee. 016 —right lobe of thyroid grown TCO sete ee ene ema slit a 587 Lungs, edema of, caused by ad- OMe ese Melt er, katte ee OOD Lurous, G. (Emmett): Absence of “fat soluble A’’ in certain duct-
lesseeslamdsSeerm. es ce ee es LO Lusk, G. (Gephart, Aub and Du- Bois): Clinical calorimetry... .357 Luzzato: Diabetes insipidus.....364 Luzatto, A. M.: Diabetes insipidus from shemorrhage. .... 2.2). 0. 206 Lydston, G. F.: Sex gland im- MiaAMbaviOne wget eee are ee cee rae — Testicle implantation........ SI5 — Transplantation of testes...-.405
Trauma and diseases of testes. 404 Lymphatic glands, enlarged, in sudden death during tonsillec- [HOMIZ WS 5 Bl mreucho DuChER ORO Go amcdoirnceccra Nets) — -—hormonic action of....... 81 Lymph gland extract, antagonis- tic action of and adrenalin... 80 —-—-—preparation and _ thera- MDEUtIC action S... ss. 80 Lynch, R. C.: Tumor of pituitary gland Lyter, as (Cs: soldiers
McArthur, L. L.: Tumor of pitui- oer SAN Geert ets «tc cite pee Onli McAuliff, G. R.: Hypertrichosis. 80 McCall, R. (Cramer): Effect thy- roid feeding gaseous metabol- ism thyroidectomized rats....572 — — Thyroidectomy in rats, gas- eous metabolism.......£ ite McCanlish, A. C.: Milk produc- HLOTIMAMO NCEE Stesesareie cas we tees 401 McCann, F.: Recent progress in gynecology McCann, W.S.: Blood plasma in experimental tetany. Bere SaaS MecCarrison, R.: Pathogenesis of dehieiency: diseases... ....6.% 201 — Production of congenital goi- EEGs, Ste Wee there ete aie ne ee Se 249 McCaskey, G. W.: Basal meta- bolism and hyperglycemic tests for hyperthyroidism.........588
McCord, C. P. (Haynes): Dys- function of internal secretory system in feeble minded.....515
— Pituitrin and epinephrin in fe-
CAUSA Sey arees .).6 fe yenar's ] mae Diole
McCready, E. B.: Treatment of mental defectives ....+..1.56.6 67
McGregor, J. K.: Exophthalmic MEO as 6. and e, lanahon.stieterteveuremeemecetee 415
McGuigan, H. (Hyatt): Epineph- rin and blood pressure changes 50
McHenry, H. H.: Thyroid carci- noma among salmonoid fishes. 23
Macht, D. I.: Action of adrenin
ONPMINCTCT ec ci shss +. akekonon snore, like 43 — Action of optic isomers on MNEEOT Ic secre choke eke otal e Gros ts 187
— Pharmacology of ureter. .44, 179 — (Malsumoto): Action corpus
luteum, genito-urinary or- PANG s weaeeeira tencwereesandate. che tone 509 —-— Action organ extracts on PRO SIGSEGV One © ot eee 154 — — Biological test for corpus luteum yextractsS: 2.4.5 5- Baya McIver, J.: Hypopituitarism...376 MacKenzie, D. W. (Keyes): Cryp- COnGHUGISMI Shoes use coe eee 94 Mackenzie, G. M.: Exercise, de- pancreatized Osi... 5 sme ae 61 Mackenzie, H.: EHxophthalmic SOUTO Sn a ed eee oe 415 McLachlan, L. C. (Mann): Adren- alin pamlcreasi arcs aceon: 47 Maclean, H.: Glycolysis in dia- Detic blood acca ase meebo 53 Macleod, J. J. R.: Polysaccharids im liver (bloodes2... sieees cae 54 MacNair, R. H.: Allen diet for diabetes RPA enh ces 6. Goce ee 552 McNulty, J. J.: Internal secre- LOIMSHAnG sem7AyNNeES= ti ee-ecne cee 214 McPeek, C.: Physiology of pitui- tary: *silland i: Bessie ce he ites 530 — (Brooks and Seymour): Ac- tion of epinephrin on vaso- motors and heart beats.... 47 Macpherson, L.: Early therapeu- tic use of animal extracts.....511 McQuarrie, I. (Hanson): Thyroid extract and serum proteins...118 MacWilliam, J. A.: Fibrillation insmamimialivan, Wear... :. 0 185 Macro-genitosomia praecox.....447
Madero, L. F. (Soler): Spleen.. 92 Mahnert, A.: Endocrine glands
duninieipresnanciy: <5 eukee: oeneiDelat Malaria, adrenal form of....... Le — -— insufficiency in........... 178 == Ad renalinieimee | acco Gearon: 350 Mallemciimiacvenic). = + aeasiace eer: 565 —neurasthenic cases, corpus lu- COUINIABIT siete aie a echelons 13 Mallett, S. P.: Adrenin, dental ODERALONSHes 6-2 5c. a eee Maltosuria, glycosuria complicated \ Villy) a" GRE ROro- coed TAREE ERI Carers se eae 358 Mammary cancer, hypophyseal GIiSONGE TANT es de ees: att, och voichswe 74 — extract in treatment of menor- PVD SAe reece eee ih iows hoe See 569 — gland, cyclic changes in..... 81 —-— development and testicle. .519 — — extract in gynecology..... 199 — — relation of ovary and uterus [OLS OSIREE otal or b Stn cre meee 394 — —— STUGIES, ON ve crereie eis sksne ees 387
OF S3'8) 0) oe kee eR oes 372
Mammary glands, relation of cor- DUS Vwte WIM: Ok once ee ie ——hormones, gynecomastia and.519
— hyperplasia of pregnancy, in- fluence of placenta on.308, 309
— secretion, endocrine function OLLOVATY: Amide teak ee eee 539
Mania «223% sities ie eae ere 526 Manic depressive insanity, case Of ms LOE. Ste Se eee 6 Manie, A.: Adrenal glands with COXICs InfeCHONS! =. 4s. 178
Mann: Disease of hypophysis...532 Mann, F. C.: Effect of splenec- LOM Ver OMe CMYANIUG seen eee ene 299
— (McLachlin): Adrenalin, pan- CTCAS) ssc 5. cus eet cee 47 Maranon, G: Critical age...... 493 — Experimental hyperthyroid ex- OphthalimO@si eae. 5 cee 246 — Leucocytic formula in Addi- SONS GISCASE 41.5 era eee AS — Oculo-cardiac reflex in Graves’ GisGaSGHncensee mde eee 235 — Traumatic lesion of hypophy- SIS: Fir oi ieee sae ee leg — (Pintos): Traumatic lesions Of shy pophysiSemese. eee reba — (Rosique): Glucemia and hy- perglucemia in dove....... 189
— - Hypophysis and diuresis.. 70
Marcuse, M.: Graves’ disease in MICD- Gurims? Gwiaiiresees ie cee 598
Marfori, P.: Lymphatic gland.. 81
Marine, D. (Kimball): Simple LOTTE MAM yee ae eee 430 — (Rogoff): Artificial iodiza- CiOM 3.45. lerocenk coe 99 Marinesco, G. (Athanasiu): My- ASEMSMMA ic es Oy co eee ee eaitowe raw hear Paya T Markel, ©. (Gruber): Tonus Welwes evobreimenhiale gn 6 5 a5 6 co, Dl
Marker, J. (Kramer and Murlin): Pancreatic diabetes in dog. I1.362 Marshall, Ki. K. (Davis): Adren- als, kid ney cis lio ae ee 49 — (Kolls): Effect of unilateral excision on secretion of kid-
ney: SECLetiones)- ese eee 500 Marshall, H. P.: Hyperthyroid- PST Nets ks Sok, tensa ee 240
Marshall, M.: Starvation treat- ment Of diabetes. = oe 367 Martin, C. F. (Mason): starva- tion treatment of diabetes.59, 361 Martinez, B. D.: Cholesterin in thyroid! insufiiciency. «a5. 4. - 425 Mason, E. H. (Martin): Starva- tion treatment of diabetes.59, 361 Masculine type of pseudo-her- MapPhTOGUeIsiy wae cae ceeenoeenee 518 Massage of nose and throat in treatment of exophthalmic goi-
CTO ic es wiouatis “evencne ae Terereenememeies 576
——— “ss.
Massalongo, R.: Pathology and
treatment of asthma........ 45 GAZ ie PACTOMCZALY « «5 cu 380 Masson, P. (Leclere): Metastatic
OME ee fos oh ora =. e k+ apse eu etistion= 418 MatenmalmahinyTOSIS: 5... 5. cscs «s 262
Matheson, F.: Pituitrin in labor.401 Matsumoto, S. (Macht): Action corpus luteum, genito-urinary
OLEH OS S85 se bons ©. Seo Spoarit 509
—— Action organ. extracts on IMOL SHOVE eter. st <5 = 2 154
— — Biological test for corpus lmcteum: extract 4.5... 3pm
Mayer, K.: Struma _ intratho- TEERCIGT — 4 6 ook one Clpme e aoeor 587 Mavo-oW. J-:- spleen... 5.5. ok. 94
Means, J. H. (Aub): Exophthal- FVII COMPOSER ET ego cs eos escce-siys, Nyse: oy a2 a ror %s 99 Measles and Graves’ disease....431
Medical measures in treatment of exophthalmie goitre......... 455
— treatment of Graves’ disease. .430 ——following thyroidectomy, Ochsner’s directions....478 —-—of exophthalmic goitre....583 Medicine, modern, and hormones 1 Medicines in treatment of hyper-
EDV ONCE S96 Ss whe wo eee cee 456 Meek, A.: Reproductive organs
Oil. (CHAIR TCC ee ae er 67 Meirelles, E.: Mongolism...... 387 Melancholia in case of toxic goi-
ENC? (SEUMUMIECTOMIY- 4. .-....6.<. ob 94 — relation of thyroid to........ 596
Melanphores of horned toad, re-
AGUMO MMOs EEN eos ysntc <P ks w 182 Meltzer, S. J. (Atier): Adrena- Lins, GOLOOdsDEECSSIUT EG). sis. Gb. Sek 48 — -— Adrenalin constriction.... 47 —-Adrenin intraspinal injec- ICIS)” SoS ee ee eee eee 187
— (Githens): Dilatation of pupil 43
— (Kleiner): Effect of painting pancreas with adrenalin. ..557 itr and adrenin:.. ... 88
9 Fe ER BO 110, 584
— IAL lutemmein’: &. -seese 7 — endocrine explanation of....494 — first manifestation of hyper- NeTSLOMEGUPING so... 2... 595 — high blood pressure during and POWOWIIIE Se te koe ee, le lied —neurotic symptoms following AMACIAlS< Cun? See, Sh —=OsseomMalacia and“: 622.22....53:7 Ci Wo i) 390, 397 Menorrhagia, description of case. 569 CMTE Olt o. scieua «cs ee Siar OO — X-ray treatment............ 83 Menstrual cycle, variations in cho- lestrinemia, Guring : <<. <-<0.5. 82
— disturbances, organotherapy in — function, preservation of in suppurative diseases of tubes 85
MensStrilationy aus 2 Bio ate 215 — cause of hemorrhage........556 = COSSALLOM sO lye nareene Daa, Ooo ————— of “and! acromeraliy =a... ; 8 =——I@OMPENSAtOnye oa cues si ses cowe $i ACA liVaele nz «obs Aioesbehaae! etic) steioee ke he 469 — effect of ovarian preparations
Dll ¢ ope ee ee eee co ore a
—in case with thyroid disorders. 574 TISAI CASC UO. .« =< css). ence 5) == franesinllase 5 5 ¢ A alpeoloto mare oo wee —ovarian swellings preceding. .538 —profuse or frequent, contra- indication to use of corpus NTRS Nae Ye rye oi ewre ease aos ius oss 14 SP SVCMOSISHECASCHOLe ssnve css. ee ae — relation of corpus luteum and.353 —yestored following oper ation
on hypophyseal tumor.....533 <= fmaanonel fyeval 2 aie ae ee ons aie 432 —-— enlargement at first......578 Mental defectives, treatment of.. 67 === GISUTI CHOI, Spier Goracsties boo B40 —-—and epilepsy in girl of 17.522 — disease, ovaries in.......... 389 — diseases, relation of thyroid
(HO! Boo eect Oa ito SnCu Rema ess) — disturbances in cachexia.....528
—imbecility, organotherapy in. .205 — perversions, relation of inter- nal secretions and metabol-
USMY MUOPEmeT scx itarncne: ets, = sue 6x6 80 — symptoms in acromegaly.....528 “Mental syndrome,” resulting from pituitary disturbance....528 Mentality, influence of pineal REC CMM ROM eemaerets kse pcre os syle oice 441 Mentally defective children and pineal eGenclency,. 45... .... 0. 4423 Merriam, W. E.: Mental symp- LomMs! n= acromegaly. ........ 525 Mercurial treatment in dysthy- roidism of syphilitic origin... 381 Metabolic activity in babies and pineal Teedine tess os. nate eke 442 — disturbance factor in thyroid Gisthurbancemeae . omic eso — symptoms in pineal tumors. .444 IMiGG ai Osa pie cia aciet a ccd ces Sickert DLS
— basal, exophthalmic goitre and 99 — before and after splenectomy. 93
— blood liposes and...........394 — calcium, parathyroids and 221,222 — cause of augmentation of....594 — defects of causing acidosis. ..547 — effect of removal of spleen on. 226 — — —thyroid hormone on....571 —endocrine organs regulators
CIR eee ts A lieve ois) soa (oye IOUS — gaseous, effect of thyroidec-
(OMAN, (0) the Joe ee rE epee lee 572 — glucose, action of thyroid body
(0)i! (2 SRD Be oe ot 570 — goitre due to faulty.........576 —high protein, during preg-
WANCY Sac os 2)s0e i eee ee Oe — in Addison’s disease........513
——sitl} Glabetes:: 2525.57.52) Bobs
Metabolism in diabetes, nephritis anid CHOleGYSULLIS ioc) ra cetonen ene 193
— — diseases of ductless glands. 513
—in three unusual cases of dia-
betes: 0 halo eee SV ayT —jincrease in following splenec- EOMY Oe Sie reese eaees seals 565 —jnfluence of alkali on follow- ing pancreatectomy ....... 363 — —_ —__{hyroid gland on..... - 582 — influenced by thyroxin....... 159 —=INhiDTedeDyseSDICCN .. <6 < ces 565 — internal secretions and...... 79 EO HCG Ae dis Bin aaa @otoetorc 100 —-—glucose in surviving or- PLATS y cuss one wiassuel relic kere 190 —-thyroidless dog, effect of DIMI S POW cawop cicpres cies eeu 430 — pancreas and, in diabetes....557 — pituitary and thyroid in..... 534 —relation of internal secretions 10 eR EA eM CIMED soho) DS catiocd GiO.016 38 — and to mental per- Versions ~:< 80 — relation of sex glands to..... 373 —role of calcium in tetany.....560 = Salt im GiaDeteSamertecshens1 <0 lea 363 = Scan Hy POPMYSIS AMe sar. ceenens 486 in ehwmMan solapecesinacicasi 2
Metamorphosis and growth, rela- tion between and thyroid gland.237 —jinfluence of thyroid prepara-
EL ONIG s Ole eeeee asa uousache eden 586 —relation of pituitary and thy- TOU: Oui ateesden ee eet maa —retarding influence of thymus UPON es ct oes Seah eee eos 229 Metastases following goitre oper- ACTON Aves «sod cemeeene lorone cee 426 Métivet, G.: Distribution of sec- retineim intestines)... .. esses) Metropathy of thyroid origin. ...584
Meyer, L. F.: Scleroderma in in- fants 5 Meyer, O.: Sudden death....... 406 Meyers, V. C. (Killian): Diastatic activity of blood in diabetes. .553 Middleton, W. S. (Evans and
eel fe) eve emiewme. e (v oils) ‘elre (ome) elem airele
Smith): Tonsils and thyroid
GIStumDAnGeSieiciers © <2 cietenarcne nate 2 Mieremet, C. W. G.: Hypertrophy
Ol JORDI ooo 6 oeopooodod ode 27 Mikhailoft: Pituitary extract... 89 Milk diet for toxemia of preg-
BI AKEN © aia 5 6 6 Cocco) a CRO OLS Pat tab —jnfluence of upon tetany..... 222 —— Of thyroidlessezOatsie sr... 120 — production and drugs....... 401 Miller, J. L.: Splenectomy..... 93 =k wove aoossosotadae dee 383 Miller, R. T.: Suppurative pan-
Cheéatitisies sooner 86 Miller, S. C.: Exophthalmic goitre.575 Minot, G. R. (Lee): Splenec-
tomy
elise e 1¢.,0).0) © af a (a 10) ef ieee of:6\.0).6
Mole, cyst Moleen, G. A.: Dyspituitarism...207 Monch: Third ovary de Monchy, L. B.: in ‘Child’cn.cverko,. oa eee . eee 205 de Monchy, M. M.: Pituitrin in labor Mongolian idiocy and pineal feed- ing Mongolism — in child mother Moore, C. R.: lers, II — Gonads as controllers of char- acteristicsy ior ees eee 372 Moreley, J.: cyst Moreschi, C.: Diabetes insipidus 56 Morgan, T. H.: Gonadectomy of ROWS. 2) cise feucai ene Blatant See ee 203 — Gynandromophism in insects. 226 Morgenstern, O. (Kaminer): Thy-
hydatiform, with ovarian
with myxedema in
Gonads as control-
MUS vand.Cancinomas ese ene 228 Morphia in partial thyroidec- TOMY & Wren. creas, heme econo Sane
Morphine hyperglycemia in ex- perimental pancreas deficiency.551 Morphology mammalian semini- ferous tubule Morquio, L.: Morris, Margaret (Hoskins): Thy- roidectomy in amphibia...... uhalal Morrison, H.: Mortality from di- abetes mellitus among Jews...541 Morse, J. L. (Wolbach): Primary tumor of adrenal gland...... 345 Mortality from diabetes mellitus. 542 reduction of in diabetes...... 552 — statistics of diabetes........ 59 Moschcowitz, E.: Banti’s disease. 92 focal necrosis of adrenal..... 177 Mosenthal, H. O.: Diet in diabetes THIGHS SO tee Perea sn cette 361 — (Barker): Diabetes insipidus, pituitary extract Mosher, G. C.: Pituitary extract. 87 Motzfeldt, K., Addison’s disease. 495 Mucous colitis, relation of ovary ORME anSccecnS > cons Ceol amc ip ouoci co 392 Mulon, C.: Role of corpus lu- teum Multiple sclerosis, corpus luteum TN) Spcuchspchel's + sheke oes t ome eee Mundell, J. J.: Pituitrin in la-
|\{0) Mio bic coc oo nod om cc
Murillo Campos: Genito-glandu- Ene GhySnRONNIN, Ga om aoucou veo” 374
Murlin, J. R. (Bailey): Sex glands and metabolism.......373
— (Craver et al.): Alkali in di- PWNS) 653 Gleudo-0 oi. GInS OO 62
— (Kramer): Pancreatic dia- betes in™ dope. Levon -ceenaretr 362
— (Kramer and Marker): Pan-
creatic diabetes in dog. IT. .362
Murlin, J. R. (Kramer): Pancre- atic diabetes in dog. III......363 Murphy, J. B.: Strumectomy, surgical pathology of thyroid gland — Toxic goitre with melancholia, — strumectomy Murray, J. G.: Supplying ovary and causation Of S@€x:3..5. 5.2% Muscular activity, significance of epinephrin in — dystrophy, case of.......... 388 — fatigue, action of adrenin on.. Muscle reaction after fatigue.. Mussio-Fournier, J. C.: Achon- droplasia with hypothyroid- ism — hypothyroidism WIVES AGGIE. Soi eae err 514 —w—and epileptiform attacks.. 82 — — case report — — origin of disease......... 512 —w—report of case........... 205 —-— with Graves’ disease...... 584 — studies in
«) 2)», (Ores ase 6) 2) Ure Le
Eee si elel/s) "e's ©. 6 @ © 2's ‘se 's =e. (ev 8
Myers, C. N. (Voegtlin): Secre- tin and pancreatic secretion fanG! [tei O} (ater heer 563
Myers, E.: Electricity in goitre. 433
Myers, J. A.: Mammary gland.
