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creased.’’
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is transposed.

ENDOCRINOLOGY

The BULLETIN of the ASSOCIATION for
the STUDY of INTERNAL SECRETIONS

Volume Four

pe
Lee
Published by the Association 4 9 / q /
1920 |

TABLE OF CONTENTS

THE INTER-RELATION OF THE THYREOID AND HYPOPHYSIS IN THE
GROWTH AND DEVELOPMENT OF FROG LARVAE. By E. R.
Hoskins and M. M. Hoskins, Minneapolis...............

PITUITRIN TEST. By M. Ascoli and A. Fagiuoli, Catania, Italy...

A PLEA FOR SYSTEMATIC RESEARCH WORK IN THE ANATOMY,
NORMAL AND MOoRBID, OF THE ENDOCRINE SYSTEM. By J.
Wiis eimmar, Upsala sweden cy. soi eieteiere tere

ADRENALIN IN ASTHMA. A CASE OF CHRONIC ADRENALISM. By
George H. Hoxie and H. T. Morris, Kansas City, Mo......

THE INFLUENCE OF THYROID FEEDING UPON THE PHYSIOLOGICAL
ACTION OF THE PANCREAS. By Hirotoshi Hashimoto, Tokio,
A VRS a Ge Se 5 se ails oe Gorin dodo ton tat sose> she

THYROID DIABETES. By G. L. Rohdenburg, New York...........

THE BASAL METABOLIC RATE IN EXOPHTHALMIC GOITRE (1917

WITH A BRIEF DESCRIPTION OF THE TECHNIC USED
AT THE Mayo Cuinic. By Irene Sandiford, Rochester,
Minn, 2s ees Se ore oe a On ee One Se eee

STRUCTURE OF THE THYROID AND ITS QUALITATIVE VARIATIONS:
A Review. By Vito M. Buscaino, Florence, Italy, and G.
Vercellinr (St. Pauley eee ccc sco ciel cearioteeae ieee toaceenen neue

Book REVIEW:

PATHOLOGICAL PHYSIOLOGY OF THE THYROID AND THE THYMUS
IN RELATION TO INFECTIONS (FISIO-PATOLOGIA DELLA TIRODE
E DEL TIMO NEI RAPORTI CON LE INFEZIONI).. By Mario
Barbara’ dealermoy taliye..ccsc a Scie ee eras 2 oe Cee

THE LITERATURE ON THE INTERNAL SECRETION..............-..-

HYPOPHYSEAL DISORDERS WITH SPECIAL REFERENCE TO FROELICH’S
SYNDROME (DYSTROPHIA ADIPOSOGENITALIS). By Harvey
G= Beck. Baltimore ext, .os one one Sete Sees Hee een

THE RELATIONSHIP BETWEEN THYROID AND PARATHYROIDS. By
Swale Vincent and J. S. Arnason, Winnipeg..............

GYNECOMASTIA. By Frederick S. Hammett, Philadelphia.......

FRIGHT AS A CAUSE OF EPILEPSY AND How IT Acts. By Edward
AW racy iBOStOMt cane Slog eta cians s Oe PR ta me een

A CASE OF COMPLETE AMENORRHEA WITH FULMINATING SYMP-
TOMS: SURGICAL DEMONSTRATION OF OVARIAN ETIOLOGY.
By Carleton Dederer; Bay City, Michi.) 2.2 -
Book REVIEWS:

(PATHOLOGY OF THE SYMPATHETIC) PATOLOGIA DEL SIMPATICO.
By Professors P. Castellino and N. Pende, Palermo......

(THE PUBERTY GLAND) DIE PUBERTAETS DRUESE UND IHRE WIRK-
WNGENG. UBy, AG ipschutz, (Bernina. ee oer

(A THEORY OF CANCER) LA DYSCYTOGENESE HYPOCYTOPOIETIQUE
DYSEUTROPHIQUE ON CANCER. By N. Naamé, Tunis......

(GOITRE IN THE WHITE RAT) DER KROPF DER WEISZEN RATTE. By
Th: Langhans; and C.“Wegelin. Bern=. a ~. 2 =<. aoe

THE LITERATURE ON THE INTERNAG SECRETIONS: -...<...-.-. 026

88

CLASSIFICATION OF DISORDERS OF THE HyYpoPHysis. By Wm. En-

glebach, ‘St. “Louis<6.. acs... . o/s = ee eee = 5 eee

HEMORRHAGIC SYNDROME CURED BY THYROIDIN. By Louis P. Bot-
taro and J. C. Mussio-Fournier, Montevideo..............

B47

ony

PUBERTAS PRECOX WITH ESPECIAL ATTENTION TO MENTALITY. By
Nashua Weiner NEWa VOtKe pare sar cite ceicle b.o occa cheshire

THE ENDOCRINE SECRETION OF HEN FEATHERED FOWLS. By T. H.
IEC AVOE Ka St. Sloe oe a. Med bie De els a eo sot a

SoME CONDITIONS AFFECTING THyROID ACTIVITY. By W. B. Can-
ae h)., Smilin. SOSEON. |. 5. ss ae Hecusiss a cnc eres net ee:

PHARMACODYNAMIC SUBEPIDERMAL TESTS: II, INDIRECT TESTS;
A, THYROIDIN. By M. Ascoli and A. Fagiuoli, Catania, Italy

STUDIES ON DISORDERS OF THE THYROID GLAND. II. FURTHER EX-
PERIENCES WITH THE EPINEPHRIN HYPERSENSITIVENESS
TEeEsT WITH ESPECIAL REFERENCE TO ‘‘DIFFUSE ADENOMATO-
SIS” OF THE THYROID GLAND. By Emil Goetsch, Brooklyn. .

HYPOPITUITARISM. By Henry H. Lissner, Los Angeles..........

THE EFFECTS OF INANITION UPON THE ADRENAL BODIES—PRELIM-
INARY COMMUNICATION. By Swale Vincent and M. S. Hol-
lesalaverees. \W/iha toil ofr Aas sei Rien oe, dana ean ea a ne Lal

ROLE OF THE ENDOCRINE GLANDS IN CERTAIN MENSTRUAL DISOR-
DERS, WITH SPECIAL REFERENCE TO PRIMARY DYSMENOR-
RHEA AND FUNCTIONAL UTERINE BLEEDING. By Emil
NRG ARMS CUIGNIN ORC sere, eae ater ess 6, oer, Oe cs ess eae

EFFECT OF SUBCUTANEOUS INJECTIONS OF THYMUS SUBSTANCE IN
YouNG Rappits. By Ardrey W. Downs and Nathan B.
Leigiahy, Wil@intcte(ae tll alah awoke nel ae alee aaa en ee ee eae

Book REVIEW:

PRACTICAL ORGANOTHERAPY. THE INTERNAL SECRETIONS IN
GENERAL PRACTICE. By Henry R. Harrower, Glendale,
SOR RENIN AI Pe eS eo as wins) = hw Sueh lot GO x Sass oo) o orajSaiew be

QUATRE LECONS SuR LES SECRETIONS INTERNES. By Eugene
(Glee, JESS 9 oot Bee Bp ERG oc CrEEee ICR eae eee

THE LITERATURE ON THE INTERNAL SECRETIONS.............----

EXPERIMENTAL RESEARCHES ON THE PITUITARY Bopy. DIABETES
INSIPIDUS, GLYCOSURIA AND THOSE DYSTROPHIES CONSID-
ERED AS HYPOPHYSEAL IN ORIGIN. By J. Camus and G.
EROS Ss me gel Tol See RN NS PS ree VON. “Hie syle wai oe eetss

THE RELATION OF THE THYROID AND OF THE ADRENALS TO THE
ELECTRIC CONDUCTIVITY OF OTHER TISSUES. By G. W. Crile,
NOC ATA eg eee ct me Ne cic i alti cite ie) wo svne ev'aerake

SECONDARY SEXUAL CHARACTERISTICS AND ENDOCRINOLOGY. By A.
Piewalnsl, Lents 35 at eae aes eee en eee

THE ORIGIN AND EVOLUTION OF THE INTERSTITIAL CELLS AND OF
THE OVARY AND THE SIGNIFICANCE OF THE DIFFERENT IN-
TERNAL SECRETIONS OF THE OvARY. By Isaac Ochoterena
PE ISECO MILAM Ze VERTIGO... nea s canicn seeds cise ae cule oe ss

THE INTERNAL SECRETION OF THE TESTIS. By Aldo C. Massaglia,
CURNYCRTEC, bd) cace cut oo tab EGE Su CHEN AO OO ence ee

EFFECTS OF X-Ray TREATMENT OF THE HYPOPHYSIS IN BRONCHIAL
ASTHMA. By Maurizio Ascoli and A. Fagiuoli, Catania,
ier aS Rr Tod! tae MAAS, UNA Acairolte iat DS oboe node ls, 3 04! 3-6
A FATAL CAS® OF CARDIAC DILATATION WITH ASSOCIATED GASTRO-
PATHY AND ENDOCRINOPATHY. By Chas. M. Nice, Birming-
iD iRAL Oe ate Ee a Php BCR Qe AREER AEE ae Ae Aa ho nes Se A A
THE INFLUENCE OF THE THYROIDS ON THE FUNCTIONS OF THE
SUPRARENALS. By P. T. Herring, St. Andrews, Sotcland..

411

507

EDITORIAL:
THE First CASE OF MYXEDEMA TREATED BY THYROID EXTRACT
ENDOCRINOLOGY IN RETROSPECT AND PROSPECT.............-
BooK REVIEWS:

LE SYMPATHIQUE ET LES SYSTEMES AssocriEs. By A. C. Guil-
Cy 00\- tate ae MPI, tne Se ices Fo care e ite ia hs Srna atta REN a Son. Baie
BEITRAEGE AM SCHILDDRUESENFRAGE (THE GOITRE PROBLEM).
By ‘Otto’ Bayard ere sae cere ore aan eects

IL PROBLEMA DELLA SONNO. LE AZIONI ORMONISCHE REGO-
LATRICI DEL FENOMENO. (SLEEP AND ITS HORMONE REGU-
VATION) 2_ bya erotee Vario bat banadnirme eerie crater

Die REITZTHEORIE UND DIE MODERNEN BEHANDLUNGSMETH-
ODEN DES DIABETES. By Priv.. Doz R. Kolisch.:. 2... ...°-

THE LITERATURE ON THE INTERNAL SECRETIONS. ............+-.-
INDEX FOR VOLUME IV.

600
602

606

606

PRDOCRINOLOGY

THE BULLETIN of the ASSOCIATION
for the STUDY of

INTERNAL SECRETIONS

JANUARY-MARCH, 1920

THE INTER-RELATION OF THE THYREOID AND HYPO-
PHYSIS IN THE GROWTH AND DEVELOPMENT
OF FROG LARVAE

EK. R. Hoskins* and M. M. Hoskins

(Institute of Anatomy, University of Minnesota.)

In attempts at establishing the function of the ductless
glands, investigators are limited to relatively a few kinds of
experiments. One can administer a particular gland to an ani-
mal or transplant the gland into the animal in the hope of
bringing about a condition wherein the subject receives more
than the normal amount of the hormone being studied. One
can extirpate a gland from an animal and then administer to
it preparations of the type of gland removed, and one can
remove a gland of one type and administer prepared glands of
another type. Still further, various combinations and modifica-
tions of the above kinds of experiments can be attempted. The
unsatisfactory elements in ductless gland investigations are
difficulties of controlling the experiments and the greater diffi-
culties of interpretation of the results.

In administering ductless glands one must admit that the
preparations are abnormal to begin with. The glands used are
dead and only hormones that are relatively stable can be pre-
served. Even here we have no absolutely certain method of

*The senior author succumbed to broncho-pneumonia on Jan. 30,
1920.

2 THYROID AND HYPOPHYSIS IN GROWTH

checking our findings and must usually reason by inference and
deduction in the interpretation of results. Further, as has pre-
viously been pointed out, experiments with prepared glandular
substances are more often pharmacological than physiological,
especially when extracts obtained by any agent other than
physiological salt solution are used. The body itself can hardly
be expected to prepare from its own glands extracts requiring
strong sulphurie acid, ether, acetone, alcohol and so forth. It is
one thing to bring about certain reactions by the use of such
preparations and quite another to prove that similar reactions
are normally brought about by the hving gland within the ani-
mal’s body. However, we are on reasonably safe ground when
we can, by administering preparations of a particular -gland,
prevent the occurrence of symptoms that would otherwise result
from extirpation of the gland in question.

Transplanting a ductless gland into an otherwise normal
animal would seem at first sight to be a method whereby hyper-
secretion could be brought about and the animal thus provided
with more than the normal amount of hormones from the gland
in question, but a usually ignored fact is that the host exerts a
controlling influence upon the transplant, as well as the trans-
plant upon the host, so that an equilibrium often results. We
have transplanted thyreoids into embryos for example (Hoskins
and Hoskins 19a) and observed later that they ‘‘took,’’ so that
the animals possessed an anatomical excess of thyreoid tissue,
but were apparently able to regulate the amount of thyreoid
hormones secreted by their own and the transplanted glands,
because no symptoms of ‘‘hyperthyreoidism’’ resulted.

After a ductless gland has been extirpated there is often a
considerable readjustment among the other structures of the
body, so that of the resulting symptoms, some are due directly
to the loss of the gland removed while others are caused only
indirectly by the removal, and it is usually not possible to dis-
tinguish between these categories. Metabolic processes are so
complex that phenomena occurring together may be merely con-
comitantly and not causally related. As an example of this
complexity we may consider the results of thyreoidectomy where-
in there occurs a physiological (perhaps pathological) hyper-
plasia of the hypophysis, so that the resultmg symptoms are

HOSKINS AND HOSKINS 3

brought about presumably both by the thyreoid deficiency and by
hyper-activity of the pituitary, and it is very difficult to tell from
such an experiment the normal function of the thyreoid. At best
in such cases we can only say that there is some relation between
certain processes and the gland in question.

METHODS AND MATERIAL

In the following experiments with hypophysis feeding we
have administered a commercial preparation of the anterior lobe
of beef pituitary (Armour & Co.) to otherwise normal larvae
of Rana sylvatica, and to larvae of the same species from which
the thyreoid had been removed in the embryonic stage before it
could have begun to function. This preparation consists of dry
substanee of the anterior lobes of the hypophysis, put up in
tablets of milk sugar. The tablets are composed of two grains of
bovine anterior lobe pituitary substance dried in a vacuum (rep-
resenting 10 grains fresh gland) mixed with three grains of
milk sugar. A. C. Henderson of the Armour and Company lab-
oratory states in a personal communication of June 4, 1919, ‘‘Our
anterior pituitary substance is made from carefully selected
material and is, we might say, entirely without iodin; at least
there is not any more than would be found in muscle substance,
which means practically none at all. It is absolutely free from
thyreoid tissue.”’

Dr. E. C. Kendall of the Mayo Foundation, who kindly
analysed this material for us, reported that each tablet of two
grains of dried anterior pituitary substance contains .0035 mg.
of iodine, either organic or inorganic, a content of one part in
40,000 which would be 1:200,000 in the fresh gland. Dr. Ken-
dall is of the opinion that the iodine present is soluble, and if
so, considering the amount of water in the larger aquaria, the
dilution of the iodine was 1 :570,000,000, a concentration much
less than is necessary to stimulate metabolism in tadpoles
(Swingle 719) if inorganie iodine is used.

Even if the iodine did not go into solution, only a very
small fraction of .0035 mg. of it was ingested by each larva in
one dose, yet in most cases an effect was noticeable within twen-
ty-four hours after the first dose was administered.

The active principle of the hypophysis, whether it contains
iodine or not, apparently is soluble, as shown by the fact that

+ THYROID AND HYPOPHYSIS IN GROWTH

the thyreoidless larvae continued to develop after their jaws
began to metamorphose, and they were thus compelled to stop
eating the tablets.

In several different experiments, most of which we have
not yet described, it was found that eggs collected early in the
season developed into larger animals than those taken later,
or taken early and kept for a time in cold storage before being
used.

In each experiment the controls and the experimental
larvae were of the same age and size and were taken from the
same mass of eggs.

In addition to. the hypophysis tablets the experimental
larvae received Spirogyra in abundance, and the controls re-
ceived milk sugar and Spirogyra. The water in the aquaria was
changed the day after each administration of the tablets or
sugar.

The larvae were under daily observation and were measured
from time to time as indicated.

Before being autopsied, the animals were fixed in Bouin’s
fluid.

The experiments were performed in the Anatomy depart-
ment of the University of Pittsburgh.

I. Effects of administering a preparation of the anterior
lobe of the pituitary to normal larvae.

Experiment 1. April 27, 1919.

Fifteen animals were selected for hypophysis feeding and
-15 of the same size kept for controls. Each set was kept in one
aquarium in which they had an abundant supply of normal food.
In addition to this food, one pituitary tablet was given daily to
the experimental group, while the controls received milk sugar.
The treatment was continued from April 27 to May 13, 1919,
making a total of 17 tablets given in this way.

Experiment 2. April 28.

Three sets of 13 animals each were chosen for this experi-
ment. Those of the first group (A) were taken at intervals from
the aquarium in which they were receiving their normal food,
and placed in a small jar of water, containing one pituitary
tablet. They were left in this jar for 24 hours, during which
time they ate a portion of the tablet. Five treatments were

HOSKINS AND HOSKINS 5)

given on the following dates: April 28-29, May 5-6, May 13-14,
May 15-16, May 22-23.

The second group of tadpoles in this experiment (2B) was
used at first as a control for group 2A, to make sure that the
effects observed in the latter were not due to the fact that the
animals were temporarily deprived of their ordinary food.
When group 2A was placed in the aquarium containing the
pituitary tablet, group B was also taken from its aquarium and
put in a small jar containing water and a few cracker crumbs.
The animals were left there as long as those of group A were
feeding on the pituitary substance, and then returned to the
aquarium, where they received normal food. As no effect re-
sulted from these periods of light feeding, the control was dis-
continued and the animals used in another way. They were
left in a small jar containing water and a pituitary tablet for
periods of one hour each. Nine such doses were given between
May second and sixteenth.

The third group of tadpoles (C) for this experiment was
composed of normal animals kept on an ordinary diet of leaves
and algae.

It will be seen that in these experiments care has been taken
to avoid starving the animals. In number 1, an abundant sup-
ply of normal food was always present with the hypophysis
substance, and the animals ate freely of it as well as of the tab-
lets. In 2A the effect of 24 hours at a time on light diet was
ehecked by a control, as above described; and in 2B the periods
of removal from the normal food were too short to have any
effect in themselves. The effect that the sugar content of the
tablets might have had was checked by the giving of milk sugar
to the control larvae.

RESULTS OF EXPERIMENTS
Experiment 1.

At the beginning of this experiment the animals measured
as follows:

15 for hypophysis feeding :
Body length, 9-10 mm., average 9.4 mm.
Total length 20-23 mm., average 21.1 mm.

6 THYROID AND HYPOPHYSIS IN GROWTH

15 for controls:

Body length, 9-10 mm., average 9.4 mm.
Total length, 20-22.5 mm., average 20.7 mm.

The first noticeable effect of the hypophysis feeding was
a marked wasting of the bodies of the animals, which gave them
the appearance of starved tadpoles. As has been said, the pos-
sibility of starvation has been carefully excluded from this ex-
periment, and this emaciation differs from that produced by
starvation in the time of its appearance. A normal tadpole kept
without food does not show noticeable changes in form for four
or five days, and is not strikingly wasted until several days
later. The emaciation following hypophysis feeding is seen
within 48 hours after the experiment is begun. Within a few
days, however, the animals seem to recover from the first effect
of the dose, and their bodies fill out again to the normal form.
While the wasted appearance of the body lasts, the animals are
sluggish in their behavior. Later, however, they become more
lively than the normal tadpoles, and show a high degree of ir-
ritability, so that the slightest jarring of the aquarium starts
them all to swimming about very actively.

By May 3, 1919, one week after the beginning of the ex-
periment, the measurements taken showed that the hypophysis-
fed animals were growing faster than the controls. These
measurements are:

Hypophysis-fed—B. 10-12 mm., aver. 10.5; total 25-29 mm.,
aver. 26.7 mm.

Controls—B. 9-10 mm., aver. 9.8; total 20.5-23 mm., aver.
21.9 mm.

The greater length of the tails of the hypophysis-fed ani-
mals is particularly noticeable. In them the tail made up 61
per cent of the total length, while in the normal tadpoles it was
only 55 per cent of the whole.

On May 8th the measurements showed still greater differ-
ence between the two groups of animals, as follows:

Hypophysis-fed—B. 10-12.5 mm., aver. 11 mm. Total 28-36
mm., aver. 31.5 mm.

Controls—B. 9-11 mm., aver. 10 mm. Total 20.5-25 mm.,
aver. 22.5 mm.

In addition to the size difference, which is largely due to

HOSKINS AND HOSKINS 7

the unusual length of tail, marked changes in appearance
may be seen in the hypophysis-fed animals. Figure 1, drawn
four days later, represents a tadpole of the average size on May
8th (Body 11 mm. Total 32 mm.) and a normal but older tad-
pole of the same total length is shown in figure 2. The hypo-
physis-fed specimen shows a decided approach to the adult form.
The body has become thinner both laterally and dorso-ventrally,
showing that the intestine has been reduced in length. The
anal canal has also shortened, the legs are well developed, and the
pigmentation is like that of a frog. All these changes show
that the animal has passed its maximum size and begun meta-
morphosis. The normal animal of the same length shows none
of these signs of approaching metamorphosis. Its intestine and
anal canal have not begun to shorten, its hind legs are repre-
sented by buds of tissue, and it retains the larval pigmentation.
Figures 1 and 2 also illustrate the abnormal relation of tail
and body in the hypophysis-fed specimen.

On May 13th all the hypophysis-fed tadpoles in this experi-
ment were undergoing metamorphosis. The measurements
showed a decrease in length, the approach to the adult form was
noticeable in all the animals, and one tadpole had three legs.
Five tadpoles, all of which had passed their maximum size, were
found dead on this day, and the hypoyhysis feeding was discon-
tinued.

No fully developed frogs were obtained from this experi-
ment, though several members of the group reached a condition
just short of the frog stage. Their bodies were frog-like, but a
stump of tail of a few millimeters remained. The animals
seemed to have been somewhat weakened by the treatment, so
that they could not survive metamorphosis. Those that reached
the stage at which they were able to leave the water had under-
gone a great shrinkage, but died before their tails had entirely
disappeared. There is, of course, a reduction of the size of a
normal animal in passing from the larval to the adult stage, but
it is not quite so great as that seen in hypophysis-fed tadpoles.
One member of this group died on May 14, and five more on
May 20. All of these had four legs, and the tails had begun
to shrink. On May 25 an animal which was already leaving the
water died, and on May 30 the last two were killed. One of

8 THYROID AND HYPOPHYSIS IN GROWTH

these, also, had practically completed metamorphosis, and was
leaving the water. The other still had a considerable stump of
tail.

During this time (May 13-30) the control animals had
developed much more slowly and did not reach their maximum
length (B. 15, total 40 mm.) until early in June. The repre-
sentative normal tadpole preserved on May 20 still retains the
larval form of body and the hind limbs are but shghtly devel-
oped, the digits of the foot being barely distinguishable. No
completely metamorphosed frogs were found until June 9th, ten
days later than the day on which the last of the hypophysis-fed
animals left the water. On June 17th, when the experiments
were ended, one of the normal animals was practically in the
frog condition, but others were no farther advanced than the
hypophysis-fed animals had been on May 13.

The precocious metamorphosis of hypophysis-fed tadpoles
naturally gives rise to abnormally small frogs. The first of this
group to reach the adult condition is shown in figure 3, and the
first control frog in figure 4 (Plate II). The hypophysis-fed
animal is normal in appearance except for its size. Its length
(fixed) was only 8.4 mm., while that of the normal frog (some-
what below the normal average) was 10.4 mm. (fixed). The
mininum length of the other hypophysis-fed frogs from this
group was 8 mm. ;
Group 2A

It was in this group that the effects of hypophysis feeding
were most marked. The animals were fed for 24 hours at a time
on an exclusive diet of the pituitary tablets. The toxic effect
of the first dose was very noticeable. The animals became much
emaciated, and floated at the surface of the water, often on their
backs. They remained in this condition for several days, and
although they ultimately regained their normal shape, their
growth appeared to have received a check from which it did not
entirely recover. There was no period when the animals of this
group were larger than the controls. The disproportionate
growth of the tails which was seen in experiment 1 was less
marked in this group. In the interval between the first two
doses (April 29-May 5) the average length of these tadpoles in-
ereased as follows: Body from 8.4 mm. to 8.8 mm.; total from

HOSKINS AND HOSKINS 9

18.8 mm. to 21.5 mm. The control tadpoles, in the meantime,
had grown from 8.5-18.9 to 10.5-22.4 (body and total length in
mm.). The second dose, given May 5-6, had no toxic effect on
the animals. Between May 6 and May 15, there was an increase
of 1.2 mm. in their bodies and .9 mm. in their tails. On May 16
the effect of the feeding on the form and development of their
bodies was clearly apparent. Figure 5 (Plate III) drawn at
this-date, is to be compared with figure 6, its control. The most
noticeable abnormalities appear in the lateral view of the hypo-
physis-fed tadpole, from which may be seen that the intestines
are already reduced, giving the animal a much smaller abdomen
than is seen in the normal specimen. This shortening of the
intestine is one of the later metamorphic changes in a normal
animal, but occurs in hypophysis-fed tadpoles at a relatively
early date, before the legs have developed to any very great
extent. The legs of the animal shown in figure 5 do not cor-
respond in their development to the condition of the intestine,
but are much more advanced than the legs of the control (fig. 6),
although the latter is conside rably the larger of the two.

Between the dose of May 16 and that of May 22 the tad-
poles increased very little in size. The average length on May
16 was: Body, 10 mm.; total, 23.6 mm.; and on May 22nd,
Body, 10.5 mm.; total, 26.1 mm. This was their maximum
length, and by May 26 the anal canal had shortened and meta-
morphosis had begun. Figure 7 shows the smallest animal of
this stage of development which we obtained from any of these
experiments. Although the body of this animal was only 8 mm.
long, the reduced abdomen and anal canal, the well developed
legs, and the pigmentation shows that it has already begun its
metamorphosis.

As might be expected from the small size of the tadpoles of
this group, the frogs developing from them were below the nor-
mal size. As in experiment 1, few survived metamorphosis.
Those that did so range in size (fixed) from 7 to 10.5 mm., with
an average length of 8.8 mm. They had an average volume of
0.15 ee. while the volume of the normal frogs was from 0.20 to
0.30 ee.

10 THYROID AND HYPOPHYSIS IN GROWTH

Group 2B

The animals in this experiment received less of the pituitary
substance than those in either of the experiments just described,
and the effect of the treatment was correspondingly smaller.
There was no emaciation following the early doses, and the first
result to be seen was a stimulation of the growth of the tail and
hind legs, and the reduction of the abdomen, due to shortening of
the intestine. By May 15, two weeks after the beginning of the
experiment, the hypophysis-fed animals have, on the average,
considerably longer tails than the controls, while the bodies re-
main practically the same in the two groups. The measurements
taken on this date were: Hypophysis-fed: Body 11 mm., total
30.4 mm.; controls: body 10.9 mm., total 23.7 mm. Individuals
may be found, however, among the hypophysis-fed animals,
which show normal proportions as far as length is concerned.
One of these is shown in figure 8, and is to be compared with
figure 6, which represents a normal tadpole of the same length.
The two show a striking contrast in outline, and in the develop-
ment of their legs. Figure 8 is typical of the hypophysis-fed
tadpoles at the time when the effects of the treatment are first
noticeable. Comparison of this figure with figure 1 shows that
although the animals of experiment 2B were stimulated by the
hypophysis feeding, the changes indicative of metamorphosis
took place more slowly than in the earlier experiments. Al
though most of the animals completed their metamorphosis early,
a few showed very little effect from the feeding. An example is
shown in figure 9, and its control in figure 10. The hypophysis-
fed tadpole has a slightly longer tail than the normal one, and
its legs are longer, but there is no external evidence of changes
in the intestine. The two drawings were made on June 3, when
many of the hypophysis-fed tadpoles of this group had com-
pleted their metamorphosis.

The frogs that developed from this group ranged in length
from 9 to 11 mm., with an average length of 9.9 mm., as com-
pared with the control frogs, which varied in length from 11 to
14 mm.

Discussion of Part I.

The effects of hypophysis feeding on normal young tadpoles

may be divided into two groups: the toxic and the stimulating,

HOSKINS AND HOSKINS mt

_as has been noted for thyreoid feeding. To the former group
belongs the emaciation which immediately follows the first dose
of the pituitary substance. Abderhalden 715 noted the toxic ef-
fect of pituitary extract. This effect is temporary, and does not
recur after later doses. The animals appear to acquire a toler-
ance for the hypophysis substance. This may be the result of
the repetition of doses, alone; or it may be that larger tadpoles
have a greater resistance to the toxic effect. Late in the season
an attempt was made to produce this effect on a normal tad-
pole, in order that a figure of this stage might be drawn. No
such result was obtained, however, and this suggests that a tol-
erance may develop normally in the tadpoles with increasing
size. No emaciation was produced in group 2B, the members
of which were larger at the beginning of the experiment than
those of the other group. In this case, however, the dose was
small, and may have failed to affect the animals on that account.
2A. Although these animals recovered from the toxic ef-
feet of the first dose, their growth was considerably retarded.

The more interesting results of hypophysis-feeding are seen
in various indications of stimulation. The most constant of
these is the relatively rapid growth of the legs and tails of the
treated animals. This effect is seen in animals which have re-
ceived hut a small amount of pituitary substance and are appar-
ently not otherwise affected by the treatment, as well as in those
which have had so much hypophysis that their general growth
has been retarded.

The early shortening of the intestine occurs in almost all
the animals, although. a few in group 2B were not affected in
this way. This result occurs relatively much earlier in the his-
tory of the hypophysis-fed tadpole than in that of the control;
and hence it is more precocious than the development of the
legs.

Moderate doses of the pituitary substance cause a stimula-
tion of the growth of the body as well as of the legs and tail.

Metamorphosis as well as growth is hastened by pituitary
feeding, in proportion to the amount of the substance admin-
istered. The process takes place relatively early in hypophysis-
fed larvae, so that abnormally small frogs develop, and such
larvae never become as large as the size attained later by the

12 THYROID AND HYPOPHYSIS IN GROWTH

controls. The maximum length reached by any of our hypo-
physis-fed larvae was 36 mm. as compared with 40 mm. for the
maximum of the controls. After metamorphosis the hypophysis-
fed animals were from one-half to two-thirds as large as the
control frogs, and were about three-fourths as long, as is de-
scribed above.

While we do not believe that the iodine content in our
preparation of pituitary was sufficient in itself to bring about
the results obtained, such may be the case. But whether it is
or not, the substance used was normal pituitary, and the results
indicate a similarity of its action to that of thyreoid.

The normal presence of iodine in the hypophysis of mam-
mals has been claimed by some previous investigators and de-
nied by others. Thus Bauman ’96 found no iodine in the hu-
man hypophysis, but Schnitzler 796 found a trace of it. Wells
‘97 reported finding 0.05 mg. of iodine in 1.22 grams of dried
human hypophysis. Simpson and Hunter ’09 could not find
iodine in Armour and Company’s ox pituitary preparation nor
in the fresh pituitary of sheep following thyreoidectomy, but de-
teeted a trace in fresh normal sheep pituitary. They state that
their method would detect iodine in the amount of 0.005 mg. in
1.2 grams of dried substance. Denis 711 could not find iodine
in the human pituitary either before or after the administration
of iodides. MacArthur 719 likewise did not find iodine in beef
pituitary. Thus it appears that while iodine is present nor-
mally in the hypophysis of mammals, it may be at times either
absent or in concentration too small to be detected by the tech-
nique employed. sis

Smith ’18 states that anterior hypophysis substance and
boiled lettuee fed to normal tadpoles causes a rapid growth just
before the larvae begin to metamorphose and hastens this
process, as compared to larvae to which liver and boiled lettuce is
given. This difference in size is very much less than the vari-
ation within the two groups of larvae in Smith’s experiments,
and may not be of any significance. The liver may have had
some effect upon the growth of the control larvae and if so
they were not normal and the results obtained need confirma-
tion. In our experiments the larvae to which anterior pituitary
substance was administered began their metamorphosis before

HOSKINS AND HOSKINS Se

they had become as large as larvae of this species normally
grow, and as a result, the frogs which were formed are smaller
than normal. Since Smith did not mention any such effect on
the size of his frogs, and since he did not notice any effects in
the early part of his experiments, it is evident that the prepara-
tion of hypophysis used in his experiments was different in its
action from our preparation.

II. Effects of administering a preparation of the anterior
lobe of hypophysis to thyreoidless larvae.

For this experiment twelve thyreoidless larvae were selected
as shown in the accompanying table. They varied in length
from 42 to 53 mm. and in volume from 0.90 to 1.45 ec. Each
was placed in a separate aquarium and treated as described
under ‘‘Material and Methods.’’ They were all kept under ob-
servation from 9 to 31 days, receiving from 9 to 21 doses of the
hypophysis substance.

The normal control larvae, 50 in number (see Pl. IV.) had
all passed the period of metamorphosis before most of the hypo-
physis feeding experiments were begun. ‘These controls grew
and developed normally and do not require description. . They
varied in maximum size before metamorphosis from a_ total
length of 36 mm. to 41 mm. and volume of 0.50 ee. to 0.80 ee.
After metamorphosis the control frogs varied from 13 mm. to
14 mm. in body length and from 0.30 to 0.45 ec. in volume.
The hind legs were about 14 mm. long before metamorphosis
and 15 to 18 mm. afterwards. It is easy to tell when metamor-
phosis proper is beginning by noting when the anal canal begins
to shorten. Skeletal changes have already begun before this
time, but there is no particular point in the skeletal growth that
signifies metamorphic change, since the growth of the skeleton is
at first very gradual. For a recent discussion of these normal
changes see Hoskins and Hoskins *19b.

Thyreoidless larvae differ from normal larvae in many par-
ticulars as Allen, Hoskins and others have already described,
and only a brief description will be given here. (See Pl. IV and
VI.) These larvae that have had their thyreoid removed in the
early embryonic stage, grow in volume and length more rapidly
than normal, but if kept in normal conditions and given normal
food, will not metamorphose at least for two years, although

14 THYROID AND HYPOPHYSIS IN GROWTH

the control animals taken from the same eggs will change into
frogs within four to eight weeks from the time the eggs are laid.
These thyreoidless larvae ultimately become two to four times
as large as normal larvae, but their skeleton shows little tendency
to calcify or to ossify. Their legs develop only as rudimentary
appendages a few millimeters in length.

It is interesting to note that Hahn 712 found four gigantic
larvae occurring naturally in otherwise normal cultures of Rana
esculenta, but unfortunately he did not study their thyreoids.
It is highly probable, however, from Hahn’s description that
the thyreoids of his monsters were atrophied because the
changes which he does describe are much like those occurring
in thyreoidless larvae. He attributed their gigantism to hyper-
trophy of the pituitary.

In thyreoidectomized larvae, as in other animals, there re-
sults a hyperplasia of the pituitary after thyreoid removal, but
the pituitary is not able to make good the loss of thyreoid se-
cretions.

At the beginning of the hypophysis feeding the thyreoid-
less larvae resembled those previously described.

DESCRIPTION OF EXPERIMENTS
A. (PI: V and table.)

This larva was about twice the size of a normal larva when
the feeding began, its total length being 50 mm., nose-anus
length 20 mm., hind limb buds 2 mm. and volume 1.50 ee. It
received 18 daily doses of one-half tablet each, only a small
amount of which it ate, as described above, and was observed
for 20 days. j

An effect of the medication was evident within 24 hours, at
the end of which time the tail had shortened 10 per cent and
the volume had diminished 12 per cent. The animal had be-
come more active, as was true in all the following experiments
after a single dose of hypophysis. If one approached or touched
the aquaria, the larvae swam rapidly about and were difficult to
catch, whereas before the medication began they were rather
unresponsive to ordinary stiuml. The same effect was pro-
duced by Smith ’16 by extirpating the hypophysis.

After two days the tail of animal A had decreased an addi-
tional 9 per cent in length, the volume had decreased 3 per cent,

HOSKINS AND HOSKINS 15

and the hind limbs had lengthened 25 per cent.

Between the sixth and eighth days the anal canal disap-
peared, the animal’s body now being 17 mm. long.

Between the fourth and twelfth days the tail underwent a
secondary growth period, giving the animal a total length of
48 mm. The hind limbs had grown to 15 mm., which is the
average leg length of young frogs. The volume had, during this
period, decreased to about two-thirds of the original. On the
thirteenth day the left foreleg broke through the operculum.
By this time the shape of the body and head was definitely that
of a frog. The pigmentation and other skin changes also were
those of normal metamorphosis. Two days later the other fore-
leg appeared. It came through the toughening skin with con-
siderable difficulty. On the seventeenth day the total length
was reduced again to 44 mm. The tail did not, however, have
the appearance of a normal larval tail of the same length, being
but half as wide dorso-ventrally and half as thick, showing
evidence of impending disappearance. The body was still 17 mm.
in length, but.had become very much thinner. The hind limbs
were 20 mm. long, were somewhat disproportionately thick, and
were short also in relation to the size of the body. The volume
was not measured at this time, but it appeared to be further de-
creased.

On the twentieth day of the experiment the animal was
found dead in its aquarium, too much swollen for accurate
measurement. It was much larger than a normal young frog, °
as was to be expected from the size of the larva at the beginning
of the experiment. The animal had the shape and pigmentation
of a frog, but a long narrow tail still persisted.

Autopsy showed the gastro-intestinal tract to be almost
completely metamorphosed, the liver being greatly reduced in
size and the gall-bladder enlarged as occurs normally; the gills
were small and the lungs well differentiated, as were the kid-
neys, gonads and brain. In general it may be said that meta-
morphosis was between 80 and 90 per cent completed.

A. A. (Pl. V, V1, and table.)

At the beginning of the experiment the total length of this
larva was 42 mm., the body length 19 mm., the hind limb buds
2 mm., and the volume was 0.98 ce. It was thus about a third

16 THYROID AND. HYPOPHYSIS IN GROWTH

larger than the average of the control larvae. It received 15
half-tablet doses of the pituitary substance during the first 18
days of the experiment, and was kept under observation for 31
days. In the first four days the tail increased 3 mm. in length,
but the volume decreased to 0.75 ec., a loss of about 23 per
cent, due partly to expulsion of intestinal contents.

By the sixth day the length had not changed, but the hind
limbs had doubled in length and the volume had increased very
slightly. By the ninth day the anal canal had shortened 3 mm.,
the hind legs had grown another mm. and the volume had de-
ereased to about 66 per cent of the original.

On the next day the nose-anus length had still further de-
creased to about 74 per cent of the original and the hind legs
had increased to 5.5 mm. On the twelfth day the total length
was 41 mm., but the tail was very narrow dorso-ventrally, the
volume had increased to 0.75 ce., the hind limbs were 6 mm. and
the pigmentation was changing toward that of a frog.

Three days later the tail had increased 1 mm. and the hind
limbs 3 mm., and the head and body were changing in shape
toward that of a frog. On the nineteenth day the animal looked
hke a frog except for its long narrow tail. Both forelegs had
appeared. The medication was stopped at this point.

Three days later the tail had shortened by 3 mm., the body
length had increased 1 mm., the hind limbs were 16 mm. in
length and the volume had been decreased to 51 per cent of the
original. On the twenty-seventh day the tail had shortened
again by 3 mm., and the hind limbs had increased in length
another mm. The larva frequently tried to protrude its head
from the water, so it was placed in an aquarium one end of
which contained shallow water. From this time to the end of
the experiment the animal, unless disturbed, remained in this
end of the aquarium with its head out of water. On the thirty-
first day the animal, which had practically become a frog, still
had a very narrow and thin tail 20 mm. in length. Its volume
had decreased to 36 per cent of the original, a decrease equal to
the maximum loss suffered by a normal larva during metamor-
phosis. On this day while being examined it jumped from the
observer’s hand and was killed by the fall.

Autopsy showed a fully differentiated gastro-intestinal tract,

HOSKINS AND HOSKINS 17

the liver being even smaller than that of normal frogs, and the
gall-bladder rather larger than normal. The gills had not been
reduced in size as much as occurs in normal metamorphosis,
although the lungs were well developed and functional. The
kidneys appeared normal, the ovaries were quite large, and the
brain was as fully differentiated as that of a young frog. Meta-
morphosis seemed to be complete. save for the fact that the tail
had not fully disappeared and the gills had not been very much
reduced in size.

B. B. (Pl. V and table)

This animal had received but three doses of 2 grains each
when it died on the fourth day. The total length had been re-
duced 4 per cent, its body length 7.5 per cent and its volume 33
per cent. Since the animal when measured on the previous day
was almost as long as when the experiment began, it may have
shrunken between the time it died and the time it was removed
from its aquarium. A part of the loss in volume was due to
discharge of fecal matter. At autopsy the viscera were still in
the larval condition.

B. (PI. V and table.)

This larva received eight daily doses of 1 grain and on the
ninth day while being anaesthetized to be drawn, it died and
was fixed. An effect of the pituitary substance was noticeable
twenty-four hours after the experiment began, when it was seen
that the entire length had changed from 46 to 47 mm., the body
leneth from 20 to 20.5 mm., the hind limb from 1.5 to 2 mm.,
all signs of growth, but the volume had decreased from 1.30 to
1.15 ec.

On the next day the animal was the same length, but its
volume had decreased to 1.10 ce. and the hind limbs had in-
creased to 2.5 mm.

On the fourth day the tail had lengthened another mm.,
and the hind legs 0.5 mm., but the anal canal had decreased 1.5
mm., and the volume 0.10 ec., the latter bemg now 23 per cent
less than at the beginning of the experiment. By the seventh
day the anal canal had disappeared and the body was beginning
to change in shape. On the ninth day the larva had decreased
in tota! length to 47 mm., and in nose-anus length to 16 mm.

18 THYROID AND HYPOPHYSIS IN GROWTH

The volume was 0.85 ce. or about 65 per cent of the original.
The hind limbs had grown to 7 mm. and the fore limbs beneath
the operculum were 3.5 mm. long.

Autopsy showed that the gastro-intestinal tract was changed
about half way to that of the frog stage. The liver had formed
its three lobes, was being freed from the coil of gut which in the
larval stage is embedded in it, and the gall-bladder had in-
ereased in size. The gills showed little change, but the lungs
were large and air-containing. The kidneys and ovaries showed
no peculiarities. The latter were large, but as Allen and we
have shown, thyreoidless larvae develop large gonads. The
brain showed differentiation beyond that of the thyreoidless
larval type.

C. (Pl. V and table.)

This animal reacted in about the same way as A. It re-
ceived 18 one-half tablet daily doses of the anterior pituitary
substance and was found dead in the aquarium on the twentieth
day, from drowning or other cause.

Within 24 hours after the first dose the larva began to de-
crease in volume. As in most of the experiments the tail in-
creased in length at first, but rapidly decreased in size, and after
10 days, in length also. On the tenth day the total length was
still 1 mm. greater than at first, but the nose-anus length had
lessened by 24 per cent from shortening of the anal canal and
the volume had decreased by 44 per cent. The hind legs were
now 8 mm. long.

On the seventeenth day the total length had decreased to 40
mm. and the body length to 15 mm. The hind limbs were 13
mm. long and the left foreleg had broken through the skin.
The volume was not measured, but was seen to be less than be-
fore. The shape of the head and body and the pigmentation
were definitely those of a frog, and the mouth and jaws also had
metamorphosed. The skin had become toughened to such extent
that the right foreleg could not break through it, and on the
next day a small incision was made in the skin to release this
leg.

On the twentieth day the animal, a frog to all intents and
purposes except for a narrow tail of 30 mm., was found dead.
It was somewhat swollen, so the volume could not be taken, but

HOSKINS AND HOSKINS 19

the animal had decreased in size more than the average normal
larva during metamorphosis.

Autopsy showed that the viscera were nearly completely
metamorphosed, as in animal A. The kidneys and liver were
especially small. The ovaries were large and the brain well
differentiated. The other viscera also were those of a normal
young frog.

De (PV. and. ‘table. )

This larva received 13 doses of pituitary substance, and
reacted about the same as did larva C., but somewhat more
rapidly, and in seven days its metamorphosis was further ad-
vanced than that of the other. Its volume by this time had
been reduced by a third, its nose-anus length by a fourth, and
its hind legs had lengthened to 5 mm.

By the twelfth day the total length and volume were rap-
idly decreasing, the hind legs were 13 mm. long and one foreleg
had appeared. As in animal C, the other foreleg had to be lb-
erated by operation because the skin had toughened, and lke
animal C, this animal was found dead in the aquarium two days
later.

At autopsy its viscera were seen to have metamorphosed to
the same extent as in animal C, except that the gastro-intestinal
tract was not quite so completely differentiated, and the gills
were somewhat further reduced in size.

E. (Pl. V and table.)

This larva received 21 one-half tablet doses and reacted as
did D. In nine days it lost 45 per cent of its volume, its tail
decreased in size and its head and body began to resemble those
of a frog. In twelve days one foreleg broke through the skin
and a few days later the other appeared. By the seventeenth
day, except for a narrow tail the animal appeared quite like
a frog. By the twenty-second day the volume was down to 40
per cent of the original, the hind limbs were 12 mm. long, the
tail was still present but was becoming smaller and the body
was fully reduced to the size, shape and color of a frog. The
thin ventral and dorsal fins of the tail had nearly disappeared,
giving this appendage a near-rod shape.

Autopsy showed a completely metamorphosed gastro-intes-

20 THYROID AND HYPOPHYSIS IN GROWTH

tinal tract, including a very small liver and very large gall-
bladder. There were small gills, large air-containing lungs,
small kidneys, large spleen, spherical and well differentiated
testes and a well differentiated brain.

R66 (PL V, VI and table)

This animal received 15 half-tablet daily doses, and it re-
acted very rapidly to the medication. There was at first an in-
crease of 2 mm. in the length of the tail, but a decrease in the
volume of the body. In five days the volume decreased from
0.93 ec. to 0.80 ec., the legs grew from 2 to 7 mm., and the anal
eanal shortened 2 mm. The body during.this time had become
slender from discharge of feeal contents and from contraction
and shortening of the gut. By ten days these changes had gone
on still further, and the animal had the general shape and color
of a frog.

By the fifteenth day one foreleg had appeared, but the
tough skin seemed to have prevented the appearance of the
other. Except for this, and the presence of the tail, the animal
resembled a fully formed frog. The tail had begun to shorten
and its dorsal and ventral fins had almost completely disap-
peared. The volume of the animal had decreased to 60 per
cent of the original, and the hind limbs had lengthened to 18 mm.

At autopsy were found a practically differentiated gastro-
intestinal tract, gills that had decreased somewhat in size, lungs
that were very large and full of air, small heart and kidneys,
spleen and ovaries well developed, and brain fully metamor-
phosed.

Gi(Pl. Vand: table:)

This large thyreoidless larva was kept in this group of
animals to serve as a control and was fed algae and milk sugar,
although such procedure was not really necessary since Allen,
Hoskins and others have shown that thyreoidless larvae retain
the larval condition under normal circumstances, and as shown
in section I of this paper, milk sugar alone has no direct effect
upon metamorphosis. This animal (G) was kept for 15 days
in a dilute sugar solution and fed on algae. It continued to
grow, but showed no signs whatever of metamorphosis. Its
growth was somewhat more rapid than that of average thyreoid-

HOSKINS AND HOSKINS 21.

less larvae of the same age kept on a normal diet, but was little
if any more rapid than the maximum growth of such larvae.

At the end of the experiment this animal had increased in
total length from 47 to 52 mm., including an increase in body
length of 3mm. The volume had changed from 0.98 to 1.40 cc.,
a growth of 43 per cent as contrasted with a decrease in volume
of 30 to 60 per cent suffered by the other larvae. This animal
was thus from two to three times as large as the larvae that had
received 15 doses of pituitary substance.

Autopsy showed its viscera all in the larval condition as
previously described for thyreoidless larvae (see Hoskins and
Hoskins 719b). The brain was especially small and undiffer-
entiated, whereas the ovaries, which are not retarded by thy-
reoidectomy, were well developed and contained odcytes visible
on the surface of the gonad.

H. (Pl. V and table.)

This animal received 9 daily 1 grain doses of the anterior
pituitary substance, and reacted about the same as the other
thyreoidless larvae after the same amount of medication. The
length decreased slightly, the anal canal disappeared, the volume
decreased about a third and the hind legs grew to 10 mm. The
animal was then killed, fixed and autopsied. The forelegs under
the operculum were + mm. long. The shape of the body and the
pigmentation of the skin were changing to those of a frog. The
mouth had just begun to change. The stomach was being formed,
the gut was shortened to about half the larval length, the liver
was still large, but had formed its three lobes and was decreasing
in size, having freed itself from the coil of gut formerly em-
bedded within it. The gall-bladder had enlarged. The gills
were still large, but the lungs were fully expanded and air-con-
taining and the kidneys had decreased in size. The testes were
spherical and well developed, and the brain was about half way
between that of a larva and a frog.

I. (Pl. V, VI and table.)

This larva also received nine doses of the preparation and
reacted about the same as did H, except that its loss in volume
(55 per cent) was greater, and its tail became relatively smaller.
Its leg growth was relatively the same as that of H.

22 THYROID AND HYPOPHYSIS IN GROWTH

At autopsy its liver, stomach, kidneys, lungs and spleen
were found to be completely metamorphosed. The intestine was
about three-fourths reduced to the frog type, the gills were
slightly reduced, and the brain had become nearly differenti-
ated.

J. (Pl. V, VI and table.)

This animal was treated similarly to I and reacted in the
same manner, except that its loss in volume (35 per cent) was
not so great.

The viscera were in practically the same condition as those
of I.

DISCUSSION OF EXPERIMENTS OF SECTION II

In the above experiments it was noted that in most cases
the length of the animal increased shghtly during the first day
or two of the hypophysis feeding, before involution began. In
one case (AA) this added length persisted for ten days, although
in this, as in other cases, the volume of the tail was steadily
decreasing regardless of length, because of a shrinkage both
dorso-ventrally and laterally. In this involution the tail did not
react quite the same as it does in natural metamorphosis, the
muscles and cartilage being more resistant than the skin and
connective tissue.

The volume began to decrease in every case within twenty-
four hours, and in all but one experiment, the decrease was
continuous. A considerable portion of this loss in the first few
days was due to discharge of feces, as occurs naturally with
the shrinkage of the gut. The total loss in volume suffered by
the larvae was quite as extensive as occurs naturally, being 63
per cent in one ease.

One animal (AA) continued to metamorphose for thirteen
days after the medication was stopped, indicating either that the
absorbed pituitary substance persisted for some time in the
larva or else that it had started some process within the animal
that was able to continue after the intake of pituitary ceased.
In all of the cases in which the jaws of the larvae began meta-
morphosis (AA, A, C, D, E, F) the animals quit eating the
pituitary substance and could have been influenced after that
time only by the extract soluble in the water of the aquarium

HOSKINS AND HOSKINS 23

or else by a persisting effect of the substance eaten previously.
The animals’ ceasing to eat the tablets may account for the
failure of their tails to disappear entirely.

The effect of the medication on the viscera was evident
earlier than the effect on the somatic structures so far as macro-
scopic changes could be noted. There occurred on the first day
the decrease in the size of the abdomen referred to above and the
anal canal began to disappear usually within three or four days,
being entirely gone, in some eases, in five days.

At autopsy the viscera were found, in every case, to be
further advanced in metamorphosis than were the somatic parts
as a whole, although the skeletal development was well ad-
vaneed. The gastro-intestinal tract differentiated fairly early,
being nearly half completed in nine days. The shrinkage of
the liver that occurs normally during metamorphosis was very
marked in these experiments, in one animal (E) becoming
actually smaller than the gall-bladder. The gonads which are
not directly affected by metamorphosis resembled those already
described for thyreoidless larvae. The kidneys and spleen un-
derwent their usual metamorphic changes in most of the ani-
mals of these experiments, but the gills tended to persist for a
longer time than they do in normal metamorphosis. The lungs
are not affected directly either by thyreoidectomy or natural
metamorphosis, as we have shown in a previous publication, and
there was no effect on them in these experiments. In all cases
they were noted at autopsy to be expanded and to contain air,
but this is true also of the lungs of undifferentiated larvae. The
brain, which in thyreoidless larvae develops much more slowly
than normally, was markedly stimulated in its growth by the
hypophysis feeding, and after but nine doses given to animal I,
for example, the brain had changed almost completely to the
shape found in young frogs.

The skeleton, as indicated by the growth of the legs, showed
considerable variability in its response to the pituitary sub-
stance. Animal F (Pl. V) developed a larger skeleton in a
shorter time than did E, although at the beginning of the experi-
ment it was the smaller of the two animals. The skin developed
in some cases more rapidly than did the legs, and in ©, D and
F the right foreleg was unable to break through it.

24 THYROID AND HYPOPHYSIS IN GROWTH

The action of the pituitary substance in these experiments
was somewhat less extensive and less rapid than has previously
been described for the thyreoid in experiments of the same kind.

GENERAL DISCUSSION

It has been believed for many years that the thyreoid and
hypophysis are able, to a certain extent at least, to function
vicariously. This idea was expressed by Rogowitsch ’89, who
noted hypertrophy of the hypophysis in rabbits, following thy-
reoidectomy, an experiment probably first performed by Ray-
nard ’34 and repeated since by a very large number of other
investigators. In cases of pregnancy (Paton *13) and in natu-
rally occurring myxoedema, there has also been noted pituitary
hypertrophy (Boyce and Beadles 793). Ascoli 712 has shown,
on the other hand, that after removai of the hypophysis of mam-
mals the thyreoid tends to atrophy, and Adler *14 and others
have verified this finding in the amphibia. In addition to the
above mentioned effects of removing either the hypophysis or
the thyreoid, many other changes have been described for other
organs and tissues, and changes in either the thyreoid or hypo-
physis can be produced by experiments other than removal of
one of them. Livingston 714, for example, noted hypertrophy
of the pituitary after the spaying of rabbits. Jackson 717 found
that the hypophysis of rats decreases in size during inanition ;
Cushing and Goetsch ’15 deseribed a similar decrease in the
pituitary of woodchucks during hibernation; in both cases the
hypophysis returned to normal when the animals were given a
normal diet.

The effect on the hypophysis of thyreoidectomy in mam-
mals has been seen since the experiments of Rogowitsch ’89,
by Hofmeister 94 and more recently by various workers (see
Vincent 712, Biedl 713, or Paton 713). Viguier ’11 obtained the
same effect in lizards, and Hoskins and Hoskins 718, Rogers 718
and Larson 719 have noted it in amphibia. Hence the relation-
ship between the thyreoid and the hypophysis indicated by this
kind of experiments probably obtains in all classes of animals.

Response to feeding thyreoid substance has been investi-
gated in many kinds of animals and with fairly uniform results.
When large doses are administered the animals are poisoned,
but when properly regulated amounts are used there occurs a

HOSKINS AND HOSKINS 20

stimulation which, however, has been interpreted differently by
different investigators. This effect in mammals has recently
been discussed by Hoskins 716, Herring 717, and Kojima 717, and
in protozoa by Shumway 717. The classic studies of Gudernatsch
12, 714, have shown the remarkable stimulating effect of thy-
reoid extract when fed to amphibian larvae. Morse *14 found
the action to be due to the iodine content of the thyreoid. He
was unable to obtain it with inorganic iodine, but did obtain it
with iodized blood albumen. Lenhart °15 stated that the effect
on frog larvae was proportional to the iodine content of the
thyreoid substance used, but he also was unable to get the same
results with inorganic iodine. Lenhart pointed out further that
the effect in hastening metamorphosis was of a general nature
and not due to any specific differentiating property of the thy-
reoid. Romeis 715 using Lugol’s solution likewise was unable to
bring about precocious metamorphosis of frog larvae by admin-
istering inorganic iodine. Abderhalden 7°15 showed that the
result could be obtained with thyreoid substance thoroughly di-
gested and later, Swingle 18, repeating the experiments with
iodine, was able to stimulate metamorphosis in normal frog
and toad larvae and in those which had had their thyreoids
removed. He hastened metamorphosis in frog larvae with
M/1,100,000 iodine solution (719). Allen 719 produced the same
kind of stimulation in amphibian larvae which had had both the
thyreoid and hypophysis extirpated.

From the above experiments, and especially from the work
of Kendall 719, it seems highly probable that the active principle
in the thyreoid is some iodine compound, and, as far as amphibia
are concerned, inorganic iodine appears to be as capable of
markedly stimulating metabolism as thyreoid substance itself.
There are possibly various other organic and inorganic sub-
stances able to produce the same effect, if, as Kendall points out,
it is simply in the nature of catalysis.

Experiments with the hypophysis are by no means so uni-
form in their results as are those with the thyreoid. There is
an admitted relation of the hypophysis to carbohydrate metabo-
lism as discussed recently by Keeton and Beeht 719, and to skel-
etal and other growth (Cushing 712), but the exact details of
these relationships are still in dispute. In higher animals, re-

26 THYROID AND HYPOPHYSIS IN GROWTH

moval of the hypophysis (Cushing 712) is incompatable with
life, although larval frogs are able to live without it (Adler 714,
Smith ’16 and Allen 716, Hoskins and Hoskins 719a), and
Houssay °17 was able to keep alive some adult frogs from which
the hypophysis had been removed.

From 1897 to 1916 there was about an even division of
opinion as to whether pituitary feeding would or would not
give positive results (for discussion see Schiff ’97, Biedl 713,
and Hoskins 716), but since then most of the papers published
on the subject agree that at least with the feeding of the anterior
lobe of the hypophysis, a definite stimulation of growth can be
produced. This has been claimed for protozoa (Flather 719),
worms (Wulzen 716), birds (Winternitz °16, opposed by Pearl
16) and mammals (Robertson 717 and Marinus 719). Nu-
merous other papers on the subject will be found abstracted in
the files of Endocrinology, 1917-20.

Massay ’08 tried to prevent the usual symptoms following
thyreoidectomy of dogs; by hypophysis-extract injections, and
obtained negative results. Larson 719 with somewhat similar
experiments reports that these symptoms can be prevented from
occurring in thyreoidectomized rats by hypophysis feeding, but
Allen ’19a, states that he obtained negative results when he ad-
ministered beef pituitary substance to thyreoidectomized tad-
poles. As deseribed above, anterior pituitary substance will
bring about almost if not complete metamorphosis of thyreoid-
less frog larvae.

As to the effect of feeding hypophysis substance to normal
tadpoles, Gudernatsch ’12, 714, reported negative results with
hypophysis extract carried from New York to Vienna and kept
in the laboratory at room temperature. Abderhalden 715 per-
formed a few experiments with an extract of thoroughly di-
gested hypophysis substance and found it very toxic to his tad-
poles, but noted that in a few cases it seemed to stimulate their
development. He regarded his results as indefinite. Smith 718,
states that anterior pituitary substance stimulates growth of
frog larvae just before metamorphosis and then hastens this
process.

That we were able to bring about early metamorphosis in
normal frog larvae by the administration of anterior pituitary

HOSKINS AND HOSKINS 27

substance is not surprising, in view of the fact that hypophbysis
substance has previously been shown to stimulate metabolism
and the facet that such stimulation is sufficient in itself to hasten
metamorphosis of amphibians. As Lenhart ’15 pointed out, in
the numerous experiments wherein early metamorphosis of tad-
poles has been induced, what really occurs is simply the hasten-
ing of a natural process. Nothing fundamental takes place dur-
ing this hastened change of form that does not happen naturally
at a lesser rate.

Concerning the manner of action of pituitary substance fed
to animals, we have no certain explanation. We cannot as yet
determine whether the action upon the metabolism is direct or
whether the substance acts by stimulating some gland or other
structures of the body. It is doubtful whether the influence of
the hypophysis fed to normal tadpoles is exerted entirely upon
the thyreoid because, as we described above, the same sort of
phenomenon is seen when this substance is administered to
larvae which have been deprived of their thyreoids. Moreover,
the action is not simply a stimulation of all general metabolic
processes, because thyreoidless larvae will live for months or
years on a normal diet without undergoing metamorphosis,
whereas they begin to metamorphose within twenty-four hours
if anterior pituitary substance is administered to them. The
hypophysis of these thyreoidless larvae has undergone a distinct
hyperplasia, apparently in an attempt to make up the deficiency
of thyreoid secretion, but it is not successful, and in these experi-
ments the pituitary preparation may act through the animal’s
own hypophysis. Smith 718 was unable to cause metamorphosis
of hypophysectomized larvae by hypophysis feeding, but as Allen
’19b shows, larval amphibia which have been deprived of both
thyreoids and hypophysis go nearly, if not completely, through
metamorphosis if inorganic iodine is administered to them. But
it is also true that the normal larvae in our experiments reacted
more completely to pituitary feeding than did those which were
without thyreoids, and more completely than did Allen’s larvae
which were without both thyreoids and hypophysis, react to
iodine. Hence it seems probable that when the thyreoids and
hypophysis are present their activity during metamorphosis is
augmented by the administration of thyreoid, iodine, or pitu-

28 THYROID AND HYPOPHYSIS IN GROWTH

itary, and in the absence of one or both of these glands, the
above mentioned substances are able to supplement their activity
to a considerable extent. It is quite possible that Allen’s larvae
and our thyreoidless larvae failed to metamorphose completely
because of the fact that when their jaws metamorphose’ they
cease eating the administered substances. Swingle °19, how-
ever, caused normal and thyreoidless larvae to metamorphose
by placing them in a dilute solution of iodine, so it is probable
that this halogen is absorbed in quantities sufficient to produce
the effect noted. It has long been known that the skin of am-
phibia is pervious to substances soluble in water.

In the metamorphic processes produced in thyreoidless
larvae by pituitary feeding, there was some variability of the
minute details of these phenomena as described above. In some
larvae the skeletal growth was relatively more rapid than in
others, and the changes occurring in the different viscera were
variable, the entire process not being quite so well co-ordinated
as in normal metamorphosis.

Finally, as stated in the introduction, the results obtained
by feeding preparations of dead ductless glandular substances
to animals may be pharmacological rather than physiological,
and may not represent the normal functions of the animal.
This is certainly true of feeding morganic substances such as
iodine.

SUMMARY AND CONCLUSIONS

_ We have found that a preparation of the anterior lobe of
beef hypophysis, which contains some form of iodine, 1 :200,000
of fresh substance, when administered to normal frog larvae
will bring about a precocious metamorphosis, resulting in the
production of frogs the size of which varies with the size of the
larvae at the beginning of the experiment. If the original
larvae are very small, they never become as large as the con-
trols and the resulting frogs are small. Such frogs have httle
vitality. If permitted to remain exposed to the air they die and
dry down almost fiat, losing their shape, and there remains but
a very small percentage of the original volume. We have not-
yet studied these small frogs microscopically, but they appear
to have a relatively high water content. Pituitary substance is
more toxie to small than to larger larvae.

HOSKINS AND HOSKINS 29

When the pituitary preparation was administered to thy-
reoidless larvae which would otherwise have remained in the
larval form more or less indefinitely, a beginning of metamor-
phosis occurred within twenty-four hours; it progressed some-
what more slowly than in the other experiments just mentioned ;
but it ultimately became nearly complete by the time the ani-
mals were either killed or died spontaneously.

From these experiments the hypophysis, in its relation to
amphibian metamorphosis, is to be ranked with the thyreoid as
shown by the well known work of Gudernatsch.

. We regard the results obtained as due to a stimulation of
natural general metabolic processes, either directly or indirectly,
but the exact nature of this action is not known. The effect
is both progressive, as seen especially in the skeletal and cu-
taneous development, and retrogressive, as seen especially in
the digestive tract and tail.

It is very doubtful that the action of the anterior pituitary
substance is due merely to its iodine content, although such may
be the case. Other tissues with traces of iodine will not pro-
duce the same effect as the pituitary.

It is quite possible that the initial stimulation in hypo-
physis feeding is exerted upon the calcium and phosphorus
metabolism as is indicated by skeletal changes in these experi-
ments, although intestinal transformation also begins very
early.

The hypophysis and the thyreoid are closely related physio-
logically and can to some extent function vicariously.

Recent investigations by various workers with amphibian
larvae have developed the following facts concerning the thy-
reoid and hypophysis:

1. Removal of the thyreoid hastens growth, causes hyper-
plasia of the hypophysis and prevents metamorphosis.

2. Removal of the hypophysis retards growth, retards
development of the thyreoid, prevents metamorphosis, and _ re-
tards development of cutaneous pigment.

3. Feeding thyreoid or hypophysis (or iodine) to normal
larvae hastens metamorphosis.

4. Feeding thyreoid or hypophysis (or iodine) to thy-
reoidectomised larvae brings about metamorphosis.

30 THYROID AND HYPOPHYSIS IN GROWTH

5. Feeding hypophysis to hypophysectomised larvae stimu-
lates growth but does not cause metamorphosis.

6. Feeding iodine to larvae with both the thyreoid and
hypophysis removed causes metamorphosis.

LITERATURE CITED

Abderhalden, E.: Studien ueber die von einzelnen Organen hervorge-
brachten. Substanzen mit specifischer Wirkung. I. Mitteilung.
Verbindung die einen Einfluss auf die Entwickelung und den
zustand bestimmter Gewebe austiben. Arch. f. d. ges. Physiol.
(Bonn), 1915; 162, 99.

Adler, L.: Metamorphosestudien an Betrachierlarven. I. Exstirpa-
tion endocraner Driisen. A. Exstirpation der Hypophyse. Arch.
f. Entw. d. Org. 1914, 39. .

Allen, B. M.: The results of thyroid removal in the larvae of Rana
pipiens. Jour. Exp. Zool. (Phila.), 1918, 24.

— — — — Miscellaneous notes regarding experimental studies
upon the endocrine gland of Rana and Bufo. (Abstract) Anat.
Rec. (Phila.), 1919, 15, 353.

— — — — The. relation of the pituitary and thyroid glands of
Bufo and Rana to iodine and metamorphosis. Biol. Bull. (Woods
Hole), 1919b, 34, 405.

Ascoli, G.: Die Folgen der Exstirpation der Hypophyse. Minch.
med. Wehnschr., 1912, 59, 519.

Gauman, E.: Uber das Thyrojodin. Minch. med. Wchnschr., 1896,
43, 309.

Biedl, A.: Innere Secretion. Ihre physiologischen Grundlagen und
ihre Bedeutung fur die Pathologie. Berlin, 1913.

Boyce and Beadles, ’93. (Cited by Vincent, 1912.)

Cushing, H.: The pituitary body and its disorders. Philadelphia,
OM:

Cushing, H., and Goetsch, E.: Hibernation and the pituitary body.
Jour. Exp. Med. (Phila.), 1915, 22.

Denis, W.: A note regarding the presence of iodine in the human
pituitary body. Jour. Biol. Chem., 1911, 9, 365.

Flather, M.: The effects of some glandular extracts upon the con-
tractile vacuoles of Paramecium caudatum. Biol. Bull. (Woods
Hole), 1919, 37.

Gudernatsch, J. F.: Feeding experiments on tadpoles. I. Arch. f.
Entwick. 1912, 35, 437.

— — — — — . Feeding experiments on tadpoles II. Further contri-
bution to the knowledge of organs with internal secretions. Am.
J. Anat. (Phila.), 1914, 15, 431.

Hahn, A.: Einige Beobachtungen an Reisenlarven von Rana escu-
lenta. Arch. f. Mik. Anat. 1912, 80, 1.

Herring, P. T.: The action of thyroid upon the growth of the body
and organs of the white rat. Quart. J. Exp. Physiol. (Lond.),
UCM il Wetile

Hoffmeister, F.: Experimentelle Untersuchungen tiber die Folgen
des Schilddriissen Verlustes. Beit. z. klin. Chir. 1894, 11, 441.

Hoskins, E. R.: The growth of the body and organs of the albino
rat as affected by feeding various ductless glands (thyroid, thy-
mus, hypophysis and pineal). Jour. Exp. Zool. (Phila.), 1916, 21,
95.

Hoskins, E. R., and Hoskins, M. M.: Further experiments with thy-
roidectomy in amphibia. Proc. Soc. Exp. Biol. and Med. (N. Y.),
1918, 15, 102.

HOSKINS AND HOSKINS 31

— — — — — — — (Abstract). Experiments with the thyroid, hypo-
physis and pineal glands of Rana sylvatica. Anat. Rec. (Phila.),
1919a, 16, 151.

— — — The growth and development of amphibia as af-
fected by thyroidectomy. Jour. Exp. Zool. (Phila.), 1919b, 29, 1.

Houssay, B. A.: Recherches experimentales sur l’hypophyse de la
Grenouille. Jour. de Phys. et Path. Gen. (Paris), 1917, 17, 106.

Jackson, C. M.: The effects of inanition and refeeding upon the
growth and structure of the hypophysis in the albino rat. Am.
Jeeaniatee Cehilas)e SLOG 21, 321°

Keeton, R. W., and Becht, F. C.: The relation of the hypophysis to
glycogenolysis. Am. J. Physiol. (Balt.), 1919, 49, 248.

Kendall, E. C.: The physiologic action of thyroxin. Endocrin., 1919, 3,
156.

Kojima, M.: Studies on endocrine glands. Quart. J. Exp. Physiol.
(iond:). 1917, 51, 319.

Larson, J. A.: On the functional correlation of the hypophysis and
the thyroid. Am. J. Physiol. (Balt.), 1919, 49, 55.

Larson, M. E.: Effect of the extirpation of the thyroid gland upon
the pituitary gland in Bufo. (Abstract). Anat. Rec. (Phila.),
1919, 15, 353.

Lenhart, C. H.: Influence upon tadpoles of feeding desiccated thy-
roid gland in variable amounts and of variable iodine content.
J. Exp. Med. (N..Y.), 1915, 22, 739.

Livingston, A. E.: Effect of castration on the weight of the pituitary
in rabbits. Proc. Soc. Exp. Biol. and Med. (N. Y.), 1914, 11.
MacArthur, C. G.: A method of tissue analysis applied to the pos-
terior and anterior lobes of cattle pituitaries. J. Am. Chem. Soc.

1919, 41, 1225.

Marinus, C. J.: The effect of feeding pars tuberalis and pars anterior
propria of the bovine pituitary glands upon the early develop-
ment of the white rat. Am. J. Physiol. (Balt.), 1919, 49, 238.

Masay, F.: L’Hypophyse. These, Bruxelles, 1908. (Cited by Vin-
cent, 1912.)

Morse, M.: The effective principle in the thyroid, accelerating invo-
lution in frog larvae. J. Biol. Chem., 1914, 19, 421.

Paton, D. N.: Regulators of Metabolism. London. 1913.

Pearl, R.: Reproduction in the fowl. IV. On the effects of feeding
pituitary body (anterior lobe) substance and corpus luteum sub-
eeure to growing chicks. Proc. Nat. Acad. Sc. (Wash.), 1916, 2,

0

Raynard, C. R.: C. R. des traveaux de l’ecole royale veterinaire de
Lyon pendant l’annee scholaire. Rec. de Med. Vet. Prat., 1836,
13, 8. (Cited by Vincent, 1912.)

Robertson, T. B., and Delprat, M.: Experimental studies on growth.
IV. The influence of tethelin upon the early growth of the
white mouse. J. Biol. Chem., 1917, 31, 567.

Rogers, J. B.: The effect of the extirpation of the thyroid upon the
thymus and pituitary glands of Rana pipiens. J. Exp. Zool.
(Phila.), 1918, 24.

Rogowitsch, N.: Die Veranderungen der Hypophyse nach Entfernung
des Schilddriise. Beitr. z. path. Anat., 1889, 4, 453.

Romeis, B.: Experimentelle Untersuchungen ueber Wirkung innerer-
sekretorische Organe. II. Der Einfluss von Thyroidea und
Thymus Fiitterung auf das Wachstum die Entwickelung und die
ton von Anurenlarven. Arch. f. Entwickelungsmech,

5, 41.

Shumway, W.: Effects of thyroid on Paramecia. J. Exp. Zool.

(Phila.). 1917, 22, 529.

32 THYROID AND HYPOPHYSIS IN GROWTH

Simpson, S., and Hunter, A.: The relations between the thyroid and
pituitary glands. Proc. Soc. Exp. Biol. and Med. (N. Y.), 1909, |
7 i

Schiff, A.: Beeinflussung der Stoffwechsels durch Hypophysis—und
Thyreoidtherapie. Wiener klin. Wehnschr., 1897, 10, 277.

Smith, P. E.: The effects of hypophysectomy in the early embryo
upon the growth and development of the frog. Anat. Rec.
(Phila.); 1916, 41,257.

— — — — — The growth of normal and hypophysectomised tadpoles
as influenced by endocrine diets. Univ. California Pubs. (Physiol.
Ser) pel Gis See

Schnitzler, J.: Ueber das Vorkommen des Thyreojodins im mench-
lichen Kérpers. I. Thyreojodin im der Hypophyse. Wiener klin.
Wehnschr., 1896, 9, 657.

Swingle, W. W.: Iodine as the active principle of the thyroid gland.
Endocrin., 1918, 2, 283.

— — — — — Iodine and the Thyroid. III. The specific action of
iodine in accelerating amphibian metamorphosis. J. Gen. Physiol.
(N. YaestO19 15932

Viguier, G.: Modifications de l’hypophyse aprés thyroidectomie ches
un lezard (Uromastrix acanthinurus, Bell). C. R. Soe. Biol. -
(Paris) ot 70222.

Vincent, S.: Internal secretion and the ductless glands. London.
1912.

Wells, H. G.: The physiology and therapeutics of the thyroid gland
and its congeners. J. Am. M. Assn. (Chgo.), 1897, 29, 1007.
Winternitz, M. C.: Some observations on the effects of feeding
glands of internal secretion to chicks. Johns Hopkins Hosp. Rep.

(Balt.), 1916, 48, 21.

Wulzen, R.: Effect of hypophysis feeding on the growth and fission

of planarian worms. J. Biol. Chem., 1916, 25, 625.

ELATES 1 to- VI
TABLE

PLATE I.

Fig. 1. Hypophysis-fed tadpole. (Ex. 1) 15 cays after begin-
ning of experiment. Body 11 mm. Total 32 mm.

Fig. 2. Normal tadpole. Body 13.5 mm. Total 32 mm. X 2.
Both drawn from the living animal.

PLATE II.

Fig. 8. Hypophysis-fed frog. (Ex. 1.) 28 days after beginning
of experiment. Body 8.8 mm. X2. Drawn from the living animal.

Fig. 4. Normal frog. Body (fixed) 10.4 mm. X 2.

~N

jeoae,

PLATE III. All drawn X 2 from the living animals.

Fig. 5. Hypophysis-fed tadpole (2A) 18 days after beginning
of experiment. Body 9.5 mm. Total 21 mm.

Fig. 6. Normal tadpole. Same age as above. Body 12 mm.
Total 28 mm.

Fig. 7. Hypophysis-fed tadpole (Ex. 2A) 28 days after begin-
ning of experiment. Body 8 mm. ‘Total 21.5 mm.

Fig. 8. Hypophysis-fed tadpole (Ex. 2B) 13 days after begin-
ning of experiment. Body 12 mm. Total 28 mm. Compare with Fig.
6 for tadpole of same length.

Fig. 9. Hypophysis-fed tadpole (Ex. 2B) 31 days after begin-
ning of experiment. Body 15 mm. Total 35 mm.

Fig. 10. Normal tadpole. Same age as in Fig. 9. Body 15 mm.
Total 33 mm. (Later the controls became larger than the hypophysis-
fed larvae.)

PLATE IV.

Figures D to J. Normal Rana sylvatica natural size photo-
graphed in alcohol after fixation. The larvae (D to N) had reached
their maximum size and were on the point of beginning a rapid meta-
morphosis when fixed. Note the shrinkage in size that has occurred
during metamorphosis (B to J).

PLATE V.

Figures A.A. to J. Thyreoidless Rana sylvatica, natural size.
Photographed in alcohol after fixation. For size and number of doses
of anterior pituitary substance administered see Table. Note G.
which received no medication. The development is roughly propor-
tional to the amount of pituitary given, and the size of the frogs is
proportional to the size of the larvae before medication. A, C, and D
died in the aquaria and became slightly swollen.

PLATE VI.

Thyreoidless and control larvae and “frogs” of Rana sylvatica
treated with anterior pituitary substance. Same animals as in Plate V.
but dissected. X 3. C and D—Controls; AA, F and I—Thyreoidless.

Abbreviations: G.—Gall-bladder, Gi.—Gill, H—Heart, K.—Kid-
ney, L.—Liver, Lu.—Lung, O.—Ovary, S.—Stomach.

e
v
»
-
nd
:
‘
2
g
»
s
j
~
4
*-
*
»
j

—I2 a | <=
= =~ a. a =
y= on
a
i

TABLE SHOWING THE EFFECT OF TREATING THYREOIDLESS LARVAE WITH ANTERIOR PITUITARY PREPARATION.

Beginning 2 days 4 days 9 days 10 days 12 days 15 days 22 days 31 days Doses

mm. cc, mm. ee, mm. ee. mm. : cee, mm. J cc. i mm. ee, mm. ec. mm. Ae an is Pa v
A.A. 42-19.0-2,0-0.98 | 43.5-19.0- 45-19.0-0.75 | 45-16.0- 5-0.65 | 45-14- 5.5-0.65 | 41-14- 6-0.75 | 49-14- 9-0.75 | 40-15-10-0.50 | 365151700.35 [*15
A. 50-20,0-2.0-1.50 | 41.0-20.0-2.5-1.20| 41-20-3110. | 48-17-15-0.96 | 44-17-20-8* | == ae

B. 46-20.0-1.5-1.30 | 47.0-20.5-2.5-1.10 | 48-19.0-3-1.00 | 47-16.0- 7-0.85 | ** 8
B.B, 47-20.0-2.5-1.20 | 48.0-20.0-

45-18,5-3-0.80 | * 3

C. 43+21.0-2.0-1.35 | 43.5-20.5-2.5-1.20 | 44-18.0-3-1.00 44-16- 8.0-0.75 40-15-13-"* |

D. 42-18.5-15-0.90|. a 41-14.0- 50.60. | |aodaiae | | ae Stee
B, 44-19.0-1.5-1.00| i “41-14.0- 5-0.55 j 38-14-11- | 36-14-12-0.40 | * 1
P. 45-19.0-2.0-0.93 | _ 47-17.0-7-0.80| 45-16-13.-0.70 | 42-17-18-0.56 | * ; 15
G. 47-19.0-2.00.98} 48-21.0-2-1.06| 51-21- 2.0-108| 52-22-3-140/* | ote
H. 53-23.0-2.5-1.45 ; 54-20.0-5-1.22 | 50-19.0-10-1.05 | ** ae = a a ie 9
I. 46-20.0-2.0-1.05 : 43-16,0-3-0.80 | 41-14.5- 7-0.50|* : ac albe a 9
J. 44-19.0-2.0-1.00 43-16,0-3-0.85 | 42-14.5- 7-0.65 | * Se ral eel xn

N. B.—The first number, total length; the second, nose-anus length; the third, hind-leg length, all in mm.; and the fourth, volume, in cc.
*Killed. **Died, ***Control thyreoidless.

>

i PS ir = feels 7,

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7 ) ee ae i ° = F as pelle ra
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PITUITRIN TEST

By
M. ASCOLI and A. FAGIUOLI

‘From the Institute of Internal Pathology, University of Catania
(Director, Prof. M. Ascoli)

In a previous article (1) the adrenalin test has been de-
scribed. The subepidermal (s.e.) introduction of 0.05 ¢.c. of a
1:1000 solution of adrenalin (2) provokes the appearance of a
swelling which, after a few seconds, or sometimes immediately,
assumes a dark blue color, as if ink had been injected. Some-
times the periphery of the spot is red. The swelling then be-
comes surrounded by an alabaster-like halo, which grows in in-
tensity and extent, often sending out irregular shoots in one or
more directions. Around the white halo appears in turn another
red halo, more or less intense in color and width. Frequently, a
contraction of the pilomotor muscles of the skin occurs, which
gives the appearance of goose-flesh to the alabaster zone.

The reaction in its complete form is therefore composed of
the three following elements: 1. Blue central spot, 2. White Halo,
3. Red Halo. Having reached its utmost development in half an
hour, after a stationary period, within an hour or so the reac-
tion gradually disappears, the blue spot changing to red, leaving
a slightly swollen red papule which in succeeding days goes
through the usual stage of pigmentation.

By using a more dilute solution, for instance 1 :200,000—
1 :1,000,000, the reaction is less intense, but nevertheless always
manifest and preserves the same general type. It differs, how-
ever, by the absence of the central blue spot, generally substi-
tuted later on by a small red mark. This and the white halo
around the alabaster swelling comprise in this case, the whole
picture; the red halo is not always pronounced. The more
dilute the solution, the later, up to 20 minutes and more, is the
appearance of the response.

By further dilution the reaction becomes weaker, until if
gets to be identical with the cndispensable control reaction with
distilled water. This water injection causes simply a white swell-

33

34 PITUITRIN TEST

ing and a halo, which is not white but reddish. Briefly, the swell-
ing becomes colored, afterwards to fade again with (always rela-
tively) variable duration and intensity of the single phases in dif-
ferent subjects. A small reddish brown papule remains for one
or more days and changes to a small brown spot (3).

The reactivity of the subepidermal adrenalin test in ordi-
nary circumstances is usually included between dilutions of-
1:200,000 and 1:000,000 (Parke, Davis vials). In some patho-
logical conditions, however, it may be diminished or increased.
We found it subnormal (viz., negative with these dilutions) in
some cases of Addison’s disease and of chronic adrenal insuffic-
jency ; increased (viz., positive with further dilutions, up to 5-20
millions), in some cases of disturbances of the menopause, of
arterial hypertension, of Flajani-Basedow’s disease and in some
cases of pregnancy. Children give a weak reaction. Cases of
profound anemia do not react.

Comparing in 26 cases the sensitivity to adrenalin admin-
istrated subcutaneously (s.c.) (1 ce. of 1 per thousand solution)
and subepidermally (s.e.), we have had 21 cases of normal reac-
tion in the s.e. test, no reaction to the s.c. test and likewise in two
eases of s.e. hyper-reaction. In two cases of exaggerated s.e. reac-
tion, there was only an increase of a few em. of the arterial
pressure to the s.c. test. Finally, in a case of scleroderma with
arterial hypertension with normal s.e. test, the s.c. injection
produced a marked reaction (notable increase of pressure, dizzi-
ness, tachyeardia, tremor, traces of glycosuria). The failing
cutaneous response may perhaps depend upon the sclerodermic
lesion, although not macroscopically appreciable in the place of
injection.

Another s.e. test, not hitherto described, is that with
pituitrin. After what has been recorded the description of it
is easy. Using the commercial solution, the reaction is identical
with that obtained with a solution of adrenalin, about 1 :200,000.
Under ordinary conditions there is still a positive reaction with
dilutions of about 1:500 of the commercial vials of pituitrin
(Parke, Davis), but there is a delay in the appearance of the
characteristic feature, the white halo about the swelling. We
have found the reaction strengthened (positive even in dilution
of 1:1000 and more) in arterial hypertension, in affections of the

ASCOLI 30

pituitary body, in some cases of Flajani-Basedow’s disease and
reduced in some cases of chronic adrenal insufficiency.

Worthy of special mention is the circumstance that, if at
times there may be a coincidence between the exaggerated or
reduced reactivity to the two substances, in the great majority
of cases the pathological reactions to adrenalin and pitwitrin are
clearly shown dissociated and even opposed.

We have pointed out that the solution of adrenalin at
1:200,000 gives approximately the same reaction as the vials of
undiluted pituitrin; it has also been noticed that, although the
reaction to adrenalin does not appear when the standard solu-
tion is diluted over five times (1:1,000,000), pituitrin, on the
contrary, still maintains its special action when diluted to 500
volumes. The cause of this contrast is perhaps to be sought in
the different points upon which the drugs exert their action,
these being the neuromuscular junction in the one case and the
muscle fibres themselves, in the other.

1. Ascoli (M.) and Fagiuoli (A.), Pharmacodynamic subepidermal
tests, Accademia dei Lincei, 1919. After communication of this
note we had occasion to read the review “The adrenin tests for
thyroid disorders” in Endocrinology, Vol. II, No. 4. On page 463
the following passage appears: “This result was found to be
remarkably constant. Not only does a ‘hyperthyroid’ patient
react constitutionally to a subcutaneous dose, but also locally to
an intradermic dose of one minim of 1-4000 solution of adrenin.
This latter reaction depends upon the excessive contraction of
the smooth muscle in the small vessels of the skin, supplied by
the sympathetic, and is characterized by a central large area of
blanching surrounded by a peripheral zone of reddening due to
the neighboring secondary vasodilatation. In the blanched area a
characteristic goose flesh is often seen. The reaction in a thyroid
patient (exophthalmic goitre or toxic adenoma) lasts for 1% to
2% hours as compared with % to % hour in the normal subject.
Whether the reaction will be found in other than thyroid cases
has not yet been determined.” We could not yet procure the
original work of Goetsch, “Newer methods in the diagnosis of
thyroid disorders: pathological and clinical. B. Adrenalin hyper-
sensitiveness in clinical states of hyperthyroidism,” N. Y. State
Jour. Med., 1918, 18, 259.

2. One stretches between two fingers laterally a small piece of skin of
the anterior abdominal wall; where the skin is more distended,
one introduces the point of a very fine needle attached to a small
glass syringe, graduated in at least 1/20 ec. An essential condi-
tion is that the needle be pushed quite superficially under the
epidermis, so that it is clearly visible underneath the skin: the
injection must not be intradermal, but subepidermal. We insist
on this point because the neglect of it may jeopardize the success
of the result. One presses slowly the piston until 1/20 cc. of
the desired solution is injected. As a measure of control in every
experiment an injection of sterile distilled water at a distance of
about 5 cm. must be made.

36 PITUITRIN TEST

3. The practice of the simultaneous control injection of distilled
water, as a test of the general reactivity of the skin is never to
be neglected. Usually it presents the described type. At times,
however, abnormal reactions are observed, which must be known.
At times the swelling remains white for a long time (60-90 min-
utes) ; exceptionally the phenomenon of the goose flesh may ap-
pear. The quantity of liquid introduced and the depth of the in-
jection are, moreover, important and must be considered. The
involution time of the red papule, usually about 48 hours, is also
variable. Unlike the s.e. injections of adrenalin 1:1000, and
pituitrin undiluted, which cause almost no pain, dilutions with
water are painful.

A PLEA FOR SYSTEMATIC RESEARCH WORK IN THE
ANATOMY, NORMAL AND MORBID, OF
THE ENDOCRINE SYSTEM

J. AUG. HAMMAR

Upsala, Sweden.

The above title may cause some reader to ask whether there
really is anything wrong with regard to method in the present
anatomical study of the endocrine organs. Indeed the great
progress that our knowledge of the endocrine system has made
during the last decades as well as the great profit that science
has already reaped in this department are rather proofs of the
contrary. Perfectly aware of this and of the importance that
the methods of research so far used will doubtless have in the
future as well, we must not shut our eyes to the fact that this
study has its weak point, which forms a positive risk to the sound
development of the new branch of science. This weak point is
the want of a close anatomical insight into the organs in ques-
tion.

First of all, I wish to show here that without such a deepened
insight great departments of endocrinology must either remain
completely inaccessible to us or at all events without sufficient
stability.

It is a well known fact that direct lesions of endocrine organs
occur, and frequently a certain clinical syndrome has more or
less unanimously been considered to be connected with such
lesions-of one organ or another. To discern such direct lesions,
at least when they are somewhat pronounced, our present knowl-
edge has often proved sufficient. But, both in connection with
exophthalmic goitre, Addison’s disease, acromegaly and diabetes
—to mention only some of the most studied ones—occur, as is
well known, ‘‘formes frustes,’’ in which the want of precision
in our present anatomical knowledge is perceptible.

Another circumstance is, however, of still greater importance
here. It is a commonly acknowledged and well-grounded expe-
rience that the endocrine organs are closely connected with each

CO
=~]

38 ENDOCRINE MORPHOLOGY

other functionally; so that a disturbance in the function of one
of these organs involves, according to the circumstances, a more
or less profound disturbance in the function of a larger or smaller
number of the others. Whether this state of things is character-
istic only of the endocrine system or whether after more careful
research anything of this sort will be also proved for other
organs of the body, is another question, which it is not necessary
to enter into here. It is sufficient here te establish that in such
cases we must reckon not only with direct, but also with indirect
disturbances of the endocrine organs.

But, indirect disturbances of the endocrine organs might net
occur only in the eases in which the injurious factor (‘‘noxe’’)
has affected one or other member of the endocrine system. On
the contrary, certain observations make it probable that in the
case of other sorts of disease as well, the organs in question do
not remain unimpaired. Thus, for instance, in the case of diph-
theria and other infectious diseases, such an influence in many
cases 1s established. It does not at present even seem absurd to
presume that every disease of some duration and seriousness more
or less affects the whole endocrine system, as is in fact, under
such circumstances, always true of the thymus gland.

It may now be presumed that indirect changes of one kind
or another, which up till now have for the most part not attracted
any attention, are by no means always qualitative, perhaps not
even chiefly so, but that there may also be, as in the case of the
thymus gland, essentially quantitative changes. But for the pur-
pose of fixing quantitative changes with only a fair degree of cer-
titude, our present knowledge of these organs is decidedly too
linuted.

This circumstance may at least partly account for the fact
that we have so little information about these indirect changes
in the endocrine organs. Very often the system in question may
even now be left without attention at the post-mortem examina-
tion and when really examined, no conclusions or only very
vague ones are arrived at in the absence of an adequate acquain-
tance with the normal state of the respective organs. Which
of us is able at the present time to tell how much or how little
of the medulla of the adrenals is present in a man or woman at
a certain age before the limits of the normal are exceeded?

HAMMAR 39

What is our present knowledge of the extent to which the so-
called gland of puberty is to be found at a certain age in a nor-
mal human sex gland? Or of the relation between the quantity
of acinar and trabecular tissue in the normal thyroid? Or of
the normal total number and size of the islets of Langerhans in
the pancreas at a certain age? There is no end of questions of
-such a kind that crowd upon us in this sphere without our being
able even to sketch an answer.

We may try to become acquainted with the real significance
of the conditions outlined above: that at every disturbance of an
endocrine organ, other endocrine organs too must be affected,
that in other diseases these organs probably are also concerned
without its being in our power to determine either the participant
organs themselves or the degree to which they are afflicted. It
really means that neither dissected material nor experimental
work can, as matters now stand, by any means be made duly
profitable to science.

As suggested above, in the first place normal data of com-
parison are a pressing need. Whether there is an increase or a
diminution, whether too much or too little, can only be decided
when we know sufficient about the range of the normal variation
under corresponding circumstances as to age, sex, ete.

Our ignorance begins in connection with the mere size (the
weight) of the organ. It is true that, even in the present litera-
ture, there is no lack of such indications, but | do not know a sin-
gle one which, in the case of man, can even tolerably serve the
purpose in question. They all suffer principally from two defects.
First, in most cases mere averages are given. Nowadays, I sup-
pose, no investigator holds the opinion that with regard to any or-
gan averages can be given of such a nature that what does not
agree with that standard should not be regarded as normal. Under
such circumstances, averages are of comparatively little use.
The important point is to determine as exactly as possible the
normal range of variation. Mainly in order to give an orienta-
tion as to the position of an individual value within (or outside )
the normal range the average may be of importance.

Secondly, the quality of the primary material hitherto pub-
lished is mostly far from being sufficient for the present pur-
pose. Generally, only the cases where obvious morbid alterations

40 ENDOCRINE MORPHOLOGY

of the organ in question were found or could be expected, have
been excluded from consideration, while other cases of disease
were considered available for statistical estimate of the normal
organ. It is, however, quite evident that for the very purpose of
creating a normal basis upon which eventual indirect organ
lesions, affected by disease, can be recognized and evaluated,
values thus acquired are quite useless. Only such organs as
come from individuals who have suddenly died in full health and
not by disease are available for the purpose. In the case of
human beings, principally organs from murdered people, execu-
tions, accidents or suicides (1) will thus come into consideration
for determining the normal range of variation. It may be un-
necessary to point out that even in such cases the circumstances
may give rise to criticism and exclusion of some cases. Any-
how, it does not seem necessary to enter into that question in
this connection.

The mere determination of the limits within which the size
of the organ—the weight of the organ—normally varies, is,
however, only one condition for gaining available values in the
following analysis of the organ. Generally, one will not make
much progress by using merely the size of the organ. It is well
known that a change in size may, under different circumstances,
have quite a different bearing. A goitre represents sometimes an
increase, sometimes a decrease, in the function of the thyroid.
A reduction of the pancreas has a very different significance
according to whether it has affected the exocrine or the endocrine
component of the gland; an increase of the hypophysis or the
adrenals, according as one or other of the heterogeneous com-
ponents of the respective organ is affected, ete.

For this reason we must elaborate for every endocrine organ
special methods which admit of a quantitative—numerical—de-
termination, with sufficient accuracy, of the material components
of the organ. In what manner such a method can be evolved
for a particular organ can be gathered from a paper (Ztsehr. f.
angew. Anat. u. Konstitutionsforsch. Bd. 1.), where the writer
set up the problem of fixing numerically the quantity of the
cortex and the medulla of the thymus gland and the number
and size of the Hassall’s corpuscles.

Every organ has no doubt in this respect its own peculiar
problems, a complete view of which can be obtained only by very

HAMMAR 41

close attention to the subject. Some of these problems, however,
are so obvious that they may be indicated without further in-
vestigations.

Thus, for instance, in the hypophysis, with accurate elim-
ination of the connective tissue, the amount of each of the three
principal portions ought to be ascertained. In the anterior por-
tions the number of the different cell types, in the intermediate
portion the number and size of the cysts with and without col-
loid should be approximately settled.

In the thyroid the weight of the true parenchyma similarly
with deduction of the bulk of the connective tissue is to be ascer-
tained; again, in the parenchyma the amounts of the trabecular
and adenomatous territories, respectively, should be fixed apart
from the acinar portion; and in the last mentioned part the num-
ber and size of acini with and without colloid should be caleu-
lated.

Similarly, in the parathyroid glands the true parenchyma,
the trabecular and cystie tissue should be treated separately.
Here, moreover,- we meet with the task of approximating the
relative and absolute numbers of the acidophil granulated cells.

With regard to the pancreas, the next object should be to
ascertain the quantity of the endocrine and the exocrine paren-
chyma as well as to calculate the number and size of the islets of
Langerhans.

In the adrenals the quantity of the cortex and the medulla
as well as of the different zones of the cortex requires to be ex-
pressed numerically. Perhaps it will not prove quite imprac-
ticable with morphological methods to approximate the percent-
age of lipoids and adrenine in the organ, which would evidently
be of the greatest consequence for estimating the state of fune-
tion of an individual organ.

Concerning the sex glands, it is of special importance to
ascertain the amount of endocrine tissue, in doing which for the
ovaries, the corpora lutea and the other so-called lutein tissues
should be considered separately. To settle the number and size
of the ovarian follicles lies, as Valberg (1915) (2), has shown,
within the bounds of possibility even in the case of a relatively
large material. To figure the state of the spermatogenesis with
fair accuracy seems, at all events in the case of a human being,

42 ENDOCRINE MORPHOLOGY

where the process passes on so irregularly, a difficult task; but
it would, however, evidently be of great importance.

In all these enumerations we cannot stop at apparent or
relative values; the real and absolute amount of every element of
tissue treated must be approximately fixed. We must not forget
that a relative increase of a structural element is perfectly com-
patible with an absolute reduction and vice versa, as I have
stated in my above cited paper on thymus methods in general.

These hints may suffice to illustrate the type of problems
which should, in the first place, be taken into account. It is not
my object here to plan in detail the work on every organ with
internal secretion.

That such problems can really be solved without insuper-
able obstacles is shown, inter alia, by a series of investigations
on rabbits carried out from this point of view and dealing with
most of the organs in question; these are recorded in another
place (3). Similar investigations of the hypophysis and the
adrenals in the albino rat have lately been published by Jackson
(1917, 1919) (8a). Indeed, this author has even gone further
in his analysis than I have suggested above, as he successfully
treated both the frequency of mitoses and the size of paren-
chyma cells and nuclei.

Certainly, the cases mentioned here deal with the organs of
animals and even of relatively small animals. Highly welcome as
such researches are, not least as a basis for experimental work,
the difficulties in procuring available material and analyzing
the voluminous organs increase considerably, however, when the
subject of the investigation is man. And it is precisely concern-
ing man that we are in greatest need of the norms in question.

In the case, however, of at least one human organ of this
kind, the thymus gland, I have found that investigations of this
sort, even in the case of human beings, need not be considered
impossible (4).

In the course of the last fifteen years, thanks to the liberality
of several Swedish colleagues, I have been able to collect about
120 human thymus glands from post-natal life and about 60
specimens from intra-uterine life, which satisfy fairly well the
demands made above. In analysing this normal thymus material,
I have obtained norms for the different epochs of pre-natal and

HAMMAR 43

post-natal life, against which can be tested values that have been

gained with the same method in pathological cases. In this way
it can be directly decided whether an organ from a case of dis-
ease shows any abnormality with regard to the absolute quantity
of cortex or medulla, or to their reciprocal amounts, or with re-
gard to the relative or absolute number of Hassall’s corpuscles
of one size or another. At present about 400 pathological cases
have thus been analysed. The result as to certain categories of
cases (exophthalmiec goitre, ‘‘thymic death,’’ certain acute infec-
tious diseases, congenital ues) have already been published (5).
The others are being prepared for publication. It seems to me
as if certain of the results already gained are not only of an im-
portance that is abundant compensation for the trouble taken,
but also that they could scarcely have been obtained with the same
degree of certainty by any non-numerical method.

I have now touched upon the second phase of the method of
proceeding that I recommend here. It is evident that as soon as
normal material, sufficient both in quantity and in quality, has
been numerically. analysed in the manner described, any case of
disease, analysed in the same way, can with far more ease and,
what is of still greater importance, with far greater certainty
than at*present, be estimated in all the respects that have been
objects of the analysis. Just as in the case of the thymus, by
following the attained norms, we shall be able to decide whether
a value from a case of disease falls within or outside the range
of the normal and in what direction an eventual displacement
has occurred. It is a matter of course, that under these circum-
stances, too, the manner of proceeding can never be purely me-
chanical, but that the sane judgment of the investigator is always
a decisive factor.

We shall also see how much here depends on the adequacy
of the normal test material both from a qualitative and quanti-
tative point of view. One single case, erroneously interpreted as
normal, may be sufficient to give an undue extent to the normal
range. And only as greater experience is obtained, are we able
to conclude whether the range has been too limited in one set or
other. It is also a matter of importance that, after all, for most
of the organs in question a sex difference exists; we shall thus
have to take into account both differences of sex and differences
of age.

44 ENDOCRINE MORPHOLOGY

No doubt our claims as to the nature of the normal material -
will increase as our experience grows. Indeed, once the method of
work that I plead for here prevails, this will come naturally.

It is, however, important that the method should, from the
very beginning, be at once so exhaustive, so elaborate and with
such careful foundations that it can claim to possess some sta-
bility or can even very soon become a standard for succeeding
work. For, otherwise it is to be feared that with every improve-
ment of the method that is found necessary, all the previous
analytical work may be found inferior or defective and have to
be done all over again. For this very reason | think methods
that have been, as it were, improvised to answer the purposes of
some special investigation do not come up to the mark. Every
organ must be made the object of a comprehensive revision which
takes into consideration not only the normal but also the morbid
organ structure, the various functional changes, faults caused by
shrinkage or swelling and otherwise during the technical treat-
ment, ete. And before such a method is seriously put to prac-
tical use, its precision must have been duly tested. Furthermore,
all this must be done for every separate species that 1s to be dealt
with. .

Here, indeed, an association of investigators for systema-
tized co-operation, such as I have recommended in my paper upon
constitution research work, would be of great use. Would it not
be rather a great thing for the Association for the Study of In-
ternal Secretions to put upon its program the task of elaborating
and standardizing such methods?

In proportion as, by means of a numerical working-up of
different morbid cases and their comparison with a normal test
material, our knowledge increases, the obstacles to our going deep
in this branch of science will disappear. In my opinion, there can
be no doubt that this research work must be done sooner or later,
and the sooner the better for science.

IT am not disposed to try to prophesy what positive results
will come from such a deepening of our present knowledge.
Only, before I come to an end, I should like, more by way of
example, to indicate some questions which will then be ready for
exact treatment.

From different quarters the suggestion has proceeded that
the mental diseases, or at least certain of them, are connected

HAMMAR 45

with troubles in the endocrine system. Except for the experi-
ence that has been obtained with Abderhalden’s method, results
which can hardly be described as decisive, I do not know of any
exact attempt to test this interesting hypothesis seriously. The
method of working here recommended seems to pave the way for
‘such a test.

The correlation between the brain and the endocrine system
may also possibly be elucidated to some extent in that way. That
such a correlation really exists is well known. In this connection
it is enough to point to the splendid effect on the mental state
that thyroid medication has had in certain cases of athyreoidism ;
or to remind the reader of the characteristic psychical habit in
exophthalmie goitre, a habit which, after a successful reduction
of the struma, may again give way to a normal state of mind, or
to mention the changed mentality of the castrate, compared with
the sexually normal individual. The instances could easily be
multiplied. I think that the exact anatomical study of the endo-
crine system here opens the way to the biological aspect of mental
activity, which should not be overlooked.

And a further point: only as far as we obtain an analogous
exact knowledge of the organs with internal secretion in our
experimental animals, can we lay a solid foundation for experi-
ments designed to influence these organs therapeutically ; and it
is evident that this opens wide fields to us.

And, finally, by the kind of work recommended here an
important preparatory step would be taken towards the realiza-
tion of the still greater program of an anatomical constitution
research, a subject to which I have tried to draw the attention
of anatomists in the paper quoted several times above.

Indeed, each of the branches of work mentioned here alone
is great and important enough to make the method of work
recommended seem amply profitable. In order not to be misun-
derstood I might be allowed to make a further observation. I am
far from thinking that the problems mentioned, or analogous
ones, can be solved by this method alone. I would only empha-
size that without a deepening of our anatomical knowledge by
exact quantitative work we may never be able to solve them at
all.

A systematic numerical study of the anatomy of the endo-
crine system is thus a necessary condition for an exact treatment

46 ENDOCRINE MORPHOLOGY

of the important problems that are to be solved in this field.
Upsala, September, 1919.

BIBLIOGRAPHY
Investigations on the thymus gland (Hammar: Zur Priifung des
Lymphatismus des Selbstmorders, Vierteljahrsschr. f. ger. Med.,
Bd. 53) make it necessary to reckon with the possibility that
even material of suicides is not always to be regarded as normal
in a strict sense, even when decided morbid alterations are not
to be found.
2. Valberg, M., 1915. Zur Altersanatomie des Kaninchenovariums.
Upsala Likareforenings Forh.,. Bd. 20.

3. Hammar, J. A., 1916. Uber Konstitutionsforschung in der nor-
malen “Anatomie. Anat. Anz., Bd. 49.

3a. Jackson, C. M., 1917. Effects of inanition and refeeding upon
the growth and structure of the hypophysis in the albino rat.
Am. J. Anat., 21, 321.

1919. The post-natal development of the suprarenal gland and the
effects of inanition upon its growth and structure in the albino
rat. Ibidem, 25, 221-291.

4. In this connection I wish to mention in passing that Hellman
has for the lymphoid system,of man worked out methods that
promise to put great parts of this system, so intimately con-
nected with the endocrine, into the sphere of exact numerical
methods.

5. Hammar, J. A., 1917. Beitr. z. Konstitutionsanatomie 1. Mikro-
skopische Analyse der Thymus in 25 Fallen Basedowscher
Krankheit. Beitr. z. klin. Chir., Bd. 104.

1915. Mikroskopische Analyse der Thymus in 14 Fallen sog.
Thymustodes. Zeitschr. f. Kinderheilk., Bd. 13.

1916. Beitr. z. Konst.-Anatomie 2. Mikroskopische Analyse der
Thymus in 24 Fallen meistens plotzlichen Todes aus inneren
Ursachen. Ibidem, Bd. 14.

u. Lagergren, K. A., 1918: 1. Beitr. z. Konst.-Anatomie 5. Ver-
halten der Thymus bei akuten Infectionen: mikroskopische Ana-
lyse der Thymus in 21 Fallen von Diphtherie. Ztschr. f. angew.
Anat., Bd. 2.

1918:2. Beitr. z. Konst.-Anatomie 6. Verhalten der Thymus bei
akuten Infektionen: mikroskopische Analyse der Thymus in
25 Fallen von akuten Infektionskrankheiten (Poliomyelitis ant.
ac., Scarlatina, Morbilli, Pertussis, Typhus abdom.) Ibidem.

1919. Beitr. z. Konst.-Anat. 7. Mikroskopische Analyse der
Thymus in einigen Failen von Lues congenita. Ziegler’s Beitr.

Bd. 66, 37-91.

rt

ADRENALIN IN ASTHMA. A CASE OF CHRONIC
ADRENALISM

George H. Hoxie and H. T. Morris
(From the Kansas City General Hospital)

The effect of the continued use of adrenalin has been so
seldom reported that every well marked case demands the publi-
cation of its record. Accordingly we are submitting the follow-
ing notes on a case occurring in the medical service at the Kan-
sas City General Hospital.

Case History
Female—Age 24—Married.

Chief Complaint: Asthma; Wheezing; Shortness of breath,
paroxymal in type; Cough.

History of Onset: Six years ago the patient began to have cough-
ing spells. These spells began in November and in the following
January the wheezing began. The asthma has been practically con-
tinuous ever since. These attacks are the same throughout the year.
They are always worse when lying down. At the time this trouble
started the patient was pregnant and was working in onion beds.
The patient has noticed that when she eats eggs, pears, peaches, and
other fruits the attacks are made worse.

Menstrual History: She had had two children. Up until three
years ago the menses were normal, but in the last three years she has
had only two menstrual periods.

History of Use of Drugs: Since this trouble started six years
ago the patient has been using adrenalin for the attacks, using about
7 c.c. daily. If deprived of the drug she became frantic. She also
was addicted for a time to the use of chloroform inhalations. Up
until a year ago she was also a user of morphine, the amount used
not known. These habits were the results of attempts to relieve the
almost constant dyspnea.

Physical Examination: Female appearing about 30 years of age,
in good flesh (neither obese nor emaciated) walking about the ward.
Her breathing can be heard for some feet away; she uses the acces-
sory muscles of respiration.

Head: Scalp, ears and nose negative.

Throat: The tonsillar pillars are injected and covered by adhe-
sions to the tonsils.

Eyes: The sclera is clear and both pupils are equal and react
to light and accommodation.

47

He
(o 6)

CHRONIC ADRENALISM

Neck: Palpable glands at angles of jaws. Thyroid palpable.

Chest: Lungs—There is lack of expansion on both sides. The
patient uses the accessory muscles of respiration. Tactile fremitus is
decreased. The chest is hyperresonant. Both expiratory and inspi-
ratory sounds are prolonged with various types of dry whistling rales
throughout the respiratory cycle.

Heart: Cardiac dullness seemed normal. The heart tones are
strong and regular and no murmurs are heard. Pulmonic second
sound seems exaggerated. The blood pressure at the first examina-
tion was systolic 155, diastolic 140. At other times it was 160-98.

Abdomen: Because of voluntary rigidity of abdomen, the patient
is hard to examine. There are no palpable masses of liver or spleen
or notable tenderness.

Skin: Both arms and legs are scarred by the use of the hypo-
dermic needle. On the forearms and ankles there are girdles of this
scar tissue about four inches wide.

Extremities: Reflexes are normal.

Death: Patient died suddenly and unexpectedly. Her last dose
of adrenalin had been 2% hours before (1 cc.). Before death the pa-
tient was very nervous and noisy, throwing things about the room.
She was found dead, lying on the floor, and when found appeared
anemic. It had been discovered that patient had adrenalin and a
hypodermic outfit and was self-administering the drug while in the
hospital and for this reason she had been taken from the ward and
put in a locked room.

Previous Entrance to Hospital: Entered Aug. 10, left Aug. 12,
1919. Entered Oct. 3, and left the same day, 1919. No record of
findings on these entrances.

Laboratory Findings: Kidney function test, phenol-sulphoneph-
thalein—15% excreted the first hour; 35% excreted the second hour.

Blood Findings: Red cells, 5,120,000; white cells, 8,400; hemo-
globin (Tallquist) 80%.

Differential Count: Polymorph. neutrophiles, 53%; small
lymphocytes, 27; large lymphocytes, 16; eosinophiles, 1; mast
cells, 3.

Cultures: Cultures from sputum after giving KI gave growths
of streptococci.

Post-mortem Findings—

Chest: The pleural cavity contained no free fluid. Both lungs
were anthracotic. The left lung appeared normal. On cut section it
showed areas of collapsed lung tissue intermingled with areas of com-
pensatory emphysema.

The right lung was partially collapsed. There were adhesions
from the lower border of the lower lobe posteriorly to the diaphragm-
atic pleura.

No obstructions along the respiratory tract were found. Cut
section across the bronchi and their branches showed them to be patent.

IOXIE AND MORRIS 49

The lumen contained some thick tenacious mucus.

Heart: The heart was slightly larger than normal. It was in
systole, the left heart being firm and contracted. The right heart was
‘dilated to a slight extent, with some hypertrophy of its musculature.
‘the valves were normal. The coronary openings were patent and
sclerotic. The aorta was normal in size, but contained several
sclerotic plaques along the ascending portion and the arch.

Abdomen: No free fluid was found. The liver was enlarged and
pushed downward and on cut section showed extensive fatty degener-
ation.

‘the stomach appeared normal. The spleen was twice the nor-
mal size and on section showed nothing abnormal. No pathological
condition was found along the bile tract. The pancreas was normal.
‘the intestinal tract was not otherwise abnormal but was very much
congested. The appendix was normal. Both kidneys were congested
and there were some drops of pus in the calyces of the right.

Sexual organs: Both ovaries were sclerotic, but the tubes ap-
peared normal. The uterus was small and was in normal position.

Vascular system: All the large vessels were filled with fluid
blood and no clots were found. There were small sclerotic patches
along the aorta (round, not stellar).

: REACTION TO DRUGS

An attempt was made to ascertain the patient’s reaction to
the various antiasthmatics and glandular extracts. As will be
seen from the accompanying charts, atropine and amylnitrite
lowered the diastolic pressure, thus increasing the pulse pressure
and affording some subjective relief. Pituitrin simply increased
the blood pressure, and gave no relief. Corpus luteum (P. D. &
Co.’s ampoule) gave no relief. Adrenalin gave varying results,
of which two charts are given. Apparently the subjective relief
was due to the increased pulse pressure.

The attempt to secure an autogenous vaccine failed, because
of some ship at the laboratory.

The use of a nonspecific vaccine (typhoid, 50 millions)
caused no reaction and no change in the subjective symptoms.

The patient was kept fairly quiet by exhibiting 15 minims
of adrenalin per os every three or four hours. But this did not
prevent her stealing chloroform or morphine whenever the op-
portunity presented. However, she did not secure enough of
these to affect materially her condition; and the picture is one
of the adrenalin habit—if it may be so called.

Whenever the patient was deprived of the adrenalin for ¢

50 CHRONIC ADRENALISM

half day, she would become frantic, and if allowed to go on
would develop a cyanosis of lips and fingers, with a loss of the
radial pulse—a condition so alarming that the attendants has-
tened to use the adrenalin and relieve her.

DISCUSSION

Sajous states that ‘‘the prolonged use of adrenal prepara-
tions may induce chronic adrenalism, manifested by marked
cardiac disorders, especially of the myocardium, dyspnea after
slight exertion, tachycardia, high blood pressure, polyuria,
icteric staining of the conjunctiva, and marked increase in
weight.’’ In our case, we noted cyanosis and circulatory failure
on three or four occasions when we had attempted to stop the
use of adrenalin, and to substitute other drugs. But at no time
did we find evidence of myocardial disorders other than the de-
creased force, or pulse pressure. She was not obese.

Erlanger and Gasser beleve as a result of animal experi-
mentation that large doses of adrenalin do long-lasting damage
to the circulation, if they do not actually carry the pressure
down to a dangerously low level. ‘‘ Peripheral constriction per-
sists for hours.’’? The heart develops irregularities under adren-
alin. ‘‘The failure of the circulation is to be attributed to the
extreme slowing of the blood throughout the body by the con-
stricting action of the adrenalin on the arteries. It is concluded
that the cause of the failure is the same as is operative after
temporary partial obstruction of the vena cava or the aorta.
This conclusion is justified by the fact that the most striking
lesion found in animals dying as a result of any of these three
procedures is alike in all cases, and consists of tremendous en-
gorgement of the capillaries and venules of the villi of the in-
testines.’’ Our findings would seem to be in accord with these
experimental conclusions. For no lesion sufficient of itself to
cause death was found. Even the collapsed lung would hardly
do more than lower the vitality of the patient.

The small plaques found in ‘the aorta show the beginning
of the sclerosis, which we had expected to find in much greater
measure.

It is interesting to note that the use of adrenalin even by
the mouth gave some relief. The subcutaneous route also gave

HOXIE AND MORRIS dl

systemic effects, so thoroughly was the patient sensitized to the
drug. And as Cushny and other pharmacologists point out, the
effect of the administration of the drug on the blood pressure
varied from time to time.

Finally, we would call attention to the almost paradoxical
effects on the blood pressure: namely, the increased peripheral
resistance as shown in the diastolic pressure, and the weakened
muscular power of the heart as shown in the decreased pulse
pressure. This of course is in accordance with the statements
of experimental pharmacologists.

SUMMARY

The history is recorded of a case of 6 years’ duration in
which the patient had taken approximately 7 ce. of adrenalin
daily, for the most part with a hypodermic needle. She had
occasionally used morphine and chloroform. Sudden death oe-
eurred. Aside from collapsed right lung and beginning aortic
sclerosis, the chief post-mortem findings were congestion of the
abdominal viscera, similar to that found in animals dead from
adrenalin administration.

Addendum Note: Since the writing of the above, a case
history of sudden death in an asthmatic has appeared (5). In
this instance the patient was given frequent doses of adrenalin
intravenously just before death, and the post-mortem examina-
tion showed the same congestion of the intestinal mucosa
noted in our case. This congestion is probably the chief effect
of the adrenalin.

BIBLIOGRAPHY

1. Binet, L.: L’action de l’adrénaline sur l’appareil cardio-vascu-
laire, Presse Méd. (Paris), 1917, 25, 191. (Dilatation of bron-
chial vessels.)

2. Erlanger, Joseph, and Gasser, Herbert S.: Circulatory failure
due to adrenalin. Am. J. Physiol. (Balt.), 1919, 49, 345-377
(p. 357).

3. Hartman, Frank A., Kilborn, Leslie G. and Lang, Ross 8.: Vascu-
lar changes produced by adrenalin in vertebrates, this Journal,
1918, 2, 122-142.

4, Sajous, C. E.de M.: Cyclopedia, Vol. 1, 760.

5. Boughton, T. H.: Anaphylactic death in asthmatic disease. J.
Am. M. Assn. (Chgo.) 1919, 73, 1912.

52 CHRONIC ADRENALISM

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HOXIE AND MORRIS 53

CHRONIC ADRENALISM

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HOXIE AND MORRIS

THE INFLUENCE OF THYROID FEEDING UPON THE
PHYSIOLOGICAL ACTION OF THE PANCREAS

By Hirotoshi Hoshimoto, M.D.
(From the Medical Clinie of Prof. K. Miura, Imperial University, Tokio.)

In the course of my experimental studies on the effect
which thyroid feeding exerts upon the pancreas of white rats,
certain interesting changes of the physiological actions were
recently observed. I will attempt to describe them here very
briefly ; the full results of my investigation in the experimental
hyperthyroidism will be described in detail and published sub-
sequently.

Upon investigation into the biological activity of the pan-
creas, only the diastase is found to be contained in this gland
in active form, while the other, 1.e., proteolytic and lpolytic
ferments, exist In an inactive state as trypsinogen and _ steap-
sinogen, and they must first be activated before they develop
their own activity.

The test by Wohlgemuth’s method shows the diastatic activ-
ity of the pancreas of normal, fully grown white rats fed on
bread and milk for several weeks as follows:

D. 38° 30’=25,000-33,000 (the average 28,825) in nine
normal male rats.

D. 38° 30’=16,700-50,000 (the average 26,620) in five nor-
mal non-pregnant female rats.

D. 38° 30’—24,717 the average of all rats of both sexes.

The amount of pancreas diastase per 100 mm. body-length

was calculated to be:

D. 38° 30’=8,370-16,750 (the average 13,217) for male rats.

D. 38° 30’=7,800-18,560 (the average 12,511) for female
rats.

D. 38° 30’—12,864, the average of all rats of both sexes.

During continuous feeding with adequate doses (0.5-0.1 gm. )
of dry ox thyroid (containing 0.4 mg. of iodine per gm.) pro-
found decrease of the diastatic activity of the pancreas occurred
in the white rats of both sexes, giving the low value of:

D. 38° 30’=16,667, 13,900, 10,869, 9,240, 5,560, 1262.

56

HOSHIMOTO 5

=~]

This result compared with the average value of normal
rats, the decrease is estimated as 40, 50, 62, 67, 80, and 92 per
cent.

My personal observations show that thyroid substance (ex-
tracted into physiological saline solution) does not at all check
the amylolytic action of the diastase obtained from pancreas of
rats; the diminution of the diastatic activity of pancreas should
be ascribed to the actual diminution of the diastase contents of
pancreas.

With regard to the relation of the decrease of diastase con-
tent to the morphogenetic change—diminution of acidophil
granules—within the pancreas cells, which was found for the
first time by M. Kojima in 1916, I confirm this result to coin-
cide generally in the degree of diminution and its period of
occurrence.

Administration of thyroid in relatively larger doses brought
forth generally more profound decrease of pancreas diastase
than that due to smaller doses.

But the individual difference in resistance against the toxic
influence which thyroid substance exerts (disposition to hyper-
thyroidism) plays a more important role in this respect. Even
in the same group of rats treated with similar doses of thyroid,
some of them showed only slight decrease of diastase, while others
showed marked decrease in relatively earlier stages of the experi-
mental process.

The symptoms of thyroid intoxication are decrease of appe-
tite, vanishment of liveliness, loss of body-weight, dyspnoea,
and hypersalivation, the last of which should be regarded as a
certain sign suggesting approaching death.

The decrease of diastase was not always accompanied by a
poor appetite. On the first day of my experiment when the
appetite was not yet affected and no emaciation visible, the diimi-
nution of diastase was already observed, and more so usually
in the third week, in spite of good or rather abnormally aug-
mented appetite. The decrease of diastase—for example that
of 80 or 90 per cent—took place only in the rats which were
suffering from extremely poor appetite, and showing other se-
vere symptoms, such as dyspnoea, hypersalivation, ete.

The quantity of acid in the stomach does not agree with

58 EFFECTS OF THYROID ON PANCREAS

that of diastase in the pancreas. The quantity of diastase in
the intestinal juice obtained from the upper half of the intes-
tines, i.e. from the duodenum and jejunum, was also estimated.

After the thyroid feeding the intestinal juice becomes milky,
less yellowish, and more thick, showing a relatively lower value
of diastatic activity, while in the case of fasting it appears very
clear, deeply yellow, and less thick, giving comparatively higher
value of diastatic activity. Even in normal rats it varies be-
tween :

D. 38° 30’=645 and D. 38° 30’=1,290, but has never gone
lower than 645.

In some of the thyroid-fed rats the diastase of the intestinal
juice was decreased to the low limit of normal rats, as also was
the pancreas diastase, the former showing:

D. 38° 30’==320-133 and the latter 10,200-1,390, while in
other cases it appeared as entirely normal or sometimes higher
than normal, notwithstanding the decrease of pancreas diastase.

It must not be overlooked here that in such cases where
intestinal juice contained normal or increased amount of dias-
tase, appetite was never decreased, but rather augmented, and
that such evidences were observed generally in the very early
or in the later stages of continuous thyroid feeding and the dimi-
nution of the intestinal diastase was always accompanied by bad
appetite and other severe signs.

Special attention was also given to the quality of the con-
tents of the cecum and colon as well as to excreted feces. In
the thyroid-fed rats the content of cecum was often very soft
and yellowish white, showing many fat drops or crystals under
the microscope, but none of the rats had suffered from diarrhoea.
Exereted feces were always in natural form, even though they
were sometimes quite soft, and in a few cases contained many
fat drops, but such was the case only when the pancreas dias-
tase was extremely diminished.

It has been found by M. Kojima that the pancreas of thy-
roid-fed rats after a certain duration of feeding becomes en-
larged, and this was confirmed afterwards by P. T. Herring.
I was also able to observe this in my experiments. The de-
crease of diastase contents was observed often in such enlarged

HOSHIMOTO 59

pancreases, when both the amount of food consumed and intes-
tinal diastase were rather increased.

The diminution of pancreas diastase may be found some-
times also in emaciated rats, the general metabolism being shifted
into pathological condition by certain exogenous or endogenous
factors, exhausting or poisoning agents. Among my rats in
reserve a female which after birth was giving its milk to eleven
young, was very much emaciated and showed profound decrease
of pancreas diastase. The same fact was observed in an emaci-
ated male rat, its liver being occupied by more than twenty
parasitic cysts.

Although a more or less marked loss of body weight, mostly
owing to a rapid disappearance of fat, is well known as the con-
stant results of thyroid feeding, I cannot explain the decrease
of pancreas diastase as due simply to the disturbed general
metabolism. The pancreas diastase begins to decrease even in
the early days of thyroid feeding, although the general metab-
olism appears as entirely normal, there being no decrease of
appetite, no loss of body weight, no vanishment of liveliness.
The next fact contradictory to this explanation is that the dias-
tase content of the intestinal juice is often of high value in spite
of the diminution of pancreas diastase as already mentioned,
while the decrease of pancreas diastase resulting from the de-
cadence of the general metabolism accompanies generally a sim-
ilar decrease of diastase in the intestinal juice.

The decrease of pancreas diastase in thyroid-fed rats can-
not, therefore, be ascribed solely to the disturbance of general
metabolism. At least in certain periods of thyroid feeding, when
appetite is not affected, and intestinal juice contains much
diastase, I should explain this as due to direct stimulation of
thyroid autacoid upon the biological actions of pancreas, fore-
ing it to discharge its ferments more quickly than in the normal
condition.

P. T. Herring, describing the action of thyroid upon the
general metabolism, has well compared it with a forced draft
on the fuel in a furnace. My observation upon the pancreas
has brought evident proof that thyroid acts in a similar way, as
Herring stated, upon one of the digestive organs.

In connection with this description, a few words may be

60 EFFECTS OF THYROID ON PANCREAS

added to explain the relation of diminution of pancreas diastase
to the disappearance of glycogen in the liver of thyroid-fed rats.
T have found that after 18 hours fasting almost 90 per cent of
the glycogen disappeared in the liver of normal rats. Follow-
ing decreased assimilation of carbohydrate in the alimentary
eanal, glycogen diminishes very rapidly in the liver. The dis-
appearance of glycogen in the liver as the result of thyroid
feeding, is observed in the rats which have poor appetite, con-
suming only a little bread and milk per day, but it is still evi-
dent in rats in the later stage of thyroid feeding, when the appe-
tite is regained or rather augmented, i.e., the amount of food
consumed is more than doubled and the pancreas is already en-
larged, containing greater quantity of diastase than in normal
rats, while the diastatic activity of intestinal juice is normal. It
seems evident that the diminution of pancreas diastase takes
only a small part, or sometimes no part, in decreasing the gly-
cogen in the liver. This can be ascribed to the direct influence
of thyroid upon the liver (or upon its nerves) or to the increased
general metabolism, stimulated by the excess of thyroid autacoid.

Certain clinical observers such as W. Falta, A. Schmidt,
Salomon and Amalgia, Schiller, and A. Bittorf noticed ste-
atorrhoea in several cases of Graves’ disease. How this symp-
tom develops there is no decided opinion, but most of the ob-
servers agree. Falta ascribed it to insufficiency of the internal
secretion of pancreas produced by the influence of thyroid, while
Bittorf asserts that the insufficiency of the external secretion of
pancreas causes such a symptom. The discussion on this prob-
lem is based upon clinical observations upon the effect of pan-
creon administration or on the quality of feces.

Toulay has estimated the diastase in the urine in ease of
Graves’ disease, but failed to confirm the decreased activity of
the external secretion of the pancreas.

No investigator has successfully studied the biological
actions of pancreas itself to explain this phenomenon. The
question whether this may be caused by the deficiency of exter-
nal secretion or due to disturbance of the internal secretion of
the pancreas is yet to be decided.

HOSHIMOTO 61

Another important point among the investigators exists in
the question whether the lesion of the pancreas itself is due to
the excess of the thyroid influence (hyperthyroidism) or to the
agent which produces chronic lesion in the thyroid gland.

During my experiments I have observed under the micro-
scope many fat drops and crystals (stained by Sudan III) in
the feces excreted by some of the thyroid-fed rats, the pancreas
diastase being extremely decreased, while in the feces of normal
rats when fed on bread and milk, not any fat drops were ob-
served (these having been of course previously fed on a simi-
lar diet).

From these observations I can assert without hesitation that
steatorrhoea may be caused by hyperthyroidism (excess of the
thyroid autacoid in the body), and the deficiency of the exter-
nal secretion of the pancreas plays an important role herein.

SUMMARY

_ Nine normal male and five normal, non-pregnant female
white rats were fed for several weeks on bread and milk. The
diastase content of the pancreas varied (Wohlgemuth’s method)
from 25,000 to 35,000 units in males and 16,700 to 50,000 in
females. The average for both sexes was 24,717. Feeding dry
thyroid in dosage of 0.5 to 0.1 gm. resulted in a marked de-
erease of the diastatic activity of the pancreas varying from 40
to 92 per cent. This was accompanied by a diminution of the
acidophile granules of the pancreas cells. Large doses of thy-
roid were more effective than small, but the effects in different
animals were variable. The diastase content of the intestinal
juice was also decreased in some cases by the thyroid. In such
positive cases the appetite was markedly depressed and the
feces were soft; in extreme cases they contained considerable
quantities of fat. Thyroid feeding frequently resulted also in
marked enlargement of the pancreas. In such cases the pan-
ereatic diastase was often decreased even when the amount of
food consumed and the intestinal diastase were augmented. The
decrease can not be ascribed to general metabolic perturbation
since it frequently antedated any evidence of such. It is rather
aseribed to stimulation of diastase discharge from the pancreas.

62 EFFECTS OF THYROID ON PANCREAS

BIBLIOGRAPHY

Bittorf, A.: Deutsch. med. Wehnschr., 1912, Nr. 1034.

Falta, W.: Verhandlungen d. Kongr. f. inn. Med., 1910, and Ztschr. f.
klin Med., 1910, Bd. 7. ;

Herring, P. T.: Quart. J. Exper. Physiol., 1917, 11, 231.

Kojima, M.: Proc. Roy. Soc. Edin., 1916, 36, 240; Quart. J. Exper.
Physiol., 1917, 11, 255.

THYROID DIABETES

G. L. Rohdenburg, M. D.

(From the Pathological Laboratory of the Lenox Hill Hospital,
New York)

The relation of the thyroid to carbohydrate metabolism
has often been commented upon, von Noorden having de-
seribed, many years ago, what he termed thyroid diabetes.
The more recent investigations initiated by Jacobsen (1), and
more fully developed by others (2), have emphasized this re-
lation still further. As is well known the work of Jacobsen
and others has shown that the ingestion of considerable
amounts of glucose is followed by a temporary hyperglycemia.
It is generally accepted that when, in the course of this hyper-
glycemia, the concentration of the blood sugar rises above
185 mgm. per 100 ¢.c. of blood, in the majority of cases sugar
appears in the urine. McCasky (3), who investigated this
phase of metabolism in some thirty odd eases of exophthalmic
goitre, was unable to demonstrate a specific curve of sugar tol-
erance in the blood during the disease, although, in common
with others, he noted that there was a hyperglycemia even
before the administration of glucose. Janney and Isaacson (4),
found that the complete extirpation of the thyroid, in dogs,
was followed by absence of hyperglycemia when large amounts
of glucose were administered.

Theories attempting to explain the mechanism of sugar
mobilization based on the data at present available are all
unsafe, since no theory as yet advanced is sound enough to
withstand the application of facts already demonstrated but
disregarded in the formulation of any given theory. It may
perhaps be permissible to state here that the question of gly-
cemia and the glycemic reaction which follows either the inges-
tion of large amounts of glucose or the subeutaneous injection
of a variety of organie and inorganic substances has a twofold
significance: one directly concerned with metabolism, the other
associated with the processes of immunity. These phases are
considered in other publications (5).

63

64 THYROID DIABETES

The cases reported in the present article are of interest
in that they apparently substantiate the current theory of
the influence of the thyroid upon sugar metabolism, and for
the suggestion they offer as to the possible etiology of the con-
dition.

Case 1. While the following cases have been grouped as
one, in reality four individuals were concerned. Two sisters
with uneventful past and family histories developed what clin- .
ically appeared to be diabetes, one at the age of 45, the other at
the age of 49. Both of these age periods corresponded with the
actual cessation of menstruation in the respective individuals.
The sister, Mrs. B., married a man who, at the age of fifty-six,
developed diabetes. This couple had two sons. The first son
was nondiabetic, and died at the age of twenty-three of a brain
abscess following a mastoid infection. The second son developed
diabetes at the age of eighteen years, and has been under obser-
vation for a period of seven years.

In order to present more concisely the salient facts in this
interesting family, it may be stated that all examinations were
negative, except for the positive facts that all the individuals
were large and exceptionally well nourished, and that in each
case the presence of sugar in the urine was associated with °
polyuria, at times itching of the skin, and excessive thirst. All
four patients had been under observation for a period of about
fourteen months, and had been placed on various restricted
diets [the Allen treatment had not at that time (1909) been
proposed], and had received various types of medication, 1.e.,
codeine, atropine, ete. <All of this was without appreciable
effect, the urinary sugar varying between 2 and 4 per cent
under restricted diet. For a period of approximately two years,
several of the endocrine glands were administered per os. The
changes in the urinary output of sugar under the influence of
this type of medication were at times uncomfortably startling.

Chart 1 presents in graphic form the variations in percent-
ages of urinary sugar under different regimes for all four cases.
During this entire period the family were under dietary restric-
tions of a general type, but during the months indicated by
‘*T)”’ the restrictions were severe, the patients receiving only fat,
proteins, and the broad group of vegetables growing above the

ROHDENBURG 65

ground—peas, beans, and lentils excepted. During the months
marked with one or another of the gland extracts, the desiccated
gland was given in the dosage of three grains, three tames a
day. Urinary examinations were made weekly on twenty-four-
hour specimens by the Fehling method, and the figures pre-
sented in the chart are the averages of: the four examinations
per month. The chart speaks for itself in that it shows in a
striking manner the increased output of sugar when desiccated
adrenal or thyroid gland was given, and the return to lower
values when this medication was discontinued.

Interesting as these observations are, the subsequent course
of events in each case is still more interesting. Mr. B. died in
in a typical diabetic coma; autopsy was not obtained. Mrs. B.,
after some financial reverses, committed suicide by using illum-
inating gas. Mrs. A. died of sepsis following a typical diabetic
earbuncle of the neck. Son B. passed from my observation
temporarily some six months after the last month indicated on
the chart. ! saw him again five years later (1915), when he
gave me the following history. About six months after seeing
me for the last time, he had developed rapid heart action and
considerable exophthalmos, and after four months in bed with
no improvement, a portion of his thyroid was removed. This
statement as to removal of the thyroid was borne out by physi-
cal examination. He had occasion to have his urine examined
about six months after the operation and it was found to be
sugar-free. The consumption of two pounds of grapes (Malaga)
and three ice cream sodas within twelve hours at the time of
his visit failed to produce sugar in the urine.

We have, then, in this family group a history of diabetes
in one of the ancestors, the development of diabetes in two sisters
at the time of the menopause, and the development of diabetes
in one son at the time of puberty. We know that at these
periods the thyroid is profoundly affected by the general changes
in the organism. Again, the administration of thyroid gland
repeatedly caused a marked increase in the sugar excretion; and,
finally, the removal of part of the thyroid gland in one member
of the family was followed by the disappearance of glycosuria.

Case 2. The second ease is the reverse of the previously
cited Son B., in that the development of Graves’ disease oc-

66 THYROID DIABETES

¢ hartl
Ponts eos
eer a NBO eed
teal ch
ee
che Lee cee ae pel sid
— imine

rae gE
Be ert

VE based on Average of 4 deverminations

PW eE Ml sel case =
eee a a fe
Rhee = lees tte Ie pel oeel ean iieco dah eae
Stbesh [ol Lal) eet le ee
E [ee asl el So gh aa ine ne
ep ep pe ae aes aes ae

Sugar

‘ay a
EH ECE
Er coe
ee Ane)

el
NS
BS
ne
Mee A ---MrsB—-—:—Mr B

(1)- Diabetic Coma (a) Sepeis, Covbuncie

(3)- Suieide

: ideal ut ela
elf alin Boece
E Be stion lies aol ele ls nes

Medicat RY A lS] o[ 4] ¥] ] se} \] ©

D=diet restricted.

a |

ROHDENBURG 6

curred first and the development of diabetes second, and
finally, a cure of both conditions followed removal of a large
portion of the thyroid gland. In this case also we have more
exact chemical details.

An American woman, married, aged fifty-three years, and
a nullipara, gave the following history. Her family history was
negative except that her father had died of diabetes. The other
members of the family were of large frame and exceptionally
well filled out, though she was small and would not be con-
sidered even plump. Her past hfe had been unuswally stren-
uous, with many excessive demands upon both her physical and
her mental energy. Her past history was without interest,
except that in 1915 she had suffered from symptoms of excessive
thyroid activity, with rapid pulse, loss of weight, and a typical
tremor. Because of this condition one lobe of the thyroid was
removed under local anesthesia by Dr. George H. Semken, to
whom I am indebted for the case. The operation was followed
by great improvement in her general condition, her weight -in-
creasing by fifteen pounds, and her pulse falling to 100. She
was very definite in stating that for a number of years previous
to her operation she had had a pulse ranging from 120 to 140.

Her present complaint was that during the past year she
had noted a loss of thirty-five pounds in weight, polyuria, exces-
sive thirst, and some itching of the skin. About six months
ago she was told that she had diabetes; the percentage of sugar
found was not stated. Physical examination at this time showed
as the only abnormalities a systolic murmur at the base of the
heart with roentgenographic evidence of a dilated aorta; pulse,
90 to 100; blood pressure, 95 d., 140 s.; and a subserous fibroid
about the size of a lemon. No exophthalmos was noted. The
Wassermann reaction was negative, and the blood count normal.
The urine for four days on a full diet showed from 1.8 to 2.5
per cent sugar without evidence of acidosis; the blood sugar
value was 140 mgm. per 100 ¢.c. The curve of sugar excretion
and of pulse rate are shown in Chart 2.

A clinical diagnosis of diabetes having been made, the pa-
tient was starved. The urine voided after sixteen hours’ starva-
tion was sugar-free, but showed acetone and diacetie acid. After
twenty-four hours’ starvation the patient commenced to vomit,

68 THYROID DIABETES

and within a few hours was vomiting every three to ten minutes,
bringing up mucus and bile. At the same time her pulse rose
rapidly to 180 at the wrist (as nearly as could be determined).
She was given a Murphy drip with a teaspoonful of sodium )i-

[e)
3 Chart 2
Bese eteeahate eee
; Ce Oa | RRB SRRBERERSEL
al esa [ese chad 2 2 [al aN a Sa
sesreerecs
A elke (ese ale ine a
Ac oaltel Lf ttt
ae Ae eS es ESS) ames
ella
ie
mica
mm
as
mS
ae
ial
fie
BRSRee
ER
EC
E
Bey
fl
&
|_|
BE
ee
+
5
ee
BE
aks

carbonate to the quart, in spite of the fact that the CO, com-
bining power of the blood plasma was 55 volumes per 100 and
sugar-free, broth was given per os. After twenty-four hours
the vomiting ceased, the pulse remaining as rapid as_ before.

ROHDENBURG 69

After five days of rapid pulse (160-180), the urine remaining
sugar-free, Dr. Semken extirpated the other lobe of the thyroid
under local anesthesia, leaving the isthmus in situ, the diagnosis
of hyperthyroidism being evident. The day after the operation
the urine showed 4.8 per cent of sugar; the next day, 2.4 per
cent; the third day, 0.5 per cent, and on the fourth day was
sugar-free. This sudden increase in urinary sugar was un-
doubtedly due to the sudden expression of thyroid secretion
into the blood current due to operative manipulation. The
pulse fell rapidly until, two days after the operation, it was 80
per minute. One month after the operation the patient had
gained twenty-five pounds; her pulse was 72; and the inges-
tion of two ounces of cane sugar in twenty-four hours plus a
diet consisting wholly of carbohydrates for two days previous
and for the day of the test failed to produce any renal leakage
of sugar. Three months after the operation she had gained an
additional ten pounds, the pulse was 70, and on an unrestricted
diet the urine was sugar-free. |

The cases described above suggest some interesting trends
of thought. The etiology of diabetes is most obscure. The dis-
ease may be induced in a variety of ways, ranging from injury
to the nervous system, as shown by the classical piqure experi-
ment of Claude Bernard, to extirpation of the pancreas or
poisoning by phlorhizin. Still, even though extirpation of the
pancreas does give rise to diabetes, it is the experience of every
pathologist that carcinoma of the pancreas may destroy prac-
tically the entire organ and not give rise to glycosuria. The
experiments of Janney and Isaacson, previously referred to, and
the experiences in the cases cited here suggest that it may after
all be possible that the condition is a manifestation of thyroid
overactivity and not primarily of pancreas insufficiency, as 1s
now commonly accepted. Personally, until the occasion of Case
2, we had lacked the courage to repeat thyroid feeding in cases
of diabetes; but we now feel inclined, should the opportunity
again present itself, to try the feeding of this gland; in the
event of an increase in urinary sugar, after such feeding, a
partial thyroidectomy could be rationally advocated.

70 THYROID DIABETES

SUMMARY

The author cites a family in which glycosuria was increased
in intensity after the oral administration of either thyroid gland
or adrenal. One member of this family was cured of his gly-
cosuria after a partial thyroidectomy. In a second case the
patient has previously had a portion of the thyroid removed for
exophthalmic goitre, developing glycosuria several years later.
The glycosuria in this case also disappeared after extirpation of
more of the thyroid gland.

BIBLIOGRAPHY

1. Jacobsen, A.: Biochem. Zeitschrft., 1913, 56, 471.

2. Williams, T. and Humphrey B.: Arch. Int. Med., 1919, 23, 537;
Mamman, J. and Hirschman S.: Arch. Int. Med., 1917, 20.
761; Hopkins, B.: Am. J. Med. Sc., 1915, 149, 254: Taylor,
F. and Hutton, M.: J. Biol. Chem., 1916, 25, 173.

3. McCasky, T., J. Am. Med. Assn., 1919, 73, 245.

Janney and Isaacson: Arch. Int. Med., 1918, 22, 160.

Rohdenburg, G. L., Bernhard, A. and Krehbiel, O.: Am. J. Med.

Se., February, 1920.

ot

THE BASAL METABOLIC RATE IN EXOPHTHALMIC
GOITRE (1917 CASES) WITH A BRIEF DESCRIP-
TION OF THE TECHNIC USED AT
THE MAYO CLINIC

Irene Sandiford, Ph.D.
Mayo Foundation, University of Minnesota, Rochester, Minnesota

‘“TIn each mammal there is a basal metabolism’’ (19). By
the term ‘‘basal metabolism’’ or better, ‘‘basal metabolic rate,’’
of an organism is meant the minimal heat production of that
organism, measured from twelve to eighteen hours after the
ingestion of food and with the organism at complete muscular
rest. This minimal heat production may be determined directly
by actual measurement by means of a calorimeter, or indirectly,
by calculating the heat production from an analysis of the end
products which result from oxidation within the organism, or
specifically, from the amount of oxygen used and the correspond-
ing amount of carbon dioxid produced, together with the total
nitrogen eliminated in the urine (although, for clinical work the
urinary nitrogen may be neglected).

The experimental work of Lavoisier (17) marks the begin-
ning of researches on metabolism, and to him belongs the con-
ception that the life processes are those of oxidation with the
elimination of heat. Technically, the problem was beset with
many difficulties, for it was necessary not only to measure the
amount of heat lost by radiation and conduction from the body
(direct calorimetry), but also to collect accurately the various
end products resulting from combustion within the body, from
which data the heat production can be calculated (indirect calo-
rimetry), in order to prove from a comparison of the results
obtained from the two methods that the law of conservation of
energy also holds for the living organism. Furthermore, before
the method of indirect calorimetry could be employed the heat
values of carbohydrate, fat, and protein had also to be deter-
mined in order to calculate the heat derived from their com-
bustion in the body. The solution of these problems was greatly
advanced by Carl Voit (23) and his pupils, the chief of whom

71

bo

METABOLISM IN EXOPHTHALMIC GOITRE

were Pettenkofer (22) and Rubner (27). The heat values of
carbohydrate and fat were readily determined by Rubner (25)
since these two substances are oxidized to the same end products
(carbon dioxid and water) whether burning in the body or in
a calorimeter. In the case of protein, however, the problem was
somewhat more difficult, for a part of the end products of pro-
tein combustion in the body is eliminated in the urine and feces
and the latent heat thereby lost had to be subtracted from the
heat value of protein as determined in the calorimeter.

In 1894 Rubner (26) constructed the first successful respi-
ration calorimeter designed for the measurement of the gaseous
exchange between a living organism and the atmosphere which
surrounds it and the simultaneous measurement of the quantity
of heat produced by that organism. By means of this apparatus
Rubner verified the method of Pettenkofer and Voit of caleu-
lating the heat production (indirect calorimetry) and he proved
that the law of conservation of energy holds for the hving or-
ganism.

It was not until 1905 that the respiration calorimeter was
brought to a high degree of technical perfection by Atwater
and Benedict (1). With their apparatus it was possible to
determine simultaneously with the measurement of the heat
elimination, not only the carbon dioxid production, but also the
oxygen consumption of the subject. Studies made by Benedict
and his associates, at the Carnegie Nutrition Laboratory, using
the perfected calorimeter, have added greatly to the exactness
of our knowledge with regard to the metabolism in prolonged
fasting (4), the metabolism of normal persons (6), of infants
(8), and of diabetics (7). They also confirmed the agreement
between direct and indirect calorimetry. Lusk (18) and Du Bois
and their co-workers have likewise demonstrated, in a large
series of pathologic conditions, the close agreement between the
two methods. As a result of these investigations the use of such
a complicated apparatus as the respiration calorimeter has been
shown to be unnecessary for clinical work and that in its place
the comparatively simple method of indirect calorimetry may
be used.

Krogh (16) of Copenhagen, and Carpenter (11) of the
Carnegie Nutrition Laboratory, have described and compared in

SANDIFORD Wo

great detail the various kinds of respiration apparatus used in
indirect calorimetry. Carpenter has shown that for indirect de-
terminations two types of apparatus are suitable, the closed cir-
cuit and the gasometer.

By far the best apparatus of the closed circuit type is the
Benedict unit apparatus (2). By means of a mask, mouthpiece
or nasal tubes, the subject rebreathes air from a closed system
in which the carbon dioxid is absorbed by soda lime, and, as
the oxygen is used up, it is replaced by oxygen in known amounts.
The air within the apparatus is kept in constant circulation by
means of a blower. A small spirometer is inserted in the cir-
cuit as an expansion chamber and volumetrically records the re-
spiratory movements on a smoked drum. Knowing the weights
of oxygen used and the carbon dioxid eliminated, one can readily
caleulate the heat production. As pointed out by Carpenter,
this apparatus is very satisfactory and indeed the best for many
purposes, especially when used in conjunction with a calori-
meter or with the cot-chamber calorimeter described by Bene-
dict and Tompkins (9). We have found, however, that for
clinical work the unit apparatus is rather cumbersome. It re-
quires constant checking to see that it is absolutely air tight,
for a leak of 20 or 30 ¢.c. during a fifteen minute determination
will appreciably affect the result, because such a leak in this
type of apparatus will be equivalent to the loss of so much oxy-
gen and not equivalent to the loss of so much air as is the case
in the gasometer method. Furthermore, the accumulation errors
of the apparatus fall on the oxygen and not on the carbon
dioxid determination, thus causing an error in the calculation of
the respiratory quotient and heat production. The absorbing
chemicals must be changed frequently and with the repairing
and constant checking of the apparatus it is on the whole difficult
to use in clinical work, particularly if many determinations are
to be made.

The portable respiration apparatus recently devised by
Benedict (5) for clinical work is a modification of his unit ap-
paratus described above. It is designed primarily to give a rapid
and at the same time a comparatively accurate measurement of
the oxygen consumption without involving analyses or weighing.
We have not adopted it, as we prefer to determine not only the

74 METABOLISM IN EXOPHTHALMIC GOITRE

oxygen consumption, but also the carbon dioxid elimination
since the heat production can thereby be more accurately cal-
culated. Moreover, the difficulties inherent in the closed circuit
type of apparatus are still present in the portable apparatus.

For clinical work the gasometer method introduced by
Tissot (29) in 1904 is considered by us the most satisfactory.
Briefly, the determinations are made in the following manner:
A mask is adjusted over the patient’s mouth and nose and by
means of expiratory and inspiratory valves the total volume of
the patient’s expired air is collected in a gasometer for a known
period of approximately ten minutes. Duplicate determinations
are made of the carbon dioxid and oxygen content of the ex-
pired air, the analyses being done in the Haldane gas analysis
apparatus (14). Since the ventilation rate for each minute is
known, as well as the amount of carbon dioxid produced and the
oxygen absorbed, it is possible to calculate by means of calorie
tables the total number of calories produced each hour.

The following points in the routine determination of the
basal metabolic rate deserve further discussion: To obtain
comparable results the patient must be in the postabsorptive
condition, that is, he must fast for at least twelve hours pre-
ceding the test. It is very important that this rule should be
observed, because all kinds of foods cause an increase in the heat
production and this effect may not entirely disappear for twelve
hours after their ingestion (28). Moreover, the patient must be
at complete rest and the effects of previous muscular exertion
eliminated by requiring him to rest in bed for twenty minutes
before the test is started, for we have shown in a series
of experiments that a rest period of this length of time is quite
sufficient to obtain the basal metabolism (10). During the pre-
liminary rest period an observer sits with the patient, noting
at intervals the character and rate of the heart beat and the
respiration; likewise, about the middle of the period, the blood
pressures, both systolic and diastolic, are obtained. After
tweuty minutes’ rest a mask is accurately adjusted over the nose
and mouth of the patient and securely held in place by means
of tapes so that there is no leakage of air around the mask
(Fig. 1). A mask is preferable to either a mouthpiece or nasal
tubes. With a little experience it is possible to adjust the mask

SANDIFORD

—l
On

so that it is not only comfortable for the patient, but also air-
tight. One of the chief advantages of the gasometer method is
that should a very slight leak of a few cubic centimeters occur
around the mask during the course of an experiment the end

Fig. 1. Mask and connections showing valves, intake
pipe and towel with tapes.

result is not appreciably affected, while a leak of a similar volume
in the closed circuit apparatus has a value at least five times as
great, because in the latter case it is equivalent to the loss or
gain of so much pure oxygen.

76 METABOLISM IN EXOPHTHALMIC GOITRE

During the test proper the observer sits with the patient,
recording his pulse and respiration rates and noting and record-
ing on a special chart any movements. Care is taken to impress

on the patients that even slight movements materially affect the

Fig. 2. Moveable gasometer.

test and it is almost always possible to obtain their complete
co-operation. Sometimes, however, in an extremely nervous
person, a basal rate cannot be obtained on the first test. Instead
of repeating the determination the same day the patient is in-

SANDIFORD T7

structed to return the following morning for a second test. In
such instances the rate will occasionally be ten points lower
than. that obtained the first time when the patient was unduly
nervous and frightened about an unknown procedure.

The total volume of the expired air is collected in a gaso-
meter (Fig. 2) over a known length of time. Unlike in the work
with the closed circuit apparatus no appreciable error is intro-
dued by failing either to start or stop the experimental period at
exactly the end of a normal respiration, a difficult thing to do
with accuracy in the case of patients who breathe irregularly.
Samples of the expired air are then collected over mercury in
sampling tubes and analyzed in duplicate for carbon dioxid and
oxygen. Approximately 10 ¢.c. of expired air are transferred
into the burette of the Haldane gas analysis apparatus (Fig. 3)
and after adjusting certain levels the reading of the initial
volume of the sample is made, reading to the nearest 0.001 ¢.c.
The gas sample is then passed back and forth over a solution of
dilute potash to absorb the carbon dioxid. The levels of the sola-
tion are again adjusted and a second reading of the volume of the
remaining gas in the burette made. The contraction in volume of
the gas, due to the absorption of the carbon dioxid by the potash
solution, divided by the original volume, gives the percentage
of carbon dioxid in the expired air. In like manner the per-
centage of oxygen is determined, potassium pyrogallate solu-
tion being used as the absorbent for oxygen.

The gasometer method is particularly suitable for clinical
work because each step in the procedure can be checked by a
second assistant, reducing to a minimum the chance of technical
errors. . Although the method requires care and accuracy in
every part of the procedure, it is possible to teach the
technie to laboratory workers who have had no preliminary
scientific training other than that obtained in a high school.
The most difficult step in the procedure is the analysis of the
expired air. This, however, we have found to be inconsider-
able. Our assistants can obtain routinely duplicate analyses
agreeing within 0.04 per cent for carbon dioxid and 0.06 per
eent for oxygen, and they are able also to take entire care of
their gas analysis apparatus. The equipment necessary for this
method is simple and inexpensive and when properly constructed

78 METABOLISM IN EXOPHTHALMIC GOITRE

is rarely out of order and, except for cleaning, requires very
little mechanical care. Furthermore, the apparatus is free from
the many mechanical difficulties inevitably inherent in a closed
circuit system in which the air current is driven by an electric

Fig. 3. Haldane gas analysis apparatus.

pump. In the metabolism laboratory at the Mayo Clinic we are
averaging 30 cases a day and have developed a very definite and
routine procedure which has decreased the chance of technical
error to less than 1 per cent.*

* The details of the technic are described in a laboratory man-
ual by Boothby and Sandiford (10). The apparatus may be obtained
from H. N. Elmer, 1136 Monadnock Bldg., Chicago.

SANDIFORD 79

The calculation of the basal metabolic rate from the experi-
mental data is very simple. Knowing the volume of air expired
by the patient in a minute (the ventilation rate) and the per-
centage of carbon dioxid and oxygen in the expired air, it is
possible to calculate the volume of oxygen absorbed by the pa-
tient in one hour, as well as the corresponding amount of carbon
dioxid produced. Since the respiratory quotient, that is the
ratio between the volume of carbon dioxid produced and the
volume of oxygen absorbed, indicates the kind of food being
burned at the time of the determination, and since by means of
calorie tables the calorific value of one liter of oxygen absorbed
by the body in the burning of these substances is known, the
total heat production each hour can be calculated readily. The
total number of calories must be divided by the surface area, a
factor dependent on the patient’s height and weight. The num-
ber of calories for each square meter of body surface each hour
must then be compared with the normal standards of compari-
son which are dependent on the age and sex of the patient. For
convenience, basal metabolic rates are expressed in percentages
of the normal, and when the heat production is greater than the
normal the percentage is plus, and when less than normal the
percentage is minus.

A very important contribution was made by Du Bois (12,
13) in determining the heat production in normal controls.
Rubner (24) had suggested that the heat production of an indi-
vidual is proportional to his surface area. For the determina-
tion of the surface area Meeh (21) proposed the formula:
Surface area in square centimeters—12.3 (a constant)
weight in grams*. However, using the surface area ob-
tained by this formula as a basis of comparison, the heat pro-
duction of normal controls still showed quite wide variations,
although not so great as when compared on the basis of weight
alone. By exact measurements of the surface area of several
bodies Du Bois demonstrated an error in the above formula due
in greater part to the fact that the height of the subject was
neglected. Asa result of further studies Eugene F. Du Bois and
Delafield Du Bois (12, 13) devised a formula based on height

80 METABOLISM IN EXOPHTHALMIC GOITRE

and weight by means of which the surface area can be calculated
with an average error of 1.7 per cent. This formula is:
0.42: 0.725
A—— De i xX 71.84

Where A is the surface area in square centimeters, W is the
weight in kilograms and H is the height in centimeters, and
71.84 is a constant. On the basis of this formula they then con-
structed a height-weight chart by means of which the surface
area can be estimated at a glance. Du Bois (12, 13), using this
new height-weight chart for the determination of the surface
area in conjunction with his standards of normal basal metabo-
lism with regard to age and sex, further showed that the metab-
olism of normal persons can be predicted with an accuracy of
+10 per cent. This fact has been confirmed both by Means (20)
and by Boothby (19). Benedict (3) has severely criticized the
method of predicting the heat production from the unit of sur-
face area, maintaining ‘“‘that the metabolism or heat output of
the human body, even at rest does not depend on Newton’s law
of cooling, and therefore, is not proportional to the body sur-
face.’’ Harris and Benedict (15) in a very exhaustive treatise
have reconsidered the entire problem of the prediction of the
normal basal metabolic rate and show that by proper biometric
formulas based on stature, body weight, and age (the same fac-
tors used by Du Bois), ‘‘results as good as or better than those
obtainable from the constant of basal metabolism per square
meter of body surface can be obtained by biometric formulas
involving no assumption concerning the derivation of surface
area, but based on direct physical measurements.’’ Since their
publeation there has not been sufficient time to study in detail
the fundamental accuracy of the two methods of prediction ; we
have, however, tabulated 404 determinations of the basal meta-
bohe rate expressed in percentages above and below normal,
using both the standards of Du Bois and of Harris and Benedict.
The average rates of all the cases show that the rates obtained
by Harris and Benedict’s method are 6.5 points higher than
those obtained by Du Bois’ method. The parallelism between
the results obtained by the two methods is strikingly shown by
the fact that 195 of the 404 determinations are within + 2.5 of
the average variation. Only 52 of the entire 404 rates deviate

SANDIFORD 81

more than 7.5 from the average variation. The comparative
agreement, therefore, of the two methods is very satisfactory,
indicating as it does the similarity of both methods of compari-
son, and supporting in a high percentage of the cases the clini-
eal conclusions based on the Du Bois and Du Bois height-weight
chart and the Du Bois normal standards for comparison.

The metabolism laboratory at the Mayo Clinic was opened,
in March, 1917 by Boothby and Sandiford, under the clinical
direction of Dr. H. S. Plummer, and in that year 1143 metabolic
rates were determined on 549 patients. At that time the number
of cases that could be studied in the laboratory in proportion
to the number of thyroid cases at the clinic was rela-
tively small. In consequence, considerable care was taken by
Dr. Plummer to select typical cases of the various groups of
thyroid disorders and with his permission this analysis of the
metabolic rates in the exophthalmic goitre cases studied during
1917 is presented.

The basal metabolic rate is of the greatest value in thyroid
disorders because it gives a very accurate mathematical index
of the degree of functional activity of the thyroid gland.
For example, in exophthalmic goitre the metabolic rate may
rise well over 100 per cent above normal while in myxedema,
with apparently complete cessation of thyroid activity, the
rate falls to the region of 40 per cent below normal. In the
milder cases of both groups the metabolic rate variations
from the normal are proportionately smaller. On the other
hand, beside thyroid disorders, there are no diseases that
have sa far been shown to have a constant and distinct vari-
ation from the normal in the basal metabolic rate except disor-
ders of the pituitary gland, conditions of profound inanition,
and fevers. However, an occasional case is met with in which
there is a variation in the basal metabolic rate that at present
cannot be explained or properly classified. Such variations
are more frequent in patients with considerable evidence of
nephritis or anemia. No definite instance of an increased
basal metabolic rate has been found in that group of cases
known as neurasthenia or chronic nervous exhaustion. The
basal metabolic rate has proved, therefore, to be of great value

82 METABOLISM IN EXOPHTHALMIC GOITRE

in the differential diagnosis of neurosis simulating hyper-
thyroidism and true hyperthyroidism.

In 182 cases of exophthalmic goitre before any treatment
was instituted the average metabolic rate was +51 per cent,
with an average pulse rate of 115. In 13 patients whose average
metabolic rate, as outpatients, was +59 per cent, with an aver-
age pulse rate of 115, the average metabolic rate fell to +46
per cent, and the average pulse rate to 108 as a result of approxi-
mately one week’s complete rest in bed. In 5 patients whose
average metabolie rate, determined within two to five days after
they entered the hospital, was -+-59 per cent and the pulse 118,
after a further rest in bed of approximately one week’s dura-
tion there was a definite improvement in their condition, as
shown by a fall in the metabolic rate to an average of +48 per
cent and pulse to 104,

The effect of a single ligation was studied in 16 cases. The
basal metabolic rate taken after the patient had had several
days’ rest in bed and within five days before the first hgation
was --54 per cent and the pulse 116. One week after the single
ligation the average metabolic rate had decreased to +44 per
cent and the pulse to 112.

The immediate result of ligation or thyroidectomy in hyper-
thyroidism is to cause at first a rise in the metabolic rate for a
few days, followed by a gradual fall to a distinctly lower level on
the average than that obtained preceding the operation. The
curve of the basal metabolic rate on the average roughly par-
allels the pulse rate curve. The former is, however, a far more
accurate index of the degree of hyperthyroidism than is the
pulse rate, as the latter shows more individual and extraneous
variations, for example, the irregularities of auricular fibril-
lation.

The effect of the second ligation is likewise a general
improvement in the patient’s condition as evidenced by a
decrease in the metabolic rate. An average figure of any
value on the immediate result of the second ligation in the pa-
tients in the 1917 series cannot be given, as practically no rates
were obtained in the same case immediately preceding and fol-
lowing the second lgation. There is a very marked improve-
ment in these patients when they return for their thyroidectomy

SANDIFORD 83

two to four months after the second ligation. In 22 patients
(Table 1) there was an average decrease in the basal metabolic
rate from +46 per cent to -+ 39 per cent, and in the pulse from
115 to 107 with a gain in weight from 46.4 to 54.5 kilograms in
the determinations made a few days after the second ligation as
compared with the data obtained after three months’ rest at
home and just previous to thyroidectomy. From the clinical
history it is probable that the basal metabolic rate determined
at the time the patients returned for operation after having
had two ligations and three months’ rest at home may not
necessarily represent in all cases the period of maximum im-
provement produced by the two ligations and rest. A definite
improvement from thyroidectomy in those patients who had had
two ligations and a three months’ rest was shown two weeks fol-
lowing operation by a decrease in the basal metabolic rate from
+39 per cent to +16 per cent, and in the pulse rate from 107
to 89.

In another group of 19 patients (Table 2) with exophthal-
mie goitre in whom the preliminary basal metabolic rate varied
between +13 per cent and +50 per cent, giving an average of
+31 per cent with an average pulse rate of 104, and in whom
a primary thyroidectomy was done without any other prelimin-
ary treatment, except for a short rest in bed, the basal metabolic
rate fell, about two weeks after operation, to +5 per cent and
the pulse to 84.

The general effect of the treatment adopted at the Mayo
Clinic for severe cases of exophthalmie goitre may be illustrated,
_ then, by the following data: In a group of 22 patients (Table
1) the average basal metabolic rate, before any treatment was
instituted, was +66 per cent, with a pulse rate of 123. Asa
result of rest in bed and two ligations the rate in these patients
before they went home had decreased to +46 per cent and the
pulse to 115. The further improvement that occurred from
three months’ rest at home reduced the average metabolic rate
to +39 per cent and the pulse rate to 107 and finally, after
thyroidectomy and just before the patients were discharged from
the clinic, the rate was +16 per cent and the pulse 89.

As will be noted, following thyroidectomy there is almost
always a marked decrease in the basal metabolic rate within

TABOLISM IN EXOPHTHALMIC GOITRE

ni
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67 TL GOs
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late OOT VALS
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LOSI6T
9SEL6T
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SANDIFORD 85

two weeks after the operation and, as a rule, there is still fur-
ther improvement in the succeeding months, just as is seen to
occur in the interval after the second ligation. Occasionally, a
varying degree of hyperthyroidism may persist, as shown by

Table 2

THE EFFECT OF PRIMARY THYROIDECTOMY ON THE
BASAL METABOLIC RATE IN EXOPHTHALMIC GOITRE

About two weeks

Before treatment after operation

Case Fulse B. M. R. Pulse B. M. R.

Per cent Per cent
214581 88 50 70 +19
196806 109 +45 93 tn B
202992 107 +45 92 a 5
200219 145 +42 115 se
201229 102 +40 WD +14
202481 105 +39 68 a oh
202527 112 +36 92 a als
194686 97 aS) TE + 1
212298 108 +34 91 Se
202232 113 SLAY, 118 SELBY
203326 ern +30 89 +10
3396 101 +29 83 alg
198725 99 = ray 67 0
196664 79 +21 58 —11
203291 87 +18 133 — 6
199740 95 +18 69 — 7
217150 99 +16 85 — 5
215895 118 SENS 98 — 9
208637 89 lS 84 + 6
Average 104 +31 84 + 5

an elevated basal metabolic rate. In these cases a second (and
rarely a third) thyroidectomy is indicated.

BIBLIOGRAPHY

1. Atwater, W. O., and Benedict, F. G.: A respiration calorimeter
with appliances for the direct determination of oxygen. Car-
negie Inst., Washington, 1905, Pub. No. 42.

2. Benedict, F. G.:

4. Benedict, F. G.:

Ein Universalrespirationsapparat. Deutsch.

Arch. f. klin. Med., 1912, 107, 156.
3. Benedict, F. G.: Factors affecting basal metabolism. Jour. Biol.
Chem., 1915, 20, 263-313.

A study of prolonged fasting. Carnegie Inst.,

Washington, 1915, Pub. No. 203.

METABOLISM IN EXOPHTHALMIC GOITRE

Benedict, F. G.: A portable respiration apparatus for clinical
use. Boston Med. and Surg. Jour., 1918, 178, 567.

Benedict, F. G. and Carpenter, T. M.: Metabolism and energy
transformation of healthy man during rest. Carnegie Inst.,
Washington, 1910, Pub. No. 126.

Benedict, F. G., and Joslin, E. L.: Metabolism in diabetes mel-
litus. Carnegie Inst., Washington, 1910, Pub. No. 136.

A study of metabolism in severe diabetes. Carnegie Inst., Wash-
ington, 1912, Pub. No. 176.

Benedict, F. G., and Talbot, F. B.: The gaseous metabolism of
infants. Carnegie Inst., Washington, 1914, Pub. No. 201.

The physiology of the new-born infant. Carnegie Inst., Wash-
ington, 1914, Pub. No. 238.

Benedict, F. G., and Tompkins, Edna H.: Respiratory ex-
change, with a description of a respiration apparatus for clin-
ical use. Boston Med. and Surg. Jour., 1916, 174, 857.

Boothby, W. M., and Sandiford, Irene: Technic of basal meta-
bolic rates determinations. Philadelphia, Saunders, 1920.

Carpenter, T. M.: A comparison of methods for determining
the respiratory exchange of man. Carnegie Inst., Washington,
1915, Pub. No. 216.

Du Bois, D., and Du Bois, E. F.: The measurement of the sur-
face area of man. Clinical calorimetry. Paper V. Arch.
Int. Med., 1915, 15, 868-881.

Du Bois, D., and Du Bois, E. F.: A formula to estimate the ap-
proximate surface area if height and weight be known. Clin-
ical calorimetry, Paper X. Arch. Int. Med., 1916, 17, 863-871.

Haldane, J. S.: Methods of air analysis. London, Griffin, 1912.

Harris, J. A., and Benedict, F. G.: A biometric study of basal
metabolism in man. Carnegie Inst., Washington, 1919, Pub.
No. 279.

Krogh, A.: The respiratory exchange of animals and man (with
excellent bibliography). London, Longmans, Green & Co., 1916.

Lavoisier, A. L., and Laplace: Mémoire sur la chaleur. Mém.
de math. et de phys. de |’Acad. d. Se., 1780, 355.

Lavoisier, A. L., and Seguin: Premier mémoire sur la respira-
tion des animaux. Mém. de math. et de phys. de |’Acad. d. Sce.,
1789, 566. (Also: “Oeuvres de Lavoisier,’ 1862).

Lusk, G.: <A series of papers on clinical calorimetry by Lusk
and his associates appearing in Arch. Int. Med., beginning in
LOLS:

Lusk, G.: Science of nutrition. Philadelphia, Saunders, 3 ed.,
1917, 641 pp.

Means, J. H.: Basal metabolism and body surface. A contri-
bution to the normal data. Jour. Biol. Chem., 1915, 21, 263-268.

Meeh, K.: Oberflachenmessungen des menschlichen Korpers.
Ztschr. f. Biol., 1879, 15, 425-458.

Pettenkoffer, M.: Ueber die Respiration. Ann. d. Chem. u.
Pharm., 1862, 2, Suppl. 1.

Pettenkoffer, M., and Voit, C.: Untersuchungen tiber die Respi-
ration. Ann. d. Chem. u. Pharm., 1862, Suppl. 52.

Rubner, M.: Ueber den Einfluss der Kérpergrésse auf Stoff-und
Kraftwechsel. Ztschr. f. Biol., 1883, 19, 535-562.

Rubner, M.: Calorimetrische Untersuchungen. Ztschr. f. Biol.,
1885, 21, 250-334.

26.
27.

28.

7

SANDIFORD 87

Rubner, M.: Die Quelle der tierischen Warme (Comparison of
direct and indirect calorimetry). Ztschr. f. Biol., 1894, 30, 73.

Rubner, M.: Die Gesetze des Energieverbrauchs bei der Ernih-
rung. Leipsic, Deuticke, 1902, 426 pp.

Soderstrom, G. F., Barr, D. P. and Du Bois, E. F.: The effect
of a small breakfast on heat production. Clinical calorimetry,
Paper XXVI. Arch. Int. Med., 1918, 21, 613-620.

Tissot, J.: Nouvelle méthode de mésure et d’inscription du
débit et des mouvements respiratoires de ’homme et des ani-
maux. Jour. de phys. et de path. gen., 1904, 6, 688.

STRUCTURE OF THE THYROID AND ITS QUALITATIVE
VARIATIONS: A REVIEW. G. Vercellini, M. D., St. Paul,
Minn.

A promising field for productive investigation is that of
histochemistry. Although the tinctorial reactions by which cell
structure is commonly studied amount, in effect, to qualitative
chemical analyses, this fact has been little stressed. This pos-
sibly is due to the condition that investigators who utilize tissue
stains are usually interested primarily in morphology. Acecord-
ingly, stains are chosen primarily for their ability to reveal
structure and relative little attention has been paid to the funda-
mental chemistry involved.

There now are in use a large number of analytic procedures
which depend upon qualitative color reactions for determining
the composition of body products. Many of these would lend
themselves to the analysis of cell components. Such micro-
analyses might well add much to our knowledge of conditions
in the endoerine organs and their variations in health and dis-
ease.

An interesting series of studies in this field has been made
by Prof. Buseaino of the San Salvi Chinie at Florence. (1)

Several mental diseases (epilepsy, paresis, ete.) im which
a true condition of dysthyroidism exists, have not afforded con-
elusive histo-pathological findings in the thyroid, because,
Buscaino remarks, the research was turned to the size of the
acini, to the quantitative variation of the colloid, of the interal-
veolar connective tissue, to the proliferation of the epithelium
and so on, instead of to qualitative variations of the colloid and
of the elements apt to be found in it. Buseaino’s object in this
study has therefore been to look for such qualitative variations
and see if it were possible to give an anatomical basis to the de-
scribed conditions of dysthyroidism.

I. It was found that a first variation consists in real erys-
tals (octahedral) in the mass of the colloid. They are not
soluble in water, in alcohol, in acetone, in sulphuric ether, in
mineral acids, in acetic acid or in alkali. They do not take the
Sudan III stain. Therefore they are neither inorganic, nor fats,
nor carbohydrates. With the xanthoproteic reaction, Millon’s,
Lieberman-Wurster’s and Axenfeld’s tests they appear to be of
protein substance, and to contain, besides other groups, aromatic
groups with oxyphenylic structure. These crystals vary in size
(1) Buseaino (V. M.) Rivista di Patologia nervoso -e mentale

(Firenze), 1914-15, 19, fasc. 7-8; 20, fase. 2, 3, 4, 5, 10.

88

BUSCAINO-VERCELLINI 89

and are found in very few thyroids—usually in the normal, very
seldom in the chromophil colloid.

II. There are also calcium oxalate crystals, which never
appear in the octahedral form. They are to be found in the
colloid, more or less close to the epithelium. They are not found
in all thyroids and their number varies greatly.

Ill. Other erystals of organic nature have also been found
in the colloid. It has only been determined that they are not
amino-acid, uric acid, hippuric acid or xanthin. They have been
found only once in a case of Basedow’s disease.

IV. The colloid itself may vary; one of its modifications
we call ‘‘chromophil colloid” on account of its reacting to sev-
eral stains (Niblau, Mallory’s reaction) in a different way than
the normal colloid. It may fill the acini or appear only as an
admixture with the normal colloid in a small amount. Charac-
teristic is its way of never adhering to the epithelium, which is
usually low and often degenerated.

VY. The ‘‘Sudanophil’’ is another variation of the colloid.
With the Sudan III and Delafield hemotoxylin the normal col-
loid is bluish and the chromophil intense blue, while the Sudano-
phil is reddish yellow. It hardly gives a positive xanthoproteic
reaction and does not give the Millon’s. It is found in enlarged
acini and looks different from the normal and the chromophil
colloid. It can be found in the interalveolar spaces,—very often
where there are hemorrhages, which seem due to its toxic action
on the walls of the blood vessels.

VI. The colloid may also appear in a degenerated form as |
broken in fragments more or less broad, with regular margins,
mixed with detritus of epithelial cells.

VII. Granules of neutral fats and lipoids are also found
which, stained with Sudan III, become intensely red-orange.
They are believed to increase with the age of the subject. They
are never found in the new born. They begin to show during
early youth and their maximum is reached between 70 and 85.
They are increased in senile dementia.

VIII. Abnormal fatty substances are also found as doubly
refracting epithelial granules in the acinar epithelium; as. ethers
of cholestrol in the colloid and, finally, under conditions when
the whole epithelial protoplasm takes the Sudan III, a reaction
due to the presence of true lipoids, which are never found in
the normal condition.

IX. Dark granules are also found in the alveolar epithe-
lium which, by their reactions, are shown to belong to neither
fats, proteins nor carbohydrates. It is believed that they are
of melanotic pigment.

X. Granular inclusions are often found in the sudanophil
colloid, not necessarily accompanied by hemorrhage; they ap-

90 QUALITATIVE VARIATIONS OF THYROID

pear when acini are lacking. These granules may be of three
kinds, sometimes all together in one cell: (A) Sudanophil
granules, mostly constituted of neutral fat and lipoids; (B)
Black granules very similar to the ‘‘dark granules’’ (IX) ;

XI. (C) Thiophil granules (becoming violet-red with
thionin) which are very likely protein.

XII. Other substances may appear in the interacinar
spaces colored yellow-red with Sudan III, like the sudanophil
colloid.

XIII. Finally, infiltration of lymphocytes has been found.
This is supposed to be due to persistence of the thymus and
status lymphaticus.

As regards lymphocytosis in connection with thyroid dis-
orders, the author claims that the leukopenia observed in cases
of Basedow’s disease, with increase of the mononuclears, is not
characteristic of this disease, but is found in almost all abnormal
conditions of the thyroid. This condition seems to be due to a
reaction on the part of the thymus and of the lymphatic system
to any form of dysthyroidism ; in other words, whenever an in-
fectious toxemia can be excluded in cases of lymphocytosis it is
to be considered as an expression of an endocrinic toxemia, 1.€.,
a functional variation of thyroid, thymus and lymphatic sys-
tems.

In eases of simple goitre Buseaino found dilated acini, suda-
nophil colloid and hemorrhages. No protein crystals, no, or
very little, chromophil colloid, and no calcium oxalate crystals
were found.

In cases of Graves’ disease, extreme diminution of the nor-
mal colloid, the presence of sudanophil and chromophil colloid,
and absence of protein crystals and of calcium oxalate were
noted.

From the post-mortem examination in cases of epilepsy,
paresis, dementia precox, senile and arteriosclerotic dementia
and amentia, the author came to the conclusion that all these
forms (in which the patients showed more or less evidence of
dysthyroidism while living) show the presence of chromophil
colloid. Without being pathognomonic for any of these forms,
such colloid seems to have a special importance in eases of
paresis.

The crystals of calcium oxalate show only an active par-
ticipation of the thyroid in calcium metabolism. They were
found mostly in eases of dementia precox.

The octahedral protein erystals have a special significance
in epilepsy. It was found that the cases of essential epilepsy
showed signs of dysthyroidism; microscopic examination dis-
closed chromophil colloid and octahedral crystals of protein.
In cases of symptomatic epilepsy the findings were negative.

BUSCAINO-VERCELLINI 91

To summarize: Chromophil colloid and sudanophil colloid
were found in nearly all cases of mental disease which offered,
during life, symptoms of dysthyroidism; the calcium erystals
were seldom found and then, almost exclusively in dementia
precox; the octahedral protein crystals were found in eases of
epilepsy or other diseases with epileptic seizures.

In a study of the corpuscular variation of the blood in epi-
lepsy and the psychoses the author could find variations of the
formula in almost all forms. But the variations were not so
constant as to afford any definite pathognomonic data. He
found, though, that in epilepsy (in two-thirds of the cases) there
was a very definite eosinophilia. Such condition of the blood
seems always to be determined by disintegration and successive
parenteral penetration of foreign or homologous proteins into
the blood.

Owing to the frequency of eosinophilia in epilepsy, to the
finding of crystals of protein in these cases and to the conclu-
sions drawn by Schlecht, Schwenker, Ah] and Schittenhelm that
the eosinophilia has a great importance in the phenomena of
anaphylaxis, representing as it does the reaction of the organism
against foreign or homologous protein, when it enters parenter-
ally into the circulation, the author was brought to look for any
possible analogy between epilepsy and anaphylactic shock, and
to see if epileptic attacks could not be considered as an anaphy-
lactic reaction of the organism against the penetration of abnor-
mal protein from the thyroid. He therefore draws a parallel
between the symptoms offered by these two conditions (epilepsy
and anaphylaxis) which leads him to the conclusion that the
‘epileptic seizures offer the symptoms of an anaphylactic crisis,
determined by intoxication of either peptones or substances
resembling peptones in their protein Beaesis and in their toxic
effects.

Of course not all the cases having epileptic attacks show
protein crystals (as has been noted in a previous paragraph
in regard to the difference between essential and symptomatic
epilepsy) and not all the cases showing protein crystals have
epileptic seizures. But in this case we must not forget that first,
the eosinophilia, when present, can counteract the epileptic at-
tack; second, that to obtain an anaphylactic condition there is
required a certain amount of toxie substance which, besides, in
its repeated action must enter the circulation at not too brief
intervals in order to permit sensitization of the organism.

In studying paresis Buscaino found in every case the pres-
ence of chromophil colloid and came to the following conclusions:

1. Among the anatomo-pathological findings of dysthyroid-
ism in paresis the chromophil colloid is the expression of a qual-
itative alteration of the thyroid function, leading to intoxication

92 QUALITATIVE VARIATIONS OF THYROID

of the organism and ultimately to hypofunction of the thyroid.
2. The chromophil colloid is not the cause of the disease, but an
effect of it. 3. Its formation seems to be an effect of the lesions
which determine the paralytic process and consequent formation
of special cerebral toxic substances. 4. The chromophil colloid
has been found in all cases of paresis studied. 5. The forming
of the chromophil colloids is the starting point of the alteration
of metabolism through alteration of other endocrine glands.
There may be a predisposition to favor the incidence of thyroid
complications. 6. Paresis is a cerebral spirochetosis which de-
termines dysthyroidism which in its turn brings about organie
decay. 7. Also, in paresis the epileptic seizures represent an-
aphylactie crises. In all these cases protein crystals have been
found. 8. The association of thyroid treatment with specific
antiluetic treatment helps to diminish the intensity of the Was-
sermann reaction (blood and spinal fluid).

Finally, a study was made of the possible alterations in the
blood serum in connection with the presence in the thyroid, and
probable introduction into the circulation, of the protein crystals
and of the chromophil colloid, which both were proved to contain
a substance with oxyphenylhe structure (oxybenzoic).

Believing that the organism usually reacts against the pres-
ence of abnormal substances with the production of specific fer-
ments, an attempt was made to determine if there were forma-
tion in normal serum of phenolysins for substances with cyclic
groups with oxyphenylic structure; and if so, what kind of
variation exists in cases where such substances were found in
greater amount, as in epilepsy and paresis.

The ability of the blood serum to bring about oxidation of
hydroquinon was investigated. Although the reaction was posi-
tive, the effect was not due to a real ferment, since this ‘‘phe-
nolysin’’ kept its power after heating to 100° ©. for a few min-
utes, and after precipitating the blood proteins with 96% alcohol
filtering and boiling for ten minutes.

The conclusions were as follows: In normal conditions the
human blood serum has in vitro a powerful oxydizing action on
hydroquinon, due to a substance scluble in 96% alcohol and
thermostable; this power increases a great deal in cases of
paresis, and to a less extent in epilepsy—that is, the oxydizing
power is more marked during the interacessual periods, less
before the seizure.

Owing to the fact that in these two diseases in which eyclie
groups with oxybenzolie structure are found, the blood serum
offers an increased oxydizing power toward such substances, the
author asks if it might not be possible, with the above quoted
reaction, to recognize in vivo the presence of these qualitative
thyroid variations.

BOOK REVIEW

PATHOLOGICAL PHYSIOLOGY OF THE THYROID AND
THE THYMUS IN RELATION TO INFECTIONS (FISIO-
PATOLOGIA DELLA TIROIDE E DEL TIMO NEI RAP-
PORTI CON LE INFEZIONI). Mario Barbara, R. Universita
di Palermo. Societa Editrice Libraria, Milano, 1918, pp. 260.

The book is based on an extensive consideration of the liter-
ature, a long bibliography of which is included, together with
personal researches by the author. In the introduction are con-
sidered the relations which exist between the endocrine glands
and infections and the relations of the thyroid and the thymus.

The first section of the thesis, proper, takes up a study of
the thyroid in relation to infections. The gland has a defensive
action against such. After thyroidectomy animals show a con-
siderable degree of diminution of effectiveness of the immuniz-
ing mechanisms, as complement, bacteriolysins, opsonins and
phagocytic power of the leucocytes. Through its relation with
the liver and kidneys also the thyroid affects resistance. His-
tologic changes in these organs can be demonstrated after dis-
turbances of thyroid funetion as in myxedema, cretinism and
exophthalmic goitre, as well as after acute and chronic infec-
tions, which the author believes particularly influence the thy-
roid. In these conditions he has found either progressive thy-
roid metamorphosis (epithelial cell proliferation, increase of
secretory granules and of colloid, accumulation of lymphocytes,
etc.) or of regressive metamorphosis manifested as_ sclerosis,
atrophy, alterations of the colloid and epithelial degeneration.
These changes in turn lead to thyrogenic symptoms which vary
more or less in accordance with the nature of the infection.

In the second part of the book the author summarizes a
series of studies on thymectomised guinea pigs, as regards the
phagocytic power of the leucocytes, and the complementary,
opsonie and agglutinating power of the blood serum. It is con-
cluded that in the thymus originate substances which stimulate
phagocytosis; such substances can be demonstrated in extracts
of the gland. It either forms complement or through its hormone
influence on other structures stimulates complement formation.
Similarly, it can be shown to form or augment the formation of
opsonins, but apparently has no essential part in the formation
of agglutinins. Neither does it play a significant role in the
resistance to chloroform poisoning, as has been previously
claimed. Thymectomy results in a loss of balance among the
defensive mechanisms of the body but, later, compensatory
changes take place in other structures to restore the balance.
The opsonic power of the serum was found, however, to remain
permanently lowered after thymectomy.

93

94 THYROID AND THYMUS IN INFECTIONS

Anatomically, it was found that, following infections, the
thymus reacts as do lymphoid organs and that ordinarily atrophy
results. On this basis the question is raised whether primary
thymus insufficiency may not be one of the conditions predis-
posing to infections. It is pointed out that in such conditions
as pregnancy and starvation, when infection is more prone to
occur, thymus atrophy is seen. As signs pointing to thymus
insufficiency Barbara mentions trophic changes in the skin,
cachexia, muscular atrophy and weakness, metabolic perturba-
tions—especially of calcium metabolism in tubereulosis, ete. He
describes the syndromes of ‘‘athymism,’’ ‘‘hypothymism,’’ status
thymolymphaticus and the exudative diathesis of Czerny and
then the corresponding opotherapy.

Thymic dysfunction is ascribed partially to infections in
the parents. Such dysfunction leads to greater liability to some
infections than to others. For instance, in Barbara’s experience,
tuberculosis is rare in individuals having thymus hyperplasia
whereas, conversely, in cases of active tuberculosis, thymic
atrophy is marked. Such atrophy, it is claimed, cannot in many
cases be ascribed to the general wasting effect of the disease, be-
ing noted at a stage when time has not sufficed for such effect.
It appears to the reviewer, however, that there is nothing so
definite in the thymic changes recorded as to force upon us the
conviction that they are specifically causal rather than a part
of the general effect of disease in the organism.

Other objections to Barbara’s conclusions might be offered.
The inflammatory changes of the thyroid in acute infections, and
sclerosis, atrophy and degeneration in chronic diseases would
‘ather point to a non-specific reaction. In regard to the thymus,
if we consider it as a lymphoid organ, it is evident that, in case
of its suppression, there comes a greater strain on the lymphatic
system; this may account for the lowered resistance of the or-
ganism as well as its subsequent recovery of balance after a cer-
tain length of time. Furthermore, even admitting that the
thymus is not precisely a transitory organ, still its size and
function undergo with age a remarkable diminution, but there
is ordinarily no consequent impairment of organic resistance.
The early disappearance of the thymus seems to be an occurrence
common to all wasting diseases, rather than a pecuharity of tu-
berculosis and, as yet, we cannot state whether the disappearing
thymus opens the door to the infection, or the infection makes
the thymus disappear.

Notwithstanding the several points, which may be open to
discussion, this work of Prof. Barbara shows a thorough knowl-
edge of the literature and his diligent research opens new fields
to the activity of investigators.

G. VERCELLINI.

ABSTRACTS

(ADRENAL) Sergent’s ‘‘white line’’ in suprarenal insuffi-
ciency. Anon, Lancet (Lond.), 1918 (ii), 713-714.

An abstract of an article by Prof. Massalongo in which he
deseribes the attempt to produce the white line in 400 cases
of various diseases. The line was found in an unequivocal form
in only 300 cases; the majority of these were typhoid or para-
typhoid. Because of its rarity, inconstaney and transiency and
because of its presence or absence in equal proportion in cases
where changes in the suprarenal capsules are indisputable, he
eredits the white line with only a relative diagnostic 1mpor-
tance and does not consider it as pathognomic. It has, how-
‘ever, some value from a prognostic point of view, since its
maximum frequency is met with in cases of serious import
with almost invariably a fatal issue. See Endoerin., 1917, 1,
18-23.—L. G. K.

(ADRENALS) A case of Addison’s disease with unusual
onset. Anon., Guy’s Hosp. Gaz. (Lond.), 1918, 32, 286.

Report of sudden collapse and death of a patient three
months after a radical mastoid operation. Previous to the col-
lapse no particular abnormalities could be detected in any
system. The collapse was accompanied by a fit, with twitch-
ings of the limbs on the right side, and later, with rigidity on
same side. This was followed by unconsciousness. Rupture of
a cerebral abscess was thought of, but the cerebro-spinal fiuid
was clear. The patient died next day and at autopsy the only
abnormality found was enlargement of the suprarenal bodies.
These were 214 inches long and 14 inch broad. On section no
cortex was to be seen. In the medulla there were large case-
ating nodules; no normal suprarenal tissue was seen at all.
The only pigmentation was a slight coloration on the internal
aspect of the thigh.—F. 8. H.

(ADRENALS) A case of Addison’s disease from the surgical
wards. Anon., Guy’s Hosp. Gaz. (Lond.), 1918, 32, 286-287.

A patient had a septic tarsus (tubercular), the X-ray show-
ing well marked bone destruction and no bone formation.
The previous history revealed broncho-pneumonia with slow

95

96 ABSTRACTS

recovery, total alopecia and a feeling of lassitude during the
past three years. Preliminary to amputation, phthisis was
found in right lung. Though reacting unfavorably to the
continued anesthetic he came out and did well for 18 hours,
but suddenly collapsed and died of cardiae failure in about ten
minutes. The autopsy demonstrated an extensive tubercular
involvement of the whole body. Particularly to be noted were
the enlarged adrenals filled with typically caseous tuberculous
material.—_F.. 8. H.

ADRENALS, Nervous control of the secretory function of
the—(Die Innervation der Nebenniere durch den Splanch-
nicus). Asher (l.), Arch. f. d. ges. Physiol (Bonn), 1917,
166, 372.

Asher points out, against the criticism made by Popielski,
that in his experiments on the effect of splanchnic stimulation
pressure upon the adrenals was carefully avoided. He, there-:
fore, still maintains that the secretory function of the adrenals
is controlled through the splanchnie nerve.—E. U.

(ADRENAL) The action of adrenalin on blood pressure (Die
Blutdruckwirkung des Adrenalins). Bauer (J.), Deutsche
med. Wehnschr. (Berlin), 1919, 45, 1217.

On page 955 of the same journal Dresel published an ar-
ticle in which he stated that the blood pressure reaction after
adrenalin injection affords a good eriterion to distinguish nor-
mal individuals from those having vagotonia and sympathico-
tonia. Bauer discusses Dresel’s article and comes to the con-
clusion that the method indicated has no value. But we do
not need a method for this purpose, as, also according to Bauer,
the existence of ‘‘vagotonia’’ and ‘‘sympathicotonia’’ has
never been proved and is extremely improbable.—J. K.

(ADRENALS GONADS) Tumor of the adrenals and destruc-
tion of the gonads in a man (Nebennierentumor und Gesch-
lechtsdriisenausfall beim Manne). Bittorf (A.), Berl. klin.
Wehnscehr., 1919, 56, 776.

Description of a remarkable case. A man of 26 years no-
ticed that his sexual desires had diminished. The testicles
became atrophic and at the same time a tumor developed in
the abdomen. The breasts hypertrophied, resembling the fe-
male type. The urine contained red and white blood cells,
casts and large cells. The skin showed but little pigmenta-
tion. The diagnosis, hypernephroma, was confirmed by post-
mortem examination.—J. K.

ABSTRACTS on

- (ADRENAL) Acute suprarenal disturbance in the course of
hereditary syphilis with a polymorphic erythema (Sur-
rénalite aigué dans le cours d’une syphilis secondaire et a la
suite d’un erytheme polymorphe). Blum, Bull. Soe. Méd. des
Hop. (Paris), 1916, 40, 1767-1774.

A ease report.—A. L. T.

(ADRENAL) Influenza as a cause of acute Addison’s disease
(Grippe als Auslosungsfaktor von akutem Addison). Bru-
necke, Therapeutische Monatshefte (Berlin), 1919, 33, 354.

A remarkable case. A girl of 12 years with tuberculosis of
the lungs and of the ulna gets influenza. Acute Addison’s dis-
ease with pigmentation of the skin (not of the mucous mem-
branes), enormous weakness, apathy and a blood pressure of
70 mm. develops. The child becomes so extremely weak that
she cannot sit up alone in bed. Following treatment with
*‘partial antigens’’ (Deyke-Sluck), the blood pressure rose,
the child regained strength, the pigmentation began to disap-
pear and after some time the child was able to play again in
the garden.—J. K.

ADRENAL, enlargement of—in starvation. Byrne (C. H. C.)
Brit. Med. J. (liond.), 1919 (31), 185.

The author noted that in a series of eight autopsies on
soldiers who had died from underfeeding in a German prison
camp, the adrenals were enlarged to almost one and a half
times the normal size. The enlargement seemed, from naked-
eye appearance, to be mostly in the cortex.

The suggestion is made that the adrenals had hypertro-
phied to counteract the low blood pressure produced through
insufficient nourishment. The author is apparently unfamiliar
with the more recent work on the subject of the effect of the
adrenals on blood pressure.—hL. G. K.

(ADRENAL) On the clinical evidence of involvement of the
suprarenal glands in infiuenza and influenzal pneumonia.
Cowie (D. M.) and Beaven (P. W.), Arch. Int. Med. (Chgo.),
1919, 24, 78-88.

Necrospy reports indicate hypoplasia and evidence of su-
prarenal dysfunction following influenza. The occurrence of
suprarenal dysfunction in influenza and influenzal pneumonia
may be regarded as indicated by the cardinal symptoms—
asthenia and low blood pressure—the characteristic rise in
blood pressure following the prolonged administration of epine-

98 ABSTRACTS

phrin, and the prolonged blood pressure curve following epi-
nephrin injections. Further, the prolonged blood sugar curve
after injection of epinephrin and the prolonged sugar curve
after the ingestion of glucose also indicate an endocrinal dis-
turbance in influenza. Hypoglycemia is not present in influ-
enza or influenzal pneumonia as has been found to be the case
in certain diseases of endoerinal origin. The administration
of epinephrin is of no use in the treatment of influenzal cases.
Possibly the proper method of administration has not been
evolved; subcutaneous injections of epinephrin is valueless.

—H. W.

(ADRENAL PINEAL HYPOPHYSIS) The effects of some
glandular extracts upon the contractile vacuoles of Para-
mecium caudatum. Flather (M. D.), Biol. Bull. (Woods
Hole), 1919537, 22:

This paper describes a series of experiments to determine
the influence of some glandular extracts upon the contractile
vacuole of Paramecium caudatum. An exhilaration of pulse
frequeney was produced by solutions of pituitary substanee,
adrenalin and pineal extract, the extent and duration being de-
pendent upon the concentration of the solution. The greatest
exhilaration was produced by pituitary substance, the least by
pineal extracts. The author believes that the stimulation is
produced, not by the direct effect of the autacoid principles
upon the vacuole itself, but by the indirect effect of height-
ened metabolism in the entire organism. The vacuoles become
more active in compensation for this increase in metabolism.
A review of the literature giving the nature and function of
the contractile vacuole is given. (Author’s abstract.)

Shumway had previously shown that thyreoid substance
placed in cultures of Paramecium also will hasten metabolism,
but he called the activating principle of the thyreoid a “‘dis-
similatory’’ hormone. The idea expressed by the present
writer is probably more accurate than that of Shumway.

—E. R. H.

(ADRENAL) Da asthenia suprarenal. de Fonseca (J. M.),
Arch. Brasil. de Méd., 1919, 9, 149-163; Physiol. Abst., 4, 340.

The author by means of electric stimuli exhausted the
gastroenemius muscles of frogs and determined that by the
injection of adrenin into the tissue mass the muscle could be
immediately restored. Curare injected simultaneously with
adrenin at once loses much of its effect. From these results
and those of other investigators de Fonseea accepts the theory

ABSTRACTS oo

that adrenin neutralizes the products of muscular activity,
preventing their curare-like effects. Similarly, the asthenia
observed in certain pathologie conditions is regarded as due
to a failure of the adrenal glands to secrete adequately.

—R. G. H.

(ADRENALS) Syndrome of incipient or abnormal Addison’s
disease with presence of ‘‘white line of Sergent’’ (Syndrome
d’addison fruste avec présence de la ligne blanche).
Mussio Fournier (J. C.) and Sergent (E.) Bull. Soe. Méd. des
Hop. (Paris), 1919, 43, 207.

An atypical ease of Addison’s disease, characterized by
acute abdominal pains, pigmentation on skin areas normally
subjected to pressure and in the sclera and buccal mucosa. A
history of serofulous glands existed. There was a high degree
of sugar tolerance, failure of appearance of glycosuria after
ingestion of 200 gm. of glucose, or after injection of 3 mg. of
epinephrine.

Treatment: 40 gtt. adrenalin per day was followed by
disappearance of vomiting, diarrhoea, and for the most part
pain and fall of heart rate from 120 to 80. However, the heart
continued to be very unstable as, under effort, the rate would
rise to 130 to 140, yet without serious fatigue or feeling of
weakness. The ‘‘white line’’ of Sergent no longer appeared.

—A. L. T.

(ADRENAL) The relation between central nervous system,
adrenals and carbohydrate metabolism. A discussion of the
problem: Sugar puncture and adrenals (Uber die nach zen-
traler Reizung zur Storung des Kohlehydratstoffwechsels
fiihrenden Vorgange. Eine kritische Studie zur Frage:
Zuckerstich und Nebennieren). Kahn (R. H.), Arch. f. d.
ges. Physiol. (Bonn), 1917, 168, 326.

A discussion of experiments relating to the role of the
adrenals in the glycogen mobilization occurring after sugar
puncture. It was concluded that both the glycolytic ability of
the liver cells and the adrenalin excretion by the adrenals are
controlled, through the splanchnic nerve, by the central ner-
vous system. Sugar puncture makes the liver cells more sensi-
tive to the action of adrenalin and increases adrenalin secre-
tion. Therefore a slight increase of the glycogen mobilization
may take place after sugar puncture also in the absence of the
adrenals, while in their presence glycogen mobilization after
sugar puncture is far more marked. The mobilization of sugar
after sugar puncture demonstrates one of the physiological

100 ABSTRACTS

activities of the adrenals, the funetion of which is probably to
regulate carbohydrate metabolism under the control of the
central nervous system.—KE. U.

ADRENAL glands, The effects of a scorbutic diet on the—.
McCarrison (R.), Brit. Med. J. (Lond.), 1919, (11), 200.

The effects of a scorbutie diet on the adrenal glands were
studied in guinea-pigs fed on crushed oats and autoclaved
milk. The naked-eye changes consist in enlargement of the
adrenals with increase in their weight and in congestion. The
weight of the adrenal glands of animals dying in consequence
of the scorbutie diet is approximately double that of health.
The increase in weight is even more marked when the weight
of the glands is caleulated per kilo of original and final body
weights.

Microscopically hemorrhagie infiltration and disintegra-
tion of the cellular elements of the cortex and medulla are
seen. The areas of hemorrhagic infiltration are situated around
the periphery of the cortex. These changes are regarded as
pre-scorbutie, since they occur in animals exhibiting no clinical
evidences of scurvy during life.

The adrenalin content of the glands (estimated by the
method of Folin, Cannon and Dennis) is less than half that
present in healthy guinea-pigs, in spite of the greater weight
of the organs.

It is pointed out that normally the total adrenalin per
gram of gland in pigeons is approximately ten times greater
than in guinea-pigs. The author has previously shown that a
ereat inerease in the adrenalin content of the adrenals occurs
in pigeons deprived of accessory food factors of all classes
(Endoerin. 1919, 3, 201-2). He now finds that when vitamines
of the ‘‘A’’ class in the form of fresh butter are added to the
diet, an increase of adrenalin does not as a rule oceur. He
therefore concludes that lack of accessory food factors of the
‘“A’’ class causes excessive production of adrenalin associated
with oedema in aves, and that in guinea-pigs the lack of
factors of the ‘‘C’’ class causes diminished adrenalin produe-
tion associated with hemorrhage into the body tissues.

ty G. Ke

The ADRENAL glands and toxi-infections. Marie (A.), Ann.
inst. Pasteur (Paris), 1918, 32, 97-110.

Tetanus toxin can be rendered innocuous for mice by mix-
ture and incubation with adrenalin. Simultaneous injection of
adrenalin with the toxin does not, however, prevent the onset

ABSTRACTS 101

of symptoms. Mixture and incubation must precede injection.
Such mixtures retain the power of producing specific antitoxin
on injection into rabbits. Tetanus toxin, non-diffusible in the
pure state, dialyzes after contact with adrenalin, the dialysate
being capable, on injection, of producing specific antibody, but
not of causing tetanus.—Chem. Abst. 13, 3233.

(ADRENAL) A study of hyper-adrenalism; its influence in
producing congenital pyloric hypertrophy and subsequent
obstruction. Pirie (G. R.), Lancet (London), 1919, (ii),
513-515. |

The author suggests that congenital pylorie hypertrophy
is the result of spasm primarily due to hyper-adrenalism before
birth, and that other subsidiary post-natal causes determine
the persistence or recurrence of the spasm. This condition is
supposed to be due to a lack of balance between the secretions
of the various endocrinic organs in the process of their develop-
ment and involution, which may result either in a relative or
an absolute hyper-adrenalism.

Phimosis is mentioned as one cause contributory to the
pyloric hypertrophy and the phimosis is supposed to be due to
a precocious sexual development resulting from slow involu-
tion of the suprarenals. Hyper-adrenalism is also suggested
as a cause of pancreatic insufficiency. The consequent absence
or reduction of the alkaline pancreatic secretion, which nor-
mally neutralizes the acid chyme in the duodenum, allows the
pylorus to remain closed longer than usually. This again tends
to produce hypertrophy of the sphincter muscle.

The hypothesis is entirely speculative and no real evidence
is offered in its support. The author evidently forgets that in
fetal life the cortex rather than the medulla is hypertrophied
when he advances the large size of the fetal adrenal gland as a
possible: cause of hyper-adrenalism.—lL. G. K.

(ADRENAL) Adrenin and Adrenals. 1. The Presence of
adrenin in the venous blood of the adrenals the result of
pressure exerted upon the adrenals. (Adrenalin und Neben-
nieren. 1. Komprimierung der Nebennieren und Adrenalin.)
Popielski (L.), Arch. f. d. ges. Physiol. (Bonn), 1916, 165,
565.

The fact that adrenalin is found in the venous blood of
the adrenals is no proof of the adrenalin being the product of
a secretory activity of these glands. First, it seems that
adrenaiin occurs, not as free secretion, but enclosed in the
parenchyma cells of the adrenals. Second, these cells can be
pressed through the walls of the vessels by means of the

102 ABSTRACTS

slightest pressure exerted upon the adrenals, and such a pres-
sure cannot be avoided in handling the glands. P.’s experi-
ments show that compression and even the slightest touch upon
the adrenals is sufficient to make adrenalin appear in the
circulation. In dogs, after cutting the spinal cord in the region
of the medulla oblongata, the splanchnic and the sympathetic
nerves, pressure exerted upon the adrenals resulted in a
considerable increase of the blood pressure, which was the
higher the more pressure there was exerted and the longer it
lasted. Defibrinated blood obtained from the circulation of the
dog after the pressure experiment increases the blood pressure
of the rabbit injected with the blood, and, added to Tyrode’s
solution, it abolishes tonus and contractions of the isolated
intestine. The possibility that the increased blood pressure
was the result of a stimulation of the peritoneal membrane was
excluded by cutting the medulla oblongata and the splanchnic.
P. finds that stimulation of the sympathetic, even in the ab-
sence of adrenalin, causes a rise of the blood pressure similar
to that resulting from compression of the adrenals; the action
of the sympathetic is independent of adrenalin. Yet, in the
above deseribed experiments the rise of the blood pressure was
actually due to compression of the adrenals and not to stimu-
lation of the splanchnic nerve; this was made sure by especially
careful experimentation. If the aorta is compressed for one
minute, the pressure in the carotid artery rises very high;
sudden removal of the clamp from the aorta results in the
production of a rapid flow of blood through the adrenals,
which would carry adrenalin accumulated in the vein of the
adrenals into the general circulation and make the blood pres-
sure rise. No rise, however, took place in this experiment. It
was concluded that adrenalin is not an internal secretion of
the adrenals, since it is not exereted by the adrenals and is
found in the cireulation only when pressed out of the paren-
chyma by compression of the glands. The function of the
adrenals is to detoxicate the blood by removing adrenalin
and storing it in the parenchyma of the glands in the form of
an unstable compound. If the cells containing this compound
are pressed through the walls of the vein of the adrenals, the
adrenalin ean be broken away from this compound by the CO,
of the venous blood.—E. U.

(ADRENAL) Adrenin and the Adrenals. II. Normal blood,
nervi splanchnici and adrenin (Adrenalin und Nebennieren.
II. Normales Blut, Nn. splanchnici und Adrenalin). Popielski
(L.), Arch. f. d. ges. Physiol. (Bonn), 1616, 165, 581.

Blood, taken from the vena cava inferior by means of a

ABSTRACTS 103

device which secured blood coming from the adrenals only
and yet did not permit of compression of the adrenals, was
carefully defibrinated and injected through the vena jugularis
of the animal from which it was taken. It did not raise the
blood pressure, but on the contrary, like defibrinated blood of
all organs, decreased it. The adrenals, therefore, do not excrete
the adrenalin into the circulation. In order to determine
whether or not the sympathetic nerve controls secretion of
adrenalin, the sympathetic was stimulated under conditions
which avoided any compression of the adrenals. Such stimula-
tion caused no exeretion of adrenalin; blood taken from the
animal during stimulation of the nerve did not increase blood
pressure if injected into circulation. PP. eriticizes severely
Cybulsky’s experiment, according to which adrenalin acts
upon the central nervous system, and claims that its action is
purely peripheral. But, since under normal conditions the
tonus of the vessels is actually controlled by the central nerv-
ous system, P. thinks that adrenalin has nothing to do with
normal maintenance of the tonus of the blood vessels.—E. U.

(ADRENAL) The excretory innervation of the adrenals. A
critique of the work of Asher, Elliot, Cannon and de la Paz,
Anrep, Tscheboksareff, and Kahn and Eiger (Uber die
sekretorische Innervation der Nebennieren. Kritische Bem-
erkungen iber die Arbeiten von, Asher, etc.). Popielski (L.),
Arch. f. d. ges. Physiol. (Bonn), 1918, 170, 245.

A eriticism of various papers, maintaining the standpoint
that adrenalin found in the blood during stimulation of the
splanchnic nerve entered the circulation, not because of the
stimulating effect of the splanchnic upon adrenalin excretion,
but because it had been forced from the adrenals into the
circulation by pressure exerted upon the glands in the course
of the experiment.—E. U.

(ADRENAL) Addison’s disease of war (L’addisonisme de
guerre). Ramond (F.) and Francois (R.), Bull. Soe. Méd.
des Hop. (Paris), 1917, 41, 1001.

From a series of studies the authors conclude that it is
extremely probable that Addison’s disease as observed in, and
initiated by, stress of war is in all cases ultimately tubercular
in origin. This tuberculosis may be secondary to any other
latent or active focus, and is but rarely primary.—A. L. T.

104 ABSTRACTS

(ADRENAL) A case of hypoadrenia simulating intestinal
obstruction. Rashbrook (H. M.) and Carter (F. W.), Lancet
(Lond.), 1918, (ii), 240.

A ease is deseribed of tuberculous destruction of the
suprarenal glands, the symptoms of which were repeated at-
tacks of epigastric pain and vomiting, accompanied by con-
stipation. The patient was weak and had a temperature of
95° F. and a pulse of 110. There was no pigmentation. <At
autopsy the suprarenal glands were found to be almost com-
pletely replaced by caseous masses, and the few remaining
cortical cells showed cloudy swelling.—lL. G. K.

(ADRENAL) A case of coexisting suprarenal and renal disease
of uncertain origin. Sparrow (H. G.) and Soden (W. S8.),
Brit. Med. J. (Lond.), 1919, (ii), 461-462.

The patient, a British soldier in Palestine, was admitted
to hospital with weakness, vomiting and night blindness. He
appeared very weak and anemic. Blood films were negative
for malaria. He had occasional attacks of pyrexia. The blood
pressure was low. The urine contained albumin. Some two
weeks after admission a blotchy purpurie eruption appeared
on the chest, abdomen and extremities. Acetone was then
detected in the breath, and the patient vomited a large ascaris
worm. The acetone odor then gradually disappeared. The
deep reflexes were gradually lost and abnormal skin pigment
became evident. There was slight leucoeytosis, with a relative
increase in polymorphonuelears. The patient was treated with
quinine through the greater part of the illness. He died about
two months after admission.

The autopsy showed a narrow, atrophied suprarenal cortex
and no trace of medullary substance unless represented by
some fatty spaces. The kidneys showed a certain amount of
degeneration. The intestine showed numerous purpuric¢
patches, with evidence of recent bleeding. No worms were
present.—L. G. K.

ADRENIN, Action of—on the spleen (Milzwirkung des
Adrenalins). Schenk, Deutsche med. Wehnsehr. (Berlin),
1919, 45, 1037.

In eases of haemolytic icterus the author injected adre-
nalin. Twenty minutes after an injection the enlarged spleen
returned temporarily to its normal size. The injection of
adrenalin is quite useful to distinguish an enlargened spleen
from other tumours (tumours of left adrenals or left kidney).

—J. K.

ABSTRACTS 105

(ADRENIN HYPOPHYSIS PANCREAS) Action of organ ex-
tracts on induced hyperglycemia (Action des extraits d’or-
gans sur l’hyperglycémie provoquee). Achard (Ch.), Ribot
(A.) and Binet (Leon), C. R. Soe. de Biol. (Paris), 1919,
82, 788; Abst. Presse Méd. (Paris), 1919, 27, 401.

The authors produced hyperglycemia in dogs by intrave-
nous injections of glucose. They conelude that the rate and
duration of the hyperglycemia depends on the quantity of
glucose injected. It is particularly clear in regard to duration.
£0.50 gm. of glucose per kilo. body weight is given, the
ayperglycemia lasts 20 minutes; if 1 gm. per kilo. is given, the
luration is 40 minutes. Having determined this, they tried

1e effect of injecting the active principle of various organs.

Adrenalin. They first injected 3.5 gm. glucose; two days
ater, 1 mgm. adrenalin; two days later still, 3.5 gm. glucose
pus 1 mgm. adrenalin. The figures show that the addition of
drenalin causes an increase in the blood sugar greater than
the sum of the increases obtained with glucose alone or adrena-
fin alone. The duration of the hyperglycemia was also pro-
longed, as if under the influence of adrenalin the organism was
incapable of fixing or burning the sugar.

Extract of Hypophysis. Injection alone causes a slight
hyperglycemia. Sugar plus hypophysis increases the hyper-
glycemia, but not to the same extent as in the case of adrena-
lin; the rate more than the duration is affected.

Pancreas. Commercial extracts alone, or associated with
slucose, have no effect. Extracts of fresh pancreas added to
the glucose injected causes a diminished hyperglycemia, both
in amount and duration.

Added to the glucose-adrenalin mixture, pancreas extract
inhibits the action of adrenalin. The same is true when hypo-
physis is used instead of adrenalin.—T. C. B.

(ADRENIN) Hemorrhage and adrenalin. Remarks on the vas-
cular reaction to infinitesimal doses (Hémorrhagie et Adrén-
aline. Remarques sur la réaction vasculaire aux doses infini-
tésimales). Bardier (E.), C. R. Soe. de Biol. (Paris), 1919,
82, 758.

The observations of Rous and Wilson (see Endoerin. 1919,
&. 188) are confirmed in all points. Hemorrhage causes a
diminished pressor response to minute doses of adrenalin.
(Does ftinis mean augmentation of the depressor component
of the rea@tion ?—Ed.)—T. C. B.

(ADRENIN) Hemorrhage and adrenalin. Remarks on the
cardio-vascular reaction to large doses (Hémorrhagie et

se —_ “ — 2
2aréiz 0° Eemaroues sur le réaction cardio -vasculaire aux
fog. Aras 5 = — <* = =»
lortes dose, Bardier (E_). C_ B. Soe de Biol (Paris), 1919.

-.2_ifihe pressure bemg nearly zero. the respiratory
svererts Bing pearly disappeared. and with premorial
‘2rl2c 1+ 20§tion, It is possible, by injectmg 016 mem of
ir-enzln pele bedy weisht_ to observe am energetic cardio

In -2= @& after Dieeding to the extent of 67% of the

: _ This, m strengthenme the heart action. favors
n+ resimp-ig@ ef the respiratory rbythm and augments the
=} : mival of the animal. if at the same time we give
- 1-7 2° 2>ijelal serum or transfusion. The conclusion is
that ithe ability of the cardiovascular system to e
doses of glin im the dog decreases with the epee of
- Lemorrog®, bat dees not disappear until the ““ ode
time | aqpersistenee of this irritability may be of 7 prot
_ ins treatoulit of hemorrhace —T_ C. B.

ADEENIN, gsphenmamine and WNeoarsphenamine plus—
B b.@), Am. J. Syphilis, 1919, 3, 129.

gther’s purpose to emphasize the use of adre-
Satment of the “‘nitroid erisis”’ and “serous
DOT *filan. The literature is collected which tends
to pla Gelogy of these two conditions largely m an
zdire wency. The evidence upon which this conception
r-sts is: 1 fre is a similarity of symptoms m these con-
: Geute adrenal insufficiency, 2) the destructive
@ upon the adrenals has been proven experimen-
tall Ae ily demonstrated in the autopsy findings of
“2s<3 (yg aly salvarsan injections, and (3) adrenalm has
therapeut ae in treatment of both these conditions.
Th discusses other factors which may play a part
i the “i oi “‘nitroid ertsis”’ and *‘eneephalitis hemor-
rhagica . elie the importance of adrenal imsuf-
ficie _| TiQmmends that 1 mg. adrenin (1 mil of a 1-1000
solution Gen intramuscularly ten mimutes_before the
tfetson. As a curative agent, p will
risj but its chief use is as ap The
author siggestiihat the best index te the g malin
is the markedjallor which it produces. Puc
reaction : 128 termed, is well marke
injection and @ the face. it is anal di =
has been sufiem@=-——J_ F-

(ADERENIN) ‘ie action of Ay
apparatus (lJaction de

ABSTRACTS 107

vasculaire). Binet (L.), Presse. Méd. (Paris), 191 25, 191.

An historical review of the literature of the phamacody-
namic actions of epimephrine on heart, systemic, cor@ary and
pulmonary blood vessels. No original data are prented—
A. L. T.

» =>

ADRENALIN, desiccated THYROID and certain torganic
salts; Effect of, on catalase production. Burge (W~.. Am.
J. Physiol. (Balt.), 1919, 50, 165.

The injection of adrenalin into the portal vein smulates
the liver to an increased production of catalase. sSsuming
that adrenalin is increased during combat, this wil explain
the increased oxidations. Desiccated thyroid introdped into
the alimentary tract also produces an increased o@tput of
catalase from the liver. The same is true for large gantities

P of water, urea, sodium chloride, etc—T. C. B.

(ADRENIN) Effect of epinephrin on the electrocariograms
of patients with ‘‘irritable heart.’ Clough (H. D. Arch.
Int. Med. (Chgo.), 1919, 24, 284-294.

Patients with “‘irritable heart’’ who were semtive to
epinephrin (Goetsch test) gave the following deviatins from
the normal electrocardiographic records: Changes ieonduc-
tion (delayed conduction, partial heart block) and he pro-
duction of ventricular extrasystoles. Other findims were
about the same as in normal individuals.—B. T. S$.

-(ADRENIN) The changes of blood pressure after ijection
of adrenalin as a measure of the tonus of the imyluntary
nervous system (Die Blutdruckveranderung nach Arenalin
injektionen als Gradmesser fir den Tonus in atonomen
und sympatischen Nervensystem). Dresel (K.), ©u
med. Wehnschr. (Berlin), 1919, 45, 955.

The author injected adrenalin subcutaneously am meas-
ured blood pressure every five mimutes. Thus he ofmined a
eurve. In normal individuals this curve is a paraola. in
vagotonia it has the form of the letter S (im serious tses the
blood pressure is first largely dimimished). In symathico-
tonia the curve rises and falls very steeply —J. K.

ADRENALIN in annelids. Gaskell (J. F.), J. Physiol. Lond.
1919, 53, Proe., xxviii.

Certain annelids, ictading the Hirudineae, posses nerve
eells in their central ganglia which give the chromaffic reac-

106 ABSTRACTS

adrenalin. Remarques sur la réaction cardio-vasculaire aux
fortes doses). Bardier (E.), C. R. Soe. de Biol. (Paris), 1919,
82, 760.

In the dog, after bleeding to the extent of 6-7% of the
body weight, the pressure being nearly zero, the respiratory
movements having nearly disappeared, and with premortal
cardiac retardation, it is possible, by injecting 0.03 mgm. of
adrenalin per kilo body weight, to observe an energetic cardio-
vascular action. This, in strengthening the heart action, favors
the resumption of the respiratory rhythm and augments the
chances of survival of the animal, if at the same time we give
either an artificial serum or transfusion. The conclusion is
that the irritability of the cardio-vascular system to large.
doses of adrenalin in the dog decreases with the magnitude of.
the hemorrhage, but does not disappear until the ‘‘periode
ultime.’’ The persistence of this irritability may be of prof,
in the treatment of hemorrhage.—T. C. B.

ADRENIN, Arsphenamine and Neoarsphenamine plus—
Beeson (B. B.), Am. J. Syphilis, 1919, 3, 129.

It is the author’s purpose to emphasize the use of adre-
nalin in the treatment of the ‘‘nitroid erisis’’ and ‘‘serous
apoplexy’’ of Milan. The literature is collected which tends
to place the etiology of these two conditions largely in an
adrenal insufficiency. The evidence upon which this conception
rests is: (1) there is a similarity of symptoms in these con-
ditions and in acute adrenal insufficiency, (2) the destructive
action of arsenic upon the adrenals has been proven experimen-
tally and repeatedly demonstrated in the autopsy findings of
cases dying after salvarsan injections, and (3) adrenalin has
therapeutic value in treatment of both these conditions.

The author discusses other factors which may play a part
in the production ef ‘‘nitroid erisis’’ and ‘‘encephalitis hemor-
rhagica’’ only to emphasize the importance of adrenal insuf-
ficiency, and recommends that 1 mg. adrenin (1 mil of a 1:1000
solution) be given intramuscularly ten minutes before the
intravenous injection. As a curative agent, adrenalin will
shorten a erisis, but its chief use is as a prophylactic. The
author suggests that the best index to the action of adrenalin
is the marked pallor which it produces. When this pees
reaciion,’’ as it is termed, is well marked about the site o¢
injection and on the face, it is an indication that the dosage
has been sufficient.—J. F.

(ADRENIN) The action of epinephrine on the cardio-vascular
apparatus (L’action de l’adrenaline sn’ l’appareil cardio-

ABSTRACTS 107

vasculaire). Binet (L.), Presse. Méd. (Paris), 1917, 25, 191.

An historical review of the literature of the pharmacody-
namie actions of epinephrine on heart, systemic, coronary and
pulmonary blood vessels. No original data are presented.—
Ae. Tie?

ADRENALIN, desiccated THYROID and certain inorganic
salts; Effect of, on catalase production. Burge (W. E.), Am.
J. Physiol. (Balt.), 1919, 50, 165.

The injection of adrenalin into the portal vein stimulates
the liver to an inereased production of catalase. Assuming
that adrenalin is increased during combat, this will explain
the increased oxidations. Desiceated thyroid introduced into
the alimentary tract also produces an increased output of
catalase from the liver. The same is true for large quantities
of water, urea, sodium chloride, ete.—T. C. B.

(ADRENIN) Effect of epinephrin on the electrocardiograms
of patients with ‘‘irritable heart.’’ Clough (H. D.), Arch.
Int. Med. (Chgo.), 1919, 24, 284-294.

Patients with ‘‘irritable heart’? who were sensitive to
epinephrin (Goetsch test) gave the following deviations from
the normal electrocardiographie records: Changes in condue-
tion (delayed conduction, partial heart block) and the pro-
duction of ventricular extrasystoles. Other findings were
about the same as in normal individuals.—B. T. S.

-(ADRENIN) The changes of blood pressure after injection
of adrenalin as a measure of the tonus of the involuntary
nervous system (Die Blutdruckveranderung nach Adrenalin
injektionen als Gradmesser ftir den Tonus in autonomen
und sympatischen Nervensystem). Dresel (K.), Deutsche
med. Wehnschr. (Berlin), 1919, 45, 955.

The author injected adrenalin subcutaneously and meas-
ured blood pressure every five minutes. Thus he obtained a
eurve. In normal individuals this curve is a parabola, in
vagotonia it has the form of the letter S (in serious cases the
blood pressure is first largely diminished). In sympathico-
tonia the curve rises and falls very steeply.—J. K.

ADRENALIN in annelids. Gaskell (J. F.), J. Physiol. (Lond.),
1919, 53, Proe., xxviii.

Certain annelids, including the Hirudineae, possess nerve
cells in their central ganglia which give the chromaffine reae-

110 ABSTRACTS

influence on the biological action of the extract on the eye of
the frog or the blood pressure in dogs.—J. K.

(ADRENIN PANCREAS) The supposed antagonism between
internal pancreatic secretion and adrenaline on smooth mus-
cular fibres of vessels. Polettini (B. D.), Atti ist. Veneto,
1916, 16, 503-508.

‘Surviving vessels, in Ringer’s solution, modified specially
after Meyer and Miiller for these tissues, were treated with
(1) an adrenaline-panecreatie solution, the two being left in
contact for 48 hours; (2) Ringer’s solution and adrenaline.
Graphs show no appreciable difference in the two cases. Ves-
sels and adrenaline from cattle were used.—Physiol. Abst., 4,
340.

ADRENIN, Influence of—and physostigmine upon the blood
picture in malaria. Pulay (E.), Ztschr. f. exp. Med., 1917, 7,
108-118.

Adrenaline causes an increase in the relative lymphocytosis
but still below the normal; physostigmine causes a decrease.
Both produce an increase in the polymorphonuelear leucocytes.
—Chem. Abst., 13, 2925.

ADRENALIN in blackwater fever. Robertson (J. A.), Brit.
Med. J. (liond.), 1919, Gi); 272.

Adrenalin chloride is given in a dose of 20 minims every
four hours. After the first three or four doses the urine clears
up remarkably. No quinine is given. Iron tonics without
quinine are prescribed during convalescence. The author sug-
gests that the adrenalin balances a suprarenal insufficiency,
which is perhaps the cause of the hemoglobinuria in some
cases of malarial infection. No evidence is submitted that such
is the case.—hL. G. K.

(ADRENIN) Neglect of the internal secretions as a cause of
high mortality in many diseases. Sajous (C. E. de M.),
J. Med. Soe. New Jersey (Orange), 1918, 15, 109-116.

