teen Pat ro eaeewese te Sacdim pepe en ged enna an err Son are eS = —— ~ Ontario Count of my | we ENDOCRINOLOGY The BULLETIN of the ASSOCIATION for the STUDY of INTERNAL SECRETIONS Volume Five Published by the Association 1921 TABLE OF CONTENTS * ADENOMA OF THE THYROID WITH HYPERTHYROIDISM (THYROTOXIC ADENOMA). HISTORY OF THE RECOGNITION OF THIS DISEASE AS A CLINICAL ENTITY. A STUDY OF THE SYMPTOMATOLOGY WITH BASAL METABOLIC RATES. Walter M. Boothby, Roches- ter, Minnesota sci. 's aisles. tie vlc wis be seio cnsiaebe sede seek A CASE OF DYSTROPHIA ADIPOSOGENITALIS. Franklin G. Ebaugh and R. G. Hoskins, Baltimore........ shenatetstekegehepensters var ctoveee te DETERMINATION OF RELATIVE ACTIVITY OF THE THYROID LOBES. IN: Worth Brown. Loledo stance ccc tener Eee oreraicle THE HYPOPHYSIS CEREBRI OF THE “i aanetaviens (MARMOTA Won aan WITH SPECIAL REFERENCE TO HIBERNATION AND INANITION. A. T. Rasmussen, Minneapolis............... : THE CONTROLLING FACTORS IN Sereeraries Maiarencene A REvIEW. John F. Fulton, Jr., Cambridge, Mass............ BOOK REVIEWS a4ccccu cin cases Sieveystohe testa eee ABSTRAGE DEPARTMENT iio: 6 S552 oes eae emake DIABETES INSIPIDUS AS A HYPOPITUITARY SYNDROME. G. Marafion, Madrid. esa eae 5 pera HyYPoPHysIs TUMOURS IN Nee oS, H. A. Vermeulen, Utrecht ios. 2 Od. ine ere ee Se Lo eee ees PHYSIOLOGICAL HYPERTHYROIDISM. Harlow Brooks, New York. DEGENERATIVE CHANGES IN THE SEMINAL EPITHELIUM AND Asso- CIATED HYPERPLASIA OF THE INTERSTITIAL TISSUE IN THE MAMMALIAN Testis. Albert Kuntz, St. Louis.............. THE SPECIAL SERVICE RENDERED TO THE HUMAN ORGANISM BY THE SYMPATHETIC AND PARASYMPATHETIC SYSTEM, INCLUDING BoTtH NERVES AND GLANDS OF INTERNAL SECRETION. Vals Ws Pottenger, Monrovia, California.................. Steet F CHANGES IN THE ENDOCRINE GLANDS OF A TUMOR- sreowe ie MALE Rat. Frederick S. Hammett, Philadelphia........... FURTHER OBSERVATIONS OF THE PIGMENT CHANGES FOLLOWING REMOVAL OF THE EPITHELIAL HyPOPHYSIS AND THE PINEAL GLAND OF THE FROG TADPOLE. Wayne J. Atwell, Buffalo... BOORAREVIOWS isicass hos eeb ase. Ee. INSUFFICIENCY. G. N. Stewart, Cleveland...... THE Microscopic APPEARANCE OF Two TESTES NINE MONTHS ho LOWING UNILATERAL VASECTOMY. Homer Wheelon, St. Louis THE INTERNAL SECRETION OF SANDSTROEM’S GLANDS. PARATHY- ROID HYPOFUNCTION AND ECLAMPSIA. mids Cc. i aed Chicago HYPOPITUITARISM — FROEHLICH TYPE. IN AN INFANT ae MONTHS OLD. M. Boyd Kay, Detroit.......... EDITORIAL: THE ADRENALS AND THE EMOTIONS.... 21 THE ACTION OF HYPOPHYSEAL EXTRACTS......... . «beets Bao TEHITE ingen! coododdadopoocooUoUd 000 CUdoDUDO OOOO CO COnUUOoId ABSTRACT DEPARTMENT .....-.----eeececcr tcc te esse eeeteeeces THE PARATHYROID GLANDS. A REVIEW OF THE LITERATURE. Wal- ter M. Boothby, Rochester, Minn...........---- estaeyernerel otans EPILEPSY SUGGESTIVE OF ENDOCRINE RELATIONSHIP. Henry J. Van den Berg, Grand Rapids, Mich......... Sabatier oe rao DOES THE ADMINISTRATION OF THE ANTERIOR LOBE OF THE Hypo- PHYSIS TO THE TADPOLE PRODUCE AN EFFECT SIMILAR TO THAT OBTAINED FROM THYROID FEEDING? Philip E. Smith and Garnet Cheney, Berkeley...........--++-- RNa oes torts THE INTERNAL SECRETION OF THE SPLEEN. Nathan B. Eddy, Hidmonton, Canada .........0sceeceee cere eee tete rc tecee EDITORIAL: ENDEMIC GoITER: ITS PREVENTION AND TREATMENT.......-- Book REVIEWS ....-.--++---- SO AO Oboe OO DUDE OOD MORO C.O10 OSLO ABSTRACT DEPARTMENT .....- Mevererstete Berraes bare aiaeetavere lars) sxele ie onsuoleroteners THE SIGNIFICANCE OF THE INTERNAL SECRETIONS IN DISTURBANCES oF METABOLISM AND DIGESTION. Prof. Dr. Arthur Biedl, Prag ENDOCRINE PROBLEMS IN PELVIC SURGERY WITH SPECIAL REFER- ENCE TO VICARIOUS MENSTRUATION. Curtice Rosser, Dallas. . THe New VIEWS AS TO THE MoRPHOLOGY OF THE THYMUS GLAND AND THEIR BEARING ON THE PROBLEMS OF THE FUNCTION OF THE THyMus. J. Aug. Hammar, Upsala, Sweden.........- A CLINICAL StuDY OF UNUSUAL DISTURBANCES OF THE ENDOCRINE GLANDS. Oliver T. Osborne, New Haven........-+++-++++++ Report OF A CASE OF HyPOPHYSEAL TUMOR, WITH RADIOGRAPH. Mary Lawson Neff, Phoenix, Ariz......+-+-++++++++> rere THE HEART IN THE EXPERIMENTAL HYPERTHYROIDISM WITH SPE- CIAL REFERENCE To Its Histotocy. Hirotoshi Hashimoto, INJSIO) gaocvsucdasndoadoo0000 condondoooncaAGobAcuaoCnnoE CHANGES IN THE BLOOD PRESSURE IN A CASE OF HYPERVAGOTONIA CAUSED BY THE INTRAVENOUS INJECTION OF ADRENALIN. de J. Izquierdo, Mexico City.......-.-+---+ss+essseeeee aysteee EDITORIAL: Wuat Is ENDOCRINOLOGY?....-..--+eee eee e tere teeter tees IAN IRMA) sac oacaue poUbo od 50000 DOD OO ODT CONDO ICO UdCC ABSTRACT DEPARTMENT .....----eeseeeeeescesseerrte Med otera Stelle CLINICAL REPORT OF A CASE OF GRAVES’ DISEASE WITH RapPip IM- PROVEMENT FOLLOWING THE ORAL ADMINISTRATION OF FRESH Ox SUPRARENAL GLAND. S. Shapiro and David Marine, New Vand’ gnoonpaonooooDOdacudonnoOodono mya sieve Aa “OODC siaietors TESTICULAR SUBSTANCE IMPLANTATION. L. L. Stanley, San Quen- inh, Colby SondoooopbaGoueDO A e(osiieiaicheiaretel Bie restos aye reKers reais THE IMPORTANCE OF VISUALIZING ESTABLISHED SCIENTIFIC DATA WITH REFERENCE TO THE SIZE OF THE Bopy CELLS AND THEIR CHEMICAL SUPPLIES IN THE CIRCULATING BLOOD. Georgine Luden, Rochester, Minn.........-.-.++++++++- teeters Sn eue Somr NovEL EFFECTS PRODUCED BY STIMULATING THE NERVES OF ae Liver. W. B. Cannon, J. E. Uridil and F. R. Griffith, OSLO mateverere) -vorelevelayarelerere:s\0\ eereiafarere waters THE NEw VIEWS AS TO THE MORPHOLOGY OF THE THYMUS GLAND AND THEIR BEARING ON THE PROBLEM OF THE FUNCTION OF THE THYMUS. (Concluded.) J. Aug. Hammar, Upsala, Sweden! scree sceierciecisi-i~ xota sere Brae 699 708 EXPERIMENTAL DIABETES INSIPIDUS AND GENITAL Annopay. “Perei- } val Bailey and Fritz Bremer, Boston....... mists sie Meise as oa: OL: EXTIRPATION AND TRANSPLANTATION OF THE THYMI IN LARVAE _ oF RANA SyLyaticaA. Margaret Morris Hoskins, Richmond. 763 ENDOCRINE THERAPY IN CASES OF Low BLoop PRESSURE. George H. Hoxie; ‘Kansas‘City jt. mses pees RE ee coe ercke 773 ROOK VREVIEWS) 02 ves cps seen a \oleinta eericin afeinie cae ies eaten re ; eiepstay th ilome ABSTRACT DEPARTMENT ...... We aes. cen a iS he te . 779 INDEX FOR VOLUME V | Endocrinology The Bulletin of the Association for the Study of Internal Secretions January, 1921 ADENOMA OF THE THYROID WITH HYPERTHYROID- ISM (THYROTOXIC ADENOMA). HISTORY OF THE RECOGNITION OF THIS DISEASE AS A CLINI- CAL ENTITY. A STUDY OF THE SYMPTOM- ATOLOGY WITH BASAL METABOLIC RATES.* WALTER M. BOOTHBY The Mayo Foundation ROCHESTER, MINNESOTA Recent advances in the practical application of indirect calorimetry have rendered it possible for the physician to meas- ure accurately and fairly readily under standard conditions one of the most fundamental phenomena of life, namely, the rate at which the life process of combustion is proceeding within the body. Calorimetry, like the taking of the temperature, is a meas- urement of certain heat phenomena. Just as the thermometer has furnished the means of distinguishing accurately and readily two ereat classes of diseases, the febrile and the afebrile, indirect cal- orimetry similarly allows precise differentiation of three large eroups of diseases: (1) diseases characterized by a normal rate of metabolism; (2) diseases characterized by an increased rate of metabolism, and (3) diseases characterized by a decreased rate of metabolism. Furthermore, just as there are various diseases with abnormal temperatures, there are several diseases that have per se abnormal basal metabolic rates. So far the most clearly *Presented before the Harvard Medical Society, Boston, February 17, 1920. . 2 ADENOMA OF THYROID defined groups of cases with abnormal basal metabolic rates are those due to disturbances in the functional activity of the thy- roid gland. In this paper I shall diseuss the condition of hyper- thyrvidism due to adenoma of the thyroid gland which is en- tirely distinct from the hyperthyroidism of exophthalmie goiter. The confusion in recognition and classification of diseases with hyperthyroldism, usually considered under the group name of exophthalmie goiter, (Parry’s, Graves’, or Basedow’s disease), is due to the fact that there are at ieast two separate and distinet clinical entities, as yet generally unrecognized, classified under this one term: the one, true exophthalmie goiter and the other, adenoma of the thyroid with hyperthyroidism. For this reason, the pathologist has been unable to find a consistent histologic picture in all the cases diagnosed exophthalmie goiter by the clinician. HISTORY OF THE RECOGNITION OF ADENOMA OF THE THYROID WITH HYPERTHYROIDISM AS A CLINICAL ENTITY Mobius in 1887 suggested that Basedow’s disease is due to an abnormally inereased activity of the thyroid gland. Greenfield (1893) was the first to demonstrate a specific pathologie altera- tion in the thyroid gland as the cause of exophthalmie goiter; he showed that in exophthalmic goiter there is a characteristic in- crease in the parenchyma with simultaneous enlargement of the individual cells from a cuboidal to a columnar shape and a decrease in the size of the acini and a reduction in the colloid content. Ilis studies were limited to six typical eases of exoph- thalmic goiter. Other observers found that frequently hyper- trophy was present in insignificant amounts only or was en- tirely absent in some of the cases clinically diagnosed exophthal- mic goiter. MaeCallum (1905) and Kocher (1912) considered, however, that very small areas of hypertrophy, sometimes only a few cells in seattered acini, fulfill the requirements for the path- ologie confirmation of the clinical diagnosis of exophthalmic goiter. The absence of hypertrophy in eases clinically diagnosed exophthalmie goiter was explained by the fact that the case was either atypical or of short duration. Lewis (1906) stated, how- ever, that the secondary exophthalmice goiter of some years’ stunding does not differ histologically from the simple colloid or parenchymatous goiter unassociated with Basedow’s syn- BOOTHBY 3 drome. Wilson, in his report of 1908, recorded an apparent dis- agreement between the pathologic findings and the clinical diae- nosis as then made in 20 per cent of the cases. Clinically it was early recognized that under the generic name of Basedow’s disease were atypical cases which were sub- divided by various authors into more or less ill defined, inconsist- ent groups and designated as primary and secondary (Gauthier and Buschan), formes frustes, or incomplete (Marie), goiter heart (Kraus, Gitterman and Stern), sympathicotonic and vago- tonic (Eppinger and Hess), Basedowoid (Stern), Basedowized (Kocher). Of these the syndrome deseribed by Gitterman most closely resembles that designated here as adenoma of the thyroid with hyperthyroidism. Although Gitterman recognized the char- acteristic age of occurrence in these cases and the association of a goiter of long duration, he considered the syndrome essentially from the viewpoint of cardiac therapy. Plummer has come to the conclusion from an intensive study of the clinical findings in the large number of cases of different types of goiter examined at the Mayo Clinie, that there are two separate and distinct clinical types of hyperthyroidism, each associated with a distinctive pathologie change in the thyroid gland; that in one type the hyperthyroidism associated with the clinical syndrome of true exophthalmie goiter is always accom- panied by hypertrophy and hyperplasia of the thyroid gland: and that in the other type the hyperthyroidism, pathologically not associated with this typical hypertrophy and hyperplasia, but with the occurrence of adenoma in the gland, is due to the adenoma and that the resulting clinical syndrome is distinguish- able from that occurring in true exophthalmic goiter. These conclusions were reported by Plummer :: 1911 before the Ameri- can Medical Association, but they mrst appeared in literature in his discussion of Marine’s paper in 1912, as follows: “Dy, Marine has done excellent work on the thyroid. My observa- tions, however, do not confirm his conclusions that the anatomic changes in the thyroid in cases of exophthalmic goitre are neither con- stant nor specific. We have known for several years that hyperplasia of the thyroid is present in most cases with a well developed clinical complex of Graves’ disease; that marked hyperplasia is seldom noted in the thyroid except in patients having Graves’ disease, and that exophthalmos is but rarely associated with any type of goitre except the hyperplastic. In each year of our series, in fact, in all reported series, there have been sufficient exceptions to the above rules to cause doubt in definitely associating the toxic symptoms, exophthalmos and hyperplasia of the thyroid. In going over my statistics for the last 4 ADENOMA OF THYROID five consecutive years I find that exceptions to the above rules have gradually diminished. This has come about from a clearer conception of the clinical pictures that may accompany hyperplasia and “simple goitre” (adenoma and diffuse colloid). “The statistics of operation at the Mayo Clinic seem to warrant these conclusions: (1) that hyperplasia of the thyroid never exists without a production of thyroid secretion in excess of the demands of the individual; (2) that exophthalmic goitre is a clinical entity asso- ciated with a definite pathologie process in the thyroid; (3) that, if hyperplasia of the thyroid is of a sufficient degree or extends over a long enough period, exophthalmos is almost sure to develop; (4) that no matter how intense the intoxication from an adenomatous or colloid goitre not associated with hyperplasia, exophthalmos will not develop. Patients having simple goitre noticed the goitre at the average of 22.8 years, the evidence of intoxication at 36.6 years and came to operation at 39.6 years. That a patient 23 years of age having an adenoma has a definite fixed chance of developing thyrotoxicosis during her thirty- seventh year and that the symptoms may so closely resemble the clin- ical complex of Graves’ disease that the two cannot be distinguished is one of the strongest arguments in favor of the latter disease being directly due to a disturbance of the function of the thyroid.” In 1913 Wilson showed that in cases of exophthalmie goiter as defined and diagnosed by Plummer the thyroid always shows histologically typical parenchymatous hypertrophy and hyper- plasia. Wilson, as well as other observers, has been unable, as yet, to find any consistent pathologic differentiation of adenomas that produce symptoms of hyperthyroidism and those that do not produce symptoms of hyperthyroidism. Goetsch in 1916 emphasized the importance of the relative number of mitochondria in thyroid adenoma and stated the belief that they were more numerous in those adenomas causing symp- toms of hyperthyroidism and that thereby a means was afforded of distinguishing pathologically between adenomas that produce hyperthyroidism and those that do not produce hyperthyroidism ; this differential feature apparently is not confirmed by the data reported in his later papers. Goetsch (1916) is also of the opinion that there is a very different form of intoxication in thyroid ade- noma from that found in true Basedow’s disease and is in this respect in agreement with the position maintained and repeat- edly emphasized by Plummer since 1911. In addition to the two distinct clinical entities of adenoma of the thyroid with hyperthyroidism and exophthalmic goiter Plummer recognizes a small intermediate group. At operation thé thyroid in these eases is found, on pathologie examination, to have beside the adenoma more or less typical areas of hypertro- phy and hyperplasia of the parenchyma, varying between very BOOTHBY Or small intra-adenomatous or extra-adenomatous areas to a small adenoma embedded in a typical hypertrophic parenchymatous thyroid. A discussion of this group is reserved for a subsequent paper. In the differential diagnosis of adenoma with hyperthyroid- ism and exophthalmie goiter it is obviously necessary to exclude definitely cases presenting the syndrome of neurasthenia, usually of the cardiae type, with many of the earmarks of hyperthyroid- ism, but in which no hyperthyroidism nor over-activity of the thyroid is actually present. The co-existence of an enlarged thy- roid, often not distinguishable from those producing hyperthy- roidism, renders the exclusion of many neurotic cases most diffi- cult, and in certain instances impossible unless the basal metabol- ie rate is known. Many of these patients with normal basal meta- bolic rates give a definite reaction to the epmephrin sensitiveness test, as pointed out by Goetsch and by Woodbury. In our opinion a normal basal metabolic rate eliminates hyperthyroidism. The determining points in the differentiation of exophthal- mie goiter and adenoma with hyperthyroidism were presented by Plummer in 1913. These principle points were: 1. The difference in the average ages of the patients when the goiter was first noticed. Enlargement of the thyroid was noted from five to ten years earlier in life by the patients with non-hyperplastie goiter than by the patients with hyperplastic (exophthalmic) goiter. 2. The time elapsing between the appearance of the goiter and the onset of the hyperthyroid symptoms. In exophthalmie goiter the symptoms of hyperthyroidism followed the onset of the goiter within nine-tenths of a year, while fourteen and one-half years elapsed before the thyrotoxie symptoms appeared in the eroup of non-hyperplastic adenomas with hyperthyroidism. 