Myers, V. ©. (Killian): Dias- . Eauceacuivity of blood... ...... 53
Myerson, A.: Solar plexus in in-
RESIN CONGILIONS 2)... 56. 3s 404 MyopapnieSs primary. ...3..... 536 Myopathy, adiposogenital dystro-
RV EIRE te rot os. sles. os. os a D6 Myotonia, atrophic, and cat-
SUS DEMOS IO ree io veo fey =o oes MOON Ane pots ras) oe oo eek we Sigale so 99 —and Graves’ disease, possible
BG-CSISTONCE 6.6 5.6 6.6 belo ease 574 —and nervous system......... 110 — — osteomalacia 587 ——jaVeCbare- OL CASE... 2.62.02 eee 480 = Se ie ee ee 408 —caused by military service. ..584 —due to hypofunction of thy-
TEE tet lie jell ae Rr 597 cy LALO; 4305 59/2 — in infant of five months..... 120
— in mother, mongolism in child.584
Sri iiikey pa 243 —jinfluence of thyroid extract Eile: nik 2 Soa eRe Ser rr 413 — menopause and ........ 110, 584 — postoperative, a result of thy- roid--enucleation: . <<... éis.< 480 SS rr 431
— vagotonia a predisposition to.584 — with sporadic hemophilia, a roid therapy in case of....570
Naccarati, S.: Primary myopath- MINORS 2 La ates) aeeda cis 1st gee 536 Naegeli, T.: 1000 cases of goitre.431
Nagayoshi, N.: Synthetic adre-
FEUDS = Seeheee tes aye Met eR Sky, 186 Nails, disorders of during preg-
WAN Cease c ccc tesa Tage ete che: 263 Nakahara, W Oocytes of stone
VER Sn se Os oC hche ee ce Ee ee 5 Nasal hydrorrhea due to dysthy-
ROUSE A ate jt too oe he a S 29 Nausea of pregnancy, corpus lu-
CUI GR ene tert ok Eas Tk 191
Necrosis oe aes Pland eee 236
Neei, A. V. Lipodystrophia pro-_ pressiva
Neoplasms of pineal, two groups
OEeSyIMphOMS ms 4 ee 444 Nephritis, blood sugar in....... 3D5 — CaScaOlmchronics sates. cs os 501 — effect of hypophyseal extract
18 AS ie a gt el a ea 209 = MEAD OMSIM inet nt. 8 ee 193 =e WILK IMbantrism= a .s85. 52 5.00 385 Nervous jeretinism 5... s-. 2.2 2: 426
— disorders, organotherapy and.426 — system, endocrine glands and..199 — — internal secretions and... .342 —-— myxedema and Nesbitt, G. E.:
ROU EADCUESL oo eo ag 61 — Remarks on Allen treatment OlsdIAHeSEeS <0 fete See oy DO Neste: Status thymolymphati- cus and suicide in soldiers... .406 Neurasthenia an endocrine as- PERC TEig gene Ss ict a es aitfil —in women, internal secretions UENO geneity ae iy kms ae 80 Neurocirculatory asthenia 374 aad ICUVEICASCS. ete ck fe a 243 ae COMIELES tea es 154 a BY Neuroblastoma sympathicum with Addison's. disease -...-...... 495 Neurogenic type of endocrine SAVOY ONO TING % SST he ee a 331 Neurohypophysis, hemorrhage of causing diabetes insipidus... ..206 Neurological practice, corpus lu- COMIN GIN hyo age Ee, 7, aac ee oe 1 —— symptoms in pineal tumors...444 Nicholson, M. A.: Typhoid inocu- lation in endemic goitre.....250 Nicolyasen, L.: Diabetes insipi- COLLIS % Sree 8 ie 0 te Se eee ee 523 Nicotine, action on ureter...... 44 — -— — liberation of adrenin.. .502 Nitrogen balance in thyroid dis- ESTEE en St oy RNa (Cae ee 592 Nobel, E.: Lipodystrophy in girl Git. TED i ate i ee ae 535
Nobl, G.: Skin diseases caused by abnormal endocrine functions. 499 Nollan (Buckner, Wilkins and Kastle): Effect of grain ra- tions on growth of chicks... .564 Nonne: MHypophysis diseases. ..525 Noordenbos, W.: Goitre in girl of 16
Nordentoft, J.: Hydatiform with ovarian cyst Pas UTE Norgaard, A.: Diabetes insipidus treated with pituitrin....... .)20 Norris, C. C.: Menopause......-- 396 Norris, E. H.: Morphogenesis of human thyroid Nose in disease of thyroid and
116
thiyaUS akan er. stoe= oe 98 Novak, J.: Gynecomastia and mammary hormones ....-.---- Sas) Novocaine-adrenalin stock solu- tion Be ee es CA 06 Nubiola, P.: Graafian follicle... 84 ==\(Domingo): Ovary -3--.--* 84 Nuzen, T. W. (Pember): Differ- ential diagnosis of goitre..... 421
wo
Obermann, W.: Sexual precocity.22 Obesity and genital hypo-func-_
TOT seek oe ras Sh eee boat ee 2 —of glandular origin......--- 64 — thyreogenic Sy ea a ee Obregia, A. (Urechia and Popea):
Hypophyseal GYSELOP WY wer enep 8-2 212
Obstetrics, internal secretions in.386
— pituitary extract in.......--- 87. FAQs Sal gods e ©
—seven years of hypophyseal Medication dM sepa - oe a Py — some problems in.......--.--- 381
Ochsner, E. H.: Corpus luteum. 395 Ochsner’s directions for medical treatment following thyroid Sb AeInT Ja 5 Se OM oe o.oo Saale O’Day, G. P.: Ovarian cyst...-- 51 O'Day, J. C.: Boiling water injec- tions in hyperthyroidism..... 109 — Carbohydrate tolerance hyper- thyroidism Oechler, J.: Diagnosis malignant PF OLERC peat 64.2 peace (=o dene 570 Gehme: Man of 19 with hypo- physeal dystrophy .......--- Se) Oehme, C.: Acromegaly......-- 20% Ogata, A. (Ogata): Henle’s reac- fiom im -adeenals. ..2) cue 189 Ogata, O. (Vincent): Vasomotor TaD CER) ee eS See co ie Do Dib Slates Ogata, T. (Ogata): Henle’s reac- in mire to aos ooo oe 189 Okuda, K. (Kaneko): Spirochaeta icterohaemorrhagia .........504 Olaechea, M. G.: Pituitary syn- drome Oliver, O. J.: Goitre, in-crook ankle, stunted growth ...... .589 Oliveri, E. M. (Ronchi): Boiling water injections in goitre..... 409 Olkon, D. M.: Thymus gland in- jection Dee Operative treatment for thyroid GiSCASC, cree eet eno 102 — — of exophthalmiec goitre.454, 458
56
< ‘ncilelawh ah wes oo. 0.e 0 igieis(« ese: Bled
Ce GUESS Cees coes 581 - === toxie 20llre pene aoe
Opotherapy, see organotherapy.
—and neurasthenia .......... 426 —in menstrual disturbances.... 6 — modern conception of....... 215
—of shock, endocrinology and. .20 Opthalmiec practice, thyroid ther-
ADY il “sc. 5.5 oe, sos cs eae Zoe Optic nerve atrophy, Rontgen Lays os ek « cele ee cee 77 — — — with pituitary tumor... 520, 520
— nerves, atrophy of four cases.513 Orbison, T. J.: Vegetative ner-
VOUS. SYSteM:....2% 2 tometer See 566 Organ extracts, therapeutic ap- plication:of; 2&2 Sc) oeke eee Organotherapeutics in skin dis- CASOSi il. s-tiycniete Medea 597 Orzanotherapy: 2.450545 6 eae 82 — Adrenals. (oii cocoto ere 345 — €arly lMistony: 3... >See eee lh —in diabetes ........ 488, 489, 490 ——JN FYNeECOlOLY a a. esta cA 82 —— —— infantilism <..2 oe ce eee PALL —-mmenstrual disturbances ... 6 —- menstruation insanity .... 6 — -—mental imbecility ....... 205 —-nervous disorders........ 426 — -— practice of medicine...... 215 — — sexual impotence.........518 —-skin diseases ........... 499 — — treatment of heart in myxe- GEM hood west cca Seen 592 ~—influence of parathyroid on calcification of bone) ..2. ae 559 — modern conception of....... PAS <—new phasewol . «= .-14 eee 82 —— non-specific, effects), =. = + asaee 514 — OVALE. << so 3s ee 835393 ——-—in depressed lactation ....509 == pimealieg. =o te) ees sce ee ee 452 == FACIOM Gls er) = eeonet) ee 2a Orchitis, feminism following : doubles...2 toc. eee eee 225 Orr, D. (Rows): Interdependence of sympathetic and central ner- VOUS SYStEMS: os )ss5. sa) «eee 200 Orth, O.: 300 operations for POUT’... ob. alslecseaee ee ee 412 van Os, P.: Thyroid glands.....238 Osato, S. (Kumagai): Internal . secretion of pancreas........5957 Osborne, O. T.: Ovarian and cor- pus luteum administration ...391
—— Qvary; corpus luteum .-.--.-: 391 Osmic acid in staining adrenals. 496 Osteogenesis imperfecta and its relation to osteomalacia...... 536 Osteomalacia..... 349. 392, doabs dot —a pluriglandular condition. ..537
—and diseases of ductless elands Seow heii 2 ee 537 —-jnfantilism, with horshoe KLANG Ys 5.5.2. cha eee 536 — =, MEN OPBUSG. ces cic cose eee bo — CAS: Offense ee eee 216
— internal secretion of ovary in.396
Osteomalacia, non-puerpal...... 537 —relation of osteogenesis to...536 — starvation, and tetany....... 536 — theory and treatment of..... 395 Osteomalacia-like diseases in WATVET OT | ae ee ee eee 516 Otistis media, case of cheate. with hypophyseal tumor. aD Oto-rhinology, endocrinology and 13) Ovaradentriferrin, action of..... 539 Ovarian and corpus luteum ab- RCO SSE sen coi ole tence? Sos) Sch Sow Sh wttens 541 —cystadenoma, case of........ 394 ——'@¥Sts TepoOrt OL CASE... .-6 e6% ss 51
— cysts, hydatiform mole with. .217
—extract, action on pupil of ROS EVE ait fcieis-s cis ss ahs 154
— effect on metabolism in TOI 6(0 patie io —-in case of menopause..... 584 — —-— menstrual disturbance... 6 —-—-—menorrhagia ......... 84 — feeding in tadpoles.........228
— function following X-ray treat- JUSTINE Seth eg ee ae eee 390 Cy thre) 610 | oe 391
— — effects of hysterectomy TRC an 5: eae ees eee 218
— functioning, endocrine factors 5 ITM ae xe tae ie Stel eee sd, oe lc 197 SEED Me 393
— hemorrhage, relation to extra-
uterine hemorrhage ...... 219 —— hormone functions -..:.....:.514 TI OCTUGES tutes 6 Sos aoe desc « 216 _ insufficiency, exophthalmic rofoshiids: Gaal. Aiea ene ar 234 —-— therapy of ..............539 —IOPZanotmmerapy. 6.5.2.2 66% 83, 393 — -— in depressed lactation ....509 — salvation vs. destruction..... 394 — substance, symptoms caused by administration of...... 391 —swellings, alternating peri- CPOE es Ast. sisson els 538 — tissue transplantation in rats. 23 — transplantation ............ 396 —tumor of thyroid structure. ..541 CLL EAN Ta ds CUR na vei ae 82-86, 217-219, 388-390, 538-541 SSS oie At) On 86 —and artificial deciduomata...385 —— corpus luteum antagonistic TE OLO RM 8 et ends) oe 8
— —thyroid, antagonistic action 8
—— —— general consider- BtiCus. ete 391 —and mammary secretion .....53
—— precocious puberty Ovaries, atrophy of in case of plu-
riglandular insufficiency .....562 — behavior of mammalian .... 85 Case. OLia tMird 272. 1ieen es 83 a POLOSECTIN, '. tat.) .. vShu eole see 84 5 = ee he ee ep ae Ce 391
Ovaries, cyclic changes in inter- Stitial Cells; Ohsjpersmeeast ee cs < s yay ——— ——— — Mammalianes.. cs... -. o4 ——CYSUIC’, 20s See oe oe Seater a's G2 == degeneration Of 525...-'..040 = CNdockimne tinction OL s. - > Nay) = FORMU MAELO, (OL) cies eye esos tolls ais 565 ———. (CEI GIF COC: at aye atic en eRe 538 —— Sua, Palactogoeue...-... - Sas) — evolution of Graafian follicle... 84 — hematogenous infection of. 84 —Merniad, OL, treatment. ..... > "392
—in mental disease, examina- LOUIE OUMP aS Swe) ec. cee ck Ses 389
—-w-metabolic instability dur-
ing preznancy -....-:.-.096 — influence of sexual intercourse
itis A= RG eaERe Pee ae cee ee CIE, —— SI MMOEV ULOM AOL s ceis Stee ee aoe 84 — insufficiency, treatment of...539
— internal secretions of........540 — — — — early function
— —- — — jn osteomalacia ———— ———jnberstitial cells—ofs.da6
—malionant diseases OL. <5 2-. 7... 3 —of spermophile, study on....218 —=goeytes. of stone fly. ...5... 85 = OreaiObleLADY ses 2.62 12 OOo —relation between mucous co-
NII SPAIN © 2. Seve enw eeetotts. 66% 392 —relation of endometrium and,
COMMeEMOnRTNALe: 5s fer. ss eee 85 —-—— — to uterus and mammary ATT |: Je ane eee Ree 394 —— to causation of sex....... 218 — —-—hyperthermia ..... ..424 — — — other ductless glands. ovo: Tole in osteomalacia. = = 5 ..- ee aU COMMA OLE wre os she are See) are 394
— secretion of during pregnancy.538
TTA IME ee eS cake te ce DO — transplantation of ..... 26. Diop Ovulation, continuation during DURING Via. = sees Sh. cars eles rope Oxidation, deficient, causes of...504 — of fats in diabetes mellitus. 545
Palmer, W. W.: Concentration of Gextrose: im. GISSINeS). 2 fae. 2. «ste 364 Pakiaism= siprarenals ims: =o... :, 347 Pancoast, H. K. (Hopkins): Pitu- itrin and gastro-intestinal tract of man
Pancreas. .86, 219, 220, 397, 541-558 —and diabetes BYERS eit cliss ses 485 —-— metabolism in diabetes. ...557
— appearance of trypsogen in fe- IE A sic sis sys cee ss OO — cirrhosis of, in diabetics.....546
— deficiency, hyperglycemia in experimental! 22%... 25. ae ok — diabetes mellitus and....... 195 — diseases of and retarded growth in children........548 — disturbance of digestive func- tons” Of 5. Wee ee eas TD LD
— effect of coagulation of...... 60
Pancreas, effect of painting with