The author holds that the persistent high mortality of
many diseases is due to the fact that the physio-pathological
role of the ductless glands in these diseases is virtually disre-
garded. He cites among other diseases the mortality of which
has not been reduced by modern knowledge, pneumonia, char-
acterized by Osler: ‘‘ Almost the natural death of old people,’’

ABSTRACTS aE

in which death sometimes occurs unexpectedly, in the midst of
the patient’s daily occupation. Sajous does not regard this
senile form—the cause of a large proportion of the deaths
attributed to the disease—as a true pneumonia, but as the
result of a more or less sudden failure of the adrenals. The
symptoms in most of these eases, in fact, include but few of
those peculiar to pneumonia: the fever is slight, there is a
moderate rise of blood pressure, but little if any cough or
expectoration, no pain in the chest, soon followed by rapid
lowering of the arterial tension, marked lividity, pulmonary
edema and extreme asthenia—all typical signs of adrenal
failure. A suggestive fact in this connection is that dilatation
of the right heart sometimes precedes infection, thus indicatng
that the latter is secondary to the adrenal failure. An illustra-
tion shows the steady loss of vascularity of the adrenals as
age advances, a condition which leads these to fail readily
under varying degrees of stress in the aged, primarily in some
cases or a slight pneumococcie infection due to exposure,
fatigue, ete., in others. Sajous states many of these cases
would be saved were the role of the adrenals in the process
recognized and the patient carried safely through the stage
of acute adrenal failure. Injections of 10 minim doses of
epinephrin 1:1000 solution in a syringeful of saline solution,
are administered slowly, avoiding a vein, every two hours,
three times, then, when the cardiac action improves sufficiently,
four times daily. Antistreptococcus serum is indicated, rather
than vaccines, the latter serving only to excite adrenals that
are unable to respond, while the serum contributes to the
systemic asset in antibodies. Sustaming food in small quan-
tities, creosote carbonate to prevent tympanites and avoidance
of depressants, particularly the opiates and coal tars, are impor-
tant therapeutic aids.

Another phase of adrenal failure connected with infections
which the author has termed ‘‘terminal hypoadrenia’’ may
occur at all ages. As its name suggests, this condition occurs
late in the history of the disease, owing mainly to exhaustion
of the adrenals during an exceptionally severe and prolonged
febrile process. Hence its frequent occurrence in typhoid
fever, broncho-pneumonia, diphtheria, scarlatina, erysipelas,
septicemia, mumps, severe measles and peritonitis. The signs
differ but little from those observed in senile pneumonia, and
if the failure of the adrenals is overlooked in these cases, death
often occurs from exhaustion, notwithstanding the so-called
‘““supporting’’ treatment. Conversely, the use of epinephrin
as above deseribed, in addition to these measures, often turns
the tide with surprising promptness.—Author’s Abst.

112 ABSTRACTS

ADRENIN, The action of—on the muscular coat of digestive
organs. Spadolini (I.), Arch. di Fisiol. (Firenze), 1918, 16,
135-150.

Both adrenalin and sympathetic nerve fibres may provoke
inhibitory as well as motor reactions on the part of the mus-
cular coat of the stomach and small intestine. These antago-
nistiec reactions are in relation with the quantity of adrenalin
injected into the blood-stream; the inhibition is provoked by
solutions more dilute than those necessary to produce motor
phenomena. These results are explained by Spadolini having
recourse to Langley’s doctrine of receptive substances. Small
quantities of adrenalin would become bound by the inhibitory
receptive substances, whereas larger quantities could combine
also with the motor ones; inhibitory receptors would have a
greater affinity for adrenalin than the motor ones, which could
combine with adrenalin only after the inhibitory receptors
have been fully bound by it. For that, of course, both imhibi-
tory and motor receptors must be present in the same sets of
eells—Physiol. Abst., 4, 340.

(ADRENIN) The effects of epinephrin on the basal metabolism
in soldiers with ‘‘irritable heart,’’ in hyperthyroidism and
in normal men. Tompkins (Edna H.), Sturgies (C. C.) and
Wearn (J. T.), Arch. Int. Med. (Chgo.), 1919, 24, 269-283.

The same technique was employed as in the preceding
experiments.

Conclusions: Intramuscular injections of epinephrin cause
an increase of total metabolism in normal men and patients
with ‘“‘irritable heart’? and in hyperthyroidism. Inerease in
metabolism is greater in cases showing a positive ‘‘Goetsch’’
reaction to epinephrin. The inerease in metabolism is due to
some other factor than excitement or stimulation of heart by
the injection of epinephrin; it may be due to inereased mus-
cular tonus or hyperglycemia.—B. T. S.

ADRENIN treatment of serious lung diseases in infants
(Adrenalinbehandlung schwerer Lungenerkrankungen bei
Sauglingen). Vogel, Wiener klin. Wehnschr., 1919, 32, 850;
Berl. klin. Wehnschr., 1919, 56, 503.

The author saw good results from subcutaneous injections
of 2-5 ee. of adrenalin (1:1000 solution) in serious capillary
bronchitis and bronchopneumonia of infants.—J. K.

ABSTRACTS 115

(ADRENIN) Effects of the injection of epinephrin in soldiers
with ‘‘irritable heart.’’ Wearn (J. T.) and Sturgis (C. C.),
Arch. Int. Med. (Chgo.), 1919, 24, 247-268.

Studies were begun to determine the relation of the thy-
roid gland to the symptom complex of ‘‘irritable heart of sol-
diers.’’ From this study it was concluded that hyperthyroid-
ism does not play a significant role in the condition. In these
studies of the basal metabolism it was decided to employ at
the same time the ‘‘Goetsch’’ epinephrin test. It was soon ob-
served that some cases with normal basal metabolism showed
definite hypersensitiveness to epinephrin.

Studies were made on both normal soldiers and soldiers
with irritable hearts, who had been in training for a number of
months. The technic was the same as that followed by Goetsch.
After an hour’s absolute rest in bed, control readings of blood
pressure, pulse and respiratory rates are made; also a note is
made of objective symptoms. After satisfactory control read-
ings are made, 0.5 ec. 1:1000 solution of freshly prepared epine-
phrin is injected deep into the deltoid muscle. Readings as
above are made at five minute intervals for one hour. A posi-
tive reaction manifests itself in about twelve minutes as a rise
in systolic blood- pressure, increased pulse rate, tremor, pre-
cordial pain, nervousness, ete.

The results of the studies were as follows: Of twenty-six
normal soldiers (controls) who had had severe army training
for fourteen months, not one gave a positive reaction; of sev-
enty-three patients with symptoms of ‘‘irritable heart’’ sixty
per cent gave a reaction which definitely indicated a hyper-
sensitiveness to epinephrin.—B. T. S.

(AUTONOMIC N.S.) Treatment of vagotony and sympatheti-
cotony. Noronha (H.), Arch. Brasil. de Med. (Rio de
Janeiro), 1919, 9, 92-100.

Noronha warns that the main thing in treatment of either
condition is to aim to restore tone to the unstable nervous sys-
tem as a whole; atropin can then be given for vagotony and
epinephrin for sympatheticotony, but the doses should be small
and cautiously given.—J. Am. M. Ass., 73, 650.

(BLOOD SUGAR ADRENIN DIABETES) Permeability of
erythrocytes to sugars in hyperglycemia. Kozawa (S.),
Tokyo Igak. Zasshi, 1916, 30, 9-18; Jap. Med. Lit., 1917, 2, 2.

In vitro the hexoses and the pentoses readily penetrate the
erythrocytes of man and the monkey, and penetrate those of the

114 ABSTRACTS

dog to a certain extent, but do not at all penetrate those of
the puppy, goat, pig, cat, or cattle. In a diabetic patient the
sugar content of the corpuscles was definitely increased, and
approached, but never exeeeded, that of the serum; the cells
were swollen; and the hematocrit reading was twice the normal
value for the same number of cells. Adrenaline hyperglycemia
in puppies did not alter the sugar content of the red cells; in
dogs it produced a definite inerease in the sugar content of
these cells, though not to such a degree as occurred in the ex-
periments in vitro—Physiol. Abst., 3, 504.

Cataract and INTERNAL SECRETION. Schioetz (C.), Norsk
mag. f. laegevid. (Christiania), 19138, nr. 9.

Cataracta centralis congenita is fairly frequent in cretinous
ealves, which has first been demonstrated by the Norwegian
veterinary surgeon Loeken. This fact brings the author to dis-
cuss the occurrence of cataract in various endocrine disorders.
Cataract is observed after extirpation of the parathyroids and
diabetic cataract may possibly be referred to the pancreas;
Langfeldt (Norway) has seen cataract in dogs after pancreatec-
tomy. Senile cataract is hypothetically referred to hypofune-
tion of the sexual glands. Cataract is further discussed in rela-
tion to diseases of the thyroid, pituitary and suprarenals.

—K. M.

(CORPUS LUTEUM) Double ovariectomy because of bilateral
ovarian cysts, at the end of the fourth month of pregnancy.
Suppression of the corpus luteum. Delivery at term. (Ovario-
tomie double pour kyste ovariques bilateraux, a la fin du
quatrieme mois dela grossesse. Suppression du corps jaune.
Accouchement terme). Grosse (A.), Ann. de Gyn. et d’Obst.
(Paris), 1919, 18, 464-473.

A report of a case of bilateral ovarian cysts necessitating
removal by laparotomy in the fourth month of pregnaney, fol-
lowed by delivery after a normal and uneventful course. The
milk secretion was marked and the child breast fed. Refer-
ences are given to the literature of similar cases from which,
and in consideration of his own results, the author concludes
that it does not appear as if the corpus luteum is indispensible
for embryonic and foetal development at the beginning of

pregnancy and that its suppression is not sure to cause abor-
tion.—F. 8. H.

ABSTRACTS 115

CORPUS LUTEUM, The use of—in pregnancy. Welz (W. E.),
-J. Michigan State M. Soe. (Grand Rapids), 1919, 18, 373-376.

The toxemia of early pregnancy is equivalent to corpus
luteum deficiency. Extracts of the corpus luteum relieve such
symptoms and may control habitual abortion. The latter is
considered the result of deficient corpus luteum development
in early pregnancy.—H. W.

(CORPUS LUTEUM) Corpus luteum extracts in the vomiting
of pregnancy, with report of cases. Quigley (J. K.), Am. J.
Obst. UN. Y¥-), 1919; 80, 183-185.

Of seventeen cases of vomiting of pregnancy, twelve were
benefited permanently by the use of corpus luteum extracts,
four were benefited but relapsed, and one was a complete
failure.—H. W.

DIABETES innocens. Solomon (H.), Wiener klin Wehnschr.
1919, 32, 871.

An important article. The author saw cases of diabetes in-
nocens during five years, not becoming more serious. The
blood sugar is on the empty stomach mostly normal; in a few
cases it was slightly increased. There are cases who have a
earbohydrate tolerance, but in other cases, even after the
smallest amount of ingested carbohydrates, a trace of sugar
comes in urine. If more carbohydrates are given the amount
of sugar in the urine is not increased. In rare cases larger
amounts of sugar are excreted (up to 40 grams) daily. In
these cases blood sugar estimations are necessary to distinguish
them from ordinary diabetes.—J. K.

DIABETES and complication with surgical diseases (Glyko-
surie und Diabetes bei chirurgischen Erkrankungen). Wei-
land (W.), Berl. klin. Wehnschr., 1919, 56, 887; same article
but more detailed, in Mitt. a. d. Grenzgeb. Med. u. Chir.
(Jena), 1919, 31, 473.

Traumatic diabetes is very rare; the author has seen only
one ease. Traumatic glycosuria is, however, very frequent.
Surgical diseases caused by diabetes do not exist. The gan-
grene as it is frequently seen in diabetes is of arteriosclerotic
origin.—J. K.

116 ABSTRACTS

DUCTLESS GLANDS in military practice. Sajous (C. E. de
M.), Penn. Med. J. (Athens), 1919, 22, 215-220; N. Y. M. J.,
1999 OO S569! :

The author calls attention to the large number of hyper-
thyroid soldiers detected in army practice. The asthenia of
excessive strain, the sudden deaths of adrenal failure, the sol-
dier’s irritable heart, warfare shock, the terminal hypoadrenia
of infections, the collapse following antityphoid vaccination are
examples of disorders in which the adrenals take a prominent
part, and in which appropriate therapy can accomplish consid-
erable good, and even save life. Sajous ventures the belief that
the irritable heart of the soldier is frequently due to exhaustion
of the adrenals, while in others an overactive thyroid is respon-
sible. In the latter group adrenalin, nitrites and digitalis are
ineffective and prolonged mental, physical and emotional rest
are necessary for recovery.—H. L.

DYSTROPHIA musculorum progressiva. Schmidjell (F.),
Wiener klin. Wehnscehr., 1919, 32, 867.

Of no direct endocrine interest.—J. K.

ENDOCRINE DISEASE, Progressive muscular dystrophy as
an—. Timme (W.), Arch. Int. Med. (Chgo.), 1917, 19, 79-104.

Exhaustive search of the literature, by the writer, im-
pressed him with the fact that accompanying the muscular
dystrophies, endocrine disturbances of one form or another
were present. He reports a somewhat atypical form of muscu-
lar dystrophy resembling the familial infantile form. This
disease occurred in four generations. Four out of five inmdi-
viduals having this condition, showed distinct changes in the
region of the pineal gland. Three of the four patients were
under twenty-four years of age.—J. H. L.

(ENDOCRINE EXTRACTS) Treatment of shock by complex
artificial serum (A propos du traitement du shock. Essais
d’un sérum artificial complexe). Descomps and Clermonthe,
Bull. Soe. de Chir. (Paris), 1918,—,—, (July 18).

The ‘‘serum’’ referred to is a modified Ringer-Locke solu-
tion plus strychnine, digitalin and extracts of endocrine organs
(thyroid, spleen, pituitary, adrenal and testis).—Physiol. Abst.,
4, 346

+] .

ABSTRACTS 1A7

ENDOCRINE GLANDS, Affections of—in acquired syphilis.
Hazen (H. H.), Am. J. Syphilis, 1919, 3, 205.

This paper does not lend itself readily to abstracting inas-
much as it is a resumé of the literature. Syphilis is discussed in
its relation to hyperthyroidism and hypothyroidism. Emphasis
is placed upon the suggestion of Mendel that many of the so-
called cases of thyroid syphilis might be merely examples of
iodine thyroiditis. The literature of syphilis of the parathy-
roids, thymus, pineal gland, adrenals, and pituitary is treated.

—J. F.

(ENDOCRINE GLANDS) The climacteric of life. Rankin
(G.), Brit. Med. J. (Lond.), 1919, (i), 63-67.

The author claims that for men as well as for women there
is a climacteric period, which coincides with life’s full ma-
turity. It occurs from seven to ten years later in men than in
women, and in both is a time of special lability to the develop-
ment of disease, especially of such as may be regarded as the
expression of hereditary tendencies that have down to this
period remained dormant. The immediate counterpart in man
of the ovarian ehanges in woman is to be found in the struc-
tural alterations which become established in the prostate
gland. Acute illnesses occurring during this period are at-
tended with more than average risk, and the frequeney of ma-
lignant growths at this age is well known. Besides these con-
ditions arteriosclerosis, interstitial nephritis and diabetes are
common ailments in men between 55 and 63, while in women
colitis, rheumatoid arthritis and hyperthyroidism are common
accompaniments of the change of life.

The author claims that at this age the starvation treatment
for diabetes is such a-tax upon the nervous control of the pa-
tient that it imperils his ‘‘serenity of temper and happiness of
hife.’”’ And besides, the author minimizes the importance of
sugar in the urine of elderly men, claiming that it does not in-
terfere with their hfe or work to an appreciable extent.

—L. G. K.

ENDOCRINE influence of the pylorus. Frumson (LL. G.), Med.
Fortnight. (St. Louis), 1919, 51, 157-158.

A most facetious attack upon all known facts and theories
relative to gastrointestinal disturbances and upon investigators
generally. However, Frumson claims for himself great results
in the treatment of achylia by the administration of watery
extracts of the pylorus of cattle—H. W.

118 ABSTRACTS

ENDOCRINE manifestations. Strauss (S. G.), U.S. Nav. Med.
Bull. (Washington, D. C.), 1918, 12, 609-615.

An appeal for the study of subjective as well as objective
symptoms and for a consideration of the patient as a whole,
instead of the complainant part alone. The article is accom-
panied by a description of two cases presenting no laboratory
proofs of adrenal derangement but which, being studied from
a general knowledge of the possibilities of such disorder and
treated accordingly, gave favorable response and substantiated
the value of the method advocated.—F. 8. H.

(ENDOCRINE ORGANS) Cerebral localization from the point
of view of biologic psychology (Las localizaciones cerebrales
bajo el punto de vista de la Psicologia Biologica). Enrique
Mouchet, Prensa Med. Argentina, 1919,—,—, (No. 2.)

The totality of intelligence is derived not through the
senses alone. The cerebrum receives an inner stimulus through
the blood as well as internal secretions proper which contribute
to the formation of instincts and, to a notable extent, of the
psychic qualities.—B. A. H.

(ENDOCRINE ORGANS) The differentiation of mankind into
racial types. Gallwey (T.J.), Lancet (Lond.), 1919, (ii), 666.

Gallwey eriticises the view of Keith (see abstract in this
issue) that the differentiation of the races of mankind has been
due to varying degrees of endocrine activity. He claims that
environment alone is responsible for the various types, although
he does not show why environment could not modify the type
through modifieations in the ductless glandular system .

—h. G. K.

(ENDOCRINE ORGANS) Dystrophie myotonica. Kastan,
3erl. klin. Wehnsehr., 1919, 56, 837.

A ease of dystrophia myotonica (myotonia atrophieca).
The thyroid was only half the size of a normal organ; both tes-
ticles were atrophic. The X-rays showed no changes in the
hypophysis.—J. K.

(ENDOCRINE ORGANS) The differentiation of mankind into
racial types. Keith (A.), Lancet (Lond.), 1919, (11), 553-556.

This paper has attracted a good deal of attention in the
lay press as evidenced by the number of newspaper articles
which have lately appeared on this subject. The author sets

ABSTRACTS 119

forth the view that the distinguishing characteristics of the
races of mankind have been produced by the varying degrees
of activity manifested by the ductless glands in the different
races. For instance, he explains the sharp and pronounced
nasalisation of the face, the tendency to strong eyebrow
ridges, the prominent chin, the tendeney to bulk of body and
height of stature in Europeans as a result of a greater activity
of the pituitary gland in them than in the Negro or Mongol
races. Similarly the beardless face and almost hairless body of
the Negro and Mongol are attributed to a lesser degree of
activity on the part of the interstitial cells of the gonads. The
suprarenals, because of the darkening of the skin in Addison’s
disease, are said to regulate the amount of pigmentation of the
skin A reduced activity of the thyroid is supposed to account
for the characteristic aspect of the Mongolian face. The hy-
pothesis thus attributes to the Caucasian a slight degree of
acromegaly while it declares that the salient characteristics
of the Mongolian and Negro races are due to a tendency toward
eunuchism, Addison’s disease and ecretinism. Achondroplastie
dwarfs and Mongoloid idiots are regarded as the results of
defects in the growth regulating mechanism of the thyroid, and
since, in the opinion of the author, both these types resemble
the Mongolian, this is advanced as an added piece of evidence
that hypothyroidism has been partly responsible for the Mon-
golian type of man.

(The hypothesis is unsupported by experimental evidence,
and the author has apparently taken advantage of the unsettled
condition of our knowledge of the duetless glands to put forth
a theory which explains the unsolved in terms of the un-
known. )—L. G. K.

(ENDOCRINE ORGANS) Endocrine _glands and fever.
(Glandes endocrines et fiévre). Leopold-Levi, C. R. Soe.
Biol. (Paris), 1919, 82, 410-412.

The author is of the opinion that endocrine activity and
the production of fever are very closely related. He believes
that the thyroid, ovary, suprarenal and anterior lobe of the
pituitary can all produce fever or increase the fever of auto-
infection, the premenstrual period and particularly the fever
of tuberculosis.—h. G. K.

(ENDOCRINE ORGANS) Bradykardie mit Hypotonie. Lom-
mel, Deutsche med. Wehnschr. (Berlin), 1919, 45, 1096.

The author observed many eases of slow action of the
heart combined with a low blood pressure. Often the temper-

120 ABSTRACTS

ature was low, there were oedemas and eosinophilia. Perhaps
an abnormal function of the endocrine organs plays a part in
the disease, but treatment with adrenalin, with thyroidin, with
pituglandol and with extract of gonads had no effect what-
ever.—J. K.

ENDOCRINE organs, Diseases of the—. Poulten (KE. P.),
Guy’s Hosp. Gaz. (Lond.), 1918, 32, 234-241.

This is an abstract of two clinical lectures by the author
and contains but a brief survey of the outstanding features of
the clinical significance of adrenal, pituitary, thyroid and
parathyroid syndromes.—F¥. 8. H.

(ENDOCRINE ORGANS) Changes in the weights of the va-
rious parts, systems and organs in albino rats kept at birth
weight by underfeeding for various periods. Stewart (C.
A.), Am. J. Physiol. (Balt.), 1919, 48, 67-78.

The weights of the various organs, systems and parts of
the body were studied in eight newborn controls and 15 test
rats kept at birth weight by underfeeding for period ending
at 11 to 22 days of age. In the test animals the individual
endocrine glands showed the following percentage increase
in weights when compared to the corresponding organs of
newborn rats: Testes 374, spleen 33, hypophysis 29, pineal
gland 21. The thyroid, ovaries and suprarenals showed prac-
tically no change, while the thymus decreased in weight 49
per cent.—lL. G. K.

(ENDOCRINE ORGANS) Diet in chronic arthritis. Thom-
son (F. G.), Practitioner (Lond.), 1919, 103, 10-121.

In discussing the importance of vitamines in feeding cases
of chronic arthritis the author states that lack of these food
constituents results in ill-balaneed funetion of the endocrine
glands, which he considers a constant feature of arthritis.
‘“Whereas in rheumatoid arthritis, hyperthyroidism due to
toxic thyroiditis occurs with great frequency, in osteo-arthritis,
fibrositis, and chronie gout, the balance swings in the other di-
rection, with thyroid inertia and hyperactivity of the supra-
renal system. — — —-— Modern investigation has shown that
uncooked food is an essential element in diet, owing to the
action of vitamines in promoting normal digestive and assimi-
lative processes. and maintaining the balance of endocrine
activity.’’—H. L.

ABSTRACTS 121

ENDOCRINOPATHIES, Clinical manifestations and basis for
treatment of some—. Timme (W.), J. Nerv. and Ment. Dis.
(N. Y.), 1918, 47, 446-449.

Timme points out the inadequacy of some of the present-
day endocrine terminology in that such names as exophthalnic
goitre do not cover the entire or even the fundamental path-
ology. He distinguishes between the abnormal glandular mani-
festations which dominate the clinical picture and the disturbed
gland which is the key to the whole syndrome. The two are
not always identical and certainly difficult to determine be-
cause of such complicated inter-relations between the various
glands. The problem then lies in selecting the crucial symptom
or the crucial gland on which to base the therapy.—A. R. T.

(GONADS) A case of hypernephroma (Ein Fall von Hyperne-
phrom). Bittorf, Deutsche med. Wehnsechr. (Berlin), 1919,
45, 981.

A very short description of a man with hypernephroma,

atrophy of the testes and development of female breasts.
J Ke

(GONADS) Steinach’s.treatment of homosexuality (De behan-
deling van homosexualiteit volgens Steinach). de Boer (S.),
Geneeskundige Bladen (Haarlem), 1919, 21, 175.

Gives a very good review on the work of Steinach and the
literature on this point. No new facts.—J. K.

(GONADS) Masculine tubular hermaphrodism. Abdominal
hysterectomy in the course of a radical cure for inguinal
hernia in a man of 31 (Hermaphrodism tubulaire masculin.
Hysterectomie abdominable au cours d’ une cure radicale de
hernie inguinale chez un homme de 31 ans). Couvelaire
(A.) and Duclaux (H.), Ann. de. Gyn. et d’Obst. (Paris),
1919, 13, 474-478.

An interesting case of masculine tubular hermaphrodism of
the internal variety consisting in the heterologous development
of the Miillerian ducts to a normal degree, in contradistinetion
to the usual condition observed in the female organs when
found in the male, which are usually rudimentary in character.
The external appearance was thoroughly masculine without
any secondary sexual characteristics of the female. He was
married and his wife had given birth to two children since
that time. The testicle that was removed contained sperma-
tazoa as did his semen on ejaculation. On operation for in-

122 ABSTRACTS

guinal hernia, scrotal variety, there was discovered in the
scrotum a well developed uterus 10 em. in length and 4 em. in
breadth at its maximum.—F. S. H.

GONADS, Structure of—. (Bauplan der Keimdriisen). Kohn
(A.), Wiener klin Wehnschr. (Vienna), 1919, 32, 50; Ber-
liner klin. Wehnschr., 1919, 56, 70.

A general review.—J. K.

(GONADS) Influence of the interstitial gland upon body tem-
perature (Uber die Abhangigkeit der Korpertemperatur
von der Pubertatsdrise). Lipschiitz (A.), Arch. f. d. ges.
Physiol. (Bonn), 917, 168. 177;

The rectal temperatures of normal male and female, of
castrated male and female guinea pigs without grafts and of
castrated male and female guinea pigs into which ovaries and
testes, respectively, had been grafted, were measured. Result:
The interstitial gland of the male sex gland has no influence
upon the body temperature of the male and probably no influ-
ence upon the temperature of the castrated female when it is
grafted into the latter. The interstitial gland of the female
gonad increases the temperature from 0.4 to 0.5° C., as indi-
cated by the fact that in castrated females the body temper-
ature is 0.4° C. lower than in normal females, while in castrated
males into which ovaries were grafted, it 1s 0.5° C. higher than
in castrated males into which no ovaries had been grafted.

—H. U.

GONADS, The formation of sexual characters by the—. (Die
Gestaltung der Geschlechsmerkmale durch die Pubertais-
drisen). Lipschiitz (A.), Arch. f. Entw. (Berlin), 1918, 44,
396.

A review of the work on the influence of the removal and
transplantation of the gonads on sexual characters. No new
data —M. MEE.

(GONADS) Transformation of the clitoris into a penis-like or-
gan through experimental masculinization. (Umwandlung
der Clitoris in ein penisartiges Organ bei der experimentellen
Maskulierung.) lLipschiitz (A.), Arch. f. Entw. (Berlin),
1918, 44, 198.

After implantation of a testis in a spayed female guinea
pig, the clitoris develops into an organ somewhat like the penis
of a normal male. The foreskin and the corpora eavernosa

ABSTRACTS 123

penis are well developed, and ‘‘piercing’’ organs are present,
though abnormally placed. The organ is shorter than a normal
penis and the growth of the corpus cavernosum urethrae is not
stimulated by the operation.—M. M. H.

GONADS, Fundamentals of knowledge about the—. (Prinzi-
pielles zur Lehre von der Pubertiatsdriise). Lipschiitz (A.),
Arch. f. Entw. (Berlin), 1918, 44, 207.

Further discussion of the reasons why different parts of
an organ (e. g. the clitoris) react differently to transplantation |
of the gonads. No new data.—M. M. H.

(GONADS) Die spermatogenesis des Grottenolmes. Stieve
(H.), Anat. Anz. (Jena), 1918, 51, 321.

A eytological study of the germ cells of the amphibian
Proteus anguineus. Not of endocrine interest.—E. R. H.

(GONADS) Hermaphroditism in men (Ueber Zwitterbildung
bein Menschen). Polano. Deutsche med. Wehnschr. (Ber-
lin), 1919, 45, $231.

Report of a remarkable case. The clitoris was developed
like a penis, but the urethra ended at the base of the organ.
By an operation the end of the urethra was transplanted to
the glans. When the patient was 18, she menstruated regu-
larly from this artificial orifice. The secondary sexual char-
acteristics were mixed, but more female than male. At opera-
tion for an abdominal tumor a normal uterus was found. In
one of the ovaries normal testicular tissue was seen. To this
ovary was attached a vas deferens with a normal epididymis.

—J. K.

(GONADS) Mannlicher Pseudohermaphroditismus. Schmalfuss.
Berl. klin. Wehnschr., 1919, 56, 789.

A girl with female external genitals underwent a “‘herni-
otomy.’’ One normal and one atrophic testicle were found.
Six months later the patient died of sepsis. Though during the
operation two testicles were removed, at the postmortem ex-
amination living spermatozoa were found in the vesiculi

seminalis.—J. K.

(HORMONES) An hypothesis of ‘‘hormone hunger.’’ Har-
rower (Henry R.), Med. Ree. (N. Y.), 1919, 96, 276-278.

Harrower notes that in his experience with organotherapy

124 ABSTRACTS

briliant results are obtained in some eases of endocrine dis-
turbance and no results whatever in elinieally similar eases.
This has led him to formulate ‘‘an hypothesis of hormone
hunger.’’ He believes that each organ in the body has a
selective capacity to pick up and utilize certain hormones that
are circulating in the blood stream, and that the more urgent
its requirement for a specific hormone, the more ‘‘hungry”’
it is, the more readily it picks up and utilizes this hormone.
The interrelationship of the ductless glands, with the result
that abnormal secretion of one produces alterations in the
activity of the others, justifies pluriglandular therapy, in
Harrower’s opinion, and removes from it the odium of ‘‘shot-
gun’’ therapy. In giving pluriglandular products, Harrower
thinks the opportunity is given the body to do its own select-
ing. ‘‘We ean trust the organism to pick out from the menu
we offer it those hormones that it needs most, and, too, in
the degree it needs them.’’ (If this hypothesis be true, why
should patients with the same clinical signs and symptoms,
and therefore the same ‘‘hormone hunger,’’ respond differently
to the same duetless gland diet? The author has not proved
his point, and the encouragement of unintelligent, indiserimi-
nate pluriglandular therapy, usually in totally inadequate
dosage, is most unwise; Osler has recently given a timely
warning and deserved criticism of this latest therapeutic
‘*fad.’’)—H. L.

HORMONES and phosphatides. Fraenkel (S.) and Herrmann
(E.), U. S. Patent No. 1,314,321, Aug. 26, 1919.

A preparation suitable for treatment of disorders pro-
duced by failure of the ovarian functions is prepared in the
following manner: 50 pieces of human placenta are earefully
dried in vacuo and pulverized and the resulting material, about
5000 g. of dry substanee, is extracted with ether. After evap-
oration of the ether, the phosphatides are precipitated from the
residue by adding a 4-fold amount of acetone. The acetone-con-
taining mother liquid is freed from solvent in vacuo. The resi-
due is then taken up in cold alcohol, by which treatment a
great part of cholesterol and cholesterol esters (less soluble in
the cold solvents) is separated out. After evaporation of the
aleohol, the residue is purified by fractional distillation in the
highest vacuum possible. Under a pressure of 0.06 mm. Hg a
mixture of hormones with cholesterol distils over as the princi-
pal fraction. By treating this distillate with cold alcohol, the
hormones are dissolved, while cholesterol and saturated esters
of cholesterol crystallize out. For a further purification of the
desired product, a second fractionation in a high vacuum can

ABSTRACTS 125

be utilized after evaporation of the alcohol. The product is a
thickly flowing oily liquid showing the typical reactions of
cholesterol. Various modifications of the procedure are de-
seribed.—Chem. Abst. 13, 2736.

HORMONES, Hypothesis concerning—. (Hypothése sur les
hormones). Ide, C. R. Soe. de Biol. (Paris), 1919, 82, 944.

The role of the ‘‘glandes sanguines’’ ean be explained by

their embryologie origin. They produce substances useful to
themselves and to their sister cells. This hypothesis is sug-
gested by a number of facts.

Adrenalin is a specific excitant of the dorso-lumbar sym-
pathetic. Embryologically, there are two elements in the
suprarenals, nervous ganglia coming from the dorsal region
of the cord and going to meet the coelomic islets. These two
elements intermingle and unite intimately, the nervous part
forming the medulla of the suprarenals. These echromophile
cells are nervous cells that have become secretory, and their
secretion is a special excitant to their group. They work for
their cell-sisters. The other glands are considered from the
same point of view.

If we some day find a ‘‘vagotonin’’ analogous to adrenalin,
but exciting the terminations of the vagus or parasympathetie,
it will spring from a parasympathetic nervous element orig-
inating in.the cervical or cranial portion of the medullary
eanal. It is useless to look for it in the lymphatics or the
marrow of the bones. It will be necessary to look for it in
the head about the pharynx, or at the surface of the mid-
brain.—T. C. B.

(HYPOPHYSIS) Hypophysaire Polydipsie. Arnstein (A.),
Wiener klin. Wehnschr., 1919, 32, 928.

The author demonstrated a woman of 47 with polydipsia.
Four years before a stomach cancer had been removed. Per-
haps the polydipsia was due to a metastasis of the first tumor
into the hypophysis. Injections of pituglandol was followed
by improvement.—J. K.

(HYPOPHYSIS) Hypophysispolydipsie und—polyurie. Arn-
stein (A.), Deutsche med. Wehnschr. (Berlin), 1919, 45, 1176.

A woman of 47, three years after an amputation of a
breast for cancer, developed diuresis of 5 liters daily. The
urine had a specifie gravity of 1003-1007. She drank over 5
liters of water in 24 hours. Injection of pituglandol diminished

126 ABSTRACTS

the quantity of urine to about 2 liters. The quantity of in-
gested water diminished also in the same proportion.—J. K.

HYPOPHYSIS, Tumor of the—(Hypophysisgezwel). Beukers
(A. C. M.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919,
63 (II), 1312.

A patient had adiposity but no polyuria of acromegaly.
There were also present bilateral atrophy of the optic nerve
and headaches. The roentgenogram disclosed no abnormality.
Other endocrine organs than the hypophysis were apparently
normal. At operation a hypophyseal tumor was removed. The
microscopic diagnosis was cancer. After the operation the
patient saw much better, but her adiposity increased. The
headaches disappeared and the psyche was much improved.—
ins INS

(HYPOPHYSIS) Posterior pituitary secretion in the treatment
of mitral regurgitation. Bate (R. A.), Ky. Med. J. (Bowling
Green), 1919, 17, 419-422.

Cases of ‘‘rheumatic’’ endocarditis may be supported to
compensation by posterior pituitary extracts.—H. W.

(HYPOPHYSIS) The infundibular syndrome in a case of
tumor of the third ventricle (Le syndrome infundibulaire
dans un cas de tumeur du troisieme ventricule). Claude
(H.) and Lhermitte (J.), Presse méd. (Paris), 1917, 25, 417.

The well-known syndrome consisting of nareoleptic at-
tacks, of cardiovascular irregularities (tachyeardia, irregular-
ity of the pulse, extra-systoles, embryocardia and increased
blood pressure) and polyuria with polydipsia are not, as it
is frequently claimed, due to lesions of the hypophysis, but
to lesions of the infundibulum. The authors had occasion to
observe a patient in whom, at autopsy, a tumor of the third
ventricle was found. Examination revealed an epithelial eystie
tumor formed from the ventral wall of the third ventricle
and distinetly confined to the infundibulum; the hypophysis,
however, was completely normal. This patient had shown
the following symptoms: Bitemporal hemianopsia, attacks of
dysarthria, amnesia and delirium, attacks of narcolepsy, tachy-
cardia, irregularity of the heart beat, extra systoles, embryo-
cardia and increased blood pressure, polyuria and polydipsia.
The first two symptoms proved to be due to pressure exerted
by the tumor upon the optic region and upon the peduneuli
cerebrales, respectively. The disturbances of the mental con-
dition are not due to the lesions of any specifie region of the

ABSTRACTS 127

brain, since they are caused very frequently by all sorts of
brain tumors; it may be that they are the result of circulatory
disturbances caused by these tumors.

In contradiction to A. Salmon’s hypothesis of a hypo-
physeal origin of narecoleptic attacks, the case in question
demonstrates that a disturbance of the exeretory function of
the pituitary gland is not the cause of this phenomenon, since
the hypophysis was entirely normal. The same is true for
the cardio-vascular disturbances, and in this respect clinical
experience fully confirms the experimental results obtained
by several observers, and particularly by Aschner, which show
that it is the excitation of the tuber cinereum and the infundi-
bulum, and not of the hypophysis, which produce the phenom-
ena in question. Finally the experimental data obtained by
J. Camus and G. Roussy proving that experimental lesions of
the tuber cinereum and infundibulum cause polyuria seem
to be well in accordance with the clinical data observed here;
‘polyuria accompanied by polydipsia is due to lesions of the
basis of the third ventricle, but not to lesions of the hypophysis.
The most important result of this clinical observation seems
to be that the secretion of the pituitary gland does not play
any role in the cardio-vascular phenomena in question, nor in
the regulation of the metabolic processes of water excretion.

—kE. U.

(HYPOPHYSIS) Pituitary treatment in gynecology. Dalché
(P.), Rev. Mens. de Gynée. et d’Obstét. (Paris), 1919, 14,
165-182.

Dalché gives pituitary by the mouth, preferring the dry
extract of the whole gland, giving from two to four eachets
a day of 0.10 gm. each. This treatment can be applied in
every case of metrorrhagia, and it often will give good results.
But success depends on its being kept up perseveringly for
weeks and months with bleeding fibromas, diffuse fibromatosis
and sclerosis of the uterus, retrodisplacement with congestion,
Virginal metrorrhagia, intermenstrual dysmenorrhea—when-
ever, in short, the aim is to modify a condition of long stand-
ing. For example, a young girl with too frequent and too pro-
fuse menstruation should take the pituitary extract every day
for a month, then for two weeks each month, beginning the
week before the anticipated menses and continuing till the
close. The other two weeks he orders 10 drops of tincture of
hamamelis in a little water before the two principal meals.
In ease of a fibroma he alternates the two pituitary weeks with
other organotherapy, and may conclude with roentgen treat-
ment. Congestions and excessive functioning of the ovaries or

128 ABSTRACTS

thyroid may likewise benefit by pituitary treatment, as also
certain types of headache, even these suggesting false brain
tumors, with exacerbations at the menstrual periods. It seems
in these eases as if the endocrine upset had induced congestion
in the pituitary body and that this congestion was what causes
the headache. The action of pituitary treatment is not re-
stricted to the genital organs; it may attenuate and suppress
the hot flashes and sudden sweats of the menopause and other
symptoms of ovarian insufficiency. It seems to promote sleep,
appetite and diuresis, and combat asthenia——J. Am. M. Ass.

(HYPOPHYSIS) A case of dystrophia adiposogenitalis in a
man after trauma of the skull (Hin Fall von Dystrophia adi-
poso-genitalis bei einem Manne nach Schadeltrauma). Golds-
steig. Berl. klin. Wehnschr., 1919, 56, 958; Miinchner med.
Wehnschr., 1919, 66, 1009.

A short note on a ease. The temperature showed an in-
clination to rise. From time to time temperatures up to 42.3°
C. (107.6 F.) were observed; the pulse stayed at 70. Probably
the centre for heat regulation was disturbed.—J. K.

(HYPOPHYSIS) Conditions in ‘‘hyperhypophysized’’ ani-
mals. (Ueber Befunde bei hyperhypophysierten Tieren).
Hofstatter (R.), Monatsschr. f. Geburtsh. u. Gynak. (Berlin)
1919; 19; 387.

Results from transplantation and from feeding were nega-
tive. Injections of ‘‘pituitin’’ were given to 70 rabbits. The
doses (1 ce. each) were given every two days, until from ten
to forty had been given. The results were as follows: 1, Hy-
pertrophy of the heart, with hyperemia of all the organs; 2,
Diuresis not influenced; 3, No effect on growth or on skeleton;
4, Decrease of the colloids of the thyreoid; 5, Hypertrophy of
the adrenals; 6, Shght hypertrophy of the hypophysis; 7, Has-
tening of ovulation and spermatogenesis in young, but no such
effects on full-grown animals; 8, No effect on the atrophy of
the uterus after castration ; 9, Development of mammary glands
stimulated; 10, Sexual stimulation. The author concludes that
the hypophysis aids embryonic development, ‘‘protects’’ the
sex glands and their functions, as well as the milk glands, and
inhibits the thyreoid. Hypophysis medication is indicated for
general hypoplasia, amenorrhea and Graves’ disease.

—K. R. H.

(HYPOPHYSIS) Epilepsy combined with endogenous adiposity
[Epilepsie kombiniert mit endogener (hypophysarer?)

ABSTRACTS 129

Fettsucht]. Ibrahim. Miinchener med. Wehnschr., 1919, 66,
1069.

A girl of twelve years suffered from epilepsy. After the
first fit adiposity began. The Wassermann reaction was nega-
tive; there was no increased brain-pressure; blood-pressure
was low. The skin showed abnormal pigmentation. Adrenalin
injection did not produce glucosuria. After 100 grams of
glucose a trace of sugar was found in the urine. The sella
tureica was not enlarged, but showed the form of a rhombus.
The patient was mentally deficient. The blood serum gave a
positive Abderhalden reaction with hypophysis, ovary and
thyroid and a negative reaction with adrenals and kidney.

—J. K.

(HYPOPHYSIS) An experimental investigation of the phar-
macologic properties of the active principle of commercial
pituitary extracts, and the comparative action of histamine.
Jackson (D. E.) and Mills (C. A.), J. Lab. & Clin. Med. (St.
Louis), 1919, 5, 1-27.

The active principle of the posterior portion of the pitu-
itary gland is a simple body of. the sympatho-mimetic amine
type which, in the dog, produces contraction of the uterus but
fails to contract the bronchi. This is probably due to action of
the substance on certain nervous elements and not a direct
muscular action. Certain commercial preparations of pituitary
gland contain small, variable proportions of histamine which
might exert some therapeutic action, but it is not a necessary
constituent of first-class preparations of posterior portion of
the pituitary. It is probable that the action of histamine on
the bronchioles of spinal dogs can be used as a commercial test
for the presence of small amounts of this substance in ordinary
commercial extracts. For obstetrical uses pituitary extracts
have obvious clinical advantages over the broncho-constricting
and blood pressure lowering histamine.—B. T. S.

HYPOPHYSIS, The relation of—to glycogenolysis. Keeton
(R. W.) and Becht (F. C.), Am. J. Physiol. (Balt.), 1919, 49,
248-253.

The authors show that stimulation of the hypophysis in
dogs causes hyperglycemia independently of the ether used for
anesthesia. This hyperglycemia is absent after transection of
the cord at the level of the second thoracie vertebra and after
section of the splanchnies, but persists after section of the
nerves in the hepatie pedicle, i.e. where the nerve supply to the
adrenals is not interfered with. Consequently, if a hormone

130 ABSTRACTS

is liberated by stimulation of the hypophysis, it must have a
central action. Following hypophysectomy a transitory hyper-
elycemia, persisting three to five hours, occurs. After this the
sugar level remains normal until death. The authors favor the
view that the pathway is a nervous one mediated through the
splanchnic nerves to their terminations in the adrenals and
liver. Also, they are of the opinion that the hypophysis does
not affect glycogenolysis but is concerned with the utilization
of sugar by the organism.—L. G. K.

(HYPOPHYSIS) Hypophysaire diabetes. Koopman (J.), Ned.
Tijdschr. v. Geneesk. (Haarlem), 1919, 63 (II), 1071.

A short abstract of an article published in Endocrinology,
3, 485.—J. K.

(HYPOPHYSIS-PANCREAS) Acromégalie et diabéte. Labbé
(M.) and Langlois (S.), Bull. Soe. Méd. des Hép. (Paris),
1919, 43, 229-234.

Observations are herein reported of a typical ease of
acromegaly, in a miner of 48, but superimposed upon this were
polyuria and glycosuria. Neither polyuria nor glycosuria were
in any definite way influenced by hypophysis medication,
either by whole gland or by extracts of posterior lobe. On the
other hand, reduction of the carbohydrate intake or fasting
for three days cured the glycosuria without affecting the
polyuria. Furthermore this particular patient did not lose
weight nor become emaciated and had in effect a high tolerance
for sugar.

The polyuria was thought to be due, following the ideas
of Loeb, to irritation of the centers at the base of the brain by
the enlarged hypophysis. The glycosuria was thought to be
due in part to irritation to this region and in part was thought
to be alimentary glycosuria in the ordinary sense.—A. L. T.

(HYPOPHYSIS) Antipituitary serum. In arteriosclerosis and
diabetes mellitus. (Preliminary communication.) Laura
(CEE) Na Yi Mied: ewan, S) eal 0 eb gale

A preliminary report of the action of serum obtained from
the horse following immunization with extracts of posterior
and infundibular pituitary, upon blood pressure and sugar
metabolism. This ‘‘antipituitary serum’’ was used on about
40 patients who received several intramuscular injections, in
doses of from one to three cec., at intervals of from two to five
days. The larger number of patients were diabetics, some were
suffering from arteriosclerosis, some from various diseases and

ABSTRACTS 131

two were normal. In all of the patients except two, and after
every injection, the blood pressure was affected with small as
well as large doses. Within thirty minutes following the in-
jection, the blood pressure became reduced by 15 to 20 mm.
and gradually reached a maximum depression in one or two
hours and remained down for several hours. Of 30 patients
suffering with diabetes mellitus treated with the serum, eight
did not respond, fourteen had a complete disappearance of
sugar from the urine, while the intake of carbohydrates was
notably increased, and eight had a diminution of glycosuria.
Polyuria commonly disappears with rapidity, even in the most
unfavorable cases—H. W.

(HYPOPHYSIS) An explanation of acromegaly (Ein Strei-
flicht auf die Akromegalie). Lentz (F.), Miinchener med.
Wehnschr., 1919, 66, 992.

The author tried to answer the question why in acro-
megaly do the hands, feet, nose, ears and chin grow. He tries
to find a relation with the experiments of Schultz, who experi-
mented on Russian rabbits with white hair, except on the ears,
where it is black. If a part of this white hair is removed and
the animal is kept in the cold, the new hairs on this spot are
black. Because of these experiments Lentz believes that hands,
feet, nose, ears and chin grow in acromegaly because they are
the coldest parts of the body.

(The experiments of Schultz are interesting, but the con-
clusion of Lentz is at least unproved, not to use another
word) .—J. K.

(HYPOPHYSIS) A method of tissue analysis: Applied to the
lobes of cattle pituitaries. MacArthur (C. G.), J. Am. Chem.
Soc., 1919, 41, 1225-1241.

The method of separation into proteins, lipins, and ex-
tractives is based upon the method of W. Koch (J. Am. C. S.
31, 1329). The original method has been simplified and made
available for amounts of.material extending from 10 gms. to
as low as 2 gms. Methods are given for the determination of
Ca, Mg, total N, ammonia N, urea N, amino N, creatinine,
creatin, urie acid, total S, S as sulfate, neutral S, extractive S,
neutral P, lipin residue N and P, cholin N, absorbed iodine,
sugar, cholesterol, humin-N, in the three fractions. Complete
analyses of the anterior and posterior lobes are given.

The anterior lobe has 2.4% more solids, 4% more protein,
0.9% less lipins, 0.9% less extractives than the posterior lobe.
The distribution of the various elements and compounds in the

132 ABSTRACTS

protein fraction indicates a close similarity in nature of the
proteins of the two lobes. Except for the small amount of
sulfatides in the hypophysis the distribution and amounts of
the various lipins are similar to those of the cortical gray
matter. The extractives predominate in the posterior lobe.
This predominance consists mainly in the non-phosphate P,
amino N, and undetermined N fractions. The two latter may
be present in the pressor compound.

The chemical composition of the hypophysis resembles the
gray matter of the brain or young nervous tissue in most re-
spects. There are points of resemblance to the thyroid and
spleen, quite a few to the liver, but practically none to the con-
nective tissues, muscle, or white matter of the brain.

In those respects in which the two lobes differ the posterior
is more like the gray matter than the anterior. Both lobes
resemble each other more closely, than either resembles any
other tissue. It cannot be stated that the pituitary is more like
unmedullated nervous tissue than it is like undifferentiated pus
cells. It can be assumed as an hypothesis that the partly dif-
ferentiated embryological materials, after union of the two
parts, develop together, resulting in a similarity of composi-
tion.—V. K. L.

(HYPOPHYSIS) The effect of feeding pars tuberalis and pars
anterior proprior of bovine pituitary glands upon the early
development of the white rat. Marinus (C. J.), Am. J.
Physiol. (Balt.), 1919, 49, 238-247.

A group of 53 rats was fed upon pars anterior proprior of
the pituitary gland, a second group of 37 animals upon pars
tuberalis, while a control group of ten received beef muscle.
During the 12 weeks of feeding the rats of the first group ex-
hibited an increased growth rate accompanied by a more rapid
development of the reproductive system, evidenced by gross
and microscopic hypertrophy of the organs and by the earher
birth of young. Jn the pars tuberalis-fed rats there was no
change in the sexual development as compared with that of
the control group. The growth rate was slightly slower in
the second group, due perhaps to the smaller amount of meat
received. The author concludes that his study does not show
that any of the functions aseribed to the anterior lobe as a
whole are due to the pars tuberalis—hL. G. K.

(HYPOPHYSIS). Report on the use of tethelin. Mayo (Helen
M.), Med. J. Australia (Sydney), 1918, 5, 413.

This is a report of the treatment of an electrical burn on
the leg of a long-standing diabetic, with combined injections

ABSTRACTS 133

and applications of ‘‘tethelin.’’? The burn had been compli-
eated by the application by the patient of carbolic solution.
The tethelin was administered in 100 milligram doses divided
between the two methods of procedure for ten days, when heal-
ing was practically complete. No further trouble was experi-
enced with the leg, but the patient died four months later,
insane, and in coma.—F’. S. H.

(HYPOPHYSIS) The possible cause of hereditary optic
atrophy. Pancoast (H. K.), Am. J. Roentgenology, 1919, 6,
“7.

Fisher has advanced the theory that this disease might be
due to a transient disorder of the pituitary body with enlarge-
ment occurring at definite epochs of the sexual life. With the
idea that the roentgen examination would seem to be the most
certain means of proving this point, provided the enlargements
were sufficient and of a necessary prolongation to produce a
sellar deformity, the author presents his studies of the affected
members of two families. These studies tend to lend weight
to Fisher’s theory of the etiology of this disease, but cannot be
regarded as proof positive.—J. F.

(HYPOPHYSIS) Operation der Hypophysistumoren. Piffl.
Berl. klia Wehnschr., 1919, 56, 863; Wiener klin. Wehnschr.,
1919, 32, 870. ;

Only of technical surgical interest.—J. K.

(HYPOPHYSIS) Action of endo-hypophysin and infundibulin
on the pregnant uterus (L’azione dell’ endo-ipofisina e dell’
infundibulina sull’ utero gravido). Pugliese (A.) Terapia,
1916, No. 22 (Reprint, p. 16.)

The former preparation is an extract of the whole pitu-
itary; the latter of the infundibulum with a portion of the
pars intermedia. Although the non-pregnant uterus of the
guinea-pig and rabbit reacts well enough when isolated in a
bath of Ringer’s solution it does not respond readily in situ to
a hypodermic injection. For this purpose a pregnant uterus is
necessary, and since the therapeutic method of administration
is a hypodermic one, the author considers this method also
necessary for laboratory testing. Hence he employs pregnant
guinea-pigs or rabbits, removes the fetuses and allows a uterine
horn to protrude through a small opening in the abdominal wall
into a myograph chamber jacketed with warm water.—Physiol.
Abst., 3, 386.

134 ABSTRACTS

HYPOPHYSIS, On an uncommon disease caused by an ade-
noma of the— (Uber ein ungewohnliches Krankheitsbild bei
Hypophysenadenom). Reichmann (V.), Deutsches Archiv. f.
khn. Med. (Leipzig), 1919, 130, 133; Miinchener med.
Wehnschr., 1919, 66, 1103.

Two cases are described with the same symptoms: red
swollen face, protusion of the eyes without other symptoms of
Graves’ disease; no goitre, bradyeardia, myasthenia, general
cachexia, edema of the legs; slight glycosuria, no albuminuria,
arteriosclerosis, high blood pressure (without Bright’s dis-
ease), osteoporosis of the vertebral column. One patient died.
The post-mortem examination showed an eosinophil adenoma
of the hypophysis. The second patient showed an abnormal
shadow in the place of the sella turcica on the roentgenogram.
Probably the disease may be considered as a hyperfunction of
hypophysis and adrenals and a hypofunction of the thyroid.

—J. K.

(HYPOPHYSIS) Hypophysare Kachexie. Reye. Berl. klin.
Wehnschr., 1919, 56, 790.

A woman with general cachexia and oedema was treated
with hypophysis with good suecess. Her treatment was not
continued and in four months the patient became seriously
ill with cachexia, oedema and a blood pressure of 80 mm.
Again treatment with hypophyses gave splendid result, but,
though the oedema disappeared, the patient gained enormously
in weight.—J. K.

(HYPOPHYSIS) Signs and symptoms of hypopituitarism.
Roberts (Stewart R.), Proe. Southern Med. Assn., J. Am. M.
Assn. ((Chgo.),; 19195 173; 1195:

Undergrowth, dwarfism, dysgenitalism, feminine hirsuties,
feminine type of skeleton, lack of secondary sexual character-
istics, genital atrophy and impotenee, headaches, languor and
weakness may appear in varying degrees in different cases at
different periods. The classic signs and symptoms of hypo-
pituitarism are subnormal temperature, dry skin, adiposity, low
blood pressure, slow pulse, constipation, amenorrhea, drowsi-
ness and inactivity. Lack of attention, impairment of memory,
actual dulness, and mild psychoses to actual convulsive seizures
with epileptie attacks may oceur. The cause may be glandular
deficiency of one or both lobes, a pituitary tumor with damage

ABSTRACTS 135

of the gland, or a neighborhood tumor or hydrocephalus with
pituitary pressure. The symptoms of intracranial tumor may
be more prominent than those of pituitary deficiency. Infan-
tilism, dysgenitalism and obesity, and symptoms of intracranial
tumor, warrant pituitary study.—Quoted.

(HYPOPHYSIS) A metabolism study in a case of diabetes in-
sipidus. Rosenbloom (J.) and Price (H. T.), Am. J. Dis.
Child. (Chgo.), 1916, 12, 53-60.

The writers recognize two types of diabetes insipidus in
children: (1) primary or idiopathic cases, including those in
which there is no evident organic basis for the disease; (2)
symptomatic, including those cases in which some organic dis-
ease is present in the brain or elsewhere. According to them,
there are three theories as to the etiology of this condition, as
follows: (1) that it is due to a lack of ability of the kidneys
to concentrate the urine; (2) that primary polydipsia exists
with normal kidney function; (3) that it is a polyuria, purely
symptomatic in origin, produced by stimulation of the kidneys
by many causes, but in some eases by a hypersecretion of the
hypophysis. They give a brief review of the literature on the
relationship between the hypophysis and diabetes insipidus.

—M. B. G.

(HYPOPHYSIS) Pituitary standardization. The relative
value of infundibular extracts made from different species of
animals and a comparison of their physiclogical activity with
that of certain commercial preparations. Roth (George B.),
U. S. Pub. Health, Hygienic Lab. Bull. No. 109 (Washing-
ton), 1916.

The determination of the activity of infundibular extracts
made from the pituitary body obtained from various species of
mammals—namely, cattle, sheep, horses, hogs, rabbits, cats, and
dogs—was made by both the blood pressure and the isolated
uterus methods, and it was found that the infundibular ex-
tracts made from cats or dogs were more active than similar
extracts made from the other species of mammals. An indi-
vidual variation was shown in extracts made from the same
species of mammals. Commercial infundibular extracts exam-
ined in the same way showed a variation of 800 per cent by the
blood pressure method and of 1,000 per cent by the isolated
uterus method. A commercial preparation of infundibular ex-
tract which contained chlorbutanol as a preservative was shown
to depress the motility of the isolated intestine of the rabbit
when used in coneentrated solution.

136 ABSTRACTS

It was concluded that the activity of infundibular extracts
on the isolated uterus of the virgin guinea-pig should not be
taken as an index of their activity on the blood pressure. In-
fundibular extracts made from the pituitary bodies obtained
from cattle, horses, hogs, cats, dogs, and rabbits differ quanti-
tatively in their activity. The infundibular lobe of the pitu-
itary body of cats, dogs, and hogs contains a greater amount of
active materials than from eattle, sheep, horses, or rabbits.
Commercial infundibular extracts vary widely in their physio-
logical activity. The motor depression of the isolated intestine
which is caused by certain commercial infundibular extracts is
due in certain instances to the depressing effect of the preserv-
ative chlorbutanol.—Author’s Summary.

HYPOPHYSIS, Development of the form of the human—.
(Formentwickelung der menschlichen Hypophysis cerebri).
Rudel (E.), Anat. Heft. (Weisbaden), 1918, 55, 187.

Technical description of the hypophysis, as indicated by

thie bible —— Fa eee

(HYPOPHYSIS) Hypophysentumoren, Saenger. Berl. klin.
Wehnscehr., 1919, 56, 789.

Demonstration of two patients in whom tumors of the hy-
pophysis were extirpated. In the first case neither the amauro-
sis nor the dystrophia adiposo-genitalis were beneficially influ-
enced, but the patient felt better. In the second case the eye
symptoms became first better after the operation, but returned
later on and acromegaly developed.—J. K.

HYPOPHYSIS, X-ray treatment of tumors of the—and acro-
megaly with temporal hemianopsia (Zur Rontgenbehandlung
der Hypophysistumoren und der Akromegalie mit temporaler
Hemianopsie). Schifer (F.), Deutsche med. Wehnschr. (Ber-
lin), 1919, 45, 981; Berl. klin. Wehnschr., 1919, 56, 886.

A short note. Of eight cases treated with X-rays, six were
largely improved. It is most important to place the head in
a way that the hypophysis is situated in the focus of the
X-rays.—J. K.

HYPOPHYSIS. Operation der Hypophysistumoren. Schloffer,
Berl. klin Wehnschr., 1919, 56, 863.

Only of surgical interest.—J. K.

ABSTRACTS 137

(HYPOPHYSIS) The action, use, and abuse of pituitrin.
Schulze (A. G.), Jour.—Lancet (Minn.), 1919, 39, 584-589.

Nothing new—H. W.

(HYPOPHYSIS) Post-mortem examination of a dwarf. (Sek-
tionsergebnis bei einem Zwerg). Simmonds. Berl. klin.
Wehnschr., 1919, 56, 790.

The post-mortem examination showed atrophy of the tes-
ticles; the anterior lobe of the hypophysis was nearly com-
pletely destroyed by cysts. The posterior lobe was normal.

—J. K.

(HYPOPHYSIS) Case of acromegaly. Soner, Med. J. S.
Africa (Johannesburg), 1918, 13, 102-104.

A clinical presentation and discussion of a case presenting
a syndrome indicative of myxoedema, but which on X-ray an-
alysis showed undoubted acromegalic characteristics, though
with some accompanying thyroid derangement.—F. S. H.

(HYPOPHYSIS) On the use of very small doses of pituitrin in
inducing labor at term in combination with nitrous oxide
anaesthesia to alleviate the labor pains. Stein (A.), Trans.
Am. Gyn. Soe., Am. J. Obst. (N. Y.), 1919, 80, 471.

No new data.—H. W.

(HYPOPHYSIS) Dyspituitarism, with limitation of the visual
fields). Symptoms disappearing under the use of internal
glandular therapy, with a return of the visual fields to nor-
mal, Timme (Walter), Arch. Opth., 1917, 46, 151-153.

This patient came under observation after suffering six
years from constant headaches and diminished vision. On ex-
amination contracted visual fields were found. A diagnosis of
pituitary enlargement was made with dyspituitary symptoms.
Treatment was with extracts of thyroid and pituitary and,
because of the low blood pressure manifested, whole suprarenal
gland was administered with excellent results—J. H. L.

(HYPOPHYSIS) A case of pituitary tumor treated by opera-
tion. Whale (H. L.), Lancet (Lond.), 1919 (ii), 11-12.

Sellar decompression and removal of endotheliomatous
tissue from the anterior lobe of the pituitary gland was fol-
lowed by great improvement in the previous pressure symp-
toms.—L. G. K.

138 ABSTRACTS

(INTERNAL SECRETION) Phenomena of transformation of
larval tissues into reserve tissues, observed during the meta-
morphosis of some metabolan insects. (Phénomeénes de
transformation de tissus larvaires en tissus a réserves ob-
servés pendant les métamorphoses des insects metaboles.
Bordage (E.), C. r. Acad. d. Sei. (Paris), 1917, 165, 477.

Bordage observed that in insects, the developmental cycle
of which includes a chrysalis stage, the larval tissues during
the chrysalis stage undergo a direct (without the action of
phagocytes) and complete histolysis (lyolysis of Anglas) in the
course of which they are entirely dissolved. It seems that this
histolysis is exactly equivalent to the histolytic processes
known to take place during the metamorphosis of amphibians.
(In the latter case we are fairly certain that the histolysis of
the larval tissues is caused by the thyroid hormone. Bordage’s
suggestion that in insects a histolytie secretion may be excreted
into the body fluids by some organ, seems, therefore, to have
some already well established facts in favor and it would be
of greatest importanee to look for those organs or tissues
which might exerete such substances in insects. Possibly we
will find here the predecessors of the vertebrate thyroid gland.)

—E. U.

INTERNAL SECRETIONS, Progress in the knowledge of—
(Fortschritte in der Lehre von der inneren Sekretion).
Pitter (A.), Deutsche med. Wehnsechr. (Berlin), 1919, 45,
1008.

A general review of some well known facts of endoerin-
ology.—J. K. '

(INTERNAL SECRETIONS) Exophthalmos in leukemia.
Schioetz (C.), Tidsskr. f. d. norske laegeforen., 1916, —, —.

Details are given of two cases of acute lymphatic leukemia,
where exophthalmos was a prominent symptom. This is dem-
onstrated anatomically to be due to edema of the fatty tissue in
the orbits. The various toxie and endocrine causes of exoph-
thalmos are discussed; the explanation is offered that certain
toxic substances, especially aromatic amino-compounds, have
an elective effect on the orbital fat—kK. M.

LIPODYSTROPHIA progressiva, A new case of—. Weber
(F. P.) and -Gunewardene (T. H.), Brit. J. Child. Dis.
(Lond.), 1919, 16, 89.

Weber reports another case of this rare condition. The

ABSTRACTS 139

patient was a girl of 1214 years of age, who since the age of
71% years, has been losing the subcutaneous fat over her face,
neck, upper extremities and trunk as far down as the pelvis,
being emaciated in these parts, but normal below the hips.
The change occurred following attacks of measles, pertussis
and pneumonia, in rapid succession. The previous ease of this
condition which was reported by Weber was abstracted in
Endocrin. 1917, 1, 481.—M. B. G.

MYOTONIA ATROPHICA. Slecht. Berliner klin. Wehnschr.,
1919, 56, 405.

Three typical eases. All three showed eataract, loss of
hair, atrophy of skin and atrophy of the thyroid and testes.

J. K.

OSTEOMALACIA, A case of infantile—(Ein Fall von kind-

lichem Osteomalazie). Blencke, Miinch. med. Wehnschr.,
1919, 66, 948.

Of no direct endocrine interest.—J. K.

OSTEOMALACIA, An epidemic of— (Ueber gehauftes Auf-
treten von Osteomalazie). Partsch (F.), Deutsche med.
Wehnschr. (Berlin), 1919, 45, 1130.

The same epidemic that has been observed in Vienna has
been seen in Dresden. The description is of no direct endo-
erine interest.—J. K.

(OSTEOMALACIA) Familial starvation-osteomalacia (Fami-
laire Hungerosteomalazie). Schlesinger (H.),- Wiener klin.
Wehnschr., 1919, 32, 929.

The author demonstrated two sisters and a mother and a
daughter with osteomalacia. The latter two patients had
large goitres.—J. K.

(OVARY) On the origin of the corpus luteum of the sow from
both granulosa and theca interna. Corner (G. W.), Am. J.
Anat. (Phila.), 1919, 26, 117.

The ovary of the sow possesses certain advantages for the
solution of this problem. The paper is based upon a large series
in which the stage of the reproductive cycle was determined
by observation of the living animals and their ova. The re-
sults may be summarized as follows: In swine the membrana

140 ABSTRACTS

eranulosa is retained intact after the rupture of the Graafian
follicle. Its cells inerease in size without division, the cyto-
plasm becomes laden with hpoid substances, and they become
the larger elements commonly ealled ‘‘lutein cells’’ in the fully
formed corpus luteum. The membrana granulosa is invaded
by blood eapillaries from the theea interna which ramify to
form an extensive vascular plexus throughout the new strue-
ture. The hpoid-laden cells of the theea interna are increased
in number by mitotie division, lose many or all of their fatty
inclusions, and pass into the corpus luteum to become lodged
between the granulosa cells throughout the whole structure.
There is no evidence that cells of the theca interna are ever con-
verted into fibroblasts of the usual spindle-cell type or that
they lay down the fibrils of the close-meshed reticulum which
is present in the corpus luteum. There appears to be good evi-
dence that some of the theca interna cells persist throughout
pregnaney as distinet elements of the corpus luteum, but the
exact fate of all of them cannot be learned by present methods
because of the confusing resemblance between some of the
theea and some of the granulosa derivatives. (Author’s ab-
stract. )

(OVARY) Uterine haemorrhages and their relation to internal
secretion (Uber Gebarmutterblutungen und ihre Beziehung
zur inneren Sekretion). Flatau, Miinch. med. Wehnschr.,
1919, 66, 1069.

Gynecologists too often forget that many uterine haemor-
rhages find their origin in the ovary. In these cases treatment
with the curette is a failure. Treatment with corpus luteum
preparations may give good success in these cases.—J. K.

(OVARY) Two cases of hypernephroma of the ovary. Gordon
(AL Ke), Brit. Med. J: -Guond:) S1919 4G) 495:

Not of endocrine interest.—lL. G. K.

(OVARY) Are the operative procedures done for dysmenorrhea
and sterility justifiable in the light of developmental study?
Holden (F. C.), Am. Jour. Obst. (N. Y.), 1919, 80, 415-420.

Report of beneficial results following endocrine therapy in
cases of sterility and dysmenorrhea.—H. W.

(OVARY) Preliminary report on the influence of alcohol and
nicotine upon the ovary. Ogata (S.), J. Med. Res. (Boston),
TONGS 4O 1 23 27.

ABSTRACTS 141

No apparent changes were found in the ovaries following
repeated injections of ethyl alcohol into the ear vein of rabbits,
though in some eases there were fewer developing Graafian
follieles than in the normal, in addition to inhibition of growth
of the ovary. Similar experiments with extract of cigar to-
bacco resulted in no apparent changes in the ovary either
macroscopically or microscopically —Chem. Abst., 18, 2924.

(OVARY) Absence of uterus, fallopian tubes, one ovary and
vagina, with one large central kidney. Parakh (F. R.), Brit.
Med. J. (Lond.), 1919, (ii), 496.

The condition found during an exploratory coeliotomy is
indicated in the title. The woman was perfectly healthy, ex-
cept that she had never menstruated.—lL. G. K.

(OVARY) Ovulation, conception and abitrary impregnation.
(Ovulation, Konzeption, und willkirliche Geschlechtsbesti-
mung). Ruge (C.), Verhand. der Gesall: f. Geburtsh. u.
Gynak zu Berlin, Ztschr. f. Geburtsh. u. Gynak (Berlin),
OES 31, 256.

An extended series of clinical observations, the number of
which is not recorded, has led the author to the conclusion that
ovulation follows the first half of the menstrual cycle. It can
begin as soon as the progressing corpus luteum, which during
its growth inhibits the complete development of other fol-
heles, begins to retrogress, and is dependent as much upon
internal factors still unknown to us as upon external, among
which, apparently, the sexual stimulus plays a significant part.
The optimum conception time is after menstruation.—l’. 8. H.

(OVARY) Osteomalacia in an antelope. Schumann (EF. A.),
Trans. Obst. Soc. Philadelphia, Am. Jour. Obst. (N. Y.),
1919, 80, 223.

A pregnant antelope was so weak that it could not stand.
It misearried and later regained health and at the end of six
months again became pregnant. Weakness became marked and
the animal finally died. An autopsy revealed cystic ovaries
and a partly developed embryo in the uterus. The skull was
typical of osteomalacia, the pelvis was distorted and the bones
throughout were flexible. Osteomalacia appears to be common
in wild animals held in captivity. The author is inclined to -
believe that the condition is essentially the result of improper
metabolism. However, the occurrence of the symptoms of

142 ABSTRACTS

osteomalacia with pregnancy seem to indicate that the disease
is in some way associated with pathological states of the pri-
mary reproductive organs.—H. W.

OVARY, Experimental degeneration in the—of the fowl,
caused by altered surroundings. [Ueber experimentelle
durch veranderte dussere Bedingungen hervorgerufene Ruck-
bildungsvorgange am Hierstock des Haushuhnes (Galeus do-
mesticus)]. Stieve (H.), Arch. f. Entw. (Berlin), 1918, 44,
530.

Actual anatomical changes (degeneration of follicles) take
place in the ovary of a fowl kept in close confinement. The
author concludes that this is not due to absence of sexual
stimulation, though this possibility is not absolutely excluded.
Too much food and too little exercise caused fatty degenera-
tion in some eases, but in the majority of instances no other
cause than psychic disturbance can be assigned.—M. M. H.

(PANCREAS) Diabetic lipoidemia. Bang (Ivar), Biochem.
Zischr., 1919, 94, 359-391.

From an extended study of a number of cases B. concludes
that there is not necessarily a relationship between carbohy-
drate tolerance and lipemia. Experiments also indicate that
diabetic lipemia is of alimentary origin. Coma is an exception.
Hyperlipemia is not of pure alimentary origin. That the
diabetic organism cannot take care of the resorbed fat is prob-
ably due to the liver. Since this liver insufficiency cannot be
associated with acidosis or with hyperglycemia, it stands rather
alone and B. questions the significance of lipemia. Is it a good
or bad prognostic symptom ?—Chem. Abst., 13, 3239.

(PANCREAS) The dietetics of diabetes and glycosuria. Brown
(W. Langdon), Practitioner (London), 1919, 103, 88-99.

The author, in addition to an interesting review of modern
methods of treating diabetes calls attention to ‘‘non-diabetic
alycosuria.’’ Overaction of either the thyroid or the pituitary
lowers carbohydrate tolerance, and may excite frank glyco-
suria. He considers the glycosuria of pregnancy (as distinct
from lactosuria) probably due to its stimulating effect on the
thyroid and pituitary.—H. L.

* (PANCREAS DIABETES) Glycosuria in pregnancy. Cam-

eron (M. H. V.), Can. Med. Assn. J. (Toronto), 1919, 9,
(EGE ers

ABSTRACTS 143

In 468 cases of pregnaney, five cases of glycosuria were
found. In four of these the sugar was identified as glucose
and in the other, as the patient died of diabetes, the sugar
supposedly also was glucose. Consequently finding of sugar
in the urine during pregnancy must be regarded seriously and
not lightly dismissed as a probable lactosuria. Where glyco-
suria exists, true diabetes may be about to manifest itself or
may be already in existence. Regulation of the diet keeps the
symptom in abeyance. A careful selection of anesthetic and
any means possible to lessen the shock of delivery helps to
prevent the onset of such changes in the endocrine system,
already strained beyond the normal, as indicated by the gly-
cosuria and which might result in diabetes. Should the glyco-
suria be controllable by diet regulation, frequent examination
of the urine may be sufficient to protect the patient during
gestation. This does not, however, decide whether her dia-
betes is under control because of the possibility of foetal hor-
mones, functioning in the maternal economy, nor does it differ-
entiate a glycosuria due to hyperalimentation or secretion of
inverted lactose. The only means of arriving at definite con-
clusions is by estimation of the sugar in the blood.—L. G. K.

(PANCREAS) Diabetes, The fasting treatment of—. Cam-
midge (P. J.), Brit. Med. J. (Lond.), 1916, (ii), 160-161, 245.

Contains a table showing the carbohydrate content of
various foods to be used in the fasting treatment of diabetes.
Excellent results from this method are reported.—h. G. K.

(PANCREAS DIABETES) Glycosuria in elderly persons.
Cammidge (P. J.), Brit. Med. J. (Lond.), 1919, (i), 112-113.

Cammidge eriticizes the view of Rankin (see abstract in
this number), that a moderate amount of sugar in the urine of
elderly persons need not cause alarm. In the author’s experi-
ence there are two types of such persons, and the difference
depends largely upon the sugar content of the blood. Even a
moderate excretion of sugar associated with hyperglycemia
leads in the course of time to complications, whether the pa-
tient be young or old, whereas glycosuria unattended by an
excess of sugar in the blood is not likely to give rise to trouble
or shorten life, especially if, as often happens in elderly per-
sons, the reducing substance in the urine is not really a sugar
but the ketonie acid previously described by the author under
the name of ‘‘pseudo-laevulose.’’

The success of the Allen treatment of diabetes in elderly
persons depends upon individualization of the treatment and

144 ABSTRACTS

education of the patient, so that he may follow his diet intel-
ligently. Such persons do not stand starvation well, but as
a rule, actual fasting is not necessary to secure a normal blood
sugar and a sugar-free urine if a earefully arranged system of
dieting is followed.—h. G. K.

(PANCREAS) Dehydration of blood and organs in diabetic
coma. (La déshydratation du sang et des organes dans le
coma diabétique). Chauffard (A.), Le Conte, Darie. Presse
Méd. (Paris), 1917, 25, 185.

A careful study was made of two instances of diabetes
mellitus in which there was found definite evidence of dehydra-
tion in various tissues. The blood was characterized by a
polycythemia and increase in density. In other tissues an in-
crease in density or decreased water content of kidneys, liver
and pancreas was found. The most marked changes in tissue
density were in the pancreas.—A. L. T.

(PANCREAS) Disappearance of glycosuria in diabetics dur-
ing intercurrent infectious diseases. (De la disparition de la
glycosuria chez les diabetiques ou cours des malades infec-
tieuses intercurrents.) Cottin (E.) and Saloz (M. C.), Arch.
d. mal. de l’appar. digest (Paris), 1916-1918, 9, 371-383.

The authors report that in four diabetics with glycosuria
the occurrence of an intercurrent infection with fever was ac-
companied by a cessation of the urinary sugar excretion. This
they consider may be due to an abnormal destruction of pro-
tein; an alteration in the glyco-regulating mechanism by virtue
of the septic process; an activation of combustion by the in-
creased temperature; or, as seems more plausible, consumption
of the glucose by the infectious agent.—F. S. H.

(PANCREAS) Diabetes mellitus of four years standing fol-
lowed by pulmonary tuberculosis with apparent cure of both
as told by patient. Cram (E. A.), Ky. Med. J. (Bowling
Green), 1919, 17, 408-409.

Content indicated by caption.—H. W.

(PANCREAS) Diabetes mellitus. Densten (J. C.), N. Y. Med.
J. (N. Y.), 1919, 110, 613-615.

There is little or no interference within the animal economy
of a diabetic with the ingestion and metabolism of animal
nitrogenous foods and some vegetable proteins. The major

ABSTRACTS 145

metabolic fault hes in the noncleavage of sugar into alcohol
or its radicles. Hence, alcohol is indicated in amounts suf-
ficient fully to account to the system the lack of nourishment
which the sugar should furnish if spht further by a normally
constituted system. The withdrawal of carbohydrates from
a diabetic of any age is not advisable. Starvation only causes
the body to utilize its own fat. Moreover, such procedures
only tend to result in inanition. Diabetes should not be con-
sidered a disease per se, but rather a symptom of some exist-
ing constitutional organie abnormality or disease. It may be
a sequel of syphilis, or it may be traced to some viseus as the
pancreas, liver, spleen, appendix, ete., or to a deranged fune-
tion of the pituitary body. Hence, the etiology of diabetes
should be sought and treated.—H. W.

(PANCREAS) Diabetes mellitus. Edgar (T. W.), N. Y. Med.
J. (N. Y.), 1919, 110, 612-613.

Starvation of diabetics is not applicable in all cases and
should not be used empirically. Emaciation and lowered bodily
resistance contraindicate starvation. The emaciated or eachetic
diabetic who has resorted time and again to starvation with
ever decreasing tolerance does better if carried along on his
last assimilation limit for a short time. The intermittent
starvation of animals first results in an increased ability to
assimilate sugar, but is later followed by a decrease as time
advances, that is, after body weight has been sacrificed, hence
a decreased resistance has a direct bearing on the ecarbolytie
action of the sugar enzyme or enzymes. The diabetic patient,
although rendered aglycosurie by starvation, will require a
longer period of time to attain his previous point of tolerance
than if granted a short reprisal and allowed to continue his
last diet in spite of the urine showing sugar.

Specific serum therapy (Edgar serum) is highly recom-
mended in the treatment of diabetic cases. No discussion ap-
pears relative to this serum.—H. W.

(PANCREAS) Edgar serum treatment of diabetes mellitus.
Edgar (T. W.), West. Med. Times (Denver), 1919, 39, 172-
174.

Treated elsewhere.—H. W.

PANCREAS, Relation of the—to the diabetic state. Ervin
(D. M.), J: Lab. & Clin. Med. (St. Louis), 1919, 4, 711.

The pancreatic diabetic state is characterized by several
pathological changes—absence of glycogen, hyperglycemia,

146 ABSTRACTS

fatty changes, acetone bodies and glucose in the urine and a
lower respiratory quotient. Experiments were performed to
test the glucose consumption in the diabetic animal. The lat-
ter was produced by the removal of the pancreas. The results
showed that, while after depancreatization, the blood sugar
increased in amount, the actual oxidation by the tissues is prac-
tically the same as before the operation. The hyperglycemia
is readily explained by assuming a glycogenetie function for
the panereas through an internal secretion of the islands of
Langerhans.

The internal secretion contains an enzyme which resembles
that of the external secretion. It is assumed that the enzyme
acts by stimulating a reversible chemical reaction. The ex-
ternal secretion reduces the starch in the intestine to glucose
while the internal secretion poured into the portal circulation
reverses the action upon the absorbed glucose, synthesizing it-
into glycogen which is stored by the liver. By clamping the
panereatic vein and injecting glucose solution in the small
intestine, a marked hyperglycemia was produced. <A _ con-
trolling experiment did not show this rise. The same results
occurred with the removal of the pancreas.—B. T. 8.

(PANCREAS) Diabetes with pancreatic insufficiency. Treat-
ment by glandular extracts; selective therapeusis of the ex-
ternal secretory function of the pancreas (Diabéte avec insuf-
fisance pancréatique. Traitment opothérapique; disjonction
thérapeutique des secretions externe du pancréas). Faroy
(G.), Bull. Soe. méd. des Hop. (Paris), 1917, 41, 235.

A ease of diabetes is described running a typical course
until there appeared, in addition to endoerine deficiency, a de-
ficiency of the external secretion of the pancreas. The exo-
erine dysfunction of the pancreas was alleviated by the ad-
ministration of pancreatic extract. The true diabetes, how-
ever, was not in the least affected by this therapy. The case
is illustrative of the independence of the endocrine functions
of the pancreas, and of the fact that the exocrine function may
be replaced, or secretion stimulated by exhibition of pancreatic
extracts without any diminution of the glycosuria, polyuria
and other signs of true diabetes mellitus.—A. L. T.

(PANCREAS) Notes on the starvation treatment of a young
diabetic. Fenwick (P. C. C.) Lancet (Lond.), 1919 (1), 299.

Record of a case of diabetes in a boy of 16 who recovered
under the starvation treatment.—L. G. K.

ABSTRACTS 147

(PANCREAS DIABETES) Hyperglycaemia and glycosuria.
Hamburger (H. J.), Brit. Med. J. (Lond.), 1919 (i), 267-271.

This paper is a summary of a number of articles appear-
ing in other journals, and is indirectly of interest to endocrin-
ologists. The research was primarily undertaken to deter-
mine whether it is necessary to assume the existence of a com-
bined sugar of colloidal form in the blood in order to explain
the complete impermeability of the normal kidney to glucose.
By means of perfusion experiments with frogs in which the
renal portal system was tied off so that only the glomeruli
could function, it was found that the glomerular membrane has
the power of retaining free glucose. This power is governed
by the influence of the chemical composition of the perfusion
fluid upon the glomerular epithelium. When Ringer’s solution
of the usual composition containing 1% glucose is used then
0.3% 1s excreted and 0.7% is retained. In the perfusion liquid
the quantities of potassium and calcium ean be altered with
respect to each other in such a way that the retentive power
need not be changed, and the potassium ean be replaced by
radium or uranium, the amount required being proportional
to their radioactivity: rather than to their atomic weights.
However, when the concentration of the sodium bicarbonate in
the Ringer’s solution is raised from 0.2% to 0.285%, the quan-
tity which is present in frog’s serum, all the glucose in the
perfusion fluid is retained, the artificial urine being sugar-free.
It is, therefore, unnecessary to postulate a combined sugar in
the blood.

However, when the amount of glucose in the perfusing
fluid is increased some of the sugar is not retained, and the
greater the degree of hyperglycemia produced the stronger the
permeability becomes. Once the kidney has become permeable,
it cannot again be rendered impermeable by reducing the
amount of sugar, at least not during the several hours taken
by the experiment.

The retention of glucose is not due to the size of the
molecule since sucrose, maltose, lactose and raffinose are not
retained. It is probably due to the configuration of the mole-
cule since the isomeric fructose, the stereo-isomeric mannose
and galactose and even the laevo-rotatory glucose pass through
the glomerular membrane. If a mixture of glucose and an-
other sugar is present the glucose only is retained.

The following provisional hypothesis is submitted. As
long as the concentration of sodium bicarbonate in the blood
plasma is normal, even a moderate hyperglycemia will cause
no glycosuria. If, however, the sodium bicarbonate concen-
tration is diminished, the glomerular epithelium becomes sen-

148 ABSTRACTS

sitive to the proportions of calcium and potassium in the blood
plasma. <A deficiency in the potassium must be met artificially,
but the exeretion of sugar can be prevented also to a large
extent by increasing the concentration of NaHCO,.—L. G. K.

(PANCREAS). _Notes on two cases of diabetes melltius. Hors-
burgh (P.) and Nicol (W. D.), St. Barth. Hosp. J. (Lond.),
1917-18, 25, 43-45.

_A detailed clinical report of two cases of diabetes mellitus,
the first of whom, a young boy, responded favorably at first to
the hunger and vegetable diet, but failed a fortnight later and
improved on having 25 gms. of carbohydrate added to the diet.
The second case had 40 grams added suddenly to the diet and
showed a tolerance for the same.—F. 8. H.

(PANCREAS) Diabetes, The fasting treatment of—. Hume
(John), Brit. Med. J. (Lond.), 1916 (11), 160.

See previous abstract.—L. G. K.

(PANCREAS) Pancreatic diabetes. (Le diabete pancre-
atique). Labbé (M.), Ann. de Med. (Paris), 1919, 6, 204-217.
After giving an historical resume of the evolution of the
ideas concerning pancreatic diabetes, Labbé presents six cases
with the clinical picture of a double syndrome: insufficiency of
of the glyco-regulating mechanism through the abolition of the
internal secretion of the pancreas, and digestive insufficiency
through suppression of the external secretion. The glyco-
regulative mechanism presents various degrees of disturbance
ranging from a small and passing glycosuria to a complete
and continuous glycosuria accompanied by hyperglycemia,
polydypsia, polyuria and other symptoms. Jn the most typical
cases there frequently occurs protein denutrition and acidosis.
The author considers that the moderate cases without a nega-
tive nitrogen balance can be regulated by dietary regime.
The digestive syndrome is characterized chiefly by the type
of stools voided; these are abundant, fatty, soft and have a
butyrie odor. Opotherapy with pancreatic products has proven
beneficial in Labbé’s hands in some eases of the digestive type,
but not in all.—F. 8. H.

(PANCREAS) Gas metabolism in diabetes (Gaswechsel beim
Diabetes.) Loffler. Ztschr. f. klin. Med. (Berlin), 1919, 87,
309.

In not too serious cases of diabetes the effect of the ad-
ministration of a dose of casein on the respiratory quotient is

ABSTRACTS 149

just the same as in normal individuals. If in these cases a dose
of glucose is given, about as high as the tolerance for carbo-
hydrates, no influence on the respiratory quotient is observed.
A second dose of glucose raises the excretion of CO,, but less
than would be expected, theoretically. Probably the first dose
of glucose fills the glycogen depots. The author concludes that
in diabetes there are only quantitative changes in carbohydrate
metabolism.—J. K.

(PANCREAS) The cause of the increased heat production fol-
lowing pancreatectomy in the dog. Murlin (J. R.), Am. J.
Physiol. (Balt.), 1917, 42, 584-585.

In three experiments on dogs the heat production was de-
termined before and after pancreatectomy; and immediately
following each respiration blood was drawn and examined for
blood fat. In one ease, also, the CO, carrying power of the
whole blood was determined by the Haldane method. Thus it
was possible to compare the heat production with the intensity
of the protein metabolism (N output in urine), with the con-
centration of blood fat and with the actual acidosis.

Two dogs were fed before and after pancreatectomy and
on the second day the heat production rose 31 and 42 per cent
respectively. In a third dog which fasted throughout it rose
only 7 per cent, and the increased protein metabolism alone
was sufficient to account for the heat production, but not in the
dogs that were fed.

In none of these cases did the maximum heat production
coincide with the maximum concentration of blood fat, while
normally after an injection or meal of fat the increased heat
production runs parallel to the blood fat concentration. Since
the CO, carrying capacity of the blood rose after pancreatec-
tomy in the one case studied, acidosis was not considered to be
the cause. Nor could any combination of the protein and fat
factors be made to account for it in the two fed animals.

—hL. G. K.

(PANCREAS) Blood sugar in diabetes (Blutzuckeruntersuch-
ungen bei Diabetes Mellitus). Roth (N.), Berl. kin.
Wehnschr., 1918, 55, 589-592.

The blood sugar rises after meals in the early stages of
diabetes, but in later stages falls; it is thus no parallel to the
glycosuria—Chem. Abst., 13, 2399.

(PANCREAS) The control of acidosis in the treatment of
diabetes. Stillman (E.), Arch. Int. Med. (Chgo.), 1919, 24,
445-457.

150 ABSTRACTS

A deseription of the methods employed at the hospital of
the Rockefeller Institute in the detection and prevention of
acidosis in diabetie patients. Typical cases are discussed.

(PANCREAS) Diabetes mellitus, The etiology of—and the
diet and condition of life during the war. Williamson (R.
T.), Brit. Med. J. (Lond.), 1918 (1), 139-141.

The histories of 300 cases of diabetes show the following
as predisposing causes: (1) prolonged great excess of sugar,
sweet food or sweet drinks (alone or combined with other pre-
disposing causes) in 31 per cent; (2) prolonged and intense
mental anxiety, worry, overstrain or sudden mental shock
(alone or combined with other predisposing causes) 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 pre-
disposing factors.—hL. G. K.

(PARATHYROIDS) Chondrodystrophie. Dietrich, Miinch.
med. Wehnschr., 1919, 66, 945.

The author found at the post-mortem examination of a
chondrodystrophie dwarf of 35 years a hypoplasia of the para-
thyroids.—J. K.

PARATHYROIDS, Tetany and the functions of the—. Paton
(D. N.) and Findlay (L.), Brit. Med. J. (Lond.), 1917, (i),
aoa.

Data published elsewhere. See Endocrin., 1917, 1, 476-480.
—hL. G. K.

(PARATHYROIDS) On glandulae parathyroidea. Vermulen
(H. A.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919, 63
(II), 1448.

An anatomical description of the parathyroid in different
animals. See also Endocrinology, 1, 333.—J. K.

PITUITRIN in labor. Agnew (A. P.), Brit. Med. J. (Lond.),
LONG (Gin) Sl.

Advoeates the use of pituitrin to hasten the late first stage
of labor. The pains are more severe but of shorter duration
following its use.—L. G. K.

ABSTRACTS 151

(PITUITRIN) Sieben Jahre, etc. Hofbauer, Monatschr. f.
Geburtsh. u. Gynak. (Berlin), 1918, 325.

Correction Endocrin. 3, 402: For ‘‘Holfauer’’ read
‘‘Hofbauer.’’

(PINEAL) On the pineal region in human embryos. Warren
(J.), Anat. Ree. (Phila.), 1917, 11, 428. (Abstract).

A deseription of the primary arches in the roof of the
forebrain of human embryos of 10 mm. and 15 mm., the para-
physis in embryos of 15 mm. to 44 mm. and the post-velar arch
in embryos of 23 mm. to 44 mm. [ull paper published later. .
See Endocrinol. 1918, 2, 67.—E. R. H.

POLYGLANDULAR disease, Case of —. Climenko (H.), J.
Nerv. & Ment. Dis. (N. Y.), 1918, 47, 276.

Report of a case showing menstrual disorder, rapid gain
of weight followed by loss, polyuria, weakness and mental de-
rangement in which treatment had produced no change.

—A. R. T.

(REPRODUCTION) Yellow pigmentation and fecundity.
Palmer (L. 8.) and Kempter (H. L.), J. Biol. Chem. (N. Y.),
1919, 39, 313-331.

The authors have shown in a preceding paper that the
natural yellow pigment of fowls is derived from the xantho-
phyll of the food and that it bears no important relation to
growth or to the functions of fecundity and reproduction, at
least for one generation. The fading of the yellow pigment
from the ear lobes, beak, shanks, ete., of hens during fecundity
is due to the fact that fecundity deflects the normal path of
excretion of the xanthophyll from these parts of the skin to
the egg yolk. This fading as the result of egg production is
an index of continued fecundity only, and not of heavy laying.
VW. KK. Gh.

SCLERODERMA in infants (Sklerodermie im Saiiglingsalter).
Kraus (A.), Wiener. klin. Wehnschr., 1919, 32, 830.

Of no direct endocrine interest.—J. K.

(SECRETIN) Chemical stimulation of the glands of the mucous
membrane of the stomach. I . The influence of organ extracts
upon the excretion of the gastric juice. (Uber die chemischen
Erreger der Magendriusen, 1. Der Einfluss von Organextrak-

152 ABSTRACTS

ten auf die Sekretion des Magensaftes.) Tomaszewski (Z.),
Arch. f. d. ges Physiol. (Bonn), 1918, 170, 260.

The experiments reported in this paper do not support
Edkin’s hypothesis of the existence of a specific substance
(gastric secretin) contained in the mucosa of the pylorus and
causing gastric secretion. Intravenous injection of pylorus
extract, like that of other organ extracts, does not produce
gastric secretion; subeutaneous injections of extracts of the
mucosa of the pylorus and fundus, of the muscularis of the
stomach, of the pancreas and of the small and large intestine
all cause outpouring of large amounts of gastric juice. This
proves that the substance in question is not only contained in
the mucosa ot the pylorus but in many other organs also. Since
only subeutaneous injection of these extracts is effective, it 1s
likely that the effective substance is produced by chemical re-
actions occurring in the subcutaneous tissue. Attempts to
isolate the effective principle were not successful, but revealed
a number of its characteristics.—E. U.

SEX, The control of—. Bey (L.), Urol. and Cutan. Rev. (St.
Louis), 1918, 22, 642.

A purely theoretical discussion adding but another theory
to the long list of sex-control or determination theories. Not
of endocrine importance.—A. R. T.

(SEX?) Uroleptus mobilis Engelm. II. Renewal of vitality
through conjugation. Calkins (G. M.), J. Exp. Zool. (Phila.),
VSD E PAS en A

Experiments proving that conjugation in protozoa reju-
venates. The usual isolation culture method was employed; a
standard food medium was used throughout, and all series were
kept under the same conditions. A single ex-conjugant of
Uroleptus mobilis, kept from conjugating and from endo-
mixis, goes through approximately 300 generations by di-
visions, the division rate steadily declining until the pro-
toplasm dies from old age in from seven to nine months.
Closely related individuals from such a series will conjugate.
Such ex-conjugants invariably give an optimum division rate
regardless of the vitality of the parent race at the times of
conjugation. The first sixty-day period of all ex-conjugants
shows a uniform vitality measured by approximately 17.4 di-
visions in ten days. If vitality of the parent series is high
(e.g. 15 divisions in 10 days) the inerease of vitality in the
filial series is low (2.4). If vitality of the parent series is low
(e.g. 0.2 division in 10 days) the increase of vitality is high

ABSTRACTS 153

(e.g. J series ex-conjugant from A311 showed an increase in
vitality 17.6 divisions in 10 days). Fourteen such series were
studied, the conjugations giving rise to them oceurring in all
phases of vitality of parent series. In all cases the results
were the same—high initial vitality, declining division rate,
and ultimate death. <A sexual reorganization (parthenogenesis
or ‘‘endomixis’’) occurs during eneystment. Individuals re-
covered from eysts have the same high rate of division and
length of life as individuals after conjugation. Parthenogen-
esis, therefore, as well as conjugation, rejuvenates. (Author’s
abstract. )

SEX, Studies on—in the hermaphrodite mollusc Crepidvia
plana. III. Transference of the male producing stimulus
through sea water. Gould (H. M.), J. Exp. Zool. (Phila.),
1OFG 29; 118.

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
conditions 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 the ma-
jority of cases develop male characters of various degrees of
maturity. 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 forni-
cata, a species related to Crepidula 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 abstract.)

(SEX) Studies on inbreeding. IV. A further study of the
effects of inbreeding on the growth and variability of the
body weight of the albino rat. King (H. D.), J. Exp. Zool.
(Pinla,); 1919, 29; 71.

The data given show that the growth and variability of
the body weights of over 600 albino rats along in the sixteenth
to the twenty-fifth generations of the strain inbred brother and

154 ABSTRACTS

sister from the same litter only. The chief points of interest
are as follows: 1. Continued inbreeding does not produce
any deterioration in the original albino stock as regards rate
and extent of growth and body weight, and neither has it al-
tered the form of the growth graphs for the two sexes. 2. Nor-
mal body weight relations of the sexes have not been changed
by twenty-five generations of inbreeding. 3, The variability
of the body weights of these animals is relatively high at all
age periods, and did not. decrease as inbreeding advanced.
4. A comparison of the variability of the body weights in dif-
ferent series of stock albinos with that for inbred rats indi-
cates that the increased variability in the inbred animals was
due to an environmental and nutritive action, not to inbreed-
ing. (Author’s abstract.)

(SYMPATHETIC N. §.) The irritable heart in general prac-
tice. A comparison between it and the irritable heart of
soldiers. Neuhof (S.), Areh. Int. Med. (Chgo.), 1919, 24,
51-64.

The irritable heart as observed in general practice is sim-
ilar to that found in soldiers save for the fact that vasomotor
symptoms are more pronounced in the former. The etiological
factors are similar, but because of severe training and war
conditions, dormant and latent neuroses are more readily
evoked in the soldier. Hence, the cardiac syndrome is more
violent and lasts longer. Infection is a factor only in so far
as it induces and produces nerve or muscular fatigue and
psychasthenia. No pathologie changes occur in the ecardiovas-
cular system. The fundamental cause of the cardiac neurosis
with its various manifestations, appears to be due to hyper-
excitation of the sympathetic nervous system. Such cases are
best treated with mixed bromides and suprarenal gland ex-
tracts. The latter seems to stabilize and decrease vasomotor
instability by its action on the vasomotor centers, thus counter-
acting the cause of many of the symptoms.—H. W.

TESTES, A study of the seasonal changes in avian—. Watson
(Alex.), J. Physiol. (Lond.), 1919, 53, 86.

Histological. The interstitial cells show their most marked
development in the non-oestrus period, and decrease in number
as spermatogenesis advances.—T. C. B.

TESTES, A case of—in a ‘‘girl.’’ Cooke (G.), and Smuts (Ph.
A.), West London M. J., 1918, 23, 21-24.

ABSTRACTS 155

A description with pictures of an individual presenting
the normal secondary sexual characteristics of the female, as
well as a clitoris and partial vaginal chamber, but devoid of
uterus. She possessed two oval bodies in the ingunial region
which, on removal by surgical interference, were found to be
immature testes.—F. S. H.

(TESTIS) Detection of protective enzymes in very small quan-
tities of serum—micro-Abderhalden reaction. Pregl (Fritz)
and de Crinis (Max), Fermentforschung, 1917, 2, 58-73.

The authors describe a technique whereby Abderhalden
reactions can be determined with 2-3 ce. of serum. They in-
vestigated among other things the effect of serum from cases
of dementia precox upon dried testicular material. The reac-
tion was positive. Numerous other data on technique, etce.,
included in the article will be of interest to those undertaking
studies of the Abderhalden reaction. (Further details in
Chem. Abst., 13, 3230.)—R. G. H. -

(TESTES) The form of the tubules in the embryonal testicle
of the mouse (Over den vorom van de zaadkanaaltjes in den
embryonalen testikel van de muis). de Ruiter (H. T.),
Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919, 63 (IT), 1503.

Of no endocrine interest.—J. K.

(TESTES) Muskelatrophie. Schmidt. Berl. klin. Wehnschr.,
1919, 56, 667.

A ease of dystrophia musculosum of the masseter and the
temporal muscle and of myotonia (so-called atrophic myo-
tonia), with formation of cataract and atrophy of the testicle.
Je i:

(TETANY) Endemic rickets in adults (Endemisches Auftreten
von Spatrachitis). Bittorf (A.), Berliner klin. Wehnschr.,
1919, 56, 652.

In Breslau many eases of rachitis were observed in men
of 15-18 years. In all cases symptoms of tetany were seen. In
one case there was a goitre with slight symptoms of Graves’
disease. Treatment consists in rest, good and abundant feed-
ing and calcium preparations.—J. K.

(TETANY) Endemic disease of the bones (Endemisch auftre-
tende Erkrankungen des Knochensystems). Fromme, Berl.
klin Wehnschr., 1919, 56, 667.

156 ABSTRACTS

In Gottingen many eases of a rickets-like disease were ob-
served in male individuals of 11-18 years. The bones contained
less calcium than normal. In many cases symptoms of latent
tetany were observed. The cause is probably an abnormal
function of the endocrine organs, caused by poor nutrition.

—J. K.

(TETANY) Ueber sensible und sensorische Tetanie. Cursch-
mann (H.), Miinch. med. Wehnschr., 1919, 66, 983.

The author describes two new symptoms of tetany. One
patient had attacks in which ‘‘she felt her own body,’’ an ab-
normal sense perception. Another patient had attacks of
spasms in the tongue. During these attacks her taste and her
smell were changed: bitter substances tasted sour, ete.—J. K.

(TETANY) Hemi-tetany and lesions of the cerebrum (Hemi-
tetanie bei Grosshirnlaesion). Spiegel (E.), Deutsche med.
Wehnschr. (Berlin), 1919, 45, 928.

After removal of a goiter paralysis of the left side was
observed, with tetany in the paralyzed muscles. The author
thinks that during the operation an embolus caused a disturb-
ance in the function of the right side of the brain.

Perhaps during the operation the parathyroids were partly
removed; this would not be enough to cause tetany in a nor-
mal muscle, but the lesion of the brain had inereased the ir-
ritability of the muscles of the left side. Therefore one-sided
tetany was seen.—J. K.

(THYMUS) A review of the recent literature ere on the
function of the thymus gland. Blatz (W. E.), J. Lab. and
Clin. Med. (St. Louis), 1919, 5, 50-54.

The content is sufficiently indieated in the caption.
—B. T.S.

(THYMUS, PARATHYROID) Fragile skeleton and blue
sclerae (Het. broze skelet en de blauwe sklerae). Bolten
(G. C.), Medisech Weekblad (Amsterdam), 1919, 26, 289, 301.

This disease is due, according to Bolten, to insufficiency of
the thymus and the parathyroids and a beginning hyptonia of
the svmpathie system. The X-rays show that the bones are poor
in calcium. It was reported by Klose, Vogt and Erdheim that
thymectomy or parathyroidectomy are followed by fragility of
the bones. In experiments on animals after thymectomy symp-

ABSTRACTS 157

toms of tetany have been reported. Bolten saw in all his cases
symptoms of latent tetany. (Recent detailed experiments in
Japan and in the United States show that thymectomy causes
none of the effects postulated.—Ed.)—J. K.

THYMUS, A recent thesis upon the biology of the— (A propos
d’une these récente sur la biologie du thymus). Dustin (A.
P.), Arch. Zool. Exper. et Gen. Notes et Revue (Paris), 1916,
55, 95-109.

The author reviews briefly a recent article by Salkind on
the thymus of mammals, birds, reptiles and amphibians. The
author regards the small thymie cells as epithelial in origin.
He states that in amphibian larvae on a thymus diet (rich in
nucleins) the epithelial pouches of the pharynx that give
origin to the thymus become very large, forming large thymus
glands which contain a relatively large number of small thymie
cells, but not of the other cellular elements, and the reverse is
true in starving larvae. Thymus feeding also causes an in-
erease in the number of small thymie cells, and thyroid feed-
ing a destruction of the small thymie cells of adult frogs.

Dustin states that the small thymic cells are the only
fundamental, constant, specific elements in the organ, and that
all other elements are inconstant and variable, are produced
by metaplasia, and are simply episodes in the degeneration of
the thymus. It is concluded that the thymus is not a true
eland, but is rather the center of nuclein metabolism acting
as a reserve for nucleins which are liberated by hormones
from other organs such as the liver and pancreas. (The au-
thor’s conclusion finds some support in the rapid loss of
thymie substance in inanition and wasting diseases.)—E. R. H.

(THYMUS) A few words on the human thymus gland
(Quelques mots a propos du thymus humain). Dustin (A.
P.), Ann. et Bull. Soe. Royale Sci. Med. et. Nat. (Bruxelles),
1919, —, 30.

Sections through the thymus glands of individuals who
succumbed suddenly to accidents demonstrated that the thymus
remains functionally active to a relatively high age. In indi-
viduals of 40 years the thymus is still rich in small lymphocytes
and consequently in chromatin. In persons who died from dis-
eases of longer duration, typical thymus involution was ob-
served, similar to that in fasting vertebrates. The thymus
reacts in a most sensitive way to nutritive disturbances. Dustin
also calls attention to the work of Delezenne who recently
found that the thymus is among the organs very rich in zine,

158 ABSTRACTS

this being closely associated with the nucleolytie ferments.
D. thinks that this is another fact supporting his theory, accord-
ing to which, the thymus plays a very important role in regu-
lating the nuclein metabolism of the body.—E. U.

THYMUS and THYROID (Thymus et corps thyroide). Dustin
(A. P.) and Zunz (E.), Bull. Soe. R. Se. Méd. et Nat. Brux-
elles, 1919, —, 27-28 (Mech. 3)

The thymus is rarely atrophic in men of 19 to 34 years of
age who have succumbed rapidly to war wounds. Large thy-
muses were found associated with small thyroids and vice versa,
which fact seems to indicate that there is a balance between
the two organs.—Physiol. Abst., 4, 339.

(THYMUS) Infantile eczema and status lymphaticus. Lindsay
(L. M.), Can. Med. Assn. J. (Toronto), 1917, 7, 135-136.

A ease of sudden death in a child suffering from infantile
eczema is recorded. At autopsy an abnormally large thymus
gland was found. The diagnosis of status lymphaticus was
made. The case is presented because of the existence of a dif-
ference of opinion as to the cause of sudden death in infants
with eczema.—h. G. K.

(THYMUS) Malignant neoplasms of the thymus gland.
Strauss (S. G.), N. Y. Med. J. (N. Y.), 1919, 110, 646-648.

The thymus is an endodermal epithelial structure remnants
of which surely persist to forty, probably longer. Malignant
neoplasms arising from the gland may be divided into sarco-
mata and carcinomata, and a diagnosis of such may be made in
spite of the absence of Hassal corpuscles in the growth. Sar-
coma is more common than carcinoma in the young, carcinoma
more frequent in the aged.—H. W.

(THYMUS, THYROID) Operation upon the thymus in Graves’
disease (Thymusoperation bei Basedow). Melchior, Deutsche
med. Wehnsechr. (Berlin), 1919, 45, 1061.

When, during operation for Graves’ disease, the thymus
is removed, exacerbations may just as well be observed as in
cases where the thymus is left in its place. Removal of the
thymus has sometimes a fatal influence on the symptoms of
Graves’ disease.—J. K.

(THYMUS) Studies on the reputed endocrin function of the
thymus gland (Albino rat). Takenouchi (M.), J. Exp. Zool.
(Phila.), 1919, 29, 311.

ABSTRACTS 159

The serum obtained from rabbits immunized with the
thymus substance of the albino rat shows a positive precipitin
reaction with thymus extract, but this is not strictly specific.
The anti-thymus rabbit serum does not show any positive
hemolytie action against rat corpuscles when guinea-pig nor-
mal complement or rat normal serum is used as complement.
The anti-thymus sera injected into rats do not cause symptoms
of ‘‘primary antiphylaxis,’’ neither are the rats affected in
their growth. No modifications of the viscera were observed.
Nearly the same results were observed with anti-testis serum
from rabbits injected with rat-testis emulsion. Hemolysin pro-
duction in rabbits by injection of washed rat blood corpuscles
was attempted, but the normal rat serum with its complement
cannot activate the hemolysin against the rat corpuscle, owing
to the presence of some inhibiting substance. The chicken is
not suitable for the production of the hemolysin acting on the
rat corpuscles. Our attempt to produce strong anti-thymus
serum from the rabbit by the injection of rat thymus failed
probably because of anti-body production in the rabbit and
because the thymus cells of the rat are protected. We cannot
yet admit that any endocrin function of the thymus gland has
been established. (Author’s abstract.)

Persistent THYMUS in exopthalmic goitre. Tebbutt (A. H.),
Med. J. Australia (Sydney), 1918, 5, 430-431.

A report of a case of exitus after removal of the right
lobe of the thyroid gland and the finding at autopsy of a per-
sistent thymus. This, however, is not considered to be the
cause of death through pressure and cardiac inhibition since
the terminal phases did not present a picture leading to such
conclusion.—F. 8. H.

(THYMUS?) Clinical notes of a case of myasthenia gravis.
Thomson (J.), Brit. J. Child. Dis. (Lond.), 1919, 16, 92.

The author gives a good elinical report of this rare condi-
tion in children in a girl of 11% years of age. The child died
five and a half months after he had seen her. He does not
make any mention of any treatment employed.—M. B. G.

(THYMUS) Sudden death by acute dilatation of the heart con-
secutive to excessive strain of a man with an enlarged thy-
mus (Mort subite par dilatation aigue du coeur consécutive
au surmenage chez un homme porteur d’un gros thymus).
Tricoire (R.), Bull. Soe. Méd. des Hop. (Paris), 1919, 48,
98-100.

160 ABSTRACTS

A description of a case of sudden death of a young man
with an enlarged thymus. Autopsy revealed a greatly dilated
heart, and hypertrophied thymus. There were no other lesions.

The author suggests that ‘“‘hyperthymisation’’ appears to
lead to hypotonicity of the heart muscle whereby conditions of
stress acting as secondary causes overwhelm the weakened
heart leading to death by acute dilatation —A. L. T.

THYROID and HEAT REGULATION (Schilddriise und
Warmeregulation). Adler, Berl. klin. Wehnschr., 1919, 56,
958; Mimehner Med. Wehnsehr., 1919, 66, 1039.

When in warm-blooded animals the temperature rises
one or two degrees, the exeretion of carbonic acid is increased
approximately 80-100 per cent; in frogs this is not seen. The
author tried to explain this difference. He found that frogs
from the Alps have a strongly developed thyroid. If these
animals are kept at a high temperature, the thyroid becomes
atrophic. Probably in frogs the thyroid has a regulatory fune-
tion. In mammals the same function may be observed. In bats
during hibernation, the colloid in the thyroid disappears and
the whole gland shows a largely diminished funetion. If thy-
roid extract 1s injected in a hedge-hog during hibernation, 114
hours after the injection respiration becomes more frequent ;
after approximately three hours the animal gets up and runs
away. Extracts of other organs have no influence. Only ex-
tract of thymus may have some influence. A remarkable symp-
tom in the hedge-hog is also that after the injection of extract
of thyroid the temperature rises from about 9° to 34-35° C.

—J. K.

(THYROID) Radium therapy in hyperthyroidism with obser-
vations on the endocrinous system. Aikins (W. H. B.), In-
ternat. J. Surg. (N. Y.), 1918, 31, 217-224; Radium (Pitts-
burs). 1918s 1h Si-90:

See Endocrin., 2, 537.

(THYROID) Development of the thyroid glands of Bufo and
their normal relation to metamorphosis. Allen (B. M.), J.
Morph. (Phila.), 1919, 32, 489.

The accumulation of colloid material of the thyreoid glands
of toad tadpoles begins just as the hind limb buds appear.
The colloid masses inerease in size and number until the fore-
limbs break through the skin. The accumulation of colloid
material is accompanied by a marked inerease in the size of the

ABSTRACTS 161

thyreoid gland, which appears in the main to be a direct result
of it. The apparently paradoxical fact that there is a cessa-
tion in growth and actual diminution in the size of the thyreoid
gland and of the colloid masses at the very time when the
process of metamorphosis is most active might in part be ex-
plained as the result of a partial drying process due to the
emergence of the tadpoles from the water were it not that they
do not emerge upon the land until later. The reduction in size
is thus under way before this factor can prove effective. It is
much more probable that this diminution may be due to the
absorption into the blood of an unusually large amount of
stored colloid at this time when it would prove most effective.
The tail steadily increases in size to a certain point, shows a
slight diminution and then quickly disappears. Either the
thyreoid secretion does not cause the shrinkage of the tail or
it must reach a considerable volume before it is able to accom-
plish that result. It is certain that limb development in the
process of this appearance of the tail follows the accumulation
of colloid in the thyreoid glands of Bufo. (Author’s abstract.)

It might be noted that anurans decrease in size during
metamorphosis more than do their thyreoids, so that despite
some actual decrease in the size of the thyreoids at this time
there is a relative increase.—E. R. H.

(THYROID, HYPOPHYSIS) The relation of the pituitary and
thyroid glands of Bufo and Rana to iodine and metamor-
phosis. Allen (B. M.), Biol. Bull. (Woods Hole), 1919, 36,
405,

Hypophysis removal in the larval amphibia retards the
development of the thyroid glands as was shown by Adler ’14.
Thyroid removal causes hypertrophy of the pituitary (shown by
Hoskins and Hoskins 718, Rogers *18 and Larson °19). The
author believes that the thyroid probably plays the role of
iodine storage and controls its distribution and that it is pos-
sible that the pituitary might play the chief role in the utiliza-
tion of iodine by the body, because tadpoles deprived of either
the thyroid or pituitary fail to metamorphose on a normal dict
but either group and those deprived of both these glands will
metamorphose when iodine is administered. (One possible ob-
jection to Allen’s theory is that larvae deprived of the thyroid
ean be brought to metamorphosis by the administration of
pituitary substance, which is practically free from iodine. )

—K. R. H.

(THYROID) Hypothyreoidismus, Rachitis und Tetanie. Bauer
(F.), Wiener klin. Wehnschr., 1919, 32, 929.

162 ABSTRACTS

A short note on a case with symptoms of myxedema, rick-
ets and tetany.—J. K.

(THYROID) Basedow’s disease and war (La maladie de Base-
dow et la guerre). Berard (Leon), Bull. Acad. de Méd.
(Paris), 1916, 76, 428-430.

Berard refers to the frequent occurrence of Basedow’s dis-
ease among soldiers and also civilians under conditions of spe-
cial stress. These may develop from a pre-existing goitre of
varying size or may appear without any evident pre-existing
abnormality. Proper treatment consists of: (1) complete iso-
lation of the patient in such a situation as to induce complete
security and comfort; (2) Hydrotherapy; (3) quinine sulphate,
1 gram, and sodium salicylate, 2 grams, given on alternating
days. Some good results have been obtained by ingestion of
fresh thymus, and by subcutaneous injections of serum of thy-
roidectomized animals.

If after five to six months of this methodical drug treat-
ment the subject has not properly responded, he is submitted
to surgical treatment—the ligation of thyroid vessels, or ex-
cision of portions of the glands. As anaesthetic Berard uses
ether, with morphine and atropine.—A. L. T.

(THYROID) Neuroses and hormone therapy. Dysthyroidism
as a factor in neuroses. The oculo-cardiac reflex as a control
of hormone therapy (Névroses et opothérapie. La dysthy-
roidie facteur de névroses. Le réflexe oculo-cardiaque régu-
lateur de l’opothérapie thyroidienne). Blane (Jean),
Progres Méd. (Paris), 1917, 32, 95.

In certain psychoneuroses the author has studied the claim
that the oculo-eardiae reflex of Aschner indicates the relative
tonicity of the sympathetic as opposed to the parasympathetic
nervous system. In hypothyroidism when pressure is made on
the eye-ball there is a greater slowing of the heart than normal;
on the other hand, in hyperthyroidism the decrease in heart
rate is excessive. Occasionally after thyroid medication the
result is ‘‘negative,’’ i.e. instead of slowing of the heart there
occurs acceleration. This was taken to indicate an excessive
irritability of the sympathetic system. Blane begins thyroid
medication with doses of 0.002 mg.(!) given alone or with 1 mg.
of parathyroid. These doses are given two or three times a
day, results being followed or controlled by general clinical
appearances and by the reflex of Aschner.—A. L. T.

(THYROID) The relation of neurocirculatory asthenia to hy-
perthyroidism as determined by the effects of injection of

ABSTRACTS 163

epinephrin. Boas (E. P.), Arch. Int. Med. (Chgo.), 1919, 24,
419-421.

Individuals suffering from neurocireulatory asthenia show
a positive epinephrin reaction, as indicated by alterations in the
pulse rate, blood pressure and augmentation of nervous phe-
nomena. Some positive reactions are accompanied by precor-
dial pain, vertigo, headache, epigastric distress and nausea. In
four cases of palpable thyroid only one gave a positive epine-
phrin reaction. On the other hand, individuals showing a
negative epinephrin reaction may have well defined goitres.
Henee, it is impossible to predict from any criteria at present
available whether or not any particular case of neurocireula-
tory asthenia is sensitive to epinephrin.—H. W.

THYROID gland, Malignant epithelial growths of the—. Bonn
(H. K.) J. Ind. State Med. Assn. (Ft. Wayne), 1919, 12,
67-69.

Reviews the literature on malignant tumors, discussing
the pathological and histological diagnosis, and reports one
case of squamous cell carcinoma, three of adeno-carcinoma and
one of sarcoma of the thyroid. Bonn coneludes that early
diagnosis of malignant thyroid growths may be made when a
goitre long quiescent suddenly increases in size, accompanied
by a change in consistency.—L. F. W.

(THYROID) Surgical treatment of exophthalmic goitre. Crile
(George W.), Proe. Clin. Congress Am. Col. Surgeons, 1919,
Abst., J. Am. M. Assn. (Chgo.), 1919, 73, 1633. Discussion,
Lewis (Dean D.); Mayo (Charles H.)

Of 2,250 thyroidectomies, 50 per cent were subjected to
ligations. In 333 eases, ligation was first done, then a thy-
roidectomy. Among 116 ligations, one death occurred in the
stage of dissolution. In the first 100 cases the mortality was
16 per cent. With the use of gas and oxygen anesthesia this
was reduced to 2.5 per cent. By the adoption of special man-
agement of cases, the mortality has been further reduced to 0.6
per cent. Since the war, special precautions have been added
against postoperative hyperthyroidism due to excessive chem-
ieal activity and destruction by oxidation. With each degree
of rise of temperature this chemical activity is increased 10
per cent. With a temperature of 106 F., metabolism is in-
creased 70 per cent. Another point of importance was the dis-
covery by the British research department that the wound can
be Jeft open in statu quo, by the use of a dressing of 1:5,000
flavine. This permits the surgeon to stop at any point at
which he considers the patient is not enduring the operation

164 ABSTRACTS

well. Lobectomy is performed under analgesia, as the inhala-
tion anesthesia interferes with internal respiration in a patient
already suffering from suboxidation. Hypersensitiveness is
sufficient to destroy the patient. Complete team work is es-
sential to suecess. The operation is performed by the hospital
and not by the surgeon. The differential diagnosis is greatly
aided by the Goetsech epinephrin test and basal metabolism de-
termination.
DISCUSSION

Tachycardia without exophthalmos does not differ from
ordinary thyreotoxie goitre. Hyperplasia of the thyroid epi-
thelum presents the four classical signs of goitre. Surgeons
are likely to want to operate too soon. The exercise of judg-
ment makes all the difference between one surgeon’s success
and another’s lack of it. I have seen patients die after liga-
tion. I have not seen anything that will control that.

—D. D. L.

The Surgeon-General’s report showed that 15 per thousand
is the rate of goitre in the northern Pacific States. There is
almost no goitre in New Hampshire and Vermont. There are
perhaps more mistakes in diagnosing exophthalmie goitre than
any other condition. The thyroid is not essential to life, but it
is Synonymous with making life worth living. The cell changes
in the thyroid are due to inerease of biochemical produets by
bacteria, coming from different parts of the body and acting
on the thyroid. Two-thirds of the cases are simple hyperplastic
elands. A second type is caused by areas of degeneration
throughout the gland. A hyperplastic gland sometimes goes
with myxedema—a sort of burned-out condition. In hyper-
thyroidism there is a burning of fats, a rapid oxidation, and
these people literally destroy their own cells. The thyroid
gland bears relation to the elimination of nitrogen. Nitrogen,
if retained, leads to tetany. Creatin and creatinin have almost
the same chemical constitution as the thyroid secretion. There
is, however, no positive determining factor to tell what is the
controlling influence in thyroid action. We do not all agree as
to methods, but the important point is that the mortality has
been brought down.—C. H. M. (Quoted).

(THYROID) Nervous cretinism. Crookshank (F. G.), Lancet
(Lond.), 1917 (41), 604-605.

Nervous cretinism was first described by MeCarrison as
occurring in India. The author describes a number of cases
observed by him in English children. In almost every case
there is evidence of dysthyreosis in the mother or other mem-
bers of her family. The earliest manifestations of mild ner-

ABSTRACTS 165

vous eretinism are generally regarded as tetany and occur to-
wards the end of the second year of life. Sometimes a pale
puffiness representing the myxoedematous phase of dysthyre-
Osis 1s present ; this is usually transient. Later there may ensue
a stage of weakness, with tottering gait, and a more persistent
spasm that passes into a condition not to be distinguished from
“congenital spastic diplegia’’ or “‘Little’s disease’’ of moderate
degree. In the more severe cases mental defect is obvious al-
most from the first, and the early appearance of spasm with
nystagmus leads to the diagnosis of congenital spastic diplegia.
All cases of nervous cretinism are found to improve under thy-
roid medication.—L. G. K.

The THYROID gland, Local anesthesia in operations upon—.
De Courey (Joseph L.), Am. J. Surg. (N. Y.), 1919, 38, 245-
248.

De Courey advises early operation whenever possible on
the ground that in skilled hands there is no more danger in
rémoving a simple adenomatous or benign (not exophthalmiec)
goitre than there is in interval appendicectomy; and benign
goitre should be considered as potentially dangerous as a
simple appendicitis or a hernia. Preliminary observation and
treatment in all cases of exophthalmic goitre with intensive
study of the heart, kidneys and blood, are important. If case
does not respond to internal medication and rest, arterial liga-
tion should be performed. As a general rule the author does
not perform thyroidectomy when the pulse after a moderate
amount of exertion exceeds 120 per minute. He believes that
a greater risk can be taken when local anesthesia is used than
is possible under general narcosis, and that arterial hgation
will be less often indicated. Removal of both lobes and isthmus
gives the best results in exophthalmie goitre and causes less
reaction following operation. Thyroidectomies can be done
painlessly and thoroughly under local infiltration—R. G. H.

(THYROID) Endemic goitre (Vom endemischen Kropf). Deist
(H.), Sehmidt’s Jahrbiicher (Bonn), 1919, 330, 1.

A general review of the theories as to the cause of endemic
goitre. The author supports the well known theory of Bircher.
He believes that it is absolutely necessary that all researches
done on goitre in the whole world be international and judged
by a central international commission.—J. K.

(THYROID) A case of Graves’ disease (Ein Fall von Morbus
Basedowii). Falta (W.), Wiener klin. Wehnschr., 1919, 32,
gy

166 ABSTRACTS

Description of a case with exophthalmos of only one eye.
There are 109 of these cases reported in the hterature.—J. K.

THYROID aplasia (Kin Fall von Thyreoaplasie). Falta (W.),
Wiener klin. Wehnschr., 1919, 32, 157.

A new-born baby suffered with marked constipation.
Later there was no growth of the hair. Thyroid treatment had
a good effect. During war it was impossible to get thyroid
tablets. The child became worse and worse; obstipation re-
appeared, the psychic development became bad. <A piece of a
thyroid of a patient with Graves’ disease was transplanted
without suecess. As soon as it was possible, thyroid tablets
were regularly given. The suecess was complete.—J. K.

(THYROID) Myxoedema. Fischl (R.), Berliner kin. Wehnsehr.
1919, 56, 479.

A case of myxoedema with retarded ossification of the
bones of the hands was benefited by the administration of thy-
roid preparations. A short note.—J. K.

(THYROID) Paralyse chez une hypothyroidienne. Fournier
(J. C. M.), Rev. Neurol. (Paris), 1918, 25, 62-65.

Published elsewhere. See Endocrin., 2, 536.

(THYROID) The operative treatment of simple enlargements
and tumors of the thyroid gland. Frankau (C.), Brit. Med.
Je (onds); 1919) Gi) aoe eos

Operation is rarely necessary in colloid goitre since it
yields fairly readily to medical treatment. Surgical treatment
should be carried out only when there are definite symptoms
or deformity. No palliative treatment gives relief in diffuse
adenoma, hence operation is justifiable if the enlargement is
marked, even if no symptoms are present. Cysts of the thyroid
form the most frequent class operated on, since they may grow
to a very large size and dyspnoea is usually present.

A certain amount of detail concerning the surgical tech-
nique is ineluded in the paper.—tL. G. K.

(THYROID) Mental symptoms predominate in some cases of
myxoedema. French (H.), Guy’s Hosp. Gaz. (Lond.), 1918,
32, 72-73:

Brief description of two cases of myxedema presenting
marked mental disturbances. The first case cleared up on thy-

ABSTRACTS 167

roid opotherapy and continues normal. The second case was
diagnosed as frontal lobe tumor and was trephined, but no
tumor was found. Dying of erysipelas, the patient was autop-
sied and the only abnormality found was that the thyroid
gland existed as a trace only, the right lobe being fibrous tissue
and all weighing about 0.7 gram. The left lobe weighed still
less. The conelusion is that this latter case might have been
benefited by thyroid treatment and that myxedema may have
mental and cerebral symptoms as its predominant features.
—F.S§. H.

THYROID, Malignant tumor of—. Graves (S.), Ky. Med. J.
(Bowling Green), 1919, 17, 325.

A case report.—H. W.

(THYROID) Toxic, non-exophthalmic goitre. Haggard (Wil-
lam D.), Proce. Southern Med. Assn., J. Am. M. Assn. (Chgo.),
Loe, fe 1796.

This type of goitre is quite as dangerous, if not more so,
than exophthalmie goitre, because the toxin seems to have a se-
lective action on the heart, causing the so-called ‘‘ goitre heart,’’
thyrotoxie, instead of the mechanical “‘goitre heart’’ from
pressure. It is more likely to be overlooked on account of the
absence of exophthalmos. Many simple adenomas are prone
to degenerate and produce toxic symptoms. An atoxie goitre
may be of long duration before producing toxic symptoms.
There is danger in administering iodin in a ease of goitre of
long standing. It may set up toxic and sometimes fatal symp-
toms. Toxic, non-exophthalmie goitre occurs in one out of four
goitres that are not hyperplastic. Toxic goitre is not definitely
improved by ligation. Operation for toxie goitre is quite as
dangerous, if not more so, than in the exophthalmic type,
owing to the condition of the patient. In my last series of 100
toxic cases, exclusive of the so-called simple goitre, two deaths
occurred in thirty-three operations, and only two deaths in
sixty-seven exophthalmice cases.—Quoted.

(THYROID) Struma apoplectica. Hering. Deutsche med.
Wehnschr. (Berlin), 1919, 45, 1061.

A very short note on hemorrhage into the thyroid observed
in a patient after severe coughing.—J. K.

THYROID, A case of acute purulent inflammation of the—
(Ein Fall von Thyreoiditis acuta suppurativa). Hdopfner
_(H.), Berliner klin. Wehnschr., 1919, 56, 944.

168 ABSTRACTS

Description of a not very important case of an abscess
in the thyroid, cured by incision.—J. K.

(THYROID) Growth and development of amphibia as affected
by thyroidectomy. Hoskins (EK. R.) and Hoskins (M. M.)
J. Exp. Zool. (Phala.), 1919, 29, 1.

The thyroid anlage was removed from very young em-
bryos of Amblystoma punctatum and Rana sylvatica. The
technique is described. In some larvae the gland regenerated.
When correctly performed, this operation will inhibit metamor-
phosis more or less indefinitely if the animals are kept on a
normal diet. Thyroidless larvae grow more rapidly than the
controls and ultimately become two to three times as large.
Inhibition of metamorphosis in these animals is attributed to
a defective metabolism, especially of calcium, since the earliest
and most striking effects were noted in the skeleton which
calcified and ossified less completely than normal. Other char-
acteristics of thyroidless amphibians are: retention of the
larval form, and the ability to regenerate lost parts; the brain
develops slowly; the hypophysis hypertrophies; the thymus
persists and becomes relatively large; the epitheleoid (para- ~
thyroid) bodies and kidneys become relatively large; the
spleen is not affected; the internal gills persist; the lungs de-
velop and become functional; the intestine retains its larval
character; the ovaries differentiate and form large odcytes
which do not completely maturate; the testes develop to
maturity, producing spermatozoa which eseape through the
kidneys. The changes in the body and organs of normal larvae
during metamorphosis are described and also the histology of
the endocrine glands and organs of normal and thyroidless
animals.—Author’s abstract.

(THYROID) An experimental and clinical study of the isolated
thyroid hormone. Janney (Nelson W.), Dental Cosmos,
(Phila.), 1918, 60, 133-139. :

An address covering the work of the speaker and his co-
workers on the subject. The data were previously reported
in the following articles:

The anabolic action of the thyroid gland. Proc. Am. Soe.
Biol. Chem. (N. Y.), 1916, 11, 6.

An experimental and clinical study of the isolated thyroid
hormone. See. on Ped., N. Y. Acad. of Med., 1917, April. See
Med: Ree. (NY. )31917, 91; 1161.
hormone. Apr. Dental Cosmos (Phila.), 1918, 60, 1338-139

An experimental and elinieal study of the isolated thyroid

ABSTRACTS 169

The blood sugar in thyroid and other endocrine diseases
Arch. Int. Med. (Chgo.), 1918, 22, 1690.

The influence of thyroidectomy and thyroid diseases on
protein metabolites. Ibid, 1918, 22, 174.

In addition experimental data were mentioned which mili-
tate against acceptance of the well known theory of endocrine
function of Falta, Eppinger and Rudinger of the Viennese
school. Probably the endocrine glands have (1) a general
somatic action on the building and replacement of the protein
molecule and (2) a specific action as exemplified by develop-
ment of the secondary sexual characteristics at the time of
functioning of the sex glands.

(THYROID) Arhythmias in Graves’ disease (Arhytmien beim
Morbus Basedowii).- Huber, Ztschr. f. klin. Med. (Berlin),
1919, 87, 465.

Very often in Graves’ disease, extrasystoles may be ob-
served. They are nearly always seen after injection of adren-
alin. Also tachycardia of the sinus and arhythmia perpetua
may be observed. Digitalis has a good influence.—J. K.

(THYROID AUTONOMIC N. §.) Voluminous goitre, compres-
sion of trachea and sympathetics. Exaggeration of the oculo-
cardiac refiex [Goitre volumineux, compression trachéale et
sympathique (Syndrome de Claude Bernard-Horner). Ex-
agération du réfiexe oculo-cardiaque]. Jacob (P.) and La-
beaume, Bull. Soe. Méd. des Hép. (Paris), 1919, 43, 446.

On the side of excessive pressure, ocular signs indicate
sympathetic nerve trauma or paralysis, as shown by exoph-
thalmos, miosis and narrowing of the palpebral fissure. Asch-
ner’s eyeball-heart reflex appeared more prominent on the
injured than on the normal side, producing a slowing of the
heart from 88 to 52, while the slowing on the uninjured side
was from 88 to 72. This was taken to indicate that the sympa-
thetic nerve injury on the left side upset the balance between
the sympathetic and vagus in such a way as to leave the vagal
effects predominant.—A. L. T.

(THYROID) Symptoms of hyperthyroidism observed in ex-
hausted soldiers. Johnson (W.), Brit. Med. J. (Lond.), 1919
(i), 335-337.

Observations were made on 50 soldiers who left the firmg
line complaining of weakness, uncontrollable nervousness,
throbbing headaches, dizziness, palpitation and _ precordial
pains, more especially on exertion. Occasionally digestive. dis-

170 ABSTRACTS

comfort and diarrhoea or frequeney of micturition were com-
plained of. Sleep was irregular and easily disturbed. Dreams,
in which the patient would wake up in a profuse perspiration,
were common.

On examination these patients appeared pale, looked ill
and were exhausted. The mental state was usually one of
subdued excitement. More or less prominence of the eyes was
exhibited by all the cases. Tremor was a constant phenomenon.
Other signs of ‘‘hyperthyroidism’’ were also generally present.

It was found that after a rest in bed (with full diet, suit-
able tonics and occasionally Dover’s powder at night) the
condition of all the patients rapidly improved in ten or twelve
days. The exophthalmos greatly decreased or disappeared.
The pulse remained rapid and excitable, and the general sub-
jective symptoms always appeared to be within eall if the pa-
tient experienced any excitement. These cases then merged
into the group labelled ‘‘neurasthenia,’’ and were indistinguish-
able from them.

The author advances the following hypothesis.

1. That a large number of so-called psychoneuroses are
cases in which the symptoms are due to a state of disordered
internal secretion, the result largely of emotional exhaustion,
and, to a less degree, of physical exhaustion. 2. That many
eases which are later diagnosed irritable heart, ‘‘D. A. H.’’
soldier’s heart and neurasthenia are really cases of this class,
and that possibly many have passed through a slight state of
exophthalmos without its importance being realized.

The phrase ‘‘exhaustion syndrome’’ is suggested as a
suitable term to apply to this group of symptoms, and exhaus-
tion is declared to be the active etiological factor in all these
eases of breakdown.—lL. G. K.

(THYROID) Pit in the thorax in a child with Graves’ disease.
(Dellenformige Einziehung der Herzspitse bei Basedow).
Just, Deutsche med. Wehnschr. (Berlin), 1919, 45, 1119.

Demonstration of a girl of 9 with Graves’ disease and a
pit in the thorax at the location of the cardiac apex. Of no
special endocrine interest.—J. K.

(THYROID) Local anesthesia for operations for goitre. Keller
(A. A.) New Orleans M. & S. J., 1919, 71, 305-310.

The author discusses the dangers of general’ anesthesia.
He believes that local anesthesia offers greater safety and is
particularly suited to thyroidectomy. He has employed novo-
cain and aposthesine with good results, and observes that there

ABSTRACTS 171

is less post-operative pain and a shorter convalescence after
local than after general anesthesia. He reports forty-five oper-
ations on the thyroid under local anesthesia.—L. F. W.

(THYROID) Isolation of the iodine compound which occurs in
the thyroid (first paper). Kendall (KE. C.), J. Biol. Chem.
Gps) A919. 39. 125-149.

The original must be consulted for details in isolating the
active principle ‘‘thyroxin’’ in quantity from the glands. Thy-
roxin is shown to be 4, 5, 6—trihydro—4, 5, 6, triiodo—2 oxy,
betaindole-propionie acid and exists in three forms: (1) the
keto form with the carbonyl group adjacent to the imino; (2)
a tautomeric enol form of this, with an alpha hydroxyl group
and double bonded nitrogen, with no hydrogen attached to the
imino, and (3) a form in which there is an open ring strue-
ture, the elements of water entering between the imino and
the carbonyl with the formation of an amino and carboxyl
group.

Five chemical reactions are involved in controlling the
conditions of its isolation. (1) Iodine breaks off from the acetyl
derivative when an acid suspension is neutralized by NaOH.
Temperature greatly influences this reaction. (2) Pure thy-
roxin is easily reduced, yielding free iodine, when hydrolysis
is carried on in metallic containers. (3) CO, causes two dis-
tinct reactions. It precipitates thyroxin from its impurities
and, by forming thé monometallic derivative form from the
dimetallic, produces an optimum condition for the closing of
the indole ring. (4) Increase in temperature during CO, treat-
ment results in liberation of free iodine. (5) Glands vary in
their thyroxin content, the yield being 400-500% higher in
summer than in winter. Deamination and decarboxylation are
believed to be the cause of the loss in therapeutic power of
desiccated glands. This loss may be brought about by bacteria
without change in the iodine content.—V. K. bL.

(THYROID) Survey of thyroid enlargement among students
of the Puyallup Indian School. Kerr (W. T.), Northwest
Med. (Seattle), 1919, 18, 110-112.

Of 310 Indian students representing 43 tribes from six
states and Alaska, 10.6 per cent showed definite enlargement
of the thyroid. The survey shows that in full-blooded Indians
the incidence of goitre is very low as compared with part
blood or the pure Caueasian race.—H. lh.

172 ABSTRACTS

(THYROID) A preliminary survey of the thyroid gland among
two thousand, one hundred and eighty-two recruits at Camp
Lewis, Washington. Kerr (W. J.), Arch. Int. Med. (Chgo.),
1919, 24, 347-358.

Study of recruits from eleven northwestern states. Inei-
dence of simple goitre was found to be highest in Washington
and Oregon and lowest in California and Nevada. Endemic
goitre was found largely confined to Pacifie Northwest. Ex-
ophthalmic goitre was rarely seen, subjects having this condi-
tion being rejected by local boards. Twenty-one per cent of
all troops showed definite enlargement of the thyroid gland, of
which twenty-seven per cent were rather large. Goitres had
been noticed in other members of the family, especially the
females. Tremor and tachyeardia were occasionally noted.
No definite conclusions as regards etiology could be drawn.

—B. T.S.

THYROID, Influence of extract of—on certain secondary sex
characters in the Triton (Influence de 1’extrait de thyroide
sur certaines caractéres sexuels secondaires des Tritons).
Kollmann (Max), C. R. Soe. de Biol. (Paris), 1919, 82, 793.

Male tritons when in full sexual activity possess a dorsal
crest and large nictatory membrane. These secondary sex char-
acters disappear in.the intervals between sexual periods. This
recalls the regression of the caudal membranes in tadpoles,
which is the first external manifestation of metamorphosis. A
eroup of Molge vulgaris were treated with injections of thyroid
extract. The results showed an opposite effect to that ex-
pected. Instead of accelerating the disappearance of the crest
and membranes, thyroid extract seems to favor their perma-
nence, even after the close of the period of reproduction.

—T. C. B.

(THYROID) The influence of thyroidin on normal metabolism.
Krogh (Marie), Ugeskr. f. Laeger (Copenhagen), 1916, 72,
2237-2341.

Correction of reference in Endocrin. 2, 73, 200.

(THYROID) Diarrhea in Graves’ disease (Durchfalle bei Base-
dowscher Krankheit). Koslowsky, Deutsche med. Wehnsehr.
(Berlin), 1919, 45, 1219.

The author observed two eases in which diarrhea was the
first symptom of Graves’ disease. The other symptoms, were
not very distinct. Treatment with ovary tablets had a good
influence on the diarrhea.—J. K.

vv

ABSTRACTS 3

(THYROID) Some details of the acceleration of metamorphosis
in Anura under the influence of thyroid extract (Quelques
précisions sur 1’accélération de la métamorphose des Bactra-
cien Anoures sous 1’influence de l’extrait de thyroide).
Kollmann (Max), C. R. Soc. de Biol. (Paris), 1919, 82, 1009.

Having shown that simply adding thyroid extract to the
water produces the same effect as feeding thyroid, the author
points out that aside from other factors it is necessary to con-
sider the age of the tadpoles and their state of nourishment.
The desirability of the maintenance of a constant temperature
is emphasized, and the stage of development of the posterior
extremities is taken as a criterion of age.

A large number of tadpoles was selected, as nearly alike
as possible, and was then divided into eight lots. Lot 1 had no
visible traces of the posterior extremities; lot 2 with whitish
buds indicating the posterior extremities; lot 3, posterior ex-
tremities visible but very small; lot 4, legs longer, but straight ;
lot 5, like the preceding, but longer legs; lot 6, legs flexed in the
adult position; lot 7, like the preceding, but the body com-
mencing to take the adult form; lot 8, the anterior extremities
present. Each lot was divided into two groups; one group
was kept in ordinary water, the other had added 2 ee. extract
of thyroid for each 100 ce. water.

Under these conditions the extract seems to exert no ef-
fect on groups 1, 2, 3 or 4, except in rare individual cases in
lot 4, due to the fact that specimens at the identical stage of
development cannot be rigorously selected. In lots 5 and 6 it
is the rule to have metamorphosis rapidly produced in the
“‘thyroidized’’ animals, while it is exceptional in the controls.
The other lots remain uninfluenced by the thyroid extract.

In regard to nourishment (giving food in addition. to thy-
roid extract), alimentation simply furnishes the material neces-
sary to attain a condition where the animal becomes sensitive
to the action of the extract.

Kahn’s assertion that the left anterior extremity appears
before the right, is not confirmed.—T. C. B.

(THYROID) Demonstration von Kretinen. Lange, Miinch.
med. Wehnschr., 1919, 66, 945.

The author demonstrated at a medical meeting some ecre-
tins treated with thyroid with very little success.

Probably the patients were too old when treatment began;
such patients ought to be treated at as early an age as pos-
sible. In countries where cretinism is frequent, popular lec-
tures ought to be given to teach the public that treatment
must begin when the first symptoms are observed.—J. K.

174 ABSTRACTS

(THYROID) The little signs of thyroid disturbance. Leiner
(Joshua H.), Med. Ree. (N. Y.), 1919, 96, 99-101.

The author calls attention to the ‘‘little signs’’ of thyroid

disturbances, believing that numberless cases are unrecognized
that might be benefited by early recognition and judicious
therapy. Most physicians diagnose correctly outspoken syn-
dromes such as Graves’ disease, myxedema, cretinism, but neg-
lect the mild incipient modifications. He cites a few illustra-
tive examples.—H. L.

(THYROID) Suppurative thyroiditis due to the bacillus para-
typhosis A (Thyroidite suppurée a bacille paratyphique A).
Lemierre (A.) and Taberlet, Bull. et Mem. Soc. Méd. des
Hope (Paris), 1919; 43518:

A ease report of a suppurative thyroiditis occurring in
the course of paratyphoid fever.—A. L. T.

(THYROID) Making the cure of goitre safe. Levy (Louis),
New Orleans M. & S. J., 1919, 72, 170.

The author emphasizes the importance of careful prelim-
inary treatment for exophthalmie goitre before operation in
any case. To prevent shock he uses local or nitrous oxid anes-
thesia and, following the operation, gives enough morphine to
keep the patient quiet, even though the respirations go down
to 10-12 per minute. This morphine treatment is usually con-
tinued for three days.—L. F. W.

THYROID, Effect of extract of, on tadpoles. Lim (R. K. 8.)
J. Physiol. (uond.), 1919, 53, Proc. xxvi.

Precocious metamorphosis as described by Gudernatsch
was observed. Microscopie sections show concomitant changes
in the viscera, and a remarkable number of mitoses, indicating
rapid cell proliferation—T. C. B.

Preliminary THYROID operations. Link (G.), J. Ind. State M.
Assn. (Ft. Wayne), 1919, 12, 64-66.

The author believes that better results follow thyroidec-
tomy when it is preceded by ligation of one or more arteries
or by the injection of boiling water. He observes that in-
-ereased mortality is often due to neglect of this measure.

—L. F. W.

ABSTRACTS 175

(THYROID) The use of laboratory methods in the diagnosis
of early hyperthyroidism. Lueders (C. W.), Arch. Int. Med.
(Chgo.), 1919, 24, 432-444.

A study was made to discover a means of differentiating
early or borderline hyperthyroidism from functional cardiac
disorder. The tests used were sugar tolerance, epinephrin test,
nitrogen loss and test for acidosis.

The results showed that the laboratory affords a most re-
lable aid toward the recognition of early hpyerthyroidism.
The sugar tolerance test is an important aid in detection of
borderline cases. Epinephrin tests did not prove diagnostic
of hyperthyroidism. Tests for nitrogen loss and _ acidosis
seemed suggestive aids. Also creatinuria determinations in
conjunction with other tests were of value.—B. T. 8.

(THYROID) Some points in the surgical treatment of goitre.
Mackenty (J. E.), Laryngoscope (St. Louis), 1917, 27, 912-
914; Tr. Am. Laryngol. Assn. (N. Y.), 1917, 39, 215-227.

Advises operative measures as the surest cure of goitre
and thinks that the rhinolaryngologist should do neck surgery.
—H. W.

(THYROID) The basal metabolism in hypothyroidism.
Means (J. H.) and Aub (J: C.), Arch. Int. Med. (Chgo.),
1919, 24, 404-418.

Determinations of basal metabolism in untreated cases of
myxedema showed definite reduction below that of normal in-
dividuals. Studies on a cretin and a ease of cachexia strumi-
priva showed the same. Thyroid therapy brought the basal
metabolism up to normal. Basal metabolic determinations form
a convenient method of governing the dosage of thyroid prep-
arations in hypothyroidism and may be of value in diagnosis.

—B. T.S.

(THYROID) A note on the question of the secretory function
of the sympathetic innervation to the thyroid gland. Mills
(C. A.), Am. J. Physiol. (Balt.), 1919, 50, 174.

The evidence regarding the innervation of the thyroid be-
ing conflicting, the object of the experiments was to determine
whether the thyroid could be stimulated to greater activity by
the use of cocaine according to the method of Froelich and
Loewi. Daily injections of 10 mgm. cocaine per kilo, body
weight, were given over a period of days and the thyroids were
examined histologically for evidence of hyperactivity. No such

176 ABSTRACTS

evidence could be observed, and the writer considers this an
indication of a lack of secretory function of the sympathetic
fibres to the gland.—tT. C. B.

(THYROID) Radium. Mowers (S. W.), Northwest Med. (Se-
attle), 1919, 18, 153-156,

In mentioning the many therapeutic indications for radium,
the author states that it is very useful in exophthalmie goitre.
The majority of the cases are clinically cured and a very large
pereentage have an actual decrease in the size of the goitre.
Others have reported similar success, but further confirmation
and longer observation is necessary.—H. L.

(THYROID) Ligation of the vessels in toxic goitre. Noble
(T. B.),. J. Ind: State M. Assn: (Ft. Wayne), 1919, 12-230:

Noble urges an early diagnosis of the mild forms of toxie
goitre, and prompt surgical interference if the best results are
to be obtained. Formerly the condition of the patient was de-
termined by the intensity of the four cardinal symptoms. At
the present time it is possible to determine the metabolism rate
and thus place the patient on a definite scale of toxicity, se-
lecting the treatment best suited to his needs. Ligation should
be reserved for the severe forms of goitre when the life of the
patient would be jeopardized by a lobectomy. In the average
ease lobectomy should never be preceded by a ligation.

—L. F. W.

(THYROID) The toxic element in goitre. Pern (S.), Med. J.
Australia (Sydney), 1918, 5, 276-278.

A report of twenty-three cases purporting to substantiate
the author’s opinion that the cause of goitre lies in a defensive
reaction of the thyroid accompanied by hypertrophy due to
toxins engendered in the system from infectious processes
largely in the teeth and tonsils.—F. S. H.

(THYROID) The blood picture in exophthalmic goitre. Plum-
mer (H. §.), Collected Papers of the Mayo Clnie (Roches-
ter, Minn.), 1918, 10, 359.

This paper is based on the study of the blood counts in 578
patients with exophthalmie goitre. The hemoglobin, erythro-
eytes, and the total leukocytes are all within normal limits.
There is, however, both a relative and an absolute mononucle-
osis, together with a percentage decrease in the polymorphonu-
clear neutrophiles. The eosinophiles are slightly under the

ABSTRACTS ir

normal average. Although some writers still maintain that
anemia of the chlorotic type is a characteristic of this disease,
this is neither borne out by the author’s findings nor those
published by Kocher. The author concludes that there is
much to indicate that the changes in the leukocyte formula
are owing to two more or less independent variables. One
which causes a lymphocytosis and another which influences the
neutrophilic count. The first may be found in a hyperplasia
of the lymphoid tissues, and the second in a fluetuating abnor-
mal distribution of the neutrophiles in the vascular tree.

J.

(THYROID) Ueber Volumen pulmonis diminutum. Pollitzer
(H.), Miinchener med. Wehnschr., 1919, 66, 1103.

In diseases with chronic contraction of the blood vessels
in the lung the volume of the lungs may seem diminished.
When the left lung diminishes in volume, it gives the impres-
sion that the heart is dilated. This may be observed in chlo-
rosis, chronic malaria and Graves’ disease.—J. K.

(THYROID) Factors for safety and ultimate results in goitre
operations. Potter (C.), J. Missouri M. Assn. (St. Louis),
1917, 14, 506-511. 5

Of surgical interest only.—A. R. T.

(THYROID) Thyroidism and Graves’ disease as a form of
traumatic neurosis (Thyreoidismus und Morbus Basedowii
als eine Form der traumatischen Neurose). Pulay (E.),
Ztsehr. f. klin. Med. (Berlin), 1919, 88, 87.

According to the author Graves’ disease is a form of in-
creased irritability of the sympathetic system. But the in-
creased irritability does not alone cause Graves’ disease unless
the patient has also a ‘‘status degenerativus’’ and unless there
occurs also a special stimulation of the sympathie (psychical,
traumatic, or infectious). This stimulation gives rise to the
beginning of the disease. It is not true that the cause of the
disease is abnormal functioning of the thyroid. The thyroid mal-
function is, rather, a result merely of augmented sympathetic
activity, as are the many other Graves’ symptoms. No value
is to be attached to various theories which ascribe a primary
etiolozic role in the disease to the thymus or the pancreas.

J. KK.

THYROID therapy in skin diseases. Pulay (E.), Therap.
Monatshefte, 1919, 33, 115.

178 ABSTRACTS

A large number of dermatological conditions have been
correlated with disturbances in thyroid function. Among
these are erythema, hyperhidrosis, alopecia, atrophy of nails,
and especially scleroderma. Administration of thyroid sub-
stance has been advocated in these cases. In the author’s ex-
perience there is no specific or favorable result noted after
such therapy.—Chem. Abst.

(THYROID-PARATHYROID-ADRENAL) The role of the thy-
roid-parathyroid apparatus in uremia (Du role de l’asso-
ciation thyro-parathyroidienne dans l’uremie). Remond
(A.) and Minvielle, Bull. Acad. de Méd. (Paris), 1917, 77,
504-507. :

In an effort to study the mutual interrelationship between
the thyroid, parathyroid and kidney, three series of experi-
ments were performed: (1) nephrectomy, (2) nephrectomy
with thyroidectomy, (3) thyro-parathyroidectomy with neph-
rectomy. It was found that survival of animals was the same
in simple nephrectomy as in thyro-parathyroidectomy with
nephrectomy, while in thyroidectomy with nephrectomy the
survival was about half that in the other two series. The urea
content of the blood was essentially the same in the first and
third series, but in the second, the urea was much decreased
while the chlorides were slightly increased. Summary:

Thyro-
Thyroid- parathyroid-
Nephrectomy nephrectomy nephrectomy
Survival in hours........ Tt 34 68
Urea in blood, per hter 5.97 1.99 5.69
Chloride, per liter. Tai . 8.22 fe!

Thus, the removal of the parathyroid glands delays the
early onset of intoxication occurring in the removal of kidneys
and thyroids. In this the authors see an inhibitory action on
the adrenal glands. Removal of thyroids with the kidneys has
but little effect on the adrenal glands, while after removal of
the parathyroids the adrenal appears to have been intensely
active—A. L. T.

(THYROID) Two cases of nephritic exophthalmos (Deux cas
d’exophtalmie néphrétique). Rondopoulo (P. J.), Bull. Soe.
Méd. des Hop. (Paris), 1919, 43, 4.

Two eases are described in which exophthalmos occurred
in nephritics. That the exophthalmos was of thyroid origin
was indicated by the presence of two of the Graefe, Mobius
and Stellwag signs. The frequeney of occurrence of exoph-

ABSTRACTS 179

thalmos in nephritics was estimated to be about 3 per cent, oc-
curring mostly in subacute or chronie nephritis.—A. L. T.

(THYROID) Case of myxedema. Saunders (A.), West Lon-
don Med. J.,; 1917, 22, 129.

A case of myxedema in a child of seven was shown. She
had an enlarged thyroid at the age of two. At the age of five
the left lobe was removed, after which the symptoms of myxe-
dema developed. Her hair came out in patches and what was
of additional interest were attacks of cyclic vomiting, which
occurred every four months; simultaneously she became putty
over her entire body. Under persistent treatment with thyroid
extract all her symptoms mentioned above vanished.—J. H. L.

(THYROID) Exophthalmic goitre. Schioetz (C.), Med. Rev.
(Bergen), 1917, 34, 1-20.

Report of a case of exophthalmie goitre, where the patient
died after rapid loss of weight, vomiting, jaundice and albu-
minuria. Autopsy revealed an hyperplastie thyroid, thymus
and anterior lobe of the pituitary; ovaries and pancreas were
atrophie, liver and kidneys degenerated.

General remarks are offered as to the pathogenesis of the
disease. The effect of thyroidin upon the protoplasm consisted
of two phases: first, stimulation and later on destruction—an-
alogous to the effect of certain inorganic poisons, e.g., mer-
eury.—K. M.

(THYROID )Riedel’s goitre (Riedelscher strumitis). Schloffer,
Wiener. klin. Wehnschr., 1919, 32, 930.

Description of a patient with an enormous goitre, hard as
iron. No swollen lymph glands were detected. The clinical
diagnosis ‘‘strumitis’’ (in the form described by Riedel) was
confirmed by histological examination.—J. K.

THYROID gland, Influence of the—upon metabolism. I. Carbo-
hydrates. Sekita (N.), Tokyo Igakukai Zisshi, 1918, 32, 1-49;
Jap. Med. Lit., 1919, 4, 34.

From a study of thyroid functions, adrenaline glucosuria,
and their relationship, the conclusion is drawn that the influ-

ence of the thyroid on carbohydrate metabolism has not been
proved.—Chem. Abst., 13, 2070.

(THYROID) Operation for thyroid tumor. Sherrill (J. G.),
Ky. Med. J. (Bowling Green), 1919, 17, 323-325.

Case report.—H. W.

180 ABSTRACTS

(THYROID) Trauma and Graves’ disease (Trauma en Morbus
Basedowii), Simons (A.), Tijdschr. v. Ongevallen-Geneesk-
unde (Amsterdam), 1919, 4, 247.

Description of two cases: Ist. A man fell with the abdo-
men against an engine. ‘Twelve years before the accident he
had been suffering from a Graves’ disease which had disap-
peared after treatment. After this accident an acute Graves’
disease developed. Some weeks after this he developed psycho-
sis and died. The author believes that the trauma had an influ-
ence on the parasympathetic and sympathie systems and that
the disease is caused by a disturbed equilibrium between these
two systems. 2nd. A man fell in the water and developed, a
fortnight later, acute Graves’ disease. The patient died of
cachexia. Autopsy showed a large thyroid with only a little
colloid and status thymicus (large thymus and narrow aorta).

JK.

(THYROID) A brief study of goitre based on 1000 cases oper-

ated upon. Sloan (E. P.), Ill. Med. J. (Chgo.), 1919, 38,
226-227.

Summarizes the results with special reference to the onset
of symptoms, age, sex, etc. Nothing new.—L, F. W.

THYROID gland, The function of the—in relation to infec-
tions. Sohmer (A. E.), St. Paul M. J. (St. Paul, Minn.),
OVAL, 297-301

The author calls attention to the various known thyroid
functions, developmental and metabolic. He cites experimental
and clinieal evidence that thyroid secretion has bacteriolytie
and anti-toxie properties. He lays stress on the thyroid en-
largement accompanying chronic infections, and coneludes
that it is only a step from this chronie irritation of the gland
to the formation of a goiter with elaboration of toxie secre-
tions.—A. R. T.

(THYROID) Familial exophthalmic goitre. Souques and
Lermoyez (J.), Rev. Neurol. (Paris), 1919, 26, 20-26.

Souques and Lermoyez relate that in the family deseribed
there have been seven cases of exophthalmie goitre among the
sixteen members of the family in three generations. They give
illustrations of the four members they have personally exam-
ined. The tendency seemed to be transmittd by the males.

ABSTRACTS 181

There were no signs of inherited syphilis; the trouble must be
some inherited predisposition rendering the thyroid peculiarly
susceptible to diverse infections and intoxications. They list
the few similar familial cases on record. In one, dating from
1884, eleven of the sixteen members of the family had devel-
oped exophthalmic goitre.—J. Am. M. Assn., 73, 799.

THYROID treatment of alopecia areata. Strandberg (J.),
Acta Medica Seandinaviea (Stockholm), 1919, 52, 165-176.

Strandberg now has a record of nine cases in which endo-
erine disturbances seemed to be responsible for malignant
patches of alopecia. All were in men exeept three, but there
was nothing to indicate positively endocrine disturbance. Two
of the patients had dementia precox and one signs of syphilis.
Thyroid treatment was applied in every ease, but only briefly
in two; in three of the cases the hair grew again under the
thyroid treatment. In one man with dementia praecox the
hair began to grow in as the mental condition improved. One
woman who was not benefited by the thyroid had her hair
drop out again during a pregnancy, and also when menstru-
ation returned. The article is in German.—J. Am. M. Assn., 738,
1736.

(THYROID) A new ocular muscle symptom in exophthalmic
goitre. Suker (G. F.), J. Am. Med. Assn. (Chgo.), 1917, 68,
1255.

‘“After extreme lateral rotation of the eyes, with fixation
on an object at this point maintained for a second or two, on
attempting to follow this fixation point as it 1s rapidly swung
into the median line, one of the eyes fails to follow the other
in a complementary manner into proper convergence. An ap-
parent divergent strabismus is momentarily manifest.’

(Quoted. )

(THYROID) An urgent tracheotomy (Een spoed-tracheoto-
mie). von der Tak (H.), Nederl. Tijdschr. v. Geneesk.
(Haarlem), 1919, 63, (II), 1448.

In a ease of malignant goitre a very acute attack of
dyspnea made immediate tracheotomy necessary.—J. K.

(THYROID) Chagas’ disease in Venezuela. Tejera (E.),
Gaceta Méd. de Caracas, Venezuela, 1919, 26, 103.

Tejera presents conclusive evidence that the trypanosome
thyroiditis deseribed by Chagas in 1907 as common in children

182 ABSTRACTS

in certain parts of Brazil prevails also in Venezuela. He re-
ports two eases, In an infant and a boy of 2, belonging to the
states of Trujillo and Zulia. His extensive study of the sub-
ject has demonstrated further that 4t is transmitted by a dif-
ferent insect from the one responsible for it in Brazil, Lamus
(Conorhinos) megistus, as this does not seem to occur in Ven-
ezuela. The bug responsible for the transmission in Venezuela
is Rhodnius prolixus Stal, as he determined by extensive experi-
mental research and these clinical experiences. These insects
in nature may harbor Trypanosoma cruzi. The insects are
called by various names, pito, chupon, quipito, chinche de
monte and chipo. It is a night-biting insect of the reduvidae
family. Some specimens sent to Paris in 1913 from Venezuela
were artificially infected by feeding them with Trypanosoma
eruz1 sent from Bahia, Brazil. Rincones presented Tjera’s re-
port sent from the laboratory of the Caribbean Petroleum
Company at Mene Grande, and he added that a few years ago
he urged research in Venezuela to find whether this American
trypanosomiasis was restricted to Brazil alone. Tejera men-
tions in conclusion that, as goitre seems to be endemic in the
Santander district in Colombia, Chagas’ disease probably
could be discovered there also. He was examining the rhodnius
for Leishman bodies, in a study of American leishmaniosis,
when he was surprised by the discovery in them of Trypano-
soma eruzi of Chagas’ disease. But his clinical eases of the
latter came from a different district, and he found the trypano-
some likewise in specimens of rhodnius from the environment
of the patients. Rats, cats, monkeys and other animals inocu-
lated from the insects developed the trypanosomes in large
numbers in the blood. Ayala added that Tejera’s research
seems to exculpate the drinking water in respect to endemic
goitre. He appealed further for research to decide whether
there may not be some plant which serves as a host for the
trypanosome like the euphorbia for the leptomonas (Iturbe),
suggesting some zoological affinity between plants, Leishman
bodies and trypanosomes.—J. Am. M. Assn., 73, 565.

(THYROID) Hyperthyroidism in influenza. Todd (A. T.),
Laneet (Lond.), 1919 (41), 733-734.

Among 1500 eases of influenza 16 eases of hyperthyroidism
developed. In all but one fatal case it appeared during con-
valescence. The onset was sudden in all cases.—hL. G. K.

(THYROID) Relation between water-supply and goitre. ‘Tol-
man (Mayo), Eng. News-Record, 1919, 83, 516.

ABSTRACTS 183

The cause of goitre is unknown, but has frequently been
laid at the door of the water supply. T. claims that voleanie
formations, the crystaline rocks of the Archaic period, and all
deposits laid down in fresh water are free from goitre-produc-
ing characteristics. In the United States the greatest ende-
micity is found in Paleozoic areas. An estimate is made of
12,000 cases of goitre in West Virginia—Chem. Abst., 13, 3228.

(THYROID) The psycho-neurotic syndrome of hyperthroidism.
Woodbury (M. S.), J. Nerv. & Ment. Dis. (N. Y.), 1918, 47,
401-410 ; Clifton Med. Bull. (Clifton Springs), 1918, —, 18-23.

An excellent review and bibliography of the nervous and
mental symptoms occurring in the course of Graves’ disease.
The author concludes that there is no distinct thyrotoxie psy-
chosis, but that certain well-defined neurotic and psychotie
symptoms arise in well-defined thyrotoxie cases. In the exoph-
thalmie toxic cases, these symptoms are of the overcerebra-
tion and overstimulation type, dependent upon (1) cerebral
hyperemia, (2) thyrotoxicosis per se, (3) toxicity from the in-
creased waste products of metabolism. In the non-exophthal-
mic toxic cases, the mental picture is rather one of depression
minus delusions. The latter cases comprise the adenomatous
type of goitre and run a more sluggish course. They are dis-
tinguishable from non-endocrine neurasthenoid states by means
of studies of the basal metabolism and the adrenin chloride
test of Goetsch.—A. R. T.

(THYROID) Iodin content of human thyroid glands (Sur la
teneur en iode du corps thyroide de l’homme). Zunz (E.),
Réunion soc. belge biol., 1919, 22 Fév., 894-895.

The iodin content of the thyroid glands of normal human
subjects, 21 to 34 years of age—men killed in war—was deter-
mined. In the majority of cases the range was 1.5 to 3 mgm. of
iodin per gram of dry gland, or 0.46 to 0.84 mgm. per gm. of
moist gland. The entire gland contained from 3.15 to 44.49
mem., averaging 15.53 mgm. Diminution of the iodine content
was noted in cases of bronchopneumonia.—Physiol. Abst., 4,
338.

(VAGOTONIA) Ueber Vagotonie und Sympathikotonie.
Klieneberger (C.), Berliner klin. Wehnschr., 1919, 56, 719.

No new data. Cases of vagotonia, as described by Eppin-
ger and Hess are very rare. The theory of vagotonia is very
interesting, but it is only a theory. A great part of the liter-

184 ABSTRACTS

ature on this subjeet shows a lack of eritical sense and of
pharmacological and physiological knowledge.—J. K.

(VAGOTONIA) Ulcer of the stomach and autonomic nervous
system (Ulcus pepticum und vegatitives Nervensystem). [eh-
mann (G.), Berl. klin. Wehnsehr., 1919, 56, 772

The author tried to find whether there is a relation be-
tweel vagotonia and ulcers of the stomach. He found that
the theory that the vagus and sympathiec are antagonists is cer-
tainly not true. Most patients who are very sensitive to
adrenalin are just as much so to pilocarpine. In modern lit-
erature we often read that patients with ulcers of the stomach
show symptoms of vagotonia. The author could not confirm
this. It is, however, true that such patients may show a dis-
turbed function of their involuntary nervous system, but this
is rare. In these cases the author believes that the ulcer is the
cause of the change in the nervous system (through hemor-
rhave, under-feeding, ete.) The theory that ulcers of the stom-
ach are caused by an abnormal function of the nervous system
has never been proved and is not probable. Approximately 80
per cent of patients with ulcers show no symptoms whatever
of so-called vagotonia. The clinical value of the word ‘‘vago-
tonla’’ is very small.

The abstracts in this number have been prepared by the
staff assisted by:

Jonathan Forman, Columbus

Margaret M. Hoskins, Minneapolis

L. G. Kilborn, University of Toronto

Victor K. La Mer, Columbia University, New York
Arthur R. Timme, Los Angeles

Eduard 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.’’

PeroOCRINOLOGY

THE BULLETIN of the ASSOCIATION
for the STUDY of

INTERNAL SECRETIONS

APRIL-JUNE, 1920

HYPOPHYSEAL DISORDERS WITH SPECIAL REF-
ERENCE TO FROELICH’S SYNDROME
(DYSTROPHIA ADIPOSOGENITALIS)

Harvey G. Beck, M.D.

Department of Medicine, University of Maryland School of Medicine
and College of Physicians and Surgeons, Baltimore, Maryland.
The question of obesity or its congener, fat dystrophy, has

not received much study or attention until quite recently. This
was undoubtedly due to the lack of knowledge concerning the
fundamental principles involved in the process of. fat meta-
bolism. Formerly, excessive accumulation of fat was usually re-
garded as the result of surcharging by overeating and underex-
ercising, a normal metabolic function, a condition designated
exogenous obesity. Since a better knowledge has been gained
of the physiological function of the endocrine glands, the fact
has become definitely established that the vast majority are due
to a disturbance of function of certain of these glands, which
form is designated endogenous obesity.

Although it has been observed from antiquity that eunuchs
show changes in skeletal development with a type of fat distri-
bution differing from the normal, it was not until Reverdin and
Kocher (1882-1883) associated a form of obesity with the loss
of function of the thyroid after complete extirpation, and
Froelich in 1901 deseribed a syndrome with obesity and genital
hypoplasia associated with hypophyseal deficiency, that its full
clinical significance was comprehended.

186 FROELICH’S SYNDROME

The discussion in this paper will be limited to the hypo-
physeal form, presenting a review and correlation of the most
valuable literature on the subject to date.

The obesity, as well as the other features embraced in the
clinical syndrome deseribed by Froelich in 1901, was previously
recognized and referred to as cerebral adiposity, and although
lesions of the pituitary were demonstrated in some of the cases,
no definite relation between the two was suspected.

As regards the earlier literature, Dr. Garrison of the Sur-
geon-General’s Library, stated the following: ‘‘The only early
reference to pituitary obesity known to me is the case given by
Barnhard Mohr in Woehenschr. f.d. ges. Heilkunde, Berlin,
1840, VI, 565-571. This is the solitary case of any importance
before the time of Froelich.’’ This patient, a woman 47 years
old, had an enlarged hypopysis cerebri, due to sarcoma causing
cerebral pressure, especially upon the optic nerve and chiasm
producing visual disturbance. In addition she had vertigo, peri-
odical headaches, clumsy movements, mental deterioration, and
finally, symptoms of apoplexy. Unusual obesity developed with
extraordinarily large abdominal dimensions, especially in the
transverse diameter. Autopsy showed a very large degenerated
pituitary gland, an enormous deposit of subcutaneous fat, 31%
inches in thickness, with increase of fatty tissue in the heart,
liver, and about the intestines.

Froelich’s case was that of-a boy fourteen years old, who
had suffered for two years with headaches, vomiting, and a
rapidly developing obesity with infantilism of the genitalia. To
this picture Bartels gave the name dystrophia adiposogenitals.
The hypophyseal origin of the disease was not unanimously ac-
cepted until Cushing and Ashner by experimental investigation
successfully demonstrated that obesity and genital hypoplasia
developed in hypophysectomized animals, and further they defi-
nitely stated that adiposity was due to posterior lobe deficiency.

Cushing explains these phenomena as follows: Functional
hyperplasia of the anterior lobe stimulates tissue growth, espe-
cially the skeletal, cuticular, and subcuticular tissues; con-
versely, anterior lobe insufficiency should inhibit skeletal growth
and sexual development. Functional hyperplasia of the pos.
terior lobe appears to be more concerned with tissue metabolism,
for when rendered inactive by disease or compression, meta-

.

BECK 187

bolic processes are checked, and high tolerance is acquired for
carbohydrates, which are promptly stored up as fat.

Recent investigation by Robertson on the influence of the
anterior lobe of the pituitary upon growth through its growth
controlling constituent, tethelin, emphasizes the fact that over-
activity leads to gigantism or acromegaly, according to the age
when the disease first manifests itself; and he asserts that under-
activity, the result of pathological conditions partially or totally
destroying the function of the anterior lobe, produces the clinical
picture of adiposity, underdevelopment of the skin, bones and
sexual organs, and secondary sexual characters.

Goetsch obtained very interesting results from pituitary
feeding experiments upon rats. Feeding of the anterior lobe
extract caused increased weight and greater and more vigorous
body growth and development over the control. The period of
complete sexual development is shortened by at least one-third
of its normal time, and the sexual instincts are early awakened.
The feeding of the posterior lobe extract does not stimulate
erowth nor the development of the sex glands. :

Feeding experiments of endocrine diets on normal and hypo-
physectomized tadpoles by E. Smith show that the latter were
retarded in growth on all, diets except the glandular lobe of the
hypophysis. “The retardation of growth in hyophysectomized
tadpoles was entirely prevented by a diet of anterior lobe, so
that these tadpoles exceeded in size either normal tadpoles on a
control diet or controls fed glandular lobe.

SYMPTOMOLOGY

The most striking symptom in hypophyseal dystrophy is
obesity with a fairly definite type of fat distribution. Fat is
accumulated chiefly about the hips, upper thighs, lower abdomen,
and mons veneris. In addition, Biedl observed a remarkable
deposition of fat in the omentum and retroperitoneal space.
There is a type in which the fat distribution is more general,
involving the mammae, shoulders and supra- and infra-clavicular
areas; the hands and arms, legs and feet remain normal. This
occurs as a familial type and presents a picture of obesity some-
what intermediate between thyroid deficiency and hypophyseal
deficiency, and is probably due to a functional hypoplasia or the
sex glands, secondary to hypopituitarism.

188 FROELICH’S SYNDROME

Integumental changes are also quite characteristic. The
skin is remarkably delicate and white, sometimes described as
alabaster. It is mostly coo] to the touch, usually dry and some-
times exfoliates. The hands and feet are usually small. The
fingers taper and the nutrition of the nails is normal, although

Fig 1 and Fig. 2—TIllustrate case of dystrophy adiposogenitalis in
which the fat is accumulated below the waist.

the crescents at the base are often absent. If the disease mani-
fests itself before puberty the stature remains small; sexual de-
velopment is delayed, which delay may result in permanent sex-
ual infantilism.

Hewett, in a study of infantilism as related to pituitary
disease, states that the symptoms may be roughly divided into
two classes: Those due to mechanical effects of the tumor and
those which seem to be due to an altered internal secretion. To

BECK 189

the former group belong the headache, vomiting and visual dis-
turbanees. The most characteristic of them, primary optic
atrophy and unilateral or bilateral temporal hemianopsia, are
due to direct pressure on the optic chiasm or nerves. To the lat-
ter group belong the sexual disturbances, (retarded sexual de-

Fig. 3—Represents a type of case in which the fat distribution is
more general.

velopment, cessation of menses, ete.) the obesity, the stunted
growth, and possibly the occasional diabetes insipidus—these
are due, in part at least, to diminished secretion of the anterior
lobe of the gland. He coneluded that infantilism associated with
disease in or near the pituitary gland may resemble either the
Brissaud or Lorain type.

190 FROELICH’S SYNDROME

The Brissaud type of infantilism in which the characteristics
of infancy or early childhood are especially retained is described
as follows: ‘‘Round, chubby face, lips projecting and plump,
small nose, smooth face, fine clear skin, fine hair, eyebrows and
eyelashes scant, eyes prominent, large round cheeks, infantile
face and head, skeleton under-developed, neck short and chubby,
body long and eylindrical, abdomen prominent, limbs round
and large, layer of fat over the whole body, infantile pelvis,
lumbar lordosis, rudimentary sexual organs, no hair except on
head, high-pitched voice, thyroid small, mind slow, retardation
of ossification, absence or retardation of second dentition.”’

The Lorain type, has been described as follows: ‘‘Small
stature, delicately formed, slender skeleton, skin soft and pale,
large shoulders, lower extremities lone and slender, trunk rela-
tively small, infantile sternum and pelvis, epiphyses normally
united, no fat, abdomen normal, finely chiseled face, voice high,
neck long, genital atrophy, absence of or sight secondary sexual
characteristics. ”’ |

In the female the menses are irregular or absent, and if the
condition arises before puberty there are hypoplasia of the
genitalia and deficient development of secondary sexual charac-
ters with absence or deficiency of hirci and crines pubis; the lat-
ter if present assume the angular outline or masculine tendency.

The male in early life shows the same disposition to sexual
infantilism with absence or delayed secondary sex characters,
such as the absence of hair on the face or body-hair, ete. The
tendency to reversal of sex type is more marked in the male.
In addition to the beardless face, horizontal erines pubis and
delicate skin, other signs of feminism present are broad pelvis,
mcderate degree of genu valgum, rounded limbs, small feet
and hands with tapering fingers and occasionally well developed
breasts.

If the disease develops in adult life, retrogressive changes
take place in the sexual organs with a corresponding diminution
or loss of functions, with the same tendency of the features to
revert to the opposite sex. Sugar tolerance is very much in-
creased. The metabolic functions are below normal, which
accounts for the subnormal body temperature, subnormal blood
pressure, slow pulse and diminished carbon dioxide exchange.
The basal metabolic rate as observed by Plummer is usually from

BECK | A971

16 to 18 per cent below normal, and frequently 25 per cent or
more.

Pardee describes as one of the first symptoms of pituitary
disease, headache, which he ealls ‘‘ Pituitary’’ headache. It has
three characteristics: (a) Its location; (b) Its duration and
persistence; (c) Its relief under specific medication.

His conclusions are as follows: (1) Pituitary disturb-
ances constitute a fairly common cause of headache; (2)
Pituitary headache is located between the temples, deep in be-
hind the eyes and is accompanied by dyspituitary signs; (3)
Abnormality of the sella turcica is demonstrable in almost every
ease of pituitary disease; (4) Administration of the whole
gland cures these headaches and the accompanying symptoms in
a large percentage of cases, provided there is not a progressive
neoplastic growth.

Cushing observed certain mental distur Danees in hypo-
pituitarism ranging from mild psychosis to extreme mental de-
rangement, epilepsy, impairment of memory, lack of concen-
tration and drowsiness. And Beverly Tucker ascribes certain
forms of adolescent psychosis to hyposecretion.

Polyuria is a frequent symptom, and occasionally a true
diabetes insipidus develops. The condition has been attributed
to posterior Jobe deficiency as a result of some lesion. Since the
exhaustive studies of Houssay and Leschke this view is open to
doubt. Houssay experimentally established a cerebral basal
zone within which pricking generated polyuria. The posterior
lobe of the pituitary may constitute a part of this zone, although
he does not deem it probable. This zone is limited in front by
the optic chiasma and behind by the penduncle protuberance.

Leschke pointed out the fact that while lesions of the hypo-
physis, such as trauma, sarcoma, metastatic carcinoma, tuber-
culosis, syphilis, ete. have been demonstrated in cases of diabetes
insipidus, similar lesions in the midbrain, especially those in-
volving the tuber cinereum may produce diabetes insipidus with
the hypophysis intact. Removal of the gland itself does not
produce polyuria; on the other hand a piqure in the tuber
cinereum does produce polyuria. He regards the hypophyseal
lesion as incidental, and if associated with diabetes insipidus,
the latter condition is due to pressure or extension of the lesion
into the tuber cinereum. Cases of diabetes insipidus have been

192 FROELICH’S SYNDROME

reported by Schiiller and Christian, in which extensive patho-
logical changes occurred in the bones of the skull. Dr. McLean
and myself reported a case of cranial bone lesion in a girl with
lues, who had severe diabetes insipidus and well marked dys-
trophy adiposogenitalis, but no abnormality of the sella turcica.

The degree of fat dystrophy varies according to the extent
of the impairment of the function of the hypophysis. In this
respect it is somewhat analagous to thyroid deficiency. When
the functional impairment is slight a mild form develops (forme
fruste) with very little genital hypoplasia or fat dystrophy, cor-
responding in degree to Kocher’s thyreopenia. When the fune-
tional capacity is very much lowered Froelich’s syndrome de-
velops with its characteristic clinical picture. This phase cor-
responds to Gull’s disease of the thyroid or the myxedematous
syndrome.

Many of the cases advance into a state of cachexia. Most
of the reports of this condition have appeared in the German
literature and are described as hypophyseal cachexia. Simmonds
published the reports of three cases of severe chronic cachexia
ending fatally, in which the pathological findings showed total
destruction of the hypophysis,—in two of the cases from neo-
plasm, in the other from an old embolus. In a later article he
attributes cachexia to destruction of the anterior lobe and cites
four cases in support of this view. The cachexia usually occurs
in the fatal cases, although recoveries from the symptoms of
cachexia under hypophyseal feeding have been reported.

INTERRELATION OF GLANDS

Many of the symptoms of dystrophy adiposogenitalis are
dependent upon the close interrelationship between the function
of the pituitary and other ductless glands. This feature is espe-
cially important in its relation to the sex glands. Clinically
and experimentally it has been demonstrated that anterior lobe
deficiency produces hypoplasia of the sex glands or the genital
syndrome, and posterior lobe deficiency lowers the carbohydrate
metabolism.

After primary change in the sex glands, as in pregnancy
or after castration, there is a consequent hyperplasia and hyper-
trophy of the pituitary gland. The interesting contribution on
this subject by Goetsch has been of great therapeutic value in
the treatment of functional conditions of both glands.

BECK . 195

In underfunetion of the thyroid, as in cretinism or myxoe-
dema, Eichorst observed changes very similar to those following
loss of function of the gonads. At first the pituitary becomes
larger and hyperaemic, hemorrhages are often observed, the
glandular cells grow, the chromophile cells degenerate. Later,
connective tissue changes take place with glandular cell
atrophy ; necrosis and cysts are formed in the connective tissue ;
the gland becomes smaller.

TREATMENT

The advancement along the lines of therapy in pituitary
disease has kept pace with the progress made in the study of the
physiology and symptomology. Treatment has become more
rational, and, as is the case in disorders of other glands of in-
ternal secretion, organotherapy is most efficacious in the de-
ficiency syndromes.

In hypopituitarism these include:

Anterior Lobe Deficiency—

1. Disturbance of growth (infantilism).
2. Development of obesity (dystrophia adiposogenitalis).
3. Genital hypoplasia (infantile genitalia with frigidity,

sterility, and amenorrhea).

4. Temperature anomalies.

5. Cachexia Hypophysopriva.
Posterior Lobe Deficiency—

1. Hypotension.

2. Increased sugar tolerance.

3. Diminution of basal metabolism rate.

In addition there occur pressure symptoms—headache, ver-
tigo, vomiting, ete.

Polyuria (diabetes insipidus), which was formerly attrib-
uted to posterior lobe deficiency or hypoactivity of the pars
intermedia, is not included in the above classification of symp-
toms, owing to the results of the clinical and experimental
studies of Houssay and Leschke mentioned previously.

Fortunately most of these indications, if they can be in-
fluenced by treatment, are controlled by the administration of
the hormones of the thyroid, pituitary and gonads, either singly
or combined. The thyroid is probably the most important. This
gland has been called a sex gland because it is a powerful stim-
ulant to the sex organs; and the presence of the thyroid hormone,

194 FROELICH’S SYNDROME

as well as the pituitary, is essential to normal function of the
yonads. The thyroid is the greatest stimulator of metabolism
known, acting, probably, by its effect in increasing muscle tonus
through irritation of the automatic nervous system. The thy-
roid is also a stimulator of the pituitary function. It is thus
easily conceivable how thyroid extract would favorably influ-
ence the majority of the groups of symptoms above mentioned.
Through its influence on metabolism it has a tendency to im-
prove the fat dystrophy, decrease sugar tolerance and increase
the rate of basal metabolism. The changes in the metabolic rate
will favorably influence the subnormal temperature, slow pulse,
hypotension, dry skin, ete. Through its accelerating influence
on the pituitary and sex glands it will augment the effect of
pituitary and ovarian extract upon sexual hypoplasia and hy-
pogonadism, as well as on infantilism of hypohyseal origin.

Anterior pituitary lobe has its greatest value in cases of
dystrophy adiposogenitalis. In combination with thyroid it has
the effect of redistributing the fat and increasing the functional
activity of the sex glands, besides correcting some of the anoma-
les due to hypoplasia of the genitalia.

Most of these cases are not pure hypopituitarism ; symptoms
referably to thyroid and ovarian deficiency are frequently pres-
ent. It is owing to this fact that better results are obtained by
combining the respective hormones than by giving them singly.

In a study of a group of cases with hypophyseal fat dys-
trophy it has been the writer’s experience that mere loss of
weight is no adequate criterion as to the effect of treatment on
the fat dystrophy. Patients under treatment must be syste-
matically measured and measurements recorded. The most strik-
ing example was a woman whose hip circumference was re-
duced 715 inches while under treatment, without her losing
weight. By mensuration it was definitely established that the
fat is actually redistributed in certain types of these patients.
As a rule the measurements of circumference increase from the
waist up, and decrease from the waist down. The dose employed
in the treatment of these cases was 214 grains of anterior pitui-
tafy lobe, (Parke, Davis & Co.), 2 or 3 times a day, and thy-
roid from one-half to one grain 2 or 3 times a day. Small doses
of ovarian or testicular extract were added in some eases. To
my mind the latter is of doubtful value.

BECK 195

Polyuria. The chief symptom of diabetes insipidus, which
is occasionally associated with hypopituitarism, can best be con-
trolled by the hypodermic administration of extract of the pos-
terior lobe and infundibulin. In my personal experience it has

20%...

13%.1

52=—

ea le

17%...

Fig. 4—The dark continuous line and figures represent the body
outline and circumference measurements before the administration of
anterior pituitary lobe and thyroid gland. The dotted lines and figures
represent the same 8 weeks later.

Note the increase in circumference from the waist up and decrease
below the waist.
been found that 1 ¢.c. of pituitrin every day or two will abso-
lutely control this annoying symptom, but the amelioration is
only temporary. The remarkable effect of a single dose of 1 c.c.

196 FROELICH’S SYNDROME

pituitrin promptly reducing the 24 hour urine from 13000 c.e.
to 1800 ¢.c. the next day led to the view that diabetes insipidus
is due to posterior lobe deficiency; the oral administration has
no effect.

The so-called pituitary headache is often promptly relieved
by the administration of pituitary extract; Pardee recommends
whole gland in doses of 14 to 2 grains three times a day. When
the headache is relieved the dose is diminished. Timme in his
article on a ‘‘New Pluriglandular Compensatory Syndrome’”’
jays stress on the importance of recognizing these cases at their
onset when the best results are obtainable by the early adminis-
tration of pituitary substance. He considers pituitary gland
almost a specific. The whole gland in doses of 2 to 3 grains,
three times a day, is given in appropriate cases. This he sup-
plements at times with pituitrin hypodermically, 0.5 to 1 ee.
per day or alternate days, for one or, at most, two weeks. With
genital delay he occasionally feeds anterior pituitary lobe, which
oives fair results. Atropine is recommended in those cases with
vagotonic symptoms. Timme states that pituitary feeding in
itself alone produces highly satisfactory improvement in almost
every case; headache disappears, fatigability diminishes, blood
pressure and blood sugar content increase.

The whole gland substance is indicated in cases with symp-
toms of both anterior and posterior lobe deficiency. With the
use of thyroid and pituitary, de Schweinitz and How obtained
eood results in a ease of pituitary disease with the onset of blind-
ness; vision was restored. Other observers reported similar re-
sults. The feeding of pituitary substance exerts a favorable in-
fluence on the cachexia. Cases are reported in which the symp-
toms were entirely relieved.

Except for the fact that operations on the hypophysis are
fraught with considerable danger, the mortality rate being 10-16
per cent, the indications for surgical treatment of disease of this
gland would be practically comparable to those for diseases of
the thyroid. The complete removal of the gland or any process
which totally destroys the substance will lead to the condition
known as cachexia hypophysopriva; operations, therefore are
restricted largely to tumors and are resorted to more frequently
in conditions associated with hyperfunction.

BECK oir

BIBLIOGRAPHY.

Ashner (B.) Demonstr. hypophysektomierter Hunde. Wien. klin.
Wehnschr. (Vienna), 1909, 22, 1730-1732.

Bartels (M.) Ueber die Beziehungen yon Veranderungen der Hypo-
physengegend zu Misswachstum und Genitalstérungen (Dystro-
phia adiposo-genitalis). Miinchen. med. Wechnschr., 1908, 55, 201.

Beck (H. G.) Fat redistribution in the hypophyseal type of dystrophy
adiposo-genitalis. Am. J. Med. Sc. (Philadelphia), 1918, 156, 711-
720.

Beck (H. G.) and McLean (G.) Diabetes insipidus associated with hy-
popituitarism and structural changes in the skull, showing the
effect of hypophyseal extract on the excretion of urine. The
Therapeutic Gazette (Detroit), 1919, 43, 158-160.

Biedl (A.) Hypophysis Cerebri (Cerebral Appendage, Pituitary

‘ Gland). The Internal Secretory Organs (New York), 1912, 305-
abe |

Brissand (E.), De l’infantilisme myxoedemateux. Nouv. Icon. de la
Salp, 1897, 10, 240-262.

Cushing (H.) Surgical experiences with pituitary disorders, Weir
Mitchell Lecture, J. Am. Med. Assoc. (Chicago), 1914, 63, 1515-
1525.

Christian (H.) Defects in membranous bones, exophthalmos and dia-
betes insipidus; an unusual syndrome of dyspituitarism; Med.
Clin. N. A., 1920, vol. 3, No. 4, pp. 849-873

de Schweinitz and How: A case of pituitary body disease and the re-
sults of glandular administration. Arch. Opth. (N. Y.), 1917, 46,
139-146.

Hichhorst: Hypophysis changes in the pituitary body in cretinism
and myxedema. Deutsches Arch. f. klin. Med. (Leipzig), 1916,
124, 207.

Frolich (A.) Hin Fall von Tumor der Hypophysis cerebri ohne Ak-
romegalie. Wien. klin. Rundschau (Vienna), 1901, 15, 883-906.

Goetsch (E.) The influence of pituitary feeding upon growth and sex-
ual development—An experimental study. Johns Hopkins Hosp.,
Bull. (Balt.), 1916, 27, 29-50.

Hewlett (A.) Infantilism in pituitary disease. Arch. Inter. Med.
(Chicago), 1912, 9, 32-43.

Houssay (B. A.) Los Principos Activos de los Extractos Hipofisiarios.
(Estudio Critico y Experimental), Prensa Medica Argentina
(Buenos Aires), 1915-16, 2, 82; 91; 105.—The pituitary body and
polyuria, Endocrinology, 1918, 2, 94-97.

Kocher (Th.) Ueber Kropfexstirpation und ihre Folgen. Arch. f. klin.
Chir. 1883, 29, 254.

Krogh (M.) Thyreoidinets Indflydelse paa Standardstofskiftet. Uge-
skrift for Laeger (Copenhagen), 1916, 78, 2337-2341.

Leschke: Beitrage zur klinischen Pathologie des Zwischenhirns.
. Ztschr. f. klin. Med. (Berl.), 1919, 87, 201-279.

Lorain (P.) De Jinfantilisme et du feminisme chez les phthisiques.
Faneau de la Cour (F. V.), Paris, 1871, 5-11.

Mohr (B.) Hypertrophie (markschwammige Entartung?) der HBypo-
physis cerebei und dadurch bedingter Druck auf die Hirngrund-
fliache, insbesondere auf die Sehnerven, das Chiasma derselben
und den linkseitigen Hirnschenkel. Wehnsch. f. d. ges. Heil-
kunde (Berlin), 1840, 6, 565-571.

Pardee (i.) Pituitary headaches and their causes. Arch. Int. Med.
(Chicago), 1919, 23, 174-184.

198 FROELICH’S SYNDROME

Reverdin (J.) Note sur 22 operations du goitre. Rev. Méd. Suisse
Rom. (Genéve), 1883, 3, 413-415.

Robertson (T.). Recent investigations on the influence of the anterior
lobe of the pituitary upon growth, and on the properties of tethe-
lin. Endocrinology, 1917, 1, 24-37.

Schuller: Ueber eigenartige Schadeldefekte in Jugendalter. Fort-
schritte auf der Gebiete der Roentgenstrahlen, 1915-16, 23, 12.
Simmonds (M.) Ueber Kachexie hypophyséren Ursprungs. Deutsche

med. Wchnschr. (Berl.), 1916, 13, 190.

Smith (E.) Growth of normal and hypophysectomized tadpoles as in-
fluenced by endocrine diets. Univ. California Pub. Physiology,
1918, 5, 11-22.

Timme (W.) A new pluriglandular compensatory syndrome. Endo-
crinology, 1918, 2, 209-239.

Tucker (B.) Pituitary disturbance in its relation to the psychoses of
adolescence. J. Am. M. Assn. (Chicago), 1918, 71, 330-333. -

THE RELATIONSHIP BETWEEN THYROID AND
PARATHYROIDS

Swale Vincent and J. S. Arnason

(From the Physiological Laboratory, University of Manitoba,
Winnipeg.)

The present communication is in the nature of a recanta-
tion. .

We shall make no attempt to give a complete historical ac-
count of the discussion of this subject. Such an account up to
the year 1912 has been given by Vincent (10) and up to 1913
by Biedl (1). .

The earlier investigators looked upon the parathyroids as
embryonic thyroids and a belief in some kind of morophological
and physiological relationship between the two glands has per-
sisted up to the present time. But since the appearance of the
papers of Vassale and Generali (7, 8, 9) the majority of authors
have regarded the parathyroids as organs sui generis.

The experimental evidence for and against this view has
been somewhat contradictory. Vincent and Jolly (11, 12) found
that on microscopical examination of parathyroids left i situ
after removal of the thyroid an alteration in structure had oc-
eurred. The parathyroid approximated in appearance to ordi-
nary thyroid tissue. Their experiments were carried out on
eats. Similar changes after thyroidectomy were found by Hal-
penny and Thompson (4) in the parathyroid of a dog. Hal-
penny (3) later reported a somewhat more doubtful instance
occurring in a rabbit.

These results have not been generally accepted. Although
the rabbit, among laboratory animals, lends itself in a special
way (from anatomical considerations) to experiments bearing
upon this problem, we can find in the literature very few de-
tailed accounts of work directed towards this point carried out
upon the animal in question.

It was in rabbits that Gley (2) rediscovered the external
parathyroids, and it is undoubtedly true that it is largely to this
author that we owe our present knowledge of the importance of
these bodies. In his earlier papers on the subject, Gley sup-

199

200 THYROID AND PARATHYROID

ported the view that the parathyroids could (after removal of
the thyroid) develop into thyroid. Later on he changed his view
though he has maintained a belief in some kind of relationship
between the two structures. Biedl (1) reports that, although he
has noticed very considerable hypertrophy of parathyroids (in
the rabbit) left behind after removal of the thyroid, yet he has
never seen any structural changes in the former under these cir-
cumstances.

The present series of experiments has been carried out upon
rabbits of different ages, some of them being full-grown, others
only half-grown. The thyroid has been carefully extirpated
under aseptic conditions, and with it, of course, both internal
- parathyroids, leaving behind one or both external glandules.
The animals have been kept under the best possible conditions
after the operation for periods varying from seven to eight bun-
dred days, but of twenty-two animals which survived the opera-
tion for more than twenty-four hours, two have died within a
few weeks of infections which are so common after thyroidect-
omy. The rest, to the number of twenty, have survived for
periods varying from eighteen to eight hundred days, after
which time the parathyroids were removed and examined micro-
scopically. In some, instances the animals were allowed to live
after the second operation.

Our results are briefly as follows:

In none of the parathyroids have we found any distinct
traces of vesicle formation. It is possible that there are changes
of other kinds and of less significance in the glandules which had
been left behind, but on this point we do not wish to be posi-
tive.

This series of experiments, then, does not lend support to
the view that parathyroids left behind after thyroidectomy be-
come converted into thyroid tissue. It is possible that the an-
atomical differences between rabbits on the one hand and eats
and dogs on the other, involves also a difference in the poten-
tiality of parathyroid to change into thyroid. Notwithstanding
these considerations, and in spite of the fact that negative re-
sults are in such cases of less value than positive, we must con-
fess that these experiments have led us to suspect the possibility
that there were some errors of observation in the cases reported
by Vincent and Jolly and Halpenny and Thompson. It is clear

VINCENT AND ARNASON 201

that in dogs and cats where the parathyroids are in close prox-
imity to the thyroid, there is a great danger of leaving behind a
shred of thyroid tissue at the operation for thyroidectomy. |
This might subsequently be mistaken for transformed parathy-
roid. This suspicion is at any rate strong enough to suggest
that further careful experiments upon animals other than rab-
bits ought to be carried out.

A few observations of another character bearing on the
functions of the thyroid-parathyroid apparatus have been made
in the course of these experiments. In the first place it may be
desirable to call attention to the fact emphasized by Vincent and
Jolly and other observers that after thyroidectomy, animals are
particularly liable to various infective diseases, particularly of
the respiratory tract. Again, stress must be laid upon the ob-
servation that none of our animals suffered from a condition
which resembled in the remotest degree the disease known as
myxoedema in the human subject. It is true that some of them
suffered from falling out of hair and other skin diseases, but it
is also true that many contro] animals suffered in the same kind
of way. In none of-the animals, young or old, was there any
puffiness of the face or swelling of the subcutaneous tissue of
any part of the body.

It is also important to note that we have not seen distinct
tetany in any of the animals, and some have survived a removal
of the remaining parathyroids for several weeks without symp-
toms. We are aware that tetany does sometimes occur in rab-
bits, but the precise conditions which determine its onset are by
no means clear.

Noél Paton (5) has recently urged the functional distine-
tions between thyroid and parathyroids, and has suggested that
in rabbits the explanations of a comparatively large proportion
of survivals after complete thyro-parathyroidectomy is due to
the fact that parathyroid tissue nearly always occurs in the thy-
mus in these animals (Pepere, 6).

In our notes of the earlier experiments we find frequent
record of hypertrophy of remaining parathyroids. But the
measurements made in the later experiments did not lend sup-
port to the view that this hypertrophy is generally found. We
thought it best, therefore, to omit all such statements, though

202 THYROID AND PARATHYROIDS

our impression is that in many cases there was distinct hyper-
trophy. This accords with the statemrent of Biedl (vide supra).

It was suggested to us by Sir E. Sharpey Schafer that some
experiments of the character described above should be carried
out in dogs and eats. Such experiments can only be performed
in selected animals, and we have had the misfortune to lose by
accident two dogs which had lived for some time with only one
parathyroid, the thyroid and three parathyroids having been
removed.

We beg to acknowledge the valuable assistance of Mr. John
Carmichael in all the experiments.

PROTOCOL OF EXPERIMENTS.

Exp. 1. Nov. 11th, 1916. Rabbit, female, full-grown. Thyroid and
both internal parathyroids (as well as the left external body) re-
moved. On Feb. 22nd (103 days) the animal was killed, and the right
parathyroid examined. On microscopical examination it showed no
structural changes. .

Exp. 2. Nov. 17th, 1916. Rabbit, male, full-grown. Thyroid and both
internal parathyroids removed, both external glandules left behind. The
animal remained well till Jan. 6th (50 days), when the two external
parathyroids were removed under aseptic conditions and the animal
allowed to live till Jan. 17th, when it was killed. Tetany did not
develop. The parathyroids removed on Jan. 6th showed no signs otf
vesicle formation. At the post-mortem no accessory bodies could be
found.

Exp. 3. Noy. 18th, 1916. Rabbit, male, full-grown. Thyroid and both
internal parathyroids removed, along with the right external parathy-
roid. The animal remained well until Jan. 18th (61 days), when the left
external body was removed for microscopical examination. The ani-
mal was then allowed to live till Jan. 31st, when it was killed. The
left glandule showed no structural changes. No symptoms of tetany
developed after its removal, and on post-mortem eXamination, no
accessory parathyroids could be found.

Exp. 4. Noy. 22nd, 1916. Rabbit, male, full-grown. Thyroid and
both internal parathyroids removed. Both external bodies left behind.
The animal remained well until Feb. 1st (71 days), when a second
operation was performed and both the external parathyroids removed.
No symptoms of tetany supervened and the rabbit was killed on Feb.
20th. Neither of the parathyroids showed any distinct structural
changes.

Exp. 5. Nov. 23rd, 1916. Rabbit, female, full-grown. Thyroid and
both internal parathyroids removed. Both external bodies left in situ.
On Dec. 9th (16 days) the animal died of pneumonia. The external
parathyroids showed no changes.

Exp. 6. Nov. 23rd, 1916. Rabbit, female, half-grown. The thyroid,
both internal, and the right external parathyroids were removed. On
Dec. Ist (8 days) the animal died of pneumonia. The external para-
thyroids of the left side had undergone no structural changes.

Exp. 7. Nov. 25th, 1916. Rabbit, male, full-grown. Thyroid with
the two internal parathyroids was removed, leaving behind both ex-
ternal bodies. The animal remained in good health till Feb. 28th (95
days) when it was killed. No vesicular formation could be detected.

Exp. 8. Dec. 1st, 1916. Rabbit, male, full grown. Thyroid and
internal parathyroids removed. Eocth external glandules left in situ.

VINCENT AND ARNASON 203

Remained well till Mar. 27th (115 days). No sign of vesicle forma-
tion was found in the external glandules.

Exp. 9. Dec. 2nd, 1916. Rabbit, male, full-grown. Thyroid and
internal parathyroids removed, the two external bodies left in situ.
Remained well till Mar. 27th (114 days) when the two external para-
thyroids were removed. They showed no structural changes.

Exp. 10. Dec. 4th, 1916. Rabbit, male, full-grown. Thyroid and
internal parathyroids removed. External giandules left in situ. On
Feb. 28th (86 days) the animal was killed. No changes in external
parathyroids. -

Exp. 11. Dec. 7th, 1916. Rabbit, female, full-grown. Thyroid,
both internal and left external parathyroids removed. On Feb. 20th
(75 days) the rabbit was killed and the right external parathyroid
examined. This showed no structural changes.

Exp. 12. Dec. 7th, 1916. Rabbit, male, full-grown. Thyroid and
internal parathyroids removed, both external parathyroids left behind
in situ. On Jan. 28th (52 days) the animal died of intercurrent dis-
ease. Parathyroids showed no structural changes.

Exp. 13. Dec. 18th, 1916. Rabbit, female, full-grown. Thyroid,
internal parathyroids and left external body removed. Killed on Mar.
27th (99 days). No change in right external parathyroid.

Exp. 14. Dec. 18th, 1916. Rabbit, male, full-grown. Thyroid,
both internal and right external parathyroids removed. Died on Mar.
2nd (74 days) of pneumonia. During the last few months the hair
had been falling out, first in patches round the neck, then on one side
of the body. The parathyroid left behind at the operation showed no
structural change.

Exp. 15. Feb. 3rd, 1917. Rabbit, male, half-grown. Thyroid and
internal parathyroids removed, both external glandules left behind
in situ. Animal remained well till Mar. 26th (52 days) but did not
increase in size or weight. The parathyroids did not show any
changes.

Exp. 16. Feb. 10th, 1917. Rabbit, male, half-grown. Thyroid and
internal parathyroids removed. Both external parathyroids left. Re-
mained well till Mar. 26th (44 days) but did not increase in size or
weight. The external parathyroids did not show any structural
changes.

Exp. 17. Oct. 14th, 1917. White rabbit, female, young and in
good condition. Wt. 1.5 K. Thyroid and internal parathyroids re-
moved. Both external parathyroids left. The right glandule meas-
ured 7 mm. x 2.5 mm. and reached from the 10th to the 14th rings of
the trachea. The left body was 7 mm. x 2.75 mm. and extended from
the level of the 5th tracheal ring to that of the 10th.

On Dec. 23rd, 1919, the animal, whose weight had reached 2 K,
was killed. The right parathyroid measured 5.5 mm. x 2 mm., the left
7.5 mm. x 2.5 mm. Both were found to be unchanged histologically.

Exp. 18. Oct. 30th, 1917. Rabbit, light brown, female, young.
Wt. 2.1 K. Thyroid and internal parathyroids removed. Both exter-
nal glands left behind. The right one measured 8 mm. x 3 mm. and
lay opposite the 7th-llth rings of the trachea. The left measured 9
mm. x 3.5 mm. (Tracheal rings 9-14).

On Dec. 23rd, 1919, the animal was found to weigh 2.2 K and was
in excellent condition. The right parathyroid now measured 8 x 3
mm. and the left was almost exactly the same size.

On examining the parathyroids histologically, we were astonished
to find undoubtedly thyroid tissue in connection with the right glan-
dule. But we are inclined to think that this really represented a true
accessory thyroid which happened to be united to the external para-

204 THYROID AND PARATHYROIDS

thyroid. The left parathyroid was of normal microscopical appear-
ance. ;

Exp. 19. Oct. 30th, 1919. Young white female rabbit weighing
1.6K. The thyroid and both internal parathyroids removed. Both
external bodies left behind. The left measured 7 x 2.5 mm. The
right was not measured.

Dec. 23rd, 1919. The rabbit is normal and weighs 2.8 K. A
shred of thyroid had been left behind. The left glandule measured
9 x 2.5 mm., the right 8 x 2.5 mm. The bodies were unaltered in
structure.

Exp. 20. Dec. 23rd, 1917. Male rabbit, white, weighing 1.5 K.
Thyroid, both internal parathyroids and the right external glandule
removed, the left external parathyroid being left behind. The latter
measured 8.3 mm. at one operation.

Dec. 23rd, 1919. The animal was killed. Wt. 1.8 K. Left gland
now measured 15 x 4mm. On microscopical examination appeared to
consist of lymphoid tissue. (It is remotely possible that this body
was not the parathyroid, but a lymph gland.)

REFERENCES.

1 Biedl, A., Innere Sekretion, etc. 2te. Aufl., Berlin, 1913.

2. Gley, E., Archives de Physiol. Janv. 1892.

3. Halpenny, J., Surgery, Gyn. and Obstet., Chicago, 1910.

4. Halpenny, J.. and Thompson, F. D., Anat., Anz.; 1909, 34, 376.

5. Noél Paton and Findlay—Quart. Journ., Exp. Physiol., 1916-17,
10, 214.

6. Pepere, Le ghiandole paratiroidee, 1906, Turin; and Arch. de
med. exp. et d’anat. path., 1908, 20, 21.

7. Vassale and Generali, Riv. di Patol. nerv. e ment, 1896, 1, fax.
iii, and vii. :

8. Vassale and Generali, Arch. ital. de Biol., 1896, vol. 25, 26.

9. Vassale and Generali, Arch. ital. de Biol., 1900, 33, 154.

10. Vincent, S., Internal Secretion, etc., London, 1912.

11.- Vincent, S., and Jolly, W. A., Journ. Physiol., 1905, 32, 65.

12. Vincent, S., and Jolly, W. A., Journ. Physiol., 1906, 34, 295.

GYNECOMASTIA

Frederick S. Hammett

Pennsylvania Hospital. Department of Mental and Nervous Diseases.
Philadelphia, Pennsylvania

The term “‘gynecomastia,’’ derived from the two Greek roots

yuvi-feminine and waotés-mamma, is applied to the occurrence
in the male of a unilateral or bilateral mammary development

resembling that of the female in its gross anatomical character-
istics, with or without the production of milk.

This enlargement of the male mamma is not by any means a
rarity, the phenomenon having been an object of recorded in-
terest since the time of Aristotle (1), who reported having
himself examined several individuals possessing the anomaly.

The surgical removal of the overdeveloped tissue was advo-
cated at an early date, the procedure for which was apparently
first described by Paulus Aegineta (2). Later the Persian
physician, Ali-Ben-el-Abbas (3) and the Arabian, Abul-Casimir
el Zahrawi (4) reported the methods of operation in vogue in
their respective countries, and Fabricius ab Aquapendente (5)
developed a technique that savors much of modernity.

From the time of these early contributions to the subject
down to the present medical literature contains many reports of
the occurrence of abnormal enlargements of the male breast.
Doubt, however, is thrown upon the validity of the interpreta-
tions of many of these cases as true gynecomastia, since there is
often an evident failure to differentiate between the chronic or
acute pathological conditions, such as carcinoma or breast
abscesses, and the physiological mammary enlargement or gyne-
comastia vera unaccompanied by pathological stigmata.

In 1884-1885 Schuchardt (6) (7) (8) reviewed the litera-
ture concerned with new tissue formation in the male breast in
three papers, two of which were devoted to the enlargements of
the mammae due to obviously pathological conditions, while one
detailed 272 cases which in all probability were authentic ex-
amples of true gynecomastia.

Gruber (9) who studied the subject intensively considered
that true gynecomastia is a physiological phenomenon, and is

205

206 GYNECOMASTIA

generally characterized by the non-painful and non-inflamma-
tory character of the growth and the fact that it presents to the
touch the characteristic lobulation of the female organ, unaccom-
panied by any of the usual clinical stigmata of pathological
import.

Among the pathological causes of the enlargement of the
male breast, carcinomata seem to occupy the center of the stage.
But enchondromas, adenomas, fibromas, myomas, fibro-adeno-
mas, lipomas, atheromas, cystic formations, tubercular growths,
simple hypertrophy, calcification, and gummas have all been
found at one-time or another among those conditions leading to
what Schuchardt (6) (7) calls the ‘‘Neubildune’’ of the male
breast ; while chronic induration and chronic mastitis can also be
included if the term is taken in its widest sense.

In addition to the differentiation made between these and
other pathological enlargements of the male mamma and gyne-
comastia there should be introduced a second group of over-
erowths in which the enlargement consists simply of an addi-
tional deposition of fat or fibrous tissue in the mammary region.
This latter type of increase was justly called by Gruber (9)
adventitious or spurious gynecomastia.

Early studies of the gross and microscopic anatomical char-
acteristics of the human breast were made by Gruber (9),
Langer (10), Luschka (11), Momberger (12) and others. These
seemed to show that there are no demonstrable differences in the
manner of growth and development of the mamma of the two
sexes up to the beginning of puberty. Even the post-partum
enlargement as described in Halban’s (13) diagram of mammary
erowth occurs irrespective of sex, as has been noted by Albers
(14), Steifensand (15), de Sinéty (16), Opitz (17), Storch
(18), Seanzoni (19) and others. Although the mode of develop-
ment is apparently the same in the two sexes up to the com-
mencement of the pubertal period, the degree of the enlargement
is normally somewhat less in the male. At puberty, however, a
marked quantitative differentiation appears to take place, and
although the development and ramification of the glandular
tissue occurs in both male and female, that of the former is
normally of slight degree. Nevertheless, there does take place a
progressive advancement in the development of the mammary
elements of the male over the condition found in the infantile

HAMMETT 207

stage, and the same type of change occurs which in the female
leads to the production of the mammary volume characteristic of
the sex. The main histological difference seems to lhe in the

apparent cessation of glandular growth just prior to the forma-
tion of the alveolar fundaments and a lessened fat and fibrous
tissue infiltration.

On the other hand histological studies of Kolliker (20) seem
to indicate that the growth of glandular tissue in the male with
the formation of the end-bulbs is more extensive than is that of
young nulliparous women of the same age. While this change
is taking place the milk passages are ramifying by lateral
buddings, as well as by multiple dichotomie terminal divisions,
so that there are now found single canals connected with small
groups of ‘‘Blascheh’’ of the second and third order. The ratio
of the end-bulbs and the fundaments of the glandular ‘‘Lapp-
chen’’ to the breast mass as a whole in young women and nulli-
parae is consequently very much less than in the male of the
same age, while the glandular tissue development to and beyond
the degree found in the male occurs in the female only during
pregnancy and lactation. Although these two sets of observa-
tions have led to apparently conflicting conceptions of the dif-
ferences of the glandular development occurring in the two
sexes, a review of the observations on which the ideas were based
would seem to indicate.a greater degree of completeness in those
of Kolliker (20). This latter investigator has clearly differen-
tiated the histological structure and the developmental changes
taking place in the female breast before, during and after child-
birth, while the other workers are somewhat hazy in respects to
these points. Accepting the histological studies of Kolliker (20)
as being the more accurate, it is evident that this tissue presents
similar morphological potentialities for assuming the function of
milk-production as does the virginal mammary gland. Under
certain, though rare, conditions this potential function appar-
ently becomes actual, as will be later discussed. That it is the
exception rather than the rule for this phenomenon to occur, the
same being true for the enlargement of the male breast to a
volume and texture resembling the female breast, may be due
either to the presence in the organism of a chalone-producing
tissue inhibiting the hyperplasia or to the absence of a specific
hormone capable of bringing about such growth.

208 GYNECOMASTIA

Turning now to the histological studies of the male breast
in gynecomastia, it is seen that they have generally failed to take
into account the glandular conditions found by Kolliker (20) in
the normal male mamma during the second and third decennium
as compared with those found in young nulliparous women. For
while it is usually admitted that the manner of glandular rami-
fication and end-bulb formation is the same in the gynecomast
as it is in the female, it is frequently stated, with no added com-
parative evidence of a direct nature, that the degree of glandular
tissue development in gynecomastia is not as great as is that in
the female at puberty and during pregnancy, thus, obviously
sliding over the differential histological picture obtaining during
these two periods.

The most comprehensive summary of the microscopic condi-
tions occurring in the abnormal physiological enlargement of the
male mamma is given by Stieda (21), who considers that the
term gynecomastia is only justified insofar as it is concerned
with the outer form and volume increase of the male breast: that
it should not include or express a histological uniformity or
similarity of such a breast with the functioning female organ.
The condition consists in a hyperplasia of the normal tissues of
the male, primarily the connective tissue, which invades the sur-
rounding fat tissue: the fat and the glandular tissue take some
part in the hyperplasia it is true, but it is a minor one. Struc-
tures similar to acini are found but not to the same degree as in
the normal female breast. In general this conception is sup-
ported by the histological findings of Scheiber (22), Ingleby
(23), Galliet (24) and others, although the statements made
comparing the findings with the female breast do not take into
account the original structure as described by Kolliker (20). It
is accordingly highly probable that the gynecomastie breast is
but little if any different in its glandular development from the
breast of the young virginal or nulliparous female and is aecord-
ingly potentially capable of assuming the elaboration of milk
provided the appropriate stimulus be afforded.

The onset. of this anomaly may take place apparently at any
time after the organism commences the development of the
sexual changes accompanying puberty, although Foot (25)
reports a case of so-called pre-pubertal gynecomastia of the right
breast that was painless, non-inflammatory and presented a dis-.

HAMMETT 209

tinetly lobulated structure in a boy of twelve, and Ingleby (23)
and Moorehead (26) have recorded similar occurrences. in boys
of eleven and twelve years, all of whom presented no other signs
of approaching puberty. Such a designation if tending to dis-
sociate the phenomenon from the influence of pubertal stimuli
is hardly justified since it is pretty generally accepted that the
first faint stimuli heralding the approach of puberty are begin-
ning to make themselves felt at this time, or even earlier (Heyn
27). However, it is during puberty that gynecomastia makes its
appearance most frequently, Villeneuve (28), Bertherand (29),
Gruber (9), Weber (8) and others citing many instances of the
anomaly occurring at this period.

But the occurrence of the anomaly is not restricted to the
pubertal period, since Curveillier (31), Galliet (24), L’Abbé
(23) and Bryant (33) have all noted its development in men
from 20 to 30 years of age. It is possible that these individuals
were examples of a delayed sexual development (27). The same
objection cannot be raised to the cases reported by Scheiber (22)
and others in which the enlargement did not occur until well
along into middle life nor to those individuals who had reached
a ripe old age before the development of the gynecomastia as re-
ported by Hall (84), Gorham (35) and Villeneuve (28). These
eases are evidently definitely dissociated from direct connection
with the changes taking place in the organism at puberty.

Since the incidence of gynecomastia in most eases is near
the time of puberty, one is inclined to consider the phenomenon
as in some way associated with an abnormality of the endocrine
stimuli concerned with adolescence—particularly since it is dur-
ing this period that the gross enlargement of the female mamma
occurs. This latter phenomenon is generally agreed to be due to
stimuli derived from glands of internal secretion. Such a con-
ception, however, does not exclude the possibility that those cases
occurring later than the adolescent period are also associated
with abnormalities in gonad activities, the nature of which is
unknown.

Gynecomastia may occur either unilaterally or bilaterally.
No attempt has been made to compile the statistics relative to the
locus of incidence, but it is interesting to note that out of forty-
five cases Gruber (9) found that ten were unilateral, five being
on the right side and five on the left.

210 GYNECOMASTIA

The condition seems to be rarely hereditary in character,
and those instances in which it has occurred in more than one
generation may be considered as expected under the general law
of probability. Savitsky (35) has reported a peasant gynecomast
whose father, elder brother, and cousin were also similarly
afflicted.

The familial occurrences of the phenomenon are also rare,
Schaumann (20) finding but two instances where the anomaly
occurred in more than one member of the family. This lack of
definite, positive evidence that either hereditary or familial
characteristics are concerned in gynecomastia allows the assump-
tion that it is an untransmissible sport.

Whether actual milk production occurs in gynecomastia has
been questioned. Stieda (21) and others seem to have failed to
observe any consistent or valid evidence of this. Nevertheless,
the literature contains many presumably authentic reports of
instances of the secretion of milk and nourishment of the young
by gynecomasts, Humboldt, Franklin (37), Schmetzer (38) and
others giving excellent descriptions of personal observations of
such cases.

The chemical analysis of ‘‘buck-milk,’’ as the secretion of
the male breast is usually called, shows that it can hardly be
considered as a complete food for the growing infant. One
analysis given by Schmetzer (38) in 1837, showed 1.23 per cent
of fat, 3.58 per cent of alcoholic extractives, 1.50 per cent of
water extractives and 1.18 per cent of insoluble materials.
Nevertheless, there are instances reported of infants thriving on
milk obtained from gynecomasts and it is accordingly within
the bounds of probability that if the reported analyses had been
derived from such specimens quite different results would have
been obtained.

It is a generally accepted theory that for milk to be secreted
there must be produced by or introduced into the organism a
substance or substances stimulating the mammary glands to take
up and earry on the function of lactation. Although it is well
known that there are substances elaborated by endocrine glands
common to both sexes that have been found to act as galacta-
ceogues, the source of the actual stimulus to lactation in the male
is decidedly uncertain.

HAMMETT ~ 2h

Gruber’s (9) studies of the individuals coming under his
observation and reported in the literature led him to consider
that true gynecomastia is the result of a physiological process.
He divided the gynecomasts into two groups depending upon
whether or not there was a concurrent abnormality of the geni-
talia. Those whose genitalia appeared normal were classed as
essential gynecomasts, while those with abnormal genitaha were
considered as examples of acquired gynecomastia.

The anamnesis of the gynecomastic individuals coming to
record gives validity to the conception that the condition may be
acquired and associated with abnormalities of the genitalia.
There is evident a strikingly frequent occurrence of defective or
pathological states in these organs. Not every case of pathologi-
eal or defective testicles exhibits a gynecomastia nor every case
of the anomaly exhibits defective or pathological conditions of
the genitalia, but there is found in many gynecomasts a simul-
taneous disturbance in function and structure of the procreative
apparatus. Not only the testicles but also the penis seems to be
incompletely developed in many cases. Schaumann (20) reports
six cases of gynecomastia accompanied by immature genitalia.
Malformations such as hypospadia and epispadia accompanied
by atrophic testicles or penis are frequently noted. Definite
mammary hypertrophy has been known to accompany testicular
atrophy caused by orchitis following parotitis (Lereboullet 39) ;
while Martin (40) was of the opinion that castration may bring
about a similar result. It is not improbable, however, that the
mammary enlargement in the latter cases is more in the nature
of a spurious gynecomastia than of any other form. Laurent
(41), Gorringe (42), Galliet (24), Weber (30) and Paulicky
(43) all report similar cases in which there was atrophy, defect
or pathological condition of the testicles accompanying the gyne-
comastia; and the evidence is sufficiently extensive to indicate
the validity of Biedl’s (44) summary conclusion that the
anomaly is due in many instances to such conditions.

Turning for the moment to the so-called essential type of
gynecomastia in which there is no evident abnormality of the
genitalia, it is found that Coes (45), von Nelaton (47), Paulicky
(43) and others have observed and reported such instances.
Moreover, definite statements are frequently made that the
sexual libido and potency in such individuals is entirely normal.

212 GYNECOMASTIA

It is accordingly evident that gynecomastia may or may not be
accompanied by a disturbance of the generative instincts and
functions, from which it can be inferred that the stimulus to the
anomaly formation does not necessarily he in a perversion of any
normal erotic hormone.

As might be expected, however, certain types of gyneco-
masts do present evidence of a lack of sexual desire and potency.
A survey of the literature reveals that this expression of funda-
mental instinct was never developed at all or began to recede
with the onset of the anomaly when accompanied or preceded by
the appearance of defective genitalia. One case of sexual per-
version is reported by Raggi (48) in which insanity was accom-
panied by a distinct mammary enlargement which receded to
normal volume on recovery.

The mental trend and emotional reactions of the greater
number of the gynecomasts seem to lie along those lines ordi-.
narily reserved for the opposite sex. There are exceptions, but as
a rule they give evidence of a preponderance of feminine traits
where masculine would be expected. In many instances such an
impression may have been enhanced in the observer by the lack
of abundant hirsuties and the presence of a feminine voice. The
degree to which this is true is indeterminable.

However, since the anomalous enlargement of the male
breast is frequently accompanied by an atrophy, defect, or path-
ological condition of the male genitalia, and is usually associated
with some deviation from the normal primary and secondary
sexual characteristics of the male, the assumption is justified
that the condition is a sequel of an abnormal endocrine trend in
the organism. But two reports showing a possible direct asso-
ciated endocrine disturbance accompanying gynecomastia, aside
from those cases in which there are present abnormalities of the
genitalia, have been found in the literature. The first one of
Wagner (49) is, however, doubtful, due to the lack of general
information existing at the time. Freeman (50) reports a
hyperthyroidosis accompanied by enlargement of the mamma,
but the existence of a causal relationship is hardly proven on the
basis of this single observation. The results of the observations
recorded up to the present may now be briefly summarized.

Gynecomastia is a physiological enlargement of the male
breast to the volume and appearance of the normal female mam-

HAMMETT 213

ma. It may be non-painful and non-inflammatory ; to the touch
it gives the feel of lobulation found in the female breast; it is
not accompanied by pathological stigmata. It may arise at any
time after the beginning of puberty or after the termination of
the changes taking place at this period, but taken by and large,
the greater number of cases have their incidence during the
pubertal stage. It may occur as a one-sided enlargement, but
possibly is more frequently bilateral. Heredity seems to play no
part in its development. Apparently authentic reports give evi-
dence that the gynecomastic breast may produce milk, which
conclusion is supported by the histological studies of Kolliker.
These seem to indicate a structural similarity of the development
of the normal male mamma to the virginal or nulliparous breast.
Finally, the anomaly may or may not be accompanied by
atrophy, defect, or pathological condition of the genitalia.

Is there any experimental justification for the assumption
that this anomaly is connected with endocrine dysharmony ? Two
facts seem to support the hypothesis that a disturbance of the
normal internal secretory functions of the sex glands of the male
is the chief contributing factor to its production. The first is
that the onset of the phenomenon is usually so closely associated
with the changes taking place in the primary and secondary
sexual characteristics at puberty and the second is the frequent
presence of defective genitalia in these individuals. This latter
eondition is associated with a tendency to femininity and lack of
sexual desire and potency.

The normal pubertal enlargement of the female mammary
glands is undoubtedly due to the elaboration of an internal
secretion by the ovary. The experiments carried on by Halban
(13), Kehrer (51), Hegar (52), Knauer (53) and others in
which it .was conclusively demonstrated that if the ovaries of
young female animals be removed, normal mammary develop-
ment fails to occur, while if the removed ovaries be again homo-
logously implanted there follows normal development to func-
tional capacity. This apparent relationship between the ovaries
and the secondary sexual characteristics of the female is
correlated in the male by the dependency, at least in part, of
the usual development of the secondary sexual characteristics
upon the presence of a certain amount of functioning testicular
substance within the organism. The experiments of Foges (54)

214 GYNECOMASTIA

with cocks and of Larcher (55) and Morgan (56) with hens in-
dicate that the testicles produce an internal secretion concerned

with the development of the male characteristics. Halban (13)
has expressed the opinion that gynecomastia may be due to fun-
damental similarity in the nature of the internal secretory prod-
ucts of the ovaries and the testicles. Foges (57) criticises this
hypothesis and the experiments of Aschner and Grigoriu (58)
would tend to support the criticism. These latter investigators
succeeded in producing a hyperplasia and so-called colostrum-
secretion in the mammae of rabbits or guinea pigs by the injec-
tion of testicular extract, but similar results with extracts of
spleen, muscle and liver indicate a lack of specificity of the re-
action. If the normal internal secretion of the testicles is the
same as that of the ovaries with reference to its relation to the
development of the secondary sexual characteristics, why then
are not all males possessed of mammae of volume equal to those
of the female? It has been said that the anlagen of these
characteristics, such as the beard, are predetermined and have
but little if any initial relation to the sexual glands, Tandler
(59) being one of the most strenuous opponents of the conecep-
tion of a dependency of the secondary sexual characteristics
upon the sexual glands. In the male the mammary anlagen are
present to the same extent as in the female yet they fail to de-
velop except in abnormal cases. On the other hand it is well
known that boys may experience a slight tendency to swelling
of the mammae at puberty, giving evidence of some sort of
stimulus working at this time, affecting this tissue. And we also
know that the eastration of boys before puberty prevents the de-
velopment of the male characteristics, but yet does not cause fe-
male tendencies to be produced.

It might appear at first sight as if the cases of ,acquired
eynecomastia were such because of the removal of a substance
produced by the testicles inhibiting the development of the
heterologous secondary sexual characteristics such as the mam-
ma. Steinach (60) seems to be of such opinion, in which he is
apparently supported by Lipschiitz (61). This opinion is based
on a series of remarkable experiments. Young male rats and
euinea pigs were castrated and ovaries from consanguinous ani-
mals were implanted and grew to the conditions normally found
in the female. As a result of these transplantations the male

HAMMETT 215

animals developed the physical and psychic characteristics of the
normal female. The sexual appurtenances also, such as the
mammae, became entirely feminine so that true, fat, rich milk
was produced sufficient to nourish young and growing animals.
From this it is evident that the implanted ovaries do not stimu-
late the growth and development of the male characteristics, but
do give rise to the formation of the distinguishing female type,
the penis remaining infantile in structure while the mammae
evolve to the volume and function of the female type.