3. ‘The relative frequency of exophthalmos in exophthalnic eoiter contrasted with its almost complete absence in non-hyper- plastic adenomas with hyperthyroidism. Exophthalmos occurred in 87 per cent of the cases of true exophthalmie goiter with symp- toms lasting more than two years. It was less frequently present in the early stages of exophthalmiec goiter, averaging 50 per cent in cases of less than three months’ duration. In contrast, exoph- thalmos, even of questionable degree, was only rarely noted in eases of non-hyperplastie adenomas with hyperthyroidism. It 6 ADENOMA OF THYROID did not occur in any of the twenty-five cases of most intense intoxication in which operation was done in 1912. An immense mass of evidence of the differences in the aver- age blood pressures of the two syndromes has been collected by Plummer. Saye es a MA pean ce a = [i catalase 2 |b ee Uh es omens 5 Bs 3 hale Ba i OE Bolebee si) Ey] Bice ee Se) eee | $ $48] §& $ 28 Sou 25 ae | Bo) ee | ue eS ee a ee e|ePe | £ | eS) 2 he. cee | § | & g5 5.) .eicte's"|| soi Sete alae a\ae Ae = ce *The cases in this group of more than five years’ brackets because the duration of the goitre is confused is a greater difference between the average floor systolic blood pressure and the average resting systolic blood pressure both in adenoma with hyperthyroidism and in adenomas without hyper- thyroidism (13 mm., 14 mm., and 16mm.) than in exophthalmic goiter (7 mm., 8 mm., 8 mm., and 9 mm.), indicating the ten- deney to hypertensive contraction of the vascular tree. These facts led Plummer, in 1915, to state that adenoma of the thyroid both with and without symptoms of hyperthyroidism is fre- quently associated with vascular hypertension, causing a rela- tively contracted periphery, while in exophthalmic goiter, al- though the systolic pressures are high, there is no hypertension of the arterial tree but rather a relatively open periphery. Basal metabolic rate—A study of the basal metabolic rate brings out several very interesting facts, especially from the practical standpoint. Two distinct groups of adenomas of the thyroid have the same pathology, but one group is characterized BOOTHBY 13 TABLE 1. Exophthalmic Goiter Before and After Treatment GorreR Rest and Thyroidectomy One Ligation and Thyroidectomy Thyroidectomy 55 52 22 52 36.7 38 33 309 (1.0) 3.5 (1.1) 3.2 ( 1.4) 33.7 (35.7) 345 (36.9) 29.8 (31.6) 14 1.0) Le, (1.3) 1.3 ( 1.0) 35.3 (33.7) 36.3 (36.7) 31.7 (32.0) 148 142 75 73 Lo EE 66 466358 m2 109 90 49.2 53.9 MEAN 1S: ocr 2 pga ae 3) SEE isise : ae: So See 5 ae: BM ae ee: 2) ahs Selainnnie Ene 3 5: =! “n ee = Bea = me Bot = ies Ee eee eae ER care Bi) Cees te = mails = e& > p=} se p= a > = > 3 es aa S Beds 3 en BA 3 Be 2 aS a) 2 a = m : a8 s oS B fan Fs eB Sag Bolas Sis & Se g 5E = 2 see B ale = z os g 22 Bf 2 ss 3 8s Be 2 Se a = a a = a oe a Q B duration are omitted from the averages given in the by a pre-existing adenoma. by hyperthyroidism with an increased basal metabolic rate and the other group presents no definite evidence of hyperthyroidism and the basal metabolic rate is within normal limits. The clini- eal histories of these two groups show a gradation from the adenoma with hyperthyroidism into the adenoma without hyper- thyroidism both in the number and intensity of the symptoms that point to hyperthyroidism and in the lower basal metabolic rate. However, there is a change in the general character of the history and a distinct difference in the impression made by the patient on the examiner in the group of patients with adenomas and a basal metabolic rate above + 10 per cent and those with rates below + 10 per cent. Although in an individual case a reading of + 9 per cent or + 11 per cent or even between + 8 per cent and ~ 12 per cent does not absolutely determine the presence or absence of hyperthyroidism, if on a check reading the basal rate persistently remains above + 10 per cent fewer 14 ADENOMA OF THYROID clinical errors will be made if such readings are accepted as posi- tive of mild or beginning hyperthyroidism and those with rates below + 10 per cent as not indicating hyperthyroidism. Patients having sitmply neurasthenia, even those whose symptoms most closely simulate hyperthyroidism, do not have persistently ele- vated basal metabolic rates. On the other hand, occasionally a normal metabolic rate is found in a case of quiescent hyperthy- roidism either from exophthalmie goiter or adenoma that may be misleading unless attention is paid to the history of the disease carefully elicited from the patient. Such findings instead of de- creasing the value of the metabolic rate really increase its practi- eal value just as a normal or nearly normal temperature does in remittent or intermittent febrile diseases. On the other hand the number of these cases is very small and does not include the large group of neurasthenies who give a positive epinephrin re- action, but who have normal basal metabolic rates. We have found no evidence that this group of neurasthenics with normal basal metabolic rates, although they have some of the symptoms resembling those of mild hyperthyroidism, is dependent on varia- tions in the physiologic activity of the thyroid gland, as sug- gested by Goetsch. Technical errors of material magnitude in a properly con- ducted laboratory for routine work occur in less than 1 per cent of the cases. A moderate elevation of the metabolic rate some- times occurs from the fear of the patient in submitting to the test. This is of practical significance, however, only in the bor- derline cases and therefore a check rate on a subsequent day should be obtained in patients whose first rates are between + 10 per cent and + 20 per cent before a final conclusion is reached. An elevated temperature curve due to a cold, sore throat, incipi- ent tuberculosis or other cause raises the basal metabolic rate ; the temperature curve at the time of the test must be known, there- fore, because the febrile diseases as a group give an inereased metabolic rate. In adenoma with hyperthyroidism the curative effeet of par- tial thyroidectomy (frequently simple enucleation of the adeno- mateous mass) is very strikingly shown by the drop in the basal metabolie rate within two weeks after thyroidectomy : the average metabolie rate fell from + 35 per eent to + 7 per cent or well within normal limits. In 67 per cent of the cases tabulated it ee ett —— BOOTHBY 15 returned to normal within two weeks after operation; in 80 per eent it dropped to below + 15 per cent, in 92 per cent to below + 20 per cent, and in all the cases to below + 30 per cent. Plum- mer has frequently pointed out that thyroidectomy almost imme- diately cures the patient who has hyperthyroidism from adenoma and that recurrence does not follow unless a new adenoma or parenchymatous hypertrophy develops in the remaining gland. This is in contrast with the results obtained from thyroidectomy in exophthalmie goiter. Even in the mild cases of exophthalnic goiter with an average basal metabolic rate of + 36 per cent before operation which dropped to + 8 per cent after thyroid- eetomy only 45 per cent are within normal limits at the end of two weeks, although 76 per cent are below + 15 per cent. In a more severe type of exophthalmie goiter in which it was necessary to precede the thyroidectomy by a single ligation the average metabolic rate fell from -++ 52 per cent to + 15 per cent after operation; only 38 per cent of these were within normal limits and only 52 per cent below + 15 per cent. The improvement from a single ligation is shown in the average of twenty-two cases in which the average metabolic rate before treatment was + 57 per cent, and after the single ligation + 41 per cent; after thyroidectomy the average metabolic rate dropped to +16 per cent. The first of two groups of the most severe type of exophthalmie goiter in which two ligations were performed and, after from two to four months rest at home, thyroidectomy was done showed an average metabolic rate obtained before treat- ment of + 66 per cent; after the second ligation and just before the patient went home the average metabolic rate was + 50 per cent: on return after prolonged rest at home the average meta- bolic rate was + 42 per cent, and after thyroidectomy it dropped to +19 per cent. In the second group, similar to the first except that no metabolic rate was obtained directly after the second ligation and before the patient went home, the average metabolic rate before treatment was + 66 per cent; after the two ligations and approximately three months’ rest at home the average meta- bolic rate was + 42 per cent and finally, after thyroidectomy, the average metabolic rate was + 16 per cent. The basal meta- bolie rate in only 36 per cent of the patients with exophthalmic goiter who had two ligations, rest at home, and thyroidectomy 16 ADENOMA OF THYROID returned to within normal limits two weeks after thyroidectomy ; in 21 per cent it was still above + 30 per cent. The metabolic rates in exophthalmie goiter will not be dis- eussed in this paper, except to point out that after thyroidect- omy: (1) the degree of hyperthyroidism is materially de- ereased; (2) the improvement, especially in the more severe eases is not so rapid or complete as in adenoma with hyperthy- roidism; and (3) hyperthyroidism may still persist in certain eases and necessitate a second, and, rarely a third thyroidectomy. SUMMARY 1. According to Plummer’s classification there are two sep- arate and distinct types of hyperthyroidism, each due to a differ- ent pathologic change in the thyroid gland: in the one type, the hyperthyroidism associated with the clinical syndrome of true exophthalmic goiter is always accompanied by diffuse hyper- trophy and hyperplasia of the thyroid gland, in the other type the hyperthyroidism, not associated with this typical diffuse hypertrophy and hyperplasia, but with the occurrence of adeno- ma in the gland, is due to the adenoma, and the resulting clinical syndrome is distinguishable from that occurring in true exoph- thalmic goiter. 2. The syndrome associated with the hyperthyroidism from adenoma of the thyroid is considered by Plummer to be a distingt clinieal entity and may be defined as a disease associated with adenoma, characterized by an increased basal metabolic rate excited by an excess of the normal thyroid hormone in the tissues. About middle age the adenomatous tissue gradually begins to furnish an excessive amount of the apparently normal thyroid hormone (thyroxin) and this produces the increased metabolic rate and intoxication clinically evidenced by nervousness, tremor, tachycardia, loss in strength and weight, and a tendency to hy- pertension, and in the later stages myocardial disintegration. The underlying cause or stimulus that activates the thyroid to adenomatous growth and over-secretion is not known. 3. Detailed metabolic rate and blood pressure studies are reported in seventy-five cases of adenoma with hyperthyroidism in which the average basal metabolic rate before treatment was + 35 per cent and after operation + 7 per cent. Similar studies of 201 cases before treatment are also given in which the average BOOTHBY “7, basal metabolic rate was + 28 per cent. In contrast the average basal metabolic rate in 167 cases of adenoma without clinical evidence of hyperthyroidism was ~ 2 per cent; in eighteen of these cases the average basal metubolic rate before operation was — 4 per cent and it remained practically unchanged, — 8 per cent, as a result of thyroidectomy. 4. Three groups of exophthalmic goiter cases of varying degrees of severity were studied. Tn thirty-six patients with the severest type of the disease the average metabolic rate before treatment was + 66 per cent; these patients were subjected to rest in bed and two ligations at an interval of a week or more and within ten days after the second ligation the basal metabolie rate TABLE 2. Improvement Following Operative Treatment ExopaTHALMic GOITER Adenoma with B. M. R. Hyperthyroidism ~ after After After 1 Ligation After 2 Ligations, Thyroidectomy Thyroidectomy ‘ and Home and Thyroidectomy Thyroidectomy Percent Percent Percent Percent Percent Percent Percent Percent below above below above below above below above +10 67 33 45 55 38 62 36 64 +15 80 20 76 24 52 48 48 52 +20 92 8 91 9 67 33 59 41 +30 100 0 96 4 | 87 13 79 21 +40 100 0 94 6 87 13 +50 98 2 97 +60 100 0 100 0 was + 50 per cent. After three months’ rest at home these patients returned to the Clinie and were found to have an aver- age basal metabolic rate of + 42 per cent, with corresponding clinical improvement ; within two weeks after thyroidectomy the rate had dropped to + 19 per cent. Ina second group, fifty-two ~ moderately severe cases, the patients were subjected to a single li- gation and thyroidectomy one to two weeks later. The basal meta- bolie rate before treatment was + 52 per cent. after thyroidec- tomy + 15 per cent. In twenty-two the basal metabolic rate be- fore treatment was + 57 per cent and ten days after the prelimi- nary ligation was + 41 per cent ; within two weeks after thyroid- ectomy the basal metabolic rate in this group had fallen to + 16 per cent. In fifty-two patients with mild exophthalmic goiter on 18 ADENOMA OF THYROID whom a primary thyroidectomy was performed the average basa! metabolic rate before treatment was + 36 per cent and two weeks after operation + 8 per cent. 25 BIBLIOGRAPHY Basedow: Exophthalmus durch Hypertrophie des Zellgewebes in der Augenhoéhle. Wehnschr. f. d. ges. Heilk., 1840, 6, 197-220. Bensley, R. R.: The thyroid gland of the opossum. Anat. Rec. (Phila.), 1914, 13, 431-440. Boothby, W. M.: The clinical value of metabolic studies of thyroid cases, Boston M. & S. J., 1916, 175, 564-566. - The value of the basal metabolic rate in the treatment of diseases of the thyroid. Med. Clin. North Am. (Phila.), 1919, 3, 603-618. Boothby, W. M., & Sandiford, Irene: Basal metabolic rate determi- nations. ,Philadelphia, Saunders, 1920, p. 115 Buschan, G.: Ueber Diagnose und Theorie der Morbus Basedowili. Deutsch. med. Wehnschr. (Berl.), 1895, 21, 336-338. DuBois, E. F.: Metabolism in exophthalmie goitre. Arch. Int. Med. (Chicago), 1916, 27, 915-964. Eppinger, H., & Hess, L.: Vagotonia, a clinical study in vegetative neurology. Translation by W: M. Kraus and §, E. Jelliffe. J. Nerv. & Ment. Dis. (N. Y¥.), 1915, 42, 47-50. Gauthier, G.: Des goitres exophthalmiques secondaires ou symp- tomatiques. Lyon méd., 1893, 72, 41-48; 87-89; 120-127. Gittermann, W.: Struma und Herzkrankheiten. Berl. klin. Wehnschr., 1907, 44, 1487-1490. Goetsch, E.: Functional significance of mitochondria in toxic thy- roid adenomata. Johns Hopkins Hosp. Bull. (Balt.), 1916, 27, 129-1338. Studies on disorders of the thyroid gland: Hypersentitiveness test with especial reference to “diffuse adenomatosis” of the thyroid gland. Endocrinol. (Los Angeles), 1920, 4, 389-402. - Newer methods in the diagnosis of thyroid disorders; path- ological and clinical. N. Y. State J. M. (N. Y.), 1918, 18, 259-267. Graves, R. J.: Lectures. Lecture XII. M. & S. J. (Lond.), 1835, 7, Greenfield, W. S.: Some diseases of the thyroid gland. Lancet (Lond.), 1893, (i), 1493-1497; 1553-1555. Judd, BE. S.: Results of operations for adenoma with hyperthyroid- -ism and exophthalmic goitre. Ann. Surg. (Phila.), 1920, 72, 145-151. Kendall, E. C.: Isolation of the iodine compound which occurs in the thyroid. J. Biol. Chem. (Balt.), 1919, 39, 125-146. Kocher: The pathology of the thyroid gland. Brit. M. J. (Lond.), 1906, (4), 1261-1266. Kocher, A.: Ueber Morbus Basedowii. Mitt. a. d. Grenzgeb. 4d. Med. u. Chir. (Jena), 1902, 9, 1-304. Kocher, A.: The surgical treatment of exophthalmic goitre. J. Am. M. Ass, (Chicago), 1907, 49, 1240-1244. * —_: Diseases of the thyroid gland. Keen's surgery. Philadelphia, Saunders, 1908, (ill), 336-398. Die histologische und chemische Veriinderung der Schilddrtise bel Morbus Basedowli und ihre Beziehung zur Funktion der Driise. (Virchow’s) Arch, f. path. Anat, (Berl.), 1912, 213, 86-296. Kocher, T.: Ueber Kropf und Kropfbehandlung. Deutsch. med, Wehnschr. (Berl.), 1912, 38, 1313-1316. Kraus: Ueber Kropfherz. Berl. klin. Wehnschr., 1906, 43, 1412. Lewis, D.: The pathological anatomy_ of exophthalmie goitre. Sure. Gynec, & Obst. (Chicago), 1906, 3, 476-483. MacCallum, W. G.: The pathological anatomy of exophthalmic goitre. Johns Hopkins Hosp. Bull. (Balt.), 1905, 16, 287-288. MacCarty, W. C.: Pathologic anatomy of goitre (A macroscopic and microscopic study of fresh material from 2,500 cases). N. Y. State J. Med. (N. Y.), 1912, 12, 595-599. i Magnus-Levy: Ueber den respiratorischen Gaswechsel unter dem Einfluss der Thyroidea sowle unter verschiedenen pathologischen Zustiinden. terl. klin, Wehnschr., 1895, 32, 650. BOOTHBY 19 Marie. P.: Contribution a étude et au diagnostic des formes frustes de la maladie de Basedow. Thése de Paris, 1883. - Maladie de Basedow et goitre basedowifié. Rev. neurol. (Paris), 1897, 6, 91. Mayo, C. H.: A summing up of the goitre question. Surg. Gynec. & Obst. (Chicago), 1914, 18, 322-325. : Hyperthyroidism; primary and late results of operation. Surg., Gynee. & Obst. (Chicago), 1914, 19, 351-359. . : The principles of thyroid surgery. J. Am. M. Ass. (Chicago), 1918, 71, 710-712. ‘ - Adenoma with hyperthyroidism. Ann. Surg. (Phila.), 1920, 72, 135-140. Mébius, P. J.: Ueber das Wesen der Basedow’schen Krankheit Centralbl. f. Nervenheilk. (Leipzig), 1887, 10, 225-229. - Ueber die Basedow’sche Krankheit. Deutsch. Ztsehr. f. Ner- -venheilk. (Leipzig), 1891, 1, 400-444. Parry, C. H.: Enlargement of the thyroid gland in connection with enlargement or palpitation of the heart. Collections from the un- published medical writings. London, 1825, ii, 111. Plummer, H. S.: Discussion following paper by Marine: The anat- omie and physiologic effects of iodin on the thyroid gland of exophthalmic goitre. J. ‘Am. M. Ass. (Chicago), 1912, 59, 325-327. : The clinical and pathologic relationship of simple and exophthalmie goitre. Am. J. Med. Se. (Phila.), 1913, 146, 790-796. - The clinical and pathologic relationship of hyperplastic and non-hyperplastie goitre. J. Am. M. Ass. (Chicago), 1913, 61, 650-651 : Recognition and treatment of exophthalmie goitre (Discus: sion). J. Am. M. Ass. (Chicago), 1913, 61, 1484. - Studies in blood-pressure. I. Blood-pressure and thyro- toxicosis. Tr. Assn. Am. Phys. (Phila.), 1915, 30, 450-457. ___: he function of the thyroid, normal and abnormal. Tr. Assn. Am. Phys. (Phila.), 1916, 31, 128-133. eaerar coe function of the thyroid gland. Med. Rec. (N. Y.), 1918, 94. ° __: Classification of goitres. Med. Rec. (N. Y.), 1919, 95, 1074-1075. ——: phe function of the thyroid gland . Med. Rec. (N. Y), 1919, 96, 52 ———: Symposium on goitre: Thyroid disease. Med. Rec. GNoaY) 1919, 96, 780. ———: Thyroid disease. J. Am. M. Ass. (Chicago), 1919, 73, 1466. —: Thyroid disease. N. York M. J. (N. Y.), 1920, 111, 41-42. Plummer, W. A.: Some_phases of the differential diagnosis of exophthalmic goitre. St. Paul Med. Jour., 1916, 18, 297-300. : The blood picture in exophthalmic goitre. Minn. Med. (St. Paul), 1919, 2, 330-332. Plummer, W. A., & Broders, A. C.: Tuberculosis of the thyroid. Minn. Med. (St. Paul), 1920, 3, 279-283. Sandiford, Irene: The basal metabolic rate in exophthalmic goitre (1917 cases) with a brief description of the technic used at the Mayo Clinic. Endocrinol. (Los Angeles), 1920, 4, 71-87. The effect of the subcutaneous injection of adrenalin chloride on the heat production, blood pressure and pulse rate in man. Am. J. Physiol. (Balt.), 1920, 51, 407-422. Sistrunk, W. E.: The selection of operation for exophthalmic goitre. J. Am, M. Ass. (Chicago), 1920, 74, 306-308. Stern, R.: Differential Diagnose und Verlauf des Morbus Base- dowii und seiner unvyollkommenen Formen. Jahrb. f. Psychiat (Leipzig), 1919, 29, 179-273. U. S. War Department, Office of Surgeon General: Bulletin II: Physical examination of the first million draft recruits: Methods and results. Washington, Government Printing Office, 1919. Willius, F. A.: Auricular fibrillation and life expectancy. Minn. Med. (St. Paul), 1920, 3, 365-380. Observations on changes in form of the initial ventricular complex in isolated derivations of the electrocardiogram. Arch. Int. Med. (Chicago), 1920, 25, 550-564. 