AGTEWANT. «1c. «% ois ee ore eae ere 557 ——-— secretin on........... 564 —extirpation and starch diges-
TION | 5.0.2.2 loeeas ee oie ee Sil —-— producing diabetes .......549
— influence of external secretion WHOM AIA eles eee oe ODO == —. ON FEN Y TOM wn ote he 5k én Piles — internal secretion of....556, 557 — — — — disturbed by chr onic— diarrhoea — reaction of —relation between hypophysis and —removal, glycosuria following. 220 —response to thyroid stimula-
EYOM As sia, cheers nei eee OLS — sclerosis of in case of acrome- SAV tor have tvlaet lel aRe) spac eae ores 88 — shell wounds cause of pancre- ate) PSCUGdOCYStion eee 86 =——= SY PNIIS Ol pen ccyetiee ents ares 61 — unchanged in hypophyseal di- ADECTCS Feces ones eaves a 488
Pancreatectomy, effect on cata- lase content of tissues....... 397
— infiuence of alkali on metabo- lism following ; Pancreatic diabetes, acidosis and. 355
— — caused by change in liver. .554 —— —— 1 Of: . ax. Sas cee 5; 3863 —ferments, pathology of..... 220 — insufficiency, recognition of,
HWOEGWINEESESS = 5 lasso ees DoS Pancreatic pseudocyst ......... 86 — secretion, action of adrénalin
ONRAS ica. 6 dan eo omc nds Coe 47 —- Stimulation of |. | a: eae —— ty penoidiabeLes)=.5 25. 2. haem DAO —vitamine in cases of infant
VVC CION, seve el eee 87 Pancreatitis, parotitis and...... 86 ——(SUDDURALLVES « 0.. 2). chsldastscceeee 86
Pancreo-hepatic type of diabetes.546 Pandolfo, P.: Gynecological evo-
LUTON Se eee... < cucroutnee ae ee ST Paraglandularesystem 2. scs- cc 87 Parathyreoprivic tetany ....... 566 —w— metabolism in... 514
Parathy Godan ce os 84, 219, 221-223, 558-561
—— AT AUOMY, MOL. (o choke sce. a ieee 222 — and calcium metabolism..221, 222 — — —-— in tetany .........560 —antagonism between thymus ayn! 5 4 Sc ene Oe ee 406 —dysfunction and myasthenia SLDIVAS camer A sa. cote DL — function and tetany.........560 — in bone fragility............569 —in cases of osteomalacia.....537 — influence on skin........... 597 — —— tetany .........0%000. 559 ——insiiicieney iam ss DOL —-~ cannot be treated........ 561 —organotherapy and _ calcifica- LON: Of DONC ie 559
Parathyroid removal with thy- roidectomy, danger from..... 480 —— Tetany, SLUGIeCS) Ont eee 221 — thyroid and, relation between.111 — transplantation. .25) sae 398, 560 Parathyroidectomy, influence on gastro-intestinal mucosa Paley, S. H.: Allen treatment in diabetes mellitus Paludism, treatment of major syndromes in Pardee, I. H.: ACHES) iy. He cee oe 2122319 Parker, sk ouvie- See structure and development. Parotitis and pancreatitis....... 86 Parsons, J. P. (Vincent): Blood pressure and splanchnic nerve
Stimulationys....2.-- sree 44 Pars tuberalis of hypophysis,
early appearance of anlagen
OR) ees cls 4 es eee ee 78 Passini: Diseases of pancreas. ..548 Pathological methods in diagno-
sis of thyroid disorders...... 102 Patholofyo Obs Soitres oe eee a7) Patient, new point of view in di-
agnosis and treatment of..... 164 — study of rather than disease. .493 Paton, D. N. (Findlay): Tetany
and parnathyroids) =... eee 560
Paul, N.: Xanthoma diabetico- PULIMy ecieeteh esc eee 53 Pearl, R.: Corpus luteum, sex character Pearlman, I. (Vincent): of chromaphil tissues ....... 1 Peck, C. H.: Splenectomy...... 95 Pediatrics, role of pineal in. 437 Pellegrini, R.: Congenital aa 412 Pelvis in man with hypophyseal _ dystrophy Pember, J. F. (Nuzen): Differen- tial diagnosis of goitre....... 421 Pemberton, J. D. (Judd): Opera- tions for exophthalmic goitre. .103 Pende, N.: Endocrine pathology
Function
Of WAT) A. bi. 5's we Bee eee 329 Pepe, R.: Ovary and mammary
secretion: 2. cic ca8 tote ee ee 539 Pepper, O. H. P. (Austin): Splen-
ectomy. $<o200 25 ot eee 93
Peptie uicer, due to endocrine gland disturbance: ei. 223 Persistent thymus in man of 22..528 Pern, S.: Functions of thyroid. .107 —— Thyroid) Mechanisms seis Sy Pernicious anemia, splenectomy hire Ne ae SA eee 93 Peterson, E. W.: Goitre in chil- GTOM: £hochenies And Gee sexsacateseenenes 420 Petit, G.: Thyroid tumors...... 110
Pézard, A.: Castration in fowls. 66
— Secondary sex characters.... 65
Pfahler, G. E. (Zulich): X-ray and exophthalmic goitre
Pharynx and tonsils, recurrent in- fections of in treatment of OTE Cima, sa edna shel wat owes or6 wr eilat se 576
—— diabetic ulceration of..... 55, 358
Phocas, A.: Adrenin hyperglyce- mia z
Piaggia, Garzon, W.: Case of TAREE CLC TIT ee GS arias Sryo! Sulaiva .o whasietens 120
Pico, O. M.: Experiments with COUPOTUEUT ESS a5 crc gelis. a. + loud ome 308 498
Piffi: Operation for hypophysis inci: SS Lee eee err ee 52 Pigment changes following hypo- DAY SISETOMOV Als cage < opaks lode iene ens 383 — migration, effects of adrenin on 48 Pigmentation, brown, in tetany with chronic diarrhoea due to adrenal insuiieienecy =... ....s..-. 561 — changes in frog larvae follow- ing hypophysectomy....... 76 === THE Sic Se Bee eee 562 Pilocarpine, antagonists of..... 185 — effect of injection of on starch CUPESE SNC ays, eye says 6, once oo ot ease, enw sHa — — — repeated injections ....182
Physical examination of patient.166 Pincherle, M.: Early pituitary
SGOT ee eee 208 — Hypophyseal syndromes...... AU Pincherle (Polidori): Spasmo-
ih, aa Ghee GS eee eae erie. ois fe fc kk eee oe OOS —— active Substance in.......... 451 —a gland of internal secretion?.451 — body, glandular nature of....398 —-— hyperplasia of .......... 87 CEES COL. 6 ond gs bce a ue 437 — — relation to other organs...437 — -— shape, size and location. ..437 ——¢ysts, two. Zroups of........ 443 —deficiency and mentally de-
TEehiverChildTen ji:..... <<... 442 EP SGISCAS@ Ol. occ oss s wet ela cies Ss 444 — disorder, analysis of symp- TGS ee 448 —-—and endocrine glands..... 450 ——SJOMEIMD AION, Of % <.chtueecalecw cs a 438 = EE Gis Gee) a 452 — feeding and hypo-pinealism.. . 450 —— — metabolic activity in ba- [OLIGTS eas ahs Ire ie 442 ————jexperiments -........6 440 —-—jn children ............. 442 —-— influence on body weight and mentality ......... 441 —-— in Mongolian idiocy. .442, 443 te OMULLES® (oles s oot etnies on ois 442,451 — findings following feeding ex- RUCMARMNOUICN, w..'a,5) 5 ee enaice 2.0 441 —functional activity of....... 451 —furnishes a ferment or cata- WVIAC MAL OMG eee) «cise. ose eevee 451 — gland and sexual precocity.. .223 —-— apparently not essential to TILOS Na Oe fy ees 440 —— enlargements, disturbances caused by: *.. S22 estan ae 445
Pineal gland, experiments with in
FT OS ALN CM owe cateciey ceaseless era. 424 — — extract, observations on use
Ole, siete eet eee Ae shete s 398
— -—function of ......... 447, 450
—-— mechanical function of....450
—-—oorganotherapy .......... 453
— — reaction of to toxemias....449
— —relation to various types of
MMS QUMGTES F yses) os fe, oo Sb, cae 449
— greatest post-natal develop- TINCTURE Aw oy we as caviatilctas. 5x6. ooh are 437 —jin pluriglandular syndrome. ..448 — involution, a type of tumor. .443 — neoplasma, varieties ~et43
—no apparent endocrine func-
Mel OM Manna Wau cist onc ae 10a chon es si V6, cvs 440 —- period of involution......... 437 —primary myopathy .........536 Se S1O Mae SMACOWWS) (1M).rtcsies ei ei ere) « 449 — retention, a type of tumor...443 — retrograde changes in....... 438 —role in pediatrics........... 437 —— — progressive muscular
dystrophy — secretion and growth and men- tai and sexual development. 450
——UeAbOM a Ol ae gtuate ce citisbieysve.c 2 443 = DATION (CSUISE OES ae 4 aad ClO aoe 448 —-—relation of pituitary body OMA cc ctickor ooh ae ak hereee rene 446 —— SVM BOM ALOLOL Yas ais cs as oe 444 ——= HERI IOEI TN Bees fie ao, o oe oi Ohne 449 — — two groups of symptoms...444 — use of cautery in destroying. .439 Pinealectomy, changes in other glands followin?) <ia.er. . 2% < 43 — difficulties attending ....438, 439 —in animals, difference in ef- CCUM ates rote eles ad See ors 439 Pintos, G. (Maraion): Traumatic lesions of hypophysis........ yg kal
Pita, A.: Modern conception of opotherapy — Uric acid diathesis an endo- crine disorder Pitaluga, G.: Defective develop-
NLENG, OF DlOO Gir. 8 so css aos ee 386 Pitfield, R. L.: Myxedema...... 110 Pittinger, P. S.: Effect of alcohol
OLAIGUOreDYy PODMYVSIS > a.y4ei. oer 78
Pituitary, see hypophysis. —and thyroid, functional reci-
LOCI VACA eicic rexetss« < 6.6 aciesonele DOD — — — glands, relation to meta- MOLDMOSIS, ©. os, 212.90 tee 424 —autacoid taking place of thy- roidiehormone <;... >... .% . Jot ny OAR See Re ates Sie cna: cuetebe 78, 523 — — disease of, treatment.....561 — — relation to pineal tumors. .446 OMY ALTIA, suc e's ele wee letatenelens Tere — — relation to sexual glands... 11 —control of polyuria.........521 — diseases, study of 100 select- Cd MCASGS: a xeec eee Coe 69
Pituitary dysfunction cause of AMENMOLTNEA «<5 5 sn cures eae eee LiL — dystrophy, lipin-content of liver in) two Cases OL «nme. 68 ——@xtract; abuse.ol.).% saw coe 87 — and bladder activity...... 370 — -—effeet of alcohol on...... 78 — — —on excised vagina...... 50 — — for induction of labor..... 401 ——jin concealed accidental Hemornhascei ee secs sHO0 —-—-— control of symptoms of diabetes insipidus... .382 ——— gynecology ........... 207 — — IKACYONe? eoh eis Bia wiaulore 6 crows
— — —obstetrics ........ 311, Sol — — —-— and gynecology .... 87 —-—-— treatment of asthma...383 diabetes insipidus. 206
——-—w-~-—of incontinence of UTING ss Ae ees 89 — -—jinhibiting gastric secretion.232 — — physiological action of....173 — —standardization ......... 88 — -— thyroid and, in case of pit- litany. disease aoe. 56 | —-— (whole gland) in menstrual disturmbancestsacieiaeie oes 5) —— fossa, enlargement of. ....... 561 — gland, effect of thyroid extir- PAatvion: Oni cee hee Meee 242 —-hypertrophy with thyroid sland satropiy Gaaeaewes sens 100
— — large tumor of........... 380 — gland muscle stimulating con- stituent of, posterior lobe. .529
= phiystOlosya Ob skeen Bee oes) — -——report of cases of disorder Oley oe Ree 207 = SV POUMISHOL As a ene = Seer 4§8 —-—treatment of case of ¢Ca- Ghiexdan cil is ahi oS een —-—tumor of...... AP otha eke 213 —egrowth, optic atrophy sole SVMMUPEOMMNOT . +. jie sees cheeeee 68 — headaches and their cure.212, 379 — VRAIS ree . cis apse wie 7a Akal = SECECtION: AmHmencel Ol. 1 = 69 — solution, rupture of uterus EOMOWINIS Te eh-o.ste 5 3 eee ee 9 — syndromes, early Poe OS —therapy in Basedow’s. dis- (GENS acd inn log UA ne eRS Eee Se as qs) —thyroid and, extirpation in AAD OSS ire trea het sos isan ace Byehe cence 243 —treatment of Graves’ disease. .384 — — — menorrhagia 4 6 31d OY) IS VN OM Cuan a EeMen st tee tersie eo ee 381 —tumor and acromegaly...... 8 SS CASCR OL nn ear — -—with optic nerve atrophy. .521 Patiwitrinases aerscccecasmetere che ets: sins 88-90 ——‘ADUSE MOL ata reetmemen ter temot as cee rics 90 —astimulant to unstriped muscle tissues. &, wera ee cars meee iol: —— Ania adrenaline essere ene 88
Pituitrin and adrenin, influence
Coay oboNl CoN MENON Cm So ado on
— antagonism between adrenin and
o © (9 8) 0 (s) Sle’ @ (e 16; 6s) elie (6) eo eatane:
as intestinal stimulant follow- ing abdominal operations. .531 —— benefits of, in labor......2.722 378 — containing chloreton —contraindications for — does administration to mother
eitect imfanil?.aa-eseie seer eiene 400
— effect on gastro-intestinal tract of man"... JS eee ee 5390
—-—-—metabolism in young GOzZS: 12 Caan ae 79 — —-— milk production ...... 401 — —-— vasomotor reflexes..... 428 —extract of whole gland...... i5yca) it —— in Levall spitultanye eae een Hiato — — hemorrhage 8. as eee aval —-——homonyous hemianopsia . .522 ——'— labor. ist tee eee SO eZee —-— obstetrics .......... 212, 531
— -— post-abortion curettment.. 89 —-— pregnancy coincident with
Cabes dorsalish.-eeesdemeee 88 — -—retention of urine ....... Diz