Similar experiments on the transplantation of testes into
young castrated females resulted in non-development of the
female characteristics and the evolution of the male type, in
psychic, physical and sexual trend. Lipschiitz (61) and Sand
(62) observed that in such masculinized females the clitoris
tends to develop into a penis. As previously stated, Steinach
(60) considers the so-called ‘‘pubertal glands,’’ that is, the
internal secretory portion of the testes and ovaries, to be in-
hibitory to the development of the usual heterologous sex char-
acteristics when implanted into the opposite sex, and to be
specifically stimulative to the production of the sexual type
normally accompanying the developing gland in the donor. Such
an antagonism, however, is doubtful since Sand-(63) has success-
fully transplanted a testicle and a consanguinal ovary into a
young castrated male rat and obtained therefrom an experimen-
tal hermaphrodite. Hence by the simultaneous transplantation of
male and female sexual glands into an infantile mammal the
hypothesis of an inhibitory action of either on the other is not
effectually substantiated. Moreover, the hypothesis of Halban
(13) that the internal secretion of the sex glands is the same in
both male and female would seem to be disproven by the fact of
the development in the male of the female characteristics follow-
ing implantation of consanguinal ovaries. If the secretion were
identical for the two sexes there would be nothing to prevent the
development of the usual female characteristics in the latter
ease. An interesting phase of these investigations is the influence
of the heterologous sex gland secretion on the psychic reactions
of the host, there being reported an evident adaptation of psy-
chic sexual nature to that normally connected with the sex of the
donor (64).

216 GYNECOMASTIA

The experiments of Sand (62) showing the possibility of the
simultaneous occurrence of both male and female characteristics
in the same individual when both secretory testicular and ovarian
substance are present are virtually experimental, productions of
the essential type of gynecomastia in animals. The studies of
Steinach (60) (65) showing that in the absence of functioning
endocrine testicular substance the presence of functioning endo-
erine ovarian substance causes the appearance of female sex-
ual characteristics have a similar significance. Animal experi-
mentation having thus demonstrated conclusively that it is pos-
sible to produce in males an enlargement of the mamma at pu-
berty resembling that taking place in the female and that fur-
thermore this development may continue to the point of milk
production, the endocrine origin of the condition of gyneco-
mastia is reasonably well established.

The source of the stimulus giving rise to the phenomenon of
eynecomastia in man is in all probability connected with gonad
hormone secretion. Since Steinach (60) has demonstrated that
the internal secretion of the sexual glands is specific for the
sex insofar as the production of the sexual characteristics is con-
cerned, and since Sand (62) has shown the conception of an
inhibitory function of the one on the expression of the function
of the other is unsupported, it is possible to believe that in the
eynecomasts there is present somewhere in the body in addition
to testes an amount of functioning ovarian or ovary-like tissue
sufficient to cause the abnormal development of the male mamma.
This assumption would explain both the essential and the ac-
quired types of the anomaly. For in the former eases it can
easily be supposed that there is present a condition in which
neither the testicular nor the ovarian stimulus is prepotent or
insufficient so that both masculine and feminine characteristics
are produced. In those cases where the anomaly arises in con-
nection with an atrophy defect or pathological condition of the
testes it is possible that an originally prepotent testicular secre-
tion has been so weakened that the balance swings to the side of
the ovarian stimulus, which, becoming prepotent, gives rise to
the mammary enlargement as an expression of its function. Such
a conception does not by any means imply acceptance of Stein-
ach’s (60) theory of the reciprocal inhibitory actions of the
heterologous sex glands in the production of the characteristics

HAMMETT 217

of the sex, this having been disproved by Sand (62). The con-
ception is based on the facts demonstrated by the latter imvesti-
gator that both secretions may be present and functioning in the
same animal with the added, though gratuitous, assumption that
in gynecomastia one or the other may be prepotent or that both
may be equally potent and depending upon attendant circum-
stances give rise to either type of the phenomenon.

There has recently appeared a series of papers by Steiach
(66) having to do in large part with an attempt to correlate
homosexuality with gonadal endocrinology. One finding of par-
ticular interest in connection with the present discussion which
tends to support the hypothesis previously proposed is the obser-
vation that the testicles of some five homosexuals showed the
presence of certain cellular elements ordinarily foreign to the
male glands and resembling in their structure and staining prop-
erties the cells of the corpus luteum, even to the presence of
chromaphile material.

These observations, the results of the heterologous and
homo-heterologous implantations of Sand, and the clinical re-
ports of the literature, afford cumulative evidence validating the
expansion of Novak’s (67) expression that the phenomenon of
gynecomastia is attributable to a diminution of testicular func-
tion into the conception that coincident with the ‘lessened tes-
ticular function there exists a potent hormone-producing tissue
resembling in its effects that of the female ovary and giving rise
to the mammary enlargement characteristic of the sex.

Such being the present indications it remains for future
investigations to show whether the production of the stimulus
is due to a perversion of the hormone producing gonadal tissue
of the male in the nature of its becoming similar to that of the
female, or whether there is actually present in these individuals
functioning ovarian endocrinal tissue.

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Paulicky (A.) Ueber congenitale Missbildungen. Deutsch. mil-
itararzt. Ztschr. (Berlin), 1882, 11, 222-223.

Biedl (A.) Internal secretory organs. (New York). p. 372, Wm.
Wood and Sons. 1913.

Coes: Case of gynecomazia. Am. J. Obst. (New York), 1889,
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Schufeldt (R. W.) Gynecomastia with a description of a remark-
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von Nelation: Hypertrophie doulerouse de la glande mammaire
chez un homme. Gaz. des hop. (Paris), 1856, 29, 126.

Raggi (A.) Aberrazione del sentimento sessuale in un maniaco
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Wagner: Hypertrophie der rechten Brust und der rechten oberen
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GYNECOMASTIA

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Hegar (A.) Korrelationen der Keimdriisen und Geschlechtsbes-
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teren. Arch. f. d. ges. Physiol. (Bonn), 1902, 93, 39-58.

Larcher (O.) Contribution a lhistoire des femelles d’ oiseaux
chez qui se développent les attributs exterieurs du sexe male,
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Morgan (T. H.) Goodale’s experiments on gonadectomy of fowis.
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Foges (A.) Beitrag zu den Beziehung von Mamma und Genitalia.
Wien. klin. Wchnschr. (Vienna and Leipzig), 1908, 21, 137-142.

Aschner (B.) and Grigoriu (Chr.) Placenta, Fotus, and Keimdriise
in ihrer Wirkung auf die Milchsekretion, Arch. f. Gynak.
(Berlin), 1911, 94, 766.

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Steinach (E.) Willkiirliche Unwandlung von Satigetiermannchen
in Tiere mit ausgepragt weiblichen Geschlechtscharakteren
und weiblichen Psyche. Arch. f. d. ges. Physiol. (Bonn), 1912,
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Lipschtitz (A.) On the internal secretion of the sexual glands.
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Sand (K.) Sexual characters in mammals, experimentally stud-
ied. Diss. Copenhagen, 1918, pp. 256.

Sand (K) Experimental hermaphroditism. J. Physiol. (London),
1919, 53, 257-263.

Moore (C. R.) On the physiological properties of the gonads as
controllers of somatic and physical characteristics. J. Exp. Zool.
(Philadelphia), 1919, 28, 137-161.

Steinach (E.) Feminisierung von M&annchen und Masculierung
von Weibchen, Zentralbl. f. Physiol. (Leipzig and Vienna),
IMIS Are YA Gye-B8s

Steinach (E.) (a) Die antagonistich-geselechtsspezifische Wir-
kung des Sexual hormon vor und nach der Pubertat; (b)
Kiunstliche Zwitterdriisen bei Saugern und Vogeln; (c) Ex-
perimentelle und histologische Beweis flir den ursachlichen Zus-
ammenhang von Homosexualitat und Zwitterdriise; (d) His-
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(Leipzig), 1919, 43, 253.

FRIGHT AS A CAUSE OF EPILEPSY AND HOW IT ACTS.

Edward A. Tracy, M. D., Boston, Mass.

That a fright may be the exciting cause of epilepsy, especi-
ally in the young, is a fact that cannot be too well impressed
upon parents, teachers, and all who have the care of children.
Most men who have given special attention to the malady believe
that a predisposition to the disease exists in the cases of epilepsy
that follow fright. In this they follow the teaching of Gowers,
who wrote: ‘‘We must regard as the exciting cause of epilepsy,
the condition or circumstances to which the first fit was appar-
ently due. It may be again pointed out to prevent misconcep-
tion, that these exciting causes cannot be regarded as the essen-
tial causes of the disease except in a very few cases. They would
not have been effective had not a predisposition existed, due to
inheritance or to causes which are generally beyond our recog-
nition’? (1). He also wrote: ‘‘Of all the immediate causes of
epilepsy the most are psychical—fright, excitement, anxiety. Of
these three forms of emotion, fright takes the first place. The
relation of this cause to age, however, is very distinct. It is ef-
fective chiefly in early life, when emotion is so readily excited,
and most powerful at the transition from childhood to adult life,
while after middle life it is almost inactive’’ (2). And further
on he states: ‘Predisposition usually exists. Hence in speak-
ing of fright as a cause of epilepsy, it must be remembered (as
already stated) that its effect is only that of the exciting
spark’’ (3).

In this article, the writer reports a case, carefully investi-
gated, in which a severe fright in a healthy boy, produced epi-
lepsy, the first convulsion occurring two months after the fright.
Moreover, he does not think his case unique, for Gowers him-
self, as above quoted, qualified his statement about predisposi-
tion by stating it ‘‘usually’’ exists, and that the exciting causes
cannot be regarded as the essential cause of the disease ‘‘except
in a very few cases.’’ One of the twelve cases (Case 5) of epi-
lepsy caused by fright reported by Paravicini in his valuable
paper, “‘The Etiology of the Epileptic Psychosis’’ (4) appar-
ently is of this nature since there was no bad heredity in the

~ 291

222 FRIGHT AS CAUSE OF EPILEPSY

ease, and, insofar as predisposition to the disease went, was re-
warded by Paravicini as ‘‘immune.”’

In those cases in which fright causes epilepsy to arise in a
previously sound nervous system, we may inquire whether there
are any facts physiological, clinical, or pathological, that can
illumine the genesis of this disease, facts that by the light they
shed upon the pathway of our investigation help also to define
the gaps that exist in our knowledge of the disease, and thus to

emphasize the need of their investigation.

Research has shown that in idiopathic epilepsy the sympa-
thetic nerve fibres are demonstrably diseased, that it is, in fact,
a sympathicopathy. The demonstration that idiopathie epilepsy
is characterized by objective signs—chronie vascoconstriction
spots, demonstrable abnormalities of sympathetic nerve reac-
tions—is an advance in our knowledge of the disease. It is a
satisfaction that physical, objective phenomena that can be seen,
measured, photographed, can now claim attention in place of
the notions based on vagary (e. g., ‘‘the fit is the expression of
the afflicted one’s desire to return to its mother’s womb’’) of
which recent years have been so prolific. The demonstrable in-
volvement of the sympathetic system is one of the facts that
claim our consideration in an attempt to elucidate the genesis of
the disease.

The next fact to claim consideration is that fear acts pow-
erfully on the mechanisms of the body and that this action is
by means of the sympathetic nerves. The physiologist, Can-
aon (5), teaches that impulses originated by emotion, flow over
sympathetic nerves and cause an increase of the secretion of
adrenin in the blood, accelerate the heart and dilate the pupils.
The glycogen is mobilized and changed into sugar; the available
energy of the skeletal muscles is increased by the extra adrenin
produced; the coagulability of the blood is increased. All of
these actions are produced by stimuli flowing over the sympa-
thetic, and having for purpose the betterment of the individual’s
chances in the fight or flight, brought about by the original emo-
tion. In other words, the bodily metabolism is profoundly influ-
enced by terror, and an increased secretion of adrenin is de-
monstrably produced, which has itself a large share in the pro-
duction of the demonstrable changes in the metabolism,

TRACY 223

Another fact to claim consideration is that certain toxins
produce convulsions. But adrenin, if toxic, is not in this class.
Can its continued hypersecretion lead to a peryerted metabolism
in which a convulsant toxin is produced? This is one of the
gaps in our knowledge that needs exploration. Suggestive ex-
perimentation, bearing upon the possibility of a hyperadrenin-
aemia producing a convulsant is that noted in another connec-
tion, by Dr. Schaller of San Francisco. ‘‘He reported that in
1906, while working in the pathological laboratory of Dr. Wil-
liam Ophiils, he had undertaken some experiments to produce
arteriosclerosis by repeated injections of adrenalin intravenous-
ly into the rabbit, following the experiments of Josué. By this
method, striking specimens of arteriosclerosis were obtained. He
had used doses of adrenalin maximal within lethal limits in or-
der to produce maximum effects; and he had by this means fre-
quently produced typical epileptic attacks in these rabbits. The
attacks were manifested by periods of unconsciousness, by fall-
ing, tonic and clonic convulsions, dilation of the pupils, loss of
sphincter control; in short, by typical epileptic attacks’’ (6).
That adrenin can bring on attacks in human individuals subject
to the malady has recently been demonstrated (7).

Another fact to bear in mind is that sudden anemia of the
brain produces convulsions. Kussmaul and Tenner (8) proved
“‘that sudden arterial anemia of the brain, as also faradization
of the cervical sympathetie nerve, which determines permanent
spasms of the blood vessels gives rise to epileptic fits.’’ In epi-
leptics, reflex vasoconstriction of the peripheral vessels can be
frequently seen (as in the arm) to be more intense and to last
minutes longer than that evokable in normal individuals. Is it
not conceivable that this intensity of vasoconstriction as wit-
nessed in the peripheral vessels of epileptics may also affect the
cerebral circulation and with convulsive results?

The facts that we have under consideration we shall briefly
review in their possible relation with the genesis of cases of epi-
lepsy that have for sole cause a severe fright, first relating the
history of a case coming within this category.

H. O., Swedish-American, male, aged 21 years. (Referred by Dr.
F. W. McVey of Boston.) No mental or nervous diseases, alcoholism,
or tuberculosis on the father’s or mother’s side. Both parents healthy.
Five brothers, all healthy. In childhood the patient had no infectious

disease except measles at eight years of age. When seven years
old he suffered a severe fright. Three boys took him into the woods

224 FRIGHT AS CAUSE OF EPILEPSY

near by his home. One held him while another held open his mouth,
while the third boy poured a nasty fluid down his throat. He re-
turned home very pale. For two months afterward he cried out
nightly in his sleep. He was afraid all the time, showed constant
pallor, and had to be coaxed daily to go to school, fearing the boys
who had maltreated him. After two months had passed, one morn-
ing when ready to go to school, he came back into the kitchen very
pale; he looked up towards the ceiling and became rigid, “like a
stick” as his mother said, and she carried him to bed. This was
his first convulsion. For a while after this, every three weeks he
would have several convulsions near together. Then a period of five
months elapsed without one; this was followed by a period in which
two or three light attacks occurred every day for awhile. Since then,
for a period of thirteen years, the convulsions have averaged two a
month. An impediment of speech, slight stuttering, came on after his
first attack and remained permanently.

We have now to consider, in the light of known extraneous
facts, the genesis of epilepsy caused by a severe fright in a pre-
viously sound nervous system. As shown by the experiments of
Cannon, fright influences the bodily mechanism through stimuli
passing over the sympathetic nerves. The secretion of adrenin
is increased, with the resultant effects previously mentioned. In
our case, the sudden onset of quite constant pallor, showed that
the sympathetic nerves were hyper-active in discharging stimuli
which produced the evident peripheral vasoconstriction. Fear
was constantly in the mind of the boy, evidenced by the night
terrors, and the coaxing of the mother necessary to get him to
go to school after the fright. Thus, while this fear lasted, a
period ‘of two months, there was a hypertonia of the sympathetic
nerves manifested externally by the almost constant pallor. The
period between the causative fright and the onset of convulsions
(in cases of epilepsy caused by fright) is termed by Paravicini
the intervalic period. During the intervalie period in the case
here reported there was manifested a hypertonia of the sympa-
thetic system—a fact not surprising in the light of Cannon’s
experiments. The writer has observed carefully several cases of
incipient idiopathic epilepsy, in the etiology of which, however,
fright played no part, and in them there was a hypertonia of
sympathetic nerves present, demonstrated by neurological tests.
Hence it is evident that hypertonia of sympathetic nerves is con-
nected with the incipient or preconvulsive stadium of idiopathic
epilepsy. It is the only abnormal physical condition that we can
feel sure was present in the intervalic period of the case here
reported.

Is sympathetic hypertonia in itself sufficient to cause con-

TRACY 225

vulsions? That might depend on the sympathetic fibres in-
volved in the hypertonia. Thus Kussmaul and Tenner’s experi-
ment of producing epileptic fits by ‘‘faradizing the cervical sym-
pathetic nerve which determines permanent spasms of the blood
vessels’’ is nothing but the artificial production of a hypertonia
in the sympathetics innervating the blood vessels of a brain area ;
and anyone who has seen. the intense and long lasting vasocon-
striction evokable in some skin area of a chronic epileptic cannot
- but reflect, in the hght of Kussmaul and Tenner’s experiment, on
the result of a similar vasoconstriction automatically produced
in the epileptic’s brain vessels. (That the brain, encased as it is
in the unyielding cranium, cannot undergo vasoconstriction en
masse is of course recognized. That differential distribution of
the blood within the brain may, however, give results such as
those herein postulated must also be recognized. )

The length of the intervalic period, two months in the case
here reported, suggests the probability of some other factor in
the production of the convulsions besides the hypertonia of sym-
pathetic fibres, and thus we are led to inquire if the hyperadren-
inaemia present during that time could so vitiate metabolism
that substances were formed which acted as irritants to the cere-
bral cortex. The periodicity of the convulsions in epilepsy sug-
gests such a toxin formation. Very little, however, appears to
be known of the metabolism of epilepsy, and a line of investiga-
tion that has enlarged our knowledge of diabetes mellitus and
diseases of the thyroid, is conspicuous for its utter neglect in
case of the epileptic. All that can be said, therefore, about the
production of nerve-irritating substances by the hyperadrenin-
aemia (caused by the hypertonia of the sympathetics lasting for
a considerable period) is that such a production is possible.

Bringing these various facts, pathological, clinical, and
physiological, into closer relation with our case report, we find
that H. O., a healthy boy with no predisposition to epilepsy (no
damaged nervous system from bad heredity or infectious dis-
eases) suffered a severe fright (its severity manifested by night
terrors for two months) which caused a hypertonicity of the
sympathetic nerves (manifested by the marked and constant
pallor of sudden onset). This was supposedly accompanied by
a hyperadreninaemia—the normal accompaniment of emotional
hypertonia of the sympathetics (Cannon’s experiments). After

226 FRIGHT AS CAUSE OF EPILEPSY

two months of this condition, convulsions oceurred and have
recurred for fourteen years. Physical examination now shows
a diseased condition of the sympathetic nerves, manifested by
chronic vasoconstriction spots and abnormal vasoconstriction re-
flexes, phenomena that investigations have shown to be
characteristic of idiopathic epilepsy. We have therefore three
outstanding facts: 1, a sound nervous system; 2, a severe
fright, causing a hypertonia of the sympathetic nerves with a
resultant hyperadreninaemia lasting for two months; 3, sixteen
years after the onset of convulsions, a diseased sympathetic sys-
tem.

While it may be assumed that in the intervalic period there
was a hypertonia of the sympathetic system, the relation of this
hypertonia with the outbreak of convulsions is as yet obscure.
We do not yet know the topography of the sympathetic fibres in
the brain. The fact that emotion is the cause of this hypertonia.
indicates brain connections with sympathetic fibres. -Waiving
the possibility of stimuli reaching the motor cortex from the hy-
pertonic sympathetic fibres, are there other considerations that
may aid in explaining the onset of convulsions in this ease?

It is generally admitted that the convulsions in epilepsy
originate in the cortex. The experiments of Tsiminakis (9)
indicate that the cortical cells, especially the motor cells, of the
normal brain react to anemia differently than do those of the
epileptic. This investigator compressed the carotids for a minute
in 30 normal subjects. Outside of a momentary unconscious-
ness there was no reaction of brain cells. He compressed the
carotids likewise in 116 patients, mostly epileptics. The epilep-
tics became unconscious more quickly than the others, at latest
in thirty seconds, and the onset of unconsciousness was quickly
followed by epileptiform convulsions, struggling or kicking
movements for ten to forty seconds; later these were followed
by the characteristic stare of epileptic somnambulence (‘‘ Ab-
senz’’). These experiments indicate two things: a greater irri-
tability of the motor cells in chronic epilepsy, and the influence
of anemia in provoking an outburst of stimuli from such over-
irritable motor cells in the cortex, causing convulsions.

This leads to the question: What in the intervalic period
might cause a hyperirritability of the motor cells in the cortex,
the condition which is apparently present in chronic epilepsy,.

TRACY 227

the condition in which a momentary anemia so readily leads to
convulsions? It may be that the hypertonia of the sympathet-
ics caused a pallor of the motor cortex as it caused that visible
in the skin during the intervalic period and thus led to the pro-
duction of acid metabolites resulting in hyperirritability of the
motor cells. Or the hyperirritability may have been caused by
an irritant in the blood, a product of perverted metabolism
due to the hyper-adreninaemia of the intervalic period. These
are mere hypotheses used as stop-gaps in our chain of facts to
explain the onset of the convulsions in our case of epilepsy.
Once convulsions ocenr, their recurrence is facile, as Gowers has
remarked.

If the convulsions are caused by spastic constriction of cor-
tical vessels, and if the sympathetic fibres originate in the cortex
{facts that point to such an origin have been described else-
where (10)] the progressive character of idiopathic epilepsy is
explainable, together with the cortical gliosis that accompanies
the disease. For the recurrent spastic contraction of the cortical
arterioles could have for results, the cortical gliosis that is found
accompanying the disease, and the descending degeneration of
sympathetic fibres that Echeverria found and described (11).
The physical signs of chronic vasoconstriction spots, and abnor-
mal sympathetic nerve reactions demonstrated by neurological .
testing, have previously been shown to go with this disease so
constantly as to determine idiopathic epilepsy to be a sympa-
thicopathy, a diseased condition of sympathetic neurones (12).

SUMMARY

Eliminating all theory from consideration (it has been used
only in an endeavor to account for some of the facts) the facts
in the genesis of our case are these: 1, a sound nervous system ;
2, a severe fright; 3, a hypertonia of the sympathetic nerves for
two months, a direct result of the fright; 4, outburst of convul-
sions at end of two months and their recurrence during sixteen
years; 5, the present status, a chronic diseased condition of the
sympathetic nerves, manifested by chronic vasoconstriction spots
and abnormal vasomotor reactions characteristic of idiopathic
epilepsy. It is concluded that severe fright can produce idio-
pathie epilepsy in a child without a predisposition to the disease.
It acts by causing a hypertonia of the sympathetic nerves. A

228 FRIGHT AS CAUSE OF EPILEPSY
hypertonia of sympathetic nerves is the evident beginning of
the disease in the case reported.

REFERENCES

1. Gowers (Sir William R.), Epilepsy and other Chronic Convulsive
Diseases. 2nd. Ed. Phil., 1901, p. 19.

28 Sibidssp: 25:

See Abidsp.26-

4. Paravicini (Giuseppe), Contributo all ’etiologia della Psicosi epi-

lettica. Giornale di Psichiatria Clinica a Technica Maniconi-
cale, 1908, 36, 603.

5. Cannon (Walter B.), Bodily Changes in Pain, Hunger, Fear and
Rage. UN Ye ob. :

6. Shaller, Remarks at a meeting of the American Neurological As-
sociation, reported in the Journal of Mental and Nervous Dis-
eases, 1918, 47, No. 1.

7. Benedek, tber die AusloOsung von epileptischen Anfallen mit Neb-
ennierenextrakt. Wiener klin. Wehnschr., 1918, 31, 1365. Sil-
vestri (T.), Nella provocazione degli accessi epilettici coi pre-
parati surrenali. Gaz. degli Ospedali (Milan), 1919, 40, 852.

8. Kussmaul and Tenner. Quoted in Echverria’s book, On Epilepsy,
N. Y., 1870, p. 35. (Quotation verified.)

9. Tsiminakis (C.), Epileptic and hysteric seizures brought on by
brief test compression of the carotid arteries. Wiener klin.
Wehnschr., 1915, 28, No. 44. Abstracted in J. Am. M. Assn.,
1916, 66, 230.

10. Tracy (KE. A.), Chronic vasoconstriction spots and their signifi-
cance. Boston M. and §S, J., 1919, 180, 1-8.

11. Echeverria, On Epilepsy, N. Y., 1870, p. 111.

12. Tracy (E. A.), Idiopathic epilepsy a sympathicopathy. Boston
M. and S, J., 1918, 178, 775, 810, 871.

A CASE OF COMPLETE AMENORRHEA WITH FULMI-
NATING SYMPTOMS: SURGICAL DEMON-
STRATION OF OVARIAN ETIOLOGY +

Carleton Dederer, A.B., M.D., M.S., Bay City, Mich.

(From the surgical service of the Jones Clinic.)

Most of the evidence as to the relationship of the ovaries to
menstruation has been of negative character. By this I mean
that we are better acquainted with the effects of destroying
ovarian function than we are cognizant of the results of restor-
ing activity to a functionless ovary. Being presented with an
apparently unique case, any therapeusis undertaken must neces-
sarily be an experiment.

The literature revealed no case similar to the one herein
reported.*

In the midst of an attack the patient’s condition presents
a striking picture. She is seen at one time prostrated and the
next moment half raised on the edge of a lounge giving the ap-
pearance of one with a wild, uncontrollable mentality, with an
extremely flushed appearance and an almost suffocating cyano-
sis and widened palpebral fissures. Besides this her arms may
be covered with blood from unsuccessful attempts to establish
.a flow of blood, unsuccessful because repeated venesection month
after month had destroyed the continuity of the superficial -

veins of her arms.

Case No. 115. Chief complaint, complete amenorrhea. Age, 30;
single; school-teacher. The family history was negative as to similar
conditions, tuberculosis and cancer. Tonsillectomy was performed
about 1909, appendectomy in 1915.

Menstrual history: The first menstruation was in 1903 at the age
of twelve. For some reason not now known, the right breast was re-
moved in 1905, the left one was removed in 1906. After the removal
of the first breast, periodic attacks of numbness and unconsciousness
ensued with complete amenorrhea for two and one-half years. Later
there were some scanty menstruations. As time went on conditions be-
came much worse. The menstruations became vicarious. Nose-bleeds
were the chief source of the escape of blood.

In 1915 the patient underwent an operation for the ingrafting of a
sheep’s breast. This was soon absorbed, as could be expected, without

+ Read at the meeting of the Association for the Study of Internal Secre-
tions, New Orleans, April 26, 1920.

*“We are unable to find any literature dealing with amenorrhea following
amputation of the breasts in a young woman.’’—Robt. IE. Noble, Brig. Gen.,

Med. Dept., Librarian S. G. O.

AAS)

230 OVARIAN FUNCTION

any definite results. Following this, the patient consulted many physi-
cians, but the only relief obtainable was artificial bleeding either from
curettments or from venesection. There was a complicating leukorrhea
which was first noticed by the patient on the day following a curett-
ment, in Feb., 1919.

Prior to coming here the patient had not had a natural menstrua-
tion, unless started by a venesection of about a pint of blood or by a
curettment, during six months. During the next six weeks, while the
patient was under our observation, she had to be bled twice to relieve
conditions of extreme cyanosis associated with unconsciousness and
delirium. These symptoms entirely disappeared as soon as the first
twelve ounces of blood were removed.

Physical examination: July 22, 1919; height 5 feet 2 inches;
weight about 105 pounds; pupils react to light; mouth, numerous
crowns, bridgework, pyorrhea and root abscesses; tonsils, no visible
portions remaining; no superficial lymph nodes; thyroid, not enlarged;
breasts, one-half of the right breast and one-fourth of the left breast
were still present; heart, lungs, liver, spleen and other abdominal
organs, negative; uterus, very hard; cervix, lacerated; vagina, small,
leukorrhea; rectum, spine, joints, patellar reflexes, extremities and
skin, negative.

Blood pressure 118, systolic and 78, diastolic; pulse 90; Wasser-
mann test, negative. Vaginal smear was positive for Neisser infection.
Urine analysis, sp. g., 1.026, acid, no albumin, no sugar. In a second
test albumin and pus were present.

Blood count: Erythrocytes,

July 23, 1919; 10,000,000 per c.mm.

July 24, 1919;12,000,000 per c.mm.

July 26, 1919; 5,600,000 per c.mm. (after venesection).

Operation: Aug. 1, 1919. Ether anesthesia. Low mid-line incision.
Findings: Ovaries, normal in size and position; ovarian veins tor-
tuous and congested; uterus, normal position; fundus, about four cm.
in major diameter, and marked by several areas of hyperemia and of
ischemia.

The operation comprised the incision of the peritoneum behind the
ovarian vessels on each side, sectioning of the sympathetic nerves to
the ovaries and the removal of the adventitia from the major ovarian
vessels. One vein which became lacerated was ligated. The abdom-
inal wound was closed.

Results: Normal menstruation, lasting for five days, began on the
day following the operation. The next menstrual period was skipped
but without any of the nervous and vascular symptoms as before. Sub-
sequently, the menstruations became regular and normal, as follows:

Oct. 28-Nov. 1.

Nov. 22-28.

Dec. 18-24.

Jan. 17-21.

On March 6, 1920, the patient stated in a letter that she was “‘feel-
ing fine” and had gained twenty-five pounds.

DISCUSSION
Prior to deciding upon a therapeutic plan, this case offered
many perplexities. As the patient was demonstrably suffering
from focal infections, it was considered advisable, before try-
ing other means, to remove the foci. The patient, however, pre-
ferred to submit to an experimental abdominal operation rather
than to lose her infected teeth. It was thought that the ovarian

DEDERER 231

nerves and perhaps the blood-vessels also, directly or indirectly,
were being stimulated by the toxins of infection and thereby
altering the circulation and hence the functions of the ovaries.
With this as a hypothesis, the operation was undertaken with
a view to eliminating the nervous and vascular control of the
ovaries.
SUMMARY

A case is reported in which a patient suffered from amenor-
rhea for about fourteen years following the surgical removal
of parts of both breasts, for reasons not now known. Sectioning
of the sympathetic nerves to the ovaries and resection of the
adventitia of the ovarian vessels was followed by the establish-
ment of normal menstruation.

232 BOOK REVIEWS

(PATHOLOGY OF THE SYMPATHETIC) PATOLOGIA DEL
SIMPATICO, by Professors P. Castellino and N. Pende. F.
Vallardi, Milan, Italy, 1915.

That the internal secretions will ultimately be proved to
play an important role in the genesis of numerous disorders in
addition to the well recognized endocrinopathies is a prophecy
frequently and safely offered. The data justifying such a
statement are widely scattered and confused. Castellino and
Pende’s widely quoted book is of interest to the endocrinologist
primarily as an attempt to bring together these data and to
organize them systematically. The attempt involves a consid-
erable amount of theorizing which will be valued more or less
in accordance with the temperament of the individual reader.

The book—of some 500 pages—is divided into two sections.
In the first the anatomy, physiology and pathology of the en-
doerine-syvmpatheti¢ system is discussed at length. The point
is emphasized that the relations between them are so intimate
that the two components can most profitably be treated together.
In the concluding chapter of this section a critique is offered on
the theories of vagotonia and sympatheticotonia as expounded
by Eppinger and Hess. The conception is regarded as of re-
stricted practical significance.

The second part of the volume begins with a chapter on the
cyanoses and erythroses of the skin. The habitual acrocyanosis
is related to hypothyroidism, as are chillblains and sym-
metrical gangrene. Chronic acroasphyxia and Raynaud’s dis-
ease involve also ‘‘hyperadrenalism.’’ Other conditions con-
sidered are acroerythrosis erythromelalgia, erythrophobia and
acroerythrosis indolora. Quincke’s disease is regarded as re-
lated to thyroid dystrophy and gonad alteration. Similarly the
trophoedema of Meige may be allied to dysthyroidism, as dem-
onstrated by forms passing into myxedema. Next the lipodys-
trophies are taken up, with a detailed description of Dercum’s
disease, which is considered as a pluriglandular syndrome with
prevalence of hypophyseal symptoms. Then adiposis analgesica
and lipomatosis symmetrica are treated with adenolipomatosis
symmetrica and neurofibromatosis of V. Reklinghausen.

Scleroderma, sclerodactylia and hemiatrophy of the face
are discussed in a chapter with hemihypertrophy, congenital and
acquired, considered as trophoneuroses. As regards atrophy of
the skin (idiopathic) hypoadrenalism is claimed to be a causal
factor.

Trophoneurotic gangrene of the skin is treated in all its
known varieties, in connection with Raynaud’s disease. A very
detailed chapter follows on skin dystrophies, with special em-
phasis on the adrenal as related to the pigmentary anomalies.

Hypertrichosis is regarded as of pluriglandular origin, but
always mediated by the sympathetic system.

BOOK REVIEWS 233

After a discussion of the causal action of various endocrine
glands on sympatheticopathies of the locomotor apparatus (Du-
puytren’s disease, hydroartrosis intermittens of Moore. Paget’s
disease, osteomalacia and several angiomyopathies), hemicrania
is considered as a cervical sympathetic disorder.

A short discussion of negative tenor is added on the pos-
sible connection between epilepsy and glaucoma and the sym-
pathetic. The sympathetic conditions are not considered as
causal; in regard to the glaucoma the operation on the cervical
sympathetic did not lead to any encouraging result.

A long and detailed chapter on the heart follows; in this
Castellino claims that the thyroid is cardio-exciting while the
gonads are cardio-depressor. Other topics treated are asthma,
laryngospasm, hysterical hemophthysis, coeliac and gastro-in-
testinal neuroses, urogenital sympathetic neuroses, chlorosis,
Basedow’s syndrome as an endocrine-sympathetic dystrophy
and two pluriglandular syndromes.

The book as a whole does not lend itself to adequate analy-
sis In a review of restricted scope. For many interesting de-
tails the original should be consulted.

—G. VERCELLINI.

(THE PUBERTY GLAND) DIE PUBERTAETS DRUESE
UND IHRE WIRKUNGEN, by A. Lipschiitz. Bern, 1919,
pp. 496.

Lipschiitz’s book is a masterpiece of artistic and lucid
’ scientific exposition. It will rank not only as the best on the
particular subject treated, but is also one of the best in general
medical literature. The illustrations are good, many even splen-
did. Much of the book is devoted to the experiments of Steinach,
but the author details also his own work. He was the first to show
that castration of female animals, followed by transplantation
of a testicle, leads to development of the clitoris to an organ
resembling a penis. The theory that sex is already determined
in the ovum is discussed at length and finally rejected. New
theories on hermaphroditism and homosexuality are given.
Lack of space renders impossible an adequate discussion of
them. They are well deserving of careful attention in the
original.

The literature is not very completely reviewed. The au-
thor does not seem to know, for example, of Blair Bell’s in-
teresting book ‘‘The Sex-gland.’’ This is regrettable for there
are some contradictions between the two authors; it would have
been interesting to have them discussed by Lipschiitz.

—J. KOOPMAN.

234 BOOK REVIEWS

(A THEORY OF CANCER) LA DYSCYTOGENESE HYPOCY-
TOPOIETIQUE DYSEUTROPHIQUE OU CANCER.
Naamé, Maloine et Fils. Paris, 1919, pp. 43.

Dr. Naamé offers a theory of the etiology of cancer. The
thesis is based on a review of the literature and on personal
therapeutic observations. It is largely a speculative develop-
ment of the conception that ‘‘Cancer is a dyscytogenesis with
local hypocytopoiesis and glandular dyseutrophy.’’ By this
verbalistic feat the author would seem to have formulated a
conception with which many would agree. By ‘‘dyseutrophy’’
apparently is meant functional imbalance which Naamé_be-
lieves can be more or less constantly corrected by judicious
organotherapy. He reports the successful treatment of uterine
eancer by ‘‘mammo-hypophyseal and thyro-mammary extracts”’
and of breast cancer by ‘‘thyro-ovarian’’ extract, and, more
recently, a few other successes along similar lines. In view of
the dubious history both of organotherapy and of ‘‘cancer
eures’’ only an overwhelming mass of detailed evidence would
carry conviction of the validity of the method proposed.

—R. G. H.

(GOITRE IN THE WHITE RAT) DER KROPF DER WEIS-
ZEN RATTE, by Th. Langhans and C. Wegelin. Bern,
9 pp, say

This book would perhaps be more interesting if there did
not exist quite a number of similar books and booklets on the
same topic and with the same general content. Langhans and
Wegelin fed white rats with water (boiled and not boiled) or
with milk from districts in Switzerland where goiter is preva-
alent. The effect was at times the development of goiter, but
often no effect was seen. So the conclusion is, as in most other
publications, that the water may have some relation to goiter,
but that it is certainly not the only cause and that, after all, we
know little about the matter It seems extremely doubtful
whether a new book was needed to reiterate this. It was found,
however, that minute doses of iodids protect the rats from
goiter. The corroboration of this observation and the excellent
illustrations are perhaps the most valuable features of the work.

—J. KOOPMANN.

ABSTRACTS

(ADRENAL) Hematoma de la capsula suprarrenal. Baciga-
lupo (J.) and Perazzo (E.). Prensa Med. Argentina, 1919,
6, 161.

Anatomical observations of technical interest upon a newly
born child.—R. G. H.

(ADRENAL) Addison’s disease. Balen (M. J.), J. Am. M.
Assn. (Chgo.), 1920, 74, 82-83.

A brief case report with the following points of interest:
A male, age 48, tailor, six months before admission complained
of marked fatigue, dizziness, and headache, accompanied by a
gradually increasing brownish pigmentation of the skin, espe-
cially on the face, chest, hands and abdomen. The heart action
was very feeble, blood pressure low (systolic by mm. Hg).
The lungs showed evidence of chronic tuberculosis. Death oc-
eurred 24 hours after admission.

Necropsy more than 24 hours after death, showed extensive
miliary and many ealcified tubercular lesions of the lungs. The
spleen was greatly enlarged, but without tubercles. The adrenals
were greatly enlarged, especially the left, and one section
showed a diffuse fibrocaseous degeneration of the medullary por-
tion, with marked cortical atrophy. The cortex on microscopic
examination showed a number of small but typical tubercles.

—F. C. P.

(ADRENALS) Urea excretion after suprarenalectomy. Bevier
(G.) and Shevky (A. E.), Am. J. Physiol. (Balt.), 1919,
50, 191-203. ~-

The removal of the suprarenals in rabbits is followed by a
depression of the rate of urea excretion. The result is like that
obtained by subcutaneous injection of optimum doses of pituitrin
and contrary to that obtained after injections of epinephrin. It
is suggested that these findings support the hypothesis that
there is an epinephrin-pituitrin balance in the blood which may
regulate the rate of kidney function.—T. C. B.

(ADRENALS) The development of the urogenital system in
the Marsupialia with special reference to Trichosurus vul-

235

236 ABSTRACTS

pecula. Buchanan (G.) and Fraser (E. A.), J. Anat. (Lon-
don), 1918, 53, 35.

The discussion deals almost entirely with the urinary ap-
paratus, but there is a brief description of the adrenals also.
The development of these is quite as in other mammals.

—E. R. H.

(ADRENAL SYMPATHETIC SYST.) The treatment of sea-
sickness (Sur le traitment du mal de mer). Cazamian (P.),
Bul. gen. therap. (Paris), 1919, 170, 782-784; Bull. Soe. Med.
des Hop. (Paris), 1919, 48, 638-640.

In a study of over fifty subjects suffering with sea-sick-
ness C. found normal urine and blood. There was generally
present blood pressures higher than normal, and an inversion
of the oculo-cardiac reflex. Lumbar punctures were without ef-
fect, and showed varying degrees of pressure in the cerebro-
spinal fluid, which was otherwise normal.

He considers that the majority of subjects presented a
fundamental sympathicotonia by virtue ef hyperadrenalism in-
duced by the stimulating effect of the rolling of the ship acting
upon the vegetative nervous system. It is only when the supra-
renal cortex is exhausted that the sympathetic tone decreases
and the arterial tension is lowered. Apparently among adults
the svmpathicotonies are predisposed to mal de mer, while the
vagotonics have a chance to escape.

The majority of medicaments utilized against sea-sickness
have no relation with the fundamentals of the disorder. Basing
treatment on the above considerations it was found that in the
cases showing faulty action of the sympathetico-adrenal system,
1-2 mg. of neutral sulfate of atropine given subcutaneously was
entirely satisfactory, when supplemented by adrenalin (6 mg.
in 3 doses) orally administered at half hour intervals.—F. 8. H.

(ADRENALS) Physiological action of the adrenalin discharged
as the result of the stimulation of the splanchic nerve (Accién
fisioldgica de las descargas de adrenalina por excitacion del
nervio esplacnico), Cevera (l.) and Houssay (B. A.), La
Prensa Med. Argentina (Buenos Aires), 1919, 5, ——
(Nov. 20).

Stimulation of the splanchnic nerve in chloralized dogs
produces a greater elevation in arterial pressure when the
adrenal veins are free than when they are obstructed. If the
obstruction is removed during stimulation there is observed a
sharp elevation of the pressure preceded by a brief fall. Rarely
this step (described by V. Anrep and others) occurs with the
veins occluded. When the veins are unobstructed a constric-

ABSTRACTS 237

tion of the paws is to be observed which does not take place
when the adrenal veins are compressed; in the latter case the
volume of the paw follows the variations in pressure; even if a
marked hypertension is produced by intense stimulation of the
splanchnic nerve.

Medullary puncture in dogs having the spinal cord de-
stroyed to the level of the 12th dorsal vertebra, produces hyper-
tension, particularly if the vagus nerves have been previously
eut. At the same time there is a marked and long continued
constriction of the paw deprived of its nerves. This constric-
tion does not occur if the adrenals have been removed or their
veins obstructed.

All these experiments demonstrate that excitation of the
splanchnic nerve and bulbar puncture produce a discharge of
adrenaline capable of producing vascular effects which are
added to the vaso-constrictor action of nervous origin.—B. A. H.

(ADRENAL) Clinical notes from France. Cumston (C. G.),
Ne Me Mied i J:; 1920, 111, 154-157.

The vomiting of pregnancy is found clinically in three
forms: ‘‘simple,’’ ‘‘incessant’’ and ‘‘incoercible.’’ Suprarenal
vomiting of pregnancy may offer in a general way all the clas-
sical characters of gravid vomiting, but the symptomatology of
suprarenal disturbance is superadded. Apparently the adrenals
do not participate in the genesis of the simple type. In all in-
stances of the adrenal form, vomiting is incessant or incoercible
and offers the aspect of a very serious type of cases. Good thera-
peutic results are claimed for the control of adrenal vomiting
by the administration of extracts of the entire adrenal oland.
Adrenalin hydrochlorate by mouth (5 to 10 drops) and hypo-
dermatically (0.5 5 to 1 mg.) is also of great service in these cases.

—H. W.

(ADRENAL) Endocrine imbalance with predominant adrenal
deficiency (A proposito di un caso di squilibrio endocrinico
pluriglandolare con prevalente insufficienza delle glandole
surrenali). Farmachidis (C. B.), La Riforma Medica
(Naples), 1919, 35, 829.

The case belongs to those whieh Pende calls ‘* pluriglandu-
lar syndrome with uniglandular predominance.’’ In the present
ease adrenal symptoms were particularly in evidence but poly-
uria from dysfunction of the hypophysis and several dis-
turbances referable to the celiac plexus were also manifested.

Although the Wassermann reaction was repeatedly nega-
tive, owing to the hardening of the peripheral arteries and the
enlarged spleen and lymphatics the patient was tentatively

238 ABSTRACTS

treated with mereury and the effect was a slow, but total re-
covery.—G. V.

(ADRENAL) Acute peritoneal form of adrenal insufficiency
during the course of chronic adrenalism (Insuffisance sur-
rénale aigué a forme péritonéale au cours d’une surrénalite
chronique). Fiessinger (N.) and Leroy (K.), Rev. gen. de
clin. et de therap. (Paris), 1917, 31, 825-328.

The autopsy findings in this ease showed marked lesions
of the adrenal bodies justifying the diagnosis of acute adrenal
insufficiency made at the onset of the disorder. The case record
reports frequent emesis of bile-containing matter, accompanied
by the facies and pulse of the peritoneal type. The treatment
consisted of subcutaneous injections of 2 mgm. adrenalin per
day, but this was unavailing —F. S. H.

(ADRENAL EDOCRINE ORGANS) The functional connection
between the reproductive organs and other glands of internal
secretion. Hewer (E. E.), Brit. Med. J. (London), 1920,
(i), 293.

The paper gives a preliminary summary of the results
of injecting white rats with various preparations of suprarenal
cortex. In nearly every case the hair began to come out, al-
though the coat was usually very fine and glossy. In a few
cases so much hair came out that the coat appeared ragged. Most
of the animals were perfectly healthy. The thymus was found
to become more vascular. In the pancreas an inconstant hyper-
trophy of the islets of Langerhans was observed. The adrenals
were not altered in size, but the cortex was unusually vascular.
Large spaces containing blood and debris were seen between
the cells in the zona glomerulosa. Signs of disintegration were
found in the two outer zones of the cortex. Very marked de-
generation was obtained in the testes. The spleen and liver were
not affected. In another series of experiments, feeding the
animals with desiccated suprarenal cortex brought about some
change in the rate of growth.—lh. G. K.

(ADRENAL DIABETES) The relation between blood pressure
and blood sugar (Over de vorhouding ausschen den bloeds-
druk en het suikergehalte van het bloed). Hovens Gréve (C.),
Inaug. Dissertation, Leiden, 1919.

It is well known that adrenalin has an influence both on
the blood pressure and on sugar metabolism. Increases in
blood pressure after injection of adrenalin may be accompanied
by glucosuria. On the other hand, the low blood pressure in Ad-

ABSTRACTS 239

dison’s disease is accompanied by a diminished amount of
blood sugar. Therefore the author examined the blood in
nephritis, in hypertonia without nephritis and in diabetes. In
many cases no relation between blood sugar and blood pressure
could be detected. There are, however, striking cases of hyper-
tonia without demonstrable anatomical lesions with hypergly-
cemia.

In diabetes there are two forms, those with and those with-
out increased blood pressure. It is possible that this last form
is of chromaffin origin. The treatment of these patients requires
perfect psychic rest. Perhaps atropine or pilocarpine is of some
use.

When a patient has increased blood pressure and hyper-
olycemia we have, however, no right to speak of a ‘‘latent dia-
betes.’’ The author proved that when a large amount of car-
bohydrate was given to such a patient, the influence on the
amount of blood sugar was much smaller than when even a
very small dose was administered to a true diabetic.—J. K.

ADRENAL, syndrome, Dystrophies and necrotic lesions in—
(Dystrophies et lesions nectrotiques dans les syndromes sur-
renaux). Hutinel (P.), Bull. Med. (Par.), 1916, 30, 573-585.

The author postulates an endocrine factor in various infec-
tions and intoxications, which modifies altogether the aspect of
the morbid process. The adrenals are especially charged with
this abnormal reaction and the resulting groups of signs and
symptoms are together spoken of as a suprarenal syndrome.
This consists chiefly of cardiovascular phenomena, giving rise
to general malnutrition of all of the tissues which prolongs the
duration of the original disorder. The symptoms of myocardial
insufficiency are closely simulated in some respects: The skin
shows signs of malnutrition and may show diffuse pigmentation.
The urine changes resemble those of acute febrile conditions.
In some cases there are said to be marked psychic changes of
various kinds.—I. M.

(ADRENAL) Endocrine tropisms. Adrenotropisms. Kaplan
(D. M.), N. Y. Med. J., 1920, 111, 241-248.

The author ascribes certain ‘‘thyro-rheumatic,’’ ‘** thyro-en-
docardial’’ and ‘‘pituito-appendical’’ syndromes to a tonsillo-
pathy requiring endocrine interpretation and attention. The re-
sult of indiscriminate tonsillectomies is not immediate but an in-
sidious cachexia tonsilloprevia which may assume the clinical
form of unmanageable headache, cardiac distress, osseous or
articular manifestations, obscure leucocytoses, peculiar febrile
rigors or a fulminating appendiceal infection.

240 ABSTRACTS

Individuals dominated by their adrenal apparatus, are
‘‘adrenotropic.’’ Manifestations of adrenotropism are: Pigmen-
tation of the skin, hyperchlorhydria, biotrophic tendencies to
diphtheria, influenza and tuberculosis—or rather their preferen-
tial selection of the adrenals—weak toleration of depressant coal
tar derivatives, tobacco tolerance, physical and psychical vigor,
energy and persistence, hirsutism, long and pointed canines,
dark complexion, red hair, carbuneles, asthma, adrenal diabetes,
adrenal Basedow’s disease, epinephroma, anencephalia, hyper-
ehlorhydria adrenopathica, masculinism, vascular hypertension
and hypotension, pulmonary edema, acroparesthesia, erythro-
melalgia, dementia praecox, psychasthenia, polychromatophilia,
‘‘nernicious anemia,’’ certain hernias, carcinoma and other con-
ditions !—H. W.

(ADRENAL) The hyperglycaemia of asphyxia, and the part
played therein by the suprarenals. Kellaway (C. H.), J.
Physiol. (Lond.), 1919, 53, 211-235.

The difference of opinion between Stewart and Rogoff and
Cannon and Hoskins as to the part played by the suprarenals
in the hyperglycemia of asphyxia has led to a reinvestigation
of the subject. The observations were made on cats without
anesthesia, and the paradoxical pupil reaction was taken as an
index of the output of adrenalin. The author has satisfied him-
self that asphyxia causes an increased output of adrenalin, and
has attempted to determine the responsibility of this output for
the hyperglycemia which follows asphyxia. The conclusions
drawn are as follows: (1) The increase of adrenalin and of
sugar in asphyxia are mainly due to lack of oxygen. (2) The
main effects in ordinary anoxemia are due to action on the cen-
tral nervous system, through the splanchnics. (3) In severe
anoxemia with the splanchnies cut, both effects are produced by
peripheral action. (4) The increase in blood sugar is only in
part due to adrenalin.—T. C. B.

(ADRENAL) The treatment of Addison’s disease (Zur Behand-
lung der Addisonischer Krankheit). Quincke (H.), Therap.
Halbmonatshefte (Berlin), 1920, 34, 42.

A description of two patients who had lived during the war
in extremely bad environment. Both showed all the classic symp-
toms of Addison’s disease and were cured by the administra-
tion of 100 mgm. of desiccated adrenals daily. The author sug-
gests that in these cases there is no anatomical lesion but a
diminished function of the adrenals caused by undernourish-
ment.—J. K.

ABSTRACTS 241

ADRENAL deficiency and adrenalin in cholera and seasickness
(Insuffisance surrénale et adrénaline; ‘‘Cholera et mal de
mer’’), Naamé, Paris Med., 1917; 7, 415-416.

Naamé agrees with several of the French observers that the
symptomatology of cholera is due largely to acute adrenal insuffi-
ciency and that administration of adrenalin is the logical treat-
ment.

A theory is offered that sea-sickness is due to inhibition of
the adrenal glands brought about by the action of the undula-
tory movement upon the solar plexus. In substantiation of the
theory, the observation is recorded that the administration of
adrenalin has an excellent effect upon the malady. Numerous
successes are reported. Large doses should be employed, 5 to
-6 mem. in 24 hours, the doses being given at half-hour or hour
intervals, especially when the stomach is empty. The nausea is
promptly relieved and the normal ability to retain food is re-
stored.—R. G. H.

(ADRENAL) Action of drugs on the output of epinephrin from
the adrenals. V. Curara. Stewart (G. N.) and Rogoff (J. M.),
J. Pharm. & Exp. Therap. (Balt.), 1919, 14, 343-354.

Curara in doses sufficient to paralyze the skeletal muscles
in the cat depresses the output of epimephrin from the adrenals
to a marked degree. The depression begins promptly and may
be still well marked when the paralysant effect on the muscles
has begun to disappear. Although precise calibration was not
attempted it was found that the output of epinephrin was de-
pressed markedly at a time when stimulation of the vagus caused
eardiae inhibition.—F. F.

(ADRENAL) Asthmatic spasm treated by adrenin (Crise d’
asthme, traitement par 1’ adrenaline). Thiroloix (J.), Bull.
gen. de Therap. (Paris), 1916-17, 169, 97-98.

T. reports six cases in which the subcutaneous injection of
1 ce. of adrenaline relieved the asthmatic spasms completely. He
recommends the drinking of black coffee by the patient after the
administration of the drug to relieve the after effects of the large
dose given.—F.. 8. H.

(ADRENAL) Morphology and cytology of the chromaffine sys-
tem of saurians (Nuovo contributo alla conoscenza del sis-
tema cromaffine dei Sauri. Studi morphologici e citologici
sulle capsule surrenali, con speciale riguardo ai paragangli
omonimi.) Trinci (G.), Arch. ital, Anat. e Embryol.
(Firenze), 1916, 14, 513.

242 ABSTRACTS

An anatomical study of the adrenal, and inter-renal chro-
maphil tissue and paraganglia of reptiles; of technical interest.
—KE. R. H.

(ADRENAL) The hypertrophy of the suprarenals in the preg-
nant rabbit should not be attributed to the presence of the
foetus (L’hypertrophie des capsules surrénales chez la lapine
gestante ne doit pas étre attribuée a la présence du foetus).
Watrin (J.), C. R. Soe. de Biol. (Paris), 1920, 82, 1405-1407.

In previous experiments the action of the corpus luteum
and the unattached ovum were studied. In this paper another
factor, the placenta, is considered.

The placenta consists of cells of maternal origin, and cells
of foetal origin, either of which may have an action on the
suprarenals. By making an incision in the uterus of a rabbit
whose ovaries contain corpora lutea, it is possible to produce
cellular elements in the absence of the foetus, that are identical
with those of normal maternal origin. Under these circumstances
it is found that the placental elements of maternal origin have
no action by themselves, and the hypertrophy of the suprarenals
must be due to uterine traumatism.

It is impossible to produce the foetal placenta in the ab-
sence of the foetus, but if we submit a rabbit to a fecundating
eoitus and. on the 10th day remove the embryo through a small
incision in the uterine wall, the wound heals quickly and the
placenta continues to develop. If we examine the suprarenals
10, 15, or even 20 days after the operation, they show hyper-
trophy equal or superior to that observed in a normal gestation.
As the foetus has been removed and the traumatism is shght,
we must look to the placenta as the cause. This is in opposition
to most biologists who make the foetus the direct factor in the
hyperfunetioning of the suprarenals.

?

The author thinks this ‘‘hypertrophie gravidique’’ is of the
same order as the hypertrophy of other glands of internal seere-
tion, such as the thyroid and hypophysis. It is a reaction to
specifie substanees secreted by the attached ovum and by the
elements of the foetal placenta. It is believed that the capsules
have been ‘‘sensitized’’ by the secretion from the corpus luteum.

—T.C. B.

(ADRENAL) A case of Addison’s disease (Een geval van
ziekte van Addison). Wertheim Salomonson (J. K. A.),
Nederl. Tijdschrift v. Geneesk. (Haarlem), 1919, 63 (11),
19380.

A description of a classical case.—J. K.

ABSTRACTS 243

ADRENIN, Unusual action of — in elderly persons
(Ungewohnliche Wirkungen des Adrenalins in hoheren Leb-
ensalter). Arnstein (A.) and Schlesinger (H.), Wien. khn.
Wehnsehr. (Vienna), 1919, 32, 1179.

Precaution is necessary in the giving of adrenalin to elderly
persons since frequently after the injection of small doses of
this drug the rise of blood pressure is followed by a sharp fall
and the heart-beat may become very slow for some hours. Tachy-
cardia may be produced in individuals having cardiac insufti-
ciency and when there is present a sclerosis of the coronary
arteries the injection of even small doses may be followed by

severe attacks of stenocardia. In rare cases glycosuria results.
—J. K.

(ADRENIN) Adrénaline et dissociation auriculo-ventriculaire
(Etude a l’electro-cardiographe). Arrillaya, Thése de Paris,
1918-1919; Abst. Presse med., 27, 389.

By means of the electrocardiagram, Arrillaya studied the
reactions of six subjects of auriculo-ventricular dissociation to
injections of adrenin. In the records the auricular and ven-
tricular beats could, of course, be differentiated. It was found
that adrenin caused a simultaneous increase in the rate of born
auricles and ventricles. It did not ever result, however, in a.
recomposition of the cardiac rhythym. In four eases the auri-
cles and ventricles began to react simultaneously and in two,
the ventricles reacted more promptly. It is stated that the reac-
tion to adrenin is more marked in patients exhibiting adrenal
deficiency. Although not able to restore synchrony in the ac-
tivity of the two parts of the heart, adrenin has a_ beneficial
symptomatic effect, especially in dissociation due to intoxication
with salicylates, digitalis or emetine.—R. G, H,

(ADRENIN PITUITRIN ) Permeability of the blood vessels
(Uber die Durchlassigkeit der Gefasse). Bauer (J.) and
sl anad (B.), Wien. klin, Wehnsehr, (Vienna), 1919, 32,

The injection of adrenalin caused an increase in the per-
meability of the blood vessels towards water and chlorine while
pituitrin had no such effect.—J. K.

(ADRENIN ) Studies on the regulation of the blood diastase.
Fugimoto (B.), Am. J. Physiol. (Balt.), 1919, 50, 208-215.

__ The object of the investigation was to determine if pos-
sible how the blood diastase is regulated. Among other things
the effect of injections of adrenalin was tried. After injuring

244 ABSTRACTS

the liver by hepatotoxin, injections of adrenalin had no effect
on the diastase content of the blood.—T. C. B.

(ADRENIN) The secretion of adrenalin is not necessary for the
maintenance of arterial pressure (La sécrétion surrénal d’ad-
rénaline n’est pas nécessaire au maintien de la pression
artérielle). Gley (E.) and Quinquaud (A.), C. R. Soe. de
Biol i(Paris) 1919682 At Aai78)

The experiments of Strehl and Weiss have been repeated
with negative results. When the right suprarenal was removed,
and the vein of the left lhgatured to prevent circulation, there
was no fall of blood pressure as reported by Strehl and Weiss.

—T. C. B.

ADRENALIN, The action of—on the heart. I. Action
on the turtle heart. II. The modification of the action of
adrenalin by morphine. Heinekamp (W. J. R.), J. Pharm. &
Exp. Therap. (Balt.), 1919, 14, 17-24, 327-342.

Heinekamp finds that adrenalin exerts a direct stimulating
action on the vagus centers of the turtle. After repeated use it
loses this effect. Injected directly into the heart muscle it
inereases both rate and amplitude, principally affecting the
systole.

It was found that adrenalin has a direct central action and
is synergistic with morphin. Morphin to a degree sensitizes
the vagus center. The aggravated adrenalin action following
morphin is due, therefore, both to the morphin sensitization and
the adrenalin-morphin synergism. The increased blood pressure
plays but a sheht part in affecting the inhibition of the heart.

—F. F.

(ADRENIN) Cecal stasis with betaiminazolylethylamine
(histamine) intoxication in relation to dementia precox; indi-
cations for treatment. Holmes (Bayard), Am. Med. (Chgo.),
1916, 11, 405-413.

Holmes discusses the problems connected with the etiology
and treatment of dementia precox with special reference to the
association of the disease with functional disturbances in the
glands of internal secretion and with constitutional toxemia.
The fact that dementia precox cases manifest the adrenalin
paradoxes observed in animals or persons under the influence
of toxic amines, such as those in ergot, suggested the possi-
bility that this disorder might be due to excessive amounts of
such substances in the body. With the assistance of a chemist,
a number of patients were examined and a large excess of
Biminazolylethylamine was found in their feces.

ABSTRACTS 245

Study of the motor activity of the intestines of these same
patients gave definite evidence of spasm of the colonic sphincter
and exaggerated cecal stasis, which favor the production of the
toxic histamine from histidine by bacillus aminophilus intesti-
nalis and its absorption into the blood stream. From these re-
sults Holmes suggests that the treatment of dementia precox
cases be directed against the production of the toxic substances
in the cecum and proposes appendicostomy with protracted irri-
gation of the proximal colon through the artificial opening until
better means can be found.—I. M.

ADRENIN treatment of influenza (Adrenalinbehandlung der
Grippe). Jaksch-Wastenhorst, Deutsche med., Wehnschr.
(Berlin), 1920, 46, 112. Miinch. med. Wehnschr. (Munich),
1920, 67, 31.

Many authors have recommended the use of adrenalin in the
serious cases of influenza but J. has never obtained good results
from its use and warns against employing this drug in the dis-

ease.— J. K.

(ADRENIN) A new conception of asthma. Knapp (M. L.),
N.Y. Med: J., 1920, 111, 55-59.

Asthma is considered the result of gastrointestinal dis-
turbanees, especially insufficientia pylori. The use of adrenalin
in controlling asthmatic attacks is not justifiable, in the au-
thor’s opinion, because of the transitory relief given and the ef-
fect upon structures other than the lungs.—H. W.

(ADRENIN) The mode of action of adrenaline on the bac-
terial toxins (Du mode d’action de ]’adrénaline sur les tox-
ines bacteriennes). Marie (A.), Ann. ]’Inst. Pasteur. (Paris),
1919, 33, 645-656.

Although adrenaline renders innocuous bacterial toxins
such as those of diphtheria and tetany, and is also antagonistic
to the vegetable poisons crotine, and abrine, it is not effective
in preventing the fatal effect of the alkaloids, strychnine sulfate
or morphine chlorhydrate in the usual lethal dose. The same
can be said for its lack of neutralizing action against nicotine,
cocaine, and tubereulin. Marie bases this difference in protect-
ive effect on the fact that the one group produces antibodies in
the blood, while the other group, the vegetable alkaloids, does
not so do, and although adrenaline does not destroy the anti-
genic properties of the tetanus toxin, it does neutralize doses
ordinarily fatal. The mode of action is tentatively given as one
of preliminary oxidation of the toxin by the adrenalin, facili-
tating its absorption by the antibodies.—F. S. H.

246 ABSTRACTS

ADRENIN, The effect of —upon the rate of locomotion
of Planaria and of toad larvae. Moore (KE. L.), Biol. Bull.
(Woods Hole), 1919, 37,:157.

Planaria, so far as known, do not produce any secretion
corresponding to adrenin, yet they are made more excitable
by dilute solutions of this substance, with resultant early
fatigue. The increased excitability resulted in in-coordinated
movement and in many eases interfered with locomotion. Toad
larvae which have adrenals tended to react to adrenin in the
Same manner as Planaria.—E. R. H.

(ADRENIN PITUITRIN) Action of certain drugs on the brain
circulation inman. Raphael (T.) and Stanton (J. M.), Arch.
Neurol. & Psych. (Chgo.), 1919, 2, 389-392.

Records of the pulsations of a subtemporal cerebral hernia
were made after the inhalation of amyl nitrite and the intra-
venous injection of epinephrin, ecaffein, and pituitrin. Epine-
phrin induces a primary constriction of the brain vessels, fol-
lowed by a marked dilatation. Pituitary extract injections re-
sult in a dilatation of the brain vessels.—F. C. P.

(ADRENIN PITUITRIN) Cardiac death due to diphtheria.
Rohmer (P.), Berl. klin. Wehnsehr., 1917, —, 1059; Abst., La
Pediatria.

Owing to the adrenal insufficiency found in paralysis of
the heart, Rohmer recommends adrenalin hypodermically (not
intravenously since this proves too often dangerous). One to
3 ce. of 1:1000 adrenalin hypodermatically used very often,
or adrenalin and pituitrin in association, is claimed to be of
a great usefulness.—G. V.

(ADRENIN) The occurrence of epileptic seizures after the in-
jection of adrenalin preparations (Nella provocazione degli
accessi epilettici coi preparati surrenali). Silvestri (T.),
Gaz. degli Ospedali. (Milan), 1919, 40, 852.

A claim for priority of recorded observation of the pro-
duction of epileptical seizures by the administration of adrenalin
to epileptics. (See Endocrin. 3, 349).—J. K.

(ADRENIN PITUITRIN) Rhythmic contractions of vessels.
Soloveitchik (D. E. A.), Dissertation, Petrograd, 1917, pp. 82.

A method of Kravkov (isolated ear of a rabbit) was used
with a modification which consists in excluding the veins. by
ligaturing them in order to observe only the changes of arterial

ABSTRACTS 247

aperture. Spontaneous contractions of vessels can be observeé
while perfusing the preparation with Locke’s solution; their
strength varies within wide limits; sometimes they are totally
closed. If the ear is kept at the temperature about 0° it is pos-
sible to observe the contractions even 6 to 10 days after the
operation. The temperature of the body is more favourable for
these contractions than lower ones. Oxygen does not produce
any visible influence on these contractions. Adrenaline aug-
ments the spontaneous contractions at body temperature, but has
little effect at room temperature. Atropine antagonises adrena-
line. The most efficient concentration of a drug is that which
produces a strong vaso-constrictor action. Histamine, ergo-
toxine, and pituitrin augment these contractions; rabbit serum
in concentrations which produce a strong vaso-constrictor ef-
fect, extracts of suprarenals and of the heart of rabbits aug-
ment the contractions. Strophanthin and digitalin augment
them if the pressure of the perfusion liquid is increased after
the contraction of vessels evoked by the drugs used. Nicotine
and strychnine augment the contractions, veratrine lowers them.
No visible influence is produced by pilocarpine, eserine, caffeine,
quinine, chloroform, camphor, barium chlorate, or lactic acid.
The contractions described above are spontaneous in a real sense ;
the constituents of the blood merely regulate them. It is an in-
herent property of the muscular fibres.—Physiol., Abst., 4, 388.

(ADRENIN) Hemophilia. Sugiura (J.), Jikwa Zasshi, 1916,
199, 1-22: Jap. Med. lit., 1917, 2, 6.

A ease is deseribed in which fibrin factors were normal, but

in which the blood contained a large amount of adrenin.—
Physiol. Abst., 3, 536.

ADRENIN treatment of influenza (Grippebehandlung mit Ad-
renalin). Wagner (G. <A.), Miinch. med. Wehnschr.
(Munich), 1920, 67, 31.

The use of adrenalin in influenza is indicated only when the
ease is complicated with penumonia and the lungs are rapidly
invaded by a serous exudate. The drug should never be given
intravenously since it causes a diminution of the blood vessel
permeability.— J. K.

(ADRENIN OVARY) Treatment of osteomalacia of pregnancy
with adrenalin (Behandlung der Schwangerschaftsosteo-
malazie mit Adrenalin). Wagner, (G. A.), Miinch. med.
Wehnsechr. (Munich), 1920, 67, 31.

This is a report of a case of a pregnant woman with
bronchitis, bronchiectasis and thoracic pain accompanied by

248 ABSTRACTS

symptoms of osteomalacia. After a few injections of adrenalin
the pain disappeared. During 58 days a total of 91ec. of adrena-
lin had been injected. After a premature confinement the pa-
tient’s ovaries were removed. The interstitial cells of both
were found to be enormously developed.—J. K.

AUTONOMIC NERVOUS SYSTEM, The arrangement of.
Langley (J. N.), Lancet (Lond.), 1919, (1), 954.

Prof. Langley points out that since the appearance of Gas-
kell’s book, ‘‘The Involuntary Nervous System,’’ there has
been a tendency.among writers to consider that the main prob-
lems of this system were settled by Gaskell. The truth is that
Langley himself worked out a great many of the facts. of funda-
mental importanee attributed to Gaskell.—L. G. K.

(BLOOD SUGAR DIABETES) The influence of muscle activity
on the amount of blood sugar (Der Einfluss von Muskelarbeit
auf den Blutzuckergehalt). Brosamlen (O.) and Sterkel (H.),
Deutsches Arch. f. klin. Med. (Leipzig), 1919, 180, 358.

The authors found that in normal persons the blood sugar
concentration with the subject at rest and with empty stomach
shows, when examined at different moments, but few varia-
ticns. in diabetes these variations are more pronounced but
never very great.. In normal persons much activity diminishes
the amount of blood sugar: this may be preceded by a very
short moment of hyperglycemia. The blood sugar reaches the
lowest amount, approximately an hour after the end of the
muscle activity. In diabetes the same influence may be ob-
served, though extremely rarely ; nearly always muscle activity
is followed by hyperglycemia, lasting for many hours.—J. K.

A BLOOD SUGAR tolerance test. Janney (N. W.) and Isaac-
son (V. I.), Proc. Soc. Exp. Biol. & Med. (N. Y.), 1917, 15,
5 -AiG:

It is considered that the hyperglycemia response to in-
gested sugar is a better test of sugar tolerance than the appear-
ance of sugar in the urine. The test is carried out by first de-
termining the blood sugar of the patient who has fasted over
night, and then administering pure glucose in the ratio of 1.75
gm. per kgm. of body weight in a 40 per cent aqueous solution,
witly the addition of a iemon, and again determining the blood
sugar at the end of two hours. In normal subjects the blood
sugar has by this time returned to its fasting level. If hyper-
elycemia still persists, the blood sugar tolerance is lowered.
Preferably half hourly observations are made following the

ABSTRACTS 249

glucose ingestion as well as the sugar eliminated in the urine,
and for the twenty-four hours.

Glycosuria which is normally absent under the conditions
of the test is not a necessary accompaniment of decreased tol-
erance. A normal blood sugar curve accompanied by glyco-
suria usually indicates renal diabetes. All cases of Graves’ dis-
ease examined show a prolonged blood sugar curve, as do cer-
tain cases of chronic interstitial nephritis. Hypoendocrine con-
ditions such as cretinism and muscular dystrophy are charac-
terized by increased sugar tolerance with the ordinary urinary
test, but blood sugar determinations showed hypoglycemia and
a delayed tolerance curve.—F. S. H.

(CAROTID GLAND) The function of the so-called carotid
gland (Uber die Funktion der sogenannten Carotisdriise).
Massaglia (A.), Frankf. Ztschr. f. Pathol. (Wiesbaden),
1916, 18, 333-347.

The author being unable te obtain the chromaffin-reaction
in the earotid-gland after fixation in potassium bichromate and
formalin, studied the effect of its cauterization or removal from
cats, dogs, and rabbits, with particular respect to the produc-
tion of glycosuria. The cauterization, removal, or cutting of the
nerves to the gland caused but a transient glycosuria in cats
and dogs, and but little, if any, effect in rabbits. This is ex-
plained on the basis of a stimulation of the sugar center as a
result of the operation and not as due to the glandular prop-
erties of the tissue itself. The author concludes that on the
basis of this evidence the so-called carotid-gland should be con-
sidered as a paraganglion.—F. S. H.

(CORPUS LUTEUM) Organotherapy in uterine hemorrhages
(Zur Organotherapie der Gebairmutterblutungen). Hannes
(W.), Monatsch. f. Geburtsh. u. Gynik. (Berlin), 1919, 50,
199-205.

The logical course of treatment of menorrhagia not due
to a tumor formation or disturbance of pregnancy is essentially
organotherapeutic, and dependant upon the use of some prepa-
ration of the corpus luteum. It was found that the subcu-
taneous injection of the contents of a 1.1 ¢.c. ampoule represent-
ing 1 gm. of fresh tissue gave satisfactory results. As examples
three cases are cited in which the hemorrhage in a 24 year old,
a 25 year old, and a 44 year old woman had lasted for 3 weeks,
2 weeks, and 20 days respectively. In all three cases the hemor-
rhage was brought to a complete stop by one injection of the
extract. All cases do not necessarily respond so quickly, but, by
and large, the final results are the same. It frequently happens

250 ABSTRACTS

that the first menstruation after the treatment is somewhat de-
layed while the duration of the period is usually shortened.
—F.S. H.

CORPUS LUTEUM, Menses-increasing substance from—. Seitz
(L.) and Wintz (H.), U. S. Patent 1,318,698, Oct. 14, 1919.

A menses-increasing substance is obtained from corpus lu-
teum by separating the watery liquid containing the active sub-
stance from a mixture of alcohol extracts and CHCl* extracts
obtained by successive extraction of ovaries with cold alcohol, hot
alcohol, CHCl* and boiling alcohol, by adding an excess of
CHCI to the mixture of extracts, and then isolating the active
substance by evaporating the aqueous liquid and purifying the
residue with ether. U.S. 1,318,699 relates to a modification of the
method, according to which there is separated from the alcohol
extracts obtained by extracting ovaries successively with alcohol,
acetone, cold and warm ether, CHCI® and hot alcohol, first the
H,O and constituents soluble in H,O by the addition of an excess
of CHCI* and then there is recovered from, the remaining alco-
hol CHCl’ mixture the menses-controlling substance by evapor-
ating and extracting again the residue of the evaporation with
both the ether extracts previously obtained, evaporating the ex-
tract thus obtained to dryness, redissolving the orange-yellow
mass obtained, filtering the solution and evaporating it in vacuo
until a mass of uniform consistency is obtained.—Chem. Abst.

(CORPUS LUTEUM) Ueber die Beziehungen des Corpus
Luteum zur Menstruation. Seitz (L.) and Wintz (H.),
Monatschr. f. Geburtsh. u. Gynaek. (Berl.), 1919, 49, 1-23.

Correction of reference, Endocrin. 3, 353.

DERCUM’S DISEASE following exposure to war, with biopsy
of the tumors (Morbo di Dercum in seguito a vita di guerra,
con biopsia di qualche tumore). Boschi (G.), Riv. Pathol.
nerv.e ment. (Firenze), 1918, 23, 161-192.

In his original deseription of adiposis dolorosa Dereum
mentioned the possibility that it is primarily of endocrine origin.
A case is described by Boschi which throws light upon the prob-
lem. A young soldier having this disease showed, among other
things, swelling of the thyroid approximately contemporan-
eously with the first appearance of lipomata, hyperidrosis, fron-
tal and bitemporal headaches, asthenia and hypoaphrodisia. The
illustration published shows transverse crines. Blood pressure
was 160/100. These findings are interpreted as indicating a
pluriglandular etiology of the disease, in which the hypophysis

ABSTRACTS 251

played the principal role. The psychological, neurological and
somatic findings are reported in detail and the etiology discussed
at some length.—R. G. H.

DERCUM’S DISEASE, Researches on metabolic exchange in
—(Di alcune ricerche sul ricambio nella malattia di Dercum).
Martelli (C.), Patholgica, 1916, —, 189.

The author noted that in a ease of Dereum’s disease the
nitrogen and mineral components of the urine were in general
diminished. After thyroid-adrenalin therapy they were in-
ereased. The increase was noted in both urea and non-urea
nitrogen, but the quantity of amino acid nitrogen was de-
cereased.—Riv. Patol. nerv. e ment., 22, 503.

(PANCREAS DIABETES) Diet reduction with retention of
protein to relieve glycosuria in diabetes mellitus. Fenlon
(R. L.), Boston M. and S. J., 1920, 182, 168-171.

The tendency to develop acidosis is decreased by keeping
the protein intake of the diet at a ‘‘necessary level.’’ This is
considered to be 0.12 grams of nitrogen per kilogram of body
weight. The patients complain less of hunger on such a dietary
measure than when this factor is ignored. The author believes
the protein indirectly maintains the serum protein of the blood
and possibly aids in the nutrition and functioning of the kidney
during diet reduction.—H. W.

DIABETES, The lime deficiency of—. Kahn (Max) and Kahn
(Morris H.), Arch. Int. Med. (Chicago), 1916, 18, 212-227.

The object of the investigation was to show the import-
ance of lime deficiency in diabetes. Much evidence that calcium
deficiency occurs with great frequency is cited from the litera-
ture. Studies were made on early cases of diabetes. These
showed that calcium was being lost constantly from the body.
Calcium chloride injected intravenously caused marked improve-
ment in the symptoms. Glucose excretion fell markedly and
glycemia gradually declined. The quantity of urine was reduced
and acetone bodies did not appear in the urine of any of the
patients.—I. M.

(DIABETES) The ‘‘Allen’’ treatment of diabetes modified by
the administration of alikalies in full doses. Mulvany (T. E.),
Practitioner (Lond.), 1918, 101, 171.

A brief report of a case of diabetes in a man of 19 years.
The Allen starvation treatment only temporarily cleared the
urine of sugar and the patient appeared to be on the verge of

)
Or
iS)

ABSTRACTS

coma. Starvation was then tried again and a teaspoonful of bi-
carbonate of soda in a glass of water was administered every
four hours. In four days the patient was sugar-free, and at the
time of writing, about five months later, the patient’s health
was excellent and he was still sugar-free.—L. G. K.

(DWARFISM) An unusual case of dwarfism in twins. Gold-
stein (H.) and Schneck (M.), N. Y. Med. J., 1920, 111, 98-100.

Case report of dwarfism in one of twins. The authors con-
elude this case to be one of a class of dwarf growths, showing no
evidence of any preverted internal secretion or defective consti-
tutional condition. The case is considered one of achondropla-
sia or chondrodystrophia (Kaufman).—H. W.

ENDOCRINE disturbances, Multiple—(Sindrome pluriglando-
lare). Fici (Vincenzo), La Riforma Medica (Naples), 1919,
35, 778-782.

Fici reports a ease of pluriglandular syndrome (hypoadren-
alism, hypopituitarism, hypo-ovarianism, status lymphaticus and
splenomegally) in a woman of 33. The illness began seven years
ago. The only antecedent symptom that might be connected
with the later syndrome had been a fit of diarrhea, vomiting, and
cramps in the lower limbs, which lasted about twenty days. The
patient ascribed the beginning of the malady to sorrow over
losing a child. She had severe headaches and intractable ec-
zema of the eyes, probably ascribable to pituitary or other endo-
erine anomalies. Injections of pituitary, ovarian and thyroid
extracts failed to elicit a reaction. There was only a slight re-
sponse to adrenalin, but a marked one to atropine and a partial
one to pilocarpine. These latter findings, together with a ten-
dency to vomiting, diarrhea and asthma, indicate vagatonia. As
to etiology nothing beyond psychic trauma was discovered. Tu-
bereulosis, which is frequently found in such cases, was absent
in this.—G. V.

ENDOCRINE GLANDS, Studies on the conditions of activity
in—. V. The isolated heart as an indicator of adrenal secre-
tion induced by pain, asphyxia and excitement. Cannon
(W. B.), Am. J. Physiol. (Balt.), 1919, 50, 399-432.

This is the full report promised by Cannon in a short arti-
cle in Science (May, 1917, 45, 463) delayed on account of his
absence. It is an answer to the criticisms of Stewart and Rogoff
and others, and should be read in the original. The positive
evidence in favor of adrenal secretion during pain, emotion and
asphyxia is reviewed and criticisms of the catheter method are
considered. The author defends the use of the isolated heart as

ABSTRACTS 2a

Or
OO

an indicator of adrenal secretion, criticises the methods yielding
negative evidence, and reaffirms the emergency theory of the
function of the adrenals.—T. C. B.

(ENDOCRINE INSUFFICIENCY) The clinical picture of in-
anition osteopathy (Zum klinischen Bilde der Hungeroste-
opathie). Hamel (O.), Deutsche med. Wehnschr. (Berln),
1920, 46, 68.

Five cases are described in this paper, two of which showed
tetanic symptoms. The probable cause is endocrine insufficiency
resulting from undernourishment.—J. K.

ENDOCRINE neuroses and their treatment. Rogers (J.), N.
Y. Med. J., 1920, 111, 229-232.

The autonomic nerve and plates spray out like fingers
around the receiving cells. Between these cells and the nerve
spray lies the circulating lymph and blood with all the nutrient
matter and endocrine products. The impulses discharged from
the nerve spray can be imagined as pushing nutriment into the
receiving cells. In this process the product of the thyroid, and
probably other organs, seems to accelerate the cell chemistry,
while that of the adrenal, and possibly the pituitary, seems to
retard the cell’s metabolism. The thyroid products acts only
through or upon the terminal sprays of the vagus system, while
the adrenal is limited in its inhibition to the terminal sprays of
the sympathetic. A circle drawn around the receiving cells and
the terminal neuron or spray of the motor and vagus and sym-
pathetic nervous systems seems now to indicate the point of
action of at least the pituitary, thyroid, parathyroid and adrenal
glands. The circle also necessarily includes the point at which
nutriment gains access to the cells and the products of their met-
abolism are excreted. The parasympathetic seems by vasodila-
tion and stimulation of functional activity to drive all the or-
gans, while the sympathetic seems to check them, and this drive
influence is vastly reinforced by the thyroid. The adrenal, on
the other hand, exhibits an equally strong influence upon the
sympathetic check. These opposing effects are most clearly
shown in the stomach and pancreas. (See abstract Endocrin.,
1919, 3, 409.)

The moist and flushed skin, the overacting heart, abnormal
appetite (vagus hunger contractions), frequent bowel move-
ments and the diuresis of hyperthyroidism all point to excessive
thyroid drive. Such cases usually appear to begin with an ini-
tial hypothyroid disturbance which, in turn, has its origin in
fatigue or an acute infection of traumatism. Apparently both
sroups of nerves fail in the initial stage of these disorders. Then
if the fatigue or toxemia continues, the cheek upon the metabol-

254 ABSTRACTS

ism becomes more deficient than the drive and the result is hy-
perthyroidism. If, on the other hand, the drive becomes more
and more deficient, the primary hypothyroidism deepens into a
myxedema. To say that there is an excess of drive or excess of
check in any instance, is probably not strictly correct. For what
appears as an excess of drive may really be a lack of check, and
the excess of check, a lack of drive upon the metabolism.

The treatment not only of thyroid disturbances, but of all
functional disorders of the viscera, is or should be, primarily
that of reinforcing the deficient drive or the deficient check. The
thyroid nucleoproteins, in doses of 1/50 to 1/10 grain frequently
repeated, are most satisfactory. The liquid residue or nonecoag-
ulable part of an aqueous extract (as prepared by the author)
sometimes proves better. The commercial preparations made by
desiccation of the entire gland tend to be inert or toxic. The
thyroid nucleoproteins or residue are useful in all frankly hypo-
thyroid or deficient drive conditions and in many so-called
mixed hypothyroid and hyperthyroid disturbances in which
there is evidence in some viscera of good or active functioning
and in others of deficiency. The residue is clinically better
than the nucleoproteins in the hypothyroid or mixed thyroid
disorders which are accompanied by a high blood pressure and
also in cases with gastric hypofunetioning. Thyroid and other
neuroses such as those of the stomach and intestine, which show
excess of the drive over the check upon metabolism, can be
benefited by almost any adrenal derivative; adrenalin is the
least satisfactory. The adrenal nucleoprotein in doses of 1/10
to 1/2 grain every 2 hours, or the adrenal residue in doses of
5 to 20 minims every 2 hours, are the most useful of the adrenal
derivatives for medical treatment of hyperthyroidism.

Whenever hyperthyroidism is present and not speedily
changed to the preceding hypothyroid disturbance, surgery is
indicated, particularly, ligation of thyroid-arteries. In recoy-
ery these patients always pass again in the order of the develop-
ment of symptoms through the initial stage of hypothyroidism.

The pituitary, at least in the stomach and some parts of
the intestine, seems to reinforce or support the adrenal check.
The parathyroid apparently reinforces the thyroid drive, but
not exactly at the same anatomical point. Henee, in the present
state of knowledge, it is legitimate, when the drive or check
symptoms cannot be helped by either thyroid or adrenal feed-
ing, to experiment with the associated derivatives.—H. W.

(ENDOCRINE ORGANS) An introduction to the study of the
endocrines in gynecology. Bandler (S. W.), N. Y. Med. J.,
1920: Ad e271 225:

ABSTRACTS 295

Menstruation is dependent upon the normal development
of the genitalia and the normal trophic control of these struc-
tures. Every menstruation is a crisis in which the ovary,
thyroid and pituitary participate. Menstruation is preceded
by premenstrual changes varying in intensity and degree ac-
cording to the action and interaction of these glands. Women
whose menstrual periods occur every 35 days are in need of
endocrine stimulation. They are more likely to begin labor at a
date later than estimated. Women with hypoplasia of the
uterus and those who become pregnant after endocrine therapy
often have a long and tedious labor. Those who have repeated
miscarriages are probably hyperpituitary and when they finally
carry a viable child may not go to term.

Disorders most amenable to endocrine therapy are actual
or relative amenorrhea, lactation atrophy, menorrhagia, metro-
rrhagia, dysmenorrhea, sterility, ‘‘one child sterility,’’ threat-
ened and habitual miscarriage, disturbances of the climacter-
ium, fibromyomata, and hyperthyroidism, dyspituitarism and
similar conditions. Nervous and irritable gynecological patients
usually are suffering from thyroid or pituitary disturbances.
The relation between the various endocrine structures is_ less
stable in women than in men, hence alterations in the cyclic
functions of the sex apparatus result in endocrine disturbances
manifested as changes of the body, altered nervous function
and psychic instability.—H. W.

(ENDOCRINE ORGANS) Trauma and constitutional disease
(Trauma en constitutioneele ziekten). Brocx (D.), Tijdschr.
v. Ongevallen Geneesk. (Amsterdam), 1919, 4, 257, 289, 321.

A general discussion, without new data, on the relation
between trauma and diseases of the endocrine organs.—J. K.

(ENDOCRINE ORGANS EMOTIONS) Biochemical researches
in normal and in frightened animals (Richerche bio-
chemiche in animali normali ed in animali emozionati).
(Preliminary report.) Buscaino (V. M.), Rivista di Patologia
nervosa e mentale (Firenze), 1920, 24, 400-403.

In the previous issue of this Journal Busecaino’s earlier
researches on the histo-chemistry of the endocrine organs were
reported. The present paper deals in a preliminary way with
some of the results obtained by the application of these methods
to the study of the reactions of the various organs to the emo-
tions. In addition to numerous negative or dubious findings
there are reported a variety of positive results. Confirming
earlier investigators, it was found that frightened guinea pigs
and cats become elycosuric. Likewise the oxidizing power of

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56 ABSTRACTS

the blood serum is increased, especially in animals showing ob-
jective signs of fright.

Guinea pigs as well as dogs show diminution of the yellow-
ish color assumed by pieces of central nervous substances
treated with Lugaro’s solution. - Parallel to this runs a
diminished affinity of all the nervous tissue for the toluidin
blue. In guinea pigs augmented nuclear activity of the nervous
cells occurs as shown by an increase of the granular contents in
the cerebral cortex and still more in the nuclei of the base. The
neurogla cells become richer in fats.

Vascular congestion in the liver (cats), diminished eglyco-
gen (guinea pigs, cats), increased neutral fats (guinea pigs),
diminution of neutral fats (cats), imereased poids (guinea
pigs, cats), increased fuchsinophil formation of the protoplasm

euinea pigs, cats), increased argentophil formation of same
(guinea pigs, cats), marked nuclear variations and increase of
special nuclei in guinea pigs as well as in cats were seen.

In the adrenal cortex there were noted vascular congestion
(cats), increase of neutral fats and stearin (euinea pigs),
diminution of neutral fats and stearin (eats), increased lipoids
(cats), increased fuchsinophil formation of the protoplasm
(guinea pigs, cats), marked nuclear variations and increase of a
special form of nuclei in cats as well as in guinea pigs.

Similarly, the thyroid reacted by vascular congestion
(guinea pigs, cats), increased volume of the protoplasm (cats,
guinea pigs), marked nuclear variations and increase of the
special nuclei (cats). In the interstitial cells of the testis
(guinea pigs) only increase of the cellular size was noted. In
the interstitial cells of the ovary (eats), there was increase in
size of the cells, marked nuclear changes and increase of the
special nucle1.—G. V.

(ENDOCRINE ORGAN) Glands and emotions under bom-
bardment (Glands et emotions de bombardments). Etienne
(G.) and Richard, Revue med. (Paris), 1918, —,— (Oct. 12),
Reprint, pp. 7.

During the bombardment of Nancy the populace was sub-
jected to intense emotional stress. The authors had _ several
opportunities to observe striking endocrine defects -which
resulted in patients so excited. Various instances of mammary
depression and of chlorosis were seen; these were ascribed to
perturbation of ovarian functions. Two eases are described in
which marked transcient glycosuria resulted. In two eases
Graves’ disease with hypertension and two with hypotension
were seen. ‘These also are described. In the light of Cannon’s
researches the authors regard the adrenal glands as playing a
major role in the genesis of the maladies —R. G. H.

ABSTRACTS 257

(ENDOCRINE ORGANS) Arterial pressure and emotions of
war (La pression arterielle et les emotions de guerre)
Etienne (G.) and Richard, Paris med, 1919, 9, 109. Re-
print, pp. 18.

The authors had extensive opportunity during the war to
study the genesis of hypertension as a reaction to emotional
stress. They believe that the initial hypertension is due to ex-
citation of the vasomoter system directly, but that continued
stress leads to changes in the endocrine organs whereby the
initial effect is augmented and continued. As evidence, cases
are mentioned in which sudden shock resulted in amenorrhea,
elycosuria, and swelling of the thyroid gland. Especial impor-
tance in this connection is ascribed to the adrenal glands, which
ean both reinforce the vasomotor impulses directly and second-
arily stimulate other endocrine organs.—R. G. H.

(ENDOCRINE ORGANS) Must the extracts of glands in the
study of endocrinology be substituted by blood or lymph,
coming from these glands (Gli estratti ghiandolari devons
essere abbandonati e sostituiti dal sangue o dalla linfa de-
filuente dalle rispettive ghiandole, negli studi endocrinolo-
gici)? Ghedini (G.), Gazzetta degli Ospedali (Milan), 1919,
40, 9.

The author warns once more against identification of the
pharmocological action of an extract of an endocrine organ with
the physioligical function of the organ itself. No new facts are
adduced.—J. K.

(ENDOCRINE ORGANS, BLOOD SUGAR) The significance of
a small amount of sugar in the urine. Hamman (L.), Can.
Med. Ass. J. (Toronto), 1919, 9, 961-967.

The author pvints out the advantayve of studying the fast-
ing blood sugar and the blood sugar following a meal rich in
carbohydrate in order to distinguish the hyperglycemic from
the renal type of glycosuria when only a small amount of sugar
is present in the urine. The following test is advised: The
blood sugar is determined in the morning after the night fast
and the urine is examined. Immediately thereafter 100 grams
of glucose are administered in lemonade and one-half hour, one
hour and two hours thereafter, the blood sugar is determined
and the urine examined for sugar. Normal persons react to
this test with a rapid rise in the blood sugar which seldom
exceeds 0.14 per cent. The high point is usually reached at the
end of one-half hour and the original fasting level after an hour
or hour and a half. No sugar appears in the urine.

258 ABSTRACTS

Patients with a lowered carbohydrate tolerance react with
a much higher rise of the blood sugar and the elevation persists
much longer. The blood sugar reaches 0.18 per cent or more
and remains above the original fasting level for three, four or
more hours. When the blood sugar exceeds about 0.17 per cent
sugar appears in the urine and continues to be excreted until
some time after the blood sugar has fallen below this level.

The mild cases of renal diabetes are characterized by slight
and usually transient glycosuria. On the other hand the hyper-
elycemic diabetics respond to the test not only by excreting
sugar in the urine, but by displaying as well a low elucose tol-
erance. Disturbances of thyroid and hypophyseal function,
hypertension, nephritis and diseases of the brain are also accom-
panied by a mild glycosuria which is of the hyperglycemic type.
These conditions must be distinguished from diabetes by the
clinical picture and this is not difficult if the physician is aware
of their association with hyperglycemia. (See also. Endocrin.
1919, 3, 63.)—L. G. K.

(ENDOCRINE ORGANS) Observation on the frequency of some
constitutional diseases in the tropics (Enkele opmerkingen
naar aanleiding van de menigvuldigheid van eenige constitu-
tieziekten in de tropen). De Langen (C. D.), Nederl. Tijdschr.
v. Geneesk. (Haarlem), 1919, 63 (11), 1638.

The author observed that some diseases (diabetes, Graves’
disease, hypertrophy of the prostate) are extremely rare in the
tropics. Among 422,943 patients he never saw a case of
myxedema.—J. K.

(ENDOCRINE ORGANS) Cranio-facial deformities considered
as a syndrome of dysfunction of the endocrine glands in chil-
dren (Les dysmorphoses facio-craniennes considérées comme
syndrome du dysfunctionnement des glandes endocrines chez
Venfant). Robin (Pierre), C. R. Soe. de Biol. (Paris), 1920,
83, 13-15:

The faulty functioning of the endocrine glands may, among
other manifestations, alter the form and volume of the bones of
the head and face. When we examine subjects of such skeletal
alterations we find some trouble with the endocrine glands. If
we examine the photographs and radiographs of children at-
tacked by endocrine disturbances, we are struck with the fact
that they are all cranio-facial dysmorphics. These deformities
cause functional disturbances of respiration, digestion, vision,
audition, olfaction and mastication, arrest of development,
adenoidism ; in short, a more or less pronounced disequilibrium
of the psychie and vegetative functions. These react in turn on
the endocrine glands, and a vicious circle is established.

ABSTRACTS 259

The author finds that early treatment of the jaws and
dental arches brings about an amelioration of the symptoms and
a re-establishment of the biological equilibrium.—T. C. B.

(ENDOCRINE ORGANS) The influence of experimental hypo-
function of one or more endocrine glands upon growth pro-
cesses in very young cats and dogs (Il processo della cres-
cenza nell’ipofunzione di une o pit ghiandole endocrine pro-
vocata sperimentalmente nei gatti e cani giovanissimi).
Pugliese (A.), Bioch. e terap. sperim. (Milan), 1919, 6, fase. 3.

The simultaneous extirpation of one adrenal and one thy-
roid, with or without splenectomy, does not cause any apparent
trouble in adult dogs and eats. The mono-thyro-parathyroidec-
tomy in very young animals favours increase in body weight;
this is retarded by the mono-adrenalectomy alone. The simul-
taneous extirpation of one adrenal and one thyroid is fatal in
kittens of less than four months, and a progressive cachexia fol-
lows in 80 to 100 days. The bones of such kittens are smaller than
those of the controls, and show a diminuation of nitrogenous
and fatty substances with increased percentage of ash, Ca, and
phosphorus. The same operation, if performed in very young
dogs, only retards their growth and diminishes their organic
resistance.—(Physiol. Abst. 4, 400.)

(ENDOCRINE ORGANS) The ductless glands in cardivascular
diseases and dementia precox. Sajous (C. E. deM.), Med.
Rec. (N. Y.), 1917, 91, 82-84.

A general presentation of the subject is given with special
reference to the frequency with which general arteriosclerosis
and dementia precox are associated with well-known endocrine
disturbances. Attention is called particularly to the occurrence
of arteriosclerosis in ‘‘hyperadrenia’’ in which overwork, mental
strain and emotional disturbances are said to be the cause.
Arteriosclerosis in diabetes and myxodema is suggested to be a
possible ‘result of undernutrition in the vessel walls. Abnormal
activity of the thymus, the adrenal bodies and the thyroid in
dementia precox is spoken of as being of possible causal signifi-
eance.—I. M.

(ENDOCRINE ORGANS) Osteomalacia, Three cases of (Drei
Falle von Osteomalazia). Steckelmacher, Miinch. med.
Wehnsehr. (Munich), 1919, 66, 1504.

A report of three typical cases, one of which was cured by
the administration of phosphorus and pituitrin; the patient had
also been suffering from a goiter, treated by operation. Another
case became worse after the removal of the ovaries, which leads

260 ABSTRACTS

the author to warn against such a procedure in this disease.

—J. K.

(ENDOCRINE ORGANS) Action of tissue extracts on smooth
muscle (Action des extraits de tissus animaux sur les organes
a fibres musculaires lisses). Stern (l.) and Rothlin (E.),
J. Physiol. Path. Gén. (Paris), 1919, 18, 441-485.

The effects of various tissue extracts on different organs
were studied by adding the extract under consideration to horse
serum which was being perfused either through the isolated
organ or through the entire animal. As a result of their experi-
ments the authors conclude that all the tissue extracts studied
and the body fluids in general have the power of constricting
blood vessels and of influencing the tonus of various smooth
muscle organs.

In the liver two substances exist. One of these increases
the tonus of smooth muscle. It is destroyed by alkalis, is soluble
in water and in alcohol, insoluble in ether and is dializable. It
is not destroyed by boiling or by prolonged exposure to acids.
The second substance causes hypotonus of smooth muscle, is
soluble in water, slightly soluble in alcohol and insoluble in
ether. It resists boiling and the action of alkalis. The kidney
contains several substances, some of which cause hypertonus
and some hypotonus of smooth muscle. Thyroid extract con-
tains substances producing a diminution in vascular and uterine
tonus. It also contains a hypertonic principle differing con-
siderably from the hypertonic substances of the liver and kid-
ney. The lungs contain a hypertonic substance and also an
antagonistic substance, analogous to those in the liver extracts.
The extract of muscle also contains hypertonie and hypotonic
substances which differ physically and chemically from those
of the liver. Thymus and bone medulla contain a vasoconstric-
tor and hypertonic substance apparently the same as that of the
liver. The lymphatic ganglia contain a substance producing
contraction of blood vessels, except the coronaries, and of other
smooth muscle organs independent of their innervation: It ex-
hibits the same physical and chemical properties as the hyper-
tonic substance of liver. The suprarenals are said to contain,
besides adrenalin, a substance which produces contraction of the
non-pregnant uterus, acting as an antagonist to adrenalin. In
the spleen there is found a hypertonie substance producing con-
striction of the vessels and augmentation of the tone of all
smooth muscle. This substance is soluble in water, alcohol and
acetone and insoluble in ether, chloroform, benzol, petroleum
ether and lgroin. It is thermostable, dializable and resists the
action of acids, and of enzymes. It acts as an antagonist to
adrenalin when the latter produces relaxation of the tonus of
smooth muscle. Bile in high concentration produces vaso-

ABSTRACTS 261

constriction followed by a dilation and loss of excitability of
the vessel walls. Defibrinated blood as well as serum contain,
besides vaso-constrictors, hypertonic and hypotonic substances
derived in part from the formed elements of the blood and in
part for such organs as the suprarenal capsules and the hypo-
physis.—L. G. K.

(ENDOCRINE-SYMPATHETIC SYSTEM) Clinical study of
Paget’s disease and the preponderance of lues as the causa-
tive agent of the endocrine-sympathetic process (Contribucion
clinica al estudio de la enfermedad Osea de James Paget y
sobre la preponderancia de la lies en la etiopatogenia endo-
crino-simpatico del proceso). Castex (M. R.) and Waldorf
(C. P.), La Prensa Med. Argentina (Buenos Aires), 1920,
G6, 232:

_ A ease report the authors of which promulgate the opinion
that hereditary syphilis so alters the endocrine-sympathetiec sys-
tem that the disturbance affects osseous morphogenesis.

—B. A. H.

ENDOCRINOLOGY, General Concepts of —; clinical thyroid
manifestations; hormonotherapy (Conceptos generales de
endocrinologia; clinica de los estados tiroideanos, Hormono-
terapia). Escuder Nifiez (P.), Anales Fac. Med. Univ.
(Montevideo), 1919, 4, 69-110.

Correction of reference in Endoerin. 3, 511.

ENDOCRINOLOGY in daily practice. Garretson (W. V. P.),
N. Y. Med. J., 1920, 111, 232-235.

The present paper is of much the same trend as one pre-
viously abstracted (Endoerin., 1919, 3, 371).

The author holds that complete extirpation of the tonsils
leads to subsequent compensatory hypertrophy of appendiceal
tissue and resulting chronic appendicitis. The pituitary type
of headache invariably associated with tonsil or appendiceal in-
flammation, and following extirpation of one or both of these
organs, is due to a compensatory enlargement of the hypoplhysis.
In all so-called shock states the existing condition is vagotonia
due to hypoadrenia. Relief is attained by giving atropine, or
better, by administering adrenalin. The suprarenal glands bear
the brunt of all toxic assaults upon the body, either of endo-
genous or exogenous origin. The familiar exhaustion states fol-
lowing infectious diseases (influenza) are classical demonstra-
tions of vagotonia due to hypoadrenia.—H. W.

262 ABSTRACTS

(GENERAL) The interrelationship of menstruation, hair color,
and libido (Ueber Menstruation, Haairfarbung und Libido
und ihre gegenseitigen Beziehungen). Heyn (A.), Ztschr. f.
Geburtsh. u. Gynak. (Stuttgart), 1919, 82, 136-152.

An extensive statistical study of the relations existing be-
tween the age of incidence, duration, and molimina or
menstruation and social position, place of residence, color of
hair, degree of hairiness and libido. The details are too intri-
cate to be compiled in an abstract.—F. S. H.

(GENERAL) The biology of old age (Sulla biologia della vec-
chiaia). Scala (Guglielmo), La Riforma Medica (Naples),
1919, 35, 813.

From an endocrine point of view Scala postulates three
stages in human life, namely, childhood, puberty and old age.
From 25 to 35 there is a complete balance of the ‘‘vagotonic”’
and sympathicotonic hormones; after this period there is vago-
tony for a while, then, in old age, even the ‘‘vagotonic hor-
mones’’ give way. It is not only that the endocrine glands in
common with other organs are approaching decay, but, accord-
ing to Richter and Galdi, early senescence and physiologic old
age correspond to a pluriglandular syndrome manifested by
such conditions as increasing connective tissue and fat distribu-
tion resembling that in eunucoidism. Furthermore, with the
dysfunction of the skin, too much strain is laid on the kidneys
with consequent impairment of the same. With diminished
efficiency of the cerebrospinal and sympathetic nervous systems
there is a degree of failure in organic correlation, hence, as
Canstatt observes, in old people the individual organs may
undergo disease more or less independently, as though they were
isolated from the rest of the organism.—G. V.

(GENERAL) Diagnosis of the lesions of the nervous system
produced by violent explosions in close proximity without
external lesions. Williams (T. A.), Boston M. and S. J.,
1920, 182, 27-34.

Refers to endocrine factors only as a means of differentia-
tion of lesions of the nervous system.—H. W.

GIGANTISM, Notes on a case of pre-adolescent—. MacPher-

son (J.), N. Zealand Med. J. (Wellington), 1918, 17, 203-207.

Report of a case of gigantism accompanied by low-grade
imbecility.—F. S. H.

GLYCOSURIA, Some unusual cases of—. Brown (W. L.),
Clin. J. (London), 1916, 45, 29-36.

ABSTRACTS 263

Several types of glycosuria are discussed with illustrative
cases. These are: 1, glycosuria with hypoglycemia or renal
glycosuria; 2, pancreatic glycosuria due to a deficiency of this
gland; 3, pituitary glycosuria and, 4, thyroid glycosuria, the
last two types being due to hypersecretion. For the treatment
of diabetes the author recommends the practice of determining
the carbohydrate tolerance of each case and then selecting a
carefully balanced diet including the proper amount of carbo-
hydrate. Alkalis and a small quantity of alcohol in the form
of whiskey are also advised.—lI. M.

GLYCOSURIA, Injury and malingering. Collie (Sir J.), Med.
Press. and Cire. (London), N. S., 1916, 102, 425.

The medico-legal aspects of glycosuria following accidents
is discussed by the author, who questions the likelihood of a
permanent glycosuria resulting from injury. Attention is
called to the frequency with which malingering is practiced by
patients following accidents in the industries. Means for its
detection, such as finding cane sugar or excessive amounts of
lactose in the urine, are suggested.—I. M.

GLYCOSURIA from the military point of view (Les glycuries
au point de vue militaire). Derrien (E.), Montpelier Médi-
eal, 1917, 39, 550-554.

A brief description of the various possible causes of gly-
cosuria which points out that emotional states are to be taken
into consideration before rejections for military service on the
basis of sugar in the urine.—F. S. H.

(GONADS) On the cause of pseudohermaphroditism (Over de
oorzaak van pseudohrmaphroditisme). van der Broek
(A. J. G.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919, 63
(ii), 1625.

An interesting article. When in pregnancy the child ‘“in
utero’ is a girl, the hormones of the ovary of the mother come
into the blood of the child. The ovary of the child itself has
probably an internal secretion; so these two secretions will in-
crease each other. If the child, however, is a boy, mother and
child together form an organism that may be compared to the
animals of Steinach with one ovary and one testicle. The in-
fluence of the ovary is the more important; therefore, at birth
boys have some of the female characteristics (large breast, pro-
ducing milk). After birth the influence of the ovary ceases and
the breasts become again smaller. If in a pregnant woman the
ovary shows an increased function, this will have an influence
on the child, when it is a girl. When it is a boy the quantity

264 ABSTRACTS

of ovarian hormone will be too great; the equilibrium between
ovary and testis is broken, the influence of the testicle dimin-
ished and the result may be male psendohermaphroditism. A
diminished function of the ovary in pregnancy will have an
influence on a boy; on a girl it would be possible (but this has
not yet been made probable) that when the ovary of the child
is not or not enough supported by the ovary of the mother, the
Wolffian duet develops. Then female pseudohermaphroditism
occurs. These last statements are very theoretical; perhaps they
explain why male pseudohermaphroditism is much more fre-
quently seen than the female form.—J. K.

(GONADS) On the existence of a secretion of the epididymis
of the hibernating bat and its significance (Sur 1’existence
d’une sécrétion épididymaire chez la chauvesouris hiber-
nante et sa signification). Courrier (M. R.), C. R. Soe. de
Biol. (Paris), 1920, 83, 67-69.

In the bat, during hibernation and after the arrest of
spermatogenesis, there exists a considerable mass of sperm con-
tained in the tail of the epididymis, and an intense glandular
secretion from the cells of the initial part of the epididymal
canal. The region distal to the canal is therefore transformed
into a reservoir for the sperm, while the proximal region is dif-
ferentiated into a glandular organ the products of which mix
with the living sperm contained in the subjacent zone of the
same canal. The cells of the epididymis are described in their
various stages of secretion, and Henry’s opinion that this secre-
tion serves to nourish the sperm in its passage through the
canal, is confirmed. It is also suggested that the glandular
activity of the epididymis is conditioned by the secretion from
the interstitial (endocrine) gland. Experimental proof will be
given later.—T. C. B.

(GONADS) A case of gynecomastia following unilateral trau-
matism of the scrotum (Un cas de gynécomastie unilatérale
consécutive 4 un traumatisme des bourses). Decléty (J.),
Thése de Paris, 1919. Abst. Presse Méd., 27, 772.

Mammary hypertrophy in the human male is rare. It may
be unilateral or bilateral. The latter, Decléty states, is always
secondary to a testicular defect, inherited or acquired, and most
often, to trauma. The breast hypertrophy is usually on the
same side as the injured testicle. The case is described of a
young man of’ 25 in whom unilateral right-sided gynecomastia
developed following a wound of the scrotum. The breast was
removed surgically. Histological examination showed a pure
hypertrophy of the gland; the sections were comparable to those -

ABSTRACTS 265

from the breast of a normal young nulliparous woman with
manifest activation of the epithelium (Letulle). In explana-
tion of the phenomenon the author advances the following
theory: There develops in the testicle at the time of puberty
a hormone which stimulates mammary growth. The later, more
complete functioning of the testicle inhibits the action of this
hormone, apparently by means of reflex action originating in
the gonad. Pathological conditions in the testicle may suppress
this reflex function, permitting free play of the growth hormone
and leading to gynecomastia. This explanation accounts for its
unilateral manifestation.—R. G. H.

(GONADS) Historical remarks on experimental hermaphro-
ditism (Historischer Beitrag zur experimenteller Hermaphro-
ditismus). Foges (A.), Zentralbl f. Gynaek. (Leipzig), 1920,
44, 87.

A review of the historical development of this line of ex-
perimentation. It is pointed out that Hunter as early as 1780
reported gonad transplantations.—J.. K.

(GONADS HYPOPHYSIS) The effects of inanition in the
young upon the ultimate size of the body and of the organs
in the albino rat. Jackson (C. M.) and Stewart (C. A.),
J. Exp. Zool. (Phila.), 1920, 30, —.

Rats were underfed from birth to 3, 6, or 10 weeks and
from 3 weeks of age to 20 weeks or 1 year, and were then given
a full diet for a time and autopsied. Those starved a long time
were permanently stunted. The hypophysis and ovaries failed
to regain their normal weight but the testes were somewhat over-
developed.—E. R. H.

(GONADS) The innervation of the gonads in the dog. Kuntz
(A.), Anat. Ree. (Phila.), 1919, 17, —.

The nerves follow the ovarian and spermatic arteries, and
are derived mostly from inferior mesenteric ganglia. There is
no evidence that the interstitial cells receive any innervation,
especially since cutting the nerves to the testis results in over-
erowth of interstitial cells as the germinal cells degenerate.

(GONADS) Case of pseudohermaphroditism. Méndez §
(Martin), Repertorio de Medicina y Cirugia (Bogota), 1919,
11,68-71.

Mendez gives an illustrated description of another instance
of blunder in sex, the androgynoid being unmistakably of male
sex, although baptized and brought up as a girl.—J. Am. M. Ass.

266 ABSTRACTS

(GONADS) Experiments on the internal secretion of the sexual
glands, especially on experimental hermaphroditism. Sand
(Knud), J. Physiol. (Lond.), 1919, 53, 257-263.

Steinach’s results are confirmed. Also, hermaphroditism
has been produced by the formation of artificial ovario-testes by
a special technique, placing the ovaries in the middle of the
testes and leaving the latter in place. The ovary grows easily
into the testicular tissue, and is able to develop and form corpora
lutea. The testes develop to perfect spermatogenesis, the go-
nads of different sex thriving in intimate union, apart from
traumatie injury. Sand thinks this points more to an immunity
of the normal organism to the heterologous gland, rather than to
an ‘‘antagonism,’’ as suggested by Steinach.—T. C. B.

(GONADS) The specific antagonistic sex-gland action before
and after puberty (Die antagonistich-geschlechtsspezifische
Wirkung der Sexualhormone vor und nach der Pubertat).
Steinach (E.), Kaisl. Akad. der Wissenchft. (Vienna), 1919,
No. 36.

The sexual glands produce certain hormones which are
antagonistic in action to the effects of the sexual glands of the
opposite sex. This is shown by the apparent inhibition of the
taking of the graft of implanted heterologous sex glands when
the glands of the host are still present, and the prevention of
the development of the secondary sexual characteristics of the
host on successful implantation. The transplantation of the
ovary into cats causes the feminization of the animals whether
male or female. These results can be obtained either before or
after puberty. Lichtenstern has observed that implantation of
eryptorchic testicles into men wounded in the war or into indi-
viduals having lesions of these glands seemed to cause a reap-
pearance of the morphological, functional, and _ psychic
characteristics of the male sex. In one ease the results lasted
over three years. And in one case of transplantation after four
years of eunuchism because of tuberculosis of the testicles, there
was a return of the hair, musculature and virile potency. In
an infantile case masculine characters developed after implanta-
tion of a graft.—B. A. H.

(GONADS) Artificial hermaphroditic glands in mammals and
birds (Kinstliche Zwitterdriisen bei SAugern und Vogeln).
Steinach (E.), Kaisl. Akad. der Wissenschft. (Vienna), 1919,
No. 37.

In spite of the antagonism of the heterologous sexual glands
it is possible to obtain hermaphroditism in rats and guinea pigs.

ABSTRACTS 267

The result, however, depends on the amount of active tissue in
each gland and on the period when the transplanation is made.
The animals may take the characteristics of both sexes; e. g

3°)
females may take on the skeletal growth of the male—B. A. H.

(GONADS) Experimental and histological proof of the pres-
ence of a causative relationship between homosexuality and
hermaphroditic sex glands (Experimentelle und histologische
Beweise fiir den ursachlichen Zusammenhang von Homo-
sexualitat und Zwitterdiise). Steinach (E.), Kaisl. Akad.
der Wissensechft. (Vienna), 1919, No. 38.

The author observed that when crossed testicular implanta-
tion was done there frequently occurred in man an induced
homosexuality which was usually but not always permanent. In
animals, however, this perversion of sex was periodic and now
one type would become evident and then the other.—B. A. H.

(GONADS) Histological properties of the generative glands in
human homosexuals (Histologische Beschaffenheit der Keim-
driise bei homosexuallen Mannern). Steinach (E.), Kaisl.
Akad. der Wissenschft. (Vienna), 1919, No. 39.

This is a report of a study of the testicles of six men who
were homosexual, the material in the majority of cases being
obtained at autopsy. There was found evidence of degenerative
changes regardless of age, a restricted number of the semini-
ferous canals, the aspect as a whole resembling that of the eryp-
torchie testicles. There were present large cells, having abun-
dant protoplasm, a clear nucleus, and some chromatin, resem-
bling corpus luteum cells.—B. A. H.

(GONADS THYROID HYPOPHYSIS) Dwarfism (Uber
Zwergewuchs). Sternberg, Miinch. med. Wehnsechr. (Mu-
nich), 1920, 67, 59.

Although many cases of dwarfism are of hypophyseal
origin there are cases that are caused by diseases of the gonads
or the thyroid. The author examined post-mortem a tubercular
dwarf of 17 years in whom no secondary sexual characteristics
had developed. The testicles were atrophie and the hypophysis
small but apparently normal in structure.—J. K.

HORMONES and hormone therapy. Caldwell (J. E.), J. Flor-
ida M. Ass. (Jacksonville), 1916, 3, 161-165.

A general discussion of the topic.—R. G. H.

268 ABSTRACTS

(HYPOPHYSIS) Histamine and pituitary extract. Abel
(J. J.) and Macht (D.I1.), J. Phar. & Exp. Therap. (Balt.),
1919, 14, 279-293.

Abel and Macht report that the uteri of both mice and
euinea pigs respond readily to small and comparable doses of
both pituitary extract and histamine salts, the uterus of the
euinea pig being the more sensitive to minute doses. Both tracts
of plain muscle are easily paralyzed by concentrated doses of
pituitary extract and of histamine salts.—F. F.

(HYPOPHYSIS) The decomposition of the oxytocic principle
of pituitary solution. Adams (H.S8.), J. Biol. Chem. (Balt.),
1917, 30, 235-242.

An extended study of the effect of heating on the sta-
bility of the uterine-contracting factor in pituitary extracts
brought out the fact that this constituent is rapidly destroyed
at the temperature of boiling water when the H-ion concentra-
tion of the solution is of the order of 10°. The rate of destruc-
tion indicates that a single substance is being destroyed and
that the valuation of pituitary solution by the isolated uterus
method consists in the measurement of a single substance. There
is no evidence that this does not constitute an adequate measure
of the clinical oxytocic value. It is possible, however, that the
substance measured may not be concerned in the characteristic
pressor effect of pituitary solution. Oxygen does not seem to
be concerned in this destruction of the active principle which
apparently is determined by the H-ion concentration since in
an Nx10° concentration there is no destruction at the tempera-
ture of boiling water.—F. 8. H.

HYPOPHYSIS surgery (Chirurgia ipofisaria). Aievoli (E.),
La Riforma Medica (Naples), 1919, 35, 1080.

The article is a review of the surgery of the hypophysis
with special reference to the endonasal and the transsphenoidal
methods of approach, especially the method of Hirsch.—G. V.

(HYPOPHYSIS) Entotic aural bruit, audible on oscultation of
the head, due to a tumor of the pituitary region. Alexander
(L. D.), Ann. Otol., Rhinol. & Laryngol. (St. Louis), 1916,
25, 735-737.

A ease report, the salient features of which are indicated
in the caption. The patient had diplopia and contracted visual
fields. The diagnosis of hypophyseal tumor was supported by
the appearance in the roentgenogram of an enlarged and prob-
ably eroded sella turcica.—R. G. H.

ABSTRACTS 269

(HYPOPHYSIS) Le diabéte insipide et son origine hypo-
' physaire. Anon., Presse Méd. (Paris), 1919, 27, 746-747.

A review of some of the literature of recent years em-
phasizing the value of hypophyseal extract in the treatment of
diabetes insipidus.—R. G. H.

(HYPOPHYSIS) Some observations on the action of pituitary
extract. Bandler (S. W.), Med. Ree. (N. Y.), 1916, 89, 300.

The various uses to which pituitary extract is put are dis-
eussed. The author has found the drug of value in stimulating
intestinal peristalsis in post-operative cases in which symptoms
simulating intestinal paresis are found and as an aid to moving
the bowels with catharties or by enemata. In eases of atonic
bladder, the use of the catheter is said to be preferable. Cases
of menorrhagia in young girls, in which currettage and other
surgical procedures are not advisable for any reason, are often
relieved by repeated administration of the posterior lobe ex-
tract. In addition to its ordinary use in obstetrics, it is employed
with great advantage by the author to prevent excessive bleed-
ing and to facilitate closing the uterine incision wound in
caesarian section.—I. M.

(HYPOPHYSIS) A case of acromegaly. Barr (H. W.), N. Y.
Med. J., 1920, 111, 248-250.

Report of a case of acromegaly in a middle grade imbecilie
male who died of hemorrhages from a neoplasm of the upper
respiratory tract.—H. W.

(HYPOPHYSIS) Deficiency of the pituitary body. Barrett
(Lady), Lancet (Lond.), 1919, (1), 465.

The patient, a girl of 19, had primary amenorrhoea, and
on examination was found to have a very small, undeveloped
uterus. She had no thyroid deficiency, and was well developed
except in the size of the skull. The circumference was 19 inches,
the occipito-frontal measurement, 614 inches and the transverse,
5 inches. A skiagram showed a very small pituitary fossa, with
the anterior part especially underveloped.——L. G. K.

(HYPOPHYSIS) Posterior lobe of the pituitary body and its
use in obstetrics. Bear (J.), Virginia M. Semi-month. (Rich-
mond), 1917, 22, 65.

A brief description of the anatomy and function of the
hypophysis is given, followed by a statement as to the use of
extract of the posterior lobe in therapeutics and conditions in
which it is contraindicated. Nothing new.—I. M.

270 ABSTRACTS

(HYPOPHYSIS) Giant formation in larynx accompanying
hypophyseal trouble. Beck (Joseph C.), Ann. Otol., Rhinol
& Laryngol. (St. Louis), 1916, 25, 790.

A brief case report of acromegaly in a man of 65. He had
hemianopsia and the x-ray plate indicated destruction of the
sella turcica. The ‘‘giant formation’’ referred to was a neo-
plastic mass in the larynx. It appeared to be due to hypertrophy
of the mucosa. It was regarded by the author as a manifesta-
tion of an acromegalic tendency.—R. G. H.

(HYPOPHYSIS) The therapeutic future of the anterior lobe
of the pituitary gland (L’avenir du lobe anterieur de la
glande pituitaire en therapeutique). Barnard (A.), Rev.
Internat. de med. et de chir. (Paris), 1917, 28, 80-83.

A review of the results obtained in testing the properties
of the active principle of the anterior lobe of the hypophysis and
a prophecy that such extracts will be used in promoting growth
at certain periods, in stimulating epidermal growth of wounds
and in the treatment of exopthalmic goitre and epilepsy.

(HYPOPHYSIS) Acute suppurative hypophysitis as a compli-
cation of purulent sphenoidal sinusitis. Boggs (T. R.) and
Winternitz (M. C.), Johns Hopk. Hosp. Rep. (Balt.), 1919,
18, 56-61.

So far as the authors were able to learn, this is the first
ease of acute inflammation localized in the hypophysis that has
been recorded. A white woman of 48 complained of intense
stiffness and soreness of the neck muscles, headache, pain back
of the eyes and tenderness over the scalp. She had been robust
and active but had had every month dysmenorrhea accompanied
by severe frontal headaches. She developed fever and contin-
uing headache and finally coma. At the time of her death her
temperature was 108.5°. Autopsy was performed shortly after
death. The most striking conditions found are indicated in the
caption of the article. The hypophysis was removed with dif-
fieulty on account of marked friability and extensive red
granulations obscuring its demareations. The anterior lobe was
large and its engorged blood vessels contained numerous
leucocytes. The cells at the periphery were not infrequently
separated from their basement membrane. An infarct occupy-
ing from 1/6 to 1/2 of the anterior lobe area was found. The
pars intermedia appeared to contain colloid in normal amount,
but the cells were not well preserved. Large portions of the
posterior lobe were necrotic. In the pancreas the Langerhans
islands were made out with difficulty. The adrenals appeared

ABSTRACTS 271

to be normal. The condition of other endocrine organs was not
reported. That there may have been other endocrine disturb-
ances, however, is indicated by the fact that both hyperegly-
cemia and glycosuria were observed in the symptomatology.

—R. G. H.

(HYPOPHYSIS) Club fingers as acromegalic manifestations
(Ueber Trommelschlagelfinger als akromegalische Verande-
rungen). Braum (L.), Med. Klin. (Berl.), 1918, 14, 3-37;
Abst., La Pediatria, 1920, —, 101.

These fingers are found whenever there are long lasting
lesions of the lungs; the osteoartropathy of P. Marie shows the
same symptoms, but referable to osseous. formation, while the
lung eases, where other acromegalic symptoms co-exist, can be
referred to a hypophyseal dysfunction, secondary to the lung
trouble.—G. V.

(HYPOPHYSIS) The development of the glandular portion of
the human hypophysis (Sullo sviluppo della porzione ghian-
dolare dell’ipofisi nell’ uomo). Bruni (A. C.), Arch. Ital.
Anat. e Embryol. (Firenze), 1917, 15, 139-192.

The hypophysis is deseribed in embryos of 7, 11, 14, 15, 16,
17, 20, and 28 mm. It arises from four parts of the pharyngo-
oral epithelium (ectoderm and entoderm), namely, the anterior
eavity of Woerdeman, the pouch of Rathke, the median diverti-
eulum and the pouch of Seessel. These four regions together
form the pharyngo-hypophyseal diverticulum from which the
elandular portion of the hypophysis arises. This ultimately
forms the intermediate lobe and the principal lobe which is sub-
divided into the body, the chiasmatic lobule and the medial and
lateral processes. The pharyngo-hypophyseal diverticulum also
forms the pharyngeal, (vestigeal) hypophysis. It is now rather
generally believed that the entoderm (Bruni to the contrary)

does not enter into the formation of the human hypopbhysis.
Hh. R. Hy,

(HYPOPHYSIS) Dystrophia adiposogenitalis of hypophyseal
origin (Distrofia adiposo-genital hipofisaria). Casas (A.),
La Semana Medica (Buenos Aires), 1919, —, 728.

A typical case is reported. On surgical interference a
slioma of the pituitary was found. Pluriglandular therapy
gave some slight degree of relief —B. A. H.

HYPOPHYSIS, Two cases of tumor of the—with acromegalic
syndrome treated with X-rays (Due casi di tumore dell ipofisi

212 ABSTRACTS

con sindrome acromegalica, curati con i raggi X). Cavaz-
zeni-Bergamo (8.), La Riforma Mediea, 1920, —, 162.

Two cases are reported, a man and a woman; both had de-
pressed vision, hemianopsia, headaches, vertigo, acromegalic
facies and physical and psychic weakness. The sella turcica was
enlarged in both eases. With X-ray treatments both were very
much benefited as regards vision and physical strength. The A.
employed Beclere’s method,—deep radiotherapy through the two
temporal and frontal regions, first every week, later less fre-
quently.—G. V.

(HYPOPHYSIS) The hypophysis cerebri of the California
ground-squirrel Citellus beechii (Richardson). Cooper
(H. J.), Am. J. Anat. (Phila.), 1919, 26, 185-208.

The cytology of the gland indicates to the author that the
various cells in the glandular part of the hypophysis represent
different stages of the same type of cell, as has been reported
previously by other authors.—E. R. H.

(HYPOPHYSIS) Diabetes insipidus and its hypophyseal origin
(Il diabete inspido e la sua origine ipofisaria). Costagli,
Rivista critica di Clin. Med. (Firenze), 1919, 20, 571.

Costagli subscribes to the causative effect, in diabetes in-
sipidus, of lesions of the hypophysis and to the benefit secured
by hypophyseal treatment. The mechanism of the syndrome, he
believes, however, has not yet been demonstrated. Camus and
Roussy found that after removal of the hypophysis in dogs,
pituitary treatment did not improve the syndrome of diabetes
insipidus and it was inferred that the essential factor might be
a lesion of the adjacent zone of the brain. No proof has yet
been offered. In the author’s opinion, pituitrin constitutes a
genuine hormone. It is possible that merely by reducing the
size of the hypophysis it seems to improve conditions brought
about by compression. In this connection, it is known that
lumbar puncture can temporarily diminish the polyuria.

—G. V.

(HYPOPHYSIS) Histamine and pituitary extract. Cow
(Douglas), J. Pharm. & Exp. Therap. (Balt.), 1919, 14, 275-
277.

Cow found that while pituitary extract greatly stimulated
the mouse uterus, histamine produced paralysis. These observa-
tions led him to conclude that histamine and the plain-musele-
stimulating principle of the posterior lobe are not identical.

—F. F.

ABSTRACTS 273

_(HYPOPHYSIS) Some observations on the active principles of
the pituitary gland. Dudley (H. W.), J. Pharm. & Exp.
Therap. (Balt.), 1919, 14, 295-312.

By extraction of powdered, desiccated, fat-free posterior
lobes of the pituitary body with acidulated water, treatment of
the solution with collodial ferric hydro-oxide and subsequent
continuous extraction’ of the filtrate with butyl alcohol at re-
duced pressure and final evaporation of the alcohol, Dudley ob-
tained a crystalline residue containing all the uterine stimulant
of the posterior lobe together with some of the pressor principle
and impurities (‘‘contaminating substances’’) such as amino
acids, ete. The comparison between the behavior of this residue
and of histamine toward solubility in butyl aleohol and chloro-
form, alkalies, and tryptic hydrolysis leads the author to con-
clude that the uterine stimulant of the posterior lobe and his-
tamine are not identical, but are two distinct chemical sub-
stances. No description of the erystals or analytical data to
establish their constitution, are furnished.—F. F.

(HYPOPHYSIS) Concerning the U. S. P. standard for pitui-
tary extract (Liquor Hypophysis). Eeckler (C. R.), Am. J.
Pharm. (Phila.), 1917, 89, 195-202.

A general description of the writer’s method of testing the
strength of liquor hypophysis and a plea for the raising of the
U. S. P. requirement so that it will coincide with the strength
of the ordinary commercial product, which he usually found to
be ten times as strong as the U. 8. P. standard.—F. 8. H.

(HYPOPHYSIS) Influence of pituitary extracts on the genital
tract. Frank (R. T.), J. Am. M. Assn. (Chgo.), 1919, 73, 1764.

Six litters of three weeks’ old white rats, were fed for 35
days with extracts of anterior lobe of the pituitary gland. At
necropsy all animals showed increase in size or weight or in the
genital organs. Certain rats, some of them the controls, showed
ereater increase in weight, the presence of corpora lutea in the
ovaries and enlargement of the internal genitals. However,
Frank does not believe this growth was due tu the pituitary
feeding and believes that more extended experimentation is
necessary before the extracts of anterior lobe of pituitary gland
can be used with assurance of efficacy.—F. C. P.

(HYPOPHYSIS THYROID) Metastatic deposits in the pitui-
tary body from carcinoma of the thyroid, causing bilateral
opthalmoplegia. Haman (C. A.), Cleveland Med. J., 1916,
a0, 220-220.

274 ABSTRACTS

A report of a case diagnosed as pituitary lesion because of
corneal anesthesia, opthalmopiegia and hemianopsia accompany-
ing carcinoma of the thyroid. At autopsy the sella turcica was
found to be filled with a tumor mass seemingly continuous with,
and inseparable from, the pituitary body. Histologically, the
growth was a cuboidal-celled carcinoma. There were no other
metastases in the cranial cavity —F. S. H.

(HYPOPHYSIS) Multiple hemangiomas of the skin associated
with dyspituitarism. Head (G. D.), Arch. Int. Med. (Chgo.),
1917, 20, 24-31.

An extensive report accompanied by color photographs of
two cases of multiple hemangiomas of the skin associated with
clinical manifestations of pituitary gland changes. In ease 1,
the skin of the scrotum, penis, inside of the thighs, arms, back
and abdomen was affected. In case 2, the skin of the scrotum
and the mucous membranes of the lips and mouth were in-
volved.—F. 8. H.

HYPOPHYSIS substance, Treatment of amenorrhea with—
(Wber die Verwendung von Hypophysensubstanzen bei der
Behandlung der Amennorrhoe). Hofstitter (R.), Zentralbl
f. Gynaek. (Leipzig), 1920, 44, 68.

rood results are here reported from the administration of
pituitary preparations in cases of amenorrhea accompanied by
uterine and ovarian hypoplasia.—J. K.

(HYPOPHYSIS) Functional diagnosis of polyglandular dis-
ease in acromegaly and other disturbances of the hypophysis.
Howard (C. P.), Am. J. Med. Soe. (Phila.), 1919, 158, 830-
839.

A brief summary of three cases of acromegaly, two cases
of dystrophia adiposo-genitalis, and one of brain tumor with
flattening of the pituitary body from increased intracranial
pressure. The author reports in detail the results of tests for
sugar tolerance, conjunctival and subeutaneous adrenalin tests
and conjunctival and subcutaneous pituitrin tests. He con-
cludes that a secondary hyperpituitarism may result from a
greatly increased or rapidly increasing intracranial pressure;
that a decrease in sugar tolerance in the presence of other
symptoms of pituitary disturbance justifies a diagnosis of in-
creased activity of the pars intermedia; the conjunctival adre-
nalin test may be of positive value in certain cases of dyspitui-
tarism in demonstrating hypofunetion of the chromaffin system ;
the subcutaneous adrenalin test is of doubtful value in both
normal and pathological cases; the conjuntival and subeutaneous

ABSTRACTS 275

pituitrin tests are of doubtful value in studying the functional
activity of the hypophysis. The internal administration of
pituitary extraet, either the whole gland or the anterior or the
posterior lobes, appears to exert no definite influence.—F. C. P.

(HYPOPHYSIS) Roentgen-ray treatment of pituitary tumors
(Contribution nouvelle a la radiothérapie des tumeurs hypo-
physaires).. Jaugeas (M.), Journal de Radiologie et d’Elec-
trologie (Paris), 1919, 3, 508-516.

The death of Jaugeas was reported recently. He said in
this article that the action of the roentgen rays can be esti-
mated with greater precision in the effect on a tumor in the
hypophysis region than in any other field of application of deep
irradiation. The changes in the visual field parallel the benefit
otherwise, and form a gage for the efficacy of the treatment. He
describes a case of tumor in the pituitary with acromegaly in a
woman of 25. The history of the case is shown by the charts
of the field of vision at one and two-year intervals, the visual
acuteness finally approximating normal. Similar findings in
another case rayed in 1914 show that the benefit has been per-
manent, so that the term ‘‘cure’’ is not out of place applied to
such cases. The visual acuity is even better now, five years
later, than when the patient was first dismissed. The acrome-
galy has not retrogressed, but it was arrested. Roentgen-ray
treatment in these cases has to be applied early, when symptoms
of hyperactivity become manifest, before the elements of the
gland are destroyed. The raying must be cautious, to refrain
from destroying the functional elements, as otherwise symptoms
of deficiency would follow, analogous to experiences with the
thyroid. The pulse in exophthalmie goiter and the visual field
with pituitary tumors should be the guide to treatment. It
should be suspended when these findings enter a stationary
phase. It can be resumed if headache and impairment of vision
indicate a new ‘‘poussée évolutive.’’ The exposures should thus
be given and suspended according to the individual findings
from week to week, without any arbitrary regularity.

—J. Am. M. Assn.

(HYPOPHYSIS) The pharmacology of drugs used in parturi-
tion (Die Pharmakologie der Wehenmittel). Joachimoglu
(G.), Monatsehr. f. Geburtsh. u. Gynik. (Berlin), 1919, 50,
453-460.

A review of the pharmacology of the various preparations
used in parturition.—F. 8. H.

(HYPOPHYSIS) Clinical and surgical remarks on tumors of
the hypophysis (Consideraciones clinico-quirirgicas sobre

276 ABSTRACTS

tumores de la hipofisis). Jorge (J. M.) and Natale (A.),
Comm. del Hosp. oftalmél. (Buenos Aires), 1919, 2, 45.

Six clinieal reports of tumors of the hypophysis, three of
which were operated upon with improvement of the sight. Re-
lapse occurred in one case.—B. A. H.

HYPOPHYSIS, On the pathogenesis of acromegaly and the
relation between this disease and anomaly of the—. Kamo
(K.), Bull. Nav. Med. Assn. (Tokyo), 1916, No. 13, 6-8.

A case of typical acromegaly investigated pathologically is
described. An adenomatous tumor, consisting chiefly of peculiar
eosinophilic cells which differ morphologically from the normal
eosinophiles of the hyhophysis, is described in connection with
a small pit. The latter corresponds to the remains of the em-
bryological canalis craniopharyngeus. The author believes that
the tumor had sprung from the germs of the hyhophysis, re-
maining with the canalis rest, and that acromegaly is due to
hyperfunction of the special eosinophilic cells. The intact
normal testicles in this case contradict the hypogenital theory
of the development of hypophyseal adenoma as the cause of
acromegaly.—l. M.

(HYPOPHYSIS ADRENAL) The pathogenesis of deficiency
disease. II. The effects of deprivation of ‘‘B’’ accessory food
factors. McCarrison (Robert), Indian J. Med Res. (Cal-
eutta), 1919, 6, 550-556.

Food-deficiency experiments were carried out on pigeons
in which the ‘‘B’’ factor only was withdrawn: The diet con--
sisted of autoclaved rice plus butter and onions. It was found
that the morbid state resulting from deprivation of this class
of food resembled very closely that resulting from complete
vitamine starvation but was less often associated with oedema.
Unmilled rice, like butter and onions, appears to contain some
factor which tends to prevent the onset of edema. Avian beri-
beri seems to depend upon the absence of two food factors: (a)
the so-called antineuritie factor, and, (b) the anti-edema factor.
The brain, the adrenals and the hyhophysis are very sensitive
to vitamine influences in the food. These increase, whereas most
of the other organs diminish in size.—I. M.

(HYPOPHYSIS TESTES) Akromegalie kombiniert mit Dia-
betes. -Machwitz, Miinchener med. Wehnschr., 1920,67, 198.

Report of a man of 46 years; his acromegaly began when
he was 22. Gradually symptoms of diabetes developed; glyco-
suria showed some relation to the amount of carbohydrates in

ABSTRACTS 217

the food. There developed marked atrophy of the gonads. The
patient has a son of 18 years with acromegaly.—J. ral

(HYPOPHYSIS) Pituitary extract in obstetrics and other
cases. Measham (J. E.), Univ. Durham Coll. Gaz. (New-
castle), 1916-17, 17, 42-44.

Fourteen cases are reported in which the use of pituitrin
was followed by gratifying results. These included post-par-
tum hemorrhage, uterine inertia and delayed retraction of the
uterus. In a man pituitrin was used after a hemorrhoid oper-
ation to avoid the necessity of painful catheterization. Free
micturition was established. Similar results occurred after an
operation for anal fissure, followed by atony of the-bladder. In
another case a gun-shot lesion of the spinal cord was followed
by atony of the bowel, leading to stubborn constipation. This
was promptly and completely relieved by pituitrin. In a sec-
ond, less severe case, pituitrin proved useless. In nine cases of
collapse following trauma, saline solution containing 1 ce. of
pituitrin to the pint was administered intravenously. The
author was convinced that the restorative effect was materially
greater than could have been expected from the saline solution
alone.—R. G. H

(HYPOPHYSIS) Cure of hypophyseal form of congenital lues
by combined antisyphilitic and organotherapeutic treatment
[Ueber Heilung der hypophysaren Form der Lues congenita
(Lues congenita pituitaria) durch kombinierte antisyphili-
tische und Organ-Therapie]. Nonne (M.), Neurol. Centralbl.
(Leipzig), 1918, 37, 194-197.

Nonne reports a case of a boy of 16 years with infantil-
ism, physical and psychic, and with feminism and polyuria.
The treatment with mercury and iodides and hypophysin tablets
produced development of the genitalia and pubie hair and
checked the polyuria.—G. V

(HYPOPHYSIS) Zur Lehre vom Diabetes insipidus. Oehme,
Med. Klin. (Berl.), 1918, 14, 749; Berl. klin. Wehnschr, 1918,
55, 798; Deutsche Med. Wehnschr. (Berl.), 1918, 44, 1037.

See Endocrin. 2, 496.
HYPOPHYSIS, A case of sarcoma in the region of the—. Owen
(S. A.), West. Lond. M. J. (London), 1916, 21, 138-140.

A ease of sarcoma of the hyphophysis cerebri with post-
mortem findings is reported.—I. M.

278 ABSTRACTS

(HYPOPHYSIS) A case of dwarfism of Paltauf’s type
(Dwerggroli van Paltauf). de Monchy (l. B.), Nederl.
Tijdschr. vy. Geneesk. (Haarlem), 1920, 64 (i), 605.

A case is reported the symptoms of which are the opposite of
acromegaly, the parts usually exhibiting the acromegalic en-
largement being small in this form of dwarfism. The injection
of 0.1 mgm. of adrenalin caused glycosuria. The disorder is at-
tributed to a probable diminution of hypophyseal function.

—J.K.

(HYPOPHYSIS) The development of the hypophysis cerebri
pre-oral gut, and related structures in the Marsupialia.
Parker (K. M.), J. Anat. (Lond.), 1917, 51, 181.

Several species are described. The notochord does not aid
in the formation of the hypophysis. In most cases Seessel’s pouch
degenerates early, but in some it forms a small part of the hypo-
physis. Rathke’s pouch develops from ectoderm. It grows up
over the entoderm of the oral cavity and comes to lie under the
diencephalon where it gives rise to the glandular part of the hy-
pophysis in contact with the neural lobe. The glandular portion
is subdivided into pars juxtaneuralis and pars distalis or ante-
rior. The former is again subdivided into a pars tuberalis sur-
rounding the stalk and a pars infundibularis in contact with
the neural lobe and, separated from the rest of the glandular por-
tion of the hypophysis by the lumen.

The histological differentiation of the anterior lobe occurred
in the later stages studied (9 to 13 mm.) where there were seen
chromophobice and chromophilic cells. These both develop from
ectoderm and not one from entoderm and the other from ecto-
dern as claimed by Miller.

The pars neuralis is formed by a simple down-pouching in
the floor of the diencephalon.—H. R. H.

(HYPOPHYSIS) Hypophyseal adiposity in children (Kinder
mit hypophysérer Adipositas). Peritz, Miinch. med.
Wehnschr. (Munich), 1920, 67, 141.

It is the opinion of the author that many cases of hypophy-
seal adiposity in children are caused by a syphilitic hydro-
cephalus. An increase in the blood sugar can always be demon-
strated. —J. K.

(HYPOPHYSIS) Diagnosis of pituitary tumor. Potts (J. B.),
Nebraska M. J. (Omaha), 1916, 1, 52-54.

A brief article discussing the physiology and functional

pathology of the hypophysis and reporting four cases in which
the gland was surgically removed.—R. G. H.

ABSTRACTS 279

(HYPOPHYSIS) Raynaud’s disease (Rainaudsche Krankheit).
Pribram, Deutsche med. Wehnschr. (Berlin), 1920, 46, 87;
Miinech. med, Wehnschr. (Vienna), 1920, 67, 27.

A case report of a classical example of Raynaud’s disease
accompanied by no evidence of acromegaly but showing an en-
larged sella turcica on X-ray examination.—J. K.

(HYPOPHYSIS) Hypophyseal dwarfism (Uber hypophysarem
Zwergwuchs). Priesel, Miinch. med. Wehnschr. (Munich),
1920, 67, 59.

There are two forms of hypophyseal dwarfism, the primor-
dial form in which the individual is subnormal at birth and de-
velops symmetrically, though remaining a dwarf, and the in-
fantile form in which the birth size is normal as is the growth
during the first years. In this latter form, however, the growth
becomes retarded between the fifth and fifteenth years. The case
reported is one of a dwarf of 90 years with an ‘‘abnormal”’
neurohypophysis and sphenoidal sinus.—J. K.

(HYPOPHYSIS THYMUS) Diabetes insipidus. Richter (G.),
J. Missouri Med. Assn. (St. Louis), 1916, 13, 308-313.

An interesting report of a case of diabetes insipidus in a
girl of fourteen, presenting general adiposity, well developed
breasts, and a persistent thymus. Her character was infantile
though not stupid, and she was subject to attacks similar to petit-
mal. The X-ray examination showed no enlargement of the
sella turcica. Her urine elimination amounted to about a gallon
in 24 hours. Experimentally she showed a sugar tolerance of
over 400 gms. The author concludes that the case is one of
diabetes insipidus due to hypopituitarism.—F. S. H.

(HYPOPHYSIS) The influence of tethelin and of other alcohol
soluble extractives from the anterior lobe of the pituitary
body, upon the growth of carcinomata in rats. Robertson
(T. B.) and Burnett (T. C.), J. Exper. Med. (N. Y.), 1916,
23, 631-639.

The results of these experiments are best summarized in
the author’s own words: ‘‘The hypodermic administration of
tethelin increased markedly the rate of growth of the primary
tumor and the tendency to form metasteses in rats inoculated
with carcinoma in this, as in other respects, reproducing the
alcohol soluble extractives of the anterior lobe of the pituitary
action of the whole anterior lobe of the pituitary body. Other
body, with the exception of the lecithin fraction, exert no appre-
ciable effect upon the growth of carcinomata in rats. The leci-

280 ABSTRACTS

thin fraction, as in previously reported experiments in which we
employed lecithin obtained from eggs, causes evident retarda-
tion of the growth of carcinomata in rats.’’—F. §. H.

(HYPOPHYSIS) Dystrophia adiposo-genitalis durch hoch-
gradige Hypoplasia und Atrophie der Hypophyse. Rossle,
Naturwiss. med. Gesellsch. (Jena), 1916, —, —. (Abstract
-in Folia neuro-biol. (Haarlem), 1918, 11, 570.) (Wolffens-
perger).

A man of 27 who had been weak since childhood and who

died following an operation for ‘‘coxa vara,’’ was autopsied. The

data obtained were: body-leneth 1.62, body-weight 50 ke., adi-
posity, hypoplasia of the thyreoid (11 em.), thymus (3 om.),
adrenals (5 9m.) and especially of the hypophy sis which was
separate from the infundibulum. After fixation the hypophysis
weighed only 180 mgm. Microscopically there were found in the
hypophysis a small posterior lobe and a cystic anterior lobe, but
no stalk. The testes were the size of those of a 3 year old child.

The other genital organs were much under-developed.

Another man of 68 had a large tumor in the region of the
hypophysis, and at autopsy no hypophysis could be found. The
tumor was a pure psammoma. The body form was that of a fat
female, the adrenals and thyreoid were of normal weight, but
the testes weighed only 8 gm. and the other genital organs were
small. The seminiferous tubules were degenerated and there
was no growth of interstitial cells —E. R. H.

(HYPOPHYSIS) Present status of the definite treatment of
the pneumonias. Solis Cohen (8.), J. Am. M. Assn. (Chgo.),
1919, 73, 1741-1743.

Solis Cohen advocates the use of posterior pituitary lobe ex-
tract to sustain blood pressure and prevent gastro-enterie paraly- —
sis. Pituitrin should be given in 1 ec. doses at 3 hour intervals
until the systolic blood pressure in mm. of Hg exceeds by five
points or more the pulse rate per minute.—F. C. P.

(HYPOPHYSIS GONADS) A case of traumatic hypophyseal
adiposity (Ein Fall von traummatischer hypophysarer
Fettsucht). Schiinemann, Miinchener med. Wehnschr., 1920,
67, 198.

After a fall from a carriage the patient developed an enor-
mous adiposity. Glucose in 200 gram doses failed to cause glu-
cosuria, as did also injections of ‘adr enalin. The testes and the
prostate were atrophic. There was noted polyphagia, polydip-
sia and polyuria.—J. K.

ABSTRACTS 281

(HYPOPHYSIS THYROID) Acromegaly and goiter (Acro-
megaly et goitre). Sicard and Roger, Marseille med., 1917,
53, 381.

A ease is described in which goitre and typical acromegaly
(enlarged, protruding lower jaw, enlarged extremities, etc.) oc-
curred simultaneously in a man 49 years of age, who had lived
in the Basses-Alpes where goitre occurs so fr equently. Exami-
nation showed the presence of a large indurated thyroid and the
sella turcica was shown by radiography to be greatly enlarged.
The only symptom complained of was lumbar pain. There was
no glycosuria and no ocular disturbances were found. The cere-
brospinal fluid showed only an insignificant increase in globu-
lin.—I. M.

HYPOPHYSIS, Report of a case of congenital syphilis of the—.
Simonds (J. P.), Tr. Chicago Path. Soe., 1915-18, 10, 30-34.

Simonds was able to find recorded in the literature only ten
previous cases of congenital syphilis of the hypophysis. In his
ease the examination of the new born child showed diffuse pro-
liferation of the connective tissue throughout the hypophysis.
This was mostly perivascular. The cells of the anterior lobe
were mostly of the ‘‘chromophobe’’ variety. The mid-cleft was
large, dilated and contained masses of large cells with pale and,
in some cases mutinuclear nuclei. In case of the adrenals, a de-
formity was present which, so far as could be determined, had
not previously been recorded. The right and left glands were
united across the mid-line. They were slightly hemorrhagic but
otherwise apparently normal. Some degree of connective tissue
proliferation was observed also in the thyroid and parathyroid
elands and in the testes. No colloid was present in the thyroid.
The islands of Langerhans in the pancreas were frequently also
invaded by fibrosis.—R. G. H.

(HYPOPHYSIS) Standardization of pituitary extracts.
Spaeth (R. A.), U. S. P. H. Hygienic Lab. Bull. 115 (Wash-
ington), 1918.

Several theoretical and practical objections are advanced
against the use of beta-iminazolylethylamine hydrochloride as a
standard for assaying pituitary extracts of unknown strength.
The theoretical and “practical advantages of using potassium
chloride to produce qualitative effects upon the isolated virgin
guinea pig uierus, which are comparable to the effects of pitui-
tary extracts, have-been studied. It is suggested that a Locke
solution epntaining 0.14 per cent KCl in place of the normal
0.042 per cent 1.Cl be employed as a new standard for determin-
ing the physiological activity of pituitary solutions of unknown

282 ABSTRACTS

strength. Seven commercial pituitary preparations have been
comparatively studied. Variations between the strongest and
weakest solutions have been found to be in the ratio of 5:1. No
positive correlation has been found between the relative acidity
of the commercial preparations and their physiological activity.
It is suggested that in order to maintain their physiological po-
tency commercial pituitary preparations should contain
hydrogen ion in a concentration of the order N10 (Ph=3).
In order to make the proposed new standard conform as far as
possible with the present U. S. P. LX recommendation, it is sug-
gested that the effect of commercial pituitary extracts in a con-
centration of 1:4,000 should be equal to the effect of the potas-
sium standard solution when the isolated uterus of a virgin
guinea pig is used as a test organ.—Author’s abst.

(HYPOPHYSIS) Zur Organotherapie bei Diabetes insipidus.
Strauss (H.), Therapie der Gegenwart, 1916, —, —. Ab-
stract by Lubowski in Fol. neuro-biol. (Haarlem), 1917, 10,
477.

This author decreased the output of urine by one-fourth and
raised the specific gravity, by treatment with ‘‘Pituglandol’’
(post. lobe extract). ‘‘Glandulen’’ (anterior lobe) had no effect
on diabetes insipidus, but in true diabetes there was some sug-
gestion that it tended to decrease glycemia.—E. R. H.

HYPOPHYSIS and THYROIDECTOMY (Hypophyse und
Thyreoidektomie). Trautmann (A.), Frankf. Ztsch. f.
Pathol. (Wiesbaden), 1916, 18, 173-304.

This lengthy communication contains an almost exhaustive
summary of the literature concerned with the problem inyesti-
gated. Complete and detailed protocols are given of the macro-
scopic and microscopic changes occurring as the result of thy-
roidectomy, particular reference being made to a study of the
hypophysis, in all a total of 30 goats being used for the purposes
of the investigation. It was found that in goats, the removal of
the thyroid gland resulted in marked alterations in all of the
three parts of the pituitary gland. A complete extract of the
work is impossible because of its length and detail; it deserves
direct study by those particularly interested. The main conclu-
sion to be drawn is that there exists an inner physiological rela-
tionship between the hypophysis and the thyroid. The complete
or partial elimination of the thyroid function causes an actual
pathological alteration in the properties of the blood which acts
in a harmful manner on the different parts of the pituitary. The
alterations that occur are mainly of a degenerative type. There
was no evidence produced supporting the idea that the hypophy-

ABSTRACTS 283

sis might serve vicariously for the thyroid. The author is of the
opinion that none of the parts of the pituitary should be con-
sidered as insignificant in function, but that they should all be
looked upon as integral and necessary parts of a whole.—
Lape ee s ©

(HYPOPHYSIS) Roentgen-ray treatment of case of early
acromegaly. Webster (J. H. D.), Arch. Radiol. and Electro-
therapy (Lond.), 1920, 24, 261-264.

In acromegaly, roentgen-ray treatment at present rests al-
most entirely on a theoretic basis. Webster contends that it
should be eminently a disease suitable for roentgen-therapy,
especially in its early stages, when the anterior lobe of the pitui-
tary would show merely a simple chromophil hyperplasia, and
before secondary tumor-like formation, local pressure damage,
and much skeletal change has been produced. In his case so
treated the disease had been of almost four years’ duration. She
had sixteen treatments with hard filtered rays from temporal
and frontotemporal areas, the first eleven at weekly intervals,
then fortnightly, latterly at monthly or longer periods. The
effect was remarkable. The severe headache was rapidly relieved,
and soon entirely disappeared. The ‘‘queer feelings’’ almost
entirely left her: from two or three weekly they dropped to about
one amonth. The irritability and depression almost completely
left her. She lost about seven pounds in weight. The most strik-
ing changes were in the eyes; the optic dises returned practically
to the normal, while the fields of vision (especially for red)
greatly enlarged. The right eye still presented some irregular
contraction, chiefly inferior temporal. Apart from one or two
bromid powders there was no treatment beyond irradiation. The
patient was lost sight of for nearly two years; her condition,
subjectively and objectively, had become aggravated again. She
was then operated on successfully by the nasosphenoidal route.

—J. Am. M. Assn.

INFANTILISM (Infantilismo genuino). Bufalini (Emilio),
Riv. eritica di clin. med, 1919, 20, 517.

Bufalini reports a case of true infantilism, which does not
show any connection with the different forms of endocrine in-
fantilisms. He advances the hypothesis that in such cases there
might be an inherited, latent morphologic dystrophy, a congeni-
tal lack of developmental tendency. A complete arrest of devel-
opment may result whenever there appears an intervening (tox-
ico-infective) cause of dystrophy.—G. V.

The glands of INTERNAL SECRETION (Las glandulas de
secrecion internas). Crispin (A. M.), Rev. del Cireulo med.

284 ABSTRACTS

y Centro Estudiantes de Med. (Buenos Aires), 1919, 19,
1204-1209.

A general discussion containing no new points of interest.
—B. A. H.

INTERNAL SECRETIONS, The significance of the doctrine
of—and their utilization for gynecological practice (Die
Bedeutung der Lehre von der inneren Sekretion und ihre
Nutzanwendung fiir die praktische Gynakologie). Fehling
(H.), Monatschr. f. Geburtsch. u. Gynak. (Berlin), 1919, 50,
143-162.

A polemical discussion of Aschner’s book and of such a
nature as not to be satisfactorily abstracted.—F. 8S. H.

(LYMPH GLANDS AUTONOMIC N. §.) Sistema linfatico y
sistema nervioso vegetativo. Estudios experimentales acerca
de la funcién hormonopoiética de los ganglios linfaticos.
Noévoa Santos (R.), El Eco de Santiago, 1919, pp. 37.

The author has investigated the possibility that the symp-
tomatology of status thymo-lymphaticus may be due in whole or
in part to the action of hormone factors originating in the lym-
phatie gland tissues. The investigation follows the general line
developed by Eppinger and Hess in their well known studies of
‘*Vagotonia and Sympathicotonia.’’ As criteria of overactivity
of the parasympathetic system are considered: Dilatation of
the pupils, relaxation of the bladder, dilatation of the heart and
stomach, tachycardia, vascular hypotension, glycosuria and
hypochlorhydria. The pertinent literature is discussed at some
leneth,—ineluding the evidence adduced by Vincent and others
pointing toward a lack of specificity of extracts of such tissues
as those of the lymphatic glands (See Endocrin. 2, 421).

The observations are recorded that in 599 cases of infants
and children giving evidence of status lymphaticus, the ecardio-
ocular reflex was usually positive, indicating hypertonic condi-
tion of the vagus. The injection of extracts of lymphoid tissue
provoked in human subjects a lymphocytosis as well as lowered
blood pressure and diminished frequency of the pulse. A simi-
lar hypotensive effect was noted in dogs and rabbits. In the
frog’s eve a marked mydriasis was produced. These effects are
antagonistic to those of adrenin. Similarly, the glycosurie effect
of adrenin was depressed by lymphoid extracts. (The experi-
ments were apparently not controlled by the use of indifferent
organ extracts.) The final conclusion was that the lymphatic
eland cells elaborate a specific substance with pharmacodynamic
influence precisely the opposite to that of adrenin and corre-
spondingly related to the parasympathetic system as is adrenin
to the sympathetic —R. G. H.

ABSTRACTS 285

MYASTHENIA (Over myasthenie). Schermers (D.), Medisch
Weekblad (Amsterdam), 1920, 26, 566-577

A general review. The author does not believe that there
exist any relations between this disease and the endocrine or-
gans.—J. K.

The MYOMETRIAL endocrine GLAND in the uterus of the
pregnant rat (Glande myométriale dans l’utérus de la rate
gestante). Weill (Paul), C. R. Soc. de Biol. (Paris), 1919,
82, 1433-14385.

Aneel and Bouin have found in the uterus of pregnant rab-
bits ‘‘myometrial cells’? which in structure resemble an endo-
erine gland. Frankel has confirmed these observations. Weill
gives a histological description of similar cells found in the uter-
ine wall of pregnant white rats. The capillary vessels at the
site of the placenta are surrounded by a great number of large
cells filled with granules, clearly acidophilic, with the nucleus
displaced toward the periphery. Weill thinks this mass of cells,
which forms a true perivascular gland, must have a well deter-
mined function, but it is impossible to elucidate it at present.

—T. C. B.

(ORGANOTHERAPY) Indications for internal gland therapy.
Timme (W.), N. Y. Med. J., 1920, 111, 226-229.

The tissue manifestations of endocrine disturbances are
manifold, hence we have come to regard some of these tissue
changes as fairly pathognomonie of certain states. In the large
proportion of cases showing characteristic evidence of disturb-
ances, there are also evidences of compensation, hence not all
are suitable for glandular therapy. Terminal types, such as
Addison’s .disease, exophthalmie goiter and others, are largely
beyond the reach of treatment. However, such conditions as
fatigability, headache, structural abnormalities, gonadal and
secondary sex changes and vasomotor and neurological disturb-
ances yield readily to organotherapy. The necessity of detect-
ing beginning endocrine disturbances and treating them is
graphically emphasized.—H. W.

(ORGANOTHERAPY) Urological problems. Vecki (Victor
G.), Cal. State J. Med. (San Francisco), 1917, 15, 495. (Dec.),
Reprint, pp. 7.

In the course of a general address the author remarks that
after a very unfortunate history, organotherapy is gradually
being re-established in the esteem of the medical profession. To
the genito-urinary specialist endocrine advancement is particv-

286 ABSTRACTS

larly significant. Many eases of so-called sexual neurasthenia
intractable to local treatment will yield rapidly to judicious use
of thyroid or pituitary preparations, but careful discrimination
in regard to the preparation itself, in regard to the various indi-
cations and in regard to dosage are indispensable conditions of
success. Thyroid medication is frequently indicated in enuresis.
In any case the patient should be carefully watched and gland
medication controlled by blood-pressure studies.—R. G. H.

(MUSCULAR DYSTROPHY) Biological study of a case of
progressive myopathy (Recherches biologiques sur un cas de
myopathie progressive). Adraid (Ch) and Binet (Leon),
Arch med. exp. d’anat. pathol. (Paris), 1919, 28, 549-562.

A rather complete study of a case of progressive muscular
dystrophy giving no evidence of any disturbance in the fune-
tions of the endocrine glands.—F. S. H.

OSTEOMALACIA, Two cases of— (Zwei Falle von Osteo-
malazie). Edelmann (M.), Wiener klin. Wehnsehr., 1919,
32, 82.

No new data. Disturbed function of the endocrine system
plays an important part in the etiology of such cases. Adrenalin
therapy has a good effect.—J. K.

(OSTEOMALACIA), Undernourishment and disease of the
bones in Munich (Hungerknochenerkrankungen in Miinchen).
Heyer, Minch. med. Wehnsehr. (Munich), 1920, 67, 98.

A study of nine cases of osteomalacia in which nothing new
is reported.—J. K.

(OSTEOMALACIA) Uber Osteomalazie. Striimpell, Miinch.
med. Wehnschr., 1919, 66, 1304.

Ke

A general review without new facts.

(OVARY) Uterine contractions and ovarian extract. Barry
(D. T.), J. Physiol. (Lond.), 1916, 50, 259-264.

Barry studied the effects of ovarian extract on the contrac-
tions of the pregnant uterus in three cats at about the middle of
pregnancy. The extract was given intravenously in some cases,
locally in others. It was found that the normal contractions
were increased in both frequency and force in all cases and that
the increase in tone persisted for a comparatively lone period.
Increasing the pressure within the sac was found to increase the
tendency to contraction, whereas decreasing the tension dimin-
ished it appreciably.—l. M.

ABSTRACTS 287

(OVARY) Resume of a series of cases of ectopic gestation and
ruptured graffian follicles. Brooks (C. D.) and Clinton (W.
R.), J. Michigan State M. Soc., 1920, 19, 22-23.

There are many cases of rupture in ectopic pregnancy with-
out a history of missed menstrual period and in many eases there
is a history of normal amount, scanty flow and ‘‘spotting.’’
Along with the characteristic symptoms of rupture there is pain
in the rectum and referred pains down the thigh on the affected

side.—H. W.

(OVARY) Sulla struttura dell’ovario nei Teleostei. De Castro
(E.), Arch. ital. Anat. e Embryol. (Firenze), 1918, 16, 1.

A eytological study of fish eggs and one of endocrine inter-
est.—E. R. H.

(OVARY ENDOCRINE ORGANS) Genital findings in de-
mentia praecox and physiological observations on genital
infantilism (Der Genitalbefund bei, Dementia Praecox nebst
physiologischen Betrachtungen uber den Infantilismus geni-
talium). Fraenkel (L.), Monatschr. f. Geburtsh. u. Gynik.
(Berlin), 1919, 50, 433-440.

The studies of I*. on cases of dementia praecox occurring in
women have given a new proof of the endocrine nature of this
disorder and show the presence of a marked hyperfunction of
the ovary. Two explanations are possible: either the basis of
the disease is general ‘‘infantilismus, praecipue cerebri et ovari-
orum,’’ or the disease is founded on a pathological property or
function of the glands of internal secretion accompanied by a
marked hypofunction of the sexual glands.—F. 8. H.

(OVARY) Innere Sekretion des Eierstocks. von Franqué (0.),
Biol. Zentrabl. (Leipzig), 1919, 39, 193. -

A review of the German literature on the subject with espe-
cial reference to the work of Steinach. No new data are added.
E. R. H.

(OVARY) Hydatidiform mole associated with pernicious
vomiting. Geist (S. H.), Trans. N. Y. Obs. Soc., Am. J. Obs.
(N. Y.), 1919, 80, 215-216.

Report of a case of pernicious vomiting associated with a
uterine fibroid. The uterus was the size of that of a four months’
pregnancy. No luteal cysts were present in the ovaries.—H. W.

bo

88 ABSTRACTS

(OVARY THYROID) An explanation of the action of iodine in
dysmenorrhea (Versuch einer Erklarung des Weges der Jod-
wirkung bei Dysmenorrhoe). Grumme, Berl. klin. Wehn-
schr., 1919, 56, 1188.

It is pointed out that there is a well established relationship
between the thyroid and the ovaries and that the administration
of iodine in dysmenorrhea would act on the thyroid and the
improved function of this gland would then influence the ovaries.

—J. K.

OVARIES, Sterilization by roentgen exposures of the—.
Guillermin (R.), Revue Médical de la Suisse Romande
(Geneva), 1919, 39, 326-336.

Guillermin declares that exposures to the roentgen rays
form the simplest and least harmful means for arresting ovarian
functioning in women with pulmonary tuberculosis. Even men-
struation may have a decidedly unfavorable action on tubereu-
losis, including congestion and whipping up hemoptysis, so that
there is every reason to suspend the functioning of the ovaries
in such eases, to say nothing of the menace from a pregnancy.
Bezanzon long ago called attention to ‘‘these tuberculous women
killed by their menstrual periods.’’ In two cases he suppressed
menstruation by fourteen and by four exposures. In the first
case the menopause was complete; in the other there was merely
arrest of menstruation, but this put an end to the monthly per-
iods of fever and the recurring congestion, and this patient soon
considered herself completely cured. The condition of the lungs
in the other case also has materially improved.—J. Am. M. Assn.,
1920, 74, 426.

(OVARY CORPUS LUTEUM) The relation between the corpus
luteum and menstruation (Uber das Verhalten des corpus
luteum zur Menstruation). Labhardt (A.), Zentralbl. f.
Gynak. (Leipzig), 1920, 44, 185.

The changes in the mucous membrane of the uterus before
menstruation depend upon the corpus lutem. At the time the
function of the corpus luteum ceases, menstruation begins. The
ovary has no influence whatever on the intensity of menstrua-
tion. Seitz has prepared from the corpus luteum a substance
which he called lipamine. Probably this, according to the au-
thor, is the hormone of the corpus luteum. It is possible that
some abnormalities of the mucous membrane of the uterus de-
pend upon the ovary; for instance menorrhagia may be caused
by the ovary. When, however, the uterus is normal the ovary
never has an influence on menstruation.—J. K.

ABSTRACTS 289

(OVARY) Nervous and mental disturbance after ovariectomy.
Mendoza M (R.), Revista de Psiquiatria (Lima), 1919, 2,
97-107.

Mendoza summarizes nine cases in which artificial meno-
pause induced unusually severe nervous disturbances and change
in character. No benefit was realized from organotherapy in most
of the women. In the most refractory cases an element of hys-
teria or neurasthenia was manifest. One woman of 40 had at-
tacks of unconsciousness, besides the usual phenomena of the
menopause; no benefit was obtained from ovarian treatment, but
under ergot for a time conditions gradually returned to normal.
Headache, insomnia, neuralgias and pain in the lumbar region

were common.—J. Am. Assn., 74, 430.
E

(OVARY) The maturation of the human ovum. Thompson
(A.), J. Anat. (London), 1919, 53, 172.

The specimens were obtained from the ovaries of women
who died suddenly or were accidentally killed, and not subjected
to prolonged illness. This is the first time that the maturation
stages of the human egg have ever been published. The human
egg is shown by the author to be ovoid in shape about 0.11 x 0.95
x 0.10 mm. The zona pellucida is but loosely held to the corona
radiata and hence easily separated at ovulation, There seems
to be a true vitelline membrane, and a perivitelline space. The
first and second polar bodies are both expelled within the ovary
and the former undergoes division. Contrary to the rule for
vertebrates in general, the human egg, then, is fully mature be-
fore the spermatozoa encounter it. There is evidence to show
that the polar bodies are not really polar in position. It could.
not be determined whether or not the two polar bodies are
extruded from the same point.—E. R. H.

(OVARY) ‘Three cases of reappearance of ovarian peritoneal
sacculation. Reynolds (E.), J. Anat. (London), 1916, 50, 308.

A morphological discussion of the relation of the ovary to
its endometrium in vertebrates in general and three human
cases in particular, in which it was found that the ovary lay
within a definite sac in the broad ligament corresponding to the
condition existing normally in many of the lower animals. These
are evidently cases of degressive mutation (de Vries).—E. R. H.

(OVARY) Embryology of coccids with especial reference to
the formation of the ovary, origin and differentiation of the
germ cells, germ layers, rudiments of the mid-gut and the
intracellular symbiotic organisms. Shinji (G. O.), J. Morph.
(Phila.), 1919, 33, —.

Of technical interest.—E. R. H.

290 ABSTRACTS

(PANCREAS) War and Diabetes (Krieg und Diabetes). Albu,
Minch. med. Wehnschr., 1917, 64, 422; Berl. klin. Wehnschr.,
1917, 54, 470.

The diabetics form but one per cent of the sick list of inter-
nal medical wards, more than half of which patients had been
previously shown to be diabetic. The tolerance lost by exposure
and continued field diet was usually quickly restored under hygi-
enic dietary regulation. Albu considers that a tolerance of 100
ge. of glucose is sufficiently high for acceptance for military serv-
ice.—F. 8. H.

(PANCREAS) Principles and possibilities in the dietetic treat-
ment of diabetes. Allen (F. M.), Wisconsin Med. J. (Mil-
waukee), 1917, 16, 231-239.

Diabetes mellitus is defined as a disturbance in metabolism
in which there is an inability on the part of the body to assimi-
late all classes of food. The author’s principle of treatment is
then stated, followed by a consideration of its practical applica-
tion. The methods of recognizing diabetes and of determining
its severity and progress are outlined, emphasis being laid upon
the value of blood sugar determinations from time to time. Man-
agement of the cases with various complications such as meta-
bole disturbances and infections is outlined. In the case of
coma, the author places the patient under fasting, if coma comes —
on while a diet is being given, and gives a diet if the patient is
fasting at the time it appears. Diabetics with tuberculosis are
given the fasting treatment like others, often with improvement
in both conditions. To prevent starvation in these patients,
-when some food must be given, protein is superior to other food
elements. In all cases after the urine is sugar-free the diet is
gradually built up by giving on the first day 10 grams of carbo-
hydrate, with gradual addition of 10 gms. for each successive
day until the limit of tolerance is reached and the blood sugar
kept within normal limits. Mild cases are not necessarily treated
like the more severe but require some restriction and careful
watching. The author does not claim the treatment to be cura-
tive but palliative—I. M.

(PANCREAS) Diabetes mellitus. Blodgett (S. H.), Boston
M. & S. J., 1919, 181, 422-427.
No new data.—H. W.
(PANCREAS) Acidosis in diabetes mellitus; its significance

and treatment. Bridges (W. O.), Med. Herald (St. Joseph),
1916, n.s. 35, 40-44.

A general, brief discussion of the subject.—F. 8. H.

ABSTRACTS 291

(PANCREAS) A consideration of diabetes. Brooke (Banner
R.), Med. Sentinel (Portland, Ore.), 1916, 24, 3214-3218.

A readable discussion of the principles and methods of diag-
nosing and treating diabetes. Emphasis is laid upon the inade-
quaey of quantitative determinations of urinary sugar without
controlling the diet. A small quantity of sugar upon a restricted
diet might be much more significant than a large quantity upon
a carbohydrate-rich diet. It is recommended that the patient be
kept for three days upon a diet totaling 80 gms. of protein, 200
ems. of fat and 100 ems. of carbohydrate. A quantitative deter-
mination of urinary sugar can then be made and to a considerable
extent relied upon as indicating the degree of severity of the
disease. The value of quantitative ammonium determinations
as routine procedure in every day practice is lauded. These can
be made quickly and accurately without special equipment.
They afford a valuable criterion as to the rate of depletion of
the alkaline reserve, and may often give warning of impending
‘‘acidosis.’’ The formalin titration method of ammonium deter-
minations is described and recommended.—R. G. H.

(PANCREAS DIABETES) Edgar serum treatment of diabetes
mellitus. Edgar (T. W.), West. M. Times (Denver), 1920,
39, 299-302.

Edgar bases the justification of his serum treatment of dia-
betes mellitus upon the following: True diabetes mellitus is not
hereditary, but dietary, fostered through the medium of environ-
ment; Diabetic glycosuria is always preceded by a ‘‘preglycosu-
ria’’ stage characterized by intestinal stasis and toxemia which
may manifest itself either subjectively or objectively, this latter
being the predisposing cause of the symptoms; we are dealing
with a cycle of endocrine or pluriglandular events, and not spe-
cifically with pancreatic insufficiency ; pluriglandular therapy is
indicated and is of distinet benefit in all uncomplicated cases.
Three cases reported.—H. W.

(PANCREAS) The relation of glycogen to the pathologic
changes in pancreatic diabetes. Ervin (D. M.), J. Lab. and
Clin. Med. (St. Louis), 1919, 5, 146-153.

A theoretical deduction is offered that glycogen is greatly
diminished in the cells in pancreatic diabetes, based upon the
fact of the stabilizing power of glycogen in experimental emul-
sions. Glycogen is a stabilizing colloid in the cell and as such
prevents the breaking of the emulsion or fatty degeneration by
its resistance to acids, salts, etc. Glycogen is hydrolized. by
acids, and when hydrolized, there is left a protein-fat emulsion
that is but poorly resistant toward acids. In diabetes, no gly-

292 ABSTRACTS ;
ecogen is formed and the fat is only slightly emulsified, permit-
ting a high concentration of the fats or soaps to reach the cell
and a consequent lmited oxidation, with production of acetone
bodies. The equilibrium of glycogen with glucose is shifted
towards the glucose side by the presence of the hydrogen ion;
this is the explanation of the high blood sugar in fever, mercury
and phosphorus poisoning and nephritis.—B. T. 8.

(PANCREAS) Xanthoma diabetica (Zur Frage des diabeti-
schen Xanthoma). Fahr, Deutsche med. Wehnschr. (Berlin),
1919 45, 1373.

The diabetic xanthomas generally contain large quantities
of cholesterin, but in the case described only traces of this com-
pound were found, the mass consisting almost entirely of neutral
fat. The opinion is expressed that diabetic xanthoma is caused
by lpaemia with diminished lipolytic activity of the blood.

—J.K.

(PANCREAS DIABETES) A case of galloping diabetes in a
child of fifteen years (Un cas de diabetes a marche rapide
chez une enfant de quinze ans). Gautiere (P.) and Saloz
(C.), Arch. de med. des enf. (Paris), 1917, 20, 314-317.

An extensive report of a rapidly fatal case of diabetes
occurring in a child of 15 who gave a positive Wassermann reac-
tion. The striking facts were the rapid course of the disease,
which is exceptional in a child of this age; the short coma, lasting
hardly a day; the inefficiency of the intravenous administration
of sodium bicarbonate which had no action whatever on the
acetone bodies of the urine; the leucocytosis; the high sugar
content of the cerebro-spinal fluid; and, finally, the histological
normality of the liver and pancreas on misroscopic examination.

—F. 8. H.

(PANCREAS) Importance and interpretation of urinary
analyses in the diabetic (L’importance et 1’interpretation
des analyses des urines chez le diabetique). Gulpa, Bull. gen.
therap. (Paris), 1919, 170, 808-815.

A resume of the importance of, and reasons for, frequent
analyses of the urines of diabetics, illustrated by a single case
report.—F. 8. H.

(PANCREAS DIABETES) Retinal changes in glycosuria.
Hawthorne (C. O.), Opthalmoseope (Lond.), 1916, 14, 365-
367; Tr. Ophth. Soe. U. Kingdom (Lond.), 1916, 36, 338-344.

ABSTRACTS 293

A presentation of three summarized case-records of gly-
cosuria accompanied by retinitis and retinal hemorrhages; from
these it is argued that such phenomena may be utilized as a help
in the diagnosis of early diabetes.—F. S. H.

(PANCREAS) The starvation treatment and fasting cure in
diabetes (Hongerdagen en vastkuur bij diabetes). Hoogslag
(W.), Nederl. Tijdschrft. v. Geneesk. (Haarlem), 1919, 63
Gay 1770:

A report of excellent results in the Allen treatment of dia-
betes.—J. K.

(PANCREAS) Treatment of diabetes (De strijd tegen de
suikerziekte). Hoogslag (W.), Nederl. Tijdschr. v. Geneesk.
(Haarlem), 1920, 64, 295.

A recommendation of the Allen treatment, which is de-
scribed.—J. K.

(PANCREAS) The treatment of diabetes mellitus by alimen-
tary rest. Hume (J.), Practitioner (Lond.), 1916, 97, 430-
434; See also: Brit. M. J. (Lond.), 1916, (i), 587 and (ii)
160.

A theory is developed that diabetes is essentially an acid
autointoxication, the toxin originating from stasis or other ab-
normal conditions in the alimentary canal. This toxin formation
can be prevented by purging and fasting. Checking of the toxin
formation is regarded as the significant factor in the ‘‘ Allen’”’
treatment. Hume regards detailed metabolic studies and ‘‘calorie
feeding’’ as unnecessary refinements in the treatment of ordi-
nary diabetes.—R. G. H.

(PANCREAS) Diabetes mellitus in the Japanese, compared
with its occurrence in Europe and America (Le diabete sucré
““tono byd’’ chez les Japonaise et son étude comparative avec
le diabete observé en Europe et an Amerique, étude clinique
et expermentale). Iwai, (T.), Arch. de med. exper. (Paris),
1916-17, 27, 1-54.

It is a rare thing to find among the Japanese diabetes pre-
senting the fundamental symptoms of polydipsia, polyuria, and
emaciation; almost always the disease is found associated with
some other disorder. The malady is benign and rarely fatal.
The author is of the opinion that the Japanese have a higher
sugar tolerance than other races, and that this is presumably
a racial characteristic rather than a dietary one.—F. S. H.

294 ABSTRACTS

(PANCREAS) Protein-sparing by glucose in experimental dia-
betes. Janney (N. W.) and Isaacson (V. I.), Proce. Soc. Ex-
per. Biol. & Med. (N. Y.), 1917, 15, 69-70.

The surgical removal of about 90 per cent of the pancreas
of several dogs did not cause any diminution of the protein-
sparing action of glucose in any of the animals. It appears that
pancreatic tissue is provided far in excess of actual requirements
or that this gland is not solely responsible for the protein-spar-
ing action of carbohydrates.—F. 8. H. E
(PANCREAS) Glucose formation from protein in diabetes.

Janney (N. W.), Arch. Int. Med. (Chgo.), 1916, 18, 584-605 ;
Tr. Coll. Physicians (Phila.), 1916, 3.s., 38, 168-194; Med. Ree.
(N. Y.), 1916, 90, 346.

A series of pure isolated proteins was found to yield 48-
80% glucose when fed to a diabetic subject. Whether from
animal or vegetable sources made no apparent difference in the
yield. Beef, ‘rabbit, fish, chicken and egg, when similarly tested
yielded 36-48% glucose. For this reason Janney regards the
well known food tables of Van Noorden as inadequate as a guide
in framing diabetes dietaries, since no cognizance is taken of
such protein foods as sourees of sugar. Ege was found to be the
most satisfactory of the protein foods tested, since, weight for
weight, it yielded only about 1/6 as much sugar as did bread.
Various proprietary ‘diabetic foods’’ were found to be so high
in protein as to be quite unsuited for the use of diabetics. From
the foregoing data the conclusion is drawn that a mixed diet
rather low in protein is no more injurious than is the high pro-
tein and fat diet often prescribed and it has the advantage of
being more palatable.—R. G. H.

(PANCREAS) Diabetes, The causes of death in—. Joslin (E.
P.), Am. J. Med. Se. (Phila.), 1916, 151, 313-321.

The author believes that death following coma in diabetes
is avoidable and that all diabetics have a certain carhohydrate
tolerance which should be determined. Out of 475 deaths, 147
have been without coma and due to other causes than diabetes.
Death with coma was responsible for 273 cases and many of
these could have been forestalled by earlier treatment. Some
added burdens that should be prevented are: ether anesthesia,
impaired kidneys, infections, mental excitement, fat poisoning
and loss of body fluid. Salt should never be left out of even the
starvation treatment.—F. 8. C.

(PANCREAS) Effect of intravenous injection of pancreas
emulsion upon the hyperglycemia due to depancreatization.

ABSTRACTS 295

Kleiner (I. 8.), Scientific Proceedings, Am. Soe. biol. chem.
XIII. J. Biol Chem. (Baltimore), 1920, 41, xviii.

If fresh dog’s pancreas be hashed and mixed with three or
four times its weight of sterile distilled water, allowed to stand
in the refrigerator for from 1 to 20 hours and then strained
through muslin a solution is obtained which, when diluted with
five volumes of 0.9 per cent sodium chloride solution and injected
slowly into depancreatized dogs during the course of an hour,
causes a marked reduction in the blood sugar and a reduction
of the glycosuria . Reduced glycosuria was also produced by
similar injections with extracts of other organs but this was not
accompanied by reduction in the blood sugar.—F. 8. H.

(PANCREAS) War diet in diabetes (Kriegskost in Diabetes).
Falta (W.), Wiener klin. Wehnschr., 1919, 32, 398-400.
Elias (H.), and Singer (R.), (ibid., 503-4).

The author of the first paper has long held that reduction
in protein intake is an important factor in diet for diabetes. The
war has proved it. The second paper is the third of a series,
and is largely polemical against Falta.—Physiol. Abst. 4, 218.

(PANCREAS) Surgery in diabetics. Labbé (Marcel), Am. J.
Surg. (N. Y.), 1919, 33, 257-259.

The author outlines the results of his surgical experience
with diabetic subjects, discussing the special features of impor-
tance in this class of patients. These he considers under the fol-
lowing topical headings: (1) hyperglycemia, (2) acidosis, (3)
the anesthetic and (4) pre-operative and post-operative treat-
ment. He finds that in the less severe cases, various operations
may be performed with impunity, if proper precautions in tech-
nique and treatment are taken. He recommends pre-operative
anti-diabetic treatment to reduce hyperglycemia and acidosis and
favors the administration of bicarbonate of soda both before and
after operation to prevent the development of acidosis. Local
anesthesia with cocaine, if possible, or, if not, spinal anesthesia
is recommended. When general anesthesia is necessary ethyl
chloride is preferable to ether. Chloroform is to be avoided.

—I. M.

(PANCREAS) A preliminary report of a case of diabetes mel-
litus at the present time under treatment, with short review
of the recent literature. Larsson (B. Hjalmar), Detroit M.
d., 1916, 16, 163-165.

A modification of the Allen treatment was employed. In-
stead of maintaining absolute starvation, 800 calories was admin-
istered daily in the form of whiskey in black coffee.—R. G. H.

296 ABSTRACTS

(PANCREAS) The cause of pancreatic diabetes (Das Wesen
des Pancreasdiabetes). Lesser, Miinchener med. Wehnschr.,
1920, 67, 307.

When the surviving liver of a frog is fed with Praeger’s
solution and adrenalin is added, sugar for a short time is formed
in the liver. It might be thought that diastase is formed in the
liver, but this is not true, for the solution leaving the liver has
no increased amount of diastase. When, however, from a frog
the pancreas is removed and then the liver is brought into Ring-
er’s solution, addition of adrenaline causes the formation of dias-
tase. It is probable that in the normal liver there is a separation
of the glycogen and diastase. Removal of the pancreas brings
the glycogen and diastase together.—J. K.

(PANCREAS) The recognition and management of threaten-
ing diabetic coma. Levison (Louis A.), Ohio M. J. (Colum-
bus), 1916, 12, 11-17.

Greatest care should be taken to recognize the signs of
threatening diabetic coma. The usual symptoms of this are
somnolence, gastro-intestinal disturbances,—vomiting, diarrhea
or constipation,—inereased irritability and muscular cramps in
various parts of the body. Treatment should be begun early and
pushed vigorously. In severe eases not only should alkalis be
used, but also alcohol by mouth and rectum. Heart weakness
should be looked for and appropriately treated, since it may lead
to death from unexpected sources.—R. G. H.

(PANCREAS) The treatment of diabetes mellitus in children
and adolescents. Leyton (O.), The Practitioner (Lond.),
1919, 108, 370-380.

Diabetes mellitus is defined in some detail and means of
recognizing it and of measuring its severity are discussed. Meth-
ods of treatment and control of the disease are likewise outlined.
Infections, general anaesthesia and any other conditions that
will disturb the metabolic processes are strictly to be avoided in
diabetes. The Allen starvation treatment is strongly praised.
Children are said to do exceptionally well on it if removed from
sympathetic relatives and friends. After the urine is sugar-free
the tolerance for the carbohydrates, fats and proteins is sepa-
rately determined. The fact that intolerance for fat or protein
frequently gives rise to sugar in the urine more easily than does
carbohydrate food is pointed out. The optimum diet given to
the diabetic when sugar-free is two-thirds of the limit of carbo-
hydrate tolerance plus 2 gms. of protein per Kg. body weight
per diem, plus sufficient fat to make the energy of the diet equal
to 60 calories per Ke. body weight per 24 hours.—I. M.

ABSTRACTS 297

(PANCREAS) Uber Diabetes mellitus. Lichtwitz (L.), Ztschr.
f. arztliche Fortbildung (Jena), 1919, 16, 601.

A general discussion without new facts.—J. K.

(PANCREAS) Lowering of the freezing point of the blood in
diabetes (Blutgefrierpunkterniedrigung bei Diabetes mel-
litus). Lippmann (A.), Zentralbl. inn. Med. (Leipzig), 1920,
41, 41.

A number of patients having diabetes, though with normal
kidney function, showed a very marked depression of the freez-
ing point of the blood. This depression did not run parallel
with the amount of blood sugar and it is presumed that the blood
sugar is not the only substance that is increased in these cases.
There is evidence of the presence in the blood of diabetics of
other reducing substances, for the amount of glucose determined
by the reduction of Fehling’s solution is always higher than
when it is determined by other methods. In the author’s opinion
(as in that of Stepp) the increased glucose in the blood is accom-
panied by the occurrence of other substances.—J. K.

(PANCREAS PROSTATE) Diabetes and prostatectomy (Dia-
béte et prostatectomie). Loumeau, Gaz. hebd. de sc. med. de
Bordeaux, 1916, 37, 71-72.

A report of the nature and the effects of removal of the
prostate from a diabetic. Apparently both these prostatic dis-
order and the diabetes were cured. The author considers dia-
betes no contra-indication to surgical procedures under anesthe-
sia.—F. 8. H.

(PANCREAS) Diabetes treated by the Allen starvation
method, with report of seven cases. Love (Tracy R.), Colo-
rado Med. (Denver), 1916, 36, 205-209.

Of seven severe cases of glycosuria all showed marked im-
provement following Allen’s starvation treatment. Two cases
did not show sugar-free urine owing to complications, but the
treatment allowed the relief needed for operation. The author
believes that the amounts of acetone, diacetic acid and ammonia
in the urine are not a safe guide to the degree of acidosis, due
to the fact that the oxybutyrie acid is so combined with the tis-
sues that it is not liberated until cases are well advanced.—

Bes, C.

(PANCREAS DIABETES) Intermediary metabolism in dia-
betes. Lusk (G.), Trans. Coll. Phys. (Phila.), 1916, 38, 244-
248.

298 ABSTRACTS

A brief statement of the simpler chemical changes that the
carbohydrates may undergo during their metabolism in the tis-
Boole

sues.

(PANCREAS) A case of fatal diabetic coma without diacetic
or betaoxybutyric acid. McC askey (G. W.), J. Am. M. Assn.
(Chgo.), 1916, 66, 350-351.

A fairly typical case of diabetes ending in coma in a woman
of 53 is reported. The case is recorded as showing that coma
may develop in the absence of the acetone bodies mentioned and
as a warning that a negative Gerhardt reaction does not neces-
sarily exclude impending coma.—Rk. G. H.

(PANCREAS) Observations on the sugar of the blood and the
sugar in the urine in varying conditions of health in the Ben-
gali. McCay (D.), et al., Indian J. Med. Res. (Calcutta),
1919, 6, 485-507.

This is Section II of a paper describing the extensive studies
made by MeCay and his co-workers on the sugar of the blood
and urine. A general discussion of the relationship of the sugar
of the blood to that of the urine and the factors concerned in
regulating the excretion of sugar is entered into. The method
employed. was to determine the reducing power of the blood and
urine by a special method in normal individuals, in elycosuries
with normal kidneys and in individuals with nephritis. It was
found that the threshold stimulus of the kidney for sugar excre-
tion varies widely in different individuals and in the same per-
son under different circumstances. Glycosuries are met with in
whom: (1) the threshold is high—usually the condition seen in
the fat, over-fed classes; (2) the threshold is low—as in (a) the
later stages of the above; (b) those who have lost the power of
storing sugar, oxidizing it or of converting it into fat; (c) those
who present an excessive permeability of the kidney to sugar as
a result of oxaluria, gout, or stone. The limits of the normal
variations of the sugar of the urine of Bengalis are from 0.015
per cent to 0.15 per cent, the average being 0.065 per cent.

No parallelism or arithmetic proportions exist between the
concentration of the sugar of the blood and that of the urine in
any of the following conditions: (1) normal health, (2) agly-
cosuric diabetes, (3) varying degrees of glycosuria in different
individuals; (4) varying degrees of glycosuria in the same indi-
vidual. The ingestion of glucose is always followed by an in-
crease in the sugar of the urine, whether the sugar concentration
of the blood increases or not, i. e., in the healthy, potential dia-
betics, and diabetics. Kidney ,disease may prevent glycosuria
even when very marked hyperglycemia is present—up to 0.86
per cent.—l. M.

ABSTRACTS 299

(PANCREAS) Observations on sugar of the blood and the
sugar in the urine in varying conditions of health in the Ben-
gali. McCay (D.) et al., Indian J. Med. Res. (Calcutta),
1919, 6, 508-549.

The present is the third paper on this general subject by
McCay and his co-workers. Their studies consisted of observa-
tions on the onset and. progress of glycosuria with reference to
the cause of the prevalence of diabetes in India. A large num-
ber of the natives from the various classes were examined. The
authors believe that they have established the following points:
(1) The fat, flabby, indolent individual who is over-fed with
carbohydrates possesses a lower tolerance for carbohydrates than
the lean, energetic, hard-working individual. (2) In the pregly-
cosuric stage of diabetes, the fat and sugar of the blood are
much above normal and are both increased still more by the
ingestion of sugar. (3) As the ability of the tissues to convert
sugar into fat is gradually diminished, sugar begins to appear
in the urine and is found to increase as the fat content of the
blood decreases. (4) <A tendency to glycosuria occurs in nor-
mal persons when excessive amounts of sugar are ingested over
long periods, hence the difference in the normal and the diabetic
individuals is not a qualitative but a quantitative one. (5) The
obesity so common in the preglycosuric or early elycosuric is
associated with the hyperglycemia and is due to a physiological
storing-up of reserve material, the excess sugar of the blood
being synthesized into fat. (6) The subsequent wasting is prob-
ably pathological and may be explained as due to loss of the
power of the tissues to convert sugar into fat and the actual
breaking down of fat to furnish energy to the body. . (7) There
is a strong hereditary factor in diabetes. (8) The over-feeding
with carbohydrates is said to be sufficient in itself to account
for the onset of hyperglycemia, lipemia, obesity and glycosuria.
(9) Excessive carbohydrate also is thought to lessen the secre-
tion of the HCl of the gastric juice, which leads to gastrointesti-
nal inflammation. This inflammatory process is said to spread
in turn to the pancreas, causing a depression in the internal se-
cretion, which condition interferes with the oxidation of sugar.

—I. M.

(PANCREAS) Diabetic therapy. MacLeod (J. J. R.), J. Lab.
& Clin. Med. (St. Louis), 1916, 1, 780-781.

A general discussion. The points especially emphasized are
that fasting will lower acidosis either in health or diabetes if it
has the effect of stopping a one-sided metabolism and throwing
the tissues onto a more nearly balanced ration of fatty acids and
glucose. Other things being cqual, there is more danger of

300 ABSTRACTS

serious acidosis developing in fat than in lean diabetics.—
ReG. He

(PANCREAS) Diabetes mellitus. McMillan (D. W.), J. Flor-
ida M. Assn. (Jacksonville), 1916, 3, 238-242

A general discussion of the cause, prevention and treatment

of diabetes.—R. G. H.

(PANCREAS) Diabetes during the war (ttber den Diabetes im
Kriege). Magnus-Levy (A.), Deutsche med. Wehnschr.
(Berlin), 1919, 45, 1379; Berlin. klin. Wehnschr., 1919, 56,
1150.

In Germany in 1914 the number of deaths caused by dia-
betes was double that of 1900, while in 1919 the number of fatal
eases of this disease was the. same as in the year 1900. During
the war acidosis and diabetic coma were extremely rare, the
coma that did occur failing to show the classical Kussmaul respi-
ration. It is probable that under-feeding has played a part in
the diminished number of fatal cases of diabetes.—J. K.

(PANCREAS) Diabetes during the war (Uber Diabetes im
Kriege). Magnus-Levy, Miinch. med. Wehnschr., 1919, 66,
1303.

During the war the number of cases of diabetes has dimin-
ished in Germany. Coma diabeticum became very rare. It may
be a lesson to be careful with fat in the treatment of diabetes
since fat was very rare in Germany during the war.—J. K.

(PANCREAS) Diabetes mellitus. Mettam (A. E.) and Craig
(M. A.), J. Comp. Path. & Therap. (Edinburgh and London),
1916, 29, 1-26.

An interesting case of spontaneous diabetes in a dog is de-
scribed. The owner had noted the first evidence of disease three
months before. The animal was thin and ‘‘skraggy’’ and had
cataract. Appetite and thirst were normal. The sp. g. of the
urine was 1.050. Glucose was noted as varying from 4.8 to 10%.
The doe was killed and post-mortem examination made immedi-
ately. The blood plasma contained .39% glucose. The liver
cells gave a positive glycogen test. The pancreas appeared nor-
mal in the gross; but careful search, using a variety of technical
methods, failed to reveal any islands of Langerhans. The tech-
nique was controlled upon other pancreas material in which the
structures were readily demonstrated. The thyroid was appar-
ently normal. In the adrenals the cortex was somewhat hemor-
rhagic. Many of the medulary cells were vacuolated and showed

ABSTRACTS 301

appearances suggestive of colloid degeneration. The nervous
elements appeared normal. Many other details of the examina-
tion, not of endocrine interest, are omitted in this abstract.—

i. Ge H.

(PANCREAS) The treatment of diabetes mellitus. Mosenthal
(H. O.), J. Med. Soe. N. Jersey (Orange), 1916, 13, 339-355.

A valuable article for any one desiring a brief but compre-
hensive and readable discussion of the salient features of pres-
ent day management of diabetes. The article includes useful
food tables, diet and urine chart, methods of freeing the urine
from sugar and acids and quantitative tests for ‘‘acidosis.’’—
box Ge.

(PANCREAS) Urinary output of nitrogen, chlorine, calcium,
and magnesium in diabetes mellitus. Nelson (C. F.), Scien-
tifie Proceedings, Am. soc. biol. chem. XIII., J. Biol. Chem.
(Baltimore), 1920, 41, xiv.

Determinations of calcium, magnesium, and sodium chlo-
ride in nineteen eases of diabetes mellitus showed marked varia-
tions, as did the values obtained for the total nitrogen. In 26
per cent of the cases magnesium was excreted in larger amounts
than was calcium. Eleven determinations, made from 5 to 21
days after six of the cases had been rendered free from sugar m
the urine, showed a striking change in the urinary calcium mag-
nesium ratio, magnesium appearing in larger amounts than cal-
cium in 72 per cent of the determinations. The total nitrogen
in each of the latter cases was from 1 to 6 grams higher than in
the former.—F. 8. H.

(PANCREAS) Accessory pancreas (Over het accessoire pan-
creas. Nieuwenhuyse (P.), Nederl. Tijdschr. v. Geneesk.
(Haarlem), 1919, 63 (11), 2106.

During a post-mortem examination there was found a small
tumor in the stomach which proved to be an adenoma, the cen-
ter of which showed typical pancreas cells, but no islets of
Langerhans.—J. K.

(PANCREAS) Diabetesstudien. Petrén (K.), Arkiv for inre
medicin (Nord. Med. Arkiv, Avd. II), 1918, 51, 107-173.

Petrén records (in German) the results of a detailed study
of 21 cases of diabetes. The study was undertaken to learn the
conditions under which the carbohydrate tolerance could be aug-
mented and the degree of improvement that, by dietary control,
could be attained. The data on each ease are tabulated. It ap-

302 ABSTRA( ‘r NG

peared that the shorter the duration of the disease, the better
‘is the prognosis. The author agrees with Naunyn that those
cases only ean be regarded as mild in which glycosuria can be
overcome by the reduction of carbohydrate to 60 ems. of bread
a day. In any ease the diet should be adjusted, if possible, to
maintain an unbroken aglycosuric condition and. gradually to
build up tolerance. The age of the patient is regarded as the
most important factor in the determination of results, but the
data available did not permit any final conclusion as to the oper-
ation of this factor. The duration of treatment is also an im-
portant factor. By careful systematic attention to the diet it

yas found possible to increase the carbohydrate tolerance within
a few weeks from 33 to 118% and as much as 128% by longer
treatment. The improvement seemed to be progressive. The
higher the initial tolerance the greater was the possibility of
improvment. When the tolerance was 40 ems. at first, it could
be raised from 50 to 100 ems. higher. It is held that dieto-
therapy is indicated, not alone on account of symptomatic im-
provement but as rationally directed toward modifying the
underlying etiologic factors. For numerous details the original
should be consulted.—R. G. H.

(PANCREAS) The treatment of diabetes. Robin (A.), Monde
med. (Eng. Ed.) (Paris), 1916, 26, 129-146.

The author defines: four forms of diabetes and discusses the
effect of treatment in the various forms. The first type is the
true pancreatic diabetes not amenable to functional therapy, be-
ing benefited in but a few cases. The second form, hepatic or
hepatogenous diabetes, is that in which the soil is already pre-
pared by acquired or inherited arthritism and is precipitated by
overfeeding or nervous wear and tear. These cases are claimed
to be attenuated by treatment. The next type is the mild dia-
betes or gouty type, which is in most cases curable. Fourth in
the classification are the cases of grave or complicated diabetes
which call for special intervention and medication not admissi-
ble in ordinary diabetes. The necessity of educating the dia-
betice subject is pointed out. The habits of life with respect to
general hygiene, diet and exercise must be carefully supervised.
The various schools on dictary treatment are discussed and spe-
cific details as regards the various elements of the diabetic’s diet
are given. The diet is drawn up in each case on the basis of 30
calories per Ke. body weight per 24 hours as the minimum re-
quirement of the diabetic, and after determining the 24-hour
nitrogen output, to learn the nitrogen needs of the individual.
The results of hydrotherapeutie and special hygienic measures
and of various sorts of medication and electrotherapy are con-
sidered in some detail.—lI. M.

ABSTRACTS 303

(PANCREAS) Conservative treatment of diabetic gangrene;
two cases, patient. Sammis (G. Frank), Long Island M. J.
(Brooklyn), 1916, 10, 202-203.

Two brief case reports. Standard diabetic regime served
to conserve the resistance of the patients, so that successful re-
sults were obtained in gangrene of the feet by conservative oper-
ations.—R. G. H.

(PANCREAS) The clinical control of diabetes mellitus.
Schroeder, Henry, Lancet—Clin. (Cincinnati), 1916, 115,
102-108.

The nature of diabetes mellitus as a disease and the prob-
lems involved in its control are briefly outlined. The author
emphasizes the importance of studying the blood sugar as well
as the urinary sugar. The studies on eight cases of diabetes on
the starvation diet are tabulated; these show that hyperglycemia
very frequently persists long after the urine is sugar-free. The
conclusions drawn from pathologic and clinical observations are
that effective supervision of the patient with respect to diet and
general hygiene makes possible the raising of the sugar toler-
ance, whereas dietary abuses lead to a lowering of tolerance. The
paper is followed by discussion from other observers.—I. M.

(PANCREAS) Diabetic retinitis. Shafer (J. J.), Am. J. Surg.
(he vYs), 1918. 32; 67-68.

Four forms are deseribed. (1) Central punctuate retini-
tis: at the posterior pole of the fundus, especially in the macular
region, are found numerous ivory white points, spots and stripes
which surround the macula in an irregular manner. The spots
are round, oval, or irregular in outline; their margin may be
serrated. Some of them cover the small blood vessels, thus
showing that they are within the nerve fibre layer. Between
the white areas fine blood points, stripes or little spots may be
seen. (2) Hemorrhagic diabetic retinitis in four forms: (a)
fine punctiform hemorrhages; (b) larger hemorrhages which
may-enter the vitreous humor and produce localized bluish dim-
ness; (¢) sudden large hemorrhages (often with very little sugar
in the urine); (d) hemorrhagie glaucoma, with no hope of re-
covery. (3) Diabetic albuminuric retinitis: in addition to an
opaque and slightly swollen optic nerve-head and retina with
alterations of the blood vessels characteristic of albuminurie
retinitis, there are groups of white spots which are peculiar to
diabetic retinitis. (4) Albuminurie retinitis is wholly inde-
pendent of the coincident diabetic process.—L. G. K.

304 ABSTRACTS

(PANCREAS) The starvation treatment of diabetes mellitus.
Steiner (Walter R.), Proe. Connect. M. Soc. (New Haven),
1916, 124, 176-186.

The principles of starvation treatment are briefly explained
and the histories of eight cases of diabetes mellitus are reviewed
with special reference to the importance of this form of treat-
ment. Discussion of this paper with reports of other similar
eases by a number of other investigators is appended.—l. M.

(PANCREAS) The treatment of diabetes with special reference
to acidosis. Stilman (Edgar), Med. Ree. (N. Y.), 1916, 89,
390.

A very brief note on the principles of determining
: 9? 1
sis.’’—R. G. H.

‘

‘acido-

(PANCREAS) Prognosis and treatment of diabetes as infiu-
enced by recent studies. Strouse (Solomon), Illinois M. J.
(Chgo.), 1916, 30, 332-337.

A general discussion not amenable to abstracting.—R. G. H.

(PANCREAS) Diabetes in the young. Strouse (Solomon), Med.
Clin. (Chgo.), 1916, 2, 327-329.

Cases of diabetes mellitus in children are presented and dis-
cussed with special reference to the successful employment of
the Allen starvation treatment in the young. The author em-
phasizes the importance of careful supervision of the diet after
the patient leaves the hospital. A comparison of the results
obtained by modern methods of treatment in diabetes with those
of old shows marked improvement, making the prognosis in
children decidedly more hopeful. A case of typical renal gly-
cosuria is presented, with a warning against treating such cases
of lowered sugar tolerance as true diabetes mellitus.—I. M.

(PANCREAS) Inanition in the treatment of diabetes mellitus.
Strouse (Solomon), Med. Clin. (Chgo.), 1916-17, 2, 999-1006.

A brief historical review of various methods of treatment
employed in diabetes mellitus is given, followed by a short expo-
sition of the ‘‘Allen treatment.’’ The author does not fully
agree with Allen that the weight curve should be entirely neg-
lected for the urine chart. The general nutrition of the patient
must be carefully guarded.—I. M.

(PANCREAS) Syphilis as a cause of diabetes mellitus. Wil-
liams (J. R.), J. Am. M. Assn. (Chgo.), 1918, 70, 365-367.

ABSTRACTS 305

Careful clinical and laboratory examinations were made on
a large number of patients suffering from diabetes mellitus to
discover signs of syphilitic infection. Only 4 out of 143 cases
showed a positive Wassermann reaction, while the physical ex-
amination of 126 cases for lesions characteristic of syphilis did
not lend support to the view that the disease is a common causal
factor in diabetes. Literature corroborative of Williams’ con-
clusion on the subject is cited. The study, therefore, does not
support the view advanced by Warthin that syphilis is the chief
etiologic factor in the production of pancreatic diabetes. If it
proves anything it is that syphilis is rarely the provocative
agent.—lhL. G. K.

(PANCREAS) The treatment of diabetes mellitus. Williams
(John R.), Vermont Med. (Rutland, Vt.), 1916, 1, 341-348.

Following a general discussion of the topic Williams con-
eludes that liability to diabetes is undoubtedly transmissible
from parent to offspring. Infections have a very deletarious
influence on diabetes and should be sedulously guarded against.
Instruction of the patient is a major part of the treatment. Un-
less he understands the reason for procedures undertaken, and
is willing and able to co-operate, the treatment will fail. Inter-
current complications demand careful study; they may be more
serious than the diabetes. Difficult eases should be sent to insti-
tutions adequately equipped to make metabolic studies.

—R. G. H.

(PANCREAS) The dietetic treatment of diabetes mellitus.
Williamson (R. T.), Practitioner (Lond.), 1918, 100, 35-40.

Three different dicts are described which are said to check
elycosuria if restricted or rigid diabetic diets fail. Starvation
is advised only if all other methods have failed. Fast days,
once a week, are said to be of service. After the glycosuria has
been checked the diet is gradually changed, bacon, green vegeta-
bls and eggs being permitted. Later, diabetic bread or biscuits
are allowed. Salicylate of soda and acetyl-salicylic acid are
often of value when given in large enough doses, and should be
tried if the dietetic treatment fails—hL. G. K.

(PANCREAS) The dietetic treatment of diabetes. Worcester
(G. F.), N. Eng. Med. Gaz. (Boston), 1916, 51, 127-139.

The historical development of various forms of dietetic
treatment in diabetes mellitus is briefly reviewed with a consid-
eration of the present systematic methods. The importance of
early treatment is strongly emphasized.—lI. M.

306 ABSTRACTS

(PANCREAS) Ear affection and diabetes. Zimmerman
(Chas.), Ann. Otol. Rhinol. & Laryngol. (St. Louis), 1916, 25,
637-648.

The otologist is concerned with diabetes in that the lowered
resistance characteristic of the disease may aggravate several
of the conditions with which he has to deal. Furunculosis of
the auditory meatus is sometimes encountered while otitis media
and mastoiditis in diabetics are particularly hard to deal with.
The literature is reviewed and five cases illustrative of the rela-
tionship are deseribed.—R. G. H.

PARATHYROIDS, Transplantation of—in postoperative te-
tany (Epithelkorerverpfianzung bei postoperativer Tetanie).
Borchers (E.), Zntralbl. f. Chir. (Leipzig), 1919, 49, 907.

The author has described a case of post-operative tetany
perfectly cured by transplantation. The patient became preg-
nant; in the fourth week she complained of pains in arms and ~
legs and she lost a great part of her hair. In the fifth month
very severe attacks of tetany were seen and it was necessary to
produce abortion. This proves again what was already known
from experiments on animals, that during pregnancy the func-
tion of the parathyroids must be increased and that, when the
glands are not able to increase their function, tetany may occur.
This patient is of importance as Adler and Thaler proved that
animals without parathyroids never become pregnant. The au-
thor believes that in these cases of postoperative tetany, it is
better to add to the transplantation sterilization of the woman.
This patient was again restored to health after abortion. A sec-
ond case of successful transplantation in postoperative tetany
is also reported.—J. K.

(PARATHYROID THYROID) Considérations sur la paralysie
agitante. Gauthier (G.), Le Méd. Francais (Bourg-la-Reine),
1919, 12, 181-183:

The author regards Parkinson’s disease as due primarily to
disturbance of calcium metabolism which is regulated especially
by the action of the parathyroid glands. In 1902, struck by a
resemblance between paralysis agitans and Graves’ disease, Gau-
thier began treating his patients with a glycerine extract of the
thyroid-parathyroid glands. His success therewith ‘‘has been
incontestible.’’—R. G. H.

(PARATHYROID) Treatment of postoperation tetany (Zur
Therapie der postoperativen Tetanie). Haas (W.), Zentralbl.
f. Chir. (Leipzig), 1920, 47, 171.

ABSTRACTS 307

A ease is reported in which the author obtained good results
from the administration of tablets of parathyroids (up to 0.1
eram dried glands six times daily). In the literature are de-
scribed eases of postoperative tetany cured by thyroid prepara-
tions. Many theories are given to explain this result. Haas,
however, believes that such cases are instances of spontaneous
amelioration and that the administration of thyroid has no
effect whatever. During pregnancy, post-operative tetany is
very serious. In this connection a case is described in which,
during pregnancy, strumectomy had to be performed for steno-
sis. There was found a very marked hypertrophy of the para-
thyroids.—J. K.

(PARATHYROIDS) Treatment of postoperative tetany by
transplantation of parathyroids (Die Behandlung der post-
operativen Tetanie durch Epithelkorpertransplantation).
Landois (F.), Zentralbl. f. Chir. (Leipzig), 1920, 47, 74.

The results of animal experimentation and a clinical case
have led L. to the conclusion that in general postoperative para-
thyroid transplantation is unsuccessful in relef of postoperative
tetany unless the patient had previously shown no symptoms of
latent or manifest tetany. One case is reported in which the
implantation of three parathyroids gave but temporary relief,
the patient later dying of tetany.—J. K.

(PARATHYROID) Studies on the relation of the human para-
thyroid glands to the occurrence of calcium deposition in the
organism (Untersuchungen tber das Verhalten der Glandulae
parathyroideae des Menschen beim Vorhandensein von Kal-
kablagerungen im Organismus). Tomaszewski (Zdzislaus),
Frankfurt. Ztschr. f. Path. (Wiesbaden), 1918, 21, 38-56.

The post-mortem pathological findings made with a view to
studying the apparent histological changes evidencing activity
in the parathyroids. The occurrence of calcium depositions re-
sulted in the author’s classifying his subjects into three groups
according to the intensity of the glandular function indicated
in this manner.

In the first group were nine individuals in whom the histo-
logical picture of the glands showed the presence of all the ele-
ments commonly aseribed to an increased glandular functioning,
such as many oxyphil cells, follicles and colloid.

The second group, although showing the presence of some
activity by histological criteria, did not present a complete pic-
ture, there being usually omitted one or two of the factors going
to make up a unified and active composite. There were seven
subjects in this group.

308 ABSTRACTS

In the four members of the third group there was but little
evidence of glandular activity and if any had been present it
was of a low order. Many of the cases were complicated by the
demineralizing activities of tubercular processes, but notwith-
standing this, those cases presenting histological pictures of
heightened glandular activity also presented evidence of exten-
sive calcium deposition.—F. 8. H.

(PARATHYROID?) A case of osteomalacia and tetany (Hin
Fall von Hungerosteomalazie und Tetanie). Sauer (H.),
Deutsche med. Wehnschr. (Berlin), 1920, 46, 45.

Description of a case which in contradistinction to those fre-
quently observed in Vienna presented no pain when the bones
were subjected to pressure.—J. K.

(PARATHYROID?) Tetany in the eunuchoid: report of case.
Woltman (H. W.), J. Nerv. & Ment. Dis. (Phila.), 1919, 50,
433-447.

The history of tetany and its relation to the parathyroids is
briefly reviewed. The detailed case history may be summarized
as follows: A barber, aged 36, complaining of convulsions, pre-
sented himself for examination. His family history showed some
tendency toward endocrine disturbances. The patient had con-
vulsions for one year in infancy. He married at 29, but his
wife has never been pregnant. At 29 he noticed that his legs
became very easily tired. This grew progressively worse. At
33 he noted marked abdominal distension, at intervals of about
one week, lasting 45 minutes. One month later he noticed that
his legs ‘‘jerked up,’’ and he was able to walk only by stagger-
ing along on his toes. These spasms increased in frequency and
intensity. Six months later they were accompanied by ‘‘cramp-
ing of the jaw’’ and lasted 30 or 40 minutes. He improved
somewhat and was able to be about on crutches, but soon his
legs began to swell and he noted edema of the abdominal wall
and back and complained of burning pain in the legs. Soon
after this he was unconscious for three days, developed contract-
ures of the legs and some mental symptoms. The muscles were
atrophied, the skin dry and sealy, and, over the abdomen, coy-
ered with brown spots. The spasms diminished in intensity and
number, but any attempt to get up was followed by vomiting.

Physical examination. The hair was seen to be thin and
dry; there was hypotrichosis of body hair with female distribu-
tion over the pubis. The right testicle was very small, the left
absent (surgical removal). The voice was high pitched and
somewhat cracked. Palpation of the thyroid was uncertain.
The blood serum and-<spinal fluid Wassermann reaction was

ABSTRACTS 309

negative. Roentgenograms of the sella and the hands were
negative. There was slight pallor of the optic discs.

On compressing the left upper arm (testing for the Trous-
seau phenomenon) the fingers grew pale and cold and in one-
half minute passed into a tonic spasm. The spasm extended up
the arm and almost simultaneously appeared in the right arm,
muscles of the floor of the mouth, tongue, lips and, to some ex-
tent, in the legs. The jaw was fixed by a tonic spasm, inter-
rupted occasionally by painful clonic movements. The patient
was conscious and able to talk. The spasm was terminated after
65 minutes by a hypodermatic injection of 14 grain of morphine.
The spasm gradually disappeared, leaving the fingers last. About
two weeks later the spasms involved the throat muscles, and the
eye-balls were rotated upward until only the border of the cornea
was visible.

Medication (thyroid gland and calcium Jactate) produced
no results. Death occurred about one year later. The case re-
port is followed by an able discussion of the symptoms and their
individual frequency and a list of references to medical litera-
ture. :

The author states that it would seem justifiable to assume
that when there appears marked evidence of polyglandular par-
ticipation in which the disorder is not initiated by a disturbance
of the thyroid gland the prognosis is very grave. A distinct
heredofamilial tendency to glandular disturbance, especially
when associated with the psychoses or certain neurasthenic
states, renders the prognosis much more grave.—F. C. P.

PARATHYROID, Histological examination of—in a case of
chorea (Nuovo reperto istologico delle paratirodi in un case
di corea volgare). Zibordi (F.), Gazzetta degli Ospedali
(Milan), 1919, 40, 471.

In a case of goitre only two parathyroids were found and
these contained very few chromophil cells—J. K.

PINEAL innervation in teleosts (Zur Frage der Epiphysen-
Innervation bei Teleostei). Holmgren (N.), Fol. neuro biol.
(Haarlem), 1918, 11, 1.

A brief description of the nerves to the pineal body of var-
ious fishes.—E. R. H.

(PINEAL) Histology and embryology of the human pineal
(Histologische und embryologische Untersuchungen iiber die
Zirbeldriise des Menschen). Krabbe (K. G.), Anat. Hefte,
1916, 54, — (Abstract by Lubowski.in Fol. neuro-biol. (Haar-
lem), 1918, 11, 68.)

310 ABSTRACTS

The development of the pineal has already begun in the sec-
ond fetal month, at which time it consists of two parts: a fold in
the roof of the second vesicle and a cell mass anterior to this;
later, these two parts unite. During fetal life the original type
of cell differentiates into three forms from which the parenchy-
ma of the gland develops, during infaney and adolescence. These
cells are glial, neural, and parenchymatous, proper. <A descrip-
tion of them is included. Connective tissue follows the blood-ves-
sels. It contains mast cells, previously called acidophiles, pig-
ment cells and, in senile individuals, plasma cells. The latter
are present in children under certain pathological conditions,
such as progressive paralysis. Concretions are present at 6 years
and sometimes earlier. The pineal grows very little after child-
hood.

As to function the gland may be a sort of sense organ to
reculate the pressure of the ‘‘central process’’ or it may have
an internal secretion. The author states that, anatomically, it
looks more like a gland than a sense organ.—E. R. H.

(PINEAL) Effect of feeding the pineal body upon the develop-
ment of the albino rat. Sisson (W. R.) and Finney (J. M.
T.), J. Exp. Med. (N. Y.), 1920, 31, 335-346.

Pineal bodies of young calves were fed to albino rats of
three weeks of age for a period of three to six weeks. Fourteen
were fed powdered pineal body and ten were used for control.
About half of the treated animals remained slightly smaller than
the controls. The microscope revealed no differences in the
pineal bodies of the treated animals when compared with those
of the controls. The authors conclude that ‘‘feeding the desic-
cated pineal body of young calves to young albino rats fails to
produce any effect upon the development of these animals.”’

—B. T.S.

(PINEAL) Menstruatio precox. Volhard, Munch. med. Wehn-
sehr. (Munich), 1919, 66, 1502.

A short note concerning a girl of 8 with regular menstrua-
tion and adiposity, in whom, at the time of menstruation, eclamp-
tic-like seizures occurred. The diagnosis as given is a probable
teratoma of the pineal.—J. K.

(PLACENTA) The placenta as a birth-promoting organ (Die
Placenta als wehenforderndes Organ). Ludwig (F.),
Monatsehr. f. Geburtsh. u. Gynak. (Berlin), 1919, 50, 256-282.

In view of the interest taken in the endocrine aspects of the
placenta L. has made a study of the effect of placental extracts
on the contractability of the isolated intestinal segment of the

ABSTRACTS 311

rabbit and guinea-pig. He found that both fresh and boiled
extracts of the placenta caused contractions of such segments
from both types of animal. Moreover, the extract exerted a sim-
ilar type of stimulating effect on segments of a pregnant guinea-
pig uterus as well as on a bit of human fallopian tube. How-
ever, liver extract and pituitary extract gave similar responses,
but apparently not to the same extent. On the basis of these
experiments he concludes that there must exist in the placenta a
specific substance initiating and faciliatating parturition. It is
the opinion of the abstractor that the evidence for this conelu-
sion is insecure, first, because of the fact that the published
curves fail to show any marked difference in action between the
placental extracts and those obtained from the liver and pitui-
tary, and in the second place, since it is distinctly stated that
the extract of a freshly delivered placenta is completely inactive,
the active extracts having been obtained from the _ so-called
‘*yipe’’ material.—F. S. H.

(PROSTATE) Action of extracts of hypertrophied prostate on
the bladder (Action des extraits de prostate hypertrophiée
sur la vessie). DuBois (Ch.) and Boulet (L.), C. R. Soe. de
Biol. (Paris), 1919, 82, 1054-1055.

The intravenous injection of extracts of normal prostate
causes a contraction of the bladder. Extracts of hypertrophied
human prostate have no such effect in most cases. Positive re-
sults are occasionally obtained, but it is due to the presence of
normal tissue in the hypertrophied gland. The retention of
urine in subjects of hypertrophied prostate is due to the fact that
the gland no longer furnishes the internal secretion which is the
excitant of the vesical muscles. The return of micturition after
prostatectomy is due to the removal of the growth which has
obstructed the normal function of the gland, allowing it to re-
cover its functional activity.—T. C. B.

(PROSTATE TESTES) Organotherapy in prostatism (Organo-
therapie des Prostatismus). Rohleder, Deutsche med.
Wehnschr. (Berlin), 1920, 46, 70.

Not only is it generally accepted that the prostate has an
internal secretion, but it is usually acknowledged that there is a
relationship between the secretion of this gland and the internal
secretion of the testicle. This conception is derived from the
fact that castration is followed by atrophy of the prostate and
that hypertrophy of the prostate generally begins to appea.
when the sexual desires begin to diminish. It has already been
shown that when dogs are castrated and extracts of the testicles
injected there fails to occur any atrophy of the prostate (Walk-
er). This affords valuable indications for treatment. In the

312 ABSTRACTS

first and second stages of hypertrophy of the prostate the admin-
istration of testicular preparations by mouth may have a tem-
porary good effect, but in the last stage no beneficial results are
obtained. The author advises the implantation of fresh human
testicles into individuals suffering from hypertrophy of the
prostate, although he himself has never performed the opera-
tion.— J. K.

SCLERODERMA, Two cases of—with sclerodctylia (Due casi
di sclerodermia e sclerodattilia). Capezzuoli (Cesare), Rivista
eritica di Clinica Medica, 1919, .., 577-598.

The A. reports two eases of scleroderma with sclerodactyla,
one complicated with Raynaud syndrome. Both cases had tuber-
culosis in their parental anamnesis; neither of them showed any
thyroid or thymus disorder, but in both slight adrenal deficiency
was apparent with, in one case, marked melanoderma. There
was no alimentary glycosuria and no adrenal glycosuria could
be obtained.—G. V.

SCLERODERMA, The relations between—and diseases of the
endoctrine organs (Uber die Beziehungen der Sklerodermie
zu den Erkrankungen der endokrinen Driisen). Roesch (W.),
Deutsche med. Wehnschr. (Berlin), 1919, 45, 1329.

Scleroderma is a symptom of polyglandular insufficiency.
In the case described by the author, there were symptoms of
adrenal and thyroid insufficiency. —J. K.

(SECRETIN) On the influence of atropine on the secretion of
pancreatic juice. Savich (V. V.), J. russe de physiol., 1917-
1918, 1, 134-140.

The secretory effect of soap and fats on the pancreas is rap-
idly inhibited by atropine, if used in acute experiments, but not
in animals with permanent pancreatic fistule; this difference is
explained by the difference of method of administration of the
drug in these cases, intraveneously or subeutaneously—i. e., it
depends upon the quantity of poison which reaches the secreting
cells. The secretory effect of soap is thus under the influence,
not only of a nervous mechanism, but also of a humoral one. On
the other hand, the author is inclined to believe that some hor-
mone, perhaps secretin, is produced in the duodenum, under the
stimulation of the secretory nerves of the panereas.—Physiol.
Abst. 4, 391.

(SEX) Intersexuality and hermaphroditism in man (Die bio-
logischen Grundlage der kontraren Sexualitaét und des Her-

ABSTRACTS 313

maphroditismus beim Menschen). Goldschmidt (R.), Arch.
f. Rassen-u-Gesell. Biol. (Berlin), 1916, 12, 1.

The author discusses the biological foundation for the ex-
istence of individuals who are neither truly males nor females,
but have certain primary and secondary characters of either sex.

He has shown by his studies in genetics on certain insects,
that it is possible to produce, experimentally, every grade of
intersexuality from the male to the female, not only in external
body form but also in the internal organs. (See Endocrinology
1917, 1, 433.) The experimental animals showed also, all grades
of instinets and habits between the extremes of the two sexes.
He points out that no animal, including the human, is either
purely male or female, but each has the potentialities of both.
Usually, of course, the one sex or the other predominates, but
either sex may normally show secondary characters of the other.
Animals of either sex will take on characters of the other follow-
ing eastration or transplantation of gonads (Steinach).

Hermaphrodites, pseudohermaphrodites and many persons
considered sexually abnormal are simply sexual intergrades, and
therefore not pathological, but simply natural variations, the
result of the chromosome complex, and perhaps partly of abnor-
mal internal secretions of the gonads. (Lillie has shown that
the free-martin is a sex intergrade caused by male hormones,
acting through the placental circulation, on a female fetus.
danxp: Zool., 1917, 23, 371.)

Goldschmidt believes that these human sex intergrades are
not degenerates, since 50 per cent of them are found in sound
families, but that they are the natural result of crossed matings
of people of different genetic constitution. The number of ‘‘con-
trary sexuals’’ is much greater in these peoples than where the
race is pure.

There are psychic as well as physical sex intergrades.

The author suggests that’ intersexuals (individuals with
characters of both sexes) be treated with gonad extracts or trans-
plants.

This paper affords a possible answer to those who blame the
thymus for the appearance of secondary sex characters of the
opposite sex in eases of so-called ‘‘status thymicus,’’ and espe-
cially in the ‘‘recessive’’ cases of Symmers wherein, so far as
can be demonstrated microscopically or otherwise, the thymus is
perfectly normal or even atrophic, and probably entirely blame-
less of the condition obtaining.—E. R. H.

SEX, The determination of—. McConnel (Mrs. D.), Med. Press
(Lond.), 1918, n. s. 106, 27-29.

Not of endocrine interest.—L. G. K.

314 ABSTRACTS

(SKIN) On a protective function of the skin (Ueber eine nach
innen gerichtete Schutzfunktion der Hant). Hoffmann (E.),
Deutsche med. Wehnsehr. (Berlin), 1919, 45, 1233.