63. ADENOMA OF THYROID Wilson, L. B.: The pathological changes in the thyroid Pland as related to the varying symptoms in Graves’ disease; based on the pathological findings in 294 cases. Am. J. Med. Se. (Phila.), 1908, 136, 851-861. ; “y i : The pathology of the thyroid in exophthalmie goitre. Tr. Assn. Am. Phys. (Phila.), 1913, 28, 576-586. te ; : A study of the pathology of the thyroids from cases of toxic — non-exophthalmie goitre. Am. J. Med. Sc. (Phila.), 1914, 147, 344-351. : Experimental lesions in the cervical sympathetic ganglia in — eee to exophthalmic goitre. Am. Med. Sc. (Phila.), 1918, 156, — Woodbury, M. S.: A comparison of methods for determining thy- rotoxicosis. J. Am. M. Ass. (Chicago), 1920, 74, 997-999, cua 7 ool A CASE OF DYSTROPHIA ADIPOSOGENITALIS FRANKLIN G. EBAUGH AND R. G. HOSKINS (From the Henry Phipps Psychiatric Clinic, Johns Hopkins Hospital, Baltimore.) Two considerations have impelled us to report the following ease of dystrophia adiposogenitalis. One of the outstanding characteristics of the condition in question is a more or less pro- nounced psychotic trend. The subjects are frequently intro- verted and have a more or less pronounced inferiority complex. Timme has recently emphasized this fact. There are in the liter- ature, however, relatively few cases reported with regard to psychopathological features. A second consideration is the de- sirability of more data on the therapeusis of the condition. The patient, E. O’F., male, age 16, was first seen in the dis- pensary, January 28th, 1920. At that time plans were made to keep him under observation while undergoing treatment for his endocrine disorder. As a matter of fact, he proved to be a recal- citrant patient and it was only with difficulty that sufficient co-operation was obtained to permit carrying out a diagnostic and therapeutic study. For this reason the data reported are de- ficient in certain particulars,—and especially as regards basal metabolism and blood sugar determinations. Family History: One grandfather was inebriate. The mother, now 50 years of age, is short, stout and has gradually gained in weight for the past 15 years. She stated that all her family have the same tendency toward obesity. Otherwise, the family history afforded no pertinent data. There is no evidence in the family strain of gigantism, dwarfism, goitre, or diabetes. Personal History: The patient. was born in Baltimore, March 12th, 1904. The mother “felt poorly” during her entire pregnancy; she had frequent attacks of dizziness and often refused food. She suffered much discomfort from what seemed like a lump in her neck. The patient was a full-term child, and except for his being undersized, his early development was normal. Breast feeding was continued until his third year and weaning was accomplished with some difficulty. The patient slept with his mother up to the time he came to the clinic. Since the age of 10, the patient has become exceedingly obese, this hav- ing become especially noticeable in the past three years. During this latter period he has grown in height 3% inches. He had enuresis until the age of 4, but rarely since. He never has had night terrors. He has had the usual childhood diseases, including measles and chickenpox. 21 22 DYSTROPHIA ADIPOSOGENITALIS The patient did fairly satisfactory work in school from the 6th to the 15th years, reaching only, however, the high 5th grade. He has always enjoyed good general health. There has been no complaint of headache or dizziness; no visual complaints; no difficulty of any of the special senses. During the past 5 years the patient has complained of dyspnoea on exertion, which has advanced in proportion to his obesity. There have been no gastro-intestinal complaints except occasional nausea and vomiting and an inclination to constipation. The appetite is excessive. The patient states that he usually urinates from 5 to 7 times a day, and there is some hesitancy. Nocturia has been absent. Photographs of patient, BE. O'F., showing genital infantilism, distri- bution of fat, lumbar lordosis and genu valgum. Present Illness: The patient resents teasing, is inclined to be infantile, cries on the slightest provocation, and is inclined at times to be over-affectionate. He has frequent spells of irritability. His em- ployer states that he appears bright and alert in the morning, but is dull, obtuse, and complains of feeling tired “all over” in the afternoon. At home, it is noticed that the patient is over-affectionate, especially in regard to his mother. He is very obstinate and sullen at times. He EBAUGH AND HOSKINS 23 takes little interest in his work and gets along poorly with his asso- ciates on account of his sensitive and quarrelsome nature. The patient is ashamed of sleeping with his mother and is afraid that someone outside may discover it and make fun of him. Recently he has shown an increasing tendency to be quarrelsome, irritable and stubborn. He shows little initiative in his work, is rarely punctual, and is inclined to lie to his employer. He has a fair range of activities; goes swimming with other boys and plays baseball, although he feels handicapped and sensitive on account of his obesity and lack of genital development, about which he constantly worries. Recently, his mother has been very much concerned regarding the increasing frequency of his crying spells, his marked infantilism and his complaints of weakness and tired feelings, especially marked in the evenings. : Mental Status: The patient is markedly infantile in his general demeanor. He is apprehensive, especially when any special tests are made, and cries when the finger is pricked. He talks ina well-modu- lated, high-pitched voice, and impresses one as being stupid. Point scale estimate of mental age by Dr. Scott reveals that of 10% years: the intelligence coefficient is .77. Physical and Endocrine Status: The patient is 5 feet 1% inches in height and weighs 162 pounds. He presents a striking appearance with special reference to distribution of fat and rudimentary condi- tion of the genitals. The deposits of fat are especially marked in the mammae, which are large and pendulous. He has a marked protruding and over-hanging abdomen, a large pad of fat just above the symphisis pubis and across the buttocks. The thighs are large, graceful and tapering. The pelvis is broad, suggesting the feminine type. He ex- hibits genu valgum and there is a slight degree of lumbar lordosis. Measurements in the various planes of the body are as follows: In the planes of the nipple..........--. Here tn HAC IGA DOO Oa 96 cm. Planes of umbilicus ........220ecs ese sccer errs cree seer e tsetse 106 cm. Planes of trochanterS....-..2.---:eee- ese e erste etter ernst 102 cm. At the internal malleolus, right and left......---+-+++++++s22-- 23 cm. 10 em. above internal malleolus 20 cm. < Af Go 6 ORIG D GAD oc .GUIner DD CoO 6 right 35.0 cm. left 35.5 cm 30 cm. oF - SOD OR Pai staiester shovel Sretatals ates dei oye Katacaibyeree right 38.0 cm. left 39.0 cm 40 cm. “3 ve Cee GSE GEL oad che octet ood right 47.5 cm. left 47.7 cm £0 cm. es o Ce) Sse amaooe og oto Go Oona right 54.0 cm. left 54.0 cm 60 cm. ; < Ca.) sae Se Si ene ae aioe eos cma right 60.0 cm. left 59.0 cm At the styloid process of ulna........--- seeee errr e reese right 17.5 cm. left 17.2 cm 10 cm. above process of ulna.......-.--- ES ts OES right 24.0 cm. left 23.5 em. 20-em. ° a “ CIT 555 SRO OOOO OOO ORCI O right 25.5 cm. left 25.0 cm. 30 cm. s a < fh ea UO Geet Ons Obeid. one right 28.5 cm. left 28.0 cm. 40 em. « “5 = Seay acts vorefaletaln ie ALSO AR SOOO right 34.5 cm. left 34.0 cm. Sub-mental plane ......--+.-++++-+8 NO DOR OGE LUO GOT pO SDS 51.5 cm. Occipital mental plane.....-..-+-+--+« PEN iatateta ecsiarccoisie. sistareuslorsherei oie 50.0 cm The skull is somewhat of the acromegalic type. There is a slight tendency towards prominence of the malar bone, and the lower half of the face is more prominent than the upper. There is a slight palatine ridge. The jaw is broad, with slight spacing of the teeth. The dates of dentition were not obtained, but the mother states that she thinks 24 DYSTROPHIA ADIPOSOGENITALIS there has been retardation of second dentition. The teeth are of nor- mal color, shape and consistency. There is a slight disproportion between size of the extremities and trunk, The torso-lez measurements are 46/80 em. and the spread of arms, 56 em. The hands and feet are small. The patient wears a no. 5% shoe. The distance from the styloid of the ulna to the tip of the second finger is 1844 cm. A moderate degree of flat foot is present. The joints cannot be hyperextended. Marked under-development of the genital organs is evident, cor- responding to those of a boy 10 years younger. The penis is rudi- mentary and the scrotum is small and buried in fat. Both testicles are undescended. No evidence of puberal changes is found. There is no history of autoerotism or of any homo- or hetero-sexual trends. There is a marked deficiency of hair. This is especially marked in the axillae and pubic regions. On close examination, three short hairs are seen in the left axilla and four in the right. There is slight eyebrow deficiency. The hair of the head is fine and dry and has a slight ten- dency to curl. There is a marked ridging of all the nails. There is also a tendency to brittleness, and they crack readily. They are of slow growth.’ Several white spots are noticed, especially on the thumbs and the first and second fingers. No abnormal areas of pigmentation were made out in the skin. It is thick and dry and shows no atrophy, naevi, or eruptions. There is a marked tendency toward “goose-flesh,” especially marked on the arms and legs. There is a slight mottling of the face. On light strok- ing with the soft part of the finger tip, a red line is obtained with a broad, white border. In the mucous membranes there are no abnormal pigmentations sae atrophy. The tongue is thick, with a normal number of papillae. The patient shows a rapid muscle fatigability, especially during the skipping and hopping tests. When seen for the first time in the dispensary, after one hundred hops he complained of feeling exhausted and immediately rested on a couch. General weakness of all the muscle groups is present, but there is fair carriage. : The tonsils are small and atrophic. The axillary and inguinal lymphatic glands are not palpable. There is no thyroid enlargement detectable by palpation. The systolic blood pressure is 140, the diastolic, 80. The pulse, at rest, is 68, standing, 80. The vessel walls show no sclerosis. The relative cardiac dullness measures 21%4x10% cm. There is no retro- manubrial dullness. The heart sounds are of good quality and intensity, the second pulmonic being more marked than the aortic. Blood examination shows: R. B. C.—4,126,000. Hemoglobin—75% W. B. C.—8,960. Differential Count: PP Me By, 5% The red cells are of normal size, shape and color. No parasites are found. The urine is normal in constituents and shows normal range of specific gravity. EBAUGH AND HOSKINS 25 The radiographic examination shows an apparently normal sella turcica. In the bony structures there is delayed ossification for the age. The lungs are clear and no evidence of any mediastinal abnor- mality is detected. The teeth show nothing abnormal. The perimeter chart shows normal visual fields for white, blue and green. Treatment and Progress: Since the patient was unable to. come into the hospital, arrangements were made with his employer to have him return to the dispensary at occasional intervals. The patient con- sented to return to the clinic for observation on Sundays. A resumé of his progress follows. Beginning February 11th, 1920, he began to receive desiccated pituitary (whole gland, Armour preparation) —two grains, four times a day. February 18th, 1920, the patient’s mother reports that she has noticed that he shows less tendency toward weeping, is less irritable and stubborn, appears more active and alert, does not resent teasing as much as previously and sleeps better. He complains less of short- ness of breath. He complains of frequency of urination, stating that he often urinates twelve and thirteen times a day; he also complains of frequent nocturia, three to five times a night. February 20th, 1920, the patient states spontaneously that he is feeling better and stronger, has more vigor and does not notice the shortness of breath that he had previously. He ascends three flights of stairs and shows no abnormal degree of dyspnoea. He continues to complain of frequency of urination, but states that he has no nocturia. February 25th, 1920, the mother states that the patient is more industrious, shows more initiative in work, is punctual, is sleeping bet- ter, is less irritable and has not had a crying spell for the past two weeks. Pituitary medication is increased to 12 grains a day. March 8rd, 1920, the patient returns for observation and for blood and urine examination. While venous blood was being drawn he had a short fainting attack and crying spell. The next day he complained of dizziness while at work and was sent home by his employer. However, he was able to return the next day without any complaint. On March 4th, his mother states he had the first enuresis that was noticed since childhood. March 10th, 1920, the patient’s mother reports he has more self- confidence, shows more interest, is more buoyant at work and has no somatic complaints. He shows an increase in range of activities and is beginning to make plans with other boys in regard. to preparations for a ball team. He appears less emotional, less infantile and asso- ciates more with boys of his own age. (Previously he has been in the habit of domineering the boys of his neighborhood five or ten years younger than himself.) March 16th, 1920. The patient is becoming much dissatisfied be cause he is not losing any weight. In the hope of stimulating his cata- bolic processes, desiccated thyroid gland, 2 grains daily, is prescribed, the pituitary being reduced to 8 grains. March 23rd, 1920. The pulse is 88 and blood pressure 140/85. The weight is 160 pounds and the temperature, 98.6°. There are no somatic complaints and no objective evidence of any tendency toward hyperthyroidism. The urine examination is negative. March 27th, 1920. In the hope of stimulating genital develop- ment desiccated suprarenal gland, 4 grains a day is added to his other treatment. The patient’s mother continues to note general improve- ment in his condition. She states that the boy is now walking home in half the time in which he did previously. He is getting along better 26 DYSTROPHIA ADIPOSOGENITALIS with his associates, and the people in the neighborhood notice a marked change in him, but the patient remains discontented since he has not been josing any weight. Maren 28, 19zv. The patient returns for observation. He shows his first loss in weight since treatment began, this amounting to two pounds. ‘the pulse is 98; the blood pressure, 135/78. Measurement of the different planes of the body reveals a decrease of 4 cm. in the planes of the umbilicus, indicating a change in body configuration. The urine examination is negative. The ditterential blood count shows: P. M. N., 60.5%; P. M. B., 0.%; P. M. E., 1.%; Lymphs., 29.%; L. M., 0.5%; Trans, 4.%. The patient exhibits a slight, fine tremor of the hand, but no other objective symptoms of hyperthyroidism. The von Graefe and all other eye signs are negative; there are no complaints of nervousness or palpitation; no vasomotor symptoms. The patient states that he urinates usually from five to seven times a day, but that he has lost all his former tendency to polyuria. His bowels move from two to four times a day. ‘he patient thinks that he is getting along much better in his work, and he does not have any weak spells in the after- noon, as previously. He spontaneously mentions that all his friends and associates are very much surprised at the change in him. He mentions with some degree of ostentation that he can now walk home in thirteen minutes, when it previously took him twenty-five. He has no spells of shortness of breath. He is taking exercise regularly, play- ing baseball with more vim than ever before. Subsequent to March the patient became increasingly less co- operative. During April, May and June, he received suprarenal, 12 grains, thyroid, 2 grains, and pituitary, 8 grains, daily. During this period his weight dropped from 162 to 152 pounds. In June a slight growth of hair was apparent in the axillae and in the pubie region. No evidence of hyperthyroidism could be de- tected. He continued dissatisfied because there was no noticeable change in the size of the genitalia, although frequent erections were reported. Despite the medication, his basal metabolism at this time was found to be 4 per cent below normal. In view of the initial blood pressure finding of 140, careful observations were made at intervals to forestall any deleterious effects from the thyroid medication. An electrocardiographic examination at this time disclosed no abnormali- ties. There was no significant change in pulse rate or blood pressure. There appeared to be some further redistribution of fat, the diameter at the plane of the umbilicus decreasing 1.5 em. more. At the same time the diameter at the plane of the nipples was augmented 2.5 cm. During July, treatment was discontinued. During August, it was resumed in the same dosage as before. The patient, however, refused to return to the hospital for any further study. When seen at his home he stated that marked changes in his genital organs had occurred. He seemed apprehensive and complained that the medicine was “too strong.” On August 27th, 1920, he was seen for the last time. He refused to continue with any further treatment and was discharged. He was stubborn and self-assertive in demeanor, in striking contrast with his infantile behavior when first seen. He was working regularly, driving a two-horse team and earning twelve dollars a week. A. striking change in the genital sphere was evident. Both testicles had descended. By palpation the diameter of each was estimated as 1.5 cm. The penis had increased somewhat in size, and the crines pubis and axillary hirci, although still scanty, were obviously augmented. The patient had developed a marked reticence as regards sex matters. He felt EBAUGH AND HOSKINS 27 alarmed at the genital changes. He continued to deny any autoerotic episodes and there was no evidence of heterosexual activity. There were no significant changes in blood pressure, pulse, or body