— -— superficial hemorrhage.45, 46 —-—uterine inertia and post- partum hemorrhage ... 90 ——treatment of diabetes in- sipidus - with polydipsia and polyuria 77 — —- _— —— {diopathicepllepsyeaoo 531
So NOC ke ae eee
——- 1 —— sy M promce ss koMlonwanes
pregnancy in wWwo- TOT sihertae Cec pekeuewe Biri
— injections and pituitrin out- DUC: onshn Rae omcetee nomen 523 hel (lighovetesh5.6 namo ob aD oo c 194 —— MIS OCS ey -nepeen eens PA ALAL
— — -—— hypophyseal dystro- Diiivn Metres crore eee 523 ISOC Keen cere seslave once 202 —Neneth on actionOl-. -.enaenenste 531 = USES ana) ADUSES: Oluse unmet nena 530
— (with adrenin) treatment of asthina.-3 5) oe oe eee 45 Pizza, C. (Massalongo): Acrome-
PAY ow ets ave Oe ee Se eee 80 Placenta as an endocrine gland. .313 —— influence ony SrLoOwth\. cue Sule ——ineernal Secretion (Ofe-ee-siemnees 224 —function of internal secretion
Of" 2. S 2 ae en 307 — galactogogie activity assign-
abletto mene ee on oc ronal —role of in development of
eclampsia =...) © ae 307
Placental extract in gynecology. .199
Platou, E.: Ovarian tumor of thyroid structure
Platero, H. F. (Colistro): Annu- EWE CRYO) Goo econ od oboadcos 73
Plummer, H. S.: tion Pluriglandur condition, osteoma- LiGVEiGl E> AR Say ep eget selena eae ane 537 — deficiency, spacing of teeth in 11 — disturbance in eunuchoidism.516
Thyroid func-
——insufficiency in case of sup- MOSCOMUCLATIY: .< . creole icqoe.s.s « 559
—-—- patients with diarrhoea NGE LAI Y:— = 22.5 oucy ss. = 61
——probable cause of sclero- @erma in infants. 2... =< 563 —-—report of case........... 562 ——_—— some rare forms.........- 370 — origin of hypertension...... 596 — syndrome, pineal in......... 448
— therapy, therapeutic value of.214 Pneumonia, Addison’s disease fol- lowing — followed by inflammation of goitre Polak, O.: Menstrual function... 85 Polak Daniels, L.: Ovarian ex-
PMACh sin MeCNOLFNASIA . 2... < «=. 84 Polidori (Pincherle): Spasmo- TEPIIRG). 2c a ee 92 Poliomyelitis, experimental, and CHUEOTGMIIGSTIS «02 <2 c-s.0+ . s' 3 ail LEG IEG Ta ce eo Ae a i rr 74, 530 —in two cases of diabetes in- SHV: 2S See eee Sass aE APMC Gs a's > > se 6 ons soe s FOL Polyglandular insufficiency in Ma eWaG MN TICKEUS <2 co ws.cnn.er eis 514 == Si Pai 402 — theory of diabetes........... 485 Polypeptide, substance influencing Secreriomw OF UPime sls. o.eks 25 Polysaccharids in liver blood of PIAL AMEN AIS |e 'o 5 keh s es, aos ts 54 CECE ei RNS ee ee iy ea 74, 530 — following removal of pituitary nui) hy hee Sree 520 — hypophyseal, rhythm of...... 210 a DOPMYSIS ANG, ©... 2... sce. 2s 74 — in case of adiposity.........526
— — diabetes insipidus, cause of.521 — — — —relation to ingestion
DE) ee 524
— pituitary body and.......... A — produced by hypophyseal ex-
ETT ial eet ES eet Se as 523
SSH if¢f
Popea, A. (Obregia and Urechia): Hypophyseal dystrophy ...... 212 Popielski, L.: Secretory innerva-
PIG OL HOPTCTIAIS 4. tye Zusicucne « le.0 0 181 Porak, R.: Adrenal gland of tu- AETRUASULS © 5, 6, 5 ¥emcros « (hte eel ds Eieaeies ae ab G6 — Adrenal medulla in tuberculo- Se NR oi a aie, ach ain abbas tua ieps 346 — Adrenin content of suprare- WL eS Ag See a Ran 8 343 Porencephaly hypophyseal _ adi- AVON MeL EPR oat, ess fo or, oben ieee 22 Porges, A. (Hofstatter): Hypo- physeal medication in obset- ES ot SS oS A SS SE eee 529
637
Porter, A.: Goitre from drink-
(ieee Soa aie 6 4S Seo SIC (al Porter, C. A.: Surgery of thy
Mortleaeinth 6 acess ase oso Ge 587 Porter, M. F.: Malignant diseases
GiMOVATICS fk hod cee ences crore en 3.6 83 — surgical treatment of goitre. .239
Portocalis, A.: Acute adrenal insufficiency Posner, C.: Libido and hormones.518 Pottenger, F. M.: Asthma and vegetative nervous system....350 — Symptoms of visceral disease. 493 Potter, A.: Experimental goitre
RRMR ACS ee a cere cps o's Boas ois yes ase me Dit ti Potter, H.: Alteration of thyroid
IAN GS eal elaUS teseas ous. sys) shen space TTS Poulton, E. P.: Modern views
GTUMGTADCUCS sue u sca e o apens ccs siieue 193
— Starvation in treatment of dia- DeLeseMlelNbWS ey cuct sce © see DIDO
Precocious puberty, cause of evo- lution of —— —— X-ray examination in..... 459
Pregnancy, albuminuria and tox- IV AMO IEE ee 20 creer casas © sica.e 264 —— ST GetaDes. GOESAaliS® .. «... .<. - 88 — continued ovulation during...217 — corpus luteum in vomiting of.191
— disorders of hair, nails and ECCUMMGUMING. ; seccstote cscs sy sce 263
—dysfunctioning of some endo- erine’ zlands during.......517
——— CAT TNO gota te eRe 105
—high protein metabolism dur-
TRIPS See oso s stesso ores 264 — hyperplasia of mammary gland GURU CUEe te 2 so ae lee. Shc oh 308 — hypophyseal tumor during... .532 — in sporadic cretinism........ 428 —-— women followed by complex DiS VIN LOMS!: .T... <0 6 2 oe Dee — iodine requirement during...268 — milk diet for toxemia of..... 271 —nausea of controlled pie cor PAS UCU... 2 ss 2 re bie oie ——osteomalacia during ........ 216 — pituitrin in hemorrhage in...530 —pseudo extra-uterine relation of corpus luteum to....... 395 —secretion of ovary during....538 —thyroid and ovaries in meta- polic-instabiity-of .s...... 596 — thyroid hypertrophy in...... 582 Pregnant women, need for abun- dant supply of iodine........ 271 Prior, G. P. U. (Jones): Epi- lepsy and ductless glands.....200 Prince, A. L. (Henderson and Haggard): Surgical shock... 40 Progressive muscular dystrophy, Hide: (OL INCEPLION =). si6 «is © oben 449 i TOL OL Plleawl tiie. aides 448 DOC VStLO DUN: . cine ek yaaa OO Pron, L.: Adrenalin in gastric WIGISCULALUILE" sions a = aetna 347 Prophylaxis of endemic goitre. ..585
Prosecretin, existence never been
RONG! INR Sin iceerOnmtods oo 564 Prostate as cause of Graves’ dis-
BASSAS 5 cus e Oe OO —— TY NEREE OD Liv.» Oly sensnehs teeelemeene rene 227 Proteins in thyroid extracts, in-
fluence of on metamorphosis. .586 Pseudohermaphreditism SPARS A) UI ——. CASE) Oy Mt orcs exicumke tens oceete omreis = SALT
externally female.518 — endocrine sex structure in... .565 —-— masculine type..........& 518 Psychasthenia an endocrine as-
CHENTAG scan bree crehotoueae ene as7al Psychoneuroses, deninition ..... 513 — fundamental considerations in
EUGALIMGMIE: <ohucieusvendl« oe cuss 513 PubertaseprecOxaes «seleicra a. 256, 562 — -—epiphyses in ............ 459 —— —— IN SLE OL elas. cu aerotcueee 460 Puberty, disturbances of...... -di/3 —effect of thyroid development
OD) ses\ctsce Get er Eee 578 —— An }CRetitn AAs ee Sake sive DIS “Pudding face’ type of dyspitu-
LEATIS IN: Sl. fetesn ec oreeste eo aceeda als es (2)
Pulay, E.: Influence thyroid and parathyroid yon) skinew ae cies: FO — Myasthenia gravis, case of...511
Pulse, effect of hypophyseal ex- CTACtSIONM 4 kc eee 523 PULrDUTa Sess Je hesliiceede ee 186 Quesada Pacheco, R. (Soler): Aidrenalsdeficiencys =... ex eres 37 de Quervain, F.: Goitre opera- TIONS Yes os SER 105 Quinine and urea injections in LOU we eelehenses ts Se Ree 579 — — —_ —_ — hyperthyroidism 1-472 — — — in treatment of goitre. .583
—hydrochlorid in treatment of AON ets Coo ORES NG RCFE OT 583
Quinquaud, A. (Gley): Adrenal secretion and splanchnic..... 180 —-— Function of adrenals..... 182 —w— Function of suprarenals. ..346 Rachiticsd warhsmy iss. sss ee 567
Radiotherapy in internal medi- CLM C:Bavshoeeech. ces a ee ne 431
—of neoplasm in region of hypo- DEY SUSP cecpeneite sets eaten a aresehar elas 69
—thymectomy after failure of. .2 Radium therapy in hyperthyroid- ismies — treatment of goitre...... hans UDR, Aas Yaoe ai Rahe, J. M. (Rogers and Abla- hadian): Gastric secretion and. OLZanwexeGaAGuSrunm stores cc Dod Rahlff, A.: Anti-thyroid treat- ment Ramon: Innervation of ovary.. 84 Ransom, R.: Antagonists of pilo- carpine
Rasmussen, A. T.: Cyclic changes in’ interstitialyeells sree 217 Ravitch, M. L. (Steinberg): zema in infants, and thyroid gland Rawls, J. L.: Uses and abuses of Ditwienin' —<.cuccsvsedeks he tokens 530 Razetté, L.: Date of fecundation. 215 Reach, F.: War edema and tes-
ticular NOLMONE Beedle 405 Redfield, A. C.: Adrenals...... 182 — Coordination of chromato-
phores by hormones....... 187 Refeeding after underfeeding,
effect invalbinio rats =e eieeeene 369 Refraction, sudden changes of in
Giabetes: <. sccksachecoteomeoeenene 361
Renal function, influence on hy- perglycemia and glycosuria in diabetes mellitus
— permeability
Reproductive organs of Cetacea. 67
Respiration, action on, of hypo- physeal substance
Respiratory disturbances as func- tional symptoms of enlarged
thy Mus 2:02.25 «anes en) Polen 567 — exchange and blood sugar TPELWAHOM . saa ct) e eee ueene 9S GQ wotiente 6 <s. 2 < s epahowealo eine yi L3: —— influence of spleen on..... 565 — Rest in treatment of diabetes. ..557
— — — —- hypertension in wom- Ol 5 he whet oe enone 596 — — — — goitre —treatment in goitre Retropharyngeal tumor of hypo- physealsstructure,. sae ee 528 Retinal pigment, relations of adrenale lands tO. sunscreens 346 Reye: Hypophyseal cachexia. Rheumatism, thyroid . treatment Of CHLONIC Face cs ee ees 119 Ricaldoni, A.: Treatment of in- fluenza. -with .adrenin........503 — tumor of hypophysis, adiposo- genitalis Rice, J. F.: Medical treatment exophthalmic goitre ..... 103, 439 Reinhart, A. (Btlirger): Xantho- sis diabetica 3 Richard, G. (Etienne): dow’s disease — -— Basedow’s disease of emo- tional origin with Addi- SON'S GiISCaSe) hie ei) -aeen enon Zoe Richardson, E. H.: Effects of hys-
terectomy on ovarian func- HO 1. 2 sR oer era ols 218 Richardson, H. B. (Barker): Car- diac annrhbyahimilaseensryor-bbceieene PABIE) Richter, E.: Biochemistry of hy- pophysis, adrenal and thyroid Slandse 105% Sethe eas eto ee ‘ Richter, P. F.: War diet in dia- betes “ss Sate. Bact cususterencenenemeeer 62
Rickards, E. (Jones): Abnor- mal sexualbecharacters...>..% ; A6 Rickets, case of in man of 19...514 === Wali Sm With 05 5 ces ers ee ies 567 Riely, L. A.: Diabetic coma....548 Ries, E.: Ovarian swellings....538
Riesman, D.: Hypertension in AD IGiKESt| capac Meee ieee eee aa eee 595 — Mild diabetes in ehildren. Bevo!
Ringer, A. I.: Classification of
Gia DELeS MICIIILUS: = is edes ae le le 6 553 Ritchie, W.: Cystic ovaries..... 82 Robertson, T. B. (Burnett): Ac-
celeration of tumor growth by
NB Telia” ot A aR See oecire 209 — (Delprat): Studies on growth, TSC 2 A Se ee oe ee 317 Rocha, A. D’A.: Glycerine muscle UVM ie ee eh cle e fisccuclavebin o's 204 Rogers, J.: Conservation of thy- roid in hyperthyroidism...... 1090 —Fatigue and _ disorders. of stomach and thyroid...... 409 Rogers, J. (Rahe and Abladah- —ian): Gastric secretion and DEPAMMERUTACES 2). el. sie we Od Rogers, O. F.: Blood sugar in @iipetes- mellitus: s..<2.......0438
Rogoff, J. M Liberation of in- ternal secretion of thyroid into [EC Gb 3 ode Senn eee” 1 &
— Preparation of soluble extract
eit (Hin Arertsl = hs tee Peace 246
— Standardization of thyroid PEEDALACIONSS 22%. ete = of 2 size 249
— (Marine): Artificial iodiza- HIGUIIME Ura =k ', te oalw) sco Ges rele 99
— (Stewart): Adrenalin distri-
TERE oes obser eeie dds sFanc iets 5
— — Asphyxia and rate of liber- ation of epinephrin..... 187
— -— Drugs and epinephrin out- pit of adrenals... ......501
— — Effect of stimulation of sen-
sory nerves on rate of lib- eration of epinephrin...498
— — FE pinephrin exhaustion.... 38 —-—Epinephrin from adrenals not indispensable SOD — -— Epinephrin liberation ..40, 41 — — Liberation of epinephrin.. .186 — — Liberated epinephrin exert- ing action upon heart. ..497
—— Output of epinephrin in OE ie. Shs ee Pel cn chs fo 189 Rohdenburg, G. LL. (Bernhard
and Krehbiel): Sugar toler-
HCE Ti CAN COIs .2% kl. crenichateesl a0 386 Romana, L. (Houssay): Hypo- BoyAeal POlyuTia «isis cates 13
Romeis, B.: Thyroid and devel- opment and metamorphosis. ..585
Romero, O.: Ovarian organother- apy in depressed lactation....509
Ronchi, P. (Oliveri): Boiling water injections in goitre..... 409
Rontgen ray, see X-ray.