The author does not believe that the function of- the skin is
only a mechanical one. It is known that the skin is able to
produce an enzyme (‘‘dop-aoxydase’’) that is required for the
formation of pigment. It is also generally accepted that infec-
tious diseases with well developed symptoms of the skin (syphil-
is, scarlatina, typhus exanthematicus) have a better prognosis
than when the eruption is not well developed. The irritation of
the skin seems to have a favorable influence on the resistance of
the body. Therefore the author thinks that it may be possible
that the skin has an internal secretion. Stimulation of the pro-
duction of this internal secretion may have an influence on other
diseases of the organism. In this way it is perhaps possible to
explain the splendid effect of lght-therapy, of artificial **sun-
light,’’ and other therapeutic procedures directed toward in-
ternal diseases in patients who have skin affections.—J. K.

SPLEEN, Effects of the removal of the—upon the metabolism
in dogs. Preliminary report. King (J. H.), Johns Hopk.
Hosp. Rep. (Balt.), 1919, 18, 7-9. For abstract of earlier re-
port see Endoerin. 3, 226.

Metabolic studies were made on dogs before and after splen-
ectomy. Metabolic processes were in general little affected. Af-
ter the operation, however, there was observed an increase in the
fat and cholestrin of the blood, together with increased absorp-
tion of fats and increased elimination of fatty acids. The blood
thereby acquired an increased efficiency against hemolytic
agents, a fact which probably explains to some extent the effi-
cacy of splenectomy in the treatment of hemolytic types of ane-
mia. An increased elimination of calcium was noted which, it
is suggested, may stand in some causal relation to the clinical
tendency of these cases to hemorrhage. The calcium disturbance,
however, can hardly be considered of moment because it was
found that it was not sufficient to interfere with the skeletal de-
velopment of puppies after the operation. The studies as a
whole fail to bring to light any group of findings which can be
correlated into a clinical symptom complex dependent upon a
loss of function of the spleen. A detailed report is promised at
an early date.—R. G. H.

SPLEEN, The importance of the—in resistance to infection.
Morris (D. H.) and Bullock (F. D.), Annals of Surgery,
191910; oes:

ABSTRACTS 315

An experimental study of the problem, which is more of
immunological than endocrine interest. The experiments in-
volved 392 rats. One-half of these were splenectomized and one-
half were subjected to a laparotomy and the removal of one testi-
cle. This operation was selected as furnishing a fair basis of
comparison. The operations were done under ether and every
precaution taken to guard against operative complications.
The animals were all exposed to chance laboratory contagion and
kept under observation for several months. The results show in
a very definite manner that, while the animals may get on fairly
well without a spleen in the absence of any infection, the reverse
is true when the organism is put to the strain of resisting acute
bacterial invasion. The death rate among the splenectomized
rats was 80.5% as compared with 38.9% among the controls
during the time they were under observation.—J. F.

STATUS LYMPHATICUS, Its occurrence and significance in
war neurosis. Davis (T. K.), Arch. Neurol. & Psych. (Chgo.),
1919, 2, 414-418.

The author studied two groups of soldiers (114 psychoneu-
rotics, and 119 surgical cases) all of whom had seen front line
duty. The term status lymphaticus was applied in this series
of cases to the soldiers showing bodily hypotrichosis in contrast
to abundant scalp hair, feminine type of pubic hair, a velvety
skin, a tendency toward abnormal length and narrowness of the
thorax, and slenderness of the long bones. Of the 114 psycho-
neurotic cases 23.68% were of this status type, and among the
surgical cases only 12.6% showed this syndrome. Davis con-
eludes that an endocrine abnormality (status lymphaticus) in-
creases the susceptibility to the neurosis. (See Endocrin. 3,
209.)—F. C. P.

(SYMPATHETIC N. §S.) ‘‘Trichotonia’’ and ‘‘trichograph-
ism’’: a new sign of hyperirritability of the sympathetic
(Tricotonia e tricografismo: un nuovo segno d’ipereccitabilita
sympatica). Pende (N.), Gazz. Ospedali Clin. (Milan), 1917,
—, — (No. 60). Abst. Riv. Patol, Nerv. e ment, 22, 998.

Pende has applied the term ‘‘Trichographism,’’ to the phe-
nomenon commonly known as ‘‘goose-flesh,’’ when it is caused,
not by cold, but by mechanical irritation. The phenomenon is
due to the contraction of the musculi arrectores pilorum which
are under control of the sympathetic nervous system. When
the sympathetic system is hyperirritable, stroking the skin along
the sternum or mammary region with a -blunt point sets up
local reflexes and causes the ‘‘goose-flesh’’ to appear as a zone
of closely placed elevations in the path of the stroke. The re-

316 ABSTRACTS

action signifies a condition of augmented activity of the muscles
concerned, hence ‘‘trichotonia.’’ The phenomenon is seen espe-
cially in conditions of hyperthyroidism and may be regarded as
a special manifestation of ‘‘sypathicotonia.’’—R. G. H.

(TESTES) Operation for cryptorchism (Zur Operation der
Kryptorchismus), Frangenheim (G.), Zentralbl. f. Chir.
(Leipzig), 1920, 47, 173.

J. K.

Of technical surgical interest.

(TESTES) Demonstration of the appearance after castration
of chick feathering in a hen feathered cockerel. Morgan
(T. H.), Proce. Soc. Exper. Biol. & Med. (N. Y.), 1916, 13, 31.

In Seabright fowls the cocks normally have “‘hen feather-
ing,’’ i. e., the hackles and saddle feathers are similar to those
of the female. If the male adult is castrated and the saddle
feathers removed those which grow in are more nearly of the
masculine type. There is reason to believe that cock feathering
is the fundamental tendency of both sexes but that normally
this is inhibited in females by hormones from the ovaries. Mor-
gan suggests that in the Seabright variety a similar inhibitory
influence emanates to some extent from the testes, also.

—R. G. H.

(TESTES, ADRENAL) Normal and morbid conditions of the
testes from birth to old age in one hundred asylum and hos-
pital cases. Mott (F. W:), Brit. Med. J. (Lond.), 1919, (11),
655-659, 696-700, and 737-742. -

The testes were examined in 100 subjeets who had died in
asylums and hospitals at all ages from birth to 86 years. The
contents of the vesiculae-seminales were examined in a majority
of the cases and in a few, the thyroid, suprarenal and pituitary
glands also.

The study showed that at birth there is a large amount of
interstitial tissue between the seminiferous tubules; the intersti-
tial cells of Leydig are numerous and have the appearance of a
gland; these cells contain a lipochrome substance like lutem and
lipoid granules. At four months the tubules have doubled in
size, the interstitial cells are hardly visible and no lipoid gran-
ules are seen. At eleven years there is little change in the size
of the tubules and the interstitial cells are only discernible with
an oil-immersion lens. Little or no interstitial lipoid is seen.
There is commencing evidence of nuclear activity and karyo-
kinetic figures, but no spermatids nor spermatozoa. At 15 (pu-
berty) the tubules are closely approximated and all stages of
active spermatogenesis are observable. There is abundant in-

~

ABSTRACTS 31

terstitial lipoid and lipoid granules are seen in the cells of Ser-
toli, though not so abundant as in the adult.

Cases dying before puberty of chronic diseases (tuberculo-
sis, congenital syphilis and morbus cordis) show complete arrest
of development of the seminiferous tubules. This seems to con-
firm Kyrle’s view that arrested development of the seminiferous
tubules is a sign of deficient vital resistance to disease.

Normal spermatogenesis was studied in cases of death fol-
lowing injury. Active spermatogenesis is seen in all stages; the
interstitial cells contain much lipoid, and the spermatogonia, and
especially the Sertoli cells. are filled with fine hpoid granules.
Where there are sheaves of spermatozoa these granules in the
Sertoli cells are fewer. The immature sperms dive into the Ser-
toli cells and there acquire their tails, which consist almost en-
tirely of lipoid, lecithin and some cholesterin.

Evidence is given to show that the lipoid granules seen in
the interstitial tissue and in the cells lining the basement mem-
brane of the tubules constitute the raw material from which the
nucleic acid, necessary for active nuclear proliferation and
spermatogenesis, is formed. These lipoid granules give the oxi-
dase reaction owing to the presence of traces of unsaturated
fatty acid. Decomposition and recomposition processes are
brought about by catalytic action of the iron of the cell nucleus
upon the oxidase, causing molecular oxygen (O.) to be converted
into free atomic oxygen O-O on the surface of the granules.

Reasons are given for supposing that these lipoid granules
are derived from the lipoid store in the adrenal cortex. Elliot’s
work, showing that the lipoid content of the cells of the adrenal
cortex is diminished in microbial intoxication, is confirmed.
However much it is diminished on this account, the lipoid gran-
ules in the testes are not appreciably so. This may explain the
fact that prolonged microbial toxemia does not arrest spermato-
genesis. It seems as if the lipoid substance in the testes acted
not only as the phosphorized raw material of nuclear activity,
but as a protective barrier against the effects of circulating mi-
erobial poisons.

The remainder of this series of papers deals with changes
in the testes in cases of general paralysis, dementia precox and
other forms of insanity. In general no correlation between psy-
choses and testicular conditions could be determined.—L. G. K.

(TESTES) Growth of testicular grafts in the goat (Evolution
des greffes testiculaires sur le bouc). Growth of testicular
grafts in the ram (Evolution des greffes testiculaires du
belier). The testicles in the aged (Testicules des vieillards).
The conditions which cause variations in the growth of the
testicular epithelium (Des conditions qui font varier 1’evolu-
tion de l’epithelium testiculaire). Retterer (Ed.), C. R. Soe.

318 ABSTRACTS

Biol. (Paris), 1919, 82, 1022-1025, 1099-1102, 1123-1126, 1153-
1156.

These papers deal with the histological changes in the testes
and testicular grafts under various conditions. The general con-
clusion seems to be that when the epithelial cells of the tubules
are transformed into connective tissue, they lose a plasma,
which, when resorbed determines the secondary sex characters.

—T. C. B.

(TESTICLE) Geroderma genito-dystrophico (lean type) with
delayed hereditary lues [Geroderma (Senilismo) génito dis-
trofico de Rummo y Ferrarini (tipo magro), por lues heredi-
taria tardia]. Castex (M. R.) and Waldorf (C. P.), Rev.
Assoc. Med. Argentina, 1919, —, 177-178 (Aug.-Sept.).

A typical case is described to which the authors attribute
a syphilitic origin (hereditary). A bit of testicle removed
for examination showed marked sclerosis with disappearance of
the glandular elements.—B. A. H.

(TESTIS) Transplantation of testicle in man (Wher Hodenim-
plantation beim Menschen). Kreuter (E.), Zentralbl. f. Chir.
(Leipzig), 1919, 46, 954.

The removal of tubercular testicles was followed by a loss
of sexual desire which reappeared after the implantation of a
normal testicle. The desire was accompanied by the ability to
have erections.—J. K.

TESTICLE Implantation. Voncken (8.), Archives Médicales
Belges (Brussels), 1919, 72, 64.

Voneken reviews what has been accomplished in this line,
citing Lydston’s work and Steinach’s experimental, research, the
clinieal ease reported by Steinach and Lichtenstern and Roh-
leder’s experimental and clinical experiences with treatment of
homosexual perversions. He then describes Voronoff’s ‘‘pains-
taking experimental research carried on for more than a year at
the College de France. He studied on sheep and goats the influ-
ence of transplantation of testicle tissue. He found it easy to
follow by the external manifestations the changes in the fune-
tioning of the internal secretion of the testicles.’’ Castration of
a young goat arrested the development of the horns. He con-
ducted three series of experiments: In the first series, testicle
implantation in the young castrated animals restored in a short
time their normal vigor. The growth of the horns, arrested by
the castration, began anew as soon as the implant had grown
into intimate connection with the adjacent tissues. In his see-

ABSTRACTS 319

ond series of experiments implantation of testicle tissue in fe-
males transformed their character: Gravid goats were deliv-
ered normally, but they exhibited marked repulsion for suckling
their young and other maternal cares. The testicle implant
seemed to stifle all the instincts of maternal affection. In his
third set of experiments, he implanted the testicle tissue in rams
and goats 14 to 15 years old. This age in these animals corre-
sponds to the human age of 65 to 70. The senile animals, with
sluggish reactions, underwent a radical transformation within
periods ranging from a few days to three weeks after the 1m-
plantation of the testicle graft. Voncken emphasizes that the
photographs which Voronofit exhibited with his report at the
recent Congres de chirurgie at Paris testified most significantly
to the truth of his statements. One of the goat bucks impreg-
nated a female.

‘‘Counter experiences were equally significant,’’ he adds,
‘‘removal of the graft reducing the animal to his former senile
condition. A new implantation restored anew les avantages de
la jeunesse.” In view of such an ensemble of facts,’’ Voneken
comments, ‘‘can one doubt further the preponderant infiu-
ence of the internal secretions of the testicle on senile phenom-
ena?’’ He adds that Voronoff’s histologic study of the grafts
showed that the vessels growing into the graft do not reach the
center in time to perpetuate its vitality. The center dies and is
resorbed; only the periphery retains its vitality. Hence small
grafts take better than large ones. He only succeeded in keep-
ing two alive out of thirty whole testicles implanted, while the
partial grafts were constantly successful. A number of small
grafts can be implanted under the skin in any part of the body,
or in the peritoneal cavity, or under the vaginalis in the scrotum.
He found this latter technic the most reliable. Voncken adds
that Liydston’s experience has given a practical confirmation of
the experimental results thus realized in the laboratory. ‘‘Or-
ganotherapy is invading more and more the different chapters
of pathology, and this surgical opotherapy seems to augur a
fruitful future which is only the natural sequence of the marvel-
ous results already realized with transfusion of blood.’’ He
suggests the possibility that grafts of thyroid tissue might be
used in treatment of cretinism. ‘‘With any endocrine insuffi-
ciency, some harmless surgical intervention might definitely re-
store the organic balance.’’ (Voronoff’s report of improvement
in a case of myxedema after implantation of monkey thyroid
tissue was summarized in J. Am. M. Assn., 1914, 63, 810. (Abst.
J. Am. M. Ass., 74, 62.

(TESTIS) Mitoses of seminal epithelium in the cat (Les mitoses
de 1’épithélium séminal du chat). de Winiwarter (H.), Arch.
de Biol., 1919, 30, 1.

320 ABSTRACTS

A cytological study of spermatogenesis in the cat, together
with a short description of the interstitial cells. These latter are
said to resemble those of the ovary in the cat. They contain
lipoid droplets and some small bodies which stain readily with
safranine, the number of two kinds of bodies varying inversely
with each other in different cells, and hence the author believes
it possible that the lipoid is formed from the other body as has
been described for sebaceous cells. He found a few examples
of mitoses among these interstitial cells, the number of chromo-
somes being about 35. These mitoses prove that the interstitial
cells are able to multiply as in the ovary, but the rarity of
mitoses indicates that some of the cells are transformed from
the stroma.—E. R. H.

(TESTIS) Orchidopexy for inguinal testicle (Zur Orchidopexie
bei Leistenhoden). Glass (E.), Zentralbl. f. Chir. (Leipzig),
1920, 47, 174.

Of technical surgical interest.—J. K.

(TETANY) Edema in children with tetany (Oedembildung bei
tetaniekranken Kindern). Bossert, Deutsche med. Wehnschr.
(Berlin), 1920, 46, 45.

Evidence is presented tending to show that in tetany a low
salt diet may produce edema. The eating of porridge with an
ego gave rise to tetanle contractions and edema.—.J. K.-

(THYMUS) Certain peculiarities of thymus development (A
proposito di alcune particolarita di svilluppo del timo, in
Amia calva e Lepidosteus osseus). Castellaneta (V.), Arch.
ital. Anat. e. Embryol. (Firenze), 1917, 15, 218.

A discussion of the development of the thymus in these
bony fishes. In the case of Amia, Castellaneta agrees with Ham-
mar that the original epithelium forms a reticulum not spon-
taneously, as Hammar says, but as the result of mechanical
forces, as stated by Maximow. At the time of the early reticu-
lum transformation there are present a few lymphocytes and
large numbers come into the gland coincident with its later for-
mation.

It is decided that some of the small lymphocytes are formed
in the thymus from larger cells, but that most of them come in
from the mesenchyma. The thymus of ganoids is regarded as
a phylogenetic descendent of several primitive thymic anlagen
fused together.—M. M. H.

(THYMUS) Les réversions épithéliales dans le thymus humain.
Dustin (A. P.), Arch. Zool. expér. et gén. (Paris), 1917, 56,

(o-oo

ABSTRACTS . 321

The author describes some small bodies of cells often found
in the thymus of mammals, birds, reptiles and amphibians, and
which represent a reversion to the original epithelial type. These
bodies sometimes are cystic and lined with ciliated epithelium,
and sometimes are compacted, resembling parathyroid tissue.

In many they become more numerous in older persons in
whom the thymus has undergone involution.

As regards the various cells found, the author disagrees
with Hammar, who believes that the original embryonic thymus
(epithelium) forms the reticular cells of the adult which in turn
eive rise to all the atypical thymus elements,—epithelial nodules,
ciliated cysts, Hassl’s corpuscles, epithelioid cells, myoid cells
and mucous cells,—and that the small thymus cells which are
true lymphocytes enter the thymus from the outside. Dustin
believes that the small thymic cells are derived directly from
the original epithelium (stem cells) and that the epithelioid cells
and Hassl’s corpuscles are mesenchymal in origin. He holds
that the thymus is in some manner associated with nuclein met-
abolism, acting as a sort of storehouse for nuclein substance.

—K. R. H.

THYMUS and tetany. Honeyman (J. T.), J. Physiol. (Lond.),
1919, 53, 207-210.

Observations on young guinea pigs in which the thymus is
functionally active, show that’ when the thymus and parathy-
roids are both removed, typical parathyreopriva]l tetany devel-
ops, with increased electrical excitability. The author believes
that this disproves Uhlenhuth’s claim that the thymus secretes
a substance capable of producing tetany.—T. C. B.

(THYMUS) Pathology of Graves’ disease (Die pathologischen
Grundlagen der Basedowschen Krankheit. Nach verglei-
chende pathologischen und klinischen Studien). Klose (H.),
Bruns. Beitr. z. Anat. Phys. Path. usw., 1916, 102, —. (Ab-
stract in Folia Hematol. by Miiller.)

The author says that in Basedow’s disease the thymus is
next to the thyroid in importance, in that it undergoes morpho-
‘logical changes (‘‘epithelization’’). The thymus can ‘‘thymu-
size’’ the thyroid. The two glands can cause a general hyper-
plasia of the lymphoid system.—E. R. H.

THYMUS, Involution of the—in birds. MecCarrison (Robert),
Indian J. Med. Res. (Caleutta), 1919, 6. 557-559.

McCarrison studied the thymus in a large number of pig-
eons, varying in age from sixty-one days to two years, to deter-
mine the relationship of the size of the gland to the age and sex

322 ABSTRACTS

of the bird and also to the body weight under different condi-
tions. The following facts were elicited: The thymus is twice
as large in the male as in the female. In the pigeon the involu-
tion of the thymus is dependent upon factors other than the
maturation of the sexual functions. These factors are mainly
nutritional. Starvation causes thymic atrophy out of all pro-
portion to loss of body weight. Deprivation of ‘‘B’’ accessory
food factors causes a like atrophy which is marked. Excessive
feeding with grains and butter causes no increase in size in the
thymus as it does in most of the other organs.—l. M.

(THYMUS) Case of enlarged thymus gland and some remarks
on status lymphaticus. Newton (R. C.), Am. J. Med. Se.
(Phila.), 1919, 158, 534-544.

A man of 20 years complained of lassitude and dyspnea
beginning two weeks after a cold plunge when overheated. Mus-
cular weakness progressed, soft edema of the neck, chest and
shoulders developed. Examination revealed a double cardiac
murmur. <A skiagram showed the presence of a thymic shadow
nearly covering the pericardium. Six X-ray treatments at
weekly intervals resulted in the patient’s return to work and in
his resuming his active athletic life. One year later a run of
about one mile resulted in the return of his former symptoms
and the development of an aortic aneurysm. A rupture of the
aneurysm about a year after this time caused his death. No
autopsy could be obtained. The case report is followed by a
brief summary of the literature on the anatomy, the growth and
involution, the physiology, and the pathology of the thymus
gland and status lymphaticus.—F. C. P.

(THYMUS THYROID) Extirpation of the thymus in Graves’
disease (Thymusexstirpation bei Basedowscher Krankheit).
Nordmann, Deutsche med. Wehnschr. (Berlin), 1920, 46, 109.

The partial resection of the thyroid and the removal of the
thymus in a girl of 20 years having suffered for 3 years from
Graves’ disease, resulted in a general improvement, although the
tachycardia remained. The author believes that it is necessary
in every operation for Graves’ disease to look for the thymus.
In cases with symptoms of status lymphaticus or hypoplasia of
the sex organs the thymus should first be removed before any-
thing is done with the thyroid. In 11 fatal cases of thyroidec-
tomy there was found a persistent and enlarged thymus. In
one other case in which thyroidectomy only was performed, the
symptoms of the disorder did not subside and the patient died
some time later. At autopsy the thymus was found present.

—J. K.

ABSTRACTS 323

(THYMUS) Thymusectomy and its relationship to rickets.
Renton (J. Mill) and Robertson (Madge E.), J. Path & Bact.
(Cambridge), 1916-17, 21, 1-18.

The claims of Klose and Vogt and of Matti that extirpation
of the thymus gland in puppies leads to a sydrome somewhat re-
sembling rickets, but associated also with other growth and
psychic abnormalities, have had wide publicity. That these
claims have failed of confirmation at the hands of various com-
petent observers seems less generally known. The authors re-
port an attempt to confirm the earlier findings. The thymus
was completely removed from 8 puppies from 13 to 25 days old.
These were kept for varying periods up to several months. The
experiments were controlled by keeping other dogs under the
same environmental conditions. It was found that there was
not the slightest effect ascribable to the loss of the thymus. Un-
favorable environmental conditions alone were found to produce
ricketslike changes such as were described by the earlier inves-
tigators, and it was concluded that such was the probable source
of these changes.—R. G. H.

(THYMUS) Myasthenia gravis pseudoparalytica. Steckel-
macher, Miinch. med. Wehnsechr. (Munich), 1919, 66, 1504.

In the case deseribed no persistent thymus was found.

J. K.

THYMUS gland in infants, Normal and pathological anatomy
of the—. Vasyutochkin (A. M.), Kharkov Med. J., 1916, 22,
160; ‘215.

V. summarizes his extensive data on the weight of the thy-
mus glands of infants in health and disease. During the first
year of post-natal life the thymus increases in weight uninter-
ruptedly from 7 to 12 grams. The weight of the thymus of
males is greater than that of females. The weight of the thy-
mus of well nourished infants exceeds by 11% times the weight
of the gland of emaciated infants. Inherited syphilis in most
cases produces a sharp atrophy of the thymus. Gastro-intestinal
diseases produce a hyperplasia of the thymus. Diseases of the
respiratory system (non-tuberculous) produce no change in the
weight of the thymus other than a decrease corresponding to
the disturbance in nutrition. Similarly there is no effect on the
thymus in septic cases. In tuberculosis and diphtheria the
weight of the thymus is diminished; but only a few of these
cases were investigated.—sS. H.

The THYMUS; a summary. Wooley (P. G.), J. Lab. & Clin.
Med. (St. Louis), 1916-17, 2, 632-637.

O24 ABSTRACTS

A general article giving an interesting review of the ltera-
ture on the physiology and functional pathology of the thymus.
—R. G. H.

(THYROID) Considerations in the medical treatment of goitre.
Anders (J. M.); Trans: Am. Therap..Soc. (Nz Y¥.), 196.16:
85-90.

A brief summary of the kind of treatment best suited to
the various types and stages of thyroid disorder. Emphasis is
laid upon the necessity for differentiating these factors. For
definite hypothyroidism sodium iodide in gradually ascending
doses, beginning with five grains three times a day, up to a
maximum of ten grain doses is recommended. When gastro-
intestinal fermentation is an accompaniment, thyroid extract is
indicated in beginning doses of one grain, three times a day, to
be slowly inereased if the pulse reaction is not noticeably affect-
ed, up to a maximum of five grains daily. In general this treat-
ment is contraindicated in Graves’ disease. In the latter, the
problem is to remove, as far as possible, the recognizable causes,
such as emotional excitement, shocks, tuberculosis, rheumatism,
syphilis and intoxication from the intestinal canal. Quinine hy-
drobromide and antithyroidin have given good results in the
author’s hands.—F. 8. H.

(THYROID) Blepharochalasis with goiter and doubling of the
mucous membrane of the upper lip (Blepharochalasis mit
Struma und Schleimhautduplicatur der Uberlippe). Ascher,
Miineh. med. Wehnsehr. (Munich), 1919, 66, 1365; Deutsche
med. Wehnsehr. (Berlin), 1919, 45, 1400; Wiener klin. Wehn-
sehr. (Vienna), 1920, 33, 73.

The author reports having sometimes seen the combination
of the three conditions mentioned in the title. This combination
has never previously been described and he considers it a sign
of an abnormally functioning thyroid.—J. K.

(THYROID) The treatment of toxic goiter. Batchelor (F.S8.),
N. Zealand Med. J. (Wellington), 1918, 17, 214-218.

Surgical treatment, either hgation or excision, is recom-
mended for these cases.—F. 8. H.

(THYROID) The development of Basedow’s disease as an in-
creasing cause of post-war female sterility (L’accroisement
d’une cause de sterilité feminine depuis la guerre par la de-
veloppement de la maladie de Basedow). Blondel (R.), Bull.
gen. therap. (Paris), 1919, 170, 816-823.

ABSTRACTS 320

The text of the argument lies in the author’s observations
that Basedow’s disease is commonly accompanied by a marked
diminution in the size of the uterus which he considers clearly
attributable to disordered thyroid and that such atrophic uteri
tend toward sterility. Therefore, since emotional shock or stress
is admitted as one of the possible causes of thyroid disorder, and
since women are notably emotionally unstable, the sequence of
war, emotions, Basedow’s disease and small uteri will tend to
result in an inereased sterility among the females of France.

(THYROID) Long-standing case of goitre cured by inunctions.
Bazett (Henry), The Practitioner (Lond.), 1919, 103, 389-
390.

A typical case of exophthalmic goitre with advanced symp-
toms was apparently cured by inunctions of the following
fomula:

Give belladonnae ._.......-.-........- 1 part
Minmomebodan. 23) S80 oo Pee a 2 parts
Maem yarare. Co.) 24.....3c2s8t 4 parts
Bas Plambi-Subdacet. 2...5.2..2205- 6 parts

15 m. Donovan’s solution were given internally over part
of the period of treatment. One lobe of a large firm goitre had
been removed at a previous operation which had caused only a
temporary relief from the tachycardia, tremor and exophthal-
mos. Twenty days of the above treatment caused a marked im-
provement in the symptoms and a very noticeable dimunition
in the size of the tumor. One year later there were remaining
no signs or symptoms of the disease. The author claims several
other cures on less diffieult cases.—I. M.

(THYROID) The treatment of goitre by radiation. Boggs
(R. H.), Am. J. Roentgenol., 1919, 6, 613-624.

A restatement of the indications and contraindications for
the roentgen or radium treatment of goitre.—J. F.

(THYROID) An address on goitre. Boyd (H. J.), Brit. Med.
J. (Lond.), 1919 (ii), 169-170.

According to the author’s observations goitre was almost
unknown 25 vears ago in the section of Ireland in which he is
practicing, but at present is extremely common. The water sup-
ply apparently had some connection with a number of the cases,
since a change caused a decrease in size or disappearance of the
goitres. Also when several people in one house were affected,
the one who drank the most water was observed generally to
possess the largest goitre. Some who drank nothing but boiled

326 ABSTRACTS

water in the form of tea, ete., were also affected. Water from
one well was found to be infested with micro-organisms similar
to those described by MeCarrison as a cause of goitre—L. G. K.

(THYROID) Suppurating thyroid: complication of blenor-
rhagia. (Thyroidite suppurée: complication de la blenor-
ragie). Buscarlet (F.), Bull. mem. Soe. de Chir. (Paris),
1917, 43, 2286-2288.

A detailed clinical report of progress and treatment of a
case of septicemia of blenorrhagic origin which terminated in
recovery after discharge of contents of a thyroidal abscess.

—F.S. H.

(THYROID) Further course of an interesting case of Flajani-
Basedow’s disease (Ulteriore decorso di un interessante caso
di morbo di Flajani-Basedow). Capezzuoli (Cesare), Riv.
Critica di Clin. Med., 1919, 20, 469.

The author reports a case which he has followed since 1915,
when the patient was 35. After a partial thyroidectomy in
1915, she improved and was almost well until the fall of 1916,
when a psychic trauma started the syndrome again with consid-
erable swelling of the residual thyroid. Besides nervous and
digestive symptoms, tetany developed. Improved, yet not
eured, she went back home and married. After the marriage
there was a considerable improvement of all her symptoms,
which remained favorable despite a confinement in August, 1917.
She then lost her husband, and felt very low in spirit, yet there
was no recrudescence of the Basedow symptoms, and the thyroid
remained small.

The author emphasizes the fact that in this case marriage,
pregnancy and nursing, instead of bringing back the symptoms
seem to have favored recovery. Even her character, which had
been, during the sickness, changeable and intolerant, underwent
a complete modification, becoming calm and steady.—G. V.

(THYROID) The facilitation of difficult strumectomy (Erleich-
terung schwieriger Strumectomien). Claessen (M.), Zen-
tralbl. f. Chir. (Leipzig), 1920, 47, 9.

ae KE

Of technical surgical interest.

(THYROID) Consideration of the surgical treatment of exoph-
thalmic goiter. Clark (P. S.), Clinique (Chgo.), 1917, 38,
22-2,

A brief review in which because of the low mortality of 4%
or less, and the high percentage of cures or improvement after

ABSTRACTS 327

operation, the author strongly advocates surgical interference
in eases of exophthalmic goiter.—F. 8. H.

(THYROID) A case of exophthalmic goitre and anoci-associa-
tion. Corner (Edred), Brit. J. Surg. (Bristol), 1916, 3,
568-569.

The operation for removal of a hyperplastic thyroid was
modified by Corner by the introduction of Crile’s principle of
anoci-association. As a preparatory measure the skin surface
over the gland was painted with picric acid solution. Three
days later thyroidectomy was performed under nitrous oxide
anesthesia. Quinine-urea hydrochloride solution was injected
into the subcutaneous tissues before these were incised and then
into the tissues surrounding the thyroid itself before it was re-
moved. Recovery with marked improvement in the symptoms
was very prompt and satisfactory.—lI. M.

(THYROID) Medical treatment of exophtha!mic goitre (Trata-
miento médico del bocio exoftalmico). Dominguez (C.), Rev.
Assoc. Méd. Argentina (Buenos Aires), 1919, 31, 370-374.

A general discussion of the dietary, medical, and surgical
treatment of exophthalmic goitre. Although medication produces
amelioration in the majority of cases it is rare that a cure is

obtained.—B. A. HEI.

(THYROID) The medico-legal significance of trauma as an etio-
logic factor in Basedow’s disease (Graves’ disease, exophthal-
mic goiter). Drysdale (H. H.), Ohio State Med. J. (Colum-
Bos), 1917, 13, 310-316.

This paper presents the case reports of four litigants out
of a total of thirteen, all of whom were seeking financial recom-
pense for disabilities and ill health alleged to have resulted from
trauma, who were found to be afflicted with exophthalmie goiter.
The author is of the opinion that although the disease was al-
leged to have been caused by trauma, there is conclusive evidence
that there was in these cases an inherent predisposition to the
malady. It is Drysdale’s opinion that the degree of physical
violence had little, if any, significance, and whatever harm was
done in this respect arose from shock and emotional stress act-
ing through an unstable nervous and psychic constitution.
Trauma then becomes only an exciting factor in the etiology.

—F.S. H.

(THYROID) The constitutional disturbances which come with
chronic goiter. Dowd (C. N.), J. Am. Assn. (Chgo.), 1917,
69, 614-619.

328 ABSTRACTS

The paper is a report of 37 cases of chronic goiter selected
from a total of 181. The average duration of the goiter in the
patients studied was ten years; the average duration of the
more disturbing symptoms was one and one-tenth years. The
surgical interference consisted in removing about two-thirds of
the enlarged glands, the posterior capsules and adjacent gland
tissue being regularly left in position. In one instance boiling
water was injected with excellent results. In studying the later
histories of this group of patients one has been observed fourteen
vears; one has been followed into the fifth year; five into the
fourth; six into the third; twelve have been followed into the
second year, and seven into the first. All made good recoveries
from the operation. Twenty-seven are reported free from symp-
toms and in excellent health; eight are greatly improved; two,
respectively, eleven and four months after their operation, are
far from well. The constitutional disturbances have according-
ly been largely relieved.—F. S. H.

(THYROID ADRENAL) Lymphatic tissue in the thyroid in
Addison’s disease (Uber das Vorkommen lymphatischer
Herde in der Schildriise bei Morbus Addisonii). Dubois
(M.), Berlin. klin. Wehnschr., 1919, 56, 1178.

Large centers of lymphatic tissue may be observed in the
thyroid in eases of Addison’s disease. Apparently they are not
caused by inflammation but by a chronic irritation of the thy-
roid gland following abnormal adrenal function. It is also pos-
sible that they are a manifestation of the status thymo-lymphati-
cus which is often present in this disorder.—J. K.

(THYROID) Skin complications in Graves’ disease (Complica-
tions cutanees di la maladie de Basedow). du Castel (J.),
Paris Médiecal, 1919, 31, 382-385; Abst. from La Riforma
medica, 1919, 35, 509.

Numerous cutaneous complications are found in this syn-
drome, part of which the author claims to be common to all neu-
ropathie conditions, some exclusively from dysfunction of the
thyroid, and some from secondary endocrino-sympathetie condi-
tions. He differentiates them into vasomotor, trophic, toxic and
microbic. To the first division belong flushing, edema, and pur-
pura; among the trophic manifestations are melanoderma, sel-
dom vitiligo and scleroderma and alopecia. Burney Yeo has
reported the case of a patient in whom, after hypertrophy of
the right lobe of the thyroid, left exophthalmos and fall of the
hair of the left eye-brow oceurred and in whom, when the left
lobe started to hypertrophy, analogous symptoms referable to
the right eye appeared. Toxic erythema—especially urticaria—

ABSTRACTS 329

is frequent; and according to some authors, ferunculosis, pyo-
dermatitis and eczema are connected with dysfunction of the thy-
roid, as is indicated by subsequent development of exophthalmic
goitre in some patients with a tendency to recurring attacks of
these maladies.—G. V.

(THYROID) Papilloma of the larynx. Report of a case treat-
ed with radium, with resultant chronic diffuse thyroditis.
Duffy (Wm. C.), Johns Hopk. Hosp. Rep. (Balt.), 1919, 18,
417-438.

A Negro boy, 3 years of age, was treated with radium for
papilloma of the larynx. At autopsy there was found, among
other pathologie conditions, a chronic diffuse thyroiditis of wide
extent. The connective tissue was overgrown and had encircled
the acini and even invaded them, causing involution. The fibro-
sis had spread through the gland capsule also and invaded sur-
rounding parts. The acini were small for the most part and the
epithelium mostly collumnar or flat. Colloid was scanty. In
many acini was seen faintly staining granular material regarded
as representing much attenuated colloid. In acini of various
sizes were seen groups of lining cells with both nucleus and eyto-
plasm poorly stained. In the thickened stroma were found occa-
sional clumps of epithelial cells apparently residuals of de-
stroyed acini. In numerous acini were seen groups of exfolliated
epithelial cells the cytoplasm of which exhibited eosinophilic
tendencies greater than normal. Red blood cells also were seen,
but were regarded as normal. The resulting histologic picture
was closely similar to that of ‘‘thyroiditis’’ as first described by
Riedl in 1896.—R. G. H.

(THYROID) Experimental studies of Basedow’s disease (Ex-
perimentelle Untersuchung der Basedow’schen Krankheit).
Kiger, Cor.-Bl. f. Schweiz. Aerzte. (Basel), 1916, 46, 1567-
1568.

The author found that the feeding to rats of preparations
of the thyroid gland caused flooding of the blood with the glandu-
lar products, which phenomenon can be utilized as a clinical-
biological method of testing thyroidal activity. Correlated with
this is the fact that the blood plasma of six cases of Basedow’s
disease enhanced the action of adrenalin, while the plasma from
two eases of struma gave negative results. E. claims to have
objectively proven the presence of the specific thyroid secretion
in the blood of the vena thyroidea in man and animals, and is
convinced that thyroid extracts enhance the automatic contrac-
tion and movement of the isolated intestine. Very strong doses
of the extract inhibit the movements and bring the peristalsis
to a standstill.—F. 8S. H.

330 ABSTRACTS

(THYROID) Clinical forms of Basedow’s disease (Formas.
clinicas de la enfemedad de Basedow). Escudero (P.), Rev.
Asoe. Méd. Argentina (Buenos Aires), 1919, 31, 278-309.

Delimination and classification of the various clinical types
of Basedow’s disease.—B. A. H.

(THYROID) Surgical treatment of exopthalmic goiter (Trata-
miento quirtrgico del bocio exoftalmico). Finochietto (R.),
Rev. Assoc. Méd. Argentina (Buenos Aires) ,1919, 31, 342-352.

A general discussion of the subject in which early surgical
procedures are advocated.—B. A. H.

(THYROID) The surgery of thyrotoxicosis. Frank (lL. W.),
Kentucky Med. J. (Bowling Green), 1920, 18, 10-15.

Toxic goiters should be immediately removed.—H. W.

(THYROID) The importance of the Basedow symptoms in the
early diagnosis and treatment of pulmonary tuberculosis
(L’importanza dei segni di Basedow nella diagnosi precoce e
nella cura della tubercolosi polomonare). Gallotti (A.), Ri-
forma medica (Naples), 1920, —, 88-92.

The author reports six cases of symptomatology of Basedow
in incipient tuberculosis, where the first symptom, sometimes
contemporary with and sometimes preceding the tuberculous
symptoms, is enlargement of the thyroid. Such enlargement he
considers as of toxic origin. Basedow symptoms may be regard-
ed in many instances, as probable symptoms of latent pulmonary
tuberculosis. Enlargement of the thyroid often appears as a
complication in tuberculosis and gives to the disease a typical
character with benign evolution. In cases of pulmonary tuber-
culosis with Basedowian complication the treatment of the thy-
roid gland may favorably influence the course of the pulmonary
lesion, even to a full recovery.—G. V.

THYROID and acquired immunity. The influence of thyroidec-
tomy (in the rabbit) upon the formation of heterohemolitic
sensitizing substances [Thyroide et immunité acquise. Sur
l’infiuence de la thyroidectomie (chez le lapin) sur la forma-
tion de sensibilisatrices hétérohemolytiques d’immunisation].
Garibaldi (A.), C. R. Soe. de Biol. (Paris), 1920, 83, 15-16.

As the experimental results of Fjelstad, Launay and Levy-
Bruhl and Frouin do not agree, the problem has been reinvesti-
gated. This first note gives the results of thyroidectomy on the
formation of hemolytic immune bodies. Rabbits were used: 4
thyroidectomised, and 3 controls in which the gland was laid.

ABSTRACTS 331

bare, but not touched. Protocols are given and the conclusion
arrived at that the serum shows a hemolytic titer superior to that
of the controls. Thyroidectomy seems to favor the formation of
antibodies.—T. C. B.

(THYROID) Iodine action in goiter (Zur Joddarreichung bei
Kropf). Grumme (D.), Cor. BL. f. Schweiz. Aerzte (Basel),
1916, 46, 494-499.

A review of the literature concerned with the mode of action
and form of administration of iodine in goitrous conditions.
—F. S. H.

THYROID, Observations on the—. Hagerty (J. F.), J. Med.
Soc. New Jersey (Orange), 1917, 14, 341-348.

A general review of the known data concerned with the dis-
eases of the thyroid and their treatment.—F. 8. H.

(THYROID) Etiology of Basedow’s disease (Etiologia de la
enfermedad de Basedow). Hardoy (P. J.), Rev. Asoc. Méd.
Argentina (Buenos Aires), 1919, 31, 228-236.

It is the opinion of the author that Basedow’s disease arises
in individuals constitutionally predisposed to the disorder.
Among the etiological causes he has observed the presence of
syphilis in 55 per cent of the cases and tuberculosis in 18 per
cent.—B. A. H.

(THYROID) Operation for intrathoracic goiter (Zur Opera-
tion der intrathoracale Struma). Hartert (W.), Zentralbl.
f Chir. (erpzig), 1919, 46, 929.

Of technical surgical interest.—J. K.

The THYROID-PARATHYROID mechanism, The significance
of—with special reference to its metabolic function. Hewit-
son (W. A.), Univ. Durham Coll. Med. Gaz. (Neweastle),
1916, 16, 45-51.

A general review of the physiology and functional pathol-
ogy of the glands mentioned.—R. G. H.

(THYROID) The treatment of thyrotoxicosis by means of
roentgen ray. Holmes (G. W.) and Merrill (A. 8.), J. Am.
M. Assn. (Chgo.), 1919, 73, 1693.

A report of a series of 152 toxic thyroid cases treated by
x-ray. The authors believe that it is possible to decrease the

iw)

ABSTRACTS

activity of the thyroid gland and probably to destroy its glandu-
lar structure by such treatment.—F. C. P.

(THYROID) Pathogenesis of Basedow’s disease (Patogenia
de la enfermedad de Basedow). Houssay (B. A.), Rev. Asoe.
Méd. Argentina (Buenos Aires), 1919, 31, 237-277.

Detailed discussion of the present status of this problem.—
BecA. EF:

(THYROID) Chemical identification of the thyroid hormone.
Kendall (KE. C.), Scientific Proceedings, Am. Soc. Biol. Chem.
XIII. J. Biol. Chem. (Baltimore), 1920, 41, xxi.

A brief resume of the chemical nature of the iodine-con-
taining compound of the thyroid which has been reported else-
where in Endoerinology.—F. 8S. H.

(THYROID) ‘‘Funnel breast’’ in Graves’ disease (Einzeihung
des Brustkorbes bei Basedow). Just, Deutsche med. Wehn-
sehr. (Berlin), 1919, 45, 1373.

The author describes this as the second case he has seen of
a retraction of the thorax in the region of the apex of the heart
accompanying Graves’ disease in a girl of 13. He suggests that
this condition may perhaps be found somewhat frequently in
this disease when occurring in children.—J. K.

(THYROID) The prevention of simple goiter in man. Kimball
(O. P.), Rogoff (J. M.) and Marine (D.), J. Am. M. Assn.
(Chgo.), 1919, 73, 1873:

A report of the re-examination of girls (5th to 12th grade)
in the public schools of Akron, Ohio, 19 months after the begin-
ning of the prophylactic use of iodine. Tabulated reference is
made to reports published in 1917 and 1918. The treatment con-
sisted in giving 2 ems. of sodium iodide, in 0.2 gm. doses, for ten
consecutive school days, repeated each autumn and spring in
those taking the iodine. No enlargements, in previously normal
cases, were seen, while 15.9% of those not taking the prophylac-
tic treatment are reported as showing definite enlargement. <A
distinct decrease in size of the slightly enlarged glands was noted
in 38.1% of the pupils using the iodine, while only 27.8% of
those listed as not taking treatment showed this decrease in size.
Similar therapeutic effects were noted in the cases classed as
having moderate or marked enlargements of the thyroid gland.

—F. C. P.

(THYROID) The problem of the etiology and pathogenesis
of endemic goiter and cretinism (El problema de la etiologia

ABSTRACTS 303

y patogenesis del bocio y cretinismo endémico). Kraus
(R.), Rev. Asoc. Méd. Argentina (Buenos Aires), 1919, 31,
206-227. Rev. del Inst. Bact. del Dep. Nacional de Higiene
(Buenos Aires), 1919, 2, 309-323.

A discussion of the theory of the infectious origin of goiter.
Goiter exists in the Argentine in the mountainous regions while
the ‘‘Vinchueca’’ or triatoma infestans occurs on the plains.
There is thus no relation between endemic goiter and Trypano-
somiasis crusi.—B, A. H.

(THYROID) Dominant sex-linked inheritance and heredity of
the Basedow’s diathesis (Uber dominant—geschlechtsbe-
grenzte Vererbung und die Erblichkeit der Basedowdia-
thesis). Lenz (F.), Arch. f. Rass. u. Gesellsch. Biol. (Berlin),
1918, 13, 1.

The author points out the fact that many inherited defects
such as color blindness, progressive muscular atrophy, inherited
optic atrophy, some near-sightedness, some nystagmus, albinism
of the eyes, ete., are sex linked characters dominant in males
(heterozygotic), recessive in their daughters (homozygotic) and
appear again in their grandsons, following the laws of genetics
and easily explained. There are also sex-linked defects which
appear dominant in females.

In his study Lenz included as of Basedow’s diathesis (ten-
deney toward goitre) patients with any or all of the following
symptoms: classical syndrome (exophthalmos, tachycardia and
struma), fine tremors of the fingers, temperature easily raised,
moist glistening eyes, enlarged heart, dyspnoea, anxiety, insom-
nia, night sweats, troubled dreams, and general debility. He
describes several families, following one for eight generations,
in which there seems to be some evidence of hereditary tendency
to goitre.—E. R. H.

THYROID, A consideration of the treatment of the disease of
the—with special reference to so-called hyperthyroidism.
Lichty (J. A.), Am. J. Roentgenol., 1919, 6, 608-611.

This paper by an internist is a plea for the prompt employ-
ment of the proper treatment be it medical, surgical, or X-ray.
The author has evolved a classification of goitre patients which
has been very helpful to him as a working basis for the determ1-
nation of the proper treatment in the individual. According to
this plan, patients having diseases of the thyroid gland are di-
vided into four groups:

I. Those patients with thyroid disturbances without
any apparent pathological change in the gland. A
study of the basal metabolism and possibly the ap-

334 ABSTRACTS

plication of the Goetsch test may be necessary to con-
firm the diagnosis in the more doubtful cases. These
are strictly medical cases.

Il. Those patients having an enlargement of the thyroid,
but in whom, from the age of the patient and the
absence of certain symptoms, the diagnosis of adoles-
cent goitre may be made. Such patients need only
prophylactic care; if more than this is required they
belong in the next group.

III. Those patients having an enlarged thyroid with
definite hyperthyroidism active or at times potential.
This enlargement may be due to Graves’ disease, col-
loid goitre, cyst, adenoma, or any combination, This
eroup may be medical for a while and later require
surgical or x-ray treatment.

IV. Those patients having definite pathology of the
gland with disturbances in function. This group in-
cludes neoplasms, simple colloid goitre, tuberculosis,
lues, and other chronic infections of the gland. This
croup is always surgical, but presents an enticing
field for investigation with the x-ray.

From the author’s experience, he concludes that surgery
has the larger field of application. It also has the advantage of
furnishing definite information in that tissue removed may be
studied. The earlier that hyperthyroidism is recognized, the
more likely is medical treatment to be sufficient and give perma-
nent results. In hyperthyroidism the roentgenologist and the
surgeon can at best only break through a vicious circle for which
the internist may or may not be responsible.—J. F.

(THYROID) Goiter and cretinism in the Argentine Republic
(El bocio y el cretinismo en la Republica Argentina). Lo-
zano (N.), Rev. Asoe. Méd. Argentina (Buenos Aires), 1919,
31, 169-205.

A general consideration of the distribution of this disorder
in the Argentine Republic, following the various censuses.
—B. A. H.

(THYROID) Goiter, Some surgical aspects of. Mann (A. T.),
Journal-Lancet (Minneapolis), 1916, 36, 703-706.

Thyroidectomy should not take place until the patient has
given no response to medical treatment. This does not apply to
a diseased tissue which causes constant autoactivation of the
whole gland or marked pressure. As treatment, rest, the judi-
cious use of iodine, antithyroid serum, the ligation of the blood
vessels and nerves of the thyroid, and partial thyroidectomy,

ABSTRACTS 339

each has its place according to the case in question. The author
gives the technic of the larger operation, in which he puts empha-
sis on the care needed to prevent injury to nerves, to prevent
the removal of the parathyroid and of the entire thyroid.
—F. 58. C.

(THYROID) The absorption of potassium iodide by perfused
thyroid glands and some of the factors modifying it. Marine
(David) and Feiss (H. O.), J. Pharm. & Exper. Therap.
(Balf.), 1916, 7, 557-576.

Experiments were conducted to determine whether the thy-
roid cells exhibit a specific affinity for iodine or not and to com-
pare their activity along this line with that of other tissues. The
thyroid gland, the spleen and the kidney were separately per-
fused both in vivo and in vitro with Ringer’s solution containing
KI. Hyperplastic glands of otherwise normal, dogs were used in
all cases. From their studies the authors draw the following
conclusions: Artificially perfused thyroids take up and retain
KI to the same extent as do in vivo-perfused thyroids. KI is not
absorbed by the cells of the spleen, kidneys, liver or muscles.
The amount of KI absorbed by the thyroid is independent of
the concentration of KI in the perfusate. Only surviving glands
exhibit the ability to take up the KI. KCN inhibits this activ-
ity. Small amounts of iodothyreoglobulin wash out during per-
fusion with defibrimated blood. Autolysing glands do not take
up KI, but give up what was previously stored. The KI stored
in surviving cells is pharmacologically inactive —l. M.

(THYROID) Physio-therapeutic treatment of exopthalmic
goiter (Tratamiento fisioterapico del bocio exoftalmico).
Marque (A. M.), Rev. Asoc. Méd. Argentina (Buenos Aires),
1919, 31, 333-341.

A general discussion of the subject.—B. A. H.

(THYROID) Pathology and treatment of exophthalmic goiter
(Le goitre exophthalmicque. Sa pathogénie. Son tratement).
Masson (Guy), These, Geneva, 1918, pp. 172. Abst., J. Physiol.
et de Pathol. Gén. (Paris), 1919, 18, 638.

Masson treats in order the theories of the pathogenesis of
exophthalmie goitre and various forms of therapy and follows
this with a eritique on both. He favors the dysthyroidism theo-
ry of pathogenesis. As to treatment, he recommends the serum
of thyroidectomised animals, and even the milk of such has been
found useful. In either case, however, adequate dosage and con-
tinuation for some time is needed. Such therapeutic measures

336 ABSTRACTS

directed toward neutralization of circulating toxins might well
be supplemented by radiotherapy to depress the activity of the
thyroid. Surgery is reserved as a last resort for rebellious cases
in which prompt measures are essential—R. G. H.

(THYROID) The pathological physiology of human body tem-
perature (Zur pathologische Physiologie der menschlichen
Korperwarms). Mayer (A.), Deutsche med. Wehnscehr.
(Berlin), 1919, 45, 1382.

During the war the author observed a number of men with
slightly enlarged thyroid glands and a slightly increased temper-
ature, not caused by organic disease. The injection of milk
raised the temperature of these patients, a reaction which does
not occur in normal persons. The injection of antithyroidin
eaused the temperature to become normal. Apparently the en-
doerine organs play a most important part in the regulation of
the temperature, since in normal persons the injection of adrena-
lin or thyroidin raises the temperature and antithyroidin dimin-
ishes it. These things are considered as important in the treat-
ment of fever.—J. K.

(THYROID) The basal metabolism in exopthalmic goitre.
Means (J. H.) and Aub (J. C.), Arch. Int. Med. (Chgo.),
1919, 24, 645-677.

The results of the present work substantiate conclusions
drawn in a previous paper (J. Am. M. Assn., 1917, 69, 33). The
discussion is based upon 345 observations on 130 patients. The
degree of elevation of gas exchange above normal is used as a
measurement of thyroid intoxication. Normal and pathological
cases were used for controls. The studies were made upon cases
of exophthalmic goitre treated either surgically or by exposure
to roentgen-rays. The authors believe determinations of
basal metabolism very important and valuable for purpose of
differential diagnosis of obscure thyroid disease. The results
are tabulated. The object of the experiments has been to deter-
mine the exact effect of roentgen-ray therapy and partial thy-
roidectomy in exophthalmic goitre, using the basal metabolism
as an index of toxicity. Studies were made of the effect of rest,
quinine hydrobromid, roentgen rays and of surgery.

It is the opinion of the authors that treatment by roentgen-
rays is first indicated, the result being controlled by metabolic
studies; when relief cannot be had by this method, operation is
then recommended. It was concluded that in the majority of
cases, results after two or three years are equally as good with
roentgen-ray as with surgery. With surgery, a rapid fall of
metabolism and with roentgen-ray, a gradual progressive fall
is noted. There is no mortality with roentgen-rays. Surgical

ABSTRACTS 337

patients do best who have been previously rayed. Surgical risk
is greater in cases of very high metabolism. Routine radiation
of exophthalmic goitre with surgery held in reserve is recom-
mended. Surgery 1S contraindicated in patients whose metabol-
ism is rising in spite of complete rest in bed. Periodic determi-
nations of basal metabolism should be made in management of
all cases of exophthalmic goitre—B. T. 3S.

(THYROID) Vasomotor symptom of hyperthyroidism. Mara-
non (G.), Revista Espanola de med. y. Chir. (Barcelona),
1919, 2, 598-600.

Maranon found in ninety-two of 100 cases of hyperthyroid-
ism that rubbing the skin in the neck lightly with the fingers
made it turn very red in the region of the thyroid, a much
brighter red than could be elicited by rubbing the skin in the
same way elsewhere. This vasomotor reaction may be more pro-
nounced in the milder cases, and is more distinct in the nervous,
in women, in the young, at the menopause, and in persons in-
clined to sympatheticotony rather than vagotony. He has not
seen any mention in the literature of this induced localized ery-
thema in the thyroid region; it may be a uniform or irregular
redness, and there may be slight swelling of the red patches.
J. Am. M. Assn., 74, 429.

(THYROID) The cause of exophthalmos in Graves’ disease.
Murray (G. R.), Brit. Med. J. (Lond.), 1916, (ii), 540.

Murray expresses a belief that exophthalmos in Graves’ dis-
ease is due to an excessive increase in the amount of retro-orbital
fat, which mechanically causes protrusion of the eye-ball. Post-
mortem findings in a human case and experiments on animals
in which melted parafin was injected retro-orbitally led him to
this conclusion.—I. M. ,
(THYROID) Sporadic. cretinism caused by a thyreoaplasia of

specific origin (Cretinismo esporadico por tireoaplasia ae
origen especifico). Novaro (Raul) and Gonzalez *(J. “Qr-
tuno), Anales del Inst. Mod. de Clin. Méa> (Birenoss Aino) °°
ee Woe, teas) yar” a

- ©
A description of a. myxoedematous*cretin fifteen years of
age and 1.40 m. in height ‘The parents gave a positive Wasser-
mann reaction, but the patient ts rself gave a negative reaction.
—B. A. H.

(THYROID HYPOPHYSIS ADRENAL) Interdependence of
the function of the ductless glands. O’Day (J. C.), N. Y.
Med, J. 1920, 111, 250-251.

338 ABSTRACTS

From a brief consideration of the function of the thyroid,
adrenal and pituitary the author concluded that no part is
played which in any way might make one gland’s function de-
pendent upon the functions of others——H. W.

(THYROID) Three hundred goitre operations. (Klinische
Erfahrungen bei 300 Kropfoperationen). Orth (Ose
Deutsche Ztschr. f. Chir. (Leipzig), 1919, 148, 360-384.

Orth reviews his experience with 300 goiter operations; the
mortality was 0.17 per cent. A number of cases showed the close
correlation between the various endocrine glands which surgeons
have to bear in mind; for instance, one woman first developed
goiter after splenectomy. In another woman the goiter devel-
oped at once after removal of a myoma, while Wettergreen has
witnessed the subsidence of a myoma as exophthalmie goiter de-
veloped. Several have reported increase in the size of the thy-
roid after removal of both ovaries, and Orth had a case in which
the woman aborted three days after resection of the thyroid.
Such happenings show the necessity for investigation of the
genital organs before operating for goiter. In three cases a
moderate form of tuberculosis seemed to be whipped up by
removal of a goiter which had been compressing the trachea, and
the patients soon died. Clairmont has reported some similar
experiences with tuberculosis patients. The blood pressure was
high in 70 per cent of Orth’s cases, and after the thyroidectomy
it dropped below normal, but gradually righted itself in a few
weeks. No change in the coagulation of the blood was apparent.
Transient albuminuria was evident in ten cases after the opera-
tion, not before. One patient had a spontaneous fracture of the
femur a year after resection of the thyroid, and she died in six
weeks. Orth is inclined to ascribe this fragility of the bones to
abnormal conditions such as are observed in the bones of thy-
roidectomized dogs. The displacement of the trachea should be
determined with radioscopy before the intervention, as a guide
to the operation. His only recurrences were in the four cases in
which radioscopy had been neglected, and the protrusion of the
goiter in the depths was not fully appreciated. He had fatal
hemorrhage or embolism in two malignant cases, and in one case
the esophagus was injured during the operation, as also the
trachea in another, but both healed without mishap after suture.
Anomalies in the vessels were not infrequent, and this possibility
should never be forgotten. In conclusion he warns of the neces-
sity for caution in using disinfectants in this region; some have
witnessed the flaring up of latent hyperthyroidism after applica-
tion of iodized dressings, ete. Another danger from them is the
effect on the vocal cords, similar to Cisler’s experience with
dogs; the voeal cords kept in the cadaver position whem their

ABSTRACTS 339

innervation had been cauterized with silver nitrate. After thy-
roidectomy the vocal cords are liable to keep in the median posi-
tion for a long time before they resume normal movements, and
any chemicals in the vicinity might exaggerate this.—J. Am. M.
Assn.

(THYROID) Exophthalmic goiter and pregnancy (Bocio exof-
talmico y embarazo). Peralta Ramos (A.), Rev. Asoc. Méd.
Argentina (Buenos Aires), 1919, 31, 289-309.

The coexistence of the two conditions is rare and in the
majority of cases pregnancy does not aggravate the goiter; when
such does oceur it is necessary to operate.—B. A. H.

(THYROID) Congenital goitre. Peterson (Edward W.), Med.
Ree. (N. Y.), 1916, 90, 789.

A ease of congenital goitre is described in which a large
adenomatous thyroid was found displaced to the right side of
the neck. The removal of the tumor was followed within a short
time by tetany, which, however, disappeared after administra-
tion of thyroid extract. The extract was employed until the
child was four years of age, when its use was discontinued. Men-
tal and physical development remained normal.—lI. M.

(THYROID) Goitre and psychoses. Phillips (N. R.), J. Ment.
Sei. (Lond.), 1919, 65, 235-248.

That the role played by goiter in the psychoses is more
extended than is indicated, is the theme of Phillips’ paper. Of
200 patients examined by him, the actual proportion of goiter
was 12 per cent. No less than seventeen of these patients suf-
fered from manicdepressive insanity or from the melancholia of
involution, i. e., 70 per cent of the whole number. Of the re-
maining seven, four were cases of dementia precox and three
were cases of paranoia. Phillips believes that those cases show
that the nature of the psychosis is, in some degree, determined
by the form of the functional disturbance of the thyroid gland,
e. g., hyperthyroidism is usually associated with states of excite-
ment, agitation, etc. (manic-depressive insanity), whereas hypo-
thyroidism is more often associated with states of apathy and
indifference (dementia precox).—J. Am. M. Ass. 74, 423.

(THYROID PARATHYROID) Concerning the surgical anat-
omy of the thyroid with special reference to the parathyroid
glands. Pool (Eugene) and Falk (Henry K.), Ann. Surg.
(Phila.), 1916, 63, 71-77.

340 ABSTRACTS

A eareful study was made in the human cadaver to deter-
mine the anatomical relations of the thyroid and parathyroid
glands and the recurrent laryngeal nerve with a special view to
learning specifically how much latitude is available in operations
upon the thyroid gland. The findings are illustrated by 21 half-
tone plates. So far as immediate results are concerned, it was
determined that a single lobe of the gland can be removed freely
and completely, the recurrent laryngeal being sufficiently pro-
tected by its capsular sheath. The loss of the two parathyroid
elands involved could readily be compensated by those remain-
ing. The possibility would remain, however, that a second sur-
gveon in a subsequent operation might repeat the same procedure
upon the other lobe with consequent acute parathyroid deficiency.
The authors are acquainted with two cases in which this actually
occurred. It is advised, therefore, that in a primary thyroid
operation the posterior part of the lobe excised should be left in
situ, by way of conserving the parathyroid tissue in that locality.

—R. G. H.

(THYROID) On certain dietary factors to be considered in the
treatment of cases of hyperthyroidism. Rosenbloom (Jacob),
Proc. Soc. Exper. Biol. &-Med. (N. Y.), 1919, 17, 28.

The writer has obtained clinical evidence that in formulat-
ing a diet for patients suffering from hyperthyroidism, two
important factors must be considered: first, the diet should
contain the minimum amount of protein; and second, foods low
in iodine content should be selected.—Quoted.

(THYROID) The surgical treatment of exophthalmic goitre.
Rowan (Charles J.), J. lowa State M. Soe. (Des Moines),
1916, 6, 199-208.

Rowan believes that while some cases of exophthalmie goiter
can best be treated by medical means, the majority are surgical.
Proper surgical treatment will cure approximately 70 per cent
and greatly improve most of the remainder. Great harm is
done when futile medical treatment is prolonged until the patient
becomes a poor surgical risk or permanent damage has been
done to various organs,—especially the heart. An extremist’s
attitude toward either method is deplored.—R. G. H.

(THYROID) Concerning the ‘‘rickets,’’ so-called, of rabbits
from thyroidectomised parents. Rusea (G. L.), La Pedria-
tria (Naples), 1919, 27, — (No. 10) ; Abst., Presse Méd., 1920,
28, 10.

Claude and Rouillard claimed in 1913 to have observed
experimental rickets in young rabbits, the parents of which were

ABSTRACTS 341

subjected to thyroidectomy. The principal manifestations of
the disease were arrest of skeletal development and changes in
the muscles, viscera and bones which both microscopically and
macroscopically resembled those seen in human rickets. Rusca
repeated the experiments, claiming for himself a rigorous tech-
nique. The results were completely negative. The author is
convinced that these results cannot be ascribed to failure to re-
move all the thyroid tissue, since in all cases they were consist-
ently negative. It is concluded, therefore, that the results of
the previous investigators were merely examples of ‘‘spontan-
eous’’ rickets such as have been noted by various other observ-
ers.—R.. G. H.

(THYROID) Congenital thyroid atrophy (Angeborene Schild-
driisenatrophie). Schultze, Deutsche med. Wehnschr. (Ber-
lin and Leipzig), 1916, 42, 1211.

A elinieal report, in which nothing new is given, of a case
of partial myxcedema in a mentally and physically retarded
girl of 15.—F. S. H.

(THYROID) The non-surgical treatment of Graves’ disease—a
counter-blast. Scott (T. B.), Practitioner (Lond.), 1918, 100,
442-450.

The author contends that in Graves’ disease we have ‘‘a
pluriglandular disturbance, not only as to quantity of secretion,
but as to quality also, and that this disturbance is in the great
majority of cases caused by bacterial poisons from within.’’ He
believes that shock, grief and fright are only emergencies stir-
ring up partly latent trouble. ‘‘The glandular disturbances act
partly by direct action on certain organs, such as the heart, and
sympathetic, but chiefly, perhaps, by producing discord in the
glandular system of the whole body.’

Intestinal antiseptics such as beta-naphthol and salicylate
of bismuth are recommended, since there is frequently a gastric
or intestinal dyspepsia and often colitis. In addition to these,
duodenal extract is said to act ‘‘like a charm on duodenal catarrh
and on colitis that has not gone too far.’’ The following formu-
la is advised :

Ppugdenaeextract ) 00.2202... ers. 2
Petia oanmapis’ Tids.: A002... ers. 1/6

In tablets; one, three times a day, an hour after food.

Parathyroid is also advocated to help control the tremors
and other nervous manifestations of the disease.

The observation that thyroid hypofunction ending in a
form of myxcedema occurs at the end of a fair number of cases
of Graves’ disease causes the author strenuously to object to the

342 ABSTRACTS

surgical removal of any thyroid tissue whatever, since in old
age the patient is likely to require all the thyroid he ean get.
X-ray treatment is also condemned because of probable destruc-
tion of thyroid tissue.

“That brilliant craftsman, the thyroidectomist, should be-
come an anachronism, a tradition only of the dark days that are
eone; and medicine, strong in physiological and philosophical
faith, should resume her peaceful sway.’’—L. G. K.

(THYROID) Fatality under roentgen treatment of exophthal-
mic goiter. Secher (K.), Nordiskt Medicinskt Archiv (Stoek-
holm), 1918, 51, 63-70.

Secher reports the case of a previously healthy woman of
39, who had developed exophthalmie goiter in the course of a
year. He gave eight roentgen exposures in two days, each a
one-half Sabouraud- Noire dose, with a 2 mm. filter, exposing
three fields on the thyroid gland and one on the thymus. The
condition became ageravated even during the roentgen treat-
ment, and the condition erew rapidly worse till death the fifth
day. He reviews the three cases on record in which roentgen
exposures of simple goiter were followed by symptoms of exoph-
thalmic goiter. In Rieder’s and Vernine’s cases the aggrava-
tion proved speedily fatal, as in the case here described. (See
also Endocrin. 3, 573.)—J. Am. M. Assn.

(THYROID) Treatment of goiter with injections of phenol,
tincture of iodin and glycerin. Sheehan (J. E.) and New-
comb (W. H.), J. Am. M. Assn. (Chgo.), 1920, 74, 81-82.

In an attempt to produce a local inflammation, which would
eventually cause a fibrosis in the gland, these authors injected
80 eases of goiter (55 parene hymatous, 14 exophthalmic, 8 cys-
tic, 2 colloid, and 1 adenomatous) with five drops of equal parts
of pure phenol, tincture of iodin, and glycerin, at five days in-
tervals. The number of injections varied from five to fifty-five.
They report cures in 76.4% of the parenchymatous goiters, and
improvement in 80% of the toxie cases. In the cystic, colloid
and adenomatous group they found no improvement.—F. C. P.

(THYROID) Studies on hyperthyroidism. Smith (IF. M.), J
Am. M. Assn. (Chgo.), 1919, 73, 1828-1832.

Thirty men who were convalescing from influenzal pneu-
monia and showed rapid pulse, enlargement of the thyroid gland,
fine tremors of the hands, moist, clammy skin and some of the
eye.signs usually associated with exophthalmic goiter, were exam-
ined to determine, if possible, whether the thyroid gland was
the basis of these symptoms. In addition to the usual physical

ABSTRACTS 343

examination and laboratory work, blood sugar determinations,
following the administration of glucose by mouth, were made.
The response to epinephrin and the effect of thyroid feeding
were also noted.

Seventeen of the cases were diagnosed as simple tachycardia,
and seven as irritable heart; none of these cases responded to 5
grain doses of desiccated thyroid, nor gave any evidence of dis-
turbed carbohydrate metabolism. Six cases were finally diag-
nosed as hyperthyroidism, the diagnosis being based on the re-
sponse to thyroid feeding, a positive response to epinephrin and
a suggestive disturbed carbohydrate metabolism.—t!’, C. P.

(THYROID ENDOCRINE ORGANS) Angioneurotic edema.
Staffieri (D.), Revista Médica del Rosario, 1919, 9, 293-298.

Staffieri summarizes the prevailing views in regard to
Quineke’s edema, in the statement that it is characterized by
abnormally exaggerated excitability of certain nerves which
have control of the secretion and circulation of lymph. This
hyperexcitability is almost always constitutional, the result of
‘‘dysendocrina’’ (defective functioning of the endocrine
glands), with thyroid insufficiency predominating. This excit-
ability is rendered manifest by influences of different kinds,
including some which behave like antigens, inducing anaphylax-
is. In the first of his two cases, one side of the throat was affect-
ed but there was no inflammation. The young man showed signs
of thyroid insufficiency and hypogenitalism, and under thyroid
treatment there has been no recurrence of the acute edema of
the throat. Atropin and a saline purge relieved the immediate
symptoms; it was the first and only attack to date. In the other
case there had been fleeting edema at various points during
seven years. In this latest attack the face alone was involved,
and the edema was so extreme that the eyelids could not be
closed. As usual, the edema subsided completely in a few days.
The patient was a healthy married woman of 35 with two healthy
children and negative Wassermann reaction, and there are no
signs of derangement of any of the glands of internal secretion.
J. Am. M. Assn.

(THYROID THYMUS) Thyroidectomy for vagotonic type of
on disease. Stettin (W.), Med. Ree. (N. Y.), 1916,
, 080.

A brief case report. A patient was operated upon for
Graves’ disease, part of the thyroid being removed. A relapse
was experienced. At a second operation another portion of the
thyroid was removed, together with a small retrosternal mass
which, upon microscopic examination, proved to be atrophic
thymus tissue. Recovery was satisfactory.—R. G. H.

O44 ABSTRACTS

(THYROID) The etiology of mongolism (Zur Aetiologie des
Mongolismus). Stoeltzer (W.), Miinech. med. Wehnschr.
(Munich), 1919, 66, 1493.

The author observed ten children with Mongolian idiocy.
No noteworthy features were presented, but in three the mother
had complained during pregnancy of a loss of appetite and con-
stipation ; she became fat, did not perspire, lost hair and became
dull. It is suggested that these cases of mongolism were due to
hypofunction of the thyroid of the mother.—J. K:

THYROID treatment, The results of—in nine cases of alopecia
areata maligna. Strandberg (J.), Acta Med. Seand., 1919,
52, 165-175.

Five cases out of 9 showed marked improvement upon ad-
ministration of thyroid. However, results do not warrant con-
clusion that the etiology of the disease is found in the disturb-
ances of the endocrine glands.—Chem. Abst.

(THYROID) Method and results of a study of the distribution
of iodine between cells and colloid of thyroid glands. Tatum
(Arthur L.), Proce. Soc. Exper. Biol. & Med. (N. Y.), 1919,
17,428:

Method: Use was made of the fact that from frozen sec-
tions, as prepared for histological study of fresh, unfixed tissues,
the colloid of the thyroid gland completely disappears out of
the acini when the sections are floated in physiological salt solu-
tion. The sections were picked out by means of a needle, washed
in another salt solution, dried at 105° C., weighed and analyzed
for iodine by the technique of Kendall. The iodine in the eol-
loid portion was sometimes determined by evaporation of the
salt solution—and at other times differentially by analysis of the
whole dried gland.

Results: In a series of about 30 experiments on dogs’ thy-
roids the iodine was found in the majority of cases to be wholly
in the colloid. In a smaller number the cell mass gave only
qualitative tests for iodine, which, at the present stage of this
investigation might be considered due to small unopened acini.
The physiological significance of these findings is being investi-
gated.—Quoted.

(THYROID) Some blood pressure phenomena in exophthalmic
goiter. Taussig (A. E.), Tr. Assn. Am. Physicians (Phila.),
1916, 32, 121-127.

The blood pressure in exophthalmic goitre shows the same
sort of anomalies, but to lesser degree than those seen in aortic

Or

ABSTRACTS Bez

regurgitation. The pulse pressure is high as compared with the
diastolic. Both systolic and pulse pressures are higher in the
leg than in the arm. Non-toxic goitres, on the other hand, do not
give rise to this difference, the pressures in both upper and lower
limbs being equal. This differential arm and lee pressure, al-
though characteristic of exophthalmic goitre, is by no means
pathognomonic. Identical pressures in arm and lee are re-
garded, however, as of considerable value in ruling out this type
of goitre.—R. G. H.

THYROID and PANCREAS, Giant-cell sarcoma of—(Reus cel-
lensarcom van de schildklier en het pancreas). van Rijssel
(EK. C.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1919, 63
(ii); 2914.

A pathological-anatomical description of two cases, the first
of which was a sarcoma ot the thyroid with metastases in the
lungs and the second, a sarcoma of the pancreas associated with

5S . y . . .
gastric ulcers. The article contains some e@00d microphoto-
graphs, but no clinical details.—J. K.

(THYROID) The ‘“‘hydro-telluric’’ theory of Bircher and its
application to the regions of endemic goiter in Argentina
(La ‘‘Teoria hidrotelurica’’ de Bircher y su aplicacion a las
regiones de kocio endémico en la Argentina). Wernicke
(R.), Rev. del Inst. Baet. del Dep. Nacional de Higiene
(Buenos Aires), 1919, 2, 325-332.

The drinking waters from Rosario de Lerma and Chicona
(Province de Salta) which are regions very strongly infected
with endemie goiter do not have the low surface tension observed
in the waters from the endemic regions of Switzerland by Bireh-
er. The geological characters of the goiter regions in the Argen-
tine fail to confirm Bircher’s hydrotellurie theory.—B. A. H.

(THYROID AUTONOMIC N. §.) The histopathology of the
autonomic system in goiter. Wilson (Ll. B.), Journal-Lancet
(Minneapolis), 1917, 37, 368-370.

An examination by the above writer of the nerve cells, ete..
of the cervical sympathetic in all cases of goiter, revealed var-
ious degrees cf degeneration. Glandular degeneration was shown
in the ganglion cells of cases of exophthalmic goiter. The degree
of degeneration always paralleled the intensity of the manifested
toxicoses.—J. H. L.

(THYROID) Goiter, considered from the standpoint of the
pathologist. Wilson (L. B.), Miss. Valley M. J. (Louisville,
Ky.), 1916, 25, 225-228.

346 ABSTRACTS

The author divides the pathologic enlargements of goiter
into four groups: (1) non-symptomatic or simple goiters,
in which the primary parenchymatous hypertrophy and hyper-
plasia are absent. The enlargement is colloidal in nature and in
the belief of the author is caused by a water-borne, chronic infec-
tion. (2) The toxie non-exophthalmic, as a rule, are associated
with encapsulated adenomas. The differentiation from the path-
ologic standpoint between the toxic and non-toxic adenomas is
not complete. (3) In toxic exophthalmic goiter there is @ener-
ally found either primary hypertrophy and hyperplasia or both.
The additional over-production symptoms are probably due to
the irritation of the cervical sympathetic gangha. (4) Malig-
nant neoplasms of the thyroid are not so common nor so easily
recognized. Most cases were originally encapsulated tumors
containing small cells with large nuclei.—F. S. C.

(THYROID AUTONOMIC N. S.) Further study of the histo-
pathology of the autonomic nervous system in goiter. Wil-
son” (Li. B.), J. Lab. & Chine Med a(St: ouis)s, 19nG sje.
295-307.

The following pathological changes were found in the ecervi-
cal sympathetic ganglia (twenty ganglia) which were re-
moved at operation from sixteen patients with hyperplastic, tox-
ic (exophthalmic) goiter: (1) Definite change in the cells of
the ganglion. (2) All showed various changes of degeneration.
(3) Degeneration was also shown in some of the nerve fibers.
(4) The pathologic changes in the cervical sympathetic ganglia
were parallel to the stage and intensity of the symptoms of hy-
perthyroidism.—J. H. L.

The abstracts in this number have been prepared by the
staff assisted by:

B.S. Campbell, Mayo Clinic, Rochester, Minn.

Mrederick Fenger, Chicago.

Jonathan Forman, Columbus

Samuel Hanson, San Francisco.

Margaret M. Hoskins, Minneapolis

lL. G. Kilborn, University of Toronto

Irvine MeQuarrie, Baltimore.

I’. C. Potter, Kalamazoo, Mich.

With the permission of the editors, certain abstracts have

been quoted from ‘‘Physiological Abstracts,’’ ‘‘Chemical Ab-
stracts’’ and ‘‘Surgery, Gynecology and Obstretrics.”’

,&

EPooOCRINOEOGY

THE BULLETIN of the ASSOCIATION
for the STUDY of

INTERNAL SECRETIONS

JULY-SEPTEMBER, 1920

CLASSIFICATION OF DISORDERS OF THE
EYPOPEYSIS*

Wm. Engelbach, M. D.
St. Louis

To have the opportunity of submitting a classification of
the disorders of the hypophysis to this audience, many of whom
have done original work upon this gland, is indeed a privilege.
This presentation is made with the view that the many com-
plexities encountered in correlating the clinical manifestations
of these disorders, with the changes in function and histology of
the hypophysis, will be clarified by its discussion. The pri-
mary essentials relative to the physiology of the pituitary body,
upon which this classification is based, have been deduced almost
entirely from the theoretical conclusions of pituitary function
advanced by American investigators (Cushing, Goetsch, Homans,
Crowe, and Bab). The application of these principles has been
stimulated by our analysist of 892 endocrine eases, of which 147
were diagnosed disorders of the pituitary gland; 350, of the thy-
roid; 194, of the gonads; 186, pluriglandular disorders; 10, dis-
eases of the adrenals and 5, thymus diseases. Of the 123 hypo-
pituitary disorders, 23 were grouped as anterior lobe; 3, as pos-

,
*Read before the Association for the Study of Internal Secretions, New
Orleans, April 26, 1920.
7From observations made in conjunction with Dr. J. L. Tierney, to whom
we are indebted for the determinations on basal metabolism and carbohydrate
tolerance,

348 DISORDERS OF HYPOPHYSIS

terior lobe; and 86, as bilobar insufficiencies. The hyperpitui-
tarisms totaled 24, of which 6 were anterior lobe; 2, posterior
lobe. and 16, bilobar varieties. There were 11 cases of diabetes
insipidus, or hypophyseal polyuria, some of which were asso-
ciated with an anterior lobe or a pars nervosa syndrome. Pitui-
tarism as a part of a pluriglandular complex (not included in the
147 primary pituitary disorders) occurred in 122, making a total
of 269 eases in which elinieal manifestations of pituitarism were
present. Of the total number of pituitary cases, only 8, or 6 per

cent, were neoplastic in origin. Conclusions, dependent upon the
differentiation of the clinical manifestions determined from com-
paring pituitary with other endocrine disorders, have substan-
tiated to a considerable degree the theories of the functions of
the individual lobes of the pituitary gland.

Lobar Grouping. This elassification separates the hypophy-
sis into two lobes, the anterior and the posterior, with the pars in-
termedia as part of the latter. The clinical manifestations, due
to abnormal secretions of one or both of these lobes, are taken as
the chief guide for the grouping of the disorders. The clinical
syndromes (exclusive of pituitary neighborhood signs and symp-
toms), formerly termed ‘‘glandular’’ symptoms, are named
‘‘hormonie’’ signs and symptoms, a qualification applying to all
endocrine disorders. The ‘‘hormonie’’ signs and symptoms are
defined as physical or metabolic changes associated with other
endocrine symptoms due to an abnormal secretion of a ductless
gland. Those pertaining to the pituitary disorders are divided
into the physical, metabolic, and other endocrine symptoms. The
physical ‘‘hormonie’’ signs are subdivided into the general and
regional.

Among the general ‘‘hormonic’’ signs are the well-known
changes in osseous development, producing classical dispropor-
tion in the measurements (torso, lower measurement, and span),
unusual development of the voluntary musculature, abnormal
contraction of the unstriped muscle tissue, pigmentation, and
hair distribution. Among the significant regional ‘‘hormonic’’
signs are local changes in the head, nose, teeth, chin, hands, and
genitalia, localized adiposity, pigmentation, ete. Other impor-
tant pituitary endocrine symptoms are polyuria, changes in basal
metabolism, carbohydrate tolerance, mentality, other endocrine
secretions, temperature, pulse, and blood-pressure.

)

ENGLEBACH B49

Certain combinations of the above ‘‘hormonic’’ signs and
symptoms are taken as indicative of abnormal secretion of an in-
dividual lobe or of both lobes of the pituitary gland. These com-
binations or clinical syndromes were present so constantly in
classical types and varieties of pituitary disorders, that they have
been deemed the most valuable as a grouping system for these
diseases. The neighborhood signs and symptoms, while impor-
tant as diagnostic evidence of the neoplastic varieties of the dis-
orders, were of little value for differentiating the varieties and
types for the purpose of classification or diagnosis. This is true
on account of the fact that pituitary tumors were found asso-
ciated with all the various clinical syndromes. Furthermore, the
incidence of pituitary tumor was so rare (6 per cent of the cases
herewith reported) that its symptomatology was practically use-
less as a basis for general classification. The histopathology of
the hypophysis, particularly of the a-neoplastic type, has been
too poorly defined to make it a dependable basis worthy of
classification.

Functions of the Lobes of the Hypophysis. In order to
justify this lobar classification of these disorders, it becomes
necessary to establish the function of each lobe of this gland
producing these specific ‘‘hormonic’’ signs and symptoms. As
the function of the entire pituitary body, as well as of its
individual lobes, is yet a matter of controversy, this will be
difficult and must remain somewhat questionable. In attempting
to assign definite ‘‘hormonic’’ syndromes to specific disturbances
in the lobes of the hypophysis, the writer has accepted, to a
large extent, the early experimental work of Cushing, Goetsch,
and others. Personal clinical observations, so far made upon
these hormonic complexes, have seemed to substantiate their
theories, in contradiction to those of Bell, Falta, Fisher, Bied],
and others.

As will be seen from the following table, the major hormonic
signs of the anterior lobe (A and B) are those referable to the
growth and function of the osseous and genital systems, and the
minor signs (C, D, E, F, G and H), to the dermal system,
mentality, temperature, pulse and blood-pressure. The major
signs attributed to the posterior lobe (I, II, III and IV) are
those resulting in disturbed: metabolism, deposition of adipose
tissue, polyuria and unstriped muscle contraction. Associated

A.

bo

ise)

1

Cc.
1

Osseous

. Stature

a. Measurements

Head

a. Sinuses

b. Nose

e. Superior Maxilla
d. Chin

e. Sella Turcica
(X-ray)

Hands

a. Phalanges
(X-ray)

- Pelvis

a. Genu

. Genital
- Gonads

(ovary
testicle)

2. Uterus
oe

Menses

-. Sterility and Impo-

tence

. Secondary Sex
Characters

Muscular

. Muscle Tonus

D. Mental

E. Dermal

yd

ee

a. Teeth

or

HORMONIC SIGNS OF THE

HYPOPITUITARISM

A. Undergrowth.

(JN)

B

Cc.

ile

aay Dp. e

. Amenorrhea,

Preadolescent

All
Bones

LORAIN-LEVE type

. Short

a. Torso greater
than lower. Span
less than height

. Small

a. Small
b. Pointed, straight

ec. Normal

d. Pointed, sharp

e. Small, except
neoplastic type
enlarged

“en petit,”

one-third smaller

than normal

a. Narrow, taper-
ing, tuberosities
and tufting ab-
sent

Broad,
type

a. Valgum

feminine

. Infantile

Infantile

met-
rorrhagia, and
dysmenorrhea

Present

. Absent

Proportionate to

development
Normal

DISORDERS OF HYPOPHYSIS

TAB
ANTE
Postadolescent
A. Undergrowth. Short

Co bo lm

C.

iL

and flat bones
only. (Normal
long bones)

. Tall, or normal

2... -V-ac ri e's. 2borso
greater than
lower or tess
than lower (eu-
nuchoid)

Small

a. Small

b. Pointed, straight

ec. Normal

d. Pointed, sharp

e. Small, except
neoplastic type
enlarged

Small

a. Narrow, taper-
ing tuberosities
and tufting ab-
sent

Broad, feminine
tye

a. Valgum

Normal

Normal

Tendency to dys-

menorrhea,
amenorrhea,
and metrorrha-
gia

. Present

. Present

Normal

Fatiguability fre-

quent

D. Usually deficient or D. Average

b. Hair Distribution

Temperature

Pulse

. Blood-pressure

retarded

Upper incisors
enlarged, lateral
occlusion good

b. Absent

F. Subnormal

G.
1st

Hypotension,

Slow

or
normal

a. Occasional sepa-
ration and fre-
quent enlarge-
ment of upper
incisors

b. Normal

F. Subnormal
G. Slow
H. Hypotension, or

normal

ENGLEBACH B01

LE I ;
RIOR LOBE OF THE HYPOPHYSIS

HYPERPITUITARISM

Preadolescent Pestadolescent
A. Overgrowth of all | A. Overgrowth. Acral, short and
bones flat bones only. (Long bones
Normal giant i - short)
Eunuchoid giant Gigantism Acromegaly
Acromegalice giant

1. Abnormally tall J 1. Short and stocky, or normal

a. Normal giant: torso =lower, a. Acromegaly: torso greater
span — height than lower, span less than
Eunuchoid giant: torso less height
than lower, span _ greater
than height
Acromegaliec giant: torso
greater than lower, span less
than height

2. Large 2. Large

a. Large a. Large

b. Pointed, normal (eunuchoid b. Blunt, rounded
giant)

Blunt (acromegalic giant) ~
ce. Normal, except prominent in
acromegalic giant

ce. Prominent

d. Pointed, except prognathism d. Rounded, blunt. Prog-
in acromegalic giant nathism d
e. Normal, except neoplastic e. Normal, except neoplastic

type enlarged type enlarged
Type “en large,” spade hand,

3. Type “en longe,”’ one-third larg- 3. ;
wrist wide, fingers broad and

er than normal. No dispro-

ity occurs)

portion clubbed. Infiltration of soft
tissues over bones. Hands
and head involved
a. Wide, dense, tuberosities a. Wide, dense, tuberosities
large, terminal tufting, ex- large, terminal tufting, ex-
osteses ostoses
4. Narrow, masculine type 4. Narrow, masculine type
a. Varum a. Varum
B. B.
1. Large, well developed 1. Large, well developed
2. Normal 2. Normal
. Normal 3. Normal
. Absent (present in a féw years 4. Absent (present after many
with transition to hypoac- years with transition to hy-
tivity) poactivity)
5. Present (even after hypoactiv- 5. Present (even after hypoactiv-

ity occurs)

C. Normal, or overdeveloped C. Overdeveloped
1. Loss after few years’ overac- 1. Retained after age of 40-45
tivity)
D. Apathetic (after activity D. Abnormally developed, tempera-
changes) mental, loquacious, unstable
a. Enlarged and separated up- a. Separation of upper incisors
per incisors. Lowers sepa- constantly; frequently of
rated in acromegalic giant lower, with prognathism
b. Increase on torso b. Marked increase on extremi-

ties and chest

F. Normal F. Normal
G. Normal G. Normal
H. Normal. Hypotension after H. Normal, or above normal

change to hypoactivity

302 DISORDERS OF HYPOPHYSIS

with these are minor signs, affecting the secretion of other
endocrine glands, the nervous system, temperature and pulse.

While it is true that the secretion from the anterior lobe
seems to have a definite effect upon the development and function
of the osseous and genital systems, it is acknowledged that other
factors, endoerinous and endogenous, undoubtedly have consid-
erable influence upon both the growth and development of these
two systems. Not all cases of retarded osseous growth and
aplasia, for instance, can be attributed to hyposecretion of this
lobe of the hypophysis. The French school (Brissaud, Meige,
Bauer, Anton and Brammel) have many subdivisions of infan-
tilism (‘‘nanisme,’’ ‘‘chetivisme,’’ ‘‘nanisme complet’’), many
types of which have no relation to pituitary disorders. The
above table contrasts the hormonie signs related to the anterior
lobe in hypopituitarism with those of hyperpituitarism, and
demonstrates the differences dependent upon the age at which
this disturbed activity occurs (pre-and post-adolescent). Atten-
tion is directed particularly to the extreme opposite change noted
in the osseous system in pre-adolescent hypopituitarism (first
column) as compared with pre-adolescent hyperpituitarism
(third column).

The effect of the secretion from the anterior lobe upon the
muscular tonus is a subject which has received comparatively
little attention, but which has appeared to the writer as being
almost as important as the difference present in the osseous
growth and development. This is particularly striking when
one compares the muscular development and tone of pre-ad-
olescent hypopituitarism (Lorain-Levi type) with those of post-
adolescent hyperpituitarism (acromegaly). The extreme difter-
ence in the genital function and development is also emphasized
in comparing the foregoing two types. In the first (Lorain-Levi
type) the genitals are infantile and functionless, with the pres-
ence of sterility and impotence; whereas in the acromegalic, the
genitals are unusually well developed and associated with hyper-
sexuality. In pre-adolescent varieties of both over- and under-
activity of this lobe, there is a tendency to decreased genital
function. This is present as a cardinal sign in the hypopituitary
post-adolescent subject, and is soon acquired in pre-adolescent
hyperpituitarism, on account of the early transition to inactivity
in this variety. Decreased genital function and muscle tonus

ENGLEBACH 353

occurred so constantly with hypoactivity of the anterior lobe,
that they established themselves as the best indicators of the
state of activity of this lobe. Hence, the genital functions
(menses, libido, and potency) and the muscular tonus (muscle
fatigue or physical capacity), taken with the temperature, pulse,
and blood-pressure, were considered, at the time of their determi-
nation, the significant signs of activity. The osseous changes,
genital development, and secondary sex characters were inter-
preted as evidence of former activity which might have changed
to the opposite state.

The intermittent enlargement and infiltration of local parts,
such as the hands and face, in acromegaly, were undoubtedly
due to changes in the soft tissue covering the short and flat bones
involved, and not a result of osseous change. The rapid changes
in these localized swellings, besides the frequently associated
sweating of these parts, helped to prove this origin. While there
Was no nervous syndrome specific of pituitary disorder, the
different mental states, as described above, were most frequently
demonstrable. The most significant mental change was prob-
ably that occurring in gigantism and acromegaly, with change
of activity in this lobe. Change from a hypermental state to
one of depression, apathy and indifference, if associated with loss
of genital function and muscle tone, was considered particularly
significant of transition to hypoactivity. The orthodontial mark-
ings in anterior lobe insufficiencies varied considerably. In the
pre-adolescent hypopituitary individual, there was usually a
tendency to overcrowding of the lower teeth, with fairly good
lateral occlusion of the upper. The frontal incisors were con-
stantly enlarged in those cases in which there was absence of
genital function and development. The separation of the upper
_ incisors occurred in post-adolescent hypopituitarism, and was
usually present in pre- and post-adolescent hyperpituitarism ;
whereas the separation of the lower teeth was limited to the
acromegalic giant and acromegaly, being absent in other hyper-
pituitarisms, as well as in all deficient secretions of the anterior
lobe. The blood-pressure, temperature, and pulse were important
signs of activity in this, as well as in other endocrine glands,
but were by no means specific for pituitarism. Hence, they are
valuable as signs of activity, but not as signs of any individual
ductless gland. They are respectively subnormal and slow in the

304 DISORDERS OF HYPOPHYSIS

hypoactive cases, and normal or slightly above normal in the
opposite state of secretion.

Basal metabolism determinations* have been made on only
32 of the cases which came under observation during the last six
months. These cases have been grouped among the five varieties,
so that there were too few in any one variety from which to

draw satisfactory conclusions.

The basal metabolism in these few cases of disorders of the
anterior lobe of the hypophysis varied considerably. This is
in contradiction to the theories previously advanced, to the effect
that the anterior lobe secretion has no influence upon metabolism.
One would believe that either there must be some relationship
between the metabolism and the function of this lobe, or the
clinical diagnosis excluding the posterior lobe of the hypophysis
and the other endocrine glands, as an accompaniment in these
cases, was incorrect. In the simple anterior lobe dyscrasias
reported herewith, 7 cases had a basal metabolism varying from
the normal. In 5 eases it was decreased, varying from 2 to 30
per cent, and in 2, it was increased 14 and 15 per cent respec-
tively. In one ease in which anterior lobe extract was given
therapeutically, the basal metabolism was increased from —30
to +8 per cent during six weeks’ treatment. This increase in
metabolism to slightly above the normal was accompanied by
relief of other symptoms, such as headaches, mental disability,
muscular fatigue, loss of libido, ete. In the pure hyperactivities
of the anterior lobe, the same discrepancy in basal metabolism
determinations occurred. In the 4 cases in which the metabolism
was determined, it was found normal in 2, and increased in 2.
In 5 eases originally diagnosed as simple anterior lobe hypo-
activities, it was found that the basal metabolism was increased
beyond 10 per cent, and the sugar tolerance markedly decreased,

*Benedict’s Portable Apparatus No. 49 was used for these determinations.
The linear formula of D. Du Bois and E. F. Du Bois was used for computation
of the area of body surface. 'The following table of Aub and E. F. Du Bois was
taken as the normal standard for the calories per square meter of body surface
per hour:

(Height-Weight Formula)

Age, Years Females
De en Uehara urate ic bagi tord p-c aero colada iteAn eas 43.0
GSE Srey. sie, syeuserers eudictelchenememe eee mecenchenetetate sts 40.0
fit 4 Re AeA Oy PHO.CWeAN oC Cac. Guts Orato eo OE 38.0
VAl-aiVatroaoco cia sagqbonpc.dnobaodn ooo sO OnE >$ 37.0
SOARS ye ioe tes cel one ede aia feta Meehan eee ever eme ¢ 36.5
4AO-DO 5.5. estar tfer nase op).a.eudlavenere. sj elereus tobeagansretel ne 56.0
DIOEGOs. Bee dic adele = Eacgaue eich oc eauehe as Raa Eheletae 55.0
GOL Oi acho jo enotsvatatantin sere ee ee ee 54.0
COLO Silecis Siihs Sel oelarcl evel autenehe lane reter meta cians woes 33.0

ENGLEBACH 399

which necessitated a change in the diagnosis and grouping to
the bilobar division, under the heteroactive variety.

The carbohydrate tolerance* was estimated in 10 eases of
anterior lobe dyscrasia. Of these, 7 were decreased, and 3 were
increased in activity. Of the hypopituitarism cases, 5 showed
an increased, and 2, a decreased sugar tolerance; whereas, in the
hyperactivities, 2 cases showed an increased, and 1, a decreased
tolerance. In the 2 cases having an increased basal metabolism,
the sugar tolerance curve was normal.

The hormonic signs due to increased and decreased activity
of the posterior lobe are given in detail below. It will only be
necessary to refer to the fact that they are exactly opposite, a
statement that cannot be proved absolutely on account of the
considerable difference of opinion regarding the functional
effects of this lobe, as related to specific influence upon other
processes and structures of the body. It will be observed that
the writer is of the opinion that this lobe of the hypophysis has
practically no relation to the growth or function of the osseous
and genital systems. On the contrary, its function is limited
directly to the regulation of the metabolism, and indirectly to
effects upon other organs and tissues which deal with metabolic
procedure.

The influence of the secretion of the posterior lobe upon
metabolism, estimated from personal observations based upon
the determination of basal metabolism and carbohydrate toler-
ance, was found more definite in its relationship than those
changes of metabolism associated with the simple anterior lobe
dyserasias. The following is a summary report of the basal
metabolism and earbohydrate tolerance determinations made
upon cases of pituitary disorder in which the posterior lobe
was involved independently, or was associated with an anterior
lobe syndrome. Many of the cases having anterior lobe dis-
order had a secondary gonad disturbance, but none was of the
pluriglandular syndrome haying hormonie signs of the thyroid,
adrenals, or other ductless glands. The basal metabolism determi-

*The sugar tolerance was estimated by the Janney-Isaacson method. The
blood sugar was estimated first after 15 hours’ fasting. Glucose, 1.59 grams
per kilogram of body weight, was given, and blood sugar estimations were again
made, one hour and two hours following the ingestion of this amount. A normal
curve was arbitrarily established, as follows: after 15 hours’ fasting, 0.10: after
the first hour, 0.18; and after the second hour, 0.15. <A decreased tolerance was
considered one which would produce a higher curve during the two hours’ esti-
mations than the normal curve. Increased tolerance would show a curve 3 or 5
points below this curve.

DISORDERS OF HYPOPHYSIS

TABLE II

HORMONIC SIGNS OF THE POSTERIOR LOBE OF THE HYPOPHYSIS
HYPOPITUITARISM

II.

TT:

Ty.

. Metabolism

a. Basal Metabol-
ism

b. Carbohydrate
Tolerance

ce. Glycosuria and
Hyperglycemia

Adiposity

Polyuria

Involuntary Mus-
cle Contraction

a. Intestinal

b. Uterine

. Endocrine Secretion

a. Thyroid

b. Adrenals
ce. Gonads

d. Pancreas

. Nervous

Temperature

Pulse

1

Ie

10

live

V.

. Apathy;

a. Decreased
b. Increased

ce. Absent

Marked girdle,
mons and mam-
mary

Present (Pars In-
termedia 7?)

a. Absent; fre-
quent intestinal
atony

b. Absent

a. Hypoactivity
(hibernation )

b. Insufficiency ?

e. Hypoactivity
(with Anterior
Lobe disorder)

d. Normal (increas-
ed sugar toler-
ance)

Somno-
lence frequent

Subnormal

Slow

if

Ie

Til.

TV

VI.

HYPERPITUITARISM

a. Increased
b. Decreased

ce. Present

Absent, usually
emaciation

Absent (or pres-
ent with glyco-
suria)

a. Present; fre-
quent intestinal
spasticity

b. Present

a. Hyperactivity

b. Hyperactivity ?

ce. Hyperactivity
(with Anterior
Lobe disorder)

d. Hypoactivity
(decreased sugar
tolerance)

Psychie instability

VII. Normal
VIII. Rapid

ENGLEBACH 397

nations were made in 18 cases in which the posterior lobe was
involved. Of these, 14 cases were hypoactivities, and 4, hyper-
activities. In the hypoactivities, this metabolism was decreased
in 5 eases, normal in 5 cases, and increased in 4 cases. Of the
4 cases showing an increased metabolism, against the rule for
hypoactivities of this lobe, it occurred in 2 after treatment, and
in 1 associated with a polyuria. This practically left only 1
ease which had an increase in metabolism, not conforming to the
supposition that decreased secretion of this lobe is constantly
associated with decreased metabolism. Of the 4 hyperpituitar-
isms, the metabolism was increased in 2, and normal in 2, all
fitting perfectly into the clinical diagnosis.

In 61 eases diagnosed as posterior lobe disorders, the
carbohydrate tolerance was determined. Of these 61, 3 were
grouped with the hyperactive variety, in 2 of which the sugar
tolerance was increased, and in 1, decreased. In 58 cases a
diagnosis was made of hypoactivity of this lobe, which showed
in 53, an increased, and in 5, a decreased sugar tolerance. A
recent contribution by Rohdenburg, Bernhard and Krehbiel,
upon the study of the sugar mobilization, based upon 228 cases
(eaneer, tuberculosis, thrombo-angiitis, cirrhosis of the liver,
myoearditis, etc.), discredits to a considerable extent the value
of the carbohydrate tolerance test in metabolic disturbances.
They conclude that in other conditions, as widely different as
diabetes, tuberculosis, epithelioma, and pregnancy, a blood sugar
curve is found, similar to that in metabolic disturbances; that
many of these conditions are accompanied by hyperglycemia and
that concentration of the blood sugar is not the sole factor con-
cerned in the development of glycosuria.

The classical obesity interpreted as a ‘‘hormonic’’ sign of
posterior lobe hypopituitarism, consists of girdle- and mons-adi-
posity, to which, in some cases, is added mammary adiposity.
There is yet considerable controversy concerning the cause of this
obesity. Its character and location have suggested secondary
gonad insufficiency as its origin, because this frequently accom-
panies the: bilobar cases having anterior lobe insufficiency. An
argument against this cause of the obesity is that it is absent in
the pure anterior lobe insufficiency in which there is complete
aplasia and absence of function of the gonads. The writer has
observed cases of this kind, in the female, aged 36 and 38 years,

308 DISORDERS OF HYPOPHYSIS

in which there was complete amenorrhea and infantilism of the
genitalia during the entire life, without the development of this
typical adiposity. The emaciation which is present in hyper-
secretion of this lobe is easily accounted for on the basis of
inereased metabolism. The rapid loss of weight and emaciation
frequently accompanying hypophyseal polyuria, however, is
more difficult to explain, particularly if this polyuria is attributed
to decreased secretion of the posterior lobe. If both these funce-
tions (polyuria and adiposity) are attributed to hyposecretion
ot the posterior lobe, then we should obtain adiposity much more
frequently with the diabetes insipidus syndrome, which elinical
experience demonstrates is more constantly associated with
emaciation. Biedl has reported some exceptional cases, how-
ever, in which this peculiar combination of adiposity and poly-
uria occurred. It is not uncommon to have a history of early
transient polyuria, followed later by adiposity, which might be
due to a change of activity of this lobe. Bab’s theory that the
_polyuria is due to hyposecretion of the pars intermedia, not
including the pars nervosa, seems to approach nearer to an
explanation of the clinical combinations, as well as the thera-
peutic relief which many of these cases obtained from hypo-
physeal treatment. The argument that this polyuria is really
due to hypersecretion, on account of the fact that it is associated
with so many other symptoms of posterior lobe hypersecretion,
such as increased metabolism, decreased sugar tolerance, hypo-
physeal glycosuria, emaciation, and bladder and _ intestinal
tenesmus, has not been entirely disproved.

The control of the contraction of the unstriped muscles, par-
ticularly those of the intestine and uterus, as well as of the
bladder and the vascular and bronchial systems, is one of the
most striking and easily demonstrable effects of the secretion of
the posterior lobe. The writer has used the constriction effect
of this substance upon the intestinal muscle (‘‘intestinal reac-
tion’’) to define the tolerable dose of pituitary extracts in the
treatment of posterior lobe insufficiency. Extracts of the poster-
ior lobe are given in dosage to the amount producing definite
intestinal cramps, followed by evacuation. This reaction occurs
within ten or fifteen minutes after giving this substance hypo-
dermically. The dosage at which this reaction occurs is taken as
the normal physiologic dose, and increase above this amount for

ENGLEBACH 399

therapy is deemed inadvisable. If a larger dose is given, that
which is described as a ‘‘general reaction’’ occurs. This con-
sists of tremor, tachyeardia, and emotionalism. The effect of
extracts of this lobe upon the nervous system is strikingly
demonstrated by giving so intolerable and untoward a dose. Men-
tal symptoms from so large an injection, consisting of emotional
attacks, crying, laughing, shouting ,and, in some, definite brain-
storm, simulating temporary insanity and obsessions, have been
produced. The ‘‘intestinal reaction’’ was tested out by the
writer for its diagnostic value to determine whether the amount
of extract producing these intestinal symptoms might not indi-
cate to some degree the sufficiency of the posterior lobe. It was
thought originally that cases having a deficient secretion from
this lobe, would require a much larger injection to produce the
‘“‘intestinal reaction’’ than those having a normal or increased
secretion. While it was found that the cases of hypopituitarism
usually required a larger does for its production, this did not
occur constantly, or in a sufficiently larger percentage to make
it of value as a diagnostic sign.

The effect of posterior lobe secretions upon the other
endocrine glands is not absolutely defined. The fact that a
hypothyroid state is frequently associated with hypopituitarism,
especially if it occurs in late adult life, which produces a com-
bination that is believed necessary for the production of pituitary
hibernation, has led to the conclusion that hypoactivity of the
thyroid more frequently accompanies decreased function of this
lobe. It has also been noted that peculiar hyperthyroid states
have been frequently associated clinically with hyperpitui-
tarism of the posterior lobe. This relationship may possibly be
accountable for the increased basal metabolism and decreased
sugar tolerance present in these cases, and it might help to
explain the discrepancies which have existed in basal metabolism
determinations made in pituitary disorders.

The adrenals are supposedly insufficient in the hypopitul-
tary, and hyperactive in hyperpituitary disorders of this lobe.
The peculiar pigmentation (chloasma) so frequently found
about the hairline, angles of the mouth, eyes, lateral aspects of
the neck and nipples, has been taken by the writer as a sign
probably associated with the anterior lobe disorders, and not
due to the adrenals. This is thought to be true on account of

360 DISORDERS OF

HYPOPHYSIS

TABLE III

CLASSIFICATION-
I. Anterior Lobe

A. Hypoactivity

1. Preadolescent |

a. A-neoplastic \

b. Neoplastic J)

\

|

2. Postadolescent |
a. A-neoplastic ,
b. Neoplastic

B. Hyperactivity

1. Preadolescent
a. A-neoplastic
b. Neoplastic

2. Postadolescent
a. A-neoplastic
b. Neoplastic

II. Posterior Lobe*
A. Hypoactivity
1. Pars Intermedia (7?)

Priest INIGAVOR ino cone canobue

B. Hyperactivity

Ill. Bilobar*
A. Anterior and Posterior Lobes
a. Hypoactivity

b. Hyperactivity

ce. Heteroactivity
1. Anterior Lobe hyperactive

Posterior Lobe hyperactive

2. Anterior Lobe hypoactive
Posterior Lobe hyperactive

DISORDERS OF THE

PITUITARY GLAND

. Lorain-Levi Type

( Amenorrhea, Dysmenorrhea, Me-
trorrhagia reacting to Anterior
Lobe treatment. No signs of Pos-
| terior Lobe disorder

Gigantism (no signs of Posterior
Lobe disorder)

Acromegaly (no signs of Posterior
Lobe disorder)

(Polyuria (Bab) (Reaction to Pitu-
itrin. Signs of Anterior Lobe and
| Pars Nervosa disorder absent)

{ Pituitary Obesity (Decreased met-
abolism, increased sugar tolerance.
| Polyuria and signs of Anterior
Lobe disorder absent)

AS

Hypophyseal Glycosuria (Increased
metabolism, decreased sugar toler-
ance. Polyuria and signs of An-
(eee Lobe disorder absent)

[ Froelich’s Type without, or with
polyuria (Bied1)

lGieantien or Acromegaly with in-
creased metabolism and decreased

sugar tolerance. Adiposity absent

L

Gigantism or Acromegaly with

Polyuria

Genital Aplasia, Nanism, Amenor-
thea, ete., with Pituitary Glycosu-
ria (Increased metabolism; de-
creased sugar tolerance)

“(1) Pre- and (2) Post-adolescent varieties and (a) A-neoplastic and
(b) Neoplastic types are subdivisions under each activity (Hypo- and
Hyper-) as given under I, Anterior Lobe.

ENGLEBACH 361

its frequent presence in positive hypophyseal cases that are
entirely free from other signs of adrenal disease, such as dis-
turbed blood-pressure, marked asthenia, diarrhea, and other
symptoms.

It has been stated by some authors (Fischer, Falta and
others) that the hypersecretion of the posterior lobe has a marked
inhibitory effect upon the gonads, as well as a stimulating effect
upon the mammary gland. Personal observation in the writer’s
eases has led to the conclusion that Bell is probably correct in
stating that this relationship does not exist. In those cases of
pituitary disease in which the function of the gonads was dis-
turbed, this was attributed to the hormone from the anterior,
and not from the posterior lobe. Four cases with pure posterior
lobe pituitarism, had marked changes in metabolism and earbo-
hydrate tolerance, adiposity, etc., in which no abnormal changes,
either in function or development, of the genitals could be
demonstrated or were on record.

Pemberton and Sweet assign to the secretion of the posterior
lobe an inhibitory influence upon the pancreatic secretion. It
is known that there is a marked increase in the sugar tolerance
in hypopituitarism, and yet there is an uncertainty of a hypo-
activity of the pancreatic secretion in this condition. The nerv-
ous makeup of the individual is markedly affected in changes
of activity of this lobe. In decreased secretion, apathy and
somnolence are frequent. In hypersecretion, marked periodic
psychie instability, of various degrees and moods, is very
common. The temperature, pulse, and blood-pressure correspond
well to the activity of any other endocrine gland, being sub-
normal in decreased secretion, and normal (or at times there is a
sight pyrexia, hypertension, and tachycardia) in increased
secretion of this lobe.

With the above physiologic effects serving as a basis for the
‘‘hormonic’’ signs of the secretory functions of these lobes, the
accompanying classification has been evolved.

This classification, based solely upon the ‘‘hormonic’’
signs of hypophyseal disease, groups the disorders of this
gland into three divisions, dependent upon whether one or both
of the lobes were involved: (I) Anterior lobe disorders, in
which this lobe alone was involved; (II) Posterior lobe dis-
orders, in which this lobe, without clinical evidence of anterior

362 DISORDERS OF HYPOPHYSIS

lobe dyserasia, was affected; (III) Bilobar disorders, in which
abnormal function of both lobes could be demonstrated. Hach
lobar division is subdivided into the activities prevailing, the
anterior and posterior lobe disorders into the states of: (A)
hypoactivity and (B) hyperactivity; the bilobar group into the
states of: (A) hypoactivity, (B) hyperactivity and (C) hetero-
activity. The last named (heteroactivity) comprises mixed cases,
in which there were opposite secretory states of the individual
lobes, such as hyperactivity of the anterior lobe, combined with
hypoactivity of the posterior lobe, and vice versa. These activi-
ties are redivided into: (1) pre-adolescent and (2) post-adolescent
varieties, dependent upon the age incidence of the abnormal
secretory state. A final division is made of the age incidence,
into: (a) a-neoplastic and (b) neoplastic varieties.

Under the pre-adolescent hypoactivity of the anterior lobe
is grouped the Lorain-Levi type of pituitary insufficiency. This
type has not yet received the distinction of a special group
division. Others, besides Lorain and Levi (Meige, Allard,
Rennie, Kumell, Falta, Bell), in fact, nearly all writers who
have collected a series of cases, have described similar types,
intimating that the types were due to simple and single insuffi-
ciency of the anterior lobe. These types are characterized by
having a classical arrest of osseous growth, with complete aplasia
of the genital system, without additional endocrine symptoms
referable to the posterior lobe.

In the post-adoleseent hypopituitarism of the anterior lobe,
the writer has grouped those female cases which have had some
osseous changes indicative of early anterior lobe disorder, and
which developed, after the age of maturity, amenorrhea, metror-
rhagia, or dysmenorrhea, dissociated from any local or general
disease, that reacted completely to substitution treatment of
anterior lobe extracts. Under the hyperactivities of this lobe
are deseribed the well-known clinical syndromes of gigantism
and acromegaly. These differ from case illustrations ordinarily
found in the literature, by having negative evidence of posterior
lobe involvement, such as polyuria, adiposity, abnormalities of
basal metabolism, carbohydrate tolerance and unstriped muscle
contractions.

Under the posterior lobe dyscrasias, the differentiation be-
tween the opposite states of activity was not so clear-cut. There

ENGLEBACH 363

is yet considerable uncertainty as to whether hypophyseal poly
uria should be classified with the varieties of insufficiency or of
overactivity of this lobe. These cases are most easily explained
by Bab’s theory, which attributes them to the pars intermedia
insufficiency. The writer has observed 9 (of 11) cases of typical
diabetes insipidus, reacting positively to hypophyseal extract
treatment, 3 of which were free from other ‘‘hormonie’’ signs
both of the anterior lobe and the pars nervosa disorders. This
might be explained by defining a simple pars nervosa syndrome
as consisting clinically, in the hypoactive state, of obesity, and in
the hyperactive state, of increased basal metabolism and de-
creased sugar tolerance. On the contrary, it is true that the
majority of the polyurias attributed to the hypophysis have
other endocrine symptomatology connecting them with either
the anterior lobe or the pars nervosa portion of the posterior
lobe. The hypoactivity of the pars nervosa, independent of the
pars intermedia, is given as pure pituitary obesity, not associated
with “‘hormoniec’’ signs of the anterior lobe or polyuria, but
haying positive evidence of a decreased basal metabolism and
increased sugar tolerance. Under the hyperactive varieties of
the posterior lobe is classed hypophyseal glycosuria. This is a
glycosuria which can be differentiated from one due to pan-
ereatie disorder or one associated with ductless gland dyserasia.
It has the usual increased metabolism and decreased sugar toler-
ance, but is free from polyuria and ‘‘hormonie’’ signs of anterior
lobe disorder.

Under the bilobar divisions are grouped those cases in which
there is a concomitant anterior and posterior lobe disorder
existing in the same individual. In order to include all cases
thus represented, three activities must be considered: (1) hypo-
activity of both lobes; (2) hyperactivity of both lobes and (3)
heteroactivity, in which the lobes have an opposite secretory func-
tion. Under hypoactivity, Froelich’s disease, either with or with-
out polyuria (the former as described by Bied1) is classed. Under
hyperactivity, those cases of gigantism or acromegaly and glyco-
suria, with which are associated increased metabolism and de-
creased sugar tolerance, without adiposity, are grouped. This
classification takes many of the cases of both gigantism and
acromegaly out of the simple anterior lobe dyserasia variety, for
it has been well known for many years that a large percentage of

364 DISORDERS OF HYPOPHYSIS

these cases have been associated with posterior lobe symptoms,
such as polyuria, glycosuria, and disturbance of metabolism
and sugar tolerance. Nevertheless, they have been classed by
many authors either as simple anterior lobe dyscrasias, or have
been grouped under the gross term ‘‘pituitary dystrophy.’’

The heteroactive varieties of bilobar pituitarisms should
contain those cases in which the individual lobes of the hypo-
physis have opposite activities. For instance, gigantism or
acromegaly, associated with polyuria, a not infrequent variety,
should naturally be placed in this bilobar variety. Another con-
siderable percentage of these diseases shows evidence of anterior
lobe hyposeeretion (such as genital aplasia and infantilism,
amenorrhea, sexual impotence, muscle fatigue, and mental
apathy), associated with posterior lobe hyperactivity (such as
pituitary glycosuria, with increased metabolism and decreased
sugar tolerance). It is the hope of the writer that this con-
ception of a heteroactive bilobar division will be the means of
disentangling many of the so-called dyspituitarisms and dys-
trophies, which have been so ill-defined that they add only con-
fusion to the efforts toward diagnosis and treatment.

BIBLIOGRAPHY

Anton: Vier Vortrage tiber Entwicklungsstorung beim Kind. Berlin,
1908. Reiner Psychoinfantilismus; Forens. Psychiatrie, 1910, 2.

Aub, J. C. and Du Bois, E. F.: Clinical calorimetry, nineteenth paper.
The basal metabolism of old men. Arch. Int. Med. (Chgo.), 1917.
19, 823-831.

Bab, H.: Die Hypophyse als Regulator der Diurese und des spezifi-
schen Gewichts des Harnes. Mtinch. med. Wchnschr., 1916, 63,
1685, 1721, 1758.

Bauer, A.: Infantilisme et chétivisme. Presse méd. (Paris), Dec. 4,
1909, 870-872.

Bell, W. Blair: The Pituitary, 1919, Part I, p. 79, Incidence, The
physiology of the pituitary; Ibid., p. 287; Incidence, Hypopitui-
carism occurring before puberty; Ibid., pp. 158-177; Incidence,
Effect of posterior lobe secretion upon the gonads.

Biedl, A.: Innere Sekretion. Urban u. Schwarzenberg, Wien u. Berlin,
19135584 p28) pl.si694p., Giplise.

Brewed B.: Infantilism: no apparent cause. Clin. Stud., 1908, 6,
389-392.

Brissaud, E.: L’infantilisme vrai; Icon. de la Salpétriére (Paris),
1907, 20, 1-17.

Brissaud, E. and Meige, H.: Gigantisme et acromégalie. Rev. scient.,
1895, 3, 330-336. Ibid., Type infantilé du gigantisme. N. icon. de
la Salpétriérie (Paris), 1904, 17, 165-172; Rev. neurol., 1904, 12,
191-194.

Crowe, 8. J., Cushing H. and Homans, J.: Experimental hyvophy-
sectomy. Bull. Johns Hopkins Hosp. (Balt.), 1910, 21, 127-169;
Effects of hypophyseal transplantation following total hypophy-

ENGLEBACH 365

sectomy in the canine. Quart. J. Exper. Physiol. (Lond.), 1909,
2, 389-400.

Cushing, H.: The functions of the pituitary body. Am. J. Med. Se.
(Phila.), 1910, 139, 473-484.

Dyspituitarism. Harvey Lecture (N. Y.), 1911, pp. 31-46.
Diabetes insipidus and the polyurias of hypophyseal origin. Shat-
tuck Lecture. Communications, Med. Soc., Boston, 1913, 24,
(Part 1), 23-49.

Address on Surgery: Realinements in greater medicine, Their
Med. J. (Lond.), 1913, (ii), 290-297.

Partial hypophysectomy for acromegaly; with remarks on the
function of the hypophysis. Ann. Surg. (Phila.), 1909, 1,
1002-1017.

Cushing, H. and Goetsch, E.: Concerning the secretion of the infundi-
bular lobe of the pituitary body and its presence in the cerebro-
spinal fluid. Am. J. Physiol. (Balt.), 1910, 27, 60-86. '
Hibernation and the pituitary body. Abstr. Proc. Soc. Exper.
Biol. and Med. (N. Y.), 1918-14, 11, 25.

The pars anterior and its relation to the reproductive glands.
Abstr., Ibid., p. 26.

Hibernation and the pituitary body. J. Exper. Med. (N. Y.),
1915, 22, 25-47, 2 pl.

Du Bois, D. and E. F.: Clinical calorimetry; tenth paper. A formula
to estimate the approximate surface area if height and weight
be known. Arch. Int. Med. (Chgo.), 1916, 17, 863-871.

Falta, W.: The ductless glandular diseases. Falta and Meyers, pp.
229-328.

Fischer, B.: The ductless glandular diseases. Falta and Meyers, p.
317.

Janney and Isaacson: Blood sugar tolerance test. J. Am. M. Ass.
(Chgo.), 1918, 70, 1131.

Kumell, R.: Zur Kenntniss der Geschwiilste der Hypophysengegend.
Miinchen. med. Wehnschr., 1911, 58, 1293-1298.

Levi, E.: Contribution a |’étude de l’infantilisme du type Lorain,
N. icon. de la Salpétriére (Paris), 1908, 21, 297, 421.

Meige, H.: L’infantilisme. Gaz. d. hop. de Paris, 1902, 22, 207.

Pemberton, R. and Sweet, J. E.: Further studies on the influence of
the ductless glands on the pancreas. Arch. Int. Med. (Chgo.),
1910, 5, 466-481.

Rennie: Endothelioma of the pituitary gland with infantilism. Brit.
Med. J. (Lond.), 1912, (i) 150.

Rohdenburg, G. L., Bernhard, A. and Krehbiel, Otto: A study of
sugar mobilization based upon 228 human cases. Am. J. Med. Sc.
(Phila.), 1920, 159, 577-586.

HEMORRHAGIC SYNDROME CURED BY THYROIDIN*

Louis P. Bottaro,
Director of the Gynecological Clinic in Maciel Hospital
and
J. C. Mussio Fournier,
Chief of the Medical Clinic of the Faculty of Medicine, Montevideo

Although much has been written upon the subject of thyroid
opotherapy, the indications for this treatment are still so indeter-
minate as to demand many more data. The following is a report
of a ease in which severe hemorrhagic manifestations were suc-
cessfully controlled by the use of thyroidin.

The patient is a woman twenty years old, under-weight and
whose hereditary antecedents are of no importance. Menstrua-
tion commenced at eleven years, was profuse and usually lasted
twelve days, during which time severe epistaxis occasionally oc-
eurred. Using thyroidin the menstruation period was reduced
to three days and the nasal hemorrhages arrested. As soon as
the patient ceased taking this product the disturbances returned.

When she was about 12 years old her eyebrows began to fall
out. At 14 years of age she gave birth to a child, and during
childbirth acquired a puerperal infection, causing cervicitis and
adnexitis. From this time until she was 19 years old the patient
suffered three induced abortions and a mercurial intoxication, the
latter producing a mild nephritis of which she was cured.

During the periods when opotherapy was omitted the patient
suftered from otorrhagia and sub-conjunctival hemorrhage in ad-
dition to the other hemorrhagic disturbances. Owing to her neg-
ligence an acute hemorrhagic attack occurred, signalized by met-
rorrhagia, epistaxis, hemoptysis and purpura; this was resistant
to the classic coagulative treatment. One of us then thought of
using thyroid opotherapy, which was successful in arresting the
hemorrhages. This once accomplished, -clinical examination
proved the existence of the adnexitis already mentioned.

_*This paper has appeared elsewhere. It was accepted before the rule of ex-
clusive publication was announced.

366

BOTTARO AND-MUSSIO FOURNIER 367

Laboratory tests disclosed the following conditions.
Urine, normal.

Wassermann reaction in the blood, negative.

Thorax, by radioscopy, normal.

EVEMOOVOD Nags cree tke Sie) Sess Sas = SIRS wis s orae os 85%
Coagulation and retraction of blood coagulum Normal
RCAMCOEDISCLES: se ysis erotic 5 Scous 1018 one's cists a dua! « 4,170,000
MWirite WlOGM COLPUSGCIES..... 26. eee eee cs 8,600
RATES Seah a yaho. spoys <!o.e ol axsi<.g.s'sia.s.0%6 + sate 62%
ROSATO TONLE Stetere tices ots c- core soe) i8o she: «ere, « ois « 6%
IBASOM MMs seco iict ays Cuore cere O51) « selakw e)cgele oye = 1%
ga MOCYLESL s.ctaiky. = Aeyevete > efa.sielensiese eel 65-65 257%
Ae CMMOMOMUCIEATS: © 1s. crs ce,creee's oe Sete «6. 59
DISCUSSION

Our patient had a pale, swollen face and an abnormal tend-
eney toward vasodilatation phenomena in her cheeks. The fall-
ing of the eyebrows combined with the above was the only symp-
tom of the minor hypothyroidal syndrome so well described by
Leyi and Rothschild (1).

We believe the case is probably a form of dysthyroidism, a
diagnosis which, although it cannot be assured, should be consid-
ered, more especially in view of the remarkable results obtained
with the thyroid therapy.

In a previous publication (2) we have insisted upon the de-
sirability of taking much notice of those minor symptoms, so
that we may finally be able to make a positive diagnosis when
the aborted forms of hypothyroidism are encountered.

Without further discussion we wish merely to mention that
Hertoghe (3) Werklen and Walther (4), and Max Perlsée (5)
demonstrated some time ago the existence of hemorrhagic condi-
tions in hypothyroid cases. These may result from dyscrasic al-
terations, or as one of us (6) has demonstrated contemporane-
ously with Levi (7), from congestive phenomena. Moreover, it is
apparent that in some cases of hemorrhage that cannot as yet be
attributed exclusively to a thyroid origin the success of thyroid
therapy has been no less remarkable. This is evidenced by Shef-
fler’s (8) observations on Werlhot’s purpura, and by the studies
of Taylor (9) and Marcel Labbé (10) in hemophilia.

In conelusion, although we are unable definitely to assert
that the origin of this hemorrhagic complex lies in a purely
thyroid dysfunctioning, it is nevertheless certain that the results
secured emphasize the practical importance of thyroid therapy,
whatever its form of action.

368

or
.

SS eis oe

10.

THYROID IN HEMORRHAGE

BIBLIOGRAPHY

Leopold-Levi and Rothschild H. de: La petite insuffisance thy-
roidienne. Paris, 1913, 309 p.

Mussio Fournier, J. C:: Cecité par double nevrité optique chez
une malade atteinte d’ hypothyroidisme; amelioration remarquable
obtenue par la glandothyroine. Ann. @ocul. (Paris), 1918, 155,
265-271; Semana med. (Buenos Aires), 1919, 26, 139- 145.

Cited by Maurice Perrin, Les Sécretions Internes, leur influence
sur le sang, p. 72.

Merklen, P. and Walther, Ch.: Sur un case de myxoedeme
amélioré par la greffe thyroidienne. Bull. mem. soc. med. Hop.
(Paris), 1890, 7, 859-864.

Perlsée, M.: Opotherapie thyroidienne contre les menorrhagies
et en particulier les hemorrhagies de la menopause. Semaine méd-
icale (Paris), 1907, 27, 298.

Mussio Fournier, Ji. C.: Forma congestiva del Paar
La Prensa Med. ‘Argentina (Buenos Aires), 1918, 4, 463.

Levi, L.: Neuro-arthritisme a fluxions multiples ae instabilité
thyroidienne. Presse méd. (Paris), 1918, 26, 191-193.
Scheffler: cited by Perrin, (3).

Taylor; W. J.: Ihe internal use of thyroid extract to increase
coagulation of the blood. Monthly Clyclopedia (Phila.), 1905,
8, 298-300.

Labbé, M.: L’hemophylie. Congres de Meéd. (Paris), 1901,
p. 130.

PUBERTAS PRECOX WITH ESPECIAL ATTENTION TO
MENTALITY*

Joshua H. Leiner

Adjunct Attending Neurologist, Lebanon Hospital and Central Neuro-
logical Hospital, Blackwell’s Island, New York.

Pubertas precox is a syndrome manifested by premature
maturity, anatomically, physiologically, and often mentally, as
a result of faulty metabolism induced, supposedly, by endocrine
disturbances.

That this condition was recognized by the ancients is be-
yond doubt. For the first account of the condition recognizable
as a clinical entity we must go back to Craterus, the brother of
King Antigonus (1), who writes: ‘‘The subject was an infant,
a young man, a mature man, an old man, was married and begat
children and all in the space of seven years.’’

Pliny the elder, who lived in the reign of Vespasian, handed
- down the history of certain remarkable children; he states: ‘‘It
is well known that there be some that naturally are never but a
foot and a half high, others again somewhat longer, and to this
height they came in three years, which is the full course of their
age, and then die. We read, moreover, in the chronicles, that
Salams, one Euthimenes, had a son who, in three years, grew to
be three cubits or four and a half feet high, but he was in his
gait slow and heavy, and in his wit as dull and blockish, howbeit
in the time overgrown he was, and his voice changed to be great,
and at three years he died suddenly of a general cramp’’ (2).

In 1747 Mead (3) presented before the Royal Society of
London, a patient who was ‘‘remarkable for his bulk and height,’’
and also for the external marks of puberty, which were first ob-
served at the age of twelve months. At the age of five he had
pthisis pulmonalis and died in a few months. ‘‘He had when
dead the appearance of a venerable old man.”’

One of the first well observed cases was recorded over a
century ago by Anthony White (4). He presented **‘ Philip How-
arth in whom signs of puberty commenced at an early age.’”

*Read before the New York Neurological Society April 6, 1920.

369

370 MENTALITY IN PUBERTAS PRECOX

The family history was negative, gestation was normal, and he
was the ninth child born. At birth he had a full crop of hair;
the sutures of his cranium were closed, but a slight fontenalle
was palpable. At the end of the first year a change took place;
his hair had grown to a great length, he grew pale and ugly in
appearance. Small hairs appeared on his pubis; his testes and
penis increased in size, and his voice altered. White, who was
keenly interested in the lad, invited him to his home for further
observation. He states: ‘‘On first view of the boy the manly
character, strongly expressed, is extremely striking. His voice
is like that of a young man of sixteen years and he can whistle
very low tones; his laugh is loud. There was no hair on his chin,
but steatomatous matter was present which usually makes its ap-
pearance preceding the growth of a beard. His teeth were spaced
(how many not recorded) ; the nipples were prominent; no hair
was visible in the axilla, but there was an odor emanating as that
of anadult. His height was three feet, two inches and he weighed
47 pounds, i. e., at two years. At three years his height was three
feet, four and a half inches and his weight was three stone, nine
and a quarter pounds, or fifty-one and a quarter pounds.’’ He
was observed to have an understanding of a six-year-old child
and, quoting this keen observer, ‘‘many of his observations and
inquiries appeared to have been the result of mature reflection.
It must, however, be observed that his general character was
marked with a considerable mixture of childish playfulness. He
was mild and not easily provoked to anger. When, however, his
rage was excited, it was not expressed in the usual manner of
children, but by the lowering of the eyebrows, the shaking of his
head and with uplifted fist. He had a talent for music and
sang with correctness.’’

The factor of hereditary transmission is apparent in the
following two cases. Plumb (5) delivered a mature looking
child whose facial appearance was feminine, and gave the im-
pression of a delicate twelve-year-old child. Her external geni-
talia were developed as those of a child of seven to eight years,
and her form was that of a fifteen-year-old girl. Her head was
covered with thick, beautiful, brown curly hair which was three to
four inches in length. There was no hair in the axilla. What
was more remarkable was the beginning of menstruation when
she was six weeks old. She menstruated for two and a half days

LEINER 371

each month thereafter.. At the time the case was recorded, she
was ten months old and perfectly well. The child’s clitoris was
so long as to necessitate amputation. The parents of this child
were both very vigorous sexually. Irion (6) reported a similar
case in which menstruation first appeared seven days after birth;
the patient showed the characteristic nervous phenomena when
she skipped a period.

In the following case reported by Stone (7), there is a di-
rect history of pubertas precox in the father. The subject when
dressed gave the impression of a ten-year-old lad ; he was actually
four years old. When he disrobed, he looked the typical Infant
Hercules, showing a fine physical development of a young man
of 21. He was 4 feet, 14 ineh tall and weighed 70 pounds. His
secondary sexual characteristics were fully developed. Mentally,
the boy showed a lively intelligence; he was very talkative at
home, but shy with strangers. His speech seemed to be imper-
fect. He was nearly always in good humor, but when angry set-
tled his quarrels with old-fashioned ‘*‘ knock-down blows.’’? The
father, as mentioned above, was prematurely developed, and
his first sexual indulgence occurred at the age of eight. He
stated that between the age of ten and thirteen, ‘‘he was a better
man than he has ever been since.’’ Rogers also quoted a number
of cases that showed the factor of heredity.

The direct causative factor of precocious puberty is hyperse-
cretion of either the gonads, pineal gland or adrenal cortex, as
indicated- by hyperplasia or neoplastic development. That the
pituitary and thyroid are also concerned, secondarily, however,
is unquestionable. It will be necessary, therefore, to divide the
cases of premature precocity into those that have acquired this
syndrome through neoplasms and those due to hyperplastic
states.

Ovarian Type. Rogers has collected 101 cases of pubertas
precox ; of these 81 subjects were females and 20 males. Of the
81 female cases, 73 appear to be due mostly to hyperovarianism.
The cases of Krabbe (8), Wells (9), Lenz (10) and Bruno Wolff
(11), were also of this type. Lenz’s case was studied very care-
fully. He first saw the child when she was six and one-quarter
vears old. Menstruation had begun at 16 weeks. The secondary
sex characteristics were those of a mature woman. She was shy
and easily embarrassed. She went to school and was a good pupil.

372 MENTALITY IN PUBERTAS PRECOX

She played with children of her own age and was childish in ac-
tivity. She was again seen when twelve years old, when she ap-
peared to be twenty-two. Her behavior was still childish, and
extraordinarily shy. She was still playing with dolls. She cried
pitifully when the other children teased her about her large
breasts.

An instance of neoplasms of the ovary producing pubertas
precox is recorded by Lucas (12). The little patient was seven
years old and showed all the signs of genito-somatic maturity and
early menses. <A tumor of the ovary was diagnosed and after its
removal all the signs of adolescence and menstruation disap-
peared. Blair Bell (13) quotes Roger Williams, who collected
eleven cases of sexual precocity in female children, due to neo-
plasms of the ovary. However, one should not draw the conelu-
sion from this that all ovarian tumors in young children neces-
sarily lead to sexual precocity. There must be other factors en-
tering into this mechanism.

To summarize the mental traits and habits in these ovarian
cases, it can be said that none show mental precocity. In fact,
the subjects are of a low mental type. They speak, play and act
in accordance with their true age. The girl reported by Lenz
(10) still plaved with her dolls, although she gave the physical
impression of a girl of twenty-two. They learn well at school,
but they show no ‘‘old-fashioned’’ way of thinking, as Krabbe
(8) puts it. Neurath (14), who had a considerable opportunity
to observe them, also comes to the conclusion that their psychic
condition is not so far advanced as their physical. That some
of these children put away their toys and become seclusive is to
be aseribed to self-consciousness rather than to any mental ma-
turity

Adrenal Cortex Types. The clinical picture differs here, ac-
cording to whether the male or female is involved. When there oc-
curs hyperplasia of the adrenals in the male, it tends to accentu-
ated masculine precocity. When it occurs in the female it tends
to change the female into the male type, and to give her the see-
ondary sexual characteristics of the male.

In a case reported by Marchand (15), a girl was baptized
as a male. As a result of a medico-legal examination, it was
found that her body showed a spurious hermaphrodism with hair
over face and body, and a clitoris as large asa penis. At autopsy

LEINER 373

she showed hypertrophy of the adrenals, and particularly of the
cortex.

Tumors of the Adrenal Cortex. Pitman (16) reported a
girl of three who showed nothing child-like in either voice or
manner. She often seemed idiotic, but aggressive. She showed
bushy eyebrows and a moustache in addition to other male char-
acteristics. A tumor of the adrenal cortex was found.

Bulloch and Sequeira (15) collected 12 cases of adrenal tu-
mors. Ten were found in the female and two in the male. Orth
(15) reported the case of a girl of 414 years, who had so much
hair on her face that she had to be shaved. The clitoris was the
size of a small penis. She had a neoplasm of the right adrenal.
In Dobbertson’s (15) case, a girl had a mass of hair on her back.
Glynn (17) reports the case of a girl of 7. She had the appear-
ance of a young man, with a black silky beard, a moustache and
whiskers.

These cases therefore show uniformly hypertrichosis of the
male type. All manifest a large clitoris, which shows the tend-
eney towards male sexuality, and all showed an absence of men-
struation, with the exception of one case reported by Bulloch and
Sequeira (15), in which menstruation appeared at the age of a
little more than ten years. The appearance of menstruation at
this time can hardly be classed, however, as precocious.

A ease of adrenal origin in a boy of 514 is reported by Lin-
ser (15). The physical development was that of from 16 to 18.
Sex characteristics were of the male type. The pineal, pituitary
and thyroid glands were found to be normal.

As regards mentality and habits in these cases, the literature
is far from satisfactory. It indicates, however, that while they
show some aggressiveness, in the main, their psychic condition is
below par. Pitman states that his case showed idiocy ; Bulloch
and Sequeira and Colecott Fox (15) state that their cases showed
a dullness of intellect. Glynn’s patient was dull and apathetic ;
she took no interest in her surroundings and would answer ques-
tions only if they were frequently repeated.

Hypergonadal Condition in the Male. Sarchi (18) published
a case that showed a malignant tumor of the left testicle. At 5,
the testicle was as large as that of an adult. The boy grew rap-
idly, his voice grew to a deep bass, and hairs appeared on his
genitals. At 9 years, he was 148 em. in height and weighed 44

374 MENTALITY IN PUBERTAS PRECOX

kiloerams. The left testicle was removed and an alveolar carci-
noma was shown. Four months after the removal, his beard dis-
appeared, his voice again became child-like and his genitals were
vetting smaller, His sexual impulses, emissions and erections
ceased. His character in general reverted to the childhood stage.

A ease of hypergenitalism was reported by Strauch (19) of
the Cook County Hospital. In this instance no anatomico-patho-
logic changes were found. No cerebral symptoms were present.
No tumor of the pineal was suspected. The boy was 1114 years
old and had previously shown mental retardation. His genitals,
including the prostate and seminal vesicles, were developed as in
an adult, but no spermatozoa were found. His voice was strik-
ingly deep. As to his psychie condition and habits: He was
irritable and nervous, and cried whenever his mouth had to be
examined. He was stubborn, disobedient, troublesome and
showed a resentful disposition towards other children. At home
he played with boys younger than himself. There was no evi-
dence of sexual shame, nor was there any visible propensity for
the other sex. He could not count to more than five, and even
then he had to be helped. His handwriting was not legible, nor
could he write his own name without having a copy placed in
front of him. He attended school for three years, and he could
not execute a simple example of addition, nor did he remember
his songs or prayers.

Morsé (20) reports a boy of 23 months with genito-somatic
precocity and delayed mentality. An X-ray examination of the
skeletal system revealed the bony development of a 614-vear-old
boy. No spermatozoa were found in the emissions. Woods (21)
and Lopez (22) report eases that are of undoubted hypergonadal
origin. Both subjects showed remarkable strength. The former
was 634 years old and was nearly 5 feet tall. He was so mis-
chievous and full of animal spirits that he had to be placed in
an industrial school. It took three policemen to get. him there.
The latter subject was a colored boy of 3 years and ten months;
he showed genito-somatie precocity and lifted a man of 140
pounds from the ground with ease. The ease of Gilbert Breschet
(23) should also be included here.

The mentality and habits in these eases show no precocity.
In fact, the subjects are retarded and, according to Moreau (24),
Hofacker (25), Hudoverning and Popovitz (26), Ziehn (27)
and Neurath (14), may even show idiocy and imbecility. Neu-
rath, who reported 27 cases of this type, is quoted by Strauch
(19), that ‘‘in most cases there existed the psychic function of
their infantile age.”’

LEINER 379

Pineal Tumors. Neoplasms of the pineal gland have drawn
attention to the subject of pubertas precox, as no other condition
has. The opinion once prevailed that pineal tumors exist only
in the male. This, however, has since been disproven. Baily and
Jellife (28) collected and reported in an excellent paper 59
cases of pineal tumors, together with an additional case of their
own, making 60 in all. Seventeen cases showed involvement up
to the age of 16. Fourteen of these occurred in the male and
three in the female.

There is this to be said in reference to tumors producing
precocious puberty, that while the pineal tumors occur predomi-
nantly in the male, tumors of the adrenals as hypernephromata,
occur five times oftener in the female.

I must agree with Gordon (29) that the histories of the re-
corded cases are inadequate, not only as regards pineal tumors,
but all the subject matter herein discussed. The clinical ob-
servations are too meagre, often, for correct endocrine interpre-
tation, and it seems the further back one goes the more illuminat-
ing and keener are the clinical observations of the writers.

The following cases of pineal tumors bear on our subject.

Aesterich and Slawyks (30) report a boy who was a still
birth baby, as a result of forceps delivery, but who developed
normally during the first year of life. Convulsive attacks then
set in. At 3, this child, who was formerly bright, became strik-
ingly quiet and shy and sat in the corner and cried. Genito-
somatie precocity then became apparent. Mentally he was some-
what precocious,—what the Germans call ‘‘altklug.’’ This boy
displayed no onanism.

Von Frankl-Hochwart (31) reported a boy who, at three,
grew with excessive rapidity and showed mental precocity. At
7 years, his precocity was astonishing. He pondered and dis-
cussed at length the immortality of the soul and the life after
death. This case made such an impression on Dana and Berkely
(32), that it led to the well-known feeding experiments on the
mentally backward children in the New York Publie Schools
and to the experimental work at Vineland by Goddard (33).
At autopsy, in the case mentioned, a teratoma of the pineal was
found. In fact most of the tumors of the pineal are teratomas.

Baily and Jellife (28), who went into the mental study of
their case much more than any of the other writers, state that the
boy who was formerly bright in school work began to show a
failing memory. He also grew more reserved and apathetic.
He showed a tendency towards depression and cried often. The
Zeihn test ‘‘revealed a lack of retention, with a marked slowing
of all responses.’’

376 MENTALITY IN PUBERTAS PRECOX

Gauderer (28) reports a boy of 12 who had a fixed expres-
sion, was apathetic and who answered questions slowly but
clearly.

Raymond and Claude (30) report the case of a boy of 10,
who was mentally apathetic and answered questions well, even
shghtly better than most boys of his age. His memory was good,
but he showed a slight depression.

Kidd (30) reports the following cases, by Pellizzi and Ma-
chell. The first case of Pellizzi showed genito-somatic, together
with mental precocity ; the other case did not. The first subject,
although only 2 years ola, had seminal emissions that contained
spermatozoa. Onanism was not present.

Machell reports two cases, one of which was interesting.
This boy at 17 months had erections and emissions. In addi-
tion to his genito-somatic precocity, he showed marked mental
precocity. At 44 months of age, he showed a disdain for the
toys of small children. His habits bespoke an older boy. His
manner was independent; he was perfectly self-possessed with
strangers, and his answers to questions were given in a loud,
bass, stentorian voice.

Kidd (30), although he wrote a thorough review of the lit-
erature, historical, clinical, experimental, ete., of the pineal,
mentioned nothing concerning the mentality in pineal involve-
ment.

From a comprehensive study of the literature, by which the
various types of puberatas precox were classified, together with
their respective mentalities, it can be said that mental precocity
is non-existent, aside from its manifestation in the pineal type.
In faet, there is in the major number a hypo-mental state, which
gradually shades off into absolute idiocy. The subjects are in
the main childish, and their mentality bespeaks their true age.
In those cases, in which, through tumor growth, intracranial pres-
sure is produced, various degrees of mental disorder arise, but
such are scarcely germane to our discussion.

A trait common to all cases of precocity is the reserve,
thoughtfulness, or quiet they manifest. They like to sit in a
corner by themselves. Stanley Hall (34), in speaking of the
psychic traits attending normal puberty, states that, ‘‘ Inner
absorption and reverie is one marked characteristic of this age
and transition.’’ This observation ean, I believe, be applied ‘to
our eases, and is not in itself indicative of abnormality. Some
writers believe that early sexual desire is a sign of mental pre-
cocity. This I believe is incorrect. It is purely an instinct.

DIAGNOSIS

To reach a diagnosis as to the particular gland involved pri-
marily, and especially if there is any tendency towards readjust-

LEINER 377

ment, one must: (1) have the cases under close clinical observa-
tion; (2) study their metabolism, particularly, as Blair Bell has
advised, the calcium output, and (3) make Roentgen ray ex-
aminations for skeletal development and for the disappearance
of the epiphyseal lines, as shown by Krabbe (8), Lenz (10) and
Timme (35).

The approach to a correct diagnosis is somewhat difficult at
present, in view of the fact that glandular structures that are
seemingly antagonistic, produce nevertheless the common syn-
drome, precocious puberty. However, upon analysis there are
always found some points of difference in respect to the par-
ticular gland involved.

Gonadal Type. In the female type due to hyper-ovarianism
we always get early menstruation. This leads to excess caleium
elimination, and therefore we find the subjects (if of pure ovar-
jan type) always short in stature. If the skeletal system is ex-
amined by Roentgen ray, we find the epiphyses of the long bones
closed. This fact is borne out clinically, that girls who menstru-
ate early are usually short and those who menstruate late are tall.
This tends to hold for races as well as individuals. Again the
distribution of the hair is of the female type, as are the second-
ary sex characteristics, facies and form.

In the masculine gonadal type there is also short stature,
concomitant with closed epiphyses, marked male secondary char-
acteristics, deep voice, enlarged prostate and seminal vesicles and
often emissions, either sterile or containing spermatozoa. What
seems characteristic of this type is the marked physical strength
manifested.

Adrenal Type. In the female we find marked hypertricho-
sis and secondary characteristics of the male type,—large clitoris,
male facies and absence of menstruation. The case of Irion is an
exception.

While we were always taught that the cortex of the adrenal
has for its function the production of sex characteristics only,
the work of Cramer (36) indicates that the cortex also partici-
pates in the production of adrenalin. The question of blood pres-
sure should therefore be taken into account in a differential diag-
nosis.

The male adrenal type is difficult to differentiate from the
gonadal except, perhaps, by their stature. Both types manifest
accentuated male characteristics.

Pineal Types. In these the Roentgen plates should portray
a shadow due to the acervalus cerebri, as a result of early involu-
tion, as shown by Boas, Scholtz (37) and Timme (38). Whether
pure hyperplasia of this gland should give precocious puberty,
as indicated by the work of McCord (39), Dana and Berkeley

378 MENTALITY IN PUBERTAS PRECOX

(32), ete., or hypoplasia or recession of the gland according to
Marburg, it is at present impossible to say.

Finally one may say that there are undoubtedly individuals
living today, who were eases of pubertas precox, and undetected
as such, who will undoubtedly live to a ripe old age. What
takes place here is a compensatory readjustment of the excessive
secretions by their antagonists, just as we see in the ultimate

-adjustment in the svndrome of thymus, pituitary and adrenal of
Timme (35).
CONCLUSIONS

The literature as a whole supports the following conclusions.

1. Pubertas precox arises in certain individuals, whose pro-
genitors show a particular type of endocrine imbalance.

2. The condition may arise in utero, or as a result of func-
tionating rests, 1. e., tumors, later in childhood, previous to
puberty.

3. The entire internal glandular system is involved, but pri-
marily the gonads, pineal and adrenal cortex.

4. Gonadal types predominate, then follow the pineal, and

last, the cortico-adrenal.

5. Pineal types occur mostly in the maie; cortico-adrenal and
gonadal in the female.

6. Mental precocity is very rare and is found only in those
in whom the pineal is primarily involved, and then only in
the male.

=I

The mentality in the other types is either unaffected or re-
tarded.

The manifest mental precocity is of the child-like, imagina-
tive form, and has no real substantial basis.

CO

9, With early diagnosis in the hyperplastic type, readjustment
can be aided materially by proper endocrine therapy.

BIBLIOGRAPHY

1. Greek translation, Phlegon de Mirabilia, Cap. xxxii; Cf. White
(4) ap eciite

De ee Philemon Holland, translator, Book ii, Chapt. xvi. Cited
by White (4).

3. Quoted from Anthony White (4).

4, White, Anthony: Historical account of Philip Howarth, a boy
in whom signs of puberty commenced at an early age. Med. Chir.
Trans. (London), 1809-11, 1-2, 276-285.

5. Plumb, P. E.: Precocious menstruation; a unique case. N. Y.
Med. J., 1897, 65, 768.

6. Irion, J. W.: <A case of precocious menstruation. Ibid., 1896,
64, 227.

16.

Le

26.

LEINER 379

Stone, R. K.: Extraordinary precocity in the development of the
male sexual organs and muscular system in a child of four years.
Am. J. Med. Se. (Phila), 1852, 24, 561-564.

Krabbe, K. H.: Early synostosis of the epiphyses with dwarf-
ism in pubertas precox. This Journal, 1919, 3, 459-466.

Wells, G.: A remarkable case of early and continued menstrua-
tion. Maryland M. J. (Balt.), 1902, 45, 440.

Lenz, J.: Vorzeitige Menstruation Geschlechtsreife und En-
twickelung. Arch. f. Gynaek. (Berlin), 1913, 99, 67-144.

Wolff, Bruno: Zur Kenntnis der Entwicklungsanomalien bei In-
fantilismus und bei vorzeitiger Geschlechtsreife. Arch. f. Gynaek.
(Berlin), 1911, 94, 542-579.

Lucas, R. C.: A case of tumor of the right ovary in a child of
seven, associated with precocious puberty. Med. Press & Cire.
(London), 1888, n. s. 45, 459. Trans. Clin. Soc., Lond. 1888,
2, 224. ;

Bell, W. Blair: The sex complex, Wm. Wood & Co., N. Y., 1916,
p. 149.

Neurath, H.: Die vorzeitige Geschlechtsentwickelung, Ergebn.
f. inner. Med. u. Kinderheilk., 1909, 4, 41-81.

Bulloch, W. and Sequeira, J. H.: On the relation of the supra-
renal capsules to the sexual organs. Trans. Path. Soc. Lond.,
1905, 56, 189-208.

Pitman, H. A.: General melasma and short hair over the entire
body of a child of three years, with conversion of the left supra-
renal capsule into a large malignant tumor; the external organs
of generation resembling those of adult life. Lancet (Lond.),
1865, (i), 175.

Glynn, E. E.: The adrenal cortex; its rests and tumors, its re-
lation to other ductless glands and especially to sex. Quart. J.
Med. (Oxford), 1911-1912, 5, 157-192, 1 pl.

Sacchi, E.: Di un caso di gigantismo infantile (nedomacroso-
mia) con tumore del testiculo. Arch. di ortop. (Milano), 1895,
12, 305-318.

Strauch, A.: Sexual precocity in the male. Am. J. Dis. Child.
(Chicago) , 1918, 15, 132.

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. Pediat. (N. Y.), 1913, 30, 179.

Woods, T.: An extraordinary case of early puberty in a boy.
Lancet (Lond.), 1882, (ii), 337, 473.

Lopez, A.: Case of remarkable precocity in a male. Am. J.
Med. Se. (Phila.), 1843, 5, 500.

Breschet, Gilbert: Description d’ un enfant de trois ans offrant
tous les signes de la puberté. Bull. Fac de Méd. de Paris, 1820-21,
7, 98-111.

Moreau, J. L.: Fragment d’ une notice sur un jeune homme de
onze ans, chez lequel on observe tous les signes extérieurs de la
virilité, accompagnés de |’ accroissement extraordinaire d’ un état
pathologique du testicule. J. de Med. Chir. et Pharmacal. (Paris),
1806, 12, 274-278.

Hofacker, C.: Ein seltener Fall von Frthreife mit Menstruatio
praecox. Verhandl. d. Gesellsch. deutsch. Naturf. u. Aerzte, 1898,
(Leipz.), 1899, 70, Pt. 2, 2. Hefte., 182.

Hudoverning, C. and Popovits, U. P.: Gigantisme précoce avec
développement précoce des organs génitaux. N. inconog. de la
Salpétriere (Paris), 1903, 16, 181-192.

MENTALITY IN PUBERTAS PRECOX

Ziehn: Fall von Gigantismus. Berlin. klin. Wehnschr., 1906,
43, 1198-1199

Baily, P. and Jellife, S. E.: Tumors of the pineal body; with
an account of the pineal syndrome, the report of a case of tera-
toma of the pineal and abstracts of all previously recorded cases
of pineal tumors. Arch. Int. Med. (Chgo.), 1911, 8, 851-880.
Gordon, M. B.: The role of the pineal in pediatrics. This Jour-
nal, 1919, 3, 487-458.

Kidd, Leonard J.: The pineal body; a review. Med. Chronicle,
(Manchester), 1912, 57, 154-184.

von Frankl-Hochwart, L.: Uber Diagnose der Zirbeldriisen-
tumoren. Wiener med. Wechnschr., 1910, 60, 505-508.

Dana, C. L. and Berkely, W. N.: Functions of the pineal gland.
Med. Rec. (N. Y.), 1913, 83, 835.

Goddard, H. H.: The Vineland experiment with pineal gland
extract. J. Am. M. Assn., (Chgo.), 1917, 68, 1340.

Hall, G. Stanley: Adolescence; its psychology, etc., N. Y., 1904.
Timme, Walter: A new pluriglandular compensatory syndrome.
This Journal, 1918, 2, 209-240.

Cramer, W.: A histochemical method for the demonstration of
adrenalin granules in the suprarenal glands. J. Physiol.,
(Lond.), 1918, 52, viii-x; Abst., This Journal, 1919, 3, 496.
Boas, E. P. and Scholtz, T.: Calcification in the pineal gland.
Arch. Int. Med., (Chgo.), 1918, 21, 66.

Timme, Walter: Progressive muscular dystrophy as an endo-
crine disease. Ibid., 1917, 19, 79.

McCord, C. P.: The pineal gland. Trans. Am. Gyn. Soc., 1917;
Surg. Gyn. and Obstet., (Chgo.), 1917, 25, 250.

Horrax, Gilbert: Studies on the pineal gland; Arch. Int. Med.,
(Chgo.), 1916, 17, 607, 637.

THE ENDOCRINE SECRETION OF HEN-FEATHERED
FOWLS

T. H. Morgan

Professor of Experimental Zoology, Columbia University, New York

In the older literature there are many references to changes
that have been noticed in old hens and female pheasants that
make these birds more like the males of their species. They be-
come quarrelsome, they sometimes crow, the feathers change their
color, ete. It has been recorded. in several cases that these
changes appear after the female has ceased to lay, and in a num-

Fig. 1, A. Sebright Bantam male; B. Sebright Bantam female.

ber of cases that the change was associated with a diseased con-
dition of the ovary. Complete removal of the ovary of birds is a
difficult operation owing to its irregular shape and to its close
adherence to the body wall. Goodale has succeeded, neverthe-
less, in completely removing the ovary of young fowls. When
the adult plumage develops in such birds it is like that of the
cock of their breed. In the Leghorns, where the difference be-
tween the sexes is very great, the result is most striking. The
comb and wattles, and the spurs also, grow larger than in the
normal hen. Evidently something produced by the ovary—some
internal secretion perhaps—inhibits the full development of the

381

382 HEN FEATHERED FOWLS

plumage of the hen, of her comb, and sometimes also of her spurs.

Castration of cockerels is regularly practiced to make ¢a-
pons. The capon has all the characteristics of the male and its
feathers may be even longer than those of the normal male. The
comb, however, remains undeveloped, or, if already large, it
dwindles to a fraction of its original size. Here removal of the
‘‘reproductive gland’’ does not change the characteristic plum-
age of the male, but does change the comb in the direction of the
condition found in the hen.

There is one race of domestic fowls in which the cock is hen-
feathered. The Sebright Bantam male, Fig. 1 A, differs from

Fig. 2. Sebright Bantam male, after castration, showing cock-feathering.
the ordinary cock in that his feathers are lke those of the hen,
Fig. 1, B. Both sexes have golden feathers with a black margin.
The most striking feature of the plumage of the Sebright male is
that the feathers of the back and rump are rounded at the tip
and lack the peculiar hackles of the ordinary cock. This resem-
blance of the male Sebright to the female suggested to me the
possibility that if his testes were removed he might change as does
the hen when her ovary is removed. In a word, he might be-
come cock-feathered. I carried out some experiments of this
kind in 1915, and the results have been fully described in one of
the Carnegie Publications (No. 285, 1919). The result of the
operation was most striking. As the new feathers came in, it
was at once obvious that they were like those of the ordinary cock

MORGAN 383

bird. When the complete moult had taken place the birds ap-
peared as shown in Fig. 2. The castrated male was now a rich
orange color above; the black margin of the feathers over the
whole dorsal surface had disappeared ; the back and saddle feath-
ers were jong and pointed as were those of the neck also. All of
these had the characteristic hackles at theix outer margins. The
tail was now covered with long yellow tail coverts, that are not
present in this form in the hen-feathered male.

On the under surface of the castrated males the changes
were much less, although the golden centers of the feathers had
become darker. The comb and wattles diminished until they

Fig. 3, A. Campine male, hen-feathered; B. Campine female.

were no larger than those of the hen. The effect is the same as
in the true capon. Thus results confirmed expectation; the hen-
feathered male changed after castration into a cock-feathered
bird so far as the plumage was concerned.

There are a few races of poultry in which both hen-feathered
and cock-feathered males exist. he Campines have two such
kinds of males. In some countries one type is the standard; in
other countries the other type. It is more difficult to make from
a mixed race a type pure for hen-feathering than one pure for
cock-feathering, since the former is a dominant Mendelian char-
acter and may carry, but not show, the recessive cock-feathered
factor. For the purpose of my experiment it was necessary to
obtain a race pure for hen-feathering, and this I succeeded in
finding.

384 HEN FEATHERED FOWLS

The feathers of the hen-feathered male, Fig. 3 A, are barred
(except those of the neck) and are like those of the hen, Fig. 3 B.
In the cock-feathered male on’ the contrary the feathers of the
back and rump are white and pointed, while the tail coverts are
black and long.

When a young cockerel of a hen-feathered breed is castrated
he changes over, (Fig 4), as his new feathers come in, until final-
ly he is exactly like the cock-feathered male. His neck feathers
become very long and become completely white. The back and
rump feathers lose their barring and become white, very long
and pointed, and show well developed hackles at the margins. In

Fig. 4. Campine male, castrated, showing cock-feathering.

a word, the hen-feathered male comes to resemble the other type
of male. The comb and the wattles, however, remain small as in
ordinary capons. Concerning the source of the internal secretion
that is probably involved in these changes, the following histo-
logical facts are of great interest. In the ovary of the hen there
are groups of interstitial cells, called luteal cells (Fig. 5). They
are large, clear cells in ordinary preparations, but are found to
be filled with granules when methods of preparation are used
that avoid the loss of this material. In the adult cock-feathered
males these cells are entirely absent as a rule, or at best only
sparsely found, and then with shrunken nuclei. In the Sebright
cock and in the hen-feathered Campine large numbers of such.
cells, filled with materials, are present (Figs. 2, 3, 4). In the

MORGAN 385

hen these cells may be supposed to produce an internal secretion
that affects the development of her plumage in such a way that
it never shows its complete possibilities. When her ovary is re-
moved this secretion is no longer produced, and she then de-
velops her full plumage, which is the same as that of the male of
her race. In the male Sebright and in the hen-feathered Cam-
pine the internal secretion produced by their luteal cells may be
supposed to suppress in them also the full development of the
plumage, but when they are castrated the cells are removed and
eock-feathering develops.

Lutear cells Lutear cells

Lutear cells
an

Kyo,

Fig. 5. Lutear cells; 1, in hen’s ovary; 2, 3, 4, in testes of Sebright and
hen-feathered Campine cocks.

In young chicks of ordinary breeds, the luteal cells are pres-
ent, both in the males and in the females. This holds also for the
young Sebrights as Dr. J. F. Nonidez has recently found. These
cells disappear largely or entirely in ordinary breeds, as the
birds reach maturity; but in the races with hen-feathering they
continue to develop, and remain functional, producing in the
males the same effects as they do in the hen of all breeds. The
development of the comb and wattles of the male is dependent on
the presence of the testes, but it appears that the luteal cells are
not directly responsible for their development, because the comb
of the hen is small. Some other part or tissue of the ovary and
of the testes must be involved in the development of these organs.

ABSTRACT
SOME CONDITIONS AFFECTING THYROID ACTIVITY

W. B. Cannon and P. E. Smith

(1) Gentle massage of the thyroid gland in the eat for
two or three minutes will cause an increased rate of the de-
nervated heart amounting in some instances to 33 per cent. over
the basal rate.

(2) Massage of another gland, e. g., the submaxillary, does
not cause this effect.

(3) The augmentation of heart rate caused by thyroid
massage occurs in the absence of the adrenal glands.

(4) Stimulation of the cervical sympathetic trunk as it
leaves the stellate ganglia induces a similar augmentation of the
rate of the denervated heart; this does not occur if the thyroid
oland has previously been removed.

(5) If the cardiae fibres from the stellate gangla are sev-
ered, as well as the vagus nerves, and an afferent nerve such as
the sciatic or brachial is stimulated, under such a degree of an-
esthesia as will permit reflex retraction of the nictitating mem-
brane and dilation of the pupil, there is a primary increase of
rate, due to adrenal discharge, which is followed by the slowly
developed increase characteristic of the thyroid effect.

(6) If the vagi and the cardiac fibres of the stellate are
eut and the animal is asphyxiated under conditions which per-
mit the eye changes described above, there is a similar primary
rise due to adrenal secretion followed by the secondary thyroid
effect.

(7) If the thyroid glands have been previously removed,
sensory stimulation and asphyxia induce solely the increase of
rate due to adrenal discharge. The development of the maximal
increase of rate from thyroid activity, usually requires from 30
to 60 minutes and passes off in a similarly slow manner.

*Read before the Association for the Study of Internal Secretions, New
Orleans, April 26, 1920.

386

PHARMACODYNAMIC SUBEPIDERMAL TESTS:
II, INDIRECT TESTS; A, THYROIDIN

M. Ascoli and A. Fagiuoli

(From the Institute of Internal Medicine, University of Catania,
Director, Prof. M. Ascoli)?

A series of investigations is being undertaken in our Insti-
tute in an endeavor to ascertain to what extent the intracuta-
neous injections of endocrin substances and those especially re-
lated to the autonomic nervous system can be utilized in prac-
tical diagnosis. In a previous issue of this Journal, the results
secured with pituitrin were briefly described (2).

The desirability of investigating thyroid material in this
way was obvious although it seemed, a priori, less promising on
account of our inability to utilize a definitely identified, pure
active principle.

As compared with a control subepidermal injection of water,
that of thyroid extract differs in giving rise to a larger papule
and- a greater degree and duration of erythema. The reaction
was found to vary a great deal with the individual, however, be-
ing now more active and lasting, now so attenuated as to become
indistinguishable from the control reaction. But the same varia-
bility in the reaction picture is seen following injections made
in a given subject at the same time with other extracts, e. g., of
ovary, thymus or testicle. The problem does not seem to lend
itself, therefore, to a simple, direct attack. Can it be solved by
indirect methods?

Among the different endocrin organs there are close rela-
tionships of interdependence, synergy or antagonism. In the
ease of adrenalin and pituitrin, characteristic reactions are di-
rectly attainable by means of subepidermal injections. In case
of other endocrin organ extracts, as above mentioned, unequivo-
cal reactions are not readily secured. The problem then presents
itself: Can the adrenalin reaction be characteristically altered—
attenuated or accentuated—by the use of extracts of different en-
doerin organs? The sensitivity of the organism to such materials
might thus be disclosed. As a case in point, does the addition of
thyroid extract in a quantity not in itself causing reaction lead
to augmentation or attenuation of the adrenalin cutaneous re-

387

388 THYROIDIN SUBEPIDERMAL TEST

action as it has been reported by Falta to affect the metabolic
reaction and by Oswald and others to affect the vasomotor re-
action ?

The test has given positive results’in certain pathological
but not in normal subjects (3). A given individual reacts dis-
tinetly to adrenalin in 1:200,000 dilution, but only feebly to
1:1,000,000. If to the adrenalin in these dilutions a small quan-
tity of thyroid extract (0.01 to 0.005 ce.) be added (4)—a quan-
tity which in itself gives no direct reaction distinguishable from
that to distilled water,—the adrenalin reaction is distinctly en-
hanced and more protracted, as compared with the reaction to
the adrenalin alone. The central red color in the reacting zone
is also often deeper.

The same activation may be demonstrated in case of pitui-
trin instead of adrenalin and this second indirect test may be
found in cases in which the former is negative (5).

Contrary to the results obtained with thyroid extract, other
endoerin glands seem to attenuate the adrenalin reaction. We
shall have occasion to report further upon these latter extracts
as well as upon the clinical significance of the indirect thyroidin
test.

1. Submitted to the Reale Accademia dei Lincei, Rome, March,
1920. ‘
2. Ascoli, M. and Fagiuoli, A.: Pituitrin test. This Journal,
1920, 4, 33-36.

3. It is presumed that the failure to obtain the phenomenon in
the normal subject is due to the insufficient amount of active material
in the thyroid extract employed. The result was the same, however,
with Oswald’s thyreoglobulin.

4. The extracts employed by us are of 25 per cent strength in
physiological saline solution, obtained from bovine thyroids under a
pressure of 350-400 atm. to the sq. cm. The extract is filtered through
porcelain, preserved with % per cent chloretone and distributed in
sterilized vials. For this preparation we are indebted to the “Instituo
nazionale medico farmacologico” of Rome.

5. We have frequently alluded to the necessity of making the
injections superficially and strictly subepidermically. This condition
is all the more essential in the thyroidin test in whch are to be com-
pared only differences in intensity of reactions of the same category
such as could readily be produced merely by variations in the depth
of the injections. In order to obviate error when differences are small,
the test may be made in duplicate or triplicate and be regarded as
positive only when the result is obvious and the difference easily ap-
preciable to one not concerned in the result.

STUDIES ON DISORDERS OF THE THYROID GLAND

HYPERSENSITIVENESS TEST WITH ESPECIAL REFER-
ENCE TO “DIFFUSE ADENOMATOSIS” OF THE THY-
ROID GLAND.*

Emil Goetsch, M. D., Brooklyn, N. Y.

Further experiences with my epinephrin hypersensitiveness
test during the past year have led to a more intensive study of
the so-called border-line cases. In these is found the familiar
syndrome of asthenia, loss of weight and strength, nervousness
of varying degrees, labile pulse, mild tachyeardia, perspiration
and tremor, sometimes depressions, and often slight elevation
of temperature without, however, any special gross pathological
findings in the thyroid gland on physical examination, and with-
out positive eye changes such as are found in exophthalmic
goitre. The diagnosis in these instances lies largely between
mild chronic hyperthyroidism, incipient tuberculosis, neuro-
circulatory asthenia, effort syndrome, psychasthenia, psycho-
neurosis, neurasthenia and other allied nervous states or perhaps
even certain chronic infections, for it seems possible that a
syndrome of this character, if not actually caused by infection,
may be made worse by it. In a series of these individuals most
of whom had been suspected of having tuberculosis, while others
were thought at first to have psychoneurosis or neurasthenia,
and-who had failed to improve after the ordinary medical and
hygienic measures, there was finally obtained a positive epine-
phrin hypersensitiveness test which is so characteristic of hyper-
thyroidism, though, to be sure, not absolutely pathognomonic of
it. Because of the failure of the ordinary medical and hygienic
measures in the treatment of these individuals,—at Saranac
Lake and other sanatoria; because, further, in those suspected
of having tuberculosis, little or no tuberculosis was found upon
expert examination; because in all there was a fairly uniform
syndrome which resembled mild hyperthyroidism and, lastly,

*Read at the Fourth Annual Session of the Association for the Study of
Internal Secretions, New Orleans, April 26, 1920.

389

390 DIFFUSE THYROID ADENOMATOSIS

because of a positive epinephrin test, which is negative in pure
tuberculosis, I felt justified in advising operation. This con-
sisted usually in a bilateral partial resection of the thyroid
eland. In view of the improvement following operation, and
because of the characteristic change in the glandular histology,
| felt that these cases formed a special and interesting group im
thyroid disorders, exhibiting a new clinico-pathological syndrome
which deserved reporting, in the hope that more interest and
study be awakened in it.

Upon eareful histological study of the thyroid gland re-
moved in these cases I found a rather characteristic and striking
pathological change which has heretofore escaped general notice,
and to which I have applied the name, ‘‘ Diffuse Adenomatosis.”’
It is my purpose in this report to speak in somewhat greater
detail with regard to the importance of this condition in the
etiology of latent hyperthyroidism and with regard to its differ-
entiation from incipient tuberculosis and other conditions with
allied syndromy, by means of my epinephrin test. I shall speak
also of the very definite improvement which follows thyroid
resection and of the gross and microscopic pathological changes
oceurring in the thyroid gland.

It may be well to review briefly our knowledge of the
histological changes which occur in the thyroid gland and which
are associated with a definite, now well-recognized hyperthy-
roidism. Thus it is well to remember that the parenchymal, or
in other words, the epithelial thyroid cells occur as two types:
first, the acinar or aveolar cells surrounding the characteristic
colloid and second, the so-called foetal or interstitial cells oecur-
ring in the interstices between the normal acini, but not taking
part in the formation of the latter. Primary hypertrophy and
hyperplasia of the aveolar epithelium, when mild, gives rise to
a mild hyperthyroidism, such as is found associated with the
hyperplastic thyroid gland at puberty or at other physiological
periods, such as pregnancy and menstruation. More advanced
aveolar parenchymal hypertrophy and hyperplasia is associated
with the higher degrees of thyroid intoxication, and is found
in the characteristic gland of exophthalmic goitre or Graves’
disease.

The second well-recognized syndrome of hyperthyroidism
depends upon the activity of the so-called ‘‘foetal-adenomata’’

_ GOETSCH 391

which occur as discreet circumscribed tumors or nodules which
may be single or multiple and which are easily recognized, even
in the very early stages. There is good reason for believing that
these adenomata arise by hyperplasia and overgrowth of in-
dividual groups of the so-called foetal interstitial cells of Wolfler,
and thus develop into the discreet, circumscribed and encapsu-
lated foetal adenomata. I wish to emphasize here that there is
not in the ease of true adenoma a general overgrowth of this in-
terstitial tissue in the thyroid gland, for upon this distinction
rests the point of my paper. In both these instances of aveolar
hyperplasia, namely, in the active gland at puberty and in exoph-
thalmie goitre, I have found, upon cytological study, evidence of
cellular activity in the occurrence of great numbers of mitochon-
dria in the cytoplasm of the cells. I reported these findings in the
Johns Hopkins Bulletin, May, 1916, and stated further that I felt
I had proved from histological evidence that foetal adenomata
of the thyroid were of themselves responsible for the hyper-
thyroidism which occurred associated with them. Furthermore,
in both of these clinical states, I found that the epinephrin
hypersensitiveness test was definitely positive, and the degree
of reaction was remarkably parallel to the degree of toxicity
clinically recognizable. The test gave thus confirmatory evidence
of the presence of hyperthyroidism in these two conditions.
Before proceeding to a further discussion of the cases to
be reported, it may be well to make a preliminary statement as
to what the test really means, after my experience with it and
after the experience of others. In the first place, it is an indi-
cator of hypersensitiveness of the sympathetic nervous system.
On the other hand, I am not prepared to say that all cases
which show a positive reaction are, therefore, hyperthyroidism.
However, we do know that the test is positive in all cases of
hyperthyroidism, a fact which is founded upon abundant physi-
ological research carried out particularly by Cannon and Levy.
Furthermore, of all the diseases which may possibly be associ-
ated with a hypersensitive sympathetic system, hyperthyroidism
is by all odds the most common, the exceptions being relatively
uncommon. On the other hand, in the presence of a negative
response to the test, one can state definitely, I believe, that
hyperthyroidism is not present. To be able to differentiate to
this extent is of great value in the diagnosis of obscure cases.

392 DIFFUSE THYROID ADENOMATOSIS

Again, I wish to point out that I am not advocating operation
simply on the basis of a positive reaction; I am simply stating
the facts as we know them with regard to the test, regardless
for the present, of treatment advised.

The reaction is regarded as mildly positive when, after the
injection of 0.5 ee. of 1 to 1000 epinephrin chloride (Adrenalin
chloride, Parke, Davis & Co.) solution a rise of about 10 points
in pulse or in systolic pressure or in both is obtained, and in
which there are associated with this, certain clear-cut subjective
and objective symptoms which have been described. It is stated
by some that, exceptionally, positive reactions are obtained in
cases of effort svndrome and even in so-called normal indiyid-
uals and in neurasthenies. The response in. such cases, how-’
ever, is often atypical. A typical reaction is characteristically
sustained and is apt to occur in two phases, a primary major
reaction followed by a secondary minor reaction; it then dis-
appears in one and one-half hours, leaving the patient prac-
tically normal. Again, the reaction is parallel to the degree
of toxicity clinically recognizable just as is the metabolic reae-
tion in the higher degrees of toxicity. After operation or after
subsidence of the hyperthyroid symptoms, there is a fairly rapid
subsidence of the characteristic hypersensitiveness.

Armed with thesé facts, I proceeded to a study of the less
obvious cases which presented an obscure, though characteristic,
syndrome, with negative eye signs and with few diagnostic
findings in the gland. Many of the subjects were suspected
of having tuberculosis, but upon expert examination were found
to have little or none and showed no definite improvement after
prolonged periods of rest. Finally, a positive epinephrin test
was obtained and, after the failure of other measures, operation
was advised. I wish. to report now the results after operation
and the pathological findings in the thyroid gland.

Space is not available in this brief report for a detailed
presentation and discussion of the cases in this series. I shall,
therefore, restrict my remarks to a summarized statement.
There are in this group fifteen patients suffering with what I
have ealled ‘‘ Diffuse Adenomatosis’’ and presenting in general
the syndrome of asthenia, mild tachyeardia, nervousness, loss of
weight and strength, tremor, perspiration and, in most of the
cases, slight elevation of temperature. The majority of the

GOETSCH 393

cases were observed during the past year at the Johns Hopkins
Hospital and a few of the more recent cases at The Long Island
College Hospital. Reports since operation have been obtained
in all cases except two, and the time elapsed since operation
varies from three to twelve months. The type of operation was
the same in all instances, namely, a generous resection of both
lobes together with the isthmus, leaving possibly one-fourth of
the total gland substance. It seemed necessary to make this
extensive reduction in order to obtain the desired benefit.

I may mention now, for convenience of consideration, the
sub-groups of this series of patients, according to their previous
suspected diagnosis and their previous treatment. The larger
group, and perhaps the most interesting one, comprises ten
patients in whom the diagnosis of tuberculosis was suspected,
and all of whom had the benefit of sanatorium treatment and,
incidentally, of expert pulmonary examination. The period of
hygienic treatment varied from about three months of sanator-
ium treatment to irregular periods covering five years. In no
case was there sufficient benefit from this treatment to warrant
further rest or even to indicate that tuberculosis was the cause
of the symptoms. The clinical syndrome in all of these cases is
much the same and consists of the symptoms mentioned above.
The individual cases did not vary sufficiently to warrant special
discussion. The interesting feature about these patients 1s
that upon expert pulmonary examination there was little or no
tuberculosis found, and in all cases the epinephrin chloride test
was positive, both at the sanatoria where the tests were carried
out, and subsequently in the hospital under my own observation.
In view of the fact that these patients failed to improve under
medical and hygienic measures after long periods of time, that
their syndromy seemed to be that of hyperthyroidism even
more so than of other conditions which might give a more or
less positive epinephrin response, such as diabetes, effort syn-
drome, neuro-cireulatory asthenia, but which could be largely
excluded by history and examination; and, finally, because of
the positive epinephrin chloride test which has been found so
constantly positive in the presence of hyperthyroidism, I did
a partial thyroidectomy.

With regard to the clinical results following operation, I
might say that I have reports from all but one of the cases, and

394 DIFFUSE THYROID ADENOMATOSIS

although the time elapsed since operation is hardly sufficient as
yet to expect all the improvement that I think will come, never-
theless, after the comparatively short post-operative periods of
three to twelve months, the results are so encouraging as to make
me very hopeful about the ultimate outcome. In only one case
was there failure of definite improvement, at least of the mental
symptoms of which this patient suffered; physically she has
definitely improved. The remaining patients showed a moderate
to very remarkable improvement. The symptoms specifically
reported as relieved are nervousness, weakness, palpitation,
tremor, insomnia, perspiration, loss of weight and the mild
febrile condition. These answers were in response to a definite
questionnaire sent to these patients. Of the remaining cases of
the previously suspected tuberculosis group there were five. One
of these was a paraysmal tachycardia case referred to me by
Dr. Barker; another, a young woman suffering with weakness,
nervousness, and tremor, of unknown origin; the remainder
complained primarily of nervousness and weakness.

In the gross and microscopic study of the thyroid glands
from these patients I found some peculiarities which have lead
me to think that we are dealing with a new clinico-pathologieal
syndrome in thyroid disorders, which is a true hyperthyroidism
based upon a peculiar and very interesting pathological change
in the thyroid gland. This change is neither of the nature of
that found in puberty hyperplasia nor in Graves’ disease or
exophthalmie goitre, nor is it of the type in which true discreet
encapsulated nodules, the so-called ‘‘foetal-adenomata,’’ are
found. The glandular pathology in these latter types of thyroid
disorder is readily recognized and is well known to be capable
of producing hyperthyroidism. However, in this new and
obscure group of which I am speaking, the following character-
isties are fairly uniform. Upon physical examination the thyroid
gland is often found moderately enlarged, but may be neither
visibly or palpably so. It is fairly firm, and shghtly granular
or lobulated. No definite nodules are palpable, and signs of
increased vascularity such as thrills or bruits in the gland or at
the poles are not demonstrable. At operation one character-
istically finds that a peculiar periglandular fibrosis has caused
the gland to become loosely or sometimes quite firmly adherent
by its thickened capsule to the prethyroid muscles and to the

GOETSCH 395

large vessels and the sternomastoid, laterally. The appearance
reminds one of a possible mild periglandular reaction, which
sometimes makes difficult the delivery of the thyroid lobe. There
is increased vascularity, particularly of a venous character, in
the capsule of the gland. The thyroid arteries are only slightly
if at all enlarged. The gland contains a moderate amount of
colloid. It is of ‘‘rubbery’’ or spongy consistence, friable, more
than normally vascular and has a marked tendency to ooze from
the cut surface. There is not the familiar increased consistence
of the gland as seen in exophthalmic goitre, nor is there the
glistening character seen in colloid glands.

The microscopic findings are fairly uniform in these glands.
The most characteristic feature is the readily recognizable
increase in the interstitial cells the so-called foetal cells
which are themselves characterized by being without any very
definite arrangement. They are large and have a fairly clear
protoplasm and a round vesicular nucleus. They can be dis-
tinguished from the lymphoid cell accumulations, which are also
common, by the fact that the latter cells are much smaller, have
very little protoplasm and a dense pyenotie nucleus. This in-
terstitial tissue is distributed throughout the gland substance
and is nowhere aggregated into encapsulated nodules as one
sees in true adenoma. The glandular acini are mostly small and
irregular in size. One sees often numbers of very small acini
in the midst of, and apparently derived from, the interstitial
tissue, and appearing in cross-section like a globule of colloid
surrounded by 10 or 12 cells. The acinar cells themselves are
usually low, thinned out and do not of themselves appear active
nor are they active as indicated by the presence of mitochondria
which are usually very few or practically absent. In other
words, the hyperthyroidism which occurs with this change in
the thyroid is not due to an increased activity of the acinar cells.
In this respect the acinar cells differ from those seen either in
the normal gland where they are cuboidal or in the puberty
hyperplastic gland or in exophthalmie goitre, in which they are
cuboidal to columnar and rich in protoplasm containing abun-
dant mitochondria. Occasionally very small young adenomata
are seen no larger than a wheat grain, but this is exceptional.
These very small adenomata may possibly be regarded as an
index of the fact that the foetal tissue in the thyroid is stimu-

396 DIFFUSE THYROID ADENOMATOSIS

lated to activity and overgrowth by some hidden force. There
is some increase in the fibrous tissue which tends to divide the
gland into small lobules easily recognized under the microscope.
Because of the increased amount of diffuse interstitial tissue
which is greater with the more toxic grades of hyperthyroidism
found in these eases, and which we believe is derived from the
so-called foetal cells of Wolfler; because of the numerous small
apparently new formed acini, and the increase in lymphoid cell
accumulations ; because of the absence of true discreet adenomata
and because, finally, of hypoplasia rather than hyperplasia of
the alveolar cells, I have, for want of a better term called this
condition ‘‘ Diffuse Adenomatosis.’’ This may not be a very
fortunate term, but it has the value of being descriptive. I wish
to emphasize again, that the appearance of these glands is de-
cidedly different from that seen in puberty hypertrophy and
hyperplasia and in exophthalmic goitre, in which there is a
hyperplasia of the alveolar cells and in which the interstitial
tissue is almost entirely absent. Furthermore, the picture is
very different indeed from that seen in true adenoma, which
occurs as an encapsulated tumor in an otherwise fairly normal
looking gland.

I believe that the hyperthyroidism in these cases is depen-
dent upon the activity of this so-called interstitial tissue, and
not upon the primary alveolar cells, for when applying all the
criteria we have in addition to the criterion of mitochondrial
concentration, I find that the alveolar cells are more or less
thinned out; there is no infolding and when investigated for the
presence of mitochondria these latter structures are found very
few in number. On the other hand, the interstitial tissue con-
tains a moderate number of these structures, and at times they
are quite numerous. In May, 1916, in the Johns Hopkins Bul-
letin, in an article entitled: ‘‘Functional Significance of Mito-
chondria in Toxie Thyroid Adenomata,’’ I stated that, on the
basis of histological evidence in addition to clinical reasons, foetal-
adenomata of the thyroid were active and of themselves respon-
sible for the hyperthyroidism associated with them. I believe
this to be the case because of the very rich mitochondrial con-
centration in these adenomata, and because of the almost entire
absence of them in the gland outside of the adenoma. Similarly,
in puberty hyperplasia and in exophthalmie goitre, these mito-

GOETSCH 397

chondria oceur in moderate numbers in the former and are
excessively numerous in the latter. This was a uniform finding.
In colloid goitres they are very few or entirely absent. In other
words, I believe that the hyperthyroidism in these cases is de-
pendent upon the increase in amount and activity of the inter-
sitial tissue derived from the so-called foetal cells and not upon
activity of the alveolar or acinar cells themselves.

The question might be asked: Is this syndrome associated
with ‘‘Diffuse Adenomatosis’
might be contended that these persons were by nature endowed
with a hypersensitive sympathetic nervous system, and that the
operation merely reduces the more or less normal amount of
thyroid secretion and thus renders the abnormally sensitive
sympathetic less irritable, with a consequent improvement in
the status of the patient. This objection might be valid, I think,
if the thyroid presented a more normal appearance. But, be-
cause of the very definite pathological changes which are found

’ a true hyperthyroidism? It

and have hitherto been overlooked as a cause for hyperthyroid-
ism; second, because of the fact that these patients failed to
respond to medical and hygienic measures; third, because of
the positive response to the epinephrin test, which is the rule in
hyperthyroidism and, finally, because of the definite improve-
ment after thyroid resection, I am of the opinion that we are
dealing with a clinical state of mild chronic latent hyperthy-
roidism which has hitherto escaped notice.

If one were to rely upon the metabolic rate as an index
of hyperthyroidism one would not suspect the cases belonging
to this group, for as recently pointed out by Woodbury, the
metabolic rate in these individuals is not particularly increased ;
in faet, it may be normal or only very slightly abnormal. <A
series of these cases were operated on by Webb and a definite
improvement followed. I think Woodbury is correct in assum-
ing that, regardless of the normal metabolic rate, these patients
were suffering with hyperthyroidism. Consequently, the fact
that the metabolic rate is not increased in these individuals does
not to my mind indicate that they are not suffering with hyper-
thyroidism. I want to emphasize particularly that the epine-
phrin test, which is more sensitive than the metabolic rate de-
terminations, is positive in these individuals, though mildly so,
and hence is in this group of more diagnostic value than the met-

398 DIFFUSE THYROID ADENOMATOSIS

abolie test. This finding is somewhat similar to that in adenoma
in which Woodbury also found that in the quiescent phase the
metabolic rate may be found normal, and one would certainly
not deny the presence of hyperthyroidism when the clinical syn-
drome is so clear, and when true circumscribed adenomata are
felt in the thyroid gland and discovered at operation. In other
words, the hypersensitiveness of the sympathetic is rather a per-
sistent characteristic even in the quiescent phase of hyperthyroid-
ism at which time the metabolic rate is normal. The basal meta-
bolic level, therefore, is not so much an indicator of the disease
as an expression of the degree of toxicity which is at any one
moment present.

I think we are safe in saying on the basis of the physiological
researches of Cannon and his associates, and of my results in
the study of thyroid disease during the past six years, that
epinephrin chloride is an indicator of hypersensitiveness of the
sympathetic nervous system; that of all the diseases which are
characterized by such a hypersensitive nervous system, hyper-
thyroidism is by far the most important and the one most fre-
quently encountered. It would seem impossible for hyperseecre-
tion of the thyroid to be present in an organism without produc-
ing a hypersensitiveness of the nervous system and, therefore, a
positive reaction to epinephrin. On the contrary, given a neg-
ative reaction, I feel that one can say definitely that hyperthy-
roidism is not present except in those late stages in which nervous
and cardio-vascular degeneration have so far advanced as to
render impossible a response to the drug. A negative reaction is
thus of great diagnostic value. <A typical positive reaction in a
condition from which diabetes, neuro-circulatory asthenia and
effort syndrome have been excluded—and this can often be done
by other clinical methods—has a distinet diagnostic value, and
at other times is confirmatory of a clinical diagnosis based upon
ordinary observations and tests.

As compared with the increased metabolic rate as a criterion
of thyroid intoxication, I think the test has, in the first place, the
distinct advantage of being simpler and less liable to erroneous
interpretation. With ordinary care it can be used by any one
familar with a blood pressure apparatus and the observation of
cardio-vascular changes and with the general symptoms and
signs of hyperthyroidism. It does not require the trained ex-

GOETSCH 399

pert to obtain correct observations nor to make the proper inter-
pretations. Again, in the milder states of hyperthyroidism in
which the metabolic rate may be normal or only slightly in-
ereased, cases of whieh kind may thus be overlooked if reliance
is placed upon increased metabolic rate alone, a positive epine-
phrin test often reveals the diagnosis. Again, observers have re-
ported definite instances of clinical hyperthyroidism in which
the metabolic rate is low. I have never seen a ease of definite
hyperthyroidism, clinically easily recognizable, which has failed
to give a positive epinephrin test. This has been found true in a
series of over 450 cases of thyroid disease. In my experience I
think I have been able to differentiate the cases of neuro-circula-
tory asthenia so-called, which have given a more or less typical
reaction, from hyperthyroidism by the fact that, in the former,
there is very frequently a clear family history of nervous insta-
bility. There is an inherited constitutionally inferior nervous
system. The symptoms in this condition are rather obscure and
indefinite and upon closer examination it is found difficult for
the patient to describe them clearly. They are found to date
back to puberty or even into childhood, there being no definite
recognizable starting point of the trouble. On the other hand
there seems always, in my experience, to be a fairly definite
starting point for hyperthyroidism. It is rare before puberty
and frequently follows acute infections or severe psychic and
nervous trauma. It may have its beginning at puberty, after
pregnancy or after the menopause, the patient usually recogniz-
ing the time when the symptoms begin, whereas, previous to this
time the general health may have been, and often has been, un-
usually good. Restricted to the epinephrin test alone one might
have some doubt. Since it appears that a positive test may be
found in the condition of so-called neuro-circulatory asthenia—
which to my mind has not been demonstrated to be absolutely
unassociated with thyroid overactivity—it may be helpful if this
simple history test is applied, for in many cases a differentiation
ean thus be made from true hyperthyroidism. Again, | want
to emphasize that I do not feel or say that in the presence of a
positive reaction, particularly a mildly positive reaction, thyroid
resection is indicated. I am speaking now simply of diagnostic

facts, leaving the matter of operative therapy out of the problem.

400 DIFFUSE THYROID ADENOMATOSIS

SUMMARY

There is a group of so-called borderline cases which hereto-
fore have been very difficult of diagnosis, and even more difficult
with reference to a satisfactory treatment. The individuals be-
longing to this group are of no characteristic age but are mostly
young adults. They present a syndrome characteristic of pos-
sibly hyperthyroidism, incipient tuberculosis, neuro-circulatory
asthenia and allied conditions. They fail to show positive eye
signs, or even positive clinical findings in the thyroid gland. They
fail, furthermore, to respond to ordinary medical and hygienie
measures. Upon further examination they are found to give a
positive reaction to the epinephrin test, but on the other hand,
as shown by Woodbury, in many instances they fail to show in-
ereased basal metabolism. In this type of case a rather extensive
bilateral partial resection of the thyroid gland is followed by a
very definite and often striking improvement. The thyroid gland
upon microscopic examination shows a characteristic histological
picture, heretofore unrecognized as responsible for a definite kind
and type of hyperthyroidism. This change is not of the puberty
hyperplastic type nor of the exophthalmic type, nor is the pic-
ture that presented by the well known discreet adenomata of the
thyroid gland, all of which conditions are well known to be re-
sponsible for hyperthyroidism. In the group of patients re-
ported here the change in the gland consists primarily in a
definite and, at times, very marked increase in the interstitial
so-called adenomatous tissue, together with increased amounts of
lymphoid tissue and an associated hypoplasia of the primary al-
veolar or acinar epithelium. This interstitial tissue is not aggre-
gated into nodules, but is scattered diffusely throughout the
gland. This increase in interstitial tissue is not associated with
aveolar hyperplasia, as seen in the puberty hyperplastic gland
and exophthalmic goitre, but rather as stated with aveolar hypo-
plasia. It arises, doubtless, from the interstitial cells; produces
a picture finally to which I have given the name of “‘ Diffuse
Adenomatosis,’’? and which is capable of producing mild to mod-
erate states of chronic hyperthyroidism. It is my opinion that
this is a definite pathological-clinical entity, in fact a new type
of hyperthyroid syndrome depending upon a new conception of
pathological change in the thyroid.

The fact that this change is responsible for hyperthyroid-
ism to my mind is shown by the fact, that in the first place there

GOETSCH 401

is an associated syndrome produced which is more or less char-
acteristic of the hyperthyroid state; second, there is a failure to
improve under the ordinary medical and hygienic measures
which are directed to the treatment of similar nervous conditions ;
third, there is a positive reaction to the epinephrin chloride test ;
fourth, after resection of the thyroid there is a diminution if not
disappearance of this hypersensitiveness with a considerable im-
provement, in fact, almost a cure in some eases; and fifth, in the
gland there are found changes which are characteristic and very
different from the normal appearing gland, and very different -
also from the other well known pathological changes in the thy-
roid. Should one feel that these cases are not hyperthyroid
there still remain to be explained the rather typical symptom-
atology, the positive epinephrin chloride test, the improvement
after operation, and the very characteristic changes in the gland
upon microscopic examination.

In conclusion, I wish to state that I do not hold that the
epinephrin chloride test is pathognomonic of hyperthyroid
states. I would say, however, that a negative test excludes hy-
perthyroidism, that in all except a few very severe cases of hyper-
thyroidism the test is positive and that there are some few con-
ditions which give a more or less typical reaction and which are
to be remembered as exceptions. The latter I think can be fairly
well recognized after a careful history and physical examina-
tion. At any rate I feel that the test is practically always con-
firmatory, in many cases diagnostic, in others suggestive of the
diagnosis, and leads to further and more careful search for
causes in the small percentage of exceptions to the test. Again,
there is a remarkable parallelism between the hypersensitiveness
to epinephrin and the degree of hyperthyroidism present. The
test is rather easily applied and one can follow the well known
variations in the degree of hyperthyroidism present from time to
time, and one can regulate the treatment accordingly. I am con-
vinced that when intelligently applied it is of the greatest help
in diagnosis, in treatment, and in prognosis, and furthermore, it
has led directly to a clearer understanding of an obscure group
of cases which, I believe, are dependent for their symptomatology
upon a very definite pathological change in the thyroid gland,
which has heretofore escaped notice. This change is capable of
producing hyperthyroidism, and is different from the well

402 DIFFUSE THYROID ADENOMATOSIS

known pathological histology heretofore described. The condi-
tion might well be ealled ‘‘ Diffuse Adenomatosis’’ of the thyroid
gland.

BIBLIOGRAPHY

Goetsch, E.: Functional significance of mitochondria in toxic thyroid
adenomata. Bull. Johns Hopkins Hosp. (Balt.), 1916, 27, 129-
132

Cannon, W. B. and Cattell, McK.: Studies on the conditions of ac-
tivity in endocrine glands. II. The secretory innervation of
the thyroid gland. Am. J. Physiol. (Balt.), 1916, 41, 58-73.

Levy, R. L.: Studies on the conditions of activity in endocrine glands.
IV. The effect of thyroid secretion on the pressor action of adre-
nin. Ibid., 1916, 41, 492-511.

Woodbury, M. S.: A comparison of methods for determining thyro-
toxicosis. J. Am. M. Ass. (Chicago), 1920, 74, 997-999.

HYPOPITUITARISM
A Case Report
Henry H. Lissner, M. D.

The following case came under observation shortly before
the War. Although its interest as bearing upon endocrine
physiology and pathology was obvious, it was not possible on
account of other imperative duties to devote the time to its study
which it otherwise would have received. It is regretted, espe-
cially, that data for a detailed report on the cytological fea-
tures of the pineal and other endocrine organs were not secured.

Family History. F. B. who was 23 months old, September,
1915, was the youngest of four children, one boy of 16 years
and twin girls of seven. There is no family history of glandular
trouble or diabetes.

Personal History. The patient’s weight at birth was 814
lbs.; labor was normal; he nursed up to the eleventh month, at
which time he was placed on Mellin’s food, barley water, and
malted milk. He was apparently normal up to the ninth month,
laughed, played, noticed what was going on about him and seemed
to have a happy disposition. From this time on, it was notieed
that he was gaining very rapidly and a photograph at this
period shows an early tendency to deposition of fat and the
early expression and phases of his condition.

At this time, also, he had his first convulsion and, for a
time, at every urination he would close his eyes and fall forward
in a convulsive seizure. These convulsions, occurring sometimes
as often as seven a day, continued up to the age of fifteen months,
when they became more severe in character but still remained of
the flexor type. The number of convulsions for sixty-four days
from the 15th to the 17th month of his life was 3.6-+- spells a day.

Examination. The child has neither walked nor talked and
because of his undeveloped condition, we cannot say whether or
not certain symptoms which require some mentality for their
determination, were present, such as headache, photophobia, and
nystagmus. Because of the very thick layer of fat and small
size of the blood vessels, the systolic pressure was difficult to

403

404 HY POITUITARISM

determine. It was found to be about 80. The diastolic pressure
was not obtained.

Eyes. Examination of the eyes by Dr. F. K. Miller showed
pupils normal and no apparent oculomotor paralysis. The eye-
ground showed edema of the retina.

Photograph of subject at the age of 23 months.

Throat. Examination of the throat by Dr. C. H. Mont-
gvomery showed: ‘‘Tonsils and adenoid present; no bulging of
the naso-pharynx; no epistaxis, no cerebro-spinal rhinorrhea.’’

General Condition. He has, fairly constantly, a pro-
nounced facial cyanosis. Pressure in the anterior fontanelle
causes a drawing up of the hands and thighs and an expression
of pain and protest, rolling of the eyes, and it would seem that
if continued it would bring on a convulsion. There have been

LISSNER 405

from the onset marked muscular weaknesses and inability to
sit up. He makes no effort to help when picked up and falls
limply to either side, due no doubt to a muscular dystrophy.

His appearance is very striking: his hair is coarse, light
in color, and grows very rapidly; his fingers are puffed and
tapering. His head is enormous, breasts are prominent, and
there are rolls of fat which make decided creases about the neck,
arms, legs and abdomen.

The external genital organs are diminutive. His weight at
15 months was 3734 lbs.; at 2 yrs., 4134 lbs.; at 3 yrs., 81 lbs.;
practically doubling his weight in his third year. His measure-
ments May 18, 1917 were as follows:

Circumference of head........................ 5514 em. >
Pronto and submental....................... 59 ~=em.
Chest under the breast...................... 8814 em.
Abdomen at the umbilicus.................. 96—" "em:
ehish, at, the: gluteal fold. ..-.....2-.... 5314 em.
Calero mmles ters 6s). Ae 30 em.
Iie ei ee 2714 em.
TSCEVEI EE Go Doel aS Sine tas, ©) tee rite 100s em.

The sugar tolerance test was done. He was given 60 gms.
of levulose at 9:00 A. M. The urine secretion of the first hour
was dec. and the test for levulose, negative. The second hour it
was 13 ec. and the test was negative. The third hour secretion
was 10ce. with a slight reaction indicating levulose in the urine
but following this, there was total suppression up to 11:00 P. M.
of the same day, when the kidney function gradually returned.

The convulsions continued very severe up to July, 1917,
when he had two spells of explosive vomiting, following which
the convulsions ceased. On the same day, he began to run fever
between 99 and 101 degrees. His fever continued for one week,
during which time it gradually increased up to 103 degrees. He
was given small doses of aconite by his mother to reduce the
fever and on the 19th, 20th, and 21st of July he was fever free.
The fever started again, however, between 102 and 103 degrees,
and on the 25th of July, he began groaning and gradually went
into coma. The fever increased from 103 to 104 degrees until
on the 30th day of July, when he died at 8:00 P. M. with an
ante-mortem temperature of 10714 degrees.

406 HYPOITUITARISM

Treatment: The treatment, as outlined, was two grains of
pituitary extract three times a day. This was gradually in-
creased until he was taking twenty two-grain tablets daily with-
out any apparent benefit. There was no change in the mental de-
velopment, muscular strength nor genitals. Because of the sud-
den increase in weight he was given 1/10 gr. thyroid extract
three times daily. It seemed, however, to increase the number
and severity of convulsions so that on the third day it was dis-
continued.

Autopsy and report on sections by Dr. Herman Zeiler follow.

Inspection: Body of child which has the appearance of being
about seven years of age. Body in rigor mortis, and showed post-mor-
tem discolorations, in the dependent portions. Genitals small; entire
body appears puffed, but the pitting is not that of a true edema. Abdo-
men distended; neck very short; mammae well developed.

Palpation: Fontanelles closed.

Skull: Opening the skull the bones are hard and appear thick-
ened. There is marked edema of the piaarachnoid; dura thickened.

The base shows a small sella with the anterior and posterior cli-
noid processes under-developed. No separation of sutures at the base.
Middle ears are clear; ethmoidal and sphenoidal sinuses are clear.

Pituitary body present and under-developed. Incision of chest and
abdomen shows fat of the chest about 2 inches thick, very pale; the
layer of abdominal fat being somewhat thicker. No evidence of edema.

The pectoral muscles are thin and undeveloped; the abdominal
recti very thin; sterno-cleido-mastoid muscles are thin and_ under-
developed as are also the muscles of the legs.

Lungs show hypostatic congestion and a few epipleural hemor-
rhages. :

Heart muscle pale; heart fatty and small; on the right side it
shows thin musculation with fair musculature on left side. Valves
competent. Thymus almost absent.

Abdomen: Shows pale, fatty omentum and very fat mesentary.
The fat in the region of the round ligament, very abundant, being %4
of an inch in diameter.

Spleen is soft and enlarged.

Liver normal in size and pale.

Intestinal tract normal except for retrocaecal appendix.

Pancreas appears enlarged almost to the size of an adult’s.

Tissues Examined Histologically—Thyroid: Shows the usual
glandular structure of the thyroid, lined by low columnar epithelium
and no excess of fibrous tissue. The blood vessels are fairly numerous.
There is no cyst formation of any of the glands and but few show
colloid substance.

Testicles: The convoluted tubules are diminished in number and
separated by abundant loose connective tissue. The cells lining the
convoluted tubules are pale-staining and the nucleoli are well marked.
No mitotic figures discovered.

Pancreas: Appears normal.

Spleen: Histologically is practically normal.

LISSNER 407

Kidneys: No increase in fibrous tissue. The cells lining a few
of the convoluted tubules and collecting tubules show hyaline necrosis
and an occasional tubule shows eipthelial casts.

Hypophysis: The line of demarcation between anterior and pos-
terior lobes seems lost. Histologically, numerous thin walled blood
vessels form a plexus surrounding strands of polyhedral cells arranged
in three or four rows. These cells are of the usual two types found in
this gland and intermingle without definite arrangement or regularity,
the “chief” cells being far more numerous. Here and there are a few
follicles lined by low columnar epithelium. There is an abundance
of loose connective tissue.

SUMMARY

A child of 23 months was normal to the 9th month, when he
began gaining rapidly in weight. The onset of symptoms was
convulsions of the flexor type continuing up to within the month
of his death. The family history showed no glandular trouble
or diabetes. The eyes showed edema of the retina; the throat was
negative. There was marked muscular dystrophy with profound
facial cyanosis, diminutive external genitals, doubling of weight
in the third year of life, low sugar tolerance and ante-mortem
temperature of 10714 degrees. Treatment consisted of pituitary
extract—whole gland—from 2 to 40 grains daily without any
benefit. Thyroid extract seemed to irritate. X-ray plates of the
skull showed a small sella turcica at the age of 23 months. An
autopsy report and the histological report on various glands are
included.

THE EFFECTS OF INANITION UPON THE ADRENAL
BODIES—PRELIMINARY COMMUNICATION

Swale Vincent and M. 8. Hollenberg

(From the Physiological Laboratory, University of Manitoba, Winnipeg, Canada)

It must be admitted that it is still impossible to give a defin-
ite answer to the question, ‘‘ What is the function, or what are

the functions, of the adrenal bodies ?’’

Several important facts have been made out and some the-
ories have been put forward. The facts are:

I. A definite chemical substance of known composition and
possessing well marked pharmacodynamieal activities can be
extracted from the chromaphil tissues.

II. This substance, adrenin, can be obtained from adrenal
medulla as well as from chromaphil tissues in other situations.

Ill. There is considerable evidence that adrenin is actually
poured out into the circulation.

IV. The true adrenal body or cortex is related in some way
to the development and growth of the sex organs.

The chief theories of modern times in regard to the fune-
tions of the glands apply only to the chromaphil tissue. It has
been supposed that adrenin is continuously poured out and ex-
ercises a tonic influence upon the sympathetically imnervated
organs and tissues and so, for example, helps in maintaining the
normal blood pressure. This theory has. been generally aban-
doned. A more recent view is that the secretion of adrenin is
of service only in certain physiological emergencies. The latter
suggestion is certainly a more plausible one than the former,
though it cannot be said to be firmly established.

The conception has been formulated that the thyroid and
adrenal bodies form part of a mechanism for the chemical heat
regulation of the body, and that the cortical adrenal and the
chromaphil tissue both take part in this functional activity.
This theory involves the conception of a widely reaching influ-
ence of the adrenal bodies, taken as a whole, upon the metabol-
ism of the organism.

408

VINCENT AND HOLLENBERG 409

Recently MeCarrison (1) has made the important discov-
ery that in pigeons inanition gives rise to a remarkable enlarge-
ment of the adrenals. He remarks that, ‘‘This enlargement ap-
pears to be a true hypertrophy, since it is associated with a cor-
responding increase in the glands’ content of the medullary se-
eretion, adrenalin.’’ It would appear from this quotation that
MeCarrison regards the cortex and medulla as constituting one
gland whose whole function is the secretion of adrenin.

We have repeated MeCarrison’s experiments upon pigeons,
and have also carried out similar experiments upon rats and
dogs. We are able to confirm fully his observation that after a
period of inanition there is always a distinct hypertrophy of the
adrenal bodies. In pigeons the adrenal bodies are doubled in
weight after inanition for 15 days. In dogs after a somewhat
longer period of inanition the adrenal bodies are almost double
the normal weight. In rats the hypertrophy is considerably
greater than in pigeons and dogs, even when inanition is car-
ried out for a shorter period.

We reach, then, the remarkable conclusion that, while the
majority of organs and tissues in the body atrophy in starvation,
the brain and heart remain unaltered and the adrenal bodies
hypertrophy to a considerable degree. We have noted that the
abdominal chromaphil body (2) in the dog is markedly increased
in dimensions after 14 days’ inanition, but the chrome reaction
was less intense than in the normal dog. This indicates that, in
future investigations, a differentiation will have to be made be-
tween hypertrophy of the chromaphil tissue and an increase of
its adrenin content.

The question naturally arises, ‘‘ Have we here to dea] with a
hypertrophy of the cortex, or of the medulla, or of both?’’ This
point we do not pretend to have settled. McCarrison, as seen
above, found the adrenin content increased in his starvation pig-
eons, though in a later communication (3) he notes a diminution
of adrenin content in scorbutic guinea-pigs. It is not clear
whether McCarrison regards these differing results as due to
varying degrees of starvation, or whether he regards the scor-
butie influence as something qualitatively different from the in-
anition influence. Our own results with inanition animals have
not been quite consistent. In some cases the amount of chroma-
phil tissue and the amount of adrenin have been distinctly in-

410 INANITION AND ADRENALS

creased as a result of inanition. In other cases (and these, con-
trary to expectation, were those of the longer periods of starva-
tion), the opposite effect has been produced, namely, a reduc-
tion in the amount of chromaphil tissue, or in the intensity of its
chrome reaction, and a reduction of the adrenin content as
shown by the physiological test.

We consider these observations of MeCarrison to be of the
ereatest importance since they demonstrate clearly a relation
between the adrenal bodies and the general metabolism of the
animal organism. Since other lines of work have so far taught us
so little of the uses of the adrenal bodies, we are tempted to urge
a vigorous pursuit of investigations bearing upon their metabolic
functions.

BIBLIOGRAPHY
1. McCarrison, R.: The pathogenesis of deficiency disease. Indian
J. Med. Research (Calcutta), 1919, 6, 275-355.
2. Vincent, S: The chromaphil tissues and the adrenal medulla.
Proc. Roy. Soc., London, 1910, 82, B, 502.
3. McCarrison, R.: The influence of a scorbutiec diet on the adrenal
glands. Indian J. Med. Research (Calcutta), 1919, 7, 188-194.

THE ROLE OF THE ENDOCRINE GLANDS IN CERTAIN
MENSTRUAL DISORDERS

WITH SPECIAL REFERENCE TO PRIMARY DYSMENORRHOEA AND
FUNCTIONAL UTERINE BLEEDING*

Emil Novak, Baltimore, Md.

(From the Gynecological Department of Johns Hopkins University)

Speaking generally, the importance of the hormone asso-
ciations of an organ or of a body function varies with the de-
gree of its automaticity. The highly volitional functions, such
as the skeletal muscular movements, are under the control of the
rapidly acting nerve mechanism, while the auxiliary influence of
the endocrine apparatus is relatively shght. With the more
primitive vegetative functions the reverse is true, for here the
mechanism is usually essentially of the endocrine type, with a
greater or less degree of contributory regulating influence on
the part of the sympathetic nervous system.

Menstruation is a function which may certainly be classed
as vegetative, and hence it is not surprising that tne explanation
of its mechanism is to be sought chiefly in a study of the fune-
tions of certain endocrine glands, and that the cause of menstrual
disorders is not infrequently to be found in disorders of these
structures. That there is, even in the case of menstruation, some
association with the higher centers, is shown by the occasional
occurrence of menstrual aberrations under the influence of pro-
found psychic disturbanees—the amenorrhea which is often seen
in women who dread pregnancy, or in those with an intense
longing for it; the occurrence of either amenorrhea or excessive
menstruation as a result of sudden shock or fright, ete.

For nearly a hundred years, the ovary has been looked upon
as essential to menstruation, but no attempt was made to explain
the manner in which its influence is exerted, until the formula-
tion of the well-known theory of Pflueger, in 1865. According
to the latter, menstruation was explained as the result of a pel-
vie hyperemia induced reflexly by the pressure of a erowing

*Read before the Association for the Study of Internal Secretions, New
Orleans, April 26, 1920.

411

412 ENDOCRINE GLANDS-MENSTRUAL DISORDERS

Graafian follicle on the ovarian nerve terminations. This the-
ory was quite universally accepted until it was disproved by the
experimental work of Knauer, Marshall and others. These in-
vestigators showed that removal of the ovaries, thereby severing
all their nerve connections, does not cause cessation of menstrua-
tion, provided that the ovaries be transplanted elsewhere into the
body. In other words, the ovarian influence is exerted through
the blood-stream and not through the nerves, 1. e., 1t is of endo-
erine nature.

The next step was to determine which of the constituents
of the ovary is responsible for the menstrual function. Is it the
stroma, the follicles, or the corpus luteum? Without going into
detail, suffice it to say that the weight of evidence 1s overwhelm-
ingly in favor of the view that it is the corpus luteum which
plays the most important role in this connection. It seems almost
as certain, however, that the ovary produces more than one hor-
mone. Maranon, for example, believes that the ovarian hormones
may be divided into three groups: One, the genital, has to do
with the menstrual cycle; a second, the sexual, with the morpho-
logical sex characteristics and a third, the general, assists in all
the body functions.

The internal secretion of the ovary is closely interrelated
with that of other endocrine glands, especially the thyroid, pitui-
tary and suprarenal bodies. These relations are not easily de-
fined in the present state of our knowledge, but their existence
is demonstrated by the frequent influence exerted on menstrua-
tion by disease of any of them. Many interesting examples of
these relationships suggest themselves for discussion—the role
played by the ovaries in the development of the secondary sex
characters; the effects of castration at various ages; the rare oc-
currence of female eunuchoidism ; the relation between menstrua-
tion and ovulation, and between menstruation and lactation; the
influence on menstruation of the thyroid, pituitary and supra-
renal bodies, ete. For the purpose of this brief paper, however,
it has seemed more profitable to limit myself to the discussion of
two or three of the less obvious relations of the endocrine struc-
tures to disorders of menstruation.

First of all, I may pass with mere mention that form of
amenorrhea now generally recognized as being due to hypopitui-
tarism, and which, clinically, is commonly associated with obesity.

NOVAK 413

Frohlich’s report, in 1901, of the first case of adiposo-genital dys-
trophy, gave rise to much experimental work, which yielded re-
sults long since incorporated into clinical practice. Much has
been written concerning the amenorrhea which is found in con-
nection with hypopituitarism, and I shall not elaborate on the
subject here.

The two menstrual disorders to which I wish to call especial
attention, as regards their probable endocrine etiology, are (1)
primary or spasmodic dysmenorrhea and (2) uterine hemor-
rhage of the type commonly spoken of as ‘‘idiopathic’’ or ‘‘fune-
tional.’’

Primary Dysmenorrhea. At first thought there would seem
to be little connection between primary dysmenorrhea and the
endocrine system, and yet I believe that an important relation of
‘his sort does exist. By primary dysmenorrhea we mean that
form of menstrual pain which occurs in the entire absence of
discoverable disease in the pelvis. It is observed with great fre-
queney in young nulliparous women, either single or married,
and, in the aggregate, is the cause of a vast amount of suffering.
The factors which have been considered instrumental in the
causation of this form of dysmenorrhea may be summarized as
follows.

1. Mechanical obstructions of the uterine canal. For many
years after the publication of the work of Mackintosh in 1832, the
view was held that spasmodic dysmenorrhea is always due to
mechanical obstruction to the exit of menstrual blood from the
uterus. Most commonly, it was assumed, the obstruction is due
to anteflexion of the uterus. According to this view, the colicky
pain so characteristic of the condition is due to spasmodic con-
tractile efforts on the part of the uterine muscle. This concep-
tion is still quite prevalent among medical men, although the
evidence is clearly against its correctness. For example, primary
dysmenorrhea often occurs in the entire absence of anteflexion
or of other obstructive lesions, and, on the other hand, it is not
uncommon to find even very sharp anteflexions in women who
suffer no dysmenorrhea whatsoever.

2. Neurotic factor. Aside from the actual hysterical cases,
the importance of this factor lies in the fact that it increases the
susceptibility to pain, and thus causes a magnification into actual

414 ENDOCRINE GLANDS-MENSTRUAL DISORDERS

pain of the menstrual discomfort normally experienced by many
women.

3. Hypoplasia of the uterus. There is little doubt that by
far the most important factor in the etiology of spasmodic dys-
menorrhea is defective development of the uterus. It is extreme-
ly common to find a greater or less degree of genital hypoplasia
in women whose development otherwise is quite normal. These
cases of uterine hypoplasia may be classified under three heads,
according to the degree of hypoplasia. (a) In the fetal type,
the arrested development occurs at a very early stage, so that the
uterus resembles that of the fetus. The special characteristics
are the small size of the uterus and the fact that it is made up
almost entirely of cervix, the corpus uteri being exceedingly
rudimentary. (b) In the infantile type, the uterus resembles
that normally found in infants and young children. Here again
the cervix predominates over the corpus, although the latter is
not as rudimentary as in the fetal type. The uterus as a whole
is larger and there is often an associated anteflexion, most
commonly of the cervico-corporeal variety. (¢) In the subpu-
bescent type, the hypoplasia is relatively slight. Here, also,
there is not infrequently an associated anteflexion. For a fuller
discussion of these varieties of uterine hypoplasia and of their
clinical significance, I would refer to a previous paper which I
have published on the subject.

The pertinence of the question of uterine hypoplasia in con-
nection with the present discussion rests on two factors: first,
that an extremely frequent symptom of uterine hypoplasia,
though not by any means a constant one, is primary or spasmodic
dysmenorrhea ; secondly, that the underlying cause of the various
grades of uterine hypoplasia is undoubtedly of endocrine nature.
In searching for a cause for the hypoplasia, we at once make
contact with the endocrine apparatus in the body. Which of the
endocrine glands is responsible for the defective development of
the uterus noted in these eases? In the first place, does the ovary
exert any important influence on the development of the uterus
before the age of puberty, that is, during the fetal and infantile
periods of life? Certainly no such influence can be assigned to
the corpora lutea, for the latter do not appear before the age of
puberty. The possibility suggests itself that some other element
of the ovary may possess this function, but the evidence is not

NOVAK 415

convincing. Mayer believes that the growth of the uterus in very
early life follows the general laws of body growth, and that it is
not especially influenced by the ovaries. He believes, for exam-
ple, that in the exceedingly rare congenital anomaly of absence
of both ovaries, the uterus may still be present. With unilateral
absence of the ovary, the uterus is usually quite normal, as I ob-
served in a recent case. This observation is, however, of no par-
ticular significance when we consider that the ovarian influence
is blood-borne, and would, of course, exert its effect equally upon
the Miillerian ducts of both sides. Mayer attempted to attack
this problem with greater directness by performing castration of
the animal fetus in utero. The operation was performed trans-
peritoneally, but, unfortunately, terminated fatally as the result
of infection. While, therefore, the predominant influence of the
ovary during menstrual life is universally admitted, there is no
convineing evidence that it is equally important before this
period.

_ There is much reason to believe that the earlier growth of
the uterus is under the influence of other endocrine glands, espe-
cially, perhaps, the hypophysis. This seems all the more probable
in view of the undeniable role played by the pituitary in the
production of acquired sexual hypoplasia. For this there is
abundant evidence, both experimental and clinical. It would be
rash for those of us whose work is chiefly clinical to offer an ex-
planation of the exact mechanism involved in these cases. The
point which I wish to emphasize is merely that this type of men-
strual disorder may, with reasonable certainty, be classified as
an endocrinopathic manifestation.

Functional Uterine Bleeding. Another gynecological com-
plaint the endocrine origin of which permits of very little doubt
is the so-called functional uterine hemorrhage. This symptom
is of very frequent occurrence, especially at the two extremes of
menstrual life, puberty and the menopause. It may, however,
oceur at any age. In these cases the most careful examination
may show perfectly normal pelvic organs, and yet bleeding may
be persistent and perhaps very profuse. Most commonly it takes
the form of menorrhagia rather than metrorrhagia. Cases of
this type usually come to curettage sooner or later, and indeed,
in the case of climacteric hemorrhage, the indication for this pro-
cedure is urgent, owing to the importance of excluding carci-

416 ENDOCRINE GLANDS-MENSTRUAL DISORDERS

noma. In the non-malignant climacteric cases, and in those of
puberty, the pathological report on the curettings has usually
been some such designation as ‘‘normal endometrium,’’ ‘*‘hyper-
trophic glandular endometritis,’’ ‘‘chronie endometritis,’’ ete.
It has seemed difficult to incriminate the endometrium as the
cause of bleeding of this type. Equally unsatisfactory have been
the efforts to explain this form of bleeding by such factors as
artesiosclerosis of the uterus, the ‘‘insufficientia uteri’’ of Theil-
haber, ete. The point which I should lke to emphasize is that
the endometrium in a very large proportion of these cases—I am
not as yet prepared to put it in percentage figures—conforms to
the type described by Cullen as hyperplasia of the endometrium.

The histological picture presented by this condition is ex-
tremely characteristic. As the term indicates, there is a genuine
hyperplasia of the uterine mucosa, with an increase of both the
epithelial and stromal elements. Owing to the epithelial pro-
liferation, many of the glands become much enlarged and of eys-
tic appearance. The disparity in the glands is perhaps the most
conspicuous feature of this condition apparent on casual exam-
ination, so that as a rule the diagnosis may be made almost at a
glance. That the cystic condition of the glands is not due to mere
retention of the contents is suggested by the fact that the epi-
thelium, instead of being flattened out, is commonly quite intact.
Not infrequently the epithelial cells are seen to be several layers
thick. The stroma is also markedly increased, and occasionally
mitoses are noted. Grossly, the endometrium in these cases is
almost always much thickened, sometimes enormously so. In the
extreme cases curettage will often bring away large masses of
fungoid tissue, which lead to a strong suspicion that a malignant
condition exists. In other cases the thickening is relatively slight.

An endometrium of the type above deseribed is never ob-
served except in association with the symptom of uterine bleed-
ing. The reverse is, of course, not true, for uterine hemorrhage
may be due to many anatomic causes. With most of the ordinary
pelvie lesions the endometrium is perfectly normal. It is of in-
terest, however, to note that with certain pelvic conditions, espe-
cially myoma and adenomyoma, the endometrium may exhibit
the condition of hyperplasia, as above described. There is some
evidence to indicate that both myoma and adenomyoma are due to
some as yet unknown aberration of ovarian function and, as we

NOVAK 417

shall see, there is little doubt that the same factor is responsible
for hyperplasia of the endometrium.

The finding, in a case of uterine bleeding, of such a definite
structural alteration as hyperplasia of the endometrium, would
seem at once to take a case out of the category of functional hem-
orrhage. There is good reason to believe, however, that this char-
acteristic change in the endometrium does not represent a pri-
mary lesion, but that it is secondary to a disturbed function of
the ovary. Under normal conditions the endometrium is cer-
tainly subordinate to the influence of the ovary. The ever chang-
ing histological appearance of the uterine mucosa at different
phases of the menstrual cyele is undoubtedly called forth by cor-
responding cyclical changes occurring in the ovary, and especial-
ly in the corpus luteum. So that there is nothing revolutionary
in the idea that the characteristic picture of hyperplasia may be
associated with some definite endocrine disturbance of the ovary.
Hyperplasia, generally speaking, is observed only during
the reproductive life of the woman, that is, during the period of
Ovarian activity. This fact in itself would suggest some influ-
ence on the part of the ovary. Furthermore, curettage, in cases
of hyperplasia, is most frequently unsuccessful in the relef of
the accompanying hemorrhage, the latter symptom recurring in
a large proportion of cases. Were the hyperplasia a local lesion
in the endometrium, its removal should be followed by cure. That
this is not the case would seem to indicate that the underlying
cause, an endocrine disorder of some sort, still remains operative.
Although repeated curettage frequently does not cure these cases,
radium or the X-ray usually brings about a cessation of the ab-
normal menstruation, apparently by its destructive action on the
follicles of the ovary.

As a matter of fact, there is no little evidence that almost
all eases of uterine hemorrhage, with the exception of those due
to such destructive lesions as cancer, are functional in the sense
that the bleeding is due, in part at least, to disturbances of the
ovarian secretion, as a result of the pelvic disease, whether this
be myoma, pyosalpinx or some other condition. In other words,
the simple congestion caused by-these lesions is not in itself suf-
ficient to explain the menstrual excess which is often present, and
which is probably due to hyperfunction of the ovary. I shall not
review the evidence along this line, but it is so impressive that no

418 ENDOCRINE GLANDS-MENSTRUAL DISORDERS

intelligent gynecologist can afford to overlook the importance of
the pathological physiology of the ovary in the consideration of
possible causes of uterine bleeding.

Efforts have been made to ascertain whether the ovarian dis-
order is associated with any characteristic histological changes in
the ovary. The most recent, and also the most valuable, work
along this line is by Schroeder. According to this author, the
secretory stage normally exhibited by the endometrium just be-
fore menstruation is absent altogether in cases of hyperplasia.
In the latter, he concludes from his own studies, there is an ab-
sence of active corpora lutea in the-ovaries. The hyperplastic
endometrium, he believes, represents only a persistence of the
proliferative stage which, in turn, is due to the persistence of the
maturing Graafian follicles upon which this stage is normally de-
pendent. The work of Schroeder is extremely suggestive but
needs further confirmation before it can be accepted. Certainly
the absence of the corpora lutea is not, as he says, a constant ob-
servation, for a well-marked corpus luteum, in the stage of late
vascularization, was found in the ovary of one of my recent cases
of hyperplasia.

As to the nature of the endocrinopathy present in these
cases, We cannot as yet speak with much definiteness. In view of
the excessive menstruation characterizing cases of this type, the
natural assumption would seem to be that we are dealing with a
hypersecretion of the ovary, or, at any rate, with that element of
the ovary concerned with the production of normal menstruation.
Since most of us are inclined to assign this role to the corpus
luteum, it is not easy to explain the absence of corpora lutea
which Schroeder believes to be the characteristic finding in the
ovaries of these cases.

Hypersecretion of the ovaries (hyper-odphorism, female hy-
pergonadism) is a condition concerning which we know far less
than we know about female hypogonadism. From what has been
said, however, the evidence would seem reasonably complete that
hyperplasia of the endometrium is the result of hypersecretion
of the ovaries. I know of no other clinical condition concerning
which this statement may be made with as much justification.

In this brief paper I have merely touched upon a few of the
less obvious relationships which exist between the endocrine ap-
paratus and the mechanism of menstruation. There is, perhaps,

NOVAK 419

no field in which the study of endocrinology is of such funda-
mental importance as in that of gynecology. The truth of this
statement I trust will be apparent from the foregoing discussion
of the etiology of three important menstrual disorders—one of the
most common forms of amenorrhea, perhaps the most important
type of dysmenorrhea encountered by the gynecologist, and a
form of uterine hemorrhage the study of which had previously
given rise to many theories, all inadequate.