measure- ments. The weight had again reached 160 pounds. SUMMARY A boy of 16 presented a case of dystrophia adiposogenitalis with psychic infantilism and marked fatigability. During the eourse of six months he was treated with desiccated pituitary, thyroid and suprarenal gland substance. At the end of the period there was a striking change in the psychic attributes from infantile to self-assertive stubbornness. He had become able to earry out a full day’s work and to engage in vigorous athletics. At the same time the testicles had descended and erections were frequent. There was some growth of axillary and pubic hair. DISCUSSION To what extent should the psychic changes in the patient be ascribed to ‘‘desensitization’’ and suggestion, and to what extent to the medication? The data do not permit any very satisfactory conclusion. At the beginning of the treatment the prognosis, as- suming that suggestive therapeutics alone were to be employed, eould not have been at all favorable. Yet striking improvement, from a psycho-pathological point of view, did occur. The patient was transformed from a querulous, childish weakling to a robust lad, psychically fairly well adapted to his environment, and able to do a creditable day’s work. He developed a keen interest im baseball and swimming and showed qualities of leadership. The therapeutic plan carried out was not at all satisfactory as a scientific study. Each of the gland substances should, of course, from this point of view, have been administered inde- pendently and over periods of at least a year. In view of the uncooperative attitude of the patient, however, it seemed desir- able to make the treatment as effective as possible, at once. The pituitary was administered on the supposition that the chief etio- logie factor in the case was hypopituitarism. Favorable results from this alone seemed to appear promptly. The psychic attri- butes began to alter and the muscular fatigability to decrease. The thyroid was added in the hope that it would add to the pa- tient’s enthusiasm by augmenting a supposedly sluggish metab- olism, and especially by leading to a decrease in weight. The fact that there was an initial systolic blood pressure of 140, 28 DYSTROPHTA ADIPOSOGENITALIS however, seemed to preclude any very vigorous pushing of the thyroid medication. As a matter of fact, the trend of the avail- able literature seems to indicate that the addition of thyroid to pituitary material, on empirical grounds, is advisable in eases of the type discussed. Whether the addition of suprarenal substance contributed to the therapeutie results, cannot be determined. That tumors of the adrenal cortex may cause an accentuation of the masculine characteristics is well known. Glynn has reviewed the literature on this point, up to 1912, in some detail. Apparently the thera- peutic efficacy of the desiccated gland substance as a sexual stim- ulant has been but little investigated. Animal experimentation on the point has also received little attention. In 1916, one of us in collaboration with Augusta D. Hoskins reported the results of a preliminary study of the effects of suprarenal feeding in the white rat. The data, while not conclusive, numerically, seemed to indicate testicular hypertrophy as a result of the feeding. There is under way, at the Phipps Clinic, at the present time, a continuation of the study. BIBLIOGRAPHY Timme, W.: Indications for internal gland therapy. N. York Med. J. (N. Y¥.), 1920, 111, 226-229. Glynn, E. E.: The adrenal cortex; its rests and tumors, its relation to other ductless glands and especially to sex. Quart. J. Med. (Oxford), 1911-12, 5, 157-192, 1 pl. Hoskins, R. G., & Hoskins, Augusta D.: The effects of suprarenal feed- ing. Arch. Int. Med. (Chicago), 1916, 17, 584-589. DETERMINATION OF RELATIVE ACTIVITY OF THE THYROID LOBES.* (With 3 figures in text) N. WORTH BROWN, M.D., TOLEDO, OHIO Muscular activity ean be measured and recorded by means of a modern string galvanometer. The electrocardiograph gives a record of the cardiae mechanism by registering the changes in electric potential which occur with each phase of the cardiac eyele. Bayliss and Bradford in 1885 reported an investigation of the electrical changes attending glandular activity. Cannon and Cattell and later Gesell, have recorded the secretory action of the salivary and thyroid glands by placing one electrode of a ealyanometer upon the gland and the other on neighboring tis- sues. They have offered evidence that the electrical changes are dependent upon variations in the activity of the glandular tissue itself. It is reasonable to suppose that the glandular activity of superficial glands, such as the thyroid, can be recorded by means of electrodes placed upon the skin directly over the glands. In the electrocardiograph we have an instrument well adapt- ed for such observations. The tension of the fibre can be adjusted to meet requirements and the resistance and standardizing cur- rents can be utilized to regulate the deflection of the string. The camera makes possible a graphic record of the electric changes. In the following observations no attempt was made to measure the thyroid activity of one individual as compared with another but rather to estimate the activity of one lobe of the thyroid as compared with that of the opposite side. The procedure consists in attaching one electrode to the left leg or placing it on the back in the interseapular region, and placing the other electrodes on the right and left lobes of the thyroid, the second lead of the elec- trocardiograph being used for the right lobe and the third lead for the left lobe. Small German silver electrodes, 34 inch square, were substituted for the ordinary electrodes used in obtaining a cardiographic record. The tension of the string was adjusted so that the deflections would fall within the photographie field. A record with an electrode placed on the manubrium was first made *From the Medical Clinic of the Toledo Hospital. 29 30 RELATIVE ACTIVITY OF THYROID LOBES in order to determine the deflection produced by the skin and body tissues, excluding so far as possible the influence of the thyroid gland. When a lobe of the thyroid was connected, with adjustments unchanged, the negative deflection increased. By changing ‘‘leads’’ without readjusting, the negativity of each lobe was compared with the manubrium and with that of the opposite side. The negative deflection was recorded photograph- ically. The following observations have been made. ri GW Yinks : Left Lobe of Thyroid Manabriam, Right Lobe of Thyred, Deflection Al B peslecfion BE Deplection B-p = 0.9 em. or (F wiv. =O.3emur Ome = 1.3 Sm. oF AGM”. Fig. 1. (Reduced %) Adolescent hypertrophy of thyroid with no evidence of thyrotoxicosis. Right lobe larger than left. \-B=—deflection produced by skin and other tissues. C=—additional deflection caused by right lobe of thyroid. ;-D=—additional deflection caused by left lobe of thyroid. The activity of the left lobe is greater than that of the right. Case 1. (88) G. W. L. 4/12/20. Male, age 20. Adolescent hypertrophy of the thyroid gland with no evidences of thyrotoxi- cosis. The right lobe was larger than the left. The tension of the string was adjusted to give a deflection of 1 em. for each 20 millivolts. The lead from left leg to the man- gy Mrs. x | Wa4/ao. \le.m=: S mu Mana brian Fi 2. (Reduced %) Simple bilateral hypertrophy with normal basal metabolism Right lobe larger than left. B-C=—deflection caused by including right lobe. B-D=—deflection caused by including left lobe. The activity of the right lobe is greater than that of the left. ubrium gave a deflection of 0.9 em. The lead from left leg to the right thyroid gave a deflection of 1.2 em., 0.3 em. more than from the manubrium. The lead from the left leg to the left thyroid gave a deflection of 2.2 em., 1.3 em. more than from the manu- BROWN 31 brium. If this difference indicates the relative negativity of the two lobes we may state the condition in the following equation :— Activity of right lobe: activity of left lobe :: 0.5 cm., 1.3 Cm, and the right lobe, the larger of the two, is the less active. Case 2. (90) Mrs. N. 4/24/20. Age 32. Moderate bilateral hypertrophy with no symptoms of hyperthyroidism and with a normal basal metabolism. The right lobe is slightly larger than the left. One electrode was placed in the interseapular space, the two small electrodes upon the two thyroid lobes. The tension of the string was adjusted so that a deflection of one centimeter was equivalent to 5 millivolts. The difference between the deflection in leads from the manubrium and from the right thyroid was 3 em. The difference between the deflection im leads from the man- ubrium and from the left thyroid was 1.8 em. Activity of right thyroid: activity of left thyroid ::3.0 em. :1.8 cm., and the right thyroid, the larger of the two lobes, is presumable more active than the left. \mana brinm Manubrinm t Fj j B Fig. 3. (Reduced %) Mild hyperthyroidism. Both lobes slightly enlarged. B-C—deflection caused by including right lobe. B-D—=deflection caused by including left lobe. The activity of the two lobes is equal. Case 3. (31) 4/27/20. Mrs. E., Age 22. Slight bilateral hypertrophy of the thyroid with symptoms of a mild hyperthy- roidism. The lobes are equal in size. The tension of the string was so adjusted that 1 cm. defiec- tion equaled approximately 5 millivolts. The difference between the deflection in leads taken from the manubrium and from the right thyroid was 1.7 em. The difference between the deflection in leads taken from the manibrium and from the left thyroid was 1.8 em. A second observation on this patient gave a deflection of 1.3 for the right lobe and 1.5 for the left lobe. The activity of the two lobes is presumably equal. 32 RELATIVE ACTIVITY OF THYROID LOBES The three cases recorded, the first showing relatively greater activity in the left lobe, the second showing more in the right and the third showing equal activity, indicate that the application of this method may be of practical value. Our observations are too limited to do more than suggest a method by which the activity of the right and left lobes of the thyroid may be compared and graphically recorded. , BIBLIOGRAPHY 1. Cannon, W. B., & Cattell, McKeen: Studies on the conditions of activity in the endocrine glands. I. The electrical response as an index of glandular action; III. The influence of the adrenal secre- tion on the thyroid. Am. J. Physiol. (Balt.), 1916, 41, 39-57; 74-78. Gessell, R.: Some electrical phenomena of the submaxillary gland. Proce, Am. Physiol Soc., Am. J. Physiol. (Balt.), 1918, 45, 559-560. bo THE HYPOPHYSIS CEREBRI OF THE WOODCHUCK (MARMOTA MONAX) WITH SPECIAL REFER- ENCE TO HIBERNATION AND INANITION (With 5 figures in text) A. T. RASMUSSEN Institute of Anatomy, Medical School, University of Minnesota CONTENTS Tameadielion Golds obenge Soda an Po ae UR eon Sean Uo iame serum mpeg Car Fa 30 Dinan aUGl MOUTOVs Goes odo se Doe sIa Sean ODOR aC PRIOR PSs Siac 38 Description of the hypoph TERE Car eee socers soto adevictsustiek= Gobatenes-yete\srsimumreionencns 43 =, GOT GMOS sonsesoocdoud uc SosOO oye oD Ole CORON UD oo. id eS 438 (b), TPERE TOROS Ge Salus oe 0.0 eee oO CO cena Dra Oa SOO 2 RRS 2 45 @, JEAIG ARUOHOR G o.cosid go bom ona Sno OI Ei ia ei aD Scie ca 45 Gi, Want HGeGGtNy Boe occa do veaeN ooo ao SO Oma De ro OCs CRS aia 49 a, TRG iinl imi “Suge esse coo da Op Oo a Dae O sO DED RI SIRE Gas = 52 2, (DONT SRA Scone ocs.5 aoc DOE BE CUO DE SDR REO Bho Sissi S 9 53 g. Post-hibernating PONUUL Woes sea Fear Sm Be POCO Sie poD G oteiBie CoC 54 Walkmie Ge ik WAS jess oo ae 6 Soo a OAD SOOO CEE CII GSAS a 55 a. Before hibernation ....-.-.----+--- aS SunGis Scan eb Seon oreceg omar 55 il) unin eye ibern abloxiy teen: -f=1= tafe whee ci -conrre cstchate gel = Ca 56 @, ISTE Waa EhMO) 56 aaigos cole oun Or oor EOI n COMBO ITER Ss 57 d. Sex differences ......------+--++-:> dhe ere abwid SECOND pUD OS 58 SHre Gr CAI Gaelnind lane. cgscce0s Foo. 1 nbG FoR ora Bc Or OTE aaa kaa ci a9 PMA cpa COriO Dy s cpersctete ye oe auc tts fos i= ps ie fenann iellesnictcs tgs sichc ic) tye taish ro oe 59 ih. BIG) TAOONIED, seomomeesooe Bees o sul COON ert UO Oe bse 50 Relative number of granular cells.....---. 2h We EE DODO RHO OOIG 61 Pe efOrerhibernatlonr. Aciiec ot sieeiag see aarr sas ire inte yeas Sie 61 Hue unin=e hibernation c seis satel) = bere mi ies as 61 UMA TOR Un ipern ation yas = se einaters=sttabenstat er Ge onsane seve aes a elr ceive Tha 61 di Significance (of. cell tyPess ons to one nein nnn ahi a 62 Summary nw Before 3 10 15 20 25 30 35 injeclion minutes after ® Injection of d.c.c. of adrenalin 1 p. {ooo in the vein. pressure be explained, since this indicates excitation of the vagus in the hypervagotonie individuals? Guillaume, in his interest: ing book on the sympathetic, classifies adrenine as clearly tonic for the sympathetic, without including it among the substances partially sympathetie and parasympathetic tonicals. To explain its different action in the vagotonie individual, Dresel speaks of an indirect action exercised upon the vagus, which predominates over the action exercised upon the sympathetic, but he fails to deseribe its nature, while Guillaume does not speak at all of it. I believe that the phenomenon can be explained without casting doubt on the execlusiveness of the action of the adrenine IZQUIERDO 609 on the sympathetic. The vagus contains a certain number of very interesting fibers which, forming a group may be consid- ered as constituting the depressor nerve of Cyon: the sensory eardiovascular nerve, which is mainly derived from the vagus, but which probably possesses important connections with the cervical sympathetic in man. The sympathetico-tonic stimulat- ing action of adrenine would cause an increase in blood pres- sure, which at the moment of its initiation would become an exciting agent of sensory fibers of Cyon’s nerve coming from the aorta and with their trophic centers in the plexiform and jugular ganglia, which through the sensory column of the tenth eranial pair would connect with the vago-spinal nucleus; this vagus-vagus reflex would then produce a fall in the arterial pres- sure. From this point of view the phenomenon would not be considered as excitement of the pneumo-gastric but would be looked on as an exaggerated reflex action resulting from the in- creased aortic pressure. BIBLIOGRAPHY Dresel, K.: Die Blutdruckverinderung nach Adrenalin injecktionen als Grademesser fur den Tonus in autonomen und sympatischen Nerven- system. Deutsche med. Wehnschr., Berlin, 1919, 45, 955. Guillaume; Le sympathique et les systémes associés. Paris, 1920. Izquierdo, J. J.: Un caso de hipervagotonia. Rev. Mex. de Biologia, 1, 3, pag. 124. Editorials WHAT IS ENDOCRINOLOGY? There is a class of writers who affect the term ‘‘so-called endocrinology,’’ the implication seeming to be either that the existence of endocrine organs is doubtful or else that the vol- uminous literature pertaining to them is of such uncertain sig- nificance as not to deserve formal recognition. That the litera- ture does include an intolerable deal of twaddle, no well-in- formed reader can deny. Such pretentious nonsense might well be designated pseudoendocrinology. The proponents of this sort of literature are coming in for criticism on all sides. A recent editorial in the Journal of the American Medical Association concludes: ‘‘How much longer will our profession continue to merit such criticism? Just so long as our profession continues to give serious consideration to pseudoscientifie rubbish promulgated by exploiters of organie extracts.’? The writer might well have added: ‘‘and by clinical incompetents seeking easy paths to fame.”’ Upon the members of the Association for the Study of Internal Secretions a special responsibility devolves lest a long suffering medical profession in disgust with the rank growth of weeds in our fertile field in reformatory zeal uproot wheat and tares alike. It fortunately happens that the pseudoendocrinologists have developed such a characteristic array of methods that they are relatively easy to identify. They are strikingly addicted to theorizing. If, in a given article, the ‘‘explanatory’’ portion bulks larger than ten or twenty per cent. of the original data adduced, one is rarely in error in classifying it as ‘‘pseudo- scientific rubbish.’” As Elliott has sagely remarked: ‘‘ Medicine owes no thanks to him who, without proof, would formulate her theories.’’? Those who are attempting to elicit our gratitude in this way often put forth the specious plea that they are pointing the way to research,—as though the competent investigators in this field were not beset with an almost bewildering array of problems. 610 EDITORIAL 611 The pseudoendocrinologists are much given to appeals to ‘“‘physiology.”’ But the physiology cited, one seeks in vain in any first class treatise on that subject. The guesses of novices and the deductions of shallow thinkers are habitually quoted as on a par with substantiated facets. Gross distortion of the evi- dence is constantly encountered. Such data as support the pre- conceived theories of the writer are cited while opposing data are ignored. This is not infrequently carried to the point of actual mendacity. Systematized delusions masquerading as the “teach- ings of experience’’ are not uncommon. Marvel mongering 1s also an ear-mark, though this is going out of style. Examples could be cited by the volume. One recent para- graph, and it by no means the worst available, may be quoted : “‘T have frequently been asked why adrenal gland and pancreas can be given together in hyperthyroidism. . . - This is readily explained. .. . Adrenal extract is a cardiac tonic and slows and strengthens the heart. Further, when administered in this form, its influence upon the adrenal glands and the factors controlled by them is supportive rather than stimulative. . . . In the com- plex hormonic mixture in the blood all the hormones, both antag- onists and stimulants, are to be found and the remarkable selec- tive capacity of the organism to avail itself of those which are needed, and in proportion as they are needed, explains why, when antagonists are given simultaneously, benefit may accrue in both directions represented by the opposing principles. Suffice it to say that... the antagonistic value of pancreas over adrenal medullary irritability as well as the thyroid itself makes the pluri- glandular idea not so unreasonable after all.” Space and patience are lacking for a full analysis, but a few of the violations of sound physiology may be indieated. That adrenal extract given by mouth has any effect on the circulation is without evidence that competent pharmacologists can now accept. ‘‘Its influence is supportive rather than stimulative’’ is only verbalism that obscures rather than clarifies. The ‘‘com- plex hormonie mixture of the blood’’ is quite possibly non- existent. In few cases has it been proved that the endoerine organs contribute anything to the blood stream. They may function by a process of subtraction rather than addition. Hor- monie ‘‘antagonists’’ are, so far as proof is concerned, largely 612 EDITORIAL mythical. That epinephrin is rapidly destroyed in alkaline media and that pancreas extract is alkaline comprise the sum total of clean-cut evidence on the point. ‘The ‘‘remarkable se- lective capacity of the organism’’ is, so far as can now be de- termined, a mere figment of the imagination. which is being grossly overworked as an excuse for haphazard, pluriglandular dosing. If the body cells were possessed of any such critical acumen as postulated, why should we ever encounter a case of acromegaly or hyperthyroidism? It is definitely proved that the cells will take up thyroxin or epinephrin in lethal (uantities, when exposed to excess of these substances. Finally, the ‘‘value’’ of pancreas extract as a source of hormone is, according to all reliable evidence, nil. That given endocrine gland substances may be valuable in given clinical conditions may or may not be true, as a matter of empirical observation. That enlightened empiricism may lead to further valuable therapeutic deductions is not improbable. Such results are to be expected, however, not from promiscuous dosing with hit-or-miss mixtures, but from carefully controlled experi- ments carefully analyzed. Rigid critique and rigid logic are in- dispensable. Any data adduced must stand on their own merits as data. Confusing the issue by the introduction of impression- istic physiology is deplorable. In the endocrine field, as in all other fields of medical science, progress depends upon intelligent discrimination. Sound work- manship deserves every support, mere tinkering, none. Pseudo- endocrinology will disappear as soon as it ceases to be profitable. The medical profession at large can alone determine when this time will arrive. —R. G. H. Book Reviews HARROWER’S MONOGRAPHS ON THE INTERNAL SECRETIONS. HYPERTHYROIDISM: MEDICAL AS- PECTS. By Henry R. Harrower, Glendale, Calif., 1921. The Harrower Laboratory. 119 p. Sie The author’s use of words in this eaption is unfortunate. The article is not a monograph in any adequate sense of the term and ‘‘hyperthyroidism’’ is applied promiscuously to all such conditions as Graves’ disease, toxic adenomatosis, puberty hyperplasia, etc. The brochure is published with the declared purpose of enhancing the reputation of the commercial laboratory from which it emanates. This is seemingly a euphemistie admission that it is motivated as an advertising eireular. Caveat emptor. The topics discussed receive an interesting presentation, but permeated with no little ‘‘pseudoscientifie nonsense’? and here and there a generous touch of autogenous laudation. It is apparently addressed to those unfortunately eredulous clinicians who hope to get a command of present day endocrinology with- out the labor of serious study. Such readers should realize that ‘easy endocrinology’’ in the current state of our knowledge is on a par with Euclid for the nursery or Einstein made simple. It is, in short, sheer futility. Altogether, the ‘““monograph’’ is entertaining, but unreliable. ReGa te MECHANISMUS UND PHYSIOLOGIE DER GE- SCHLECHTSBESTIMMUNG. By Richard Goldschmidt, Berlin, 1920. Gebr. Borntrager. 251 p. For review see Ber. ii. d. ges. Physiol. u. exper. Pharmak., Berl., 1921, 6, 38-41. EXOPHTHALMIC GOITRE AND ITS NON-SURGICAL TREATMENT. By Israel Bram, St. Louis, 1920. C. V. Mosby Co. 438 p. 8°. The work is largely a republication in convenient book form of chapters that appeared originally in the periodical literature as independent articles. These have been previously abstracted in this journal, hence need not again be summarized. The author writes frankly as a partizan of the teaching that in nearly all 613 614 BOOK REVIEWS eases exophthalmie goitre can and should be successfully treated by non-surgical means. These means are discussed at some length. The work is subject to adverse comment in that a judicial attitude is sacrificed to vigor of debate and that little is made of the author’s personal experience. The book may serve an important end in counteracting the extreme teaching, unfor- tunately common, that surgery is the only successful type of therapy in exophthalmie goitre. RiGee DIE INNERER SEKRETION. By Dr. A. Weil, Halle. Berlin, 1921. Verlag von Julius Springer. 140 p. This is one of the few books written with a new idea. We are used to our textbooks dealing with each endocrine gland one after the other. Weil, however, first gives a short review of the embryology and histology of eash gland and then discusses : circulation of the blood, respiration and formation of voice, metabolism, growth, procreation, sexual feeling, and psyche and how they are influenced by the endocrine organs. In this way a most interesting, readable little book has been made. It is, how- ever, a pity that many problems are treated in a very superficial way. So when the author discusses homosexuality he quotes the histological changes in the testicle as described by Steinach, but he does not write that many authors have never confirmed this. It would not be difficult to find other examples. On the whole - the book is interesting and valuable, but demands critical read- ing.—J. K. MICROSCOPISCH EN MACROSCOPISCH ANATOMISCH ONDERZOEK NAAR DE ONTWIKKELING VAN HET OVARIUM VAN HET RUND (Microscopic anD MACROSCOPIC ANATOMICAL STUDIES ON THE EMBRYOLOGY OF THE OVARY OF tur Cow). By W.F. van Beek. Gonda, 1921. 143 p. This book deals in an exhaustive way with the embryology of the ovary in the cow, on which the author has earried out many studies. It is not possible to give a short review of the contents. For those interested in the question and understand- ing Dutch, the study of the work will prove of great use. The 38 microphotographs are excellent.—J. K. KRANKHEITEN DES BLUTES UND DER DRUESEN MIT INNERER SEKRETION (Diseases OF THE BLOOD AND OF THE GLANDS Wire INTERNAL SECRETION). By Prof. Dr. O. Naegeli, Ziirich. Leipzig, 1920. Verlag von Georg Thieme. (2 p. This little book is a part of a collection of similar books which appear under the title: Diagnostic and therapeutic mistakes and how to avoid them (Diagnostische und therapeutische —E———— BOOK REVIEWS 615 Irrtiimer und deren Verhiilung). Professor Naegeli has most brilliantly discussed the problem how to deal with the principal mistakes made in diagnosing or not diagnosing endocrine disease in 17 pages (the rest of the book is taken by the blood-diseases ) . He discusses: Graves’ disease and warns against calling every neurosis with a small goiter by this name, and warns to be eare- ful with the diagnosis of formes frustes or even formes ‘‘frus- tissimae’’; thyroid insufficiency ; tetany ; diseases of the hypo- physis; dysgenitalism ; and Addison’s disease. In each sentence the clinician with an enormous experience is heard and, there- fore, this booklet may even prove useful to medical men who have made a special study of the diseases of the endocrine apparatus. —J. K. DAS VEGATATIVE NERVENSYSTEM (THE INVOLNUTARY Nervous System). By Prof. Dr. L. R. Miiller. Wirzburg, Berlin, 1920. Verlag von Julius Springer. 299 p. Professor Miiller is a clinician and, therefore, it 1s highly interesting to see that in his book he devoted 298 pages to the anatomy and physiology of the vegetative nervous system, and 17 lines to the elinic. He considers our knowledge of this system absolutely insufficient to think even of clinical application at this moment. What he writes about anatomy and physiology is good, with beautiful illustrations. Only the chapter on the involuntary nervous system and the blood is superficial and in- complete. There are no fantasies in this book; it has not at all the brilliant style of other works on the same subject, but from a severely scientific point of view it is by far the best book on the anatomy and the physiology of this part of the nervous system. —J. K. ENTWICKLUNG, BAU UND BEDEUTUNG DER KEIM- DRUESENZWICHENZELLEN (D8VELOPMENT, STRUCTURE AND SIGNIFICANCE OF THE INTERSTITIAL CELLS OF ‘THE Go- naps). By Dr. W. Stieve. Miinich and Wiesbaden, 1921. Verlag von J. F. Bergmann. 249 p. Stieve calls his book ‘‘a criticism of the teachings of Steinmach on the ‘Pubertitsdriise’ (Interstitial gland).’’ It is true that in the sexual glands there exist two kinds of cells, interstitial cells and ‘‘Keimzellen.’’ It is also true that the sexual gland has a double function, a sexual one and a function regulating growth. In puberty im man as well as in animals the testicle pro- duces an increased number of spermatozoa, in the ovary the num- ber of egg-cells increases. Is not it much more probable that these histological processes are related to the onset of puberty than the interstitial tissue, as Steinach believes? The interstitial cells develop from simple connective tissue and their function is 616 BOOK REVIEWS to gather the substances necessary for the metabolism of the germ cells. When these last cells are damaged, the interstitial cells in- erease in number and contain more substances that will be wanted by the new germ cells after regeneration. Total degeneration of the germ cells, however, always produces total degeneration of the interstitial gland. In lower animals there exist specimens that have no interstitial cells; in these animals the sexual char- acters are perfectly developed. It is not possible to believe that in higher animals a differentiation has taken place because we ought to believe then that a function originally due to epithelium would have been given gradually to connective tissue. In testicle as well as in ovary the endocrine sexual function is due to the ‘‘germ cells’’ or to cells derived from them (Sertoli-cells). A special endocrine function of the interstitial gland has never been proved and is even not probable. As to Steinach’s rejuvenation, after the operation (ligation of the vas deferens), an unim- portant atrophy of the epithelium and an unimportant small growth of interstitial elements is seen during a short time, but soon a perfect regeneration of the sperm elements takes place. Steinach’s histological work is of little value, according to the author, as he compares in his book ‘‘Verjiingung’’ the testicles of senile animals with the testicles of animals of one year, which had been operated upon, and from this comparison between two absolutely different organs he draws his conclusions. As to the eases of Lichtenstein, we ought not to forget that cure from a disease as hypertrophy of the prostate itself can produce a real rejuvenation, with or without ligation of the vasa-differentia. These are only a few points from this highly important book. It is impossible to give more detail, as it would be necessary to translate the greatest part of it—J. K. Abstract Department The effect of ADRENALECTOMY upon the total metabolism of the eat. Aub (J. C.), Forman (J.) & Bright (EB. M.), Am. J. Physiol. (Balt.), 1921, 55, 293. The metabolism of three epinephrectomized cats was determined by means of a Benedict unit apparatus and a small water-sealed copper box. The experiments were carefully controlled. The con- clusion seems justified that adrenal ablation in the cat causes a 25 per cent. reduction in the basal metabolism.—T. C. B. X-ray treatment of ADRENALS in diabetes (Rontgengestrahlung der Nebennieren bei Diabetes). Beumer, Deutsche med. Wehnschr. (Berlin), 1921, 47, 369. The influence of x-rays on the adrenals in diabetes, as first recommended by Dresel, was tried in a boy of 6 years with diabetes and serious acidosis. An enormous fall of blood sugar occurred, but the carbohydrate tolerance was not increased. The acidosis became much less serious; the diacetic acid disappeared from the urine. —J. K. ADRENAL GLYCOSURIA, its connection with the method of admin- istration (Glycosurie adrénalique, ses rapports avec la voie d’ad- ministration). Bordier (H.) & Stillmunkés (A.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 613-615. Protocols of experiments on rabbits and dogs, in which it is again shown that glycosuria follows subcutaneous injections of adre- nalin, whereas intravenous injections are not followed by glycosuria in normal animals, within the limits of dosage of about 0.383 mgm. per kilo of body weight.—T. C. B. Epilepsy and ADRENALS (Epilepsie und Nebennieren). Briining (A.), Therap. Halbmonatsh. (Berlin), 1921, 35, 297-301. In some cases the author saw a good result from removal of an adrenal (see the abstract from his article in Zentralb. f. Chir., 1920, p. 1314). The operation is specially indicated in patients of 15-25 years, in whom fits are occasioned by emotions and probably in status epilepticus. The author recommends further to remove one adrenal in cases of serious juvenile diabetes. He does not describe cases in which this operation has been carried out.—J. K. Carbohydrate metabolism in animals without ADRENALS (Métab- olisme hydrocarboné chez les animaux sans surrénales). Catan 617 618 ABSTRACTS (M. A.), Houssay (B. A.) & Mazzocco (P.), Compt. rend Soc. de biol. (Paris), 1921, 84, 164-166. The experiments of Lewis raise the question whether ablation of the adrenals causes a disturbance in carbohydrate metabolism which could account for the sensitiveness of rats to various poisons. Rabbits and rats were decapsulated and the glycemia determined by the Benedict method. Comparatively little disturbance was found and the conclusion is, that the sensitiveness to toxic substances is not due to disturbed carbohydrate metabolism.—T. C. B. Remarks on the extirpation of an ADRENAL for epilepsy (Bemer- kungen zu der Extirpation der Nebenniere zur Behandlung von Kriimpfen). Cordua (E.), Zentralbl. f. Chir. (Leipzig), 1921, 48, 116-167. Brunings has operated on some cases of epilepsy and removed one adrenal. Cordua does not believe that these cases prove much as the results were published only 5 months after the operation. Probably the loss of blood may temporarily have a good influence on the spasm. This the author proves by citing a case in which, during a brain operation, much blood was lost and the same tem- porary effect was observed.—J. K. Sudden death and total caseous tuberculosis of the two ADRENAL capsules (Mort subite et tuberculose caséeuse totale des deux capsules surrénales). Creyx & Ragot, Compt. rend. Soe. de biol (Paris), 1921, $4, 127-128. A description of two cases of sudden death in which autopsy showed the suprarenals to be nothing but blocks of caseous material. without a trace of normal tissue. There were no premonitory symp- toms, and the authors point out the fact that sudden death may occasionally be the first sign of adrenal insufficiency.—T. Cus: (ADRENAL, BLOOD SUGAR) Fetter hyperglycemia and glycosuria of rabbits (Uber Fesselungshyperglykimie und Glykosurie beim Kaninchen). Fujii (1.), Tokohu J. Exper. Med. (Sendai), 1921, 2, 9-64. Boehm and Hoffman reported in 1878 that fettering a cat to an operating board would suffice to cause glycosuria. Cannon, Shohl and Wright in 1911 observed that such glycosuria resulted only in animals that were emotionally disturbed. Fujii of the Tohoku Uni- versity has subjected the problem anew to extensive study. Male rabbits served as experimental animals. It was found that fetter- ing for several hours resulted in a marked rise in the blood sugar, as well as a slight fall in body temperature and some depletion of the chromaphil material in the suprarenals. Fettering for a few minutes to an hour evoked a less extensive though positive reaction. ee ido) ABSTRACTS 61 When the animal’s body temperature was prevented from falling the reaction was much diminished. Cutting the splanchnic nerves on both sides lessened the degree of blood-sugar reaction and prevented. the suprarenal depletion. For numerous details the original should be consulted.—R. G. H. (ADRENALS) Hypernephroma (Zur Hypernephromfrage) . Gag- statter (K.), Wien. klin. Wehnschr., 1921, 34, 225-226. Of no endocrine interest.—J. K. The vasomotor action of the SYMPATHETIC fibers on the ADRENAT, gland (L’action vasomotrice du sympathique sur la glande sur~ rénale). Hallion (L.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 515-517. According to Biedl, stimulation of the peripheral end of the splanchnic nerve causes vasodilation in the adrenals. The author has found vasoconstriction as a result of the same stimulation. He has, therefore, repeated the experiments with his plethysmograph, and demonstrates that the sympathetic supply to the adrenals is undoubtedly a vasoconstrictor. It is doubtful if there are vaso-- dilators. When vasodilation occurs it is probably passive. The results are discussed at some length.—T. C. B. The principles of ADRENAL support. Harrower (H. R.), Med. Record (N. Y.), 1920, 98, 391-392. The (hypothetical) functions of the adrenal glands in regulat- ing the tonicity of unstriped muscle, and in responding to toxic sub- stances are briefly described, and the clinical picture of so-called hypoadrenia is outlined. The author believes most cases of neuras- thenia to be the result of adrenal insufficiency. Emotional shocks are said to deplete the adrenals. Fatigue, asthenia, lack of energy and ambition are pictured as characteristic of hypoadrenia. Low blood pressure is usually noted. Most tonics containing strychnine are contraindicated in this condition, according to the author, be- cause they stimulate the adrenals to increased function when they are already worn out. Hypoadrenia should be treated by adminis- tration of adrenal preparations, together with some thyroid, which helps to stimulate cellular activity, and spermin the assumed endo- erine principle from the interstitial cells of Leydig.