— optic nerve atrophy......... F(T
Rontgen ray treatment of exoph-
Chalimie te Ore yes eerie sense = 457 Roper, J. C. (Eddy): Pancreatic vitamine in malnutrition..... 87
Rosenfeld, G.: Diabetes insipidus treatment with pituitary ex- (ERE KC LE: «Ge EEA coe Seep Ire ore ere ears: 206
Rosenheck, €.: Myasthenia gra- Nel SME ett et, ico. /arice\.<).«r evade es enanexe 215
Rosenthal, G.: Adrenin and col- Loidal scold injections: .. 2... 348
— Adrenin and colloidal quinine
TMH CCUIOMS 26 5. 0le ee sie, so we 348
— Colloidal gold reaction sup-
pressed by adrenalin...... 348
Rosique, A. (Marafon): physis and diuresis
—-—Glucemia and hypergluce-
TUE LNG OMC) cuek oer ew sc ec 189 Ross, E. L. (Keeton): Ether hy- DGLSIMIGCMIAn tae oe wes sss <a 88 Roszle=7 DP wallsmy cs eeos oie er ene 526 Roszle, R.: War pathology 514 Roth, O.: Lactation in acrome- PUT Cwm Aele Miss rens, cles cusus) ais eleders 210 Roth, N.: Addison’s disease. ...495 Rothacker, A.: Hyperthyroidism AMM SOUGTETS aay af atichcns, a Sie se au spekaueta 241 Round, J.: Cancer, a disease of GEHCTENCYse si. 3 oun den eo eres ee 67 Rous, P. (Wilson): Influence of anaesthesia, etc., on pressor ef- FECETOM AGLENIN ss asc isn cetera 188 Rowe, A. H.: Fasting treatment LM OTAD CEOS ares. c)0%s, » ois is. een seme 192 Rowntree, L. G. (Beard): Salt metabolism in diabetes....... 363 Rows, R. G. (Orr): Interdepend- ence of sympathetic and cen- tral mMenvOussSYSteMSs. ... 5.2.7. 200 Rubenstone, A. I. (Lowenburg): EVENIVO TTA ects ccilcigs = fens ie “sis weters 244
Ruschhaupt, L. F Dietetic man- agement of diabetes mellitus. .553 Rutelli, G.: Addison’s disease in
SCRUM O Deel Ovargte terete, = siuc.s. 2 levehate ious -< 178 Ryan, G. M.: Medical treatment
OEM OUGLS. eyes esteteks oie ve 's'tav at eel ebelle 583 Sack: Influenza and loss of hair.583
Safian, J.: Elements of success in treatment of diabetes..... 549 Sailer, J.: Clinical aspect diseases
of ductless glands ..........512 Sailors, hyperthyroidism in..... 422 Sajous, C. E. de M.: Hemanden- ology: a new specialty.......504 Sajous, L. T. de M.: Corpus lu- teum in therapeutics.........539 — Hypophysis preparations and therapeutic use ..........525 Salngelndy Gla WCLICS) 2. + = s.stele ste s 554 Salt metabolism in diabetes....363
Salvarsan, anaphylaxoid of pre- TONtCEG. DS. ACTON oe pete ie tees 348
Salzman: Treatment of Graves’ GUISCASC!: <-ci0 c.5 avo eee ee ees 594
Sampson, J. J.: Trypsogen in fe- Talepancreas, ww.c). eee aoe
Sand, H.: Experimental herma- phroditism 5
Sand, K.: Sexual characters in mammals, experimentally stud- LOG) ee ok ee ters Ge aieireiicrs fare 564
Sanes, K. I.: Vertigo of meno-
DAUSE:) wes, bie akee we ere ae 390, 397 Sanger: Hypophysis tumor sur- Zically treateds paves cteks Gene 532 Santesson, C. G.: Influence thy- roid preparations on _ action AGTENITA Reo eke ere er DIO Sarcoma of nervous lobe of hypo- DIYViSTS eee eetete titties e 6 cide ee 525 = OVARY SiS Srenck canta Steieiens reeoeee 394 ——- —=s Thyroid .): ste eee eee 428 —-——report of case. 249 Satani, Y.: Studies of ureter. 504 Satire, A.: Hypo-adrenalism in BLD) xz svodenee Groh ones ote ere 38 Sawyer, A. W.: Goitre in girl of DOF ee ee ee eee 433 Schafiner, P. M. (Howard): Ad- dison’s disease of syphilitic Onisiny SoA aS ee ee 496 Scheffer, C. W.: Congenital acro- MeCZaly MS... eee ee eee 205
Schekter (Chaput): Gangrene fol- lowing adrenalin anesthesia.. 51
Scheltema, G.: Infantile myxoe- GEGNNaP os cacecccytc Gem. acer eee 243 Schilling, K.: Coagulation of DIOOG) rai Ree os wc see be Le Schippers, J. C. (deLange): Sple- NOMeCZ aly ewes. «20. cae eae 94 Schirmer, A.: Status thymo- lymphaticus in infants. ... 22% 567 Schlesinger, H.: Insufficiency of adrenals and Addison’s dis- CAS Cee ene. sas see Rola OnE — Osteomalacia-like diseases in Wivemnagee nes + (2 273 52d pe ala osteomalacia and SEH ae. ots PER HO cado wie oe 535 Schmalfuss: Pseudohermaphro- Gitisnies 2. aoe. Se Oh ees ay Lif Schmidtmann, H.: Rare forms of CALEIMO Maret. oes eee DIO Schneid, L.: Action of adrenin On=museciwlar*fariewer s: 2.7 e- 183
Schneider, E. H.: Syphilis of thy- LOE ane wn. ee eke cae ae 258
Schnoor, E. W.: Hypophysis and hypophyseal disease
Schreiber, J.: Influence of cas-
tration on larynx SN ROT REPS Schreiner, B. F. (De Noird): Di- astatic activity of blood...... 219 Sehucany. els- -Adiposityes..a. 2) -.o1 0 Schumann, E. A.: Dystrophy adi- posogenitalis in women......207 Schut, H. (de Langen): Blood sugar sin; CrOpicsSeerie eee 355 Schwaab, M.: Pituitary extracts im obstetrics ffee rete ee oe Silt
Schwarzenberg Lobeck, J.: Met- ropathy of thyroid origin..... 584
de Schweinitz, G. E. (How): Pit- uitary body disease and glan-
dular administration. 2.42 561 Schweizer: Adiposo-genital dys- trophy. oe area oe eee 3771, 384
Sciatica following pregnancy in
women, pituitrin treatment....521 Scipiades, E.: Internal secretion Of OVariesy 2 in. eee 540 =— Osteomalaciay 2224... eee Ba} 4 Sclera in children with bone fra- SUity See ae See A eee 569 Sclerodermaiuas...o 52 aoe 563 === CAUSChOL SS ote, Soe 436 =—— Nile wleviehuaime en cores cae ool) > — — infants, probable cause... .563 —=Onerstagesin= infants: oe eee ore ——"TeCport OL fours Cases 40 ae 499 == 'skin in) ig tere ee eee 499 — three stages in adults.......563 — thyroid extract in...112, 429, 500 — tuberculosis an etiologic fac- CON LH aes ee eee 500 Scopolamine in partial thyroid- CCtOMLy 126.02 SR eee Scott, C. M.: Non-toxic goitre...234
Secher, K.: Death after X-ray treatment of Graves’ disease. .573
— (Hertz): Neuroblastoma with Addison’s disease in child....495
Characteristics developed in DLR Ses Si ae eee PAPAS
Secondary sex characters, adrenal therapys inj sa we eee 92 Secretin — action, mechanism ce t ts eRe 90
— and change in corpuscle con- tent lof blood Ase ee eee — distribution in intestine..... 225 — extracts from duodenum......564
— importance for functioning of DANICGTEAST Ahi a cis Cee Oe
— influence on pancreatic secre- ClONVANGs hile Mow. se. ceo 563
—-—-——red and white corpus- cles
— is vitamine identical with?... 224, 402 — observations on
— physiology of
— place of formation of....... 564 — powder, method of obtaining. 91 — stability of —red and white corpuscles dur-
ing digestion) 234 91 Secretions of thyroid gland..... 107 Secretory function of stomach... 92 — innervation of adrenals...... 181 Sega, A.: Contribution to study
of Jhypenehyroidism sae 241 Seitz, L. (Wintz): Corpus lu- teum and menstruation....-..353 Sekiguchi, S.: Mammary cancer, hypophysis’*.. 223-24. 74 Sekita, N.: Thyroid gland and metabolism -9-cc.--e ete one 582
Selfridge, G.: Endocrine glands,
UM ASS AR CSpeteuel o.cts © © i -eeueienta 3867 SelicmetinelGan sueitharnei) => 61-02)» Die 0. Dio —— abnormal shadow in place
OME ose he oe
— — absence of and imbecility..205
—-— enlargement of.. .526, 532 £1533 case of acrome-
galy in .205
—— —— in case OL adiposogenitalis. sid t
Se Of hy perpituitarism..0 22 — — — — — hypophyseal tu-
ONO ks S auRIae ea Oe
—— —— —jnfantile dwarfism Ne 210
—— pinay meadaches 212
———— In pubertas precox ....... 462 ——Jarge in hypophyseal adi-
OSUIVARENE RS tec cone cual a cus D2.o —-—yelation of size of to pitu-
iuahy, SyMOrOMLeS= <7)... 208
=== PSN Sanegilll big sen ol ao owe
Sensory nerves, stimulation of and liberation of adrenin.... Sergent, E.: Administration of
AGING! AAS Secs IOR Rae wena aCe 347 ——=AMronalnwhiteoliMmG. <a. +... 29 19 — Distribution of goitre in AIl-
ETS) Satya has. G Been ace can amen 106 — (de Bergevin): Endemic
goitre transmission by in-
SECs. VSS Beet nO acne ne 106 Sergent’s white line in adrenal
TA SECM OMONG wees) cee md ae myay a) oe ss 4] SerumierOrvaGlapetes >... 2. oss sas 194 Selhorst, J. F.: Osteomalacia...216 SIDS locos cB ey eee Hons we2or BO2, 403 — causation of, relation of ovary
HOMME RM ae rca esake dine te: eben 218 — characteristics, male, devel- oped in female birds. eo) —-—male secondary .........528 — characters, relation of corpus EEUU EO! fake sos eu nels oe evens 52 —-— secondary, influence of go- TN a ks onal aa ce eae ones 564 — determination of ........ 92,403 — gland implantation ......... 226 — glands, relation of pituitary to 11 — — — —to metabolism ...... ili — hormones and glycerine muscle Rapa MM eet Rat sic Poe ek oe tes 204 —intergrade strain of Clado- QE Pe ee 190 — intergrades in Cladocera..... 226 ——-— insect ............... 226 SNCS (OLS LLM cal "ako: fas ocay's, seniors 402 Sexual aberrations in men......565 —changes a symptom of pineal STIS VO Sl ee i ene eA eee 445 —-—manifestations in pineal RMUIIUONES URS alas. 6 eucre te Avot 446 — characteristics, female second- UAVs oe Mee Le ne Sire) .arsss.ona doe ot ar ate 80 — characters in mammals...... 564 Séxual development and thyroid BISOASC. 4.0.8 yedlads Goede: oe poe 418
6 ¢/
Sexual function, loss following re- moval hypophyseal tumor. .532
— hormone, cessation of growth after puberty
— impotence, organotherapy and.515
—maturity, due to hyperpineal- LSUMGES AM tes aie te cceme ee ee a oaths 447 —organs and their internal se- CMO GLOMUS Mes ae tate ess cn syn sescieoes 67 —-— pineal and overgrowth of. .447 EO OCOCMUV Era ranehcneienera tis. stele: oie) sere Dike NCAT S ES) Olt tckens crabs ate ste where « 446 ————— TT NNO) oie ade ee ele els ew ee ws 386
Seymour, R. L. (Brooks and Mc- Peek): Action of epinephrin on vasomotors and heartbeats. 47
Shadows in pineal region, cause ORG een neat aN R eee casera tons 449
Sharp, J. G.: Thyroid atrophy with pituitary hypertrophy...100
“Shell shock” and adrenals..... 178
—— — —jnternal secretions eran! —-endocrine disturbance in. .199 Sherer, J. W. Thyroid extirpa- SO Timewrers es hha a eoona: Snare whens 416 Shoemaker, J. F.: Absence of eye- brows and eyelashes......... 64 Shock, adrenin output in....... 189
—epinephric content of blood in 40
—in railway accident cause of Nadison-s, GIiSCASCE « o.5.04 -- 503 —opotherapy Of ..25. 0.65... 202
—pituitrin in treatment of....! Shulmann, E.: (Bergé): Rhythm of hypophyseal polyuria Silva, A. S.: Contribution to study. of hypophysis.....).. 2.0% Silvestri, T.: Uric acid and en- docrine system Simmonds: Dwarfism and atro- phy of anterior lobe of hypo- physis Simmonds, H.: Dwarf growth... Simonds, J. P.: Low blood pres- SURO te ictalic rc, Cid be eee een ero ee 42 Simonton, L. J.: Thyroid gland.417 Simple polyuria, not diabetes in-
bo vs
Sipidus: wa sCase. ....0. 08 soos Simpson, B. T.: Pathology of goitre Meera Set Sih eee
Sinclair, H. H.: Endemic goitre..575
Singer, H. D. (Clark): Psy aieees with diabetes mellitus.......360 Sitler, Ida (Atwell): Pars tube- ralisvand hypophysis:........ 78 Skeletal muscle contraction, in- fluence of adrenalin in....... 49 Skin diseases, caused by endo- Chine sOyStiUIMCtlON v.02). 3. ewe os 499 — diseases, endocrine; organo- therapeutic treatment of...499 —-—jnfluence of thyroid and parathyroid; ON sa.) ee OG == 1Tl Graves, GISCASC. niente. — —organotherapeutics in .....597 hy in) CLEtIMISIMs | ele snort mene 570 —— in <SCLELOGeLIMat tes sa wate bee 499
Skin, pigmentation of in Addi- son’s disease Skin transplants, exchange of.. Smith, A. J. (Evans and Middle- ton): Tonsils and thyroid dis- turbances Smith, E. P.: transplants Smith, E. V.: Goitre, surgical vs. medical treatment Soler, F. L. (Madero): Secretory function OL stomachs «+ gece 92 — (Quesada Pacheco): GERCICNICY tests eet ee 3 Smith, G. E.: Fetal and mater- MaleachnyTOsis: wills Seite 262 Smith, P. E.: Ablation of epithe- lial hypophysis — Growth of tadpoles as influ- enced by endocrine diets. ..209 — Pigment changes following hy- pophysis removal Smith, W. G.: Acute diabetes, ACIUGOSIST t.isce se hone ca Te Los och ete 541 Snow, W. B.: Hyperthyroidism. .581 Sodium carbonate, action on lib- eration Of adrenin=--~.. ee |e UZ — iodide as a prophylactic for endemic=Z01tre sees oe OD Solar plexus, changes in cells of in intestinal conditions ...... 404 Soldiers, adrenal insufficiency in.178 — hyperthyroidism in .241 — Tapid heartiinae.....% a5 eo 0
“Soldier’s irritable heart’’. .335, 374 Solling, H. A.: Blood changes in Graves: tdiseasey ...... 21. cn oe — Graves’ disease, etiology and Leable mttuas .. cites cee. aoe oO SOMMOLEN Cease Ae oie lois cee neiel: aie 530 de Souza, O. (de Castro): Dys-
trophie genito-glandulaire.... Spaeth, R. A.: Pituitary extract
Standardization! = - « atere es oes cee 88 Spasmophilia in infancy...... 92 Spence, L. B.: Hyperthyroidism. 108
Spermin, effect on metabolism in VOUNSAdOLScweswee s x sy sdans eerie 79 Spinach in treatment of diabetes.552 Spirochetes, distribution in body.504 Splanchnic nerve end, blood pres- sure curve produced by stimu-
MATT OM OL cdi secucneine «si ckeaeliogse 44 — — relation between adrenal se- CLeTiONgANG ss. oi. -cote ae 180 TOMS G5 ay ae REPS Cee Stee 92-94 —and thymus, relation between.299 — antagonist of thyroid....... 565 — association with liver in cer- tain blood conditions...... 94 — effect of removal of......... 226 —-— upon metabolism......... 226 —endocrine function of....... 226 —hyperplasia of follicles of in StatuspehymiCismeere eee 567 —in relation to secretory func- tion of sstomachhewieen ee. 92
Spleen influence on respiratory quotient...<3 6 s<riast eee 565 — inhibits metabolism Nomis vere 565
— thyroid and, relation to bone MAT TOW. “awqeahets ess cco oe 113