BIBLIOGRAPHY

Cullen, T. S.: Cancer of the uterus. New York, 1900, p. 479.
Address in gynecology, Can. Med. Assn. J. (Toronto), 1913,
3, 658-671.

Frohlich, A.: Ein Fall von Tumor der Hypophysis Cerebri ohne Akg
megalie. Wien. klin. Rundschau, 1901, 15, 883; 906.

Knauer, E.: Die Ovarientransplantation. Experimentelle Studie.
Arch. f. Gynak. (Berl.), 1900, 70, 322-376, 2 Tab.

Mackintosh, John: Elements of pathology, and practice of physic.
2nd ed. 2 v, 14, 554 pp.; 17, 467 pp. 8° London, 1831.

Maranon, G.: La Edad Critica, Madrid, 1919. (Abst. in Internat.
Abst. of Surgery, March, 1920).

Marshall, F. H. A.: The comparative physiology of menstruation and
the allied processes. Internat. Clin. (Phila.), 1907, 17 S., 2,
190-197.

Mayer, August: Uber den Einflusz des Eierstocks auf das Wachstum
des Uterus in der Foétalzeit und in der Kindheit und tber die Be-
deutung des Lebensalters zur Zeit der Kastration. Ztschr. f. Ge-
burtsh. u. Gynak. (Stuttgart), 1915, 77, 279-300.

Schréder, R.: Anatomische Studien zur normalen und pathologischen
Physiologie des Menstruationszyklus. Arch. f. Gynak. (Berl.),
1915, 104, 27-102.

Novak, E.: Infantilism and other hypoplastic conditions of the uterus.
J. Am. M. Assn. (Chgo.), 1918, 71, 1101-1107.

EFFECT OF SUBCUTANEOUS INJECTIONS OF THYMUS
SUBSTANCE IN YOUNG RABBITS

Ardrey W. Downs and Nathan B. Eddy
(From the Physiological Laboratory, McGill University, Montreal, Canada)

In a previous paper one of us (N. B. E.) reported the effect
on full-grown rabbits of subcutaneous injections of desiccated
thymus substance (Armour & Company). The doses adminis-
tered were 10 mgm. and 20 mgm. per kilogram of body weight
dissolved in a mixture of one part of glycerine to four parts of
physiological saline solution. For control, other rabbits were in-
jected with the glycerine-saline mixture. Each rabbit received
forty injections during a period of eight weeks. At the conelu-
sion of the experiment, half of the rabbits were autopsied. Both
control and thymus rabbits gained in weight, the former 18.31
per cent, the latter 17.85 per cent. There was no apparent differ-
ence in the behavior of the two groups of animals. At autopsy
the thyroid glands of the thymus rabbits averaged slightly
heavier, 8.57 per cent, than those of the controls. There were no
differences in the other organs.

Before this paper appeared, Olkon reported a series of ex-
periments in which he had injected desiccated thymus gland
(Armour & Company) suspended in physiological saline solution
intraperitoneally into young guinea-pigs. He found that the
injections produced marked loss of weight, muscular spasms ‘and
convulsions. As a control he injected into other guinea-pigs
desiccated muscle protein. These injections caused similar re-
sults but in degree much less marked. He coneluded, therefore,
that the effect in the first case was a specific toxie action of the
thymus substance. However, the doses of thymus substance
which he employed were not based on body weight. He does not
state the dose of desiccated muscle protein used.

Because of this difference in results, we have performed
further experiments in which subcutaneous injections of desie-
cated thymus substance were administered to young rabbits.
Twenty-four animals were used, comprising seven litters of three
to five animals each. The rabbits of a litter were kept together
and separate from all the others. One or two animals of a litter

420

DOWNS AND EDDY 421

served as controls; the others were given the thymus injections.
The first four litters (14 rabbits) were six to seven weeks old at
the beginning of the experiments; the others were nine to ten
weeks old at the beginning. Details of the grouping of the rab-
bits by litters, their age, sex, ete., are given in Table 1. All were
in good condition and apparently normal. The rabbits were fed
and cared for under our personal supervision and the diet and
environment were as uniform for all as it was possible to obtain.

TABLE I
Age at
Number Litter beginning
weeks Sex Genitalia
f A 6 Female Control Normal
ii A 6 Female Thymus Normal
i A 6 Female Thymus Normal
| 4 B 6 Female Control Normal
| 5 B 6 Male Thymus Normal
| 6 B 6 Male Thymus Normal
’ | as Cc 7 Female Control Litter during 20th week ;
Group I pregnant at autopsy
Ss Cc 7 Female Thymus Pregnant at autopsy
| 9 (ed Tf Male Thymus Normal i
110 D Gf Female Control Normal
141 D 7 Male - Control Normal
112 D 7 Female Thymus Infantile
113 D 7 Male Thymus Normal
{14 D w Iremale Thymus Litter during 20th week
fas E ¢ Male Control One testicle
116 3 DF 9 Male Thymus Normal (separate from
| others of litter from
| 10; 9 10th week on)
[17 r 9 Female Thymus Pregnant at autopsy
Group II J 18 Ir 9 Male Control Normal
719 Male Thymus Normal
| 20 Fr 9 Female Thymus Normal
mel G 10 Male Control Normal
[22 G 10 Male Control Normal
| 23 G 10 Male ‘Thymus Normal
[24 G 10 Male Thymus Normal

As in our previous experiments we used for the injections
powdered desiccated thymus gland (Armour & Company) one
gram of which is said to represent approximately five grams of
fresh thymus gland of the calf. .This preparation is but indiffer-
ently soluble in water, so that we have found it better to mix
the dry powder first with glycerine and then to dilute with
physiological saline solution. By this means a satisfactory sus-
pension for hypodermic administration can be obtained. We
used one part of glycerine to four parts of saline solution and
the final preparation contained twenty milligrams of thymus
substance per cubic centimeter. A mixture of one part of gly-
cerine to four parts of saline solution was made for the control
injections. The materials were warmed to 37°C. and injected
ander aseptic precautions. No infection occurred in any of the
rabbits, but with the larger doses considerable induration was

422 THYMUS INJECTIONS IN RABBITS

produced at the site of injection. The injections were given
twice a week.

Lz 4+ 10 Id I+ 18 Week
Percentage increase in growth of all rabbits
—— Control rabbits =“ Thymus rabbits

The initial dose for each thymus rabbit was two milligrams
per one hundred grams of body weight. The dose was increased
each week by one milligram per hundred grams to a maximum
dose of ten milligrams per one hundred grams of body weight.
This dose was continued to the end of the experiments. Each

DOWNS AND EDDY 423

control rabbit at the same time and under the same conditions
received an injection of the glycerine-saline mixture proportion-

CHART 2

12 {8 20Weexs

Percentage increase in growth of rabbits in group I
a=—_e Control rabbits .... Thymus rabbits

ately equal in bulk.” The injections were continued for twenty
weeks, that is, until even the younger rabbits were apparently
matured. One control and one thymus rabbit died during the
course of the experiments. In both cases death occurred more
than twenty-four hours after the last injection.

424 THYMUS INJECTIONS IN RABBITS

Each rabbit was weighed prior to injection. Growth and
development progressed steadily in all. The average rate of

CHART 3

18 2OWeexs

Percentage increase in growth of rabbits in group II
—— Control rabbits ~.-.Thymus rabbits

growth is shown in Charts 1,2 and 3. For the first ten weeks the
average percentage increase of weight in the thymus rabbits is
slightly greater than in the controls; but during the seeond ten
weeks the gain in weight is considerably greater in the controls.

DOWNS AND EDDY 425

At the end, the controls have gained 262.41 per cent, while the
thymus rabbits have gained 215.38 per cent. When the animals
are grouped according to age, as indicated in Table 1, and the
average gain for each age group computed, a more striking differ-
ence is observed. From the eighth week on the control rabbits
of Group I, the younger group, gained much more rapidly than
the thymus rabbits until, at the end of the experiment, the form-
er have gained 414.57 per cent as compared with 308.66 per cent
for the latter. On the other hand, the older thymus rabbits,
Group II, maintained to the end the slightly greater percentage
gain shown by all the thymus rabbits in the early weeks. The
younger rabbits presumably had more active thymus glands. It
is possible that the thymus injections added to this higher de-
gree of activity of the rabbit’s own thymus may have been just
sufficient to affect the weight as described.

TABLE 2
Control Rabbits
Weight of Weight of Weight of
Weight teduced thyroid in thymus in spleen in
when body weight mgm.per kilo. mgm. per kilo. mgm. per kilo.

Number killed R. B. W. of R. B. W. of R. B. W. Oo: RB=Ws
i! 3.105 2.950 9.1. 2383.0
7 3.055 2.613 63.9 540.7
10 3.260 3.078 61.0 1330.4
11 3.355D 3.208 78.8 1049.8
1" 1.63 1.485 121.8 1587.8
18 2.200 2.012 95.9 1427.4
pat 2.140 2.049 95.1 562.7
22 2.210 2.132 110.6 1386.0
Averages .....2.619 2.440 79.5 1283.4

None of our rabbits developed muscular spasms or convul-
sions. Their behavior was normal so far as we could detect.

At the end of the twenty weeks the rabbits were killed and
autopsies performed. The method employed was practically that
of Livingston and as described in our previous report. The
weight of the animal minus urine and contents of the gastro-
intestinal tract, i. e., reduced body weight, was determined. The
thyroid and thymus glands and spleen were removed from each
rabbit and weighed. The sexual apparatus was examined macro-
scopically. The reduced body weight and the weight of each of
the glands removed, in milligrams per kilogram of reduced body
weight, are given for the control rabbits in Table 2 and for the
thymus rabbits in Table 3: A comparison of the figures shows
that in the thymus rabbits the thyroid glands average 25.78 per
cent heavier, the thymus glands 28.18 per cent lighter, and the

426 THYMUS INJECTIONS IN RABBITS

spleens 23.84 per cent heavier than in the control rabbits. A
closer analysis reveals that the difference in the thyroids is con-
fined to the younger group of rabbits. The average weight of
the thyroids in the control rabbits of this group is 53.2 mgm.
per kilogram of reduced body weight; the average weight of the
thyroids in the thymus rabbits of the same group is 102.4 mgm.
per kilogram of reduced body weight, a difference of 92.48 per
cent. In the group of older rabbits, the thyroids-in the controls
averaged 105.8 mgm. and in the thymus rabbits, 96.8 mgm. per
kilogram of reduced body weight, a slight difference in the oppo-
site direction. We find the weight of the thymus reduced about
equally in both groups. There is considerably more difference in
the weight of the spleens of control and thymus rabbits in the

TABLE 3
Thymus Rabbits

Weight of Weight of Weight of
Weight Reduced thyroid in thymus in spleen in
when body weight mgm.per kilo. mgm. per kilo. mgm. per kilo.

Number killed R. B. W. of R. B. W. of R. B. W. of R. B. W.
3 2.575 2.597 99.2 236.1 878.1
D 2.360 2.154 109.0 1295.2 295.2
6 Deyo 2.391 148.4 1082.3 506.0
8 2.475 2222) 100.3 Ia S7ATe 546.8
9 2.640 2.429 109.5 916.0 518.3
2 1.815 1.678 85.2 101.9 758.6
13 2.340 2.184 90.2 904.3 787.5
14 2.515 2.241 77.6 1599.7 708.1
16 1.990 1.905 75.0 570.6 640.4
U7 1.685 1.579 155.1 1067.1 17321
19 2.175 2.032 78.7 i la Vek 499.5
20 2.310 2.102 66.1 973.8 5)
23 2.185 2.017 94.1 842.3 vy
24 2-315 2.200 112.2 966.8 3)
Averages Rea) 2.109 100.0 921.7 att

younger than in the older group. In the former, the spleens of
the thymus rabbits were 34.22 per cent heavier than those of the
controls and in the latter, 19.57 per cent.

The most striking feature of these results is the increased
weight of the thyroid glands of the thymus rabbits of the younger
group. Burget has shown that high protein diets produce thy-
roid hyperplasia. It is possible that protein would have the same
effect when injected hypodermically. The thymus preparation
employed in these experiments obviously contained a large
amount of protein. Therefore, we cannot say positively that the
increased size of the thyroids is not due to protein. However,
if the causative factor were protein, the change should have been
just as marked in one group as in the other, since both received
proportionately the same amounts of the preparation and, there-

DOWNS AND EDDY 427

fore, of protein. As we have pointed out, the difference was lim-
ited entirely to the group of younger animals.

The inereased weight of the thyroids occurring in the same
group of rabbits which showed the relative loss of body weight
may be indicative of direct action of some active principle of the
thymus. As already mentioned, its greater influence in the
younger animals might be because the thymus glands of these
younger rabbits were normally at a more active stage when the
injections started.

The total weight of the thyroid gland in rabbit number 1 A,
a female control, was only 27 mgm., 9.1 mgm. per kilogram of re-
duced body weight. The thymus gland in the same rabbit was
larger than in any of the other rabbits. It weighed 7.030 grams
or 2383 mgm. per kilogram of reduced body weight. This find-
ing does not support the idea that hyperplasia of the thymus
causes increase in the thyroid. The large thymus might of course
have been compensatory to a deficient thyroid.

With two exceptions, the sex glands of all the rabbits ap-
peared normal. There was only one testicle visible in number
15 E, a control, and at autopsy no sign of another could be found.
The internal sexual apparatus of number 12 D, a female of the
thymus group, was infantile in type. The thymus gland of this
rabbit was extremely small. It weighed 101.9 mgm. per kilo-
gram of reduced body weight, only a twelfth of the average
weight of the thymus glands of the control rabbits. This defect
of the sexual apparatus was congenital since the organs were not
even at the stage of development to be expected in a rabbit of
seven weeks, the age of this animal at the beginning of the ex-
periments. While our thymus injections cannot be said to have
caused the retarded development neither do they appear to have
caused any improvement.

Eleven female rabbits were used in these experiments, of
which six could have become pregnant, and four did become
pregnant. Of the other two, one was a thymus rabbit, the other
a control. One thymus and one control rabbit each gave birth
to a normal litter during the twentieth week of the experiment.
The other pregnancies were noted at autopsy (see Table 1).
There is no evidence that the thymus injections exerted any 1n-
fluence upon the sex glands of these rabbits.

428 THYMUS INJECTIONS IN RABBITS

CONCLUSIONS

1. Subcutaneous injections of large doses of desiccated thy-
mus substance, while checking the putting on of weight in young
rabbits, did not otherwise impair growth or development.

2. <A considerable increase in the weight of the thyroid
eland and spleen and a decrease in the weight of the thymus were
produced in young rabbits by subcutaneous thymus injections.

The expenses of this research were defrayed in part by a grant from the
James Cooper Fund for Medical Research.

BIBLIOGRAPHY

Burget, G. E.: An attempt to produce experimental thyroid hyper-
plasia. Am. J. Physiol. (Balt.), 1917, 44, 492.

Eddy, N. B.: The role of the thymus in exophtholmic goitre. Can.
M. Assn. J. (Toronto), 1919, 9, 203-212.

Livingston, A. E.: Effect of castration on the weight of the pituitary
and other glands of. internal secretion in the rabbit. Am. J.
Physiol. (Balt.), 1916, 40, 161.

Olkon, D. M.: The effect of thymus gland injection on the growth
and behavior of the guinea-pig. Arch. Int. Med. (Chgo.), 1918,
2252815:

BOOK REVIEWS 429

PRACTICAL ORGANOTHERAPY. The Internal Secretions
in General Practice. By Dr. Henry R. Harrower, Glendale,
Cal. The Harrower Laboratory, 1920, 268 p.

This is an ambitious little book written by an optimistic
endocrinologist who attempts to crowd into 268 pages a resume
of all the present knowledge on endocrinology and organother-
apy. He succeeds in presenting his views on the subject in
a readable and interesting manner, but with no great success
as to scientific accuracy. The book contains statements which
have not as yet been accepted, advancing claims which some
experimenters and clinicians would be slow to accept.

All in all, this book must be considered in the light of a
commercial publication and accepted in the same class as, for
example, Merek’s Index. Considering it from that viewpoint,
the general practitioner will find many helpful hints on an
interesting and timely subject:—M. B. G.

QUATRE LECONS SUR LES SECRETIONS INTERNES. By
Prof. Eugene Gley, Paris. Paris, 1920, Bailhére et fis, 154 p.

Professor Gley is competent, as few are, to indicate the
course of development of endocrine science and to discuss
the philosophie aspects of the subject. In a series of four lee-
tures delivered before the ‘‘Sociedad de Biologia’’ of Barcelona
in 1917, an engaging presentation of the matter was made,
and the lectures are now fortunately available in book form.
The topies covered were: the evolution and present status of
the endocrine question; the physiological conditions necessary
to internal secretion; new orientation of researches upon hor-
mones and hormazones and, finally, the essential results of the
study of the internal secretions—a revolution in biology.

The first chapter is a critique on the general doctrine of
the internal secretions, centering about the work of Claude
Bernard. As to the present status of endocrinology, Gley
reminds us again that the doctrine has not acquired precision
and stability pari passu with the rich accumulation of new
facts. The field is encumbered with incomplete experiments,
adventurous hypotheses, vain theories and even errors. Ex-
perimental observations are often applied without reflection
and, indeed, without logie—both of which, one may add, are
eminently required.

In the second chapter are defined the precise conditions
that must be met before an endocrine function ean be postu-
lated. Sundry new ‘‘Hormones’’ have been introduced which

430 BOOK REVIEWS

we might have been mereifully spared had their sponsors com-
prehended these principles. To any who are sanguine of find-
ing ‘‘hormone x’’ or y or z, this chapter is especially com-
mended.

The third chapter comprises a critical discussion of meth-
odology and the fourth, a formulation of a conception of the
significance of endocrinology in the field of general biology.

In the present stage of development of our subject, all
sorts of attempts at exposition of its underlying philosophy
are perhaps to be expected. It is fortunate when, as in this
case, the expositor is a master in the field, who has gone both
deep and wide.—R. G. H.

ABSTRACTS

ACHONDROPLASIA, Effect of—on menstruation. Miller (J.
L.), West Va. M. J. (Huntington), 1920, 14, 366-367.

The article gives a brief resume of the leading character-
istics of achondroplasia, and a report of two cases that have
been under observation for twenty years, particularly in regard
to their menstrual life.

The characteristics common to both patients were: both
had mothers under the normal female stature, but normal in
every other way; both were members of large families, their
brothers and sisters being normal, except in one case they
were slightly under normal adult stature. No history of other
dwarfs in either family, and no evidence or history of thyroid
trouble in either patient or any member of their respective
families was elicited.

One patient, aged 26 years, height 4 feet 2 inches, weight
126 pounds, physical development typically achondroplastie,
intellect excellent, began menstruating at the age of two weeks,
the lochia having the gross appearance of an adult female,
and has continued at twenty-eight day intervals until Decem-
ber, 1918, when she went into the menopause with the charac-
teristic nervous and physical phenomena of this condition in
the normal female. Pubic hair appeared at age of five or six
years and breasts and facial appearance became that of the
mature adult.

Case two: the subject was twenty-five years old, 3 feet 11
inches in height, and 125 pounds in weight; all features were
very typical of achondroplasia, especially the marked bowing
of the femurs and bones of both legs. The intellect was nor-
mal. Pubie hair and development of the breasts appeared
about the 12th to 15th years, but no indication of the menstrual
flow appeared until the twenty-first year, though for several
months preceding the appearance of the flow there was a gen-
eral malaise for a few days at four to six weeks’ intervals.
Corpus luteum and thyroid extract were tried at different
times in the second case, but with no apparent result.

The conclusions are that the menstrual phenomena in these
eases, and probably the physical development as well, were

431

432 ABSTRACTS

due to some severe disorder of the endoerin system, and that
probably in the first case certain hormones which normally
stimulate growth and development of the sexual functions were
present to an excessive degree, and in the second case insuffi-
cient or nearly suppressed.—Author’s Abst.

ADIPOSIS DOLOROSA (Zur Kenntnis der Adipositas do-
lorosa). Grafe (E.), Miinchen. med. Wehnsechr. 1920, 67,
339-341.

The author describes a case in a woman of 21. The disease
began at the same time as the beginning of menstruation, with
psychical alterations, and gradually increasing adiposity. The
blood sugar was normal. The thyroid could not be palpated.
The symptoms are not those of Dercum’s disease, for in Der-
cum’s disease pain is not spontaneous, but the tumors are pain-
ful only upon pressure; such condition did not obtain in this
ease. There was a certain degree of periodicity in the symp-
toms. The patient showed an enormous retention of water.
Oophorin, hypophysis and thyroidin had a good influence, as
well on the retention of water as on metabolism, but were not
able to cure the disease.—J. K.

ADIPOSITY, Cerebral versus lacteal—. Reuben (M. S.),
Arch. Pediat. (N. Y..), 1919, 36, 636.

To prove that every fat baby has not a tumor of the pitui-
tary, the author reports a case of a girl, 10 months of age, who
gave the following dimensions: circumference of head, 1714
inches ; chest, 24284 inches; length, 291% inches; mid-thigh, 1534
inches; mid-leg, 101% inches. The anterior fontanel was closed.
She did not show any symptoms of dyspituitarism; there was
no hyperglycemia, no reaction to pituitary extract. The Was-
sermann was negative. The eye grounds were normal. An
analysis of the mother’s milk showed 6 to 7 percent fat, which
the author felt accounts for the adiposity. He also reported
another case of a child who weighed 7 pounds at 7 months and
35 pounds at one year of age. When last seen at the age of 6
years, She had not shown any signs of hypopituitarism.

—M. B. G.

(ADRENALS) Addisonian symptom complex. (Addisonscher
Symptomenkomplex.) Wien. klin. Wehnschr. (Vienna),
1918.31, 799.

A elassieal ease. No new data.—F. S. H.

ABSTRACTS 433

(ADRENALS) The time relations of the blocd pressure
changes after excision of the adrenal glands, with some ob-
servations on blood volume changes. Bazett (H. C.), J.
Physiol. (Lond.), 1920, 53, 320-339.

The experiments described consist of some controls made
at the commencement of an investigation of the relation of
the adrenals to vascular tone. Animals may survive one to
three days after excision of the adrenals, but low blood pres-
sure is found some time previous to death. The time of devel-
opment of these changes has not been earefully investigated.

Most of the work was done on eats; a few experiments
were also made on rabbits. The rate of the fall of blood pres-
sure was measured in animals in which the glands were re-
moved under ether and which were then allowed to recover;
in animals under continuous urethane anesthesia, and in ani-
mals previously decerebrated. It was found that excision of
the adrenals in the cat is not followed immediately by a fall
of blood pressure, but the changes develop more rapidly in
decerebrate animals than in those under urethane anesthesia.
They are least rapid in ether anesthesia followed by recovery
from the ether. Urethane anesthesia may be used in eats for
experiments lasting twenty-five hours or longer. The pressure
falls 10 to 20 per cent lower than in ether or decerebration,
and after eight hours of anesthesia may fall still further. De-
cerebrate preparations may be used for blood pressure experi-
ments lasting several days, if care is used. Excision of the
adrenals in a urethanized cat causes a fall in blood pressure
in two or three hours, and death results in about ten and one-
half hours. In the decerebrate cat excision of the adrenals is
followed by a fall of pressure in one hour, and death in six
hours. In ether anesthesia it is eighteen hours before the fall
reaches 30 to 40 per cent. With excision of the adrenals there
is an immediate slight dilution of the blood, but later as the
pressure falls there is little further dilution. After adrenal
excision under urethane, the various types of response to sciatic
stimulation could not be obtained with any degree of con-
stancy.—T. C. B.

ADRENAL insufficiency, Anatomical clinical study of two
cases of—(Etude anatomo-clinique de deux cas d’insuffisance
surrénale). Betchov (N.) and Demole (V.), Rev. méd. de la
Suisse Rom. (Geneva), 1918, 38, 379-386.

A detailed description of two cases of adrenal insufficiency
presenting nothing new but substantiating the idea that ‘‘Ser-

434 ABSTRACTS

vent’s line’’ is clinical evidence of a lessened adrenal efficiency.
B.S Ee

(ADRENALS) Addison’s disease (Maladie bronzee d’Addi-
son). Boinet, Marseilles med., 1918, 55, 176-181.

A elinieal report and autopsy findings of two cases of Ad-
disonian coma following extreme fatigue. In three non-fatal
cases adrenal opotherapy was successful in ameliorating the
distress.—F’. 8. H.

(ADRENALS) A case of Addison’s disease. Cabot (R. C.),
Case Records Mass. Gen. Hosp. (Bost.), 6, 920, No, 18, part 1.

The case of a carpenter aged sixty-four years is presented.
The patient’s family history is negative and his health had
been unusually good. At twenty-four he had measles ; at thirty-
two typhoid fever without sequelae, except constipation. For
ten years he had hemorrhoids with a little bleeding. He had
occasional headaches. Before the typhoid fever he weighed
230 pounds, his best weight. His usual weight has been 190,
and he thinks he has lost about fifty pounds in the past two
yeuls.

The patient’s bowels have been irregular and constipated,
especially for the past three or four years. Three years ago
for a period of two weeks he was nauseated, and regurgitated
all food in a few minutes after it had been taken. He was in
bed on a diet. He recovered and again ate the same kind of
food as the rest of the family, but less of it. He went back to
his work. One year later he had a similar but much less severe
attack lasting for a week. For five months he missed one or
two days’ work in a month, and then two months ago he gave
up work entirely on account of general weakness. Since then,
also, he has been unable to retain anything but a quart of milk
a day, malted milk, spinach, and an occasional cracker. There
has been no pain.

Examination revealed that there was no expansion of the
left lung during respiration and the x-ray plate gave the
appearance of an old tuberculous infection involving both
lunes and the left pleura. Pulse, 92 to 129, was of poor volume
and tension. Blood pressure: systolic 110, diastohe 80. Urine
and stools negative. Blood: hemoglogin 70%, leucocytes
12,880 with 57% polynuelears, slight anisocytosis ; Wassermann
reaction negative.

The patient died on the third day after admission and
autopsy revealed: tuberculosis of the adrenals by which they

ABSTRACTS «485

were transformed into fibrocalcarous masses; arteriosclerosis
and dilatation of the heart; chronic pleuritis; absolute tuber-
culosis of the bronchial lymph nodes, and cholelithiasis.—J. F.

(ADRENAL) The pathology of experimental rabies. I. The
kidneys, adrenals, liver and spleen. Cornwall (J. W.), In-.
dian J. Med. Research (Caleutta), 1919, 7, 148-159; Abst.,
Chem. Abst., 1920, 14, 2204.

Hyperglycemia is a late phenomenon in fixed-virus rabies.
It is sometimes followed by glycosuria. There is little change
in the glycogen content of the liver. The urine becomes acid
(rabbits) and globulins are excreted with but little albumin.
The specific gravity of the urine falls markedly on the 5th
day and the percentage of chlorides at first increases and then
decreases. The weight of the adrenal gland increases by one-
third and autolytic changes occur, chiefly in the medullary
cells. Kymographie studies show a diminution in the pressor
effects of adrenal gland extracts during the 48 hours following
sub-dural inoculation. This is followed by recovery and then
toward the end of the disease there is a second diminution in
the quantity of pressor substances. Chemical tests show a
diminution of adrenaline in the adrenal glands of rabbits sue-
cumbing to fixed-virus rabies and also of guinea-pigs dying
from intramuscular inoculation with street virus. It is con-
cluded that growth of the rabies organism in the central
nervous system causes irritative stimuli to pass along the
splanchnic nerves to the adrenals and liver and gives rise to the
discharge into the blood stream of an excess of sugar. Some-
times an excessive secretion of adrenaline occurs. Much dam-
age is caused to the kidneys and adrenals by toxie agents in
the blood derived from the growth of the rabies organism in
the central nervous system.—R. G. H.

(ADRENAL) The pharmacc-dynamics of quinine. II. Some
effects of quinine on the adrenals, kidneys, and spleen of
healthy rabbits. Cornwall (J. W.), Indian J. Med. Research
(Caleutta), 1919, 7, 160-166.

Quinine administered intravenously and intramuscularly
to rabbits over a period of 9 months causes damage to the
cellular elements of the adrenals and kidneys and increases
the rate of disintegration of the red blood corpuseles in the
spleen.—Chem. Abst., 14, 2218.

(ADRENALS) Direct transmission of Addison’s disease
(Transmission directe de la enfermedad de Addison). Es-

436 ABSTRACTS

pina, Real Acad. Nae. de Medicina (Madrid), 1919, ——,
(Mech. 15).

Espina gives-a clinical description of two boys with Ad-
dison’s disease whose father had died of the same disorder.
The opinion is expressed that these cases arose through direct
transmission from the father to the sons.—E. B.

(ADRENALS) Some observations on the functions of the
suprarenal glands, in white rats. Exner (H. V.), Dublin J.
Med. Sce., 1920, 4, 79-89.

Investigation by means of asphyxiation experiments, per-
formed on white rats, showed, that despite the presence of
the adrenals, a fall of blood pressure was noted, similar to that
in animals from which the adrenals were removed. This inves-
tigator concludes, therefore, that the adrenals normally play
no part in the rise of blood pressure, despite the fact that an
injection of adrenal extract produces this phenomenon. He
also found that when the central end of the vagus was stimu-
lated in those animals from which the adrenals were extir-
pated, sugar was found in the urime. He concludes that “the
glycogenie function of the suprarenals is dependent on, or
works in conjunction with, some nervous control, which func-
tionates, at least in part, even in the absence of these organs.”’

J. et:

(ADRENALS) Symptoms produced by the plexus solaris in
tuberculosis of the lungs (La sindrome solare negli ammalati
di tuberculosi polmonare). Gallotti (A.). I] Morgagni
(Milano and Napoli), 1920, 62, 81-96.

The author observed in two eases of tuberculosis of the
lungs symptoms resembling tabetie crises or lead cole. No
changes in the abdomen could be detected, even at autopsy.
The ‘‘ligne blanche surrénale’’ of Sergent was present, and
there was low blood pressure. Defective functioning of the
plexus solaris is probably the cause of these symptoms. This
point the author discusses in some detail. Cases have been
deseribed in which the plexus was compressed by tuberculous
tissue: but even without these gross changes the affinity of the
sympathicus for the toxins of the tubercle-bacillus is well
known. The primary affection here is probably insufficiency
of the sympathicus, the secondary, insufficiency of the adrenals.

|e

ABSTRACTS 437

(ADRENALS) The significance of the chromaffin system (Die
Bedeutung des chromaffinen Systems). Hart (C.), Ztschr. f.
arztliche Fortbildung (Jena), 1920, 17, 221-225.

An interesting general discussion without new facts. The
author beheves that Addison’s disease is caused by a patho-
logical process in the adrenals in patients with a hypoplastic
constitution. As Graves’ disease is also f)und in persons with
this constitution the (very rare) combination of Graves’ and
Addison’s diseases may perhaps be explained on the same basis.

—J. K.

(ADRENAL) A case of uterine epithelioma presenting the
typical characteristics of cortical suprarenaloma (Un cas d’
epithéliome utérin preseutant les caractéres typiques du cor-
tico-surrénalome). Hartmann (H.) & Peyron (A.), Gynee.
et Obst. Rev. Mens. (Paris), 1920, 1, 1-19.

The review of the literature reveals 11 reported cases of
tumors of suprarenal type occurring in the internal genital
organs of women. The paper is a report of a case operated
upon by the authors. It was found that the broad hgaments
were free and the tumor was intrauterine. Nine plates are
shown of the histological findings compared with normal ma-

terial —F’. S. H. ;

ADRENAL insufficiency in the infections (Insufficiencia supre-
renal en las infecciones). Maranén (G.), Acad. med.-quir.,
1919, ——, ——, (Mch. 18).

In all infectious diseases there are frequently accidents of
the nature of collapses which have been heretofore attributed
to alterations of the myocardium, the question of suprarenal
insufficiency should be considered. Both types occur. These
glands possess two functions, the one an antitoxic, protective
function accomplished by the internal secretion of cholesterol
of corticak origin, and the other the tonic effect of adrenalin of
medullary origin. When this latter is diminished or lacking,
collapse is produced. These accidents can be either chronic or
acute; the first recall cases of Addison’s syndrome; the second
are rapid syneopes with hypothermia and asthenia resembling
shock. They are very frequent in diphtheria and typhoid;
sometimes they are observed in exanthematous typhus. Au-
-topsy often shows small suprarenals with little adrenaline and
cholesterol. During the life of the patient these constituents
are seen to diminish in the blood. From these facts it follows
that adrenaline should be administered in the form of extracts

438 ABSTRACTS

of the whole gland in those infections in which collapse is
feared.—E. B.

(ADRENAL) Nicotine apnea. Ozorio de Almeida (A.), J. de
physiol. et path. gén. (Par.), 1920, 18, 744-752.

When nicotine is injected intravenously into anesthetized
dogs, a prolonged arrest of respiration is produced which can
properly be called nicotine apnea. It is not due to the sharp
rise in blood pressure following the injection since double
vagus section does not inhibit the apneie effect. Neither stimu-
lation of the central end of the eut vagus, nor ablation of the
adrenals prevented the appearance of the characteristic re-
response.—F.. 8S. H., Chem. Abst., 14, 2219.

ADRENALS, Chloroform narcosis and the— (Chloranarcozi e
funzioni surrenale). Pitini (A.), Gazetta degli Ospedali
(Milano), 1920, 41, 415.

After narcosis with chloroform the content of adrenalin in
the adrenal glands is diminished. Perhaps the high blood pres-
sure in the beginning of narcosis and the low pressure during
the rest of this period may be explained in this way, that first
the chromaffine system is stimulated and produces more adre-
nalin. This would be followed by an exhaustion of the chro-
maffine system. [This idea was proposed by Elliott years ago. |
The suggestion is again offered that injections of adrenalin
are of use in narcosis.—J. K.

(ADRENAL) A case of hypernephroma in the renal hilus.
Stenstrém (N.), Hygiea (Stockholm), 1919, 81, 843-851.

The tumor, which occurred in a woman of 46 years, was
the size of a Mandarin orange. It was histologically benign.

—J. A. H.

(ADRENALS) Further observations on the relation of the
adrenals to certain experimental hyperglycemias (ether and
asphyxia). Stewart (G. N.) & Rogoff (J. M.), Am. J.
Physiol. (Balt.), 1920, 51, 366-377.

The paper is an answer to recent crities, especially Kella-
way, with some new experiments to show that epinephrin out-
put is not essentially concerned in the hyperglycemia induced
by ether narcosis and by asphyxia.—T. C. B.

ABSTRACLS 439

ADRENAL bleeding in the new-born (Ueber Nebennierentblut-
ungen bei Neugeborenen). Toepffer (H.), Arch. f. Gynaek.
(Berlin), 1920, 112, 342-356.

A elinieal and post-mortem description of an infant dying
three days after birth with some evidence of adrenal involve-
ment. The histological picture of the adrenals seems to Justify
the conelusion that the condition is the result of a primary,
early occurring fatal thrombosis of the suprarenal vein, which
in turn has caused chronic fibrous induration and local paren-
chymal necrosis. There had taken place extravasation of blood
into the necrotic area. As a consequence of the act of birth
arterial congestion apparently had occurred, resulting in a still
further escape of blood into the tissues.—F. S. H.

(ADRENAL) The action of adrenin and of various extracts of
glandular organs on veins. Tugane (S. H.), Sei-I-Kwai M. J.
(Tokyo), 1919, 38, 51.

Cow’s method, with but slight alterations, was employed
for registering the contractions of the veins which were ob-
tained from freshly killed pigs, dogs and cats. The author
observed that ring preparations of veins, when treated with
adrenin, contract with reduction in volume just as do arteries,
which indicates, in his opinion, that they are probably sup-
plied with sympathetic venoconstrictor fibers. He found, on
the other hand, that treatment with saline extracts of lymph
gland, spleen, kidney, liver and muscles brings about a dilation
of the ring preparations, indicating perhaps the existence of
venodilator fibers. No histological evidence is presented.

—E. V. C.

ADRENAL syndrome, Contribution to the study of— (Con-
tribution al estudio de los sindromas suprarrenales). Vene-
gas (F.), La Clin. Castellana. 1919, ——-, ——.

E. B.

General review.

ADRENIN, The intravenous injection of—in the treatment of
hemorrhage (A propos des injections intraveineuses d’adré-
naline dans le traitement des hémorragies). [ardier (E.),
Compt. rend. Soe. de biol. (Paris), 1920, 83, 91-94.

A continuation of studies already reported (see Endoerin.
4,105). Two experiments on exsanguinated dogs showed that
in spite of the loss of blood and the serious symptoms result-
ing, the intravenous injection of adrenalin causes hyperten-

440 ABSTRACTS

sion, acceleration and augmentation of the heart beat, and re-
sumption of respiration. The action is of short duration—three
to four minutes—but ean be reproduced by successive injec-
tions.

Two observations on human subjects are also reported:
one was a man of sixty with a severe crushing of the lower
extremities and loss of blood, the other a woman, exsangui-
nated by rupture of a fallopian tube. Both eases responded
to the adrenalin, but only the woman recovered. She lived
eight days, and then died of pneumonia. The proceeding
seems indicated as an extreme emergency measure, and may
keep the heart going while preparations are made for trans-
fusion.—T. C. B.

ADRENALIN, The effect of the subcutaneous injection of—on
the heat production, blood pressure and pulse rate in man.
Boothby (W. M.) & Sandiford (Irene), Abst., Proceedings
Am. Physiol. Soc., Am. J. Physiol. (Balt.), 1920, 51, 200-201 ;
in full, Ibid, 407-421.

The results are reported of forty-six experiments on
eroups of patients showing variations in the activity of the
thyroid, pituitary or adrenals, as well as a small group of nor-
mal controls. Adrenalin causes an increase in heat production,
increase in the respiratory quotient, ventilation rate, respira-
tion rate, heart beat per minute, volume of each beat, peri-
pheral vascular dilatation and systole and diastole pressures.
Not all come into play in any one case, but some combination.
There is no relationship between the character of the adrenalin
reaction and the degree of activity of the thyroid, and there-
fore the reaction is not indicative of the presence or absence
of hyperthyroidism. The metabolic rate curve is similar to
that of carbohydrate plethora and suggests the possibility that
the increased heat production may be due to an excess of ear-
bohydrate metabolites. There may also be direct chemical
stimulation of cellular combustion.—T. C. B.

ADRENALIN treatment of rachitis (La adrenalina en la trata-
miento del raquitismo). Corominas (F.), Arch. Espan. de
Pediat. (Madrid), 1919, 3, 215-224.

The author reviews the current theories with respect to
the etiology of rachitis and insists that every case is accom-
panied by an endoerine dysfunetion, which paves the way for
the alimentary toxemias, ete. The parathyroids, thymus and
suprarenals are the glands which play the major role in this

ABSTRACTS 441

process by reason of their influence on the calcium metabolism.
Corominas has used several extracts of endocrine glands as
therapeutic agents and considers that adrenaline produces the
best results, since it acts directly and at the same time whips
up the endocrine system as a whole. It is preferably admin-
istered by the gastric route two to three drops daily of the one
to a thousand solution.—E. B.

ADRENALIN, The excretion of—according to recent studies,
particularly of G. N. Stewart and his students (De 1’excré-
tion de l’adrénaline d’aprés les travaux récentes, particulier-
ment cieux de G. N. Stewart et de ses éléves). Heitz (J.),
Arch. de. mal du coeur (Paris), 1918, 11, 215-218.

iA review. \..S. EH.

Concerning ADRENIN. I. The alterations of the vasopressor
action of adrenalin after its treatment with bacterial prod-
ucts (Zur Kenntniss des Adrenalins. I. Uber die Anderung
der blutdrucksteigeinden Wirkung des Adrenalins nach Be-
handlung desselben mit bakteriellen Produkten). v. Grier
(F.) & Hecht (A. F.); Biochem. Ztschr. (Berlin), 1920, 102,
i:

When adrenalin is kept in contact with diphtheria toxin
for a considerable period of time it loses its ability to cause an
increased blood pressure in dogs. The bacterial nucleo-proteins
have a still greater destructive action. This disturbing effect
cannot be attributed to the presence of free OH-ions. When
the toxin or the bouillon is boiled they are much less, if at all,
active in destroying the effectiveness of adrenalin.—F. 8. H.

Concerning ADRENIN. II. The alterations of the vasocon-
strictor action of adrenalin under the influence of different
hydrogenion concentrations and after its treatment with
bacterial products and proteins (Zur Kenntniss des Adrena-
lins. II. Wher die Anderung der gefassverengenden Wir-
kung des Adrenalins unter dem Einfluss verschiedener Was-
serstaffionenkonzentationen und nach Behandlung desselben
mit verschiedenen bakteriellen Produkten und Ejiweisskor-
pern). v. Groer (F.) & Matula (J.), Biochem. Ztschr. (Ber-
lin), 1920, 102, 12-38.

Under anerobie conditions alkali reacts on adrenalin to
cause an initial increase followed by a decrease of its vaso-
constrictor activity. This is accomplished through retarding
the oxidation of adrenalin, the optimum effect being obtained

442 ABSTRACTS

between PH==7.5 and PH=8.5. Contact with bacterial nucleo-
proteins has a similar effect even under anerobie conditions and
regardless of the reaction of the medium. This property of
the nucleoproteins is weakened by heating. Both nucleo-
proteins and other protein compounds retard the oxidation of
adrenalin through which an air-current is passed: this reaction
occurs regardless of the reaction of the medium and is lessened
if the proteins be heated. Many true proteins, and also tuber-
culin, cause an increase in the adrenalin activity after long con-
tact under anerobie and H atmospheric conditions; while they
exert an inhibitory action on the disturbing effect of OH-ions.
The adrenalin disturbing action of the diphtheria toxin 1s com-
plex and bound up with the nucleoprotein as well as with the
OH-ion activity.—F. 8S. H.

(ADRENIN) Bodily symptoms caused by emotion (Lichame-
lijke afroijkingen tengevolge van emotie). Kooy (F. H.),
Neder. Maandschr. Geneesk. (Leiden), 1920, 1, 29-44.

Cannon has reported that emotion (fear, rage) causes hy-
peractivity of the sympathicus and a hypersecretion of adrena-
lin. The author found in agitated patients with psychoses a
higher amount of blood sugar and a higher blood pressure
than normal. It is suggested that the changes in temperature
(hysterical fever) and in the function of the intestines during
emotion may perhaps be explained in the same way.—J. K.

ADRENIN, Action of Rontgen rays on—. Liidin (M.), Strah-
lentherapie, 1918, 8, 441; Zentralbl. f. Biochem., u. Biophys.,
Pel ALTiey

Previous observations of Richter and Gerhartz have indi-
cated that the action of adrenaline is impaired or inhibited
by Réntgen rays. L. was unable to confirm these observations.
By determining adrenaline according to the Magnus procedure
in the surviving intestine, L. found that no change in the
activity of adrenaline on account of the action of Rontgen rays
could be detected—Chem. Abst. 14, 1125.

(ADRENIN) The substance in the blood-serum resembling
adrenalin (Over de op adrenaline gelikjende stoffen in bloed-
serum). Rassers (J. R. F.), Nederl. Tijdschr. v Geneesk.
(Haarlem), 1920, 64, 785-791.

Of no immediate endocrine interest.—J. K.

ABSTRACTS “443

(ADRENIN) The practical value of curved needle injection in
the intercricothyroid region (La pratique usuelle de 1’ injec-
tion intercricothyroidienne par l’aiguille cousle). Rosenthal
(G.), Bull. gén. therap. (Paris), 1920, 171, 156-158.

Of technical interest, and mention of the use of adrenalin
by this method.—F. 8. H.

Effects of ADRENIN (Adrehalinwirkungen), Schlesinger
(H.), Deutsche med. Wehnschr. (Berlin), 1920, 46, 335.

A short note to the effect that injections of adrenalin in
the aged may cause stenocardia and a fall of blood pressure.
This may be explained by the fact that adrenin has an effect
on the vasoconstrictor as well as on the vasodilator mechan-

isn).

(ADRENIN) Vascular reaction to epinephrin in perfusates of
various H-ion concentrations. Snyder (C. D.) and Camp-
bell (W. A., Jr.), Proceedings Am. Physiol. Soc., Am. J.
Physiol. (Balt.), 1920, 51, 199-200.

Confirmatory evidence is given to show that the reversal
(dilator) effect of epinephrin may be due to H-ion concentra-
tion.—T. C. B.

(ADRENIN) Further observations on the relations of the cen-
tral nervous system to epinephrin secretion. Stewart (G. N.)
& Rogoff (J. M.), Abst. Proceedings Am. Physiol. Soc., Am.
Jour. Physiol. (Balt.), 1920, 51, 175-176; in full, Ibid, 484-
524.

Former experiments on the epinephrin output after tran-
section of the spinal cord at different levels in cats have been
confirmed and extended by a new series of experiments. After
section of the cervical cord the output of epinephrin was undi-
minished in several animals, while in others it was more or less
diminished. When the brain and bulb were eliminated there
was a full normal output. In survival experiments the output
was one-half to one-third the normal average. In acute experi-
ments with dorsal cord transections, the output was greatly
diminished or abolished. Strychnine caused a marked increase
in the output in both acute and survival cases. Further experi-
ments on cats with denervated hearts confirm their previous
conclusion that the reactions obtained do not constitute a dem-
onstration of epinephrin output with asphyxia and nerve stimu-
lation (as reported by Cannon and von Anrep), until it is

444 ABSTRACTS

shown that redistribution of the blood with normal output
cannot account for the reactions.—T. C. B.

(ADRENIN) Case of ptyalism during pregnancy treated with
adrenalin (Un cas de ptyalism gravidique traité par 1’adréna-
line). Trillat (P.), Bull. Soe. Obst. et Gyn. (Paris), 1919, 4,
85-87.

A primipara of 30 years complained of excessive salivation.
On examination it was found that the patient was secreting
from 900 to 1100 ce. of saliva daily. The daily oral adminis-
tration of 10 drops of adrenalin 1:1000 for 3 weeks resulted
in a gradual diminution of the output to normal.—F. 8. H.

ADRENALINE, The use of—in obstetrics (Empleo de la adre-
nalina en la obstetricia). Udaeta, Soe. Ginecol. Espanola,
1918, , —— (Feb. 6).

This paper presents the clinical case histories of two cases
of suprarenal insufficiency during pregnancy showing asthenia,
hypotension, lumbar-abdominal pains, vomiting and Sergent’s
line. The administration of thirty drops of adrenaline a day
generally resulted in relief of the symptoms and the satisfac-
tory completion of the pregnancy at term.—E. B.

ADRENIN, Treatment of gestation osteomalacia with— (Be-
handlung des Gestationsosteomalazie mit Adrenalin). Wag-
ner (G. A.), Wien. klin. Wehnsehr. (Vienna), 1920, 33, 324;
Deutsche med. Wehnschr. (Berl.), 1920, 46, 423.

Data reported elsewhere. See Endocrin., 4, 247.—J. K.

ADRENIN, Treatment of influenza with— (Grippebehandiung
mit Adrenalin). Wagner (G. A.), Wien. klin. Wehnschr.
(Vienna), 1920, 33, 324; Deutsche med. Wehnsehr. (Berl.;,
1920, 46, 423.

Data reported elsewhere. See Endoerin., 4, 247.—J. K.

ADRENIN, Abdominal complaints cured by— (Buikklachten
onderdrukt door adrenaline). van Waveren (A. G. W.),
Med. Tijdschr. v. Geneesk. (Haarlem), 1920, 64, (1), 1716-
TAIT.

From a patient with abdonimal pains the appendix was
removed. During the operation pericolitis was observed. The
operation had no influence on the pain, but it disappeared
when 25 milligrams a day of dried adrenal gland was given.

ABSTRACTS 445

The pain returned as soon as the administration of the adrenal
was discontinued.—J. K.

(AUTONOMIC N. SYST.) Constitutional kinesthopathy (I
cenestopatici constituzionali). Buscaino (V. M.), Riv. di
Patol. nerv. e ment. (Firenze), 1918, 23, 257-285.

The author during the war was struck by the unusual num-
ber of cases coming under his notice with such ominous diag-
noses as epilepsy, dementia precox, etc., who after a time
completely recovered. From the total number he was able to
differentiate a group of two hundred with sufficient similarity
as to permit their classification as ‘‘Constitutional cenesto-
pathies.’’ These are discussed in detail. Their general char-
acteristics were neuropsychopathic heredity, cranial and facial
asymmetry, abnormal kinesthesia, great irascibility and
marked irritability throughout the vegetative mechanisms.
They were predominantly sympathicotonic, as shown, for ex-
ample, by tachycardia and vasomotor instability. For numer-

ous other details those interested should consult the original.
==. -V-

CORPUS LUTEUM, The physiology of the—. Hermann (E.
T.), Minnesota Med. (St. Paul), 1918, 1, 181-185.

A general discussion containing no new data.—F. 8S. H.

CORPUS LUTEUM extract, The use of—hypodermically in
cases of repeated abortion without demonstrable cause. Hirst
(je) Am. J. Obst. CN: Y.); 1918: T7, 662-664.

A report of three patients with histories of repeated abor-
tion, two of whom were enabled to carry to term and deliver
infants by the empirical use of 1 ce. of corpus luteum extract
administered hypodermically once daily for periods of nine
weeks. The cases were discussed and the results favorably
commented upon.—F. 8. H.

(CORPUS LUTEUM) The question of ectopic decidua (Zur
Frage der ektopischen Deszidua). Lahm (W.), Arch. f.
Gynaek. (Berlin), 1920, 112, 427-435.

A description of the histological pictures of the decidua
of a case of ectopic pregnancy, in which it is shown that no
structural differences exist between this type and that found
in the uterine decidua of two months or over. Since the case
showed no histo-pathological structures L. is inclined to be-

446 ABSTRACTS

lieve that the phenomenon is attributable to an abnormality in
the locus of action of the corpus luteum secretion giving the
decidual reaction.—F. 8. H.

(CORPUS LUTEUM) The origin of the corpora lutea. West-
man (Ax.), Hygiea (Stockholm), 1919, 81, 865-879.

The author considers that the lutein cells originate from
the cells of the vascular epithehum.—J. A. H.

DIABETES, Experimental studies on—. Series 1. Production
and control of diabetes in the dog. Gross anatomic rela-
tions of the pancreas. 2. Effects of carbohydrate diets. Allen
(F. M.), J. Exper. M. (Balt.), 1920, 31, 363-380. Ibid, 381-402.

These studies were based upon a form of diabetes pro-
duced by the removal of the greater part of the pancreas of
animals, leaving a remnant about the duct secreting normally
into the duodenum.

Allen reports an extensive series of studies upon dogs
in which, by removal of the greater part of the pancreatic
tissue, a diabetes closely similar to the clinical human type is
produced. It was found that the injurious effects of excessive
carbohydrate diet are demonstrable in partially depancreatized
dogs, in the same manner as in human patients. With severe
diabetes there is raptd progress of emaciation and weakness
and early death. With milder diabetes, there is frequently a
transitional state following operation, when the fate depends
on the diet. If the tolerance is spared for a time, recovery
sometimes occurs to such extent that diabetes cannot be pro-
duced by any kind or quantity of feeding, but only by re-
moval of a small additional fragment of pancreatic tissue. The
proper degree of carbohydrate overfeeding is important in this
early period for producing the most useful type of diabetic
animals; namely, those having good digestion and general
health combined with a permanent lowering of assimilative
power, like the condition of human patients. In the early
stage, glucose is more powerful than starch in produeing dia-
betes, and animals which are progressing toward complete re-
covery on starch diet can be sent into hopeless diabetes by
admixture of glucose. The difference seems to be merely of
the rate of absorption, and indicates that a rapid flood of earbo-
hydrate is more injurious to the pancreatic function than a
slow absorption. Whenever permanent diabetes is present,
so that complete recovery is impossible, starch brings on glyco-
suria more slowly than sugar, but just as surely. The differ-
ence in time in different cases amounts to days, weeks, or

ABSTRACTS 447

months. The clinical lesson from such experiments is that even
if a patient becomes free from glycosuria on withdrawal of
sugar only, nevertheless other foods should also be limited. No
significant differences were observed between the assimilation
of different starches, or any extreme lowering of the carbo-
hydrate tolerance by proteins, such as alleged by certain writ-
ers in connection with the ‘‘oatmeal cure.’’ Repair of trau-
matic inflammation and hypertrophy of the pancreas remnant
have been mentioned incidentally as the basis of the early
tendency to recovery, and also hydropie degeneration of Lan-
gerhans islands as an accompaniment of the lowering of toler-
ance by excessive diet. These are believed to have their paral-
lels in human eases, and are to be described more fully here-
after —B. T.S.

DIABETES, Acidosis in relation to—. Anklesaria (B. N.)
Indian M. Gaz. (Calcutta), 1919, 54, 96-98.

A didaetie exposition of the author’s opinion that diabetes
is caused by a low type of latent toxemia affecting the internal
secretion of the pancreas.

DIABETES mellitus and war diet in Vienna (Diabetes mellitus
and Kriegskost in Wien). Elias (H.) and Singer (R.),
Deutsche med. Wehnsehr. (Berlin), 1920, 46, 561-562.

In Vienna, as well as in Berlin, the underfeeding incident
to the war has had a good influence on diabetes. There are,
however, differences. In Berlin the patients showed glycemia
even when the urine was sugar-free ; in Vienna, when there was
no glycosuria the amount of blood sugar was lower than nor-
mal. In Vienna, elderly patients with diabetes during the war
were in better condition than young patients. The good influ-
ences of underfeeding most probably are to be attributed to
the small quantities of proteins ingested.—J. K.

DIABETES, The significance of extreme hyperglycemia in—
(Zur Frage der Bedeutung extremer Hyperglykamie beim
Diabetes mellitus). Friedlander (G.) Berlin. klin. Wehnschr.,
1920, 57, 207.

A man of 22 years showed diabetic symptoms for 3 weeks
and died in coma. This coma was not the sort characteristic
of diabetes, for there was no acidosis or air hunger. The urine
contained 6 per cent of sugar and the blood, 1.03 per cent.
The author considers this as a case of death by intoxication with
‘‘olyeosis.’’? No post-mortem changes were found.—J. K.

448 ABSTRACTS

(DIABETES) Fats and lipoids in the blood in diabetes mel-
litus. [Ueber das Vorkommen und die Verteilung von Fetten
und Lipoiden im Blute (Plasma) des Menschen bei Diabetes
mellitus. Chemische Beitrage zur Kenntnis der Entwick-
lung und des Aufbaues spezifischer Lipamien. IV.] Fiegl
(J.), Biochem. Ztschr. (Berl.), 1918, 90, 173-214.

Analyses are reported of 100 cases of diabetie lipemia, with
regard to technique and distribution of the blood fats and
hpoids.—Physiol. Abst. 3, 576.

(DIABETES) Zur Pathologie und Therapie des Coma diabeti-
cum. Fischer, Deutsche med. Wehnschr. (Leipz. u. Berlin),
1918, 44, 503.

No new data.—F. S. H.

DIABETES, Fat metabolism in—. Geelmuyden (H. C.), Norsk
Mag. for Laegevid (Christiania), 1920, 81, 479.

xyeelmuyden’s comparative study of the acute diabetes in
pancreatectomized dogs and human diabetes has, he thinks,
thrown lght on the processes in the intermediate metabolism
and their genetic connection, especially in regard to the pro-
duction of sugar from fat. In research of this kind, he empha-
sizes, all the changes in the metabolism must be taken into
account, not only the glycogen and blood sugar, the glycosuria
and the ketonuria, but the migration of fat, the transformation
- of albumin, the total metabolism and the transformation of
energy. Such studies hitherto have been restricted to only
some ,)f these elements and their interrelations have been over-
looked. He shows that carbohydrates promote the formation of
sugar from fat, and that the output of sugar is not increased
by feeding fat unless a certain amount of carbohydrate is
given with the fat. This he thinks is probably the reason why
carbohydrates are so injurious in human diabetes. Diabetes in
pancreatectomized dogs seems to be due to the very same
anomaly in the metabolism as in human diabetes. The chief
difference between them is that it occurs suddenly in the dogs,
while in man it is of long, slow development.—J. Am. M. Assn.,
74, 1684.

DIABETES mellitus and complications, Treatment of—. Gil-
liam (H. A.), Kentucky M. J. (Bowling Green), 1918, 16,
71-73.

General article containing no new data—F. 8. H.

ABSTRACTS 449

(DIABETES) Dispensary treatment of diabetes. Granger (A.
S.), Calif State M. J. (San Fran.), 1918, 16, 524-526.

No new data.—F. S. H.

(DIABETES) The influence of menstruation on acidosis in dia-
betes mellitus. Report of a case. Harrop (G. A.) & Mosen-
thal (H. O.), Bull. Johns Hopkins Hosp. (Balt.), 1918, 29,
161-163

An extensive case report, accompanied by urine analyses
of a diabetic showing exacerbations during menstruation.

—F. 8S. H.

(DIABETES) Blood sugar concentration and blood sugar
methods. Host (H. F.), & Hatlehol (R.), J. Biol. Chem. (Bal-
timore), 1920, 42, 347-358.

A comparative study has been made of the various meth-
ods for the determination of blood sugar; from the study the
authors conclude that it is uncertain whether any of the
blood sugar methods hitherto used give only the amount of glu-
eose. Bang and Hatlehoel’s method and Hagedorn and Jen-
sen’s method give in normal individuals and in diabetics
values which approximately agree. Folin and Wu’s method,
as well as Meyers and Bailey’s modification of Lewis and Bene-
dict’s method, may, at any rate in diabetes with hyperglyce-
mia, give too high results. This is especially the case with the
last mentioned method.—F. S. H.

DIABETES, The modern conception of the pathogenesis of—,
with special reference to the pancreas (Der jetzige Stand der
Pathogenese des Diabetes, mit besonderer Bericksichtigung
des Pankreas). Herkimer (Gotthold), Deutsche med.
Wehnschr. (Berlin), 1920, 46, 522-524.

The author believes that the endocrine function of the pan-
creas is due to the cells of the acini and the cells of the Lan-
gerhans islands. But when body cells, especially the islets,
are changed by pathological processes diabetes occurs. The
islets have no relation with the external secretion of the pan-
ereas. Two cases are shortly described which prove that the
liver plays an important part. In these cases the patients
with diabetes got cirrhosis of the liver. They lost the diabet-
ical symptoms. In both cases at autopsy, a cirrhosis of pan-
ereas and liver were found.—J. K.

450 ABSTRACTS

DIABETES; The results of past treatment and future prob-
lems. Joslin (KE. P.), Bull. Johns Hopkins Hosp. (Balt.),
1918, 29, 80-85.

A general view of the author’s studies accompanied by
charts and dietary tables.—F. S. H.

(DIABETES ADRENALS) Acetone in cerobrospinal fluid
(Aceton in de ruggemergsvloeistof). Koopman (J.), Nederl.
Tijdschr. v. Geneesk. (Haarlem), 1920, 64, 1346-1350.

Acetone may be found in the cerebrospinal fluid in several
pathological conditions. During diabetic coma acetone and
diacetic acid are found and its pressure is high. When the
pressure in diabetes tends to rise it is often significant of ap-
proaching coma. Acetone and diacetie acid may be found in
the cerebrospinal fluid in diabetic acidosis, also.. In a case of
adrenal apoplexy it was likewise found.—J. K.

PANCREATIC DIABETES. The alteration of the diastatic
activity of the liver and the lack of influence of the glyco-
lytic capacity of muscle on the extirpation of the pancreas
in the frog. [Wher das Wesen des Pancreas diabetes. (Die
Anderung der diastatischen Wirksamkeit der Leber und die
Unbeeinflussbarkeit der glykolytischen Fahigkeit des Muskels
durch Pankreas- exstirpation beim Frosch) ]. Lesser (E. J.),
Biochem. Ztsehr. (Berlin), 1920, 103, 1-18.

Induced panereatie diabetes in the frog causes an increased
elycolysis in the intact and isolated liver, while the glycolytic
function of either intact or isolated muscles is no different
than the normal. No valid conclusion can be drawn concern-
ing the fate of the muscle glycogen from the results of intra-
venously injected grape sugar for the increase in CO, output
does not occur if the glycogen content has previously been
strongly reduced by hunger and work. The glycogen-poor
liver synthesizes glycogen only slightly more rapidly than does
the liver containing moderate amounts of glycogen. The fat-
sparing action of sugar through the decomposition and rapid
synthesis of glycogen in the liver are two coordinated processes,
both of which oceur only when the glycogen content of the
liver passes a certain minimum which does not occur in pan-
ereatic diabetes.—F. S. H.

ABSTRACTS 451

(DIABETES) Influence of flying on glycemia (Infiuencia del
vuelo sobre la glucemia). Maranon (G.), Siglo Méd. (Ma-
drid), 1919, 65, 573-574.

In a series of tests made on aviators it was found that an
increased glycemia resulted from the flying, caused by the emo-
tional state induced. In the majority of cases the blood sugar
values were increased from the normal of 0.09 to 0.12 to values
represented by 0.15 to’0.19. In the pilots the hyperglycemia
was less, but nevertheless values above the normal were found.

—E. B.

DIABETES and influenza. Motzfeldt (K.), Norsk Mag. f.
laegevid (Christiania), 1920, 81, 372-379.

During the influenza epidemic of 30 years ago diabetes was
not infrequently noted in connection with this disease; few
observations regarding this have, however, been published dur-
ing the last epidemic.

Details are given of four cases of diabetes, in which the
first symptoms set in during a regular attack of influenza, or
shortly afterwards.

The diabetes was of a very mild form in spite of the
youth of the patients (age: 35, 14, 15 and 20 years) ; in 3 of the
patients the tolerance for carbohydrates increased consider-
ably during the treatment. Particular interest attaches to
ease 1: During the course of influenza a man of 35 noticed a
peculiar deep epigastric pain. Thirst and polyuria started,
when the temperature had been normal for one week. On
admission to the hospital one month later the urine gave a
positive ferric chloride reaction; the sugar disappeared after
5 days treatment. The tolerance was tested one vear and a
half later; 500 grams of bread could then be taken without
elyeosuria. After 50 grams glucose, glycosuria appeared and
lasted for 3 hours. The possibility of a pancreatic infection
is suggested—Author’s abstract.

DIABETES, Dietetic treatment of serious cases of—(Zur dia-
tetischen Behandlung schwerer Diabetesfalle). Petrén (K.),
Deutsche med. Wehnschr. (Berl.), 1920, 46, 589.

The chief principle in treatment of diabetes is restriction
of proteins as well as carbohydrates. Only fat may be taken
in unlimited quantities. The results are splendid. Meat is a
poison in serious diabetes.—J. K.

452 ABSTRACTS

(DIABETES) Coma diabeticum during pregnancy. (C. d. bei
Schwangeren). Umber, Deutsche med. Wehnschr. (Berlin),
1920, 46, 589.

It is extremely rare that a pregnant woman dies in diabetie
coma. The author saw three cases in which death thus oe-
eurred. Two of the patients were known to the author before
pregnancy. Both had previously had acidosis, which had dis-
appeared under a dieting regime. In all three cases the fatal
influence of pregnancy on the diabetes was obvious.—J. K.

DIABETES innocens. Wynhausen (O. J.) and Elzas (M.).
Arch f. Verdaungskrank. (Berlin), 1920, 26, 33-53.

To decide whether a glucosuria may be considered as dia-
betes innocens the authors give to their patients on an empty
stomach a test breakfast consisting of 150 gms. white bread
with a little butter and a cup of tea without sugar or milk.
Only these cases may be considered as ‘‘innocent’’ when before
and after this test breakfast the blood sugar content is normal
or when, after this breakfast, the blood sugar is between 0.15
and 0.17%. The amount of sugar in the urine does not permit
a prognosis. Even high glucosuria may be perfectly harmless
and accompanied with a normal blood sugar level.—J. K.

(DIABETES INSIPIDUS OSTEOMALACIA) Secretion of
iodine in saliva in health and disease after subcutaneous in-
jection of sodium iodide (Jodausscheidung im Speichel bei
Gestinden und Kranken nach subkutaner Injektion von Jod-
natrium). Zak (E.), Wien. klin. Wehnschr. (Vienna), 1920,
33, 281.

When sodium iodide is injected subeutaneously it reappears
in the saliva on the average in 9 minutes and 40 seconds, in
men; in women after 7 minutes and 42 seconds; in men with
“osteomalacia 5 minutes and 14 seconds; in women with the same
disease it appears in 4 minutes and 54 seconds. In osteomalacia
the amount of iodine exereted in the saliva is larger than nor-
mal. In diabetes insipidus, without treatment, it appeared in
about 4144 minutes. Treatment with strychnine lengthened the
period to about 10 minutes.—J. K.

DUCTLESS GLAND SUBSTANCES, Infiuence of certain—on
the growth of plant tissues. Budington (R. A.), Biol. Bull.
(Woods Hole), 1919, 37, 188-193.

In an attempt to learn what effects, if any, extracts of the
endocrine organs of animals may exert on the growth of plant

ABSTRACTS 453

tissues, onions were grown upon 120 cc. of Pfeffer’s medium to
which varying amounts of thyroid, pituitary and suprarenal
substances were added. Addition of thyroid substance de-
layed the growth of the roots, apparently in direct proportion
to the amount employed. There was no interference with the
growth of the young leaves. lodine, in the form of KI, did
not show this effect. Pituitary and suprarenal substances
exerted no appreciable influence.—W. J. A.

DYSTROPHIA MYOTONICA. Maase (O.) & Zondek (A.),
Deutsche med. Wehnschr., (Berl.) 1920, 46, 418.

In this typical ease the endocrine symptoms consisted of
large nose and lips, polyuria (hypophysis), low blood pressure
and a small amount of blood sugar (thyroid), increased salt
metabolism and a diminished protein metabolism (thyroid),
and sexual impotency.—J. K.

A mass of ENDOCRINE EPITHELIUM in the roof of the mid-
ventricle of the Algerian lizard (Amas épithéliaux endo-
crines dans le toit du ventricule moyen chez un lézard
algérien). LeBlane (E.), Compt. rend. Soc. de biol. (Paris),
1920, 83, 162-163.

In the roof of the ventricle of Uromastix acanthinurus
and in the basal region of the epiphysis, there exists, imme-
diately under the ependymal epithelium, a mass of cells which
suggests at once an endocrine gland, strikingly like the genital
interstitial glands. Other saurians are to be investigated.

—T. C. B.

(ENDOCRINE ORGANS) A therapeutic suggestion concerning
endocrines. Bandler (S. W.), Med. Ree. (N. Y.), 1919, 95,
429-432.

Bandler believes that the future of medicine lies along the
lines of endocrine therapy and states that in his own practice
90% of all prescriptions for internal use consist almost entirely
if not wholly of endocrine extracts. ‘‘The varying forms of
amenorrhoea, menorrhagias and metrorrhagias, threatened mis-
carriage, habitual miscarriage, sterility, the disorders and dis-
turbances of the climacterium, and many other states met with
in gynecological practice may be corrected in many instances
specifically by a certain extract; in many other cases, by com-
bination of extracts.’’ The author believes that the influenza
toxin exerts an almost selective action on the endometrium.

454 ABSTRACTS

This conclusion is based on observations of the complications
of the disease, especially in its sequelae affecting the uterus—
which organ he considers lymphoid tissue, part of the thymico-
lymphatic system.

Normal secretion and interaction of the ductless glands
preserves a proper state of growth, which leads Bandler to
believe that the cause of benign and malignant growths will
be found in abnormal gland function. He ascribes fibromata
and myomata of the uterus to hyperpituitarism of the posterior
lobe, with resultant hyperovarianism. He considers hyper-
activity of the pituitary as responsible for many premenstrual
disturbances. He further theorizes to the effect that in preg-
naney, the placental secretion holds in check the menstrual
activities of the pituitary, thyroid and ovaries and that failure
to inhibit these glands results in habitual miscarriage. The
nausea and vomiting of pregnancy are considered as due either
to a toxic placental secretion or hyperactivity of the posterior
lobe of the pituitary. The use of mammary extract, thymus, or
placental extraet to overcome hyperpituitarism is recom-
mended, the statement being made that each one diminishes
menstrual activity. Glycosuria of pituitary origin is empha-
sized and is controlled according to the author by mammary,
thymus or placental extract. [The article contains many fas-
cinating speculations which are advanced rather positively, but
without much concrete seclentifie evidence to support them.
Many of these brilliant theories may prove to be correct, but
they cannot as yet be accepted].—H. L.

ENDOCRINE ORGANS, The influence of extracts of—on the
secretion of the stomach (Uber der Einflusz von Blutdrisen-
extrakten auf die Magensekretion). Boeheim (T.), Archiv
f. Verdauungskrankheiten (Berlin), 1920, 26, 74-120.

The author examined the influence of injected extracts ot
endocrine organs on the function of the stomach after a Boas-
Ewald test breakfast and after a so-called ‘‘plasmon break-
fast’? (15 grams plasmon dissolved in 300 ce. water). The fol-
lowing results were noted.

I. In eases with hyperacidity: After a plasmon test meal
injections of extracts of all endocrine organs tend to diminish
the quantity of content of the stomach. After injection of
thymus or ovary this diminished quantity is only temporary and
is followed by an increase. The acidity becomes still higher,
though the influence of thymus and adrenalin is not so marked
as that of the other extracts. Extract of thymus increases the
quantity of peptones in the content of the stomach; the other

ABSTRACTS 455

extracts, however, increase the quantity of albumoses. After
a Boas-Ewald test breakfast all extracts excepting hypophysis
increase the quantity of content of the stomach; hypophysis
diminishes it. All extracts except thymus diminish the acidity ;
thymus increases it. Therefore, perhaps in some eases of hyper-
acidity organotherapy (thyroid or hypophysis) may advisedly
be carefully tried.

II. In eases with normal acidity: After a plasmon break-
fast thymus and hypophysis increase the quantity of content
of the stomach; thyroid and ovary diminish it. Only hypo-
physis diminishes the acidity. After a Boas-Ewald breakfast
all extracts diminish the acidity ; thymus, hypophysis and ovary
raise the quantity of content of the stomach, thyroid diminishes
it. All extracts delay the digestion of proteins.

Ill. In eases with sub- and an-acidity: After a plasmon
breakfast as well as after the Boas-Ewald breakfast injection
of extract of pancreas produces a marked rise of acidity. The
digestion of proteins goes further than without these extracts.
Thymus and thyroid have the same influence. Therefore, these
three organs may be tried in such eases. |For earlier observa-
tions along the same line see Rogers, Rahe and Ablahadian
(Abst. Endocrin., 3, 231-232) ].—J. K.

(ENDOCRINE ORGANS) Experimental basis for organo-
therapy in infectious diseases (Experimentelle Grundlagen
der Organtherapie bei infektious Krankheiten). Borchardt,
Deutsche med. Wehnschr. (Berlin), 1920, 46, 533.

The author examined the influence of various glandular
products on the formation of agglutinin for typhoid baeilli.
Adrenalin, hypophysin and spermin subcutaneously gave an
increase of the agglutinin-titer of the blood serum. Thyroid
tablets administered by mouth had the same effect. [See also
Koopman, Endocrin., 3, 318-320.]—J. K.

(ENDOCRINE ORGANS) On the origin and significance of
lipase in human blood (Herkunft und Bedeutung von fetts-
paltenden Fermenten des menschlichen Blutes). Caro (L.),
Ztschr. f. klin. Med. (Berlin), 1920, 89, 49-76.

This article is the report of a study of the influence of dis-
ease on the content of lipase in the blood. Adiposity, arterio-
sclerosis, many cases of Bright’s disease and others give an
increased lipase content. In the first stage of pulmontry tuber-
culosis an increase is observed; in the later stages, the lipase
content diminishes rapidly. On the other hand, all diseases

456 ABSTRACTS

with cachexia tend to diminish it. In lymphoid and myeloid
leukemia no influence on the lipase was observed. Graves’ dis-
ease, When accompanied by emaciation, presents: a lowered
lipase. In myxoedema no effect is observed. Now the question
arises as to the origin of the lipase. Bergel has maintained
that the lymphocytes produce this ferment. This cannot be
true since there is no parallelism between the number of lymph-
ocytes and the lipase content of the blood. This is also true
with respect to the cerebrospinal fluid. Probably the lipase is
a product of the endocrine system. The author believes that
the pancreas plays an important part in its formation. The
antagonists of this gland are the thyroid, the chromaffine sys-
tem, the infundibulum, the ovary, and the thymus. These
glands have an important influence on fat metabolism ; increased
funetion diminishes the fat in the body; diminished function
increase it. Diminished function of these glands increases the
internal secretion of the pancreas, which produces a large
amount of lipase. When the opposite happens, the pancreatic
function is diminished and its influence on the lipase content
is demonstrated.—J. K.

ENDOCRINE ORGANS, Functions of—(Wesen und Wirken
endokriner Dritsen). Hart (C.), Berlin. klin. Wehnschr.,
1920, 57, 101-104.

The author fed tadpoles with thymus and studied the
resulting atrophy of the thyroid. The tissues of the animals
showed a swollen aspect which may perhaps have some analogy
with the tissue reactions in myxoedema. This is further proof
that a monoglandular disturbance is followed by changes in
the other organs of the endocrine system and that what appear
to be monoglandular diseases are often polyglandular—J. K.

(ENDOCRINE GLANDS) The use of x-rays and electricity in
exopthalmic goitre and other disorders of the ductless glands.
Hernaman-Johnson (F.), Arch. Rad. & Elee. (N. Y.), 1918,
23, 91-99.

Brief case reports and general discussion from which it is
concluded that x-rays are specific in the sense that the secre-
tion of the thyroid may be diminished to any required degree,
although cure cannot be effected in the face of persistent irri-
tation from any souree.

The carefully controlled use of x-rays in dysmenorrhea of
ovarian origin is advocated.—F. S. H.

ABSTRACTS 457

ENDOCRINE ORGANS, The significance of, in the toxemias
of pregnancy (Die Bedeutung der innersekretorischen Drii-
sen fur die Klinik der Graviditatstoxikosen). Hofbauer,
Deutsche med. Wehnschr. (Berlin), 1920, 46, 589.

During pregnancy, metabolism is increased. This may be
explained by the hyperplasia of thyroid, adrenals and hypo-
physis. These glands increase the irritability of the sympathi-
cus and parasympathicus. This is perhaps the cause of the
vomiting of pregnant women. It may be cured by extracts of
ovary, which tend to diminish the irritability of the sympathi-
cus. In eclampsia, the serum of the patients has vasoconstrict-
ing properties; the substances with these properties are prob-
ably produced by the increased function of the hypophysis-
adrenal system. Therefore extract of ovary ought to be tried
in these conditions. The edemas and the abnormalities of the
kidneys in pregnancy may perhaps be explained by a dys-

(ENDOCRINE ORGANS) The mechanism of vitamine action
(Le mecanisme d’action des vitamines). Ganassini (D.) &
Maneini (P.), Bull. gén. de Thérap. (Paris), 1920, 171, 125-
133.

A brief review of the physiological, pathogenic and thera-
peutic action of the vitamines in which the opinion is expressed
that their physiological role is to regulate trophic exchanges
in synergic connection with the trophic -regulatory eee
of the products of the glands of internal secretion.—F. S. H.

(ENDOCRINE ORGANS) On the decisive proof of the ana-
tomical situation of the glands of internal secretion (Sur
les raisons déterminantes du siege anatomique des glandes
a sécrétion interne). Hallion (L.), Compt. rend. Soe. de
biol. (Paris), 1920, 83, 295-296.

The author claims priority by about ten years, for the
hypothesis suggested by Ide, that the role of the endocrine
glands can be explained by their embryologic origin (See En-

docrin., 4, 125).—T. C. B.

(ENDOCRINE ORGANS BLOOD SUGAR) Studies in the dia-
static activity of the blood and blood sugar curves indicating
a decreased carbohydrate tolerance in hyperthyroidism.
Killian (John A.), Proc. Soc. Exper. Biol. & Med. (N. Y.),
1920, 17, 91-93.

458 ABSTRACTS

Patients received a breakfast of one egg, two slices of
bread and a cup of black coffee or a glass of water. Two hours
later the bladder was evacuated and 100 ee. of water drunk.
One hour after this a specimen of urine and one of blood were
taken as controls. Glucose was then administered in 50%
solution, 1.75 gm. per kilo, body weight. At hourly intervals
thereafter blood and urine samples were taken and the sugar
content and diastatie activity were determined. Twenty-three
cases were presented. Three hours after the standard meal
the sugar in the blood varied, in normal cases, from 0.09 to
0.10 per cent. In Frélich’s dyspituitarism, acromegaly and
Addison’s disease hypoglycemia was noted. In ‘‘hyperthy-
roidism’’ (type not specified) the blood sugar ranged from
0.11 to 0.13 per cent. In normal cases urinary sugar excretion
ranged from 20 to 30 mg. for the control hour. In dyspitui-
tarism, acromegaly and Addison’s disease it was less. In hy-
perthyroidism, excretion varied from 248 to 95 mgs. In normal
eases blood sugar reached its maximum, 0.13-0.15 per cent, in
one hour and returned to normal in two hours. In endocrine
hypofunection there was practically no inerease in blood sugar.
In ‘‘hyperthyroidism’’ there was hyperglycemia persisting 4-5
hours, accompanied by glycuresis. Blood diastase was de-
ereased in the hypofunction cases and increased in the hyper-
funection.—R. G. H.

(ENDOCRINE ORGANS) Observations on starvation bone-
disease in Munich (Beobachtungen von Hungerknochener-
krankungen in Munchen). Mayer, Deutsche med. Wehnschr.
(Berlin), 1920, 46, 168.

The etiology of this disease is considered as a disturbed
endocrine balance.—J. K.

(ENDOCRINE ORGANS) Therapeutic problems of the future.
Middleton (G. W.), Northwest Med. (Seattle), 1919, 18, 225-
229.

In a general presidential address the author devotes a para-
graph to the duetless glands. He refers to the more obvious
diseases connected with perversion of the thyroid, adrenal and
pituitary body; the neuroses of women associated with ovarian
deficiency. The significant advance by Kendall in isolating the
erystalline active principle of thyroid secretion is commended.
He warns against bizarre commercial pluriglandular preserip-
tions, but prophesies an important destiny for scientific, digni-
fied organotherapy.—H. L.

ABSTRACTS 459

ENDOCRINOLOGY, Some phases of. Garretson (W. V. P.),
Med. Press (London), 1918, N. S. 105, 488-491: N. York M. J..
1918, 107, 866-869.

A general discussion containing no new data save an ad-
mission of the conversion of a scoffer (the writer) to an ad-
herence to the practices of endocrinology.—F. S. H,

ENDOCRINOLOGY, The present aspect of—. Lescohier (A.
W.), Med. Rec. (N. Y.), 1919, 96, 532-534.

The author wisely states that ‘‘the erying need of endo-
erinology at present is carefully controlled therapeutic inves-
tigation.’’ He objects both to the class of practitioners who are
wildly seizing upon organotherapy as a cure-all, and to the
class of pessimistic skeptics who barely recognize any place at
all for ductless gland therapy. He suggests that gland extracts
will probably prove more valuable in the treatment of mild
degrees of hypofunction than in outstanding clinical aberra-
tions and accordingly urges that more attention be paid to the
recognition of minor deficiencies.—H. L.

FROHLICH’S SYNDROME, Case of—(Un nuevo caso de sin-
drome de Frolich). Crespo Alvarez (A.), Siglo Méd.
(Madrid), 1919, 66, 713-716.

A detailed history of an interesting case of Fréhlich’s syn-
drome in a boy of 20 years.—E. B.

(GENERAL) The relation of the glands of internal secretion
to surgery. Haeberlin (J. B.), Hlinois M. J. (Chicago), 1918,
33, 262-267.

A general discussion presenting no new data.—F. 8. H.

(GENERAL) A method for manganese quantitation in biolog-
ical material together with data on the manganese content of
human blood and tissues. Reiman (C. K.) & Minot (A. S.).
J. Biol. Chem. (Baltimore), 1920, 42, 329-345.

While this paper is not primarily of endocrine interest,
the data concerning the manganese content of various glands
of internal secretion are given and thus made a matter of
record.—F. S. H.

(GONADS HYPOPHYSIS) Eunuchoid gigantism (Ein Beitrag
zum eunuchoiden Riesenwuchs). Jédicke (P.), Ztsehr. f. d.
ges. Neurol. u. Psychiat. (Berlin), 1918, 44, Orig. 385-390.

460 ABSTRACTS

Report of an acromegalic eunuch with high sugar toler-
ance, the condition being attributed primarily to the sex gland
disturbance with resultant hyperfunctioning of the pituitary.

—F. 8. H.

(GONADS) Eunuchoidismus. Krisch, Deutsche med.
Wehnschr. (Leipz. u. Berlin), 1918, 44, 615.

Rather complete clinical report of two cases of eunuchoid-
ism with no points of particular endocrine interest.—F. S. H.

(GONADS) Hypoplasia of the testicle in youth and its signifi-
cance as regards the development of the gonads (Ueber die
Hypopilasie der Hoden in Jugendalter und ihre Bedeutung
fiir das weiter Schicksal der Keimdriisen). Kyrle (J.), Wein.
klin. Wehnschr. (Vienna), 1920, 33, 185-188.

Hypoplasia of the testicle in youth is frequent. The hypo-
plastic organs are characterized by an increased development
of the interstitial tissue. During puberty they may develop to
a considerable extent but rarely become of normal size. Nev-
ertheless an adequate function is usually present.—J. K.

(GONADS) The psychology and psychopathology of puberty
with some remarks on the internal secretions of the sex
glands (Zur Psychologie und Psychopathologie der Pubertat
nebst einige Bemerkungen iiber die innersekretorischen Funk-
tionen der Keimdriisen). Miinzer (A.), Berliner klin.
Wehnscehr., 1920, 57, 346-349.

A general discussion in which no new data are presented.

—J. K.

(GONADS) Hermaphroditism in man. Sheppard (H.), Anat.
Ree. (Phila. ), 1920; 18, 259. :

A dissecting room ease is reported which is held to exhibit
true hermaphroditism. Testes, located in the scrotum, and
ovaries in the pelvic cavity, were present. The case is an
unusual one if, as is stated, both ovaries and testes show a
normal structure microscopically —W. J. A.

(GONADS) Hermaphroditismus. Wagner (G. A.), Wein. klin.
Wehnschr. (Vienna), 1920, 338, 226; Deutsche med.
Wehnschr. (Berl.), 1920, 46, 423.

A description of two cases. The first subject was a “‘girl”’
of 16 years with a typical psycho-physical male status. The

ABSTRACTS 461

penis was short and hypospadie. The scrotum was divided into
two parts in one of which there was a testicle, and in the other
a eryptorchidic testicle. The second subject was a girl of 21
years who had not menstruated. The characteristics were those
of a female both as regards mind and the external genitalia, the
clitoris and labia were normal. The vagina was 3 em. in depth
and there were no internal sexual organs. <A bilateral hernio-
tomy had been performed, but since a tumor was felt in the old
scar a new incision was made and a testicle found therein at-
tached to a normal funiculis. Histological examination of the
removed organ showed it to be of normal tissue and containing
no traces of ovarian cells.—J. K.

HYPOPHYSIS, The development of the human—. Atwell (W.
J.), Anat. Ree. (Phila.), 1920, 18, 220.

An account is given of the morphogenesis of the human
hypophysis beginning with the stage of the 10 mm. embryo.
The pars tuberalis, or ‘‘lobulus bifureatus’’ of Bolk, ean be
recognized in the younger stages and is then traced contin-
uously to the oldest. It is shown that Herring’s ‘‘tongue-like
process of the pars intermedia’’ is developed quite independ-
ently of the pars intermedia. Thus the name applied by
Herring is misleading.—W. J. A.

(HYPHOPHYSIS) Presentation of a case of diabetes insipidus.
Clausen (J.), J. Missouri State M. Assn. (St. Louis), 1918,
15, 189; Proc. Wash. Univ. M. Soe. (St. Louis), 1918, 48, 8.

C. reports that the injection of pituitary extract invari-
ably caused a marked reduction in the urinary output and
thirst, the daily output falling from 7 liters to 2, per diem. The
dose given was 0.25 to 1 ce. once a day, and was ineffective
when given by mouth.—F. 8. H.

(HYPOPHYSIS) The history of a case of acromegaly with
gigantism in the family. Craft (M. T.), Neurol. Bull. (N. Y.),
1918, 1, 32-34.

A very interesting personal report by the patient of the
development of the acromegalic condition accompanied by

blindness and the statement that a paternal uncle was a famous
Kentucky giant.—F. 8. H.

(HYPOPHYSIS) The acromegalic tendency and the theory of
the internal secretions (Ueber Akromegaliodismus und zur
Theorie der inneren Sekretion). Ehrmann (R.), Ztschr. f.
phys. u. diatet. Therap. (Leipzig), 1918, 22, 343-345.

462 ABSTRACTS

Several observations were made of individuals demonstrat-
ing by x-ray examination the classical acromegalie picture, who
failed to give marked evidence of hypophyseal disturbance at
autopsy. The author theorizes on the absence of the effective
secretion from the glandular parts of the adrenals but presents
no experimental data.—F. 8. H.

(HYPOPHYSIS) A study on the separation of the physiologi-
cally active portion of the posterior lobe of the pituitary
body. Fenger (F.) & Hull (Mary), J. Biol. Chem. (Balt.),
1920, 42, 153-158.

This paper reports an attempt on the part of the authors
to separate in pure form the oxytocice principle of the posterior
lobe of the pituitary. It is concluded on hardly sufficient
evidence that the uterus-contracting principle does not occur in
the fresh gland in free or crystalline form, but is linked to or
part of some protein complex. ‘‘In its original protein asso-
ciation the uterine stimulus is insoluble in ether, petroleum
ether, chloroform and practically insoluble in absolute alcohol.
It is sparingly soluble in 95 per cent alcohol, but yields a highly
active split produet when treated with hot 95 per cent alcohol.
The split product is amorphous in nature, very hygroscopic and
much more sensitive to desiccation than the original basic ma-
terial from which it was derived.’’ Alkaloidal reagents are
not sufficiently good precipitants for general use in the isolation
of the active principle.—F. 8. H.

(HYPOPHYSIS) Case of hypophyseal tumor showing improve-
ment under x-ray treatment (Kinen durch Rontgenbestrah-
lung gebesserten Fall von Hypophysentumor). Fleischer &
Jiingling. Miinchen. med. Wehnschr., 1918, 65, 1362.

A report of a case of hypophyseal tumor in a 55 year old
woman with acromegalic symptoms and visual disturbances.
She was distinetly benefited by 2 x-ray applications at intervals
of four weeks. The technique of the applications is given in
brief and is not appheable to American made apparatus.

—F. S. H.

(HYPOPHYSIS) Cases of hypophyseal tumor (Falle von Hypo-
physentumor). Gerhardt, Miinchen. med. Wehnschr., 1918,
65, 950.

Report of two eases of hypophyseal tumors, one in a 24
year old soldier and the other in a 51 year old laborer. Evi-
dence of acromegaly was present in each case.—F. 8. H.

ABSTRACTS 463

(HYPOPHYSIS) Headache and dyspituitarism in the light of
therapeusis. Glassburg (J. H.), Med. Ree. (N. Y.), 1919,
96, 461-463.

Glassburg emphasizes the desirability of limiting of the term
dyspituitarism to exclude acromegaly on the ‘‘hyper’’ side and
infantilism on the ‘‘hypo’’ side, but to include all other disorders
of pituitary secretions. In this way a definite class of eases ean
be recognized which may be benefitted by organotherapy,
whereas gland extracts are useless in acromegaly and infan-
tilism. Cases of dyspituitarism will show signs and symptoms
of both hyper- and hypo-activity depending on the stage of the
disease. Dyspituitarism is not necessarily accompanied by an
abnormal sella turcica. The author presents a typical case in
which the bitemporal headaches, muscular fatigue, ete., were
promptly relieved by pituitary extract, 4-8 grains a day by
mouth. It was noticed that administration of the extract at
the menstrual period resulted in inereased flow; the author
therefore cautions against using it at that time—H. L.

(HYPOPHYSIS) A case of acromegalic gigantism (Un caso de
gigantismo acromegalico). Gouce (F.) & Poyales (F.), Pe-
diatria espan. (Madrid), 1919, 8, 271-283.

A report of a girl of eight years afflicted with acromegalic
gigantism. The case is very well presented. No glycosuria was
present but a shght hyperglycemia was found.—G. M.

(HYPOPHYSIS) A physiological response to the administra-
tion of pituitary. Hammett (F. S.), Patten (C. A.) & Suitsu
(N.), Am. J. Physiol. (Balt.), 1920, 51, 588-592.

A study of the changes induced by administration of
pituitary substance, in the total nitrogen, non-protein nitro-
venous constituents, sugar and alkaline reserve of human blood.
The experiments were carried out on six human males who were
not endocrinopathic. The period of observation covered nine
weeks; the first three weeks no pituitary was fed; during the
second three weeks a 2-grain tablet of desiccated pituitary
substance was given three times a day; during the last three
weeks the pituitary was discontinued. The only valid and
consistent change noted was in the blood urie acid. In four
out of the six cases the ingestion of pituitary substance caused
an increased concentration of urie acid in the blood. This is
interpreted as being due, probably, to a decreased permeability
of the kidney.—T. C. B.

464 ABSTRACTS

(HYPOPHYSIS) A case of suspected tumor of the pituitary
body. Hansell (H. F.), Trans. Coll. Phys. (Phila.), 1918,
3.8., 39, 360.

Brief case report presenting no new data.—F. S. H.

(GENERAL) Gastric changes of endocrine origin (Algunas
alteraciones intestinales de origen endocrino). Hernando
(T.), Med. Ibera (Madrid), 1919, 8, 239; 9, 523, also Acad.
med.-quir. espan., 1919.

The glands of internal secretion act on the digestive tract
through the mediation of the vegetative nervous system in-
directly and directly by their secretions. The author studied
the endocrine supervision in many eases of diarrhoea and con-
stipation. In all the Basedowians studied diarrhoea frequently
occurred and many cases of the latter disorder presented symp-
toms of hyperthyroidism (18 cases of hyperthyroidism out of
149 chronic diarrhoeas). The intestinal disturbance is explained
on the basis of a vagotonia which in turn determines the hyper-
thyroidism. The same reasoning apples to the occurrence of
diarrhoea in many cases of suprarenal insufficiency. As to
treatment it should correspond in general with the observed
syndrome, belladonna and atropine as moderators of the vagus,
and adrenaline (principally as enemas according to de Woor-
den) which bring about the the least moderating action in an
indirect manner exciting the sympathetic. Constipation is also
influenced by the endocrine glands. Here hypopituitarism
comes into play (the constipation of Frohlich’s syndrome) and
in some eases of senile constipation also (atrophy of the hypo-
physis in the old). Hypersuprarenalism by its sympathicotonic
action is a factor. It is possible to understand the constipation
of the arterio-sclerotics and the climateric in which ovarian
insufficiency plays a role since this also has its effect on vago-
tonia. Finally there exists a certain group of cases of hyper-
thyroidism exhibiting constipation in which vagotonia is deter-
mined by a condition of the imtestinal musculature which is
much more frequently found in the cases of hypothyroidism.
This intervenes by virtue of a lack of vagal tone and diminu-
tion of calcium metabolism, which in turn diminishes the neu-
romuscular. excitation of the intestine.—H. B.

(HYPOPHYSIS) Gigantism (Riesenwuchs). Hoffmann.
Deutsche med. Wehnschr. (Berlin), 1920, 46, 311.

A demonstration of a woman of 21 years with gigantism,
multiple exostoses and myxoedematous symptoms of the fatty
tissues of the legs. These symptoms developed after a fall 8

ABSTRACTS 465

years previously, when the hypophysis was injured. No symp-
toms of a tumor were noted. Sexual functions were normal.
The author considers this disorder as due to dysfunction of
the pituitary. J. K.

(HYPOPHYSIS) Akromegalie. Hégler, Wien. klin. Wehnschr.
1918, 31, 769.

A ease report presenting no new features—F. S. H.

(HYPOPHYSIS) Roentgen observation of the pituitary region
in intracranial lesions. Johnson (G. C.), Am. J. Roentgenol.
(N. Y.), 1918, n. s. 4, 555-563.

An extended study with 15 plates of the pituitary region
by means of the x-ray. J. concludes that the first requisite
for study of intracranial lesions, particularly of the sella, is a
wide familiarity with roentgenograms of the normal conditions.
There is a wide variation in size and character of the sella
which must be considered within the limits of normal. Pitui-
tary struma manifests itself by deformation and destruction of
the sella and rarely by visualization of the tumor itself.

— FS. E.

(HYPOPHYSIS) Hypophysentumor. § Killian, Berl. kin.
Wehnschr., 1918, 55, 891.

Of technical interest.—F. S. H.

HYPOPHYSIS, Secretion antecedents in the pars intermedia of
the—of the pig. Lewis (D. D.) & Maurer (S.), Anat. Ree.
(Phila.), 1920, 18, 238.

Two kinds of epithelial cells are described for the juxta-
neural portion of the pars intermedia. These are: ‘‘(1) cells
related to the colloid-containing vesicles, and evidently the
secretory source of this colloid; (2) the secretory cells which
are the characteristic element of the pars intermedia, hitherto
vaguely deseribed as finely granular, basophile, neutrophile,

ete.’’—W. J. A.

HYPOPHYSIS, Diabetes insipidus with destruction of the pos-
terior lobe of the— (Diabetes insipidus bei Zerstorung des
Hypophysenhinterlappens). Neubiirger (K.), Berlin. klin.
Wehnschr., 1920, 57, 10.

466 ABSTRACTS

A deseription of a case of diabetes insipidus with a metas-
tatie cancer in the pars nervosa. The anterior lobe showed no
changes.—J. K.

(HYPOPHYSIS) Hypophyseal adiposity in children (Ueber
Kinder mit hypophysarer Adipositat.) Peritz, Berlin. klin.
Wehnschr., 1920, 57, 379.

The most ordinary cause of hypophyseal adiposity in ehil-
dren is a syphilitic hydrocephalus. Blood sugar is often in-
ereased. The author demonstrated some of these cases and
also a ease of hypophyseal dwarfism, caused by syphilis.

See

(HYPOPHYSIS) Akromegalie. Pribram, Deutsche med.
Wehnsehr, 1920, 46, 424.

This classical case was remarkable because of its beginning
during puberty.—J. K.

HYPOPHYSIS and Raynaud’s disease (Hypophyse and Ray-
naudscher Krankheit). Pribram, Berlin. klin. Wehnschr.,
1920, 57, 67.

Data reported elsewhere. See Endoerin., 1920, 4, 279.
Jae

The HYPOPHYSIS cerebri of the American marmot (Mar-
mota monax) with special reference to changes during hiber-
nation. Rasmussen (A. T.), Anat. Ree. (Phila), 1920, 18, 255.

The author has not found the marked changes in the hypo-
physis which other writers have reported as taking place during
hibernation. The most constant and striking alteration occurs
after waking up when the basophilic cells become very promi-
ent and show large vacuoles and a conspicuous ‘‘macula.”’

—W. J. A.

(HYPOPHYSIS) Pituitary feeding and egg production in the
domestic fowl. Simpson (Sutherland), Proce. Soe. Exper.
Biol. & Med. (N. Y.), 1920, 17, 87-88.

Clark in 1915 reported that feeding desiccated hypophysis
resulted in marked inerease in ege laying by hens. Simpson
repeated Clark’s experiments, using hypophysis from both
adult and young cattle. The experiments were made in three
stages: when egg laying was low and declining, when it was

ABSTRACTS 467

at its height and again when it was low. White Leghorn hens
were used as experimental animals. The results were com-
pletely negative, not only with the dosage used by Clark (the
equivalent of 20 mg. fresh gland) but also with double and
treble this dosage.—R. G. H.

HYPOPHYSIS, The action of extract of—on the distribution of
the blood (Die Wirkung der Hypophysesextrakte auf die
Blutverteilung). Rosenow, Deutsche med. Wehnschr. (Ber-
lin), 1920, 46, 559.

Intravenous injection of extract of hypophysis produces in
normal individuals a momentary increase of the volume of the
arm, as may be proved by use of the plethysmograph. This
may be explained by the constricting effect of hypophysis ex-
tract on the blood vessels innervated by the splanchnic nerves.
The author recommends this method for the functional study of
the splanchnies.—J. K.

HYPOPHYSIS, A biclogical study of the—. Saito (T.), Sei-I-
Kwai M. J. (Tokyo), 1919, 38, 328 (Japanese).

The chief points indicated in this paper are that the weight
of the hypophysis of the horse varies with the month of the
year; that it is relatively much larger in the horse than in
either the cow or man, and that its weight decreases during the
fourth month of pregnancy in the horse and during the third
month in man.—E. V. C.

(HYPOPHYSIS) Cure of a case of meningitis after endonasal
overation for hypophyseal tumor by trypaflavine infusions
(Heilung einer Falles von Meningitis nach endonasaler Oper-
ation eines Hypophysentumors durch Trypafiavininfusionen).
Spiesz (G.), Deutsche med. Wehnschr. (Berlin), 1920, 46,
207-209.

a. HK.

Of no immediate endocrine interest.

(HYPOPHYSIS) Contribution to the pathogenesis of dystro-
phia adiposo-genitalis (Bydrage tot de pathogenese der dys-
trophia adiposo-genitalis). Stenvers (H. W.), Nederl.
Maandschr. Geneesk. (Leiden), 1920, 1, 45-60.

Stenvers describes three cases of dystrophia adiposo-geni-
talis. The first case was a girl of 17, without menstruation,
with adiposity. The diagnosis was tumor of the hypophysis.
Death followed some hours after operation. At autopsy the

468 ABSTRACTS

hypophysis proved to be normal, both grossly and micro-
scopically, but the infundibulum of the third ventricle was very
atrophic. The second case was a girl of 21; the menses had
become irregular and finally ceased. There were symptoms
of brain pressure. The skiagram showed an enlarged sella. The
post-mortem examination disclosed a normal hypophysis and
a large tumor in the right temporal lobe of the brain with
dilatation of the third ventricle. In this case there was no adi-
posity, but the changes in the third ventricle were not so
great as in the first one. The third ease, a boy of 14, had head-
ache, giddiness and vomiting. There were eye symptoms.
During two years the boy became fatter and fatter and ac-
quired a female form. The skiagram showed changes which
may be explained only by dilatation of the third ventricle.
These changes developed pari passu with the adiposity. The
author coneludes that dystrophia adiposo-genitalis is caused
by a disease of the third ventricle; this may be caused by a
tumor of the hypophysis, but also by any process causing in-
creased intracranial pressure. [An obvious comment is that
cerebral pressure may result in functional inadequacy of the
hypophysis as well as hypophyseal tumor cause cerebral pres-
sure.]—J. K.

(HYPOPHYSIS) Paroxysmal nasal hydrorrhea based on dys-
pituitarism. Strauss (S. G.), Med. Ree. (N. Y.), 1919, 96,
463-464.

Strauss records ease of periodic discharge of copious color-
less mucous from nose, 2 months after striking forehead against
a door. Discharge would last about 6 weeks, then suddenly
cease, to reappear in 3 months. Physical characteristies of
patient suggested dyspituitarism and whole pituitary gland
was administered with prompt and so far (6 months) per-
manent relief.—H. L.

(HYPOPHYSIS) Atrophia adiposo-genitalis. van Valkenburg
(C. T.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1920, 64,
(1)3°997-998.

A description of a ease of a boy 14 years old with symp-
toms of meningitis, dullness, epilepsy, Argyll-Robertson pupil,
negative Wassermann reaction, optic neuritis, no changes in
urine or blood, loss of memory and econfabulations. The tes-
ticles were small. The patient gradually became more fat.
Post-mortem examination showed tubercles in the cerebellum,
tuberculosis of the pia-mater, infundibulum, optic nerves and
traet, also a large thymus, small pancreas, atrophic testicles,

ABSTRACTS 469

atrophic adrenal medulla and a normal thyroid, parathyroid
and hypophysis were noted. The blood vessels in the latter
were increased in number and were congested.—J. K.

(HYPOPHYSIS) The relations between experimental polyuria
after ‘‘piqure’’ and diabetes insipidus (Die Beziehungen der
experimentellen Piqure—polyurie zum Diabetes insipidus).
Veil, Deutsche med. Wehnschr. (Berlin), 1920, 46, 558-559.

The author describes two classes of diabetes insipidus,
one in which the blood contains an increased amount of Na
Cl and one with a normal amount of NaCl in the serum. In
the first cases the urime is poor in NaCl, in the latter there is
generally hyperchloruria. ‘‘Piqure’’ in the fourth ventricle
produces polyuria with an increase of NaCl in the urime;
‘‘piqure’’ in the midbrain produces polyuria with hypoch-
loruria.—J. K.

(HYPOPHYSIS) Dystrophia adiposo-genitalis, with report of
a case. Whyte (G. Dunean), China M. J. (Shanghai), 1920,
34, 139.

A typical case is reported in a man of 46 years which
showed only temporary Improvement on feeding hypophysis.

—KE. V. C.

(HYPOPHYSIS ADRENALS) Prophylaxis of paralysis of the
intestines (Zur Verhitung der Darmlahmung). Zondek (B.),
Zentralbl. f. Chir. (Leipzig), 1920, 46, 270-272.

Unger has advised the administration of asthymolysin after
operations as a prophylaxis against paralysis of the intestine.
Asthymolysin is a combination of 40 milligrams hypophysis
and 0.8 milligrams adrenal. Zondek calls this a bad combina-
tion as hypophysis will increase the tonus of the intestine, but
adrenaline will inhibit the -peristalsis by stimulation of the
sympathic apparatus.—J. K.

(INTERNAL SECRETIONS) The importance of a knowledge
of the internal secretions and its availability for practical
gynecology (Die Bedeutung der Lehre von der inneren Se-
kretion und ihre Nutzanwendung fir die praktische Gyna-
kologie). Aschner (B.), Monatsch. f. Geb. u. Gynak. (Ber-
lin), 1920, 51, 130-136.

A polemical reply to H. Fehling’s article of the same title
(idem. 50, 143) and.defending the author’s book, ‘‘Die Blut-

470 ABSTRACTS

drusenerkrankungen des weibes und ihre Beziehung zur Gyna-
kologie und Gebursthilfe.’’ (Wiesbaden, Bergmann, 1918).

—F. 8. H.

INTERNAL SECRETIONS, Influence of—on the formation ot
bile. Downs (A. W.), Proceedings Am. Physiol. Soe., Am. J.
Physiol. (Balt), 1920, 51, 193-194.

See Endoerin., 1919, 3, 214.

INTERNAL SECRETIONS, Vitamines and—(Vitaminen en in-
wendige afscheiding). van Driel (B. M.), Nederl. Tijdschr.
v. Geneesk. (Haarlem), 1920, 64, (1), 1350-1361.

A general review without new data. The author concludes
that the avitaminoses are closely related to endocrine dis-
turbaneces because in all such conditions the endocrine organs
(with the exception of the hypophysis and the adrenals) are
atrophied, and because in certain forms of the disorder the
amount of adrenalin in the adrenals is increased.—J. K.

INTERNAL SECRETIONS, The. Friedman (E. D.), Med.
Ree. (N. Y.), 1919, 96, 916-935.

The author’s intention apparently was not to present any-
thing new, but to compress into ten pages a resume of our
knowledge of the internal secretions. He has packed an extra-
ordinary amount of information into this article, including a
historical survey. He then crowds an immense amount of infor-
mation under the headings: thyroid, hypophysis, adrenals,
pineal, thymus, sex glands, internal secretions, uterus, para-
thyroids, pancreas, internal secretion of the alimentary tract,
placenta and spleen. It is obviously impossible to abstract this
paper, for it is a veritable abstract in itself. It might be
recommended to those unfamiliar with endocrinology, who
might desire a rapid introduction to its essential features.

—H. L.

INTERNAL SECRETION, Feeding rats on glands of—. Guder-
natsch (J. F.), Anat. Record (Phila.), 1918, 14, 35. (Proe.
Am. Assn. Anat:, 1917_)

Gudernatsch reports the results up to the time of going to
press of feeding seven sets of albino rats on a mixed diet plus
desiccated thyroid, thymus, hypophysis, testicle, ovary, and
mammary gland respectively, one set being used for control.
Thyroid fed rats when pregnant deliver many dead, or the
young die early. The remaining rats are classed in three

ABSTRACTS 471

groups: 1. Hypophysis; thymus. 2. Normal. 3. Testicle;
ovary. The animals in group 1 grow faster and the animals in
3 slower than normally. Testicle- and ovary-fed homologous
animals do not live as long as the others and a decline in weight
often begins as early as seven months. Heterologous testicular
and ovarian feeding causes an improvement in growth over the
homologous fed animals. The members of group 1 are fine
breeders and the young are viable. Females of group 3 are
poor breeders in respect to the vitality of the young. Pituitary
fed animals seem to be precocious in adolescence.—F. S. H.

INTERNAL SECRETIONS, Pernicious anemia and the—.
Schauman (O.), Finska. Lak. Sallsk. Handl., 1919, 61, 796-
827.

The author ealls attention to certain critical constitutional
impulses which may precede anemia. They are primarily
achylia, dental caries, and glossitis. He further points out
that there are certain points of similarity between Addison’s
disease and pernicious anemia, such as bronzing of the skin; in
certain cases extraordinary good condition of nourishment,
stomach and intestinal symptoms of like nature, ete. Among
other symptoms present in pernicious anemia significant of an
endocrine possibility are polyuria, cardiae enlargement, tem-
perature increases of a peculiar kind, ete. It is also emphasized
that the blood changes in themselves may be considered as of
dan internal secretory nature. The disturbances of the internal
secretory balance combined with constitutional anomalies of
the hemopoietic apparatus are the fundamental causes, the
exogenous influences are but the adventitious motivations of
the disease.—J. A. H.

LIPODYSTROPHIA PROGRESSIVA, Sequel of the case of—
shown on January the 24th, 1919. Weber (F. P.) and Gune-
warcaene (1. H.), Brit. J. Child. Dis. (Lond.), -1920, 16,
200-204.

The authors present the findings in what they claim to be
the first published autopsy in lipodystrophia progressiva. Their
patient was a girl of 13 who died from chronie pyemia. The
body was wasted, but by naked eye examination the fat was
practically completely absent from the subcutaneous tissue ot
the upper part of the body above the pelvis. A moderate
amount of fat was present in the gluteal regions, orbits, omen-
tum. about the kidneys, heart and pericardium and under the
serous membranes. Microscopic sections of the scalp and ab-
dominal wall show that fatty tissue is almost completely, if

472 ABSTRACTS

not completely, absent. One of the sections of the suprarenal
elands included a little of the surrounding retroperitoneal
tissue. Definite fatty tissue was present in this. In no section
were there lobules of embryonic fatty tissue such as are found
in the fetus and in infants. No abnormality was found in either
the ovary or pituitary body. In the suprarenal bodies there
appeared to be less lipoid tissue than usual, but the effect of
the infection which caused death cannot be excluded. In the
thyroid there was an excess of colloid of a degree, however,
that is often found at autopsy. It fell far below that which
frequently occurs at puberty. Little significance could be
attached to this excess of colloid if it were the only unusual
feature, but it appeared to be associated with fibrosis and an
actual diminution in the size of the gland. The thymus gland
was represented by a scanty remnant. Original report of this
case abstracted in Endocrin., 1920, 4, 138.—M. B. G.

MENSTRUATION AND PREGNANCY, Disorders of—after
accidents [Menstruations und Schwangerschaftsstorung nach
Unfall (Verbrennung)]. Beckey (K.), Ztschr. f. Geburtsh.
u. Gynak. (Stuttgart), 1920, 82, 257-283.

Of no endoerine interest.—F. 8S. H.
Vicarious MENSTRUATION (Uber vikariierende Menstrua-

tion). Roth (A.), Monatschr. f. Geburtsh. u. Gynak. (Berlin),
1920" bay 41-57:

A statistical presentation, of no specific endocrine interest.

—F. S. H.

MYOTONIA, Variations of—(Varietaten der Myotonie). Kas-
tan, Deutsche med. Wehnschr. (Berlin), 1920, 46, 311.

Of no endocrine interest.—J. K.

MONGOLISM, The symptoms of— (Zur symptomatik des mon-
golismus). Moro, Miinchen. med. Wehnschr., 1920, 67, 360.

Data reported elsewhere.—J. K.

(ORGANOTHERAPY) Ductless gland therapy. Masterman-
Wood (J. L.) and Torquay (lL. M.), Practitioner (Lond.),
1919, 102, 259-270.

The author believes firmly in careful clinical experimenta-
tion in opotherapy, in addition to laboratory investigations,

ABSTRACTS 473

and believes that the practicing physician may thus ‘help to
shed lhght on what is yet to be discovered in the domain of
endocrinology.

Taking up hypothyroidism he emphasizes the inability of
the thyroid in this condition to react to iodides or to metabolize
iodides brought to it. This condition frequently follows acute
infections. In the secondary constitutional stage of syphilis,
the thyroid is profoundly depressed and iodides medication is
consequently ineffective until the thyroid has recovered. Ref-
erence is made to the interesting experience of Rendle Short,
who states that he has found thyroid extract quite as effective
as iodide of potassium in healing tertiary syphilis. He there-
fore recommends thyroid extract where iodides fail. Some
toxemias do not inhibit the thyroid, but stimulate it to
inereased activity, as in early tuberculosis. Some of the symp-
toms of tuberculosis are sympatheticotonic and resemble those
of Graves’ disease. The authors suggest that in children, aden-
oids, nocturnal enuresis, slight want of mentai alertness, slug-
gish bodily movements, slightly sleepy appearance of the eyes,
sluggish bowels and foetid stools, and a tendeney to develop
flat foot are sometimes indicative of hypothyroidism and are
markedly relieved by small doses of thyroid extract. <A case
of asthma is cited which was relieved by thyroid extract. An
ingeneous hypothesis is constructed to explain this phenom-
enon.. They believe that the vagus is exerting a preponderant
influence, inducing bronchial spasm and that thyroid extract
stimulates the suprarenals, which in turn stimulate the sym-
pathetic system and overcome the vagus spasm. The wonder-
ful efficiency of adrenalin in attacks of asthma corroborates this
viewpoint. Other cases of sub-thyroidism are cited. in which
administration of thyroid extract was efficacious. They stress
the importance of recognizing mild degrees of thyroid defi-
ciency. The article is suggestive, but not entirely convineing.

—H. L.

ORGAN EXTRACTS. Note on the use of—in place of virulent
blood in immunization and hyper-immunization against rin-
der-pest. Boynton (W. H.), Philippine J. Se. (Manila),
1918, 13, Sect. B, 151-158.

Of no endocrine interest.—F. S. H.

ORGANOTHERAPY in certain diseases of childhood.
McCready (E. B.), Med. Ree. (N. Y.), 1919, 96, 529-532.

A large part of the article is a tribute to Sajous’ doctrines
in the domain of the ductless glands. The rest of the paper

474 ABSTRACTS

contains much of general matter not readily abstacted. The
author concludes that the endocrine glands control metabolism
and preside over growth and development in infancy and
childhood; they are essential to mental, physical and repro-
ductive efficiency in adult life, and they maintain metabolic
balanee in the period of decline. Many diseases and conditions
of childhood are manifestations of organic inferiority in the
etiology of which dysfunction of the endocrine glands is a
more or less prominent and contributing factor. Treatment
directed toward the stimulation, modification or correlation of
the action of the endocrine glands is a promising field of thera-
peutic endeavor, but treatment by organotherapeutic prepara-
tions should be preceded by a careful analysis and evaluation
of the symptoms of endocrinous dysfunction. The usually
employed doses of organic preparations, particularly of thy-
roid, are too large, are administered without due care, often
in unsuitable cases, and tend to discredit a valuable thera-
peutic measure.—H. lL.

(OSTEOMALACIA) Statistical observations on the increases
in rickets and osteomalacia in Berlin (Statistische Bemer-
kungen zur Frage der Rachitiszunahme und des Auftratens
der Kriegsosteomalazie in Bereiche von Gross-Berlin). Engel
(H.), Berlin. klin. Wehnschr., 1920, 57, 35.

Of no immediate endocrine interest. [In the German
literature at the present time are appearing various articles on
osteomalacia, postulating endocrine factors. To forestall lost
effort on the part of those interested, the endocrine bearing ot
each will be indicated.—Ed. |

OVARY, Observations on the follicular atresia in the rabbit.
Asami (G.), Anat. Ree. (Phila.), 1920, 18, 323-343.

In the rabbit atresia has been observed to oceur im the
small as well as in medium and large size follicles. In the case
of the medium and large follicles the primary factor is the
degeneration of the granulosa, while in the early stages of
atresia of small follicles changes occur in the egg as well as
in the granulosa, and of these the changes in the egg are the
more pronounced. These atretic processes do not show any
definite relation to the sexual eyele such as occurs in the
euinea pig. The article is not primarily of endocrine interest,
but attention is drawn to Loeb’s suggestion that the normal
proliferation of the granulosa is probably dependent upon an
internal secretion of the ovum which acts as a growth stimulus.

ABSTRACTS 475

What the primary cause of the observed atretic changes may
be constitutes an interesting question possibly of endocrine
portent.—W. J. A.

(OVARY) Ovarian insufficiency as a probable cause of epilepsy.
Ashe (J. S.), Dublin J. Med. Sce., 1920, 4, 142.

Ashe cites three cases of patients that have been benefited
by ovarian administration. In one following a bilateral tubal
pregnancy, menstruation ceased entirely. Concomitant with
this the subject had what the author designates *‘hystero-
epileptic attacks.’’ Injections of the fresh fluid extract of
ovarian tissue stopped these attacks. Epileptic attacks in an-
other case followed an attack of mumps. Feeding of ovarian
tissue stopped them. In a third case a polyglandular mixture,
including ovarian substance, decreased the attacks. It is sug-
gested that the toxin which serves as a predisposing factor in
certain cases of epilepsy is produced by absence, diminution
or change in the ovarian ferments leading to some polyglan-
dular deficiency. The imbalance thus set up leads to the pro-
duction of toxins which act on the cerebral cortex, causing |
the epileptie seizures.—J. H. L.

OVARY, Precocious puberty due to tumor of the—(Genitalismo
precoz por tumor ovarico). Cortiguera (J.) & Lopez Albo
(W.), Rev. de pediat, 1919, —, —.

A report of a girl of 10 years who had menstruated since
6 years of age. She was born with much hair on her head and
an early development of somatic and mental characteristics
was noted out of proportion to her years. At eight months she
cut her first teeth. Her physical appearance was that of a
person of 20 years (pubic hair, developed mammae with colos-
trum, ete.). Her abdomen was enlarged as if she were in the
sixth month of pregnancy. Palpation gave evidence of a
smooth, spherical and movable tumor underneath the skin. <A
laparotomy was performed and an ovarian tumor found.—E. B.

OVARY, On an anomaly of development of the—in Ascaris
megalocephala (Sur une anomalie du développement de
l’ovarie chez l’Ascaris mégalocephala). Dragoiu (J.) &
Faure-Fremiet (E.), Compt. rend. Soe. de biol. (Paris), 1920,
83, 123-124.

A histological description of the ovaries and genital tract
of a sterile female.—T. C. B.

476 ABSTRACTS

OVARY, Pathological pregnancy and tumors of the—(Patholo-
gische Schwangerschaft und Eierstocksgeschwilste). Fraenk-
el (L.), Berlin. klin. Wehnsehr., 1920, 57, 1-3.

Of no immediate endocrine interest.—J. K.
(OVARY) The time of ovluation (Het tijdstip der ovulatie).

van der Hoeven (P. C. T.), Nederl. Maandschr. v. Geneesk.
(Leiden), 1920, 1, 16-22.

J. K.

Of no endocrine interest.

(OVARY) Rythmical recurrence of the typical oestrus cycle
after ovarian transplantation. Long (J. A.) & Evans (H.
M.), Anat. Ree. (Phila.), 1920, 18, 245.

Suecessful transplantation of the ovaries in the rat has
been accomplished by the authors in 14 instances. In most
successful cases the first interval after the operation was only
slightly longer than the dioestrous interval of normal cycles.
Sections show that such transplanted ovaries are essentially
“normal in containing healthy and atretie follicles, corpora
lutea of several ages, and interstitial tissue—W. J. A.

(PANCREAS) Hemorrhagic pancreatic necrosis and diabetes
with acidosis (Ausgedehnte hamorrhagische Pankreasne-
krose und Diabetes mit Acidose). Caro & Winkler, Deutsch.
Arch. f. klin. med. (Leipzig), 1918, 125, 147-159.

A detailed clinical, post-mortem and histological desecrip-
tion with plate of one case of hemorrhagic necrosis of the pan-
creas accompanied by diabetes with acidosis.—F. 8. H.

(PANCREAS) A consideration of the surgical hazards in dia-
betic patients. Foster (Nelles B.), Ann. Surg. (Phila.),
1920, 71, 382.

This paper is based upon a review of the clinical records of
two good hospitals. Glycosuria is not a reliable guide in the
estimation of the severity of diabetes. The disease, however,
can be diagnosed and its severity estimated by a determination
of the degree of hyperglycemia. Infections tend to increase the
severity of the disturbance of carbohydrate metabolism and,
in that way, to bring about a variable degree of acidosis.
Anesthetics, and especially ether, intensify the disordered proc-
esses. Based upon his experience, it is the author’s opinion
that a ease with a CO, combining power of its plasma of less
than 40 does not present a reasonable margin of safety for

ABSTRACTS 477

surgical procedures. The author outlines his preoperative
treatment and dietetic management of cases of diabetes melli-
tus. The object of this treatment is the restoration of normal
metabolism and its success is measured by the blood sugar and
CO. combining power of the plasma.—J. F.

(PANCREAS) Reply to Albu concerning the diagnosis of pan-
creatic cysts (Bermerkung zu Albu: Zur Diagnostik der Pan-
kreaszysten). Holzknecht (G.) & Jonas (S.), Berl. khn.
Wehnschr., 1918, 55, 582. .

Of technical interest.—F. S. H.

PANCREATIC DIABETES, The pathology of—(Das Wesen
des Pankreasdiabetes). Lesser, Berl. klin. Wehnschr., 1920,
57, 310.

Data reported elsewhere. See Endocrin., 4, 296.—J. K.

(PANCREAS) Some remarks on the blood sugar in diabetes
mellitus. Lindblom (S.), Hygiea (Stockholm), 1919, 81,

oj --

753-759.

In diabetes the ability to regulate the relation between
production and consumption of sugar, so that equilibrium
obtains without glucosuria, is arrested or destroyed. In this
case there must of necessity be a higher blood-sugar content
than is compatible with the kidney permeability, so that the
organs or eventually their centers react with a decreased pro-
duction or an inereased destruction. The hyperglycemia
present in diabetics acts then in opposition to the metabolic
disturbance. Hyperglycemia is then in a certain degree an
advantageous symptom. According to this conception the urine
of many diabetics does not become sugar-free in spite of the
residual hyperglycemia but because of it. The favorable
action of the oat-cure is explained on the basis of the suddenly
increased hyperglycemia.—J. A. H.

PANCREAS and diabetes mellitus, The relation between the—
(Die Besiehungen des Pankreas zum D. m.). Seyfarth,
Deutsche med. Wehnschr. (Berlin), 1920, 46, 589.

The author does not believe that the islands of Langerhans
are special organs related to carbohydrate metabolism. It is
not true that in diabetes only the islets have undergone patho-
logical changes; at least it has never been proved. For the
development of diabetes it is necessary that large parts of the

478 ABSTRACTS

oland be destroyed and that this pathological process proceeds
so rapidly that regeneration is impossible.—J. K.

(PARATHYROID) Parathyroid studies. I. The normal anat-
omy of the parathyroid glands. Bergstrand (H.), Acta.
Med. Seand. (Stockholm), 1919, 52, 791-856.

These studies were made on human material. A follicular
arrangement of the gland cells was found, at times the follicles
being grouped in actual glandular nests with lumena. With
Bielchowski’s stain a hitherto unknown lattice net work was
brought out, the fibrils of which surround the capillaries and
extend out through the follicle, binding together the individual
parenchyma cells. There is only one type of cell present, the
so-called chief cells. The ‘‘achromatic protoplasm’’ of these
cells is an empty space produced by shrinkage. The granules
of the cells are artefacts which have arisen through the pre-
cipitation of the protoplasmic net by fixation. The cells of
Welsh are degenerated chief cells, their eosinophilia is not con-
cerned with granules. However, there are present in these
cells granules of another type, which have been established as
fat granules and unrelated to the colloid formation. The para-
thyroid cells are quite rich in fat granules: the fat is stable,
gives the reactions for neutral fat, and is neutral. The colloid
arises partly through degeneration of the Welsh cells and
partly by secretion from these cells as from the chief cells.
The so-called ‘‘eosin red components’’ are formed of the nor-
mal intercellular secretion. The interstitial tissues contain
large deeply granulated cells with long processes and large
vacuoles. The granules show the same metachromatic prop-
erties as the histogenie mastecells, but give, however, a positive
test with Sechulze’s oxidase reaction in differentiation from the
latter. Perhaps they are identical with Erdheim’s pigment
cells.—J. A. H.

PARATHYROIDS, Therapy of postoperative tetany (Zur Ther-
apie des postoperativer Tetanie). Borchers (E.), Zentralbl. f.
Chir. (Leipzig), 1920, 46, 293-297.

The only treatment of postoperative tetany is transplanta-
tion. Of course, one may see failures, but other treatment has
never succeeded. Especially administration of parathyroids by
mouth has no effect. The best organs for transplantation are
fresh parathyroids from children dying during accouchement.

—J.K.

ABSTRACTS 479

(PARATHYROIDS) On the origin of the muscular tremors,
clonic and tonic spasms in parathyroid tetany. Luckhardt
(A. B.), Sherman (M.) & Serbin (W. B.), Proceedings Am.
Physiol soc, Am: J. Physiol, (Balt-);~ 1920, 51,°187.

Parathyroidectomy was performed in dogs after they had
recovered from transections of the cord at various levels.
Without transection the neuromuscular phenomena are less
severe in the hind limbs than in the fore limbs. With transee-
tion the fibrillary contractions occur posterior to the transec-
tion; may be present in the hind limbs independently of the
fore limbs; may persist in the hind limb when its musculature
is isolated. Clonic spasms persist. Tonic spasms are less
pronounced. There is a great increase in reflex irritability
just prior to and during an attack of tetany, followed by a eor-
responding nervous depression after the attack. Graded doses
of strychnine can produce a condition not to be distinguished
from tetany. Experiments on dogs seem to show that the cere-
bellar are reinforces, but does not initiate the tonic spasms.

—T. C. B.

PINEAL tumor, A case of— (Een geval van gezwel van epi-
physe). Hekman (J.), Med. Tijdschr. v. Geneesk. (Haar-
lem), 1920, 64 (1), 1891-1893.

A girl of 14 years had, when she was 3, fallen from a chair
striking her head on the floor. Of recent vears her sight has
become worse and worse, and she has become very fat. From
time to time she has epileptiform attacks. Menstruation began
at 11. The child is very erotic. There are neurological symp-
toms of an old encephalitis in the neighborhood of the capsula
interna (paresis of left arm and leg with high jerks; Babinski’s
symptom, ete.). Both eyes show an optie neuritis. The fat-
ness, the increased sexuality and the eye symptoms may be
considered as evidence of localization of the etiologic process
in the pineal gland.—J. K.

(PITUITARY) Demonstration of an apparent one-sided acro-
megaly (Demonstration einer schienbar halbseitige Akrome-
galie). Biedl (A.), Wien. klin. Welinschr., 1918, 31, 487-488 ;
Med. Klin. (Berlin.), 1918, 14, 577-579.

A description of a case of one-sided acromegaly presented
before the scientific association of German physicians in Bo-
hemia. The acromegalic phenomena were exhibited on the left
side in all their usual distinetiveness. No enlarged sella tureica
was observed under x-ray examination. The anamnesis

480 ABSTRACTS

records a gradual enlargement of the left arm beginning in
the fourth year. The existing complaint was sudden loss of
vision, pain in legs, fever, and anuria, which were regarded
as due to acute meningeal or cerebral disturbance. No satis-
factory explanation of the unilateral growth is given.—F. S. H.

(PITUITRIN) Labor with special reference to pituitrin, mor-
phine and instruments. Harrison (A. G.), J. Arkansas M.
Soe. (Little Rock), 1918, 14, 211-212.

Cautions against the indiscriminate use of pitwitrin in
labor.—F. S. H.

(PLACENTA OVARY) Substances that increase the growth of
the sexual organs (Ueber Substanzen die das Wachstum des
Genitale wirksam anregen). Schroeder, Deutsche med.
Wehnschr. (Berlin), 1920, 46, 417-418

The opinion is expressed that infantilism in women is
eaused by hypofunetion of the ovaries. The author tried the
influence of extracts of various organs on the genitalia. From
an ether-acetone-alecohol extract of the placenta he obtained
a cholesterin-like substance which when injected daily into
young rabbits in doses of from 0.3 to 0.5 grams caused hyper-
trophy of the muscles and mucous membrane of the vagina and
uterus. The influence of the ovaries and fallopian tubes was
sight. When the same procedure was carried out with males
the utriculus maseulinus responded by hypertrophy, while the
effect upon the epidydimus and penis was neghgible. The ex-
tracts seem to be effective even when diluted to one-fiftieth.
Extracts from other organs were tried but, with the exception
of the liver, gave uniformly negative results. Commercial prep-
arations of the ovary were without effec

POLYGLANDULAR DISORDER (Pluriglandulaire Erkran-
kung). Pribram, Deutsche med. Wehnschr. (Berlin), 1920,
46, 424.

A demonstration of a 26-year-old girl who had complained
for three years of headache, goitre, and cessation of menstrua-
tion. Two years previously strabismus set in with diplopia.
The fingers became thicker. A strumectomy was performed.
At present there is hemianopsia, insufficient power of renal con-
centration, an enlarged sella turcica, claw-like hands and hypo-
plasia of the genitals. After the removal of an adenoma of the
hypophysis the eye symptoms improved, but diabetes devel-
oped. This case is characterized as a diseased condition of the
thyroid, hypophysis, pancreas, and ovaries.—J. K.

ABSTRACTS 481

(PROSTATE) The action of prostatic extracts on isolated gen-
ito-urinary organs. Macht (David I.) & Matsumoto (S.),
Proe. Soe. Exper. Biol. & Med. (N. Y.), 1920, 17, 102-103.

The action of prostatic extracts on the contractions and
tonicity of uterus, fallopian tube, bladder, vas deferens and
seminal vesicle was studied in vitro. Extracts were made from
ram’s, dog’s, bull’s, steer’s and human prostates. All the
tissues mentioned were stimulated, the uterus and fallopian
tube with least quantities, bladder and uterus, next, and vas
deferens and seminal vesicles requiring the largest amounts.
It was concluded that prostatic extracts have no specific or
marked influence on the tonus and contractions of the blad-
der.—at least, under the conditions of the experiments re-
ported. A more extensive report is to appear in the Journal
of Urology.—R. G. H.

PROSTATE, The action of extracts of the—on the isolated
genito-urinary organs. Macht (D.I.) & Matsumoto (M.),
Proc. Am. Physiol. Soc., Am. J. Physiol. (Balt.), 1920, 51, 203.

The uterus, fallopian tube, bladder, ureter, vas deferens
and seminal vesicle are all stimulated in vitro by aqueous ex-
tracts of mammalian prostate, including the human. Different
organs require different doses. The conclusion is that pros-
tatie extracts can not be regarded as having any specifie influ-
ence in vitro on the tonus and contractions of the bladder.

=" ‘CBt

PUBERTY (La pubertad). Blane Fortacin (J.), Soc. Espan. de
Obst. y Ginec., 1919, ——,

Puberty is considered in its physiology and its pathology
as an endocrine event in which the secretions of the genital
glands, the hypophysis, the thyroid and the suprarenals take
part as excitants of the sexual development while the thymus
and the pineal act as inhibitors. The harmonious action, reac-
tion and interaction of the endocrine system determines the
successful pubertal development; a disturbance in the balance
results in the evolution of a pathological condition.—E. B.

(SPASMOPHILIA) Case of spasmophilic diathesis, with some
remarks on the types of convulsions occurring during the
suckling period. Wirseen (J.), Hygiea (Stockholm), 1919,
$1, 992-997.— J. A. H.

482 ABSTRACTS

(TESTIS) Spondylitis rhyzomelica (of Marie-Strumpell).

Hertzberger (l.), Inaug. Dessertation, Amsterdam, 1920.

The author considers ‘‘spondylitis rhizoméliqne’’ as due
to gonadal dysfunction. It is much more frequent in men than
in women. The subjects are nearly always sterile. In some
respects the disease resembles osteomalacia but differs among
other ways in that it is characterized by high calcium content
of the bones. Osteomalacia is often seen in localities where
Graves’ disease is common, whereas, in Holland the spondylitis
is rather frequently seen in the Friesland district, where
myxedema is the common thyroid disorder. In spondylitis
rhyzomélique, the administration of ovarian preparations leads
to marked augmentation of excreted phosphates and urates.
The thesis is further supported by the arguments that the sex-
elands are known to have an important relationship to osteo-
venesis and that in the subjects of this malady a history of
eonorrhea is often obtainable —J. K.

(TESTIS) Induced testicular degeneration and accompanying
hypertrophy of the interstitial tissue. Kuntz (A.), Anat.
Ree) (Philas)s 1920516, 137.

Experimental evidence is presented to show that hyper-
trophy of the interstitial tissue in the testis occurs more
promptly as an accompaniment of degeneration of the seminal
epithelium than as a compensation process. In the series of
operated dogs reported bilateral degeneration of the testis
followed unilateral vasectomy with occlusion of the duct. In
unilateral castration the testis on the unoperated side showed
no evidence of degeneration.—W. J. A.

(TESTICLE) Myoteonische Dystrophie. Minkowski, Berl. klin.
Wehnschr., 1920, 57, 234.

Dystrophie myotonica is a polyglandular disease. The au-
thor demonstrated a case with cataract and atrophy of the tes-
ticles.—J. K.

TESTICLE, Tissues of the—and avitaminosis (Tessuto testi-
culare ed avitaminosi). Novaro (P.), Gazetta degh Ospedali
(Milano), 1920, 41, 424.

The author observed that pigeons fed on a diet without
vitamine B show degeneration of the epithelium of the tubuli
testiculari and a hypertrophy and hyperplasia of the intersti-
tial cells.—J. K.

ABSTRACTS 483

THYMUS hyperplasia in children, Clinical study and treatment
of—(Beitrage zur Klinik und Behandlung der Thymushyper-
plasie bei Kindern). Birh (W.), Monatschr. f. Kinderheilk.,
1918, 14, 363.

Birh reiterates the clear distinction between the symptom-
complex of status lymphaticus and simple thymus hypertrophy.
In the latter condition there is an isolated enlargement of the
thymus dating back to fetal life, and here death comes from
suffocation from pressure of the thymus on the trachea in a
congenitally predisposed child ; in such cases radiotherapy gives
the best therapeutic results. In five cases reported by the
writer there was rapid cure, from a clinical standpoint, with a
gradual diminution of the gland itself as shown by radio-
graphic examination. One of these cases showed a recurrence,
but the others were followed to the fifth year of life, and
showed a definite cure. The diagnosis of thymie hyperplasia
is based upon a cardinal triad of symptoms; stridor, increased
thymic dullness and radiographie evidence of enlargement.
Other signs are attacks of asphyxia, dysphagia and, especially,
lymphocytosis.—W. H. D.

Enlarged THYMUS gland in childhood. Brayton (H. W.),
Proc. Connecticut M. Soc. (New Haven), 1918, 126, 117-127.

This paper presents in a brief manner seven case reports in
which enlarged thymus was diagnosed by x-ray examination.
Three of the children died before radium therapy could be
initiated; the remaining four responded satisfactorily to the
treatment, and later x-ray pictures demonstrated reduction of
the enlarged gland.—F. S. H.

(THYMUS) Thymic asthma in infants (L’asthme thymique
chez les enfants). Exchaquet (L.), Rev. méd. de la Suisse
Rom. (Geneva), 1918, 38, 403-404.

E. considers that Paltauf’s theory of the status thymo-
lymphaticus is not supported by the faets and that from his
own observations the mechanical action of a hyperplastic thy-
mus is sufficient to explain the syndrome. He divides the cases
into two categories: the one consists of individuals from 6 days
to 14 months old, who are continually bothered with respira-
tory difficulties; the other group comprises those children in
whom crises of suffocation occur while they apparently are in
good health. Diagnosis is sometimes uncertain but ean ordi-
narily be arrived at by exclusion. Radio-therapy lasting from
two weeks to six months proved uniformly suecessful. The

484 ABSTRACTS

report is followed by a brief discussion of thymus size and
treatment.—I’. 8S. H.

(THYMUS) Studies on acute leucemia. Lindblom (0O.),
Svenska. Likaresillsk. Handl., 1919, 45, 83-338.

It is of particular endocrine interest that the author found
thymus alterations not only in the cases of lymphatic leucemia
but also in several of the myeloid types. In 5 eases of the latter
type myeloid inclusions, mainly of a perivascular type, were
encountered.—J. A. H.

THYMUS, Changes in the—of children following different in-
fectious diseases (Veranderungen der Thymusdrise der Kin-
der bei verschiedenen Infektions-Krankheiten). Takeuchi
(K.), Fukuoka-Ikwadaigaku-Zasshi, 1919, 12, 25.

The author has made a study of the changes in the thymus
gland in different infectious diseases, including ‘‘ Ekiri,’’ dys-
entery, simple enteritis, diphtheria, septicaemia, pneumonia
and tuberculosis. Altogether he has collected 252 cases of
which 162 were examined microscopically as well as macroscop-
ically. He coneludes that the chief changes are degenerative
and destructive. He noted marked destruction of the so-called
small thymus cells of the cortex and medulla, enlargement and
phagocytosis of the reticulum cells of the cortex, and degen-
erative enlargement of the Hassall’s corpuscles. In consequence
of these regressive processes it is possible to recognize a pri-
mary increase and secondary atrophy of the parenchyma, an
initial increase and subsequent decrease in the eosinophile cells,
followed by an increase in the interstitial tissue. The regres-
sive processes increase in proportion to the duration of the
illness, reach a maximum between the 2nd and 4th days, and
then gradually slacken. In the most acute infections, such as
‘*Ekiri,’’ dysentery and diphtheria, destruction is most appar-
ent, while in the more chronic conditions there is more atrophy.

—KE. V. C.

((THYROID) The causative factors of hematocele of the thy-
roid gland. Anon., Med. Ree. (N. Y.), 1919, 95, 198-199.

The editor discusses the mechanism in formation of thyroid
hematocele, and considers it comparable to a pelvic hematocele
only that purulent transformation is much more frequent in
the former. —H. L.

ABSTRACTS 485

(THYROID) The physiological action of the proteinogenous
amines, III. The infiuence of the proteinogenous amines,
phenyl-and p-oxyphenylethyl amine on the carbohydrate
metabolism of the liver (Beitrage zur Kenntniss der physio-
logischen Wirkung der proteinogenen Amine. III. tiber den
Kinfiuss der proteinogenen Amine, Phenyl-und p-Oxyphenyle-
thylamine auf den Kohlenhydratstoffwechsel der Leber).
Abelin (J.), and Jaffee (1), Biochem. Ztschr. (Berlin), 1920,
102, 39-57.

The subcutaneous injection and feeding of phenylethyla-
mine and tyramine raise the catabolic processes of white rats
and cause a lowering of the glycogen content of the liver. In
view of the results on the gas exchange under similar condi-
tions, it is concluded that this increased carbohydrate oxida-
tion is related to a glycogen destruction in the liver. Since
the injection of these amines and the feeding of the active sub-
stances of the thyroid lower the glycogen content of the liver
and the animals remain alive, these compounds ean be used to
get this organ of the rat glycogen free.—F. S. H.

(THYROID) The physiological action of the proteinogenous
amines. IV. Influence of di-iodo tyramine and tyramine on
the development of frog larvae (Beitrage zur Kenntniss der
vhysiologischen Wirkung der proteinogenen Amine. IV.
Einfluss von Dijodtryamin und Tyramin auf die Entwick-
lung von Froschlarven). Abelin (J.), Biochem. Ztschr. (Ber-
lin), 1920, 102, 58-88.

Tyramine usually acts as accelerating agent for frog larva
metamorphosis. This action is greatly inereased if iodine is
attached to the tyramine molecule, and is similar to that ob-
tained when thyroid feeding is tried. The thyroid acts to
increase disassimilation in that growth is retarded and meto-
morphosis accelerated. Di-iodotyramine gives this effect only
on larva of a certain age, since young tadpoles are mainly
inhibited in growth. Feeding with KI or iodo-lipoids had no
accelerating effect on the metamorphosis of either young or
older larva. Phenylethylamine in weak concentrations acts as
a narcotic and shows itself to be a strong local anesthetic. [Cf.
Swingle, Endocrin. 3, 114-115.].—F. S. H.

(THYROID PARATHYROID) Strumipriva tetanie. Arnstein
(A.), Deutsche med. Wehnschr. (Berlin), 1920, 46, 224.

A demonstration of a woman of 54 years with sclerotic
symptoms in muscles and connective tissues, who had a goiter

486 ABSTRACTS

for 25 years. Four days after the removal of the goiter tetany
developed in its classical form.—J. K.

(THYROID) Murillo’s method for the evalution of antithyroid
serum (Acerca del mitodo de Murillo para la valoracion del
suero antitiroideo). Banus (J. 8.), Siglo Méd. (Madrid),
1919, 66, 668-671.

Murillo’s method is based on the effects by which the
antithyroid serum raises the resistance of guinea-pigs to the
amount of diphtheria toxins necessary to produce death within
twenty-four hours. Autopsy has shown the inhibition of the
adrenal defensive mechanism. The author describes a series
of experiments which showed the role played by the thyroid in
the antitoxic defense against cocaine, which is taken as further
proof in the confirmation of the defensive function of the gland.

—K. B.

Vital THYROID-PARATHYROID activities. Ball (C. F.),
Vermont Med. (Rutland), 1918, 3, 17-20; 33-37.

A review—F'. S. H.

(THYROID) Creatine and creatinine metabolism in myxoe-
dema and the effect of the administration of thyroidin upon
it (Kreatin-kreatininstoffwechsel bei Myxoedem und unter
Einwirkung von Thyroidin). Beumer (Hans), & Tseke (C.),
Berlin klin. Wehnsehr., 1920, 57, 178-179.

A patient of 13 years with myxoedema was treated with
thyroidin and the creatinine metabolism studied. Large
amounts of creatine were excreted but no changes were ob-
served in the creatinine output. In normal individuals the
same reaction is obtained after the administration of thyroidin,
although it is less intense. The reaction in myxoedema may
be explained on the basis of an increased destruction of pro-
teins under the influence of the thyroidin.—J. K.

THYROID intoxication, Observations on—. Blackford (J. M.),
Northwest Med. (Seattle), 1919, 18, 199-201.

The author studied 74 exopthalmie goitre autopsies. All
subjects under 40 years were found to have persistent thy-
muses of varying size. One-half of those over 40 had a large
thymus and one-half no thymus at all. From these facts Blaek-
ford formulates the following deductions: 1, the thymus plays
no causative role in exopthalmic goitre because half of the

ABSTRACTS 487

older people died of that disease but had no thymus; 2, the

thymus may exert a protective influence in exopthalmie goitre.
These conclusions would be difficult to reconcile with the ob-
servations in cases of exopthalmiec goitre which have been im-
proved or cured by thymectomy. From a clinical standpoint,
study of histories and autopsies suggest that if a patient with
exopthalmie goitre lives one year after the inception of symp-
toms, he probably will not die from the disease before ten years.
have passed, and if then, usually from cardiac degeneration.
No case of exopthalmie goitre showed active tuberculosis. No
case of thyroid carcinoma was observed developing from exop-
thalmie goitre. About nine months after inception of symp-

toms most patients become suddenly very much worse. OneEt
tion at this time is accompanied by a very high mortality—25
per cent—and henee is contraindicated. Sometimes the patient
without surgical treatment dies, but usually medical measures
serve to tide them over this acute period. The author believes
that x-ray, bromide, ergot, quinine, cold, ete., are of no benefit ;

that basal metabolism has been decreased only by rest and by
operative reduction of the amount of functionating thyroid
tissue. ‘‘In other words, exopthalmiec goitre is a medical dis-

ease only until the patient is known to be in condition for
operation; then operation should always be undertaken.’’
[Many internists will disagree with the last pronouncement. |

Many thymuses were found at autopsy in cases in which ex-
cellent stereoscopic x-ray pictures failed to reveal the gland,—
even on review of plates after the autopsies. Thyrotoxie ade-
nomata have been proven toxic by basal metabolism studies
aside from clinical observation, and by striking improvement
following operation, but they have no characteristic pathology.

The author refers to the extraordinary. power of Kendall’s
thyroxin in accelerating metabolism. He has shown that in

heart block thyroxin will increase the ventricular rate, proving
that it has a direct effect on cardiac tissue, and further empha-
sizing the relation of thyroid intoxication to cardiac degenera-

tion.—H. L.

(THYROID) Blood picture in hyperthyreosis and goiter (Blut-
befunde bei Hyperthyreose und Struma). Blank (G.),
Deutsch. Arch. f. klin. Med. (Leipzig), 1920, 132, 16-34.

The diagnosis of Graves’ disease may be very simple, but
in cases where certain characteristic symptoms are absent it
may be extremely difficult. Kocher has reported that in
Graves’ disease the white corpuscles are diminished; that there
is a neutrophil leucopenia with a relative or absolute lympho-

488 ABSTRACTS

eytosis. Many authors have been unable to confirm these
findings as typical of the disorder. Blank has carefully exam-
ined the blood in many eases of hyperthyreosis and goiter.
He concludes that many contradictions in the hterature may
be explained as due to faulty diagnosis or bad technic in exam-
ining the blood. In Graves’ disease the blood picture changes
incessantly. In 30 per cent of the cases poikilocytosis was ob-
served; in 50 per cent of such cases, and also of goiter, poly-
chromatophilia was found. Basophile stippling of the red ecor-
puseles proved extremely common in both conditions seen in
approximately 75 per cent. The number of blood platelets was
diminished in 43 per cent of the classical cases of Graves’ dis-
ease; in the formes frustes and in simple goiter this was never
observed. In only 23 per cent of the classical cases of Graves’
disease was the quantity of hemoglobin normal. In the others
it was sometimes diminished, but is also often increased. In
hyperthyreosis and in goiter the number of red corpuscles was
normal. The color index in Graves’ disease was sometimes
high. It was found that neutrophilie leucopenia may be ob-
served just as often in Graves’ disease as in simple goiter.
The number of eosinophilic leucocytes in both conditions was
normal. Inerease of the number of large mononuclear leuco-
cytes was more frequently seen in the classical Graves’ disease
than in other diseases of the thyroid. In half the number of all
diseases of the thyroid the number of lymphocytes was normal.
In the remainder it was either increased or diminished. From
these facts it may be concluded that the blood picture of

Kocher has no diagnostic value m diseases of the thyroid.
—ZJ. K.

(THYROID) Loss of flesh in women during the war (L’amai-
gressement des femmes au cours de la guerre). Blum (P.),
Prog. Méd. (Paris), 1918, 33, 15.

Having eliminated from consideration those women whose
loss of weight during the war was attributable to abnormal
diet or tuberculosis, B. noticed that the greater number of
those losing weight had the symptoms of thyroidism more or
less complete. Four eases are reported as examples. The phe-
nomenon is considered the effect and not the cause of the trou-
bles, the causative factor in B.’s opinion lying in the sympa-
thetic system.—F. 8. H.

(THYROID) Basdowian psychosis (Psicosis basedowiana).
Brabo (K.), Gae. med. Castellana, 1919, ——-, ——.

A well studied ease of hyperthyroidism accompanied by

ABSTRACTS 489

mental confusion. The patient was much improved by anti-
thyroid treatment.—E. B.

(THYROID) Cardio-thyroid syndromes (Sindromes cardio-
tiroideos). Canizo (A.), Siglo Médico (Madrid), 1919, 66,
Si, 130.

The author reports two cases of hyperthyroidism with the
ordinary symptomatology of that disorder but with, in addi-
tion, predominating circulatory disturbances. The first patient
had had a very light attack of ‘‘grippe.’’ The second was a
typical case of ‘‘Kropfherz.’’ The patient had a persistent
goiter which enlarged with each successive pregnancy, but
diminished in the interim. She had had ten children. During
the last pregnancy, following a great grief, the goiter, which
had previously continued as the simple type, became hyper-
plastic, giving rise to the typical Graves’ tetrad of symptoms.
Only the cardiac conditions need be mentioned. By percussion
and radiography, the cardiac area was found to extend to the
sixth intercostal space, and laterally, to the mammillary line.
Upon auscultation the tones in the mitral area were weak but
in the aortic area somewhat resonant. ~ The pulse,—100 beats
per minute,—was small and compressible. There were irreeu-
larity and perpetual arrhythmia. In view of the fact that
there was no history of antecedent infection or toxicosis, the
author reasonably concludes that the ecardiopathy is to be
aseribed to the goiter.

In goiter two classes of cardiae disturbances are encoun-
tered, those due to the mechanical effects of the thyroid tumor
and those due to thyrogeniec toxins. Both Cafizo’s eases were
undoubtedly of the latter class. Various theories as to the
mechanism whereby the cardiopathy is produced in such cases
have been offered. Canizo leans toward the idea that the con-
tinuous tachyeardia with which the patients have to contend,—
a condition which, in the hyperirritable state of the patients
is readily evoked and continued by such causes as emotions,
pregnancy, ete., keeps the muscle fibres over-active and with-
out the normal rest period of ordinary diastole. This ulti-
mately leads to nutritive failure and degeneration of the fibres,
with consequent dilatation of the heart.—FE. B.

THYROID activity, Some conditions affecting—. Cannon (W.
B.) & Smith (P. E.), Proce. Soc. Exper. Biol. & Med. (N. be i
1920, 17, 88-89.

See Endoerin, 4, 386.

490 ABSTRACTS

(THYROID) Two cases of interest in relation to the function
of the thyroid. .Carmichael (F. A.), J. Kansas M. Soe. (To-
peka), 1918, 18, 83-85.

A report of two patients, each of whom showed a different
degenerative process affecting the thyroid. The first was a
case of calcareous degeneration of the thyroid in a cretin. On
palpation the gland appeared slightly enlarged, somewhat in-
durated and irregular in outline. On removal the gland was
found to weigh 105 grams and to contain numerous calcareous
deposits varying in size from very small to that of a large
bean. <A rather complete histo-pathological report is given.

The second case was one of benign or slow-growing malig-
naney. No detailed description is given.—F. 8. H.

THYROID, Surgical treatment of Exopthalmic Goitre. Crile
(G. W.). Surg. Gynec. & Obst. (Chicago), 1920, 30, 27.

Previously published in abstract. See Endocrin, 4, 163.

(THYROID) Treatment of myxoedema by transplanting por-
tions of a hyperplastic gland. Dowd (C. N.), Ann. Surg.
(Phita.), 1920971; 518:

The transplants were placed in the cancellous tissue of
the head of the left tibia, in the preperitoneal tissue beneath
the rectus abdominis, and in front of the rectus. Fifteen small
punctures were made in other parts of the abdominal wall and
little fragments of the gland were inserted. Marked improve-
ment in the patient’s condition is reported. After five months,
dessicated thyroid was prescribed, however, as a precaution,
for the patient’s improvement was really remarkable—J. F.

(THYROID-PARATHYROID) The influence of thyro-parathy-
roidectomy in the dog on the formation of natural antibodies
and amount of heterohemolytic power of serum [Sur 1’infiu-
ence de la thyro-parathyroidectomie (chez le chien) ; sur la
formation d’anticorps naturels; dosage du pouvoir hétérohé-
molytique du serum]. Garibaldi (A.), Compt. rend. Soe. de
biok:, (Baris), 1920-83: 9251-252:

In a former communication (See Endoerin 4, 330), Gari-
baldi has shown that thyroidectomy favors the formation of
immune antibodies in the rabbit. This raises the question of
the regulatory role of the endocrine glands on the activity of
the ‘‘antigenie organs.’’ If this function exists, it is difficult
to understand the results of Mlle. Fassin and Marbe, who
found a diminution of natural heterohemolytie power after thy-

ABSTRACTS 491

ro-parathyroidectomy, while Frouin obtained a contrary re-
sult. The present note records the author’s observations upon
the effect of thyro-parathyroidectomy on the natural hetero-
hemolytie properties of dog serum. Protocols are given and
the conclusion drawn that in the dog, thyro-parathyroidectomy
increases the natural heterohemolytic power of the serum. The
suggestion is made that the thyroids and parathyroids may
play some role in blood regeneration. [See also Koopman,
Hndocrin. 3, 318-320].—T. C. B.

(THYROID) Endemic goiter and cretinism in the high valleys
of Alberche and Tormes (Sobre un foco de bocio y cretinismo
endemico en los valles altos del Alberche y el Tormes). Goy-
anes, Siglo Méd. (Madrid), 1918, 65, (2) 43; 85; 162; 182.

This is the first study of importance of the geographic dis-
tribution of endemic goiter and eretinism in Spain. Bircher
supposed that these conditions arise only on lands that are
marine sediments, and particularly on the marine deposits of
the lands corresponding to the primary palaeozoic, triassic and
tertiary periods. The observations of Goyanes in the valleys
of Tormes and Alberche make possible the affirmation that for-
mations of the archaiac group, granite, gneiss and crystalline
deposits, are also sources of endemic struma. It is evident
that water is one of the most important agents in the trans-
mission of the supposed living cause of goiter. The theory that
there are in the drinking water certain dissolved chemical sub-
stances such as calcium, magnesium, iron, ete., that determine
the origin of endemic goiter is discredited. The studies of
Marine and Lenhard and of Gaylor explain the appearance of
endemic goiter on the basis of a living organism since they
have observed in the affected regions the presence of hyper-
trophied thyroids in certain fish, as the trout. Goyanes could
not find such conditions in the trout he studied. The experi-
ments of McCarrison are cited, on the production of experi-
mental goiter in man, and of its intestinal origin. <A study of
the dates in connection with the production of goiter seems to
show that the water is not the only medium of contagion. The
author’s conclusions are as follows: Endemic goiter and ere-
tinism appear to be diseases of infectious origin the source of
which, however, is not known; cretinism is the result of a con-
genital hypofunctioning thyroid; it cannot be denied but must
be affirmed that the transmission of the infectious agent from
mother to child determines the congenital goiter and cretinism:
sporadic goiter is also an infectious disease. Some infections
produce thyroiditis similar to goiter (Chagas disease) ; the in-

492 ABSTRACTS

fectious agent may invade the body through the bite of an
insect; it is possible that the germ resides in the soil, by prefer-
ence in those in which the organic material in decomposition 1s
more abundant, but no statement can be definitely made that it
is determined by any particular gedlogical formation. It can-
not be denied that water may be a medium of transmission
and it is very probable that the endemic spreads by immediate
contagion and mediation in the living; the strumous infection
if not congenital at least appears very early in life; the intes-
tinal localization of the organism is probable but not demon-
strated.—E. B.

(THYROID) Some observations on goiter. Hawks (J. K. P.),
Illinois M. J. (Chicago), 1918, 33, 221-224.

An expression of the theory that the cause of the preva-
lence of goiter in the middle West is due to the drinking of
the subterranean water of the glacial drift, which is analagous
in its composition to the glacial waters of Switzerland, where
goiter is so prevalent. Hawks considers that practically all
eoiters are surgical, and should receive early operative treat-
ment.—F. 8. H.

Reinforcing THYROID extract. Harrower ae R.), South
Calif. Pract. (Los Angeles), 1918, 33, 39-40.

On the basis of the hypothesis that hypothyroidism means
sub-oxidation: sub-oxidation means toxemia: toxemia means
hypoalkalinity, and hypoalkalinity means demineralization, H.
reinforces thyroid extract with a combination of salts closely
following the salt composition of the blood. Treatment con-
sists In giving 14 er. to % gr. U.S, P. thyroid t. 1. d. and 5 grs.
of the salt mixture at the same time.—F. S. H.

THYROID function, Clinical results with a method of test-
ingo—. Harrower (H. R.), Med. Ree. (N. Y.), 1919, 96, 722-

720.

Reference again to the author’s thyroid function test orig-
inally published in the Medical Record, August 3, 1918. This
consists in the administration by mouth of four doses each 14,
1 and 2 grains of thyroid on three successive days, recording
the pulse rate at regular intervals during this time, and noting
symptoms such as irritability, twitching, breathlessness, ete.
It is recommended by the author as a simple method of differ-
entiating between hypo- and hyper-thyroidism. [The accuracy
of such a test is open to question. A careful history and thor-

ABSTRACTS 493

ough clinical examination would probably reveal more informa-
tion, and if more precise studies were indicated, a Goetsch test
or basal metabolism estimation would be preferred ].—H. L.

THYROID hyperplasia and the relation of iodine to the hair-
less pig malady. I. Hart (E. B.) & Steenbock (H.), J. Biol.
Chem. (Balt.), 1918, 33, 313-323.

In an extended study of the hairless pig malady which
occasions so much economic loss among the hog-raisers of
Wisconsin, Hart and Steenbock have obtained evidence sup-
porting the view that the disease is caused by a low iodine
assimilation by either intestine or thyroid, resulting in a goi-
trous condition of both mother and young. This condition
apparently interferes to a greater extent with the fetal devel-
opment than with the normal maintenance of the mother.

When young sows are fed high-protein-level rations which
have low laxative effects, and have accompanying conditions
of lack of exercise and unclean surroundings, they are prone
to develop thyroid enlargements. This is not so prevalent
among the older sows. It is considered possible that some
rations are so low in iodine as to make the searcity of this
element the direct cause. However, the authors state that the
stage has not yet been reached when it is wise to advocate the
general use of iodine in the feed of all brood-sows. But they do
consider that in regions and on farms where hairless pig pro-
duetion is endemic or persistent in character the direct use of
iodides should be made. [See also Smith, Endoecrin. 3, 262-
272|.—F¥. S. H.

Surgery of the THYROID. Haskins (J. B.), J. Tenn. State M.
Ass. (Nashville), 1918, 11, 91-96.

Sars balls I

Of surgical interest, mainly.

(THYROID) The question of iodine combination in the thyroid
(Zur Frage der Jodbindung in der Schildriise). Herzfeld
(E.) & Klinger (R.), Biochem. Ztschr. (Berl.), 1919, 96, 260-
268.

When the tissue liquid is squeezed from pig thyroids and
varrous iodine solutions are added thereto a certain amount of
the element combines with substances in the extract. The re-
sults of these studies seem to indicate that the iodine in the
thyroid is not only combined with the decomposition products
of the protein surface, but is also in large part ‘‘built into’’ the
cell protein. The authors conclude that these observations

494 ABSTRACTS

speak against the conception that the iodine is an actual part
of the thyroid secretion.—F. 8. H.

(THYROID) Chemical studies of the physiology and pathology
of the thyroid gland (Chemische Studien zur Physiologie und
Pathologie der Schildrise). Herzfeld (E.) & Klinger (R.),
Miinch. med. Wehnschr. (Munich), 1918-19, 65, 647-651.

From the results of their studies on the effects of thy-
roidectomy the authors come to the conclusion that the thyroid
secretion is not a protein complex, but is a dialysable split
product. They consider that iodine is not an actual constituent
of the secretion, but are of the opinion that its role is that of
stimulating the formation of the secretion.—F. 8. H.

(THYROID) Case of tertiary luetic thyroiditis accompanied
by a high-grade laryngeal stenosis. Hceggstrom (A.) & Berg-
strand (H.), Acta oto-laryngolog. (Stockholm), 1920, 2, 207-
PE

Hoarseness, air hunger, difficulty in swallowing, and eya-
nosis were present in a patient 41 years old. A tumor arising
from the thyroid surrounded the larynx and trachea. Trache-
otomy was performed on account of oedema of the glottis and
suffocation. The Wassermann reaction was positive. Mercury
treatment resulted in improvement, but this failed to last, and
death ensued from suffocation about six months after the first
appearance of the symptoms. Histological examination of the
thyroid showed both interstitial and parenchymatous altera-
tions. Each was a combination of gumma formation and inter-
stitial chronic fibroplastie inflammation. A high grade of sym-
pathetic involvement was also evident in the surrounding
tissues. The parenchymatous alterations consisted in a pro-
liferation of the thyroid follicles, which were entirely similar
to those present in Basedow’s disease. The panenchyma still
present in traces in the gummatous necrosis was, however, of
normal structure. This circumstance, taken with regard to
the rest of the normal colloid, speaks for the idea that the pro-
liferation of the follicles was of recent date, and a consequence

of the action of the infectious agent.—J. A. H.

(THYROID) Goiter: Its early diagnosis and treatment. - Hol-
land (J. W.), Bull. Univ. Maryland School Med. (Balt.),
1918-19, 3, 183-194.

A general presentation of the classification, causes, symp-
toms and treatment of goiter with clinical records of four eases,
presenting no new data.—F. S. H.

ABSTRACTS 495

(THYROID) Esophageal obstruction due to accessory thyroid.
Hopkins (F. E.), Ann. Otol. Rhinol. & Laryngol. (St. Louis),
1918, 27, 1258-1260.

Report of a case.—F. S. H.

THYROID response to overstrain. Hoxie (G. H.), Med. Her-
ald (St. Joseph); 1920, 39, 19-20.

The author cites the literature to show the tendency to
consider thyroid hypertrophy as a reaction to adreninemia, to
toxemia or to fatigue. He cites the experience of the troops
in France as proof that the symptoms of hyperthyroidism may
be simply such an attempt on the part of the body to maintain
its chemical equilibrium. In brief, his experience was that
soldiers came back to the base hospital after exhausting battles,
with exposure to gas and infectious disease, showing a low
blood pressure, dilated heart, and similar signs of exhaustion.
The blood pressure would gradually rise until it reached 160
mm. With this increase in pressure was urinary urgency,
tremor, heightened reflexes, and an increase in the size of the
thyroid. In other words, in this stage the men presented the
picture of Graves’ disease.—Author’s Abst.

(THYROID) Clinical data on goiter. Jones (E. G.), South. M.
J. (Birmingham, Ala.), 1918, 11, 682-685.

No new data—F. S. H.

(THYROID) An unusual case of cretinism. Kerley (C. G.),
Arch. Pediat. (N. Y.), 1919, 36, 465-468.

This is the report of a case of a girl eight and a half years
old, who displayed typical symptoms of ecretinism when first
seen by the author. Continual treatment for one year with
thyroid extract 0.5-1.0 grain twice daily gave an increase of
6°% inches in height and of 834 pounds in weight, and also pro-
duced an appearance of normality. The case was reported be-
eause of the unusually good results obtained in one year’s
time, and despite its beginning at a relatively late age.

—M. B. G.

THYROID in uterine hemorrhage. Klass (O. C.), J. Oklahoma
M. Ass. (Muskogee), 1918, 11, 125-128.

A partial review of the literature and brief description of
the favorable results obtained with personal cases of uterine
hemorrhage by the use of thyroid extract. No details are
given.—F. S. H.

496 ABSTRACTS

(THYROID) Thyreohypoplasia congenita. Kasten, Med. Klin.
(Berlin), 1918, 14, 503; Deutsche med. Wehnschr., 1918, 44,

Dou.

A demonstration of a 7-year-old girl presenting the class-
ical symptoms of a hypoplastic thyroid.—F. S. H.

(THYROID) Acute strumitis (Akuten Entzindungen des
Kropfes). Klose (Heinrich), Berlin. klin Wehnsehr., 1920,
57, 202.

A general review.—J. K.

(THYROID) Further course of the earlier described cases of
retarded muscle contraction [Weiterer Verlauf der friher
vorgestellten Falle von verlangsamter Muskelkontraktion
(Myxddem)]. Kramer, Berl. klin. Wehnschr., 1918, 55, 989.

Three cases of retarded muscle activity were diagnosed as
of hypothyroid etiology and thyroidin therapy initiated. The
results in all three patients were good. There was increase in
weight, decrease in lassitude, and a psychic rehabilitation.
The muscular retardation has entirely disappeared and the re-
flexes have become normal.—F. S. H.

(THYROID) Myxoedema adultorum. Krisch (H.), Deutsche
med. Wehnscehr. (Leipz. & Berlin), 1918, 44, 871.

Brief deseription and clinical findings of a case of myxoe-
dema benefited by thyroid treatment.—F. S. H.

(THYROID) Local anaesthesia and technic of operations in
goiter (Zur ortlicher Betaubung und Technik der Kropfoper-
ationen). Kulenkampff (D.), Zentralb. f. Chir. (Leipzig),
1920, 46, 246-249.

Of technical surgical interest.—J. K.

(THYROID ADRENALS) The influence of thyroid feeding
upon carbohydrate metabolism. II. The epinephrine content
of the adrenals of thyroid-fed rats. Kuriyama (S.), J. Biol.
Chem. (Balt.), 1918, 33, 207-213.

The epinephrine content of the adrenals of normal, medium
sized rats is 2.2 mg. per gm. of the gland. In comparing this
finding with the results of other investigators, the author de-
cides that the epinephrine content of rat adrenal is the nearest
to that of the dog, larger than that of the cat, and smaller than

ABSTRACTS 497

that of sheep and calf. Thyroid feeding of either short dura-
tion with large doses or long duration with small doses does
not materially change the epinephrine content, nor the weight
of the adrenals of medium sized albino rats.

Kuriyama considers that if hypersecretion of the adrenals
really exists in experimental hyperthyroidism, these results
indicate that the excess of epinephrine is promptly transported
into the circulation, the adrenaline content of the adrenals
being kept fairly constant.—F. S. H.

THYROID, Cold abscess of the— (Abcés froid du corps thy-
roide). Labey (M. G.), Bull. et mem. Soe. de chir. de Paris,
1918, 44, 697-698.

Presentation of a specimen of abscessed thyroid removed
from a goitrous woman. The diagnosis of tuberculous thyroid
is given.—F. S. H.

THYROID in immunity, On the role of the—(A propos du
role de la thyroide dans l’immunite). Launoy (L.) & Lévy-
Bruhl, Compt. rend. Soe. de biol. (Paris), 1920, 83, 90-91.

-An answer to Garibaldi. (See Endocrin. 1920, 4, 330.) In
the author’s experience thyroidectomy does not enhance the
production of antibodies.—T. C. B.

(THYROID) A case of cretinism. Lennox (W. G.) & Read (B.
K.), China M. J. (Shanghai), 1920, 34, 140.

The case is that of a boy, 18 years old by Chinese count,
who was admitted to the Peking Union Medical College Hos-
pital, and who showed marked improvement on feeding six
grains per day of dried thyroid gland.

The authors remark upon the fact that this is the only
instance of cretinism which they have found in 35,000 eases
treated at the dispensary, and that ‘“‘perusal of a number of
hospital reports from various parts of China fails to show
record of cases of cretinism.’’ This is the more remarkable
since goiter is quite common in the vicinity of Peking and in
other districts. They note, in addition, that the remarkable
prevalence of goiter in some parts of China, and the fact that
the Chinese are said to drink only hot tea, are inconsistent with
the view that goiter is due to an infection caused by drinking
unboiled water. The paper is accompanied by careful urine
and water analyses.—E. V. C.

498 ABSTRACTS

(THYROID) Graves’ disease (Ueber die Basedowsche Erkran-
kung). liek. Deutsche med. Wehnschr. (Berlin), 1920, 46,
445-446.

The author observed 160 eases, including 100 of which the
subjects were operated upon. There exists an intimate rela-
tion between the thyroid and brain. The ‘‘cireulus vitiosus’’
in Graves’ disease is: Increased secretion of the thyroid—
inereased irritability of the brain—inereased secretion of the
thyroid. Treatment may try to diminish the irritability of the
brain or the hypersecretion of the thyroid. The first treat-
ment, the internal one, is suitable for light cases only. The
prime essential of this treatment is absolute psychical rest.
The author is not convinced that x-ray treatment or milk of
thyroidectomized goats has any therapeutic value. The best
treatment attacks the thyroid surgically. The most important
element is not the operative technique but the preparation of
the patient. Before the operation he should be isolated and
kept in bed for many days. The author advises ether anesthesia.
The narcosis must begin and finish in bed, and not on the opera-
tion table. Of his 100 operated patients 3 died immediately
after the operation; 2 died some time later of other diseases;
15 cannot be traced; 52 are cured; 20 are much better, and 8
are just the same as before the operation. Of these 8 eases,
two underwent removal of the thymus; only in one case was
‘any influence seen. In 3 other cases, after failure to benefit
from thyroid extirpation, x-ray treatment of the ovaries was
efficacious in euring the disorder.—J. K.

THYROID insufficiency after influenza (Dos casos hipotiroi-
dismo post-grippal). Lopez Albo (W.), Progresos de la
Cliniea (Madrid), 1919; 7; 217-220.

The author gives the clinieal histories of two children of
10 and il years, respectively, who, followimg an attack of in-
fluenza, developed extreme somnoleney and headache. The fact
that the cases improved under thyroid therapy is taken to indi-
eate that they were due to hypothyroidism. They might, per-
haps, be regarded as walking forms of encephalitis lethargica.

—K. B.

THYROID, A case of post-influenzal—hypo-function (Un
nuevo caso de hipofuncion tiroidea post-grippal). Lopez
Albo (W.), Prog. de la Clin. (Madrid), 1919, ——,

Clinieal history of a patient who presented the following
conditions after having had a slight attack of the grippe:

ABSTRACTS - 499

paresthesia, general malaise, cephalagia, chills, cold extremi-
ties, lack of appetite, and edema of the eyelids. He was cured
by thyroid therapy. The author is of the opinion that this
case can be ineluded among the thyroid disturbances of Lévi
and Rothschild.—E. B.

(THYROID) Simple goiter—A public health problem. McCord
(C2 P.) & Walker (R. C.), Mod. Med. (Chicago), 1920, 2,
124-132.

McCord and Walker have compiled all recent data with
reference to the prevalence of simple goiter throughout the
world, together with measures for the prevention of the ocecur-
rence of this disease. From the evidence available in these
data they draw the following conclusions. The prevalence of
simple goiter is common to many portions of this entire coun-
try. Inexpensive and readily applied measures have been de-
vised for the eradication of this condition. These measures,
although not yet fully standardized and simplified, have been
demonstrated to be harmless and practicable. The school age
coincides with the age of the highest incidence of goiter. The
publie and high school systems afford a splendid mechanism
for carrying out these measures. It is believed that faithful
application of these measures by public health workers, school
and industrial physicians will go far in stamping out this
widespread and distressing malady.—Author’s Abst.

(THYROID) The surgical treatment of exophthalmic and thy-
rotoxic goiter with special reference to bilateral resection.
MacLean (Neil J.), Surg. Gynec. & Obst. (Chicago), 1919, 29,
475-480; Trans. West. Surg. Ass. (Minneapolis), 1919, 28,
89-104.

The author points out the diversity of opinion between
internist and surgeon in the treatment of exophthalmic goiter
and the lack of unanimity as to operative indication and oper-
ative technique among surgeons themselves. It is stated that
medical treatment in Graves’ disease has not been satisfactory
and the mortality and morbidity statistics of Sattler, Hector
McKenzie, Kuttner and Hale White are quoted. While McCar-
rison says ‘‘there is no definite proof that the cures effected
by surgical means are more lasting than those effected by med-
jieal means,’’ Osler and Forehheimer are quoted as advo-
cates of surgical treatment as both logical and scientific. The
various surgical procedures are discussed, and the method of
bilateral resection of the thyroid as advocated by Halstead was

500 ABSTRACTS

the method adopted in the eases recorded, and had been the
method used before the author heard Dr. Halstead’s paper in
Washington in 1913.

Emphasis is laid on the preparatory treatment for opera-
tion, especially having patience to wait until the wave of thy-
roid intoxication has well passed. By adopting this method
the annoyance of preliminary hgation of vessels could in many
cases be dispensed with and the complete operation of bilateral
resection done in one stage. Emphasis is laid on the fact that
exophthalmie goiter should never be considered a_ surgical
emergency. The anaesthetic used in all cases was a combina-
tion of local anaesthetic (14 of one per cent anocaine with
adrenalin) and nitrous oxide with oxygen to induce uncon-
sciousness. The operation consists in the low collar incision of
Kocher and a flap of skin, superficial fascia and platysma dis-
sected upwards. The infrahyoid muscles are separated in the
mid-line and retraced laterally or, if necessary, divided trans-
versely. Each lobe is then freed and dislocated from its bed.
The superior thyroid vessels are first clamped and divided at
the upper pole. Hemostats are now applied to the large veins
as they course from before backwards on the surface of the
eland. In applying these clamps the amount of gland to be
preserved is borne in mind (usually one-sixth) and that above
the clamps cut away. Bleeding from the eut surface is con-
trolled by an over stitch. The remaining steps of the opera-
tion are completed in the usual manner with the exception that
all veins in the flaps are underrun with fine catgut at some
distance from the flap-edge, and tied so that no catgut comes
in the line of ineision. The platysma and skin are united by
two separate silk worm gut sutures introduced subcutaneously.
The resulting sear is almost invisible.

There are several advantages of bilateral resection over
unilateral lobectomy or unilateral lobectomy with partial re-
section of the opposite lobe. Minimum injury is done to the
parathyroids. Absolute safety for the recurrent laryngeal
nerve is assured. If for any reason further removal of gland
should be indicated, such as for recrudescence of symptoms
of thyrotoxie activity, or the rare but possible occurrence of
malignaney, the one side could now be completely removed
with an assurance that some portion of gland remained. It is
a physiological fact that where there are paired organs, should
one be removed the other undergoes hypertrophy. This, while
desirable in a condition where one is normal, is what we wish
to avoid in the case under discussion, and this end is best
obtained by double resection. Finally, for cosmetic purposes,
in the operation of lobectomy there is a well marked depression

ABSTRACTS 501

on the side from which the lobe has been removed, and on the
other side the portion of gland left produces an undue promi-
nence, while in bilateral resection the neck is obviously sym-
metrical.

In 31 eases in which the operation has been done there
have been no fatalities—Author’s Abst.

-(THYROID) Diagnosis and treatment of hyperthyroidism
(Sobre el diagnostico y el tratamiento del bocio exoftalmico
y de los estados hipertiroideos). Maranén (G.), Revista
Ibero-Americana de Ciencias Médicas (Madrid), 1917, :
—. (June.)

See Endoerin. 2, 343.

(THYROID) Mongolismus mit Myxoedem. Moro, Deutsche
med. Wehnschr. (Berlin), 1920, 46, 536.

. A short note. A child presented typical mongoloid eyes,
hyperflexibility, aplasia of the thyroid, dry hair, obstipation
and idiocy.—J. K.

(THYROID) Osseous demineralization and its treatment (La
deminéralization osseuse et son traitement). Robin (A.),
Bull. gén. therap. (Paris), 1920, 171, 61-74.

The loss of mineral substances from the bones is attributed
to infectious diseases, such as tuberculosis and syphilis, dys-
pepsias accompanied by marked hyperechlorhydria, undernutri-
tion, lowered alkalinity of the blood and lesions of the nervous
system. The treatment consists in furnishing the organism an
excess of the mineral salts it is losing, not in the pure form but
as contained in foods rich in the necessary elements; in dimin-
ishing the ingestion of acid producing substances; and among
other medications giving 2 mgm. of desiccated thyroid gland
twice a day. Tables are given of the calcium and magnesium
excretion of several individuals.—F. 8. H.

(THYROID) Medical treatment of goiter. Ryan (G.), Med.
Ree. (N. Y.), 1919, 96, 534-536.

A brief, readable, conservative article, but presenting no
new data.—H. L.

(THYROID) Curative versus symptomatic treatment of ex-
ophthalmic goitre. Sajous (C. E. de M.), Med. Ree. (N. Y.),
1919, 96, 536-541.

502 ABSTRACTS

A very interesting contribution leading to the conclusions
that the symptomatie treatment of exophthalmie goiter gener-
ally resorted to compromises the chance of the patient’s re-
covery, by leaving unassailed the primary cause of the disease.
Many patients are subjected to thyroidectomy, entailing risks
and morbid after-effects, who could be cured by medical treat-
ment did the latter aim to remove the primary cause of the
disease and its morbid effects. The remote results of surgical
treatment would be greatly improved were removal of the pri-
mary cause of the disease and its morbid effects first insured.
All eases of exophthalmie goiter are due primarily to some toxin
originating from some pathological process in one or more
organs, either the tonsils, sinuses, nose, nasopharynx, teeth or
gums, stomach, intestines, genito-urinary organs, the nervous
sytem, ete. Even the cases due to emotional stress have as their
primary cause toxie wastes formed in the cerebrospinal neu-
rons subjected to stress,—cholin, phosphoric acid, and partieu-
larly neurin, a highly poisonous waste product. These poisons,
by exeiting the thyroid apparatus to supranormal activity,
owing to the active part taken by this apparatus in the de-
fensive functions, cause it to excrete excessively, thus produc.
ing an additional toxicosis. The thyroid hormone, particularly
when produced in excess, taking part also in tissue catabolism,
breaks down fats, including the fatty bodies in nerves and
brain cells, thus accounting for the striking nervous phenomena
of the disease. Exophthalmie goiter thus becomes the produet
of a vicious circle in which three toxins take part: the primary
causative poison which excites the thyroid; the excess of thy-
roid hormone as second poison; the excess of catabolie wastes
due to the thyroid hormone, as third poison. Timely removal
of the disorder which produces the primary causative poison,
by arresting the excessive thyroid activity, will thus prevent
the triple toxicosis, and cure the disease. The after-treatment,
some such as described above, to insure cure, must also aim to
remove the effects of the poisons. ‘‘Symptomatie treatment”’
should be dropped as an empiric method unworthy of modern
science. —H. L.

(THYROID) A case of functional chorea with hyperthyroidism
(Un caso de corea functional con hipertiroidismo). Sanz
(F.), Real Acad. Nac. de Med. (Madrid), 1919, : .
(Feb. 22).

The elinieal history is as follows: mother neurotic, father
normal; one sister presents symptoms of nervousness; personal
antecedents unimportant; first menstruation at fourteen years
at which time the first symptoms of the disorder appeared,

On
no
Oo

ABSTRACTS

which have increased and consist of irregular movements that
are brusque, incoordinated and involuntary, involving different
parts of the body and many tics. During emotional stress they
are augmented. Accompanying the chorea is a goiter and
slight tremor; tachycardia is absent. The author considers it
a ease of hyperthyroidism but not of exophthalmie goiter, since
the ocular symptoms are lacking. [In the opinion of the re-
viewer, the author attributes too much importance to the mere
absence of exophthalmos. It is only one of many manifesta-
tions of hyperthyroidism and is by no means the most fre-
quent. |—E. B.

THYROID function as influencing growth (Influencia de la
function tiroidea sobre el crecimento). Sanz (L.), Aragon
Méd., 1919, ——-, —— (Feb.).

The results of this study lead the author to the conclusion
that the thyroid secretion acts directly on growth in contra-
distinction to the other glands of internal secretion, which
apparently act indirectly. The principal point of influence
is osseous metabolism and the activle principle is a specific
iodine containing compound. The thyroidal alterations are
accompanied by changes in other glands of internal secretion,
particularly the hypophysis and gonads, which also add their
quota to the growth processes. The climatic influence on
growth is exercised through its modifying effect on the thyroid.
All diseases which alter the nature of growth produce disturb-
ances in the thyroid functions.—E. B.

(THYROID) Metabolism, report of a case. Schwartz (C. W.),
Am. J. Roentgenol. (Detroit), 1920, 7, 229.

A preliminary report on the case of a young man, twenty-
seven years of age, who came to the hospital because of ex-
treme nervousness and restlessness. He presented upon exam-
ination an enlarged thyroid gland, a loud bruit, tachycardia,
exophthalmos, lid lag, tremors of the hands, sweating, and
Hutechinsonian teeth, together with a positive Wassermann test
and a markedly increased metabolic rate. In the course of
three months, by means of a series of x-ray treatments, the
technical details of which are given by the author, the rate was
lowered 67 points.—J. F.

(THYROID) Aetiologie des Mongolismus. Stélzner, Deutsche
med. Wehnsehr. (Berlin), 1920, 46, 200.

The mothers of mongoloid children are often rather old or
worn out by many confinements. In three eases observed by

504 ABSTRACTS

Stilzner, the mother showed hypothyroidism. The author ad-
vises the administration of thyroid during pregnancy.

Homoplastic THYROID transplants. Swingle (W. W.), Anat.
Ree. (Phila.), 1920, 18, 263.

Experimental evidence is presented in support of the
author’s hypothesis that the long period of larval life of cer-
tain species of anurans (Rana catesbiana, for example) is due
to the slow rate of thyroid development. Grafting the thyroid
glands of advanced second-year tadpoles into small, immature
first-year tadpoles produced rapid growth in the latter up to
the stage of development shown by the animals from which
the glands were obtained.—W. J. A.

(THYROID) A study of the distribution of iodine between
cells and colloid in the thyroid gland. I. Methods and results
of study of beef, sheep, and pig thyroid. Tatum (A. L.), J.
Biol. Chem. (Balt.), 1920, 42, 47-54.

When frozen section preparations of unfixed thyroid
olands are floated in isotonic salt solutions the colloid separates
out. Using this phenomenon as a basis of procedure Tatum pre-
pared large amounts of sectioned material from relatively fresh
glands and extracted with Ringer’s solution and centrifuged.
This was repeated and iodine determinations were made
on the residual cell bodies, the whole glands and the extracts.
There appeared to be a wide variation in the absolute amounts
of the total iodine in the whole glands and cell masses. Never-
theless, the ratio of the percentage of iodine in the cells to the
percentage of iodine in the whole gland was found to be a
fairly constant value, and was considerably less than 40 per
cent. From these results it is evident that iodine exists in
both the cells and the colloid of beef, sheep and pig thyroid

glands.—F. S. H.

(THYROID PARATHYROID) Tetanie-epilepsie. Tilling.
Deutsche med. Wehnschr. (Berlin), 1920, 46, 200.

There exists a close relationship between tetany and epi-
lepsy. The author treated two cases with thyroidin (3 times
daily with 1 gram) as indicated by Bolton and with para-
thyroidin (Freund and Redlich) without result.—J. K.

(THYROID) Diagnosis of Basedow’s disease. Troell (A.),
Hygiea (Stockholm), 1920, 82, 33-45.

ABSTRACTS 505

Goetsch’s adrenalin diagnosis test was carried out on 6
Basedowians and 4 uncomplicated goiter cases with entirely
satisfactory results.—J. A. H.

(THYROID HYPOPHYSIS OVARY) Remarks on the cure ot
‘various forms of headache and ‘‘faceache’’ by electrical
methods. Hernaman-Johnson (F.), Practitioner (Lond.),
1919, 103, 297-305.

As far as the ductless glands are concerned, the author
refers to headache as a frequent symptom in exopthalmic
goitre which disappears under suitable x-ray treatment. Dis-
ease of the pituitary gland may cause headache of a very ter-
rible kind. <A few cases, he says, are on record in which x-ray
treatment of pituitary gland enlargement has produced benefit.
He believes menstrual headaches to be due to ovarian hyper-
secretion and maintains that such headaches yield to x-ray
treatment given with a view to reducing ovarian activity.

Th

(THYROID) Changes in the larynx and trachea in benign
goiter (Veranderung des Larynx und der Trachea bei gutar-
tiger Struma). Wodak, Miinch. med. Wehnschr. (Munich),
1919, 66, 1365; Deutsche med. Wehnschr. (Berlin), 1919, 45,
1400; Wien. klin. Wehnschr. (Vienna), 1920, 33, 73.

In many eases of benign goiter there may be seen in the
larynx and trachea changes of the nature of displacements,
compression, distortions, catarrh of the mucous membranes and
paralysis of the recurrent laryngeal nerve. The distortion is
rarely described, but frequently occurs.—J. K.

(THYROID) A mentally deficient child with a protracted ele-
vation of temperature. Wolf (G. D.), Med. Ree. (N. Y.),
1919, 96, 880-883.

Report of a case presenting difficult problems of differen-
tial diagnosis, much improved by administration of thyroid.

—H. L.

THYROID and PARATHYROID tumors of the tongue. Wood
(F. C.), Proce. N. York Path. Soc. (N. Y.), 1916, 16, 84-89.

Wood describes briefly three cases of thyroid tissue masses
occurring at the base of the tongue, in two of which were found
small areas resembling parathyroid tissue. <A brief reference
is also made to other such cases reported in the literature.

506 ABSTRACTS

These aberrant masses usually occur in the median line or near
it at the base of the tongue. It is suggested that parathyroid
tissue may in such eases as these arise from the second branchial
pouches, as well as from the third and fourth, as normally.
I. M.

TISSUE EXTRACTS, Action of—upon coagulation of blood.
Uchihara (K.), Taiwan Igakukai Zasshi, 1918, No. 182, 119-
130.

The author isolated a globulin from extracts of different
organs, and found that it accelerated the clotting of blood. He
also isolated a nondialyzable albumin-like substance which hin-
dered blood coagulation. This substance was always present in
the same amount, while the amount of the globulin was varia-
ble. (Abstract in China Med. Jour.)—L. G. K.

(THYROID) Basedowism in a syphilitic family. Zeleneff (I.
F.), Russk. J. Kozhn. i. Ven. Bolizen (Mosk.), 1916, 31, 19-24.

In the cases studied Basedowism developed after infection
with syphilis. Antisyphilitic treatment diminished the symp-
toms of Basedowism. Z. concludes, therefore, that the poison
of syphilis has an etiological relationship to the symptoms of
Basedowism.—S. H.

The abstracts in this number have been prepared by the
staff, assisted by:

E. Bonilla, Madrid, Spain.

W. H. Donnelly, Brooklyn, N. Y.

Samuel Hanson, San Francisco.

L. G. Kilborn, University of Toronto.

Irvine McQuarrie, Baltimore.

With the permission of the editors, certain abstracts have
been quoted from ‘‘ Physiological Abstracts,’’ ‘‘Chemical Ab-
stracts’’ and ‘‘Surgery, Gynecology and Obstetries.’’

ENDOCRINOLOGY

THE BULLETIN of the ASSOCIATION
for the STUDY of

INTERNAL SECRETIONS

OCTOBER-DECEMBER, 1920

EXPERIMENTAL RESEARCHES ON THE PITUITARY
. BODY

DraBeTes INsrpipus, GLycosuRIA AND THOSE DystTROPHIES CON-
SIDERED AS HypoPHYSEAL IN ORIGIN®*

Drs. J. Camus and G. Roussy
Professeur, agrégé, a la Faculté de Médicin de Paris

In recent vears, notably before the War, we have carried
out a series of researches on the pituitary body. These researches,
undertaken without any preconceived idea, have furnished some
results which have for the most part been published in various
journals. It is of these results that we wish now to offer a sue-
cinet review.

I. DIABETES INSIPIDUS AND THAT WHICH IS TERMED
‘“HYPOPHYSEAL POLYURIA’’

We must consider in succession the relation of polyuria to
the removal of the pituitary body, the relation of polyuria to the
lesions of the base of the brain, the site of the lesions which lead
to polyuria, the interrelation of polyuria and polydipsia and the
question of the regulation of water retention in the body.

1. Polyuria and removal of the pituitary body. In a very
great number of hypophysectomies, partial or total, practised
on the dog by the buceal-transpalato-sphenoidal route, we have

*Read before the Association for the Study of Internal Secretions, New
Orleans, April 26, 1920.

508 RESEARCHES ON THE PITUITARY

observed a marked polyuria. We were surprised at the outset of
our researches at the copiousness of the polyuria. It even hap-
pened in the first two animals we operated upon that we could
not measure the urine passed because we had placed under the
cage receptacles of from only one to two litres and during the
night these overflowed.

fo 2 [22 [oe [2525] 27 | e950

3
a

4 Boggemals Lo),

Fig. 1. Female Dog Tigrette (weight 9 k.). Total extirpation of hypo-
physis Oct. 22, 19138, followed by profuse polyuria. Death, Dec. 26. Autopsy
findings: Excoriation and dilation of the tuber at the border of the inser-
tion of the stalk, the stalk itself has been removed; no trace of hypophysis
in the sella turcica. On section a small fragment found in the cavity of the
infundibulum at the right. The graph A shows the urine volume following
operation on the 22nd; B, base of the brain showing infundibulum (If.)
dilated; C, right hemisphere, inner surface; Ch, optic chiasma; T.m., mam-
millary body; X, lesion.

Thinking, at the commencement of our work, that the pitui-
tary body was alone involved, we wished to begin by measuring
the relative importance of the different parts of the organ in the
production of the phenomena. But we were very rapidly
brought to a realization that the key to the phenomenon is not
to be found in an attenuation of the hypophyseal function. Con-
trary to the generally accepted view, these ablations—whether

total or limited to one lobe—did not influence diuresis.

CAMUS AND ROUSSY 509

There follow, chosen from among the others, two examples
which bring out this point. Of two hypophysectomized dogs
there appears in the first (Tigrette) complete removal of the
hypophysis resulting in a notable polyuria and in the second
(Agrippine) a removal equally complete which does not give a
trace of polyuria.

Decembre 1912

Dates

Fig. 2. Female Dog Agrippine (weight 7 k.). Total ablation of hypo-
physis Dec. 5, 1910. Polyuria followed. Animal killed Apr. 28. Autopsy
showed stalk intact, infundibulum intact and not dilated, even constricted.
Brain absolutely normal superficially at the base and upon median section.
In the sella turcica no trace of hypophyseal tissue. Graph A shows the
absence of polyuria; B, base of brain with infundibulum (If.) not altered;
C, internal aspect showing integrity of the infundibulum (lIf.), of the chiasma
(Ch.), and of the mammillary body (T.m.).

The autopsies showed that in the first case the base of the
brain had been somewhat injured during the hypophysectomy,
while in the second the brain was absolutely intact. This brings
us to a consideration of our second question.

2. Polyuria and lesions of the base of the brain. Later, in
evaluating the role played by lesions at that part of the base of
the brain which borders on the pituitary body, we began injur-
ing this region with a heated needle, meanwhile respecting the
hypophysis itself. To do this we perforated the sphenoid with
a gimlet. We have performed this operation successfully five
times, each time with a very marked consequent polyuria—this
despite an absolute lack of any change in the pituitary body, as
shown at autopsy (Amilear and Télémaque).

To exhibit the phenomenon even more evidently, we per-
formed on each of two other dogs (Alexander and Annibal) two
operations, separated by an interval of several weeks. In the
first operation we removed the pituitary body, which ablation
was followed by a passing polyuria. In the second operation,
now that the pituitary could not be the cause, we injured the

510 RESEARCHES ON THE PITUITARY

base of the brain. <A polyuria of equal intensity or even more
marked than that after the first intervention, made its appear-
ance.

Decembre /9/2

as] 28] 26 [27] 20] 20 |0]ar] [2 |
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Fig. 3. Male Dog Amilcar (weight 11.2 k.). Puncture of the base of the
brain Dec. 26, 1913. Following this, elevation of urinary output surpassing
ingested water, which demonstrates that the polyuria is primary. Dec. 29,
when the animal was allowed to drink as desired, there was noted a great
polyuria and polydipsia. The dog was killed May 1. Autopsy showed in-
fundibulum widely dilated and gaping. Upon median section small cica-
trices of the former lesion seen in the infundibular cavity at the right.
At the left the lesion is doubtful. The stalk is intact; the hypophysis is
intact. In A solid line indicates urinary output; broken line, water inges-
tion. B, base of the brain with infundibulum (lIf.) dilated and altered. C,
internal aspect of the right hemisphere with lesion showing at X.

In reality, as the autopsies showed, we injured the base of
the brain in both operations—the first time involuntarily, the
second time voluntarily.

The duration of this polyuria arising from a lesion of the

base of the brain is variable—sometimes fleeting, at other times
of a more permanent nature. We have seen it prolonged in one

CAMUS AND ROUSSY d11

dog more than 15 days (Attila); while in another it was ex-
tremely intense and lasted from the operation of October until
May when the animal was killed (Moustachu). In this last dog
we noted, for several hours after the puncture, a mild glycosuria,
whereas the diabetes remained insipid for seven months. We
believe that a diabetes equally marked and lasting has never pre-
viously been experimentally produced.

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Fig. 4. Male Dog Télémaque (weight 11.7 k.). Puncture of the base of
the brain on Jan. 22. Following this a marked elevation of the curve of
urinary output is seen, which surpasses the quantity of water ingested
(phenomenon identical with that observed in Fig. 3). Animal killed on May
5. Autopsy showed infundibulum gaping and altered. Within the brain
substance a symmetrical lesion of the two hemispheres partially traversing
the optic thalamus. Hypophysis and stalk intact. In graph A solid line
indicates curve of urinary output; broken line, curve of water ingestion. B,
lesion of the infundibulum at X. C, lesion X pénetrating into the brain and
passing between the chiasma (Ch) and the mammillary body (Tm.).

This experimental polyuria was not in the least modified in
some animals on which, in the way of tentative therapeutics, we
employed injections of pituitary extracts. We tried extracts of
the posterior lobe, of the anterior lobe and of the whole gland
—H. Carrion & Co. obligingly prepared these for us—and also
the pituitrin of Parke, Davis & Co., all with no effect. These
results gleaned entirely from our own animals do not confirm
those of previous authors.

3. Site of the cerebral lesions which determine polyuria. A
single glance over the figures we published allows a determina-
tion of what is important and what is accessory in the lesions
that we produced. A comparative study of these figures, espe-
cially in conjunction with the urine charts, quite naturally forces

O12 RESEARCHES ON THE. PITUITARY

the conclusions of which we now make a résumé in a few para-
graphs.

The lesion which determines polyuria in no way concerns
the pituitary body. In five cases in which the experimental
puncture has not touched the pituitary body, a consequent in-

Novembre

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TOPCECE Eee er) S

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Fig. 5. Male dog Alexandre (weight 1.500 k.). Hypophysis extirpated
Oct. 14, 1913, with resulting polyuria, as shown in graph A. On November
25 deep piqutre was followed by a longer lasting polyuria. The autopsy
showed: infundibulum slightly dilated; posterior to this a lesion of the left
mammillary tubercle independent of the infundibulum; upon median section
a superficial lesion of the tuber penetrating 3 mm. and injuring the left
mammillary body; in the right hemisphere a similar lesion but less discrete.
In the sella turcica there remained a small fragment of the glandular lobe,
verified microscopically. The graph A shows the curve of urinary output
in the intervening days; B shows the base of the brain with the infundi-
bulum (If.) dilated, and at X the lesion; C, the left hemisphere, showing
at X the superficial lesion involving the mammillary tubercle (T.m.).

tense polyuria followed. The polyuria was neither more nor
less marked when the pituitary body was involved in the lesion.

The total removal of the pituitary body, done without in-
volving the base of the brain, does not result in polyuria
(Agrippine). Nor does a previous ablation of the pituitary body
hinder the production of polyuria if, in a second operation, the
opto-peduncular region in injured (Alexander and Annibal).

CAMUS AND ROUSSY 513

As far as the production and the intensity of the polyuria
is concerned, the depth of the puncture and the participation
in it of the optic thalamus or of the peduncle seems quite without
interest (Amilear and Télémaque).

Novembre 19/3

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Fig. 6. Male dog Annibal (weight 11 k.). Extirpation of the hypophy-
sis Nov. 8, 1913, followed by polyuria. November 20th deep piqfre was fol-
lowed by a more marked polyuria. Autopsy revealed the disappearance of
the stalk with no hypophyseal tissue in the sella; at the base of the brain
the infundibulum gaping and greatly altered; upon median section a gross
bilateral lesion extending in depth to the optic thalamus; chiasma intact;
mammillary body altered at the left. The graph A shows the curve of urinary
output; B, the lesion of the base is here somewhat extended (X); C, in the
left hemisphere ‘‘X’’ shows the involvement posteriorly of the mammillary
tubercle (T.m.).

The important fact is that a superficial lesion of the base
of the brain, often involving only the surface and produced in-
voluntarily in the removal of the pituitary body, is followed by
polyuria.

In our animals it seems that the opto-peduneular region
alone marks the zone within which a lesion is followed by poly-
uria. It lies at the level of the grey substance of the tuber cine-
reum in the vicinity of the infundibulum.

514 RESEARCHES ON THE PITUITARY

A lesion made in front of this zone at the level of the chiasm
(Horace), or back of it at the level of the protuberance (Curiace),
gives no polyuria.

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Fig. 7. Male dog Moustachu (weight 13 k.). Piqtire Oct. 27, 1913, and
trephining of the sphenoid and penetration thereby of the hypophysis. A
considerable degree of polyuria resulted and persisted for several weeks.
Autopsy May 17 showed: infundibulum much dilated; anterior to the infundi-
bulum and posterior to the chiasma a light colored nodule forming a projec-
tion; hypophysis small and atrophied (weight 0.20 grams); upon median
section hemorrhagie linear scar (X) in the infundibular cavity. Graph A
shows curve of urinary output; B, the lesion at the base of the brain at
X; C, the dilated infundibulum (If.) and the lesion anterior to this at X.

4. Correlation of polyuria and polydipsia. Regulation of
the water retention in the body. Along with the polyuria we
observe, in the operated animals, a marked polydipsia. Is the
polyuria primary or only secondary to the polydipsia? To an-

CAMUS AND ROUSSY d15

swer this question it is necessary only to put the animal on a
constant water régime. That is, after the puncture in the opto-
peduneular region we maintain for the animal a constant water
intake.

Fig. 8. Male dog Horace (weight 8 k.). A deep lesion made intention-
ally anterior to the hypophyseal region on May 26, with no polyuria follow-
ing. Autopsy May 29: Hypophysis and stalk intact; lesion involving ante-
riorly the chiasma and penetrating to the anterior part of the left optic
thalamus on both sides. In the graph A the solid line is the curve of urinary
output, and the broken line the curve of water ingestion; B, base of brain
showing normal infundibulum (If.) and at X the lesion involving the chiasma;
in C lesion (X) is shown penetrating deeply.

This we have done with many dogs and we have seen the
polyuria appear with no possibility of an increased water intake
for the 24 hours. We even note an increase in the urine volume

Fig. 9. Male dog Curiace (weight 8.5 k.). May 26 piqfre of the base of
the brain made intentionally posterior to the hypophyseal region. No pol-
yuria followed. Autopsy May 29: hypophysis and stalk intact; lésion poste-
riorly at the middle part of the protuberance and penetrating to the depth
of 1 em. In the graph A the solid line shows the curve of the urinary out-
put, and the broken line the curve of water ingestion; B, the lesion shown
at X in the protuberance; C shows superficial lesion at left.

to a point above that of the liquid intake. Under these condi-
tions the water of the tissues diminishes and the phenomenon
cannot persist for any length of time without some supplement

516 RESEARCHES ON THE PITUITARY

in the water given to the animal. If now we offer the animal
water as he wishes, he repairs his losses and absorbs an enor-
mous amount of water. Two of the dogs (Amilear and Télé-

ST TT
Lanta aaeas

FBoqtemans web

Fig. 10. Male dog Enée (weight 8.500 k.).. March 13 experimental lesion
in the optopeduncular region, followed by polyuria and considerable poly-
dipsia but equal in degree, indicating no disturbance of water ingestion. The
injection of glucose on the 7th and 23rd of March and of caffeine on March
25th gave insignificant result. Urea on the 11th had caused polyuria and
on the 18th polydipsia also. Autopsy showed: Infundibulum dilated and
altered; within the brain substance a large lesion involving posteriorly the
optic thalamus at the left but extending to the right. The stalk is intact
and the hypophysis definitely altered. In the grapn A the solid line indi-
cates the curve of urinary output and the broken line water ingested; B,
lesion (X) of the infundibulum; C, lesion (X) penetrating deeply and involv-
ing posteriorly the mammillary body (T.m.).

maque) demonstrate these phenomena clearly—the polyuria fol-
lowing the puncture, then the polydipsia and marked polyuria.
These facts allow us to consider that the polyuria is produced
independently of the polydipsia.

When all of the animals have all the water they wish to
drink, they do not. react in identical fashion. Some repair ex-
actly the water losses which the polyuria produces, others repair
in excess, while still others repair insufficiently.

The dog Enée repairs her water losses perfectly; with her
the regulation of water retention in the body is impeccable.

CAMUS AND ROUSSY D17

The dog Castor repairs in exaggerated fashion the losses of
water which have been inflicted upon him. It seems that he
drinks much more than he has need of, the urine volume being

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Fig. 11. A young male dog, Castor (weight 12.500 k.). April 17 experi-
mental lesion in the opto-peduncular region, followed by polyuria and con-
siderable polydipsia, but without parallelism, as in the case of Enée (indi-
eating probably a slight disturbance of regulation connected with the youth-
ful age of the animal). The first, second and fourth periods of augmenta-
tion of polydipsia were due to previous deprivation of water; the third was
secondary to polyuria caused by cerebral piqtire. Piqtire Apr. 17, followed
by considerable polyuria. Autopsy showed: infundibulum dilated; lesion
anterior and to the right of this latter involving the optic tract; in the
depths the large symmetrical lesion, more marked in the right, and reaching
to the middle of the optic thalamus; stalk intact; hypophysis intact. In
graph A the solid line indicates the output of urine, dotted line water in-
gested; B, base of the brain with infundibulum (Tf.) dilated and the lesion
anteriorly at X; C, the lesion (X) in the right hemisphere.

secondarily increased. But this dog was still young and it is
possible that in him the mechanism regulating the retention of
water was functioning in some defective way. It is a classic no-
tion that other mechanisms, other regulators of different fune-

518 RESEARCHES ON THE PITUITARY

tions (cireulatory, respiratory, thermic, ete.) comport them-
selves in imperfect fashion in young animals.

From this group of researches just summarized, there stand
out the following conclusions :

(a) It is neither the injury to nor the removal of the pitui-
tary body which leads to polyuria in the dog, but rather a super-
ficial lesion of the base of the brain.

(b) This region corresponds to the opto-peduncular space.
In the dog a lesion of this zone is followed by an abundant poly-
uria. The polyuria thus produced is much more marked and more
lasting than that which can be produced in any other way—as
by the injection of urea, glucose, caffeine or chloride of sodium
or by preliminary water deprivation.

(ec) This zone seems to play some part in the mechanism
of the regulation of water retention in the organism. Lesions of
this region—mayhap in accordance with their extent—are fol-
lowed by a polyuria either with a parallel polydypsia which
means, of course, that there is no trouble with the regulation, or
by a polyuria without a consequent polydipsia, which is to say
with disturbance of the regulator mechanism. Thus as to the
production of polyuria we arrive at results sensibly the same as
those we obtained in the study of glycosuria and the trophie
genital troubles. Many authors have ascribed these phenomena
directly to lesions of the pituitary body.

I. HYPOPHYSECTOMY AND GENITAL ATROPHY.

During some experimental researches on the pituitary body
we observed, quite as a side issue, trophic troubles of the genital
organs.

Our experience was gained from five dogs.

The first dog (Keureuil), which had suffered a partial re-
moval of the pituitary body, presented neither any modifications
in growth, nor any genital atrophy. The second dog (Flick),
after total or almost total removal of the pituitary body, has
grown enormously—his weight almost doubling—but his genital
organs are normal and function normally.

The third dog (Negro), after total or almost total removal
of the pituitary body, appears to comport himself normally as
far as concerns his development and genital organs.

CAMUS AND ROUSSY d19

The fourth dog (Narcisse), after partial removal of the
pituitary body and extensive cauterization of the parahypophy-
seal region, has presented some modifications of the hind quarters
and of the extremeties of the limbs with very marked genital
atrophy. Obesity did not appear.

Finally in the fifth dog (Moustachu), which did not suffer
a removal of the pituitary body but only a deep lesion of the
surrounding region, marked polyuria and testicular atrophy de-
veloped almost immediately.

Of these five animals only the last two have presented any
trophic troubles of the genital apparatus. In the fourth dog
(Narcisse) we ecauterized the region of the pituitary body and
almost certainly we must have injured the neighboring parts
since the animal developed difficulty in codrdination and equili-
bration, symptoms which this dog alone, of all the great number
we have worked with, showed. In the fifth dog (Moustachu)
we purposely made a lesion of the base of the brain.

These experimental facts allow us to conclude that in the
incidence of atrophy of the genital organs we are dealing rather
less with any hypophyseal lesion than with trouble at some point
in the base of the brain, the exact site of which remains yet to
be determined with more precise methods.

As far as the obesity is concerned, it seems that it is not
necessarily dependent upon the existence of genital atrophy and,
moreover, that it is possible to see a breaking up of the ‘‘ adiposo-
genital syndrome.’’ Jn this regard it is fair to question whether
the adiposo-genital syndrome may not be due to lesions of sep-
arate centers—often affected coincidentally but not necessarily
by the same process.

I. THE GLYCOSURIA OF HYPOPHYSEAL ORIGIN.

Our experimental researches on hypophyseal glycosuria
may be separated under two heads: (1) those dealing with a
spontaneous glycosuria consecutive to an operation on the pitui-
tary body, and (2) those which deal with the tolerance of the
operated animals for carbohydrates.

1. Glycosuria observed after an operation on the pituitary
body and the adjoining part of the base of the brain. These re-
searches on the glycosuria appearing spontaneously after opera-

520 RESEARCHES ON THE PITUITARY

tions on the pituitary body and the bordering region, included
45 dogs and 9 cats. In the 45 dogs, glycosuria was observed but
6 times. That is, in 39 cases the result, so far as the presence of
sugar in the urine is concerned, has been negative.

We may make further subdivisions in these 39 cases. In
30 of the animals we have not produced any lesions of the base
of the brain. In 14 of these 30, the ablation of the pituitary
body seemed to us to be entire. It seems useless to discuss here
the question of total removal, histologically speaking, and of
remnant adherent hypophyseal tissue. At another time we will
come back to this point: The only essential matter, as far as the
glycosuria is concerned, is a profound blow to the pituitary body
and, particularly, the removal of a fair share of the pars nervosa.
Thus, we repeat, in 14 of our animals the removal seemed to us
to be complete. In the 15 others the removal has been partial—
often very considerable—and, for the most part of the cases, espe-
cially involving the pars nervosa.

In all these eases, let us repeat, we have not observed any
elycosuria after the operation.

In 9 other dogs we have made, voluntarily or involuntarily,
a more or less extended lesion of the tuber and of that region
of the base of the brain bordering on the pituitary body.

In these 9 cases, 3 times (once partially and twice totally)
the pituitary body was removed at the same time that we in-
jured the base of the brain. In the 6 other cases, the base of the
brain was wilfully injured, leaving the pituitary body un-
touched. In these 9 animals we did not observe any glycosuria.

The dogs which furnished these 39 negative cases represent
every category. There were adult or aged dogs, dogs but a few
weeks old and dogs in gestation. The phenomenon was thus not
influenced by the animal’s age, sex or physiological state of ges-
tation.

This brings us to the 6 cases in which we have observed
positive results. We may subdivide these as follows:

One time we were dealing with the apparently complete re-
moval of the pituitary body in a dog in gestation. This dog
has not as yet been killed and we do not know what the state of
the brain is.

CAMUS AND ROUSSY 521

Twice the brain was manifestly badly injured.

Once we had ecauterized the hypophysis and the neighbor-
ing cerebral region.

Once we cauterized the hypophysis with a red hot iron and
it can scarcely be doubted that the adjoining regions were in-
volved in this energetic procedure.

Once, finally, the removal seemed complete and the autopsy
disclosed no lesion of the brain. In this case, however, the gly-
cosuria was inconsequential.

~ How does the glycosuria show itself in these positive cases?

It appeared rapidly following the operative shock. It was
always light and fugacious, disappearing in from less than 24
to 36 hours after the operation. It appeared quite independently
of the polyuria which was often marked even without this gly-
cosuria, as we have cited in numerous eases (Cf. Bull. Société de
Biologie). The character of the food consumed prior to the
operation seems to have had no influence on the appearance of the
glycosuria.

Remember that of the 6 positive results in the 45 operations
on dogs, at least 4 showed lesions of the base of the brain.

In the cat after 4 out of 9 partial ablations of the pituitary
body, glycosuria occurred—suddenly appearing and disappear-
ing. Under our experimental conditions the glycosuria seems to
be more easily attained in the cat than in the dog, but as yet we
are unable to state any fixed rule as to its mode of production.

2. Tolerance to carbohydrates on the part of animals de-
prived of the pituitary body—alimentary glycosuria. We have
given glucose, through an oesophageal tube, to some dogs totally
or in part deprived of the pituitary body.

We determined the quantity of glucose which just produces
glycosuria. Then, administering a slightly smaller amount of
the substance, we injected into the animal an extract from the
pituitary body (the posterior lobe, the total gland or only the
anterior lobe). Thus, if we had found that 90 grams just gave
a glycosuria, we administered 80 or 85 grams, injecting at the
same time the hypophyseal extract.

Conclusions: a. The different interventions practiced
on the pituitary body—partial removals of one or both lobes

522 RESEARCHES ON THE PITUITARY

or total removal—modify in appreciable fashion neither the
tolerance to carbohydrates nor the appearance of alimentary
olycosuria.

b. The injections of concentrated extracts of the pos-
terior lobe, the anterior lobe or of the whole hypophysis,
do not sensibly modify—in the animals operated on—the
limit of tolerance to carbohydrates.

THE RELATION OF THE THYROID AND OF THE
ADRENALS TO THE ELECTRIC CONDUCTIVITY
OF OTHER TISSUES *

G. W. Crile, M.D., Cleveland, Ohio

The Thyroid—Osterhout has shown that iodin increases
the electric conductivity of lying vegetable tissue. In our
laboratory in a research undertaken in collaboration with Miss

series I

Cerebellum

Cerebrum

Series I

Cerebellum
Cerebrum

Spinal Fluid

Adrenals
Heart

Fig. 1—Relative Percentile Increase in the elie Conductivity
of Various Organs and Tissues Produced by Iodoform averages from
two series of observations.

Helen R. Hosmer and Miss Amy F.. Rowland, we have found
that the electric conductivity of the brain, the liver, the spinal
fluid. the heart and the lungs, is increased in iodism pro-
duced by the injection of idoform into the peritoneal cavity
(Fig. 1). A limited number of observations indicated that an

* Read before the Association for the Study of Internal Secretions, New Or-
leans, April 26, 1920.

On
bo
Oo

524 THYROID, ADRENALS, TISSUE CONDUCTIVITY

increased conductivity of the brain and the liver is an early
effect of thyroid feeding. In exhaustion produced by thyroid
feeding for prolonged periods the conductivity of the brain is
deereased as in exhaustion from other causes.

The relation of the increased electric conductivity produced
by iodin to the function of the thyroid gland becomes apparent
when we consider that, as far as is known, the only function of
the thyroid gland is to metabolize, to store, and to deliver iodin;
and that the excessive administration of iodin will produce
symptoms identical with those produced by abnormal amounts
of thyreo-iodin manufactured by the thyroid gland. A limited
number of observations indicate that excessive lodin and ex-
cessive thyroid activity alike produce increased sensitivity to
adrenalin, increased metabolism, increased respiration, tachy-
cardia, elevated temperature, with ultimate emaciation, delirium
and death.

Todin is an essential element in the normal functioning of
the organism. Iodin is found only in traces in other tissues and
organs of the body outside the thyroid. It is the function of
the thyroid gland alone and it is the only proven function of
the thyroid gland to take in iodin from the blood, to manu-
facture it into the compound in which it will be of the greatest
use to the organism and to give it to the circulation as called
for by the needs of the organism.

The normal activities of life in the normal individual are
made possible by the amounts of iodin received from the thyroid.
Abnormal amounts of iodin inerease the activity of the organ-
ism as a whole. In the light of our experiments this increase
may be interpreted as due, in part if not wholly, to the effect
of iodin upon electric conductivity.

Exophthalmiec goiter patients tolerate iodin poorly. If too
much iodin or thyroid extract be given to a patient with simple
goiter, exophthalmic goiter may be induced. Such cases are
identical with exophthalmie goiter induced by any other cause.

On the other hand, if the thyroid gland does not metabolize
sufficient iodin to meet the need of the organism there results
a condition of subnormal metabolism in which the individual
is dull, stupid, and more or less in a state of torpor.

The Adrenals—Our electric conductivity researches have
shown that a single dose of adrenalin immediately increases the

CRILE 529

conductivity of the brain. The administration of an excessive
amount of adrenalin causes a decreased electric conductivity
of the brain (Fig. 2). This action of adrenalin is probably
due to its influence upon oxidation.

The immediate activating effect of adrenalin is most strik-
ingly demonstrated in the reaction to the Goetsch test in cases
of exophthalmic goiter.

REPEATED
DOSES

REPEATED
DOSES

Fig. 2—Percentile Changes in Electric Conductivity Immediately
After the Injection of Adrenalin and After Repeated Injections (Note
Antithetic Effects on Brain and Liver).

If we accept the view of physicists and bio-chemists—
notably DuBois-Reymond, Nernst, Bethe, Lillie, MeClendon,
Mathews, Osterhout, Loeb, Crehore and Williams, Ostwald, A.
V. Hill, ete., that the functions of the cells of the organism
relate to electrical processes, it would appear that the fabrica-
tion of electric energy within the brain cells is immediately due
to oxidation; that oxidation in turn is facilitated by adrenalin ;
and that the passage of the electricity through the tissues is
facilitated by thyreo-iodin.

The interaction of these two agents within the organism
may be best demonstrated by a consideration of their relation
to exophthalmic goiter

526 THYROID, ADRENALS, TISSUE CONDUCTIVITY

The Thyroid and the Adrenals in Their Relation to Ex-
ophthalmic Goiter—lodin increases the electric conductance of
living tissue; increased electric conductivity is probably synon-
omous with increased permeability ; increased permeability in-
creases function.

According to Ashoff and Cannon stimulation of the nerve
supply of the thyroid causes a discharge of thyreo-iodin; hence,
we may suppose that the output of iodin is in part, at least,
under the control of the nervous system. In exophthalmie goiter
there is marked nervous activity, and we may suppose that the
thyroid is under active stimulation. That this is the case is
shown by the low iodin content of the gland in exophthalmiec
goiter. According to Cannon and others adrenalin activates
the thyroid. We assume that the stimulated thyroid throws
out large amounts of activating thyreo-iodin, which by so much
facilitates permeability, hence increases activity of the body,
including the activity of the thyroid itself and of the adrenals.
Oxidation is the basic process in metabolism; adrenalin increases
oxidation; iodin increases electric conductance, hence increases
metabolism.

Therefore, through the mediation of the nervous system,
a reciprocal interaction is established among the thyroid, the
adrenals, and the nervous system. lIodin alone, adrenalin alone,
thyroid extract alone, emotion, exertion, or infection alone, each
causes a ‘‘Kinetie Drive’? with phenomena similar to those of
exophthalmic goiter.

If the foregoing interpretation be correct, then the drive of
exophthalmie goiter should be diminished by lessening the ac-
tivity of any of the three interacting organs—of the brain, by
rest cure; of the thyroid, by its‘resection; of the adrenals, by
their partial removal. Although evidence of the positive value
of the last-named procedure is thus far incomplete, nothing in
surgery is more striking than the immediate benefit of the
surgical treatment of exophthalmic goiter.

It is of interest to note that the active principle of the
thyroid seeretion has been synthetically produced by Kendall;
adrenalin is synthetically made and the generation of electric
energy is a commonplace; hence, the equivalents of the acti-
vators of exophthalmie goiter, of emotion, of exertion, and of
fever may be made in the laboratory.

SECONDARY SEXUAL CHARACTERISTICS AND
ENDOCRINOLOGY

A. Pézard
(From the Laboratory of General Biology, Collége de France, Paris)
INTRODUCTION

The question as to the physiological conditions determining
the secondary sexual characteristics has been for twenty years
the subject of numerous and important researches. Not only do
these characteristics form in themselves an imposing array,
morphologic, physiologic and psychic, but it was early discovered
that their relations, one to another, are particularly close. From
the point of view of general biology the problem perhaps presents
a more suggestive aspect : the characters in question which appear
at the time of puberty and serve to give the animal its distinctive
attributes, male or female, are more or less superadded or supple-
mentary and can, better than any others, be eliminated without
endangering the life of the subject. Their evolution and their
suppression are quite accessible to scientific investigation; their
study promises not only to afford specific data but also to throw
a light on the general problem of morphogenesis. If, finally, it
is considered that in certain species the secondary sexual char-
acteristics are utilized for the determination of the race, it is
seen that the problem, transcending its immediate interest, may
lead us to the mechanism of the evolution of species. Such are
the ideas which have inspired the present article. It is proposed
to discuss the endocrine role of the testes of fowls and the dedue-
tions which may be derived.

I. HARMOZONE AND GROWTH

Secondary Sex Characteristics. It will at once be recog-
nized that cocks afford particularly favorable material for such
studies. Their secondary characteristics appear in great variety
and in adults are easily perceptible grossly. Among such features
are the great development of the comb, wattles and auricular
appendages which, at puberty acquire a well-known redness;
the ruffle of supple, tapering plumes about the neck (camail)
and across the back (lancettes); the long and recurved caudal

527

528 SEX AND ENDOCRINOLOGY

plumes, large and small; spurs at the bases of the metatasals ;
—such are the morphologic criteria.

On the psychic side the array is not less varied: the
strongly developed sex impulse leads to ardent regard toward
the female and querulous intolerance toward male rivals ; by lusty
crowing and spirited strutting the emotions are given vent and
victories announced.

Since these characteristics appear sharply at the time of
puberty,—1. e., with the development of the testes,—hiologists
have not hesitated to postulate their dependence upon the sex
glands. Castration experiments and the necessary control ex-
periments, however, have failed wholly to justify such a general-
ization. It is true that if the genital glands are extirpated in
young cocks the comb and wattles remain small, pale and rather
bloodless; neither the amorous nor ‘the combatative instincts
appear and our animal maintains a demure silence. But on the
other hand the spurs elongate in the absence of the gonads. As
we have shown, they grow as rapidly as in the intact animal (1).
There is no demonstrable relation between their development
and the internal secretion of the male glands. Nor in
the matter of plumage have we been able to establish any
relation, either in the common variety of fowls which is
raised about Paris or the Faverolles and Dorking races.
It is true that Morgan, operating upon Seabright cocks (2),
obtained an unexpected result,—the development of a magnifi-
cent male plumage of which the animals are normally destitute.
This is an important fact to which we shall revert. In every
case it is possible to recognize an influence of the testes upon
only the erectile organs, the sex instinct and the voice. Every
control experiment has remarkably verified this point of view.
The most decisive, in the opinion of the writer, consists in
ovariotomy of pullets, which has been carried out simultaneously
by Goodale (3) and by me (4, 5). Deprived of the sex glands
the young fowl rather soon undergoes a transformation and
acquires the plumage and the spurs of the cock. The meta-
morphosis is definitive. Hens without ovaries, which have been
kept for several years, have with each moult retained the male
type of plumage, while their spurs have reached a cumbersome
length (9em.).

PEZARD 529

That the testes mediate their influence through internal
secretion is demonstrated by two sorts of facts: (1) the char-
acteristics abolished by castration reappear if one transplants
into the peritoneum thin fragments of testes (Berthold, Foges,
Pézard) ; (2) the same result is obtained by periodical injections
of testicular extracts (Loewy, Pézard). We have personally
employed in such experiments extracts from the glands of
eryptochidie hogs which, it is claimed, are reduced to interstitial
tissue only. Since, with several repetitions of the experiment,
concordant results have been obtained, we must conclude that
the testes elaborate an internal secretion with morphogenic role
(harmozone-Gley) and that this harmozone possesses a physio-
logie specificity.

(a) Law of Continuity. These preliminaries having been
established we reach now the vital part of the subject. In a
remarkable report in 1913 Gley (6-p. 57) formulated a problem
relative to the internal secretions in which endocrinologists have
not failed to become much interested. ‘‘If one now considers but
a single part of the developmental mechanism (the action of the
internal secretion on development) it can be no better explained
than by the idea that this development is arrested of itself at a
given moment. Is it to be supposed that the interstitial tissue
of the testicle—or similarly, any other organ, diminishes its
functioning, reduces, for example, the amount of active sub-
stance which it sends to the organs on which it works? But there
is no proof that such functional diminution occurs, and, more-
over, these substances act in very minute doses, hence it is the
absolute suppression of their functioning that would have to be
supposed. The problem is pending.’’

Our experiments in post-pubertal castration allow the set-
tling of the debate and the demonstration of the judiciousness of
the reservations formulated by Gley.

If it is a fact that the endocrine function of the testicle
stops at the moment when the secondary sexual characteristics,
which are conditioned by its activity, have reached their complete
development, the extirpation of the genital glands ought to be
from this time on without effect on the animal.

Now that is not what oceurs. If we castrate an adult cock
at full sexual maturity, a few days later the sexual instinct and

530 SEX AND ENDOCRINOLOGY

the crowing definitely disappear. The erectile organs begin
an immediate regression: they diminish in volume, grow pale,
and finally acquire the reduced dimensions of the homologous
organs of castrates. From the periodical measurements of the
comb we have determined that the regression oceurs with re-
markable regularity, though this does not mean that the rapidity
is constant. On the other hand, sections made of the erectile
tissue show that the structure of this tissue has not been visibly
affected, therefore the phenomenon should be imputed to a real
regression.

We have carried out our experiments on cocks of different
ages and have obtained the same results. Always, the regression
of the comb is effected according to the same rhythm, going from
the initial constant stage (sexual comb) to the final equally con-
stant stage (capon’s comb).

All these facts show clearly that the testicular funetion
is constantly necessary for the maintenance of the erectile
organs and the sexual instinct. Gley reasons correctly when
he states that there is no proof of functional diminution. We
can even say,.in view of the uniformity of the results, that
the testicular harmazone exercises a sustaining action that is
always equal. It is true that the duration of the experimental
regression of the comb is slightly increased with age, but we are
tempted to see the explanation for this, not in the harmozone
itself, but in a conditional property of the tissue.

We can further affirm that the internal secretion of the
testicle disappears immediately after castration; that is to say,
it does not outlast the ablation of the genital glands,—its action
is immediate.

This was indicated by the manner of the beginning of the
regression. We will state forthwith that all harmozonal per-
sistence, after castration, would have as its result a more or less
continued persistence of the characters it influences. Now what
do we find? The regression of the comb immediately follows
castration: the regression is maximum for the first few days at
its beginning, a fact which is shown on the charts by a sharp
fall in the curve. Thereafter the regression is retarded and,
finally, the curve becomes horizontal. The regression is then at
an end. Now the sharpness of the decline as established for

PEZARD 531

the beginning of the phenomenon is incompatible with the per-
sistence of the harmozone. It must then be admitted that the
harmozone is effectually destroyed in the blood. Moreover, we
have established that for the injections of testicular extract to
be efficacious they must be repeated very often, which indicates
still further, a rapid destruction of the active product.

