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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.

He FOO aie

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oe

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10.

WHEELON

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I

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.

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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

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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.

ABSTRACTS

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(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

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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

262

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

ABT 279

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

ABT 281

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

ABT 283

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

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4. Ascoli, G., Vorlesungen uber Uraimie. Jena, 1903.

)». Weichardt, W., Zur placentiren Theorie der Eklampsiei-
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Shenk, F., Ueber besonderheiten der Giftwirkune des
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Shenk, F., Schutzeffekte normaler Sera gegen die Wirkung
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a

ca |
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314

LO:

2

IE

do
On

INTERNAL SECRETION OF PLACENTA

Lichtenstein, W., Kritische und experimentelle Studien zur
Toxicologie der Placenta, zugleich Beitrag gegen die
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Gynak. (Berlin), 1908, 86, 484. (Literature).

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Lichtenstein, W., Im Kampfe gegen die placentare Theorie
der Eklampsieitiologie. Centbl. f. Gynak. (Leipzig),
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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
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Dienst, A., Die Pathogenese der Eklampsie und ihre Bezie-
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zur Schwangerschaftsniere. Arch. f. Gynak. (Berlin),
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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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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.

bo

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

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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,

467

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

BRAM 469

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:

BRAM 471

(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

BRAM 473

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

474. THERAPEUSIS OF EXOPHTHALMIC GOITRE

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.

BRAM 475

‘““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.

BRAM 479

“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.

480 THERAPEUSIS OF EXOPHTHALMIC GOITRE

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

BRAM 481

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

482 THERAPEUSIS OF EXOPHTHALMIC GOITRE

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

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