— X-ray treatment to in status Lym pHaAviCisi ws see eee 568 Splenectomy, effect on thymus...299 —-— upon metabolism......... 226 — for hemolytic jaundice...... 93 — in (aAnIemiaAs’ 47. oa ree 93 Splenic anemia, splenectomy in.. 93 —— ‘extracts /emiect.. 2k 1c nes ckeee Oe PAPAL Splenomegaly, familial ........ 94
Spolverini, L. M.: Adrenin, asth- WVU che) Oke a a Seta es en cee ae 42 SVOLACICXCEehINISMY sex eesae eee ee 570
Spriggs, EK. I.: Fasting treatment Of “diabetess t4.ns a cee 510 Starvation treatment of diabetes
59, 61, 361,°367, 548, 5545 555 —in treatment of diabetes mel- ICUS? 2S peepee s eee he eee Len — osteomalacia and tetany..... 536 Starkey, F. R.: Organotherapy in practice of medicine....... 215 Status lymphacicuss ..12cucneekseees s)t — — and tuberculosis in soldiers.340 —-—death by following thy- ROLAECEOM=yiw aan eee 480 —-—from clinical standpoint. .567 —w—treatment of epileptic sub- JECUSCOLSs Shee @ cde eee 568 Status-hymus lymphaticus..... 97 — 406 —-—-and sudden death..... 406 — -— —and tuberculosis in sol- diers=*. 3.23 4 see ee 340 — — —jn infants -5.:ss..: o.: 567
Stearns, T. (Wilson, Janney and
Thurlow): Parathyroid tetany. 221 Steensma, F. A.: Glycosuria in GiaDeCCSige a cosice- eae Ewen oes 549 Stefano, J.: Case of adiposogeni- PBS” 2 omeprare ssh. Ae se even enone 530 Steinberg, S. A. (Ravitch): Ec- zema in infants and thyroid Sane, ...0 es ee a he eae ee 417 Stengel, A. (Tonus and Austin): Treatment of diabetes mellitus, Allenis smiethod ite 5 ea.) e are 556 Stephenson, S.: Dyspituitarism in Sirk Of Lb aie ee 295 Stepp, W.: Blood sugar in human diabetes dupindaetle neorettenens pate Gee 191, 542 Sterility: .. of) se eee 403 — “higher up’’ theory of, in wom- Ch... tees Se eee toe 201
—relation of corpus luteum to.395 Stettner, E.: Thymus and gonad
Feedinehs. aces. 5 creeks Cee 228 Stewart, C. A. (Jackson): Inani- tion, in\ young... > eee Buys
— — Recovery of normal weight.369 Stewart, F. W.: Thymus of cat.. 96
Stewart, G. N. (Rogoff): Adrena- ir (GistripublOM =". > - <6 stcrtjens- 50
— — Asphyxia and rate of liber- ation of epinephrin..... 187
——Drugs and epinephrin out- put of adrenals........901
—-— Effect of stimulation of
sensory nerves on rate of liberation of epinephrin.498 —-—FEpinephrin exhaustion.... 38 —-Epinephrin from adrenals not indispensable....... 505 — — Epinephrin liberation. . — — Liberation of epinephrin.. — — Liberated epinephrin exert- ing action upon heart. ..497 —— Output of epinephrin in
HOG Kreator ietencrete << ets 55s 189 St. George, A. V. (Gettler): Mod= ern plood chemistry 2: 2.38502 55 Stheeman, H. A.: ‘‘Calciprivic”’ CONSEOLIOM ss tecc-s taxes 6 shies SA 565
Stillman, E. (Van Slyke, Cullen
and Fitz): Studies of acidosis. Vis" OE eee cece Saka Oe Sere Ort 363 Stomach, functional disorders of, yang fatieue Gisease: . . ss um ik% 409 — secretory function of......,., 92 Stoeltzner: Chrome reaction of chromaffin tissue indicator of POURS, 5 SS SoS eee ee UE Stoland, O. O. (Kinney): Effect external temperature upon tox- TCI OPMDIYTOULS. ccs ce oes D4 Stoney, Florence A.:_ Fibroid HLELUIS GANG 26-TAVS). so cs even ss 435 Storm van Leeuwen, W. (van der Hade): Adrenalin activity.... 48 Strada, F.: Anatomy of parathy- GUIS th RS Saami oar seen 222 Strauch, A.: Hypophyseal dys- TOTIIONT 60 3.2 ot ee 378 — Sexual precocity in male..... 386 Strauss, E.: Iodine in thyroid. ..404 Strauss, I. (Climenko): Eunuch- CIGNA ee Oe 516 Straussler: Hydrocephalus and hypophyseal adiposity........ 527
Streuli, H.: Thyroid spleen extir-
(PED C1 9 sy a a rr ial? Strophantin, action on adrenin
PRELUDE Umest relate tearis ste sss « s DO2 Struma, intralaryngeal......... 423 Strumectomy in case of toxic. goi-
Cette eae eons et ey noc. oe OS Strychnine, action on liberation
me UPOMIM Yo soto e soe ay a DOL Strumitis, postpneumonic...... ~ 248 Stursberg: Infantile dwarfism... .210 Sugar tolerance in case of adi-
POSUReCHIBMUINe s,s oe... te OT DOT —— TY CANCOL cleyehe oles 0 se 0 0 386 Summer, F. B.: Superfetation and
deferred fertilization......... 217 Superficial burns and adrenals.. 39 Semiprarenal rests’... oc. +d ee. 258
Suprarenals, see adrenals. — effects of thyroidectomy and thyroid feeding on adrena- Ibual <COVMESINE Clio gon a5 Sao o 40 — fatal superficial burns and... 39 Surgeon and internist, co-opera- tion between, in treatment of
exophthamlic goitre...... 454, 458 Surgery, goitre, report of cases. .580 == iit, SOT > avakp- 6 Occ oCnONG cmaLO oon 468 eG UI CULCS nes 6 ss 8 ees as 8s 360 Pee ROMVISESIN sisi. ss sis.s¢ -e « © 70 —— — thyroid SLO Se U5, 42.9, 8 Surgical diseases, diabetes and. .5438 —lesions of thyroid, classifica-
foneand treatment......- 587 — pathology of thyroid gland... — recovery not permanent cure.477
FS MOLEL SS, ie veo cai ORT Cie RE OD 40 — treaiment of Grophthalmic goi- Ie Soe borates ects 454, 458, 587 —= = —— FOitre ... LIS, 238, 468, 583 ———— presents Status Os. ..eial ee GA Vesa GISGCASC. sie eicusl 429 —— —--—jntrathoracic goitre... 583 = = (CAE GUERKEROGS wag ooouede ——-—_thymus hypertrophy... .568 — = -—— fypophyseal tumor... ..5o2 —therapy of toxic goitre.......573 Surraco, L. A.: Blood cholestrin TIGER eI cictase bile fon evs sce sere 497 Swan, J. N.: Blood pressure in GQYSERYTOUISMI i socle so ewes ss 246 Sweat, action of adrenin on se- CRETION® Ole mire fers Choe ele oe 183 Swingle, W. W.: [odin feeding to TOP mM DIEVGLC a eras. ys 0\, <.an/018 sere 114 — lodin feeding to tadpoles..... aake: Symmers, D.: ROntgen ray treat- ment of epileptic subjects of SthacuseelbyauoupMAtlCUS's. <<. 3.55.06 568 Sympathectomy as cure for hy- DETEMYTOIGISTN eal cis sos 2,2 ae 471 Sympathetic and central nervous systems, interdependence of..200 — nervous system, hypotonia of .569 ——w-— myasthenia .......... 227 — system in goitre......... 94, 430 =< ATUL Sas gehts shen eee ia sie etetn, Sie eee fe 434 Sympathicotonia in patients with OSLCOMMAIACTANS : acc erore «corset es 537 Syphilis, congenital, causing adi- posogenital dystrophy........526 — diabetes mellitus and.......544 — diastatic activity of blood in. .219 — exophthalmic goitre and..... 36 — hereditary, studies in....... 412 — in patient with obesity...... 562 TA CUNGTLAS is vers «ros 0, se 0%. 8, 806 496 ————=ITVDODMYSIS, 1.200.000.0006 526 —— S——9 OF: a 2): ir 61 —ITIOCAL Ls cn See 00 20 ets lane ate 444 —-— pituitary gland........... 488 ——thyroid gland........... 238
Syphilitic diabetes insipidus.... 56 — lesion affecting hypophysis... — origin of Addison’s disease. . — pancreatitis
Tabes dorsalis, pregnancy and, PLGMUGNN LT)... 5 colors opel o aie 88 Tachan: Case of eunuchoidism. .517 Tachycardia in hyperthyroidism .589 Tadpoles, studies on endocrine flands .Of¢ ..cjccnc cee ot 242 Takaysu, S.: Adrenin and skeletal Muscle: (\CONETACHION Ge oe nestor e- Talbot, F. B.: Metabolism of Creltine oe ee woos Susy 6 Sines 100 Tangu, Y.: Thymus function.... Teeth, demineralization of, duced by thyroid disorders... .574 — disorders of, during pregnancy 262
—spacing of, in pluriglandular deficiency... 2 eee 11 ‘heratomay Ol PinGalise.. )- levator oerke 443
— with adiposogenital dystrophy.525 Terminology, proposed improve- MICGRES: “iN. ois 2 eens he eee 185 RESTS (cn a eee 94, 95, 227, 404, 405 —atrophy of, with hypertrophy. of mammary glands....... 372 ——GASC OL Mane wit hnetivie sie ae 95 — conservation in management OLGISCASESOLens sey ee 2 404 — cross racial transplantation of.405 — internal secretion of —of guinea pigs, study — organs of internal secretion.. 16 Testicle and mammary gland de-
histological
Velopment 22-55 eees, core ane Hag —retained, operative treatment Ol: Une. 2. oe eae 94 — implantation ]:.. .-. see. ans 95 —-— in impotency............ 95 Testicles absent in man of 22...528 —extinpabions OF =. jcisree eae ete ea aie 565 — in adiposogenitalis.......... DATS —-— case of hypophyseal dystro- PERVANECR., = 3, 02 lo 5 eae ee 523 — -— hypophyseal adiposity.....522 — - Didelphys, interstitial cells OMe... - vet eee 96 —— transplantation Of... 5- eee 565 Testicular extract in adiposogeni- Calisns Ks 2a. ee ee eee 27 — extracts, experiments with... 65 — feeding in tadpoles.......... 228 ——IMOTIMNONG. sa s.ca.> ache Sa ses ere ete 16 —-w-and hypertrophy of pros- EALC Sn oh bere eee tc ene eee 227 —————— SWATCH eMia ANG. 5.2 tense 495 —-tissue transplantation. = ...- - 23 — transplantation a eunuch. 20 Testis” cn. Seaeee ee 27, 228, 405, 565 — degeneration ti due to defi- ClEnE Rehr eee =e-vereha cs AES | — innervationsor, im GO2-4 .4)2 a+: 405 — transplantation in man...... 228 Tetania. CnNuUretiGaawaee. scien =). 398 Tetania parathyreopriva........ 560 — -— guanidin content of muscle ink 5S Sa Pa ee 559 —— thymus a factor causing. . .296
Tetany~..¢25 < .2ja%e.ats, ce eee 514
—a hypofunction of parathy- TOIGS tas oo %5 wet ok ee 561
— and) Créetilism): 52.2 ei ae eee 267
— — functions of parathyroids. .560 —-— symptoms of Erb and Chyo-
SECKS). oes .c 6 ee eee 566 — blood calcium content in..... 566 —-plasma in experimental... .223 — case of familial edema with. .569 — diarrhoea, With <...:6..6..4-5 561 — — endemic, in India, prevalent in pregnant. women... -se-.s-ee 267 —— — — — seasonal variation...268 —— jin an: adult: <.22-7 eee 558 — incontinence of urine and.... 87 — influence of milk upon..... 222 —— A tERE; «in: patienti-aceee seme 562 — -—-three children.........569 —-—not proper term.........566 —nutritive disturbances in in- fantile ~. 2h n2ie eee — observations on cause of..... 559
— parathyroid transplantation in 398
—parathyroids and calcium me- tabolism: in: 32.9520) Gee 560
— signs of latent, in boy of one.563
— starvation osteomalacia and. .536 -— studicslOn 2.3 sso Oe eee rae Hik — strumipriva, influence of para- ,
thyroid -on.:: 3.2 6 eee — symptoms. Of :..>: 2 7 oo diene eee — -—-—in case of edema...... 569 — treatment of post-operative. .221
— vegetative nervous system in infantile - 3 Aeol eee 5 Tethelin, accelerative action of. — influence upon growth in whitel mice — observations on action of.... Therapeusis of exophthalmic goi- CEE +31. ie Ane ess oe oe 467 Therapeutic application of organ @xXtracts.°. 4452S ae eae — progress in treatment of hy-
perthyroidism: ~~ . =.= < eee 480 —use of hypophysis prepara-
tions .. .. 260; -3<beeeeeeee Thermic instability in mneuro-
thyroid mechanism.......... 425 Thierry, H.: Transplantation of parathyroids Thirst in diabetes, cause of..... 524 Thomsen: Multiple strumameta- stasen ..<:<..0-:82 ee 426 Thorne, L. T.: Hyperthyroidism and irritable heart in soldiers.582 Throat in diseases of thyroid and
thymus see eerie 2 ee 98 Thurlow, Madge DeG. (Wilson, Stearns and Janney): Parathy- TOid: -fetany=: a... <i. /s Giemsa 221 Thymectomy after failure of ra- diotherapy. « «02% )s/--- > eee 230 —pblood changes as indications for. 2:4 ¢2<2 ss 571
a a
Thymic dwarfism.......... 3 ART — stridor, differentiation between laryngeal stridor and...... 568 Mobi NUS eee Sea's als 2s wtepsiss 96, 97, 228-230, 406-408, 567-569 —an endocrine gland Jaye 292,465 =n CarcinOMd.. ..-< «2%. 2i0 2 * e 229 ee Gr VCS: VOISEASE\. sna <4 sucrene = = 598
—-—parathyreoprival tetany...291 —w—thyroid glands, functional
J ‘relation between....... 408 —antagonism between parathy-
POLO cATNG. 6 os. . ss: cece hie oe 406 —elinical symptoms and treat-
ment of hypertrophy of. 25167
<a pheaisint Va Awe ee Rey CRE ROR Caan Lee 96 —dysfunction and myasthenia
ETDS e bie Beso pee oO Ean ay bs
— effect of splenectomy on..... 299°
— enlarged, in sudden death dur-
ing tonsillectomy.........568
— enlargement and X-ray...... 406
Te oie 408
— extirpation, influence of...... 230
—extract in pubertas precox...465 — feeding, influence in tadpoles.228
—-—to pregnant animals...... 598 —function of, considered from effects of extirpation...... 23 —-—symptoms of enlarged.....567 —egland, collapse under anes- Aine (th (ol oe 96 EN CHION VOL. joie ots) a sie as eee «280 ——-— jection. leiect. Of: 37... 229
— — role in exophthalmic goitre.407 —hypertrophy with hyperthy-
OUCINER Es eos swAiroh on lee DLO — influence on body growth....406 —-—-— bone regeneration.... 229 —— —tthyroid and on growth.598 — insufficiency and fragility of
RP eimai os. aietc bie Bee we 569 —nature of retarding influence
Di ey eee 229 —not an organ of internal se-
PCRCATOMN C12) ees. aus Tie cilve ae Gke S oo 231 ERIE TIS tence ccy 5 feist ove elisiefo ne 407 —rare forms of thyroid of.....569 — relation between spleen and. .299 = OK OS Si eee i 96 — thyroid and, eye, ear, nose and
throat in diseases of...... 98
— -— — in treatment of goitre..119
Thyreogenic heart disturbance, CIEE Seats Oe ton rr 591
—ypertrophy of heart (Hin- PGES Gade < hes Seeyswa vee) 5s iD OS — obesity and diabetes.........562 Ee OLORIC, NCAT .< sesus sévcerecceneeiD Gul
eG ee 97-120, 231-251, 408-434, 514, 569-598
—acuye principles of.....;.2.% 43
—adenomata and hyperthyroid- hie so) rrr ePaper 102
—-— cardiac arrhythmias in pa- MeHLe- With. 22s... a2 es 233
—and adrenal, functional rela- RIOR "DOE C Mg stata, Saye init tie 98
Thyroid and calcium metabolism.537 —— cardio-inhibitory apparatus.101 = IN tern abe Se Chet OW ers -esst< << 97 ———— MN GUSHLM ah One meet ey ats. =< 432 —-— ovaries, antagonistic action 8
— parathyroid, relation be- EWP CMe incive opalc) eee ae owenens rata k