I conclude: The continuity of the endocrine function of the
testicle is an indispensable condition for the maintenance of the
conditioned characters. The morphogenic action of the testicle
presents in addition a remarkable constancy which is dissembled
by the arrest of growth in the adult.

It may be remarked in passing that the acquisition of these
suggestive ideas is the consequence of two particularly favorable
experimental conditions in our studies: on the one hand the pos-
sibility of measuring the comb, which permits a continuous
cinematic study, and on the other hand the reversibility in the
growth of that organ which makes significant the counter-proofs.

(b) Law of Minimum Efficacy. Observation shows that
the glands of internal secretion are more than sufficient to
assure the role that has devolved upon them. All biologists
know that an insignificant fragment of the adrenal or thyroid
preserves the animal from the consequences resulting from the
complete extirpation of these glands. There is a luxus endo-
erine secretion, as there are digestive secretions in excess, as
there is a margin of safety in respiration (6-p. 50). Is this so
in the case of the testicle ?

Two types of facts permit an affirmative answer: the fre-
quently unsuccessful attempts at castration of cocks and the sys-
tematic experiments in testicular transplants. Minute frag-
ments of testicles scattered in the peritoneum, far from the
normal locus of the gland suffice to activate. the development of
true male characters and to assure their maintenance: such is
the usual result.

In view of this effect, we have attempted to determine the
mass of testicular substance below which the tissue is incapable
of exerting its function. But apropos this subject a prelim-
inary remark is necessary concerning the structure of the
testicular nodules. These structures are highly variable and we
classify them into three categories: (a) nodules having con-

532 SEX AND ENDOCRINOLOGY

served, even a year after castration, the normal aspect of the
cock’s testicle, seminal canals containing spermatids with almost
no interstitial tissue; (b) nodules presenting the seminal canals
degenerated and reduced to a few Sertolian nuclei scattered in an
extremely vacuolated cytoplasm with interstitial tissue more
abundant; (¢) completely necrosed nodules, comprising degen-
erated seminal canals replaced by connective tissue in which
interstitial cells are rare. The first two types alone are efficacious
and it is with them alone that one can make weight comparisons.

Fig. 1. Graph showing the changes in the length of the comb of a cock
succeeding castration. A regressive stage is followed by a progressive stage and
fina! equilibrium.

On the other hand an elementary precaution is imposed rela-
tive to the appreciation of the secondary sexual characteristics of
a subject. An isolated observation means nothing. In order to
judge of the state of these characters, a long continued cinematic
study is necessary. For example, in fig. 1 are presented the data
regarding a cock which we had castrated in November, 1912 and
which had received at the same time some ovarian fragments
from a hen. For a month the comb diminished, going from
84 mm. to 56 mm.; then suddenly the growth of the comb again
commeneed and from December to April the length increased

PEZARD 533

from 56 mm. to 108 mm. At autopsy we found a testicular
nodule weighing 1.5 gm. An isolated observation would have
made us consider the animal in December a castrate, in February
an incomplete castrate, and in May a normal animal. So the
characters should not be appraised until they have attained an
equilibrium.

Neglecting this precaution, Foges (7),-in a memoir relative
to testicular transplantations in cocks, has reported results the
interpretation of which is open to question. During the course
of his study, carried out on 33 animals, he made but a single
measurement the data of which, according to our mind, lead to
a false conclusion. The data may be quoted:

Comb Wattles Spurs
Height Base Height Base Length
Control-cock ss. 2s... 8 12 5% 2 2
Capon SNG is ees. 4 8 2% 2, %

From this Foges concludes that in cock No. i, which possessed
two testicular nodules, the growth of the comb, wattles, and
spurs, is diminished. And yet he has earlier admitted that in
capons ‘‘the spurs can exist just as in the hens.’’ In reality,
animal No. 1 is probably a castrate the spurs of which have
developed tardily.

Having made these reservations with regard to methods,
we will again turn to the question of the transplant-bearing cock.
In subjects presenting characters in equilibrium and with func-
tionating nodules, we determine at autopsy the total mass of
the fragments. We have found that these subjects can be
divided into two groups: those that possess more than 0.5 gm.
of testicular substance have the aspect of normal males; those
that have less than 0.5 gm. are essentially castrates. The mean
weight of the testicles being 15 gm. it is evident that the endo-
crine function of the testicle is assured when 1/30 of the normal
gland weight is present. The testicle does not deviate from the
law of luxus secretion.

(c) All-or-none Law. We are naturally led to an examina-
tion of the correlation that may exist between the mass of testicu-
lar parenchyma and the quantitative development of the con-
ditioned characters, a correlation that is particularly interesting
as we approach the minimal effective limit. If we consider the
figures relative to those of our subjects the characters of which
were in equilibrium, and to make the matter more clear, if we

534 SEX AND ENDOCRINOLOGY

arrange them in the order of diminishing size of the testicle and
compare the weight of the seminal parenchyma in grams with
the length of the comb in millimeters, we can establish a curve
as shown in figure 2. The ordinates correspond to the succes-
sion of animals as in the table and the abcissae to the weight of
the testes and length of the comb.

sia a ens teal ReRRASE
P| tT WAlod dle bowed oid reen.| | tt
140 PEPE All-or-none lew | | | | | | | °
ee ih] LEST a

130 ee Cees
BSRRERRReE Wee enoess
Pata ok ara
Seis eeaeeas
ETE 08 eS ES
as eee
is pa SEES

SS a}
+++ +

Pa Seas
EVA ISS eas
Ae

f"
BERGE
Sige No
tet
Pe se a

i
an
ee

fal
|_|
ie
il
il
|_|
alles i
[a
|_|
||
a
inal
x

3 9 to 1 — te

Fig. 2. Graph showing the length of comb as related to the weight of tes-
ticular tissue present in 25 cocks.

Wt. Ibe Wt. ee Wt.
No. Test. Comb No. Test. Comb No. Test. Comb

i 42 110 9 1.5 82 7 0 56
2 28 106 10 is 40 18 0 55
3 20 113 11 1.0 78 19 0 62
4 14 81 12 1.0 Bi 20 0 65
5 12.5 115 13 0.7 97 21 0 55
6 9 97 14 0.5 Talat 22 0 57
7 8.3 86 15 0.1 59 23 0 54
8 Z 85 16 (Oeil 60 24 0 58
25 0 63

Or

PEZARD 53:

An examination of the chart shows clearly that there is no
parallelism between the testicular weight and length of comb.
In the part A-B of the curve which pertains to the cocks showing
male characteristics, the curve is very high and presents varia-
ations; but these vary from one side to the other with a mean
value of 100; they do not correspond to the variations of the
morphogenic power of the testicles, but to racial characteristics,
and are the result of the fact that the cocks to which they pertain
are of different races. The part B-C of the curve which corre-
sponds to the so-called neutral cocks, also shows variability but
relatively less marked. Without doubt the variability again is
to be aseribed to difference of races. The subjects fall in series
with those of the region A-B and consequently are comparable
with them; the mean of the second part of the tracing is 58.

At the point B the least efficacy is found; the curve here
undergoes a sudden drop, passing from the level A-B to the level
B-C. This turn of the curve and its obvious discontinuity seem
to us, better than any reasoning, to show that the morphogenic
effect of the testicle follows an all-or-none law. That is to say,
as soon as the functional threshold value is passed, whatever may
be the mass of the active gland, a cock takes on as a whole its
secondary sexual characteristics. It appears that these mani-
festations can not be fractionated.

It would be interesting to determine if the moment these
characters are started in their development in the cock is exactly
that point when the testicle has attained this minimal weight of
6.5 ¢m. In this case the morphogenic action of the testicle would
be at the beginning and throughout the sexual life a constant
which directs the conditioned processes. There would result a
great simplification in the study of the growth of the comb.
Further researches should decide the question.

The all-or-none law carries another implication of general
significance in relation to the factors operative in all conditioned
growth. When one studies the morphology of the testicle of a
cock, a uniformity of structure is found throughout the whole
extent of the gland; moreover, this is maintained throughout the
first years of life, from the third month on. Since the testicle is
richly vascular, the conclusion is justified that the amount of the
active harmozone thrown into the blood is proportional to the

536 SEX AND ENDOCRINOLOGY

amount of active parenchyma,—that is to say, in short, to the
total weight of the gland (with the exception of the albuginous
matter). If this harmozone actually constituted merely a sub-
stance promoting unrestricted growth, there is no reason to
believe that the law of mass action would not obtain. The two
curves in figure 2 would have the same trend, which is not the
case. The observations cannot be interpreted unless one admits
on the part of the harmozone a stimulative action upon a tissue
the growth capacity of which is limited. This growth capacity
which is a property of the conditioned organ represents, in these
circumstances, the influential factor.
HARMOZONE AND EVOLUTION

(a) The Sebright Breed. In 1918 we wrote: ‘‘The theories
of evolution presuppose the occurrence of progressive organic
modifications which effect the transformation of the animal
species through growth or atrophy of the organs. The environ-
mental influence, the manner of living, the habits, constitute,
outside of sexual reproduction, the possible causes of individual
variations. One may well ask if the action of these different
factors has no influence on the harmozones, the directors
of the morphogenic processes. In fact an equilibrium can not
be modified if something has not disturbed the cause operative
in its maintenance; on the other hand, every cause acting on an
endocrine gland is profoundly echoed throughout the entire
organism.’’

This point of view has received confirmation through two
observations as exact as they were unexpected. The first is
related to the Sebright cocks, so well studied by Morgan.

Considered as very close to the original ancestral strain of
the Gallus domesticus the Sebright variety differs from ordinary
cocks by the racial characters selected from the secondary sexual
attributes; they have neither hoods nor lancets; the recurved
plumes hardly extend beyond the straight feathers of the tail.
In fact so lacking are they in these male attributes that their
plumage resembles more that of a hen. The wattles and the
comb, however, are always of the characteristic male type. Now
it is a curious thing that if a Sebright cock is castrated, there
develops a rich male plumage, as has been shown by Morgan;
hoods, lancets, and the curved caudal plumes elongate meas-
ureably ; the animal loses its racial peculiarities and follows the

PEZARD O37

common law. It should be noted that in this circumstance the
testicle, far from conditioning the male plumage, as has been
previously considered, seems, on the contrary, to exert an inhib-
iting action similar to that of the ovary.

In the absence of histological studies of the testicles of the
Sebright cock, in order to explain the plumage characters, we
have thought of a state of false equilibrium, a condition which
would be supplanted by castration or by a violent traumatism
(1-p. 143). New studies advanced by Boring and Morgan (8)
prevent us from attributing the cause of the anomaly to a somatic
property of the cocks, and oblige anew a return to the conception
of a conditioning by harmozone activity. In fact, on examining
the structure of the testicles of the Sebright cocks, Boring and
Morgan found a special type of cell which is not found in the
testicles of other cocks. They are large elements with well
defined margins, clear cytoplasm, nucleus more or less spherical,
and forming more or less well defined islets in the interstitial
tissue. Near them masses of yellow pigment were observed which
suggested for the elements in question the name of luetin cells.
Now the lutein cells are a normal part of the ovary of the hen
(Boring and Pearl) ; we have described similar structures in the
ovaries of the silver pheasant, Ewplocomus nycthemerus (1-p.
116). Since these interstitial cells in the female ovary prevent
the development of the male plumage, we believe with Morgan
that the same is the case with the Sebright cocks. This now
explains the assumption of the male plumage after castration.

It is certain that the special characters of the plumage of
the Sebright cocks give to these animals an apearance such that
one would think they are of a different species. These racial
attributes strike the most casual observer much more than the
histological structure of the gland. However, if one establishes
a subordination of characters, as results from our studies on
conditioning, one should admit that the presence of lutein cells is
a dominating character, while the specialities of plumage con-
stitute a subordinate character. From this, we must conclude
that if, in the evolution of the Gallus domesticus, a variation is
produced at a given moment, with regard to the plumage it has
been preceded, prepared, unloosed, by a correlative modification
of the conditioned glands; our hypothesis receives verification
in an exact manner.

538 SEX AND ENDOCRINOLOGY

The zoologists ask a question here that can not be allowed
to pass. Which is the primitive form, the structure of the
testicles of the Sebright cocks, or the ordinary structure? It is
customary to consider the Sebright cocks as being the older
strain, on account of the simplicity of their plumage and because
of their resemblance to the cocks of Asia. The conditions of
breeding and selection have brought about the development of
races having most luxurious male plumage, such as those of
Japan, in which the tail has taken on an extraordinary develop-
ment; this seems clear.

But the conclusions are reversed if one considers that eas-
tration causes the appearance in the Sebright cocks of the
abundant plumage of the males. These animals possess then
in a potential state, the same characters as other cocks, and an
added influence has been necessary to prevent the development
of these characters at puberty. From that point of view one
should consider them as being more highly evolved. This notion
of potentiality deserves to be retained when it is a matter of
comparing racial characteristics; it forces us to revise our judg-
ments based on simple morphological ideas. What problems still
remain to be studied !

The Sebright cocks are not unique in the possession of simple
plumage. According to Morgan and Boring, one finds in the
Campine and Hamburg races cocks having plumage like that of
a hen. In these species it is simply a matter of exceptional
cases,—the majority of the males having normal plumage. With-
out doubt, no histological study has bound up these accidental
variations with the structure of the genital glands, but it is allow-
able, in view of facts already acquired, to prophesy an accidental
variation in the structure of the male glands. We would witness,
if that view is correct, an actual transformation in the plumage
equilibrium, a change brought about by a preliminary trans-
formation of the conditioned gland. Intensive studies alone can
definitely decide the question.

(b) The results of exclusive carnivorous diet in cocks and
rats. One such mechanism is assumed in the supposition that
the reproductive glands may be modified by the habitual causes
of variation, alimentary regime, state of environment, etc. The
time has come to examine the foundation of this allegation.

PEZARD 539

In a series of experiments carried on from 1901 to 1906,
Houssay (9) studied the modifications produced in Gallinacea
(cocks and hens) by an exclusive meat diet. Among the results
obtained, the author noticed a reduction in the sexual dimorph-
ism: progressive sterilzation, the cocks losing the fighting
instinet, ete. Put in the presence of their rivals, certain meat-
fed cocks appeared timorous and tried to hide; they did not
resist, they were the attacked. More often, they were accepted
by their normal companions who did not deign to pick a quarrel
with them. We should add for the sake of completeness that the
carnivorous régime did not produce constant results and that
many cocks on this diet retained the aspect and functions of the
normal bird. In all cases Houssay attributes the effect to a direct
influence of the meat diet.

Pursuing the same line of thought, Paul (10) submitted
several series of male rats successively to an exclusive meat diet.
As controls, at the beginning of this regime he took rats that had
just been weaned and castrated them; at autopsy he determined
that the reproductive organs were little developed in comparison
with those of the controls. The reduction affected the seminal
vesicles, prostate and penis. Paul attributed the modification to
a direct influence of the exclusive meat diet.

In the two eases it is interesting to call attention to the devel-
opment of the testicles in the animals so modified. As far as
the carnivorous cocks are concerned, we have determined, from
the autopsy tables accompanying Houssay’s memoir, that these
glands had received a setback under the meat régime and had
not developed,—at least in the animals having the eastrate char-
acters. The mass of glandular parenchyma in these various
subjeets varied from 0.7 to 0.2 gms. Among the meat-fed cocks
which retained their sexual attributes completely, the figures are
higher, varying from 1.9 to 42. gms. We eall to mind here our
conclusion relative to the potency threshold and the all-or-none
law. A similar conclusion follows from the work of Paul, which
is illustrated by two charts showing the reduction of the genital
tract and the testicles; the male glands of the subjects submitted
to the carnivorous diet are so small in comparison with those of
the normal males that one would think them atrophied.

In one case as in the other, it is not expedient actually to
attribute the non-development of these secondary sexual char-

d40 SEX AND ENDOCRINOLOGY

acteristics to the direct action of the dietary regime. The truth

is that the exclusive meat diet determines in the two species a
slow intoxication, an abnormal chemical process, to which the
genital glands are particularly sensitive; it has then produced
the modifications secondarily consecutive to castration. These
experiments prove, in our opinion, that the reproductive glands
are capable of responding to a definitive chemical influence, even
though the nature of the response is not such as to produce a
new race.

In conclusion, the testicular harmozone holds as dependents

a certain number of secondary sexual characters. Its action,

which begins at puberty, presents during the sexual life, in the
ease of cocks, a continuity and a constancy that are really
remarkable. It does not survive the ablation of the genital glands
although a small amount of the glandular parenchyma suffices to
assure the integrity of the function. Histological modifications
of the gland are able, as in the Sebright cock, to induce modifica-
tions in the external characters and to determine the very differ-

ent races. Finally, these glands are sensitive to the action of a

dietary regime considered up to now as one of the primary fae-

tors in evolution.
BIBLIOGRAPHY
1. Peézard, A.: Le conditionnement physiologique des caracteres
sexuals secondaires chez les Gallinacés. Bull. biol. Fr. et Belge.
1913, 52; Wao:

2. Morgan, T. H: Demonstration of the appearance after castra-
tion of cock-feathering, in a hen-feathering cockerel. Proc. Soc.
Exp. Biol. and Med. (N. Y.), 1915-16, 13, 31.

Goodale, H. D.: Castration in relation to the secondary sexual

characters of brown Leghorns. Am. Naturalist (Lancaster, Pa.),

1913, 47, 159-169.

4. Peézard, A: Développement expérimental des ergots et crois-
sance de la créte chez les femelles des Gallinacés. Compt. rend.
Acad. d. sc. (Paris), 1914, 158, 513-516.

5. Pezard, A.: Transformation expérimentale des caracteres sex-
uels secondaires chez les Gallinaces. Ibid., 1915, 160, 260-263.

6. Gley, E.: Relation entre les organes a sécrétion interne et les

troubles de ces sécrétions. 17th., Internat. Cong. of Med. (Lon-

don), 1913; Les sécrétions internes (Paris), 1914.

Foges, A.: Zur Lehre von den secundaren Geschlechtscharac-
teren. Arch f. d. ges. Physiol., (Bonn), 1902, 39-58.

8. Boring, Alice and Morgan, T. H.: Lutear cells and hen-feather-

ing. J. Gen. Physiol., (N. Y.), 1918, 1, 127-181. eat

9. Houssay, F.: Variations expérimentales; études sur six génera-

tions de poules carnivores. Arch. de zool. expér. et gén., Hist. Nat.
fetes (Paris) 190% 4a saGlsiesoe.

10. Paul, C. B.: On the influence of an excessive meat diet on the

male reproductive organs. Proc. Physiol. Soc. Lond., J. Physiol.,
1906, p. xiv.

co

THE ORIGIN AND EVOLUTION OF THE INTERSTITIAL
CELLS AND OF THE OVARY AND THE SIGNIFI-
CANCE OF THE DIFFERENT INTERNAL
SECRETIONS OF THE OVARY

Isaac Ochoterena and Eliseo Ramirez, Mexico

In the ovary two functions may be distinguished, one in
relation to reproduction and consisting of the development of
ova and the other referring to its role as an organ of internal
secretions. From this point of view two sorts of histological
structures are to be distinguished, the corpus luteum and the
interstitial cells.

The corpus luteum was first recognized by Coiter in 1573,
and the interstitial cells by Pfliiger in 1863. Following Frankel
the reports upon the endocrine function of the corpus luteum
have been almost innumerable. The functions of the interstitial
tissue have been considered by Limon, Bouin, Frinkel, Regaud,
Ganfini, Ancel and Bouin, Below, Graves and Felner.

According to our embryological researches, the corpus luteum
has a dual origin from the connective and the epithelial tissue,
this being the source of the theca and the membrana granulosa,
respectively, from which the corpus luteum is derived. Accord-
ing to Sobotta and Cohn it is of epithelial origin and according
to Guilera Molas it is of connective tissue origin exclusively.

Della Drips, who has studied the corpus luteum of the Sper-
mophile, Citellus tridecemlineatus has noted that immediately
after the formation of the corpus luteum there appear globules
of protoplasmic secretion ; these are colored red with the fuchsin-
methyl green stain following fixation in Bensley’s fluid. This
latter is substituted by another secretion of lipoid nature; the
latter is related to the post-partum retrogressive changes of the
uterus.

In our preparations of the ovaries of rabbits and rats the red
elements begin to appear as early as the membrana granulosa
and discus proligerous stages of development. The secretory

Resume of memoirs presented before the Sixth Mexican National Con-
gress of Medicine.

541

542 INTERSTITIAL CELLS, SECRETION OF OVARY

activity is manifested, therefore, before the production of the
corpus luteum proper (Fig. 1). Our work shows also that the
corpus luteum persists until after parturition.

We do not coincide in the opmion of Edem and Lokyer,
Frinkel, Asher, ete., that the corpus luteum gives rise to men-
struation. In short, the corpus luteum succeeds the rutting
period, as demonstrated by us in the rabbit, by Della Drips,

Fig. 2—Microphotograph of the uterus of the rabbit during the rutting
period, showing the characteristic modifications of the mucosa, the extravasa-
tion of blood and the blood-filled lacunae.

Donaldson and others in different animals; rutting is accom-
panied by phenomena analogous to menstruation. The accom-
panying microphotograph (Fig. 2) shows the details observable
in the uterus of the rabbit during the rutting. Our work thus
confirms that of Wallich. That the sanguineous discharge is
to the exterior in women and the macaca is due principally to
the anatomical circumstances of the presence of the type of
muscular wall found in these primates.

OCHOTERENA AND RAMIREZ 543

During menstruation arterial hypertension frequently is seen
whereas extract of corpus luteum produces hypotension. Such
extract, futhermore, is of no utility in the treatment of preco-
cious menopause and does not augment the menstrual flow. In
cases of various women, we have noted, on the contrary, a di-
minution and retardation of the flow, confirming the observation
of Epley, MacCann, Climenko and others. We accept as indubi-

Fig. 3—Microphotograph of the cortical region of the rabbit ovary,
showing an ovule developing and the interstitial cells, some with two nuclei
and one in regression.
table that the secretion of the corpus luteum depresses men-
struation, not by inhibiting any hormone secreted by the uterus
but by its antagonistic action on the interstitial tissue of the
ovary. We have studied the uterus in a great number of mam-
mals and have never encountered any histological formation nor
cytological process which would support the existence of a ‘‘myo-
metrial gland’’ nor any definite evidence of internal secretion.
We, therefore, take issue with Seitz and Wintz. That bilateral

544 INTERSTITIAL CELLS, SECRETION OF OVARY

ovarian extirpation suppresses menstruation is to be aseribed
not to loss of corpus luteum but of the secretion of the inter-
stitial tissue.

We have made studies of the interstitial cells, their embry-
ology, evolution and endocrine function, arriving at the follow-
ing conclusions: These cells may be considered as a constant
formation in the ovaries of a great number of animals. The

Fig. 4—Microphotograph which shows the interstitial cells of the rabbit
onary The chondrioplasts secrete lipoid material colored brown with osmic
epithelial cells of the gonads which form a layer in immediate
relation with the celom, multiply, invade the subjacent con-
nective tissue, pass through the stages designated by Wine-
warter the ‘“‘protobroca’’ and ‘‘deutobroca’’ and evolve in this
manner: some pass through the well known stages to form
oocytes ; others constitute the interstitial cellules. These undergo
a process of phagocytosis encountered by us in the ovaries of
the rabbit (Fig. 3) comparable to that deseribed by the bota-

OCHOTERENA AND RAMIREZ 545

nists in the sexual elements and by Balfour and Lane-Claypon
in other animals. Some of the cells are able to reach a stage
analogous to that which precedes the formation of oocytes, in
the cells previously described.

The interstitial cells are the site of a cyclical phenomenon
manifested principally by the evolution of chondriosomes. The
mitochondria of these cells in which the hormones are elaborated

: Fig. 5—Microphotograph showing the interstitial cells of the ovary dur-
ing the dispersal of the chondriomites.

appear in the ovary of the fetus and undergo notable changes
during the development of the animal. They are probably
concerned in the appearance and conservation of the secondary
sexual characteristics and especially the modifications character-
izing puberty.

During menstruation in women, and in rutting, which is
the equivalent of menstruation in animals, the activity of the
mitochondria is clearly evident, characterized by the appear-
ance of chondrioplasts, which in turn give rise to a substance

546 INTERSTITIAL CELLS, SECRETION OF OVARY

of lipoid nature that by osmie acid is stained a coffee brown
(Fig. +). At the termination of the rutting period the chon-
drioplasts give way to the smaller mitochondria and these form
the starting point for a new secretory cycle (Fig. 5).

Of the two endocrine functions of the ovary, the corpus
luteum mediates that having to do with the formation of decidual
cells and the modification of the uterine mucosa which favor
nidifieation of the ovum. If fecundation occurs the structure
is transformed to the corpus luteum of pregnancy and alters
the nature of its secretion. It assumes relations with the mam-
mary glands and other endocrine organs. The secretion of the
corpus luteum being, as previously mentioned, antagonistic to
that of the interstitial ovarian cells, when the corpus luteum
retrogresses or is experimentally suppressed, the action of the
interstitial secretion is manifested. This secretion is the deter-
mining faetor of menstruation; during the menstrual period
the corpus luteum is either non-existent or in a regressive
phase, while the interstitial cells manifest with maximum inten-
sity the secretory phenomena. The ovarian congestion which
coexists with menstruation favors the maturation of the graafian
follicle. This ruptures and gives rise to a new corpus luteum
which in turn depresses the interstitial secretion, causes the
discontinuance of menstruation and thus again initiates the
eyele previously described.

Fig. 1—Microphotograph of a preparation of the ovary of a rabbit. The
chondriomites of the zona granulosa have been cclored red directly from the
slide by aid of the camera lucida. Fixation and staining by the methods
of Bensley and Cowdry.

THE INTERNAL SECRETION OF THE TESTIS
Aldo C. Massaglia, Patten Fellow

Department of Physiology and Pharmacclogy, Northwestern University
Medical School, Chicago.

The researches of Mantegazza and Brown Séquard in the
second half of the last century on the testis in order to deter-
mine if that gland produces an internal secretion which gives
secondary characters to the male, opened the way for the study
of the endocrine glands.

Although we know, if only imperfectly, the internal secre-
tion of some of the ductless glands and we are able in certain
cases, when the function is disturbed, to give treatment with
success, the knowledge of the function of the sexual glands,
although the first studied, is not even yet well known. This is
due to the fact that though the anatomic and pathologic re-
searches of Ancel and Bouin are arguments for the concep-
tion that the testis has an internal secretion, which is elaborated
from the interstitial cells, the experiment did not give definite
proofs.

Aneel and Bouin, after ligature and resection of the ductus
deferens in the rabbit, obtained degeneration and atrophy of the
seminal epithelium; the Leydig’s cells remained without change.
The animal kept the secondary sexual characteristics until the
day that it was killed. Gosselin, Fabris and others, on the con-
trary, did not observe lesion of the testis from hgature and re-
section of the ductus deferens. Hence the conclusion as re-
gards the internal secretion of the interstitial cells of the testis
is not uncertain; the difficulty of solution of the problem is due
to the disposition of the interstitial cells, which, as remarked
lately by Cushing ‘‘is such as to make it impossible to observe
the consequences of their ablation apart from the other cells of
the organ.’’

Therefore, [ believed it would be of value to repeat the study
of the internal secretion of the testis and began the investiga-
tion herein described. The experiment of Ancel and Bouin was
repeated, but with the rooster instead of the rabbit as the ex-
perimental animal. The rooster differs from rabbits in that it

547

548 INTERNAL SECRETION OF TESTIS

has very marked secondary sexual characteristics: the comb, the
spurs, the plumage, the sex instincts, the crowing and fighting
tendency. After castration these characteristics disappear or
become greatly modified. It is indeed easy to distinguish a eapon
(castrated rooster) from a rooster. If some time following the
operation of ligature and resection of the ductus deferens the
rooster, while alive, keeps all the secondary sexual characteristics
of the male but the testes have become small and, on microscopic
examination, atrophy of the cells of the seminiferous tubules is
noted while the interstitial cells of Leydig show no lesion, one
would be justified in agreeing with Ancel and Bouin that the
interstitial cells have the function of internal. secretion of the
testis.

In addition to simple ligation of the ductus deferens a
further experiment was made. Three or four months after
the initial ligation, when atrophy of the cells of the seminif-
erous tubules had occurred, the testes were removed by a sec-
ond operation. This amounted in effect to extirpation of the
Leydig cells. Any changes in the secondary sex characteristics
could then be ascribed to loss of these cells.

Fichera has found that castration in the rooster and in
other animals produces hypertrophy of the pituitary body with
increase of the eosinophile cells. Accordingly, in each experi-
ment the condition of the hypophysis cerebri was observed. In
the light of Fichera’s results it would be expected that the
pituitary body would remain normal after the first operation
(ligature and resection of the ductus deferens with subsequent
atrophy of the seminiferous tubules) and after the second opera-
tion (removal of the atrophic testis) it would become like that of
the capon. Control observations were made upon normal roosters
and ordinary capons.

Finally the experiment of Pézard and Lespinasse (the trans-
plantation of testicular substance into the peritoneal cavity) was
repeated in order to study the eventual change of the secondary
sexual characteristic in comparison with the changes of the cells
of the testis. In these experiments, also, the pituitary body of
each rooster was examined.

The experimental series included many animals, because
sometimes we observed reconstruction of the ductus deferens

MASSAGLIA 549

after ligature and resection. In order to hinder this reconstrue-
tion as much as possible the vas deferens was dissected from the
ureter for about 2 cm. and ligated at both extremities; at a
point midway between the two ligatures a third knot was tied.
The vas was then cut between the middle knot and that nearest
the cloaca.

Fig. 1—Normal testis of cock. Note seminiferous tubules full of sperma-
tozoa. The spaces limited between two or three seminiferous tubules show
the interstitial cells. Fixation, formalin; staining, haematoxylin-eosin; mag-
nification, 60 diameters.

The tissue of testes and pituitary bodies for the histological
study were fixed in formalin solution, in Zenker’s, in Miiller’s
or in Flemming’s fluid; the sections were stained with haema-
toxylin-eosin, haematoxylin-Van Gieson, safranin-Flemming’s,
‘‘thionine pheniquée’’ of Nicolle, and fuchsin of Altmann. Espe-
cial regard was paid to degenerative changes and chondriosomes
as indicative of secretory activity.

do) INTERNAL SECRETION OF TESTIS

A. THE INTERSTITIAL CELLS OF THE TESTIS OF NORMAL ROOSTERS

This series comprised 7 normal cocks. The testis in the
rooster hes in antero-superior part of the peritoneal cavity in
relation with the anterior-inferior surface of the kidney. It is
an ovoid body of very large size considering the size of the
animal; the average weight of the testis in a rooster of about
214 Kg. is 10 grams. The spermatic ducts are two tortuous
canals which extend from the epididymis to the cloaca, where
they end. The vas deferens with its nerves and blood vessels
follows the internal side of the ureter, and these structures
cross the abdomen longitudinally.

The testis is made up of the seminiferous tubules and inter-
stitial connective tissue. The interlobular or interstitial stroma
contains groups of peculiar rounded polygonal elements, the
interstitial cells. These are more frequent in the spaces limited
between two or three seminiferous tubules, where there often is
a small blood vessel. The interstitial cells sometimes do not
show well defined limits. The nucleus has a spherical form and
stains well. Some authors have studied the substances secreted
from the testis, particularly the lipoids and pigments (Loisel,
Pézard). Loisel says that the cells which le in spaces between
seminiferous tubules of the rooster secrete two kinds of pig-
ments: ‘“‘les unes, élaborent des pigments clairs, proviennent de
Vébauche germinale et doivent etre considérées comme des
éléments soeurs de cellules germinatives; les autres élaborent des
pigments foneés, insolubles, sont des éléments conjonctifs hyper-
trophiés apparaissant a une époque plus ou moins avancée de
Vevolution du testicule. I] foudra done sans doute reserver
l’expression classique de cellules interstitielles pour désigner les
éléments de la premiere eategorie.’’? I believe that one should
consider the fat and especially the chondriosomes of the inter-
stitial cells, because they give evidence as to whether the cells
have secretory properties. The detection of the pigment in cells,
when we are able to establish that they elaborate these pigments,
does not demonstrate that the cells have a secretion.

I found in the interstitial cells of the testis of the rooster
small and numerous fatty granules (safranin-Flemming method)
and many small granules (mitochondria) well stained by the
acid fuchsin with Altmann’s methods. Rasmussen also found

MASSAGLIA do1

mitochondria in the interstitial cells of the testis of the wood-
ehuek.

B. THE PITUITARY BODY OF NORMAL ROOSTER AND CAPON

The pituitary body of the rooster (Piersol) consists of two
distinet parts, the anterior and posterior lobes. The anterior
part (glandular) constitutes the major part of the organ. It is
surrounded by a fibrous capsule that is continuous with the
thinner one inclosing the posterior lobe. We shall first consider
the anterior parts. From the capsule extend inward fine pro-
cesses which form a delicate fibrous reticulum; within the retic-
ulum lie the cells. These are situated for the most part very
close together and constitute a real cellular cord. Sometimes
they are arranged almost like glandular tubules. The cells are
apparently of two kinds: the chief cells which we can stain with
basic dyes (only slightly with acid) and chromophile cells, which
are larger and which have affinity for such acid dyes as eosin.
The cosinophile cells in the hypophysis cerebri of the cock are
generally very scarce. The blood vessels consist almost entirely
of capillaries which lie in a mesh work.

The weight of the pituitary bodies of 7 normal cocks is
recorded in Table 1.

TABLE 1.
Body Hypophysis Weight of
Age. Weight. weight, gms. 2 testes, gms.
if 6 months 0.720 Kg. Oita! 2.16
2 6 months 0.600 Ke. 0.16 4.00
3 1 year 1.300 Kg. 0.13 9.00
4 3 years 3.200 Ke. 0.14 20.00
5 3 years 2.000 Ke. 0.12. 16.00
6 3 years 2.600 Kg. 0.14 18.00
4 3 years 2.500 Kg. 0.18 16.00

The pituitary bodies of 4 capons were found to average
heavier in weight than those of the roosters. The hypophysis of
the capon is far richer in the eosinophile cells than that of the
rooster; it is also more hyperemic. The data pertaining to this
series are comprised in Table 2.

d02 INTERNAL SECRETION OF TESTIS

TABLE 2.

Weight of pituitaries of 4 capons:

Approximate

Ageat Weight at Weight of Weight at Weight of
Castration, Castration, testes, Interval, Autopsy, Pituitary

mos. Kg. gms. months. Kg. oms.

1 6 0.720 2.16 6 1.500 0.260

2 6 0.748 2.00 6 1.800 0.225

3 6 0.500 0.50 6 1.800 0.275

4 6 0.750 2.20 6 1.600 0.262

Castration then produces, as was observed by Fichera, a
hypertrophy of the pituitary body and an increase of its eosi-
nophile cells. But I believe, if the increase of the eosinophils in
the gland signifies its greater activity, we could have eosinophilia
also in other conditions. Indeed, I have found a certain degree
of eosinophilia in the hypophysis cerebri of the 6th and the 7th
roosters (the roosters were perfectly healthy) and Vassale found
that the pituitary body of the puppy has more eosinophils than
that of the adult. Therefore, perhaps, the eosinophilia may be
related to the skeletal growth.

C. RESULTS OF LIGATION AND RESECTION OF DUCTUS DEFERENS IN
ROOSTER

(1.) From a young rooster about 75 days old and weighing
0.550 Kg. was removed (June 4, 1910) the right testis (weight
1 gm.) ; the left spermatic duct was ligated and resected. The
animal developed lke a normal rooster. January 18, 1911, the
animal (weight 0.950 Kg.) was killed. At the autopsy the left
testis (weight 0.75 gm.) was found smaller and harder than the
normal. In the epithelinin of the tubules degenerative changes
were noted; the tubules were smaller than normal. In a few
seminiferous tubules some spermatozoa still remained. The in-
terstitial connective tissue was slightly increased and in this
tissue the Leydig’s cells were increased in number.

The pituitary body weighed 0.215 gm.; it was heavier than
normal, but did not reach that of the capon. The quantity of
the eosinophile cells in the pituitary was normal.

(II.) In a young rooster (weight 0.900 Kg.) about 6
months old (November 16, 1912), ligation and resection of

MASSAGLIA 5D3

both spermatic ducts was carried out. The animal developed
normally. June 18, 1913, the rooster was killed (weight 1.450
Kg.). At autopsy the right testis weight 3 gm., viz., less than the
normal ; the left testis was very small and weighed 0.20 gm. The
pituitary body weighed 0.2 gm. The study of this experiment
was interrupted ; the microscopical examination of the testis and
pituitary body was not made. It is included as showing atrophy
of the testis.

Fig. 2—Testis of cock, Series C, Experiment I, after ligation and resec-
tion of spermatic duct. Shows some spermatozoa’'in a few seminiferous
tubules and degenerative changes in its epithelium, slight increase of the
interstitial connective tissue and the Leydig’s cells. Fixation, Bouin’s fluid;
staining, haematoxylin-eosin; magnification, 60 diameters.

(III.) In a young rooster (weight 0.850 Kg.), age 6
months (November 18, 1912), ligation of both spermatic ducts
was carried out; they were not cut. The bird grew normally.
June 18, 1913, the rooster, in good condition, was killed (weight
1.700 Kg.). At autopsy it was found that the ligature had
yielded; the ducts were open. Together the testes weighed 5.25

dd4 INTERNAL SECRETION OF TESTIS

em. They appeared normal. The pituitary body weighed 0.215
om. It was normal in structure.

(IV.) In a rooster one year of age (weight 2.050 Kg.)
ligation and resection of both spermatic ducts was carried out
(January 6, 1920). The animal recovered in a few days.
February 29, 1920, the rooster (weight 2,400 Kg.) was in good
health. A laparotomy was done and it was found that the left
ductus deferens was reconstructed and its testis normal. The
left testis was removed (weight 11.00 gm.). The right testis
appeared small and seemed harder than normal; its vas deferens
was also small. The animal recovered slowly. March 20th, the
animal was well, but it seemed that its secondary sexual charac-
teristics were less marked than normal. The crowing was not
clear and strong. April 16th, the animal was in good health; a
third laparotomy was made. It was very difficult to ablate the
testis because the gland was sclerotic. It was removed in pieces.
After the operation the rooster recovered in a few days, but at
the same time it ceased to crow, lost its sexual instinets and the
desire to fight.

The animal, when killed, weighed 2.530 Kg. The left testis
(the first removed) was normal. The right testis (the second
removed) showed: (a) the spermatogenetie cells with degenera-
tive changes; (b). the Sertoli’s cells normal; (¢) a few sperma-
tozoa; (d) inerease of connective tissue and a slight decrease of
Leydig’s cells; (e) edema, hyperemia, lymphangitis and infiltra-
tion as in chronie orchitis. The loss of the left testis and the
decrease of the Leydig’s cells in right testis after the first opera-
tion may be the explanation of the diminished male instincts.
The pituitary body weighed 0.23 gm. Microscopic examination
showed a marked increase of the eosinophile cells,

(V.) Rooster, age about 3 years (weight 3.200 Kg.) ;
January 9, 1920, both spermatic ducts were ligated and resected.
The animal recovered in a few days; it remained male in its
attributes. March 4th, the animal was in good condition. <A
laparotomy was done; the spermatic duct appeared small and
almost empty. The testes were small, but the right testis was
larger than the left. The right testis was removed. In one
week the animal recovered and showed no changes in the secon-
dary sexual characteristics.

MASSAGLIA 599

April 8th, the animal (weight 3.100 Kg.), showing all the
male characteristics, was killed. At autopsy the left testis
(weight 2 gm.) was small and hard. The pituitary body weighed
0.18 gm. Microscopic examination of the right testis (which
was removed March 4th) showed the seminiferous tubules smaller
than normal; in the lumen were found a very few spermatozoa.
It seemed that spermatogenesis had stopped. The spermato-
genetic cells did not show important degenerative changes.
There was marked hyperemia. The interstitial connective tissue
was increased as well as the interstitial cells. The right sperm-
atic duct contained no spermatozoa. The seminiferous tubules of
the left testis were smaller than those of the right; nevertheless
it was possible with careful search to find a few spermatozoa.
Almost all of the spermatogenetic cells showed marked atrophy.
The interstitial cells were slightly increased in number. The
left ductus deferens was small; its epithelium was atrophic and
no spermatozoa were found in the lumen. Very few eosinophile
cells were found in the pituitary body.

(VI.) In a rooster age two years (weight 2.900 Kg.), on
January 24, 1920, both spermatic ducts were ligated and _ re-
sected. In a few days the animal recovered. March 30th, the
rooster was quite well (weight 2,950 Ke.). The abdomen was
opened and the right spermatic duct was found to be closed;
it appeared greatly swollen; the left spermatic duct was recon-
structed. We hoped to repeat the operation, but the rooster
died.

At the autopsy the left testis (weight 11 2m.) appeared
normal ; the right, which had the duct closed, appeared the larger
(weight 22 gm.). On microscopic examination of the right testis
the seminiferous tubules appeared swollen with spermatozoa; the
tunica albuginea was extremely extended. The spaces between
the seminiferous tubules were large; there was edema in the
testis. The pituitary body weighed 0.18 gm. The eosinophile
cells were normal in quantity.

(VII.) In a rooster, age two years (weight 1.775 Kg.), on
January 26, 1920, ligation and resection of both ducts was ear-
ried out. The animal recovered in a few days. April 22nd, the
animal was in good health and had kept its secondary sexual
characteristics and male instincts. A laparatomy was done; the

596 INTERNAL SECRETION OF TESTIS

duets were still obstructed and full of the testicular secretion.
The left testis was removed (weight 11 gm.). The testis that
remained appeared larger than normal. During the days follow-
ing the operation the animal became very ill. It recovered slow-
ly; but seemed to preserve its male instincts. It fought with
other roosters, although very weak (May 5, 1920). On June Ist,
the rooster had recovered, but it was yet weak. On June 3rd, it
was killed.

Fig. 3—Left testis of cock, Series C, Experiment VII., after ligation and
resection of spermatic duet. Seminiferous tubules dilatated and full of
spermatozoa; hydropic degeneration of the epithelium of the seminiferous
tubules; interstitial connective tissue increased; Leydig’s cells in normal
number; edema. Fixation, formalin; staining, haematoxylin-eosin; magnifi-
cation, 60 diameters.

At autopsy the right testis was found very small and harder
than the normal (weight 2.50 gm.). The pituitary body weighed
0.17 gm. Microscopic examination showed that the left testis,
which had been removed April 22nd, had the seminiferous tu-
bules dilated and full of spermatozoa of which many displayed
degenerative changes. There was hydropic degeneration of its

MASSAGLIA 5OT

epithelium ; the interstitial connective tissue was increased; the
Leydig’s cells were normal in number; the organ was edematous.
The right testis showed no spermatozoa in the seminiferous
tubules, which were retained; the epithelium showed marked de-
generative changes; there was a marked increase of the inter-
stitial connective tissue and increase of the number of the Ley-

Fig. 4. Right testis of same cock as shown in Fig. 3. Note absence of
spermatozoa in the seminiferous tubules and marked degenerative changes in
their epithelium; marked increase of the interstitial connective tissue and
increase of the number of the Léydig’s cells. Fixation, formalin; staining,
haematoxylin-eosin; magnification, 60 diameters.
dig’s cells. The epithelium of the vas deferens showed extensive
degenerative changes and marked increase of the fibrous coat.
The pituitary body showed an increase in the number of the
eosinophile cells; this, of course, may have been due to the in-
feetion to which the rooster had been subject for a long period

of time.

DD8 INTERNAL SECRETION OF TESTIS

(VIII.) In a rooster, age about two years (weight 2.900
Keg.), January 27, 1920, hgation and resection of both spermatic
ducts was performed. The animal recovered in a few days, but
was always weak; it kept its secondary sexual characteristics.
On February 22, 1920, it was killed (weight 1.650 Kg.).

Fig. 5. Testis of cock, Series C, Experiment IX, after ligation and resec-
tion of spermatic duct. Shows edema throughout the testis; hydropie de-
generation in the epithelium of the seminiferous tubules, which are distended
and full of very numerous spermatozoa; Leydig’s cells normal. Fixation,
formalin; staining, haematoxylin-eosin; magnification, 60 diameters.

At autopsy no infection in the abdominal cavity was found.
The cause of the weakness remained unknown. The testes were
small; the right weighed 1.10 gm.; the left, 1 gm. The vasa
deferentia were obstructed. The pituitary body weighed 0.15
gm. Microscopic examination of the testis disclosed albuminous
degeneration and atrophy of the epithelium of the seminiferous
tubules; no spermatozoa were present. A marked increase of
the interstitial cells was found. The pituitary body was normal.

MASSAGLIA 599

The atrophy of the testis was due probably more to the general
condition of the animal than to the effects of the operation. But
what is important from my standpoint is that the animal always
preserved the male characteristics. For this reason the experi-
ment is included in this series.

(IX.) In a rooster, age about three years (weight 2.700
Kg.), January 30, 1920, ligation and resection of the ductus
deferens was performed. The animal recovered in a few days
following the operation. The ducti deferentii were obstructed.
During an attempt to remove a testis the animal died.

At autopsy it was found that each testis weighed 22 gm., and
the pituitary body, 0.15 gm. On microscopic examination of the
testis the following were noted: (a) edema in all testis; (b)
hydropie degeneration (vacuolisation) in the epithelium of the
seminiferous tubules; (¢) very numerous spermatozoa in the
seminiferous tubules, which were distended; (d) the Leydig’s
cells were normal. The pituitary body also appeared normal.

(X.) In a rooster about two years old (weight 2.900 Kg.),
February 3, 1920, ligation and resection of the spermatic ducts
was carried out. During the operation the right ductus deferens
was accidentally ruptured near the kidney. It was not possible
without risk of killing the animal to reach the duct again; it
remained pervious so that the semen was poured into the peri-
toneum. In a few days following the operation the animal re-
covered. March 28th, the rooster was in good health. The right
testis was ablated. The left testis felt larger than normal. The
animal in the following days recovered and preserved complete-
ly its secondary sexual characteristics and instincts. The right
testis was normal. On May 18th, during an operation for re-
moval of the left testis, the rooster died. The testis was harder
than normal; it weighed 12 gm. The pituitary body weighed
0.1 gm.

On microscopic examination the following observations
were made: (1) the right testis was normal (the first removed
and which had the vas deferens accidentally broken. (2) The
left testis showed: (a) the seminiferous tubules swollen by
spermatozoa; (b) hydropice degeneration of the epithelium lin-
ing the seminiferous tubules; (¢) the lumen of the seminiferous
tubules not distended; (d) the interstitial connective tissue in-

560 INTERNAL SECRETION OF TESTIS

creased and the Leydig’s cells more numerous than normal.
(3) The pituitary body showed few eosiniphile cells.

The increase of the interstitial connective tissue explains
why the left testis was harder than normal; probably this state
represents the beginning of the sexual period, when the testis
becomes atrophic because of the sclerosis of the interstitial con-
nective tissue. (See Exp. I.)

(XI.) Ina rooster about two years old (weight 2.520 Kg.),
on February 11, 1920, ligation and resection of the spermatic
ducts was done. The animal recovered in the days following.
April 27th, the animal (weight 2.400 Kg.) was well. The peri-
toneal cavity was opened. The spermatic ducts were found to
be reconstructed; the testes appeared normal. The left testis
was removed; the right was distributed in peritoneum, divided
in small parts. The animal died after two days, due to infection
of the peritoneum.

On microscopic examination it was found that the pituitary
body had numerous eosinophile cells. This eosinophilia might
have been due to diminished testicular internal secretion (of the
testes, one was removed and the other was spread in the peri-
toneum) or by the infection.

The foregoing data show that after ligation and resection
of the ductus deferens we can have the following results:

1. The ductus deferens may be reconstructed (See Exp.
IV, VI, XI; in Exp. III only ligation was done). In these cases
we have no changes in the testis.

The ductus deferens may remain obstructed, but the con-
sequences in the testis are not always the same: (a) sometimes
following the operation the vas deferens and the testis increase
in volume. After three months the testis may become enormous
(See Exp. VI, VII, IX). On microscopic examination of the
gland we find the seminiferous tubules greatly dilated and con-
taining an extraordinary number of spermatozoa. Numerous
spermatozoa are found in the vas deferens. In the epithelium
of the seminiferous tubules we find hydropie degeneration. The
interstitial connective tissue and Leydig’s cells are normal or
slightly increased ; the testes are edematous throughout. To this
first period sueceeds a second (See Exp. I, II, VII, X) marked
by increase of the interstitial connective tissue followed by

- MASSAGLIA d61

atrophy of the testis. After 4 or 5 months the seminal gland has
become harder than normal and yery small. On microscopic
examination the seminiferous tubules appear small and the
spermatogenetic function greatly diminished or almost disap-
peared.

At times, on the contrary, we have early atrophy of the
testis. The gland becomes smaller and harder (Exp. IV, V,
VIII) ; on miscroscopic examination we find the seminiferous
tubules smaller and degenerative changes in spermatogenetic
cells; few of these complete their cycle so as to become sperma-
tozoa. The Leydig’s cells, on the contrary, remain normal or
increase in number. The time necessary to have these results
varies within two or three months. I believe that the early
- atrophy seen in these cases depends upon the fact that during
the operation the nerves which follow the vas deferens are in-
jured. Marrassini, who obtained the same results in dogs by the
ligation and resection of the ductus deferens, offers such a
hypothesis. This author did not consider the consequences of
the operation on the secondary sexual characteristics. Researches
to establish the etiology of the different results will be under-
taken in dogs in which it is easier to operate and to follow the
consequences of the operation. But the important observations
as regards the scope of the present study are that in no case in
roosters after ligation and resection of the ductus deferens did
there occur changes in the secondary sexual characteristies ; in
case of young animals development was normal (Exp. I, II).
The observations of Ancel and Bouin in the rabbit are thus con-
firmed in the rooster. But the removal of the atrophic testes in
which the Leydig’s cells were in good condition (as confirmed
by microscopic examination) caused in the adult animal a sud-
den cessation of crowing, a loss of the sexual instinets and of the
desire to fight; I have observed no other changes.

The study on the hypophysis cerebri has shown that until
the atrophic testis is removed, the organ in the rooster does not
undergo the changes characteristic of castration (See Exp. I,
II, V, VIII), but after its removal the pituitary body presents
the same changes we have observed in the capon (See Exp. IV).
Apparently then the hypophyseal changes are due to loss of the
internal secretion of the testis. In the pituitary body of the

562 INTERNAL SECRETION OF TESTIS

roosters of Exp. VII and Exp. XI the number of the eosinophile
cells exceeded the normal, but was less than in the eapon. In the
pituitary body of normal roosters we can find sometimes, as we
have seen, a certain degree of eosinophilia. Such eosinophilia
ean also be the consequence of infection from which the animals
have suffered.

D. CONSEQUENCES OF THE TRANSPLANTATION OF TESTICULAR
TISSUE IN THE ROOSTER

This research was undertaken to determine the eventual
changes occurring in testicular tissue (particularly the Ley-
dig’s cells) transplanted in the peritoneal cavity and the rela-
tion of such transplantation to the secondary sexual character-
istics and sex instincts. The operation was the removal of both
the testes and the division of one into small pieces, which were
scattered upon the peritoneum. —

(I.) A young rooster about five months old, weighing 750
ems., was operated upon June 5, 1909. Complete removal of
both the testes from their normal position was accomplished.
The left testis weighed 15 gm. The right testis, which was
about the same weight, was scattered about the peritoneum. The
animal in the days following recovered, but crowed like a eapon.
On January 10, 1910, the animal, presenting the appearance of
a capon, was killed. At the autopsy no trace of the testis was
found in the abdominal eavity. The pituitary body weighed
0.230 gm. On microscopic examination the organ was found
to present the picture typical of the capon.

(II.) <A rooster weighing 2.017 Kg., about one year of age,
was operated upon January 5, 1920. The removal of both testes
was attempted. A small part of the left testis (weight 3 gm.)
remained in situ (approximately 1/20 of the gland). The right
testis was scattered about the peritoneum. In a few days follow-
ing the operation the animal recovered. On March Ist, the
animal, which now weighed 2.50 Kg., was killed.

Autopsy disclosed that the residue of left testis was in
normal condition and two nodules of the testis which had been
scattered about (right testis) had become adherent to the peri-
toneum. The pituitary body weighed 0.22 gm. On the micro-
scopic examination the vestiges of the testis showed numerous
spermatozoa in the seminiferous tubules and hydropie degenera-

MASSAGLIA * 563

tion of its lining epithelium ; the interstitial connective tissue and
its Leydig’s cells were normal; some edema was evident.

The pituitary body showed an increase of the eosinophile
cells. During the operation the rooster had lost almost all the
left testis, and of the right, which had been transplanted, only
a part remained grafted on the peritoneum. The microscopic
examination showed no increase of the interstitial cells in the
residue of the left testis nor in the transplanted testicular tissue.
The small number of the Leydig’s cells in the body of the animal
can explain the diminished crowing and male instinct and the
moderate hypertrophy and eosinophilia of the pituitary body.

(III) A rooster weighing 2.460 Ke., about two years old,
was operated upon May 6, 1920, both testes being removed. The
right testis was morcellated and scattered in the peritoneum.
The left testis weighed 16 gm. In the days following the opera-
tion the animal recovered but lost the sexual and the fighting
instincts. He never was observed to crow. On June 8th, the
animal, in good condition, was killed.

At the autopsy no traces of the testicular substance were
found. A few nodules adherent to the peritoneum were taken
for histological study, but they were found to be made up of fat
only. The pituitary body weighed 0.27 gm.

These experiments indicate that it is occasionally, but by no
means always, possible to graft testicular substance upon the
peritoneum. Where a successful graft is made the tissue after
some time undergoes degenerative changes that involve all the
elements of the structure. With the progress of the degenera-
tive changes the sexual instincts diminish. Since the degenera-
tive changes involve all the testicular substance it is not possible
to distinguish clearly which of the two, Leydig’s cells or epi-
thelium of the seminiferous tubules, gives rise to the internal
secretion. For this reason researches along this line were not
continued.

Coneerning the scientific question of the utility of the
transplantation of the testis in old men, which, according to
Stanley and Keller, produces in the body beneficial effects, I am
of the opinion that exciting the ’sexual activities can produce
only unhappy effects. The extinction of the sexual function in

564 INTERNAL SECRETION OF TESTIS

old age is a physiological phenomenon accompanying the decay
of the several functions of the body. The body organism is tired
and if life is to continue there is need of rest and the conserva-
tion of the failing strength, which is not to be spent as in youth.
Now it is notorious that sexual activity consumes much energy
of the body, and wastes various substances, especially the
lecithin, necessary to the nerve tissue. The consequences to the
brain of sexual excess (v. Frankl-Hochwart) are well known
and to create anew the sexual function by transplantation of the
testes into the body, which has abolished this function because
it has become old, is to contravene the normal laws of nature.

DISCUSSION AND CONCLUSIONS

The results of the work herein reported may be summarized
as follows:

I. The testis has an internal secretion, which gives to the
male the masculine sexual characters and sexual instinct and
keeps the function of the hypophysis normal. This is well shown
by the changes that come in the secondary sexual characteristics
and in the pituitary body after castration and by the fact these
changes do not come when there remains in situ or in the peri-
toneal cavity some part of the testis in functional condition. The
nervous theory (Pfliiger, Samuel) fails then, although some facts
according to Luciani ean find explanation on this theory which
cannot find an explanation on a theory of internal secretion.

II. In the testis we have the spermatogenetic cells in the
seminiferous tubules and the Leydig’s cells in the interstitial
connective tissue. Which of the two, then, produces the internal
secretion? My researches indicate that the Leydig’s cells have
the endocrine function. This conception is supported by the
following facts: (1) The Leydig’s cells have the characters of
secretory cells in that they elaborate fatty granules and mito-
chondria. (2) The animal remains normal even when we have
marked atrophy of the seminal epithelium (See Series C, Exp.
I, V, VII, VIII). (3) It is only when we remove the atroph-
ic testis with the Leydig’s cells then in good condition, that
we have the changes that are noted after castration (See Series
C, Exp. IV). (4) No facts exist which speak for the conception
that the spermatogenetic cells exercise the endocrine function:

MASSAGLIA 565

they complete a cytological cycle to become spermatozoa, which
have merely the biological function of reproductive cells.

But the new information on the internal secretion of the
testis that shows the effects of its abolition is very important not
only for itself, but also because it shows that there exists through
the internal testicular secretion a functional correlation between
the testis and hypophysis cerebri. It lends support to the view
that the pituitary body has the function of ruling the skeletal
growth, and perhaps throws some light upon the obscure etiology
of gigantism and acromegaly. In the acromegalic there is found
marked hypertrophy of the hypophysis with eosinophilia of its
cells and deficient development of sexual organs (Benda, Vas-
sale, Cushing). But in the acromegalic the more important fact
is‘that it is a lesion (hypertrophy, adenoma) of the pituitary
body, whereas in the castrated it is the loss of the internal seere-
tion of the testis, which secondarily produces hypertrophy of
the hypophysis.

TI wish to thank Professor F. C. Becht for assistance and advice
and Professor F. R. Zeit for advice regarding microscopical work.

BIBLIOGRAPHY

Mantegazza (P.) & Bozzi (C.) Sull’anatomia patologica dei testicoli.
Ann uniy. di Med. (Milano), 1865, 194, 113-149.

Mantegazza. Elezioni sessuali e neogenesi. Lettera di P. Mantegazza
a C. Darwin. Arch. per l’Antrop. e l’Etnol. (Florence), 1871, 1,
321.

Brown-Séquard. Des effets produits chez ’homme par des injection
souscoutanées d’un liquide retiré des testicules frais de cobaye et
de chien. Comp. rend. Soc. de biol (Par.), 1889, 41, 415-419.

Brown-Séquard. Troisiéme note sur les effets des injections sous-
coutanées de liquide testiculaire. Comp. rend. Soc. de biol. (Par.),
1889, 41, 430-431.

Brown-Séquard. Remarques a l’oceasion du travail de M. Variot sur
les injection de liquide testiculaire chez ’homme. Comp. rend.
Soc. de biol. (Par.), 1889, 41, 454-455.

Brown-Séquard & d’Arsonval. Effets physiologique et thérapeutiques
d’un liquide extrait de la glande sexuelle male. Comp. rend. Acad.
d. se. (Par.), 1893, 116, 856-861.

Ancel (P.) & Bouin (P.) Recherches sur la signification physiologique
de la glande interstitielle du testicule des mammiferes. Role de
la glande interstitielle chez l’embryon, les sujets jeunes et ages;
ses variations fonctionelles. J. Physiol. et Pathol. (Par.), 1904, 6,
1012-1022, 1 pl.

Gosselin (L.) Mémoire sur les oblitérations des voies spermatiques.
Arch. gen. de Méd. (Par.), 1847, 14, 405-424. .

Gosselin (L.) Mémoire sur les oblitératinns des voies spermatiques.

tigues et sur la stérilité consécutive a l‘épidimite bilatérale
Arch. gen. de Méd. (Par.), 1853, 2, 257-270.

566 INTERNAL SECRETION OF TESTIS

Fabris (A.) Sull’ atrofia sperimentale del testicolo. Arch. per le Sc.
Med. (Torino), 1903, 27, 433-452.

Cushing (Harvey). The pituitary body and its disorders; clinical
states produced by disorders of the hypophysis cerebri. Phila. &
Lond., 1912, J. B. Lippincott Co., 351 p. front. roy. 8° (p. 276).

Fichera (G.) Sulla ipertrofia della ghiandola pituitaria consecutiva
alla castrazione. Policlin. (Rome), 1905, 12, sez. chir. 250; 299;
Sule) ab yaya

Pézard. Le conditionement physiologique des caractéres sexuels secon-
daires chez les oiseaux. Thesis, Paris, 1918.

Lespinasse. Impotency, its treatment by transplantation of testicle.
Surg. Clin. (Chicago), 1918, 2, 281; Abst. Surg. Gyn. & Obst.
(Chicago), 1918, 27, 262.

Loisel (G.) Les pigments élaborés par le testicule du poulet. Compt.
rend. Soc. de biol. (Paris), 1904, —, 404-406.

Loisel (G.) Sur Vorigine et la double signification des cellules inter-
stitielles du testicule. Compt. rend. Soc. de biol. (Paris), 1904, —,
448-451.

Rasmussen (A. T.) Cyclic changes in the interstitial cells of the ovary
and testis in the woodchuck (Marmota monax). Endocrinology,
Los Angeles, 1918, 2, 353-404, 4 pl.

Piersol (George Arthur) Normal histology “with reference to the
structure of the human body. Phila. & Lond., 1912, J. B. Lippin-
COte Come426 ppl ssrnOyee See

Vassale. L’ipofisi nel mixedema e nell’acromegalia. Riv. Speriment
di Freniatria, Reggie Emilia, 1912, 27, Fasc. 1.

Marrassini. Contributo allo studio delle alterazioni del testicolo con-
secutive alle lesioni del cordone spermatico e in modo speciale del
dotto deferente. Clin. Chirurg. (Milano), 1902, —, — (No. 9).

Stanley (L. L.) & Keller (G. D.) Testicle transplantation. J. Am. M.
Ass. (Chicago), 1920, 74, 1501-1503.

v. Frankl-Hochwart (L.) Ueber den Hinfluss der inneren Sekretion auf
die Psyche. Med. Klin. (Berl.), 1912, 8, 1953-1957.

Luciani. Fisiologia dell’uomo. Milan, 1913, 3 ed., Vol. V, 11.

Benda (C.) Beitrage zur normalen u. pathologischen Histologie der
menschlichen Hypophysis cerebri. Berl. klin. Wehnschr., 1900, 37,
1205-1210.

EFFECTS OF X-RAY TREATMENT OF THE
HYPOPHYSIS IN BRONCHIAL ASTHMA

Maurizio Ascoli and A. Fagiuoli

From the Institute of Internal Medicine, R. University of Catania,
Sicily, Prof. Maurizio Ascoli, Director.

In the insufficiency of the endocrine organs the only thera-
peutic means, in use heretofore, with the exception of the casual
treatment in specific cases, have been opotherapeutie substitu-
tions. The results of such measures are at times wonderful,
though often they prove disappointing, while the cause of failure
can not always be determined. Long ago we thought of another
way to correct endocrine insufficiencies through stimulation of
the specific glandular elements; as a means to this end we chose
deep radiations with x-rays.

Hitherto radio-therapy in endocrinology has been used only
in destroying tissue, as in cases of exophthalmie goitre, in tumors
of the hypophysis, ete. It remained to be seen whether, with
hghter appleations, the opposite effect could be reached of stim-
ulating the gland cells to activity, or in other words if a stimu-
lating endocrine radio-therapy were possible.

As soon as the necessary apparatus was available we tried
the practical application of the principle suggested. The first
treatment, made last January, was made in a ease of dystrophy
adiposo-genitalis.

The patient (B. Poa boy of 15) showed marked adiposity
of the thighs, buttocks, mons veneris, breasts and inferior
quadrant of the abdomen. His genitalia and secondary sexual
characters were but slightly developed. The penis was 5 em. in
length and almost buried under the suprapubic fat; erections
were infrequent and incomplete. There was no sexual ten-
deney and no hair at the axillae, pubis and perineum. The voice
was infantile. The body was underdeveloped; he was 1.49 m. in
height and had short heavy limbs. Radiographically, no appre-
ciable enlargement of the sella turcica could be detected. The
patient had undergone several months of pituitrine and endo-
spermine treatment with hardly any improvement; in one year

D67

568 RADIATION OF HYPOPHYSIS IN ASTHMA

the penis had grown but 1 em. in length and the height had
increased only 2 em. No hair had developed.

At the beginning of this year the patient had four irradia-
tions of the hypophysis at intervals of one month. At every
sitting three different fields were irradiated, one frontal and two
temporal, for 36 minutes in all, at a distance of 45 cm., using an
aluminum filter of 2 mm., S.E. 18-20 em. and M.A., 314. Twenty-
five days after the first irradiation the pubis began to show hairs
which gradually increased in number and length; the penis and
testes increased in size, the penis in three months reaching a
length of 8.5 em. Erections became frequent and complete; the
sexual tendency was accentuated. The height increased 5 em.
to 1.56 m., and the fat tended to diminish; the chest measure-
ment dropped from 86 to 81 cm.

The irradiation treatment was also tried in a case of sclero-
derma. The patient, C. P., was a woman of 58. Her lesions,
dating back two years, were especially conspicuous at the lower
part of the thorax and superior part of the abdomen; the affected
area extended like wide ribbons around the trunk, 10 em. in
breadth, with extensions upward to the breasts and downward
to the pubis. Furthermore, there were oval and circular plaques,
3-5 em. in diameter, on the breast, in the sternal region, the
suprahyoid region, forehead and neck. The patient complained
of diffuse pains in her body and limbs, great prostration, flushes
of the face, slight tachyeardia, anorexia, nausea, heavy feeling
in the epigastrium and psychic sluggishness. Thyroid and hypo-
physeal treatment for six months had not modified either the
general condition or the local lesions.

Then the patient underwent irradiations of the hypophysis
as well as of the thyroid. Four treatments were given at inter-
vals of about a month. Irradiation of the hypophysis was con-
tinued for 12 minutes in three different fields with the tube at 45
em. distance, with a 2 mm. aluminum filter, S.E. 18-20, and with
a current of 314 ma. The thyroid irradiations lasted 5 minutes,
with 2 mm. aluminum filter, S.E. 18-20, and current, 3 M.A.

After the second irradiation the cutaneous lesions began to
change. The sclerodermice plaques of the breasts and suprahyoid
region disappeared and the wide zone of affected skin, before
shiny, copper-colored, thick and sticking closely to the under-

ASCOLI AND FAGIUOLL 569

lying tissue, became pale, pink and thinner. It was possible to
lift it in folds and the line of demarcation between the healthy
and affected tissue became less apparent. The patient still com-
plains of prostration and dyspesia, but the pains are greatly di-
minished, the pulse is slower and there is no more flushing of
the face nor feeling of tension and weight in the abdomen. The
psychic improvement is most marked.

Good results were also obtained in a ease of Basedow’s dis-
ease with two irradiations of the thymus. There was lessening
of the tremor and the tachycardia (from 116-120 to 96-100)
diminishing of the goiter (from 34 em. to 31.1 em) and subjective
relief (15 minutes irradiation through 2 mm. aluminum filter,
S.E. 20-22; M.A., 3). :

Although in the above noted eases the effect has been satisfy-
ing, in other cases no defined result was obtained in regard to the
fundamental lesion. <A typical case of eunuchoidism in a patient
of 26 was subjected to four applications to the testes and hypo-
physis and two to the thymus; a case of angioneurotic oedema
of Quinke had three irradiations of the hypophysis and ovaries
(in this case the general conditions improved and the menstrua-
tions became regular) and three cases of diabetes mellitus who
had each four irradiations of the hypophysis and pancreas. In
all these cases results were negative.

These negative results do not vitiate the principle predicated
upon the positive results, and they should not hinder us from
keeping on with the method. Other cases may improve under
such treatment and, furthermore, given the delicate interweaving
of mutuality, interference, antagonism and synergy existing be-
tween these glands, some modifications may be required, especial-
ly in regard to the Basedow eases and diabetes mellitus, which
are now considered as pluriglandular syndromes.

It is also necessary to determine to what extent the irradia-
tion may be used on the several glands to produce only the stimu-
lating effect, a subject to be studied methodically and with
prudence. Of course, there can not be obtained any stimula-
tion whenever the tissue has degenerated to such an extent as
to be no longer excitable.

We are sorry to have missed the opportunity of experiment-
ing with irradiation of the hypophysis in diabetes insipidus, or of

570 RADIATION OF HYPOPHYSIS IN ASTHMA

the parathyroids in tetany maladies that seems especially to lend
themselves to such treatment.

In view of the favorable results obtained by various observ-
ers in the use of pituitrin in asthma, irradiations of the hypo-
physis were tried in this disease. At each sitting three different
fields were irradiated—one frontal and two temporal—for 12
minutes with aluminum filter of 2 mm., S.E. 18-20 em. and 314
M.A. current.

Case I. Frank G., 29 years old, a landowner, had been
suffering from asthma for the past ten years. In the beginning
the attacks lasted but a few minutes, coming on only once every
5-6 months. Since April of last year they had become very fre-
quent—3 to 4 a day—so that the patient was hardly ever free
from them and required 2-3 hypodermic injections every day
of ‘‘asmolisina,’’ which gave him some respite. Furthermore,
every 7-8 days there were severe periods which lasted 8-10-12
hours when the patient was forced to keep absolutely immovable,
since any slight motion increased the spasm and he had to take
10 to 15 or even 20 injections a day of ‘‘asmolisina.’’ He is the
brother of a physician and by him was brought to us to see if
anything could be done for relief.

The patient is not tall, but appears very strong, and there is
nothing abnormal about him but a decided emphysema, getting
worse with the asthma. On May 15th the radio-therapeutie
treatment was begun. He was given in all five treatments at 7-
day intervals. Two days after the first irradiation one of his
usual periods began, but it was milder and shorter, 3 to 4 injec-
tions of ‘‘asmolisina’’ a day being enough to allow him to go
about. After this erisis there followed 8 days of complete relief
from symptoms. <A few days after the third irradiation a new
erisis, but even milder than the previous one occurred. The at-
tacks came on every other day, one to two a day; no “‘asmolisina’’
was required. This period lasted about a week, after which for
8 or 10 days he was well. Recently a few attacks have been
experienced, but only at night and of very slight severity.

Thanks to the treatment the patient now secures sure relief

ye

from the ‘‘asmolisina,’’ which before was only partially and

slowly efficacious.

ASCOLI AND FAGIUOLI oT1

Case II. N.S. is a woman 37 years old. Her history is un-
important. Asthma has persisted two years. It began with
brief attacks, 20 to 30 days apart. Since last November there
have been 4 or 5 a week, lasting 3 to 4 hours. ‘‘Asmolisina’”’
proved more dangerous than useful. The first irradiation of the
hypophysis was given April 2nd and followed by four others
eight days apart. From the first application the asthma ceased
except for a very slight attack of a few minutes each.

Case IIT. U. R. is a boy 15 years old, a student. He is
poorly developed, but nothing important was learned in his his-
tory. The first attacks of asthma began when he was 3 years
old; they were short and infrequent. For the past 16 months
they have oceurred every 15 to 20 days and lasted 4 or 5 days.

Four weekly irradiations were given. Two days after the
first a slight attack lasing two hours was experienced. On May
30th another attack occurred, but lasted only a few minutes.
Since that time he has been well.

Case IV. lL. M., a housewife, is 42 years old. No abnor-
mahty was found; her general condition was good. The last 15
months she suffered attacks of asthma, at first every 10 or 15
days, lasting an hour, then the last 6 months, every day and last-
ing 3 to 4 hours. Pituitrin hypodermatically did not help her.

Three irradiations were given, May 6th, 21st and 28th. Dur-
ing the treatment three slight attacks of a few minutes each were
experienced. From May 27th on she has been well, except for
an infrequent slight cough with mucous expectoration.

Case V. G. G. is a man of 34, an electrician. His family
history is unimportant. He had lues when 15 years old. In
November, 1917, he had pleurisy of the left side. He was poorly
nourished, the pleurisy not being well cured. He had also pul-
monary emphysema and diffuse bronchial catarrh. During the
past year he has had attacks of asthma every morning. Each
attack lasted about half an hour. Ivrradiations were given May
20 and 27. The attacks were reduced to only two or three a week
and these were short and shght. The bronchial catarrh was not
modified.

In these five cases the influence of the irradiations is clear.
In the opotherapeutic treatment of asthma usually pituitrin
and adrenalin are used together, therefore, whenever the stimu-

572 RADIATION OF HYPOPHYSIS IN ASTHMA

lation of the hypophysis proves insufficient one should try the
stimulating irradiation of the adrenals also.

At any rate, the above noted cases clearly demonstrate the
usefulness of the treatment; as regards the duration of the ap-
plication and the persistence of the effects we need further
experience. At the same time we need to make sure that the
effect is really due to stimulation of the hypophysis or if there
be other factors acting on the syndrome. We shall try to de-
termine any such by looking for the effects of these slight irra-
diations on the endocrine glands, studying the functional changes
as we can in the present state of science.

It will be worth while trying through the irradiations to
study the glands in their functional aspects already known as

- well as any new phenomena, which may be evoked.

The field is large and full of promise. Even in the treat-
ment of certain tumors, the development of which is influenced by
endocrine glands the irradiation of these glands may conceivably
prove useful.

The foregoing researches are reported in their incomplete
form because we are forced to interrupt them for reasons not
under our control and because of other studies that are being
made in the same field.

Stettner in two eases of arrest of development in centres
of ossification through the x-rays applied to the head and to
head and neck had good results, which he attributes to an endo-
erine factor (hypophysis.) In asthma, Klewitz irradiated the
anterior and posterior thorax in 18 to 20 fields, though without
any beneficial effect. Stephan, on the basis of researches on
the irradiations of the spleen thinks that such methods may be
applicable wherever there is any obstacle to the cellular function-
ing and consequently in endocrine dysfunctions. Frankel in a
recent meeting of the German Radiological Society, talking of
the stimulating action of very slight irradiations expressed a
belief that such treatment might prove successful in endocrine
dysfunctioning.

Precisely this hypothesis has been the starting point of our
researches and the data herein repeated indicate the validity
of the hypothesis.

ASCOLI AND FAGIUOLI 573

BIBLIOGRAPHY

Fraenkel, M.: Reizdosenanwendung, ihre Bedeutung fiir die Rénigenther-
apie. Miinchen. Med. Wehnschr., 1920, 67, 528. (No. 18.)

Klewitz, F.: Rédntgendosierung und Réntgenerfolge bei inneren Krankheiten,
Miinechen. Med. Wehnschr., 1920, 67, 285. (No. 10.)

Pais. A.: Cura della malaria fer meszo dei raggix. Ann. d’Igiene, 1919, 39,
359. (No. 6.)

Serena, M.: Di talune azioni distanza prodotte dei raggix. La Radiol. Med.,
1920, 7, 203. (Nos. 3-4.)

Stephan, R.: Reticulo-endotheliarer Zellaparat und Blutgerinnung. Miin-
chen. Med. Wchnschr., 1920, 67, 309. (No. 11.)

Stettner, E.: Anrezung riickstandigen Wachsthums durch Roéntgenstrahlen.
Miunchen. Med. Wehnschr., 1919, 66, 1314. (No. 46.)

A FATAL CASE OF CARDIAC DILATATION WITH
ASSOCIATED GASTROPATHY AND
ENDOCRINOPATHY

Charles M. Nice, Birmingham, Alabama
Chief of Medical Staff, Birmingham Infirmary,
Staff Internist, Hillman Hospital.

The subject of this report was a robust, vigorous young
woman, a brunette, who married at the age of 19. She was
the child of healthy parents and had enjoyed perfect health
herself. About sixteen months after marriage she gave birth
to a normal appearing nine-pound boy. At two months of age
the child developed infantile eczema of an extreme type, which,
after some weeks of varied treatment, responded quickly to
thyroid extract. The eczema returned each time the treatment
was discontinued.

At seven months it was decided to wean the child and
thereupon developed violent and unconquerable fits of anger
upon his part. They came on suddenly and were so notice-
able that my attention was repeatedly called to the condition.
Soon thereafter a gradual enlargement of the head, increased
adiposity, changes in the appearance of the skin and lips made
the diagnosis of cretinism positive. The thyroid treatment was
again instituted, with a gradual recovery over a period of some
months.

Soon after lactation had ceased, the mother went away for
a visit but was brought back in five weeks in a most serious
condition. This she reported had begun to develop before leav-
ing. She had lost much weight, was weak and very hervous.
Her pulse averaged between 120 and 160. She was dyspneic
on the slightest exertion,—in fact, at this time was unable to
leave her bed. Her urine contained a large amount of sugar
and her thyroid was palpable. After eight weeks the sugar
had disappeared, her pulse had decreased to between 80 and 90.
Three months later she had about recovered from the acute
hyperthyroidism but was constantly watched. She became ap-
parently well and happy.

NICE d79

_A year later she became pregnant and through the entire
gestation enjoyed perfect health, as in her former pregnancy.
A girl was born but was taken from the breast soon after birth
because of the previous experience with lactation. This child
has never developed any symptoms or condition suggestive of
glandular disease.

“Without going into all details, suffice it to state that the
mother developed nervous symptoms soon after the birth of this
latter child. The chief of these were referable to her stomach
and associated with sudden increases of pulse rate. The attacks
came on usually at night, without regard to fqod. She com-
plained of fulness, pressure around the heart, dread of fainting
and rapid pounding of the heart. The attacks becoming more
and more frequent and beginning to tell notably on her weight,
she was ordered to bed for a rest cure and a complete exam-
ination was repeated. The thyroid was palpable but not to
the same extent as during her former illness. The cardiac °
outlines were normal. The blood pressure ranged from 122
to 105 systole and 85 to 65 diastolic. The urine was negative,
as was the blood Wassermann. There was no exophthalmus or
any other goiter signs. Operative procedures were opposed for
the time by the family in an effort to try out the medical meas-
ures; this procedure was agreed to by me. Two infected teeth
and the tonsils had previously been removed, with improvement
of the patient’s general condition for a time. Chronie appen-
dicitis had been discovered some months previously.

Ten to twelve weeks later she was out again and relatively
well except for the occasional attacks with her stomach, giving
rise at times to only a transient feeling of suffocation. Her
pulse remained within normal limits.

A few months later an acute attack of appendicitis devel-
oped one night. A surgeon was called and the entire history
reported. After due deliberation, on account of the sudden-
ness, the severity of the attack and a 22,000 luecoeytie count,
she was operated upon that night. A purulent appendix of
bad type was removed and drainage was instituted. For the
next five days her recovery was exceptionally good. Her pulse
never passed 84. She laughed and joked and desired food. On
the morning of the sixth day I was hurriedly called. She was

576 CARDIAC DILATION WITH ENDOCRINOPATHY

eyanotic, with pulse of 120, diffuse apical impulse and left car-
diae border outside the nipple line, indicating a condition of
acute cardiae dilatation. Stimulants and minute eare resulted
in no improvement. She gradually grew worse and died at nine
that evening.

DISCUSSION

The points presenting themselves in this history are the
defective thyroid condition in the child, giving rise to a hypo-
function as indicated by the eczema and ecretinism; the relief
with the administration of the gland but more marked relief
upon cessation of the mother’s milk. Striking also was the
development of a hyperthyroid function in the previously nor-
mal mother upon the augmentation of her ovarian function and
discontinuance of lactation. Again during pregnancy, when
Ovarian activity was in a depressed phase, her condition became
normal in every way, only to be disturbed after parturition,
when ovarain function was again stimulated.

fm this connection I want especially to mention the gravity
in prognosis, which is not sufficiently emphasized, in cases of
so called functional heart conditions or in heart conditions with-
out physical findings, in which gastric symptoms predominate.
The feeling of fulness, pressure around the heart and _ suffo-
cative influences often described as neurasthenic, especially when
associated with any increase of the pulse beat, should be looked
upon with alarm. In my experience, whether the patients are
young or old, the majority of them sooner or later die suddenly.
And then the thought arises whether or not many of the diag-
nosed anginas and even acute dilatations do not originally arise
from thyroid intoxications which may or may not have been
previously discovered.

525, The Woodward.

THE INFLUENCE OF THE THYROIDS ON THE >
FUNCTIONS OF THE SUPRARENALS

P. T. Herring

From the Physiological Department University of St. Andrews, Scotland
CONTENTS
I. Introduction.
II. The effect of hyperthyroidism upon the size, weight and structure of the
suprarenals.
III. The effect of hypothyroidism upon the size, weight and structure of the
suprarenals.
IV. The effect of hyperthyroidism upon the adrenalin content of the supra-
renals.
VY. The effect of hypothyroidism upon the adrenalin content of the supra-
renals.
VI. The effect of hyperthyroidism upon the adrenalin content of the blood.
VII. The sensitizing action of thyroid upon structures stimulated by adrenalin.
VIII. The thyroids and suprarenals as a subsidiary heat-regulating mechanism.
IX. Summary.
Literature.
INTRODUCTION

An attempt to analyse the literature dealing with the in-
fluence of the thyroids upon the suprarenals reveals the presence
of difficulties which are due to a variety of causes.

The dual nature of the thyroids and parathyroids was not
always appreciated by the earlier investigators, and conditions
following parathyroidectomy have been ascribed to loss of the
thyroids alone. Less confusion has existed with regard to the
suprarenals, where cortex and medulla are anatomically even
more Closely related than are the parathyroids with the thyroids.
From the points of view of development, structure and func-
tions, the cortex and medulla of the suprarenals are generally
regarded as distinct organs, though the possibility of some physio-
logical interdependence of both structures is not excluded.

Another difficulty lies in the fact that the medulla of the
suprarenals is composed of cells which are not confined to this
situation. The occurrence of aberrant glands as a fertile source
of error in experimental work upon the thyroids and parathy-
roids has long been recognized, but too little attention has been
given to the same difficulty in connection with chromaphil tissues.

Swale Vincent (69) has described the anatomical distribu-
tion of the chromaphil tissues in many species of animals, and it
has been shown by Fulk and McLeod (21) that extracts of the
retro-peritoneal tissues of man, the dog, cat, rabbit, white rat,

DTT

578 INFLUENCE OF THYROIDS ON SUPRARENALS

ealf, sheep and pig have the same physiological action upon in-
testinal and uterine muscle as the active principle of the medulla
of the suprarenal gland. The exact proportion which exists be-
tween the adrenalin content of the suprarenals and that of the
other chromaphil tissues has not been ascertained, and is prob-
ably variable even in the same species of animal, but it is a fac-
tor which cannot be entirely disregarded.

Considerable doubt still exists as to the exact nature and ex-
tent of the rédle played by adrenalin in the physiological proe-
esses of the body. Following upon the earlier work of Cannon
and de la Paz (8), Cannon and Hoskins (6), and Elhott (18), a
tendency to exaggerate the influence of adrenalin has been fol-
lowed by the opposite extreme. Stewart and Rogoff (64) in
the course of a long series of carefully conducted researches find
little evidence that secretion of adrenalin plays any important
part in the ordinary mechanism of the body, and these authors
believe that adrenalin is not indispensable. Gley and Quinquaud
(26) have arrived at a similar conclusion. Cannon (5) gives ex-
cellent reasons for regarding the secretion of adrenalin as ful-
filing an emergency function. The recent work of Kellaway
(37) and Bazett (3) tends to support the earlier views that the
secretion of adrenalin is not unimportant, and the ‘‘tonus’’ the-
ory receives fresh support from Bazett’s observations. The ques-
tion cannot be considered as finally settled.

A due appreciation of the influence one gland has upon the
funetions of another is necessarily limited while we are still in
ignorance of the exact functions of each of the endocrine glands.
In experimental work and in disease, it is difficult to determine
how far the changes met with are due to alteration in activity of
any one gland. The picture which results is often a syndrome
in which there is a disturbance of balance affecting many organs.
An observed change in one gland may appear to be due to excess
or diminution of function of another when the real determining
factor lies in the disturbance of a third gland or series of glands,
or in some general change of metabolism.

The literature relative to the action of the thyroids upon the
functions of the suprarenals is not free from contradictory state-
ments. Some of the discrepancies are explainable, others need
the test of experience to prove which is true.

HERRING d79

The present paper makes no pretence to be an exhaustive
survey. The literature is widely dispersed, much of it is diffi-
eult of access, and valuable contributions may have been over-
looked. It is hoped that a summary, however imperfect, will
have some value in showing the general trend of opinion on the
subject, and that it will draw attention to the more salient fea-
tures which require further experimental investigation.

II. The Effect of Hyperthyroidism on the Size, Weight and
Structure of the Suprarenals.

R. G. Hoskins (33) in 1910 fed 28 female guinea pigs with
commercial desiccated thyroid in small doses for varying lengths
of time. Pregnancy occurred in many of the animals, but in
most cases the offspring were premature or born dead. In 21
offspring which survived, the suprarenals were smaller than in
the young of normal animals of similar age, the average loss of
weight being 53 per cent. No histological differences in pigment,
mitoses, or proportion between cortex and medulla were noticed.
Hoskins interpreted the results as indicating a reaction in the
suprarenals of the offspring to an increase of adrenalin in the
maternal blood brought about by experimental hyperthyroidism.

In a further series of experiments Hoskins fed young guinea
pigs from the day of birth on small quantities, 5 to 15 mg., of
desiccated thyroid, beginning with the lower dose and gradually
increasing. At the end of 15 days the animals were killed and
the suprarenals compared with those of normal animals of the
same sex and age. The suprarenals of the thyroid-fed guinea
pigs averaged 25 per cent. heavier than those of the normal ani-
mals. Hoskins recognized a source of error in the possible pres-
ence of toxic material in the desiccated thyroid, but in other re-
spects his experiments were carefully and suitably controlled.
His conclusions were that hyperthyroidism stimulates the supra-
renals to hyperplasia.

Iscovesco (35) prepared an ether-soluble material from the
thyroid glands, which, when repeatedly injected into rabbits
produced in addition to changes in other organs a notable hyper-
trophy of the suprarenals in both sexes.

E. R. Hoskins (32) in 1916 published the results of a very
careful and complete analysis of the effects of thyroid feeding
upon the growth of the body and organs of the albino rat. He

580 INFLUENCE OF THYROIDS ON SUPRARENALS

obtained as a result of thyroid feeding an overgrowth in the ab-
solute weights of the suprarenals of 14.5 per cent. in the younger
females, of 16.1 per cent. in the older females, of 36.4 per cent.
in the younger males, and of 38.1 per cent. in the older males.

Herring (27) employing rather larger doses of thyroid than
E. R. Hoskins, obtained even greater hypertrophy of the supra-
renals. For the male rat the increase in weight of the supra-
renals averaged 56 per cent, for the females 41 per cent, the
largest individual increase being 140 per cent in the male, and 94
per cent in the female. Herring pointed out that the increase is
mainly one of cortex, though there is also some hypertrophy of
the medulla as shown by the greater depth and extent of stain-
ing of the chromaphil material. Herring also drew attention to
the hypertrophy of accessory suprarenals which takes place un-
der the influence of thyroid feeding. These bodies are not mere-
ly cortical, but in the albino rat frequently contain masses of
chromaphil cells.

Kuriyama (41) in 1918 failed to obtain the results of the
previous observers. Working also with the albino rat he stated
that ‘‘thyroid feeding of either short duration with large doses,
or loig duration with small doses, does not materially change
the epinephrin content, nor the weight of the adrenals of me-
dium sized albino rats.’’

Hewitt (31) has recently confirmed the results obtained by
Herring and Hoskins, and brings forward evidence to show that
in the young albino rat after the cessation of thyroid feeding
there is a tendency with the subsequent growth of the animal for
the suprarenals to regain their normal proportions.

Kuriyama’s experiments are unsatisfactory in that he em-
ployed desiccated thyroid of unknown activity in doses which
would be toxie if fully active. His animals were of widely-
differmg ages and weights; the male and female rats were
grouped together. Further, the diet given, dog biscuit and
lard paste, is not above the suspicion of being deficient in vita-
mine.

Desiccation, if not properly carried out, may injure the ac-
tive principle of the thyroid. Gley (23) found that the activity
of organic extracts diminishes rapidly the higher the tempera-
ture used in their preparation. Swale Vincent (68) has noted

the possibility of impairment of dried extracts by methods which

y HERRING 581

ie ae them. Hewitt (31) has shown that commercial prepa-
rations of desiccated thyroid vary greatly in activity.

According to Carlson, Rooks and McKie (9), many of the
symptoms induced by thyroid feeding are caused by an excessive
protein diet and are not specific. This objection was avoided
by Hoskins in that he used very small doses of thyroid and gave
similar amounts of thymus and other organs to his control ani-
mals. Herring employed fresh ox thyroid in his experiments
and gave similar amounts of fresh ox flesh to his controls. In
none of -the control animals were the specific reactions of the
thyroid-fed groups observed.

R. G. Hoskins, E. R. Hoskins and Herring all found that
the reaction of the suprarenals to thyroid feeding is greater in
the male rat than it is in the female. In the normal animal it
must be remembered that the suprarenals of the male rat are
lighter per unit body length or body weight than those of the
female. The curve of growth, too, of the suprarenals differs
considerably in the two sexes (Donaldson, 16). For these rea-
sons alone male and female animals should be separately grouped
for experimental work.

McCarrison (45) has shown that the absence of certain
vitamines from the food induces hypertrophy of the suprarenals
with loss of adrenalin. It is therefore of importance that all ani-
mals used for experimental work should receive both before and
during the investigation a liberal supply of fresh and suitable
food. It is also advisable that the thyroid-fed animals and their
controls should be paired from the same litters to avoid as far
as possible individual variations.

Cramer (12) has advocated the view that the cortex of the
suprarenals, and particularly its zona reticularis, takes part with
the medulla in the formation of adrenalin, and that the cortex
and medulla are not functionally independent of one another.
By a method of staining with the vapour of osmic acid he has
demonstrated granules in the zona reticularis which appear to be
of the same nature as the adrenalin granules. Cramer also finds
that conditions producing overactivity of the thyroids increase
the size of the suprarenals and lead to changes in the distribu-
tion of fat in the cortex, and to a diminuation of the adrenalin
granules in the medulla. Such changes are, however, acute and
were brought about by poisoning with {-tetrahydronaphthyla-

582 INFLUENCE OF THYROIDS ON SUPRARENALS

mine, a drug which Elliott (18) proved to cause a rapid dis-
charge of adrenalin from the suprarenals.

There are very few references in the literature to the action
of thyroid upon the cortex of the suprarenals. EF. Munk (50)
noticed a diminution of lipoids in the cortex of the suprarenals
of animals which had been thyroid-fed.

The balance of evidence is in favour of the view that the ad-
ministration of small doses of thyroid brings about hypertrophy
of the suprarenals. The cortex of the gland is the part primarily
affected, and the histological changes require further investiga-
tion. There is also some evidence that the medulla of the supra-
renals and the chromaphil tissues generally, participate in the
enlargement.

It is doubtful how far the hypertrophy of the suprarenals
may be attributed to a direct action of the thyroid hormone upon
these organs. It is possible that, as postulated by Eppinger,
Falta and Rudinger (19), thyroid has a stimulating action upon
tissues which produce adrenalin, but the relatively greater hyper-
trophy of the suprarenal cortex is more likely to be induced by
indirect factors. The gross enlargement of liver, pancreas, heart
and kidneys which occurs in thyroid-fed rats points to a general
disturbanee of metabolism which may be responsible for the con-
dition. Further work is necessary to elucidate these changes.
III. The Effect of Hypothyroidism upon the Size, Weight and

Structure of the Suprarenals.

Marineseo and Parhon (48) in 1908 studied the changes
which take place in the fatty material of the suprarenal cortex
in dogs deprived of their thyroids. They described two varieties
of fat, and found that there was a notable diminution in the
amount and size of the lipochrome droplets, more especially in
the cells of the zona fasciculata. They regarded the cortex of
the suprarenals as being especially concerned in the elaboration
of lecithin and allied bodies, and coneluded that this function
is modified by thyroidectomy.

R. G. Hoskins (33) thyroidectomised newly-born guinea
pigs, but found no subsequent change in the weight of the supra-
renals compared with those of normal animals of the same age.

Lorand (44) stated that in senile myxoedema atrophy of
the thyroid is followed by regressive changes in other organs of
the body of which the suprarenals are examples.

OV
io.)
ws)

HERRING

Gley (24) found that the suprarenals of thyroidectomised
rabbits are notably hyperthrophied and full of fat, but he re-
garded this condition, not as a sign of hyperfunetion, but of de-
generation of the cells in the last stages of myxoedema.

Herring (28) noted that in male adult rabbits killed from
30 to 73 days after thyroidectomy the suprarenals were lighter
per unit body weight than were those of control rabbits of the
same sex. The suprarenals were used for the determination of
their adrenalin content so that no histological examination was
made. The animals appeared to be perfectly healthy when
killed.

F. W. Mott (49) in the investigation of the pathology of
myxoedema described a case in which the suprarenals showed a
marked diminution of the lipoid contents of the cortex. .

Cramer (14) stated that removal of the thyroid gland in
rats and rabbits produces histological changes in the cortex
which are, however, only slight, and appear to indicate a dis-
turbance in the secretory mechanism of the gland rather than a
deficiency in the formation of adrenalin.

The effects of hypothyroidism upon the suprarenals requires
further investigation, and no definite conclusions can be drawn
from the small number of observations quoted.

IV. The Effect of Hyperthyroidism upon the Adrenalin Con-
tent of the Suprarenals.

In estimations of adrenalin content, whether by physiologi-
eal or chemical methods, it must be borne in mind that the
echromaphil tissues not only produce adrenalin but have the
capacity of storing it to a certain degree. Changes in the de-
mand of the body for adrenalin may therefore influence the
chromaphil tissues in several ways. There may be increased or
decreased production of adrenalin with an effect upon the
adrenalin load, depending upon the rate at which the adrenalin is
given off to the blood. It follows, therefore, that the amount of
adrenalin in the suprarenals is not in itself a true index of the
activity of these organs. Its determination, however, may give
some indication of the amount of production of adrenalin if the
animal under experiment remains healthy, and if the adrenalin
load be compared with that of a suitable control animal kept
under identical conditions. Too much importance, however, must

584 INFLUENCE OF THYROIDS ON SUPRARENALS

not be assigned to the adrenalin load of the suprarenals, and its
amount must be considered in relation to evidence of increased
adrenalin in the blood. The whole question is so much compli-
eated by factors at present unknown, or only partly recognized,
that a safe deduction must of necessity be extremely guarded.
With these reservations in view the evidence of the effect. of
hyperthyroidism upon the adrenalin load of the suprarenals may
now be considered.

Herring (28) in 1916 found that the suprarenals of thyroid-
fed cats, carefully minced and desiccated at 37° C, yielded a
material which was more active when tested by Elliott’s method
(18) on the blood pressure of pithed cats than similarly desic-
cated suprarenals from the normal animals. By the subsequent
employment of the chemical method of measuring adrenalin in-
troduced by Folin, Cannon and Denis (22) Herring showed that
the adrenalin content of the suprarenals of male and female eats
is considerably increased by the prolonged feeding of these ani-
mals with small quantities of raw ox thyroid in addition to their
ordinary diet. A histological examination of the suprarenals of
the thyroid-fed animal further revealed that the cells of the
medulla were closely packed with chromaphil material.

In a later paper Herring (27) extended his observations
to albino rats. Male rats of the same age and as far as possible
of the same litters, were taken in two groups. One group was
fed on small amounts of fresh ox thyroid, the other group was
kept as a control and fed with similar amounts of fresh ox flesh,
the main bulk of the diet being in both groups a liberal supply
of bread and whole milk. The adrenalin content of the supra-
renals was estimated by the chemical method. It was ascertained
that the amount of adrenalin in the thyroid-fed group was ap-
proximately 50 per cent. greater than in the controls. It was
further noted that sudden death of the thyroid-fed animals was
apt to occur even when the animals were putting on weight and
apparently thriving. In all such cases the adrenalin content of
the suprarenals was very high, and the condition was associated
with a greatly hypertrophied heart and gross changes in other
organs. In some of the thyroid-fed rats accessory suprarenals
were found to be present and to contain chromaphil tissue in
abundance.

Or

HERRING | 58

In another paper Herring (30) dealt with the effect of thy-
roid feeding on the adrenalin content of the suprarenals of the
female albino rat. It was ascertained that the suprarenals of
the female rat normally have an adrenalin content nearly double
that of the suprarenals of the male rat of the same size. The
female animal is more susceptible to the administration of thy-
roid than is the male, and reacts in different ways. Some put on
weight and remain healthy, and their adrenalin content shows
on the whole a slight increase; other animals do not thrive and
their adrenalin content falls.

Kuriyama (41) obtained no increase in the adrenalin con-
tent of the suprarenals of the albino rat on thyroid feeding. As
already mentioned, Kuriyama grouped males and females, his
experiments were few, and he employed large doses of desiccated
thyroid of unknown activity.

It has been stated by Cramer (11) that external tempera-
ture has a considerable effect upon the adrenalin load of the
suprarenals. Cold leads to a rapid exhaustion of the adrenalin
store. Herring also noted that the mere separation of a litter of
young albino rats into different cages adversely affected some of
them. Experiments upon adrenalin content must therefore be
attended by every precaution against outside influences, and the
control animals should be of the same age and-sex and preferably
of the same litter, kept under conditions identical with those to
which the thyroid-fed animals are subjected.

EK. R. Hoskins (32) and Herring (29) have demonstrated
that small doses of thyroid lead to striking changes in many
organs. The hypertrophy of the heart and kidneys is greater
than that of the suprarenals.

Kojima (40) and Herring (29) showed that the pancreas is
also increased in size, and that this is not a mere matter of con-
gestion is proved by Kojima’s description of the numerous mi-
toses in the nuclei of the pancreatic cells brought about by the
administration of small doses of thyroid. Herring came to the
conclusion that hyperthyroidism stimulates the production of
adrenalin, and that the enlargement of the heart and kidneys
is a secondary phenomenon. The simultaneous hypertrophy of
the pancreas was interpreted as being compensatory to the dis-
turbance of carbohydrate metabolism associated with increased
adrenalin formation. The results, whatever their explanation

586 INFLUENCE OF THYROIDS ON SUPRARENALS

may be, lend some support to the theory enunciated in 1908 by
Eppinger, Falta and Rudinger (19). These observers as a re-
sult of experimental work, and from the consideration of the
pathology of certain diseases, more especially myxoedema and
exophthalmie goitre, formulated a general scheme whereby the
interaction of certain of the ductless glands might be explained.
Briefly they regard the glands as obeying the following laws:

I. Extirpation of a blood-gland has a two-fold result.
First, a direct action through the loss of its specific secre-
tion. Second, an indirect action through the disturbance
of its metabolic relationships with other glands.

II. Between the thyro-parathyroids and pancreas, and
between the pancreas and chromaphil tissue, there exists a
mutual restraining influence, while between the thyro-
parathyroids and chromaphil tissue there is a mutual stimu-
lating influence.

III. Diminution or increase of secretion of one gland
leads to over-action or insufficiency of another. For exam-
ple, hyperthyroidism brings about a relative insufficiency
of the pancreas and increased activity of the chromaphil
tissue.

The laws enunciated by Eppinger, Falta, and Rudinger can-
not be regarded as established, and they are obviously incom-
plete. They may, however, provide a working hypothesis to be
confirmed or altered as experimental evidence dictates. The loss
of balance of the ductless glands occasioned by the over- or under-
activity of any one of them may ultimately be found to have its
origin in changes in metabolism and the production in excess
of toxie substances. The work of Noél Paton (55) and his co-
workers on the relation of guanidine to tetania parathyreopriva,
and of Kendall (38) is very suggestive.

V. The Effect of Hypothyroidism upon the Adrenalin Content
of the Suprarenals.

Gley (24) in 1914 found that the suprarenals of dogs and
rabbits previously thyroidectomised show no signs of any diminu-
tion of their adrenalin content when tested upon blood pressure.
Extracts of the suprarenals of parathyroidectomised rabbits were
sometimes a little less active than the normal, but in these cases
the animals were suffering severely from the effects of the re-

HERRING 58

a |

moval of the thyro-parathyroids. Gley saw no trace of any spe-
cific action of the thyroids in maintaining the normal content of
adrenalin in the suprarenals.

Herring (28) in 1916 noted that the desiccated suprarenals
of thyro-parathyroidectomised cats yielded a material which was
less active, when tested by Elliott’s method on the blood pres-
sure of pithed cats, than was similarly treated material from nor-
mal animals. In a further series of animals Herring, using the
chemical method of estimating adrenalin, found that the loss of
activity occurs only in eats suffering from tetany and obviously
ill. In the rabbit, and in cats which show no symptoms, there is
no decrease in the amount of adrenalin in the suprarenals. It
would seem, therefore, that parathyroidectomy, and not thyroid-
ectomy, is responsible for what loss takes place.

There is no evidence, then, that loss of thyroid in itself oe-
casions any diminution in the amount of adrenalin present in the
suprarenals. On the other hand the tetany and wasting which
follow removal of the parathyroids are accompanied by loss of
adrenalin from the suprarenals.

VI. The Effect of Hyperthyroidism upon the Adrenalin Con-
tent of the Blood.

Fraenkel (20) in 1908 attempted to measure the amount of
adrenalin in the human blood by a physiological method. He
adopted Kehrer’s procedure, making the use of the isolated
uterus of the virgin rabbit. By noting the response of the uterus
to various dilutions of the blood of approximately normal indi-
viduals, and comparing the reaction with that produced by known
dilutions of adrenalin, he claimed to have demonstrated the pres-
ence and measured the amount of adrenalin in human blood.
Fraenkel also investigated the blood of individuals suffering
from exophthalmie goitre and found in this disease a large in-
crease in the amount of adrenalin. He regarded this increase as
a compensatory mechanism on the part of the body against the
lowered blood pressure brought about by increased thyroid se-
cretion.

Broking and Trendelenburg (4) in 1911 repeated the work
making use of Laewen’s method in preference to Kehrer’s. They
perfused the blood vessels of the frog’s legs with known dilu-
tions of blood serum from normal individuals and from patients

588 INFLUENCE OF THYROIDS ON SUPRARENALS

suffering from exophthalmie goitre. The results obtained by
the constriction of the blood vessels were compared with those
produced by known dilutions of adrenalin. Broking and Tren-
delenburg estimated the concentration in normal human blood
to be one part of adrenalin in from two to two and a half million
parts of blood. In the blood of patients suffering from exoph-
thalmie goitre they found from two to four times this amount
of adrenalin.

Krause (42) noted that the enucleated eye of the frog
showed dilation of the pupil when placed in the blood serum of
patients suffering from exophthalmic goitre, a phenomenon
which does not occur when the eye is immersed in the serum
of healthy individuals. He also found an increase of adrenalin
in the blood of animals previously injected with the juice ob-
tained from the thyroid glands of patients suffering from exoph-
thalmie goitre.

None of this evidence is satisfactory, for, as pointed out by
Schafer (59), the physiological tests used for the estimation of
adrenalin would also be given by pituitrin. There are other and
more serious objections discussed by G. N. Stewart (62). The
uterus alone does not furnish a suitable organ for the detection
of adrenalin, and is particularly suspectible to the foreign pro-
teins which exist in the blood of a different species of animal.

Stewart urged the necessity of control experiments in which
the specific action of adrenalin in causing inhibition as well as
contraction was made use of. He selected the rabbit’s intestine
as being best fitted to show the inhibitory action of adrenalin,
and employing these tests in conjunction could find little evi-
dence of the presence of adrenalin in human blood taken from
the general circulation. In a later paper Stewart (63), using
the same tests, found no evidence of adrenalin in the blood serum
of a man suffering from Graves’ disease.

The testing of blood for the presence of adrenalin by bio-
logical methods is complicated by the fact that a difference in
action between blood plasma and blood serum has been alleged.
O’Connor (52) believed that the coagulation of blood liberates
substances in it having an adrenalin-like action. He found that
blood serum causes a greater constriction of the blood vessels of
the frog than does a citrated blood plasma. Trendelenburg (67),
recognizing this possibility, changed his opinion as to the value

HERRING © 589

of his previous experiments, and gave a far lower estimate of
the amount of adrenalin in the blood. Stewart and Zucker (66)
investigated the action of blood plasma and serum under various
conditions, and found that the increased action of serum is
mainly confined to the blood vessels, and does not affect the uterus
and intestine.

Similar objections apply to the use of the eyeball of the frog
as a test for the presence of adrenalin in blood. Schultz (60)
found it an unreliable method for detecting adrenalin in solu-
tions where the amount present was much greater than could
ever be the case with blood.

Ott and Seott (53) obtained an increase of adrenalin in the
blood after the intravenous injection of thyroid extract. They
made use of strips of the small intestine of the rabbit, the muscle
of which responds specifically to adrenalin by loss of tone and
inhibition of its rhythmical activity (Magnus, 47). But thyroid
is not the only tissue extract which provokes increase of adrena-
lin in the blood. Ott and Scott found that extracts of parathy-
roids, pancreas, ovary and other organs have a similar action.
Schwartz (61) had previously ascribed the increase of adrenalin
after intravenous injection of animal extracts to the action of
foreign proteins, and had shown that many substances can ex-
haust the adrenalin contents of the suprarenals when injected
into the blood.

Gley and Quinquaud (25) obtained results similar to those
of Ott and Scott. They took the blood from the suprarenal
veins of dogs after the intravenous injection of extracts of thy-
roid and other organs. The blood from the suprarenal vein was
then tested on the blood pressure of another dog. It was found
that, while extract of thyroid increased the amount of adrenalin
in the blood, it was no more active in this respect than extracts
of liver and other organs. Gley and Quinquaud prevented the
coagulation of the blood by the previous injection into the ani-
mal of Witte’s peptone or leech extract so as to avoid the ob-
jections raised by O’Connor. It is quite possible that the in-
jection of these materials had something to do with their results,
for the reactions upon blood pressure which they figure are re-
markably uniform in character whatever the nature of the ex-
tract used.

590 INFLUENCE OF THYROIDS ON SUPRARENALS

It cannot be said that an increase of adrenalin in the blood
in hyperthyroidism has been satisfactorily established. Stewart
and Rogoff (64) have shown that the amount of adrenalin in the
general circulation is extremely small, and they regard its out-
put as being dependent upon the integrity of the nerve supply
of the suprarenals. In cats which had the right suprarenal ex-
cised and the left semi-lunar ganglion destroyed, the amount of
adrenalin present in the circulation was still further reduced.
Stewart and Rogoff estimated the amount in the veins of the su-
prarenals of these animals to be somewhere between 1 part of
adrenalin in 300,000,000 and 1 in 700,000,000 parts of blood and
in the general circulation to be at least 100 times less than this.
The cats, nevertheless, remained healthy, and Stewart and Ro-
goff came to the conclusion that adrenalin is not indispensable to
the body. The weight of evidence accumulated by Stewart and
Rogoff is very great, but against it must be placed the fact that
some of their results have not been corroborated by other ob-
servers whose methods would appear to have been equally care-
ful. Kellaway (37), making use of the paradoxical pupil re-
action in eats, found evidence of increased adrenalin secretion
in anoxaemia after section of the splanchnic nerves. This did
not oeeur after removal of the suprarenals, or only to so slight
an extent as might be occasioned by the action of severe anoxae-
mia upon the extra-chromaphil tissue. If Kellaway is right, lack
of oxygen would seem to have the power of increasing the out-
put of adrenalin by a local action upon the denervated glands.
It is quite possible that adrenalin secretion may also be regulated
by hormone action. In this connection it is significant that Can-
non and McKeen Cattell (7) have shown that the injection of
small doses of adrenalin evokes an action current in the thy-
roids, and that a similar result follows stimulation of the splanch-
nie nerves, provided the suprarenals have not been previously re-
moved. They further showed that the electrical changes in the
thyroid are due to the stimulating action of some material, pre-
sumably adgenalin, carried to it in the blood stream from the
suprarenals. It remains to be proved if the injection of thyroid
can similarly provoke an action current in the denervated supra-
renals.

HERRING O91

VII. The Sensitizing Action of Thyroid upon Structures
Stimulated by Adrenalin.

There is another aspect of the problem which has more ex-
perimental evidence in its support and about which there is less
difference of opinion, namely, the sensitizing action of the thyroid
seeretion upon structures which are stimulated by adrenalin.

In 1911 Asher and Flack (2) showed that the thyroids pro-
duce an internal secretion which increases the excitability of the
depressor nerve of the heart and the pressor effect of adrenalin
upon the circulation. Stimulation of the nerves of the thyroid,
or the intravenous injection of thyroid extract, greatly augment
the activity of response to adrenalin. Stimulation of the thyroid
nerves after extirpation of the thyroid has no such effect, and
idio-thyrin was also shown to be inactive. Asher and Flack laid
stress upon the nervous control of thyroid secretion, and upon the
fact that the phenomena of exophthalmic goitre can be ascribed
to the action of adrenalin upon structures which have been ren-
dered more sensitive to it by hyperthyroidism.

Further work upon the same subject has been done by Asher
(1) and his co-workers. Richardson (57) demonstrated that the
isolated heart of the rabbit beats more rapidly and powerfully
under the influence of adrenalin when perfused beforehand or
simultaneously with extract of thyroid. Shigeshi Kakehi (36)
obtained similar results, and found that the heart of an animal
which had previously been thyroidectomised shows no difference
in this respect from the heart of a normal animal. Levy (43)
ascertained that stimulation of the cervical sympathetic nerve in
cats augments the pressor action of adrenalin some 200 to 300
per cent, and that this effect does not follow if the thyroids have
been removed. He also showed that the iodine-containing com-
pound isolated by Kendall is effective in sensitizing the blood
vessels to the action of adrenalin.

Oswald (54) stated that iodo-thyro-globulin increases the
excitability of the vagus depressor and splanchnic nerves to fara-
dic stimulation, and that the augmenting effect is in direct pro-
portion to the iodine content of the material employed. lodo-
thyro-globulin from a case of Graves’ disease had a similar in-
juence.

592 INFLUENCE OF THYROIDS ON SUPRARENALS

Kiger (17), perfusing the blood vessels of the frog, demon-
strated that, while extract of thyroid itself has no action upon
them, it greatly increases their response to adrenalin. Higer
showed that the blood collected from the veins of the thyroid
augments the effect of adrenalin, while that from other blood
vessels has no such action. He also found that the blood
of rats fed with thyroid, and the blood of patients suffering from
exophthalmie goitre, have the same property of increasing the
activity of adrenalin.

Santesson (58) claimed that the intravenous injection of
various preparations of thyroid increases the sensitiveness of the
rabbit to adrenalin. A greater rise of blood pressure is pro-
duced by the same dose of adrenalin if the animal is previously
fed on thyroid or receives an injection of thyroid extract.

Schafer (59) was unable to confirm the results of Asher
and Flack as regards the prior injection of thyroid extract in
increasing the excitability of the eardiae vagus or depressor in
the rabbit, cat, or dog. He found in the last two animals that
the simultaneous injection of thyroid and stimulation of the de-
pressor nerves produce a greater fall of pressure than that occa-
sioned by either of these two alone. The increased depressor
effect of the combination he regarded as the result of summation,
for in the rabbit, where a slight pressor effect is sometimes pro-
duced by the injection of thyroid, the simultaneous injection of
thyroid and stimulation of the depressor nerve evokes a smaller
response than stimulation of the depressor nerve alone.

Dalmau (15), while believing that the pressor effect of ad-
renalin is intensified by thyroid, looked upon its action as a me-
chanical one. He considered that thyroid promotes an absorp-
tion of fluid into the blood vessels from the lymph, thereby creat-
ing a condition favorable to an increased action of adrenalin.

There is, then, a large amount of evidence that the secre-
tion of the thyroid has a sensitizing action upon the structures
stimulated by adrenalin. The reaction is not necessarily a spe-
cific one. Kepinow (39) found that the pressor effect of adren-
alin upon the ecireulation is intensified by the preliminary use
of pituitrin, and that an augmentation of the reaction of the
pupil is obtained in the same way. Cow (10) corroborated Kep-
inow’s statement as regards the blood pressure, and further

HERRING 593

showed that pituitrin activates the uterus to an increased re-
sponse to adrenalin. Cow gave reasons for believing that this
sensitizing action of pituitrin is exerted upon the peripheral
mechanism of the sympathetic system but not actually upon the
end organs. Further research upon these lines is clearly called
for,

VII. The Thyroids and Suprarenals as a Subsidiary Heat-

— Regulating Mechanism.

Eppinger, Falta, and Rudinger (19) discussed the possi-
bility of adrenalin taking part in the regulation of body tem-
perature. They noted that the injection of adrenalin causes a
rise of temperature in normal, thyroidectomised, and depancre-
atised dogs. On the other hand, towards the close of life in dogs
suffering from pancreatie glycosuria a decreased production of
adrenalin is accompanied by a gradual fall of body temperature.
They concluded that the secretion of adrenalin is an important
factor in heat production.

This theory has been developed by Cramer (11) who
regards the thyro-adrenal apparatus as a humoral mechanism
supplementing the nervous one. Cramer believes that the
thyroid hormone mobilises the liver glycogen by increasing the
production of adrenalin and sensitising the sympathetic nerve
endings. At the same time adrenalin constricts the arterioles
of the skin thereby diminishing the loss of heat from the body.
Cramer has adduced a number of experimental and patho-
logical observations in support of this theory.

That some mechanism of this kind comes into play as an
accessory factor in heat production is not unlikely. The stim-
ulating action of thyroid upon metabolism is well known.
Von Noorden (51) stated that ‘‘the thyroid acts upon metabolism
as a pair of bellows upon a fire.’’? MecCarrison (46) said, ‘‘the
thyroid gland is to the human body what the draught is to the
fire.’ Herring (29) compared the action of the thyroid
glands to the draught-regulating mechanism of a furnace.

Increased activity of the thyroid must therefore bring
about a greater production of heat. The loss of glycogen from
the liver may be simply due to the increased oxidation resulting
from hyperthyroidism. The question of the action of adrenalin
upon carbohydrate metabolism has received much attention,

594 INFLUENCE OF THYROIDS ON SUPRARENALS

and although having a distinet bearing upon the relations of
the thyroids to the suprarenals, is far from being settled and
is beyond the seope of this article. Even if it be admitted that
hyperthyroidism stimulates the suprarenals to an increased pro-
duction of adrenalin, its action upon other organs is greater.
The liver and pancreas would appear to be more intimately
eoneerned. <A disturbance of thyroid secretion upsets the bal-
ance of many organs, all of which have to be taken into con-
sideration in the interpretation of the picture which ultimately
results.

IX. Summary.

There is much evidence, though not unanimous, that hyper-
thyroidism increases the size and weight of the suprarenals.
The observations in this respect are confined to a few species
of animals, chiefly the albino rat and it does not follow that a
similar change takes place in all animals. In the albino rat
the hypertrophy of the suprarenals is due mainly to an increase
in the size of the cortex of the gland, the histological features
of which have not as yet been investigated. The hypertrophy
of the cortex of the suprarenals is associated with gross changes
in other organs and in the general metabolism of the animal,
and it is to these influences rather than to a specific action of
thyroid that the cause may be attributable.

There is some evidence that hyperthyroidism does in the
healthy animal increase the adrenalin load of the chromaphil
tissues. The adrenalin load, however, is so easily altered by a
variety of circumstances that it signifies little in itself. The
alleged increase of adrenalin in the blood of animals suffering
from hyperthyroidism is neither proved nor disproved. The
evidence is untrustworthy. There is greater unanimity in
aseribing to the thyroid hormone an activating influence upon
the structures which are amenable to adrenalin. This sensitiz-
ing action of thyroid may explain the phenomena of Graves’
disease which have been attributed to an increase of adrenalin
in the blood. It does not exclude the possibility that an increased
secretion of adrenalin may actually occur in this condition.

A specifie action of thyroid in stimulating the secretion of
adrenalin, and in sensitizing the structures amenable to its
action, though not improbable is not satisfactorily proved.

HERRING 595

Pituitrin has a similar action in sensitizing certain structures
to the action of adrenalin, and further experimental work may
extend the similarity.

Hypothyroidism is shown to have no effect upon the
adrenalin load of the suprarenals, but here again no definite
conclusions as to the absence of a specific stimulus can be drawn,
for we know nothing about the extent of the requirements of
the body for adrenalin in this condition.

The theory that one endocrine gland exercises a_ specific
influence upon another only touches a part of the question. The
changes in metabolism which occur when any gland is dis-
turbed in function must have a widely-spread effect. Many
of the metabolic changes undoubtedly take place in the liver,
and it is unreasonable to suppose that this organ takes no active
part in the problems presented by the ductless glands. Hyper-
thyroidism provokes such gross changes in the organs of the
albino rat that one is drawn to look for the explanation of its
effects in the products of a disordered metabolism. Noél Paton
(56) has emphasized the importance of the endocrine organs as
regulators of metabolism. The investigation of the substances
normally formed in the body, and the influence which the duct-
less glands have upon them, provides a line of research which
may eventually lead to the establishment of the endocrine
glands as important factors in the regulation of the general
metabolism of the body.

LITERATURE

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596 INFLUENCE OF THYROIDS ON SUPRARENALS

=<J

13.

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bye

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HERRING 597

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598 INFLUENCE OF THYROIDS ON SUPRARENALS

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51. Noorden, C. von: New aspects of diabetes, 1912, 41; quoted
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52. O’Connor, J. M.: Ueber die Adrenalingehalt des Blutes.
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53: Ott, I. and Scott, J. @:: The action of glandular ‘extracts
upon the amount of epinephrin in the blood. J. Pharm. and
Exp. Therap. (Balt.), 1911-12, 3, 625-633.

54. Oswald, A.: Ueber die Wirkung der Schilddriise auf den Blut-
kreislauf. Arch. f. d. ges. Physiol. (Bonn), 1916, 164, 506-
582.

55. Paton, D. N.: The Parathyroids: Tetania parathyreopriva:
its nature, cause and relations to idiopathic tetany. Quart.
J. Exp. Physiol. (Lond.), 1917, 10, 203-382.

56. Paton, D. N.: The nervous and chemical regulators of metab-
olism. Macmillan and Co., London, 1913.

57. Richardson, H. B.: Contribution to the physiology of glands.
XXV. The influence of internal secretions, particularly of
thyroid secretion and adrenalin, on the surviving mammalian
heart. Zeitsch. f. Biol., 1916, 67, 57-82; quoted from Physiol.
Absts. (Lond.), 1916, 1, 427.

66.

67.

68.

69.

HERRING 599

Santesson, C. G.: Ueber die Einfluss einiger Thyroideapra-
parate auf die Adrenalinempfindlichkeit. Skand. Arch.
Physiol., 1919, 37, 185-215.

Schafer, E. A.: The Endocrine Organs. Longman, Green
and Co., London, 1916.

Schultz, W. H.: Experimental criticism of recent results in
testing adrenalin. J. Pharm. and Exp. Therap. (Balt.),
1909-10, 1, 291-302.

Schwartz, O.: Diskussion: Sitz. 2 Juli, 1909. Wien. klin.
Wehnschr., 1909, 22, 984-985.

Stewart, G. N.: So-called biological tests for adrenalin in
blood, with some observations on arterial hypertonus. J.
Hxpe Med, GN. -Y¥.), 1911, 14, 377-400.

Stewart, G. N.: The alleged existence of adrenalin (epine-
phrin) in pathological sera. Ibid., 1912, 15, 547-569.

Stewart, G. N. and Rogoff, J. M.: Quantitative experiments on
the liberation of epinephrin from the adrenals after section of
their nerves, with special reference to the question of the in-
dispensability of epinephrin for the organism. J. Pharm. and
Exp. Therap. (Balt.), 1917, 10, 1-48.

Stewart, G. N. and Rogoff, J. M.: Further observations show-
ing that epinephrin from the adrenals is not indispensable.
Am. J. Physiol. (Balt.), 1919, 48, 397-410.

Stewart, G. N. and Zucker, T. F.: A comparison of the ac-
tion of plasma and serum on certain objects used in biologi-
cal tests for epinephrin. J. Exp. Med. (N. Y.), 1913, 17,
152-1738.

Trendelenburg, P.: Ueber die Adrenalinkonzentration im Sdu-
getierblut. Arch. f. exp. Path. u. Pharm., 1915, 79, 154-189.

Vincent, S.: The experimental and clinical evidence as to the
influence exerted by the adrenal bodies upon the genital sys-
tem. Surg. Gyn. and Obst. (Chgo.), 1917, 25, 294-299.

Vincent, S.: Internal Secretion and The Ductless Glands.
Edward Arnold, London, 1912.

600 EDITORIAL

THE FIRST CASE OF MYXEDEMA TREATED BY
THYROID EXTRACT

To the younger generation of practitioners organotherapy
is more or less a commonplace feature of every-day medicine.
Its real development, however, has occurred entirely within
the lifetime of this generation.

The first successful use of thyroid extract in the treatment
of myxedema was begun in 1891 by Dr. G. R. Murray of Man-
chester, England. The recent death of the subject has impelled
Dr. Murray to publish a recapitulation of the case (1).

‘‘Mrs. S., aged 46, was shown at a meeting of the North-
umberland and Durham Medical Society on February 12th,
1891. She had had a family of nine children, of whom six were
living. At the age of 40 she had a miscarriage, after which she
had menstruated once, at the age of 42. When she was 41 or
42 years of age her relations had noticed that she was becoming
slow in speech and action, and she herself began to find that it
required a great effort to carry on her ordinary housework.
The features gradually became enlarged and thickened and the
hands and feet increased in size and changed in shape, so that
at the time of this meeting she presented the typical features
of an advanced case of myxedema of at least four years’ dura-
tion. After showing the patient, I stated my intention of treat-
ing her with thyroid extract, and described the principles upon
which this treatment was based and the reasons for expecting
that it would be successful. The treatment was not commenced
until two months later, and the following note taken on April
13th, 1891, deseribes her condition at that time:

“She complains of languor, a disinclination to see strangers, and ©
great sensitiveness to cold. The temperature is subnormal, and varies
between 95.6° and 97.2° in the mouth. The pulse varies between 60
and 70. The face is blank and expressionless and the features are
notably thickened. This change is well seen in the alae nasi and lips.
The subcutaneous connective tissue of the eyelids is so swollen that
she finds it difficult to look upwards. There is also considerable swell-
ing beneath the eyes and of the cheeks. The hands and feet are both
enlarged; the former have that peculiar shape which has been de-
scribed as spade-like. The skin is very dry, there is no perspiration,
and the superficial layers of the epidermis are continually being shed
as a fine white powder. The hair is very fine in texture, and a con-
siderable quantity of it has been lost. She is slow in answering ques-
tions; all her actions are slow and are performed with difficulty. The
speech is remarkably slow and drawling and the memory is bad. No
thyroid gland can be felt in the neck. The urine contains no albumin
or sugar.

EDITORIAL 601

‘‘The experimental nature of the treatment was explained,
and the patient, realizing the otherwise hopeless outlook,
promptly consented to its trial. In order to insure that the ex-
tract was properly prepared, the thyroid gland was removed
from a freshly killed sheep with sterilized instruments and con-
veyed at once in a sterilized bottle to the laboratory, where a
glycerin extract was prepared.

‘“Tn the treatment of this first case a hypodermic injection
of 25 minims of the extract was given twice a week at first, and
later on at longer intervals. The patient steadily improved and
three months later, on July 13th, the condition was thus de-
seribed :

“The swelling has gradually diminished, and has practically dis-
appeared from the backs of the hands, the skin over them being now
loose and freely movable. The lips are much smaller. The swelling
of the upper eyelids has diminished so much that she can look up-
wards quite easily. The swelling beneath the eyes and of the cheeks
has also much diminished. The face consequently, as a whole, has
greatly improved in appearance and has much more expression, as
many of the natural wrinkles, especially about the forehead, have re-
turned. The speech has become more rapid and fluent, the drawl
being scarcely noticeable at the present time. She answers questions
much more readily, the mind has become more active, and the mem-
ory has improved. She is more active in all her movements, and finds
that it requires much less effort than formerly to do her housework.
She now walks about the streets without any hesitation, without a
companion.

“She has menstruated normally during the last six weeks at the
regular interval. For the last four weeks the skin has been much
less dry and she perspires when walking. The hair remains as before.
She is no longer so sensitive to cold. Unfortunately, owing to cir-~
cumstances, a daily record of the temperature has not been kept, but
out of four observations that have been made lately, about 11 a. m.,
three times the temperature has been 98.2° F. and once 97.4°.

‘“‘After this the injections were given at fortnightly inter-
vals, and later on, when the oral administration had been shown
by Dr. E. L. Fox and Dr. Hector Mackenzie to be equally ef-
ficient, she took 10 minims by the mouth six nights a week, so
that one drachm was consumed in the course of each week. On
this dose she remained in good health and free from the signs
of myxedema. She continued to take liquid thyroid extract
regularly until early in 1918, when it became difficult to obtain,
so she was given dry thyroid extract. She enjoyed excellent
health until early in 1919, when she died at 74 from cardiac
failure.

‘This patient was thus enabled, by the regular and continued
use of thyroid extract, to live in good health for over twenty-

602 EDITORIAL

eight years after she had reached an advanced stage of myxe-
dema. During this period she consumed over nine pints of
liquid thyroid extract or its equivalent, prepared from the
glands of more than 870 sheep.”’

1. Murray (G. R.). The life history of the first case of myxedema
treated by thyroid extract. Brit. M. J. (Lond.), 1920, (i), 359-360.

ENDOCRINOLOGY IN RETROSPECT AND PROSPECT

With this issue ENpocrRINOLOGY completes its fourth year
of publication. While the retrospections of a four-year-old
may not be regarded as highly portentous, something of value
may be deduced from the consideration of even this brief
experience:

The declared central purpose in the organization of the
Association for the Study of Internal Secretions was ‘‘to eor-
relate the work and interests of physicians and students en-
gaged in the study of internal secretions and, by concerted
effort, to broaden knowledge in this field.’? The constant aim
of the editorial staff has been to cooperate to the best of its
ability in the realization of this aim.

Starting with no resources but an idea and the enthusi-
asm of its proponents, it was expected that progress would
in any ease be somewhat slow. Almost as soon as the journal
got under way, however, it had to encounter the vicissitudes
of war. A large proportion of the active men upon whose
support reliance was placed either entered directly into mili-
tary service or assumed such heavy duties in connection with
the war that little time and energy were available for the
Association and its journal. That the infant survived this
trying ordeal seems a surprising manifestation of innate
vitality.

Not only, however, was the preoccupation of its sup-
porters a handicap to the Journal, but the disorganization of
medical and-~scientifie activities throughout the world also
proved a seriously disturbing factor. The supply of original
articles for publication was reduced almost to the vanishing
point and the periodical literature from which abstracts are
derived became difficult to secure. Many journals suspended

EDITORIAL 605

publication and those which continued publication in many
cases reached the abstracters only irregularly. In fact, many
library files are still incomplete for the period of the war.
Partly on this account, hundreds of articles published in the
past three years remain yet to be abstracted.

Three plans for dealing with the current literature have
been entertained. The first of these is to collect the literature
in abstract form, as it appears. The publication of this mate-
rial affords a cross section of the literature for the given
period. If adequately presented, such a cross section should
exhibit in a colorless way both the virtues and defects of this
literature. That various palpable absurdities have thus been
presented for the consideration of the readers is fully realized.

As regards articles of dubious value, the policy of most
abstract journals is to pass them over without notice, in the
hope of their relapsing promptly into oblivion. In the mean-
while, however, the titles have been catalogued in the more
complete bibliographic journals and they remain, to the thor-
ough student, at least, a factor that must be taken into account.
For example, an author proposes to bring up to date the litera-
ture on a given point. From the bibliographic journals he
secures a list of references to all sorts and conditions of articles.
Frequently none of these can be discarded without at least
cursory consideration. If the articles were all available in ade-
quate abstract form, those of no permanent value could at
once be dismissed from consideration. For this reason, it is
felt that the re-publication of even so-called trash is of con-
structive value. Accordingly, the policy.is to abstract ‘‘all
the endocrine literature since 1916.”’

Not the least of the difficulties encountered in earrying
out this plan resides in the scientific conscience of the ab-
stracters. In each ease the aim has been to secure the services
of men of well-balanced critical Judgment. Such men have a
readily understood hesitancy to attach their initials to mate-
rial of dubious significance, even as reporters.

So much for the first plan. It represents to a considerable
extent merely a preliminary process.

A second plan is to collect the hterature on given topics,
irrespective of date, and to publish this material as a series

604 EDITORIAL

of synthetie reviews, in which each article is critically evalu-
ated by a competent authority. Only a beginning has been
made toward the evolution of this plan. It amounts to a pre-
sentation of the literature—to carry out the morphological
simile—in reconstruction.

A third plan is to collect in abstract form and publish in
chronological sequence the literature on select topics—to pre-
sent this literature in longitudinal section. Obviously, the lt-
erature on some topics, for example, Graves’ disease, would
not lend itself to such treatment. That on other and less
extensive topics might, however, be thus presented and a
great deal of work be saved upon the part of those having
occasion to review such material. So far it has not been prac-
‘ticable to proceed with this plan.

A fourth plan, also, namely, to supply translations or
abstracts of less accessible individual articles to our members
and subseribers, has had to remain one for future develop-
ment.

At this time it may not be amiss to point out that the
limiting factor is solely the elementary one, an inadequate
budget. One of the leading scientific societies is said to expend
approximately $50,000 a year upon its abstract journal alone.
The actual realization of the maximum possibilities for use-
fulness in an abstract and bibliographic service might exhaust
an even larger budget. There is readily accessible the most
complete collection of the current literature on medicine and
medical sciences in the world. Translators and abstracters
are also obtainable. Salaries alone are lacking.

A rapidly growing subseription lst is an encouraging
indication of the future possibility of augmenting the useful-
ness of the Association and its journal. The time, however,
would seem to have arrived when, in recognition of their place
as educational institutions, associations and journals of this
sort should be supported by considerable endowments. When
the needs and possibilities of such are realized and adequately
presented, doubtless such endowment will be forthcoming.

So much for the matter of second-hand dealings with the
literature. As regards original material, the endeavor has

EDITORIAL 605

been and will be to publish at first hand a considerable pro-
portion of the best articles appearing in the field of Endoc-
rinology. Articles of wide interest and such as summarize
the results of extensive studies are especially to be desired.
The codperation of the entire membership of the Association
is needed to make the most of this phase of our activities.

With the beginning of Volume V, the Journal will appear
bimonthly. The material to be presented is constantly increas-
ing in amount, and bimonthly issues will perhaps be of more
convenient size than would quarterly. It is hoped that this
consideration, together with that of more prompt publication
of original articles and abstracts, will compensate for the addi-
tional effort and financial outlay involved.—R. G. H.

606 BOOK REVIEWS

LE SYMPATHIQUE ET LES SYSTEMES ASSOCIES. By
A. C. Guillaume, with preface by Pierre Marie, Paris, 1920.
Masson et Cie., 160 p.

In view of the close relationships between the autonomic
nervous system and the endocrine functions this book will be of
interest to endocrinologists generally. In addition to introdue-
tory and concluding sections the volume consists of six chap-
ters, taking up, respectively, the morphophysiologie conception
of the autonomic system, the connection of this system with
the organic processes, the pharmacologic relationships, the syn-
dromes due to selective excitation of the system, clinical ‘‘vag-
atonia’’ and ‘‘sympathicotonia’’ and the pathological con-
nections of the autonomies with the ‘‘organie’’ and ‘‘animal’’
systems. The morphologic relationships are brought out in a
series of unusually comprehensible diagrams. In the section
on pharmacology the author goes, in the interest of philosophi-
eal gratification, considerably beyond the limits of safety. He
postulates a function for the suprarenal cortex bearing the same
relation to the parasympathetic system as does the medulla of
the gland to the sympathetics. ‘‘Hormone x’’ in this ease is
cholin. The pancreatic secretion is alleged to have a somewhat
similar function to that of the suprarenal cholin. He also over-
simplifies the equasion in assigning to the thyroid hormone
merely a selective affinity for the sympathetic fibres rather than
regarding it as a general cell stimulant. On the whole, the
book, while illuminating and full of useful data, must be read
somewhat critically. The data are largely derived from other
compilations.—R. G. H.

BEITRAEGE AM SCHILDDRUESENFRAGE (THE
GOITER PROBLEM). By Otto Bayard. Basel, 1919.
Benno Schwabe & Co., 42 p.

The author likens goiter to beriberi, in that both may de-
velop when patients go from one country to another, owing to
differences of food encountered. He considers goiter as a de-
ficiency disease, iodine being the lacking factor. Especially dur-
ing youth the organism needs a large amount of iodine. The
less iodine in the food the larger is the thyroid. In Kiel, situ-
ated at the seaside, the average thyroid is smaller than in Berlin.
In Berlin it is smaller than in Munich. The size of the gland
in Bern is larger than in Munich. The greater the distance
from the sea, the larger the size of the thyroid.

The iodine has to be fixed in the cells of the body and the
author believes (though why is a mystery) that it is fixed only
in the nucleus. He applies Ehrlich’s side-chair theory of anti-

BOOK REVIEWS 607

toxin formation to the thyroid problem. In youth the cells
have more receptors for thyrjod (the name the author gives to
the active principle of the thyroid) than in advanced age.
Therefore, during life the cells gradually lose these thyroid
receptors. When the function of the thyroid is diminished
there will be too small an amount of thyroid to saturate all re-
ceptors and some receptors which do not get saturated, disap-
pear. When this happens during youth the cells come to have
only the number of receptors that they otherwise have in more
advanced years. Therefore . . . cretins have an oldish face
and make an oldish impression. This conception, to the re-
viewer, seems downright fantastic.

As a prophylaxis against goiter the author recommends
that the public be restricted from using salt for cooking except
such as has been supplemented with potassium iodide (5-10 mg.
to 5 k. of salt).

On the whole the book, while full of original ideas, con-
tains so many unproved assertions as to demand a highly erit-
ical attitude upon the part of the reader.—J. K.

(IL PROBLEMA DELLA SONNO. LE AZIONI-: ORMON-
ISCHE REGOLATRICI DEL FENOMENO.) SLEEP
AND ITS HORMONE REGULATION. By Prof. Mario Bar-
bara. Palermo, 1920. Scuola Tip. Boeccone del povero. 39
pes’:

The author postulates as the essential feature in sleep an
alternation of anabolic and catabolic predominance due in turn
to alternately preponderating activity of ‘‘excito-anabolic’’ and
‘*excito-catabolic’’ hormones. The problem as previously re-
garded is thus translated into newer phraseology.—R. G. H.

DIE REIZTHEORIE UND DIE MODERNEN BEHAND-
LUNGSMETHODEN DES DIABETES. By Priv. Doz. R.
Kolisch, Berlin and Vienna, 1918. Urban und Schwarzenberg,
152 p.

The question whether diabetes is caused by increased forma-
tive or diminished oxidation of sugar has given rise to an enor-
mous literature. Claude Bernard was the first who considered
increased formation as the cause. In Germany this theory was
not accepted and well known specialists like Kiilz, von Noorden
and Minkowski wrote against it. Kolisch was one of the first
authors in Germany to support in his ‘‘Reiztheorie,’’ the view
of Claude Bernard. ‘‘Diabetes is caused by increased forma-
tion of sugar in the tissues. This is due to abnormal stimuli;
these stimuli may be toxie or nervous.’’ Though in the begin-

608 BOOK REVIEWS

ning this theory received little credence, modern research has
more and more supported it.

In this little book Kolisch describes his theory and discusses
the literature pertaining to it. The best treatment is to try
to diminish the abnormal stimuli by rest. Therefore, it is neces-
sary to give as little food as possible to the patient, and not
only to restrict the carbohydrates but also the protein. The
influence of opium on glucosuria is very clear, considered from
this point of view: it diminishes the irritability of the over-
stimulated nerves.

It is unfortunate that the author has written the last five
pages of this book, wherein he discusses the Allen treatment in
a way to indicate that he scarcely knows even the most funda-
mental things about it. Except for this last chapter the book
is excellent and may be warmly recommended to those inter-
ested in the history of research in the field of diabetes.

Some figures quoted from the mortality statistics of Vienna
are used by Kolisch as evidence of the value of under-nourish-
ment in the prevention of death from diabetes.

DEATHS FROM DIABETES IN VIENNA, AND TOTAL MORTALITY
Total Mortality Cause of Death: Diabetes

Year Civilian Military Civilian Military
WTO ees ok 32,130 184 337 2
OWA ea creegees «ous 31,480 1,788 292 2
OM Decks scl sists arts 33,052 3,966 265 6
LOW eyes 338 33,494 4.137 265 15
ONT. Se eS 40,260 5,871 194 15

—J.K.

ABSTRACTS

ADRENAL insufficiency and war (L’insuffisance surrénale et
la guerre). Agnel (E.), Thése de Paris, 1918-19, 143.

The importance of adrenal insufficiency in the pathology
of war is discussed by Agnel. Its chief causes are overwork,
wounds and infections of various kinds, of which the most
important are dysentery, malaria, tuberculosis and various
intoxications, such as food poisoning, alcoholism, chloroform,
arsenobenzol, antityphoid and cholera inoculation and gas poi-
soning.—Med. Se. Abst. & Rey., 2, 133.

(ADRENAL) Recovery from Addison’s disease. Anon. Lan-
cet (London), 1920, (i), 923.

This editorial is devoted to. the description of a case of
Addison’s disease ending in recovery. It was described by
Giraudeau in his inaugural thesis (Paris, 1919-20, No. 31).
Death occurred from cancer of the stomach eleven years later,
when the autopsy findings confirmed the original diagnosis.
Sear tissue was found in the right suprarenal, indicating the
occurrence of inflammation many years previously. The na-
ture of the lesion could not be determined. There was no evi-
dence of tuberculosis or syphilis in the other organs. The
case was treated with suprarenal extract for about six months,
during which time all symptoms disappeared. Therefore Girau-
deau concludes that in eases in which generalized and tran-
sient suprarenal incompetence is the result of a localized inflam-
matory lesion treatment may be effective, whereas it is of no
avail in caseous tuberculosis of the suprarenals.—L. G. K.

ADRENAL extract as emergency medication in Erb’s myas-
thenia during severe attacks (L’extrait surrénal total, médi-
cation d’urgence dans la myasthenie de Erb an cours des
accidents graves). Marie (P.) & Bouttier (H.), Bull. et.
mem. soe. Méd d. hop. (Paris), 1920, 3. s., 44, 575-581.

Report of a case of Erb-Goldflamm’s myasthenia improved
by the intramuscular administration of extracts of the whole
adrenal gland.—F. 8S. H.

ADRENALS, Note on the development of — in the hedgehog
(Note sur les développement de la surrénale du _ béris-

609

610 ABSTRACTS

son). Célestino da Costa (A.) Compt. rend. Soe. de biol.
(Paris), 1920, 83, 878-879.

Of embryological interest.—T. C. B.

Grave ADRENAL insufficiency during influenza (Dos casos
de insuficiencia suprarrenal grave durante la gripe). Cle-
mente (M.), Siglo Med. (Madrid), 1919, 66, 1057-1060.

Two cases are described. The suprarenal insufficiency
was indicated by marked asthenia, vomiting, diarrhea, small
pulse, extreme hypotension, lividity of the nose and extremi-
ties, Sergent’s white line—in short, a syndrome amounting pre-
cisely to collapse with retention of the mental faculties. Ener-
getic treatment with adrenalin by mouth and hypodermatically
resulted favorably. [The abstractor has noted in various fatal
cases of this type in the Hospital Gral at Madrid, that the
adrenals were the site of well-marked lesions. |—G. M.

(ADRENAL) Addison’s disease in a girl of thirteen years,
death, autopsy (Maladie d’Addison chez une fille de treize
ans, mort, autopsie). Comby (J.), Arch. de Méd. d. Enf.
(Paris), 1917, 20, 28.

Report of a characteristic case with caseation of both
adrenals. Of interest because of the age——C. H. G.

(ADRENAL) Association of a marked pigmentation and lich-
enous growth on the buccal mucosa during the course of an
evasive adrenal insufficiency (Association d’une pigmenta-
tion considérable et d’un lichen de la muqueuse buccale au
cours d’une insuffisance surrénale fruste). Crouzon & Bout-
tier, Bull. et mem. Soe. d. med. hép. (Paris, 1920, 3. s., 44,
67-71.

A detailed case history unamenable to abstracting.

—F. 8. H.

(ADRENALS) Treatment of tuberculosis with adrenochrom
(Adrenochrombehandlung der Tuberkulose). Diesing,
Deutsche med. Wehnschr. (Berlin), 1920, 46, 598-599.

Adrenochrom is an extract from adrenals, made with alco-
hol, ether and benzine and containing adrenalin, sulphur and
phosphorus. It is injected in doses of 0.2-0.5 ce. of 1:1000
solution. Adrenaline dilates the pulmonary vessels; sulphur
diminishes the amount of oxygen in the lungs; phosphorus
increases the formation of connective tissue. The author saw

ABSTRACTS 611

splendid results in tuberculosis of the lungs and recommends
it also in surgicul tuberculosis.

[No histories of patients are reported; the article gives
the impression of an advertisement rather than a report of
serious pharmacological work.|—J. K.

ADRENAL-vascular syndrome (El sindrome suprarreno-vas-
cular). Duran, La Clinica Contemporanea, 1918,
Symptomalogical description without significant data.
—K. B.

(ADRENAL) Chemical and morphological studies of choles-
terin and cholesterin esters in normal and pathologically
altered organs (Chemische und morphologische Studien
iiber das Cholesterin und Cholesterinester in normalen und
pathologische veranderten Organen). Fex (J.), Biochem.
Ztsehr. (Berlin), 1920, 104, 82-174.

The free and combined cholesterin varies but shghtly from
the normal in the liver or kidneys in various pathological con-
ditions. The free cholesterin of the adrenals shows no. sig-
nificant variations from the normal but the combined choles-
terin esters vary greatly. These variations are attributed to
a normal physiological fluctuation rather than to a patholog-
ical increase.—F. 8. H.

ADRENAL apoplexy in small children (Nebennierenapoplexie
bei kleinen Kindern). Friederichsen (C.), Jahrb. f. Kinderh.
(Berlin), 1918, 87, 109.

Friederichsen emphasizes the importance of adrenal hem-
orrhage and consequent acute adrenal insufficiency in the study
of adrenal function and pathology. He reports two cases of
patients, aged 3 and 10 months, respectively, and cites twenty-
eight more from an extensive review of the literature. The
majority of the cases occur in well developed, previously
healthy children under one year of age. The onset is acute,
with a ery and often with vomiting. There is a rapid develop-
ment of cyanosis and pallor without dyspnea or pulmonary
symptoms. The temperature is high, 39-41° C. The pulse is
small, feeble and very irregular. Physical examination shows
a normal heart and lungs. Cyanosis of the extremities rapidly
appears and several hours after the onset and shortly before
exitus it is replaced by a purpuric efflorescence. This begins
as numerous dusky red petechiae, which rapidly spread and
become confluent if not well nigh universal. Exitus occurs

612 ABSTRACTS

six to twenty-four hours after the onset. Post-morten exam-
ination shows cutaneous and adrenal hemorrhages. The pri-
mary cause of the adrenal hemorrhage is unknown, though
the author states that the acute onset and fever suggest an
overwhelming infection. The clinical picture is similar to that
following adrenal extirpation in animals, and the author be-
heves it to be determined by an acute adrenal insufficiency.
The purpura is secondary to this latter, perhaps as a result
of a loss of peripheral vascular tone with consequent stasis.
The author draws an interesting analogy between the purpura
and the bronzing in Morbus Addisoni. The prognosis is de-
termined by the degree of disturbance of adrenal function
and two eases are cited in which old adrenal hemorrhage was
found at autopsy. Adrenalin therapy is indicated.—C. H. G.

(ADRENAL) Case of malignant adrenal cortex tumor with
metastasis in the liver (Ein Fall von maligner Nebennieren-
markgeschwulst mit diffuser Metastase der Leber). Fujimori
(Yuhei), Verhandl. d. japan. path, Gesellsch. (Tokyo), 1916,
6, 187.

An autopsy report. The subject was a woman of 35. The
metastatic growth had completely infiltrated the liver, which
was enlarged to a weight of 745 grams.—R. G. H.

(ADRENALS) Plethysmographic exploration of the blood cir-
culation in the suprarenal capsule (Exploration plethysmo-
graphizue de la circulation sanguine dans la capsule sur-
rénale. Hallion (L.), Compt. rend. Soe. de biol. (Paris),
1920, 83, 335-336.

Description of a plethysmograph for studying the ecircu-
lation in the adrenals.

(ADRENAL) A case of congenital sympathetic neuroblastoma
combined with Addison’s disease in a child (Ein Fall von
Neuroblastoma sympaticum congenitum, combiniert mit Mor-
bus Addisonii bei einem Kinde). Hertz (P.) & Secher (K.),
Jahrb. f. Kinderh. (Berlin), 1918, 87, 367, 1p1.

A ease report with a record of complete clinical and path-
ological findings.—C. H. G.

(ADRENALS) The functional connection between the supra-
renal cortex and other glands of internal secretion, in white
rats. Hewer (Evelyn E.), J. Physiol. (Lond.), Proceedings
1920, 58, xevii-xevill.

ABSTRACTS 613

A preliminary communication. Both feeding and inocu-
lation experiments are being carried on. The work is not com-
plete.—T. C. B.

(ADRENAL) On the suprarenal glands in congenital syphilis.
Jubo (M.), Verhandl. d. jap. path. Gesellsch. (Tokyo), 1919,

b)

The author concludes that there must be some relation
between congenital syphilis and status thymicolymphaticus
since in both eases similar alterations are found in the supra-
renals, which are characterized chiefly by hypertrophy of the
cortex and incomplete development of the medulla—kE. V. C.

The ADRENALS and pathology of war (Les glandes sur-
rénales en pathologie de guerre). Loeper (M.) & Oppenheim
(R.), Rev. gén. de path. de guerre (Paris), 1916-17, 1,
123-141.

A somewhat extensive review of the voluminous French
literature on the etiologic and therapeutic aspects of the supra-
renal glands. The authors believe that the g!ands play an
important role in muscular fatigue, exhaustion, and in the re-
actions to traumatism, infectious diseases, specific vaccina-
tions, toxins and poisons. In short, one gathers that, in the
minds of the authors, bodily weakness and adrenal deficiency
are approximately interchangeable terms. In accordance with
this conception, adrenal medication is extensively indicated.
In more severe cases adrenin in doses of 3-4 mg. hypodermic-
ally or intravenously is recommended. In less severe cases
adrenalin, 20-40 drops daily, by mouth, is advocated. Glyc-
erine extracts of adrenal substance administered hypodermatic-
ally, are said to be remarkably efficacious in grave infections.
In delayed convalescence, asthenia and chronic depression
desiccated adrenal substance is used. It is reported that
adrenal opotherapy has been largely employed among soldiers
in accordance with the foregoing principles and much service
thereby rendered.—R. G. H.

(ADRENAL) The so-called post-mortem suprarenal softening.
Materna (A.), Arch. f. path. Anat. ete., (Berl.), 1920, 227,
235-265.

Mild grades of central softening are commonly found in
the adrena!s. Most often it is associated with acute infections
such as sepsis, pneumonia and intestinal inflammations. There
is increase in weight, lvmphoceytie infiltration, hemorrhages,

614 ABSTRACTS

edema and necrosis. In the cortex there is frequently pig-
mentary degeneration and rapid disappearance of lipoidal ma-
terial—Chem. Abst. 14, 2023.

ADRENAL cortex tumor in a woman with virilism (Tumeur
de la couche corticale de la capsule surrénale droite observée
chez une femme et ayant provoqué l’habitus masculin). Mau-
claire (P.), Bull. et Mem. Soc. de Chir. de Paris, 1920, ——,
—— (May 25); Abst., Arch. méd. Belges, 73, 263.

Mauclaire adds another case of virilism of suprarenal or-
igin to those recorded in the literature by Appert, Launois,
Auvray and Tuffier, Quinby, Thumin, Glynn and others. Mau-
claire’s case was that of a woman of 38, who, for the previous
six years had noted the development of a tumor of the ab-
domen. During this time her menses became suppressed and
her facial appearance altered to a masculine type. Her body,
neck and chest became covered with hair. Her breasts atro-
phied and the feminine, rounded form of the body was trans-
formed to the muscular male type. At operation a tumor was
found in relation with the inner border of the right kidney.
Histological examination showed it to be of suprarenal origin.

—R. G. H.

(ADRENAL) Pigmentation of the limbus corneae in Addison’s
disease (Uber Pigmentation des Limbus Corneae bei Morbus
Addisonii). Meesmann, Deutsche Med. Wehnschr. (Berlin),
1920, 46, 644.

Demonstration of a case of Addison’s disease in which
there were not only the well-known pigmentations of the con-
junctivae but also a closed ring of pigment on the limbus ecor-
neae. The pigment was situated in the middle and deep layers
of epithelium. The walls of the lymph vessels were filled with
pigment.—J. K.

ADRENAL insufficiency following the injection of novarsen-
obenzol in recurrent fever. Remarkable effects of adrenalin
in this and another case, showing syndrome of toxic hemi-
paresis of like origin (Insuffisance surrénale aigue consecu-
tive a l’injection de novarsénobenzol dans la fievre récur-
rente. Effets remarquables de 1’adrénaline dans ce cas, ainsi
que dans un syndrome d’hémiparésie toxique de méme ori-
gine). Monziols & Collignon, Bull. et mem. Soe. med. d.
H6p. (Paris), 1920, 3. s., 44, 214-215.

The administration of 1 mgm. adrenaline is systematic-
ally followed out by the authors to counteract the symptoms

ABSTRACTS 615

of adrenal insufficiency after the giving of 0.3 grams novar-
senobenzol for recurrent fever. Uniformly favorable results
are reported. The case of hemiparesis was similarly cured
by the injection of 3 mgm. adrenaline the first day and 1
mgm. on each of the three succeeding days. The cause of the
adrenal insufficiency is attributed to the rapid destruction of
the spirochetes by the arsenical treatment and the resultant
liberation of a large amount of toxins. These overpower the
adrenals so that their detoxicating function can not operate
to an adequate extent and symptoms of insufficiency result.
Adrenalin is assumed to tide the patient over this period until

his suprarenals are again able to cope with the conditions.
ST ts, Het

ADRENAL changes in experimental scurvy (Uber die patho-
logischen Veranderungen der Nebennieren bei experiment-
eller Barlowscher Krankheit nebst Gewichten einiger endo-
krinen Drusen bei derselben). Morikawa (Y.), Osaka Igak-
kwai, 1920, 19, 9.

The author has found the following changes in the supra-
renals in experimental Barlow’s disease in guinea pigs: (1)
Increase in weight, (2) Inerease in hpoidal content of the cor-
tex, (3) Reduction in amount of doubly refractile fat, (4)
Distribution of the lipoid in the zona fasiculata in three layers
—an outer rich in lipoid, a middle poor in lipoid and an inner
rich in lipoid. He coneludes that this hypertrophy, which is
similar to that found in polyneuritis gallinarum, indicates that
the absence of a necessary vitamine is also an etiological factor
in Barlow’s disease.—E. V. C.

ADRENALS, Development of—in man (Considérations sur les
capsules surrénales ou cours du développement chez
Vhomme). Mutel, Compt. rend. Soe. de biol. (Paris), 1920,
83, 357-360.

An embryological and anatomical consideration of the
causes of variation in the right and left glands. Non-propor-
tional growth, fixity of the vascular pedicle and displacement
of the neighboring organs are the three causes of the varia-
tion.—T. C. B.

ADRENALS, The smooth muscle fibers of the central vein of
the— (Les fibres musculaire lisses de la veine centrale sur-
vegan Peindarie (J.), Compt. rend. Soe. de biol. (Paris),

1920, 83, 958-960.

616 ABSTRACTS

Description of a system of smooth muscle fibers connected
with the central vein of the suprarenal and its principal af-
fluants. The author thinks these museular formations play an
important role in the physiology of the g!and. Emotive
adrenal discharge appears to be only the result of general
vaso-constriction of the veins, collectors of the secretion, which
are compressed and emptied of their contents. This is said
to invalidate the seductive hypothesis of Cannon.—T. C. B.

(ADRENAL?) Premature sexual develooment. Phillips (J.)
& Lambright (G. L.), Arch. Ped. (N. Y.), 1920, 37, 282.

The authors report a case of a @irl seven years old who was
4 feet, 4 inches tall and weighed 7314 pounds. She gave a his-
tory of having been a robust child who developed unusually
large breasts at the age of two years, pubic hair at five with
well developed genitals. Between the ages of three and four
vears she was seized with convulsive attacks which gradually
inereased in severity; these resembled epilepsy, being ushered
in with a ery, followed by clonic and tonic contractures of
the right side of the face and extremities. Menstruation was
established with an increase in the severity and frequency of
these attacks. Examination showed a premature sexual de-
‘velopment in that she presented pubie hair, axillary hair,
breasts and broad pelvis. all of normal adult size. Her men-
tality was below par. The bones of the right side of the face
and the femur were large. The authors give a short resume
of the literature on the subject. No tumor was noted. X-ray
examination of the skull and the sugar tolerance test were
both negative. Because of the negative skull picture the neg-
ative sugar tolerance test and the absence of any definite piti-
tary or pineal pressure symptoms, the authors by exclusion take
the ease to be one of involvement of the adrenal cortex.

—M. B. G.

ADRENAL insufficiency, influenza and manic-depressive psy-
choses (Grippe, insuficiencia suprarrenal y psicosis maniaco-
depresiva). Rossi (Santin C.), Anales Fac. de Med. (Mon-
tevideo), 1919, 4, 801-812.

Nine eases are reported in which manic-depressive psy-
choses developed. during the weakness following influenza.
The weakness was interpreted as indicating suprarenal defi-
ciency. Similar evidence of the same sort was noted in cases
of six other manic-depressives who had not had influenza.
Adrenalin treatment proved beneficial, i. e., the patients’ con-
dition improved while they were receiving the drug. On this

-

ABSTRACTS 617

basis a far-reaching theory is elaborated to the effect that the

data reported lift the veil of mystery from this type of psy-

chosis, indicate the etiology and point out the therapeusis.
—R. G. H.

(ADRENAL THYROID) Influenza as a pulmonary necrotic
alveolitis involving the endocrines. Sajous (C. E. de M.),
hey. Med J. CN. Y-); 1920, 111, 837-846.

The Pfeifer bacillus upon reaching the alveoli of the lungs
finds all suitable conditions for growth and develops colonies
which arrest the function and cause necrosis of the alveoli.
The alveolar lesions interfere with the respiratory processes
of the system at large, thus causing asphyxia of all organs,
- ineluding the adrenals, whose hormone enables the hema-
globin to be converted to oxyhemaglobin and sustains the
tone of the arterioles. The thyroid exerts powerful influences
on the general metabolism and its secretion and iodine are
physiological constituents of an active factor in the systemic
defense against infections which acts by sensitizing patho-
genie bacteria to phagocytosis. It also facilitates the proteo-
lytie activity of the enzymes, which serve to destroy or, rather,
digest, bacteria. Hence, prophylaxis against influenza may
be established by the inhalation of iodine fumes, by thera-
peutic doses of strychnine, which excites the adrenals, and by
thyroid gland to increase general opsonic and phagocytie ac-
tivity. The active treatment of influenza consists of abso-
lute rest, calomel and salines, deep inhalation of iodine fumes
and salicylates. When the temperature is down strychnine and
adrenal preparations may be freely given.—H. W.

(ADRENAL-GONAD) Early development of the secondary
sex characters in a two-year-cld girl following a hyperne-
phroma of the right kidney (Frihzeitige Entwicklung der
sekund. Geschlechtecharaktere bei einem zweijahrigen
Madchen infolge einer Hypernephroms der rechten Neben-
niere). Schiff (E.), Jahrb. f. Kinderh. (Berlin), 1918, 87,
519.

A elinieal and pathological case report. The child was
adipose, with marked hypertrichosis, the pubie hair being
especially well developed. The breasts were normal. The
sella was slightly enlarged. The histological examination
showed the endocrine organs to be normal. Clinical differ-
entiation from Frélich’s syndrome was simple owing to the
palpable abdominal tumor.—C. H. G.

618 ABSTRACTS

ADRENIN, Pathological physiology of— (Contribucion al
estudio fisiopatolojico de la adrenalina). Septlveda V
(Ti.), Innaug. Dissertation, Santiago de Chili, 1917.

To determine the concentration of adrenin in the blood
the author used the following technique: To 4 or 5 ce. of a 5
per cent solution of mercuric nitrate in N/10 silver nitrate in
a tube graduated in small units blood serum is added drop
by drop until there is complete precipitation. This requires
1 to 2 ec. of serum. The mereury salt forms a white gela-
tinous and the silver, a whilte caseous precipitate. This is
filtered off. The filtrate is transparent or slightly opaque.
To this is added, drop by drop, standardized permanganate
solution until a light rose coloration is produced. By this
technique the author determined a maximum value of 0.30
ems. per mil. of adrenin in normal adults. Determinations
were made on ten subjects who were not fatigued. In sub-
jects who were ill the quantity of adrenin averaged in general
less than 0.30 ems. per mil. The determinations appeared to
have considerable prognostic value. With findings of less
than 0.12 gms. the prognosis is very grave; from 0.12 to 0.20,
it is doubtful; above 0.20, the majority of the patients re-
eovered.—J. R. P.

(ADRENIN) On the permeability of the placenta for adren-
alin in the pregnant rabbit and albino rat. Shimidzu (Yo-
shitaka), Am. J. Physiol. (Balt.), 1920, 52, 377-394.

In multiparous animals there may be several fetuses of
both sexes in one uterus; one pregnant animal, therefore, in-
closes several hormone systems. In deciduate animals these
systems are separated by the placenta, and the question arises
whether the placenta is permeable to these hormones. The
aim of the present experiment is to learn whether adrenalin
administered to a pregnant animal will increase the adrenalin
in the fetus. Rabbits and albino rats were used. The con-
clusion is that the placenta is impermeable to adrenalin, to
the extent at least, that we cannot inerease the adrenalin of
the fetal blood by subcutaneous injections of the drug into the
mother.—T. C. B.

(ADRENIN) Essentials in measuring epinephrin output, with
further observations on its relation to the rate uf the de-
nervated heart. Stewart (G. N.) & Rogoff (J. M.), Am. J.
Physiol. (Balt.), 1920, 52, 521-561.

A further reply to Cannon with protocols of experiments
and a full discussion of the results. The paper should be read

ABSTRACTS 619

in the original for numerous details. It is contended that the
acceleration of the denervated heart by asphyxia cannot be
taken as an index of increased epinephrin output; it may be
obtained and may not be diminished after the adrenal veins
have been hgated, after complete isolation of the adrenals
from the circulation, and after complete removal of the
adrenals. When it does not occur it is due to deterioration
of the animal. There is no good evidence that asphyxia causes
augmentation of epinephrin output by a direct action on the
cells of the adrenal medulla. Opening of the abdomen does
not interfere with the acceleration caused by asphyxia. The
catheter method of estimating changes in the rate of epine-
phrin output is defective in principle. It can only measure
changes in concentration. The fundamentally correct method
is to collect the blood and assay it.—T. C. B.

(ADRENIN) The relation of the epinephrin output of the
adrenals to changes in the rate of the denervated heart.
Stewart (G..N.) & Rogoff (J. M.), Am. J. Physiol. (Balt.),
1920, 52, 304-363.

A lengthy article in which the authors deseribe experi-
ments showing that acceleration of the denervated heart is not
a reaction by which the rate of epinephrin output can be meas-
ured. Clipping off the adrenal vein has no effect on the heart
reaction caused by sciatic stimulation, although it markedly
diminishes or abolishes reactions which are known to be gen-
uine reactions to epinephrin. Acceleration of the denervated
heart on selatic stimulation is well obtained in eats which have
had one adrenal removed and the nerves of the other sec-
tioned, and also when both adrenals have been removed. The
reaction is well obtained after opening the abdomen as in the
operation for a cava pocket. When the reaction disappears
after the removal of the adrenals it is not because of the ab-
sence of increased epinephrin discharge on stimulation of the
sciatic, but for other reasons, such as deterioration of the an-
imal which interferes with the reflexes involved in the reaction
or with the capacity of the heart to accelerate its beat.

—T. C. B.

ADRENALIN and guanidin. Preliminary communication.
Burns (D.) & Watson (A.), J. Physiol. (Lond.), Proceed-
ings, 1920, 58, xeix-e.

In the course of investigation on the action of guanidin
on the neuro-muscular mechanism of mammals the adrenalin
blood pressure reaction was used as a measure of sympathetic

620 ABSTRACTS

irritability. The injection of 1 ec. of 1.7 per cent guanidin
hydrochloride into the jugular vein of the cat produced no
effect on the carotid pressure. Three minutes later 1 ee. of
1/1000 adrenalin caused a shghtly supranormal rise of pres-
sure which was sustained for at least double the normal time.
A nerve-musecle preparation was subjected to a bath of
1/100,000 adrenalin, then 0.02 per cent guanidin hydrochloride,
and again to adrenalin. On stimulation with a minimum break
shock the contraction was supranormal in extent, duration
and rapidity of onset. The guinea pig’s uterus showed similar
effects —T. C. B.

(ADRENIN PITUITRIN) Experimental studies on the effect
of anesthetics in shock. Cattell (McKeen), Am. J. Surg.
(N. Y.), 1920:°34, 89-91.

As an incidental part of the work,.the effects of adrenin
on the heart of animals in shock under ether anesthesia, were
studied. After an overdose of ether certain animals were
resuscitated by adrenin. It was found that this resulted im
a marked lessening of the sensitiveness to ether, due to an
influence exerted apparently on the heart, since stimulation of
the peripheral blood vessels with pituitrin produced no such
decrease of sensitiveness to the anesthetic.—R. G. H.

(ADRENIN) Attempt at poisoning by adrenaline (Tentative
d’empoissonnement par la solution a adrenaline 1/1000°).
Grasset (R.), Bull. et mem. Soe. med. d. hop. (Paris), 1920,
3..8., 44, 981-985.

The attempt to commit suicide by drinking 15 grams of
adrenaline solution (1:1000) proved abortive, although two
hours or more elapsed between time of the ingestion of the
drug and medical treatment.—F. 8. H.

Influence of ADRENIN on heat regulation (Wber die Wirkung
der Adrenalins auf die Warmeregulation). Kondo (S.), Acta
Scholae Med. Univ. Imp. in Kioto, 1919, 3, 169-205.

The author finds that adrenalin only brings about an in-
crease in body temperature when it is administered in large
amounts either subcutaneously, intravenously or intraperi-
toneally, and further, that when the vagi are treated with
atropin or are sectioned this increase in temperature is in-
hibited. He is of the opinion that these observations indicate
the existence of a double innervation: a sympathetic poisoned
by adrenalin and a parasympathetic poisoned by atrophin.

ABSTRACTS 621

Intra-cerebral injection of adrenalin increases the tempera-
ture only slightly after thyroid extirpation.—K. V. C.

ADRENIN medication in the persistent vomiting of pregnancy.
(Vomissements incoercibles de la grossesse et médication
adrénalique). Rathery (F.) & Bordet (F.), Bull. et mem.
Soe. med. d. hop. (Paris), 1920, 3. s., 44, 778-784.

A report of a case of persistent vomiting in pregnancy
of two months, during which the patient suffered from in-
anition and dehydration, accompanied by acidosis. After two
or three days of treatment by injections of adrenaline in large
amounts of normal saline, the symptoms ceased and did not
reappear when the drug was withdrawn. The rapidity of the
action of the drug is to be noted. The doses used were: First
day, 0.5 mgm. subcutaneously; second day, 1 mgm. subeu-
taneously and 1 mgm. ingested; third day, same dose; fourth
day and following seven days, 1 mgm. ingested. The increase
in welght was very rapid and at the rate of one kilo per day
for nine days. The medication used was not the extract but
adrenaline; it did not cause glycosuria.—F. 8. H.

ADRENIN, The behavior of the blood pressure curve after—
injection in children with various pulse qualities (Uber das
Verhalten der Blutdruckkurve nach Adrenalininjektionen
bei Kindern mit verschiedener Pulsqualitat). Schiff (E. R.)
& Epstein (B.), Jahrb. f. Kinderh. (Berlin), 1920, 91, 128.

The authors found that children with normal pulse quality
react to adrenalin with a marked blood pressure increase. On
changing from the upright to the horizontal posture the blood
pressure is unchanged, Pale children with pulse of poor vol-
ume and tension but without appreciable vaso-lability react
with a minimal blood pressure increase or none at all. On
lying down the blood pressure increases 20-30 em. of water.
Pale children with pulse of poor tension and volume, with ap-
parent vaso-lability, show a prompt but very slight blood pres-
sure increase and no change upon standing or lying down.
The response found in the latter two groups is rather uncrit-
ically aseribed to a functional inferiority of the vascular sys-
tem leading to a defective response to stimulation of the vaso-
motor innervation.—C. H. G.

(ADRENIN) Circulatory disturbances in the acro-contrac-
tures. Direct muscular adrenalinization and electric reac-
tions (Troubles circulatoires dans les acro-contractures.
Adrénalization musculaire directe et réactions électiques).

622 ABSTRACTS

Sicard, Roger & Simom. Bull. et mem. Soc. med. d. hop.
(Paris), 1917, 3. s., 41, 811-814.

The injection of adrenalin directly into the living muscle
substance results in fibrillary contractions and hyperexcit-
ability to both mechanical and electrical stimulation.—F. S. H.

A case of general, absolute ALOPECIA of emotional origin
(Un caso di alopecia generale assoluta do origine emotiva).
Todde (Carlo), Riforma med. (Napoli), 1920, 36, 382-383.

The A. reports a case of a soldier of 34 who had previously
been wounded and then released from the service in Italy,
only to be called again to the colors and sent to Franee, where
he had to stand a week of bombardment from airplanes. After
this trying period he began to lose his hair, at first from the
exposed parts, afterwards from the whole body. He had never
before had any infection or skin disease except phlectenular
conjunetivitis, but was of lymphatic constitution. The family
history indicated hereditary nervous taint and the subject pre-
sented certain symptoms suggesting exophthalmie goiter. His
case was accordingly elassified as an endocrine disturbance
and he was put under treatment of pluriglandular therapy.
Boschi has reported the case of a woman whose hair dropped
out after severe emotional stress but reappeared under thy-
roid treatment.—G., V.

AMAUROTIC FAMILY IDIOCY, or infantile amaurotic
idiocy. Epstein (J.), Med. Rec. (N. Y.), 1920, 97, 224-227.

Epstein reports five cases of this unusual disease. ‘‘It
may not be impossible that the much wanted etiology will ulti-
mately be found in some abnormal action or reaction in the
endocrine group which has a profound influence over the gen-
eral metabolism and the hfe history of the nerve cells. But,
at present, there is no evidence of an endocrine pathology in
infantile amaurotie idioey.’’—H. L.

Endocrine factors in bronchial ASTHMA (Endokrinen Grund-
lagen des Bronchialasthmas). Curschmann (H.), Deutseh.
Arch. f. klin. Med. (Leipzig), 1920, 132, 362-378.

Asthma may be related to and caused by endocrine dis-
turbanees, though medical men rarely think of this facet. The
author observed two eases of intermittent Graves’ disease.
Each time the symptoms reappeared the patient had attacks
of asthma. That there exist relations between asthma and
the parathyroids is well known. Attacks of asthma with symp-

ABSTRACTS 62:

toms of tetany (so-called broncho-tetany) have been repeat-
edly described. These cases are cured by ealcium, which is
a specificum against tetany. Whether the adrenals are related
with asthma is not known. Real asthma during Addison’s
disease has never been described. Hyperfunction of the adre-
nals is only observed as sympathicotonia in Graves’ disease.
In these cases asthma has never been observed. The ovaries
have an influence as is proved by the asthma beginning in
the menopause. The author describes one case (which does
not prove much.—J. K.). In another case asthma regularly
returned during menstruation. Relations between asthma
and the testicles are not known. It is possible that the hypo-
physis has an influence. A case is deseribed in which diabetes
insipidus and asthma developed at the same time. Post-mor-
tem examination disclosed a tumor of the mediastinum with
metastasis in both adrenals, hypophysis, lungs, kidneys and
spleen. The author beleves that these facts may prove of
great importance in relation to treatment. In cases in which
asthma begins in the menopause, the ovary should be treated.
When there is hypothyroidism, thyroid may be given also.
Curschmann has seen no good results with hypophysis mediea-
tion in asthma, though it has been recommended by Borehhard.
—J. K.

CAROTID GLAND, Adenoma of the— Reid (M. R.), Johns
Hopkins Hosp. Bull. (Balt.), 1920, 31, 177-185.

Not of immediate endocrine interest.—R. G. H.

CORPUS LUTEUM in neurological practice. Climenko (H.),
me vor MJ: (CN: Y~), 1918, 109, 302-305.

See Endoerin., 3, 1-15.

CORPUS LUTEUM, The nausea and vomiting of pregnancy.
Davis (C. H.), Wisconsin M. J. (Milwaukee), 1920, 18,
513-518.

No beneficial results followed the administration of corpus
luteum in cases that gave a history of ovarian insufficiency
and abortions.—H. W.

(CORPUS LUTEUM) Experimental histological ssudies on the
origin of the corpus luteum. Hirose (T.), Tokyo Igakkwai,
1920, 34 (No. 2).

Mention is first made of the two conflicting theories re-
garding the origin of the lutein body. According to the first

624 ABSTRACTS

(Sabotta), the lutein cells arise from the granulosa; while
according to the second (Johann), they become differentiated
from the cells of the theea interna. The author used the fol-
lowing eriteria for differentiating between the corpus lutein
cells and the theea lutein cells: (1) Relation to the connective
tissue, (2) location in reference to the hyaline hmiting mem-
brane, and (3) fate of the granulosa cells. He used as ma-
terial the ovaries of 16 rabbits taken from 5 hours to 21 days
after copulation, and of 10 pregnant and 16 non-pregnant wo-
men. He concluded that the lutein ce!ls of the corpus luteum
and the interstitial cells arise from the cells of the theea in-
terna. The paper is well illustrated and a good deal of litera-
ture is reviewed.—E. V. C.

(CORPUS LUTEUM) War amenorrhea (Uber Kriegsamen-
orrhée). Kohler (H.), Zentralbl. f. Gyn. (Kiel), 1919, 43,
359-368.

A elinieal report of four cases of amenorrhea in which
microscopic examination of the ovaries led the author to the
conclusion that the ‘‘war amenorrheas” are primarily due to
disturbances of nutrition which in turn cause a lack of fune-
tioning of the corpus luteum.—F. S. H.

(CORPUS LUTEUM) Preservation of the procreative function
in women. Langstroth (F. W.), N. Y. Med. J. (N. Y.), 1920,
111, 982-986.

Langstroth cites an instance of a woman who suffered
one or two severe headaches each month, similar headaches
following the administration of corpus luteum preparations.
The author believes this subject had an anaphylactic reaction
to her own corpus luteum secretion. Extensive surgical repair
work was done but the headaches continued.—H. W.

CORPUS LUTEUM extract in vomiting of pregnancy. Quigley
(J. Ke), N2Y. State: J: Mi O19 S19 506:

Data reported elsewhere. See Endocrin., 4, 115.

The DUCTLESS GLANDS and constitutional diagnosis. Gut-
man (Joseph), Med. Ree. (N. Y.), 1920, 97, 558-561.

‘‘In the interpretation of a case from the constitutional
standpoint several fundamental facts concerning the functions
of the ductless glands upon which the study of human consti-
tutions is based must be borne in mind: (1) The effect of the

ABSTRACTS

SD
NG
wh

inherited powers of the endocrine system upon the development
of the individual; (2) their control of all metabolic processes
of fundamental importance; (3) their domination of all vital
functions occurring during the three cycles of life; (4) their
co-operative method of functioning and intimate relationship,
and (5) the consequences resulting from a derangement of
their funetions or of glandular dyshormonism.’’ Gutman
agrees with Fraenkel’s classification of endocrine econstitu-
tions: the thyrotrope, adrenotrope and pituitotrope, and the
mixed types. The subject in case of each type is peculiar in
build, height, skin, hair, mental capacity, character, ambition
and predisposition to certain diseases. ‘‘ Whether an indi-
vidual is to be tali or short, lean or corpulent, graceful or
awkward is all dependent upon the peculiar reaction of the
different glands individually and collectively.’’ The author
believes the eardiovascular, gastrointestinal, vasomotor, res-
piratory, sexual and other systems fully subservient to the
glandular hormones. According to Gutman every functional
expression is not an accident but a corollary of endocrine ex-
pression.—H. h.

Further development of an interesting case of ERB-GOLD-
FLAM’S DISEASE and remarks on the nature of this dis-
ease (Ulteriore decorso di un interessante caso di morbo di
Erb-Goldflame ealcune considerazioni sulla natura di questa
malattia). Capezzuoli (Cesare), Riv. erit. di clin. med.
(Firenze), 1920, 21, 97-114.

After a detailed report of a case the author insists on
the desirability of further study of this disease on the basis
of endocrine dysfunction (pluriglandular), as it seems justified
from the frequent accompanying lesions of the thymus, of the
thyroid, hypophysis and parathyroids. Its being found often
mixed with other endocrine syndromes as well as its familiar
type and the usual determining causes give a new weight to
his hypothesis. In other words, he considers the syndrome as
an individual idosynerasy to abnormal products of endocrine
dysfunction, sufficient to bring about the disease in hypersen-
sitive subjects.—G. V.

(DWARFISM) The metabolism of a dwarf. Talbot (F. B.),
J. Am. M. Ass. (Chicago), 1920, 74, 1225.

A basal metabolism study of a dwarf boy. He was seven
years of age, weighed, clothed, 12.6 K. (normal weight for boy
of seven years is 21.9 K.) and was 91.5 em. in height (normal,
114.3 em.) The author found that the total metabolism for

626 ABSTRACTS

twenty-four hours was 780 calories as compared with an aver-
age of 900 calories for a normal boy of the same age. This
is almost within the normal lmits of variation. When the
total calories for twenty-four hours were compared with those
of boys of the same weight, it was found that he was pro-
ducing more than the average (780 against 675). This is
slightly above the possible variations from the normal. When
his metabolism was considered from the viewpoint of unit of
body weight, it was found to deviate markedly from the nor-
mal. His calories showed an increase of 45 per cent (58 eal-
ories per Kem. against 40 for a normal boy of the same age)
and his metabolism per Kgm. of body weight, an increase of
i3.7 per cent above the normal. His metabolism per unit of
body surface was 12 per cent higher than that of normal boys
of the same age and 11 per cent higher than that of normal
boys of the same weight. There was no c¢linical evidence of
any disturbance of the glands of internal secretion.—F. C. P.

(DIABETES) Experiments on carbohydrate metabolism and
diabetes. I. Intravenous glucose tolerance of dogs. Allen
(F. M.) & Wishart (M. B.), J. Biol. Chem. (Balt.), 1920, 42,
415-458.

The paper forms the first of a series concerning the endo-
erin funetion of the pancreas. The results reported are gen-
erally in harmony with those of other workers and demon-
strate that in dogs rendered diabetic or near-diabetie by par-
tial depancreatization there occurs a reduction of sugar toler-
ance, although marked exceptions oceur. Extensive tables
are given in heu of protocols.—F. 8S. H.

Experiments on carbohydrate metabolism and DIABETES.
II. The renal threshold for sugar and some factors modify-
ing it. Allen (F. M.) & Wishart (M. B.), J. Biol. Chem.
(Balt.), 1920, 43, 129-147.

Extensive experiments on dogs, either completely or par-
tially depancreatized, demonstrate that a diminished renal
permeability for glucose in the sense of a raised threshold is
definitely proved as the rule in diabetic animals. As the same
rule holds for the great majority of human diabeties, this
demonstration furnishes one more point of similarity between
the experimental and elinical conditions. Various possible
causes for the elevation of the threshold are discussed. The
prolonged excess of sugar in the blood may be an important
factor, but some considerations seem to oppose it. Certain
observations suggest that high fat diets may raise the sugar

ABSTRACTS 627

threshold in diabetes even without acidosis. The renal fune-
tion may be affected by various extraneous causes, of which
the elevation of the threshold by epinephrine is one interesting
example. No interrelation of the renal and pancreatie func-
tions is demonstrable in the sense of an inereased readiness
of sugar excretion even in totally depancreatized animals. An
elevation of the threshold seems to be connected particularly
with severity of the diabetes, but a teleological interpretation
of this as a protective mechanism for saving sugar to the body
is considered dubious—F’. S. H.

(DIABETES) Estimations of sugar in the blood in the diag-
nosis and treatment of diabetes. Cammidge (J. P.), Prae-
titioner (Lond.), 1920, 104, 114-130.

The author deseribes the methods of Lewis and Benedict,
Folin and Wu, and his own for estimating quantitively the
sugar in the blood. He emphasizes the range in sugar values
which he within normal limits, 0.06 to 0.14 per cent, and how
such variations depend upon the nature of the food and the
time after a meal the determination is made. The blood sugar
curve in diabetes is similar in form to the normal, but it has
a wider time relation and attains a greater height as a rule.
In severe cases a permanent hyperglycaemia is established and
the percentage of sugar in the blood never drops within normal
limits, even after a night’s fast. Im a normal person the dif-
ference between the percentage of sugar in the blood two
hours after the sugar has been swallowed and when fasting
should not exceed 0.01 per cent. A study of over 700 cases of
diabetes induces the author to believe that there is no con-
stant blood-sugar level for the appearance of sugar in the
urine in quantities recognizable by ordinary test; and also
that there is no definite relationship between the percentage
of sugar in the blood and either the percentage or total amount
of sugar excreted by the kidneys. Hyperglycaemia may exist
without glycosuria and is sometimes the cause of boils, ear-
buneles, sciatica. Patients with a permanently high blood
sugar may pass comparatively little sugar in their urine, while,
in some instances, a normal, or even a subnormal, blood suga
curve may be associated with frank glycosuria. In either con-
dition, examination of the urine alone does not give a correct
picture of the ease, and, if it is not checked by blood sugar
estimations under controlled conditions, may readily lead to
mistakes in diagnosis and treatment. As a rule, young dia-
beties have a lower threshold point for clinical glycosuria than
those of middle age, and the threshold rises with advancing

628 ABSTRACTS

years. It is, therefore, important that the presence of even
small amounts of sugar in the urine of persons of middle age
should not be dismissed as of little significance, unless a series
of blood tests have shown that their tolerance for earbohy-
drates is not seriously defective. Hyperglycaemia may exist
without clinical glycosuria, that is with an insufficient per-
centage of sugar in the urine to give the ordinary tests for
sugar. The reverse condition, glycosuria with a normal or
subnormal percentage of sugar in the blood, is not as unecom-
mon as is generally supposed. Twenty-five per cent of obese
people have hyperglycaemia without glycosuria. Cases of
elycosuria with normal blood sugar are either examples of
latent diabetes or renal diabetes. The former group, Cam-
midge believes hepatic in origin; the latter, a congenital ab-
normality depending upon abnormal permeability of the kid-
neys for sugar. He reports a unique instance of renal diabetes
in father and daughter. He considers a low blood sugar con-
tent in ordinary diabetes as a good sign even when a large
amount of sugar is being passed in the urine. Such patients
become sugar free more rapidly and ultimately acquire a com-
paratively high tolerance. He belheves that hyperglycaemia
even without glycosuria is more readily controlled if the fat
content of the diet is materially reduced. He writes: ‘“‘Per-
manent success in the treatment of diabetes can only be se-
eured by keeping the blood sugar curve within normal limits,
even though more severe restriction of the diet may be neces-
sary to attain this end than is required to keep the urine
sugar free.’’ He considers a high blood sugar level with no
glycosuria more serious than a low blood sugar level with
moderate glycosuria. Hyperglycaemia occurs in other condi-
tions than diabetes. In nephritis its presence is a serious omen
and indicates a speedy termination. High blood sugar curves
are frequently encountered in carcinoma and hyperthyroidism.
—H. IL.

(DIABETES) The prevention and treatment of diabetic coma.
Cammidge (P. J.), Lancet (London), 1919, (1), 60-64.

The author maintains that acidosis can no longer be ac-
cepted as the sole cause of diabetic coma, but that it is often
an associated or merely an incidental phenomenon. The fail-
ure of alkali therapy has been one of the main stumbling-blocks
in the way of a general acceptance of the acid intoxication
theory. Coma is rather to be considered as the consequence of
auto-intoxication, but the available evidence suggests that
it is a toxemia resulting from the general failure of meta-
bolism occurring in diabetes, instead of from a specific toxin

ABSTRACTS 629

originating in a break in the chemistry of the body in one
particular direction. It is likely that coma is produced by
several toxins of different origin acting together. Probably
toxic substances resulting from abnormal protein metabolism
are responsible for a part of the symptomatology of diabetic
coma. A deficiency of inorganic salts may also be a factor.
In order, therefore, to prevent coma the diet must be arranged
in such a way that: (1) The patient’s tolerance for carbo-
hydrate, fat and protein is not exceeded; (2) the total load of
food is within his metabolic capacity ; (3) the diet is correctly
balanced; (4) a sufficient supply of inorganic salts is pro-
vided. If coma has already developed absolute, rest in bed is
essential. The bowels should be cleared by enemata. The
diet should consist of 2 ounces of lemon juice and 7 to 8
ounces of potato or 21% to 3 ounces of oatmeal taken in the
form of gruel, in small quantities, at 3 to 4 hourly intervals
over the 24 hours. As much liquid as possible should be ad-
ministered: If speedy improvement does not oceur alkaline
injections should be tried. Massive doses, controlled by re-
peated examinations of the blood or by estimations of the
alveolar CO, are necessary. Cardiac stimulants are advisable
at an early stage.—lL. G. K.

Syphilitic DIABETES due to sclero-gummatous pancreatitis
(Diabéte syphilitique par pancréatite scléro-gommeuse).
Carnot (P.) & Harvier (P.), Bull. et mem. Soc. med. de hop.
(Paris), 1920, 3. s., 44. 71-76.

Clinical and post-mortem report of a case of diabetes in
a syphilitic due to gummous lesions of the pancreas. The sub-
ject, a woman of 53, had shown symptoms of neurosyphilis and
diabetes for about two years. The urine had been abundant
and had contained from 66 to 72 ems. of sugar per liter. Death
was due to pneumonia. The pancreas was found to be trans-
formed almost entirely into a sclerogummatous mass. The
-authors regard this as the first reported case of diabetic mani-
festations due unquestionably to syphilitie lesions of the pan-
ereas. Four other cases from the literature are cited but in
these autopsy showed only ordinary sclerosis of the pancreas.

—F. §. H.

DIABETES A Roentgenologic study of the gastro-intestinal
tract in—; a report of seventy-two cases. Case (James T.),
J. Am. M. Ass. (Chicago), 1916, 67, 858-861.

Case found that in diabetes gall bladder involvement is
very common. The stomach empties with unusual rapidity.

630 ABSTRACTS

Duodenal stasis is rare but illiae and low grade ecolonie stasis
is very common.—R. G. H.

(DIABETES) The amount of tissue hydration in diabetes
mellitus (Le taux d’hydration des organes dans le diabete
sucré). Chauffard (A.), Brian (Mille. P.) & Jacobs (J.),
Bull. et mem. Soc. med. de hop. de Par., 1918, 3. s., 42, 49-51.

From a comparison of the water content of the tissues of
a normal (?) individual with the tissues of one dying in dia-
betie coma and one having diabetes but dying of tuberculosis,
the authors are of the opinion that among diabetics it is only
those dying in coma who give evidence of tissue dehydration
as the result of the pathological processes. [See also Chauf-
fard, Endocrin., 4, 144.]|—F. S. H.

DIABETES MELLITUS, The limitation of starvation in ——.
Edgar (T. W.), N. Y. Med. J. (N. Y.), 1920, 111, 803-806.

Starvation of diabetics will cause a loss of sugar in the
urine, but at the same time it results in the production of
acidosis and ketonuria. The prevention of acidosis, therefore,
is the logical treatment of this disease. This is accomplished
by alkinization and a diet sufficient to maintain weight. The
Edgar serum which ‘‘contains the internal secretion in hor-
mone form’’ is capable of increasing the carbohydrate toler-
ance of certain cases from 25 to 60 per cent and arrest the
progress of the disease. The serum is obtained from rabbits
after they have undergone a series of maneuvers calculated
to activate the various endocrine organs to augmented ac-
tivity.—H. W.

(HYPOPHYSIS) Diabetes insipidus after meningitis serosa
(Diabetes insipidus in Anschlusz an Meningitis serosa).
Foerster (A.), Miinchen. med. Wehnschr., 1920, 67, 694-696.

Report of a case. Subcutaneous injection of extract of
the posterior lobe of the hypophysis gave temporary improve-
ment. The most active drug is pituitin; less action was seen
from pituglandol, Hypophyisin had no effect whatever.—J. K.

(DIABETES) Transitory glycosuria of renal type. The rela-
tion between renal diabetes, phlorizin-glycosuria and dia-
betes mellitus (Transitorische Glykosuria mit renalem Typus.
Das Verhaltnis des renalen Diabetes zur Phlorizin Glyko-
surie und zum Diabetes mellitus). Galambos (A.), Deutsche
med. Wehnschr. (Berlin), 1920, 46, 600-602.

ABSTRACTS 631

No new facts. <A ease is reported of a young man with a
transitory renal glycosuria. The amount of carbohydrates
ingested had no influence on the glycosuria. The amount of
blood sugar was normal. Only when glycose was given or
phloridzin was injected was the quantity of sugar in blood
and urine increased for a short time. It is sometimes very
difficult to differentiate renal glycosuria from ordinary dia-
betes. The author observed a case of classical renal glycosuria
with acidosis.—J. K.

(DIABETES) Epileptic attacks during diabetes with acidosis
(Crises épileptiques au cours d’un diabete avec acidose).
Guillain (G.), Bull. et mem. Soe. med. de hép. (Paris), 1929,
3 s., 44, 808-810, Abst., Prog. Méd. (Paris), 1920, 35, 302.

A ease report. The case is reported of a patient who,
during the course of two months, developed acute diabetes
with polyuria, polydipsia, polyphagia and emaciation. Dur-
ing this time he #uffered numerous epileptic attacks with left
hemiparesis, the crises coinciding with marked acetonuria. The
convulsive attacks were highly characteristic, with contrac-
ture, biting the tongue and incontinence of urine. They ceased
after several days’ intensive alkaline treatment; at the same
time the hemiplegia receded. This hemiplegia was no doubt
of toxie cortical origin. The Babinski sign was consistently
negative —R. G. H. :

The history of DIABETES mellitus. Horwitz (P.), N. Y. Med.
FCM. ¥.-1920. 411, 807-812.

An interesting survey of the history of diabetes mellitus.

—H. W.

DIABETES, Advantages of class instruction in the treatment
oe anney. (NW), NY. Med.:J. (N. Y.),' 1920, 111,
806-807.

The treatment of diabetes should consist of immediate
attention and the education of the patient to appreciate his
condition and eare for himself. Where possible, classes of
instruction are of decided benefit in the handling of such
cases.—H. W.

DIABETES and exopthalmic goiter (Diabete et goitre exop-
thalmique), Labbé (M.), Bull. et mem. Soe. med. d. hoép.
(Paris), 1919, 3 s., 43, 955-962.

632 ABSTRACTS

The non-fortuitous coincidence of diabetes and exopthal-
mie goiter is well brought out by the author’s description and
discussion of 5 eases in which the two disorders occurred in
the same individual. In one of his cases the woman developed
goiter at 20; glycosuria became installed at 50, and at 54 the
symptoms of severe exopthalmie goiter developed and the dia-
betes became aggravated. Each time there was a hyperthyroid
attack, with tachyeardia, the sugar content of the urime and
blood ran up high, scarcely modified by dietetic measures, but
subsiding with the paroxysm of hyperthyroidism. He cites
Manby, Lancereaux and others’ reports of instances of diabetes
in some members of a family and exophthalmie goiter in others.
All types of diabetes apparently may occur with exophthalmie
goiter, but in general they seem to be more resistant to treat-
ment than do the ordinary uncomplicated cases. Hereditary
influences seem to play a part and the disorder easily runs
into an acidotie condition which may be associated with the
disturbed nitrogen metabolism of the goitrous. Therapeutic-
ally the medicaments, such as quinine and salicylate, which
act against the goiter, also retard the glycosuria. In two of
the eases cited iodine treatment was successful; at the same
time that the palpitations and tachycardia subsided, the gly-
cosuria also decreased. Labbé is of the opinion that the dia-
betes of Basedow’s disease is probably the result of a func-
tional disturbance of the thyroid.—F. S. H.

(DIABETES) L’épilepsie acidosigue. Labbé (M.), Bull. et
mem. Soe. med. d. hop. (Paris), 1920, 3. s., 44, 810-811; Paris
Méd., 1920, 10, 354-358.

Report of 4 cases of diabetes in which epileptic seizures
occurred accompanied by acidosis, together with a discussion
of the literature. Labbé concludes that diabetic epilepsy is a
manifestation of acidosis. In cases of acidosis in which there
is no cause for assuming uremia or any other intoxication,
occasionally epileptiform seizures develop which it seems jus-
tifiable to associate with acid intoxication. They are localized
or general, and are followed by loss of consciousness, either
transitory or prolonged. They may precede diabetic coma, or
appear after the diabetic coma has begun, or occur long before
coma sets in.—F. 8. H.

Experimental pancreatic DIABETES after partial pancreatec-
tomy. Langfeldt (E.), Acta Med. Seand. (Stockholm), 1920,
53, 1-192.

This number of the journal is devoted exclusively to an
account of Langfeldt’s two years of researches on the develop-

ABSTRACTS 633

ment of glycosuria in dogs of different ages after partial pan-
ereas ablation. In order to make the metabolism of the ani-
mals more like the human metabolism, the dogs were fed on
carbohydrates without meat for a long period of time before
the operations. Four dogs, prepared in this way, were oper-
ated upon. The tolerance for carbohydrates was tested, giving
glucose by mouth; normal dogs of the same litter served as
control animals. Two of the dogs were operated, when 3-4
months old, 8/9 and 7/8 of the pancreas, respectively, being
removed. For 3 months after the operations the tolerance
decreased; then it increased and reached that of the control
animals. Six to eight months later the tolerance gradually
decreased and the dogs developed chronie diabetes. When 8/9
of the pancreas was removed in a fully grown dog, glycosuria
developed immediately after the operation. In the last dog
operated on as a puppy, 6/7 of the pancreas was removed.
The tolerance was repeatedly tested; it was not decreased
until one year after the operation. Different portions of the
pancreas were removed in different cases, but with no change
in results. The chronic diabetes of the dogs showed close
resemblance to the human type, the symptoms being polydipsia,
polyuria, loss of weight, ketonuria, albuminuria and cataract.
The D:N ratio was relatively high and the nitrogen excretion
in hunger, low. The ketonuria reached a considerable degree.
The diabetic dogs died 8 and 13 months, respectively, after
the operations, while the others were killed when the toler-
ance decreased. In the diabetic dogs no islands of Langer-
hans were found at autopsy, but they were intact in the ani-
mals without spontaneous glycosuria. The findings thus con-
firm the preponderance of the pancreas in all diabetic phe-
nomena. It appears to have a catalytic action. When the
sugar content in the blood reached a higher level than 0.19
per cent, glycosuria followed. Duration of the high sugar
content was of greater import than higher concentrations for
shorter periods. The article is in English. The autopsy find-
ings are illustrated by 12 photomicrographs. A bibliography
of 167 titles is included.—kK. M.

DIABETES, The relation between creatinuria and acidosis in—
(Forholdet mellem Kreatinuri og Acidose ved Sukkersygen).
Lauritzen (M.), Ugesk. f. Leger, (Copenhagen), 1919, 81,
1595-1605.

After a résumé of the literature of this subject and a
description of the technique he has adopted, Lauritzen gives
details of several cases of diabetes illustrated with charts, in

634 ABSTRACTS

which he analyzed the daily excretion of nitrogen, creatin,
and ammonia. The first ease showed that the exeretion of ere-
atin followed a curve parallel with that of the exeretion of
ammonia. Only during two ‘‘hunger days’’ did these two
curves fail to run parallel. This parallelism of the creatinuria
and ammonia excretion was also observed in several other
eases. In one case the acetonuria and diaceturia were great-
est when the creatinuria was at its highest. Lauritzen sug-
gests that the eurves of creatinuria and ammonia exeretion
ran parallel because the diabetic diet affected acidosis and
ereatinuria in the same way. When, in slight cases of dia-
betes, creatinuria appears before acetonuria, this, he suggests,
shows that restriction of carbohydrates in the diet leads to
ereatinuria more readily than to acetonuria. He believes that
there is insufficient evidence for assuming that acidosis per se
leads to ereatinuria in diabetes. It is more probable that
faulty carbohydrate metabolism is the common cause of both
these conditions. He dismisses as untenable the hypothesis
that the creatinuria of diabetes is due to incomplete conver-
sion of creatin to creatinin, with consequent excretion of cre-
atin in the urine.

Probably the demonstration of creatinuria before the
development of acetonuria will prove of little value in con-
nexion with the early diagnosis of a pre-comatose state, for
its onset is indicated by symptoms easier to gauge than cre-
atinuria. But it may be of benefit to the diabetic that creatin-
uria is combated, for if it is protracted it may contribute to
weakness of the muscular system. And, as these investiga-
tions show, ecreatinuria can be controlled by the same dietetic
treatment that reduces acidosis. The degree of creatinuria is
of prognostic significance: if it is considerable and continuous,
it is of bad omen.—Med. Se. Abst. & Rev., 2, 296.

DIABETES, coma as a cause of death in .- MeGay: (Dae
and others. Indian J. Med. Research (Caleutta), 1919, 7,
22-80.

The absence of acidosis during the course of the treatment
of diabetes and even in terminal coma indicates that coma as
a terminal phenomenon in diabetes as found in India is unlike
European diabetic coma. It is probably uremic. MeCay gives
evidence that without true nephritis, simple albuminuria may
lead to fatal uremia. For comparison blood analyses of 25
normals were made. In 10 walking cases of simple glucosuria
without albuminuria somewhat higher values were found for
non-protein N (N. P. N.), urea and the ratio N. P. N.:total N.

ABSTRACTS 635

In 45 eases of albuminuria without glucosuria and 26 cases
of albuminuria with glucosuria a retention of urea or other
N. P. N. and an increase in the N. P. N.:total N. ratio were
found. Blood phosphates were normal and but slight changes
oceurred in blood alkalinity, as determined by Wright’s meth-
od, in 71 eases but anti-diabetic treatment (milk and green
. vegetables) assisted in the elimination of N-waste products.
In 25 ceases of uremia and severe kidney involvement there is
a still greater retention of N. P. N. with or without increase
in urea. The N. P. N.:total N ratio in severe cases was from
1:5 to 1:15. <A retention of phosphates and a decrease in
blood alkalinity were also observed in severe cases. In uremia
of chorea, anuria from whatever cause, and eclampsia, the
retention of N. P. N., urea and phosphates and the decrease
in alkalinity were marked. Acetone was found in the urine
and blood of some cases but not of others just as ill. In 13
cases in the terminal stages of diabetes as seen in India, diacetie
acid and acetone were generally absent. Positive results of
other workers using the FeCl, test are due to the alkaline con-
dition of some urines. Acidosis and diabetic coma practically
do not oceur in India, but the terminal coma in India is uremic
and not diabetic. The fundamental derangement of the kidneys
that accompanies diabetes is the important factor leading to
coma and death. Typical ‘‘air hunger’’ is never found among
natives. Two cases of diabetes among Europeans had ‘‘air
hunger’’ and acidosis.—Chem. Absts., 14, 2368.

The treatment of DIABETES in India. McCay (D.) and
others, Indian J. Med. Research (Caleutta), 1919, 7, 81-147.

The incidence of diabetes among the indolent well fed
classes; its comparative rarity among working classes; and
the fact that meat-eating Mohammedans living under other-
wise identical conditions with the Hindu, eseapes, while his
indolent, sugar-sodden companion develops the disease, all
point to causative influence exerted by the ill effeets of a pro-
longed and excessive, one-sided carbohydrate dietary. There
is an apparently close association between the one-sided ecarbo-
hydrate type of diet and decreased HCl of the gastrie juice,
fermentative dyspepsia, oxaluria or renal calculus, hyperphos-
phaturia and glucosuria. The oxaluria is a sign of gastro-
intestinal catarrh that often precedes glucosuria. The evi-
dence points to a slow atrophy of the panereas. The authors
confirm the fact that extracts of liver and trypsinogen lessen
the exeretion of sugar for short periods, and found the rice,
soy bean and oatmeal cures worthless. In hundreds of cases

636 ABSTRACTS

they found no starvation period necessary, and in Indian dia-
betes could always clear up the sugar excretion and lower the
blood sugar by removal of carbohydrates from the diet. Pa-
tients rarely die from diabetes as found in India and it se!dom
passes into the graver forms of the disease. Reduction of the
carbohydrate intake is practically never followed by severe
acidosis. A trace of acetone may occur in the urine; diacetic
acid was never found in thousands of analyses; the NH, of
the urine remains constant.—Chem. Abst., 14, 2369.

Treatment of DIABETES with caramel (Beitrave zur Behand-
lung von Diabetikern mit Karamel). Reimer (Georg),
Deutsehes Arch. f. klin. Med. (Leipzig), 1920, 132, 219-240.

Caramel is very useful in the treatment of diabetes; it
has a ealorie value, it does almost never produce glucosuria
and it diminishes acidosis. Some persons eannot take it, how-
ever, because they get diarrhea. It has an especially good infiu-
ence in young patients. It should be taken over a period of
several days, 100-200 grams daily in coffee, pudding or alcohol.
Vegetables and fat may be given at the same time. It is better

not to give other carbohydrates or proteins on caramel days.
—dJ. K.

DIABETES, The importance of renal function in (Die
Bedeutung der Nierenfunktion in der Zuckerkrankheit).
Schirokauer (H.), Deutsche med. Wehnschr. (Berlin), 1920,
46, 791-793.

It is a well known fact that hyperglycemia ean exist with-
out glycosuria when the kidneys are not permeable to sugar.
Von Noorden has written that often when a diabetie develops
3right’s disease the glycosuria disappears and the diabetes is
eured. This is, of course, not true. Diabetes is not glycosuria.
Glyecosuria is only one of the symptoms of the disease. On
the other hand, an increased amount of blood sugar without
glycosuria may occur without diabetes in cases of chronic
nephritis with inereased blood pressure. In eases of hyper-
tension without pathological changes in the kidney the blood
sugar may be inereased also. All glands of internal secretion
have an influence on carbohydrate metabolism. Perhaps the
kidney itself has an internal secretion. The author cites some
experiments from the literature to support this view. Hence
it is possible that the kidney has an influence on sugar metabo-
lism. It will be necessary to include in experimental and clin-
ieal work on diabetes a study of the changes in the kidneys

ABSTRACTS 637

and of the influence of the kidneys on earbohydrate metab-
olism.—J. K.

DIABETES und syphilis. Simmonds, Miinchen. med. Wehnschr.
1920, 627, 734.

The author made postmortem examinations in 300 cases
of diabetes. In 20 cases syphilis was found, but only in 3 did
there exist syphilitic changes of the pancreas.—J. K.

The drugless therapy cf DIABETES. Stark (H. S.), N. Y.
Med. J. (N. Y.), 1920, 111, 800-803.

The use of opiates and drugs in general is condemned in
the treatment of diabetes. Endocrine gland therapy is use-
less; their failure to remove or alleviate the symptoms is the
best possible argument to disprove the influence of internal
secretions in the causation of the disease. A consideration of
dietary measures is given for the treatment of diabetes ——H. W.

(DIABETES) Coma diaketicum during pregnancy (Ueber
Coma diabeticum bei Schwarigeren). Umber (F.), Deutsche
med. Wehnschr. (Berlin), 1920, 46, 761-763.

Patients with diabetes very rarely become pregnant. The
author describes two cases of women in whom the diabetie
symptoms regularly increased during menstruation. Both died
in coma during the fourth month of pregnaney. No abortion
took place. In a third case a woman with diabetes innocens
became pregnant and died in the-sixth month, in coma. In
this case the woman during coma was delivered by caesarian
section of a child that lived less than 24 hours. The blood
sugar percentage of the mother during coma was 0.437, and
that of the child only 0.091 per cent. [Carlson has found that
in partially panereatectomized animals glycosuria may be in
abeyance during pregnancy and the animals kept in fairly
good health, but succumb to diabetes after parturition].—J. K.

(DIABETES) The treatment of a mild case of diabetes melli-
tus. Woodyatt (R. T.), J. Missouri State M. Ass. (St. Louis),
1920, 17, 227:

A practical talk at a meeting of the St. Louis Medical
Society, stressing the importance of the educational phase in
the treatment of diabetic patients in securing the best average
of results in a large number of cases of all classes and illus-
trating a specific manner of teaching a patient of the dispen-
sary class.—Author’s Abst.

638 ABSTRACTS

(ENDOCRINE FUNCTION TESTS) Some results of glandular
tests made according to the previous condition of the endo-
crine functions (Quelques résultats des épreuves glandulaires
suivant l’état antérieur des fonctions endocriniennes). Claude
(H.) & Bernard (Suzanne), Bull. et mem. Soe. med. d hop.
(Paris), 1919, 3.s., 43, 1116-1120: Abst. Presse Méd. (Paris).
27, 796.

The aim of this study was to obtain a method for the de-
termination of the functional state of the endocrine glands in
those cases in which the symptomatology is evasive or complex,
by comparing the results of the effects of the administration
of endocrine products in normal individuals and in those in
whom obvious endocrine disturbance existed. The effect of
the injection of extracts of the same gland may be quite differ-
ent, however, depending upon the previous state of the fune-
tions of the endocrine gland stimulated to aetivity by the injee-
tion. In other words, the reacting tissue may have become
sensitized. In acromegaly injections of hypophyseal extracts,
even in large doses, is without effect. In subjects with typical
exophthalmie goitre subcutaneous injections of hypophyseal
extracts (posterior lobe) caused a notable but transitory slow-
ing of the pulse and marked lowering of systolic pressure. In
normal individuals, on the other hand, or in eases of tachy-
cardia independent’ of thyroid conditions, the decrease of
systolic pressure is sheht and slowing of pulse does not oceur.
In thyroid insufficiency hypophyseal extracts gave rise to accel-
eration of the pulse, while systolic pressure was decreased as
in normal subjects. The authors produced in 4 individuals
presenting hypothyroid’ syndromes the reactions of hyper-
thyroidism by feeding desiccated thyroid in doses of .010 to
.020 grams daily. Previous to the hyperthyroidization the pa-
tients responded to hypophyseal extract injections by accel-
erated pulse and the usual systolic pressure effects. After the
administration of the thyroid preparations the same treatment
with pituitary extract caused a lowering of the pulse rate.
These facts are interpreted as indicating that a slowing of
the pulse in a case of tachyeardia after the injection of pitu-
itary extract is evidence of a hyperactive thyroid. Adrenalin
injections in the same subjects gave markedly abnormal in-
creases in pulse rate. These reactions then are actually in-
volved with inereased thyroid activity ; they have been repeat-
edly tested. It seems, then, that the presence in the organism
of thyroid products in excess, either produced by the homolo-
gous gland or artificially introduced, favors the reactions to
substances contained in hypophyseal extracts and adrenalin,

ABSTRACTS 639

and induce phenomena sufficiently constant as to serve as a
diagnostic measure for hyperthyroidism.—F. S. H.

(ENDOCRINE ORGANS) What fears and states of anxiety in
a patient mean to the gynecologist. Bandler (S. W.), N. Y.
MedaJdy CON. Y¥.), 1920) 111, 619-622.

Mental states and psychoses have a neurophysical basis
and are not produced solely through psychie effects, but also
by definite and specific endocrine activity. The adrenals and
thyroid glands are the end-organs most closely related to fears,
anxieties, and phobias. However, the corpus luteum is the
primary factor which is responsible for these conditions, for
the reason that a retained corpus luteum inhibits ovulation and
excites disturbances in the thyroid and adrenal glands. Such
a condition is combatable by the administration of ovarian
extracts and suprarenal extract which contains the cortical
material—H. W.

(ENDOCRINE ORGANS) The instincts, the emotions and the
endocrines in sterility. Bandler (S. W.), Med. Ree. (N. Y.),
1920, 97, 383-391.

A lengthy article, containing much brilliant theorizing
which is positively stated as proven, but most of it on very
slender scientific basis. It is claimed that a large percentage
of cases of sterility in women are not mechanical in origin and
are unimproved by surgery, but can be cured by pluriglandular
organotherapy. The author expects to publish a series of
cases in which endocrine therapy was the only treatment
given. [It is to be hoped that the cases will be reported in
detail and the exact formule and dosage administered care-
fully recorded ]|.—H. L.

(ENDOCRINE ORGANS) The balance between the endocrines
and in each individual endocrine. Bandler (Samuel Wyllis),
Med. Ree. (N. Y.), 1920, 97, 638-647.

An elaborate consideration of the interrelationship of the
ductless glands and their relation to the intellect, emotions,
character, dreams, sleep, ete. The author goes so far as to
believe that kidney diseases are due to endocrine abnormality,
that fibroids and myomata of the uterus are the result of pitu-
itary unbalance, that all tumors, benign and malignant, are
due to endocrine action. ‘‘Many of the statements above made
cannot as yet be substantiated by laboratory investigation ;
they have, however, stood the more convincing test of thera-

640 ; ABSTRACTS

peutic applieation.’’ [Those interested in such advanced and
even startling ideas are referred to the original article, which
does not readily lend itself to concise abstracting. |—H. L.

(ENDOCRINE ORGANS) The correlation of function; with
special reference to the organs of internal secretion and the
reproductive system. Bell (W. Blair), Brit. M. J. (Lon-
don); 1920, (Gi), 1S T7191.

The paper is a reproduction of a lecture delivered before
the British Medical Association. The author is of the opinion
that over-specialization on the part of the medical profession
has led to the neglect of what he ealls the ‘‘Correlation of
Funetion’’ through the organs of internal secretion. Aceord-
ingly he advises the specialist, especially the gynecologist, to
look beyond the confines of his particular anatomical terri-
tory for an explanation of the pathological conditions eneoun-
tered.

The production of masculinity in woman by hyperplasia
ot neoplasia of the suprarenal cortex or anterior lobe of the
pituitary is mentioned, as well as the fact that the pituitary
body becomes permanently enlarged and changed in histolog-
ical appearance in a woman after child-birth. This latter fact
might be of use in medico-legal cases. The ovary is regarded
as a means of maintaining the metabolism of the female at a
higher level during the reproductive period, in order that she
may nourish the child in utero and during lactation. Men-
struation is regarded as ‘‘the monthly exeretion of substances
that would be concerned in the building up of a child were
the woman pregnant.’’ After the menopause the whole duet-
less gland system is involved. Atrophy of the thyroid co-
incident with atrophy of the ovaries has been demonstrated,
and therefore thyroid extract is advocated in the treatment of
mental conditions accompanying the menopause. Evidence is
advanced to show that pituitary insufficiency is the cause of
dystrophia adiposogenitalis. This is often produced by the
pressure of a tumor on the stalk. Besides radiography, in-
ereased carbohydrate tolerance, subnormal temperature and
low blood pressure may aid in diagnosis. The relation of the
thyroid to the reproductive organs is also discussed.—L. G. K.

(ENDOCRINE ORGANS) Action of electrical currents on
ductless glands and other tissues. De Kraft (F.), Med. Ree.
(N= Y-), 1920) 97, 136-138;

The author refers to the beneficial action of various fornis
of electricity in hyperthyroidism, obesity, amenorrhea, ete.

ABSTRACTS 641

He believes that high frequency currents promote nutrition,
check toxins, increase perspiration and elimination through the
kidneys, restore luster, softness and moisture to the hair, im-
prove the condition of the nails, increase metabolism, remove
visceral congestion, ete. He mentions the uses of the diather-
mic, static wave and galvano-faradic-sinusoidal currents.—H. L.

(ENDOCRINE ORGANS) Results and active principles in or-
ganotherapy of abnormal menstruation (Uber die Erfolge
und das wirksame Prinzip der Organestrakttherapie bei
Menstruationsstorungen). Esch (P.), Zentralbl. f. Gyn.
(Leipzig), 1920, 44, 561-568.

The influence of intramuscular organotherapy in abnor-
mal menstruation is, according to the author, not due to a
specific active principle, but may be observed after the injec-
tion of several kinds of proteins. Only the injection of hy-
pophysis preparations may have a specific influence, as it causes
contractions of the uterus.—J. K.

(ENDOCRINE ORGANS) Endocrinologist and internist. Her-
rick (W. W.), N. Y. M. J., 1920, 111, 286-287.

The author sounds a note of conservatism relative to the
present tendency to explain all things from an endocrine stand-
point. Back of the endocrine organs and responsible for their
disturbance le other conditions, i. e., infections, metabolic
disorders and psychic states.—H. W.

(ENDOCRINE ORGANS) Dietetic deficiency and endocrine
activity, with special reference to deficiency cdemas. Mc-
Carrison (Robt.), Brit. M. J. (London), 1920, (ii), 236-239.

Pigeons, guinea-pigs and monkeys were fed on diets defi-
cient in the various vitamines. It was found that all endocrine
organs, with the exception of the adrena!s and the pituitary,
undergo greater or lesser degrees of atrophy and depreciation
in funetional capacity in consequence of dietetic deficiencies.
The adrenal glands and, in the male, the pituitary body, en-
large in consequence of dietetic defects, the former greatly,
the latter shg¢htly. The adrenals are the most susceptible of
the endocrine structures to dietetic defects. The adrenin con-
tent of the enlarged adrenals varies with the character of
the dietetic defect; it is in excess of normal when the food
is deficient in vitamines, in proteins and disproportionally
rich in starch; it is below normal when the diet is scorbutie,
and also when concurrent infections are associated with diet-

642 ABSTRACTS

etic defects. Oedema is invariably associated with massive
enlargement of the adrenal glands in pigeons fed on auto-
claved rice. But massive enlargement of the adrenals is not
always associated with cedema. This association bears some
intimate relationship to the adrenalin content of the enlarged
organs, since when the content is high edema occurs in 86 per
cent of the cases and when the content is low edema does
not occur. Fresh butter contains some substance which tends
to protect against edema. This substance was not found in
cocoanut oil. The hypothetical ‘‘anti-edema’’ substance in
butter has a pronounced influence over the adrenal glands.
It appears to exert its protective action against cedema by
maintaining their adrenalin content at a low level. Butter
varies in its capacity to protect against cedema. This varia-
tion is dependent on the quality of the cow’s food. Butter is
richer in anti-edema substance when the cows are fed on
dry fodder. It is suggested that cedema is caused by the ex-
cess of adrenalin acting directly on the kidney to inhibit the
flow of urine and to cause a retention of NaCl.—lL. G. K.

(ENDOCRINE ORGANS) Grafts of glandular organs (Greffes
d’organes glandulaires). Mauclaire (M.), Progrés Méd.
(Paris), 1920, 35, 345-349.

Mauelaire reviews the literature on organ grafting. Aside
from the fact that citations of publication are lacking, the
article is a valuable summary of available data. The topies
treated are: thyroid grafts in animals and men; parathyroid
grafts; thymus grafts; ovarian grafts in animals and in women;
testicular grafts In animals and men; renal grafts in animals
and men; adrenal grafts in animals and men, and, finally, in
less detail, grafts of spleen, pancreas, salivary and mammary
glands, hypophysis, prostate and liver. In each case the meth-
ods used, animals upon which the experiments were made and,
to some extent, results are treated. The article, being itself a
summary, can not be abstracted. It is concluded that although
this type of work offers many difficulties, and more experience
is necessary, the results already secured are very encourag-

ing.—R. G. H.

(ENDOCRINE ORGANS AUTONOMIC N. 8.) The patient’s
reaction: a neglected but important phase in the study of
medicine. Pottenger (F. M.), Annals of Medicine (Hagger-
stom, Mids), 1920" 1662254

Pottenger points out the intimate relationship between the
psychie factors and the symptomatology of disease and empha-

ABSTRACTS 643

sizes the part played by the endocrine and autonomic systems
in the evolution of disease pictures. The burden of the article
is that these factors should receive relatively much greater
attention at the hands of practical clinicians. |That they do
not receive adequate attention is probably due to the paucity
of definite diagnostic criteria in the fields of endocrinology
and visceral neurology. It is the obvious duty of workers in
these fields to establish such ecriteria.|—R. G. H.

(ENDOCRINE ORGANS) The skin as an index to health.
Scholtz (M.), Med. Ree. (N. Y.), 1920, 97, 824-828.

Scholtz calls attention to the relation between skin dis-
orders and systemic diseases and mentions the syphilis syn-
drome, tuberculosis syndrome, diabetic syndrome, erythema
multiforme group and focal infection, the leukemic syndrome,
the precancerous syndrome and the endocrinous syndromes.
A thick, dry, pasty skin, suppression of perspiration, luster-
less brittle hair and alopecia suggest hypothyroidism; and
many cases of chronic eczema, psoriasis, ichthyosis and sclero-
derma are improved by administration of thyroid. Hyper-
thyroidism produces thin, perspiring, easily flushed skin, urti-
earial attacks, pigmentation, dystrophies of the nails, keratin-
ization and pruritis. The author mentions the bronze-like skin
of Addison’s disease and the successful treatment of some
eases of vitiligo by extract of suprarenal. Fibromatous growths,
warts, alopecia in men and hypertrichosis in women are some-
times due to hypophyseal disease. He also refers to the skin
changes accompanying pregnancy and following castration,
and to the angioneurotic dermatoses of Raynaud’s disease,
scleroderma, angioneurotic edema, ete.—H. L.

(ENDOCRINE ORGANS) Changes in the endocrine organs, es-
pecially the adrenal cortex, following occlusion of the pan-
creatic duct (Ueber die Verinderungen der endokriner Or-
gane, besonders der Nebennieren-Rinde nach der Unterbind-
ung des Ductus pancreaticus und ihre Bedeutung). Toku-
mitsu (Yoshitomi), Venhandl. d. japan. path. Gesellsch.
(Tokyo), 1916, 6, 21-23.

The first effect of tying the pancreatic duct in rabbits is
a general atrophy of the pancreas. Subsequently the islands
of Langerhans regenerate to, or above, the normal mass. In
the adrenals the cortex becomes hypertrophic; the medullary
cells become smaller and more thickly crowded and give a
clearer chromophil reaction. The thyroid enlarges. In the
hypophysis the eosinophil cells decrease and the ‘‘Hauptzellen’’

644 ABSTRACTS

increase. For a short time after the operation glycosuria can
be produced with a smaller quantity of adrenin than in case
of normal animals. Destruction of the adrenal cortex by
knife or cautery causes, in itself, no glycosuria, but after tying
the pancreatic duct such measures in the adrenals produce
definite glycosuria. Normal rabbits die from the loss of %4
of the adrenal cortex, but after occlusion of the pancreatic
duet the loss of 14 of the cortex is fatal. When thyroidectomy
is combined with the above procedures glycosuria is prevented.
On these data the atithor postulates a functional antagonism
between the thyroid and the pancreas.—R. G. H.

ENDOCRINOPATHIES (Syphilis hereditaire tardive; endo-
crinopathies; hypophyse. Castex (M. R.) & Waldorp (C. P.),
La Prensa Med. Argentina (Buenos Aires), 1920, 6, 309.

A report of certain clinical observations and a critical
study of the topic. The authors believe that hereditary syph-
ilis is a factor in acromegaly and that the same factor is in-
volved in most cases of gigantism. Similarly it may produce
infantilism and the Frohlich syndrome.—B. A. H.

(ENDOCRINOPATHIES) Hereditary syphilitic terrain and its
relation to tuberculosis (El terrena heredo espicifics y sus
relaciones con la tuberculosis. Marino (E.) & Barilari (M.
J.), Prensa med. argent. (Buenos Aires), 1920, 6, 312.

Hereditary syphilis produces lymphatism, asthenie hab-
itus and numerous endocrin dysfunctional states. Tuberculo-
sis is often implanted in this soil. Amelioration is to be ex-
pected, in such eases, rather from tuberculin than mercury.

—B. A. H.

Medical aspects of ENDOCRINOLOGY. Hertz (J. J.), Med.
Ree. (N. Y.), 1920, 97, 511-514.

A brief, fragmentary resume of some disturbances of the
thyroid, parathyroids, adrenals, pituitary and pancreas with
some suggestions regarding appropriate organotherapy; no
new data.—H. L.

The position of ENDOCRINOLOGY in general medicine (Posi-
cion dela endocrinologia en la medicina general). Maranon
(G.), Real Acad. Nat. de Med. (Madrid), 1918, —, —.

Interesting general review of the glands of internal secre-
tion in many diseases and syndromes the pathogeny of which
is little known.—E. B.

ABSTRACTS 645

GASTRIN Studies. V. Chemical studies on gastrin bodies.
Koeh (F. C.), Luckhardt (A. B.) & Keeton (R. W.), Am. J.
Physiol. (Balt.), 1920, 52, 508-520.

This is the fifth of a seriws of studies of gastrin bodies,
the other papers of which have appeared in the Am. J. of
Physiol., Vols. 37, 50 and 51. This paper is a report of obser-
vations bearing more particularly on the chemical phase of
the work. Various chemical procedures are described and the
results noted. The conclusions drawn are as follows:

(1) A striking similarity exists between the effects of
histamin and gastrin. (2) Gastrin appears to be more stable
than secretin is reported to be, although they are similar in
many respects. (3) Gastrin has not been precipitated by pic-
rie or picrolonie acid. (4) Gastrin appears to be a basic imid-
azol derivative which can be extracted as the free base by
amyl aleohol. (5) Thus far histamin and pilocarpin are the
only known imidazol] derivatives which stimulate the gastric
mechanism to secretion. (6) Choline acts with uncertainty
and then only faintly as compared with histamin or gastrin.

—T. C. B.

(THYROID) Goiter. Cooke (A. B.), Calif. State. J. M. (San
Francisco), 1920, 18, 82-83.

No new data.—H. W.

(THYROID) Goiter. O’Day (J. C.), N. Y. Med. J. (N. Y.),
1920, 111, 503-505.

Goiter may be defined as a partial or complete enlarge-
ment of the thyroid gland. Any benefits derived from the
ligation of the thyroid arteries is due merely to the rest sub-
sequently imposed. Focal infections cannot be considered as
causative factors in the production of goiter, for the Hawaiians,
although extremely subject to focal infections, do not develop
gcoiter—H. W.

Modern treatment of STERILITY. Armitage (H. M.), N. Y.
Med. J. (N. Y.), 1920, 111, 360-363.

Defective implantation of the ovum is indicated in women
who frequently miss a menstrual period and go over 10 to 14
days and then flood. Such cases should be treated with corpus
luteum extracts inasmuch as the corpus luteum of the indi-
vidual is not sufficient to bring about complete implantation
of the ovum. Profuse menstruation is due to over-stimulation

646 ABSTRACTS

of the endoerine organs and should be treated with prepara-
tions of thymus gland and mammary substance. Irregular
menstruation often yields to the administration of thyroid,
ovary and corpus luteum substances.—H. W.

(GONADS) A case of human bilateral hermaphroditism with
bisexual glands (Un cas humain d’hermaphrodisme bilateral
a glandes bisexuelles). Briau (E.), Lacassagne (A.) & La-
goutte (M.), Gynec. et Obst. (Paris), 1920, 1, 155-179.