—H. L. (ADRENALS) Epithelial pigmentation and its relation to Addison’s disease (Ueber das Hautpigment und seine Beziehung zur Addi- sonschen Krankheit). Heudorfer (K.), Miinchen. med. Wehnschr., 1921, 68, 266-267. Meirowsky discovered that when small pieces of skin are Kept during some days at 55° they become rich in pigment. Heudorfer 620 ABSTRACTS found that this is more intense in pieces of skin which normally contain much pigment. The same result is obtained after boiling, so it is not caused by some ferment-action, but is probably due to chem- ical changes (perhaps oxidation) of colorless products, formed by the skin. Bloch has stated that pigment is formed by the action of enzymes on some organic substances. He observed that when dioxy- phenylanalin was added to a section of skin the epithelial cells became grey or black. The more pigment the cells contained the more intense was the reaction (Dopa reaktion of Bloch). This, too, has been confirmed by Heudorfer, but when the skin was boiled for two hours the reaction was just as clear as jin the fresh skin. From this it may be concluded that ferments do not play a part in the reaction. The same effect as with the dopa reaction was obtained when nitrate of silver was added. Why is the quantity of pigment increased in Addison’s disease? Heudorfer considers the skin as a gland with an internal secretion. Extracts of skin dilate the pupil, so they stimulate the sympathetic. The pigment when iso- lated as pure as possible contracts blood vessels. So the skin has a similar relation to the sympathetic as the adrenals. The author believes that when the function of the adrenals is lowered the low blood pressure causes an increased functioning of the skin. This increase in function is the cause of the formation of pigment.—J. K. (ADRENAL) The effect of certain dietary deficiencies on the supra- renal glands. Kellaway (C. H.), Proc. Roy. Soc. (London), 1921, B. 92, 6-27. McCarrison’s observations (see Endocrinol., 1920, 4, 641, and abstract elsewhere in this issue) on the occurrence of enlargement. of the adrenals with increased store of adrenalin in pigeons fed on polished rice, are confirmed. It is further shown that these changes still occur when either protein or fat is added to the diet, but are prevented by the addition of an adequate ration of yeast extract. The addition of such a ration of yeast extract to a basic diet of polished rice with extra fat or protein does not prevent the increase in the store of adrenalin, though in this case the glands are not enlarged. It is suggested that the enlargement of the adrenals is due partly to congestion and oedema of the gland tissues and partly to the storage in the cortex of the gland, of lipoids set free by the breaking down of body tissues. The investigation of the cholesterol content of the adrenals of normal and polyneuritic pigeons does not support this theory of lipoid storage, though a well-marked hyper- cholesteraemia occurs in the latter. The artificial production of hypercholesteraemia in rabbits and pigeons by feeding with choles- terol appears to be associated with a small increase in the adrenalin- content of the suprarenals. The increased content of adrenalin in the suprarenals of birds on deficient diets is attributed to diminished output of adrenalin as a result of lowered body metabolism. The ABSTRACTS 621 oedema which occurs in some cases of experimental polyneuritis is not due to increased output of adrenalin, since the daily administra- tion of adrenalin to birds fed on normal or polished rice does not cause oedema, nor does it accelerate or retard the onset of poly- neuritis in pigeons on a polished rice diet.—L. G. K. Sensibility to toxic substance of rats deprived of ADRENALS (Sensi- bilité des rats privés de surrénales envers les toxiques). Lewis (J. T.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 163-164. White rats with both suprarenals removed were given doses of various toxic substances, such as cobra venom, curare, veratrine, morphine, etc. In all cases the rats died from smaller doses than did the controls. This may be due to the fact that the adrenals normally neutralize these substances, or that the decapsulated ani- mals undergo some modification of metabolism by which the cells are sensitized—possibly a disturbance of lipoid equilibrium.—T. C. B. (ADRENAL) The genesis of oedema in beriberi. McCarrison (R.), Proc. Roy. Soc. (London), 1920, B. 91, 103-110. In a series of cases of avian beriberi (polyneuritis gallinarum) oedema was found to be associated with massive enlargement of the adrenal glands. Of pigeons having massive enlargement of the adre- nals, 83.3 per cent. had oedema in some form. The enlargement of the adrenal glands was a true hypertrophy in so far as the medulla was concerned; no conclusions were drawn with regard to the cortex. The adrenalin content of the hypertrophied adrenals, as estimated by the chemical method of Folin, Cannon and Dennis, was slightly less per gram of gland in cases of wet beriberi than in health or in dry beriberi. Nevertheless, in 100 per cent. of the cases of wet beriberi the quantity of adrenalin greatly exceeded that found in health; in 83 per cent of the cases it was also in excess of that found in dry beriberi. The conclusion is drawn that ‘‘whatever the function of the adrenal medulla may be, the excessive production of adrenalin under conditions of ‘vitaminic’ deficiency is concerned with the causation of the oedema found in this order of cases. It must, therefore, be taken into consideration as a possible factor in the causation of oedema in general.’’ (See also Endocrinol., 1920, 4, 641).—L. G. K. The muscles of the haman ADRENAL veins and their importance for its function (Die Venenmuskulatur der menschlichen Nebennieren und ihre funktionelle Bedeutung). Maresch (R.), Wien. klin. Wehnschr., 1921, 34, 44-46; Miinchen. med. Wcehnschr., 1921, 68, 193. In the vena suprarenalis there exist longitudinal muscle columns which follow the ramifications of this vein. In the newly born child 622 ABSTRACTS they are absent. Circular muscle-fibers are always absent, even in adults. When these fibers contract the lumen of the vessel becomes narrower. Therefore, the author suggests that when via the splanchnicus these muscles contract, the blood stagnates in the gland and has a more intense contact with the endocrine cells. An- other thing is possible: when all these muscles in the veins are con- tracted the organ becomes smaller and the products of the endocrine function would be forced into the blood. The author tried to prove that this contraction really exists. In using an oncometer he proved this for the adrenals of the guinea pig.—J. K. The relation between the “Hungerblockade” and ADRENAL function Ueber die Beziehungen der Hungerblockade zur Funktion der Nebennieren). Peiser (B.), Munchen. med. Wehnschr., 1921, 68, 521. The author determined the adrenalin content of the adrenals after autopsy and found that the adrenalin content is now much lower than before the war. This is also of importance for the treatment of underfeeding.—J. K. (ADRENALS) The SUPRARENAL apparatus of Teleosts (Sur l'ap- pareil surrénal des Téléostéens). Ramalho (A.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 589-591. Histological.—T. C. B. (ADRENALS) Spasms and blood picture (IKriimpfe und Blutbild). Schaps, Deutsche med. Wehnschr. (Berlin), 1921, 47, 472. Schlund has stated that spasms may produce a temporary exhaustion of the chromaffin system. So they must have the same influence as the removal of an adrenal. This theory is false. Only after an attack of epilepsy symptoms may be seen as observed after removing an adrenal. After the epileptic fit or removal of adrenal the number of lymphocytes may £0 down. But other spasms (as chorea minor or ‘“‘tic convulsif’’) may produce an increased number of lymphocytes. Schlund also states that the blood picture after re- moval of one adrenal is just the opposite of the blood picture after injection of adrenalin and he believes that after removing an adre- nal a hypofunction of the chromaffin system occurs. This is, accord- ing to Schaps, a much too mechanical theory. We know too little of the extremely complicated relations between adrenals, chromaffin system and other organs and the blood picture to draw such simple conclusions from two cases, that have even not been properly studied. —J. K. The action of drugs upon the output of epinephrin from the ADRE- NALS. VII. Physostigmine. Stewart (G. N.) & Rogoff (J. M.). J. Pharmacol. & Exper. Therap. (Balt.), 1921, 17, 227-248. ABSTRACTS 623 Using the cava pocket method, blood was collected and assayed on rabbit intestine. The jntravenous or subcutaneous administra- tion of physostigmine increased the output of epinephrin to 10-15 times the initial output. The stage of augmentation is prolonged and is preceded by a transient diminution. Section of the splanchnic and other nerves to the adrenals appeared to abolish the physostig- mine effect.—F. A. H. The epinephrin output estimated by collecting the ADRENAL blood without opening the abdomen. Stewart (G.N.) & Rogoff (J. M.), Am. J. Physiol. (Balt.), 1921, 56, 213-219. The rate of epinephrin output is approximately the same whether it is estimated on adrenal vein blood collected without open- ing the abdomen or after opening the abdomen.—T. C. B. Post-operative depletion of the epinephrin store of the ADRENALS. Stewart (G. N.) & Rogoff (J. M.), Am. J. Physiol. (Balt.), 1921, 56, 220-229. i “The question of the relative importance of the anesthetic and the trauma in causing post-operative depletion of the epinephrin store of the adrenals, was tested (in rabbits) by removing one adre- nal under local anesthesia, and 5 to 7 hours later, killing the animal and removing the other adrenal. In 12 out of 15 rabbits no evi- dence of depletion was found.’ In the remaining three there was a moderate depletion of the second adrenal. In 25 rabbits which had been previously thyro-parathyroidectomized, 19 showed no deple- tion; 9 showed undoubted depletion of the adrenal last removed. ib, (Ca 18 ADRENAL hemorrhage in new born (Delle emoraggie surrenali nel neonato). Tronconi (S.), Pediatria (Napoli), 1921, 29, 266-274. After referring to infections and dystocia as determining causes of hemorrhage of the adrenals, Tronconi reports from the Pediatric Clinic of milan a case in a girl, four days old. She was born with intense icterus and very poorly developed. Delivery was effected in the beginning of the ninth month, owing to marginal placenta praevia. One hour after delivery the mother died of what the author calls “latent hemophilia.’ The infant died on the fourth day and autopsy revealed a right adrenal as large as a hen’s egg, adherent to the kidney, the diaphragm and the head of pancreas, the gland was transformed into a mere hemorrhagic pocket. The left adrenal was the size of a pigeon’s egs. It was adherent to kid- ney, diaphragm, tail of the pancreas and spleen. It was very much congested, soft and friable, with a pocket of blood, and still retain- ing a thin stratum of cortex. Version, which was done, is easy in a pluripara, hence cannot account for the hemorrhage. There would be more danger from the artificial respiration (Schultze’s method) 624 ABSTRACTS which was instituted. The author suggests hemophilia as, on the whole, the most probable cause of the adrenal condition.—G. V. (ADRENALS) The nervous regulation of purine metabolism (Die nervése Beeinflussung des Purinstoffwechsels). Ullmann (H.) Deutsche med. Wehnschr. (Berlin), 1921, 47, 578. The author tried to determine if the excretion of uric acid after ‘‘piqure”’ or stimulation of the central nervous system with caf- fein goes via the splanchnic and adrenals as in the “‘piqure de Barnard” for glucosuria. The increased excretion in the rabbit of allantoin after injection of caffein does not take place after section of the splanchnics, so it is probable that in the reaction the splanch- nic and the adrenals are of importance.—J. K. Changes in the ADRENAL bodies and the THYROID resulting from inanition. Vincent (S.) & Hollenberg (M.S.), J. Physiol. (Lond.), 1921, 54, lxix-]xxi. The authors reported previously (see Endocrin., 1920, 4, 408), that in the early stages of inanition there was an increase of adrenin in the adrenals, while later the amount was greatly reduced. They now confirm these results by chemical determination of the amount of adrenin by the method of Folin, Cannon and Denis. The thyroids, as well as the adrenals, hypertrophy during inanition, but the colloid substance is almost entirely lacking.—T. C. B. The technic of the removal of an ADRENAL in spasms (Zur Technik der Exstirpation der Nebenniere bei Krampfen). Vorschitz. Zentralbl. f. Chir. (Leipzig), 1921, 48, 370-372. Of technical surgical interest.—J. K. Notes on ADRENAL action. Ward (E. H. P.), Med. Record (N. Y.), 1920, 98, 845-851. Speculative endocrinology. Inverse ADRENIN action (Uber inverse Adrenalinwirkung). Ams- ler (C.), Arch. f. d. ges. Physiol. (Bonn), 1920, 185, 86-92. Nicotine and ergotamine in large doses paralyze the end-ap- paratus of the sympathetic in the frog’s heart. After their action on the ventricle, adrenaline acts in an inverse manner, producing either diastolic standstill or negative ino-and chrono-tropy.—A. T. C. Studies on the changes in fluid volume under ADRENALIN, PITUI- TRIN, pilocarpine and atrophine. Becht (F. C.), Am. J. Physiol. (Balt.), 1921, 55, 277. By connecting the subdural space through a needle with a Mariotte bottle, the volume of fluid displaced by the action of drugs . ABSTRACTS 625 can be accurately measured. The conclusion was reached that the movement of fluid was due entirely to alteration in blood volume within the skull.—T. Cc. B: The effect of the simultaneous administration of ADRENALIN and glucose (Ueber die Wirksamkeit peroraler Adrenalinanwendung bei gleichzeitiger Zufuhr von Traubenzucker). Beumer (H.), Berl. klin. Wehnschr., 1921, 58, 206-207. Beumer administered adrenalin by mouth when glucose was given at the same time, and studied the effect on the amount of blood sugar. No change could be detected in the normal course. —J. K. Have injections of ADRENALIN an influence on the formation of antibodies (Hat Hinspritzung von Adrenalin einen Einfluz auf die Fahigkeit zur Antikérperbildung) ? Bijlsma (U. G.), Centralbl. f. Bakt. (Jena), 1921, 86, 246-247. Borchart (Endocrinology, 1920, 4, 455, and 1921, 5, 253) has stated that injection of adrenalin in man increased the formation of agglutinins after anti-thyroid vaccination. Bijlsma has tried to do the same in rabbits, put came to the conclusion that neither in- jection of adrenalin, nor removal of one adrenal had the slightest influence on the formation of agglutinins.—J. K. On the action of ADRENALIN injections (iber die Wirkungsweise der probatorischen Adrenalininjektion) . Billigheimer (E.), Deutsches Arch. f. klin. Med. (Leipzig), 1921, 136, 1-32. After injection of adrenalin the protein content of the serum quickly rises, but is normal again or even lower one hour after the injection. In rare cases immediately after the injection the protein content sinks. This may be explained by retrograde filtration of fluids from the tissues into the capillaries caused by a decreasing pressure in the dilated vessels or perhaps it is due to a change in the permeability of the vessels. The hyperglycemia after injection of adrenalin has nothing to do with the changes of concentration of the blood. It is caused by irritation of the sympathic fibers of the liver. The irritability may be diminished (low glycemia, grad- ually setting in and passing away), or normal (maximum glycemia+ 1% hour after the injection and lasting during+1 hour. In osteo- malacia the irritability is increased, in Addison’s disease or sclero- dermia diminished. Pilocarpin increases the irritability, atropin diminishes it. The injection of adrenalin may, however, not be used for the functional diagnosis of the sympathic system, for its effect depends also on other facts (irritability of the kidney, quan~ tity of glycogen in the liver, ete.). The most constant change after injection of adrenalin is the change in blood picture (absolute and relative leucocytosis, first increase in lymphocytes, then an increased 626 ABSTRACTS number of polynuclear cells with decrease in the eosinophil cells). It probably acts on the blood-forming organs also. How otherwise can be explained the diminished number of red corpuscles after injection of adrenalin while the concentration of the blood is high. There exists three types of angioneural influence of adrenalin: I. Sympathie form; rapid rise and slow fall of the systolic pressure and rise of the diastolic pressure. This is often accompanied by a diminished pulse rate (stimulation of vagus). II. Parasympa- thetic form: Systolic and diastolic blood pressure both fall; no influence on the pulse. III. Mixed forms: The tracing of the blood pressure depends on the irritability of the vasomotor nerves and on the local conditions of the heart and vessels.—J. K. Reversal of the depressor action of small doses of ADRENALIN. Collip (J. B.), Am. J. Physiol. (Balt.), 1921, 55, 450-454. The depressor effect of small doses of adrenalin may be con- verted into a pressor effect by increasing the depth of the anesthesia, and vise versa. Decreasing the H-ion concentration of the blood by sodium bicarbonate will convert a depressor effect into a pressor effect. The same procedure will increase the pressor effects of mod- erate doses of adrenalin, while raising the p. H. of the blood will lessen the pressor effects of moderate doses.—T. C. B. (ADRENIN) On the presence of vasoconstrictor substances in the blood of ricket (Sulla presenza di sostanze vasocostrittrici nel sangue dei rachitici). Cozzolino (O.), Pediatria (Napoli), 1921, 29, 1-11. Blood from two normal and fifteen rachitie patients was tested by the frog preparation method, in an attempt to demonstrate the presence or absence of adrenin or other vasoconstrictor substance. Results were negative and are reported as indicating “‘the useless- ness of trying to reach valuable conclusions either in favor of, or opposed to adrenal or other endocrin pathogeny of rickets.’’—G. V. The influence of papaverin on the increase of blood pressure by ADRENALIN in man (Die Wirkung des Papaverins auf die Adre- nalinblutdrucksteigerung beim Menschen). Csépai (K.), Wien. klin. Wehnschr., 1921, 34, 186. Pal has stated that papaverin inactivates the influence of adre- nalin on blood pressure. This is true in the dog, but not in man. In man papaverin increases the rise in blood pressure, when it is already raised by adrenalin.—J. K. The influence of ADRENALIN on the blood (L’azione dell’ adrenalina sul Sangue). Dazzi (A.), Ii Morgagni (Milano), 1921, 64, 93-112. The injection of 1 milligram of adrenaline in man is always followed by an increase in the number of red corpuscles and of leu- ABSTRACTS 627 cocytes. This augmentation is not very important and is transitory for the red corpuscles. In the white corpuscles, first the lymphocytes increase in number, then the polynuclear neutrophils increase, while the lymphocytes have reached their normal number again. The lymphocytosis is due to the action of adrenalin on the spleen, by stimulating the muscle fibers to contract. The increase in number of polynuclear cells is due to the action of adrenalin on the blood vessel coming from the bone-marrow.