— — pituitary extirpation in tad- MOLES hyo: 505-6 ee = RYsiepS, shel ane 243
— — spleen extirpation, reaction EEL OU esa e rs a ey /onars layers @ ose tS
—_ — —_ relation to bone marrow.113 ——thymus, eye, era, nose and
throat in disease of..... 98
— —_— glands, functional rela- tion between........ 408 = ~rearment in, goitre....... 119
— atrophy of, in case of pluri- glandular insufficiency.....562 — body, action on glucose metab-
CONST eet eet bale oe ayes an SF oan 570 = CANGCCERIM NOTSCS toa ies shaes sue 110 = FC ALCINOM Any actos fuse) states 411,578
—-—among salmonoid fishes. ..233 — changes in, following X-ray
ELGQCINCItE pyarexcne sucvehs cache 5 572 — conservation of, in hyperthy- TOLOES Tw 1 oe ice Seats, eireice: fob oka, oe as 100 —crystalline form of active con- SEIPIBCNIL utters: @ Sescetel ets, stetais Hs ital} ——-*GOTCICNGY | a evertis me sivie os (5 ==, =, 101 — degenerations in, with atrophic HLLViO POR weet tek 1S. see walla cen, CSD lee — disease and sexual develop- ment in female... ....%<<%. 418 ———— Nitrocseny balance in. ..5.: = 5.92 — wand present method of op- erative treatment....... 102 — diseases, diet in............ 412 =——sGisorder. ana, heredity. ...2.. 234 —-— producing demineralization RCC CEM es sre tcl ofivers(s aie 3 574 ———AAISOPMOTS: sraleyciets aus slaves belies! 102 — — newer methods in diagnosis Lane ite bs cia "5; atic) 2 tet ets.o) se 102 — disturbance, metabolism fun- damental factor. 1m: 4.3.5.6. 592 ——"-_— ON SIS ANG A. os «0% 2) choke os 102 — dysfunction important factor insmmany disorders. 2... - - 200 — —of syphilitic origin........ 29 —-—symptoms of............. 235 — effect of external temperature OME POSICIUVE OLen-sehe cs es ce ee 574 — efficiency, seasonal variation..267
— enlarged in status thymicus in
ECO Ses ss + ss ee 0 nl OM —enlargement, surgical treat- MUG te sence ene 473 —————sNG Menstruation ....+.-.DNe — — —néurocirculatory asthe- TEVA en -oroiva, sy sss eck ah ie eee == sine Omi hd eee ey ae ae 242 TALS OM CLUS... io, 5, > 1c oun ene ee 103 —etiology of scleroderma...... 428
— extirpation, choked disk se- GQwel. to: 4.:..< fet sees O « oe e 416
Thyroid extirpation, effect on pituitary Bland <2 .3 iss ese os 242 — extract and serum proteins...118 —— effect on metabolism in young GOSS.) ee cto 79 — — — — vasomotor reflexes.. .428 — -—/jin deficient menstruation... 8 — ——edema...........-.6. 434 ———case of menopause and myxedema .........584 ——-— mental diseases........596 ———sclerodermia ......... 112 —— SS MIVICTEIST wes ec 5 Se eee 105
— -— influence in goitre, cretin- ism, Graves’ disease and myxedema
—-— —of, on development and metamorphosis
extract stimulation gastric se-
erction® 23.) 52. Se: eee 231
—— symptoms following use of.391
—-— with pituitary in a case of pituitary disease.......561
—feeding, effect on adrenalin content of suprarenals..... 40 —-—jin fatigue disease... petal) —-—-—tadpoles ............. 228 —-—to chicks, effect of........ 200 —funetion .....0.3.. 117, 241, 474
—w—and albuminuria and toxe- mia in pregnant women.271
—= == tests. os ce See a See 105 —functional correlation of hy- pophysis and. ...0.0e6se 534 — —and relation to goitre..... 107 — gland, acute necrosis of..... 236 —w— adenoma of........ Seca ae ONT — —a proving Of......0.0..0% 65 PANE |
—— anatomy and surgery of... —-—and tubercular lesions.... —-— atrophy with pituitary
gland hypertrophy...... 100 — -—)biochemistry of.......... eI) ——— Cancer Of... ...062 os 106, 579 — — classification and treatment
of surgical lesions of...587 —— —=-@iseases Of; . 00 6 bee ccm 578 —— daosage ....... HE Petre ee cneat i 9
—— early morphogenesis Gi....i:i3 — —effect of radium on secre-
CLONER OTE a ots a aan eee eae ake 576 —w—enlargement ............594 — -— errors in administration. ..574
—w— experiments with, in frog
LEEVAC wehcr o: crtuions GYeE Ree 424 — — fatigue in disorders of....409 —-—function and diseases of..578
— —— hypertrophy of...........580
—_—— jin dogs, carcinoma of....° Bie
— -— influence on formation of ANCIDOGIER es. ct cc05.5 50-2 318
— — —— metabolism ........ 582
—-— metamorphosis and growth.237 —-— method of enucleating....116 — — preparation of concentrated soluble extract of...... —w— relation of carbohydrate metabolism: to >--....-.. YO
Thyroid gland role in develop-
— -— relation to mental diseases. —w—treatment of adiposogeni-
ment and “disease. 2.1. 417 — — sclerosis “Of)).). 0)... 2 See: Sys) —— secretions of............. 107 — -— structural changes in dis-
Cased: (sid ini, eee eeere nN eers 208 —— —— SUFBOrY Of.% 22 Os 2. Shlers ener 587 —w— syphilis of.............. 238 —-—talk on surgical patholosy OEE ic Bierce Ge ate es aoe ae —='glands’ . f2 3% eee oe aoe 238 — -—heteroplastic transplanta- LION Of. Gee ee 236 — ZOE. 2S ee ee eee 105 — hemiplasia’: Of 332.34. Stare eee 421 — hormone, effect of administra- tion “tol “erctin’... 2 eee 5TE _—— effect on adrenals........ 572 —-—experimental and clinical study of isolated.:....: Wiel & — — physiological action of....586 —-pituitary autocoid taking place: Of 3502.2 534 — hyperplasia of, in case of my- asthenia “@ravis:., . .°. psa. 584 —— treatment of..:.....05.%2% 407. — hyperesthesia in region of....244 — hyperthermia, classification... .423 — hypertrophy in pregnancy... .582 — hypofunetion’ of? 25 235 -so se 569 — hypoplastic 2.0.20. 34%.%5. 0508 522 — influence of fats, lipoids and extracts of, on development.585 — — — pancreas on........... 273 ——-—on regeneration....... ey ———thymus on............ 598 —-—on diseases of skin....... 597 — influenced by psychic factors.341 — in gynecology. iin. ot eee 425 — — metabolic instability during préesnaney 33... 596
596
EQNS iy tec ttesssedetetestokeencemene 527 — insufficiency .....3.6-.5- 109, 404 —.— ¢holesterin ims. 2-23... =. - 425 ————ChASSHACACIONM "~~ = «2 a0 se ane 247 — —eretinism ............-.0. 572 —— frequency in general prac-
tice .2565 oe Le eee 243
— -— hemorrhages following....
—-— in animals’... ....5-05-206 223 esi CITE) We ucioloi OOo. .o oa ss 223 = — i131) wg doiiaonon oo aso oes 247 —iodin containing compound
OF 3... Sls Oe ee eee Wy —impairment of antitoxie func-
tion. Of, 2's Nekheo eee 504 — inflammation of, in typhoid fe-
Ver 2.2225 keener 582 FIMO GLE NAII, Gaooec poacoueo 468 SOM sI0. Jocaacdnomogogos - OT. — multiple transplantation of...116 — neucleoprotem Of..-....-...- 118 — origin of metropathy........ 584 —— OVABY cece ss os ae See egeorl 595-597 — preparations in myxedema... 584 —— ——_. jp’ sclerodermia. -.--nerer-) 500
Thyroid preparations, standard- : AEN ET a ease tae aa; os, pin ss) 9c5) oars 249 — rare forms of carcinoma of...569 = relation of iodin to:..-. LAS, 114
—— — pituitary and to meta- TMOEDROSIS 5s Seis ane" ss 424
—-—to confusional insanity and PRETANCTIONIA |. 3. Sic, ose iw sss 596 —— ——_ — hyperthermia ......... 423 == STEMI oars) ois ais 30> 0 oie 468, 469 —-=-—effeet on hypophysis...... 534 — right lobe of, grown into lung.587 —-—— report of case......... 249 —-—a cell stimulant.......... 251 == .SAreGmid (Olen. ais s\aiecs <yeye 428, 579 — — liberation of, into blood...251
— — influence on morphology of generative organs...... 578 — — necessary for oxidation... .504 =—=gmall. in man of 22......... 528 EOE CS OMG cy aes) ona, s ow 005 514 —nspleen antagonist of........ 565 ——— eM rate duc, 6: sieneilens.ier eo S Sumps 587
— substance, desiccated vs. fresh LOTT i 574
Sean CET ee ee
115, 429, 454, 455, 458, 472 —— medical treatment preced-
Tie a Se ee eee 478 —w—Ochsner’s. directions for
medical treatment fol-
WO AS Ee ae eee 478
— therapy in case of myxedema with sporadic ea wala
— — — ophthalmic prictice..
— — removing cause for.......
— — what internist has to offer.481
— throbbing due to increased vas-
.570 251 481
TES Roe ee ee 590
— toxic dose of desiccated, vari- SG 0 a 574
— toxin, no counteracting agent PE PEOMETEO ro ooo cca 0s oe deSeale « 583
— treatment of chronic rheuma- OSTT po 2 119 — —-— menorrhagia ......... 569 i ES 562 — traumatic lesions of......... 433 — tumors, classification of...... 110 — ultimo-branchial bodies and. .119
Thyroid-like activity produced ar- VLGSS hae as 99 Thyroidectomy ....... 120, 429, 472
— effect on adrenalin content of BIDIARONAIS, oi. o a <lckectaie ww 40
—experimental, eye affections POLLO NGLINE | 7} ee int ore Bisse ae 248 PEPPMICLCALION (205: 5%. <, Si wo cheuss aie 116 ——iieiiyperthyroidism.........-- 471
—-— rats, effect on gaseous me- pO ah ae ey 1 3 57 i.
—— TORRE IIDY) TALC... oc. 0.00 «ome s 454, 473, 475, 476, 478
— non-surgical treatment accom- DW AUUY Da tic ocee di arin pecan 478 gt DOL IOMES ns oo 6 5 2 nc ccs 471 One lODC 2s airs w oe 2 ee, oe 471
Thyroidectomy, partial, with lo-
eak anesthesia aces - =: -006 — Tectal anesthesia im o2 2.52%... ee: — results of complete..:....... 470 === FECH OIG: Oba. aiae ake eet oney okeye: = 434 — three sources of dissatisfaction
FOMOWINE.. cus.cheue.s/e1s Bie 475
Thyroidin in case of myxedema. .5
— effect on basal metabolism. ..593 TPHVTOMGIUIS: ACHE. 22s. sk we -,409 Thyroidless goats, milk of...... 120 — larvae, observations on...... 427 Thyrotoxic hypertension........ 596 —goitre, relation of thyroid THCCHAMISHVGEOr ec). 06:5. ee « s 97 ERY EOCORICOSIS Ns 4. 225 6% lo d02 eso oe 119 PAYTON Si CALALVSE : 5 5 cyeve oie ers 162 — and basal metabolic rate, quantitative relation be- EW COTEGMt Sy 2 eh iss. eek one 159. 160 — originally known as alpha WORE Soi cceeue ciel Sauce ee chs 156 — physiologic action of........ 156 von Tiling, H. M. A.: Influenza PNG, AG Te es ee eer eae 347 Tilmant, A.: Exophthalmic goitre and ovarian insufficiency..... 234 iney, H.-) Pineal body..;. -.:..%- 398 — (Warren): Significance of pi- MEADOR... Sak tN fe eet aug Timme, W.: Early recognition of some endocrinopathies....... 368 — Endocrinopathic inheritance... 63 — Internal glandular extracts...368 Tissue respiration of castrated ETERTEL ALISO pura eg toca eh areyee eters 65 ———PATESTPLLIN GS: Gina .c ore oc, 2 2 elas 8c es 32 Todd, J. L.: Thyroid, goitre..... £O5
Tomaszewski, Z.: Chemical stim- ulation of intestinal glands. ..224
Tonsillectomy in goitre........583 —sudden death during.:......568 Tonsils and hyperthyroidism... .422 —-—thyroid disturbances...... 102 — pharynx and, and treatment of CO DLOMEL EN - ofc .o cites FORO — removal of, adrenalin anesthe- SLAP METIS: oa, cg clap aster a eveLs 2
Tonus, L. (Stengel and Austin): Treatment of diabetes mellitus, PENLeH STTCLNOG... «6 2035. if acts se DDO
Torpor, hormonic anomalies and.340
Torrance, G.: Goitre surgery... .580 Toxemia during pregnancy. 264, 271 Toxemias, role in insanity...... 449 Toxic adenomata, treatment.....421 EN en IS ws os oe 0's ee OU ——four groups ............973 — -— influence of surgical ther- PUENTE soo 55.5 ce ee acdtn tok theca SW bs: ——— Management of... s-.. «.. 117 ——— treatment of -............987 —-— with melancholia.........594 —symptoms disappearing after SOILTE TEMOVAL .. terse oe 473 Tracheomalacia and goitre..... 432 Tracheoscope, goitre operations WOLCM tha cdlano,ceeters) sete ral ace een RNS
Transplantation, homioplastic, in
CECA? 5 Fs.05 Nee eee yp aa —of ovarian and testicular tis- sue, therapeutic benefits Of! Sie Ce Rese eee 25) 216 — — — tissue in rats.......... 23 —-—parathyroids ............ 398 — Ovarian 202s see DG .3016 —— == Thy POld shee es. ee 116 — —testiclesin impotency.. .. 4 - 95 — 1 NAM eee erecta eee 228 — — testicular tissue.......... 23 — — —— jin a eunuch.......: 26 —— (SORT Pa Mdl snag aie tetas eon ee 226 —— OF thyroid glands) 2ee. sce. oe . 236 Trauma and transitory glyco- suria, relation between....... PATS — conservation in management Of ate Cae Tae 404 ‘Traumatic diabetess. . cre ome 543
Traumatic lesions of hypophysis Apel 2 62,
— — — thyroid — shock, studies in secondary. 508 Treatment of diabetes 510, 549, 557
—— — present outlook of..... 366 — —— —) HOSUITES crepe usue,cuee ese eete ee DiDIe! — — exophthalmic goitre.......576 et IP OUULC. chs oi aie tahoe ee ke aE OO
—-—hypertrophy of thymus...567 — -— patient, new point of view.164 Trevino, G.: Adrenin in asthma.185
Troell, A.: Sympathetic tonus, vagotonus and _ hyperthyroid- USI esis ce dee ea cei ses eae ieee eraes 434
Tropics; ploodssugar-in:. 1.6 see ODIO
Trypsogen, appearance in fetal PAN CTCAS Aiea cuseene soon cecveat ns DDE
Tuber cinereum, influence on se- CECLIONGORULEING cua ee 5
9 —-— piqure producing polyuria. 52’ Tubercular origin of Addison’s
GISCAS Ck gitar ls ce Go 6 me eect 496 Tuberculosis, adrenal gland in..177 —and Addison’s disease....... 179 —-—eendocrine imbalance...... 340 — -— exophthalmic goitre....... 434 —-—status lymphaticus in sol-
GUCTSiemeeeie srt ese 340 —complicated with diabetes, starvation treatment not TrecommMendedsss ace gee cue DD —in adrenals......... Dilla Selec! —— in scleroderma... «. 25... 405. -506 =a NS OGMET Sates, es, 5 5 ceek teense ces 340 (it {INE soho aoeaneoedocunt 444 — process reaching tuber cine- reum causing polyuria.....525
Tubo-ovarian suppuration, types and streatmenitaeemiee cise oS oO Tumor, goitrous, report of case. .419
—egrowth, acceleration of, by tetibeliiny «teste ae etaees, ae 209 — mediastinal, in acromegaly... 68 —— Ol adnrenalerslanideaseaaee 3845, 495 —— Of <CanonidsboOdya- eee 52,509 = —— OWN OOAATS Gancoeneeooee Byreshe