An extensive and detailed report of a case of bilateral
hermaphrodism including the macroscopic and microscopic
appearance of the abnormal genitalia. The individual pos-
sessed the efferent passages normal to both sexes, a uterus
the dimensions of which would be admitted as those of a nulli-
para, two tubes of normal sizes and structure and spermatic
cords each segment of which was normal. Moreover, there
occurred bilaterally a mixed sex gland containing both ovarian
and testicular tissue. The left gland was within the pelvis
and presented the aspects of a functioning ovary together
with spermatogonia producing testicular tissue, an ovotestis
of predominantly ovarian function. The right gland was with-
in the inguinal canal, possessed an epididymus and vas def-
erens, had produced spermatocytes and contained ovarian
fragments. This the authors consider as an ovotestis pre-
dominantly testicular in function.—F. S. H.

Gonads, Histogenesis of the (Sobre la histcgenesi de la
elandula genital). Domingo (P.) & Vilaseea (S.), Treballs
de la Societat de Biologia, Barcelona, 1918, 6, 51-61, 11 pl.

The article is largely of technical histological interest. As
regards the interstitial cells of Leydig, the authors remark
that their origin has been much debated. They, themselves,
believe the cells to be derived by successive differentiations
from certain mesenchymatous cells in relation to the tunica
albuginea and of the interlobular tissue and the walls of the
tubules. In the testes of the human fetus the authors have
recognized also certain interstitial cells which are voluminous,
with clear protoplasm and irregular contour and transparent,
spherical nuclei. Among them many mitoses are seen and
multinucleate cells are observed. They seem to be analogous
with the primordial ovules. The article is illustrated with
eleven photomicrographs.—R. G. H.

(GONADS) The question of hermaphrodism in man and mam-
mals (La question de l’>hermaphrodisme chez l’homme et les

ABSTRACTS 647

mammiféres). Lacassagne (A.), Gyn. et Obst. (Paris), 1920,
d-203-296.

A bibliographie review.—F. 8. H.

(GONADS) A case of pseudohermaphroditismus masculinus
internus with tumor of testicle (Over een geval van pseudo-
hermaphroditismus masculinus internus met gezwelvorming
van den testikel). Lauwers (G. B.), Inaug. Dissertation (Am-
sterdam), 1920.

The patient, who had normal sexual desires, was operated
upon for hernia. Death by embolus followed. Post-mortem
examination showed: Penis, bladder and rectum normal. On
both sides the vasa deferentia were normal. Behind the blad-
der a mass of tissue was noted in which two Fallopian tubes
were found and a uterus bicornuus. The right testicle con-
tained a carcinoma. A very good bibliography on tumors of
testicles and hermaphroditism is ineluded.—J. K.

(GONADS) The production of artificial hermaphrodites in
mammals. Moore (Carl R.), Science (N. Y.), n. s. 52, 179-
182.

A eriticism of the works of Steinach and Sand (Endoerin.,
4, 266). ‘‘Steinach was unable to obtain either a growth or
persistence of an implanted sex gland unless the gland of the
host (gland of the opposite sex) was removed before the im-
plantation was made.’’

Sand supports Steinach on the whole. ‘‘In explaining his
failure to obtain growths of ovarian grafts in non-castrated
infantile male animals he assumes a rather indefinite type of
‘Immunity’ on the part of the host towards the implanted tis-
sue.’’ Moore has been able to obtain growths of ovarian grafts,
subeutaneously, intramuscularly and intraperitoneally in young
male rats which had one sex gland intact and normal. The
graft, eight and one-half months after implantation, presented
all of the features of a normal ovary of similar age excepting
corpus luteum tissue and the presence of a large number of
atretie follicles. The behavior of the follicles of the grafts is
similar to the corresponding structures of the young female
sex gland before the age of sexual maturity. Mammalian tes-
ticular transplantation results in the loss of the germinal epi-
thelium. ‘‘The grafts resemble a eryptorchid testis in that
both retain the well-rounded seminiferous tubules, but all that
remains of a cellular character are Sertoli cells. The testis
graft does persist after transplantation in a female, with an

648 ABSTRACTS

intact ovary, and it is as normal as autoplastic testicular grafts,
either with or without previous castration. A male rat with
one testis will function as a normal male during the time it is
carrying two ovarian grafts as an integral part of its somatic
structure.’’—F. A. H.

GYNECOMASTIA and the theory of a mammary internal
secretion (Zur Kenntniss der Gynakomastie und zur inner-
sekretonischen Theorie der Brustdrtise). Novak (J.), Zen-
tralbl. f. Gynak. (Kiel), 1919, 48, 253-258.

A report of 5 cases of gynecomastia and a discussion of
the existing theories of mammary secretion. No new data.

—F.S. H.

Experimental HERMAPHRODITISM, historical remarks on—
(Historische Beitrag zum experimentellen Hermaphroditis-
mus). Foges (A.), Wien. klin. Wehnschr., 1920, 33, 224.

ul

Data reported elsewhere. See Endocrin., 4, 265.

(HORMONES) Hormonal stimulation of the brain (Delas
estimulaciones hormonales del encefalo). . Mouchet (E.),
Prensa med. argent. (Buenos Aires), 1920, 6, 306.

Since the brain receives not only nerve stimulation but
also blood, the author deduces that the mental state is depend-
ent upon hormone as well as nervous influences.—B. A. H.

HYPERTHYROIDISM. Webster (A. B.), N. Y. Med. J. (N.
Y.), 1920, 111, 283-284.

After discussing the relation of focal infections to thyroid
disturbanees, the author bewails the fact that ‘‘surgery has
gone mad in treating end results and not dealing with the pri-
mary cause,’’ and then proceeds to justify surgical procedures
on the abnormally functioning thyroid gland. However, he
fails to state whether toxines or the thyroid itself is primarily
at fault, or whether the condition in the thyroid is or is not
the end result of altered functions in other parts of the body.

—H. W.

(HYPOPHYSIS) The pathogenesis of diabetes insipidus. Bauer
(J.) & Aschner (B.), Wiener. Arch. f. inn. Med., 1920, 1,
297-334,

The authors give in tabular form an extensive series of
metabolie findings in a typical case of diabetes insipidus in a

ABSTRACTS 649

woman who had been under observation for ten years. They
believe that diabetes insipidus may find its origin in the kidney
or its innervation. This is often observed in the familiar con-
stitutional form of the disease. A disease in the neighborhood
of the nerve centres of the midbrain or fourth ventricle is
the most ordinary cause. Nearly all cases in literature belong
to this type. A primary change of the center for thirst per-
ception in the cortex of the brain may combine itself with
an irritation of the subcortical diuresis center. In this way
psychical influences may act. It has never been definitely
proved that the hypophysis itself may be the cause of diabetes
insipidus. Even with loss of the diuresis regulating property
of the hypophyseal secretion normal compensatory processes
in the kidneys themselves may suffice to prevent diabetes in-
sipidus.— J. K.

(HYPOPHYSIS) Radium therapy of tumors of the hypophy-
sis, with syndrome of acromegaly (Radiumterapia nei tumori
ipofisari a sindrome acromegalica). Bertolotti (M.), Radiol.

med. (Milano), 1919, 6, 315.

A number of cases have now been treated by radiation
with some favorable results, and a notable improvement in sev-
eral. As there is great variation in the symptoms according to
the position of the tumor, this may account for variation in the
results of treatment, and the negative results of X-ray therapy
in some eases. In dystrophy from tumor of the hypophysis
the author’s own results have been unfavorable; similarly the
clinical results of all tumors are varied, and the course of the
disease may be from 2 to 59 years. In benign cases X-rays are
advisable and useful. The detractors of X-rays assert that the
improvement is a natural retrogression, but this is always of
short duration, whereas the improvement after X-rays lasts
much longer. The best results are obtained in early eases,
and, as eystie degeneration follows in acromegaly, X-rays
should be applied before this sets in. The author gives the
history of a case treated by the gamma-rays of radium from
the early days.

The first symptoms were seen in May, 1917, and by De-
ecember the condition was already far advanced—vision nearly
gone, impotency, asthenia, etc.—so that an adenoma or adeno-
carcinoma of the pituitary was suspected, most probably of
the anterior lobe and of rapid and malignant development. A
course of intensive radium treatment was begun, but by March,
after two treatments, the patient was worse instead of better
and the condition seemed desperate. Not till July was there

650 ABSTRACTS

a slight improvement, when the vision of the left eye began
to increase. Continuous though slow progress was made, and
in September the radiograph showed surprising improvement
in the profile of the sella turcica.

By December, 1918, the vision had so far recovered that
the patient was able to resume his work as a designer, and all
the symptoms had disappeared. This result was obtained sole-
ly by massive doses of radium apphed bi-temporally, and
neither the intrabueceal nor the intranasal method was em-
ployed. It follows that the rays are efficient at a distance of
more than 10 em. through tissues, and have probably an elec-
tive action on certain neoplastic cellular elements.—Med. Se.
Abst. & Rev., 2, 204.

(HYPOPHYSIS) Permanent experimental polyuria (Polyurie
expérimental permanente). Camus (J.) & Roussy (G.),
Compt. rend. Soe. de biol. (Paris), 1920, 83, 764-765.

A deseription of two eases of permanent experimental
polyuria in dogs. Of endocrine interest is the statement that
it is not the ablation of the hypophysis which determines the
polyuria, but the superficial lesion of the base of the brain
corresponding to the optopeduneular space.—T. C. B.

(HYPOPHYSIS) A case of acromegaly (Sobre un caso de a.).
del Canizo (A.),; Siglo Méd. (Madrid), 1917, ——, ——,
(Nov. 17.)

A ease is presented which manifested all the typical
svmptoms of acromegaly, but with certain other features
worthy of comment. The condition developed at the unusually
late age of 53 years. Especially interesting is the fact that
the thymus was enlarged, as was demonstrated both by per-
cussion and radioscopy; it was so pronounced as to give rise
to frank symptoms of mediastinal pressure. The author dis-
cusses the possible relationship of the hypophysis and thymus
to the development of the osseous tissues (citing the alleged
production of experimental rickets through thymectomy by
Klose, Vogt and Matti) and of the genital apparatus. Thy-
mic hypertrophy in eunuchs is not unusual and in such a
process as acromegaly, in which sexual activity is diminished,
a similar enlargement of the thymus, as in this case, might be
expected.—E. B.

(HYPOPHYSIS) A case of syphilitic diabetes insipidus (Ein
Fall von Diabetes insipidus auf luetischer Basis). Chiari,.
Wiener klin. Wehnschr., 1920, 33, 620.

ABSTRACTS 651

A woman of 30 manifested cessation of menstruation,
polyuria and polydipsia and multiple swellings of the bones.
The quantity of urine reached 15 liters daily, with a specific
gravity of 1001. The Wassermann reaction was positive. She
was cured by antiluetic treatment. The author believes that
a syphilitic change in the hypophysis or in the regio sub-
thalamica was responsible for these symptoms. A skiagram
showed no pathological changes.—J. K.

(HYPOPHYSIS) Study of a case of diabetes insipidus with
special reference to the mechanism of diuresis and the action
of pituitary extract upon it. Christie (C. D.) & Stewart
(G. N.), Arch. Int. Med. (Chicago), 1917, 20, 10-23.

A careful series of studies was made upon a female sub-
ject who excreted up to 20 liters of urine daily. She reacted
well to pituitary extract but required doses of 2 ec. repeated
three times in each 24 hours to maintain the effect. The rela-
tive hydration ef the blood was investigated by determinations
of electrical conductivity and by hematocrit readings of the
blood. The relative volume of the serum was found to be
slightly diminished and the conductivity slightly decreased,
showing that the extract caused a slight dehydration of the
blood. By Stewart’s calorimetric method it was determined
that the blood fiow through the hands was increased during
the period of reaction to the pituitary extract, hence the renal
fiow was probably decreased. Functional tests indicated that
the diuresis was not in any way associated with pathological
alterations in the kidneys.—R. G. H.

(HYPOPHYSIS, ADRENAL, THYROID) Hemostatic medi-
cation (Médication hémostatique). Dalché (P.), La Gyn.
(Paris), 1920, 19, 139-152.

A diseussion of the various causes and treatments of gen-
ital hemorrhages in the female. Consideration is given to the
use of the directly acting vaso-constrictor properties of hy-
pophyseal and adrenal extracts and to the indirect activity of
thyroid opotherapy in such conditions as the metrorrhagias
of myxodema and obesity. Note is also made of the favorable
eoagulative action of the posterior lobe of the hypophysis.

—F.S8. H.

HYPOPHYSIS opotherapy with favorable action in a case of
obesity and diabetes insipidus (Action favorable de 1’opo-
thérapie hypophysaire dans un cas d’obésité et de diabeéte

652 ABSTRACTS

insipide). Flandin (Ch.), Huber (J.) & Debray (M.), Bull.
et. mem. Soe. med. d. hop. (Paris), 1920, 3. s., 44, 487-490.

A new example of the action of hypophyseal extracts on
the polyuria of diabetes insipidus. In this case the uriary
output of the woman, which was around 14 liters per 24 hours,
was lowered to values of 10, 12 and even 6 liters as the result
of the administration of the drug, although the effect was in
general but transitory. No effect was observed as regards
diminution of the obesity.—F. S. H.

(HYPOPHYSIS) Dystrophia adiposo-genitalis. Foerster,
Miinchen. med. Wehnscehr., 1920, 67, 675.

Deseription of a case. The patient suffered from this dis-
ease for 20 years. There were headaches and some slight signs
of acromegaly. The skiagram showed the sella turcica to be
enlarged. The author diagnosed a benign tumor of the hy-
pophysis.—J. K.

(HYPOPHYSIS) Dystrophia adiposo-genitalis. Hannema (IL.
S.). Nederl. Tijdschr. v. Geneesk. (Haarlem), 1920, 64, 2434-
2435.

The case is recorded of a boy of 13 years with polyuria,
adiposity and extremely small genitals. There were no neuro-
logical nor any eye symptoms. Sugar tolerance was much
increased. No enlarged sella tureica was detectable radio-
scopically.—J. K.

HYPOPHYSIS, A doubtful case of tumor of — (Een twij-
felachtig geval van hypophysis gezwel). Hannema (UL. S.),
Nederl. Tijdschr. v. Geneesk. (Haarlem), 1920, 64, (I), 2436-
2438.

A woman of 34 for 4 years suffered much with headache.
There was no vomiting, no eye symptoms and no polyuria.
Recently her face has become broader and her feet have be-
come larger and hairs have developed on breast and legs.
Sugar tolerance is diminished. Radioscopiecally the sella tur-
cica.appears very large but of a perfectly normal form. There
are certain hysterical symptoms and it is certain that the pa-
tient exaggerates her complaints. A tumor of the hypophysis
is probable but not at all certain since a large sella with nor-
mal shape may be seen in healthy individuals.—J. K.

ABSTRACTS 653

(HYPOPHYSIS) On the relation between the interstitial cells
and the hypertrophy of the hypophysis. Hayami (T.), Ver-
handl. d. jap. path Gesellsch. Tokyo, 1919, pp. 43-44.

In order to determine which constituent of the testis 1s
responsible for the hypertrophy of the hypophysis which usu-
ally follows castration, the author experimented with rabbits ©
about three months old, which he divided into groups and
treated as follows: (1) Double castration; (2) Castration on
one side and vasectomy on the other; (3) Double vasectomy
and treatment of the testicles with Réntgen rays. He studied
only animals which lived for four months or more after the
operation. Double castration produced the usual hypophy-
seal hypertrophy. Castration and vasectomy caused hypo-
physeal hypertrophy together with an almost complete ces-
sation of spermatogenesis and an increase in the number of
the interstitial cells in the remaining testes. Double vasec-
tomy and treatment with Rontgen rays destroyed the epithe-
lial and Sertoli cells and increased the interstitial cells, which
must, therefore, in his opinion, be responsible for the resultant
enlargement of the hypophysis.—H. V. C.

(HYPOPHYSIS) Occurrence of polyuria (diabetes insipidus?)
in a case of epidemic encephalitis [Auftreten von Polyurie
(Diabetes insipidus?) im Verlaufe eines Falles von Enceph-
alitis epidemica]. Hoke (E.), Wiener klin. Wehnschr., 1920,
33, 562.

During an attack of encephalitis lethargica polyuria (up
to 10 liters daily) developed. When pituglandol was injected
the quantity of urine was diminished to about 3 liters. The
patient is still under treatment.—J. K.

HYPOPHYSIS extracts, Action of—on diuresis in the dog
and rabbit (Accion de los extractos de hipofisis sobre la
diuresis en el perro y el conejo). Houssay (B. A.), Galan
(J. C.) & Negrete (J.), Soe. de Biol. de Buenos Aires, June
-10, 1920.

The action of hypophyseal extracts upon diuresis is es-
sentially different in case of different animals. In the rabbit
one sees oliguria and anorexia, while in the dog there results
an augmentation of diuresis except following profuse inges-
tion of water. It can not be determined, therefore, from the
effects of such extracts in case of any one species of animal
whether or not the hypophysis exercises a physiological in-
fluence upon diuresis—B. A. H.

654 ABSTRACTS

HYPOPHYSIS Study of the carbohydrate tolerance in Eck
fistula and hypophysectomized animals (posterior lobe re-
moval). Liver function in the metabolism of sugars. Jacob-
son (Conrad), Am. J. Physiol. (Balt.), 1920, 52, 233-247.

In animals deprived of the hypophysis there is a rise in
sugar tolerance, and this rise can be lowered by administra-
tion of the extract of the posterior lobe. The lowering of the
sugar tolerance is evidenced by hyperglycemia as well as gly-
eosuria, and efforts have been made to determine the source
of this glycogen. Good sized healthy dogs were used. A
typical lateral anastomosis between the portal vein and in-
ferior vena cava was made. The portal vein was ligatured in
two places and eut between the ligatures, close to the liver
hilus. The posterior lobe of the pituitary was removed by
the intracranial method of Crowe, Cushing and Homans. The
paper is largely concerned with sugar tolerance in Eck fistula
animals, but the conelusion is reached that the glycogeniec
capacity of muscle is increased. following posterior lobe re-
moval in an Eek fistula animal as in an intact animal. The
augmentation is, however, considerably slower. No augmenta-
tion of levulose tolerance is noted—T. C. B.

HYPOPHYSIS, Modern physiology and pathology of— (Der
jetzige Stand der Physiologie und Pathologie der Hypo-
physe). Jacoby.(M.), Deutsche med. Wehnschr. (Berlin),
1920, 46, 742-743.

A general review without new facts. The author points
out once more that it is necessary in diseases of one endocrine
organ to consider the others as all these organs have a mutual
influence on each other.—J. K.

Ossification of HYPOPHYSIS causing diabetes insipidus (Uber
einen Fall von Verknocherung der Hypophysis, die Diabetes
insipidus verursachte). Kawakita (S.), Verhandl. d. jap.
path. Gesellsch., 1919, , 45-54.

Relates the case of a woman of 30 years in which dia-
betes insipidus was definitely associated with retarded de-

velopment of the internal genitalia.—E. V. C.

(HYPOPHYSIS) Observations on two cases of diabetes in-
sipidus, with account of the literature relating to associat‘on
between pituitary gland and this disease. Kenneway (E. L.)
& Mottram (J. C.), Quart. J. Med. (Lond.), 1919, 12, 225-228.

The authors studied the composition and molecular con-
centration of the urine in comparison with that of the blood

ABSTRACTS 655

serum in two cases of diabetes insipidus. When large amounts
of sodium chlorid are given the urine output is so adjusted
that the percentage of nitrogen plus that of the chlorin in the
urine remains constant. The kidney, therefore, has not the
power of concentration normally demonstrable after the in-
gestion of salt. The antidiuretic effect of pituitrin was demon-
strated both in a normal subject and in a ease of diabetes in-
sipidus. It was found that hypodermatic administration but
not administration ‘by mouth, was effective. The writers
could find no instance in the literature of diabetes insipidus
in which hypophyseal abnormality was excluded definitely
by autopsy observations, whereas, in a number of cases the
posterior lobe of the hypophysis was definitely involved.
Lesions of this structure are, however, not always accom-
panied by diabetes insipidus. The morphologic evidence is
therefore not conclusive. Therapeutic evidence, however, is
convineing that the hypophysis normally plays a part in the
regulation of renal activity.—R. H. G.

e

(HYPOPHYSIS) Two cases of adiposo-genital syndrome of
hypophyseal origin in the adult (Sur deux cas de syndrome
adiposo-génital d’origine hypophysaire chez 1’adulte).
Lereboullet (P.) & Hutinel (J.), Bull. et mem. Soe. med. d.
hop. (Paris), 1919, 3. s., 48, 745-754.

Case reports. No new data.—F. §. H.

HYPOPHYSIS, State of the—in encephalitis lethargica (Etat
de l’hypophyse dans 1’encéphalite léethargique). Marie (P.)
& Tretiakoff, (C.), Bull. et mem. Soc. med. d. hop. (Paris),
1920, 3. s., 44, 357-358.

Presentation of histological preparations of specimens of
the hypophysis from two eases of encephalitis lethargiea.
The subjects were markedly somnolent during the progress
of the disease. Macroscopically the glands were slightly con-
gested without being notably swollen. On sectioning, a mod-
erate diffuse congestion unaccompanied by leucocytie infil-
tration was evident. No appreciable alterations of the cells
of either lobe could be seen. No gross lesions of the hypo-
physis were observed in these two cases, but in one case a
small hemorrhagic area 2 to 3 mm. in diameter, accompanied
by necrosis of glandular cells without leucocytic reaction, was
found, while in the other case there appeared to be quite a
number of blackish pigment granules disseminated among
the cells or included in the protaplasm. Nevertheless, the au-

656 ABSTRACTS

thors conclude that symptomatology of lethargic encephalitis
eannot be explained by the condition of the hypophysis.

(HYPOPHYSIS) Diabetes insipidus ina baby. Narigawa (S.),
Jikwa Zasshi (Japan), 1918, No. 213, 16-26.

There was no disturbance of renal function nor of blood
pressure. Under treatment, which consisted of injections of
0.29 mil. of pituitary extract, there was improvement. The
volume of urine decreased and the concentration of sodium
chloride increased. (Abst. in China Med. J.)—L. G. K.

(HYPOPHYSIS) Two cases of hypophyseal adiposity with
dwarfism (Zwei Falle von hypophysarer Adipositas mit
Zwergwuchs). Peritz (G.), Deutsche med. Wehnschr., (Ber-
lin), 1920, 46, 613.

Both cases are of syphilitic origin. The first subject is a
girl of 14 with idiocy and a spastic paresis of the left side of
the body. Her height is 123 em. and weight 28.8 K. She shows
typical adiposity. The second ease is that of a boy of 3 years,
with a weight of 12.8 K. and height of 82 em. The skiagram
shows an enlarged sella turcica. Intraspinal pressure is high.
Probably there is here a hydrocephalus with resulting pressure
on the hypophysis.—J. K.

(HYPOPSYSIS) Hypophyseal dwarfism (Hypophysarer
Zwergwuchs). Priesel (A.), Deutsche med. Wehnschr., (Ber-
lin), 1920, 46, 704.

A short note on a case. The patient was 90 years old.
There were pathological changes in the neurohypophysis and
an abnormal sinus in the splenoid.

(HYPOPHYSIS) Acromegalia y diabetes insipida. Pittaluga
(G.), Siglo Med. (Madrid), 1920, 67, 90-93.

Description of a case of acromegaly with intense diabetes
insipidus. The author favors the hypopituitary theory of
etiology of the diabetes, explaining such cases of acromegaly
accompanied by polyuria as produced by the mechanism in-
dicated by Falta, Maranén and others, namely, compression
of the median and posterior lobes of the hypophysis by the
hypertrophic anterior lobe. The condition may spontaneously
be relieved as the compression subsides or the parts become
anatomically or functionally adapted to the compression.

—G. M.

ABSTRACTS 657

(HYPOPHYSIS) Extensive destruction of the sella turcica
without clinical symptoms. Rosenheck (C.), N. Y. Med. J.
(INE) 1920) 191, 554-555.

Case report of extensive destruction of the sella turcica
in a man of 60 years without clinical manifestations.
—H. W.

Sarcoma of the HYPOPHYSIS with acromegaly extirpated by
the frontal route (Sarcoma de la hipéfisis con sindrome
acromegalico. Extirpacion por via frontal, etc.). Sacco
(A.) & Del Valle (D.), Asoc. Méd. Argentina, See. Chirujia,
July, 1920.

The authors describe a case of acromegaly with grave
visual disorders in which extirpation of the hypophysis was
performed. The ablation was regarded as complete. The
Frazier operation, i. e., ablation with aspiration, was _per-
formed. Thereafter a considerable improvement of the vision
was noted, and this progressed, but marked glycosuria and
other diabetic symptoms supervened.—B. A. H.

(HYPOPHYSIS) A case of diabetes insipidus. Schnabel (Tru-
man G.), & Gerhard (Arthur H.), N. Y. Med. J. (N. Y.),
1920, 111, 812-815.

Report of a case of diabetes insipidus with symptomatic
arrest following the hypodermic use of pituitrin. Over three
years have elapsed since the onset of the disease and over two
years since the cessation of symptoms. The hypodermic use
of pituitrin was followed by a very immediate antidiuretic
effect. Sterile water, corpus luteum and adrenalin used hypo-
dermatically were without effect. Extract of pituitary gland
by mouth was ineffectual. The specific gravity of the urine,
while still fixed at a low figure (1.012), was raised to a rela-
tively higher one. Contradictions from the literature are
cited to illustrate the uncertain status of renal output in re-
lation to pituitary function—Authors’ Abstract.

(HYPOPHYSIS) Note on the presence of iodine in large
quantities of sheep pituitary gland. Seamen (EK. C.), J.
Biol. Chem. (Balt.), 1920, 43, 1-2.

No iodine was found in three lots of 30, 50 and 100 grams
of sheep pituitaries.—F. S. H.

658 ABSTRACTS

HYPOPHYSIS, Contribution to the study of the— (Contri-
bucion al estudio de la hipofisis). Silva (A.), Innaug. Disser-
tation, Santiago de Chih, 1917.

It was concluded from a series of experiments that in the
normal subject hypophyseal extracts give a transient or pro-
longed vascular hypotension. Such extracts give, however, a
unique reaction in the active form of tachycardia of Graves’
disease. This is sufficiently characteristic as to serve as a
diagnostic criterion. In this disorder the extracts give not
only hypotension but also polyuria, transient glycosuria, pal-
lor of the skin and contractions of the intestines and uterus.
(Relative threshold values are not stated.—Ed.) The extracts
appear to give rise also to phosphaturia.—J. R. P.

(HYPOPHYSIS) X-ray treatment of visual disorders or hy-
pophyseal origin (Le traitment par les rayons X des troubles
visuels d’origine hypophysaire). Terrien (F.), Arch. d’opth.
(Paris), 1916, 5, 257-286.

Terrien analyzes eight eases from the literature and adds
two others,—one of his own and one of Prof. Lapersonne’s.
The article includes a valuable detailed discussion of technique.
The rays can be sent either through the temples or through
the mouth, but the latter is usually preferable. A one milli-
meter aluminum screen is used and 5 H. units administered.
Experience has shown that no fear need be entertained of in-
jury to the brain. The results obtained have been mostly sat-
isfactory. The headaches have in most cases ceased at once
and the visual acuity and visual fields improved. The somatic
hyperplasia of the acromegalics has not diminished, however.
Radiations should be administered only during the period in
which the hypophyseal function is in an augmented state,
since their action is to diminish the activity of the gland.
When the process has reached a destructive stage the radiation
can only hasten the appearance of symptoms of hypophyseal
insufficiency. X-ray therapy has the outstanding advantage
that, being harmless, it can be utilized early in cases in which
indications for surgical intervention are lacking.—R. G. H.

HYPOPHYSIS extract, The action of—on peristalsis (Der-
Einfiuss des Hypophysenextraktes auf die Peristaltik). Zon-
dek (B.), Arch. f. d. ges. Physiol. (Bonn), 1920, 180, 68.

Zondek has studied the action of the glandular extract by
direct observation of the intestine through a permanent win-
_ dow of celluloid healed into the abdominal wall; the method

ABSTRACTS 659

is that of Katsch and Borchers. By each injection of the drug
there is a preliminary ‘“‘psychic shock’’ which lasts two min-
utes, with complete interruption of peristalsis. The hypo-
physis extract stimulates peristalsis of the large intestine, but
occasionally first causes slight inhibition. It also regulates
peristalsis. Injections of the drug are recommended in post-
operative intestinal atony.—Med. Se. Abst. & Rev., 2, 494.

INTERNAL SECRETIONS, Influence of—on blood pressure
and the formation of bile. Downs (A. W.), Am. J. Physiol.
(Balt.), 1920, 52, 498-507.

In a previous paper (See Endocrin., 1919, 3, 214), the
author describes the effect of various internal secretions on
the formation of bile. In the present paper the relation be-
tween blood pressure and bile is considered. The gland sub-
stances employed were mammary, orchic, ovarian, pancreatic,
splenic, thymic, and thyroid. Adrenalin and secretin were
also investigated.

There seems to be no constant relation between blood
pressure and the amount of bile secreted. Adrenalin causes
a rise of pressure and increased bile formation, while secretin,
if it has any influence, lowers blood pressure and increases
bile production. There was no constant relationship between
blood pressure and bile production after the administration
of thyroid. The experiments indicate that some at least of
the endocrine organs exert a specific influence on the secretory
activity of the hepatic cells leading to the production of bile.

—T. C. B.

INTERNAL SECRETIONS, Influence of—on the tumors of
the dog (Influence des la sécrétion interne sur les tumeurs
des chiens). Korentchevsky (V.), Compt. rend. Soe. de biol.
(Paris), 1920, 83, 779-781.

The results of experiments on fifty-two dogs inoculated
with sarcoma. In some the thyroid was removed, others were
castrated; all were controlled. Castration and thyroidectomy
clearly augmented the growth of sarcoma in the majority of
eases. In all the animals, controls as well as operated, the
tumors suffered retrogression and absorption as follows: Con-
trols, 79 per cent; castrated, 56 per cent; thyroidectomized,
28.6 per cent. The introduction of a suspension of fresh tes-
ticle arrested the growth of the tumors, and accelerated their
retogression.—T. C. B.

660 ABSTRACTS

INTERNAL SECRETIONS, Influence of—on the tumors of
mice (Influence des la sécrétion interne sur les tumeurs des
souris). Korentchevsky (V.), Compt. rend. Soe. de biol.
(Paris), 1920,. 88, 783-785.

The influence of castration on the growth of carcinoma
in mice was not clearly manifested. Extirpation of the spleen
and the genital glands resulted in an increase in strength
and rapidity of the growth of chondromata. This did not
seem to be true for the extirpation of the spleen only. In gen-
eral the same was true for carcinoma, but the results are not
so clear cut. Thyroid alimentation diminished the percentage
of successful inoculations and retarded the growth of earei-
nomata, and this was most marked with small doses. In thy-
mus feeding also, the greatest percentage of unsuccessful in-
oculations and the smallest tumors, where successful, were
furnished by the group receiving the smallest doses of thymus.
The small doses probably stimulated the defensive oncolytic
forees, retarding growth or preventing the tumor cells from
implanting themselves in the organism. Pituitrin had no
effect. The author concludes from his studies that the state
of the glands of internal secretion may be one of the im-
portant conditions determining the non-receptivity towards
tumors.—T. C. B.

INTERNAL SECRETIONS, Influence of—and of autolysate
on the tumors of rats (Influence des la sécrétion interne et
des l’autolysat sur les tumeurs des rats). Korentchevsky
(V.), Compt. rend. Soe. de biol. (Paris), 1920, 83, 781-783.

Experiments were made on rats, the tumor being a fusi-
form sarcoma. Inoculation one and one-half months after cas-
tration gave 90 per cent of ‘‘takes’’ in the controls and 100
per cent in the castrated rats. The influence of castration was
not very definite. Injection of a suspension of dogs’ testicle,
however, caused a retardation of the growth of the tumor.
Injections of an autolysate of sarcoma in small amounts caused
a retardation of growth, but larger doses were less energetic
in their action. The same may be said for corpus luteum.
Extirpation of the spleen seemed to augment the inoculability
to sarcoma and favor its growth. Castration shghtly atten-
uated the effect of splenectomy alone. Thyroid alimentation
retarded the growth of tumors, and weak doses appeared to
act better than strong. Pituitrin has shown no influence on
the growth of tumors.—T. C. B.

ABSTRACTS 661

INTERNAL SECRETIONS, Contributions to the pathology
of—(Part II.) Nakamura (H.), Verhandl. d. jap. path.
Gesellsch., 1919, , 41-48.

In the first part the author describes the effect of the
ligation of both spermatic cords in rabbits killed 1, 244, 4%
and 714 months later, as follows: (1) A general increase in
body fat which is most apparent after about 444 months; (2)
The interstitial fatty tissue of the thymus is reduced, the
lymphatie cortical substance is increased, while the Hassal’s
corpuscles show no change in either size or number; (3) The
thyroid is of the colloid type; (4) In the suprarenals there is
a thickening of the cortical substance and an increase in the
lipoid content of the cells, especially after 44% months. The
medullary substance is not increased, but after 744 months
shows a somewhat stronger chromaphil reaction; (5) There is
also an increase in the chromophobe cells of the hypophysis.

In the second part he notes the following changes in the
glands of internal secretion in persons of from 50 to 90 years
of age: (1) Atrophy of the thymus and reduction in the size
of the Hassal’s corpuscles; (2) Variability in the follicular
contents of the thyroid, deposition of lipoid and pigment in
the follicular cells and increase in interstitial connective tis-
sue; (3) Reduction in the suprarenal cortex and variability
in its lipoid content; (4) The appearance of brown granular
pigment in the posterior lobe of the hypophysis and the rel-
ative or absolute disappearance of eosinophile cells in the an-
terior lobe. In women the eosinophile cells are more numerous
than in men.

The third and last part deals with death from suffocation
in children in status thymicolymphaticus. It does not contain
any new information.—E. V. C.

(INTERNAL SECRETIONS) Some remarks on the physiology
of the ductless glands. Priestly (Henry), Med. J. Australia
(Sydney), 1920 (i), 381-383.

A short review of the subject is given. No new data are
ineluded.—J. H. L.

(INTERNAL SECRETIONS) Mental deficiency and crimin-
ality. Schlapp (Max G.), Med. Rec. (N. Y.), 1920, 97,
554-557.

The author divides mental defectives into three groups:
(1) The traumatic type, in which there has been injury to the
brain; (2) the formative type, in which the brain has not de-

662 ABSTRACTS

veloped properly; (3) the functional type, “‘where there is a
disturbance in the proportion of the different chemical factors
in the surrounding medium from which the cells draw their
necessary potential energy and activating substances, and
therefore the cells do not react normally to stimulation.”’
Schlapp believes a fair number of this latter group are caused
by a disturbance of the internal secretions, and hopes that
further study will permit more exact recognition of various
types with consequent improvement under appropriate gland
therapy. ‘‘In many of the cases examined at the Post-Gradu-
ate Hospital, chemical disturbance was found, and in more
than half of these cases the cause was traced directly to cer-
tain of the internal secretory glands; and the encouraging
part of it is that most of these people can be relieved if not
cured.’’ ‘‘Where the disturbance is of thyroid origin, methods
have been fairly well worked out, and there has been some
success with suprarenal unbalances, but the pituitary and
other glands have not yet revealed their secrets.’’—H. L.

LIPODYSTROPHIA. Langmead (F.), Brit. J. Child. Dis.
(Lond.), 1920, 17, 33..

A ease of a girl of seven years of age. The wasting was
confined to the upper part of the body and ended at the level
of the umbilicus. The face and neck were extremely wasted,
the arms to a less ‘extent, and the chest and trunk progres-
sively less in a downward direction. The lower lhmbs were
normal. The child was in general good health.—M. B. G.

(MAMMA) Homologous milk injection and mammary secre-
tion during lactation (Eigenmilchinjection und Brustsekre-
tion bei Wochnerinnen). Lonne (Fr.), Zentralbl. f. Gyn.
(Kiel), 1919, 43, 908-915.

The injection under the nates of % ee. of milk from the
breasts of the patient herself resulted in a marked increase
in the secretory activity of the mammary glands in all of the
six cases studied. Suggestion may play a role in the effect pro-
duced.—F. 8. H.

(MONGOLISM) Two cases of Mongolian idiocy in the same
family, Pardee (1. H.), J: Am. M. “Ass. (Chicago)? 1920;
74, 94-95.

An interesting case report of two Mongolian idiots. The
parents were Italians, the father 45 years of age, the mother

38 when the last child was born. These idiots were the young-

ABSTRACTS 663

est in a family of eleven children. The other members of the
family were normal. R. P., age 7 years, was born after pro-
longed labor, is undersized, has blepharitis; almond-shaped
eyes; epicanthic folds; left external stabismus; thick lips; large
protruding tongue with transverse fissures; broad, flat nose;
soft, dry, hairless skin; hypotonic joints; oblique thumb and
short little finger; undescended testicles, and no signs of the
second dentition. His vocabulary is limited to single words.
E. P., age 4 years, is very noisy, destructive and always busy.
Physically he is the counterpart of his brother. The author
diseusses briefly the relation of the birth of Mongols to the
period of the reproductive life of the mother. In this case the
mother was of pronounced dyspituitary type, with nasal eye-
brows, spacing of the incisors, obesity, frequent frontal head-
achés, and a history of diabetes in her mother. The children
with their dry, smooth, hairless skin, small stature, prog-
nathism, abnormal bony growths,, and undescended testicles
show definite signs which could be classed as polyglandular.
For these reasons the author favors a possible endocrine factor
in the development of Mongolian idiots, despite the fact that
endocrine therapy has hitherto been unavailing.—F. C. P.

Death following OBESITY (Muerta consecutiva a obesidad).
Marafion (G.), Real Acad. Nat. de Med. (Madrid), April
20th, 1918.

The case is reported of a woman of 29 years, who was act-
ually a monster. Her height was 160 em.; weight, 157 K.; bust
measure, 130 em.; neck, 44 em.; arm, 51 em.; thigh, 96 em.,
and abdomen at the level of the navel, 150 em. She began
to take on flesh after becoming affected with syphilis, men-
struation becoming suspended at the same time. The subject
died suddenly. Autopsy showed the ovaries to be larger than
normal, weighing 17 to 20 ems., and very hard. The micro-
scope revealed sclerotic ovarian degeneration. The thyroids
were small and sclerotic, and there was persistence of the
thymus.—E. B.

Clinical comments concerning opotherapeutic treatment in
gynecology and obstetrics (Comentarios clinicos al trata-
miento opoterapico en ginecologia y obstetricia). Botin
(F.), Revista espan. de Obst. and Ginec., Madrid, 1918,

?

The author dwells upon the importance of opotherapy in
many processes having relation to gynecology and the _neces-
sity for detailed study of the subjects. Frequently, besides

664 ABSTRACTS

ovarian disturbances, there intervene other endocrine gland
disturbances, these latter calling for the application of com-
bined opotherapy.—H. B.

(ORGANOTHERAPY) Treatment and management of the
neurasthenic individual. Neu (C. F.), Med. Ree. (N. Y.),
1920, 97, 341-346.

The author devotes a paragraph to organotherapy in neu-
rasthenia. He does not believe that much encouragement can
be offered as yet for this type of therapeutics. ‘“‘If it should
be finally shown that certain disturbances of the functional
interactivity of the internal glandular secretions are more or
less responsible for producing the symptom-complex under
consideration, and if it should be determined what brings
about those disturbances of glandular activity, it may be pos-
sible that a therapy along these lines will be developed, but as
yet very little is offered.’’—H. L.

OSTEOMALACIA: it is a rare or rather common disease.
Dieffenbach (W. H.), Med. Ree. (N. Y.), 1920, 97, 995-997.

‘*Nervous and mental depression during the climacteric
frequently has, as a basis, calcium deficiency and osteomalacia
is frequently associated with it. This points to gonad-ovarian
deficieney.’’ ‘‘As the parathyroid glands are now believed to
preside over calcium metabolsm as the thyroid presides over
iodin metabolism, there is some reason to look for parathyroid
abnormality in this disease. Adrenal deficiency is also be-
heved to be a factor in many instanees.’’ The author advises
trying organotherapy, particularly suprarenal, ovarian or tes-
ticular, and parathyroid, but presents no data demonstrating
sueeess by their use.—H. L.

OSTEOMALACIA, a study of the effects of certain organ ex-
tracts and oophorectomy on the metabolism of calcium and
magnesium. Freund (Hugo A.), & Lockwood (Bruce C.),
Annals of Medicine (Hagerston, Md.), 1920, 1, 67-76.

The authors record the valuable results of a study of a
sort unfortunately relatively rare in the endocrine literature.
A woman of 33 years, suffering from osteomalacia, was made
the subject of a metabolic study under earefully controlled
laboratory conditions. After a week’s control period she was
given successively desiceated thyroid gland in 5 grain doses,
three times daily ; pituitrin, 1 ec. hypodermatically, twice daily,
and, finally, parathyroid extract in 1/10 grain doses—fre-

ABSTRACTS 665

queney not stated. In each case the gland administration was
continued for a week, with rest periods between experimental
periods. Sueceeding the parathyroid administration the
ovaries were removed, both being found eystie. During each
period of the study determinations were made of the calcium
and magnesium intake and of the calcium and magnesium
output in feces and urine. It was found that there was a
marked calcium loss, as described by previous investigators
in this disease. The magnesium showed a minute loss. In
contrast with previously described cases, the greater amount
of calcium was excreted in the urine. During the thyroid ad-
ministration there was a negative calcium balance of 1.447
ems. as compared with a negative balance of 0.447 gms. during
the control period. Similarly there was a negative balance of
0.327 gms. in case of magnesium during the thyroid period
and of 0.027 gms. during the control period. During the pit-
uitrin period the calcium balance was -2.604, and the mag-
nesium balance -0.015. There was thus augmented calcium loss
during both the thyroid and the pituitrin periods. The mag-
nesium loss was more than ten times as great during the
thyroid as during the normal period. During the pituitrin
period there was little change in magnesium excretion. Dur-
ing the parathyroid period, on the other hand, there was a
marked gain, both in calcium and magnesium, the balances be-
ing positive, 0.616 and 0.775 gms., respectively. After re-
moval of the ovaries there was much greater loss of calcium
and a slightly greater loss of magnesium than during any pre-
ceding period. The negative balance for calcium was 5.086
and for magnesium 0.291. The castration was not successful
in arresting the disease, as is shown both by these figures and
by the clinical condition of the patient a year later.—R. G. H.

(OVA) Grafts of the eggs of anura upon adults of the same
species or upon adult urodeles (Greffes d’ceufs de batraciens
anoures sur des adultes de méme espéces ou sur des batra-
ciens urodelles adultes). Weber (A.), Compt. rend. Soe. de
biol. (Paris), 1920, 83, 891-892.

Not of endocrine interest.—T. C. B.

(OVARY) Effects of castration upon the automatic movements
of the uterus in the guinea-pig (Effets de las castration sur
les mouvements automatiques de l’utérus chez le cobaye).
Athias (M.), J. Physiol. et de Path. Gén. (Paris), 1920, 18,
731-743.

The uterus to be studied was removed from the body and
preserved in a nutrient fluid. The automatic movements of

666 ABSTRACTS

uteri from normal virgin guinea-pigs, before and after puberty,
and of pregnant and non-pregnant uteri of normal animals
that had had offspring were compared with the movements of
uteri from similar animals which had had both ovaries re-
moved at varying intervals before the experiment. Some of
these latter were subcutaneously autografted with ovarian
tissue a number of days after the preliminary operation. The
observations of Fano, Bottazzi, ete., were confirmed, that the
uterus possesses along with other muscular tissues a double
contractile function, clonic and tonic. The clonic type is seen
in the form of more or less marked automatie rhythmic con-
tractions. The tonie function is revealed by oscillations of
varying duration in the tone of the contracture. It was found
that castration results in definite modifications of the motility
of the uterus. These are evidenced by a gradual weakening
and final disappearance of the involuntary contractions. The
tonie function of the uterus, however, remains normal or is
even increased. These modifications are attributed to the
suppression of the internal secretion of the ovary. They are
not seen in the animals that were grafted with ovarian tissue.

—L. G. K.

(OVARY) Deficiency of the internal sexual organs (Ontbreken
der inwendige geslachtsorganen). Boshouwers (H.), Medisch
Weekblad (Amsterdam), 1920, 27, 109-110.

Description of a woman of 35 who never menstruated.
She was of a male type (large hands and feet and weight of
174 em.). The muscles were strongly developed. In the
breasts no glandular tissue could be felt. The vagina was 3
em. deep and ended blindly. Upon palpation by rectum no
uterus or ovaries were felt. The author thinks of the possi-
bility that the large hands and feet are caused by a hyper-
function of the hypophysis, the antagonist of which, the ovary,
is lacking in this case.—J. K.

(OVARY) Hormones and menstruation. Burekhardt-Socin
(O.) Corresp. Bl. f. Schweiz Artze (Basle), 1918, 48,
1431-1435.

Ovarian extract is potent in so far as it contains substances
derived from the corpus luteum. Two of these, ‘‘luteolipoid’”’
and ‘‘lipamine,’’ have been prepared in tabloid form: the first
acts as a haemostatic, the other encourages the menstrual flow.
The author claims valuable clinical results in their use in the
relief of excessive bleeding, pain, and other menstrual dis-
orders.—Physiol. Abst. 3, 528.

ABSTRACTS 667

(OVARY THYROID ADRENAL) Headache with mild endo-
crine disturbance. Garmendia (F. S.), Revista Médica del
Uruguay (Montevideo), 1920, 23, 57-61.

Garmendia reports two cases of headache for which thy-
roid insufficiency was evidently responsible, and which yielded
to thyroid treatment. In another case, latent chronic supra-
renal insufficiency was finally detected and under epinephrin
treatment, supplemented by recalcification measures, the pa-
tient regained strength and the headaches disappeared. In
his fourth case a young woman had violent headaches during
the menstrual periods, with occasional milder headaches in
the intervals, and menstruation was scanty and _ painful.
Tachyeardia, a soft pulse, and pains in the region of the
ovaries confirmed the assumption of ovarian insufficiency, and
under ovarian extract treatment there has been no return of
the disturbances during the four months to date. The symp-
toms in the suprarenal case had been great weakness, frequent
nausea, pains in the left hypochondrium, and intense and fre-
quent headaches. Small patches of shght pigmentation were
found in the axillae and at the waist. The headache in the
thyroid eases was in the upper and front part of the head and
lasted the whole day, the skin was dry, and the outer portion
of the eyebrows was secant of hairs—J. Am. M. Ass., 74, 1357.

Influence of the OVARY on metabolism (Die Beeinfilussung
des Stoffwechsels durch das Ovarium). Guggisberg (H.),
Zentrabl. f. Gyn. (Kiel), 1919, 48, 561-564.

When 0.1 cem. of a 1/1000 adrenalin solution is injected
into normal women there occurs only a slight inerease in the —
blood sugar. The injection of the same amount into women
whose ovaries have been removed causes a marked rise of the
blood sugar within half an hour. The same result was obtained
in spayed rabbits. These results indicate to the author that
the ovary plays a role in carbohydrate metabolism.—¥. 8. H.

(OVARY) Studies on the Graafian follicles (Estudio de la
genesis y evolucion del foliculo de Graaf. I. Embryologia
del foliculo de Graaf. II. Evolucion del foliculo de Graaf
hasta su madurez). Guilera Molas (lL. G.), Bol. de la Soe.
Espan. de Biol. (Madrid), 1918, 8, 246-286.

An interesting histological and physiological study im-
possible to abstract.—G. M.

668 ABSTRACTS

OVARY, Clinical results of transplantation of— (Klinische
Ergebnisse der Bierstocksiberpflangzung). Hartog, Deutsche
med. Wehnschr. (Berlin), 1920, 46, 784.

Technical details. Autotransplantation is generally fol-
lowed by reappearance of menstruation. Often two or three
years after the operation menstruation becomes irregular and
ceases.—J. K.

(OVARY) The involuntary nervous system in pregnancy and
treatment of toxicosis with ovary (Das vegetative Nerven-
system in des Graviditat und die Ovarialtherapie der Toxi-
kosen). Hofbauer, Deutsche med. Wehnschr. (Berlin), 1920,
46, 758.

The sympathetic and parasympathetic nervous systems
show during pregnancy an increased degree of irritability.
This is caused, supposedly, by the increased function of hypo-
physis, thyroid and adrenals. In cases of hyperemesis during
pregnancy the author saw good results of ovoglandol (doses,
ete., are not given). During eclampsia ovoglandol may be
tried to diminish blood pressure and to diminish the spasm of
the blood vessels. The exudation diathesis and the inclination
toward the formation of edema in pregnancy are also due to
changes in the endocrine organ.—J. K.

(OVARY) Ovarian metrorrhagia and radiotherapy (Met-
rorragios ovariales y radioterapia). Macan (J.), Revista
espan. de obst. y ginee. (Madrid), 1918, ——, ——.

In addition to metrorrhagia due to internal lesions there
exists others which are exclusively due to disturbances of the
ovarian functions. This gland possesses different hormones
which mediate distinct functions. In the successive phases of
the development of the corpus luteum, there are formed va-
rious lipoid substances which act in a characteristic manner.
The young lutein cells contain ‘“‘lipomins”’ or ‘‘lutamins’’ hav-
ing properties stimulating congestive conditions and determin-
ing the modifications necessary to bring on menstruation. In
the corpus luteum there are already developed ‘‘luteolipoid”’
substances possessing the property of inducing ischemia. To
these is attributed the suppression of the menstrual flow dur-
ing the period of gestation. When the corpus luteum is in-
sufficient and fails of complete development, the ‘‘lipomins”’
persist but without forming the ‘‘ischemic” hormones, and
therefore metrorrhagia occurs. The author recommends radio-
therapy in these cases.—E. B.

ABSTRACTS 669

(OVARY) Contribution to the clinical study of ovarian insuf-
ficiency (Contribucion al estudio dela clinica de la insuffi-
ciencia ovarica). Maranoén (G.), Revista espah. de obst. y
ginec. (Madrid), 1917,

The ovary is a mixed gland having an exocrine function,
ovulation, and another, the endocrine function. As regards
the endocrine functions there exist three classes of hormones:
(1) ‘‘Genital,’’ elaborated by the corpus luteum, which actu-
ates the genital life of the woman, affecting menstruation and
eonception; (2) ‘‘Sexual,’’ which exert their influence upon
the appearance and development of the primary and secondary
sexual characters, probably engendered by the interstitial and
folicular tissue, and (3) General, which act on the entire or-
ganism, affecting metabolism and the nervous system, prin-
cipally the vegetative. Their origin is complex. The corpus
luteum determines the structural changes necessary for men-
struation, and equally for impregnation of the ovum, to the
insufficiency of which it is possible to attribute inexplicable
abortions, those not due to habitual causes, syphilis, ete.
Other glands of internal secretion intervene in the physiology
of the ovary, thyroid, hypophysis and suprarenal capsules.
Considering these facts it becomes comprehensible how ovarian
insufficiency may manifest itself in such different forms as:
(1) Simple luteal insufficiency accompanied only by menstrual
disturbances; (2) Total ovarian insufficiency in which in addi-
tion to the menstrual disturbances there is secant develop-
ment of the primary and secondary sexual characters, ten-
deney to obesity, local adiposity, trophoneuroses, headache,
vasomotor disturbances, ete.; chlorosis and many cases of
asthma have a hypovarian pathogeny; (3) Ovarian insuf-
ficiency accompanied by the reaction of other glands, thyroid-
ovarian, suprarenal-ovarian, hypophyseal-ovarian and_ pluri-
glandular syndromes. In total ovarian insufficiency opo-
theapy ought almost always to be employed and in the com-
bined syndromes ovarian with other glandular extracts. It
is only when menstrual disturbances dominate that corpus
Iuteum extract is employed. There exists ovarian hemorrhage
due to the circumstance -that the corpus luteum possesses dif-
ferent hormones according to the epoch of its development;
some of these favor coagulation of the blood. This explains
the paradox of the appearance of menorrhagia, which gives
way to ovarian opotherapy.—E. B.

(OVARY THYROID) Two cases of catamenial angina (Sobre
dos casos de angina catamenial). Martin Calderin (A),
Revista de med. y cirug. pract. (Madrid), 1918, ——

oF

670 ABSTRACTS

The author reports the history of two young women af-
fected with thyroid-ovarian insufficiency. Coincident with
the appearance of the menses, there appeared sudden attacks
of streptococcie angina. This is a picture analagous to cata-
menial erysipelas, and undoubtedly is due to diminution of
the organie defenses because of humoral disturbances which
originate in endocrine insufficiency.—E. B.

(OVARY) The theory of ovulation and its relation to normal
and pathological processes in the uterus with some remarks
on hormone theory (Zur Lehre von der Ovulation und den
mit ihr in Beziehungstehenden normalen und pathologischen
Vorgangen am Uterus nebst Bemerkung zur Hormonlehre).
Meyer (R.), Zentralbl. f. Gynak. (Leipzig), 1920, 44, 473-479.

Complete data will be published in Archiv fiir Gynakologie.
This abstract of a larger article is of no immediate endoerine
interest.—J. K.

Perturbations in the function of the OVARY and other endo-
crine glands and digestive disorders (Perturbaciones en el
functionamiento del ovario y otras glandular endocrinas y
alteraciones digestivas). Ygea Rodriguez (F.), Rey. espan.
de obst. y gineec. (Madrid), 1917,

Observations of clinical cases frequently prove that di-
gestive alterations are due to endocrine disorders. Among
such eases was that of a young woman suffering from hyper-
thyroidism and gastric uleer and, according to the physician
who reported the ease, ovarian disturbanees, which brought
on frequent and abundant menstruation. The hyperovarian
syndrome of Dalché possesses very little clinical reality in
those cases in which there is an absence of periodical men-
strual disturbance and exaggerated flow. Modern knowledge
of the physiology of the ovary and clinical observations lead
more readily to the supposition that there exist in such eases
an ovarian insufficiency and, more or less commonly associ-
ated therewith, hyperchlorhydria and gastric uleer.. There-
fore the author with reason attributes the symptoms to vaga-
tonia, Inasmuch as the ovarian hormones tend to exeite the
tone of the vagus.—E. B.

(OVARY) The clinical signs of ovarian functional anomalies
(Die klinischen Zeichen der Funktionsanomalien des Ovari-
ums). Schroder (R.), Monatsehr. f. Geburtsh. u. Gynaek.
(Berlin), 1920, 51, 217-232.

ABSTRACTS 671

Constitutional factors may be responsible for excessive
functioning of the ovaries, or the loss of inhibitory factors
from other endocrine glands. Chronic metro-endometritis may
develop as the consequence of long continued ovarian hyper-
functioning, but transient hyperfunction is usually a period
of increased physical, mental and sexual vigor.

The etiology of ovarian insufficiency is remarkably many
sided, yet such cases can be divided into two categories:
those in which the cause of the insufficiency les in the ovary
itself—primary insufficiency, and those due to an external
harmful influence acting on the ovary,—secondary insuffi-
ciency. In the first group the author puts infantilism of all
types, congenital and acquired. In the second group are put
the various pathological growths affecting the ovary; the dis-
turbances of internal secretion—hyper-and hypo-thyroidism,
adrenal and hypophyseal insufficiencies; cachexia of any type
and acute and chronic intoxications arising from metabolic
or nutritional disturbances; primary and secondary anemias;
psychie disturbances and unknown eauses arising at the eli-
macterie; carbon dioxid intoxication from defective cirecula-
tion ; nervous or mental derangement; change of climate, and
unknown causes.

If all these can be excluded, primary insufficiency of the
ovaries may be assumed, and proper treatment instituted. Per-
verted ovarian functioning is manifested in irregular bleed-
ing from the uterus from the persistence of ripe follicles with-
out any corpus luteum stage. With cystic degeneration of the
ovaries, the follicles do not ripen, but with this hemorrhagic
metropathy the persistence of the follicles keeps the endo-
metrium in a constant state of proliferation. Another anomaly
for which perverted ovarian secretion is known to be respon-
sible is the persisting corpus luteum. It may be so large as to
simulate extra-uterine pregnancy.—F. S. H.

(OVARY) An ectopic ovarian cyst. Thompson (J. W.), Brit.
M. J. (London), 1920 (i), 437.

Not of endocrine interest.—L. G. K.

A case of PSORIASIS with AMENORRHEA cured with ovari-
an therapy (Un caso di psoriasi generalizzata con amenorrea
guarito con il trattamento opoterapico). Verrotti (G.), Ri-
forma med. (Napoli), 1920, 36, 321-322.

The patient whose case is reported had been ill of psoriasis
and amenorrhea more than six years, and no treatment had
given any lasting result. Finally, after a few months of

672 ABSTRACTS

ovarian treatment the menstruation reappeared and the psori-
asis was fully eured. Verrotti calls this psoriasis a toxidermia
due to alterations of the utero-ovarian function and insists on
autointoxication as one cause of the dermatoses.—G. V.

OVARY and symptoms of reduced function (Ovarium werking
en de Z. G. uitvalsverschijnselen). Wesselink (D. G.),
Neder. Maandschr vy. Geneesk. (Leiden), 1920, 1, 196-215.

In women suffering from menstrual disorders we must
distinguish the complaint immediately before menstruation
(which are due to hyperfunection of the ovaries) from the
complaint during menstruation (which is due to a temporary
cessation of the internal secretion of the ovary). These com-
plaints are the same, but in lesser degree, as the complaints
in the same person after castration. Therefore it is necessary
in women with menstrual disorders who have to undergo
gynaecological operations not to remove both ovaries if there
is the slightest possibility of leaving at least one. Otherwise
the menstrual complaints will return after castration in a per-
manent and more serious way.—J. K.

PANCREAS, Histogenesis of the islands of Langerhans in
certain mammals (Sur l’histogénése des ilots des Langer-
hans chez certains mammiferes). Aron (M.), Compt. rend.
Soe. de biol. (Paris), 1920, 88, 631-634.

Of technical histological interest.

(PANCREAS) Life assurance and glycosuria. Cammidge (P.
J.), Laneet (London), 1920, i, 836.

Advocates a determination of the blood sugar in eases
of apparent glycosuria where there is doubt as to the nature
of the reducing substance in the urine. Cases of pentosuria,
levulosuria and pseudo-levulosuria show a normal blood sugar
content, and after a test meal the percentage of sugar in the
blood follows a normal curve indicating that the carbohydrate
tolerance is not diminished in spite of the presence of ‘‘sugar’”’
in the urine. The author places much more reliance on ex-
aminations of the blood than of the urine in the diagnosis and
treatment of diabetes.—L. G. K.

(PANCREAS) Pancreatic dehydration in diabetic coma (La

déshydration du pancréas dans le coma diabétique). Chauf-
fard (A.) & Grigant (A.), Bull. et mem. Soc. med. d. Hop.
(Paris), 1919, 3. s., 48, 939-942.

ABSTRACTS 673

It would appear from the results published by these au-
thors that the water content of the pancreas of an individual
dying in diabetic coma was less than normal; even the spinal
fluid was thick and syrupy, and the coefficient of dehydration
in the pancreas was 170 per thousand. Since, however, the
values are apparently based on but one normal and one patho-
logical case, the ultimate decision should be withheld.—F. S. H.

PANCREAS, The diagnosis of disease of the—. Feldman (W.
M.), Brit. M. J. (London), 1920 (i), 553-554.

The author states that in individuals who are normally
sympatheticotonic the Loewi adrenalin mydriasis test for pan-
creatic insufficiency is of no value since such persons give a
positive reaction in the absence of any pancreatic derange-
ment. Other tests are suggested (Aschner’s oculo-cardiae re-
flex and the respiratory cardiac reflex) as of value in the diag-
nosis of disease of the pancreas by detecting signs of a hyper-
active sympathetic nervous system. All three of these reac-
tions are of use only when the patient is known to be normally
a vagotonie.—L. G. K.

(PANCREAS) Life assurance and glycosuria. Fox (R. H.),
Lancet (London), 1920, i, 836. Also May (0O.), ibid, 836-837.

These authors dissent from Williamson’s article (see ab-
stract elsewhere in this number) in that they belheve that an
applicant for life assurance in whom glycosuria has been
found should not be told the nature of his affection but should
be merely advised to consult his own physician. Exception
is also taken to the severity of treatment recommended for
cases of temporary glycosuria. Many such eases are said to
be ‘“‘nothing more than a functional derangement,’’ and con-
sequently acceptance by the insurance companies at ordinary
rates is advised.—hL. G. K.

PANCREAS, The Schornstein Lecture on the diagnosis of dis-
eases of the—. Garrod (A. E.), Brit. M. J. (London), 1920,
i, 459-464.

A considerable portion of the paper deals entirely with
the external secretory functions of the pancreas. Loewi’s
adrenalin mydriasis test as a sign of pancreatic insufficiency
is recommended as an aid in diagnosis. The absence of gly-
cosuria is said to afford no argument against the presence of
disease of the pancreas. The same may be said of lowered
sugar tolerance which may be present in disturbances of
other ductless glands. Cammidge’s reaction is advocated as

674 ABSTRACTS

an aid in detecting pancreatic derangements. The author em-
phasizes the fact that ‘‘practically every sign, symptom or
test may fail at times, and that in each individual case we
need to balance the quantity and quality of the evidence for
and against a lesion of the panereas.’’ It is still true, as War-
dell stated in 1871, that ‘‘no symptoms are pathognomic of
panereatic disease; an assemblage of symptoms points to the
probability of its lesion.’’—L. G. K.

(PANCREAS) Proof of nuclear digestion and the diagnosis
of pancreatic insufficiency (L’épreuve de la digestion des
noyaux et la liagnostic de l’insuffisance pancréatique). Lab-
bé (M.), Bull. et mem. Soe. med. d. hop. (Paris), 1919, 3. s.,
43, 794-785.

Of no endocrine interest.—F. S. H.

(PANCREAS) Anaesthetics and diabetes mellitus. Leyton
(O.), Laneet (London), 1920, i, 736.

The author emphasizes the fact that a general anesthetic
may lead to the transformation of a comparatively slight
case of diabetes into one of great severity. A diabetic who
has been able to take a diet supplying sufficient energy to
allow the individual to maintain his weight and to do a cer-
tain amount of manual labor finds that after a general anes-
thetic he can no longer remain sugar free on a diet which will
permit him to retain his weight. Therefore only absolutely
essential operations should be performed upon diabetics, and
spinal anesthesia and local anesthesia should be adopted when
possible. Nitrous oxide with oxygen is less likely to damage
the patient than ether, and ether is less harmful than chloro-
form.—L. G. K.

(PANCREAS) Incipient diabetes mellitus. Mason (E. H.) &
Sutherland (C. G.), Can. M. Ass. J. (Toronto), 1920, 10,
657-660.

Four cases are reported in which a transient glycosuria
was discovered during hfe insurance or other examinations.
In no instanee did the blood sugar follow a normal curve after
administration of 100 grams of glucose on a fasting stomach.
in one ease the sugar in the blood reached 0.348 per cent, a
figure frequently not exceeded in many outspoken eases of
diabetes mellitus after a similar proceeding. The blood sugar
reached its maximum econcentration on the average in 1.3
hours. The fasting blood sugar averaged 0.131 per cent, and

ABSTRACTS 675

this figure was again reached 2.8 hours after the ingestion of
the glucose. Three of the cases showed a slight glycosuria.
The glucose threshold in the kidneys, as estimated on the
fall of the curve, averaged 0.192 per cent, being remarkably
raised in two eases, 0.2 per cent and 0.226 per cent. In none
of the four cases could any abnormality in kidney function
be determined.—lL. G. K.

(PANCREAS) The glycogen in diabetes following pancrea-
tectomy (Les glycogéne dans les diabéte par extirpation du
pancreas). Paulesco (N.), Compt. rend. Soe. de_ biol.
(Paris), 1920, 83, 562-565.

A recent hypothesis explains diabetes following pancreas
extirpation by the fact that the liver and muscles have lost
their power to fix glucose in the form of glycogen. It is de-
sirable to know precisely whether the incapacity of the tissues
to form glycogen is absolute or relative; whether it is the
direct effect of pancreatic insufficiency or a phenomenon that
is secondary and contingent. The experiments consisted of
total ab‘ation of the pancreas; at the same time a lobe of the
liver was removed to determine the quantity of glycogen’ in
the beginning of the experiment and finally the autopsies were
performed. In one set of experiments the animal was starved;
in the other it was fed on various sugars. The conclusion is
that after total ablation of the pancreas the ability of the
liver to retain glycogen is considerably reduced, but not anni-
hilated. The same can be said for muscle. The power of the
myocardium to fix glycogen remains normal and persists until
death sixteen days after the operation. The glycogenie in-
capacity is relative,—a contingent phenomenon,—and not the
cause of diabetes.—T. C. B.

(PANCREAS) Pancreatic infantilism. Sainz de los Terreros
(C.), Siglo Med. (Madrid), 1920, 67, 221-223; Abstr. J. Am.
M. Ass. (Chicago), 1920, 75, 138.

The author refers to backward growth from insufficiency
of the pancreas. The literature records few instances of this,
but he has encountered it in a number of children. The pan-
creatic insufficiency does not entail diabetes in children, al-
though certain features of the metabolism resemble those
of diabetes in adults and transient alimentary glycosuria is
common in children. His experience has convinced him that
the pancreas has three hormones in all probability, one serv-
ing for carbohydrate metabolism, one for the interglandular
control of growth and development, and the third forming

676 ABSTRACTS

the active element in the pancreatic juice. In children, insuf-
ficiency of the two last mentioned hormones will cheek nor-
mal digestion and also check normal growth, while the ear-
bohydrate metabolism may proceed normally or with only
minimal glycosuria and acetonuria. A child with pancreatic
insufficiency begins to lose weight; acetone and preacetone
bodies are thrown off in the urine and the thyroid, freed from
the pancreatic hormone, functions to excess. There is usu-
ally a tendency to adenoids, pathologie tonsils, mononucleosis
and often leucopenia; the resistance 1s low and the child con-
tracts disease easily.—M. B. G.

(PANCREAS) The paranucleus of the pancreatic cell with
reference to the work of Saguchi (Le paranucleus de la
cellule pancréatique a propos d’un travail de Saguchi).
Shaves (P. R.), Compt. rend. Soe. de biol. (Paris), 1920, 88,
881-884.

Of histological interest.—T. C. B.

(PANCREAS) Life assurance and glycosuria. Williamson
(R. T.), Lancet (London), 1920, i, 708-711; 934.

The author found a family history of diabetes in 22.4 per
cent of 500 cases of diabetes while in a control series of 50
non-diabetic patients no family history of diabetes was ob-
tained. He is of the opinion that a history of diabetes in one
member of the family should not be regarded as requiring
an extra charge for life insurance. However, a minimum extra
charge is advised where two or more near relatives (brothers,
sisters, parents) give a history of the disease.

If the urme of the appheant for insurance causes redue-
tion of Fehling’s solution and other symptoms of diabetes
are present the case should be permanently rejected without
further consideration. If there are no symptoms of diabetes,
but Fehling’s solution (or some modification) is reduced
definitely, the case should be rejected, temporarily at least.
Repeated examinations may be made to determine whether
the reducing substance is sugar or some other substance. If
the reduction of Fehling’s solution is indefinite, before re-
jecting the case confirmatory tests for sugar should be made
at once. If the reduction is not due to sugar the case may
usually be accepted. The phenyl-hydrazin and fermentation
tests are advised as confirmatory tests for glucose. If glyco-
suria is detected once only in several examinations of urine
passed in the latter part of the day, and the sugar tolerance
is not found to be lowered the case may be aecepted with an

ABSTRACTS 677

extra charge. However, if the sugar tolerance is diminished
or if sugar is detected more than once rejection is advised.
The author is also of the opinion that the examining physician
should acquaint the proposer with the cause of his rejection
and inform him of the exact significance of the glycosuria
and of the importance of seeking treatment. It is essential
that the patient be not alarmed as sometimes ‘‘a fear of dia-
betes,’’ a neurosis similar to ‘‘sypilophobia’’ develops.

In a second paper the author defends his position that
applicants for life assurance suffering from intermittent or
temporary glycosuria should be informed by the examining
physician of the nature of their ailment.—h. G. K.

PANCREATIC INSUFFICIENCY, Notes on a case of—.
Symes (J. O.), Lancet (Lond.), 1920, (i), 494-495.

Not of endocrine interest.—L. G. K.

(PARATHYROID) The ammonia content of the blood and
the neutrality regulation in epilepsy (Fortsatte Under-
sogelser over Neutraliteteregulation ved genuin Epilepsi).
Bisgaard (A.) & Novig (P.), Hospitalstidende (Copen-
hagen), 1920, 63, 49-62; Abst. Med. Se. Abst. & Rev., 2,
295.

The authors made about 2,000 blood examinations in 16
epilepties and a few normal controls. They found that blood
ammonia varied in the epileptics from 0 to 1.42 mg. N. per
100 ¢.c., whereas the normal ranges is taken as 0.3 to 0.4 mg.
The higher figures were obtained with regularity before an
attack or a ‘‘psychie equivalent,’’ while low values obtained
after the attack. The urea content of the blood in epilepsy
showed little deviation from the normal. The writers then
compare the metabolism (calcium metabolism, as shown by
the condition of the enamel, protein-metabolism, and NH,
metabolism) characteristic of the three conditions, hypopara-
thyroidism in animals, tetany, and epilepsy, and they find
striking uniformity in all. The most important difference is
the absence in epilepsy of spasmophilic reactions which are
common to hypoparathyroidism and tetany. The writers con-
elude that their investigations strengthen the view that gen-
uine epilepsy is associated with hypo-function of the parathy-
roids. The recognition of a parathyroid epilepsy as a disease
sui generis may also be followed by a subdivision of this dis-
ease according as the ordinary eases differ. Other details
are given in the abstract cited.—R. G. H.

678 ABSTRACTS

(PARATHYROIDS) Study of tetany in the adult incident to
parathyroid apoplexy (Etude sur la tetanie de l’adulte par
apoplexie paratyroidienne). Cordier (Mme. V.), Ann d. Méd.
(Paris), 1920, 7, 346-360.

A detailed report of a case of tetany in a man of 41 years
with autopsy findings of a hematoma in the tracheo-thyroid
rezion which had destroyed the right parathyroids, while the
left parathyroids were hemorrhagic. The study of the prog-
ress of the disorder indicated that acidosis 1s an important
symptom of tetany in the adult, although it was impossible
to conclude that it is the basis. Opotherapy gave real relief
in the earlier stages of the illness, but was ultimately unavail-
ing. Tetany in the adult is briefly divided into five classes:
(1) Surgical tetany; (2) Tetany in women attributable to an
activity of the ovarian secretion on the parathyroids; (3)
Tetanies of digestive origin in which possibly a particular
kind of acidosis may play a part; (4) Tetany induced by in-
fectious processes in the parathyroids; (5) Localized tetanies
which are allocated to an endocrine insufficiency.—F. S. H.

(PARATHYROID) Tetany in the etiology of cataract (La
tetania en la etiologia delas cataractas). Garrahan (J. P.
& Belgeri (F.) ; Prensa med. argent. (Buenos Aires), 1920, 6,
305.

The case is presented of a little girl four years of age
who had suffered from convulsive attacks from her first to
third years. She manifested hyperactive patellar reflexes,
slight Chvostek’s sign, hyperexcitability of the external pop-
liteal nerve to mechanical stimulation and positive Erb’s sign.
She also had a zonular eataract. The authors believe that
the cataract is probably to be ascribed to ‘‘latent tetany.”’

—B. A. H.

PARATHYROID transplantation, Data on the value of—
(Erfahrungen iiber den Wert der Epithelkorpertiberpfian-
zung bei postoperativer Tetanie). Jaeger (H.), Zentralbl. f.
Chir. (Leipzig), 1920, 47, 565-569.

Two cases were treated with transplantation with only
very temporary success. In these cases administration of eal-
cium gave no success, either. In some other cases some good
effect was seen from calcium lactate——J. K.

PARATHYROID immune bodies, On the Formation of—.
Kishi (Isami), Tokyo Igakkwai, 1920, 34, ——, (No. 9).

ABSTRACTS 679

The author has attempted to make a serum for use in
parathyroid tetany. He found that the serum of rabbits im-
munized against horse’s parathyroid does contain a true para-
thyroid antibody which, however, lacks specificity, since it
works equally well against the thyroid, pineal, hypophysis,
suprarenal and lymph glands of the horse.—E. V. C.

(PARATHYROID) The importance of vagal and splanchnic
afferent impulses on the onset and course of tetania para-
thyropriva. Palmer (W. L.), Am. J. Physiol. (Balt.), 1920,
52, 581-590.

The great frequeney with which tetany: and gastro-in-
testinal disorders are associated clinically, led the author to
think that afferent impulses reaching the central nervous sys-
tem through the splanchnics and vagi might have some in-
fluence on the onset and course of parathyroid tetany. Two
methods of procedure were followed. The first consisted in
the determination of the effect of double vagotomy and
splanchnectomy, and the second in the determination of the
effect of gastro-intestinal irritation by means of croton oil.
The technic of the operation and the results are given in de-
tail. The conclusions drawn from the results obtained are, that
neither double vagotomy and splanechnectomy, nor gastro-in-
testinal irritation have any influence on the onset and course
of tetania parathyropriva.—T. C. B.

(PARATHYROID) Studies in the metabolic changes in ex-
perimental tetany. Togawa (Tokuji), (Tokyo), J. Lab. &
Clin. M. (St. Louis), 1920, 5, 299-306.

Togawa studied in eleven experimental young dogs and
four controls the following: CO,—combining power of the
blood plasma, by the Van Slyke-Cullen method; the antitryptic
power of the serum, by the Bergmann and Meyers methods;
the non-protein nitrogen content of the serum, by Folin and
Denis’ methods. It was found that after parathyroidectomy
(plus thyroidectomy) in dogs showing typical tetanic symp-
toms, a condition of acidosis always resulted, and the anti-
tryptic power and the non-protein nitrogen content of the
serum were usually inereased. In cases, however, in which
tetany did not occur, acidosis was not found. On the con-
trary a slight alkalosis was sometimes observed and the anti-
tryptic power and the non-protein nitrogen remained prac-
tically unchanged.—R. G. H.

(PAROTID GLAND) Pellagra outbreak in Egypt. Enright
(J. I.), Laneet (Lond.), 1920, (i), 998-1003.

680 ABSTRACTS

From a study of pellagra among German prisoners of
war, the conclusion is drawn that deficient diet or deficient
digestion of the diet cannot be an important etiological factor.
The food provided was abundant and varied. Parotitis was
frequently an associated condition, and the suggestion is
thrown out that the parotid gland forms an internal secretion
which is required for protein utilization—Physiol. Abst., 5,
Sie

(PINEAL) Comments on the function and clinical uses of the
pineal gland. Berkeley (W. N.), Med. Ree. (N. Y.), 1920,
98, 12-14.

There is now a recognized ‘‘pineal syndrome’’—signs of
cerebral tumor in the region of the corpora quadrigemina, con-
eurrent with abnormal growth of the body, early appearance
of axillary and pubic hair and remarkable sexual and mental
precocity. The author in 1913 reported interesting experi-
ments in feeding pineal gland to backward children with en-
couraging results in advancing the mental age. This work
was confirmed and amplified by MeCord. Horrax and Dandy
obtained contradictory results from extirpation of the gland.
The author inclines to doubt the reliability of surgical experi-
ments because of the profound brain trauma incidental to the
operation. Berkeley has continued his feeding of pineal
glands to children (over long periods of time) with gratify-
ing results. He calls attention to the advisability of combin-
ing pituitary, testis (or ovary) and thyroid with pineal gland
when evidences of hypofunction of one or other of these glands
is noticed. The gland preparation must be fresh and obtained
from some well known and reliable source. Berkeley has also
used pineal gland feeding in premature decay of the mental
powers in old people and found that it quickens the slowed
down mental processes, improves the memory and produces
a remarkable cheerfulness and sense of well bemg. Finally,
the author refers to Timmie’s recent article in which he in-
dicates a belief that progressive muscular dystrophy is of
pineal origin.—H. L.

(PINEAL) On the nature of the epiphyseal cells (Sobre la
naturaleza de las cellutas epifisarias). Hortega (Del R.),
Bol. de la Soe. Espan. de Biol., Jan., 1917.

Histological study of the epiphyseal (pineal) gland which
is considered a glio-epithelial organ, it not being possible to
mark the limits between the epithelial and neurological ele-
ments.—G. M.

ABSTRACTS 681

The PINEAL body; its structure, function and diseases. Jel-
liffe (S. E.), N. Y. Med. J. (N. Y.), 1920, 111, 235-240 ; 269-
219: |

The pineal body may be considered as an independent
organ certain parts of which have undergone a retrogressive
evolution, while other parts have persisted and are under-
going progressive evolution. The lipoid material of the pineal
body is related to visual purple of the photoreceptors of higher
forms and is found in other forms in the pineal complex.
This lipoid may be considered as an active transforming ma-
terial for light energies. Alterations of the pineal structure
can induce characteristic disease syndromes both as reactions
due primarily to alterations of the gland itself or as syn-
dromes due in part to the former, or to interference of func-
tions of contiguous structures from pressure and extension
of new growths. The article includes a general summary of
the morphology, physiology and pathological physiology of
the gland.—H. W.

(PINEAL) Pubertas praecox. Wiesenthal, Wiener klin.
Wehnsehr., 1920, 33, 549.

Description of a boy of 20 months with development of
penis as in a boy of 15 years, pigmentation of penis and erec-
tions. The voice is deep and the length of the body is as in
a boy of 5 years. Upon radioscopy the ossification of the bones
proved to be as in a boy of 12. There are no symptoms of
brain tumor. The testicles are very small. The intelligence
is normal. The cause of the condition has not been detected.

3 ec

(PLACENTA) Cytological studies on the human placenta and
decidua with special reference to their internal secretory
activity. Fujimura (G.), Tokyo Igakkwai, 1919, 33, 15.

The author obtained material from 48 cases in many
stages of pregnancy and studied it by means of the newer
methods of technique designed to show the plastosomes (mi-
tochondria). He draws a close analogy between the different
cells of the placenta and those of other glands hke the pan-
creas, suprarenal and so forth. He is of the opinion that the
secretion is formed from the mitochondria, which change first
into lipoid granules and then into droplets of more fluid nature
which appear in the preparations in the form of uncolored
vacuoles. He claims also to have determined the approximate
time at which the different types of cells produce their va-
rious secretions: (1) The cells of the syncytium, from the

682 ABSTRACTS

beginning of pregnaney to the end of the fourth month, being
most apparent in the second and third months; (2) Langhans
cells to the sixth or seventh month; (3) Zottenstroma cells
from the end of the first month to the seventh month; (4)
Small decidua cells from the end of the first month to the
seventh month, and large decidua cells from the second to
the sixth month. The paper is beautifully illustrated with lith-
ographie plates and the extensive literature is carefully re-
viewed.—E. V. C.

(PLACENTA) Histogenetic and histophysiclogic studies on
the placenta (in the mouse). Ohashi (Y.), Tokyo Igakkwai,
1920, 34, —— (No. 10).

This is a rather extensive contribution published in two
numbers of the journal. The author divides his description
into three stages, viz.: (1) Before placenta formation; (2)
Placenta formation, and (3) After placenta formation. Spe-
cial attention is paid to the origin and distribution of glycogen
in the placenta, but comparatively little is said regarding the
formation of internal secretions by the placental cells.

—K. V. C.

POLYURIA from cerebral piqure in dogs with denervated
kidneys (Poliura por pinchazo cerebral en perros con
rinones desnervados). Houssay (B. A.) & Carulla (J. E.),
Soe. de Biol. de Buenos Aires, June 10, 1920.

Four cases were reported.—B. A. H.

POLYURIA from cerebral piqure in the dog (Poliura por pin-
chazo en el perro). Houssay (B. A.), Carrula (J. E.) &
Romana (l.), Soe. de Biol. de Buenos Aires, June 10, 1920.

The piqure was made by means of the cautery in a zone
which was included between the optic chiasma and the pro-
tuberance. In some, but not all cases, this produced a marked
polyuria. Similar polyuria was never observed in ease the
piqure fell outside the zone described. The polyuria so pro-
duced is primary; it is not due to polydipsia, vascular hyper-
tension or glycosuria. The polyuria which follows hypophy-
sectomy may be due, perhaps, to the cerebral piqure involved
in the operation.—B. A. H.

PROSTATE, The internal secretion of the—and its relation
to the testes (La sécrétion interne de la prostate et ses rap-
ports avec les testicules). Bogoslovsky (G.) & Korentchev-

ABSTRACTS 683

sky (V.), Compt. rend. Soe. de biol. (Paris), 1920, 83, 718-
749.

Observations were made on eight dogs, two normal and
six castrated. The normal equilibrium of exchange was estab-
lished and the experiment divided into three periods. First,
a period of three days for establishing the normal gaseous
and nitrogen exchange. Second, a two or three-day period
during which intravenous injections of emulsion of prostate,
or of testicle, or both, were made. Third, a control period of
one to three days. The results permit the following conelu-
sions. Normal dogs show a slight increase of N exchange
and diuresis under the influence of injections of prostate. In
castrated dogs, the phenomenon is more accentuated—8 to 10
per cent. The simultaneous injection of prostate and testicle
causes an augmentation of N up to 17 per cent, and of diuresis
to 25 per cent. During the first four hours the N augmenta-
tion may be as much as 40 per cent and the diuresis 80 to 90
per cent. The prostate constitutes a powerful stimulant to
the internal secretion of the testicles. The internal secretion
of the testicles exercises a stimulating influence on the ex-
changes of protein substances especially.—T. C. B.

(PROSTATE) Loss of the specific secretion of cells cultivated
in vitro (Perte de la sécrétion spécifique des cellules culti-
vées in vitro). Champy (Ch.), Compt. rend. Soe. de biol.
(Paris), 1920, 83, 842-843.

An attempt to ascertain if the properties of cultivated
tissues are Jost at the time of disappearance of the cytologi-
eal characters. The prostate of the guinea pig was used, since
the action of the ferment on the contents of the seminal
vesicles can be clearly seen with small quantities of material.
Fragments of the size used for culture give, when placed in
vesicular fiuid, a characteristic opaque appearance. Frag-
ments placed in the ice chest for three or four days give the
reaction unweakened; but if placed on plasma the reaction
is lost by the fourth day. Histological controls show that the
epithelium of the prostatic tubes survive, but give place to
cicatrization at the surface as in other cultures; but it loses
the particular characters of the normal prostate. The cells
contain no characteristic secretion grains. There is, then, a
correlation between the loss of differentiation and the disap-
pearance of the characteristic secretion.

(SECRETIN) Action of acetone extracts of duodenal mucosa
upon arterial pressure and upon the pancreas (Accio dels

684 ABSTRACTS

extrets acetonics de mucosa duodenal sobre la pressio ar-
terial i sobre del pancreas). Cervera (L.), Treballs de la
Societat de Biologie, Barcelona, 1918, 6, 19-21.

Extracts of duodenal mucosa made with acetone were
compared with those made with acidulated saline solution as
regards their effects upon blood pressure and pancreatic se-
cretion. The acetone extracts were found to be somewhat less
active but to produce a marked acceleration of pancreatic
flow with no more than 10 mm. reduction of blood pressure.
Hence secretin is not identical with Popielski’s vasodilatin.
Cervera suggests that the secretin acts on a ‘‘receptor sub-
stance’’ as postulated by Langley.—R. G. H.

(SECRETIN) Role of bile in the formation of secretin (Paper
de la bilis en la formacio de la secretina duodenal). Cer-
vera (L.), Treballs de la Societat de Biologia, Barcelona,
1918, 6, 22-23.

In view of the fact that secretin is supposedly elaborated
normally in the duodenal mucosa in the presence of bile, Cer-
vera investigated whether this latter substance plays any sig-
nificant part in secretin formation. For a period of five days
the bile was removed through a fistula, the loss of alkali be-
ing compensated for by the administration of sodium bicar-
bonate. At the end‘of the experimental period the duodenal
mucosa was extracted in the classic manner and tested for
its secretin content. The exclusion of bile from the duodenum

had made no appreciable difference in the secretin formation.
—R. G. H.

Influence of SEX at different ages on the gravity of influenza
(Influence du sexe aux différents ages sur la gravite de la
grippe). Apert & Flipo, Bull. et mem. Soc. med. d. Hop.
(Paris), 1920, 3. s., 44, 321-324.

A statistical presentation tending to show that grippe is
of more severe effect when attacking females than the male.

—F.S. H.

SEX, Consideration of—in pediatrics (La considération du
sexe en médicine infantile). Apert (E.), Bull. et mem. Soe.
med. d. Hop. (Paris), 1920, 3. s., 44, 326-331.

From infancy on it is necessary to take into account in
medical treatment the influence of sex. Disregard of the dif-
ferences of the two sexes in planning hygienie and thera-
peutic measures is a grave error.—F’. S. H.

ABSTRACTS 685

Influence of SEX on the frequency of whooping cough (Influ-
ence du sexe sur la fréquence de la coqueluche). Apert (E.)
& Cambessédés, Bull. et mem. soc. Med. d. Hop. (Paris),
1920, 3. s., 44, 324-326.

In France as in other countries, whooping cough is more
frequent in females than in males.—F. 8. H.

SPASMOPHILIA of older children (Die Spasmophille der
adlteren Kinder). Stneeman (H. A.), Jahrb. f. Kinderh.
(Berlin), 1916, 86, 43.

The author thinks that the glands of internal secretion
may have a role in this disorder.—C. H. G.

SPASMOPHILIA, Experimental studies on the pathogenesis
of— (Experimentelle Beitrage zur Pathogenese der Spasmo-
philie). Resch (A.), Jahrb. f. Kinderh. (Berlin), 1917, 86,
294.

Resch studied the effect of B-iminazolylethylamine, para-
oxyphenylethylamine, ethylamine, tenosin, choline and hypo-
physin upon the galvanie excitability of the peripheral nerves
in the rabbit. Para-oxyphenylethylamine in subeutaneous
doses of 0.05 gm. daily for a period of ten days and hypophy-
sin in quantities of 1 ee. over a like period, increased the gal-
vanie excitability of the sciatic nerve. Tenosin was inactive,
while the others inereased the nervous threshold. In a long
theoretical discussion the author considers the possible role
of soluble toxic proteinogenic amines of either endocrine or
alimentary origin in the spasmophilic syndrome.—C. H. G.

Familial SPLENOMEGALY (Uber familiire Splenomegalie).
De Lange (C). & Schippers (J. C.), Jahrb. f. Kinderh. (Ber-
lin), 1917, 86, 459.

Also reported in Amer. J. Dis. Child., 1918, 15, 249, and
abstracted in Endocrin., 1918, 2, 192.—C. H. G.

(SPLEEN) Action of splenic extracts on smooth muscle.
Preparation and nature of the active principle (Action des
extraits de rate sur les organes 4 fibres musculaires lisses.
Préparation et nature du principe actif). Stern (l.) &
Rothlin (E.), J. de physiol. et de path. gén. (Paris), 1920, 18,
753-780.

Hot or cold water extracts of the spleens of various ani-
mals contain a substance, ‘‘liénine,’’ capable of causing con-

686 ABSTRACTS

sont-elles sous la dépendence des glandes génitales)? Mer-
eier (L.), Compt. rend. Soe. de biol. (Paris), 1920, 83, 470-
471.

Mercier has observed that the secretion of the salivary
elands of the male panorpa plays the role of an excitant to
the female at the moment of copulation, and this gives rise to
the idea that there may be a relation between these glands
and the testes. The salivary glands attain a complete fune-
tional state at the moment when spermatogenie activity is fin-
ished, and it remains to see if the sexual dimorphism is not
‘‘en rapport’’? with the more or less precocious evolution of
the genital glands.—T. C. B.

(TESTICLE) Treatment of eunuchoidism (Behandlung des
Eunuchoidismus). Lichtenstern, Miinchen. med. Wehnschr.,
1920, 67, 620.

A young man of 20 was castrated for tuberculosis of both
testicles. Eunuchoidism developed. It was cured by trans-
plantation of a testicle of the father of the patient—J. K.

TESTICLE transplantation, Influence of—on sexual life
(Ueber die Beeinflussung des Geschlechtslebens durch freie
Hodeniiberpflauzung). Muhsam (R.), Deutsche med.
Wehnschr. (Berlin), 1920, 46, 823-825.

The author made testicular transplants in three patients.
One of these had been castrated for tuberculosis of both tes-
ticles. One was suffering from bisexuality, while the third
was homosexual. From the last patient one of the testicles was
removed preceding the transplantation. In all cases the effect
was splendid.—J. K.

(THYMUS) Report of a case of malignant thymoma with ne-
cropsy. Foot (N. C.), Am. J. Dis. Child. (Chicago), 1920,
20, 1-14.

Report of a case in a child, male, aged 9 years, who gave
a negative history until one month previously, at which time
he began to complain of inspiratory dyspnea and inability to
lie flat in bed because of marked orthopnea. Two weeks prior
to admission to the hospital his mother noticed swollen veins
at the base of the neck just above the clavicle. He had oc-
easional fits of gagging and coughing, which would awaken
him at night, but no cyanosis. Physical examination showed
dullness on both sides of the sternum from the first to the
fifth rib; breath sounds and voice sounds were increased:
Radioscopy showed a large mediastinal tumor occupying the

ABSTRACTS 6387

traction of smooth muscle. This is said to be the active prin-
ciple of the organ. Details of the method of preparation are
given. lLiénine is soluble in water and in aleohol, and in-
soluble in ether, chloroform, toluol, petroleum ether and ben-
zol. It is thermostable and resists the action of acids and
enzymes. It dialyses readily and does not give the biuret or
Fehling’s reaction. It is a nitrogenous substance, probably
an amine. It acts directly on the smooth muscle fibre and not
on the myoneural junction or nerve ending, thus resembling
histamine in its site of action. (Seen also Endoerin., 1920, 4,
260.)—L. G. K.

Splenomegaly and INFANTILISM (Esplenomegalia e infan-
tilismo). Jiminez Adna (L.), Siglo med. (Madrid), 1917,
i 7 \wept:):

The author reports a case of infantilism with very marked
splenomegaly due to Banti’s disease. Other various cases are
to be found in medical literature in which infantilism was ac-
companied by splenomegaly due to Banti’s disease, hemolytic
icterus, etc. These cases may properly be included in Pende’s
group of exo-endoecrine syndromes.—G. M.

(TESTES) Experimental diabetes insipidus and genital
atrophy (Diabétes insipide expérimental et atrophie gen-
itale). Camus (J.) & Roussy (G.), Compt. rend. Soe. de
biol. (Paris), 1920, 83, 901-902.

Description of the genital organs of one of the dogs with
permanent diabetes insipidus previously reported. The dog
weighed 26 kegs., but had a small penis for its size, with small
testicles badly descended, and poorly distinguishable scrotum.
This may be due to injury of the hypophysis, but it is not im-
possible that the lesion of the opto-peduncular space of the
brain may have caused the genital atrophy as well as the dia-
betes.—T. C. B.

(TESTES) The seasonal cycle of the testicle of the blind
worm orvet (Les cycle saisonnier du testicule des l’orvet).
Dalq (A.), Compt. rend. Soe. de biol. (Paris), 1920, 83, 820-
821.

A histological description of the male genital glands in

the orvet, in different months of the year.—T. C. B.

(TESTES) Are the salivary glands of Panorpa dependent upon
the genital glands (Les glandes salivaires des Panorpes

688 ABSTRACTS

upper central part of the chest anterior to the great vessels.
At the operation the patient took the ether well until par-
tially anesthetized, but as anesthesia became more profound
he grew markedly cyanotic. The ether was stopped and the
usual restoratives administered with a resulting return of his
color to the normal and his heart in apparently good condi-
tion. He, however, never regained consciousness and one-half
hour after starting the ether he suddenly became very pale
and respiration and heart stopped abruptly.

Necropsy showed a very hard lobulated tumor occupying
chiefly the anterior mediastinum, lying just behind the sternum
but not infiltrating the bone. It showed metastasis by direct
lymphatic extension with three possible minor metastases at
a distance. It did not penetrate the lung nor other neighbor-
ing organs much more deeply than their serous coverings or
sacs. It was composed chiefly of small cells resembling micro-
lymphocytes, but having vesicular nuclei, acidophil cytoplasm
and tending very slightly to anastomose with one another
by means of slender processes. This applied only to a decided
minority of their number, the majority being discrete. The
rest of the tumor was chiefly cartilagenous connective tissue.
Neighboring lymph nodes, while they showed a few discrete
tumor cells in their sinuses, were usually not incorporated in
the tumor mass. The author feels that the tumor was of thy-
mie origin and different from the lymphosarcomas that orig-
inate in lymphnodes. He gives a short review of the htera-
ture.—M. B. G.

(THYMUS) Primary malignant tumor of the anterior medi-
astinum. Lymphadenoma of thymic origin (Tumeur ma-
ligne primitive du médiastin antérieur. Lymphadénome
d’origine thymique.) Dandy (Ch.) & Piédeliévre (R.), Bull.
et mem. Soc. med. d. hop. (Paris), 1920, 3. s., 44, 867-876.

The case is reported of a mediastinal tumor in a man of
40, which developed at the expense of the thymus. There
were symptoms of obstruction of the superior vena cava.
Under the microscope the tumor appeared as a lymphadenoma.
In spite of the absence of corpuscles of Hassal, the authors
insist that the tumor was of thymic origin.—R. G. H.

THYMUS, The normal weight of— (Ueber das normale Ge-
wicht der Thymusdriise). Ishibashi (Matsuzo), Verhandl.
d. japan. path. Gesellsch. (Tokyo), 1916, 6, 19-20.

The thymus glands from 421 autopsies in the Pathological
Institute of the Imperial University at Tokyo were weighed

ABSTRACTS 689

and the weights tabulated according to age from birth to 80
years. The smallest average weight was noted at 6 months
(5.30 gms.). The highest weight fell at 14-15 years (16.28
gms.). From this age there was a gradual decline to about 10
gms. at 30 years and finally to 6.5 gms. at 70. Thé article
affords valuable data for those interested in the anatomical
constants of the thymus.—R. G. H.

THYMUS death in children (Contribucion casuistica al estudio
dela muerte timica en los nifos). Palanecar (J.) & de Ar-
eaute (L. R.), Archivos Espanoles de Pediatria (Madrid),
1918, 2, 208-241.

This article describes the sudden death of two children,
one of 10 months and the other of 4. Autopsy revealed noth-
ing abnormal except exceeding hypertrophy of the thymus,
which weighed 30 and 28 gms., respectively. In the case of
the younger child, histological study of the thymus showed
extensive development and abundance of the corpuscles of
Hassall, which indicates to the authors that in hypertrophy
of the thymus there is glandular hyperfunction. The authors
also take into account the different pathogenic theories of
thymus death, hypertensive coagulative, and toxic action on
the myocardium (Thymusherz of the Germans) and equally,
the part which the suprarenals play (chromaffin aplasia in
status thymicus). In these cases there was no alteration in
the chromaphil system. The necropsy observations favor the
view of Popper and Fishl, who attribute thmyus death to
coagulation in the heart and vessels which impedes filling of
the aorta.—E. B.

(THYMUS THYROID) Contribution to the physiology of the
glands. 42. Studies of the function of the thymus and the
thyroid as shown by the respiratory metabolism at normal
and increased external temperatures (Beitrage zur Physiol-
ogie der Driisen. 42 Mitteilung. Untersuchungen iiber die
Funktion der Thymus und der Schilddrise, gepriift am Ver-
halten des respiratorischen Stoffwechsels bei normaler und
erhohter Aussentemperatur). Ruchti (E.), Biochem. Ztschr.
(Berlin), 1920, 105, 1-42.

Working in Asher’s laboratory with thyroidectomized and
thymectomized rabbits, Ruchti found that these animals not
only stand the removal of these glands but also are good sub-
jects for studies of respiratory exchange. Thyroidectomy
causes a marked decrease in the carbon-dioxide and water out-
put, while thymectomy has but little effect, which, however, is

690 ABSTRACTS

in the same direction. Simultaneous removal of both glands is
followed by a great decrease in carbon-dioxide and water out-
put and thyroidectomy after thymectomy has the same result,
the lower values remaining constant. When thymectomy is
done after thyroidectomy no lower results are obtained; but
here, too, the values fail to rise at a later period as occurs
when the thyroid alone is removed. These facts seem to be
the first experimental proof that the thymus and thyroid stand
in opposite functional roles. At higher external temperatures
(33° C.) the operated animals show a lesser respiration rate
than do the normals.—F’. 8. H.

THYMUS, Changes of the—in experimental infections of
mice (Die Veranderunug der Thymus bei der experimentel-
len Infektion der Mause). Takeuchi (Kiyoshi), Verhandl.
d. japan. path. Gesellsch. (Tokyo), 1916, 6, 17.

Fifty-seven mice were infected with Bacillus coli com-
munis. The ratio of the thymus weight to body weight was
studied. This ratio inereased at first, reaching its highest
value in 50-70 hours. This ‘‘hyperplastie stage’’ was followed
by an ‘‘atrophie stage.’’ In the hyperplastic stage the gland
appeared in the gross grayish-white, translucent and edema-
tous. The microscopic findings were as follows:

Hyperplastie stage—
Boundaries of cortex and me-
dulla obseure
Small cells in medulla mark-
edly increased

Reticulated tissue, no notable
change
not in-

Kosinophile — cells,

creased.

Hassal’s corpuscles, no note-
worthy changes

Connective tissue increased

(THYROID) Syphilis and Graves’ disease.

Atrophie stage—
Boundaries still more obscure

Small cells almost lacking,
leaving only reticular tissue
and Hassal’s corpuscles

Augmented growth; many
multinuclear giant cells ap-
parent

Not increased as
subjects

No changes

in human

Inereased.
Seite ibe 1B l,

Editorial note,

Med. Rec. (N. Y.), 1920, 97, 698.

Levy-Franckel, Pierre Marie, Gaucher, Sainton and Sehul!-
man have ealled attention to the surprising frequency of syph-

ABSTRACTS | 691

ilitie Graves’ disease. Jodides that are contraindicated in ordi-
nary exophthalmic goitre are beneficial in the luetic variety.
—H. L.

Thyroid and heat regulation (Schilddriise und Warmeregula-
tion). Adler (L.), Med. Klin. (Berlin), 1920, 16, 108.

Data published elsewhere. See Endocrin., 4, 160.

(THYROID) Goiter and ‘‘old tuberculin’’ (Struma und Alt- .
tuberkulin). Althen, Miinchen. med. Wehnschr., 1920, 67,
651.

Goiter and Graves’ disease are remarkably often combined
with tuberculosis. Therefore the author tried to eure goiter
with local application of Koch’s ‘‘o!d tubereulin.’’ Every
three days he rubs the left arm, the left part of the thorax,
the right part of the thorax, the right arm and the skin over
goiter with one drop of tuberculin. Often after one treatment
the goiter becomes smaller. If after one series no success is
seen, a second one is tried, but at the same time twice daily
10 drops of ‘‘jodvason’’ are rubbed on the goiter.—J. K.

THYROID Hormone, Action of the— (Die Wirkungen des
Schilddriisenhormons). Asher (l.), Therapeutische Halb-
monatshefte (Berlin), 1920, 34, 221-224.

A general review. Jodothyrin is not able to replace
the hormone of the thyroid. Oswald’s thyreoglobin, however,
ean take the place of this hormone. It has not been settled as
yet whether this is possible with Kendall’s thyrotoxin.—J. K.

(THYROID) Problems relative to prophylaxis of rural en-
demics in Brazil (Algunos problemas relativos a profilaxia
de endemias ruraes no Brazil). Aragao (H. deB.). Cruz’
and Chagas’ disease (Molestia de Cruz e Chagas), Vascon-
cellos (F.), Soc. de Med. e Cirugia de Rio Janeiro, July 15,
1919.

Chagas’ disease was discussed in important papers by two
disciples of Oswaldo Cruz. F. V. affirmed that the Trypano-
soma cruzi was discovered personally by Oswaldo Cruz, and
that for this reason the Brazilian trypanosomiasis should be
ealled Cruz’ and Chagas’ disease rather than by the name
merely of the latter.. The two authors were in agreement
that the pathogenic importance of the disease might seem to
have been exaggerated were it not known that 29 well veri-

692 ABSTRACTS

fied cases have occurred and these in acute form in young in-
fants. It is true that diagnoses of the chronic form have
often been made also by the finding of pulmonary cysts in
euinea pigs into which blood of the patients had been in-
jected, but it has been demonstrated that these pneumocysts
may be found in guinea pigs not injected at all, and that they
are due to another organism than the protozoon in question.
Both authors maintain that it has not been proven that en-
demic goitre is due to the trypanosome, and they agree with
Kraus, Maggio and Rosenbusch that there has been a con-
fusion of two diseases existing in the same district. It is cer-
tain that these restrictions oblige a renewed study of the
chronie form of the disease but do not detract at all from the
interest in the masterly study which Chagas has made of the
acute form.—B. A. H.

(THYROID-PARATHYROID) On the effects of thyro-para-
thyroidectomy in the castrated guinea pig (Sur les effets de
le thyroparathyroidectomy chez les cobaye chatré). Athias
(M.) & Ferreira de Mira, Compt, rend. Soc. de biol (Paris),
1920, 83, 876-877.

The aim of these experiments was to see if castration in
the guinea pig had any effect on the results of thryoparathy-
roidectomy. Previous results by various workers have been
conflicting. Eight:males over 3 years of age that had been
castrated at the age of one or two months, and three females
castrated three and a half months previously were the ma-
terial used, with one male and two females over 4 years old
(normal) as controls. All the animals died after removal of
the thyroparathyroid apparatus, the time of death varying
between one and seventy-three days, the symptoms in the eas-
trated animals being the same as in the uneastrated controls.
The conclusion is reached that castration does not preserve
the guinea pig from the fatal results of thyroparathyroidec-
tomy.

The THYROID in infections. Barbara (M.), Annali di Clinica
Medica (Palermo), 1919, 9, 1-20.
Data reported elsewhere. See Endoerin., 4, 93-94.
(THYROID) A preliminary report on the endocrine therapy

of high blood pressure. Bandler (S. W.), N. Y. Med. J.
CNY) 2 51920) 4a 1 972-9742

A brief report of seven cases of high blood pressure which
responded favorably to thyroid extracts. No change of diet

Nae!

ABSTRACTS 69:

was made in ambulatory cases. No teeth were pulled or ton-
sils removed.—H. W.

(THYROID) Goitre in an infant. Barnett (E. C.), N. Zealand
M. J. (Wellington), 1917, 16, 143.

In an infant five weeks of age the thyroid was enormously
enlarged, threatening asphixia. At operation the isthumus was
resected with a view particularly to forestalling asphixia.
The results were excellent. The child’s weight began at once
to increase. The enlargement of the lobes of the thyroid
gradually disappared and has not recurred. At the time of
writing the child was perfectly well.—R. G. H.

(THYROID) Hereditary occurrence of hypothyroidism with
dystrophies of the nails and hair. Barrett (A. M.), Arch.
Neurol. & Psychiat. (Chicago), 1919, 2, 628-637.

Barrett reports the case of a patient showing the disorder
mentioned in the caption in whose family history for genera-
tions have occurred trophie disorders of the nails and hair to-
gether with various mental and nervous disorders. In case
of the patient reported the skin felt somewhat thickened and
there was puffiness under the eyes. The hands were pudgy
and the fingers short and clubbed. The hands and feet showed
eyanosis. The hair of both the head and body was scanty.
The eyebrows consisted of but a few short stubby hairs. The
nails of both fingers and toes were short, failing to reach by a
quarter of an inch the ends of the digits. No lanula was pres-
ent. The ends of the nails were thickened and broken, though
the nail surface was smooth. The skin was dry and at the
ends of the digits tended to exfoliate. The patient was sub-
ject to tics of the face and shoulder. Speech was thick and
nasal. Bone conduction was lacking for the left ear. There
was marked hyperopia. Thyroid medication resulted in
marked improvement. Similar deficiencies had occurred in
the family for at least six generations. Among 61 members
both hair and nails were affected in 14 instances. The nail
defect seemed to be about the same in all, but there was much
variation in the degrees of loss of head hair. In the greater
number there was an extreme scantiness as to the amount of
hair. In no instance was there a total loss of all hair of the
head, the most extreme cases showing a fine lanugo-like cov-
ering of the scalp. Aside from this particular abnormality
there were other features that showed that in this family
group there were conditions active in the production of a
variety of disorders that are of much interest to neuropsy-
chiatry. This is the high frequency of feeblemindedness and

694 ABSTRACTS

neurologic disorders of a degenerate type among the family.
The members of the third generation who had dystrophies of
nails and hair, and all of their descendants, numbered 29 per-
sons. Of these, 22 were definitely abnormal. Twelve of the
latter had the characteristic family dystrophy, and 10 others,
who laeked this, showed other constitutional and nervous dis-
orders. These included one case of epilepsy, one of hysteria,
one of severe tic, four instances of feeblemindedness, one of
nocturnal enuresis and four died at an early age from maras-
mus. Even those who had the nail and hair dystrophy had
other abnormalities. One of these was an epileptic; one had
eanecer; four were feebleminded, and one had nocturnal enu-
resis. The well known association of abnormalities of hair
and of nails in hypothyroidism, and two fairly well defined
cases of juvenile myxedema which led to this study, and the
reaction of one patient to thyroid feeding, seems to warrant
in Barrett’s opinion the conclusion that the fundamental dis-
order in this family was of the thyroid gland.

A review of the literature discloses a number of other
families with a similar history to that cited. A summary of
these is included.—R. G. H.

(THYROID) Subtotal thyroidectomy. Bartlett (W.), Surg.
Gynee. & Obst. (Chicago), 1917, 25, 402-410.

The article is largely of technical interest, giving many
details of operative procedure. The desirability of taking
away most of both lobes of the thyroid (in exophthalmie
goitre) is stressed. A small proportion of the gland, the
amount depending upon the individual conditions, should be
left. In twenty-six cases upon which the method was prac-
ticed the results were ‘‘practically ideal.’’—R. G. H.

(THYROID) Preliminary report on a new method for the clin-
ical diagnosis of toxic thyroid states, with a note on sero-
logical technique. Berkeley (W. N.) & Koopman( J.), Med.
Ree: (N.Y), 921920,3 975 1035-03 7

Using normal dog thyroid as antigen, Berkeley tested
175 human sera of which 40 were from patients with suspected
thyroid diseases; 18 of the 40 were undoubted instances of
Graves’ disease and gave positive complement fixation re-_
sponse. Control serums in 135 cases gave negative results
in all except one. Furthermore, as the positive Graves’ dis-
ease patients improved under treatment the test changed from
four plus to two plus, ete. The test has been repeated hun-
dreds of times and has been checked carefully with controls.
The author hopes it will prove of value in differentiating per-

ABSTRACTS 695

plexing eases from true hyperthyroidism and will aid in judg-
ing the effects of treatment. Dog thyroid would seem to con-
tain a substance native in the dog but toxic in man. This
substance Berkeley calls cynothyrotoxin and presumes that
it is formed in the human thyroid under the abnormal chem-
ical conditions which appear when exophthalmie goitre de-
velops. The antigen is an extract of the mixed thyroids of
five or six dogs. It slowly deteriorates and a fresh supply
must be obtained in three weeks. Details of preparing the
antigen are given.—H. L.

Carcinoma of the THYROID. Blaxland (A. J.), Brit. M. J.
(London), 1920, (i), 454.

In the writer’s experience adeno-carcinoma of the thy-
roid is rare, and a correct diagnosis is not usually made until
the growth has spread through the capsule of the thyroid and
the chance of cure by operation is remote. He cites a ease
oceurring in a woman of 25. The lobe in which the tumor
was situated was removed without difficulty and the diag-
nosis was made on microscopical examination. This patient
had had the other lobe of the thyroid removed six years pre-
viously for parenchymatous enlargement.—hL. G. K.

(THYROID) A case of goitre with nearly total external oph-
thalmoplegia (Ken geval van struma met ophthalmoplegia
quasi totalis externa). den Boer (M.), Nederl. Tijdschr. \
Geneesk. (Haarlem), 1920, 64 (1), 2284-2286.

A woman of 34 with Graves’ disease was operated upon.
Ten years later she developed recrudescence of goiter with
ptosis of both eyelids and paresis of the eye muscles, paresis
of the levator palatina dextra and hemiplegia laryngis sinistra.
The pulse was 70; there were no tremors and no hyperhy-
drosis, i. e., there were no symptoms now of Graves’ disease.
A combination of simple goitre and paralysis of the muscles
mentioned above has never previously been deseribed.—.J. K.

THYROID, Hemorrhagic syndrome cured by thyroidin (Syn-
drome hemorragique guéri par la thyroidine). Bottaro (ML.
P.) & Mussio Fournier (J. C.), Anales de la Fac: de Med.
(Montevideo), 1920, 5, 191-194.

See Endocrin., 1920, 4, 366-368.

(THYROIDS PARYTHYROIDS) The effect of thyro-para-
thyroidectomy on the heart and circulation. Part II. Ac-

696 ABSTRACTS

tion of guanidin on the heart of the frog. Burns (D.) &
Watson (A.), J. Physiol. (Lond.), 1920, 53, 386-390.

This work was undertaken to determine whether the nico-
tine-like action of guanidin afforded sufficient explanation for
the cireulatory disturbances followimg parathyroidectomy.
Heart tracings taken after administration of guanidin com-
pared with those taken before almost invariably showed ear-
diae retardation, whether the guanidin was injected into the
dorsal sac, or painted on the heart, or the heart bathed in so-
lution. Two causes for the retardation have been adduced:
(a) Stimulation of the vago-cardiac nerves, and (b) pro-
nounced vaso-constriction with reflex inhibition. There was
a primary acceleration probably due to stimulation of the ae-
eelerator nerves of the heart. By the use of atropine and nico-
tine the point of action of guanidin has been localized. It
has a nicotine-like action on the sympathetic neurons.—T. C. B.

(THYROID) Maladies and medicines. Campbell (Arthur),
Practitioner (Lond.), 1920, 104, 305-312.

The article consists of brief notes about sundry diseases
and drugs. The author describes the first case of myxedema
he saw, which was in 1883, a few days before the disease was
first described. He mentions a case of Charcot’s latent exoph-
thalmie goitre.—H. Lh.

(THYROID) Basedow’s disease accompanied by hypertrophy
of the eyelids and cheeks (Maladie de Basedow avec hyper-
trophie des paupiéres et des joues). Chauffard (A.) &
Monnot (P.), Bull. et mem. Soe. med. d. hop. (Paris), 1917,
3. s., 41, 421-423 ; 482-484.

Report of an interesting coincidence of Basedow’s dis-
ease and hypertrophy of the eyelids and hps not oedematous
in character.—F. S.

(THYROID) Goitre in pregnancy. Crotti (A.), Am. J. Obst.
(N. Y.), 1917, 75, 450-455.

Data published elsewhere. See Endocrin., 3, 105.

(THYROID) The somatic causes of psychoneuroses. Dana
(Charles L.), J. Am. M. Ass. (Chicago), 1920, 74, 1139-11438.

The ease is reported of a boy, aged 19, with a well marked
psychoneurosis. He was subject to ‘‘seizures’’ of a pecular
sort. He would suddenly feel as if there were a burning, tor-
turing fluid in his head and pouring through his body. After

ABSTRACTS 697

a short time this feeling was superseded by nervousness, rest-
lessness and apprehension. He finally had to give up all at-
tempts at educational work. He sueceeded no better at farm
work. When seen by Dana he had been for four years nerv-
ous, hysterical and entirely lacking in courage or capacity to
earry on any sort of work. His habits were good, as were his
intelligence, affection and desire for recovery. There were
no objective signs of nervous disease nor stigmata of schizo-
phrenia. The physical description given does not point to
any definite endocrine anomaly unless a dry skin and _ sub-
normal temperature be taken to indicate such. He was put
on thyroid treatment, ten, and later, four grains a day.
‘*Within two weeks after treatment was begun the boy was
rather magically changed. He lost his fears and restlessness,
and nervousness and insomnia. He was able to go out alone.
He went back to his work and became practically well and
continued so for nearly three years.’’ He takes thyroid inter-
mittently when he notes a tendency of the nervous symptoms
to return and gets entire relief. The author refrains from
endocrine theorizing on the case.—R. G. H.

A case of INFANTILISM. Elmslie (R. C.), Brit. J. Child.
Dis: (liond.), 1920, 17, 39.

Report of a case occurring in a girl aged 15 years and
10 months, whose height was 3 feet. Skiagrams of the wrists
showed cupping of the ends of the diaphyses with widening
of the epiphyseal cartilages as in rickets, while the hips showed
coxa vara of the rachitic type. Sexual development was ab-
sent, breasts undeveloped, pubic hair absent and menstrua-
tion not yet begun. Albuminuria and chronic intestinal trou-
ble were present. No studies were made of the general metab-
olism. From the description it appears as if the condition
were due to a combined dysfunction of the thyroid, pituitary
and sexual glands.—M. B. G.

(THYROID OVARY) Polyglandular syndrome with late epi-
lepsy (Un nouveau cas de syndrome polyglandulaire avec
épilepsie tardive). Etienne (G). & Richard (G.), Bull. et
mem. Soc. méd. d. hop. (Paris), 1920, 3. s., 44, 154-158.

The authors report the case of a woman of 32 who had
for the past three years suffered with generalized convulsions
which appeared on the second or third day of each menstrual
period. The periods were much reduced. The seizures stopped
at once under combined thyroid-ovarian therapy, but for a
time there were epileptic equivalents. The patient was clearly

698 ABSTRACTS

sympathicotonic. The seizures were explained as due to spasms
of the cerebral blood vessels which were regarded as due to
thyroid-ovarian insufficiency. (The reviewer noted several
years ago that ovarian extirpation in experimental animals
leads to augmented irritability of tie sympathetic nervous
system. ) (See also Tracy, Endocrin., 4, 221.)—R. G. H.

(THYROID) A case of acute senile hyperthyroidism (Un
caso de hipertiroidismo). Fernandez Sanz (H.), Anales de
la Real Acad. de med. de Madrid, May, 1917.

A female subject of 82 suddenly exhibited a most acute
Basedow syndrome. At this age hyperthyroidism always has
a menacing prognosis, but this subject was entirely cured by
medical treatment.—G. M.

(THYROID) The treatment of goiter. Foss (H. L.), N. Y.
Med. J. (N. Y.), 1920, 111, 285-286.

A defense of surgical procedure in the treatment of
goiters, especially the exophthalmic forms.—H. W.

(THYROID) The principles ae the treatment of toxic
goitre. Frazier (Charles H.), Penn. M. J. (Athens, Pa.),
1920, 23, 437-444.

Frazier emphasizes our ignorance of the etiology of toxic
goitre. In stressing the importance of the thyroid gland he
alludes to: (1) the disturbances related to its influence on the
vegetative or sympathetic nervous system; (2) the visceral dis-
turbanees as represented by the vagotonic and sympathecotonic
types; (3) the symptoms related to disorders of the central
nervous system; (4) the disturbances of growth as in cretins,
the alterations in the skin, ete., and (5) the disturbances aris-
ing from the relationship of the thyroid to the other glands
of internal secretion. The author classifies toxic goitre pa-
tients into five groups. (1) The mildly toxie of the adolescent
group rarely require surgery. (2) In the mildly toxie of the
adenoma group operation is usually a matter of choice and not
of necessity. (3) In the grave toxicosis of the adenomata, not
the true exophthalmic type, but often with as grave an out-
look, operation is inevitable, according to Frazier. (4) In the
initial hyperplastie goitre without a pre-existing adenoma, the
author is a very positive advocate of operation,—the earlier
the better. (5) In the degenerative or atrophic or terminal
stage of a more or less prolonged hyperthyroidism, there is
manifestly no justification for surgery. In determining the

ABSTRACTS . 699
toxicity of a given case, basal-metabolism and blood sugar
tests are valuable but should never be the sole eriteria on
which to depend; other objective and subjective signs must
be taken equally into consideration, weighed and balanced.
Frazier is an enthusiastic advocate of nitrous oxide anesthesia
in toxie goitre operations. If ligation is done it should include
the superior pole and not merely the superior thyroid artery.
The author’s mortality has been 3.5 per cent.

(Frazier’s article and Goetsch’s article abstracted in this
issue were read before the Pennsylvania State Medical Society
and an interesting discussion by several clinicians, including
Plummer, is also published at the close of Frazier’s paper.)

—H. Li.

(THYROID) ‘‘Epinevhrin hypersensitiveness test’’ in the
diacnosis of hyverthvroidism. Goetsch (Emil), Penn. M. J.
(Athens, Pa.), 1920, 23, 431-437.

The author prefaces his article by reference to the work of
Eppinger, Falta, Rudinger, Hess, Oswald, Cannon, ete., in dem-
onstrating that exeessive thyroid seeretion renders the sym-
pathetic nervous system sensitive to the action of epinephrin.
He then deseribes in detail the technique of his ‘‘Epinephrin
hypersensitiveness test.’? The test may result in considerable.
‘exacerbation of the objective signs and symptoms with but
moderate increase of subtective phenomenon, or vice versa.
Either combination wou'd be considered positive. His eonclu-
sions are hased on a elinical study of approximately 300 cases
of thyroid disease. Goetsch finds the test definitely positive
in eases of exophthalmie goitre; nevative in col'oid goitre cases
without symptoms of hyperthyroidism and mildly or moder-
ately positive when increased thyroid secretion prevails. In
toxie adenoma the test is positive. in non-toxie adenomata
negative. The test is helpful in differentiating ineipient tu-
bereulosis from mild hyperthyroidism in which, clinieally, the
diagnosis may be difficult; in the former there is no response
to epinephrin, while in the Jatter the reaction is positive. The
author attaches considerable importance to this phenomenon.
He recommends the use of the test also in differentiating other
conditions simulating hyperthyroidism such as psychasthenia,
psychoneurosis, hysteria, neurasthenia. dementia precox, aleo-
holism, tabagism, acromegaly, arteriosclerosis and several other
diseases. Furthermore, he believes the test of value in estimat-
ine the degree of toxicity in a given case of hyperthyroidism,
and also finds that improvement in the response to epinephrin

700 ABSTRACTS

(that is, a less positive reaction) runs parallel with decreased
toxicity. The test also has the advantages of simplicity in ap-
paratus and technique and is inexpensive.

THYROID, Metastatic abscesses of the—associated with hy-
perthyroidism; report of a case following repeated attacks
of sore throat. Greenburg (David), J. Am. M. Ass. (Chi-
eago), 1920, 74, 165.

A report of a case of exophthalmic goitre, preceded by re-
peated peritonsillar abscesses and streptococcus sore throat.
The author believes that bacteria may be a factor in the causa-
tion of exophthalmie goitre, if not directly, at least by effecting
such changes in the physiology of the gland as to make its
appearance likely.—F. C. P.

(THYROID) Sporadic cretinism (Ueber sporadischem Kre-
tinismus). Guleke. Miinchen. med. Wehnschr., 1920, 67, 734.

Two eases. A deaf mute boy of 13 showed some spon-
taneous improvement without treatment. Perhaps there was
some spontaneous new formation of thyroid. In a second ease,
a girl of 16, three pieces of fresh thyroid were implanted with-
out marked suecess.—J. K.

(THYROID) Morphologically demonstrable fat substances and .
the oxidase reaction in the human thyroid. Haeberli (E.),
Arch. f. path. Anat., ete. (Berl.), 1916, 221, 333-351.

In young individuals the fat content of the thyroid consists
largely of neutral fats, i. e., fatty acid esters of glycerol. Thy-
roids of older individuals contain mainly neutral fats; cho-
lesterol esters are seldom found, free cholesterol never. Mi-
erochemieal staining reactions may lead to errors in the ehemi-
eal differentiation of lipins. The granules in the epithelial
cells of the thyroid, as those in other epithelial cells, consist
of a variety of substances, among which are fat and pigment.
The fat in the epithelial cells is permanent fat and increases
with age. Fresh thyroids constantly contain oxidase granules
within the epithelial cells. These granules are closely asso-
ciated with the stored fat. Chem. Abst. 14, 2023.

Investigations on the THYROID gland (Part II). Horisawa
(H.), Verhandl. d. jap. path. Gesellsch, 1919, pp. 54-57.

The author has made a study of the size and weight of the
fresh thyroid gland in 529 individuals of different ages and of

ABSTRACTS 701

the formalin fixed gland in 401 more. In males between 26 and
42 years old it weighs on an average 17.47 gms. and in females
between 20 and 33 years of age, 15.30 gms. In 223 cases he
gives also the percentage of thyroid to body weight. If de-
tailed observations were made regarding the cause of death,
anatomical variations in the gland, incidence of goitre in the
vicinity, ete., this contribution should be one of considerable
value.—E. V. C.

THYROID extirpation in the horse (La tiroidectomia en
los caballos). Houssay (B. A.), & Hug (E.), Soe. de Biol.
de Buenos Aires, May 6, 1920.

The experimental series included eight animals. These
were observed for a period of five years. Thyroidectomy re-
sulted in death with cachexia in three cases, retardation of
vrowth in case of young animals, with synovial edema, re-
tardation of sexual development, hypothermia, ete.—B. A. H.

(THYROID) Experimental goitre produced by water from
Cerrillos (Bocio experimental provocado por el agua de Cer-
rillos). Houssay (B. A.), Soe. de Biol. de Buenos Aires, May
6, 1920.

Goitre was observed in rats that had drunk of this water.
This is the first instance of experimental goitre reported from
South America.—Author’s Abst.

THYROID GLAND, Papilliferous carcinoma of the—. Hughes
(ae) erit. WJ. (uond.), 1920 (i), 362-363.

The patient was a girl of 13 years. The papuilliferous car-
cinoma which was removed at operation was of 10 months’
duration and involved the right lobe of the thyroid gland and
some of the lymphatic glands on the right side of the neck and
was also adherent to the trachea and to the carotid sheath.
At the time the paper was written, three months after the
operaion, there was no sign of recurrence. The condition 1s
extremely rare, especially in children. The papilliferous form
is far less malignant than the ordinary careinomata, the his-
tory often extending over years. These tumors show little
tendency to infiltrate; the metastases are local and situated in
the glands of the neck, and they may appear years after the
removal of the original growth. The affected glands remain
movable and discrete and their removal is easily accomplished.
The original tumor, if removed before infiltration has occurred,
shows little tendeney to reeur.—L. G. K.

702 ABSTRACTS

Carcinoma of the THYROID. Hughes (B.), Brit. M. J. (Lon-
don), 1920, (i), 586.

The author states that he has never seen a case of adeno-
carcinoma of the thyroid gland in which operation could be
definitely said to have effected a cure. The early involvement
of the trachea and surrounding structures as the growth be-
comes extracapsular makes operation extremely diffieult. The
earliest symptom may be cough and b!ood stained expectora-
tion caused by ulceration of the growth into the trachea.

—L. G. K.

(THYROID) Nerve block anesthesia in superior thyroid pole
ligation. Hunt (J.), Northwest Med. (Seattle), 1920, 19,
49-50.

The author deseribes a method of nerve block sufficient to
permit superior pole ligation and recommends it for the reasons
that time is saved by blocking before starting the operation,
since infiltration does not produce sufficient anaesthesia under
twenty to thirty minutes; that shock is lessened, and that bet-
ter skin repair results when infiltration along the line of in-
cision is not resorted to.—H. L.

(THYROID) Research on the artificial provocation of meta-
morphosis in batrachians, notably in axolotl. Biological
measure of the efficacy of thyroid preparations (Recherches
sur la provocation artificielle de la métamophose chez les
batrachiens, et notamment chez l’axolotl. Mesure biologique
de l’efficacité des préparations thyroides). Jensen (C. O.),
Compt. rend. Soe. de biol. (Paris), 1920, 83, 315-317.

The author has previously shown that intra-abdominal
injections of iodothyrin determine metamorphosis in axolotl.
Since then he has elaborated a method for measuring the aec-
tion of iodothyrin and other thyroid preparations by determin-
ing the minimum dose necessary to provoke metamorphosis.

—T.C.B.

THYROID gland and anomalies of metamorphosis in the anura
(La slande thyroide et les anomalies de métamorphose chez
les anoures). Jensen (C. O.), Compt. rend. Soe. de biol.
(Paris), 1920, 83, 948-949.

The author has studied the thyroid in specimens of Rana
esculenta, R. arvalis and Bufo vulgaris that presented various
anomalies with regard to metamorphosis. In a lot of Bufo

ABSTRACTS 703

larvae three individuals metamorphosed very early. In these
the thyroid was not hypertrophied, but the follices were filled
with masses of colloid with a stronger affinity than normal for
eosin. -In the larvae of R. arvalis, of which the development
was notably more advanced’ than that of the controls, the
thyroid attained dimensions much greater than that of the
control; the follicles were large and filled with colloid, but not
proliferated. It is possible that the secretory activity of the
thyroid had been more intense in these individuals than in
the controls. In the larvae of R. esculenta that had passed the
winter at a temperature of 6-10° the thyroid was found at the
end of March very large on account of swelling; the follicles
were filled with colloid having little affinity for eosin; the epi-
thelium was very flat. Larvae of the same size and state of
development, collected from the same pond, but killed in Octo-
ber, served as controls. Giant larvae of R. esculenta were also-
studied, and a histological description of the thyroid is given.
: —T.C. B.

(THYROID) Endocrine tropisms: thyrotropism. Kaplan (D.
M.), N. Y. Med. J. (N. Y.), 1920, 111, 275-280.

This is one of a series of articles in which the author is
attempting to show that every individual is dominated by the
makeup of his endocrine system. According to the author, a
thyrotrop may show his tropism in four different ways: an
over action, an under action, a perversion of the secretion, or
the first two may be present at the same time. The various
findings under each condition establish the character of the
individual possessing them. All thyroidal conditions cannot
be ascribed to primary disturbances in the thyroid for the
pathology of other endocrine organs results.in a condition in
which the thyroid attempting to compensate brings destruction
upon itself. Hence the thyroid. as such, should not be held re-
sponsible until the functions of the other endocrine g!ands have
been completely established, nor removed until organotherapy
and modern medical procedures have been thoroughly applied.
Many cases improve on ovarian extract, 5 grains a day, and
hand in hand with their improvement goes a dermal condi-
tion analogous to acnea rosacea.

In some respects this ‘‘dominance of the endocrines”’ re-
minds one of the old theory of phrenology and especially of
-physiogomony dressed up in modern or ‘‘new thoueht.’’ The
manner of the author in ‘‘initiating’’ the reader into the secrets
of endocrinology presupposes that the reader has scarcely heard
of the wonders of the ductless glands.—H. W.

TO4 ABSTRACTS

(THYMUS THYROID) Internal secretory organs in morbus
Basedowii. Kato (M.), Verhandl. d. jap. path. Gesellsch,
TOUS: , oe:

On the basis of the study of ten cases of Graves’ disease
the author concludes that this condition is closely related to

the so-called status thymicolymphaticus.—E. V. C.

Deficient THYROID secretion as an etiologic factor in gastric
and duodenal ulcers and in hyperacid conditions. Katz (Jo-
seph), Med. Ree. (N. Y.), 1920, 97, 916.

Brief report of four cases, three of hyperacidity and one of
gastric ulcer, which were strikingly improved by thyroid ex-
tract.—H. IL.

(THYROID) Determination of iodine in connection with
studies in thyroid activity. Third paper. Kendall (E. C.),
J. Biol. Chem. (Balt.), 1920, 48, 149-159.

A detailed description of the procedure to be followed for
the aceurate determination of iodine in amounts found in
thyroid tissue.—F. 8S. H.

(THYROID) DIABETES and exopthalmic goiter (Diabéte et
goitre exopthalmique). Labbé-(M.), Ann. de méd. (Paris),
1920, 7, 95-103.

After nothing that he has observed a coincidence of dia-
betes and Basedow’s disease in five cases, but has never found
myxedema associated with the former, the author gives brief
protocols of the patients presenting the associated pancreatic
and thyroidal disorders. The susceptibility of such patients
to acidosis is partially attributable to the increased nitrogen
metabolism induced by the hyperthyroidism.

Medication with hemato-ethyroidine and valerian and bro-
mides gave little if any relief. Better results were obtained
with quinine and sodium salicylate. Treatment with iodine
preparations gave most favorable results both in lowering the
elucosuria and in general amelioration.—F. S. H.

(THYROID) Loss of both eyes from the exopthalmos of hyper-
thyroidism. Lahey (F. H.), Boston M. & S. J., 1920, 182,
427-428.

X-ray treatments resulted in a reduction of the pulse rate,

a gain in weight and improvement of the general condition.

ABSTRACTS 705

However, the exopthalmos continued to progress and ulcers of
the right eye led to its enucleation. Later the left eye was
removed for the same reasons after severance of the sympa-
thetie cervical ganglion had failed to arrest the condition.
—H. W.

(THYROID) Metabolism as an aid in diagnosis, prognosis
and treatment of hyperthyroidism. McGuire (Stuart), South
Carolina M. Ass. J. (Greenville), 1920, 16, 107-119.

MeGuire believes that the determination of basal metabol-
ism, although a very promising method, has not yet been suffi-
ciently long in use to permit a final evaluation of its signifi-
cance in the diagnosis of ‘‘hyperthyroidism.”’

A patient with hyperthyroidism may have a high metabolie
rate and not be as seriously ill as another with a lower rate
but who has structural changes in the heart, liver or kidneys.
The onset of hyperthyroidism is insidious and difficult to recog-
nize in its early stages in which the metabolic rate will clearly
differentiate it from hysteria, neurasthenia, tuberculosis, and
other conditions with which it may be confused. Again, in the
later stages there develop symptoms due to degeneration of the
heart, liver or kidneys, and it is difficult to say how much the
patient suffers from hyperthyroidism and how much from
damage to the vital organs. Here also a determination of the
basal metabolism will be of value, not only for diagnosis but
for prognosis as well. Usually, a patient’s clinical symptoms
coincide with his metabolic rate; but sometimes they do not.
Patients with high metabolism and moderate tachyeardia are
more seriously ill than those with moderate metabolic increase
and a very rapid heart action. In treating a patient for hyper-
thyroidism, the estimation of the metabolic rate is of value first
to determine the safety of the measure to be employed, and
second to ascertain its efficiency.—R. G. H.

(THYROID) Zur Lehre der STRUMA INTRATHORICA.
Mayer (Karl), Zentralbl f. Chir. (Leipzig), 1919, 46, 536.

Mayer found that X-ray photographs enabled a diagnosis
to be made of intrathoracic goitre and enlarged thymus, al-
though a dermoid cyst cannot be distinguished from the above.
The retrosternal goitre may be a continuation of the goitre in
the neck, but an intrathoracic goitre may exist without any
enlargement of the gland in the neck. Moreover, accessory
thyroids may be met with at any point in the line from the base
of the tongue as far down as the front of the arch of the aorta

706 ABSTRACTS

and pericardium, or even in the posterior mediastinum.—Med.
Se. Abst. & Rev., 1, 178.

(THYROID) The treatment of early hyperthyroidism. Mere-
dith (Florence L.), N. Y. Med. J. (N. Y.), 1920, 111, 289-291.

The state of being generally below par leads to the ac-
quiring of infections and to metabolic and secretory disturb-
anees. In young women nonhygienie modes of living often re-
sult in thyroidal disturbances, hence the normalizing of the
life of the individuals so affected is a logical procedure in the
eare of early hyperthyroidism. In thirty young women suffer-
ing from early hyperthyroidism marked improvement followed
the establishment of a normal mode of living—H. W.

(THYROID) Functional PANCREAS insufficiency. Moyer
(A.), Ztsehr. f. exp. Path. u. Therap., 1919, 20, 273-297.

Disturbances of pancreatic function are a part of the aft-
ermath of the war. The disorders are evidenced by feeal ex-
aminations after test meals, studies of individual specimens of
panereatie juice, ete. Gastrie achylia and thyroid disturbance
frequently accompany this functional perversion of secretion.
There is apparently a gastrogenic, neurogenic, and thyreogenie
complex bound up with the pancreas disturbance, which is
fundamentally possibly connected with the tvne of novrishment
ingested during the war.—F. S. H., Chem. Abst., 14, 2027.

THYROID extract, The life history of the first case of
myxoedema treated bv—. Murray (G. R.), Brit. M. J.
(Lond.), 1920, (i), 359-360.

For data seen Editorial (p. 600) in this issue.

(THYROID) X-ray treatment of Graves’ disease (Om Be-
handlinoen af Mb. Basedowii). Nordentoft (S.), Ugesk. f.
Leger (Copenhagen), 1919, 81, 1169-1175.

In 1918 Nordentoft published fifty cases of Graves’ disease
treated with X-rays in the period July, 1915 to December, 1917.
His present paper deals with a new series of fifty cases, only
three of which were males. At the Aalborg Kommune Hospi-
tal the practice has been adopted of exposing only the region
of the thymus to the X-rays. He gives a few illustrative cases,
but does not attempt to tabulate or classify his results, confin-
ing his estimate to general terms. He is greatly impressed by
the efficacy of this treatment, with which better results can be

ABSTRACTS 707

achieved than with any other. He urges its adoption at an
early stage before the disease has got well established, and
he advocates large and few doses in preference to small and
frequent doses. With the adoption of this principle, and the
inclusion of the thymus in the area exposed, he anticipates that
severe and fatal cases of Graves’ disease will become so rare
that many medical men will never see them. Discussing X-ray
fatalities in connection with Graves’ disease, he suggests that
timid dosage may partly be responsible, and he quotes Forsell
in support of his hypothesis that the small dose merely stimu-
lates, whereas the large dose inhibits the activities of the thy-
roid. He also notes that in certain fatal cases of Graves’ dis-
ease death probably occurred in spite of, not because of, the
X-ray treatment.—Med. Se. Abst. & Rev., 2, 202.

(THYROID) Toxic goitre. O’Day (J. C.), N. Y. Med J. (N.
Y.), 1920, 111, 287-289.

The removal of each lobe of the thyroid gland in five eases
did not give the slightest relief, hence something more than
the hyperthyroidism is involved in toxie goitre. The injection
of toxic goitres with mucin is of no avail as treatment, although
mucin is supposed to be the material which infiltrates the body
tissues in cases of myxedema. The cause of toxic goitre is not
known.—H. W.

Bone tumors of THYROID origin. O’Day (J. C.), N. Y. Med.
J. (N. Y.), 1920, 111, 374-375.

The author believes that normal detached thyroid epi-
thelial cells are self-asserting within two environments, name-
ly, the bony tissue and the parent structure itself—H. W.

(THYROID) Is endemic goiter a water disease? O’Day, (J.
ear -Med. J. (N.. Y.); 1920, 111, 634.

Areas of the United States where goiter is endemic in
character without exception are supplied with water deficient
in mineral content. Hence endemic goiter, which is always
retentive goiter, is the result of the deleterious effects that
mineral free water has on the consistency of the thyroid’s
secretion. This view is the direct opposite of the one pre-
viously held. The relation of water to goiter, if there is one,
apparently remains to be solved.—H. W.

(THYROID) What is the cause of goiter? O’Day (J. C.), N
Y. Med. J. (N. Y.), 1920, 111, 556.

708 ABSTRACTS

Diffuse and nodular goiters may be assumed to arise be-
cause of obstruction of one or more of the few lymphatic
trunks which drain the thyroid. Such an obstruction would
mean the accumulation of secretion within the follicles until,
one after the other, they would burst and fuse to form a
large cavity with the euboidal epithelial cells of each flung
back to be compressed into the wall of the eyst. The cause
of this interference in drainage may be either mechanical or
physiological. The latter is due to some defect which per-
mits the production of an over-thickened product too heavy
and thick for easy egress. Hence, persons of nervous temper-
ament readily fall victims to goiterous conditions. On the
other hand, ‘‘lymphoid temperaments,’’ Hawaiians, Poly-
nesians, ete., do not demonstrate retentive goiters.—H. W.

(THYROID) Diabetes in association with toxic goiter. O’Day
(J. C.), N. Y. Med. J. (N. Y.), 1920, 111, 815-816.

Two cases of toxie goiter associated with diabetes had
their carbohydrate tolerance restored following subtotal thy-
roidectomy. In one ease the thyroid was injected with boil-
ing water, a definite reduction of the sugar content keeping
pace with the piecemeal cooking of the gland—H. W.

(THYROID) Emotive exophthalmic goiter and hypertrophy
of the parotids (Basedowisme post-émotionnel et hyper-
trophie des parotides). Railliet (G.), Bull. mem. Soc. med.
hop. (Paris), 1918, 3. s., 42, 1151-1154.

A report of a case of a soldier who suffered contusions
as the result of which Basedowian symptoms developed; these
were accompanied by marked enlargements of the parotids.

—F. S. H.

(THYROID) Intestinal hemorrhages in a hemophilic Base-
dowian treated with serum from a rabbit in a state of an-
aphylaxis (Hémorragies intestinales chez un Basedowien
hémophile. Traitement par le serum de lapin en état d’ an-
aphylaxie). Raymond & Rouquier (A.), Bull. et mem. Soe.
med. d. hép. (Paris), 1920, 3. s., 44, 485-487.

A report of a case of Basedow’s disease in which intes-
tinal hemorrhages occurred and were stopped by two injec-
tions of 10 ee. of’ rabbit serum from an animal in the anaphy-
lactic state from horse serum injections.—F. S. H.

ABSTRACTS 709

THYROID and PANCREAS, Giant cell sarcoma of—. van
Rijssel (KE. C.), Nederl. Tijdschr. v. Geneesk. (Haarlem),
1919, 63, (11), 2014-2024.

Correction of citation, Endocrin., 4, 345.

(THYROID) Toxic goiter following epidemic influenza.
pode (C. A.), Surg., Gyn. & Obstet. (Chicago), 1920, 30,
357-358.

Our knowledge of the etiology of goiter has not kept pace
with our methods of treatment, an empiricism accounting for
the prevalence of various types of enlarged thyroids. All non-
malignant goiters can be divided into (1) colloid, (2) adenom-
atous, and (3) hyperplastic, and are either toxic or non-toxic.
This simplification of the classification we owe to Plummer
and it has greatly cleared our vision of a previously hope-
lessly described pathological condition. The etiology con-
cerns us more than the treatment, and every goiter indicates
a lack of some form of prophylaxis. The thyroid may have
very little connection with the other glands of internal secre-
tion, as to date it is extremely rare to find a goiter, hypo- or
hyper-plastic, with various abnormalities of other glands. The
infectious theory has lately gained popularity, and rarely do
we find any type of goiter without a suspicious pair of ton-
sils or alveolitis and no goiter has been properly treated with-
out the eradication of such foci. The author reports eight
eases of toxic goiter (three adenomata and five hyperplastic)
following immediately on the attack of epidemic influenza;
the toxemia from the goiter succeeded the attack of influenza
so closely that recovery from the latter was not complete be-
fore the symptoms of thyrotoxicosis began. There had been
no toxie signs or symptoms from the thyroid previously. The
close relationship between the two conditions is so marked
that it can be accepted as a most convincing proof of the
etiological factor being bacterial. At the time this abstract
is being written the same author has observed fifteen cases all
following epidemic influenza.—Author’s Abst.

THYROID, Myxedema in total aplasia of the— (Ueber myx-
ddem bei totaler Thyreoaplasie). Rdssle, Miinchen. med.
Wehnschr., 1920, 67, 735.

Report of a post-mortem of a dwarf of 28. No trace of
thyroid could be detected. The skeleton was formed as in a
child of 4; there was a diminished endochondrial and periosteal
ossification. Arteriosclerosis, especially of the aorta was seen.

710 ABSTRACTS

The hair was poorly developed; the skin showed typical myx-
edema. The uterus and ovaries were as in a normal woman
of 28. Only one parathyroid was found. The hypophysis
was large (725 milligrams). The thymus consisted only of
fat. The pineal, pancreas and spleen were normal. The zona
glomerulosa of the adrenals showed a marked sclerosis.—J. K.

(THYROID ADRENAL) Fluctuations of thyrosuprarenal ac-
tivity in general diseases. Sajous (C. E. de M.), N. Y. Med
J. (N. Y.), 1920, 141, 265-269.

Such diseases as pneumonia of the aged, dementia precox,
influenza and the like represent failures of metabolism the
result of toxins which affect the endocrine or defensive organs.
Such diseases, therefore, should be treated along the lines of
organotherapy, especially with adrenal and thyroid prepara-
tions.—H. W.

(THYROID) Urinary incontinence of hypothyroid origin (La
incontinencia de orina en el hipotiroidisma). Salgado (A.
A.), Innaug. Dissertation, Santiago de Chili, 1918.

Urinary incontinence of hypothyroid origin is definitely
recognized by many authors; in such eases thyroid prepara-
tions constantly give favorable results. Salgado reports
seven eases of this sort. In his experience those eases of
enuresis that are accompanied by fecal incontinence are al-
ways due to chronic benign hypothyroidism.

[The problem of the relation of endocrine conditions to
the physiology of the sphincters could profitably receive care-
ful and extensive experimental investigation.—Ed.|—J. R. P.

(THYROID) The selection of operation for exophthalmic
goiter. Sistrunk (W. E.), J. Am. M. Ass. (Chicago), 1920,
74, 306-308. °

Of technical surgical interest.—F. C. P.

(THYROID) Goiter in skiagrams (Der kropf in Rontgenbild).
Sommer. Deutsche med. Wehnschr. (Berlin), 1920, 46, 616.

Of no endocrine interest.—J. K.

THYROIDAL constipation. Strauss (S. G.), N. Y. Med. J.
(N. Y.), 1920, 111, 281-283. -

The establishment of thyroid deficiency with constipa-
tion is an indication for thyroid therapy. Doses of from 1/10

ABSTRACTS qi

to 2 grains may be used without other catharties until recov-
ery is complete.—H. W.

(THYROID) Comparative investigations on the changes in
the thyroid in different diseases. Takeuchi (K.), Verhandl.
d. jap. path. Gesellsch., 1919, p. 58.

The author advances the following conclusions on the
basis of his study of the thyroid in 325 eases: (1) The ‘‘thy-
roiditis simplex’’ of de Quervein, which consists chiefly of
abundant desquamation of the epithelial cells and reduction
in the amount of colloid substance, is not, as he supposed,
specific for infectious diseases, for these appearances are less
apparent in typhus abdominalis and spirochaetosis icterohem-
orrhagica than in non-infectious diseases. (2) Since these
changes are more apparent in heart failure, diseases of the
larger blood vessels, nephritis and cirrhosis and cancer of the
liver, he is of the opinion that there is some connection be-
tween changes in the thyroid and alterations in the circulatory
system. (3) In tuberculosis, malignant tumors, etce., the thy-
roid is more affected when the chief lesions are present in
the thorax, which indicates a further connection between
changes in the thyroid and the organs of the chest.—E. V. C.

(THYROID) On the influence of complete thyroidectomy
during pregnancy upon the development of the fetus and on
the duration of gestation. Ukita (T.), Acta Scholae Med.
Univ. Imp. in Kioto, 1919, 3, 287-297.

This report is based upon a study of the effect of thy-
roidectomy in six pregnant rabbits. Unfortunately no nar-
cosis was used. Assuming that the thyroid gland begins to
function in the fetus after the middle of gestation, the opera-
tions were performed between the seventh and tenth days
after conception, in order to obtain the maximum effect. Ma-
ternal thyroidectomy immediately disturbs the development
of the fetus in utero. The duration of pregnancy is nearly
doubled and the young at birth are small and weak with
hypertrophied thyroids and show retardation in development
of their centers of ossification. The author believes, with Hal-
sted, that the increase in the size of the thyroids is compensa-
tory to the maternal thyroidectomy. The article is in Eng-
lish.—E. V. C.

(THYROID HYPOPHYSIS) The interpretation of headache.
Wilson (W.), Practitioner, 1919, 103, 274-296.

712 ABSTRACTS

Among other causes of headache, the author mentions
menstrual and climacteric headaches the mechanism of which
he finds difficult to explain. He refers also to headache asso-
ciated with hypothyroidism and relieved by thyroid extract;
headache due to pituitary affections and usually occurring
early in the disease before any obvious change in skeletal
structures. The pain is situated deep in the head behind the
root of the nostrils at the site of the sphenoidal sinus. These
pituitary headaches are intermittent and the patient is quite
prostrated. Rehef from the attack is quite sudden. He con-
siders these patients suffer from diminished pituitary activity
and relief is obtained by administration of whole gland pitui-
tary extract provided there is no malignant growth or spread-
ing eyst.—H. L.

(THYROID) A comparison of methods for determining thy-
rotoxicosis. Woodbury (M. S.), J. Am. Ass. (Chicago),
1920, 74, 997-999.

A report of the observation of a selected group of eleven
cases of thyrotoxicosis by clinical study, by histological ex-
amination of the thyroids removed at operation, and by post-
operative progress. The clinical observations included a eare-
ful history, the response to Goetsch’s epinephrin chloride test
and a study of the basal metabolic rate as determined by
oxygen consumption (Benedict portable apparatus). Wood-
bury states that while the epinephrin chloride test is generally
conceded to be essentially an indicater of hypersensitiveness
of the sympathetic system, it appears to be a fact that posi-
tive responses to the test are more common in eases in which
there is thyrotoxicosis. The test should be used especially in
doubtful cases since it stimulates closer study and offers ad-
ditional aid in formulating a diagnosis. Observations of the
level of basal metabolism alone, as now estimated, should not
be regarded as sufficient criteria in determining the presence
or absence of toxic states associated with the thyroid. The
author concludes that while functional tests are of great value
in the compilation of evidence, especially in relation to the
degree of toxicity, reliance should not be placed on any one
of these. The diagnosis should be based on the results of a
complete examination, with special attention to the possibili-
ties of errors in psychoneurotic patients.—F. C. P.

Endocrinogenic VISCEROPTOSIS (Les ptosis horménicas).
Quaristi (V.), Prog. de la Clinica (Madrid), 1918, ——, ——.

In addition to visceral ptoses due to mechanical disturb-
ances, such as genital prolapse in women who have borne

ABSTRACTS 713

many children and suffered from lacerations and relaxations,
the author believes there are others manifested in young per-
sons which are due to endocrine alterations. Among such are:
(1) Visceral dislocation due to spasms or ptosis; (2) Vascular
disturbance, varix, etc.; (3) Neuroses. These three symptoms
are exhibited most clearly in varicocele and rectal prolapse.
There exist, moreover, genital prolapse, nephroptosis and
gastroventeroptosis, in addition, and in all these cases we
speak of consecutive neuroses. It is the author’s opinion that
these disturbances ought to be regarded as coexistent, and
that they are due to lack of muscular and vaseular tone. This
being determined the cause is to be sought in the endocrine
and vegetative systems, especially in suprarenal and hypo-
physeal insufficiency. The rational treatment of these con-
ditions is opotherapy.—E. B.

(VAGOTONIA SYMPATHICOTONIA) Experiments on the
influence of the involuntary nervous system on the blood
(Untersuchungen zum Einflusz des vegetativen Nervensys-
tems auf das Blutbild). Friedbery, Deutsche med. Wehnschr.
(Berlin), 1920, 46, 480.

Drug injections were made in children. It is not enough
to examine the blood-picture of clinical cases of vagotonia or
sympathicotonia, but the involuntary nervous system must be
stimulated artificially and the blood-picture must be examined
after this stimulation. It was observed that after stimulating
the vagus with pilocarpin, depressing it with atropine or
stimulating the sympathie with adrenalin the blood-pictures
were practially identical. This is a strong argument against
Falta’s theory of the existence of a vagotonie and a sympatho-
tonie blood-picture. The action of pilocarpin and adrenalin
on the blood has probably nothing to do with the nervous sys-
tem but is due to an influence on the hematopoietic organs.

—J. K.

Acute and chronic VAGOTONIA (Ueber aktute und chron-
ische Vagotonie). Feilchenfeld (Leopold), Deutsche med.
Wehnschr. (Berlin), 1920, 46, 627-629.

The author makes the following classification :

I. Acute vagotonia with spasms of vagal origin; in these
cases patients are women and usually hysterical. They suffer
from fits beginning with shivering, headache, giddiness, nausea
and vomiting. Often loss of consciousness is observed; the
patients are pale; the pulse is slow.

714 ABSTRACTS

Il. Chronie vagotonia: In these cases physical stimuli
may cause the attacks as described under I.

Ill. Paroxysmal tachyeardia.

IV. Acute vagotonia in asthenocardia.

[It is a very old fact that a hysterical woman may have
attacks and that diseases of the heart may give symptoms re-
sembling those under I, but the evidence that they are due
to vagotonia is by no means convincing. |—J. K.

The abstracts in this number have been prepared by the
staff, assisted by:

E. Bonilla, Madrid, Spain.

C. H. Green, Baltimore, Md.

L. G. Kilborn, University of Toronto.

F. C. Potter, Kalamazoo, Mich.

With the permission of the editors, certain abstracts have

been quoted from ‘‘Physiological Abstracts,’’ ‘‘Chemical Ab-
stracts’’ and ‘‘Surgery, Gynecology and Obstetries.’’

INDEX

Abderhalden reaction, in epilepsy
with -adiposity
Abdominal viscera, congestion of,
following adrenalin adminis-
tration
Abel, J. J. (Macht):
and pituitary extract
Abelin, J.: Physiological action
of proteinogenous amines. I[V.485
— (Jaffee): Physiological action
of proteinogenous amines.
Jie

Histamine

OTe ree ere ea lefencicns o.<u5).dh3,08 050 4
— — — — control of aL
— following thyroid resection...3
Acetone in cerebrospinal fluid... 4:
Achard, Ch. (Ribot and Binet):
Action organ extracts on hyper-
glycemia
Achrondroplasia, effect on
struation
Acidosis and diabetic epilepsy. ..632
— bicarbonate of soda to reduce. 295
— control of, in treatment of dia-

men-

DI CUECSMEroeene o octenee is rey enhone 7s coke 149
— in diabetes, as related to crea-
HUTA Cantal oliey erst enzud ie. «jis 633
—-—w— mellitus ............. 290
—— — — — influence of menstru-
AION OW 2 eve 2.4 50's 449
— parathyroid tetany ...... 678
—-w— relation to diabetes ...... 447
———tetany ..............4. 680
—— treatment of diabetes....304
— preoperative anti-diabetic
ERLE MTIMN IN le gaye) da au'eiie Chie So en sh 'exe; « 29/5
Acromegalic eunuch, report of. .460
— gigantism, report of case... .463
Acromegalic manifestations, club
HOTESS Rp a See ae 271
—syndrome with hypophyseal
tumor, X-ray treatment....271
— tendency and internal secre-
LCI EEN ieledct so: eiioheyeuer bee 6 461
JC pri(2fa i ce 363
——accompanied by diabetes in-
REDEETENDES catemr reas fons: Vorie |s' lociauctei'e: ace 656
eM DEUCE: 6 a6 cher é.o.i0) 0. 6) avelens 13
SS = SCE ee oe 281
== (TG 1 USie2oo., ODO

———in miner of 48........ 130

Acromegaly case report........ 465
— due to hereditary syphilis....644
OX PLAN AGOM Obs ete tiene en eres aeSat

— following extirpation of hypo-

DY SISs UUM OL eres cet eoueret lr 136
— gland extracts useless in..... 463
=i SLOnVar Olea i CASC)u-nistelslokoneneie 461

— hypoglycemia in
—in two cases of hypophyseal

MbhenOP oe DpEsetko o Oars cmc 62
—=—=4TLC-GUCCCu ees sors n eh eisieks) ctenelas 479
——=PathOenesis OL. 36 cick « « 226
—relation between anomaly of

hypophiysis: and). ..2-% .....- 276
—— TENOGE OL CASS: <2. © «i ee) «ii hors 27

—report of case beginning dur-

PINE AODULDOLCY: ysis. islete ne ls) ogee 466
— summary of three cases...... 274
treated swith radium. ..... 2. 649

— with diabetes, report of case..276
—-— hypophyseal sarcoma; abla-

tion followed by dia-
WSUS eee eau Tole ie Wemnew's emotes 57
—— X-fay treatment ....... 136, 283
Adams, H. S.: Decomposition of
oxytocic principle of pituitary
SoU Geo oom ome.ctc 6 268
Addisonian symptom complex,
CAS CRE choc cca er sieters «ogee 432
INGGISONUS, GISCASG, <...0 6. 0 «-S00

—-and diminution of adrenin. 43
— — — pernicious anemia, simi-

larity between ...... 471
—— case from surgical wards.. 95
——-—of ....... eons 242, 434
SS Shin faite CONE UWS Soeee ovo bc 610
—_— case with unusual onset... 95
= (Ahi) oli Be agamo mcs Goo Cc 437
——-—Sahhanionl atcyode Bom oe coc 434
—-—combined with congenital
neuroblastoma, case of..612
— direct transmission of....435
———— hy poslycemia. IN): =... 2... - 458
TU CIZal AS) CAUSE) OLwc-ueieuels 97
—_ —— |ow: blood pressure im... .. 238

—-— lymphatic tissue in thyroid
in case of :
—-— occurring with Graves’ dis-

ease, an explanation... .437
Sy th Cite ew Rote ae oe 6 F 103
— — pigmentation of limbus

COTHECAG LIte vounns eel useeners

Addison’s disease, reactivity of

Omaagmenalin test in)... .. once. 3,4
——recovery from, with au-

MOIS ye vevccvoce fo okelets tee 609
—w-—ssuprarenal treatment of;

TECOVCLY <ila sete 609

—-—— treatment of ............240

— —tubercular origin of...... 103
——with ‘‘white line of Ser-

fent’” Sven. Soieerava.e 99

Adiposis dolorosa, report of case. 432
Adiposity and menstruation in

eirl Of Sine Aw. pee ree eee 310
— -— posterior lobe deficiency. ..186
— cerebral, =. cas tcki eee Rese 186
— VELSUS) lAaCteaAlans caer fe 432
—epilepsy combined with case
OL tS axe cnc eee eae eee 128
— hypophyseal, with dwarfism. .656
— menstruation in cases of....467
—two cases of lacteal......... 432
Adiposo genital atrophy, report
Of Case timy DOV = see see oe 468
—-dystrophy .............. 185
——-— description of three
CASES nce eee eee 467

— — — in man following trauma

ORFS ee etre tes ore 12

— -—-—influence on, of hypo-
physis extirpation....136
—-—-report of case........ 469

— - syndrome, two cases of, in
UGUITESH PE eee enc accen Smee 655
Adiposo-genitalis, case of....... 652

Adler: Thyroid and heat regula-
LIONS sche oeyersie ee Sa ee, cs 160, 690

Adraid, Ch. (Binet): Biological
study of case of progressive

MVVOPAEMYs se, So cen cherene cic eee os 286
Adrenochrom treatment of tuber-
CILLOSIS ats ic eee eee 610

Adrenal, adrenals. ..95-103, 235-242

432-439, 609-617
— action of dietary deficiency on.642
— — — drugs on output of adre-

MUR THRO wis ot.cia eo oc ant:

— administration of desiccated in
Addison’s disease.........240

—adrenin in vencus blood of,
GIECRLOMPLeSSIEbe a ess sneer 101
— and automatic nerve cells....253
<= = POVIED! 3 ora atic see 119

—-——hypophysis, combined hy-

PerlLunctiony Of =. ee 13

—-—nicotine apnea .......... 438
——= ==" pathologsy >. os hemes eee wees 613
—— —— MUDELLY. “See es ease oe ene 481
= = TICKOUS “SNe cece ete oe sie mee 440
—-—sugar puncture ......... 99
— tuberculosis ............ 235
— — toxi-infections ........... 100
— apoplexy, acetone and....... 450
—-in small children........ (ialal
= ‘asthenia; sc kcs ccc wee eae tome none tees 98
— bleeding in new born........ 439

— bodies, effect of inanition on. .408

Adrenal bodies, function of..... 408
— -— influence on metabolism. .408
— capsule, hematoma of ....... 235

— cataract in relation to diseases
(0) ORR nen er eto ty ols > 3, co. 114

—changes in experimental
SCUDVY ™ (2 .telh-c ee sue ae Rianne 615
—chloroform narcosis and..... 438

— cortex, effect of injection with
CXtPaACt. OL eis oso eee eee 238

—-—-—— on other endocrine
OTLANS* wee ee 612

— — hemorrhagic in case of dia-
betes... 7... 3 See eee 300

—-— malignant tumor of, invad-
ing, they liver: «cack 612
— — tumors of. 3.45 16 see 372
—-—type of pubertas precox...372
—-tumor of, with virilism...614

— deficiency, endocrine imbal-
ANCE Mo ths. aio ee 236
— —jin cholera and seasickness. 241
——-— scleroderma .......... Sal
— dependence of function on
other-elands* ss see aT
—derangement, two cases of
favorably treated......... 118
— derivatives in thyroid neu-
TOSCS( Sc cents coe ee 254
— development of, in hedgehog. 609
—— Man %:.4 3 eee One

—discharge of, in relation to
rate of denervated heart. ..619

—— thyroid and .......02.08e6 386
— disturbance in the course of
hereditary. sylvlise--. eee 97
—effects of quinine on ....... 435
—enlarged, filled with tubercu-
lows materiale. eee 95
— enlargement, case.......... 95
——jn starvationy $2.20. 04008 97
— excretory innervation ....... 103
— extirpation of one and one thy-
rold-emect of. =. < ..un nee 259
— extract in treatment of Erb’s
miyasthenitayt s.o..ce eee 609
— —-— treatment of metrorrha-
gia {28 ee eee 651
— fluctuations of activity of, in
general_ diseases: “.. cere 709
—— MIN CtIONS Ole ors 6 ie lene 1O2 ASG

—egland extract, whole, effect

chemical substances on ac-
tion Offa 2. as 2.3 oe 110

— — — — jin treatment of vom-
iting of pregnancy.237

——and emotions under bom-
Dardment) 2 40. 25165. 2m
—-—and toxic assaults on body. 261

— - blood pressure changes fol-

lowing excision of ..... 433

— -— in congenital syphilis..... 613

—— —— — diseases of soldiers... .106
— — — influenza and influenzal

pHeumonia® =a. 97

¥ 1 = oo"

Ss eee i es 1 el

a

Adrenal gland in rabies........ 435
—-—scorbutic diet and....... 100
— — tuberculosis destruction of.104
—-—two functions of ........ 437
—w-—(whole) administered in

case of dyspituitarism. .137
— glycogenic function of, nerv-

GUSTCONETONION <2. 5 sc)-0+ = =< 436
— hypertrophy of, following use
GL pimlitary.sextract: ..2...<. 128
—— —in pregnant rabbit..... 242
—in congenital syphilis of hypo-
(MDVRTS” “SS eo orca 281
—-— etiology and treatment of
TT 617

— -— hyperglycemia of asphyxia.240
—-—man with atrophy of hypo-

Dig 2a SS eee 280
—-—— Marsupialia .............235
—in pituitary disorders ....... 359
—— MPM PCRAUTOISCASC 2.2 205 oe sae 104

—-—vomiting in pregnancy...237
— increase in weight due to diet.100
— influence of thyroids on func-

DTI @LE Ao Re oe (ar
—-on menstruation ........ 412
his iOS ee 436
——ecase of acute ........... 238
— — clinical study two cases...433
—w— during influenza ........ 610
——w— pregnancy ........... 444

— — following novarsenobenzols,
adrenalin treatment of..614

— —jn infections ............ 437
———scleroderma ..........312
—-—w—war pathology ....... 609

—w-—marked pigmentation and
mucous lichenous growth

“oh Fi Ja. ek Se 610
— — reactivity of adrenalin test

ne) (i 34
—— Sergent’s white line in... 95

— irritation of thyroid gland...328
— medulla and secretion of adre-

Df 2 VE er 409
—nervous control of secretory
eth ec i 96
—of thyroid fed rats, adrenin
COiiicih Vp 496
—output, relation to hypergly-
ORS By ee 438
—plethysmograph ........... 612
— quantitative determination of
material components of ... 41
— relation between central nerv-
OTS SVSECTH SANG. ho5) occ 5. oc o 99
—— to electric conductivity of
SGC) oe 20
—-—— metabolism .......... 410
—-—— psychoses ............ 639
— —w— vascular tone .........43
— secretion during pain, emotion
Lav eR ih s.o. ae 252

— — of, in case of acromegaly. .462
— sensitiveness to vitamine influ-
STCOS eM EnOOG ss ene oS. cine lo cbeere 276

Adrenal softening, post - mor-
TOT er Gore acne e oye ss 613
— substance antagonistic to adre-
pibhil we oye Soe a ee ee 260
—w-—jinfluence on growth of
DIAM EISSN eels <=. < 453
—— SYN GTOMEs ao Pee eens sats 239
— — contribution to study of...439
— sudden ‘failluresO& 2 onc ~0e - ibs li
— Sy DHILIS) Olin. sagen = eee = iba Lys
— therapy in Addison’s disease. 434
— -— in diseases of soldiers..... 116
—treatment of Addison’s dis-
ease, with recovery....... 609

— —— exhaustion, infections,
delayed convalescence,

CE G2 eS = hi ae povexs aoe 613
—— ‘tuberculosis. Of 22s. o< 02 «os 434
—'fmmMor Of An mac cpa atee 96
— -—w—renal hilus, case...... 438
—-— with early development of
Sex, Characters: ci. rsee one. 617
—type of intrauterine tumor...437
———— pubertas precox ...-.. tlt

— variations of cholesterin in. .611

—vein, central, smooth muscle
Ce ete lye ode ee ee 615

— whole gland therapy in infec-
ELOISE GISECASES oc. - cc, o cee eine 427

Adrenalectomy (mono), effect on
body weight in animals......259

Adrenal-pituitrin balance of
DL GO Ree cs 6 :520e Ss or 235
Adrenal-vascular syndrome..... 611

Adrenalism, adrenin treatment of
CHU ORTCMS ax hoeucvarers.aievn tence acer 238
Adrenalism, case of chronic..... 47
AGTenIni eee oo so ane 104-113, 243-247

439-444, 618, 621

— action against soluble toxins .108
— -—of, enhanced by blood plas-

ma of Basedow’s disease.3 29

——-——-on veins ............. 439
= TH LOO G, <a. So. wletenes sh + “suel-ebe 713
———_ — — pressure .......... 95
— — — heart and blood vessels..107
—-——_ —_ hyperglycemia ........105
— —-—muscular coat of diges-
LUV. Er AC br Sesleeny ts aieeey 112
—_ — —turtle heart ..........244
—-—— X-rayS OM ..........04-. 442
— administration to epileptics,
PILE eek parsacuset 2 bakes ee LO
— alteration of vasoconstrictor
ACHIOMNIOT ep odovere cohen apc tens 441
— —-—vasopressor action of,
after treatment with
bacterial products ...441
—and blood pressure......... 498
——-— diastase, Lormation, ~.....290
— -— heart irregularities ...... 50
— — increase in blood sugar...240
—-— permeability of blood ves-
SOILS ie wy tei ooh en cee te 243

— — pituitrin reactions, opposed
toweach ethers. 2. )ien 4 35

Adrenin .and pituitrin, relation-

SUP BDOUWIOON! 5 occ. soe 8 clea eee 387
—-—tonus of blood vessels....
— — vessel contraction
assay of, in blood serum; prog-

nostic significance of find-

ings G18
-attempt at suicide by taking.. 620
— cardio-vascular reaction to

large @OSeSi-\s a5 a hee eae 166
— changes in blood pressure fol-
lowing? injection oL =... 107

—content of adrenals of thyroid

fed-Tats7 Ve oe a he ee

— -—- blood in case of heino-

Dhar OR ee ee es 247

—cure of abdominal complaints.444
—cutaneous injection, effect of

Chy noid’ ees he ee ee aT,
—discharge, relation of to
changes in denervated heart

PACs. 5 ieee 0 eb Tre ee 619
—effect of brain circulation in

PVT A ess ets Sete, ete 246
—-— -—jinjections in “‘irritable

heart of soldiers”.:..113
in aged
into muscle..... 621
circula-

— — — — of,
— — — large doses on
tion
— —-— on rate of locomotion of
Planaria Bre kee
—-——on blood pressure and
bile formation 4 on lOds)
— — —-— diastase .......... 243
pressure ourve in
children
—-——on catalase production....
— — —electro-cardiograms in
“irritable heart?” 2%...
causing hypersecre-

246

— emotion
tion of
=—— NADI. .CASCUOR “Aca. oe ee ee 49
— hemorrhage and ....... LORS 0G
— hyperglycemia and sugar con-
Cent Of Cells rc ek ee 114
— — influence of ovary on..... 667
Adrenin hypersensitiveness
in! toxic, thyroid istates;. ...... 699
— in annelids
— — asthma
— -— blackwater fever
— -blood, increase of,
by emotion
— —cholera and seasickness...241

caused

— chronic adrenalism 238
—w— diphtheria .............. 246
————— Ji [KOYOG) Goranoobeoe 102
— — obstetrics “5. 25.2% 8 so. 444

— -— physiological emergencies. 408
— — surgical shock .......... 109
— — treatment of irritable heart.154

—— — — —seasickness ........ 23
— — — — sympatheticotony pallies
— — —— ‘nitroid crisis’’ and

“serous apoplexy’’..106

Adrenin in yenous blood of adre-

nals? . 225 et se eee eee 101
— increase in asphyxia ........ 240
—-— of chemical substances on

ACHON Of ei a. ere 109
— — — heat regulation ....... 620

—-~ on blood picture of ma-
laria: o< .3hees eee eee 110
— — -— blood pressure ........238
— injection and adiposity.....:280
—-— in dwarfism ............ 278
—-—-—enlarged spleen ...... 104
— — — Graves’ disease ....... 169

— — reaction of, in neurocircula-
tory asthenia
— intravenous injections in treat-

ment of hemorrhage...... 439
— mode of action on bacterial
tOXInS” =... Ys eee 245
—modification of action of, by
MOrphimie <2 cs 4 ces eke ee 244
— neutralization of toxins...... 108
— not a free secretion......... 101
—of medullary origin, tonic ef-
fect 3.0%) Lice ee eee eee 437
—-—no use in treatment of in-
fluenZa 9.22%: see 98
— output, essentials in measur-
VN eee ae Oe eee 618
—-from adrenals, action of
drugs’ On Us. eS eee 241
— paradoxes in dementia prae-
COR SPURS ee en ee 244

— permeability of placenta to...618

—physiologic action of, dis-
charred” 223.2 eae ee 236
— point upon which action of is
Exerted se stiticut | tee 35
— production of epilepsy in hu-
MANS" 2 sre So. el etae ot nee monee Ae
— products of muscular activity
NeEWLTAliZeG Dy; /.t.persneneenenee
—reaction, alteration by other
organ Cxtracts: 4 -ci-eee eee 87
—— and heart? 2.0%. <is2. 2 243

— —as affected by guanidin...619
— — —jnfluenced by endocrine
conditions and thyroid

administration soso Ges
— -— in patients with adrenal de-
ficieney’’-< + 26s shies 243

—relation between character of
reaction and thyroid activ-

LEY se. Pete oe ee eee 440
—— SECTEtIOM {oder eons 409
—'— in rabies: <2... 2. Se wae. 435

—-of, and arterial pressure. .244
— — relations of central nervous

SyStemi “tor. . wees ceonee one 443

— substance in blood serum re-
sembling "is< ..%tiera toss ee 442
—= LESE 2 ie SR ee eee eee 333°
— —reaction tO... o.cse ee es 33
= — RH yonlesaeNl soo onaeouss 34
— tests, reports of results......274
— therapy in osteomalacia..... 286

Adrenin therapy in senile pneu-

TIVO AEE Neces Glek Selsle cise Ss ee aba bak
—treatment of adrenal insuffi-
ciency following novarseno-
ETNA Eee eats cas ss sie 2 614
——w—asthma ......... 108, 241
—-— —bronchitis ........... 108
— — — influenza ....245, 247, 444

— — — gestation osteomalacia. . 444

———lung diseases......... ES
— — — manicdepressive psycho-
SS) 1.6 5.605 BAe Aan eee 616
—-—-— osteomalacia of preg-
ERNUC Vawenche sf svecece ole -d is 247
—-— —ptyalism during preg-
PERM GV aue st ssak to ot toss 444
——w— rickets .............. 440
— —— vomiting of pregnancy..621
—secreting tissues of sympa-
thetic nervous system..... 108
— unusual action in elderly per-
SOS, eighth aha Saleen eee 243
—value of curved needle injec-
tion in intercricothyroid re-
FETT) se Gyche OC CAti nena ea ee 443
—vascular reaction to small
COSCSMEMR EE ES hinee tabs. Shes 105
Adrenin-pancreatic solution effect
Guasmoppnemuscle st... 110
AGTENOLEODISMS) & ss ..-o-s--.--. 2d
Agnel, E.: Adrenal insufficiency
SAG! Noes, a8 ey 609

Agnew, A. P.: Pituitrin in labor.150
Aievoli, E.: Hypophysis surgery.268
Aikins, W. H. B.: Radium ther-
apy in hyperthyroidism...... 160
Albu: War and diabetes....... 290
AlbUMINUTIC: TEtIMItIS 2.7%... 2s ; 303
Alexander, L. D.: Entotic aural
bruit, tumor pituitary region..268
Alimentary glycosuria in case of

ACTOMMCL LUV): setelerc 2 cBecle es see ee 1}
Allen, B. M.: Development of
thyroid glands of Bufo....... 160.

— Relation pituitary and thyroid
glands to iodine and meta-
morphosis

Allen, F. M.: Experimental stud-

TOS COTM GUADELCSc.<- 5. . fo oo eee os 446

— Principles and possibilities in
dietetic treatment of dia-
betes

— (Wishart): Carbohydrate me-
tabolism and diabetes: glu-
cose tolerance of dogs..... 626

—w-— Experiments on diabetes:
renal sugar threshold.. .626
Allen treatment in diabetes.....

a OS eee Tas, ole Oa, oO4.
— — —— report of case...... 295
— seven cases...297
— — — — jn young ..........304
— — —— mellitus .......... 296
Alopecia, endocrine disturbance

RESPOMSIDIG: LOL... 2c +. cle = ose 181
—of emotional origin, case of. .622

Althen: Goitre and old tubercu-
LIC OMR atch ae ed. SoCIS CeO ona eae 691

Amenorrhea, a case of complete. 229

— deficiency in pituitary body in

CAS HOLM rerc erecta ors eet hes 269
— due to hypopituitarism...... 412
— endocrine therapy in........255
— following shock of war...... 257
—ovary in etiology and treat-
TEN EM OLE Sraceeweresers oxsyer8) s Sis 671
—treatment with hypophysis
SUPSUAMCC, a sn iewatelie artes cole 274
Anaesthesia for goitre operations.170
— in diabetic operations....... 295
Anaesthetics, various, dangers of,
INGdiapDekeSet.. css ee ae 674

Anatomical constitution research. 45

— research endocrine organs... 45
— study of endocrine organs,
need for more careful..... 331

Anders, J. M.: Considerations in

medical treatment of goitre...324

Anemia, reactivity to adrenalin
testsin proLound. <acesce see: 3
Annelidswadreninein® sce. seh 108

Anklesaria, B. N.: Acidosis in re-
lation” to” diabetes’ ..°..22.. 2. 447
Antibody formation favored by
Ehiynordectomiyy =... «2 = eee. ele 490
Anti-edema substance in foods;
action of, on adrenals ....... 642
Antipibuitary Serum) =....62.00 130
Antithyroid serum, method for
evaluation (Of 5... © oxo cre cia 486
Apert, E.: Consideration of sex
differences in pediatrics...... 684
— (Cambessédés): Influence of
sex on frequency of pertus-
SUS) ORNS ERC ran Re tga oc 685
—(Flipo): Influence of sex on
gravity of influenza....... 684
Appetite, decrease of, a symptom
of thyroid intoxication....... 57
Aragao, H. de B.: Problems of
rural prophylaxis in Brazil
(Chagas disease) 22 -.).. 22%. 691
de Arcaute, L. R. (Palancar):
Thymus death in children....689
Armitage, H. M.: Modern treat-
MVEME Oh SGCTUUY: oc 22 t+ ee 2 645
Arnason, J. S. (Vincent): Thy-
roid and parathyroids....... 199
Arnstein, A.:_ Hypophyseal poly-
CUD STA Meets oc ne ts ess cen ace 125
— Hypophyseal polydipsia and
I OyUTaeers ceeteee oes oe vevernnay'e i PAs
—— Sirumiprivia tetanic ....... 485
— (Schlesinger): Unusual ac-
tion adrenin in elderly per-
SOUS Grete hee resreiaeneees 43
Aron, M.: Histogenesis of Islands
Of Wangernanse tae. eral gies ene 672
Arrillaya: Adrenin and auriculo-
ventricular dissociation ...... 243
Arsphenamine and neoarsphena-
mine plus adrenin 72... . es. 106

Arterial hypertension, reactivity
Hieaarenalin- test IN. ...s awe.6 34
— pressure and emotions of war. 257

Arteriosclerosis and endocrine
GasSuUnOaNnGes: <..%s \<)« cee aetere 259

FATEMEItIS: Gilet An, < svcd eens 120

Asami, G.: Follicular atresia in
thie! “rabbit.” 2.5.) eae 475

Ascher: Blepharochalasis with
goitre and doubling of the mu-_
cous membrane of upper lip. .324

Aschner, B.: Internal secretions,

practical synecolory ee ans: e 469

— (Bauer): Pathogenesis of dia-
betes? in'sipidiise a: ease oie 648

—-— Permeability of blood ves-
SOlSi j. sowec urdu eae ore 243

Ascoli, M. (Fagiuoli): Pituitrin
POST J stccep sh cncuchedmerem hori cw Roa 33

—-— Thyroidin subepidermal
COSE © 5.4 Fi cols aocentcton enc 387

—-— X-ray treatment of hypo-
physis: in asthmia’ <=. ... 567

Ashe, J. S.: Ovarian insufficiency
as probable cause of epilepsy..475
Asher, L.: Action of thyroid hor-

TMONEE cirsparen eae beho aca te ica 691
—-—Nervous control secretory
function of adrenals.... 95
Asphyxia, effect of, on adrenin
dis char eesias ee meise. sacdseie, nee 619
— part played by adrenals in hy-
perely.cemilas Ob. ein ue 240
Association for Study of Internal
Secretions, purpose of ...... 602
research work
outlined .... 44
Asthenia due to failure of adre-
nals to secrete adequately.... 99

Asthma, adrenin treatment of...
eben Ona Qe aioe A BOS DAM sence
Asthma, endocrine factors in....622
— reaction to glandular extracts. 49
— thymic, in infants, treatment.483

— thyroid treatment of........ 473
— treated by radiation of hypo-
WHY SIS orb sen5 -aclts cies kemekclcliek ek OD ONL

— use of adrenin in controlling. 245
Athias, M.: Effects of castration
upon uterine movements .....665
— (Ferreira de Mira): Effect of
thyroparathyroidectomy on
castrated guinea pig...... 692
Athyroidism, thyroid medication
DIV oS to encsptaleness iodo OU ae ET 45
Atrophia adiposo-genitalis report
Of CAaSCMINUDOYsie) ae 468
Atwell, W. J.: Development of
human eny pop hysiscess es ewe 461
Aub, J. C. (Means): Basal metab-
olism in hypothyroidism..... als
— — Basal metabolism in exoph-
Lnalmicee one... sere 336
Auto-intoxication as cause of dia-
DEtICL COMA = cae toneieeehe > <acaorenee 628

Autonomic hyperirritability in

DLCEMANCY: co. clare Chere 668
Autonomic nervous system ..... 194
———and endocrinology ....606

— stomach ulcers...184
— — — arrangement of........ 248

— —— effect of intracutaneous
injections of endo-
crine substance ..... 387
— system in disease .......... 642
—-—w-—egoitre .......... 3845, 346
Axolotl, metamorphosis of, as af-
fected) byathyroid = eso ee TAial

Bacigalupo, J. (Perazzo): Adre-
nalishematomiay ae eae eee 235
Bang, Ivar: Diabetic lipoidemia.142
Balen, M. J.: Addison’s disease. 235
Ball, C. F.: Vital thyroid para-

ChiyroldwactiviieleSyccrs seme eaeweneene 486
Bandler, S. W.: Balance among
endocrine sOnean Seman eee 639
— Endocrine therapy of high
blood pressure’ 22 cee 692
— endocrines in gynecology.....254
— Instincts, emotions and endo-
crines: in) Sternilliiityos «ere 639
— Observations on action of pi-
tuitany, extracts... seen 269
— Therapeutic suggestion con-
cerning endocrines ....... 453

— What fears and states of anx-
iety mean to gynecologist.639

Barrus, J. S.: Murillo’s method

for evaluation of antithyroid

S@CPWM» i. tates rd eosin 486
Barbara, M.: Sleep and its hor-

mone regulation) ~—.-.0 eee 607
— Thyroid and thymus infections 93
— Thyroid in infections........ 692
Bardier, E.: Hemorrhage and

AGTeNALINe ara eysedesh he tere LO Se eOG

— Intravenous injection of adre-
nin in treatment of hemor-
THAZCe cs ee cake Oe 439

Barilari, M. J. (Marino): He-

reditary syphilis and tuberculo-
SUS» oo crane eeu ee a eee 644

Barnard, A.: Therapeutic future

of anterior lobe of pituitary. ..270
Barnett, E. C.: Goitre in an in-
fant. caSeerepont oe. eee 693
Barr, H. W.: Case of acrome-
lh Meare aoe Oe OCS tO 6 Gio os o< 269
Barrett, A. M.: Hereditary hypo-
amaronehisiel 95 Gage asoaoonbac ot 693
Barrett, Lady: Deficiency of pi-
tuitary. Do diyer- Seika kee eee 269
Barry, PD. T.: Uterine contrac-
tions and ovarian extract..... 286
Bartlett, W.: Subtotal thyroidec-
COMY: 2x00 Rs egret eo cee 694
Basal metabolic determinations
and thyrTo1d = LHerayaeeeereeene 175
— — rate, definition .......... dal

Basal metabolic rate in infantil-
ism

—-—-—only accurate index to

degree of hyperthy-
WOLGHSIMNN G. eels ss 6s. 85
Basal metabolism determinations
and pituitary disorders.......3854
= effect of adrenin on ...... V2
—-—/jin exophthalmic goitre....336
— ——hyperthyroidism ...... 705
——-——_-— hypothyroidism ....... ABT AS)
— —-— thyrotoxicosis ........ 712
= tea RTL BOER utr vesteitet apie diva! fares. 'S Ge 193
Basedow symptoms in tuberculo-
SIS liar Aye es de ee 330
Basedowism in a syphilitic fam-
BiVEE crea ec eee 2 2... 506
Basedow’s disease. See Graves’
disease.
NG ee 162
— -—clinical forms of......... 330
— — development of, and femi-
MEME StCGULIGY, 2 2.20 ee ss 324
—-—— diagnosis of ............504
—-— etiology of ............. 33
— — experimental studies .....329
—-— pathogenesis of ......... aoe
—-—report of case........... 326
— —significance of trauma as
ACME s tes, cyake tele, 0) (eis 8 327
—-—treatment of ............ 162

Batchelor, F. S.:
GONG ONUT Cm 5 cyls joie oe obs Suspect eos 324
Bate, R. A.: Posterior pituitary
secretion in treatment of mi-
tral regurgitation
Bauer, F.: Hypothyroidism, rick-
ets and tetany
Bauer, J.: Adrenalin and blood

A TiNRe ye ee ee 5
— (Ascher): Pathogenesis of
diabetes insipidus a7 .648
— (Aschner): Permeability of
IMIOOGSVESSCIS, oils e ec yew sere 243
Bayard, Otto: ‘‘Beitrage zur
Schilddrusenfrage’’—review ..606
Bazett, Henry: lLong-standing
case of goitre cured by inunc-
Ue i) 22 2 a 325
Bazett, H. C.: Time relations
blood pressure changes after
excision of adrenal glands... .433
Bear, J.: Posterior lobe pituitary
body and use in obstetrics... .269
Beaven, P. W. (Cowie): Supra-
renal glands in influenza..... 97
Becht, F. C. (Keeton): Hypo-
physis, relation to glycogeno-
SIM MNE ERC Tijol%e: “Gobet asp ce setts 129
Beck, Joseph C.: Giant forma-
tion in larynx accompanied by
hypophyseal trouble ........ 270
Beck, Harvey G.: Froelich’s Syn-
Si oiis> 4 lsc eee 185

Bey, L.:

Beckey, K.: Disorders of men-
struation and pregnancy after
accidents

Beeson, B. B.: Re emenanine
and neoarsphenamine plus

AGTeNInY =e eee eens eters cos 106
Belger, F. (Garraghan): Tetany
in the etiology of cataract....678

Beil, W. B Correlation of func-
tion with reference to internal

SCCLCLION) Hangin eine ee eree anak 640
Berard, Leon: Basedow’s disease
BGP AHO Gidice Mom aoe ait-alardo bab 162

Bergstrand, H.: Parathyroid
studies: I. Anatomy of parathy-

TOU: Glad See. caters sucess oaekens 478
— (Hoeggstr6m): Tertiary luctic
Eby EOUGUUIS te, erro el ha ec aterete 494

Berkeley, W. N.: Function and
clinical uses of pineal gland. .679
— (Koopman): New method for
diagnosis of toxic thyroid
states
Bernard, Suzanne (Claude): Re-
sults of glandular tests accord-
ing to previous endocrine con-
ditions
Bertolotti, M.: Radium therapy
of acromegalica
Betchov (Demole): Clinical
study two cases of adrenal in-
STAMIKCNCITON, Saye tere ioicioreictowd ao! t- Ol: 433
Beukers, A. C. M.:
pophysis
Beumer, Hans (Tseke): Creatin
and creatinin metabolism in
myxedema, and effect thyroid-
in on it
Bevier, G. (Shevky): Urea se-
cretion after suprarenalectomy.235
Control ot, Sex..-...- 1.6 152
Biedl, A.: Demonstration of an
apparent one-sided acromegaly .479
Bile formation and blood pressure
as influenced by organ extracts.659
——relation of blood pressure
(PO Sree treed AN Cac eae re 659
— not a factor in secretin forma-
tion
Binet, L.: Action epinephrin on
cardio-vascular apparatus....107
Binet, Leon (Achard and Ribot):
Action organ extracts on hy-
perglycemia
— (Adraid): Biological study of
progressive myopathy..... 286
Biology of old age............ 262
Birh, W.: Thymus hyperplasia
in children, clinical study and

EPOALTICM Us Ol mete cietie ot cout ebare 483
Bisgaard, A. (Novig): Blood am-

monia and neutrality, regula-

HON AM CDULEDSY) =o - em sie s/s tnenes 677

Bittorf: Case of hypernephroma.121
Bittorf, A.: Endemic rickets in
VLD er oneter coene st hes, ose ae 155

Bittorf, A.: Tumor of adrenals. 96
Blackford, J. M.: Thyroid intox-
MUNA TR Gy Pse eieh as one ak oh acs Te) isigetusyaite: alte 486
Blackwater fever, adrenalin in. .110
Blanc, Jean: Neuroses and hor-
MrOMOMtHeLADY, «ic sicko Monee 162
Blanc, Fortacin J.: Puberty... .481
Blank, G.: Blood picture in
hyperthyeosis and goitre..... 488
Blatz, W. E.: _Literature on func-
tion of thymus gland. ...22.. 156
Bloxland, A. J.: Carcinoma of
Phy O1ds eee Coreen te ee 695
Blencke: Infantile osteomalacia.139
Blodgett, S. H.: Diabetes melli-
CUS apse te shoaty cee ee ol 290
Blondel, R.: Development of
Basedow’s disease as an in-
creasing cause of post-war

feminine sterility ........... 324

Blood, adrenal-pituitrin balance
My Stren size Sard Sesion (sncueN a eee ue eee PAGS)

— changes in tetany (parathyro-
DTV.) ec sae tekcieckoaciahel cen eee ee 680

— coagulation action tissue ex-
CLACUS OMG taxees noweirel oo oe eee 506

— diastase, effect of adrenin in-
JCCHLONS 2. aires esse eee one 243

— diastase activity of, in hyper-
ULB ARONG MINI Go obhid Ga oS oeets 458

— influence of involuntary nerv-
OUSE SYSUEmM yan dares 5 oe alts
— lipase content of, in disease. .455

—-product of endocrine sys-

LCS 0 0 Leap e SOR RE US Sea ML Re oer 456

— lowering of freezing point of,
LN OTADETES: =. -aaerncetes inns ie PASM
— nitrogen in diabetes ........ 635

— picture in exophthalmic goitre.176

—pressure, action of adrenin

ONG ees gianni ston pac oo eee 95
—— -—— adrenals and —. 2 ce. 6 ccc 436
—-—adrenin and ............ 408

—-—and bile formation as in-
fluenced by organ ex-

GRACES» seyerstewarear he aeenene 659

— -— changes after adrenal gland
CXCISTONS ... sconces eee 433

— — —following adrenin injec-
UO cey.ciearnetoweteintsah ces 107

—-—curve as affected by adre-
nin inechiiGdmenws ome aie 621

—-— low, and insufficient nour-
ISMIMICT ba a eelwe See ee 97

— — phenomena in exophthalmiec
FOUTS, Vis aS ON 344

——-—hbetween blood sugar
DINGS, ort ecw ieee er iOS
— —-— to bile formation ..... 659
— -—adrenin and increase in...240

—-—concentrations and _ blood
Suear methods: ..s1- ene 449
——-—and muscle activity....248
——w— variations in ......... 248

— — curve in Graves’ disease. ..249

Blood pressure, importance of
estimating, in diagnosis and

treatment of diabetes........ 627
——'—= in: (diabetes. esate. 2 cote 149
— — w— diabetes innocens ......115
—-—-— glycosuria ........... 672
—-— — incipient diabetes ..... 674

— -— methods of determining. ..449
—-—relation between blood

pressureland! =) =o ee 238

— -— tolerance test ........... 248
— vessels, adrenin and permea-

bility:.0f -. cs. ahere ee 243
Blum: Suprarenal disturbance,

hereditary syphilis <.1-.. see are
Blum, P.: Loss of flesh in wo--

men _ dunine wars... e eo oe 488

Boas, E. P.: Neurocirculatory
asthenia and hyperthyroidism. 162
Body-weight, loss of a symptom
of thyroid intoxication ...... 57
Boehim, T.: Influence extracts of
endocrine organs on secretion

Of. stomach-\. 275s. ee Oe 454
de Boer, S.: Steinach’s treatment
OL homosexualityssss tee 121

den Boer, M.: Case of goitre
with external ophthalmoplegia.695
Boggs, R. H.: Treatment of goitre
by radiation... ..32-he see oe eee 325
Boggs, T. R. (Winternitz): Acute
suppurative hypophysitis ....270

Bogoslovsky, G. (Korentchew-
sky): Internal secretion of
Prostate. Woe hess ee eee 682

Boiling water injections in thy-
TLOMd <Operavtionsie. - 2 eee 174

Boinet: Addison’s disease..... 434

Bolten, G. C.: Fragile skeleton
ands biuesclerainn-.ne eee 156

Bone development, effect of en-
docrine system upon......... 352

— -—in infantilism ........... 697

— tumors due to metastatic thy-

TOId icelllsi'. Wes se cielo core 707

Bones, fragility of following thy-
LOL! removals. eee eee 338

—of head and face altered by

endocrine dysfunction ....258

Bonn, H. K.: Thyroid gland...163
Boothby, W. M. (Sandiford): Ef-
fect of subcutaneous injections
of adrenin on heat production,
CtCe.6 3 Be Se oe ee ee 440
Borchardt: Experimental basis
for organotherapy in infectious
@GiSCASES) Bek. cme et Lae eee 455
Borchers, E.: Transplantation of
parathyroids in post-operative

tetanyra ke es ee eee 306
— Therapy of post-operative

tetany: 5 chk eee 478
Bordage, E.: Tissue transforma-

COM chore Sadek beep a, oe een eae 138

Bordet, F. (Rathery): Adrenic
treatment of vomiting of preg-
PECUMC VE te east te ls tt ek Sees a 621

Boschi, G.: Dercum’s disease... .250

Boshouwers, H.: Deficiency of
internal sexual organs 201616
Bossert: Edema in children with
tetany 3
Botin, F.: Opotherapeutic treat-
ment in gynecology and ob-
. stetrics
Bottaro, Louis P. (Mussio Four-
nier): Hemorrhagic syndrome
cured by thyroidin...... 366, 695
Boulet, L. (Du Bois): Action ex-
tracts hyertrophied prostate on
bladder
Bouttier (Crouzon): Pigmenta-
tion and adrenal insufficiency:
case report
Bouttier, H. (Marie): Adrenal
extract in Erb’s myasthenia...
Boyd, H. J.: An address on
FOIE 9 oleic. caySichGn ee e BAAS
Boynton, W. H.: Use of organ
extracts in immunization
against rinder pest

609

Brabo, K.: Basedowian psycho-
SE atl Meat SO Gee eee 488

Brain and endocrine system, cor-
relation’ between .....2..... 45
— hormone influence on....... 648

—lesion of, causing one-sided
BEUCUIDV AMER oe telis eons, oe eases 156

Braum, L.: Club fingers as acro-
megalic manifestations.......27
Brayton, H. W.: Enlarged thy-

s)
=

mus gland in childhood ..... 483
Breast, enlargement of male....

ef Pare «wc clc se as PACU era Ds
— — — —causes of.......... 206
— surgical removal followed by

complete amenorrhea .......231
Brian, Mille P. (Chauffard and

Jacobs):
in diabetes
Briau, E. (Lacassagne and La-
gouette): Human bilateral her-
maphroditism
Bridges, W. O.:
betes mellitus
Brissaud type of infantilism. .
Brocx, D.: Trauma and constitu-
tional disease
van der Broek, A. J. G.: On cause
of pseudohermaphroditism ...263
Brooke, Banner R.: Considera-
HLOUELOLSOIADELCS ~:;......2...291
Brooks, C. D. (Clinton): Ectopic
gestation and ruptured EOD
follicles
Brosamlen, O. (Sterkel): Muscle
activity, DlOOd Sugar......:.. 248
Brown, W. L.: Unusual cases of
PUVMOSULI ets of. gc se che oes oy 262

Tissue dehydration

OO SC COrriet eRe

Brown, W. Langdon: Dietetics of

diabetes and glycosuria...... 142
Brunecke: Influenza a cause of
acute Addison’s disease ...... 97

Bruni, A. C.: Development gland-
ular portion human-hyophysis..271
Buchanan, G. (Fraser): Urogeni-
tal system in Marsupialia....235
““Buck-milk,’’ chemical analysis
OLS Fes: cise HR RRO ROUSRERE SeToue ik 210
Budington, R. A.: Influence of
certain ductless gland sub-
stances on growth of plant tis-
sues
Bufalini, Emilio: Infantilism... 2
Bullock, F. D. (Morris): Impor-
tance of spleen in resistance to
PE CCLON een iche oo ln aera:
Burckhardt-Socin, O.: Hormones
and menstrual disorders......666
Burge, W. E.: Effect adrenalin

thyroid on catalase produc-

ELOMs ee cg seewnees nce es We Ree 107
Burnett, T. C. (Robertson): In-

fluence tethelin, ete., upon

growth of carcinoma in rats. .279
Burns, D. (Watson): Action of

guanidin on heart of frog.695-696
—w-Adrenin and guanidin.....619
Buscaino, V. M.: Biochemical re-

searches in normal and fright-

enedmanimals! <3 ss 5c: pete oD
— Constitutional Kinesthopathy..445
— Qualitative variations of thy-

TOO Mees sai oycre keto oe ee 88
Buscarlet, F.: Suppurating thy-
LOlds pDlenorrhagiay 4.4.25 008 326
Byrne, C. H. C.: Adrenal en-
largement in starvation ...... 97
Cabot, R. ©.: A case of Addi-
SONESMOISCASC) Sey pe: 5 See 434
Cachexia hypophysopriva .......193
Calcium Excretion in osteoma-
VACTAM Eee he roe rei om a 5 oe 664
Calcium therapy in post-opera-
LEV ELAIIYS tein eee ee 678
Caldwell, J. E.: Hormones and

normone therapy ..........: 267
Calkins, G. M.: Renewal of vi-

tality through conjugation....162
Cambessédés (Apert): Influence

of sex on frequency of per-

LUSSISA raters ore ee ee eas 685
Cameron, M. H. V.: Glycosuria

In sprLeenancy 2. 0. seece ae eee 142

Cammidge, P. J.: Estimations of
sugar in blood in diagnosis and
treatment of diabetes

— Fasting treatment of diabetes. 143

— Glycosuria in elderly persons. 143

Life assurance and glycosuria.672

— Prevention and treatment of

diabetic coma

Campbell, A.: Maladies and medi-

GIGS) 1 20 ys ee eee ese 696
Campbell, W. A., Jr. (Snyder):

Vascular reaction to epineph-

itl “Gig Se Renu CoPMORT TO Brces ein b 443

Camus, J. (Roussy): Experimen-

mental diabetes insipidus and
Senital, atlOpMy. .-.-9 cesar 686
Experimental polyuria ...... 650

— Experimental researches on

pituitary body 507
Cancer and organotherapy...... 234
—a theory of the etiology of...234
— theory Of. .i< 34S a2 ci sete 234
Canizo, A.: Cardio-thyroid syn-

GTOMECS i eke sno ener termite 489
del Canizo, A.: Case of acro-

MGR ANY Percale cara cn oe a mepegtavernk mevione 650
Capezzuoli, Cesare: Case of Fla-

jani-Basedow’s disease .......326

— Two cases of scleroderma with

Sclerodactylian avers seer 312
—Erb-Goldflam’s disease, case
Oligo e hoe cieecd ek eon e me oueae 625

Cannon, W. B.: Conditions of ac-
tivity in endocrine glands. V...
— (Smith): Conditions affecting
thyroid activity. « ac.. - 386, 489
Caramel treatment of diabetes...636
Carbohydrate diets, effects of...446

252

— metabolism in diabetes...... 149
— tolerance and diabetes.......626
—-—as affected by hypophysec-
CONN a wach mete cike ie cy ieifer eats 654
— -—in hyperthyroidism ...... 457

— -—-— pituitary disorders ....354
Carbohydrates in human diabetes.448
Carcinoma and enlargement of
TMIATEROTCASE. foil aosaeeeehe.c. aus oes 206
Carmichael, F. A.: Function of

ChiyPOrdings . aneee vss oon. Sees eaceae 490
Carnot, P. (Harvier): Syphilitic

GiaDeteshien anc da0.0h os oe Oe 629
Caro, L.: Origin and significance

of lipase in human blood..... 455
Caro (Winkler): Hemorrhagic

pancreatic necrosis and dia-

betes wibhs acid OSIS ss «cust 476
Carotid gland, adenoma of...... 623
ATEN CLLONMO Tats, creates ie alee OO
Carulla, J. E. (Houssay): Poly-

uria from piqure in dogs with
denervated kidneys
— (Houssay and Romania): Poly-
uria from cerebral piqure in

dog
Carter, F. W. (Rashbrook): Hy-
poadrenia, intestinal obstruc-
tion
Casas, A.: Dystrophia adiposo-
genitalis of hypophyseal ori-

Fae, OMA EE Ie ee te ES Oe Cee ite:
Case, J. T.: Gastro-intestinal
tract ins Giabetesae. «.uscecmeceiee 629

de Castel, J.: Skin complica-
tions in Graves’ disease...... 328

Certain pecu-
develop-

CasteHaneta, V.:
liarities of thymus
ment

Castellino, P. (Pende): Pathol-
O2V Of Sym paLrheticmet. sew 232

Castex, M. P. (Waldorf): Clin-
ical study Paget’s disease..... 261

—- Geroderma _ genito-dystro-

phico (lean type) with
delayed hereditary lues.318

— (Waldorp): Hereditary syphi-

lis in endocrinopathies....644
Cataract and internal secretions. 114
— tetany (parathyroid deficiency)

In "etlOlOLYy, OL- steer 678
Cattell, McK.: Adrenin in shock. 620
Cavazzeni-Bergamo, S.: Tumor

of hypophysis with acromegalic
syndromem treated with X-ray.271

Cazamian, P.: Treatment of sea-
sickness

Célesino da Costa, A.: Develop-
ment of adrenal in hedgehog. .610

Central nervous system, adrenals,
and carbohydrate metabolism,
relation’ between\.-- eee

Mails (AMG mecent 5 ore 99
Central nervous system, relation
of adrenin secretion to....... 443
Cerebral adiposity. ...4 ee 186
Cervera, C.: Action of acetone
duodenal extracts on pan-
CREASK¢ i ius: chsoteiem ce ore 683-684
Cevera, L. (Houssay): . Adrena-

lin discharge, splanchnic nerve.236
— Role of bile in secretion for-

MAELO, 0 sxc. a cokers geen 684
Champy, Ch.: Loss of. specific
secretion of cells cultivated in

VAT Ome oi.4.s0' oiathens, «ene ohana eee 683

Charges disease, possible cause. .491
— win Venezuela............ 181
Chauffard, A.: Dehydration of
blood and organs in diabetic
COMA ..5 sascha sus 00 6 sg
— (Brian and Jacobs): Tissue
dehydration in diabetes. ...630

— (Grigant): Pancreatic dehy-
dration in diabetic coma. ..672

— (Monnot): Basedow’s disease
with hypertrophy of eyelids
ANG CHEEKS ov arocs onesoieen enema 696
Chiari: Case of syphilitic dia-
betes insipidus <i. 2h s.nes ese 650
Children, treatment of diabetes
MOGLMIPEWS AM otecey snore: Sao tew Renee 296
Cholera. adreninginy ccs cee 241
Cholesterin in diabetic xantho-
TAS yas, sox, oieiceusiion Sen Ee eee 292
Cholin, effects of, on _ gastric
SCCTECHION-“. cecieate ee clone, oi oes 645

Chorea, parathyroids in case of. .309
Christie, C. D. (Stewart): Study
of case of diabetes insipidus. .657

Chromaffine system of reptiles. ..241
= = sIonmtteance Of... 2. 5.5.. 437
Chronic adrenalism, symptoms of 50
Chrondrodystrophie. .........: 150
Claessen, M.: Facilitation of

difficult strumectomy........ 326
Clark, P. S.: Surgical treatment

of exophthalmic goitre....... 326
Claude, H. (Bernard): Results

of glandular tests according to
previous endocrine conditions. 638

— (Lhermitte): Infundibular
syndrome in case of tumor of
EHPEGe VEMEBICICH sic 5-6 fee Kas AAT

Clausen, J.: Presentation of
case of diabetes insipidus..... 461

Clemente, M.: Adrenal insuffi-
ciency during influenza...... 610

Clermonthe (Descomps): Treat-
PREMEMMEISHOCK.. © os os cae ee 116

Climacterium, disturbances. of
endocrine therapy in.........255

GlRtacreriGrOr Mires fo. ss ke ala ly

Chinenko, H.: Case of poly-
Slandwlar Gis€ase —........-- ahah

— Corpus luteum in neurologi-

$2) ERED 2 St 23

Clinton, W. R. (Brooks):
topic gestation and ruptured
Pramian LOMICGleS... 2... 2 287

Clough, H. D.: &Epinephrin and

pinpibaple Meark 9 -.. 5... 2. se 07
Club fingers as acromegalic mani-
IES CENTRES Ie oiler PAL GAL
Cock, internal secretion of testis
Cia ee ee DAT
Collie, Sir J.: Glycosuria, injury
ANG Mana ern Toye oe 263
Collignon (Monziols): Adrenal!
insufficiency following novar-
senobenzol injections ........ 614
Coma, diabetic, etiology and
CEO AHIMOCHEMOE 2 2255 0% 8 os ee 8s 628
—-—in pregnancy ........... 637

— in diabetes in India is uremia. 634
Comby, J.: Addison’s disease in
aE EOtel ye oon ea le wis a oe 610
Complement fixation method of
diagnosing thyroid toxic states.694
Congenital goitre, description of
case .
Constipation and the Eadoanna

PRAMS Er. Se we 464
— thyroid in etiology and treat-
TESTI 0) 0 Cee re 710
Constitution, types of, based on
engoerme factors........... 624
Constitutional kinesthopathy. 445
Coseke, &. &: (Goitre. ... 2.5. 645
Cooke, G. (Smuts): Testes in a
EHS) OLY song A 0 5g er 154

Cooper, H. J.: Hypophysis cere-
bri of California ground-squir-
MOMENTS Sere sf wre ss ele ee ee PAs bp

Cordier, V.: Tetany in adult
with parathyroid apoplexy....