—J. K. (ADRENIN) The role of acids in carbohydrate metabolism. IV. The relation of acids and alkalies to adrenalin glycosuria (Ueber Rolle der Siure im Kohlenhydratstoffwechsel. IV. Mitt. Die Bezeihung von Siure und Alkali zur Adrenalinglykosurie) . Elias (H.) & Sammartino (U.), Biochem. Ztschr. (Berl.), 1921, 117, 10-40. Acid glycosuria differs from that produced by puncture or adrenalin in that it causes no increase in volume of the liver. Sub- cutaneous adrenalin injection produces a marked acidosis in rabbits and a 3-fold increase in the lactic acid content of the liver. This increase in lactic acid production begins within the first hour after the adrenalin injection and lasts for at least 3.5 hrs. Further per- fusion experiments on livers of cold blooded animals showed that the sugar mobilization effect of adrenaline is inhibited by alkali. This inhibition can be removed if the alkali is neutralized by acid. It is, therefore, concluded that the acid produced by the injection of adrenaline is an important factor in the origin of the subsequent glycosuria.—F’. S. 15i. Researches on the reaction of human heart to ADRENIN (Ricerche sulla reazione del cuore umano all’adrenalina). Fulchero (A.), Riforma med. (Napoli), 1920, 36, 1147-1150. Fulchero, at the University of Torino, carried out an experi- mental study on 59 human subjects. His results indicate that con- trary the affirmation of Roth, epinephrin injections (1.0-1.5 mgm.) cannot be regarded as always affording evidence of cardiac lesions. The epinephrin test of the functional condition of the heart may bring out different reactions according to the condition of the en- docrine system of each patient. The test might be valuable as an index of myocardial tonicity; i. e., an accentuated hypertension with- out extrasystoles would indicate right myocardial involvement only; a moderately increased pressure with extrasystoles would indicate involvement of the left myocardium. Due allowance should be made for increased excitability. Increased excitability and dimin- ished tonicity of the myocardium are best shown by adrenalin injec- tions. This condition is especially found in severe myocarditis, in cardiosclerosis and very often in pernicious anemia. In this latter 628 ABSTRACTS condition the adrenalin test is recommended as affording a valuable auxiliary sign.—G. V. Hypertension produced by isotonic solutions following injection of ADRENIN (Sur l’hypertension produite par les solutions iso- toniques a la suite d’une injection d’adrénaline). Garnier (M.) & Schulmann (E.), Compt. rend. Soc. de biol. (Paris), 1920, 83, 1619-1621. If a rabbit is given an injection of an active dose of adrenalin there is a rise of blood pressure which is transitory; it returns to normal in about two minutes and a half. But the animal remains under the influence of the adrenalin, for the injection of 1 to 2 cc. of physiological saline solution will cause a second rise of pressure that may be as marked as the first. The duration and degree of hypertension depends upon the time which elapses between the in- jection of adrenalin and the injection of saline. For instance, if seven minutes elapse, the saline causes but a feeble hypertension. ——T. 1C. 1B: (ADRENIN) V. Further studies on the antagonistic action of epine- phrin to certain drugs upon the tonus and tonus waves in the terrapin auricles. Gruber (Chas. M.), J. Pharmacol. & Exper. Therap. (Balt.), 1921, 16, 405-413. The increased tonus produced by nicotine is decreased by strong solutions of adrenalin chloride. Likewise the increased tonus and tonus waves produced by digitalis are reduced by adrenalin. Adre- nalin acts similarly toward the tonus waves set up by barium chloride, except to a lesser extent.—F. A. H. The influence of ADRENIN on gastric secretion (Der Einfluss des Adrenalins auf die Sekretion des Magensaftes). Hess (W. R.) & Gundlach (R.), Arch. f. d. ges. Physiol. (Bonn), 1920, 185, 122-136. Adrenaline inhibits gastric secretion (dogs) at whatever phase of secretory activity it be injected, and whether injected intra- muscularly or intravenously. The intensity of action is independent of the amount injected. The effect lasts at least 15 minutes (intra- yenous injection) and at most 200 minutes (intramuscular injec- tion). Usually both total quantity and concentration are decreased. These results do not agree with Yukawa’s. The cause is not psychic. The results suggest that the (thoracic) autonomic nervous system has a marked effect on the activity of the gastric glands, antago- nistic to the chief factor in vagus action, and also that the secretory and motor functions of the stomach are associated in like sense, and their regulation is associated with physiological additions of adrenaline to the blood.—A. T. C. ABSTRACTS 629 On the diminished permeability for sugar of the kidney in experi- mental ADRENALIN diabetes (Ueber die sogenannte Nierendich- tung gegen Zucker beim experimentelle Adrenalindiabetes ) . Hildebrand, Berl. klin. Wehnschr., 1921, 58, 422. Data reported elsewhere.—J. K. The action of ADRENALIN on striated muscles (Ueber die Wirkung des Adrenalin auf die Skelettmuskulatur). Lange (H.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 578. Adrenalin diminishes the permeability of the sarcolemma and changes the irritability of the muscle. Only a small note without details.—J. K. The change of blood pressure after injection of ADRENALIN as a method of determining the tonus of the vegetative nervous system Die Blutdruckveriindrung nach Adrenalininjektionen als Grad- messer fiir den Tonus im autonomen und sympathischen Nerven- system). Lehmann (G.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 41-42. Dresel has published a method for the easy diagnosis of vago- tonia or sympathicotonia. He injects 1 cc. of adrenalin solution and measures the blood pressure. In healthy individuals the line of blood pressure has a parabolic form, in vagotonia S-shaped, in sympathicotonia the blood pressure rapidly increases and rapidly falls to the norm given. Lehmann controlled this method and compared it with the result of pharmacological tests and with the reflexes of Czermst and Aschner (influence of pressure on vagus or on the eyes upon the heart). The results of these tests are nearly never the same and the author believes that Dresel’s method has no clinical value. The tracings of the blood pressure as they are given by Dresel are extremely rare.—J. K. (ADRENIN) On the duration of constriction of blood vessels by epinephrin. Meltzer (S. J.) & Auer (John), J. Pharmacol. & Exper. Therap. (Balt.), 1921, 17, 177-196. The effect of epinephrin on the vessels of the ear was studied by ocular examination. A subcutaneous injection of epinephrin into the ear of rabbits causes a constriction of all the vessels of that ear. Smaller doses (1 cc., 1:100,000) affected the arterioles more, caus- ing but a moderate constriction of the central artery; with larger amounts (0.3 ec. to 1.0 ce., 1:1,000) the central artery was greatly constricted and the veins decreased in size. The constriction endured for three to eight hours. The latent period of the constriction is shorter the nearer the site of injection to the central artery. In subcutaneous injections the epinephrin apparently reaches the mus- cular sheath through the adventitia and not through the intima 630 ABSTRACTS from the lumen of the vessel. Constricted vessels tend to become dilated when constriction passes off. Simultaneously with the con- striction in the injected ear there appears to bea transient dilatation of the vessels in the opposite ear.—F. A. H. The action of ADRENIN on protein stored in the liver (Die Wirkung des Adrenalins auf das in der Leber gespeicherte Eiweiss). Stiibel (H.), Arch. f. d. ges. Physiol. (Bonn), 1920, 185, 74-85. Stiibel of Jena reports the results of an investigation of the ef- fects of adrenin in the liver. It was found that injections of this drug result in the disappearance of the microscopically visible pro- tein stored in the liver.—A. T. C. (ADRENIN) Epinephrin hyperglycemia. Tatum (A. L.), J. Phar- mocal. & Exper. Therap. (Balt.), 1921, 17, 336-337. It was found that phloridzin sufficient to produce hypogly: cemia produces a fall in alkaline reserve capacity of whole blood. Epinephrin injected subcutaneously in conditions of low reserve from “phloridzin acidosis’ causes a rise in blood sugar without further fall in alkaline reserve capacity of blood. Hydrochloric acid by stomach produces a marked fall in reserve capacity with but little change in sugar. Epinephrin injected under these conditions pro- duces the usual amount of glycogenolysis with no further significant change in alkaline reserve capacity. For a given fall in reserve by hydrochloric acid by stomach and by epinephrin subcutaneously injected, the resultant glycogenolysis from epinephrin is so very much greater than that produced by hydrochloric acid as to be essentially incomparable. Previous induction of acidosis by hydro- chloric acid does not considerably increase or decrease the efficacy of epinephrin as a glycogenolytic agent. There appears to be no demonstrable evidence of any interdependence between epinephrin glycogenolysis, as judged by hyperglycemia, and the fall of alkaline reserve capacity as usually found to occur after subcutaneous injec- tions of epinephrin in normal animals. Glycogenolysis and acid production appear to be merely concomitant and independent phe- nomena following epinephrin injections.—F. A. H. The influence of injections of ADRENALIN on the white cell count (Die Veriinderungen des weissen Blutbilden nach Adrenalininjek- tionen). Walterhofer (G.), Deutsche Arch. klin. Med. (Leipzig), 1921, 135, 208-223. Subcutaneous or intravenous injection of adrenin always causes a leucocytosis. This increase begins quickly after the injection and is transitory. Neutrophil cells as well as lymphocytes are increased. The lymphocytosis passes quicker than the neutrophil leucocytosis; the so-called ‘‘biphasical-blood picture’ is not often observed. The intensity of lymphocytosis is independent of histological changes iu ABSTRACTS 631 the organs. It has been said that the lymphocytosis is due to con- traction of the spleen, but this is not proven. The contraction of the spleen does not go parallel with the number of lymphocytes. The leucocytosis after injection of adrenalin is not due to an unequal division of the cells in the body, but to an actual increase in number. —J. K. [Blood sugar in ether narcosis]. Boggild (D. H.), Ugesk. f. Laeger. (Copenhagen), 1920, 82, 1365. Boggild determined the glucose content of the blood in 3% cases of ether narcosis, using the Hagedorn-Jensen method. Hyper- glycemia was constantly found and is considered a typical phe- nomenon. This hyperglycemia should not be considered as a result of diminished oxydation of the organism as former authors have regarded it; the long duration of the hyperglycemia indicates 2 certain resemblance between the conditions of narcosis and those of diabetes mellitus.—K. H. K. (CAROTID BODY) A case of perithelioma of the ganglion inter- caroticum. Thomson (J. Oscar), China M. J. (Shanghai), 1920, 34, 32-33. The tumor ‘1% by 1 inch in diameter was a chronic, circum- seribed, primary perithelial neoplasm” and on its removal, the patient made an uneventful recovery. The literature is briefly dis cussed.—E. V. C. (CORPUS LUTEUM) The ovarian cycle of swine. Corner (G. W.),; Science (Garrison, N. Y.), 1921, n. s. 53, 420-421. The author studied 22 sows covering practically every day of the 21-day cycle. It was found that one or two days before the on- set of the oestrous some of the follicles enlarge from one and one- half to twice the diameter of the reserve follicles. Ovulation occurs on the second of the three days of oestrous. The corpora lutes reach full histological complexity about the seventh day. They remain in a state of full development until the fourteenth or fif- teenth day after discharge of follicles, when they begin to disin~ tegrate. By the time of the next ovulation they have diminished to a little more than their original size. During the second inter- oestral interval they shrink further so that they are not readily dis- tinguishable. That the corpus luteum persists until the fourteenth to fifteenth day harmonizes with the hypothesis that it aids in the fixation of the ova for the embryos gain attachment from the tenth to fifteenth day after ovulation.—F. A. H. The CORPUS LUTEUM of pregnancy. Is it a cholesterol-formins organ? (Le corps jaune de la grossesse. Est elle une organt 632 ABSTRACTS cholestérinigénique) 2? Gross (A.), Gynec. et Obst. (Paris), 1921, 3, 73-80. A critical review of the literature and ideas concerning the origin and function of cholesterol in the organism, the result of which leads Gross to the opinion that the hypercholesterinemia of pregnancy is not connected with any alleged cholesterol forming power of the corpus luteum.—F. S. H. The influence of the lipoids of the CORPUS LUTEUM and PLA- CENTA on bleeding, menstrual cycle and other phenomena (Der Einfluss eines Corpus luteum resp. Plazentar lipoids auf Blutun- gen, menstruellen Zyklus und Ausfallsercheinungen). Herrmann E.), Monatschr. f. Gebs. u. Gynak. (Berl.), 1921, 54, 152-164. Clinical studies of the effects of the injection of lipoid materia! from corpus luteum and placenta on menstruation, ete. Seventy- three cases in all were studied, divided into the 6 groups: pollako- menorrhagia (8 cases), menorrhagia (15 cases), metrorrhagia with inflammation (16 cases), metrorrhagia with normal genitalia (15 cases), juvenile metrorrhagia (5 cases), climacteric metrorrhagia (4 cases), others (24 cases). In 60% of the cases and 6 to 8 months after cessation of treatment, all the cases that were observed showed an altered menstruation cycle, which lasted for several months. Moreover, the excessive bleeding was controlled in 83% of the cases after 5 to 9 injections of the lipoid. The cases of menorrhagia and metrorrhagia with normal genitalia reacted best. Climacteric dis- _ turbances were temporarily improved, but not permanently. ——, S. H. The CORPUS LUTEUM of menstruation and pregnancy. A review of a monograph by John C. Dalton, Jr., M. D. Morley (W. H.), N. York M. J. (New York), 1921, 113, 230-232. Review of a paper by Dalton which appeared in the trans: actions of the American Medical Association, 1851, volume IV —H. W. (DIABETES) Physiology and pathology of carbohydrate metabolism (Zur Physiologie und Pathologie des Kohlenhydratstottwechsels ) . Arnoldi, Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. By estimation of blood sugar and gas analysis it is possible to prove that the administration of glucose, injections of suprarenin, psychic excitement, CO, baths, have all a marked influence on metab- olism, but not the same in the healthy persons as in persons with diabetes. (No details given).—J. K. Experimental facts on “working” treatment of DIABETES (Experi- mentellen Grundlagen einer Arbeitstherapie der Diabetes). Biirger, Deutsche med. Wehnschr. (Berlin), 1921, 47, 611. .- ABSTRACTS 633 Blood-sugar falls during work and for some time after. In artificially increased blood-sugar less is excreted during work than during rest. When sugar is given the respiratory quotient rises less during work than when the patient rests. Work tends to diminish the glucosuria but to increase the glycemia.—J. K. Sudden death in DIABETES without coma (Plotzlicher Tod bei Diabetes ohne Koma). Denecke (G.), Miinchen. med. Wehnschr., 1921, 68, 398-399. A patient with serious diabetes died in 5 days without “‘Kuss- maul-respiration” or acetone or diacetic acid in the urine. Probably the cause of death was situated in the heart. No post-mortem is reported.—J. K. The changes in the brain in DIABETES and the pathophysiology ot sugar regulation (Die zerebralen Veriinderungen beim Diabetes mellitus und die Pathophysiologie der Zuckerregulation). Dresel (K.) & Lewy (F. H.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. The brains were examined in 4 patients who had died in coma diabeticum. In all cases pathological ehanges were found in tha globus pallidus; the nucleus periventricularis was normal. The authors believe that the relative amount of blood sugar is regulated on the nucleus periventricularis, the absolute amount is regulated in the globus pallidus.—J. Ke (DIABETES ) Hyperglycemia and glucosuria (Zur Hyperglykamie und Glykosurie). Eisner (G.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. An increase of carbohydrates in the diet produces a temporary rise of blood sugar. This rise is specially marked in patients with sympathicotonia or with increased function of the chromafiin system. Hypophysin diminishes adrenalin hyperglycemia as well as the ali- mentary form. Therefore, it is possible that the alimentary hyper- glycemia is due to glycogen-mobilization in the liver via the sym- ' pathetic and chromaffin system. If this is true there does not exist a real difference between adrenalin and alimentary hyperglycemia. ——J. Ke DIABETES. Elias, Wien. klin. Wehnschr., 1921, 34, 190. By intravenous injection of solutions of Na, HPO, or NaH.PO, it is possible to decrease the blood sugar in diabetes or in alimentary glucosuria. These injections have no influence on the normal blood sugar. In one case of very serious diabetes with acidosis and lipemia no influence on the blood sugar was seen. Injection of other salts tend to increase the blood sugar.—J. K. 634 ABSTRACTS DIABETES of bearded women (Le diabetes des femmes a barbe). Emile-Weil (P.) & Plichet, Compt. rend Soc. de biol. (Paris), 1921, 84, 18-15. Description of a woman who, at the age of twenty-six, developed a facial hypertrichosis, and at thirty-one, diabetes. Autopsy showed total sclerosis of the ovaries. No microscopic lesions of the supra- renals nor of other blood vascular glands were found. Two other reported cases are given and discussed from the viewpoint of the interfunctional relation of the endocrine glands.