Tumor of hypophysis surgically
treated’ isc « checealns Aa eee 532 — — pineal’ vanieties.. an ee 443 — — pituitary 2lands 45 213 — ovarian, of thyroid structure.541 —_ retropharyneedless ne so ee 529 — thy roidinrerGna ae ee eee 578 Tumors of adrenal and pineal
in precocious puberty........ 463 Tumpowski, I. (Carlson and
Kanter): Stability of secretin. 402 Turner, D.: Radium treatment of
SOULS... os SS ee eee 209) Typhoid, adrenal syndrome with.503
—fever, symptoms of Graves’ disease: witha), 21.cie eee 582 Tyrosinase in human urine..... 350
Uhlenhuth, E.: tween thymus roid
— Function of thymus gland...285
— Influence of milk upon tetany. 222
— Parathyroids and calcium
Metabolismrsw ces. eee Dain 2a
— Retarding influence of thymus.229
— Thyroid gland, metamorphosis
Antagonism be- and parathy-
ANIONS Owl aac ene ee 7H05 Tl Ulceration, diabetic, of pharynx andiwilanynix lie sa aetec. coe eee 55 Uiltimobranchial@ bodies.) ee PAD A 5 Umber, F. (Gottstein): Diabetes ANG! “Wide we Seay ene ee 543 Underhill, F. P.,. Acidosis and metabolism in diabetes....... 62 Unterberger: Ovarian transplan- CatiONe orien. Gack s Grae oe teen 216 Urechia, C. (Obregia and Po-
pea): Hypophyseal dystrophy. 212 Ureter, action of adrenin on.... 43 — action of optic isomers on...187
—adrenin stimulation of ex- CISCO Giz ak re a eee eee 505 — pharmacology of ........ 44,179 — Studies: “Of niece cco Ue Uric acid and endocrine system. . 202 == =— (OX CTELIONS’ sy oss, ceva ook oea sos ede 523
—-diathesis an endocrine dis- OLVdMEr 6s awe eee 95
Urinary disease, blood choles- terin: dindexs ini -sase ae eee 497 Urine; concentration ons. nse 524
—hypophysis as regulator of SDECILCGs Slawallys Ole eee 1b — incontinence and tetany..... 87
—- pituitary extract in treat- ment Of! 4... orto cee 89
—reduction of quantity in dia- betes) insipidusss. cee Oe —retention of, pituitrin in....531
— secretion, action on, of hypo-
physealesmbstarlCesy yy -ccrcnen 524 — —— Center OL Ge ees oad orton 525 —-— under control of endo- CRIME WIS VSUCTON enw ee eee 52h — specific gravity in diabetes in- SIPIGUS: 2.05% 2.8 cakouee eee 524 —— —-—— normal person......524
rimesttyrosinaser dm. 2 0.55.) 652: 350 Urobilim elimination.: 2... i... .: 93 Urticaria a symptom of hypothy- TONG ESTM es sn hPeviets lave heaaaiensie Sass 109 — symptoms of, in case of edema.569 Uterine contractions produced by
DUCWUGIT tess ois eis S shoud s) eualevee 531 — functioning, endocrine factors THR, 5 SRG ge taster icra ae ae 197
— inertia, use of pituitrinin.... 90 —myoma, X-ray treatment of.. 83
Uterus, action on, of hypophy- Sealesmpshancec o . oes asc sot eee 52 — contractions of, caused by hy- pophyseal extracts .......523 — fibroid and X-rays.......... 435 — hourglass contraction of..... ies
— relation of mammary gland to.394 — relationship of ovarian secre-
ELON e Ome reis ons steeis occ hee he 540 — response to adrenalin........ 507 ———pituitrin ............. 507
— rupture of, following adminis- tration of pituitary solution 90 —swelling of; following extirpa-
ron. Of large) mMyonia: ..... 584 —— UNGEVELOPEd! 2... we ee ee 434 Uvers thyroid extract im... .. 105 Vagina, early bleeding from..... 460 —— NHALMACOIOSY: Of: 6... .%4.. 8 50 Wit OROMI se Same. wc se 2D2, 436
—a predisposition to myxedema. —symptoms of, in case of edema.569
WANE NOI RO aay Aaa Oe a 434
Valdizan, His Infantilism .* .. <1. 213
Valenzuela, R. J.: Insufficiency of UAVRIAV EM Teta gh ses coe ssc te leis Ss DOD
Vanden Berg, H. J.: Sarcoma of TINMN aes ote s oe ore he 6 cee sla a 1 249 Van Slyke, D.D. (Stillman, Cullen and Fitz): Studies of acidosis, WME Ee Oo ovrees 6 tee 363 Vas deferens, pharmacology of...46
Vasomotor reflexes, effect pro- duced by gland extracts...... 428 Yascular type of goitre..........576
Vass, T. E.: Structural changes himebey Old land,. . 2 suc = +s cas wie Aout
Vaughan, J. W.: Surgical treat- AMOMIA OE OIL; ouc:c eccte a ss he 115 Vegetable diet in diabetes......547 Vegetative nervous system......375 — — — and internal secretions. 387 — —-—asthma and........... 350
— — — relation to internist and SUTSCOM ie bas ec eto ve DOO
— — —relation to visceral dis- SANG). LT. Se Ss. ee 493
——-— relationship to clinical meqicine. 3. oF. te 493
Veill, W. H.: Metabolism in dia- petes' 1nkIpldus:. 2 .«sS are leery 195
Verco, J. C.: Thyroid and inter- Mal SOCLCLIONs 42 fac: ee 97
fe $4
Vermeulen, H. A.: Diseases of hy- pophysis in domestic animals.. 69 — Endocrine function of gonads
and dreredity<2eecree.. ©. 203 —Internal Secretion.......... 214 — Parathyroid glands.......... 219 Verning, P.: Pseudo-hermaphro-
ditism, externally female.....518 —Thyroidism following X-ray ERE OTMVCTI Grd oc: sacl ee mire eae 594 Verpy, G. (Loeper): Adrenal in- SHMLCLEM CY Sanat tes Save ss sae 39 —-— Test glycemia............ 186 Vertigo of menopause..........390 Vincent, S. (Arnasson): Thyroid ands paratbyitOids 2.75... <-0. oe ifauat —(Austmann and _ Halliday):
Adrenals and blood pressure 38
— (Ogata): Vasomotor reflexes. 428 — (Parsons): Blood pressure and splanchnic nerve stimula- LONG Sere eres oe eRe ee eae, Stee 44 — (Pearlman): Function of chro- IMAM SGISSWES 5c. aes eee eee haya — (Wheeler): Adrenal cortex PNG g TCO UML. 8 cies. Grats ele ys Sve 38 VEU TS TNS oxieetoucech hin) sees tee cace eee LL
Visceral disease, relation between vegetative nervous system and
SYMP LOMUSMO Lt. ue srake 0 enc ots snore 493 —— I SVIMPLOMS OL. ois 6 das, cnn, 6) 06 493 Vision impairment and loss fol-
lowing hypophysectomy......532 — failing, showing evidence of
hypophyseal pressure.. BLA — disturbance of, treated with
glandular preparations ....561 HTT PAUEMVCMG Ol. «<)s 6 6 cicciels oe Drore Visual disorders in case of hypo-
DMVSeCaly CUMOE. <ci.8s sss ose ee iog — fields enlarged following use
Ota DituibriNnes > <2 sc. « soe ee Vitamine deficiency a factor of
ehiologyisoh Cancer... O24 .hen 67 — identical with secretin?. <2 ein: Vitry, G. (Labbé): Action thyroid
body glucose metabolism.....570 Vocal cords, paralysis of, as re-
sult “of .thyroid surgery. .<:..-; 480 Voegtlin, C. (Myers): Secretin
and pancreatic secretion and DBM OWikter a neeteD ch haus oxo. ne. 5 apegst On Vogel: Treatment of lung dis- eases in infants with adrenin.506 Vomiting of pregnancy, corpus luteum in de Vries Robles, I. B.: CIUMMMCONEENL. ... 2 + 0.0. « «cae + OO
Wadell, J. A.: Pharmacology of
DEENA Rie pls Varo, aio hays eee enchely aenoine 50 Vids SCLELCTODS: . «+ > 940. 00 cte ee 46 Wago, H.: Pancreatic ferments. .220
Wagner (Loeper and Beuzard): Adrenal dyspepsia........... 34% Wallich, V.: Menstrual hemor- vid 0¢2 24 = eI Bn rar ire big relay,
Walko, K.: Hyperthyroidism and
CUIEOTGE es. So. S Bis ene aie aeons 582 “Vicker Ae CiSONISIN® cities. eiees eae rane 332 “War Basedowism’: sienna de. e374 war. diabetes’: 2): 435ee eae Sey — diabetes and........... 543, 544 — diet and diabetes........... 62 — edema and testicular hormone.405 —endocrine pathology of...... 329 — endocrinology .......... 329-341 — Graves’ disease in men during
Whale Piste ecto are ee OS —neuroses and endocrine dis-
PuTnhances isi ete ecole 199 — —In “Women snes £24 as oe eee 120 — pathology, significance of....514 — time food restrictions and dia-
betes! smelhtusienes os. oe 545 Warnshius, F. C.: Thyroidec-
EOE Y 20S SEE reed ka a eee 434 Warren, L. F. (Tilney): Signifi-
cance of pineal: body.....5-2. 399 Warren, S. L. (Corner): Ovaries
and artificial deciduomata....389 Warthin, A. S.: Pituitary dystro-
DAY eestor 2 eee eee 68 —— Syphilis of manereas.=. 1). acer 61
Wathen, J. R.: Surgical treatment of goitre Watson, L. F.: Goitre, analysis of PDS SCASCEi St Antiaeseet roe eee eee Bul 9 — Quinine and urea injections in hyperthyroidism ...... ee dia tak Webb, C. W.: Surgical treatment OL iS OER Serer nts eee 115, 429 Wegelin, C.: Thyroid and bone development Weidenmann, M.: menstruation Weight, increase in, with diabetes
Thyroid and
INSEDUGUS) eek xcleet eS - SACO — loss of, preceding coma...... 548 — recovery after underfeeding. .369 Weil's) diseasenyey.is 40's {acts See 504 Weiner, S.: Hematogenous in-
£ECLION. (OF Ovabyes. 2 eek oe 84
Weiskotten, H. G.: Burns and the suprarenals
Welt-Kakels, Sarah, Exophthal- mic goitre in children... 2... .-: 415
Weller, C. V.: Testes of guinea
LSC Pa iat era cise chs oer ee ee Wels, G.: Action of adrenin on
KNOY Spear dete, ot aus tee cole 42 Welz, W. E.: Pregnancy in spo-
EACICy CLALIMISMIs sree se Aa oe 428
Wenckebach, K.: Rachitis tarda.514 Werland: Diabetes and surgical
GiSCASESi ... Se --g-aease oe otochoee ke 543 Werley, G.: Vazotonian.-.- =. - 252 Werner: Ovarian function follow-
ing X-ray treatment......... 390 Wertenbaker, W.: Pituitary solu-
CHOM: » wc: oes ty aca ecco Ea ee
Wessely: Cataract and diabetes.542 West, G. R.: Ovarian influences. .216
Weygandt: Dystrophia adiposo- genitalis with brain tumor... .52%6 — Hypophyseal adiposity....... 522 — Sporadic cretinism.......... 570 Wheeler, T. D. (Vincent): Ad- renal cortex and medulla..... 38
Wheelon, H.: Testicular hormone 16° Whiskey, in starvation treatment Gf diabetes > tasthee to ae ee 553 Whitney, D. D.: Oxygen as factor in causing male production... 40 Wilkins (Buckner, Nollan and Kastle): Effect of grain rations on growth of chicks.-2- 54-68 564 Wilkinson, J. F.: Starvation and diet injdiahetess..2. 42-4 61 Williams, T. A.: Hypophysis ce-
es
TEDL kia. «Soles hee ee 69 — Neurasthenia due to hypoad- TODIA | pens 4s wae ee ee 388 Williams, J. R.: Recent studies in) diabetes! mellitus: 2. ose 361 — (Humphreys): Blood sugar in NepHhvritisic es bis. Ses Bee 355 —- Blood sugar in diabetes mellitusice: 233k Se ee 56 —-—Glucose in diabetes mel- Littig—Ss53 sas SSS ee 356
Williamson, C. S.: Acromegaly of long standing without subject- ive, Symptoms... <.c.. ose 205
Williamson, R. T.: Diabetes mel- litus, simple dietetic treatment OE castrate cievc Oa eee 544
— Etiology of diabetes mellitus. .544
Wilson, D. W. (Stearns, Janney and Thurlow): Parathyroid tetany
Wilson, G. W. (Rous): Influence of anesthesia, etc., on pressor
effect) of -adrenin=e eee 188 Wilson, J. M.: Surgical treatment OL SOMES. cae ee eee alas
Wilson, L. B.: Cervical sympa- thetic ganglia and exophthal- MIC sO CaS ws. sels wfoceus sa nee 415
— Sympathetic system, goitre.94, 430°
— (Kendall): Histology and io-
din compounds of thyroid. .119
Winkler, C.: Parathyroids and
tetany strumiprivas- oo. ee S18) Winslow, R.: Tumor of carotid DOGG s acco etcgees nic ahs ae oe ee 52
Winternitz, M. C.: Hyaline degen- eration of islands of Langer-
hans s) .5.6)o. wo ee eee 192 — Glandular extract feeding to Chicks 43:2... eee 200 Wintz, H.: Experimental castra- TION! is an eee a oe 388 — (Seitz): Corpus luteum and MGHSt rival Greer ae. eo oree 353 Witte’s peptone, influence upon blood sugar content......<.. 351
Woerdeman, H. W.: Development of hypophysis
Woerdeman, M. W.: Anatomy of hypophysis -: = a:...a06. oe 213
Wohl, M. G.: Carcinoma of thy-
TOTO Ret tes ict cubye ceap ec acer renee 411 Wolbach, S. B. (Morse): Primary tumor of adrenal gland...... 345 Woldert, A.: Allen-Joslin treat- ment of diabetes mellitus..... 361 Wolff-Eisner, A.: Influenza and UCM CHARI ANTO Ros e-cl i" cute, te edlerrey sears ey 6 350 Women, war neuroses in..... SLAW,
Woodyatt, R. T.: Acidosis in dia-
RGR ESM os 5) 5 o-Teoc fre eneforceeeelen se ate 53 Wooley, P. G.: Adrenal tubercu- OA SIRreree Rrats Te 5 oS shone hk ale: SLO 37 Wright, J. S., Relation thyroid to confusional insanity and mel- DITO OUT gto operas a acedend) ort sn vaps eas 596 Xanthochromia of pineal....... 444 Xanthoma diabeticorum, case of. 53 Xenomenia; memmes devii..... 81 MeMbEnNOSIS GIADETICA. we ss ce se 362 — without diabetes ........... 370 X-ray treatment and ovarian func- (HIG TIE O LES See ra a ee 390 —applications to thymus and LEDS THO 6 | ele ie eae aE 457 — examination in pubertas pre- NCPR Saree et acel otis! sive le a/c a neice “oes 459 Se WINSTON Ae ee 232 —-—in dysmenorrhea . 597 ——of epileptic subjects of
status lymphaticus ..... 568 — — — exophthalmic goitre 419, 457, 597 — — — — — and ductless gland- ular disorders. .198 ——of fibroid uterus ........ 435 OTE T Ouro iiat interes. + ote. tus 6 DSO
. f X-ray therapy of Graves’ disease 119, 581, 594
— — — death of patient following. .573, 594 — — — hyperthyroidism — — — pituitary tumor .......520 — —-— thymus hypertrophy ...5 —-— to thymus, spleen and in- testines
Yamada, M.: Blood coagulation, bhyroid and spleen)..:........ a bale Yamada, S.: Acromegaly without
nypophyseal tumor ......... nes Zabala Ortiz, E. (Jacob): Ab- derhalden reaction in demen- WAS Morte ais heey: eto e ele iste ee el oye 85 Zentmayer, W.: Eye and endo- CLINMCVOLE ANS 20:4 csreetia er cce Sicgae 64 Zimmerli: Parotitis and pancre- GIES ester we Chie ay een hte 86 Ziminerman, B. F.: Corpus lu-
teum in vomiting of pregnancy.191 Zimmerman, C.: Changes of re-
BIA CLOMm AME sew vafses sue sheet. ccs, 3.0.08 361 Zindel, L.: Postpneumonic stru- DONT TES pas ee ee Aiea ieee eal ae a 248 Zondek, H.: Heart in myxede- NIVEL western teveee a Socratic os TAOS abe Zueblin, E.: Experimental path- OlopyzOfsZOVlres © hoes tis Ls ET. Zulich, J. D. (Pfahler): X-ray and exophthalmic goitre ..... 104
Zune, E. (Dustin): Functional re- lation between thymus and thy- roid
4 be
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