Cornea, pigmentation of, in Addi-
son’s disease

Corner, Edred: Exophthalmic
goitre and anoci-association. .327

Corner, G. W.: Origin of corpus

LUTCURFEOEsSOWi Se someo oee ute 139

Cornwall, J. W.: Pathology of
experimental rabies......... 435

— Pharmaco-dynamics of qui-
WING Fare ceo ae re aioe Sete ee 435

Corominas, F.: Adrenalin treat-
ment of Trachitise fies s. oak. 440
Corpora lutea, origin of........ 446

Corpus Whutewrnir eo 8s oe g 1 Bee oo
115, 249° 250, 445, 446, 623; 624

—-—administration causing
neadache® ross see 24
—w—aand ectopic decidua...... 445
—-——embryonic development.114
— — — menstruation SANZ ANS
— — — —relation between....288
—— — ovulation ............ 141

— — as primary factor in
psychoses “3.8226 sae 639

— — extract control of habitual
abertiony = 20s. Ey

—-—-in vomiting of preg-
MANGYs sce oe ct succes 624

—-—- use hypodermically in
cases of abortion... .445

—-— —/jin vomiting of preg-
TPAC Ys bo. ieee eh. Se ene ets}
—— = IMMASENINaA® 2 See ooo. ee eee ene 49

——— etiology and treatment

of menorrhagia, ir-

regular menstruation
and “‘sterihty ). 4.254. 645
—— — menstrual disorders....666
— —-— neurological practice. ..623
———pregnancy ........... gn bs:

— — — treatment of menor-
PRA as Baws Ce ee 249

—w—influence of, on rat sar-
COMLAME Meets Site ee < Shoes ais 660

— — menses-increasing substance
Obtained from. =. ......250

—— negative results with, in

treatment of nausea and
vomiting of pregnancy. .623
— —of sow, origin of......... og
—— OTT OUT OE coe eter ce ake goto vee 623
—— ——-=—_ and significance .......541
— — physiology of............ 445

——relation of, to war amen-
OELNCAL sees, Foes cee ne 624
———_=——— menstruation to... .200
— — suppression of........... 114

—-—ttreatment of delayed men-
SURUALION: ie she cle ne eee ets 431

— treatment of uterine hem-
OTTHAGC. Se 2 eos woe 140

Cortiguera, J. (Lopez Albo): Pre-
cocious puberty due to tumor
Of (OVATY.2 <= S23 2 CI PS er 475
da Costa, A. C.: Development of
adrenal in hedgehog......... 610

Costagli: Hypophyseal origin of
diabetes insipidus
Cottin, E. (Saloz):

272

Glycosuria

in diabetes during infectious
GUIS GASES) ky wie senSiele) aS atepoeokeme 144
Courrier, M. R.: Secretion of
epididymis: Of bat. cieass aie 264
Couvelaire, A. (Duclaux): Mas-
culine tubular hermaphrodit-
BSI ey c hicee eves. eke ee ee eee iPAal
Cow, Douglas: Histamine and
DicuLtaLry, sextracte eae eee 212
Cowie, D. M. (Beaven): Supra-
renal glands in influenza..... 97
Craft, M. T.: Case of acromegaly
with gigantism in family..... 461
Craig, M. A. (Mettam): Dia-
betessmiellitusms seinen 300
Crain, EK. A.: Diabetes mellitus
followed by tuberculosis...... 144

Creatinuria in diabetes, relation

UOMACICOSIS ta ye eeheee tee eee 633
Crespo Alvarez, A.: Case of
HrolichseSymdromicweasesseen tee 459
Creatin and creatinin, chemical
constitution Ofs. 4 see ae oe 164
Cretin, case of degeneration of
owaRonGl Silo ac oon eo bate 490
Cretinism a disease of infectious
CODEN aM esis Gent craic once eee 491
Gh UHI CER. G55 op nleo ges 495
—— endemic goitre and... ... 05. Bia
— —— —— —— In walleys of Spainw.4 ot
— goitre and in Argentine..... 334
— ites OS) oS ord.ao oo On Oo Old.oso 6 164
henry iho (@laghilely oe 6 5 Gloweiaia oc 497
— sporadic; thyroid transplanta-
GION eto sic RR or eroree 699
— sporadic, caused by thyreo-
DIASTAW A. 5 \ Siete aio eset 33337
— sugar tolerance in.......... 249
— thyroid feeding in case of....497

Cretins, treatment with thyroid. .173
Crile, G. W.: Relation thyroid
and adrenals to electric conduc-
Livity, Ofsotherstissuesia. ..14.c AG.
—-— Surgical treatment of
exophthalmic goitre.163, 490
Criminality, endocrine factors in. 661
de Crinis, Max, (Pregl): Pro-
tective enzymes in very small
quantities of serum—micro-
Abderhalden reaction........ 155
Crispin, A. M.: Glands of Inter-
nalaSecretionge son cee 283
Crookshank, F. G.: Nervous
CretiniSiis. 2 As erence eomerer eee 164
Crotti, A.: Goitre in pregnancy. 696
Crouzon (Bouttier): Pigmenta-
tion and adrenal insufficiency:
case report

Cryptorchism, operation for....316

Cumston, C. G.: Clinical notes
FROM PHANG Ween. 1s) cl once Wokekereie Dien,
Curara, action on adrenin out-

put

Curschmann, H.: Endocrine
factors in bronchial asthma. .622

Meany, 30 tc Seas eee eee 156
Cynothyrotoxin, formed in exoph-
IoeNbnaKG FXO S oon oanacceovec 694
Dalché, P.: Hemostatic medica-
UIOM: =o) 5) see esi eye Gaeke ee oes em 651
— Pituitary treatment in gyne-
COLO BY: | pareieskeredenorempeeen rok een 127

Dalq, A.: Seasonal cycle of testi-
cle of sworm(orvet) ape 686
Dandy, Ch. (Piédeliévre): Thy-
mic lymphadenoma, case of...688
Dana, C. L.: The thyroid in
psychoneuroses
Davis, C. H.: Nausea and vomit-
ine FOL spree Nancie eyeacecne aioe 623
Davis, T. K.: Status lymphaticus,
occurrence and significance in

WialaneUTOSISs sic ie een ere 3b
Debray, M. (Flandin and Huber):
hypophyseal treatment of dia-
Detes) iInSiIpIdus! ~s ase 651-652
DexCastro, His: Ovary eso 287
Decidua, cytological evidence of
hormone-secretion in. .....5- 680
Decléty, J.: Case of gynecomasia
following unilateral trauma-
LISI Oh. SCLOLUM seine 264
De Courcy, Joseph L.: Thyroid
gland, local anesthesia in oper-
Ehoonass Wh oiteg eoendnodookoos 165
Dederer, Carleton: Amenorrhea,
Ovarian) funGtionis sy. eeeeeeenene
Dehydration of tissues in dia-
DEGES! saicc6 eS sce 4) Shatenepiemene meee 630
Deist, H.: Endemic goitre..... 165

De Kraft, F.: Action of electric
currents on ductless glands and

other tisSues: s.s6esv. ls seen 640
De Lange, C. (Schippers): Fa-
milial splenomegaly......... 685
De Langen, C. D.: Constitutional
diseases) ini tropics. 1. .asneens 258
Del Valle, D. (Sacco): Sarcoma
of the hypophysis with acro-
MESALY.. coe o-ae hen cha lene a eee 657
Dementia precox, ductless glands
[00S eee eR reer AR Ach Holo. ac 259
— — etiology and treatment....244
—-—in women, endocrine na-
tuneOfS).2S 2 287
Demole, V. (Betchov): Clinical
study two cases of adrenal in-
SUMIUCIENIGCY: sees tense eek ee 433
Densten, J. C.: Diabetes mel-
TREES) “searches Soon cle epere toiseeeorewets 44
Dercum’s disease, endocrine ori-
f-)01 ener Corer Ga OEOE OTe 0-000 250

— —metabolic exchange in....251

—— pluriglandular syndrome. .232

Derrien, E.: Glycosuria from
military point of view....... 263

Descomps (Clermonthe): Treat-
PCM MOLE SHOCK: << 5. 's seh eX.se6 <2 116
Diabetes. 5. .215, 116, 251, 446, 452

—a manifestation of thyroid
OWCTACE IVEY: » oy ersten shel Sess aye. 69
— acidosis in relation to....... 447
—— AELOMCEAIY GAMO osha ss ess ys%s, 130
—advantages of class instruc-
tion in treatment of....... 631
—and complications with surgi-
CDIMGISCASOS cute, = siz, ayers pemteuane es TIES
—-— exophthalmic goitre..631, 704
— hypopituitarism ......... 193
EN) 2) 072 ee 451
— -—jinternal secretion of pan-
RASH meets sila 'ehco sere lelerioun-«s 447
—-—prostatectomy .......... PW
—-—surgical procedures ......297
cet TE PENTS el cose eet a se ale oc8 # 637
—— Aen EReatorentvOl ti. 68.4... 2D 1
— — — — report of seven cases.297
—antipituitary serum in...... 130
— arteriosclerosis in.......... 259
—as a sequel of syphilis....... 145
—— PPM OOOMSML AL UNe soc.c. cpeteiis 0 6 8% 149
—caramel treatment of....... 636
— carbohydrate tolerance in....626
—case of galloping........... 29:2,
=I CaUSOWOL WAnNCrGabIC. « iio 6.0" 296
——— Hi CICA, OF 5 a)e ape es ane 294
— conditions in gastro-intestinal
LPR hI he cy ORdecr One GRRE Rene neene 629
—— SE HNSINETAUION Ol. cies oes see 2 OL
—control of acidosis in treat-
PATCH EMO eee et oslo eaves w svers 149
— danger of operation in...... 674

— ——various anaesthetics in.674

— dehydration of tissues in... .630
eee Le cP een het owcns is, atsye.sscsiatss 301
— dietetic treatment of.290, 305, 451
ANE CEUIC Sem trees chee olsy se Se sere os 142
— dispensary treatment of...... 449
—drugless therapy of......... 637
—due to sclero-gummatous le-
SIOUMOL PANCTCAS 6. 66% 2 oc 629
S— (Gl iaghtle C0 oe 300
—<tCALUAMECEIOMN ANG. cies «+ 2s. - 306
— effect of thyroid removal in
aaa eet fei s Yalveh Gs %s,-«: 6! «6 65
—=tODVOUSY TANG celsn csi ee bs Bes 632
— epileptic attacks during..... 631

—estimation of blood sugar in
diagnosis and treatment of.627
— experimental chronic... .632-633

——=—— SETMGNCR) OG o's cece oc ee ne we 446
— fasting treatment....... 143, 148
—fat metabolism in.......... 448

—following ablation of sarco-
matous hypophysis....... 657

— — pancreatectomy, glycogen
TECOMULOM AM 69. S oteshs, Ses 675
—four forms of described..... 302
—gas metabolism in.......... 148
—glycogen in pancreatic....... 291

— glycosuria not a reliable guide
BBRLOSHEVELILY. OL... 0 oes 476

Diabetes, glucose formation from

DLOLEIMMINE nse ale es as. 204
— hepatic or hepatogenous.....302
— hypophyseal psteteer = te< eres 130

— in association with toxic goitre,
improved by thyroid abla-

CIO Me ask epee chee tn cashes 708
—= oy of ViGe seer ate ie oe 146
—in dog, production and con-
CROLMORS ite Snare eee ices s 446
—— (lola meh Hao kc ooo ce aLAL yy
Stew hoo Hi: Meas cy Senet ey ieee ERE 635
—— Ere aument) (Olsens cc « 634-635
— incipient, blood sugar in..... 674
== HM NG o.Ge.ccg oo ato ocd Le ALS Liss
—jinnocens and glycosuria..... 452
— infrequency in tropics.......258
AN SV OUNEE ore sie ae eos aee 304
— lime deficiency of...........251
— lowering of freezing point of
DOORN reat eres cc ce ee 297
aT OCD OLUSTMe Me twehe anette sucne) ceect 290
——— Ind OnFZOuty. types «4... sce 302
— pancreatic dehydration in
COMAORA shies. lc aae koe ore 672
-—— pathosenesis-Of:.....5.6.6.% 449
NAL OLOMYH Ole. ae cos thee eles A477
—principles and methods of

diagnosing and treating...
— prognosis and treatment..... 304
— protein-sparing by glucose in.294

—relation between creatinuria
andeacid OSis siNita sree ee 633
— — — sugar in blood and that
Ol, UTINCG=4 2... 2S ao
—-—of carbohydrate diet to...633
—-—-to renal and phlorizen
Py COSULIam sees eees een 630
——=s OMA lee hat Ol mi acs setters cn Sc vee 636
—-—sugar threshold in....... 627
—report of case with acro-
TIVES A Viale sc Sat cite natin ACNE e ooeule «.-< 276
—results of past treatment... .450
— significance of extreme hyper-
PVC CIMA. hiece vicleeekst chasers 447
— starvation treatment in. .292, 303
—stimulation theory of and
modern methods of treat-
IDE Pot Cylch Od COCRC CEL CRMC ORCEEELS 607
—— Iya Olsaiel (CASES) c)evcus cle vems) ©) 301
mt OLY MeL NN seg et aileliidey cee vex thees iO
—technique of handling mild
CAS CSO Pets asire. 2h ioe’ Wau chews Mane de 637
—— theory as to cause..........29%
tT VT OL Mee aanor uaa els ley oie ini eveh ct ebe 63
SS nehiho hives eer eeno pom como Ss aa ss
— treatment of....... 263, 302, 304
—true pancreatic treatment....302
—— WAT) TAT. onede coach ailelecevele ear atarensta a0.
LL OG LING seco aie) ei sierci ee aD
—with acidosis, accompanying
pancreatic necrosis....... 476

— with pancreatic insufficiency. .146

Diabetes insipidus......... atetremerent ad
——aand genital atrophy...... 686
—-— —pituitary disease...... 191
——ease of, cured with pitui-
EDIN! cers. isl eee ee 657
—w-~caused by ossification of
Hypophysis’ ference 654
——control of polyuria in..... 195

— -— description of two classes. 469
— — hypophyseal extract in

treatment POfee sas eee 269
— —-— origin of......... 272, 507
——-—to hypopituitarism BAT)
—-— in a baby treated with
pituitary. “extract. sco... 656
— — — acromegaly .......... 656
— — -—in children, two types. .135
—- iodine in saliva.......... 452
—-— metabolism study in a case
ORD Fa eee on oy varias renee 35
— — pathogenesis of.......... 648
—-presentation of a case... .461
— — relation of hypophysis to. .654
—-—report of case........... 630
a ine Sarl Ofeeltare ae 2:9
— -— syphilitic, case of........ 650

— — study of a case of with ref-
erence to mechanism and

action of pituitary ex-
ERAGCC i cantec ciheate ton cesdoaateers 651
—-wthree theories regarding

etiology of symptomatic.135

— treatment of, with pitui-
EDAD, coo tetetome ety ere oes 651, 654
—-—with metastatic cancer in
PATS NeLVOSAcey. - 2 cheese 465
—-—with pituitary disease....189
Diabetes mellitus......... 144, 290
—- xa cycle of endocrine or
pluriglandular events...291
———FACTMOSIS Mul reete oe aenaeeon cheer eto O
—-— and war diet............ 447
Allen! treaumenten. aimee
—-—among Japanese......... 293
—-blood sugaring.......... 477
—-— cause prevention and treat-
TMENE “SEs suse clheee ele eto 300
= GN STAAY ONAN CHES Ap 6.0 a 6 oon 6)
— — dehydration of blood in...144
eG SP bee eae 2 ul
— —— — case of............ 148
— — dietetic treatment........ 305

— — Edgar serum treatment of.291
—-— education of patient neces-

Gary.) 2°N os ee eee were ete 305
——=—— etiology Of aes aoe eee eens 150
—-—general discussion....... 297
— — hereditary nature of...... 305
— — history of 2.5620. 6% 631
—— jn ‘children 22 sie. 3. ee 304
— influence of menstruation

Onl 7acidosis@of ses. 449
— limitation of starvation;

control of acidosis; Ed-
gar serum treatment of.630
—-—nature and control....... 303

Diabetes mellitus not hereditary

Dutdietary eo eee 291
— — notes on two cases of..... 148
—— oat-cure in.............. 477
—-—of long standing followed

by ‘tuberculosis’: Aacne 144
— — pre - operative treatment

and dietetic management.477
—-—relation between pancreas

aANGs (fe. oR eee (Ue
—-—report of case........... 295
— -— review of methods of treat-
MEME. 5S antes aed eee 304
— — specific serum therapy....145
— — starvation treatment of...304
— —syphilis as a cause of..... 304
—-treatment by alimentary
Test eee b ie a ee 293
———of .......... 301, 305, 448
——-~in children .......... 296
—-— urinary output of nitrogen,
chlorine, calcium and
magnesium: in| ee 301

Diabetic albuminuric retinitis. ..303
Diabetic coma, acetone and dia-

Getic saciid’ 22% Vc tee eee 450
—— case of fatal............ 298
——during pregnancy........ 452
——im pregnancy............ 637

— -— pathology and therapy of. .448

—-—recognition and manage-
ment? Of dcco.2 See ee 296

— gangrene, treatment of two
CASES! i 5 TRY Ot See eee 303

— glycosuria preceded by “pre-
glycosuria stages =. eer 291
—— lipemia soe See eee 448
— lipoidemia” .= 25.2 2... ee 142
— necessity of educating....... 302
— patients, surgical hazards in. .476
—removal of prostate in....... 297
— Téetinitis® 62.5 eaten eee 303
— therapy <2. ee eee 299

—treatment of burn on leg of
by “-tethelin’, 235.332 ee 132
—xanthomas > ick... eee 2912

Diabetics, importance of urinary
analyses’? 2 t.42 va eee 292,

—with tuberculosis, treatment
Of 0 ea ee ee eee 290

Dieffenbach, W. H.: Osteoma-

lacia, a rare or rather common

disease =: S82 See 664
Diesing: Adrenochrom _ treat-
ment of tuberculosis... see 610

Diet and diabetes mellitus. .447, 477
—-—and thyroid hyperplasia. ..426

— in diabetes........ 295, 301, 302
—-— diabetes mellitus........ 148
SS EIN UNC Witt eee 150
— hyperthyroidism ........ 340
Dietetic regulation of pancreatic
diabetes? Se -.e nae eee 48
—— treatment of diabetes: o-..- 451
Dietetics of diabetes and gly-
GCOSUTIAM AO ee en oe eee 142

Dietrich: Chrondro-dystrophia. .150
“Diffuse Adenomatosis’’....389, 390
Digestive disorders, endocrine
factors and vagotonia in..... 670
— organs, action adrenin on....112
Domingo, P. (Vilaseca): Histo-
Zenesis of the gonads....... 646
Dominguez, C.: Medical treat-
ment of exophthalmic goitre. .327
Dowd, C. N.: Constitutional dis-
turbances which come _ with
CHEONUCHEE OEIC. ctetet st sro tstene oh ese 320
Dowd, C. N.: Treatment of
myxoedema by transplantation.490
Downs, A. W.: Influence of in-
ternal secretions on formation
of bile ©
— Influence of internal secretions
on blood pressure and bile
formation
— (Eddy): Effect subcutaeous
injections thymus substance
LIMEVOMMLS MADD ss205, 3 > >. +. % 420
Dragoiu, J. (Faure-Fremiet): De-
velopment of ovary in ascaris
MmeZAOCepNAlaw tiers cies ese 475
Dresel, K.: pressure
changes following adrenin in-

TC CELON Mee tew ir weand tic ooeka sisal aie. 0s 107
_van Driel, B. M.: Vitamines and
InLerniale ISCCrEHIONS:. .. 662... 470
Drysdale, H. H.: Medico-legal
significance of trauma as etio-
logical factor in Basedow’s dis-
CAR CEMNIIC RoR he ones olecieser sale Se 327
DuBois, Ch. (Boulet): Action
extracts hypertrophied pros-
Pavewonwe lad dere.) So .ehe Ss kes Sle!
Dubois, M.: Lymphatic tissue
in thyroid in Addison’s dis-
CASO eee as pot vers ol arsed acess 328
Ductless gland investigations... 1
RET PV Matta tela seven) oclee cvs 472
—— aD ENTE Yate ede otaleeae cn + « «als 116
— — action of electricity on....640
—-— administration of........ 1

— -—and proper state of growth. 454
—-—in cardiovascular diseases
and dementia precox...259

— -——nmiilitary practice...... 116
— -— interdependence of func-
TROT ES ester ed ee ye. ay <s.ye tenes: Dron
——inter-relation of......... 192
— glandular feeding, effect..... 28
— -—system and racial differen-
UIE HG tht, eS Gage Gao EDR Caen 118
Duclaux, H. (Couvelaire): Mas-
culine tubular hermaphrodi-
PERSE RTRs Suttle cGyrat sie ‘ere! des eh a's, » nia |

Dudley, H. W.: Observations on
active principles of pituitary

CALC Mere alte a Shieh er wieiiois. 0 3,» so Lihike
Duffy, Wm. C.: Papilloma of

larynx. Chronic diffuse thy-

LOIRE Siok Pea dy yr ets! ails ste ibis seuss 329

Duran: Adrenal-vascular syn-
CObOpIIe! 8 eo co oo os ORO eee 611
Dustin, A. P.: Biology of thy-
TUS eet eae ie ee Re ore aie sg ILS
— Epithelial reversion in human
ChynniSwe sree ae, eee 320
— Human thymus gland....... 157
— (Zunz): Thymus and _ thy-
TOU rsaee eee port 158
Dwarf, post-mortem examination
OL coh icgie cca EAR IEE ee cue ile IHF
Dw aniiSinigensaconaet Wee ees 8 ote 267
—— case or -Paltauiistyperr. ee: 278
=a-whny iNauiists Gene ao sedda dou os 252
—— aerevovonhishesl shah o adder 625
— two cases of, with hypophyseal
adipositye AAs aac re 656
—— with thyroid anlasian= 2.5... 709
Dysmenorrhea accompanied by
severe frontal headaches..... 270
—— action! Of TOdiInesin..4- 4. 52. 288
— endocrine therapy in....140, 255
— X-fay, treatment of... .- 22s: 456
Dyspituitarism, classification of.463
— endocrine-therapy in........ 255

— with limitation of visual fields.137
Dyspnoea, a symptom of thyroid

InsKOPACANMONy Gaga bes ooo 6 c ait
Dysthyroidism a factor in neu-
TOS CSM araet © 3 Sick eech eo Me cae 162

— search for anatomical basis of. 88
Dystrophia adiposo-genitalis....
Peer ic i Ce Re eee MS 5 e938 AG's
——-— CAS CHRO, «<site-o seSonae vs cues eostoke 652
— — description of three cases. 467
— — following trauma of skull.128

— -— of hypophyseal origin..... PA {fal
— —reports of cases..........280
——summary of two cases....274
Dystrophic myotonica a_ poly-
glandular disease. ..:........ 482
Dystrophies of hair and nails in
hereditary hypothyroidism... .692
Ear affection and diabetes...... 306

Keckler, C. R.: U.S. U. standard
HOTA MUU VanCRULACE ci ac @ 2 v1 e-0 PALES

Eclampsia, extract of ovary in...457
lddy, Nathan B. (Downs): Ef-

fect subcutaneous’ injections
thymus substance in young

TEAL) MU Staten el en'sc.tereecs ooh viet losfor oh aiebiscte 420
Edelmann, M.: Two cases of os-
(HevonacleNleobieh | Gis sibs oem oe AO Che
Edema and cachexia treated with
TEVP ODI SIS Wise vse dene, sass sycrte pet oie 134
—angioneurotic, report of two
CASCSe inet asiroke a sien a enor Oe
— dietary and endocrine factors
UT), Bierts, raed ay tkeey wees oh aaa endo 642
—from dietary deficiency; adre-
MAL FACTORS ces, sao Mand Cys, peee eke 642
— in children with tetany .....320

Edema of throat, thyroid in treat-
TAG AE, (lt ee ern esl A 343
Edgar, T. W.: Edgar serum treat-
ment of diabetes mellitus....291
— Diabetes mellitus
— Edgar serum treatment of dia-

betes mellitus)... 22 nee 145
Limitation of starvation in
diabetes mellitus ...2226. 630

Editorial, Medical Record: Syphi-
lis and Graves’ disease...... 690
— Recovery from Addison’s dis-
ease
Ehrmann, R.: Acromegalic tend-
ency and internal secretions. .461
Eiger: Experimental studies of
Basedow’s disease
Electrical currents, action on
ductless glands
Elias, H. (Singer): War diet in
Ciapevesiedervesiae check. Geers OD
— —-—Diabetes mellitus and
Wat Ste tte cakes eon 447
Elmslie, R. C.: Case of infantil-
LST Tape. fo teoes aielemewtticislerte eae eteneue
Elzas, M.: (Wynhausen):
betes innocens
Emotion, bodily symptoms caused
Dye seers enee kolo etanotione ane 442
Encephalitis lethargica, condition
of hypophysis in é
Endemic goitre...... 165, 491, 492
— goitre and cretinism........ 333
—— "Tl ACIMGMNORUMWES Lee cctan fez
Endocrinal disturbance in influ-
CIUZAn Garay td etatcbe cash arte vette 98
Endocrine apparatus and mech-
anism of menstruation
—hbalance in starvation bone-
disease «oe eae cies. ci 458
—— (HHetneeqine. RESUlts) OL selene. e 187
= GHISISE 4 5.5 ppa.choitlo ls oad cho Gorc. 116
—- progressive muscular dys-
trophy on
— disorders in etiology of Erb-
Goldflam’s disease Bi Stes Oe)
— disturbance, headache with. .667
—— == fash Guieheelavoec) Go aoa Gants 464
— — — pubertas precox....... 369
——necessity of detecting and
(RCN OES ign 6 Gua cana ofced- ac 285
— dysfunction manifested through
cranio-facial deformities. ..258
—dysharmony and gynecomas-
Tia SON a fees ciate meteors 213
— epithelium in lizards
—extracts and gynecology..... 453
— wand protein digestion
—-—jinfluence on plant growth.. 452
— factor in infections and intoxi-
cations
— factors in bronchial asthma. .622
—= = -——=mMemtal deficiency. and
Criminality: se acleie ee ee 6 OL
— — —skin disorders
— function of pancreas

Endocrine function of tesitcle...531

——-— thymus gland ........ 158
—— functional tests; 0522. ...::- 638
— glands! 9: 223. 242%.. 434 2a ib aly
——~' =—‘aCtiOn VOL sire. oe eee 169
— — affections in acquired syphi-

Hse eke Ss, aa iLalyy
—'—jand sdiet: See... eee 120
——-—-emotions under bom-

bardments 2. s205 alee 256
— — = fevers .t..50... Sees 119
— — -— infections, relations be-

EWiGCTL + 25,0) <etacs,ometh onan 93
— —— lactation ............. 210
—-—egrowth and development

and
— — close correlation between. .338
—-— control of metabolism....474
— — defective functioning of...343
——effects of faulty function-

INS oa ee ee 258
—-—eextracts in treatment of

rickets: -si<48). RS eee 441
— — function in progressive my-

opathy otis aa ee 286
— -—jin bradycardia hypotonia. .119
—-— — menstrual disorders 411
— -— — pituitary disorders 359
— — influence upon uterus..... 415
—— obesity due to dysfunction

OL) nes OEE eee 185
— — role of, on activity of “‘anti-

Senie —OLZanss Hee 490

— glandular treatment, necessity
of care in

— hypofunction, influence of ex-
perimental, upon growth. ..259

— imbalance, adrenal deficiency. 236

— influence of pylorus......... 117
— insufficiency in inanition oste-
ODBthY © tases wh eo ee Pais y33
<—— manifestations! =... -areeetsnreene 118
—— Morphology .-4 56 <1. se eeeee 3

— neuroses and their treatment. 253

—organs......... 118-120; 254-260

— -— abnormal function of prob-
able cause of disease of

DOnCeS %....244 30.7.4 156
—-—— and emotions ~....2..5..- 255
———temperature .......... 336
— —-—vitamines ............ 470

— — balance among, and biologic
significance of endocrine
factors

—w-—changes in, after occlusion

of pancreatic duct......643

—-— close connection between
fuNcELOnalllliya eer eee ee 33/
— —-—-relationship of........ 387
———— (irect lesions! Of ~-. oe. sie 337)
—— ISCAS CS Oteenel oieneeneeuemen eres 120
== -——_-——_ Osteomalaciay sae eee 664
— — extracts, influence on secre-
tionnof stomach seer 454

— — — pharmocological action. .257

Endocrine organs, functions of. .456
——"— PTArLINe Of f= a-eccls oss 8 es 642

—-—in a case of lipodystrophia
WEOSNESSTVE s cas.c chs ses % 471
——— disease .............. 642
——— dwarfism ............ 709

—-—— man, need of more cer-
tain knowledge of... 41

— — indirect changes not always
OUPATTCALL VG) co ocic006. 3 osteo 38
—-— — disturbance of ........ 38

—-—— knowledge too limited £0
fix quantitative changes

Ceruaimibyertrs sas ses So eS 38
— -— need for more careful ana-
LOmmCaTeStudy: °. 2c. 22 387
—-— physiology of ........... 661
— — quantitative changes in... 38
—-— relation between scleroder-
ma and diseases of..... 312
— — —to constitutional types.
aCe asch RRO ae 624- 625
— — significance of in toxemias
Ofapreenancy ':55......2 AO.
— — Stenilityercre. 6 . 009
—— relation between trauma
UIUGse Av wel ol. coroner lei e 6% 255
— origin of gynecomastia...... 216
— — — pernicious anemia 471
— ——some gastric changes ..464

— origins, relation of suprarenal

COBRLOK OMe ers lee SS a 612
— secretion hen feathered fowls..381
— substances, effect of intracuta-

neous Injections) ~..5.....387
— sympathetic process, syphilis
as causative agent of...... 261
' ——system, discussion of......232
—symptoms in case of dystro-
pila emityotonica:... ....%: 453
— system, correlation between
TMP ON Eel cle ahtls es ote Ss Se < 45
-— — effect of disease on....... ole
——w—on growth and devel-
CMTC on este oils cs Ses Bir
—-— mental diseases and...... 44

—— systematic numerical study
of anatomy of, essential

for extract treatment... 45
—— FOTIMINOLOLY? bit fess oe eee es 72
—therapy and future of medi-
(NEG! os Ah a 453
—-—stimulating radiations of
DUS a oe ee ee DOT
—=UNOPINMIGtr. ce etr cs kee cc ke 235
Endocrinology and gynecology...419
— general concepts of......... 261
——in) Gally Tactice.....)..%86.-. 261
— — relation to automatic phys-
iology and pathology...606
— medical aspects of ......... 644
— need of conservatism in...... 641
— present aspects of.......... 459
— secondary sex characteristics
S006!" 9 ee ee en Pi |

Endocrinology, some phases of.
—= the crying need Ofs oo .3..... 459
Endocrinology in retrospect and

PLOSPCCUMe seeeye creieere Betis melee sa 602
Endocrinopathies due to tubercu-
losis secondary to hereditary
Syphilisw (ot. ceeeeeet rea eae os 644
— hereditary syphilis in etiology
OL erat et hitceerche Sues erties eres 644
—— treatmentsok Some ~ 2. 4. 26 pak
Endo-hypophysin, extract of
whole pituitary extract....... 133
Endometrium, hyperplasia of..
Sree eta eee evens 416, 417, 418
Engel, H.: Rickets and osteoma-
LACIA MMe BET see accuses 474
Englebach, Wm.: Disorders of
MYiPODIYSISH epee hie ie recreate 347
Enright, J. I.: Parotid as endo-
CLINGS AMG, cacuchenssigdeautat ence 680
Epilepsy and diabetes......... 632
— anterior lobe hypophyseal ex-
tracthin treatment. of: 2. 264 270
—— fright vaseCauSerOrs 2s. se ce 220)
— idiopathic a sympathicopathy. 222
— immediate causes of ........221
——-"Te CRUD CUES» a0 ses Ehacoee seus 631

CAMS Oye sneer s tat earn Sees See 475
—related to parathyroid defi-
CHET CYH ts ee acioie) Nees ceo loeRone 677

— relation between tetany and. .504

— treated with thyroid-ovary...697
—with endogenous’ adiposity,
CASCBOLR Siew cr aketc te fhe 28
Epileptic seizures produced by
adrenin administration ......246
HpimMephrins test 6... cece. so 389
Epstein, B. (Schiff): Blood pres-
sure cure after adrenin in chil-
CUS AL MGuccncachna, COR Once aera ater 621
Epstein, J.: Amaurotic family
1dIOCYs ((OnCASCS OL). es «2 ome os 622
Erb-Goldflam’s disease, case of
endocrine etiology .......... 625
Ervin, D. M.: Relation of glyco-
gen to pathological changes in
pancreatic diabetes .........291
— Relation of pancreas to dia-
Deticestaticw... 2. st. ses. 145

Esch, P.: Organotherapy in dis-
turbances of menstruation... .641
Escuder Nunez, P.: General con-
cepts of endocrinology....... 261
Escudero, P.: Clinical form of
Basedow’s’ disease ........%.¢ 330
Espina: Direct transmission of
Addison’s' disease
Etienne, G. (Richard): Artetial
pressure and emotions of war.257
— -— Glands and emotions under

bombardment 2s 256
— — Polyglandular syndrome
with ‘epilepsy ..%% .).."% 697

Ether, sensitiveness to, dimin-
ISHGOUDY, AATODIN © 56.6) a5 eedone 620

Eunuchoidism, report of two
ODES pS Gubkor ane Ouceeormeaictrs 0 0 oof 460

testicular transplantation in. .687
Exophthalmice goitre among re-

CUES oo ssa cus -sten 1 cues aeerenme aly
— and pregnancy eyes cerns 339
ee —— CM DeCLCULOSIS sacle eter ener 487

anterior lobe hypophyseal
extract in treatment of..270
——-—- hasal metabolic rate in. . .08 a
—-—-— metabolism in........ 336
— —h)lood picture in......... 176
— — — pressure phenomena in.344
— — caused primarily by toxins.502

—-—ccurative vs. symptomatic
ireatmient, Olieracscsetor cea ie
—-—cured by inunctions...... 325
—-——emotive, parotid hypertro-
DN. VMs, (5, 1s cise otis caren ots See 708
——=— familial), c.ccereec is Tales See 180
— — fatality under X-ray treat-
IMMCTUU (Asyceulehartue otot « fears ans 42
—— headache in ............ 505
— -— kinetic drive and .......526 -
—_-—— medical treatment... .9 2,043
—-—new ocular symptom in...181
— -—not to be considered a sur-
gical emergency ....... 500
— -— pathology and treatment of.335
— — persistent thymus in...... P59
— — — — in cases of......... 486
— — physio-therapeutic treat-
TMMEGUt (OLs scaneeNeclecis, «seat Boa
—-— preliminary treatment be-
LOLE! OPeTAtiony cians. e:
— — product of a vicious circle.
Et RRO rae oe ONTO 498, 502
— -—psychical habit in ....... 45

—-— pulse a guide in treatment

Ole PEO EIo Ss Cece Ope ror PTS
—-—radium in treatment of...176
— —report of case ........... ibe)
—-— significance of trauma as

PACEOT: INEM aceoee cmon ewee ren

— — surgical treatment...163, 326,

330, 340, 481, 487, 490
= ——— pilateral resectionwa. 7499
—- symptoms of toxic cases. ..183

—— — treatment Of........ GDS B33
= = RTA ELC abmMenite Olsens were
stove Saielraitheewees 456, 705, 706
Exophthalmos in Graves’ disease,
CAUSE: Of jaseonc RCE Ce eon
se ha Meth goog oo moo doe 138
—=—=—— nephritis. .i..scis Ge oa creer 178

Evans, H. M. (Long): Recurrence
of typical oestrus cycle after

ovarian transplantation...... 476
Exchaquet, L.: Thymic asthma

TT, AM RAMES a. Foe ah cee chain e aosenee tee 483
“Exhaustion Syndrome” .......170
Exner, H. V.: Functions supra-

renal glands in white rats... .436

Fagiuoli, A. (Ascoli): Pituitrin
TOSI: sect! ows, fo; 5, eet eg eee Reet mee Se a3
—-—Thyroidin subepidermal
LOSE, “atelier aba ae 387
— -— X-ray treatment of hypo-
Dhysis; in-asthmiay ewes 567
Fahr: Diabetic exanthoma..... 292
Falk, Henry K. (Pool): Surgical
anatomy of thyroid with spe-
cial reference to parathyroid

Slands scree ce tee ee ee Joo
Falta, W.: Thyroid aplasia....166
— Case of Grave’s disease...... 165
— War diet in diabetes........ 295

Farmachidis, C. B.: Endocrine
imbalance, adrenal deficiency. .237
Faroy, G.: Diabetes with pan-
creatic insuficiency, .. sna 146
Faure-Fremiet, E. (Dragiou):
Development of ovary in as-
caris, mecalocephalar a. seer 475
Fasting cure in diabetes........293
— treatment of diabetes...143, 148
Fat in diabetic dietary, effect on

sugar excretion threshold....627
— distribution, definite type in

hypophyseal dystrophy....18&7

— dystrophy sai2 = din eee 185

— substances in human thyroid.700
Fear, action of, on mechanisms
Of DO GYxh. esse ee ee 222
Fehling, H.: Internal secretions,
gynecological practice ....... 284
Feilchenfeld, L.: Acute and
chronicsvazatoniay er --iee eee (ales
Feiss, H. O.: (Marine): Absorp-
tion iodide by perfused thyroid

glands: 4 uwdies hen eee aon
Feldman, W. M.: Diagnosis of

disease of pancreas ..— ee eee 673
Feminine traits manifested by

gyMecomasts: 2.05 scree: eee Paley

Fenger, F. (Hull): Separation of
physiologically active portion
of posterior lobe of pituitary. .462

Fenlon, R. L.: Diet reduction
with retention of protein to re-
lieve glycosuria in diabetes
DUGG WSs) ics es harece eee eee 251

Fenwick, P. C. C.: Starvation
treatment of a young diabetic. 146

Fernandez Sanz, E.: Case of acute
senile hyper-thyroidism ......698

Ferreira de Mira (Athias): Effect
of thyropara thyroidectomy on
castrated guinea pigs sor ieee 692

Fetus, blood of, not increased in
adrenin content by administer-

ing adrenin to mother....... 618
Fever, endocrine glands and....119
Fex, J.: Chemical and morpho-

logical studies of cholesterin. .611
Fibroma, pituitary extract in

treatment. .Of) Uali1s hee See ONT
Fibromyomata, endocrine therapy
AT 55.05 Ses SoS ee ee 255

en

Fici, Vincenzo: Multiple endo-
erine disturbances
Fiegl, J.: Diabetic lipemia..... 448
Fiessinger, N. (Leroy): Adrenal
insufficiency
Findlay, L. (Paton): Tetany and
functions of parathyroids....150
Finney, J. M. T. (Sisson): Effect
feeding pineal body upon de-
velopment albino rat ........ 310
Finochietto, R.: Surgical treat-
ment of exophthalmic goitre. .330
Fischer: Pathology and therapy
of diabetic coma
Hisehi iss Myxedema......... 166
Flandin, Ch. (Huber and De-
bray): Hypophyseal treatment
of diabetes insipidus..... 651-652
Flatau: Uterine hemorrhages
and internal secretion
Flather, M. D.: Effects of some
glandular extracts upon the
contractile vacuoles of Para-
mec. Candatum....5...:.. 98
Fleischer (Jiingling): Hypophy-
seal tumor, X-ray treatment. .462
Flipo (Apert): Influence of sex
on gravity of influenza....... 684
Focal infections in goitre...700, 70
Foerster, A.: Diabetes insipidus
treatment of, with hypophyseal

ESS USE nets hal ete ere bie woe’ 630
Foerster: Dystrophia adiposo-
PS OUIN Sinaia wievere As ase Sm 3 652
Foges, A.: Experimental herma-
WOCOGTHISTOE =). 2% 55%. 8 265, 648
de Fonseca, J. M.: Suprarenal
AS PMCTUIC me Sie rs Sh cree eres we ols o%s 98
Food, uncooked, and endocrine
ACTIN MUVME IS et otha bec Sec STS 3S 120
Foot, N. C Case of malignant
DV HONMUAN sete os) 2, we ae Sao i

Foss, H. L.: Treatment of goitre.698

SSHOLMICSMUDUSUGS: © Sn sc. os tes Bal
Foster, Nelles B.: Surgical haz-
ards in diabetic patients...... 476
Fox, R. H.: Life assurance and
SUV COSIUEVAN Sa poets ato clatecee se 2 ae 674
Fraenkel, L.: Genital findings in
dementia praecox and observa-
tions on genital infantilism. ..287
— Pathological pregnancy and
GUHOrs-OL OVATY 220)... 6. 476
Fraenkel, S. (Herrmann): Hor-
mones and phosphatides...... 124
Francois, R. (Ramond): Addi-
Sons aisease of war... es 103
Frangenheim, G.: Operation for
CIVPUOFCHISM f.. 0600. oe ee 316
Frank, R. T.: Influence pituitary
extracts on genital tract...... Pate
Frank, L. W.: Surgery of thyro-
UPR OSINE Retr eI OIS ciel eas 6 sl eho eas 330
Frankau, C.: Operative treat-

ment of enlargements of thy-
roid gland

von Franqué, O.: Internal secre-
tion of thepovaries..........28:7
Fraser, E. A. (Buchanan): Uro-
genital system in Marsupialia. 235
Frazier, C. H.: Principles under-
lying treatment of toxic goitre. 698
French, H.: Mental symptoms in
myxoedema
Freund, H. A. (Lockwood): Or-
gan extracts and oOphorectomy
and metabolism
Friedberg: Experiments on in-
fluence of involuntary nervous
SY¥Stemy Ony DlOOd Iie «=, 6 eae ses (fac?
Friederichsen, C.: Adrenal apo-
plexy in small children....... 611
Friedlander, G.: Significance of
extreme hyperglycemia in dia-

DeGtCSr 426 porte. sess ae one 447
Friedman, E. D.: Internal secre-

TIOTSOR s Sees eee oe 470
Fright as a cause of epilepsy... .221
Froelich’s disease and pituitary

GUIsOrdensay. cece ae eee 363
— — hypoglycemia in F 458
— —two cases of in adults..... 655
Hroelichts Syndrome 7....6..<- 185
= |CAGE\IOL 2. «2/5 a tei o seme Siena 459

—-— due to hereditary syphilis. 64
— -—treated by radiating hypo-
WIYISIS@ 4. < . ockrehey atte ere 567
Fromme: Endemic disease of the
DOMES ls oss corcctl ore coeeenetoe 155
Frumson, L. G.: Endocrine in-
fluence of pylorus
Fugimoto, B.: Regulation of
blood diastase
Fujimori, Y.: Malignant adrenal
cortex tumor
Fujimura, G.: Cytologic studies
on human placenta and decidua
with reference to hormone se-
eretion

Galambos, A.: Transitory renal
glycosuria, relation to diabetes.630
Galen, J. C. (Houssay and Ne-
grete): Action of hypophyseal
extracts in dog and rabbit....6
Galloping diabetes ate eee tae
Gallotti, A.: Basedow symptoms
in early diagnosis and treat-
ment of pulmonary tuberculo-
ST en Oe eat, Se Ae teow
— Plexus solaris in tuberculosis
onte dh bial) 5 op aete By Bart Alero ianoranc 436
Gallwey, T. J.: Differentiation of
mankind
Ganassini, D. (Mancini): Mech-
anism of vitamine action..... 457
Gangrene in diabetes.......... aa Bs
Garibaldi, A.: Influence thyro-
parathyroidectomy on forma-
tion natural antibodies....... 490

Garibaldi, A.: Thyroid and ac-

Guinred MimiImIINitya . 0. 6 cee 330
Garmendia, F. S.: Headache with
endocrine disturbances ...... 667

Garrahan, J. P. (Belgeri): Tet-
any in the etiology of cataract.678
Garretson, W. V. P.: Endocrin-
ology in daily practice....... 261
— Some phases of endocrinology.459
Garrod, A. E.: Diagnosis of dis-

eases of the pancreas........ 673
Gas metabolism in diabetes..... 148
Gaskell, J. F.: Adrenalin in an-

NeELIGS:. Cees h ie er ees eee 108
Gastric juice, influence of organ

extracts on excretion of...... 15D
Gastrin bodies, chemical studies

OD es IE aces, cee 645
Gastro-intestinal irritation, rela-

GLONTOt abo betanyena ce eee eee 680
—— —— Uract, Conditions =1n)-ine Gia=

DECESSI ors cue cae 629

Gastropathy, with associated car-
diac dilatation and endocrin-
OM QED ete cs cree tee ioneere ey SHEE.
Gauthier, G.: Paralysis agitans..306

Gautiere, P. (Saloz): Galloping
diabetes. .o 5 2 ose es pee are

Geelmuyden, H. C.: Fat metab-
olism intdirabetessaas «csc. a 448

Geist, S. H.: Hydatidiform mole
associated with pernicious vom-

GUTS pe iaevtne Ciera krceerem ae cn wie ieee 287
Generative glands in human ho-
INOSEXUADISE svat epee eve temel cs, Coe 267
Genital atrophy and diabetes in-
SIDUGUS Mee ae oe ee eo ee 686
—-—hypophysectomy .........514
— development, effect of endo-
erine system wpon : +. <2... 352
— dystrophy, geroderma .......318
—— LVAD ODVASIAs wi, opens sioner ee aes 93
———1ODeSitys ANG) soos. emo 185

— organs, investigation of, pre-
ceding thyroid operations. .338

Genitalia and gynecomastia..... vzalal
Gerhard, A. H. (Schnabel): Case

of diabetes insipidus......... 657
Gerhardt: Cases of hypophyseal

ULIMOL eon en et ue, we en hee 462
Gestation, effect of thyroidectomy

OMIA Sonessencge ese ch on eae eh (ila
Ghedini, G.: Endocrine gland

OXET ACES Bah ots ate situa ee eLe roe eae PAD Tl
Giant formation in larynx with

hypophyseal trouble ........ 270
Gig antisipreachsenAackoe sere oman toe 363

casevorseunuchoidie. 4.4 nee 459
— due to hereditary syphilis....644
— following hypertrophy of pi-

CUA yas! sGO Si ren eee il

— notes on pre-adolescent...... 262
——1nepoxonee Oe CHRIS soucaassuumee 464
— Of sacromesalicanyaae 463

Gilliam, H. A.: Treatment of dia-
betes mellitus and complica-
GIONS: 2 ktoksoRRe- er eee 448

Gland extracts in hypofunctions. 459

—-—-— study of endocrinology. 257

—-— useless in acromegaly and

INLAanvilismpesce iy eee 463

— therapy in endocrine disturb-
ANGES a siscsns Seco Ce ene Oe 285

— generative, in human homo-
S@XSMWAIST vayecconcuototon dem oereiene 267

Glandular extracts, effects of
some upon contractile vacuoles

of Paramecium candatum.... 98
—-—in treatment of diabetes
with pancreatic insuffi-

CIGMCYe ek Sites ie spencbe Pare 146
—organ extracts, action on
WINGS +s... a.custituceiene SORE 439
Glandulen (anterior lobe extract)
in diabetes, insipidus........ 282
Glass, E.: Orchidopexy for in-
Suinale testicle mace 320

Glassburg, J. H.: Headache and
dyspituitarism in light of thera-
DCUSIS 5) &.25.c Siew ee ee 463

Internal secretions. ..429

— (Quinquaud): Secretion of

adrenalin, arterial pressure. 244

Glycemia, influence of, flying on.451

Glycogen in pancreatic diabetes. .291

—retention following pancreat-

CCtOMY? sce uae ee 675
Glycogenolysis, relation of hypo-
DHYSISs tO\ © 3 Siewtioss oo Ie 129
Gly cosuria\W>. ace ee ee eee 363
—and normal blood sugar curve,
renalvdiabetesi. oie eeaeee 249
—as factor in life insurance
TIS» 3 Sot de. wihaeheaen ere 676
— description of possible causes. 263
— diabetes innocens .......... 452
—idieteti¢cs “Ofs < & ice ale See 142
— due to partial pancreas extir-
DAtiON not Spee eee 633
— following shock of war...... 2510

—from adrenin, effect of occlu-

sion of pancreatic duct,

adrenal destruction and thy-
IKONGEKOIIAy, ON sooodudsacs 643
— -—the military point of view. 263
—hyperglycemia and ......... 147
— hypophyseal origin ..... HOMenoeg
—jin case of hypophysitis...... 270

— -— diabetics during infectious
Gisease <sanchwa oa 144
— == Giabet@s: . nen): sd hte eee 476
—-elderly persons ......... 143
—-— pregnancy ..........00.. 142
— injury and malingering...... 263
— medico-legal aspects of...... 263
—=—) non-diabetic wes.a- sc oe 142

—of hyperglycemic type in dis-
turbances of thyroid, hypo-
physeal function, etc...... 258

Glycosuria of pregnancy, probable

CRS (li Se ee eee 142

—renal and phlorizin, relation
OHGHOMOTADCECS. o ciesa ees 63

— retinal changes in ......... 292
= SG SCAT) An Re 298
— transient, insignificance of...673
—IeypesmOr WMiustrated........... 263
Goetsch, Emil: Epinephrin test,

ELVEN AING§ o. «cnet oper oss) 6: ob. tao. 289

— Epinephrin hypersensitiveness
test in diagnosis of hyper-

LM ANCite STO eo 699
Goetsch’s adrenalin test in Base-

MO WESPROISCASCs 2-055 Smeccrene. sce a0 505
— test in thyrotoxicosis ....... 712
Goitre, acromeraly and ........ 281
— adenomatous type .......... 183
— and cretinism in Argentine...334
—w—water supply ........... 325
— blepharochalsis with ........324
—— I OOCwPLCGUTE AM. bison Se 487
— case with enormous......... 179
SS ISIE CE AR Oe 176
—-—w-— unknown ............ 183
— changes in larynx and trachea

PHMIICRIOM Joie yids a co ecageveec ss DOD
— classification of pathological

GHIATZCMIENtS, - <2... 62. 6.5. 346
—— CITC ANG ALAMON «2.252 es se 495
—cured by inunctions ........ 325
— development following splen-

SELOMMV Rae Mets s cib is ee sages 338
— due to drinking water ...... 492

— —-—lymphatic obstruction. .707
— early diagnosis and treatment.494
— —-— of mild forms of toxic. .176

—endemic (Chagas’ disease)...691
—-—a disease of infectious ori-
hE De, SA es ee ae 491
— — and cretinism in valleys of
SUT) Cece err Reet eee ae 491
— -—and drinking water ...... 345
— — relation to water......... 707
—enlarged at pregnancy ...... 489

— etiology and prophylaxis of...606
— exophthalmic, and diabetes...

6 op bad coe) CERES ena 631, 704
—-—Charcot’s latent ......... 696
— —focal infection in etiology

Gi LS eee eee 700
— -— hypertrophy of eyelids and

GHECR Sie 5.5 5s 50 eens 696
— — radiation of thymus in... .569

—w—reactions to hypophyseal
extracts in diagnosis of .658
— —related to status thymico-
EUAUPIEALICUS 6.5 5.2 %2 2006500 704
— — selection of operation for. .710
— experimental, produced by
WAbGI OL COlrimllOs 20. <:0-cio+ « 701
— focal infection not cause of:
absence of among Hawai-
PREIRMIOEOEA sero, cc id is vic «ale vee 645
a eeetE IT wil ocala adios 005 6 were eye 709

Goitre, histopathology of auto-

MALICESVSELETOAN ee cpoc% - <0 345, 346
—in an infant, case report..... 693
—— case of rickets in an adult.155
——— —— are ek ouch ogee oo tens 5:8) 497
—— —= The White Tater. <jecs pore, 3 * - * 234
— incidence of, and school age. .499
— infectious origin of ......... Siented
— intrathoracic, diagnosis of...705
— iodine action. Im .s:...%....%. aol
— ligation of vessels in toxic...176
— lobectomy in toxic ......... 176
— making cure of safe........ 174
— medical treatment of........

Ses SA a pa a oie 324. 50M 02
— necessity of immediate trache-
OvOMYA INN CASCH a) .c vs 181
——-—removal of primary
CAMS CMe citen cyspe = ae nO Ure
— operation for intrathoracic. ..331
ae GORIC) . ane hole cc alc ee trees 167
— -—local anesthesia for...... 1G
— operations, review of...300, 338
— operative treatment ........ 492
— patients, classification of..... 33
— prevalence of simple through-
Ott emwiOll Gusewei-: sci epencnene 499

— prevention of simple in man. .332
— relation between water supply
UI rene cise er cher chs: sis vegee cure 183
— report of 37 cases of chronic. .328
— removal, paralysis following. .156

— role of in psychoses......... 339
— safety in operations ........ 177
—simple, a public health prob-
GTN EIS a ares ne eta siekousue, aut 499
IPAS T AIG) 2 Sefer eye cliecisveehe eters 710
— some observations on ....... 492
— -—surgical aspects of....... 334
— study of based on 1000 opera-
DLOMIS ey eben cic tekls emote eres La-sianeKe 180
——(SUTE&CrY OL TOXIC 5... ++ 330
——— UT PT CAR oh co Pewel bensieeateks «icusivsachs 492
——— treatment of....166, 175, 698
— “Symptomatic treatment’... .502
— technic of operations in......496

— toxic associated with diabetes,
improved by thyroid abla-
ELON eer ere cleo cicke heats 708
—-— cause of, unknown; mucin
injections not efficacious. ..707
— —classification and treat-

I6TS3 OU! A ea ac eC RD ION 698

————— SIEMENE IM .... 0c. 06 6 oa 176

=——-—— following influenza ...:.... 709

—————— +HON-CXOMULNALIMNICS 2.6.06 6 167
— transmission and water drink-

hth ee eer Dicks BO TO era c 497

— treatment by radiation ...... 325

=———tTCALIMCML OL... «1. 6 S24- Sol, o42
—-—with injections of phenol,

iodin and glycerin..... 342

— tuberculin in treatment...... 691

Goitre, voluminous with compres-
sion of trachea and sympathet-

MGR MES eer thiiw..s cca letguec et oemareeerea 169
—with ophthalmoplegia and

other pareses, case of......695
SG ore’ Meart’” ©...‘ 5 fae eae pene 167

Goldschmidt, R.: Intersexuality
and hermaphroditism in man.313

Goldssteig: Dystrophia adiposo-
genitalis following trauma of
skull

Goldstein, H.
ISTH VNC WANS ey eto ee re

(Schneck): Dwarf-

2

Gonadal origin of dwarfism..... 267
type of pubertas precox...... Ore
Gonads ..e ae 1 235 2i6io=2 OW
—— and? heart: Siac. soe ee ee PARIS

= ==) PID ETUY severe cuolec acs noe oes etre 481
=—— ALHOD NIC Mae eicos ein coe oes ae eee eene 28

— atrophy of in case of acrome-

SAVY ratse eet eae een 276

— cardio-depressor ........... PAYS
— destruction of in man....... 96

— effect of posterior lobe extract.361

—fundamentals of knowledge
ROGAN GING lee avec cee, eee bas
—histogenesis of ............ 646

— hormone secretion of and gyn-

CCOMASTIiaw ree: aottas Dore 216
— hypoplasia of testicle in devel-

OPMICNEVOR A e-oacas eaccouesee 460
— in congenital syphilis of hypo-

DHYSIS@ ia oe yee Lise ose nL
—-— dog, innervation of....... 265

— influence on sexual characters.122
— internal secretion of, causing

sexual variations, = a... 5: oil

== StPUCEUTETON srcretiecs + one oh ones 122

——-ETPANSDlAMCALION s sccces «ance ene 265
Gonzalez, J. Ortuno (Novaro):

Sporadic icrevinismil =... se] ee B37
Gordon, A. K.: Hypernephroma

OL-ovany. 65 £0 cee aeons 140
Gouce, F. (Poyales): Case of

acromegalic gigantism .463

Gould, H. M.: Studies on sex in
hermaphrodite mollusc

Goyanes: Endemic goitre and
CRELIMISTNGs Ae ates cicteuateren eke tor: 491

Grafe, E.: Adiposis dolorosa...452

Grafting endocrine organs...... 642

Granger, A. S.: Dispensary treat-
ment of diabetes
Grasset, R.: Attempt at poison-
ing by adrenalin
Graves, S.: Malignant tumor of
thyroid
Graves’ disease a form of trau-
MAT CeNEUNROSIS# + iy eee eae MER
— — — plurglandular syndrome.341
—-— abnormal thyroid function-
iN NOt CAUSE Olan cue aber e
—— accompanied by diabetes.65, 67
— — and lipase content of blood.456
i ——— SVT ITS tere es <ei'eys sue neice eine 690
— — arhythmias in

Grave's disease, blood picture
changes (i257... 4 cee ee 488
— — — sugar curve in........ 249

—-— case with exophthalmos of
One Gye: o, Sea e e 166

— —cause of exophthalmos in..337
—-—development of, and femi-

NINE ASteTN Gye eee ee 324
——=—— diagnosis’ . 3. 22.5 See 487
—— diarrhea in ............. 172
—-— death from following acci-

Gent. 52 Se eee 180
— -— diminished volume of lungs

DTW =, 5 Sos s che ake eokee Oe IMRT
— — following emotional stress. 256
— — “funnel breast”? in ....... 332

—hemaphilia in, treated with
serum of anaphylactic rab-

Ditto. Ae ai eae ee 708
— -—infrequency in tropic..... 258
—- medical treatment....324, 499
— — non-surgical treatment... .341

— — observations on 160 cases.. 498
—— occurring with Addison’s,

an explanation
—-— pathology of ............ 321
— — pit in thorax of child with.170
— -— report of interesting case. .326
—-—resemblance between par-

alysis azitans andes 306
— — skin complications in ....328
—-—thymus in ......... LS oles
— -— thyroidectomy in.:2-2-..4028
—-—trauma and ............ 180
— —treatment in ............ 498
—-— significance of trauma as

factor in” =o eee BAT
— — X-ray treatment of ovaries

ime. RAS a eee 498

Greenburg, D.: Metastatic ab-

scesses of thyroid associated
with hyperthyroidism sere 700
Grigant, A. (Chauffard): Pancre-
atic dehydration in diabetic
COMA. 2 aS awiralc o = oe oe 672

v. Groer, F. (Hecht): Concerning
Adrenin. I. Alterations of va-
copressor action of adrenalin. .441

— (Matula): Alteration of vaso-

constrictor action of adre-

nin after treatment with

bacterial products 441
Grosse, A.: Double ovariectomy

during” preenancy,. ... ee 114
Growth and influence of thyroid.503
—— disturbance (Ofs. 221. eierewene 193

— effect of hypophysis feeding.. 11
— influence of anterior lobe of
DItwitary< One 2. eee 187

— use of anterior lobe hypo-
physeal extract in promo-
tion’ OF es Sener eee 270
Grumme: Iodine in dysmenor-
rhea’ 35.24 554 22 tee hee Cee 288
Grumme, D.: Iodine action in
fortre: <2 see ee eee 331

Guanidin, action on heart resem-

DMO IMIGOUIT fons, oe. eye! isch one: ae 696
—effect of, on reactions to
ROHR EMT ne toate, as ejiclus,a.-sies ois: 619
Gudernatsch, J. F.: Feeding rats
on glands of internal secre-
GTS! oS Se Bes aa cierto ee 470
Guggisberg, H.: Influence of
Ovary on metabolism ........ 667

Guilera Molas, L. G.: Genesis
and evolution of graafian fol-
FiGlOM Pie. ae es oe eae 2a ie 8s 667

Guillain, G.: Epileptic attacks
during diabetes with acidosis. 631

Guillaume, A. C.: La Sympa-
thique et les Systemes Associes.606

Guleke: Sporadic cretinism....700
Guillermin, R.: Sterilization by
Roentgen EEposures of the
OMRNESy Piers eas wir Sta ens ete ete on 288
Gull’s disease of thyroid hig oem 192
Gulpa: Urinary analyses in the
GIRO LICIE ote totarare cto, oisitecsyete: os 292

Gunewardene, T. H. (Weber):
Lipodystrophia progressiva...138

—— Sequel of case of lipo-
dystrophia progressiva. .471

Gutman, J.: Ductless glands and

constitutional diagnosis...... 624
Gynecology, endocrines in. ee 2'4:
— internal secretions in. “284, 469
— study of endocrinology and. .419
— pituitary treatment in...... a PAT
(CRENGICOUIZING. SAA a 3 Opie aire on eee 205
—— AT CQHUNADMIGYs OL. wane «sie ciars se ate!
— adventitious or spurious..... 206

—and gonad hormone secretion. 216
— — pathological enlargement of

male breast, differentia-
PIONMDEEWECD: «0/600 e.6 600.2 206
— -—the adolescent period..... 209
—-— theory of mammary inter-
MAUSCETCEION <... 2. ...% 648
— associated with abnormalities
OLOSSIMGAA Geis occ ic le ems) 0 se 211
—cause of phenomenon....... PALE
— character as to heredity...... 210
—chief contributing factor....213
—endocrine origin of......... 216
— histological studies of male
leiSS TiS ite ee A 208
— familiar occurrence of....... 210
—locus of incidence.......... 209
—Mmik production -<in.:....'... 210
— physiological phenomenon..
yt ene ae SEA EA 206, 212
——IFempOre OL (CASE. oc). 2 ce sos 264
—result of a physiological pro-
COS SM MtE ARN as G5 oS sce DAA,

Gynecomasts and sexual potency.212
— mental trend and emotional
POACHOtM Ame Olio eo ssis ee 8's 212

Haas, W.: Treatment of post-
BPELAMOM ATCUANLY, . 2.0 0.2 «22 «6 306

Haeberli, E.: Morphologically
demonstrable fat substances
and oxidase reaction in human
LA'S ROLOM Mcey S-t5 ooo tee Oe 700

Haeberlin, J. B.: Relation glands
of internal secretion to surgery.459

Haentjens, H. A.: Adrenin treat-
ment of bronchitis and asthma.108

Hagerty, J. F.: Observations on

Chie athy Olde AA wes oe on
Haggard, William D.: Toxic
non-exophthalmic goitre..... 167

Hallion, L.: Anatomical situa-
tion of glands of internal se-
cretion

— Plethysmographic exploration

of adrenal circulation..... 612

Haman, C. A.: Metastatic de-
posits in pituitary body from
carcinoma of thyroid causing
bilateral opthalmoplegia..... Dulies

Hamburger, H. J.: Hypergly-
caemia and glycosuria....... Ht!

Hamel, O.: Clinical picture of
inanition osteopathy. ......4- 2De

Hamman, L.: Significance of
small amount sugar in urine. .257

Hammar, J. A Endocrine mor-

DHOLO Lda woct cis. sisi a eee Sail
Hammett, Frederick S.: Gyne-
COMVASUIA ee rere «forse sncaot ome een 205

— (Patten and Suitsu): Physi-
ological response to adminis-

EVATLIONMOL PLTUITtAT Yc. ern on 463
Hannema, L. S.: <A doubtful case
of hypophyseal tumor ....... 652
— Case of dystrophia adiposo-
PONMMUPANIS: Veh. sc. sce weds sceters 652
Hannes, W.: Organotherapy in
uterine hemorrhages ........ 249

Hansell, H. F.: Case of sus-
pected tumor of pituitary body.464
Hardoy, P. J.: Etiology of Base-
GOweSeGISCASC™ 4 sue snes ke ons «el er Jol
Harmozone and growth........527
Harrison, A. G.: Labor with spe-
cial reference to pituitrin, etc. 480
Harrop, G. A. (Mosenthal): In-

fluence of menstruation on aci-

dosis in diabetes mellitus....449

Harrower, Henry R.: ‘Hormone
lonrhayexsy PS oc CRS 6 re Lee CRO CRG DEOIC 123
— Practical organotherapy..... 429
— Reinforcing thyroid extract. .492
—— Thyroid function test....... 492

Hart, C.: Functions of endo-
able. Gidsente) giana) ole coo Oc 456

— Significance of chromaffin sys-
OTH = oes acdnon a PA loeerie ona nolo 437

Hart, E. B. (Steenbock): Thyroid
hyperplasia and relation iodine

to hairless pig malady. I...... 493
Hartert, W.: Operation for in-
ELAtHOracic’ SOLE" =. satel e = es 3 4 |

Hartmann, H. (Peyron): Case
of uterine epithelioma of supra-

MOTE GME VAC! ves coc oc. cliers. syenemenee 437
Hartog: Ovarian transplanta-
BLOM ViALULG (OL <, «5:0 nero: ten Perea 668
Harvier, P. (Carnot): Syphilitic
GIADSTES «... accuse, evotopeuslasnapchsterosus 629
Haskins, J. B.: Surgery of
GHYTOIM, ...: .foydveesparch ews bee 493
Hatlehol, R. (HO6st): Blood

sugar concentration and blood

SUsaramMechodse aera ses sewers 449
Hawks, J. K. P.: Observations

ONVSOMUTET AS oe tke ee ees 492
Hawthorne, C. O.: Retinal

changes in’ Slycosuniay.. -scusee.. 292

Hayami, T.: Relation between
interstitial cells of Leydig and

BYy.DODHYSIS" cites ooo N83
Hazen, H. H.: Endocrine glands
DNS SV;D MES cass cccuep seen eee tone IIL

Head, G. D.: Multiple heman-
giomas of skin with dyspitui-
CATISIN shoxcxce deme cco cae ete 274

Headache in exophthalmic goitre.505

——INterpretation Of sc... s+ se: fal

— relieved by pituitary extract. .463

— with endocrine disturbance. ..667

Heart, action of adrenia on..... 107

— — — guanidin on

— denervated, as indication of

adrenin discharge

— dilatation of, associated with

hyperactivity of thyroid and

OVATY ) A. the he eee OE:
—hypertrophy of following ad-
ministration of pituitrin...128

— influence of adrenin on, in

SHOCK. .c.5°s oes beets CHEE 620
—rate, relation of adrenin dis-
Charee= torn seek oe tee acne 619

Hecht, A. F. (v. Groer):
cerning adrenin. MI.
tions of vacopressor action of
adrenalin

Heinekamp, W. J. R.:
adrenalin on, heart.) cece ae 244

Heitz, J.: Excretion of adrena-
lin according to recent studies. 441

Hekman, J.: Case of pineal
tumor

Hematoma of adrenal capsule. ..235

Hemophila in Graves’ disease
treated with serum of anaphy-

lacticurabbites «see ener ee 708
Hemorrhage, adrenin treatment

OE” 356 IS Reta) atetie deb eos OPE Ton 440
—— and adrenin’ =i. se 105, 106
= CO Cy OMG # eects aes mene 167
Hemorrhagia, thyroid extract

AMNAISNNE Ol Gaousavoconnoosc 366
Hemorrhagic diabetic retinitis. ..303
Hering: Struma apoplectica....167
Herkimer, Gotthold: Pathogene-

SisZol Glabetesmarcnes cerca 449

Hermann, E. T.: Physiology of

Conpus uteuniee. ee eee 445
Hermaphroditic glands, artificial
im, manwmals amd) birdsSmes. ere 266

—sex glands, relationship be-
tween homosexuality and. .267

Hermaphroditism, case of mas-
Culinie stupwlan 7. ccene ei eaceseae all
— description of two cases..... 460
— experimental...... 265, 266, 647
—-humian, CaseOhk. « .cscrneneeonene 646
—in man and mammals....... 646
== Men} va. He eee 123, 460

Hernaman-Johnson, F.: Cure of
forms of headache and ‘“‘face-
ache’’ by electrical methods. .505

— X-ray and electricity in ex-

ophthalmic goitre and other
glandular disorders....... 456

Hernando, T.: Gastric changes
Of endocrine: origin = = sea 464

Herrick, W. W.: Endocrinologist
and internist

Herring, P. T.: Influence of thy-
roids on functions of the supra-
renals

Herrmann, E. (Fraenkel):
mones and phosphatides...... 124

Hertz, J. J.: Medical aspects of
endocrinology

Hertz, P. (Secher): Case of con-
genital sympathetic neuroblas-
toma combined with Addison’s.
disease

Hertzberger, L.:
rhyzomelica

Herzfeld, EK. (Klinger): Iodine
combination in thyroid....... 493

— physiology and pathology

of thyroid sland. s7ec8 494

Hewer, E. E.: Connection repro-
ductive organs and_ other
glands of internal secretion. ..238

Hewer, Evelyn E.: Connection
between suprarenal cortex and
glands of internal secretion...

Hewitson, W. A.: Significance
of thyroid-parathyroid mech-
anism

Heyer: Undernourishment and
disease of the bones in Munich. 286

Heyn, A.: Interrelationship
menstruation, hair color and
LiDTGO! —... ecst. veh ees see ee 262

Hirose, T.: Origin of corpus
LUtewIM OF 23% 5 Sia.. Reoee ee 2

Hirst, J. C.: Corpus luteum ex-
tract, hypodermically in abor-
LIOT AOE, SIS cae eee 445

Histamine and pituitary extract.272
—- pituitary extract, compara-
CIVE -ACLIONY . .ueeesenseneene 129
— effect (on WtheruSs’. ~.n..01. sure 268
Histimin, relation to gastrin....645

Hoeggstrém, A. (Bergstrand):
Tertiary luetic thyroiditis....494
van der Hoeven, P. C. T.: Time
of ovulation
Hofbauer: Autonomic system
and ovarian therapy in toxi-
COSISHOL I PECLMNAN Cs ov y-irene oes 2:6 668
— Significance of endocrine or-

gans in toxemias of preg-
NCA me ce Mcgrewsice toy csuis ania «3,16 st © 457
— Therapeutic use of hypo-
DUSTING ew ogs askawegsus eles 6.3 %s)\0 151
Hofimans:Gizantism 5 .-..:.-..- 464
Hoffman, E.: Protective func-
ETO MMO Tastee ys) 6 uss aucie io sysgeise one 314
Hofstatter, R.: Hyper-hypophy-
SUSU GMAIL Se tame te cclels Go eben sy ees 28
— Treatment of amenorrhea with
hypophysis substance..... 274
Hogler:= vAkromegalie <i .....0.. 465
Hoke, E.: Polyuria in epidemic
SHEKOETDNGVINUISSS tency cecioacioec ic eOR aes 653
Holden, F. C.: Operative pro-
cedures for dysmenorrhea and
SECRDMEV aM in creas sion cee ales Gre 140
Holland, J. W.: Goitre: its early
diagnosis and treatment ..... 494
Hollenberg, M. S. (Vincent):
Effects of inanition upon adre-
TDL | OYCKO HENS aie a. oe Ome eee 408
Holmes, Bayard: Cecal stasis

with betaiminazolylethylamine
intoxication in relation to de-
THETIElAMD ACCOR a) ec.cic ose a 3s 244
Holmes, G. W. (Merrill): Treat-
ment of thyrotoxicosis by
means of Roentgen ray.......331

Holmgren, N.: Pineal innerva-
POMP CLOSLSY I: oye cai is: <:0. 0,202 309

Holzknecht, G. (Jonas): Diag-
nosis of pancreatic cysts ..... 477

Homosexuality and gonadal en-
MOCRINOLOL Vettel. 4. es eed euehee ove % 2A

— relationship between her-
maphroditic sex glands and. 267
——— Od LOMB M Ole 4s) cocneyena de one, e 36 alyyak

Homosexuals, generative glands
iba) Janbhan hol tags Coote) CRCR OER enon ene a onene 267
Honeyman, J. T.: Thymus and
(EUGENE AB 5 nn ee i pO
Hoogslag, W.: Starvation treat-
mentein diabetes... os... ..293
Hopfner, H.: Purulent inflam-
MidhHOMVOL CYTO... ...... 167
Hopkins, F. E.: Esophageal ob-
struction due to accessory
RVING 9-3-2: Rave eee 495
Horisawa, H.: Investigations on
EU VAOUC MONAT a.6 6 0. esis sc) ees 7
SlOLrMmonmemmunNeer? ..:. ew. ws 123
Hormone stimulation as factor in
ineleaaic2i! (Shi1 648

=== eh a WOM 2017
— — neuroses and............ 162

Hormones and hormone therapy. 267
— -—phosphatides ........... 124
— hypothesis concerning....... 125

Horsburgh, P. (Nicol): Notes on
two cases of diabetes mellitus.148

Hortega, Del R.: Nature of
pineal, Cellssaeeee beter see cers 679
Horwitz, P.: History of dia-
betes meilitus seers Sis es oe 631
Hoshimoto, H.: Thyroid feeding,
DANCEECASS aes .occcie ore ete ahs ee 56
Hoskins, EK. R. (Hoskins):
Growth and development of
amphibia as affected by thy-
NOLAECEOMIYVS Bera ciee aie cee ee 168

—-—Thyreoid and hypophysis,
interrelation in growth.. 1

Hoskins, Margaret M. (Hoskins):

Thyreoid and hypophysis, in-
terrelation in growth........ uf

—-— Growth and development of

amphibia as affected by
thyroidectomy
Host, H. F. (Hatlehol): Blood
sugar concentration and blood
sugar methods

Houssay, B. A.: Experimental
goitre from Cerrillos water...701

— Pathogenesis of Basedow’s
disease 5

— (Carulla): Polyuria from

piqure in dogs with dener-
VACCGMCIGMEY:SS. clspcde cys .siedees 682

— (Carrulla and Romana):

Polyuria from cerebral
DIGUMen in COL -.-)4 ens oe kere 682

— (Cevera): Adrenalin dis-
charge, splanchnic nerve. ..236

— (Galan and Negrete): Ac-

tion of hypophyseal extracts

Thay (loves Guavo lint) ol olie so glenn Or 653
— (Hug): Thyroid extirpation
Thay {ENG INGORE ea Oho 5 ARB Oe oe 701
Hovens Greve, C.: Relation be-
tween blood pressure’ and
DIG OGMSULAT fF ecmersioe ieee ocetenc. 238
Howard, C. P.: Polyglandular
disease in acromegaly and
other disturbances in thypo-
DILLY. SUS ear aoe lara tihes occ cxsncore sc octal

Hoxie, G. H.:

VOMOVIETSUL UN ocirer cys) hay 211010 .6) «sie 495
— (Morris): Chronic adrenal-
nah sy GAS cache ete Cen earer re 47
Huber: Arhythmias in Graves’
GUIBCAS Cy eb Phere haaeh cach phen ree acess 169
Huber, J. (Flandin and Debray):
Hypophyseal treatment of dia-
petes’ insipidus | 2 ae. 651-652

Hug, E. (Houssay): Thyroid ex-
tirpation ini the horse: .....: =. 701
Hughes, B.: Carcinoma of thy-

TOL: Ses soas? ee ia ec ea eee ee ee 702
— Papilliferous carcinoma of thy-
LOLG@. cccees see treet cs toreeeie er ichatees 701

Hull, Mary (Fenger): Separa-
tion of physiologically active
portion of posterior lobe of
WTGUICATY <5. 0. 2 se Se eset 462

Human ovum, maturation of....289

Hume, J.: Treatment of dia-
betes mellitus by alimentary

TOS) . ccd. oR a See eee 293
Hume, John: Fasting treatment

of diabetes 4245. 6c 148
Hunt, J.: Nerve block anes-

thesia in superior thyroid pole
LIP AtION see at tee eae eek 702
Hutinel, J. (Lereboullet): Two
eases of adiposo-genital syn-
coh mMoneaKer abaleceKOl INNES! oo, Sec tmiced BiGre'G oc 655
Hutinel, P.: Adrenal syndrome. 239
Hyperacidity gastric, thyroid eti-
ology and treatment of....... 704
— organotherapy in........... 454
Hyper-adrenalism, a cause of con-
genital pyloric hypertrophy...101
— — — -— — pancreatic insuffi-
GICTICY Mechs ee 101
— and seasickness ............ 236
Hyperadrenia, arteriosclerosis in. 259
Hyperglycemia a guide in estimat-

ing severity of diabetes....... 476
— action of gland extracts on...105
— ANd) S1VGOSUEIA. srs saeco euer ene 147
— -—-—in case of hypophysitis.270
—— {N= GIANDELICS. ac aces =< + oo crete 477
—preoperative anti-diabetic

treatment to reduce....... 295

— significance of in diabetes....447
Hyperhypophysized animals, con-

GHETONS ine. Beene vcees ceeee eee 128
Hypernephroma, case in man.... 96
(OS ie aMatctee ate. aun HiT cRcaeerenan sci avon abAal
— with early development of sex _
CHATACTETS. see fact erste asus 617
Hyperovarianism, relation to
hy:perpituitarism <). 2:2 . ..enenens 454
Hyperpituitarism of posterior lobe
and fibromata of uterus...... 454
— (secondary) a possible cause
ORSgey eso lan che eee caer oettee 274
Hypersalivation, a symptom of
thyroid. intoxication... sie. so. Sy 7
Hypertension as reaction to emo-
tional stress, genesis of...... 257
—thyroid treatment of......... 692
Hypertrophy of eyelids and cheeks
in exophthalmic goitre....... 696
Hyperthyroidism accompanying
firmnctional chorea. ese 502
— acute senile, case of......... 698
—adrenin reaction and........ 440
— and excessive thyroid drive. ..253
—w—exophthalmos ...........503
— — interstitial tissue ........ 396

— — ‘irritable heart of soldiers’’.113
— — manic-depressive insanity. .339
—-—sympathicotonia ......... 316
— basal metabolism in diagnosis

Of SEA exci tens ei eee eee 705

Hyperthyroidism, blood picture
OL OS Ste eee 6 ale eee ore 487
— = sugar“in 4. Yaeee e 458
— carbohydrate tolerance in....457
— diagnosis and treatment Ke 501
— diet. Int Soe 2 wae on 5, we OE
—early, treatment of.......... 706

—effect of adrenin on metab-
OlISma nS a oe coda ee eee 112

— —-—thyroidectomy on basal
metabolic rate in .... 82

——-—on adrenals........2.2i579
—-—-—adrenin content of ad-

renals .....20) sso 583

— = blood’... Saas

— electricity in treatment of....640

—endocrine therapy in........ PAIS

— etiology and treatment of....648
— in ‘‘diffuse adenomatosis’’ of

thyroid. Ss) eat. eee eee 395
—-— soldiers ............ 116, 169
— iodized dressings and latent. .338
— laboratory methods in diag-

NOSIS: iOf ga. Os ee Coe 175
—loss of eyes from exophthal-
MOS). Of aisles, 3 oe eee eee 704
— psychoneurotic syndrome of. .183
—radium therapy in.......... 160
—relation of neurocirculatory
asthenia: to: 42% = - sea 162
— report of two cases......... 489
——"StUdies ONS yo.cc enone ane 342
— surgical treatment of........ 254
— vasomotor symptom of....... Boul
— treated with X-rays....-:...-. 704
Hypertrichosis of pluriglandular
OPTLIN: om nk ots co eae eee ee 232
Hypoadrenalism and atrophy of
Skim 2 aces, ie eee 232
— with other endocrine disturb-
ANCES. «ces ae oNat ees een een 252

Hypofunction of thyroid in
mother causing mongolism in
children

Hypofunctions, value of gland ex-

traets ins i.hsc § of. oe eee 459
Hypo-ovarianism with other endo-
crine’ disturbances). 22. soe 252
Hypophyseal adenoma as cause of
acromeégaly >... 1 eee 276
— adiposity in children........ 466
——-—-—cause of .......... 278
—w—report of case.........:. 201
— 'CaCheXIa) (sos os cel» « ecoeere 134, 192
—deficiency with obesity and
genital hypoplasia........ 185
— diabetes’ o.<.. 0 ac cea e eee 130
=———QiSORGEES! sss.6 se elec eee ee 185
— -— labor grouping .......... 348
— disturbance and case of acro-
MéLAaly, a5. vA eee eee 462
— dwarfism, ‘case (Of. ...- 00 oe8 656
— — caused by syphilis........ 466
—-—report of case 90 years of
age: 2.2.4.0" te Zile
—}—two classes .. 2... «eee 279

Hypophyseal dysfunction, club fin-
EGissl Dine aid See ewe Cae nene ee aeons 2701
—dystrophy accompanied by
multiple hemangiomas of
alfa" 25 Cho cae OER Gee en eae 274
—-— most striking symptom....187
—extract, action on hypergly-
CONMAMPES MGS ccs Sc cles oes 105
—-—and alimentary glycosuria. 522
—-— — carbohydrate tolerance.522

— —-—tonus of intestine..... 469
—- in diabetes insipidus..... 651
— —-—hyperacidity ......... 455
—-— — treatment of adiposis
OLONO SANs rare c eree Sle i 432
— — — aiabetesi as cer.t. 269

—fat dystrophy, study of cases.194
—function, diminution of a
cause of dwarfism........ 278
— — disturbances of accom-
panied by glycosuria. ..258
— origin of diabetes insipidus. ..272

—-—— dwarfism ............ 267
— ——dystrophia adiposogeni-
CUES ek pes cower a ye argaite «e's 204.
—-——glycosuria ...........519
— — ——narcoleptic attacks. .127
— polydipsia report of case....125
—w—with polyuria........... 125
—polyuria diabetes insipidus
TOME WINS Pests cite tays aoe ae 507
— treatment of amenorrhea..... 274
— tumor, causing aural bruit...268

—w—cure of case of meningitis
following operation for,467

—-— operation for ....... Laos Loo
—-—reports of six cases....... 276
— —two cases of............. 462
———x-ray treatment ..... 271, 462
Hypophysectomy and genital
ALLO DH Va Asters Sitio seers «DLS

— carbohydrate tolerance and. sik
LEM PUAN TS — 3 orn On ee
pees aie 125-137, 268-283, 461-469

—a cause of hypertrophy of....242
— absence of iodine in......... 657
— action extract of on distribu-
PLOTAEOTMNOOG Gs ooo cie weseke « 467
— adenoma of causing an uncom-
MOM ESCASES, fie fnelie 2 caterers 134
— adiposity with dwarfism..... 656
— anatomy and function of..... 269
—and adrenals, combined hyper-
TOC 10) 6) 30) re rea 134
pt EUCLID Yon clevv lens Suc 0 <u) eines 0 481
—-Raynaud’s disease....... 466
—-thyroid able to function
WAU OTIS UVES ton cyee aie ove uetic 5 24

— — — interrelation in growth. Il
— — thyroidectomy, relation be-

LACHES Gl 620i ee rs 282
——IPIOLOGiCdl StUGy Of. ....... 6 467
— case of acute inflammation. ..270
— —— sarcoma of........... 277
—cerebri of California ground-

Seb Ted [oe Ae re 212

Hypophysis cerebri pre-oral gut,
development Poti ato. <<<. 278
Ofe, sete kee ercie’.s 278
—changes during hibernation. .466
— classification of disorders of. .347
— condition of, in encephalitis. .655
— congenital syphilis of....... 281
— danger of operation......... 196

— deficiency of, causing adiposo-
genital syndrome in adults.655

—destruction of anterior lobe

Dy CYSUS 5. ckcc utes fe Selo
— development glandular. por-
TION. OLS WhO ore esto lero 27
—=—— Of Lorm of human. ...,.kson 4601
— discussion of physiology and
Datholosys (Ofs. a2 eucs skeet 278
— effect of castration and vasec-
CORNY OMe weyers, ecb tc nese 653
— — thyroidectomy on...... 24
—-—— administering anterior
Noy wes Cpe hice mere ae as Armes
—extirpation, effect on carbo-
hydrate tolerance: 2203... 654
—extract, action of in Graves’
GiSGAS Cio). anees cua seekers 658

—— action of, on peristalsis. ..658
—-—in diabetes insipidus, com-
parative efficacy of differ-

CNnitsSOrts) sa 2 cee ee enon 630
— — — treatment of diabetes in-
SULCUS ip sercsy vectok eer eee 651
—— diabetes insipidus
inv ae DaDVerctesoe 656.
— metrorrhagia ,...651
— — differing action of, in case
of dog and rabbit...... 653

— -— posterior lobe, influence of
endocrine conditions and
thyroid administration
upon reactions to...... 638

— feeding, experiments with.... 3

——_—to frog larvae......... 4, 10

—function capacity of and de-

gree of fat dystrophy...... 192

— functions of individual lobes.

Tee tare Se Oe Cae 348, 349

Der DIASTAROM. ery aleucec cis ss. 1 2

— hypersecretion of causing dia-

betes» InSsipldus'..... 4.....5... LoD

—hypertrophy of following use

ot pituitary, extract. ...< <..: 128

— hypoplasia and atrophy of

CAS CS OM enkent sts atte en sees 280

— jin a pluriglandular case..... 480

——ecase of dystrophia myo-

PSL OIMUC AAR aba sernizere ce lopuys onc eke 453

—-——- -_--—— hypopituitarism ....40i7

——-—— UMGeTied, Lats yeyer os ene tp 265

— injury of followed by gigan-

ESTOS Ce gsys ce taiehs cathe sevstetey Remake

— iodine content of active prin-

Ciple MOLeaee kas wars terete tne 3
——-=——of in mammals....... 12
—lesion not cause of “hypo-

DHYSeal 7 POLY WELA hao euerees 650

Hypophysis medication and poly-

Wi AeOrSELYCOSULIA. .:./c..0 steko 130
— — indications for........... 128
— method for testing liquor... .273

— normal in case of tumor of
third ventricle

— of cock, normal morphology of,
and effects of castration and
ligation of spermatic ducts.551

relation of eosinophil

elements of, to sex
FAGHIOIS. ninibio-tasso.o Sibi HDL

— ossification of causing diabetes
THOUS A O16 KU Sad Arad inte ner oe eee Loecuc c 654
— pharyngeal (vestigial) ...... 201

— physiology and pathology of. .654
— quantitative determination of

material components...... 41
—radiation of in treatment of

asthma” <2 28-2 od ee io os OM

— — — — visual disorders..... 658
—relation between acromegaly

NGS sesrccn Se Oe ne eee ee 276

—-—of pregnancy to......... 640

—-—-to glycogenolysis...... 129
—w-—to carbohydrate metabol-

ESO 06 QR ge PRO ee ai Riana 25

— — — diabetes insipidus...... 654
— relationship between diabetes

ANSIPIEUS: “AMdiees sss 3) ere coe 135

— resemblance of chemical com-
position of to other organs.131

— sarcoma of, with acromegaly;
ablation followed by dia-

betes es eee aa ae 657
—sensitiveness to vitamine in-
fiumences ins foodie. . 4. 5 sce 276
= SUPLErY- OF San Piet eee 268
— technical description of...... 136
— therapeutic future of anterior
NODES 6, aise et ee OO a eee 270
— treatment of cachexia....... 134
— — extirpation of in two cases.136
——CUMOT OF t5icik ete eos cee ane ore 465
— — — doubtful case of....... 652
—-——in dystrophia adiposo-
Senitalis 4 veces oe 652
—-—-report of case........ 126
— —-— treated with radium...649
— weight of during pregnancy. .467
Hypophysis-adrenal system, dys-
function of in pregnancy..... 457
Hypophysectomy, report of four
CASES 24.5 ait cestinmsl ore shee wis ahs 278

Hypophysin tablets in treatment
of syphilis
Hypophysitis, case of acute sup-
DUNALLVG™ oes eee ee ee oe 270
Hypoadrenia, stimulating intes-
tinal obstruction® sre. + eceee ee 104
Hypopituitarism and constipation.464

——(ClaSSI@ SISNS VOL... oe ee eee 134
— deficiency syndrome ........ 193
— mental disturbances in...... 191
= report(Of CaS@see .. csc see ee 403

—signs and symptoms of...... 134

Hypopituitarism, with other en-

docrine disturbances ........ 252
Hypothyroid etiology of retarded
muscle: -achivity ) «ste eee 496
— and dementia precox........339
—-—skin diseases ........... 23:2
— basal metabolism in........ Wis,
—effect upon adrenals........ 582
— -—-—adrenin content of ad-
TENAIS: si cpeps) hee eee
— hereditary, with dystrophies
of hair ands nails = see 692
— medical treatment of........ 324
—<Iparalysis’ witht =Ae.e.. ose 166
— thesthyroid@ini +4 34 =o oe 473
— with rickets and tetany, report
OF (CASO TTS Sates cee eae 161
Ey potension “<< a peo ele 193
Ibrahim: Epilepsy and _ endo-
SEN OWS ACLPDOSTEYss eee ee eee 128
Ide; CR: SHormones==. see PAS
Idiocy, amaurotic family....... 622
Idiopathicsepilepsy.. — > ee eee 222

Implantation of testis, results. ..122
Incontinence, urinary, of hypo-
thyroid origin; thyroid treat-

Mentol=s... -Sas5e ee ee 709
Infantilism® - 52s 2s2% 35. oe 193
= @ 1Case Offs. hes ee Jee 697
— — —— true .............. 283

— as related to pituitary disease.188
— associated with splenomegaly,
case of

— Brissaud type, description. ...190
— due to hereditary syphilis....644

— in-boy ‘of 165.5 3434. -e eee 277
—-— women and hypofunction

Of “OVATIES cS. See
—Lorain type, description of....190
— organ extracts useless in....463
——-pancreatie -. Ss ocak oe ee 675

Infections; influence on adrenals.613

—relation to adrenal _ insuffi-
CiENGCY **. W444 Sass ee Se 609
Influenza, adrenal glands in..... 97
— adrenal insufficiency in...... 610
— adrenin treatment of.245, 247, 444
—and diabetes’ .5:..-5-.> ee 451
—as a cause of Addison’s dis-
Case “2 sis Ss eee 97

—as etiologic factor in goitre. .709
8

— hyperthyroidism in ..-..22 oe 182
— thyroid and adrenal in etiology
and ‘treatment of... 2. . ace 617
— -— insufficiency following....498
Influenzal pneumonia, adrenal
glands in 4642.56.02 250 97
Infantile osteomalacia: =... 139
Infants, adrenin treatment of
lune diseases “ins... ese 113
Infundibular extracts, determina-
tion! OL Activity (Of. 6s oe 135

Infundibulum, action on pregnant
uterus
Internal genital tumors of supra-

PONG eetyperts sacle os ec es Seles 437
— glandular therapy in case of
GySpIEMtanism. 2.23... es ahayy
Internal secretion, glands of....283
—-—manganese content of
SAMOS Of ss sls. <to ler ahacs, 459
——— OT ONIR IGE ia Gene era 287
—— — — pancreas and diabetes. .447
— — — sex glands ........... 460
SIM is cle So oe oe be 8 314
— — — testicle, influence of...319
— — stimulating cerebrum..... 118
— secretions, utilization in gyn-
ecological practice........ 284
Internal ssecretions. 6.6... 138, 429

—-— acromegalic tendency and.461
—w—action of glands of on di-

PBSTUVCRLTACES © awe 603) o> 464
— -—-—anatomical situation of...457
—-—aand gynecology.......... 469

——Assn. for study of re-
search work outlined.44, 602

—————CALATACG AMG. oc cco cr ee aes 114

— -— disorder of producing neu-
PeUS MET eat geli lore) ops. Ss) 6! «) 70

— — disregard of role of a cause
Oneesh) mortality. .<.... ibalal

— — feeding rats on glands of. .470
— -— importance of in functional

COLGCIACIONS) axe once se 40
—-—in general practice....... 429
—-— influence on formation of

[cri Se oe Sees Ae ane ae 470
— — —— rat sarcoma........ 660
— —-——tumors ........... 660
—-— pathology of, following

spermatic cord ligation

ehocol shel ol ls hae t2 ae 661
—— pernicious anemia and....471

— — progress in knowledge of. .138
—-—resume of our knowledge
tit: 4 SxthorBicaciceee eee 470
— —vitamines and
Internal secretory function of sex
glands and gynecomastia..... 209
—— gland products, relation of
WIAMaIneS <CO.t <l. css 457
—w—glands, dementia praecox
eyt01) Pek delphi pa ei ene 244
—-——relation to surgery....459
Intersexuality and hermaphro-
obieisia, The, bool re Sly
Interstitial cells in tests at birth. 316
—— of Leydig, origin of...... 646
— — — — relation of, to hypo-
physis
—-—of ovary in case of osteo-
malacia of pregnancy... .247
— — — — origin and evolution.541
Interstitial gland and body tem-
perature
Intoxications, relation to adrenal
insufficiency

Jodine action in goitre......... So
— — of in dysmenorrhea.......288
— active principle of thyroid... 25
—administration in goitre of

IKoyaveemsyiehavehhike: oo plo orceomolwie 167
—and electric conductivity of

LISSILE] Shoot ech abo
— assimilation in hairless pigs. .493
— combination in thyroid...... 493
— compound in thyroid, isolation

OLS cys tere ge CRoete ay cates Se opie yal

—containing compound of thy-

roid, chemical nature of...332

—content of human _ thyroid
SAMS) “pal sek eee a ceke te eee 183

— — — thyroid in broncho-
pneumonia 25-222 5- 183

—determination of, in thyroid
SHUGICSie = are Bar tas eaereton ase 704
— distribution in thyroid...... 344
— in hypophysis of mammals... 12
== in “Saliva ts,.45.% 35 see wae ee 452
-—_——thyroid secretion.........494
—not found in hypophysis..... 657
—results from use of in goitre.332
Jodothyrin not hormone........ 691

‘“Trritable heart,’ effect of adre-
TUTTO TI eis a8 x: co a alten Setar teen eeeies alaly

— on electrocardio-
SLAMS" ee eee 107
— -—in general practice....... 154

Isaacson, V. I. (Janney): Blood
sugar tolerance test... 04... .- 248

— -— Protein sparing by glucose
in experimental diabetes.294
IslandsMotwmangerhaus.. ..- % .\: 270
— — — absence in case of dia-
betes
——-—aand carbohydrate meta-
bolism
— — — — function of pancreas. 449
— —-—in congenital syphilis of
NY POPH YSIS ere + dete ores 281
————_ Internal seeretion, of... 146
Ishibashi, M.: Normal weight of
thymus at different ages in
man
Iwai 7s: Diabetes mellitus
amone Japanese: ...<).<6s% ade

Jackson, C. M. (Stewart): Ef-
fects inanition in young on
size of body and organs in rat.265

Jackson, D. E. (Mills): Active
principle of pituitary extracts
and comparative action of his-

LH aha: My Pac cece Re OtOND 129
Jacob, P. (Labeaume): Volumi-
MOUS) PLOT Omterrorssisasis. elanec stents 69

Jacobs, J. (Chauffard and Brian):
Tissue dehydration in diabetes.630

Jacobson, C.: Carbohydrate tol-
erance after Eck fistula and
hypophysectomy

Jacoby, M.: Physiology and
pathology of hypophysis...... 654
Jaeger, H.: Parathyroid trans-
plantation in post-operative
tetany
Jaffee (Abelin): Physiological
action of proteinogenous ami-
mess UTT. = s)0.525 pete ec eee 485
Jaksch - Wastenhorst: Adrenin
treatment of influenza.......245
Janney, N. W.: Advantages of
class instruction in treatment
of diabetes
— Glucose formation from pro-
Ceing IM, diabetes yuseer- elena 294
— Isolated thyroid hormone....168
— (Isaacson): Blood sugar tol-
ELanCe@stleSt tepensnndoomiies snes 248
— -— Protein-sparing by glucose
in experimental diabetes.294
Japanese, diabetes among...... 293
Jaugeas, M.: Roentgen-ray treat-
ment of pituitary tumors..... PATS
Jelliffe, S. E.: Pineal structure,
function and disease......... 680
Jensen, C. O.: Provocation of
metamorphosis, efficacy of thy-

LOI) PreparabiOns see ew | ele: 702
— Thyroid gland and anomalies
Of metamorphosis, os. a. 702

Jiminez, Adna l.: Splenomegaly
and sinhancilismess is cierce ie crete 686
Joachimoglu, G.: Pharmacology
of drugs used in parturition. .275
Jodicke, P.: Eunuchoid gigan-
LISI ere eer ee PRE a. hs 459
Johnson, G. C.: RoOntgen obser-
vation of pituitary region in

INGRACRANT Ale VESTONS eevee. cere ee 465
Johnson, W.: Hyperthyroidism
in exhausted soldiers........ 169
Jonas, S. (Holzknecht): Diag-
nosis of pancreatic cysts...... 477
Jones, E. G.: Clinical data on
FOUTS ere isl hs ch Pe ee 495
Jorge, J. M. (Natale): Clinical

and surgical remarks on tumors
OtshypoOphySisi ae = ae eae
Joslin, E. P.: Causes of death in
Giabetes? we..s6. 7 eee eee Os
— Diabetes; results of past treat-
ment and future problems. .450
Jubo, M.: Suprarenal glands in
CONSENTED Sy pM UiSeee eee ee 613
Jungling (Fleisher): Hypophy-
seal tumor, x-ray treatment. .462
Just: ‘‘Funnel breast’’ in Graves’
disease

— Pit in thorax of child with
Graviesecdisecase: area 170

Kahn, Max (Kahn): Lime de-
HelenGyoOr/diabetess.-1 eee EL

Kahn, Morris H. (Kahn): Lime
deficiency of diabetes........251

Kahn, R. H.: Central nervous
system, adrenals and carbe-
hydrate metabolism ......... 99

Kamo, K.: Relation acromegaly
and anomaly of hypophysis...276

Kaplan, D. M.: Endocrine trop-

isms. Adrenatropisms ...... 239
— Endocrine tropisms: thyro-
tropism. '. 225.) See eee 703
Kastan: Dystrophic myotonica.118
Variations of myotonia...... 472
Kasten: Thyroidhypoplasia con-
Lenita: has od es ee ee ee 496
Kato, M.: Internal secretory or-
gans in morbus Basedowii....704

Katz, J.: Deficient thyroid secre-
tion in gastric and duedenal
ulcers

Kawakita, S.: Ossification of
hypophysis causing diabetes in-

sipidus ~c fu wee hes eee ee 654
Keeton, R. W. (Becht): Rela-
tion of hypophysis to glyco-
SSNOLYSIS~ cs how el eee ene a
— (Koch and Luckhardt): Chem-
ical studies on gastrin
bodies: .2 2. ane 645
Keith, A.: Differentiation of
mankind into racial types....118
Kellaway, C. H.: Hyperglycemia
oLsasphyxia® 2.4.24: oe 240

Keller, A. A.: Local anasthesia
for operations for goitre...... 170
Kempter, H. L. (Palmer): Yel-
low pigmentation and fecun-
dity
Kendall, EK. C.: Chemical identi-
fication of thyroid hormone...332
— Determination of iodin in thy-
Told’ Studies: ©2 soe ere eee 704
— Isolation of iodine compound
in thyroid
Kenneway, E. UL.
Diabetes insipidus
Kerley, C. G.: Unusual case of
cretinism
Kerr, W. J.: Thyroid among re-
Cruits=at Campy Wewis- eee L172
Kerr, W. T.: Thyroid enlarge-
ment among students of Puyal-
hup, IndiansS choolses. cere ney (il
Kidney extracts, effect on smooth

(Mottram):

MUSCIEs ak, sh: 6 oho ot 1s one 260
—threshold for sugar in dia-
DGGES : oo ienelcne cnet s Renee Ren one 627
—thyroid and parathyroid, mu-
tual interrelationship be-
EWEEN: 53% 6 de ccpapeha toa eee 178
—functioning as factor in dia-
DEES s -iogivcns tue sah es adorei 636
Kidneys, in case of hypopitui-
EALTISIN wi ogade. heron tek wicca .407
Killian: Hypophysen-tumor...465
Killian, John A.: Carbohydrate

tolerance in hyperthyroidism. .457

Kimball, O. P. (Rogoff and Ma-

rine): Prevention of simple

POIGLe SI AMIIDe 22.585. Ss Ss 332
Kinetic drive, caused by.......526
King, H. D.: Studies on inbreed-

ee Ne ae es Oe ee 153

King, J. H.: Effect of removal
of spleen upon metabolism in
dogs

Kishi, I.: Parathyroid, antibodies,
HOTS est = a ee 678

Klass, O. C.: Thyroid in uterine
hemorrhage

Kleiner, I. S.: Effect of intra-
venous injection of pancreas
emulsion upon hyperglycemia
due to depancreatization..... 295

Klieneberger, C.: Vagotonia and
sympathicotonia

Klinger, R. (Herzfeld): Iodine
combination in thyroid....... 493

—-— Physiology and pathology

SEethyroid land. = 69... . 494

Klose, H.: Pathology of Graves’
disease

— Acute strumitis

Knapp, M. I.: A new conception
Sih SSUTTS yee ce BiG Sie ane)

Koch, F. C. (Luckhardt and Kee-
ton): Chemical studies on gas-
trin bodies

Kocher’s thyreopenia .......... 192

Kohler, H.: War amenorrhea. .624

Kohn, A.: Structure of gonads.122

Kolisch, R.: “Reiztheroie und
Behandlungs method en des

PVG ECCS amie coach aie cs, by sier s,s 607
Kolman, Max.: Acceleration of

metamorphosis, thyroid ex-

nC < . Le A ee 73

— Influence of thyroid extract on
secondary sex characters in

JAUICT ot, eee ee LT2
Kondo, S.: Influence of adrenin
on near Teeulation...-..:... 620
Koopman, J.: Acetone in cere-
DEOSDRNAIUIIG) scs-wd oss 3 ae 400
— Hypophyseal diabetes....... 130

— (Berkeley): New method for
diagnosis of toxic thyroid
states

Kooy, F. H.: Bodily symptoms

caused by emotion........... 442

Korentchevsky, V.: Influence of

internal secretions and auto-

lysate on tumors of rats..... 660
— Influence of internal secretions
On tumors of dofes..:..... 659
— Influence of internal secretions
on tumors of mice..... #2660
— (Bogoslovsky): Internal se-
cretion of prostate........ 682
Koslowsky: Diarrhea in Graves’
DoDEs TG. Sa LT2

Kozawa,_ S.: Permeability of
erythrocytes to sugars....... 114

Krabbe, K. G.: Histology and
embryology of human pineal. .309
Kramer: Retarded muscle con-
traction
Kraus, A.:
fants
Kraus, R.:
cretinism
Kreuter, E.: Transplantation of
testicle: In “Manic oerae aes ccs 318
Krisch: Eunuchoidismus
Krisch, H.: Myxoedema adul-
CORUM 5 Sere. cae wheiecle eel ee
Krogh, Marie: Influence thyroi-
din on normal metabolism....172
Kulenkampft, D.: Anaesthesia ©
and technic of operations in
goitre
Kuntz, A.: Innervation of go-
MAGS £1N (AGL ape ee are eee 265
— Testicular degeneration and
hypertrophy of interstitial
tissue
Kuriyama, S.:
feeding upon
metabolism. II.
Kyrle, J.: Hypoplasia of testi- ~
Glenn eVOWEN! 5... = cece erste eee eee 460

Influence thyroid
carbohydrate

Labbé, M.: Diabetes and exoph-
thalmic goitre
— Epilepsy and diabetes. Epi-
lepsy in relation to dia-
(Hees. Ree arr ae ecto c 632
Nuclear digestion and diag-
nosis of pancreatic insuffi-
CPOMCV es che «oO Meiers ore 674
— Pancreatic diabetes......... 148

— (Langlois):
EM BCLOS rat imncta ahaeedie: overs c 130
Labeaume (Jacob): Voluminous
goitre
Labey, M.
thyroid
Labhardt, A.: Relation between
corpus luteum and menstrua-
Uitota Ae Sees Oo oko ae eee 288
Labor pains, use of pituitrin to
alleviate
Lacassagne, A.: Hermaphrodit-
ism in man and mammals....646
— (Brian and Lagoutte): Human
bilateral hermaphroditism... .646
Lactation atrophy, endocrine
GHGEAD Ys rere ie es otter eee aes fou eeet Ore)
—relation between menstruation
and
Lagouette, M. (Brian and Lacas-
sagne): Human bilateral her-
maphroditism
Lahey, F. H.: Loss of eyes from
exophthalmos of hyperthyroid-
TST cca Stspa eed eee ee och s, ae 704

G.: Cold abscess of

Lahm, W.: Question of ectopic
TIATIGIT Eye aan eens AEs Sc 445
Lambright, G. LL. (Phillips):
Premature sexual development.616
Landois, F.: Treatment post-
operative tetany by transplan-
tation of parathyroids....... 307
Langfeldt, E.: Experimental pan-
creatic diabetes, chronic..... 63
Lange: Demonstration of cretins.17
Langerhans islands, histogenesis
ODD 5S ext a aor cera es oc oe 672
Langhans, Th. (Wegelin): Goitre
injitheswhitesrate.. a..2.ssee ee 234
Langley, J. N.: Arrangement of
autonomic nervous system....248
Langlois, S. (Labbé): Acro-
megaly and diabetes......... 130
Langmead, F.: A case of lipo-
dystrophia
Langstroth, F. W.:
of procreative
women
Larsson, B. Hjalmar: Report of
case of diabetes mellitus.....295
Launoy, L. (Lévy-Bruhl):
roid in immunity
maura, (Co Gis Se Antipituitary,
serum
Lauritzen, M.: Relation between
creatinuria and acidosis in dia-
betes
Lauwers, G. B.: Case of pseudo-
hermaphroditism
Le Blanc, E.: Endocrine epithe-
lium in roof of mid-véntricle of
Algerian lizard
Lhemann, G.: Ulcer of ‘stomach
and automatic nervous system.184
Leiner, Joshua H.: Little signs

Preservation
function in

of thyroid disturbance....... 174
— Pubertas precox and mental-
GV Sake sc, 8 aE ec ORGS rarer ame ee 369
Lemierre, A. (Taberlet): Sup-
pDurnativie’ thyroiditis! 4 se 174
Lennox, W. G. (Read): Case of
Gretinism’” SANS ee parte ee 497
Lenz, F.: Dominant sex-linked

inheritance and heredity of
Basedow’s diathesis ......... 33
— Explanation of acromegaly...13

Leopoid-Levi, C. R.: Endocrine
Planidstanadere viet a cree tordenere 119
Lereboullet, P. (Hutinel): Two
eases of adiposo-genital syn-
dromesinvadults sabe eee eee 655
Lermoyez, J. (Souques): Famil-
ial exophthalmic goitre....... 180
Leroy, E. (Fiessinger): Adrenal
IN SUMMCIENCY wat4 setters aes eens 238
Lescohier, A. W.: Present as-
pects of endocrinology....... 459
Lesser: Cause of pancreatic dia-
DOLES rc secs eerees cet See oe ake 296
— pathology of pancreatic dia-
IDGLES:. siais, aos ches oc larorare Gk ire 477

Lesser, E. J.: Pancreatic dia-
DEES, sis. iis ieee eee ee 450
Leucemia, exophthalmos in..... 138
Levy, Louis: Making cure of
foitre: Ssafe.45.. heuer 174
Lévy-Bruhl (Launoy): Thyroid
ham hohohibohaces pic nea oe G50 5 of 497
Levison, Louis A.: Recognition

and management of threaten-
ing: diabetic coma... are 296
Lewis, D. D. (Maurer): Secre-
tion antecedents in pars inter-
media of hypophysis of pig...465
Leydig cells in testes of cock.
relation to sex characteristics
Sle 6 ace a aitamey Omen Te ag oNeE eR ope eke 55.2), sole:
Leyton, O.:
diabetes
— Treatment of diabetes mellitus
in children and adolescents. 296
Lhermitte, J. (Claude): Infun-
dibular syndrome in case of
tumor of third ventricle..... 126
Lichen of buccal mucosa in adre-
nal insufficiency
Lichtenstern: Testicular trans-
plantation in eunuchoidism...687
Lichtwitz, L.: Diabetes mellitus.297
Lichty, J. A.: Treatment of dis-
ease of thyroid, hyperthyroid-
ism
Liek:
Lienine, active principle of spleen,
preparation and action of, on

smooth muscle ...s-1-sos eee 685
Life assurance, glycosuria as fac-
COPA Fo. eee icuetcuacceememerene 672, 676
Lipodystrophia, a case of....... 662
Lim, R. K. S.: Effect thyroid
extract on tadpoles... 2. 174
Lindblom, O.: Studies on acute
LEWUCOMTA)- coc. < acters) eee 484
Lindblom, S.: Blood sugar in
diabetes mellituss ..- -.-) aoe 477

Lindsay, L. M.: Infantile ecze-
ma and status lymphaticus...158
Link, G.: Preliminary thyroid

Operations. <2" « \cc-ns%osepoeeeeene 174
Lipamine, the hormone of the

corpus, luteum, 22.) ee eee 288
Lipodystrophia progressiva..... 138
—-— sequel of case of......... 471

Lippmann, A.: Lowering of freez-
ing point of blood in diabetes. 297
Lipschiitz, A.: Fundamentals of

knowledge about gonads..... 23
— Interstitial gland and body

ECM PCTAtUre 4k. . sheaclach- eee 122
— Sexual characters and gonads.122
— The puberty gland.......... 233
— transformation of clitoris....122
Lissner, Henry H.: Hypopitui-

CATIS IN e#5..ciar-ns oreuten ashe 2 Aer Se 403
Thittle’s GiSCase: cc acs ate eee 165

—_

Liver, effect of adrenalin and des-
sicated thyroid on catalase pro-
CUENCROMEM ter catete ss tersisiree in * 107

— extracts, effect of each of two.260

Lockwood, B. C. (Freund): Or-
gan extracts and oOphorectomy
AGH MObtADONMSM <9... 2 cs «3s 664

Loepper, M. (Oppenheim): Ad-
renals and pathology of war. .613

Loffler: Gas metabolism in dia-
DUS MES, FOR hs xk ele elec a 148

Lommel: Bradycardia hypo-
GHA eee p ate eo Sic ois cle esis ses 119

Long, J. A. (Evans): Recurrence
of typical oestrus cycle after
ovarian transplantation...... 476
Lonne, F.: Homologous milk in-
jection and mammary secre-

(HICKS 2 eo Lin cn cae oe 662
Lépez Albo, W.: Post-influenzal
tChyroide ny poLtunction:. .:..... 498
— Thyroid insufficiency after in-
MCA Blac BAe Glee 498
— (Cortiguera): Precocious pu-
berty due to tumor of ovary.475
Lorain type of infantilism...... 190
Loumeau: Diabetes and _ pros-
Ri NCHEIMV ALE ett Pa Fees ener sicice . oi« 297

Love, Tracy R.: Diabetes, treat-
ed with Allen starvation meth-

od, report of seven cases.....297
Lozano, N.: Goitre and cretin-
ismeminvAreentine. ............ 334

Luckhardt, A. B. (Sherman and
Serbin): Origin musuclar tre-
mors, etc., in parathyroid tet-
LTA cree a ene Coe eens eb <b Wee we 479

— (Koch and Keeton): Chemi-

cal studies on gastrin bodies.645

Liudin, M.: Action Rontgen rays

CUMAGROCH Ee woh ot wos 64.5 bee 442
Ludwig, F.: Placenta as birth-
promoting Organ. s.......... 310
Lueders, C. W.: Laboratory
methods in diagnosis of early
NY PEEEHYTOLGISRI 4 i. 6 Sos es U5
Lung diseases, adrenin in treat-
ISTE (Or =. Bee Wie. AC CIE eae a HE et ai
Lungs, long lasting lesions of,
Clu MmUsers and... 6%. 5 ems Ses 272
Lusk, G.: Metabolism in dia-
RECN Brice Ponce aie Vahey 00 9 9 297
Lymphatie obstruction as cause
Ci EQhiite) SO oe ee 708

— glands, substance elaborated
by and its influence on para-

sympathetic system.......... 284
— tissue in thyroid in Addison’s
RUGCOtS Siento e ee 328

Maase, O. (Zondek): Dystrophia

JPR LG LE A 453
Macan, J.: Ovarian metrorrhagia
@nd tradiotherapy ........... 668

McCarrison, R.: Dietetic defi-
ciency and endocrine activity
with reference to Edema..... 641

— Involution of thymus in birds.321

— Pathogenesis of deficiency dis-

ease. II. Effects depriva-
tion of ‘“‘B’’ accessory foods.276

—Scorbutie diet and adrenal

lands creer enone teas 100
MacArthur, C. G.: Tissue analy-
SiS? GALLIC, PILUTCATICS!: ©. eye, ice iasal
McCaskey, G. W.: Case of fatal
adtabetic™ ‘COmaz- ss. ] bers 2 eieice-as 298
McCay, D.: Coma as cause of
adeathy an diabeteszu-reacicvo ede: 634
— Treatment of diabetes in In-
Gay oa ieks Mas oun oe heen eee 635

— Sugar of blood and sugar in
urine in varying conditions
of health in Bengali. ..298, 299
McGuire, S.: Metabolism deter-
minations in hyperthyroidism. 705
Macht, D. I. (Abel): Histamine
and pituitary: extract... a.0o6 268
— (Matsumoto): Action prosta-
tic extracts on isolated geni-
CO-UTinary ORGANS... ease 481
Machwitz: Acromegaly with dia-
WGTESt areas us: «5 yas Sean esaretesneke erode 276
Mackenty, J. E.: Surgical treat-
MENTORS OTE)... >.5 «mcr ones 175
MacLean, Neil J.: Surgical treat-
ment of goitres, bilateral re-

SOCEIOMM Re, octane ances coher ate 499
MacLeod, J. J. R.: Diabetic
GET AD DY O Ss ails < Scenes tote oss eres 299
McMillan, D. W.: Diabetes’ mel-
NINQUSPMOO ROA cos aaccens. SuSTORE A Ty -ogetotone 300
McConnel, Mrs. D.: Determina-
ELON! OL SCX as oo cscs a's caleaione
McCord, C. P. (Walker): Sim-
ple goitre, a public health prob-
VST wetsisrata sehen ates, @ Sielenetene 499
MacPherson, J.: Pre-adolescent
PAUSANTISING CO oiercteiene sie seis cye chal 262
McCready, E. B.: Organotherapy
in certain diseases of child-
TOU Cree ar caee en ress) be ete ae 473
Magnesium excretion in osteoma-
NE TONG Te aero CuChROne Ici NCC aCR ME eta 664
Magnus-Levy, A.: Diabetes dur-
ete (CN eed Cy cee eS cy Cais EERCROn ET Ono 300
Mamma, enlargement of male...
Gee OP ee 205, 212

—secretion of, augmented by
homologous milk injection. 662
— theory of internal secretion of,

and gynecomastia ........ 648
Mammae, difference in develop-
ment. OL tWO) SGXESh ce ge. seas 206

— swelling of in boys at puberty. 214
—ddepression as result of emo-
tional stress following bom-
PATGMGIG ous cyere saeve cuce eee 256
— development in female...... ZLe
— enlargement and insanity... .212

Mammal extract, effect of, on
blood pressure and bile forma-
TCT MRE E cies cls oNe! ate Welovoetedemeneeene 659

== CC) eee es ciice oc 454

— gland development stimulated
by use of pituitary extract.128
— -—effect of posterior lobe ex-

tVACt ic Lem eectonens ae eee 361
— — feeding to rats........... 470
—— “protected’’ by hypophysis. 128
—egrowth, testicular hormone
STImumlatin'e, yess rena eee 265
— hypertrophy in male........ 264
—substance in treatment of
MECNOLENASTAL Aes cee ke 646
Mancini, P. (Ganassini): Mech-
anism of vitamine action..... 457
Manic-depressive psychoses treat-
edenwith] adrenaline. -e.0. snk 616
Mann, A. T.: Surgical aspects
OLPAZOLEVER s moo.s Gas Cp oacueneme ones 334
Maranon, G.: Adrenal insuffi-
ciency In ANTeCCtliONS .,.9-.5 once ato 437
— Death following obesity..... 663
— Diagnosis and treatment hy-
DELEhYVTOldiSM) So see. ce OO

— Influence of flying on glycemia.451
— Position of endocrinology in
general medicine ......... 644
— Study of ovarian insufficiency .669
— Vasomotor symptom of hyper-
[OWAKONChIsteN Saris Sualoie os Ooo ls BiB)
Marie, A.: Action adrenalin
against soluble: toxins. ~ sci-1-s- 108
— Adrenals and toxi-infections. .100
Marie, P. (Bouttier): Adrenal
extract in Erb’s myasthenia. ..609
— (Tretiakoff): Hypophysis in
encephalitis lethargica..... 655
Marine, David (Feiss): Absorp-
tion of potassium iodide by per-
fused thyroid glands. .<... cr. 335
— (Kimball and Rogoff): Pre-
vention of simple goitre in
ATVATIC REPS @ co shoe catetl eee pen ieaets 332
Marino, E. (Barilari): Heredi-
tary syphilis and tuberculosis. 644
Marinus, C. J.: Effect feeding
pars tuberalis and pars an-
terior proprior of bovine pitui-
tary on development of white
TAGs Ses Hee aaa eye eee toe 132
Marque, A. M.: Physio-therapeu-
tic treatment of exophthalmic
goitre
Martelli, C.:
Martin Calderin, A.:

t

Dercum’s disease. .251
Two cases

of catamenial angina........ 669
Mason, E. H. (Sutherland): In-

cipient diabetes’ 2.22.0... «a. 674
Massaglia, A.: Function of car-

OvIGU eA Aeteriea.: fevons oncweuoncyere 249
Massaglia, A. C.: Internal secre-

TPiOHTOMLeStIS Ola COCK...c ieee 547

Pathology and
exophthalmic

Masson, Guy:
treatment of
goitre

Masterman-Wood, J. L. (Tor-

quay): Ductless gland ther-
ENR EN erat BNE yc dic 472

prostatic extracts on isolated

genito-urinary organs........ 481
Materna, A.: Adrenal softening

post-mortem) seth 5 oe eee 613
Matula, J. (v. Groer): Altera-

tions vasoconstrictor action of

adrenin after treatment with

bacterial; products) 2.2 =e 441
Maturation of human ovum..... 289
Mauclaire, M.: Organ grafting. .642
Mauclaire, P.: Adrenal cortex

tumor with” virilisim=.. soe 614
Maurer, S. (Lewis): Secretion

antecedents in pars intermedia

OL hypophysis on, ple eee 465
May, O.: Life assurance and

glycosurias eo. | eee 673

Mayer: Starvation bone-disease
in’ Munich. ce eee ee 458

Mayer, A.: Pathological physi-
ology of human body tempera-
LUTE i Sas oes ce eee 336

Mayer, Karl: Diagnosis of intra-
thoracic goitre and enlarged

tHYMUS = ccc) cutee cee ee 705
Mayo, Helen M.: Reports on use
Of (tethelin® -= = cs05 see ee 132

Means, J. H. (Aub): Basal meta-
bolism in exophthalmic goitre.336
— -— Basal metabolism in hypo-

thyroidism= 4). ALAS)
Measham, J. E.: Pituitary ex-
tract in obstetrics and other
CaS€S “226 Sa ake eee PAL ETS
Medical treatment of goitre..... 501
Meesmann: Pigmentation of cor-
nea in Addison’s disease...... 614
Melchior: Operation on thymus
in (Graves: diseases. 2.4. eee 158
Méndez S., Martin: Pseudoher-
maphrogitisme pes. ene 265 —

Mendoza M, R.: Nervous and
mental disturbances following
OVATICCLOMY. ce cee oe eee 289

Menopause, effect of, on endo-
crine system; endocrine ther-
apy im ss See eee ee 640

— pituitary treatment of....... 128

— reactivity of adrenalin test in

disturbancessot= o.oo 34

Menorrhagia, endocrine therapy
TT. > ay sche emer cee eco 255, 645

— organotherapeutic treatment

Of, eh RE eee 249

Menstrual disorders, endocrine
flands: ings ee eee 411

— headaches... ic. sees Smee heuees toe 712

—-—and ovarian hypersecretion.505

fumes

sa

Menstruation a vegetative func-

SOT I ae 411
—aand adiposis dolorosa ....... 432
—-— mechanical obstructions of

MrCrine: CANAl~ = 2... ce 6 6. 413

— — ovulation, relation between.412

——- =“ EWMETCUIOSIS. = 2.00 2 cee 288
— corpus luteum and, relation be-

(AGG AE ea eee 250, 288

— disorders of, after accident. ..472

— — —-— ovarian factor in...672
— effect of achrondroplasia on. .431
— endocrine apparatus and mech-
PTET TIOMaye w) or olan sé uc_o le tS" 418
Sig ai (Die ee iene 310
— influence of ovary on.......288
— —on acidosis in diabetes mel-
NUS. Selle cee See 449
—interrelationship of hair color,
IPS OED ING | a he 261
— organotherapy in........... 641
— ovarian preparations in disor-
SGU TIM A GR 666
— ovary, thyroid and pituitary
Tie 8 oo 8 ROI LO Oe a ee
— pituitary extract and ....... 463
— -—-w—in profuse ........... E27
— relation between lactation and.412
——-— ovaries and ..........229
— — — ovarian elements to .542
Se Ce 472

Mental changes in pituitary disor-

ders
— deficiency, endocrine factors

nh A ae cone Ae ee 661

— diseases and endocrine system. 44

— disturbances in pituitary dis-
(Pees)! SAN Se ee ee 191
—states, thyroid medication in
SSGpEVEC RNase terse Sg Ls. ge B sia 45
— symptoms in myxoedema2..... 166
Mentatity of gynecomasts.......212
— pubertas precox and 369

Mercurier, L.: Salivary glands
i relation to gonads........ 685

Meredith, Florence L.: Treat-
ment of early hyperthyroidism.706

Merrill, A. S. (Holmes): Treat-
ment of thyrotoxicosis by

means of roentgen ray....... So
Metabolism, action of the thyroid

ul SAE 59
—as effected by parathyroidec-

Wry OS ee 679

— basal, in exophthalmic goitre. 71

— beginning of researches on... 71

— effect of adrenin on......... th Be

— — — anterior lobe extract on.354
— —-— removal of spleen upon.314

—endocrine gland control of...474
—— PRE CEABELCS “o's ci les wc ee 297, 448
— influence adrenal bodies on...408

— -— of endocrine organs on fat..456

— —-— thyroid feeding on car-
bohydrate

— — —thyroid on

Metabolism of epilepsy......... 225
— relation between adrenals and.410
= — OF tERyTOMrm toy So2..3 36.5. 63
— — — pituitary to .......... 25
— TEDOLl O% CaSGrew ae onic a ae < 503
—study in case of diabetes in-
SIpPLdUsSiesera ee eee ee sore a 1S
—-— Of creatinin: {25.52.2122 «- 486
— thyroid a stimulator of ..... 194
Metamorphosis, acceleration of,
thyVoidy C¥tEACE Ee < pe ceec iste et52 172
—and pituitary feeding in frog
laTVAC cure satis eee aoe ak

—of batrachians as criterion of
thyroid efficacy
Metorrhagia, endocrine therapy in
ae ocs apo so Ee Se IPE ADE DLL
— Ovarian, explanation of...... 668
— pituitary extract in treatment
OLN isrer. cia cee ee Ce a bars
Mettam, A. E. (Craig): Diabetes
MU CLATUS (ose xe rst o chevawiacess EO UO
Meyer, R.: Theory of ovulation..670
Middleton, G. W.: Therapeutic
problems of the future....... 458
Milk production in gynecomastia.210
Miller, J. L.: Effect of achron-
droplasia on menstruation... .431
Mills, C. A.: Secretory function
of sympathetic innervation to
thyroid gland 7
— (Jackson): Active principle
of pituitary extract and com-
parative action of histomine.129
Minkowski: Dystrophic myoton-
ECE = Deas enctnee as one ae cence 482
Minot, A. S. (Reiman): Manga-
nese content of human blood

BE eRUES SUC! cuss cules) oie coton ed weed 459
Minvielle (Remond): Thyroid-
parathyroid apparatus in ure-
TEAS ete, ba 9 eles, ad i et ak A ee 178
Mitochondria of ovary, origin and
STOIC Creer ete « cor s, tals panei) Sake
Mode action adrenalin on bacte-
PVA CORUM ectaes eas ee iacas we Sys oye 245
de Monchy, L. B Dwarfism of
PDEAMICS UMD. wert err 66. che. o Gases 278

Mongolian idiocy, cause of...... 663
Mongolism, etiology of ....
mptoms of
—two cases of, in same family;
endocrine etiology of...... 662

— with myxoedema ........... 501
Monnot, P. (Chauffard): Base-
dow’s disease with hypertrophy

of eyelids and cheeks........ 696
Monziols (Collignon): Adrenal
insufficiency following novar-

* senobenzol injections eo Ge
Moore, C. R.: Production of ar-
tificial hermaphrodites in mam-

mMSISKT. ott Sas ee oe See 647

Moore, E. L.: Effect adrenin on
rate of locomotion of Planaria..246

Morgan, T. H.: Demonstration
of appearance after castration
of chick feathering in a hen

feathered cockerel ©. Vine... 316
Endocrine secretion of hen
Feathered fowls sa ac occ 381
Morikawa, Y.: Adrenal changes
in experimental scurvy ...... 615
Moro: Mongolism with myxoe-
Geral t if <6 Steers eeeaee re ei
— Symptoms of mongolism..... 472
Morphosis, anomalies of, and thy-
roid: Gland. och otcaseoue eee: 702
Morris, D. H. (Bullock): MImpor-
tance of spleen in resistance to
IMLCCEIONE sarceasaheresets eta ean os 314
Morris, H. T. (Hoxie): Chronic
adrenalism: (52S ee eee cteie se see 47
Mortality in goitre operations...
aac ont TCR OREO CES 163, 164
Mosenthal, H. O.: Treatment of
Guabetes mieliittus’ 2 24 soca. see 301
— (Harrop): Influence of men-

struation on acidosis in dia-
betes mellitus 2. cee one 449

Mott, F. W.: Normal and morbid

conditions of testes from birth

to old age in 100 cases....... 316
Mottram, J. C. (Kenneway): Dia-
DEECS) INSTDUGUUSt cis cuseeeorene us ole ucts 654
Motzfeldt, K.: Diabetes and in-
HITWCIUZ AMM eon woo ie icvegere: sree saenee 451
Mouchet, E.: Cerebral localiza-
GUO MRM BO te cae hen oaec ci iors 118
— Hormone stimulation of brain.648
Mowers, S. W.: Radium....... 176
Moyer, A.: Functional pancreas
PHS UMUCTE ICY? 1s eteueeue tele = eu ehere 706

Miihsam, R.: Influence of testicle
transplantation on sex life....687
Mulvany, T. E.: Allen treatment

OLEGTANSTES a eho apekswee ate Gel Passa b
Munzer, A.: Psychology and psy-
chopathology of puberty...... 460

Murlin, J. R.: Increased heat
production following pancrea-

PECEONUVAUE ra.c x. creme a cm ovone ious 149
Murray, G. R.: Cause of exoph-
thalmos in Graves’ disease....337
Murray, G. R.: Thyroid extract,
MIN POGUE ong oo US GIO OS 600, 706
Miuscularvaystrophiyies cai cies eile 155
—-—sugar tolerance in ....... 249
Mussio-Fournier, J. C.: Paralysis
With hypothyroidism =. sce sc 166

— (Bottaro): Hemorrhagic syn-
drome cured by thyroidism.
Ay oc, ROA sry pata Oe ake CD 3866, 695
— (Sergent): Addison’s disease
with ‘‘white line of Sergent’? 99
Mutel: Development of adrenals
intman ae 4 Pee CR ES 615
Myasthenia, a general review...285
(Erb-Goldflamm): Adrenal ex-
tract in treatment of. ...<:. 609

Myasthenia gravis, case without

Persistent thymus) see 323
— — clinical notes of a case of. .159
Myometrial gland of uterus..... 285
Myotonia; atrophicas = ine 139
—=WEHEENHKONS Ot aogoaoodoononc 472

Myxedema and lipase content of
blood

— basal metabolism in cases of..175
— case benefited by thyroid treat-

THENG aricdntd Beet eae 496
== CASC:4OL- <6 oe 30" 0. care 179
— first case of, treated by thyroid
extract se. Vimo eee 600, 706
—infrequency in tropics....... 258
— mental symptoms in........ 166
—— mongolism with =: .45..soee00
— thyroid medication in case...166
—thyroidism treatment of ..... 486
—thyroidectomized animals ...201
—treatment by transplantation. 490
— with thyroid aplasia ........ 709
Myxedematous cretin, description
Of as.e3 sca oh ace On ere 337
Naame, N.: Adrenal deficiency
and adrenalin in cholera and
Seasickness 4... 3 oe 241
Theory: Of ‘Cancers 2... eee 234
Nahamura, H.: Pathology of in-
ternal -Secretions, ® -).scae eee 661
Narigawa, S.: Diabetes insipidus
inva. baby. 4206 sah eee 656

Natale, A. (Jorge): Clinical and
surgical remarks on tumors of
hypophysis” 2.5.2... eee 276

Negrete, J. (Houssay and Galen):
Action of hypophyseal extracts
in dog ‘and rabbits... 24> 653

Nelson, C. F.: Urinary output of
nitrogen, chlorine, calcium and
magnesium in diabetes melli-

tus! (soho Oe Bink eee 301
Neoarsphenamine and arsphena-

mine plus adrenin <2 .-2. 4000 106
Nephritic exophthalmos ....... 178
INErvous Cretinism) 2-5 e) serene 164
— system, blood pressure changes

a) measurevor tonus) -eieee OT

— — lesions, endocrine factors. .262

Neu, C. F.: Treatment of neuras-
thHenie: 65.5.5 Heese eRe 664

Neuburger, K.: Diabetes insipi-
dus with destruction of poste-

rior lobe of hypophysis...... 465
Neuhof, S.: Irritable heart in

eveneral practicemn a. eeeaeeee 154
Neurasthenia and disordered se-

eretions, ce Admit 170

Neuroblastoma, congenital, case
of, combined with Addison’s
ISCAS «6, 51s, ate Relea 612

Neuroses and hormone therapy. .162

Neurotic factor in menstrual dis-
orders
Newcomb, W. H. (Sheehan):
Treatment of goitre with injec-
tions of phenol, iodine and gly-
cerine
Newton, R. C.: Enlarged thymus
gland, status lymphaticus.... .322
Nice, C. M.: Fatal cardiac dila-
tion with gastropathy and en-
docrinopathy
Nicol, W. D. (Horsburgh): Notes
on two cases of diabetes melli-
tus
Nieuwenhuyse, P.: Accessory pan-
CROUS GIrls chee cies ore See wee 301
Nitrogen retention in diabetes. ..635
Noble, T. B.: Ligation of vessels
TMUORAC HAL OUCTO: «cc cc ens, ' 5 we 6c 176

“‘Non-diabetic glycosuria’’.......142
Nonne, M.: Cure of hypophyseal
lues by combined antisyphilitic
and organotherapeutic' treat-
IRC emeenie orate teyicne ss ese Suiesbiaee 277
Nordentoft, S.: X-ray treatment,
MAVeSe GISCASC, «sesso. as es 706
Nordmann: Thymus extirpation
Me GGAVES = GISCAGO. . ...-o 8.6 6 «re 22
Normal blood and adrenin..... 102
Noronha, H.: Vagotony and sym-
WABHIGUIEOLORY, © <5 2.056 6 cccusc« o « iLale}
Novak, Emil: Endocrine glands
in menstrual disorders....... 411
Novak, J.: Gynecomastia and
theory of mammary internal
SOOUGETOMME Ae iat) ihc. chsaerniae Soe 2 5 648
Novaro, P.: Tissues of testicle
ANG SAavitamIinosis . 2... 566... 482
Novaro, Raul (Gonzalez): Spo-
PAGICMCTOLEMISMD seregtro tit. ooo ees aoe
Novarsenobenzol injections caus-
ing adrenal insufficiency .614
Novirg, P. (Bisgaard): Blood
ammonia and neutrality regu-
ulation in epilepsy :<........ 677
Novoa Santos, R.: Lymphatic
system and vegetative nervous
GNGLCIEL) 5 Okada noi Gene eee 284
Oat-cure in diabetes mellitus. ..477
Obesity and genital hypoplasia. .185
— cerebral adiposity .......... 186
— development of ............ 193
—due to endocrine dysfunction
(DING coenctt Gel RCRCI RARE Renee ree 185
——|GHOOMGHOUS: 2.0. ce ce ee 185
——OMOPOMOUS .l)5 0s ccc e cles eas 185
— fatal case of, with syphilitic
sclerosis of endocrine or-
EOE ai Aaeee ea ee Neds Wee eh 663
— following extirpation ....... 185
= LETT hee 186
Obstetries;, adrenalin in ....... 444

— pituitary extract in ..... 269, 277

A ital

Obstetrics, use of posterior lobe
DULUICAT Vee ieneeenste sth aus ss se © 269
Ochoterena, I. (Ramirez): Origin

of interstitial cells and inter-

nal secretion of ovary ......,541
O’Day, J. C.: Bone tumors of

thyroid vorisinwee see ee wieaeke. - 707
— Diabetes with toxic goitre....708
=A OUT Ch. oes ee kemeers sNT aeke Aastra ee 645
— Interdependence of function

Of ductless"elands 2 s4-se soo
—TIs endemic goitre a water dis-

CASO icsd sams cueeeeae ate Cae 707

= FOxies goitrTe: 2... eos oe ee 707

— What is cause of goitre?..... 707

Oehme: Diabetes insipidus..... 277
Ogata, S.: Influence of alcohol

and nicotine on ovary........ 140

Ohashi, Y.: Histogenetic and
histophysiologic studies on pla-
centa

Opotherapy in gynecology and

OSE CSM ckace ke verey vi cucieie ciap esl ioe 663
—- pancreatic diabetes ...... 148
Oppenheim, R. (Loeper): Adre-

nals and pathology of war....613

Optic atrophy, possible cause of. .133
Organ extracts, action on hyper-
glycemia
— -— influence of bile formation
and blood pressure
—-—-—oon excretion of gastric

WUCOL cc wesemerodister SOOe 151
—— use of in immunization
against rinder-pest 473
Oneaniotherapy 222... - <0. «see 472
— and medical profession ......285
—— HA UNEUURE. (OL: Wes 6 lacrseoiss vere te waders 458
Me CAINCOT cir ts, tavel opis to tere ouevlotelictte 234
—-— certain diseases of child-
HOOD seer keds eee @: cceeeyeerenel te 473
—-—disturbances of menstrua-
Us OPA ay coh Sos vse bolas nen sRene 641
— — dyspituitarism ........... Alay
— — genito-urinary diseases 285
—— gynecology ............. 127
— — infectious diseases ....... 455
—-—nervous disturbances fol-
lowing ovariectomy .289

— — neurasthenia, inefficacy of.664

— -— pancreatic diabetes ...... 148
— -— pituitary disease .........193
—prostatism .............. Ba lf
—— uterine hemorrhages ..... 249
—— THPACUIC AME as: oi teei'g atdaad oy oso puede aes 429
Orth, O.: Three hundred goitre
OPENAtIONS! “s.s.ci-ld oc ears hele erence 338
Osteomalacia and tetany........30
calcium and magnesium excre-
COT) ine. on ieas cnet 664
——gase of infantile A. 3.c rene: 139

—endocrin etiology and treat-
ment of
— —system in

Osteomalacia essentially a result

of improper metabolism...... 141
= GPT. Cp ae a 113}
——Sramiialystarvation .-. «<n sc. 139
SDM ANGANTCLONES . . ..< << sbcsche eee 141
== == JE ees eon 474
— iodine excreted in saliva..... 452
—of pregnancy, adrenin treat-

Ment OL ch, oo. eee eee 247
——ISuuay. OL nine cases: soe ee 286
—treatment of gestation with

adrenin: ie Sere eres ee re 444
——— TS GInCAS CS keene 259
Ova, grafts of, upon adults..... 665

Ovarian activity, X-ray treatment.505
— administration, cases benefited

[OM CADPR etch areas ra eens 3 Se SRE 475
—and thyroid deficiency with

MY POPICMILATISTN Nee sire 194
— disfunction, preparation for

CLCALMente OL. sao eee 124
— etiology of amenorrhea ..... 229

— extirpation and calcium and
Magnesium metabolism ...664

—-— effects on uterine contrac-
LION SV ieee eae Aes eee 665

—-—in osteomalacia, effect on

calcium and magnesium

palances 2a ae Ie 664
— extract in treatment of diar-
rhea in Graves’ disease... .172
= Ol VOMItineg “Of prer=
NANCY Peweecreatiene oe 457
— -— uterine contractions and.. .286
OCI tOmnacs am eee ee 470
— function disturbed by focal in-
RECHIONS YS pas oe OU ea
— functioning and tuberculosis. .288
— influence on menstruation... .288
— insufficiency as probable cause
OLeDILENSYA slants eee 475

— origin of uterine hemorrhages.140
— peritoneal sacculation, three

cases of reappearance of...289
— preparations in menstrual dis-

ORGETS rare. 2 eee ae 666
— removal in case of osteomala-
Cla erelectens ts. 5: «kaa eno

— transplantation, corpora lutea
and interstitial tissue in...476
— treatment of a pluriglandular

SVNGTPOM Cimcon dw 252
SS COMI YEN 4 dis and gioco oe 697
— tumor, causing precocious pu-

Dery «.,2) sieueiasecce eo ee 475
— type of pubertas precox..... 371
Ovariectomy, double during preg-

TATU C Ye ya, detox on teaic on Cae, Cueto ee 114
—nervous and mental disturb-

ance atters Ys Bide ee 289

Ovaries and menstruation, rela-
GION: DetWeCiwAvAsgwaee ee eee 229

——endochmenmaturerOLe) oe ee 412

——— hy PeETSCCheLiOnm yOLaeree ee ie 418

—hypofunction of and infantil-
Sigal HAE MV AOPONEI. S64 5.5640 0c 480

Ovaries in a pluriglandular case. 480
— — ¢ase of exophthalmis goitre.179
= undertedmndtsess yee 265
— internal secretion of: 4.5...) 287
— removal of, followed by goitre.338
— sterilization by roentgen ex-

POSUYTES': 4. eee eee 288

— thyroid and, well established
MEVERKONNS NN) Sea5o oo Gb 65% 288

— X-ray treatment of, in Graves’
GISCASe a. 2 eee 498

Ovario-testes, formation of artifi-
Cla i taedevere cc ee ee 266

Ovary....139-141, 286-289, 474-476
— absence of one, uterus, fallo-
pian tubes and vagina ....141
— and. heVer= i006 aoa ce Ene iil)
—clinical signs of functional-
anomalies’ of; causes of
anomalous functioning ....670
— constituent responsible for
menstruation. reese 412

— extirpation of, effect on reac-
tion to thyroparathyroidec-

COTY ons oar cricna evel ere 692
—— ST ALtineeln TALS. setae eee 647
— histological description of in

sterile: woman... aoe 475
—— hormones=of oe eee 412

— hyperactivity of, associated
with hyperthyroidism and

cardiac dilations lee 574
—hyperfunction of, in dementia
PracCOX: “hw eee 287

—in etiology and treatment of
psoriasis and amenorrhea. .671
—-—-—of digestive disorders. .670
— — — — menstrual disorders..672
—— In Smenstruation, @.sise eee Oe
—-— during menstrual life ....415
— -—of alcohol and nicotine on.140

—-——on adrenin hyperglyce-
MTAe heeeoys See «eh ee 667
—-—oon development of uterus.. 414

— insufficiency of, clinical mani-
festation and treatment....669

— interstitial cells and internal
secretion Of 4... eee 541

— internal secretion and enlarge-

ment of female mammary
Slands 7.52. skis cee eee Dike

— physiology and etiological sig-
nificance of different hor-
MONESMOL Mok. nee neete eee 669

—relation of different elements
of, to menstrual phenom-

CNA Ae. ee ew cate eee eae 668
—-—to uterine contractions. ...665
— substance in treatment of ir-

regular menstruation ..... 646
— tumors Of 2%. 8. oot een 476
—two cases of hypernephroma

OF ess. orks hoe Ro sk. eee 140

Ovary, value of transplantation of.668
Ovotestis, occurrence of in human

HELMPAPHTOGIEISM 9 %'...-.00 20 « « - 646
Ovulation in young, hastened by
use of pituitary extract ...... 128
— relation between menstruation
ETI sete oajecstie =... shee 3 412
EKO O1D Ooo Eee en 670
mS NTTN OM Os fata) s\s.l2.2).) wes) 2 ons! «, « 141, 476
Owen, S. A.: Case of sarcoma of
VIO MIN STS Gar strse ste cic fses me se 20
Ozorio de Almeida, A.: Nicotine
FiNGES “Ss 6 oa eee Bn te Caen 38

Paget’s disease, clinical study of.261

Palancar, J. (de Arcaute): Thy-
mus death in children ...... 689
Palmer L. S. (Kempter): Yellow

pigmentation and fecundity...151
Palmer, W. L.: Importance of

vagus and splanchnic afferent

impulses on tetany
Pancoast, H. K.: Possible cause

hereditary optic atrophy ..... 133
PAR CReASm its ciac ee 142-150, 290-306
— action of thyroid on ........ 59
—— UT ACCESSOLY: cates: cess sic sie) coo 301

— and formation of blood lipase. 456
— as affected by acetone extracts

of dueodenal mucosa ...683-84
— cell, paranucleus of
— changes in physiologic action

of, due to thyroid feeding.. 56
— dehydrated in diabetic coma..
— diagnosis of diseases of...... 673
— effects of thyroid feeding on.. 56
— emulsion, effect of injection. .z
— endocrine function of.
—enlargement of following thy-

TOME TACOIMN Ss 2s.) i016 2s cee ss 58

— extirpation, effect of on renal
sucaretoresnold: . 2.36... 626

—w— retention of glycogen fol-
MEATS de ateWens, «ie rete es 675

— extract, action on hyperglyce-
TAG,” &o3 Senco) ae een 105

— giant cell sarcoma of thyroid
ZA) 2 oy ot koe son 709

— gross anatomic relations of to
GMP GIGS 63. 5s ee 446
-—— hemorrhagic necrosis of..... 476

— histogenesis of islands of Lan-
RMT TTS MMe lel ovan hero eie's: ¥. 0% 672
— in a pluriglandular case..... 480
— — case of exophthalmic goitre.179
— — — — hypopituitarism . 406

— — congenital syphilis of hypo-
(LLRLEy eA eee 281
— insufficiency. and war ....... 706
—— causing infantilism ...... 675
—— with thyroid disturbance. .706
— internal secretion of . 626
— — — — and diabetes Ae 447
——_— lipase of plood.. .456

Pancreas isles of Langerhans. . .270
— occlusion of duct of, effect on

endocrine, organs ........ 643
— partial extirpation and chronic
Giahetes ss) aactekes cose 632-33

— quantitative determination of
material components of.... 41
— relation between diabetes mel-
litus and
—— of to diabetic state
—sarcoma of, with gastric ul-

CONS) & sca cee ea alee at oni take 345
— tests for insufficiency of..... 673
——thiree HORMONES TOL sere ce eisiel 675
Pancreatectomy, cataract follow-
Tins aaetr eR RAG HAG CRED ove OicacrDiOeche ene 114
— increased heat production fol-
Wont? Soaoopocaaacumuve 149
Parakh, F. R.: Absence of uterus,
fallopian tubes, one ovary and
vagina, with one large central
LGiGhNENS Gc oc oe ope coe codod 141
Paralysis, muscular, and goitre,
CASCHOM cx. ate cel eta aioe a eeekole Phot 695
Pancreatic cysts, diagnosis of...477
AAD ECOSE ceo s Hise chehsan ec el eMeueiette 148
Te LY COLY SIS’ rolel lle elle 450
SBE LOL |.) 2a Ae kd a
TCAD EUICESLALC) chicas vere ole re 145
——extract in treatment of pan-
creas dysfunction ........ 146
263

— glycosuria
—— infection in case of influenza..451
— juice, influence tropine on se-

elles letintadnsie: oe (e)s"e)7 eae Laie

GREGIOM sgOlawe creer cl one chicken. = 312
Paralysis agitams ........----- 306
Parasympathetic system, driving

ONG a abo ooo oe Odd UOC 25d

Parathyroids..150, 306-309, 478, 479
— activity of evidenced histologi-

ORs? Goole Gio 0 OOUMENEaDE TO. D.che
—-administration in osteomala-
cia, effect on calcium and
magnesium balance ... 664
—— and bone fragility .........- 156
TICK:CLA MMe iarie sis = 16) clelisire 440
———thtyroidectomy <-..-'..2--- oon)
—antiserum lack of specificity
CLO Sie 27s oe even aiens 679

— apoplexy associated with tet-
any in adult
—eataract following eae came
Cte ie cle ee acs ences) seats [

— deficiency as a factor in epi- is

iMehhy/* Gio 6.0 Oe Olooee mdiomei Oo OiC 677
— embryonic thyroids .....-.--- 199
— extirpation and meta boli Ce

changes in dogs
—-extract in tetany and epilepsy.. ae

fe OKGI SE ace eco Ue Cue Ort
a SS SATALONUY? (Ole «te eet et eet oe 478
—_—and paralysis agitans..... 306
— — quantitative determination

of material components. 41

Parathyroid, hypoplasia of...... 150

— immune serum against...... 678
——I7) GASG Of LOTC. ci ws sins 309
—— congenital syphilis of hypo-
DEVYSIS: ~~ 5 <j «evs, seer 281
—— pregnancy ;...i...... 306, 307
SST MGLTS: Ofis <)cue voRewel sh taeeare CMON: alle
—-—relation human to calcium
deposition... 4. eesee ee 307
—role of in blood regeneration. 491
—— tetany, acid Osisiimis -. se a eteke 678
— and functions Ofer... . pee oe. 150

—-—as influence of vagus and

splanchnic afferent im-
DILISES ROMs scutes cho reece 680
——-EMVFOUG HAN hesct a cues coe eh oes 199
— —— anatomical relation be-
CWC As octet aoe 340
— —-— kidney, mutual inter-
relationship between.178
— transplantation ........ 806, 478
— — — postoperative tetany...
Sheik pimereachoneer ots 307, 678
— treatment of postoperative
GOCAMMV aa Cais aivcveesvenece oh. tenoeene 307
— tumors of tongue...........50

Pardee, I. H.: Two cases of mon-
golian idiocy in same family. .662
Parotid gland, possible endocrin
ULM GtOM. (Ole = a occ teeeeNee eae Chau 680
— hypertrophy in emotive exoph-
Chalmiie ys oreneweecs ois ache we 708
Pars anterior proprior feeding to
WAGs PACS eis, cl tween ate otek once ae
Pars tuberalis feeding to white
rats
Parkinson’s disease, cause of...306

Parker, K. M.: Development
hypophysis cerebri_ pre-oral
PRUE ede asta <> aca ined oa ee 278

Paitsch, F.: Epidemic of osteo-
TEND ACTA seen oy > 2. for vertoe) rope) er ohich tenets 39

Pathology of the sympathetic. . .232
Paton, D. N. (Findlay): Tetany
and functions of parathyroids. 150

Patten, C. A. (Hammett and
Suitsu): Physiological re-
sponse to administration of
DUAL ATIVE ee ici shares eee ete 463

Paulesco, N.: Glycogen in pan-
CLeaAticha@ilabetesin. oo semua 675

Peindarie, J.: Musculature of
central ‘adrenaliveinwe..46 560: 615

Pende, N.: “Trichotonia”’ and
“tricographism’’: a new sign of

hyperirritability of sympa-
CHEtIC! —. sic)u BROS OS See eee 815
— (Castellino): Pathology of
sympathetic i. tie. b ae ee 232
Peralta Ramos, A.: Exophthal-
mic goitre and pregnancy..... 309
Peristalsis, action of hypophyseal
extract) (Olt a28s Gea ees dls: Sitonane 658
Peritz: Hypophyseal adiposity in

children’ 256 so hoe ate 278, 466

Peritz, G.: Two cases of hypo-
physeal adiposity with dwarf-

(500 eee er EN EAE we 5G 6 o0 U6 ones 656
Perazzo, E. (Bacigallupo): Ad-
renal, hematomials... see oie PAE)
Pern, S.: Toxic element in
SOUT) 2 yeh abe eee Ree 176
Peterson, Edward W.: Congeni-
tall @oltnen cs. nS. eee Oe 339

Petrin, K.: Diabetesstudien....301
— Dietetic treatment of serious

cases of diabetes...) 451
Peyron, A. (Hartmann): Case
of uterine epithelioma of sup-

rarenaill “types. 2 ee 437
Pézard, A.: Secondary sexual
characteristics and endocrin-

OlOBYW a5 RS ee a eee 527
Pharmacological effect of feeding
ductless glandular substances. 28
Phillips, J. (Lambright): Pre-
mature sexual development... .616
Phillips, N. R.: Goitre and
psychoses
Piccinini, P.: Influence chemical
substances on action adrenin.109
Piédeliévre, R. (Dandy): Thy-
mic lymphadenoma, case of...688

Piffl: Operation for hypophysis
11) 00K 0) pee ORE. a iGadeouS-0 cc
Pittaluga, G.: Acromegaly and
diabetes. insipidus: seen eo clee 656
Pineal body, histology of....... 679
— — nerves Of... 2.6.2. 006 tee 309
— feeding, effect on development.310
— function “Of. ..2 pee 310
— — — efficacy of as therapeutic
agent. ).c.co oe 679
— Pvland, syphilis oft. ...)..) ner 117
— histology and embryology of. .309
— innervation in telosts....... 309
—region in human embryos....151
—structure, function and dis-
GaSGS Of; 4 secs ih 4d 2 ergo 681
— teratoma: Of. 2% = 35 See 310
—tumors and pubertas precox. .375
—— == CASS (Oa hen oie ee es ee 479
— types of pubertas precox..... BIL

Piqure and production of poly-
uria

Pirie, G. R.: Hyper-adrenalism. .101

Pitini, A.: Chloroform narcosis
ands adrenals... 5 nee 438

Pituglandol (post. lobe extract)
in treatment of diabetes in-

0 O19 bic SER EEG GARG Gio 6.0.0 C 282
Pituitary, see hypophysis......
— activity and premenstrual dis-

EULDANCES as osces ese omeneme 454

—and autonomic nerve cells. ...253

KANO Sou ounce saoauadgg00 119
—-—thyroid glands, relation to
iodine and metamor-

PHOS Ei. era roe 161

— anterior lobe deficiencies..... 193

Pituitary body, case of suspected

ERUIAVOMNORE eieicte a) aos ps Blaten steel ss 464
—-— deficiency of............ 269
— -—disorder a cause of optic

UTR OCR 5 Aan Cae Cont en a3.

— —fflattening of with brain
tumor, report of case. ..274

—-—removal and polyuria..... 507
—-—researches on........... 507
— -— separation of active portion
of posterior lobe....... 462
—eataract in relation to dis-
CASCGMOMMEYEI ne hie S <ys3 66 8 as 114
— deficiency, symptoms of..... 1a
— dependence of function of on
OLNEGR TAIANGS = Jon 4 a5 one ee 337
— diabetes due to a deranged
UA CEVOM Ole so-so. us 6 oct. 145
— disease, therapy of......... 193

— disorders, neoplastic origin. ..348
— dysfunction, report of case...465
—enlargement with dyspituitary
SVMEPEONIS. “CASE... cic cles» «2 13!
— extract, active principle of and
comparative action of his-

a |

UPIPARTTIG Pe Siegler eae 129
—-—and menstruation........ 463
—w— (anterior lobe) in treat-

ment of diabetes insipi-
GIES: 4 Gabon 282

— — — — effect on metabolism. 354
—— effects of administration. .128

——w—on uterus............ 268
—-—emaciation following first
MOSCHE SC arate oe ce es iL
—-— histamine and........... 272
——-=—jin dyspituitarism.........137
—-—in hypopituitarism....... 406
—-—jn polydipsia............ 125
— — — treatment of pneu-
ROTA ates ates tote ad. 280

— — influence on genital tract. .273

—-w—injection in diabetes in-
EINES ewer eres. o's, dea es eeu 461
— — internal administration, re-
SMES TOL PESUSi< «os % 0c 275
— — observations on action of. .269
— -— physiological response to

aagmanistration Of: .<.... 463

— — — —in treatment of dia-
betes insipidus... .282
— — posterior lobe, effect. .358-359

— — standardization of........ 281
——foxie effect........:..02.- 11
—— U.S.P. standard for....... 203
— -— (whole) action on pregnant
(MIG OTS) ae SU 133
— — — gland, in case of hypo-
DAPHAGADISI =. 2 6 iec’s 407
— feeding and egg production. . .466
— — experiments, results of....187
—— to frog larvae.......... A 16
et UE SE Ag och oils so 0 es are wwe 470
— — — white rats, results..... 132
—gigantism following hyper-

oes (0) 14

Pituitary gland enlargement, x-

ray treatment Of. ..5:..-.....505
— — observations in active prin-
CipledOratan ses ee eee 3 OTS
— ‘glioma “Ofs. Vad cisco esleke sists 274
——‘FLVYEOSUBIA® Geaieteiee te oe 263
— headache..... UZ ea OMe 2 2a T LZ
—-relieved by pituitary ex-
CEACT eat ee eee 196
—= — tonsil inflammation... +. ..260L
— hyperfunctioning of and sex
gland ‘disturbance! ......- 460
—hyperplasia of following thy-
TOLAGCCEOMUY ss 1. mic enele eee siete 24
— in exophthalmic goitre....... wy)
= MeNStrMaviOm |...) leer ciel enero
— influence on menstration..... 412
= TOMI GH COMECHIE no eects ote cis olen 12
——leSione report Of Casewi.< ...16 274
— medication in sexual neuras-
18) A(ELOTIEE bos Sue cman cone Ge aye eR ESRORG Cac 286
SN NECHUN A S36 cen oo, CURR CUR ROMG OE 186
— overactivity and glycosuria. ..142
— posterior lobe deficiency..... 193
— region, tumor of causing bruit.268
—=-—_ X-ray Observation Of. .... - 465
—relation between other duct-
lesseotands andy. 2... <le. 192

— solution, decomposition of
oOxytocic principle. ..: 2.2% 268

— standardization, infundibular
QXPEACUSE: seg iene che es chs tet a5)

— substance, influence on growth
Ofmplant. tISSWe -. << = cee 453

— -— moderate doses causing
stimulation of growth.... 11
= SYP IIIS. Ol. = 5 aces « anes Laky

—thyroid and able to function
VAC AIOUS Ve. ic, cet occu: aeewelouente 24
——— and, metamorphosis....,.. 28
—treatment in gynecology..... 127
————_ Of Glabeces INSIDIGUS). « .. a 272

—-—_—-q pluriglandular syn-
drome Se AeA eee
=—=tumar and agdiposity..........402
ONO SIS: (Olvaarene ie e «)s)( sone « 278
— —treated by operation...... LST

— — visual field a guide in treat-

TOAKEN CLR BAU Ban sonceeh BACCO MR OMORe Eon Dike
—-—with acromegaly, report of

CASI te ata helehs: ic. "8; 6: ores 20D

a x-ray, treatment Of.........200
—use of posterior lobe in ob-

SIMONE ne On Gm Oo ODO De 269

— whole gland administered in
case of paroxysmal nasal hy-

‘hao gid 012): meet cer ke neat ice Gags O.0.C 468
—— —“"Wserand AUuse OL. . «6. sues ila 7
— administration in osteomalacia,
effect on calcium and mag-
NESTE. “DALANCE vice-lisncuruchorons 664
—and adrenalin reactions, op-
posed to each other....... 35
—cure of diabetes insipidus
VLE ED 01s i he cos: of eee 657

Pituitary effect on brain circula-

PPCRITMBERIOSITTCLTI So Soo) Gv/e'-scos «evalua owe 246
—in association with adrenin in

gipneheria, <./s.. 2 3..eemeeee 246

== == SSUES a 5 A 49

== 552 55)0) ees ey ot 150, 480

—-— treatment of osteomalacia..259
— influence of, on rat sarcoma. .660

— — —-—-tumors of mice..... 660
—on use of small doses in in-
ducing abotee. ooo eee ILS 37(
— point upon which action of is
CXCT LS Cigthihy® ais ee A oe 35
= testi epee Py ee ee ee 33
HSH KROL AI Oy 6 Ge KA ben eT 34
——— Le DOLtS OL wLeCSULES= nee ee 274
— to relieve constipation....... U7
—use after hemorrhoid opera-
ELODSeIY EIN ane gs eee ee 277
= SOCK. ae a 109
Placenta as birth-promoting
OT LANG Cee eee Sols eae ee 310
— cytological evidence of hor-
mone secretion in.........: 681
—histogenesis and_histophysi-
OLOZVMOL Mia AN ee ee = 682
——JHOTIMONCHOE MS: a es ee ee eee 682
— permeability to adrenin...... 618
— study of in pregnant rabbits. .242
Placentalmextractssseee ee ae 310
— -— in hypofunction of ovaries.480
—— = — US Ci Ofte up eres aes ee 454
Plethysmograph for adrenal....612
Plummer, H. S.: Blood picture
in exophthalmie goitre,...... 176
Pluriglandular compensatory syn-
drome “immerse ee. oe 196
IGS CASC CASe Oba oe ee 151
= HISORGECTSi+ 2 Shaw ee ee See 480
—insufficiency, scleroderma a
S¥MDeOM JOL as eee ee ee 312
——SVHOLOMe. CASC! Olle eke ote 252
— — with uniglandular predomi-
MANCEY.. woe ce cee ee PAB AT
— therapy in case of adiposo gen-
italVdystrophy....=s.). a stators PA bak
— win diabetes mellitus...... 291
——_ _—— _——_ normone hunzers. . ee 124
Pneumonia, adrenal glands in in-
TAITTISTO AES bis Sk OT a iy a Ew 97
—— AL LenI Mn EHeCrApy adie 6 oo ee aa ba
— sudden failure of adrenals a
Causes OLESenile-gee et ee ikibae
Polano: Hermaphroditism in
OD ewes oes eyske ens) eee eee 123

Polettini, B. D.: Antagonism in-
ternal pancreatic secretion and

AGT ON AN aq dace hee 110
Poliitzer, H.: Diminished volume
OLS UME etka. A eat ek Se ee oa aay,

Polydipsia, case of hypophyseal.125
— correlation of polyuria and. .514
Polyuria and hypopituitarism. ..193
— — lesions of base of brain... .509

Polyuria and pituitary disease. ..507
— — polydipsia, correlation of. .514
—-— removal of pituitary body.507
— cerebral lesions determining. .511
— diminished by lumbar punc- ;

CULE: - ccc te hee eee 272
— from cerebral piqure in dogs. .682
— “hypophyseal,” not due to

hy pophysis” 252). 540 eee .650
—in encephalitis, case of, with

pituglandol treatment..... 653

— pituitary extract in control of .195

—— FENOLe, OL Case... oe ee 125
Popielski, L.: Adrenin and ad-

Tenals..” Vo .).)s 3% sts ee ee 101

— Adrenin and adrenals. II...102
— Excretory innervation of the
adrenals: 0. oso eee 103
Pottinger, F. M.: Endocrine-
autonomic factors in disease. .642
Potter, C.: Factors for safety
and results in goitre opera-
tiONS! $4. ci nciihinit peer eee ieee
Potts; Jo Bs: Pituitary tumors eee
Pool, Eugene (Falk): Surgical
anatomy of thyroid with spe-
cial reference to parathyroid

flan ds Sos dietosis hate eee 339
Poulten, E. P.: Diseases of en-
docrine” organs:<-ee eee 120
Poyales (Gouce): Case of acro-
megalic zigzantism. . 2. eee eee 463
Precocious. puberty caused by
OVarian® tumor... ...- eu 475

Pregl, Fritz (de Crinis): Pro-
tective enzymes in very small
quantities of serum—micro
Abderhalden reaction........ SS

Pregnancy, a cause of nausea of.457

— and diabetic coma.......... 452

— corpus luteum in vomiting of.115

— .diabetess ing 5.4% Sic ee 637

—endocrine factors in toxicoses

OF bas Geb ed. 2S eee 668
— exophthalmic goitre and..... BE)
— glycosuria in). . i5 . 3 Beet 142
—goitre enlarging at......... 489

— increased metabolism during. 457
— nausea of, theory as to cause

Of}... 6b 3 eee eee 454
—parathyroids in........ 306, 307
—tTupture in ectopi¢=..2 see 287
— use of corpus luteum in...... 7D5

— weight of hypophysis during. .467
Preoperative treatment of Graves’

disease’ jos .aJdtcn Sei See 498
Pribram: ~Acromegalie: --—] ---- 466
— Hypophysis and Raynaud’s

GiSGAaS@xn seid acs See 466
— Polyglandular disorder...... 480
— Raynaud’s disease.......... 279

Price, H. T. (Rosenbloom): Meta-
bolism study in case of dia-
betes insipidus... 25.2 1

:
2.
a

j
ba

‘

Priesel: Hypophyseal dwarfism.
PEP atatercre teres See's oes a 279, 656
Priestly, H.: Remarks on physi-
ology of ductless glands..... 661
Primary dysmenorrhea and endo-
CLINGMESVSUCDIE. od 2 oe a0 6 ove. + abe 413
Progressive muscular dystrophy.116
—-—-— an endocrine disease. .116
Prostate, effect of extracts of on

INE GIGIGe 4 0"s, - ere one 309
— — — — metabolism 682
— internal secretion of........ Sa bat

— — — —jin relation to testis. 682
—loss of specific secretion of
cells of, cultivated in vitro.683
— urine retention in subjects of
hypertrophied
Prostatic extracts, action of....481
Prostatism, organotherapy in...311
Pseudohermaphroditism, case of .265

= (TRIED ICIS, 2S nee 263
—— se OMEMOl de CASCisvc,« ois. 0.0 seas 647
Psoriasis, ovary in etiology and
PECAMBIE ME MORei.s< s:sisk- oycise +» 671
PSYCHIC LACTOUS |: «1c 2 6 d0 8 5 «0 642
Psychoneuroses and _ disordered
INMbheMMal SSCCTELION 2 2% 566s ese 6 170
—thyroid treatment of........ 696

Psycho-neurotic syndrome of hy-
perthyroidism
Psychoses, endocrine factors in;
endocrine therapy in. .«...... 639
——role of goitre in...........% 339
Pubertas precox, a case of, with
negative, hypophyseal and pi-

ATG eV OIT Seer ctelel steve << sleuie » 616
—w—and mentality........... 369
weer E GEA acta tls, ol tris lsua’s ts o'' ee 681
— — compensatory adjustment

HPC ASCS: JOD rttansi ws sos 378
Puberty, an endocrine event....481
UTE GLS sa Monet So cle ele sss bbe be 233
—ovarian tumor causing pre-

COCIOUNMete sO eit cbse se 475
— psychology and _ psychopath-

OLOEV eObeish Sctecsre cai sb awa 460
— types of precocious......... 371

Pugliése, A.: Action endohypo-
physin and infundibulim on
Prermant UWlETUS...:.. .')s...<. iR38:

— Influence of endocrine hypo-

function upon growth.....

Pulay, E.: Influence of adrenin

259

Bite MEARE ty oc ee ac ec oe ws 110
— Thyroidism and Graves’ dis-
CETTE elo IRIGIad ae iLt( 7)
— Thyroid therapy in skin dis-
PLOTT 9 tote Sia eee Urer6
Pulse frequency exhilarated by
PAAMOGMI AT CXETACLES.... 0). ss ccc. 98

Putter, A.: Internal secretions.138

Pyloric hypertrophy caused by
hyper-adrenalism

Pylorus, endocrine influence of..117

Quaristi, V.: Endocrinogenic vis-

COT ODUOSISMe ete cre oer ets) <ns, ee << TAZ
Quigley, J. K.: Corpus luteum
extract in vomiting of preg-
THAN CY. “3 i soe sae cast oneney ees a. O24
Quincke, H.: Treatment of Addi-
SONS: sGiISCASGs enstetie sereeehe Chale 240
Quincke’s disease and thyroid
GyStrophiyn * cess. weve cheese ryas74

Quingquaud, A. (Gley): Secretion
of adrenalin, arterial pressure. 244

Rachitis and endocrine dysfunc-
tion
Radioscopy preceding goitre oper-
9

LOS Mt ettens cue. succes. chavs, chaeuonene 338
Radiotherapy in treatment otf
FOU CM ote sey eve ccke cree avsbe as ieysress 335

Radium in exophthalmic goitre. .176
— therapy in hyperthyroidism. .160
—— treatment Of 2O01tTe.,. 2.5... « 325
Railliet, G.: Emotive exophthal-
mic goitre and hypertrophy of
parotid
Ramirez, E. (Ochoterena): Ori-
gin of interstitial cells and in-
ternal secretion of ovary.....541
Ramond, F. (Francois): Addi-
sonmiss@isease’ of wats... 22>... 103
Rankin, G.: Climacteric of life. .117
Raphael, T. (Stanton): Action
certain drugs on brain circula-
TT OTUMUTIMBTATATI 2 2s oh 5; oo eveles «1c seve epee 246
Rashbrook, H. M. (Carter):
Hypoadrenia, intestinal ob-
struction
Rasmussen, A. T.: Hypophysis
cerebri of American marmot
aurine= hibernation. ........- 466
Rassers, J. R. F.: Substance in
blood-serum resembling adren-
nalin
Rathery, F. (Bordet): Adrenin
treatment of vomiting of preg-

TUATROVie Savon cial cede ca cre ie rete! o ne6* 621
Raymond (Rouquier): Hemo-
philia in Basedowian treated
with anaphylactic rabbit serum.708
Rayman, Gisease. ...a.s. +... 6.200
—-—hypophysis and.......... 466
— — report of classical case....279
Read, B. E. (Lennox): Case of
OUOLINIS TN yas =, eer sie eile. We Laie reales 497

Reichmann, V.: An uncommon
disease caused by an adenoma

OLrecne WAyPODDYSISis cuss = oe + © 134
Reid, M. R.: Carotid gland, ade-
MOWMLA OL sh \evaie co. see eh nae ekele eee 623

Reiman, C. K. (Minot): Manga-
nese content of human blood

and, tissiless!s he. coe nee 459
Reimer, G.: Caramel treatment
OL, GLADECCES > 4 se eioteen she eee 636

Remond, A. (Minvielle): Role of
thyroid-parathyroid apparatus
iin. (ele See ees Oo. selo 178

Renal derangement in diabetes in
166 i RAR cet i5c5 Geto 635

— diabetes, characterized by gly-

COSUTIA. «<u. eae eae ELE eS

— glycosuria, treatment........304

Renton, J. Mill (Robertson):
Thymusectomy and its relation

LOT TICKSUSE face ere co atecaenenetone one BIAG)
Reproductive activities in wom-
en, endocrine factors in...... 640
Resch, A.: Studies on patho-
genesis of spasmophilia...... 685
Retterer, Ed.: Growth of testic-
ular grafts. Testicles in the

aged. Conditions which cause
variations in growth of testicu-
larwepithelimme:. a srneceae en One
Reuben, M. S.: Cerebral versus
lackeal eAGipOSityr c.cieroe meres eae 432
Reye: Hypophyseal cachexia...
Reynolds, E.: Reappearance of
ovarian peritoneal sacculation. 289
Ribot, A. (Achard and Binet):
Action organ extracts on hyper-

SIVECIMTA 5 oo tee be ale ae 105

Richard (Etienne): Arterial pres-
sure and emotions of war.....257

—Glands and emotions under
pDombardimenitaws. ... ones 256

— Polyglandular syndrome with
epilepsy is |. a. Re Se eee 697
Richter, G.: Diabetes insipidus. 279
ICES Pea ercl cricketers Rae 340

— accompanied by endocrine dys-
function 440

— and osteomalacia in Berlin. ..474
155

De

Toidism and. tetany... .... -—.-h62
——tTCAtMCME ~ c.acccwereie 6 alec ere sets 155
Riedel’s goitre, case of......... US
van Rijssel, E. C.: Giant cell

sarcoma of thyroid and pan-
CHEN Ks dddolwolddons ad ac 345, 708
Roberts, S. R.: Hypopituitar-
LUSTY orehcaculs acura heeere! Sd eee mera eran 134
Robertson, Madge E. (Renton):
Thymusectomy and its relation
LOS RICKS eset Mechta cee irene eretin ris 323
Robertson, J. A.: Adrenalin in
blackwater fevers. ciesoe corece 110
Robertson, T. B. (Burnett): In-
fluence of tethelin, etc., upon
growth of carcinoma in rats. .279
Robin, A.: Osseous deminerali-
zation and its treatment......501
— Treatment of diabetes....... 302
Robin, Pierre: Cranio-facial de-
formities, dysfunction of endo-
crine glands in children...... 258
Roeder, C. A.: Toxic goitre fol-
lowing sinfliwenza;..-) «seinen 709

Roentgen-ray, see x-ray........
Roesch, W.: Relations between
scleroderma and diseases of

CNndOCrine OGLANS eye eee 312
Roger (Sicard): Acromegaly and
BOUTS ses susie toe o lee Ree 281

— (Sicard and Simon):
nalization of muscle and elec-

CLIC reactions. soe 621-622
Rogers, J.: Endocrine neuroses
and ‘thier treatment... + <a. eee Pasa

Rogoff, J. M. (Kimball and Ma-
rine): Prevention of simple
Foltre in) Man. oso ene eee 332

— (Stewart): Action drugs on

output epinephrin from ad-
renals

— -— Essentials in measuring epi-

nephrin Output eee 618
—-— Further observations rela-

tion adrenals to certain

hyperglycemias .......

—w-— Further observations rela-

tion central nervous sys-
tem to epinephrin secre-
tion

— — Relation of epinephrin out-

put to changes in heart

rate - 2... 00 ne eee 619
Rohleder: Organotherapy in
prostatism, 4... .2 19ers ailil
Rohdenburg, G. L.: Thyroid dia-
DEte@S: . an seed 5 hath ee 63
Rohmer, P.: Cardiac death due
to-diphtheria= = 5. lee 246
Romana, L. (Houssay and Car-
rulla): Polyuria from cere-
bral pigqurevin dosson. eee 682
Rondoponlo, P.° J.: Nephretic
exophthalmas| -.... =e eee 178
Rosenbloom, Jacob: Dietary fac-
tors in hyperthyroidism...... 340
Rosenbloom, J. (Price): Meta-
bolism study in case of dia-
betes! insipidus... .-. .--oneoe 135

Rosenheck, C.: Destruction of
sella turcia without symptoms. 657

Rosenow: Action extract of hy-
pophysis on _ distribution of
DLlOOM «ss. Setanta} eee 467

Rosenthal, G.: Value of curved
needle injection in intercrico-
Ehy Told Meson anes oe 443

Rossi, S. C.: Adrenal insuffi-
ciency, post influenzal, in

manic-depressive psychoses... .616
Rossle: Dystrophia adiposo-gen-
italis with hypoplasia and atro-

phy of hypophysis.... 440s 280
— Thyroid aplasia in a dwarf...710
Roth, A.: Vicarious menstrua-

TE ON" ts" 5's 500 Ne oteale ers) anes ee 472
Roth, George B.: Pituitary stan-

dardization +.\.900- 020 eee ao
Roth, N.: Blood sugar in dia-

Detes' -s.-4, 5 vee sakes see ee ee 149

Rothlin, E. (Stern): Action of
splenic extracts on smooth
OWTISCLE: 2 aie ieee 685

—-—— Action tissue extracts on
smooth muscle.........260
Rouquier, A. (Raymond): Hem-
ophilia in Basedowian treated
with anaphylactic rabbit
serum
Roussy, G. (Camus): Experi-
mental diabetes insipidus and
SEnIeAl) AETODDY. ... <5. ./-%. + 3 2 os 686
— — Experimental polyuria....650
— — Experimental researches on
DPialitary:, DOGY........ = 507

Rowan, Charles J.: Surgical
treatment of exophthalmic
BONA. pee SSC ice aes Ceara 340

Ruchti, E.: Function of thymus
and thyroid at normal and in-

creased temperatures........ 689
Rudel, E.: Form of human hypo-

URIS 4 ioe eee 136
Ruge, C.: Ovulation, conception

and arbitrary impregnation...141
de Ruiter, H. T.: Form of tubu-
les in embryonic testicle of
MTC eo oe GER eee 155
Rusea, G. L.: Concerning
“rickets,’’ so-called, of rabbits
from thyroidectomised parents.340
Rutting, relation of ovarian ele-

RI CHESMRO Mee oe coches gcc s + ce D40
Ryan, G.: Medical treatment of
EGEPEe | bo 5 See eee

Sacco, A. (Del Valle): Sarcoma
of hypophysis with acromegaly.657
Saenger: Hypophyseal tumor...136
Sainz de los Terreros, C.: Pan-
CPreabic MIntLandlismias As ol. wes s 675
Saito, T.: Biological study of
Hy PODIEVAIS Oe seis s eden se eos 467
Sajous, C. E. de M.: Curative vs.
symptomatic treatment of ex-

ophthalmic goitre...........502
—Ductless glands in military
Tis GES) A tad ee 116

— Ductless glands in cardivascu-
lar diseases and dementia

PER CCUISEMEE UNE ord Sree ws eons 259
— Fluctuations of thyro-supra-

renal activity in general dis-

E.iit . 5 32 ee 710
— Influenza as a pulmonary ne-

erotic alveolitis involving

endocrine organs....:..... 617
— Internal secretions and high

“iti tunic Ete ero ial

Salgado, A. A.: Urinary incon-
tinuence of hypothyroid origin.710

Salivary glands, relation to
CAR G TEL 0 ue se ae eer 686

Saloz, C. (Gautiere): Galloping
SUMS EERE ES hc eon on NE 6 Hele 292

Sanz, L.:
s

Saloz, M. C. (Cottin): Glycosuria
in diabetics during infectious
diseases

Salt deficiency as factor in dia-
DELIC COMME ee co eke eo ees = 629

Sammis, G. Frank: Conservative
treatment of diabetic gangrene.303

Sandiford, Irene: Basal metab-
olism in exophthalmic goitre.. 71

— (Boothby): Effect of subcu-

taneous injections of adre-
nalin on heat production,
etc.

Sand, Knud: Experiments on in-
ternal secretion of sexual
glands

Sanz, F.:
hyperthyroidism

Thyroid function as
influenting Frowth. ...... 2. 503

Sarcoma, influence of internal
Sams Oilan od op sie comme 660

— —-— testicle and thyroid on

retrogression of..... 659

Sauer, H.: Osteomalacia and
(ReGen VON? > SS atleto Ooo 6 a are Emo oC 308

Saunders, A.: Case of myxedema.179

Savich, V. V.: Influence atropine
on secretion of pancreatic
juice

Scala, Guglielmo: Biology of old

9

SWE! 6 bn BAO Odom COO OO 262
Schafer, F.: X-ray treatment of
tumor of hypophysis......... 136

Schauman, O.: Pernicious ane-
mia and the internal secretions.471

Schenk: Action of adrenin on
Siieen CAdigiineAatoosecsceod 104
Schermers, D.: Myasthenia..... 285

Schiff, E.: Early development of
sex character following hyper-
.nephroma
Schiff, E. R. (Epstein): Blood
pressure curve after adrenin in

GIMIGHASTAL 65 Bute co niga aceon Gre 621
Schippers, J. C. (De Lange): Fa-
milial splenomegaly ..... .685

Schirokauer, H.: Importance of
renal function in diabetes... .636

Schlapp, M. G.: Mental defici-
iency and criminality........ 661

Schlesinger, H.: Effects of adre-
nin
— Familial starvation
lacia

— (Arnstein): Unusual action
adrenin in elderly persons. 243

osteoma-

Schnabel, T. G. (Gerhard): Case
of diabetes insipidus......... 657
Schioetz, C.: Cataract and inter-
Hal RECLOUIOI oe ete ia =r 114
Exophthalmas in leucemia. . .138
— Exophthalmic goitre........ ig
Schloffer: Operation for hypo-
DHYSIS=tWMOL ian <jays 3 ous atetete aoe 136

== Riedel’s: Soir. scr: fern paenn 179

Schmaltuss: Psuedohermaphro-
ditism
Schmidjell, F.: Dystrophia mus-
culorum progressive.....-.-- 116
Schmidt: Muscular dystrophy. asi
Schneck, M. (Goldstein): Dwarf-
ca Shelenayabdsiqge eos sooo CoC oS 252
Scholtz, M.: Skin as an index to
health
Schriéder, R.: Clinical signs of
ovarian functional anomalies. .670
Schroeder: Substances that in-
crease growth of sexual organs.480
Schroeder, Henry: Clinical con-

trol of diabetes mellitus...... 303
Schultze: Congenital thyroid
IAIN; Bae oaoocooreauodo UC 341
Schulze, A. G.: Action, use and
EVOL COIL JORDAN FOUNG G G CloId Os Clo c sy
Schumann, E. A.: Osteomalacia
INGA ANCEClOP Cars oycersss tl <kewens 141
Schiinemann: Case of traumatic
hypophyseal adiposity.....-.- .280
Schwartz, C. W.: Metabolism, re-
port of CASO se ees he eae UD
Seleroderma, relations between
diseases of endocrine organs
Hii tee ae e eeE OS Ghoacinl cio, once ous 312
—report of two caseSs.......-- 312
— treated by radiation of hypo-
physis and thyroid........ 567
Scott, T. B.: Non-surgical treat-
ment of Graves’ disease......- 341
Scrotum, gynecomastia following
THONG Ke wo aco Sone oom otc 264
Scurvy, experimental, adrenal
changes in.....-..-- phe Wore rorsis 615
Seamen, E. C.: Presence of i0-
dine in pituitary..........-. 657
Seasickness, adrenin in.......-. 241

Secher, K.: Fatality under roent-
gen treatment of exophthalmic

ECHR 9 q BeOS Mido Ole Ss ONOL Oko c 342
— (Hertz): Case of congenital
sympathetic neuroblastoma
combined with Addison’s
Ghig{SAISe feos ae oa a cea os ec 612
Secondary sex characteristics and
endocrinology Lee, Seer are era
Svar ss 5680000 Goo 6 ab oc pal!
—effect of, on blood pressure
and bile formation.......-.- 659
— formation, not dependent upon
TiN pee Glas 5 o alasmaaions oo ono 684
—jn acetone of duodenal mu-
(os SG, sooleraio oor eo 83
— influence of production by pan-
CLEGAS) ee ce ie eons eee 312
SS TOlatiOns tOmLAStEUM sap temeneken-i 645
Seitz, L. (Wintz): Corpus lu-
teum and menstruation...... 250

—-— Menses-increasing sub-
stance from corpus lu-
teum 5
Sekita, N.: Influence of thyroid
gland on metabolism........- 179

Sella turcica, destruction of in
case of acromegaly.......... 270
—— —_-—_—_ without symptoms. .657
—w—enlarged in case of acro--
megaly and goitre..... 281
— —-— in Raynaud’s disease. ..279
—-—in case of pituitary lesion
accompanied by thyroid

: tUMOr 22: ioe Gee 274
Septlveda, V. H.: Pathological
physiology of adrenin........ 618

Serbin, W. B. (Luckhardt and
Sherman): Origin muscular tre-

mors, ete., in parathyroid
tetany

Serum treatment of diabetes mel-

LUIS Sa & ejecile ccs dim oe oe 630
Sergent, E. (Musio Fournier):

Addison’s disease with ‘‘white

line’ of Sergzent.. ss isc 99

“Sergent’s line’ and adrenal de-

fICIEN CY. = tn ea eee 433, 444
— white line in adrenal insuffi-
GLENCY 2055 oe ea eee 95
— — —in case of Addison’s dis-
@aSE.. « Gi wh em eee 99

— — — in tuberculosis of lungs..436
Serum treatment of diabetes mel-

LiGUS ” . soar co fahes SS eee 291
— — — goitre. «.. ... este eee 336
Si 2). GREE. SoM GSR Mee aS o-o's's a5 15/35
— anomalies corrected by trans-

plantation —...4 4500. Sooo 87
— characteristics, and endocrin-
OlO ZY ass: wool oe ee 527
—w—endocrine glands and sec-
ondary .2. .s65.3eneeee 169
—-—of cock as affected by liga-
tion of spermatic duct
and by testes implanta- -
iON) 2.44 ees a ee 5AT
= Control wot... aston eee ns)
—— Getermination Oli. o eee oles
— differences, consideration of,
in’ pediatrics) ss a. 2 see 684
— gland action before and after
puberty. «.)sestsceeet eee 266
—— —— and) OSteOLeNESIS. ~ - ei eeiene 482
—-— disturbance in case of gi-
SaNtISM: ; sce eels See 460
== == NOTMONES ae shoes eroden- oon 266
— —/jin rabbits, influence of thy-
mus injections on.-:.-.- 427
—- ——jInternalissecretions (Olsen 460

— — ‘“‘protected’’ by hypophysis.128
— -— quantitative determination

of material components

Of otdhaeskkike eee 41
— — transplantation. .214, 215, 266
— — disturbance of internal se-

cretory function and gy-

Necomastianencds eee 209:
—w—relation between pituitary
ANG: «ct. eos bee eee 192

— influence of, on frequency of
pertussis

Sex, influence of on gravity of in-

PUR ETUZ AN | chee eo s0's sve) i ee 684
——SiTOMCS OMA © sietcie + ss ers \'s)s, erele 153
Sexes, differentiation of mammary

developmient im... ....... 206-207
Sex-linked inheritance and hered-

ity of tendency to goitre...... SH
Sexual characters, influence of

SFONAGSHMOMs secs tis sce sss se os 122
—development and _ pituitary

BE CUUIDE arty ores vsti te si, <u si 6 «les 187
— glands experiments on inter-

Mal eSCCEELIONS) (OL S ..c2..<. 266
— infantilism in hypophyseal

CSIRO LN) SS a eee eee eee 188
—intergrades, human......... Silke
— organs, case of deficiency of,

ATE MOTIVE TY troncy et eiice «5 is iciceia-< +s 666
—stimulation following use of

DitwUitaGy: (CXtTACE... .. os cccavs 128
Seyfarth: Relation between pan-

ereas and diabetes. .... 2.6... 47

fat

Shafer, J. J.: Diabetic retinitis.303
Sheehan, J. E. (Newcomb):
Treatment of goitre with injec-
tions of phenol, iodine and gly-

EEEMUTNE® pS Ent. CeCIOI eee 342
Sheppard, H.: Hermaphroditism
TiGL ETE TC A5 GAG Bn oes 460

Sherman, M. (Luckhardt and Ser-

bin): Origin muscular tre-
mors, etc., in parathyroid tet-
DUTY ttaeouele A SEES OL eRe 479
Sherrill, J. G.: Operation for
POLO eUET ORS ca. << eis's ae als. 179
Shevky, A. E. (Bevier): Urea

excretion after suprarenalec-

lAONTiNs 2 So 5 ROS Oa a Zoo
Shinji, G. O.: Embryology of coc-
OniG ISIN © 6 aA hoc csc ee a 289
Shock, influence of adrenin on
LG REIT eA oer a 620
PERLE UNGER MANN. us siete «ci oe sc ae 109
— treatment by complex artifi-
CUMUMNCEUING 5.4 3.6 cis le cicla d's ss 116
——<USe Of A2Grenin im.......5... 109
Sicard (Roger): Acromegaly and
Sonne!” 2 oe Seeker eee seen ae 281

— (Roger and Simon):
nalization of muscle and
electric reaction...... 621-622

Silvestri, T.: Occurrence of epi-

leptic seizures after the injec-

LLOMe OL AGTENAlIN....6 665020... 246
Silvia, A.: Contribution to study
OM VNYPOMMYSIS:. .. 0.2.0. t ee 658
Simmonds: Diabetes and syph-
HS ae re 637
— Post-mortem examination of
Gayeiitin | 2 St eS ee IW

Simon (Sicard and hoger): Ad-
renalization of muscle and elec-

IAGMECACLION ..6. 506506 o's 621-622
Simonds, J. P.: Congenital syph-
MIS cOt ey POD SIS. i .c.6% ee ee 281

Simons, A.: Trauma and Graves’
disease
Simpson, Sutherland: Pituitary

feeding and egg production. ..466

Singer, R. (Elias): Diabetes
mellitus and waridiet.. o....-. 447
— -— War diet in diabetes...... 295

Sisson, W. R. (Finney): Effect
feeding pineal body upon de-
velopment of albino rat...... 310

Sistrunk, W. E.: Selection of

operation for exophthalmic
POMC Sah hoe SS te wc bn Se 710
Shaves, P. R.: Paranucleus of
PAneTeaticr Cells a <1 eteneane one 676
Shimidzu, Y.: Permeability of
placenta) to jadrenin’s. <> 22... - 618
Skin complications in Graves’ dis-
CAS CM eccrine eee ie neieistone se leteue vais 328
— disorders, endocrine etiology
ands treatment) OL). = « « «rene 643
—in hypophyseal dystrophy....188
— internal secretion of........ 314
— multiple hemangiomas of with
dyspituitarism <....5...-..214
— protective function of.......314
— stroking and hyperirritability
Of isympatheticw. .... oa ...6- Sus
Slecht: Myotonia atrophica....139

Sloan, E. P.: Study of goitre

based on 1000 operations..... 180
Smith, F. M.: Studies on hyper-

ARON CTY Mesa cise cos © hoo ek 342
Smith, P. E. (Cannon): Some

conditions affecting thyroid ac-

PAVUCVee crerece ecsvews siete ees. Bye 386, 489
Smuts, Ph. A. (Cooke): Testes
TNMs OUT Loe = to Jer o,. 5) 2 ever cua) Suleife tener 154

Snyder, C. D. (Campbell): Vas-
cular reaction to epinephrin. .443

Soden, W. S. (Sparrow): Co-
existing suprarenal and renal

GISCASEH Tens us vactore cee « elievs eteveuces 104
Sohmer, A. E.: Function of the

thyroid in relation to infec-

GIOTA icc asraser oii eked WerGewenc:c.« eveveus 180

Solis Cohen, S.: Present status of
the definite treatment of the

MMCUIMO MUAGME ese. |e Si sie ois. s sores 280
Solomon, H.: Diabetes innocens.115
Soloveitchik, D. E. A.: Rhythmic

contractions of vessels....... 246
Sommer: Goitre in skiagrams. .710
Soner: Case of acromegaly..... 137
Sonques (Lermoyez): Familial

exophthalmic goitre.......... 180

Spadolini, I.: Action adrenin
on muscular coat digestive or-

CANIS! Gace taker Stele ede enue Maren ao oe 112
Spaeth, R. A.: . Standardization

of “pituitary: Cxtractsin. si. sor 281
Sparrow, H. C. (Soden): Co-

existing suprarenal and renal
disease
Spasmophilia, Case Ol. <i. sien. 481

Spasmophilia, experimental stud-
ies on pathogenesis of....... 685
imyolder children... ««- « -er 685
Speisz, G.: Cure of case of men-

NIU ESELS 1 ts wits’ 6 oa ve eagedemetene enone 467
Spermatogenesis in young has-
tened by use of pituitary ex-
0 Ot Oo choceore Sith GiGi oc 128
Spiegel, E.: Hemi-tetany and
lesions’ Of cerebrum. ..2.- 156
Splanchnic afferent impulses, re-
lationsOhtontetany- ese eee 680
—nerve control of secretory
function of adrenals...... 95
— stimulation and _ adrenin
discharge Gua asc tie aeueyt we 236
Spleen, adrenin injections in en-
PATE OG ac cgt ooet ath eee ences isis 104
— effect of removal upon metab-
OMISING Bet seetey. ei hc eee 314

—extract, effect of, on blood
pressure and bile formation.659
— extirpation of, influence of, on

PUINOTS TO) sMICes 2s aes. e 660
— — —-—on rat sarcoma..... 660
— extracts of, action on smooth

TMNUS CLO: eateries 5. Sesc sues as face Rees 685

—in case of hypopituitarism. ..406
— — resistance to infection....314
Splenectomy, goitre following. ..338
Splenomegaly with other endo-

Crine® Gisturbancese y..o. seer 252
Spondylitis rhyzomelica descrip-
PION HOLA Gee ware iedoeus. = cuore 482

Staffieri, D.:

TDN i rahe oe a ORME Ohaus aac 343
Stanton, J. M. (Raphael): Ac-
tion certain drugs on brain cir-

(OUNMENTIOIML hi. WRN NG 6 ood Al ODS 246
Stark, H. S.: Drugless therapy

OPEGIAbEtES:. . ca ook ee ee 637
Starvation, adrenal enlargement

Da ee ere oe ce ean ane eee are 97
—treatment of diabetes.......

Pk 25 1.293, oss oU4e BUD

— — — —jn elderly men...... Ile

——-—young diabetic........ 146

Status dymphaticus...2 .. 2). + > 322
—w—and simple thymus hyper-
trophy, distinction be-

WEIS ee sh See S 483

— -—jnfantile eczema and.......158
—-— occurrence and significance.315
—wwith other endocrine dis-

tuUnbanCes! fo eee lene 252
Status thymicus in case of Graves’
GiSCaAse i. she Lee ree 180
Status thymo-lymphaticus, a
Caliserolie ee Shjss agree mee ee 284
— — — manfestation of....... 328
Steatorrhea caused by hyperthy-
TOUGISINS \.seaeee ie: ee eie er ate
Steckelmacher: Three cases of
osteomalacia. “sas Sees 59
— Myasthenia gravis pseudopara-
hy ticay ...5. 3k Sle Sere 23

Steenbock, H. (Hart): Thyroid
hyperplasia and _ relation of
iodine to hairless pig malady.

Lae OER MOR oe ts SS ce 493

Stein, A.: Use of very small
doses of pituitrin in inducing
labor

Steinach’s treatment of homosex-

Wality 2 <jocs sacs cus oe eee Ly!
Steinach, E.: Artificial hermaph-

roditic glands in mammals

and“ binds. 2 aassge eo eee 266

— Causative relationship between
homosexuality and herma-

phroditic sex glands....... 267
— Generative glands in human
homosexuals". hee 267
— Specific antagonistic sex-gland
action before and _ after
puberty 2.8 22s. eee 266
Steiner, Walter R.: Starvation

treatment of diabetes mellitus. 304
Stenstrém, N.: Case of hyper-
nephroma in renal hilus...... 438
Stenvers, H. W.: Pathogenesis
of dystrophia adiposo-genitalis.467
Sterility, endocrine therapy in...
14 O25 Deora
Sterkel, H. (Brosamlen): Muscle
activity, blood sugars one 248
Stern, L. (Rothlin): Action tis-
sue extracts on smooth muscle. 260
—-— Action of splenic extracts
on smooth muscle...... 685
Sternberg: Dwartismy, cys 267
Stettin, W.: Thyroidectomy for
vagatonic type of Basedow’s
disease
Stewart, C. A.: Changes in
weights endocrine organs..... 120
— (Jackson): Effects inanition
in young on size of body
and organs! in- rat. 2. eee 265
— (Christie): Study of a case
of diabetes... .. «<< occas 651
— (Rogoff): Action drugs on
output epinephrin from ad-
renals
—w— Essentials in measuring
epinephrin output...... 618
—-— Further observations rela-
tions central nervous
system to epinephrin se-
cretion
— — Further observations, rela-
tion adrenals to certain
hyperglycemias
— — Relation of epinephrin out-
put to changes in heart

‘efe (ole) fe; kewelie’ ri feslelieujegie xelelle,

TALC? so cates oie seca eS 619
Stieve, H.: Experimental de-
generation VOL vOVaGyaee eons 142
== iGOnAGS.. ic. 3c sgeveusen seer onewooHene 123
Stillman, E.: Control of acidosis
in treatment of diabetes..... 149

Stilman, Edgar: Treatment of
diabetes with special reference
to acidosis

Stmeeman, H. A.:
otmoideniehildren.-. 6.4. 38 ee 685

Stoeltzer, W.: Etiology of mon-
golism

Stolzner: Etiology of mongolism.503

Strandberg, J.: Thyroid treat-
ment of alopecia areata...... 181

— Thyroid treatment in nine
cases of alopecia areata ma-
LIRTG ~ 2) aedone oA EenC Rae a ane 344

Strauss, H.: Organotherapy in

diabetes! insipidus .....0..55. 282

Strauss, S. G.: Endocrine mani-

HGSIIGIUIOIOEL eygaeeyiS Gace 118

— Malignant neoplasms of thy-

TEMPS MPEG AITO Ate rast histo eh etens a3 4 158

— Paroxysmal nasal hydrorrhea,
based on dyspituitarism...468
— Thyroidal constipation.......710

Strouse, Solomon: Diabetes in
POS . aS Scat neeen eae aa nae 304

— Inanition in treatment of dia-
petesmmMelMtws. 22. SS 8S 304

— Prognosis and treatment of
GIA WEEE nna 4 /oee ao Seen 304
Strumitis, Reidel’s form....... 179
Striimpell: Osteomalacia ...... 286

Sturgies, C. C. (Tompkins and
Wearn): Effect of epinephrin.112

— (Wearn): Epinephrin and
soldiers “irritable heart’’. .113

~
‘

Sugar in urine of elderly men...11

—-—— significance of small
AMOUNGSOL S42 ss sce. ra

— of blood, relation of to that of
AULA eee ey eaten ces Be el. a rend os 298
— puncture and adrenals...... 99
— tolerance in hypopituitarism.193
Sugiura, J.: Hemophilia....... 247

Suitsu, N. (Hammett and Pat-

ten): Physiological response
to administration of pituitary. 463
Suker, G. F.: New ocular mus-
cle symptom in exophthalmic
SMC MEPEME CED ters 2. eVatals Satelite d 6 181

Suppurative thyroiditis, case of. .174
Suprarenal, see Adrenal.
— f= 00 (0100 (= oe 239
SULEery lm diabetes: ....).).%... 295
——IOLAMIYPOPDYSIS.. «sos. cee we oe 268
TAO 10 Or 493
— relation of glands of internal
BACTOUIONY LO cla.s leeGiinle views 459
Surgical diseases, diabetes with. .115
— hazards in diabetic patients. .476

— intervention in endocrine in-
UCTETIC Ye) ci ate in! choo 0 tee a, ee 319
—treatment of exophthalmic
ECOL Ee ey Be ICRORCRD IORI Sc 163, 481
— — — diseases of hypophysis. .196
——w—goitre ......+.... 65;
66; a0 7dr 3 24. 326.
330, 334, 335, 490, 499

Surgical treatment of Graves’ dis-

Gals Guetta e aliciteuecaiel cis. soo «cs 498
Sutherland, C. G. (Mason): In-
cipientmdiapevess aye es ee 674
Swingle, W. W.: Homoplastic
thyroid transplantsre:...... 42. 504
Symes, J. O.: Case of pancreatic
ThaKSRUBAKONEICAY Gigaiurs 6 & 4a a Gamer 677

Sympathetic nerves, hypertonia of
a cause of epilepsy. .224, 226, 227
—nervous system, adrenin se-

cretony: tISSUIES OL. ss. cree 108
— —-—aand epilepsy.......... 222
— system, a check to organs. 25.3
Sympathicotonia and vagotonia. .183
Sympatheticotony, treatment of. .113
Syphilis, affections of endocrine
lands: Tyee 3 ec ica tee LALe/
—— ands GliaADeLeS. ses causa le ore 637
— — Graves’ disease.......... 690
— hypophyseal adiposity....... 466
— as cause of Basedow’s disease. 331
— —-—— diabetes .......... 629
— INCOMES Mes seers ers
—-— causative agent of endo-
crine-sympathetie pro-
CESS" J Oe cee aL 261
— congenital, adrenals in...... 613
— diabetes a sequel of......... 145
— hereditary, in etiology of endo-
ChinOpPathiecs! 4.5 scene 644
—— with genital dystrophy....318
— in its relation to thyroidsm...117
—of endocrine organs with
marked: “ODeSILY. 4. <2 sono 663
—w-hypophysis ............. 281
— organotherapeutic treatment
ODM ets e os 8 har a a ee PAT
— poison of and Basedowism...506
——=tNCe CnyTOld= IN e-. me. ae oe 473
Syphilitic hydrocephalus a cause
of hypophyseal adiposity in
CHUPVGNEME ers cies wus chee a trols es 278
Taberlet (Lemierre) : Suppura-
LLVOabMyNOLLEIS tei. oct. cere ore 174

Takenouchi, M.: Endocrine func-
Gon) of wtonymuUs, eland:. -2 2.4) 158
Takeuchi, K.: Changes in thy-
mus of children following in-
fectiousy diseases it. Se i4. 2S oe 484
— Comparative investigations of
changes of thyroid in vari-

OUS*GISEASEAS laerat. So SRE < (aie
— Thymus changes in experimen-
tal infection of mice...... 687
Talbot, F. B.: Metabolism of
Gd warts26s:, so sure ties deter cereale 25
Tatum, Arthur L.: Distribution
of iodine between cells and col-
loid of thyroid glands. .344, 504
von der Tak, H.: Urgent trache-
ONO Vsre aia ats licita Gia a rarare 181

Taussig, A. E.: Blood pressure
phenomena in exophthalmic
POT OMMOEE eh le shal cd bashes eibee 344

Tebbutt, A. H.: Persistent thy-
mus in exophthalmie goitre. ..159

Tejera, E.: Chargas’ disease in

METIGZULCTS 22> ais. sscecties Eee 181
Temperature, endocrine organs
PMieereezulalion sOLem eee eee 336
—relation of, to thyroid and
thymus “function +... oe 689
“Terminal hypoadrenia’’....... Tahal

Terrien, F.: X-ray treatment of
visual disorders of hypophyseal

OTigin: gab SAe ede Pale ek 658
Testes, atrophy of, and diabetes

INSIpidush |e ek eee Lata ee 686
——CASCuOLAALLOpPDYivOle ei. eas tee 121

— effect of extracts and of abla-
tion of, on sarcoma of dogs.659

— — — — — on metabolism. ..682

— extirpation of, effect on reac-
tion of thyro-parathyroidec-

LORD 0. 2-2 ee 692
—-—— and ‘extract; influence’ of;

on “rat@sarcoma.. 2) +. 660

FIT ect e kcrho eteeee ss eine ann dees 154

—-two cases of hypophyseal
hypoplasia and atrophy. 280

= hoeKerinsyols Serine ae ee Tee 265
— normal and morbid conditions
imal OONCASES* eee pate ern ae 316

— relation of salivary glands to. 686
— study of seasonal changes in. .154
—underdevelopment and _ defi-
cient vital resistance to dis-
CAS Cimcpetene yitnohsgchee§ dace ieee aly
Testicle, endocrine function of. .531
— extract, effect of, on blood
pressure and bile formation.659

—— FOCUS FOMEALS 2. Sees ae eee ee 470
— hypoplasia of in youth....... 460
im plan taviOnsMEeSUlES ae ieee 122
— influence of internal secretion
OL eae eee «eo Ee 319
—of worm (Orvet), seasonal
eyclenotane. . ELAS conden Ohi 686

— relation between internal se-
cretion of and that of pros-

BAGG | tte hee AEM ct SO 331 lab
— transplantation in man...... 318
—-— of in eunuchoidism.....:. 687
—-— three cases treated by....687

Testicles, atrophy of in dwarf. ..137
— -—of with abdominal tumor.. 96

—— Case OLrsatloplic.. oe ae 118
—in case of hypopituitarism. ..406
——__—_ SS VACCOMASESE! ere tee enone ee 211

—-—— men who were homosexual. 267
— internal secretion of and de-
velopment of male charac-
LOPISEIGRE As 2 eee tens 214
—— Of Rea 6 ded Bee ia sale. 317
— normal in case of acromegaly. 276
—removal of tubercular, effect
OE ca ahd cen eS owen ee ay See eS 318

Testicular defect, gynecomastia

secondary” tose. foe ee 264
— degeneration with hypertrophy
of interstitial tissue....... 482

— epithelium, conditions which
cause variations in growth

OD is eee ee eee Daly
——— Prats; sero wtheot. =e ee 317
——harmozone, effect. .:,...2..08 540
— tissue and avitaminosis...... 482
— tumor and sexual precocity..
ORT CE eT CuO Fi Mia oe 373-374
Testis, effect on of ligation of
spermatic duct... . oe aoe 547
—eratting ine ratsyoe a eee 647
— implantation in cock, effect on
sex characteristics........ 548

— internal secretion of, in cock.547
—of cock, normal morphology

Of iio. ee eee 550
—relation of internal secretion
OF prostates tose eee 682
Tetany, abnormal sense percep-
LIONS") IMA 2 o's ee eee 156
— associated with cataract..... 678
— and epilepsy, relation be-
tweenrcin3e. fe eee ee 504
— —functions of parathyroids. .150
—-—lesions of cerebrum...... 156

— — relation to parathyroids...308
— case of postoperative cured by

transplantation; ~~.) . 25.258 306
— edema in children with...... 320
— following thyroid tumor re-
MOwVval 2745285 eee 339
—-—thyroidectomy .......... 486
— in case of Basedowism...... 326
— — case of rickets in an adult.155
—=—— .eunuchoid: <...0....... tone 308
—-—the adult and parathyroid
apoplexy 2.3...) ei 678
—origin of muscular. tremors,
Spasms 11 ese eos eee 479
— osteomalacia and........... 308
— parathyroid, influence of
vagus and splanchnic affer-
ent-impuises: (Ono) eee 680
— postoperative transplantation
LIP. Bei iSre eek ae 307
— — treated by parathyroid
transplantation and cal-
ClUM |... SBOE ce eee 678
—report of case of with hypo-
thyroidism and tetany..... 162
— symptoms of latent in case of
disease of bones -heineliee 155
— therapy of postoperative..... 478
— thymus) ‘and :ij2e5 3303s «eee sivaah

— thyroidectomized animals....201
— treatment of postoperation...306

Tethelin and frowthy. . .<2sooee 187
— influence upon growth of car-
cinoma An rats <.ee- ee 279
—Teport Onuse Of... 208 ees ee 132
—treatment of an _ electrical
BUPA” itis ae Oe mnt «coe 132

;

Therapeutic problems of the fu-

IMIG ey ck ch cust acer on Sceteie o: SUR teNe. 2 458
Thiroloix, J.: Asthmatic spasm

treated by adrenin.......... 241
Thompson, A.: Maturation of

Je Tiar 51) S040 00 | ne ene ee 289
Thompson, J. W.: Ectopic ovarian

(EAN SIRO SS ce COOLIO nena ae oe 671
Thomson, F. G.: Diet in chronic

ALIS CITE) OS oo Sans eek eae ae ae 120
Thomson, J.: Clinical notes of a

case of myasthenia gravis....159
Thymic asthma in infants, radio-

therapy. treatment......2... 483

Thymoma, case of, with necropsy

MGWOMIRMR tere oS ss cre sic .e se 0s ous
Rhynmas). Us6. 159" 320; 323, 483, 484
— absence in case of myasthenia

ARVIS) “5 3 6 cee Ne eh Oar 323
— alterations in leucemia...... 484
——— Ft PINGMERICK CES. -% obs sk oes os ee 440
—-— secondary sex characteris-
OS Si 6S becic ee eee Sika}
(NS) 00h ee 321
AOU PAs Osa einnshs tos Ss ee sue o-% oe 57
— case of lymphadenoma of....688

— changes in mice following ex-
perimental infection...... 690

— death in children; etiology of..689

— development, certain peculiari-

HGS Cit Cae Anak ee 320
—enlarged and _ dilatation of

LVEGITES 2? Renee eee ee 159
—— diagnosis of............. 705
—-— in child with eczema..... 158

— enlargement in acromegaly. .650
— extirpation in Graves’ disease. 322
= CORMER ACT, CMCCLIOL= .. ;..)8% ee. 260
— — — — on blood pressure and

bile formation....

— feeding, effect on thymic cells. 157
— -— influence of on tumors of

PMC CMaintyeys ate co lates e's ete» 660

——— EON SEALS) 2 cis sc os se 6, te eeu 470

= DCO (0) Ce 156
— functional relation of, to thy-

nog]. 689
—gland, enlarged, status lym-

OLE IS: | ee ees

— ——in childhood.......... 483

— — malignant neoplasms of...158
—-— studies of human........
——w—on endocrine
ei ae Be to ae ee

— hyperplasia in children, study
ANGmLreALIeNt OL. 2). 5%. ss

— jin children, changes following

infectious diseases........ 484
—-—exophthalmic goitre...... 704
—— —goitre ...... 159, 179, 486
— -— Graves’ disease...... D5S, s2.1
See PEREALTIUS): Gob ect. cc ss ace Ono
——— treatment of menorrhagia.646

— influence of on metabolism at
different temperatures..... 689

Thymus injections and body
weight
— — influence upon sex glands. .427
— insufficiency in bone fragility.156
—-—a predisposing cause of in-

POCUHIONS erry arerisione gs ss 94

— involution of in birds....... 321
— large associated with small

Py TOUGH epee ences toe mecek ses 158

—-—in case of Graves’ disease. 180
—normal and pathological anat-

OMY, (OF. crass sel terete sis 320
—— weight of, at different ages

UI, TIVETIY egies cacta seas coe temeRets 88

——=NnoL 2 true: slandisse sem «oe. aS /

— pathological physiology of... 98
— persistent in girl of 14 with
diabetes insipidus........ 279
— physiology and functional
pathology: Obs cae -n5.chonetet 323
— radiation in exophthalmic goi-
1s RS eS Ee cil te T07
—role in regulating nuclein me-
tabolism= ©. : roscoe. ohare 158

substance, effect subcutaneous
injection in young rabbits. .420
sudden death of man with en-

lies eaeYs be RM Oost Co tinny exGie se 159
——== (SVMS CO. ..s. scavopenel os secletonenens a Vali
—tumor of, with necropsy re-

DOR eis fe eka taromcsner au atoreueker eke 687
—— Variavion In Size in. SCXeS:. . 5. 322

Thymusectomy and its relation to

TICE UG oo. %; sive. oy oe Barate ate comets 320
Thyreoglobulin as thyroid hor-

TEROTUCE Pe .c. Sis ease aclio¥e dene such eee 691
Thyreohypoplasia congenita, re-

DOTtHOMCAS Els uc |.) caes sive ore ee ere 496
— causing sporadic cretinism...337
Thyroid.160, 188, 324, 346, 484, 506
— a cause of hypertrophy of....242
—'— sex gland... ccc cas bee 193
— — stimulator of metabolism. .194
—-——_— of pituitary function. ..194
——{ADSCESSe Tw sc bleeaers se * o edel niece 168

— abnormal functioning of not
cause of Graves’ disease...1
—action of on general metabo-

Lisdvin Rar cerreetots «avers cure 59
—active principle of.......... 25
—— conditions affecting.......386
—-—as manifested by augment-

ed basal metabolism....705
—-— method of testing........ 329
——"ACWES. .SUVUMMIIGIS 5-.>.90 88 ove wl rete 496
—administration during preg-

WVATICYVs woes aot. eden aes a Oe

— — effect on reactions to adre-
nin and hypophyseal ex-
tLacths t.ho. ste Baer 638
—-—in osteomalacia, effect on
calcium and magnesium
DATANCO ince eu eta tiara alters
—-—influence of, on rat sar-
COMA Ls SR ne oe 660
——4MONE VECTULS i ets 2. <1. ss ea ee 172

Thyroid and adrenal discharge. .386
—— adrenals as subsidiary
heat-regulating mechan-
ASIN has ce Bele se ee OO
— — —jin relation to exophthal-
mic goitre
anomalies of morphosis...702

— autonomic nerve cells..... 253
— -— brain, intimate relation be-
EW.GEN Sip cksscboncboriencrcncoeeeaare 498
—-w—diastatic activity of pan-
CLO AS a Mi fae. cbocbieieese: 57
= — NEAR es wee aes elaesls, slabs and Zoe
—-— heat regulation.......... 160
—-—hypophysis, inter - relation
Thole, (AON AO Oleh S: Alinrs Que erubes td 1
— — ovarian deficiency with
My POpitwitarismiyan ae eis. 194
—-ovaries, well established
relavionshupy ie. trees 28
—-—pancreas, giant cell sar-
COMA OL asco crete Meee 708
—-parathyroids ............ 199
— — -— anatomical relation be-
EWEOM a cusses eee 340
— — — functional distinctions
between: tania. ee 201

— — — role in blood regulation.49

—-—pituitary, ability to func-
HONS VAIGATIOUSIye =... alex 24
= DUD OTLEY. Sadar ee eae no ocle heres 481
—-— thymus, balance between. .158
— -— — infections ............ 93

—aplasia and myxedema in
Wiel x cacutevictc, Spathevtous, a: eyes ne arene 709
—— case of with treatment....166
— atrophy, congenital......... 341

— — following thymus feeding. .456
—autacoid and decreased pan-

creas diastase) yaeeis she onsieuele 59
— bilateral resection of........ 499
——— I DIOIO LY: Olsens s-/ots). s0scbans alteehet ees 606
—ecarcinoma and exophthalmic
SMOUETE weet.) a6. 5. aoe cee Ooo 487
OG Oe CRN Gin ciencmon 695, 702
= CATGIO-EXCUEIM ES) shee ahelevere oueia eis 233
—=Case Ofsatrophic. % ..46 6% ee 118
— — — girl with hypoplastic. ..496
— —-— tuberculosis .......... 497
—cataract in relation to dis-
CASES Oli yom wemils wisse ae 114
—eells, normal, causing bone
CUMOTS \2Cahktoe kh tere daes eee oe LONG
—changes of, in various dis-
GASES» To teusn et toatdseetoterabee (alak
——/(COld “aibSCeSSt OF... «1s sm ete 497

— decrease of colloids of, follow-
ing use of pituitary extract.128

— degeneration of in cretin....490
— dependence of function on
Otherws landSyayn.1 eel essecue eee Seu
= iMlabetes! joe Sue wheceteneiel Oper, alts 63
— — diet in case of........... 64
—discharge of suppurating in
case lof Septicemias a-aeee 326

Thyroid disease, prompt treat-
O02) oll HO) CE ety Coe Or er cided lotsa: c 333
—-— and treatment........... Sein b

— disorders, effect of, on reac-

tions to adrenin and hypo-
physeall extractsrraes-e-n-eeee 638

— -— medical treatment of vari-
OUST tYDeCS ae 6. ono cieuoeene DEIrAL:

— disturbance accompanied by
SLY: COSUTIA ay tyes eesccheuceen ene 258
—— —— J ittlexysigns Ok. se 5.4.5 ene 174

— -— with pancreas insufficiency.706
—dystrophy and Quincke’s dis-

ease

— effect of catalase production. 107

—-—- feeding on pancreas... 56
— — — underfunction of on

PItUitanyeaseec eee 193

— — — thymus injections upon..428
— efficacy indicated by effect on

MetamOEDHOSISes ee eee 702
—enlarged and hardened...... 281
— -— X-ray treatment.........503
—enlargement among Indians. .171
—-and body temperature....336
—-—— chronic infections......180
—-— preceding tuberculosis....330
—-— treatment of............ 334

— esophageal obstruction due to.495
— etiology and treatment of gas-
tric and duodenal ulcers and

hy peraciditiys Space. eee 704

— extirpation, obesity following.185

—-— in the horse, results of...701
— -— influence of, on sarcoma of

dogs
—-—of in pregnant rabbit and
effect on fetus and dura-

LION OLS Sestarionnessesaee ali
—-——one and one adrenal,

— — subtotal
—extract acceleration of meta-

MORDHOSISH ene nese Le

— -— action on isolated intestine.329

—-—and tetany.............. 339

— — assayed on

Tarvaies “05. Gio sash eee 702

—- dosage in hypothyroidism. 3824
—— effect of, on blood pressure

and bile formation..... 659
—-— —on tadpoles........... 174
—-w-—history of first case of

myxedema treated by. ..600
— -— jin treatment of headache in

hypothyroidism 22s nee
———cretinism ............ 495
— — — dyspituitarism ....... out
— —-— hyperacidity ......... 454

—— — mentally deficient child.505

—-—-—ttreatment of adiposis
GolonOsaisa ts. eae eee 432

— dwartisme-.- ose tow

— — — — — hypopituitarism 406

— — —tetany and epilepsy....504
— — influence on sex characters.172

Thyroid extract reinforced by

combinations of salts........ 492
—-—treatment of hemorrhagia.366
—fat substances in.:......... 700
—fed rats, adrenin content of

UGE I) a 496
— feeding and glycogen content
an0 TINS ee 6 oe ors 485
— -— changes in intestinal juice
POLO Se Ss oss 58
—— effect on blood..........329
—— —— thymic cells of adult
HERO (Ee eae ae ae em HT
—— in case of cretinism...... 497

— — — of, on tumors of mice. .660
— —— on carbohydrate metab-

OLTSTOT eRe. crickosin anne 496

— -—response to in animals.... 24
— fluctuations of activity of, in

general diseases.......... 710

— function as influencing growth.503

== OE a ee 180

SSS GE TESS aio One 492
— functional relation of, to thy-

NELSON ties cietcl s-s.s 2 « » <2 otk 689

— gland, basal metabolic rates
index of degree of activity. 81

— — distribution of iodine in. ..504
— — enlargement among re-
CUES Heats fear ss kk ce A 4
— -— feeding to rats.......... 470
— -—in treatment of osseous de-
mineralization ........ 501
— — influence on metabolism. ..179
— -— iodine distribution in..... 344
— — operative treatment of en-
lareements: Of2.%2.. ..... . 166
—-— physiology and _ pathology
Gil? 4 eee Se er 494
—-—relation of to “irritable
Heart of soldiers”... ...-- note
— — studies on disorders of....389
— glands, affinity for iodine....335

— -— iodine content of human. .183

—-— local anesthesia in opera-
MIS IPON,. ei ties 2 eek. 165

— —-~ Malvenant epithelial
LOM iLELOG) 0) ee 163

—-— relation of development of
to metamorphosis...... 160
EMI AIBEIA 54 Sicle Seki cd bce Se 263
— grafts in cretinism.......... 319

—hematocle, causative factors
OG 280 Ne 484
— hemorrhage into............ 167
— hormone, action of.......... 691
—-— chemical identification... .332

— -—essential to normal func-
momOr Conads::: ...%: 2.7. 194
——-—'study of isolated..:...°... 168

—human, weight of at various
LESS Veo fin ee eee eet eae 700

—hyperactivity, with cardiac
ERUACION'.. )ieis ied ois eedt oe 74

Thyroid hyperplasia and high pro-
tein diet
—-—-—relation of iodine to
hairless pig malady. .493
—hypertrophy as a reaction to
adreninemia
— hypertrophy, exophthalmic and
falling of hair accompany-

1G =e 1 eS anh RS 328
—hypofunction, case of post-
ING Wena eels Set eR ene e 498
—-— in uncommon disease..... 134
—-—az pluriglandular case..... 480
—-w-adiposis dolorosa........ 432
—-—case of dystrophia myo-
CONMTCAP Ort Aram cr are etree 453
— — —-— Graves’ disease..... 180
— -— congenital syphilis of hypo-
PY SISMic 2 casch lew otete, ckee = sets 281
—-— etiology and treatment of
constipatione. cps 710
— influenza <=... .617
— urinary and fe-
cal inconti-
NeEnCe eae 710
—-—exophthalmic goitre...... 179
—=> ——infeections” s052....66820% 692
—-—-man with atrophy of hypo-
DHYVSISh sees cee ee eee
— — relation to diabetes....... 704
— —-—— infections ......... 3
—-—uterine hemorrhage...... 495
—-w—various diseases......... 473
— incipient modifications.......17
— influence of thymus on...... 4a L
— -—-—on metabolism at differ-
ent temperatures. ...689
—-— on functions of supra-
CTS eos cee. a: cee ea
—-——-— menstruation .........412
——— MIN eTVALLON) sOlsn. 2 <lhatele come ats
— insufficiency after influenza. .498
—-—in scleroderma...........312
— intrathoracic goitre, diagnosis
aie gl (Eee hg 0: CS em 705
— iodine combination in....... 493
— intoxication, observations on. .486
—-—symptoms of............ Bit
— isolation of iodine compound
THT Se ee Boe le I a nse CL:
— large adenomatous in case of
congenital goitre.........o00s
— lymphatic tissue in, in case of
Addison's disease... -.4).% 328
— malignant tumor of......... 167
——NANILCSEAUIONS: o<-s + +. « erate ete. « 261
— medication, effect on some
wenbal, Kstavese ¥.c2 ose ee 45
— —in nervous cretinism...... 165
— — — sexual neurasthenia....286
— metastatic abscesses of, asso-
ciated with exophthalmic
SOLER) Assia a A eke 700

— nerve block anesthesia in liga-
tion of superior pole of....702

Thyroid, normal function of de-

termined experimentally ..... 3
—-—in case of diabetes....... 300
— operations, preliminary...... 174
—-—with local anaesthesia....170
— opotherapy in myxedema....167
— origin of exophthalmos...... 178
—— — — dwarfism «.. 2 seescee: 267
— overactive, and diseases of

SOIdICES): Syne abe Cee 116

— overactivity and glycosuria. ..142
— papilliferous carcinoma of...701
— parathyroid and kidney, mu-

tual -interrelationship be-

EWCOnPe tata ttc oncana ie cee ee 178
— partial resection in Graves’
GISCASC Rees cnt eee | heen 322
— pathological physiology of.... 93
— pituitary and metamorphosis. 28
— preparations in treatment of
postoperative tetany...... 307
— purulent inflammation of....168
— Qualitative variations....... 88
— quantitative determination of
material components of.... 41
—relation of to carbohydrate
MPeSCAVDOLISTNt -io eet fe 63
—-—to electric conductivity of
ELSSICSu UG inee eye eaehe canoes
SHO SUV CIPR tol o nic an) OO ee ee 119
SVE NOSCSy aches Gees olor ole 639
— removal of hyperplastic..... Bint
— resection followed by abortion.33
— response to overstrain.......495
— role of in antitoxic defense. ..486
SS = THI 4 au eee e 497
— sarcoma of with metastases. .345
— secretion, bacteriolytic prop-
CUWICS orto eee eta Elie teas 180
= STON. WN, Aes Seok oo Geode 494
— secretory function of sympa-
thetic innervation to...... a flr (l

— sensitizing action upon

struc-

tures stimulated by adrenin.591

— significance of in animal
OMe tare sees S yhxs knee
—— SHRIKE DONE! Oia Boge oko 6

econ-

— studies, determination of io-

Gin'eyeitewect so eee ee

— substance, influence on growth

OLSDlantSPet- Le
SUE OILY, Ole ccc) eke pee iene
—— SV DMNTTS. rs Qeuerete Ose ae

OO. Ome

iliErG

— swelling of following shock of

Wal A calt tole eee oe ee eC Oue
— -—-—in Dercum’s disease....
— therapy following influenza. .498
— —in retarded muscle activity.496

— —w— skin diseases.....
— toxic conditions of, clas
tion and treatment...

sifica-

—-—states of comparison of
methods of determining. 712

— — — — Goetsch test in

250

699

Thyroid, toxic states of, new
method of diagnosing comple-

ment fixation. 2 acceet: Soeee 694
— transplant and hyperthyroid-
iSTNet Scie ss Bie eee 2
— transplantation in sporadic
eretinisin Gao. 0-2 700
—transplants, influence on
STOWth Ako a..cak See Oe
— treatment in hypopituitarism. 193
— —— —_ psychoneurosis« . 2.20.25 696
— — Of epilepsy= oi. 2hictescn oe cee 697
— — — hair and nail dys-
trophies: (9.05.00 ee 693
— —-—hypertension ......... 692
— — - irregular menstruation. 646:
—— —— —— _ Metrorriacia. ... 2 ee 651
——— myxoedema...... 486, 496
—-——-—a pluriglandular syn-
Gromes 2 2. 3e ee ee 252
—————— aIODeCCIaaae eee 181, 344
= == —1Cretins) isi secs pee ee anes)
—tumor accompanying pitui-
tary ‘lesion... 4... eee 274
—— —— operation: iors. -..6 eee 17/8
—-— surrounding larynx and
UPACHEA. (odes Spe he 494
—— LLIN OLS TOF stOn les ee 506
— two cases related to function
Oo) deat nee Se eS gs - 490
Thyroid-adrenalin therapy in Der-
CUMS: GISCASC are ct. eae PASI
Thyroid-ovarian insufficiency in
CpilepSy- s\. sc saccharine 697
Thyroid-parathyroid activities. ..486
———— apparatus in! unemiac eee 178
— —-— observations on func-
tiONS Ofc ates 201

— — glands, extract of in treat-
ment of paralysis agi-
CANIS”. Ads 3 Siew ore 306

—-— mechanism, significance of.331

Thyroidectomy and antibody for-

MATIONS eine ardor ee hens 331, 497
== CASE A rePOLrt..: tis ica SER BSA |
—effect of partial in exophthal-

mic. goitre:. pane eee 336
—-—on basal metabolic rate in
hyperthyroidism 35... 82
— — — growth and development
of Vamphibias. sae aee 168
—-— —hypophysis .......... 24
— followed by tetany.......... 486
—hhypophysis and, relation be-
EWiEON) ce 2 stot aio ole soeene eee 282
—in animals, observations on. .201
— -— Basedow’s disease........ 343
— -—treatment of diabetes..... 69
— technic Lofts 4h eee 334
Thyroidin, influence on normal

metabolism)*s2a.c@e- se ation ee 172

— subepidermal test........... 387

Thyroidism and Graves’ disease
as form of traumatic neurosis.177
—-—loss of weight........... 488

,
J
*

Thyroiditis, case of suppurative. .174

— report of case of chronic..... 329

Thyro-parathyroidectomy (mono)
influence on body weight in
animals

pig
Thyro-ovarian insufficiency with

CatvamMenial ANSINA. . 6. ce. as s 670

Thyrotoxicosis, treated by X-ray.331
Thyrotoxic goitre, surgical treat-

ment, bilateral resection..... 499
Thyrotoxin, effect on metabolism. 487
== SOU AGIOMMOheteeere cre. oleceos eee ss Leal
— power of in accelerating me-

PAO OUEST ere. ei ote esas 8 Ss bs 487
SREY O GOMES owes crc ol ewer dicls oe 3 703
Tilling: Tetany and epilepsy... .504

Timme, Walter: Dyspituitarism,
with limitation of visual fields.
Internal glandular therapy...137

— Indications for internal gland

(ElEcS TH Oe Gtoec po unieNeaC Ra ae eee 285

— Progressive muscular dystro-

phy an endocrine disease. ..116

— Treatment of some endocrin-

DIL CUGS 5 46's occ eee 12
Timme’s new pluriglandular com-
pensatory syndrome......... 196
Tissue analysis, a method of....13
— extracts, action on blood coa-
PA ROTER pales Kets ceo e rans, 0.001 0.6
— — effect on smooth muscle... .260
—transformation of.......... 138
Todd, A. T.: Hyperthyroidism in
IMINO UZ Aare toke 5 21% o, chalets’ se. an <. « 182
Todde, C.: Case of general alo-
pecia of emotional origin..... 622
Toepfter, H.: Adrenal bleeding
hale like hye [ECO 0-5 ¢ St nCR ane e 439
Togawa, T.: Metabolic changes
in experimental tetany....... 680

Tokumitsu, Y.: Changes in endo-
crine organs after occlusion of

DAUGNEAMEUGICE.) fs 6s 6s oes 643
Tolman, Mayo: Water supply
eee SOLUS as rate Ao Siete <i okey @ re 183

Tomaszewski, Z.: Influence or-
gan extracts on excretion of
PSUR MICO cers, o.m or ova sc ieee 3 1 Lan |

— Relation human parathyroid

glands to calcium deposi-
tion

Tompkins, Edna H. (Sturgies and
Wearn): Effect of epinephrin. 112

Torquay, L. M. (Masterman-

Wood): Ductless gland ther-

LED VAR AT AUETTIN. GN Sb .ts fille loesneel a ho! S 472
Toxicosis of pregnancy treated

with ovarian material........ 668

Toxic, non-exophthalmic goitre. .167

Tracy, Edward A.: Fright as a
Cause Of Spilepsy.. i+... des 22k

Transplantation in treatment of
myxoedema

Transplantation of a ductless
readlewa\O lig clcit: chock ct Gg Oacney ci cic eee
—-— parathyroids ........... 306
—— —— SOX STAMOS sealers s cis ss ss 266
= OVATIANG Vatstas ede clout eons sues 476
—— parathyroid seen oe. ss 478
—“testicular inviman..-..2..-.. 318

Trautmann, A.: Hypophysis and
thyroldectomiya oun. o cesses ce
bi czhbboskenoe, (hey oyeyHess on G6 Gosbro oon e 1 Laliss
Tretiakoff, ©. (Marie): Hypo-
physis in encephalitis lethar-
PI CBW tee ereted Meds iedssxenaen See ues 655
Tricoire, R.: Death by acute
dilation of heart in man with
enlareed thymus. 2. see 159
“Tricographism,’’ goose-flesh....315
SeLTiGhOLOMIA, ciscpeicie sine cern es 316
Trillat, P.: Case of ptyalism dur-
ing pregnancy treated with ad-
TEM" fete ispeleue.< oAekers scdegebenen dishees 444
Trinci, G.: Chromaffine system
Of SAurianse sins sce Seis cee 241

Troell, A.: Basedow’s disease. .504
Trypanosomiasis as cause of en-
GCemich eGitre”. 2. seis seu eemees 691
Tseke, C. (Beumer): Creatin and
creatinin metabolism in myxoe-
dema and effect thyroidin on it.486
Tubercular origin of Addison’s

GiSCASCF ela fs bea ee is Siete 103
Tuberculosis, adrenals in....... Zp
—adrenochrom treatment of...610
—and ovarian functioning..... 288
— Basedow symptoms in diag-

nosis and treatment of....330

— destruction of adrenal glands.104
— endocrine glands and fever of .119

— following diabetes mellitus. ..144
=n ALS Fey ee eee ele Oe 434
— —lungs, Sergent’s white line

INE WOICASCS.. «a sess ee 436
—patients and goitre removal. .338
——— LDA ON eee Te ao pircltcieien ols orcs eu reuse 473
—— — CASO) OL rere ote one's ore wee e lei 497
—— Witt ‘SCLETOMCLMGs i. + cee dele 312

Tuberculin in treatment of goitre.691

Tugane, S. H.: Action adrenin
and various extracts of glandu-
larvoreans, OM Velns... 6.52.) 439

Tumor of adrenal cortex with vir-

NUTS Ts Mets Se, oes rclvontc| oc ge wee el’s 614
——adrenals in man......... 96
—of mice, influence of internal

NECTEULONA -OU. + «ces. s ar © caeee 660
——— third ventricle........... 126

Uchihara, K.: Action tissue ex-
tracts on coagulation of blood.506
Udaeta: Adrenalin in obstetrics. 444
Ulcers, gastric and duodenal, thy-
roid etiology and treatment of.704
Umber: Coma diabeticum during
pregnancy

Umber, J.: Diabetes during
TIO SMU Vie ete sw «Shel o, , croemele 637

Undernourishment and disease of
LIAS [NOISE SesseLeEeECoEIS oraro o oc 286

Uremia, thyroid-parathyroid ap-
HAMELVUIS MAT) . 2. < cisy-ishaememepeacrenerns 178

Urinary output of nitrogen, chlo-
rine, calcium and magnesium

in’ diabetes mellitus. =... ..-. 301
Urine, significance of sugar in...257
Urological” problemsie ects ons 285

Uterine contractions and ovarian
OXtraCt arate cic cater co tae east 286

— fibroid, pernicious vomiting as-
SOCIALECS Wit Mere = shares ees 287

— hemorrhage, endocrine origin
OY beh ae AUR a is Cop atu ch eae Sian 415

— -—relation to internal secre-
GION. OLS kee is ele tore 140

Uterus, absence of in woman....141
—contractions of, modified by
Castratione ee. tio caer aoe 665
—effect of histamine and pitui-
tary extract ON ce. bcs omelets 268
VO PLASiaa Ol. cue sacieiemete eeitchedls 414
— myometrial cells of, endocrine
elandsee <2. eae 1 oe eee
—tonic and clonic contractions
OLies Seis Biewstee Ree ee artes, 2) one 665
Ukita, T.: Influence of thyroid-
ectomy during pregnancy..... (akal

Vagotonia, acute and chronic....71
—and sympathicotonia.. .,.183, 23
— w— ulcers of stomach, possible
relation between....... 184
——in adigestive disorders... ......070
— AS VIM P ae MuCOLOMMA eter coche eels (als:
Vagotony, treatment of........ hale
Vagus afferent impulses, relation
OLA TO! ESCA: oH. i cane restate ters onenens 680
van Valkenburg, C. T.:
AGIPOSO=LeEMItAliS “Ft ya). cicweuen- 468
Vasconcellos, F.: Cruz
CharaswediSGase: files ics cecketagels 691
Vasyutochkin, A. M.: Thymus
gland in infants. Normal and
pathological anatomy of thy-
TIN Stee Wate weRen elec suey sustcy cuarene he acaees aio
Vecki, Victor G.: Urological prob-
UGTNISH, Seats banter Schoepeheremorekencac coke 285
Veil: Relations experimental
polyuria and diabetes insipidus.469
Venegas, F.: Study of adrenal

SYNGVOME.) oe cous ep nseerusaen ees 439
Vercellini, G.: Qualitative varia-

tIONSOL thyTOiude ee eeeee one 88
Vermeulen, H. A.: Parathyroid

Plandses..\o sot e eit eh okeae 150

Verrotti, G.: Psoriasis with amen-

orrhea cured with ovarian

therapyines ses Dace ee ise 671
Vilaseca, S. (Domingo): Histo-

genesis of the gonads........ 646

Vincent, Swale (Arnason): Thy-

roid and parathyroids........ 199
— (Hollenberg): Effects of
inanition upon the adre-

nal, bodies’. ss: 22+ eee 408
Viscera, functional disorders of,

treatment? 2. Sic cro thee 254
Visceroptosis, endocrine factors

in etiology and treatment of..712
Virilism with tumor of adrenal

COTTCR) ack waite eRe ee eee 614
Vision, disorders of, treated by
radiation of hypophysis...... 658
Visual fields, limitation of and
Orzanotherapy =. ae eee iba) 1
Vogel: Adrenalin treatment of
lung “diseases i.e Ce ee 22
Volhard: Menstruatio precox...310
Vomiting of pregnancy, adrenin
treatments sOf< a c-seres tes ore ee 621
Voncken, S.: Testicle implanta-
PLO 22 ne conc ieee O Ree 318

Von Reklinghausen’s disease... .232

Wagner, G. A.: Adrenalin treat-
ment of osteomalacia of preg-

Nancy: os ass tee oo ee eee eae
—Adrenin treatment of influ-
@NnZa- «oS ad sk Seo eee 247
— Hermaphroditismus’ ©: ...--- 460
— Treatment of gestation osteo-
malacia with adrenin..... 444
— Treatment of influenza with
adrenin:.\.).: sho cue ee 444
Waldorf, C. P. (Castex): Clinical
study of Paget’s disease...... 261

——Geroderma_ genito-dys-
trophico (lean type) with
delayed hereditary lues.318

— — Hereditary syphilis in en-
docrinopathies ........ 644

Walker, R. C. (McCord): Sim-

ple goitre a public health prob-

len Se SB ho 5, Aches 499
War-and diabetes cs. 2 stare 290
——— diabetes) *duniniey-ss- toe en ee 300
—neurosis, status lymphaticus

DM sc) as cvstauren sueeor hese See ee Bales
— pathology, adrenal insuffi-
Clenecy: ine snta4\ 2-aen eee 609

——and, adrenals. -vi-s acca 613
Warren, J.: Pineal region in

naman em DryOs--teie sie eee altsjal
Water-supply, relation between

eoitre) and. -aaeet cielo coe eee 183

Water transmission of goitre....491
Watrin, J.: Suprarenals of preg-

nant. rabbits cscs aero 242
Watson, Alex.: Seasonal changes
IN StESECS oy F50hinw ier ay « poeta 154

Watson, A. (Burns): Action of
guanidin on heart of frog.695-696
— + Adrenin and guanidin..-..619

van Waveren, A. G. W.: Abdom-
inal complaints cured by ad-
RST 5 6 SS Seo enero 444
Wearn, J. T. (Sturgis): Epineph-
rin and_ =soldiers’ “irritable
INERT ae 2 oes Sea ee ee imita}
— (Tompkins and Sturgies): Ef-
fect, oF epinephrin .......- . 2
Weber, A.:

Weber, F. P. (Gunewardene):
Lipodystrophia progressiva...13
—— Sequel of case of lipodys-
trophia progressiva....471
Webster, A. B.: Hyperthyroid-
sri “4s cle. AS ane eee ee annem 648
Webster, J. H. D.: Roentgen
treatment of case of early acro-
HNGEGIINT | Eo ehiped Cle eee 283
Wegelin, C. (Langhans): Goitre
MITMRWEPIEGCRRAC ! «ccc sec cc ie wie
Weiland, W.: Diabetes with

Sumereall Giseases’ .......-2.. Thali)
Weill, Paul: Myometrial endo-

erine sland in uterus. .......285
Welz, W. E.: Corpus luteum in

DESIG 6 SNS Sateen ab ss

Wernicke, R.: ‘Hydro-telluric”’
theory of Bircher and its appli-
cation to regions of endemic

goitre in Argentine..........345
Wertheim Salomonson, J. K. A.:
Mdidisones. dISEASEG...2..6.... 242

Wesselink, D. G.: Ovary and
symptoms of reduced functions.67 2
Westman, Ax.: Origin of cor-

Teves IPAS SS Ree eee a te 446
Whale, H. R.: Pituitary tumor

Pheahean by, Operation... «2... Siz
“White line of Sergent’? in case

of Addison’s disease......... 99

Whyte, G. Duncan: Dystrophia
adiposo-genitalis, report of a
(CANIS: so Sg eee 469

Wiesenthal: Pubertas praecox..6S81
Williams, J. R.: Syphilis as a
cause of diabetes mellitus... .304
— Treatment of diabetes melli-
TS. 33-6 Eee anes eee eee ene 305
Williams, T. A.: Lesions of ner-
WINES SUE TIN osc os se ee we ee ews 262
— Dietetic treatment of diabetes
TMI Me. sive ore = 2 2 OOD
Williamson, R. T.: Diabetes mel-
HIS) GONG Pap CSR One 150

— Life assurance and glycosuria. 676
Wilson, L. B.: Further study of
histopathology of autonomic
nervous system in goitre.....346
— Goitre considered from stand-
point of pathologist.......345
— Histopathology of autonomic
RYVSGeIM IM SOlTe...-%..2-.04D
Wilson, W.: Interpretation of
headache

sy ©
, f
de Winiwarter, H.: Mitoses of Uf
seminel epithelium in cat.....519_.
Winkler (Caro): Hemorrhagic
pancreatic necrosis and dia-

DetesewillMeacrdOSIsir... - -).2 =. 476
Winternitz, M. C. (Boggs): Acute

suppurative hypophysitis.....270
Wintz, H. (Seitz): Corpus lu-

teum and menstruation......250
—— —— Menses - increasing sub-
stance from corpus lu-

iS NONE Ahi eho plosct op ‘4 orc 250
Wirseen, J.: Case of - spas-

mophilic) diathesis: 7-2) -iseen- 481

Wishart, M. B. (Allen): Carbo-
hydrate metabolism and dia-
betes: glucose tolerance of
GOES ee ae ees eee cries 626

—— Experiments on diabetes;

renal sugar threshold. . .626

Wodak: Larynx and trachea in
benien fOltre seem eee Oo

Wolf, G. D.: Mentally deficient
child with protracted elevation

of: temperature... ..2 0. oa." sD
Woltman, H. W.: Tetany in eu-

nuchoid, report of case....... 308
79232 Endo Index — Forty-two

Wood, F. C.: Thyroid and para-
thyroid tumors of the tongue.506
Woodbury, M. S.: Comparison
of methods for determining

EhiyTOtOXICOSIS! a5 -foue sirens (12
— Psychoneurotiec syndrome of
hyperthyroidism, =... -..5- 183
Woodyatt, R. T.: Treatment of
mild case of diabetes........637
Wooley, P. G.: The thymus, a
SUUMIRIVET YA", - fsbet ore, os MEADE Occ a Beas
Worcester, G. F.: Dietetic treat-
Ment OLMGlabeLeS):,. « . tee cieeens 305
Wynhausen, O. J. (Elzas): Dia-
DELeSHAIMNMOCENSH, =... cersteh sts ee 452
X-ray, action on adrenin....... 442

application of, to endocrine or-
gans as means of stimulat-

itaex. as ee lonee So) OU CD OLD ad
—examination case of acro-

MINOR cena ene cos) terol: crete: cue ou
—exposures to ovaries and ster-

TURIASIEOAL) om B chokele eeaRatAnD Bip mo OCS

— observation of pituitary region.465
—therapy in exophthalmic goi-

Une? ACILOCL Olen <<. roneke cesta 336

— treatment in reduction of
Ovarian Activity. c..o -cr 505
——=——$@f acromegaly ..:. 4... .%. 283
——_ ——_ —_ dysmenorrhea ........ 456
—- = ——Snlarroed LyIMUus: - eee 483
Ss ——— ——— —— THY TOUN Se ec reer 503
— — —exophthalmic goitre....456
WILGET: Foes eee 342
= ——— TOUT OC. ous ci coy ee ence ae
——_ — — 'Grav6s’ disease ....... 498

Lie

X-ray treatment of hypophyseal

[Tao eS ae 27.45
— —-— pituitary enlargement..
— ——— headache .........
———Thymus hypertrophy a.
———————hyrocoxiCOSiS <j. si) au-pedre
= hy Perth yTOlGUSIis | pe ens
— —— pituitary tumor.....-.

—=— —— tumors of by pophiysis-,.
visual disorders of hypo-

physeal origin......

Ygea Rodriguez, F.: Ovarian
perturbations and _ digestive
GISORMESTS eres ee ae ene bee wrk

Zak, H.:
liva after injection of sodium
iodide

462
505
505

.483

331
704
275
136

Secretion iodine in sa-

va

we a aw aaa »
& = een
Zeleneft, I.: Basedowism
syphilitic family
Zibordi, F.: Histological exami-
nation of parathyroid in case

in a

Ot GOTCHA. ae ese ee 309
Zimmerman, Chas.: Ear affec-

tion and “diabetes. «=. sien en 306
Zondek, A. (Maase): Dystro-

Divial MEV OUOMICAp ee lelcenee meen 453

Zondek, B.: Action of hypophy-

seal extract on peristalsis..... 658

— Prophylaxis of paralysis of in-
_ testines
Zunz, K.: Iodine content of hu-
man thyroid glands

— (Dustin): Thymus and thy-
TOU: o5-4 wk Be ee ee 158

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