—T. C. B. (DIABETES) Studies on the threshold for GLYCOSURIA. Faber (K.) & Norgaard (A.), Acta med. seand. (Stockholm), 1921, 54, 289-322. There are described two cases of chronic glycosuria, persisting all through the twenty-four hours even though the blood sugar vol- ume did not exceed the normal. After the ingestion of carbohydrates the blood sugar percentage rose in the normal way and glycosuria increased. By five days fasting the blood sugar value in the first patient might be forced down to 0.06%, the glycosuria being then kept at 1.5%, whereas at an ordinary diet rich in carbohydrates it was 5-6%. The persistent, and in the one case, considerable, gly- cosuria caused no morbid symptoms, the patient feeling perfectly well on ordinary diet. In both cases the glycosuria was shown to have been present during many years. In one case similar relations were found in a brother. The cases are most readily explained by assuming an individual low renal threshold for glycosuria. Under the term of cyclic glycosuria are described cases of glycosuria in which the urine is regularly sugar-free in the morning, but contains sugar in the course of the day after the ingestion of meals rich in carbohydrates. In certain cases such cyclic glycosuria appears without the blood sugar value exceeding the normal level. These cases are termed cyclic glycosuria of the renal type. Such a new case is described, in which glycosuria appeared even though the sugar value did not exceed 0.102%. In 32 diabetics the renal thres- hold for glycosuria has been determined at the point of time when the patient’s glycosuria is about to cease consequent on a fasting treatment. The threshold values varied between 0.08 and 0.19%. In 16 of these patients the threshold level was determined several times (up to four times) in the same patient under identical condi- tions; that is to say, during fasting. The threshold in these cases was found to lie at the same level. The longest interval between the determinations was 20 months. There are thus great individual variations for the threshold level in diabetes.—J. A. H. DIABETES (Die Mehlfriichtekur) . Falta, Deutsche med. Wehnscbhr. (Berlin), 1921, 47, 609. See Endocrinol., 1921, 5, 233.—4J. K. ABSTRACTS 635 Renal DIABETES (Ueber Nierendiabetes). Frank (E.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. The cause of renal diabetes is unknown. It is not true, as often stated, that the quantity of sugar excreted is perfectly independent of the quantity that is ingested. The glucosuria in pregnancy is a form of renal diabetes. The prognosis is good. For the diagnosis, determination of the blood-sugar is necessary.—J. K. Trauma and DIABETES (Trauma en diabetes). van Gelderen (D. N.), Geneesk. Tijdschr. Ryksverzekeringsbank (Amst.), 1921, 6, 78-88, 104-112. A man suffering from diabetes stuck a nail into one of his feet. He died some time later in coma diabeticum. The author believes that in this case death was caused by the injury.—J. K. Assimilation of caramel in DIABETES (Ueber Assimilation von Karamel bei Diabetikern). Grafe, Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. The author recommends the use of caramel (Karamose from Merck) in wine or cognac during acidosis. It is possible to make caramel not only from sugar, but from all kinds of flour when some fat is added. In most cases the tolerance for these preparations is very much higher than for carbohydrates.—J. Ke Frequency of disturbances of arterial permeability in the lower limbs in diabetics (Fréquence des troubles de la perméabilité arterielle aux membres inférieurs chez les diabétiques). Heitz (GE) aewluiset mém. Soc. méd. de hop. de Par., 1921, 45, 706-711. Not of endocrine interest.—F. 5. H. The theory of the treatment of DIABETES (Zur Theorie der Dia- betestherapie). Isaac (S.), Therap. Halbmonats. (Berlin), 1921, 35, 129-134. The author recommends carbohydrate cures, preceded and fol- lowed by ‘‘vegetable days.” Urine-analysis does not give sufficient information to establish the tolerance. For this blood-sugar esti- mations are necessary.—J. K. Fasting treatment of DIABETES (Les cures de jeune chez les dia- bétiques). Labbe (M.), Bull. et mem. Soc. méd. d. hop. de Par., 1921, 45, 684-694. In diabetes where denutrition has not occurred the fasting method of treatment leads to good results. The glucosuria dis- appears, no acidosis appears if it has not already been present, al- though some slight acetone and diacetic acid excretion may take place. There is some loss of nitrogen, and body weight. The arte- 636 ABSTRACTS rial pressure is but little less during the treatment. In cases where emaciation is present the fasting treatment affords only a passing relief.—F. S. H. (DIABETES) The decomposition of carbohydrates in muscle (Ueber den Abbau der Kohlenhydrate im Muskel). Laquer (F.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. The author shows that glycogen is more readily used by the muscle than is glucose. He believes that in diabetes the formation of glycogen from glucose is insufficient and that this is the reason why insufficient carbohydrate is oxidized.—J. K. Creatinuria and acidosis in DIABETES (Kreatinurie und Azidosis bei Diabetes). Lauritzen (M.), Zeitschr. f. klin. Med. (Berlin), 1921, 90, 375-385. Creatin may be found in urine in acidosis, but it may also be present in light cases of diabetes without acetonuria. Probably acidosis as well as creatinuria are due to defective carbohydrate metabolism. A marked permanent creatinuria is a bad prognosis. —J. K. (DIABETES) The blood sugar in old age (Das Verhalten des Blut- zuckers im hoheren Alter). Loéffier (W.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. In elderly people the administration of 20 grams of glucose in 100 ce. water by mouth produces a rise in blood sugar above that found in younger persons. The fall to the original level is also much prolonged. The same reaction is seen in diabetes, hence it can only be very carefully used for the diagnosis of diabetes in the aged. —J. K. Organothrapy in DIABETES (Organtherapie des Diabetes). Loéning (K.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. A new substance has been prepared from pancreas, and is called metabolin. It antagonizes adrenalin glucosuria. A similar sub- stance can be made from yeast. The author obtained good results with it in diabetes.—J. K. Gangrene in DIABETICS (A propos des gangrénes des mémbres chez les diabétiques). de Massary (E.) & Girard (J.), Bull. et mém. Soc. méd. d. hép. de Par., 1921, 45, 670-674. Not of endocrine interest.—F. S. H. Old and new in the treatment of DIABETES (Das Neue und das Alte in der Diabetestherapie). Minkowski, Deutsche med. Wehnschr. (Berlin), 1921, 47, 609. ABSTRACTS 637 Real diabetes is due to a disturbed function of the pancreas. The other endocrine organs have an influence on the degree of glu- cosuria. How the pancreas acts is unknown. It certainly does not act only by diminishing the formation of sugar in the liver. Pan- creatic diabetes cannot be explained as an adrenalin glucosuria. A normal function of the pancreas is necessary for a normal ecarbo- hydrate metabolism. The Allen treatment, if carefully used, may be followed by splendid success.—J. K. The use of a high fat diet in the treatment of DIABETES mellitus. Il. Newburgh (L. H.) & Marsh (P. L.), Arch. Int. Med. (Chi- cago), 1921, 27, 699-705. A report of the effects of a high fat diet on the blood sugar which indicates that in uncomplicated diabetes the blood sugar is reduced when a high fat diet is instituted and maintained.—F. S. H. Treatment of DIABETES (Diabetestherapie). von Noorden, Deutsche med. Wchnschr. (Berlin), 1921, 47, 609. A description of the dietetic treatment.—J. K Syphilitic origin of DIABETES (L’origine syphilitique du diabete) . Pinard (M.) & Velluot, Bull. et mém. Soc. méd. d. hop. de Par., 1921, 45, 760-771. Favors the idea of a syphilitic causation of diabetes.—F.. S. H. Emaciation in DIABETES (L’amaigressement des diabétiques). Rathery (F.), Bull. gén. de thérap. (Paris), 1921, 172, 216-217. Three varieties of diabetic emaciation are distinguishable: the pathological, the dietary and the therapeutic.—F. S. H. The alveolar carbon dioxide tension in DIABETES (La tension de CO, dans I’ air alveolaire chez les diabétiques). Rathery (F.) & Bordet (F.), Bull et mém. Soc. méd. d. hop. de Par., 1921, 45, 498-502. Since in general there is found a lower CO. tension of the alveolar air in diabetes the authors consider that the determination of this furnishes suggestive information to the clinician with regard to the condition of acidosis of the patient.—F. S. H. The differential diagnosis between DIABETES and glucosuria in pregnancy (Die Differentialdiagnose der Schwangerschaftsgly- kosurie und des Diabetes bei Schwangerschaft). Salomon (GELS); Miinchen. med. Wchnschr., 1921, 68, 386-388. There exist three forms of glucosuria in pregnancy: 1. Traces of sugar are excreted even when no carbohydrates are given. 2. When a certain amount of carbohydrates are given sugar is found 638 ABSTRACTS in the urine. When, however, more carbohydrates are given the sugar does not increase or very little. 3. A certain percentage of the carbohydrates are excreted as sugar. These very rare cases may only be distinguished from diabetes by determining the amount of blood sugar. Generally, when the blood sugar is not increased, there is no diabetes, but glucosuria. The groups 2 and 3 are always more or less looked on with suspicion and the diagnosis glucosuria is often only possible after many years.—J. K. The therapeutic importance of acidosis in DIABETES (Ueber die therapeutische Bewertung der Azidosis im Diabetes). Salomon (H.), Wien. klin. Wehnschr., 1921, 34, 185-186. The author recommends the use of a strict non-carbohydrate diet in diabetes. From time to time some carbohydrate-days may be allowed. Practitioners are too much afraid of acetonuria or keto- nuria. Many patients have a marked ketonuria during many years without going into coma. It is, however, not advisable to begin this strict diet at once, but to change the diet gradually. It is important not to give too many proteins or too much fat (Cream!). Alkalies must be given regularly. When the quantity of acetone increases a carbohydrate-day is indicated. It is necessary to attend to the general condition of the patient.—J. K. Identification of the aldehyde-like body in the urine of patients with DIABETES (lIdentifizierung der aldehydartig reagierenden Sub- stanz im Harn von Diabetikern). Stepp (W.) & Feulgen (R.), Deutsche med Wehnschr. (Berlin), 1921, 47, 610. Stepp had preveiously found in the urine of patients with aci- dosis an aldehyde which was probably acetaldehyde (Endocrinology, 1921, 5, 261). He now identifies it as acetaldehyde by estimation of the melting-point of its compound with dimethyleyclohexandion. Even 50% of the total acetone may consist of acetaldehyde. Traces of it may be found in normal urine.—J. K. The relation between blood sugar and acidosis and its importance for the pathogenesis of DIABETES (Ueber die Beziehungen des Blutzuckers zur Blutazidose und derem Bedeutung fiir die Patho- genese des Diabetes mellitus). Toenniessen (E.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. There is no relation between the absolute amount of sugar and ketone-bodies in the blood.—J. K. (DIABETES) Acidosis and administration of fat (Acidosis und Fettzufuhr). Uhlmann (R.), Ztschr. f. arztl. Fortbild. (Jena), 1921, 18, 189-192. A short article in which the author points out that in serious diabetes it is not enough to reduce the quantity of carbodydrates ABSTRACTS 639 and proteins in the diet, but that the amount of fat must be also restricted.—J. K. Changes in inorganic metabolism in DIABETES (Ueber eine min- eralische Stoffwechselst6rung beim Diabetes mellitus). Veil (W. H.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. The author studied the polyuria in diabetes. He found most remarkable changes, for in a patient in a sugar-free period with a low elimination of chlorine, a large dose of NaCl produced glu- cosuria and ketonuria. Extract of ovary raised the NaCl elimina- tion and diminished the glucosuria.—J. K. DIABETES INSIPIDUS. Van der Heide (C. G.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1921, 65, 590. Data reported elsewhere.—J. K. A case of hereditary DIABETES INSIPIDUS (Een geval van heredi- tairen diabetes insipidus). Janzen (B.) & Broekman (J.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1921, 65, 2519-2531. A description of a patient with diabetes inspidus and tubercu- losis of the lungs. The x-ray of the sella turcica did not show any changes. It was remarkable that in the same family many other eases were observed. The familiar diabetes insipidus is very rare. In these cases the patients feel quite well, are able to do their work and can reach an old age. The symptoms generally begin in infancy and increase till the age of 25. Later on the symptoms gradually disappear. Blood pressure is normal. Sometimes during pregnancy the thirst and polyuria become worse. There are many points of resemblance between diabetes insipidus and diabetus mellitus. Both may be of endocrine origin; both may be produced experimentally from the mid brain; in Graves’ disease glucosuria as well as polyuria may occur. There exist hereditary forms of both diseases. Both diseases may be observed in one family.—J. K. DIABETES MELLITUS with INFANTILISM (Diabete mellito con infantilismo). Amenta (F.), Pediatria (Napoli), 1921, 29, 249- 253. A report of a case of diabetes in a boy 8 years old. The condi- tion began when he was one year old. He is now an underdeveloped rickety child, with rosary and dark skin. According to Amenta, the case might be classified as diabetes mellitus with Bramwell and Rentoul’s pancreatic infantilism, but it is believed by the author that the infantilism is due merely to chronic acidosis and intoxica- tion.—G. V. A case of DIABETES MELLITUS treated successfully by novarseno- benzol. Porter (F. J. W.), Lancet (London), 1920, (ii), 1051. 640 ABSTRACTS A case is recorded of a diabetic patient in which the adminis- tration of three doses of novarsenobenzol caused the disappearance of sugar from the urine, and the patient had remained practically sugar-free for the 7 months since the treatment. The diet is not indicated, except that the amount of carbohydrate had been gradually increased without any apparent ill effect.—L. G. K. DIABETES MELLITUS. Toenniessen (E.), Miinch. med. Wehnschr., 1921, 68, 523-524. A general review.—J. K. DWARFISM and GIANTISM. Case of each reported. Shuman (J. W.), Med. Herald (Kas. City), 1921, 40, 49-51. Report of a case of dwarfism and one of giantism with few data. Nothing new.—C. M. W. The EMOTIONS (Breve ensayo sobre la edad y la emocién). Maranon (G.), Arch. de med. cirug. y especialid. (Madrid), 1921, 3, 337- Bas IE A general theoretical discussion including a consideration of the part played by the endocrin organs in the genesis and manifesta- tion of emotion.—R. G. H. (ENDOCRINE) The clinical significance and therapeutic indications of abnormal blood pressure. Blumgarten (A. S.), Med. Record (N. Y.), 1920, 98, 856-859. The hypertension of nephritis, that of arteriosclerosis, and also essential hypertension are discussed. The group of climacteric hypertension cases is then referred to; outside of obesity and very high systolic pressure, in these nothing abnormal is found. Lutein or ovarian extract is often highly beneficial in reducing the blood pressure in these cases. Hypotension, unassociated with such condi- tions as anemia, tuberculosis, hemorrhage, etc., is usually merely an individual marking of an endocrine disturbance such as acromegaly or Fréhlich’s syndrome, or adrenal insufficiency. The author has not obtained much benefit from administering pituitary, thyroid or adrenal for such hypotension, though he recommends their trial. —H. L. ENDOCRINASTHENIA. Garretson (W. V. P.), N. York M. J. (New York), 1921, 113, 221-225. According to the writer, it is an expression of ignorance to label a patient with such terms as hysteria, psychasthenia, neuras- thenia, functional neuroses, ete. Individuals so classed are sufferers of “endocrinasthenia,” that is, dysfunction or perversion of the endocrine dominance. When endocrine exhaustion occurs, then, and ABSTRACTS 641 not until then, does the psyehoneurosis or psychosis, as the case may be, become apparent. Endocrinasthenia not only occurs as a result of exhaustion reactions as expressed through the nervous system, but is always present as a sequel to every disease process, and more par- ticularly the acute infections. All toxic states exhaust the glands of internal secretion and the degree of infection and toxemia depends upon the qualitative and quantitative balance of the hormones. That to which we have loosely referred as body resistance is de- pendent upon this balance. We all possess in varying degrees bi- sexual traits psychical (evident or repressed) as well as structural. The many victims of sexual perversion are those in whom there exists inherently an endocrine predominance (gonadal with either pituitary or suprarenal valencies) creative of heterosexual characteristics. The psychic manifestations of these pitiable types are purely symp- tomatic; the basis of the conditions is a physical one. By psycho- analysis an interpretative symptomatic understanding may be ob- tained, but here again to produce the complete and permanent cure, an attempt to effect physiological hormonic adjustment is essential. Every anaphylactic or shock reaction produces hypoadrenia with resulting vagotonia. Vaccines or sera serve to stimulate selectively the endocrine system to the further production of hormones which are the immunizing factors of the body. Four case reports of “endocrinasthenia”’ appended.—H. W. A case showing ENDOCRINAL disturbance. Pope (C.), Kentucky M. J. (Bowling Green), 1921, 19, 21-25. Report of a case of a boy, age fifteen, who, after a series of pro- found toxaemias—influenza, suppurative appendicitis, gastro-intes- tinal toxaemia, suppurative bed sores, and burns—developed marked disturbances of pluriglandular nature, involving especially the pitui- tary. There was a marked change in growth, mentality and disposi- tion. The body growth shows some signs of early hypersecretion and later hyposecretion of the pituitary gland.—C. M. W. Amenorrhea and sterility due to functional ENDOCRINE disturb- ances. Watkins (Thomas J.), Surg. Clinics of Chicago (Phila.), 1919, 3, 1477-1479. A woman, aged 31, whose illness consists in irregular men- struation with periods of amenorrhea, rapid-increase in weight, sterility, and extensive and abundant growth of hair over various parts of her body is reported. Improvement followed dilation of the cervix uteri and the administration of five grain capsules of corpus luteum three times daily. Later thyroid extract was added to the medication.—J. F. Congenital cardiopathies; hemolytic jaundice; hypertrophic cirrhosis; pluriglandular ENDOCRINE DYSFUNCTION and infantilism from 642 ABSTRACTS hereditary syphilis (Cardiopatia congenita; Icteria hemolitica; Cirrosis hipertrofica; Disendocrinia pluriglandular y juvenilismo por heredosifilis). Padilla (T.), Rev. Assoc. Med. Argen. (Buenos Aires), 1920, 32, 306-316. Report of a case of nanism of hereditary syphilitie origin. —B. A. H. ENDOCRINE exhaustion. Hoxie (G. H.), N. York M. J. (New York), 1921, 113, 225-227. Cites two cases illustrating the various points of difference be- tween true neurasthenics and those with endocrine exhaustion. All endocrine anomalies are not congenital, but many are the result of accidents occurring in adolescence and early adult life. Subjects of these latter furnish material for gratifying therapy. An endo- crine want or exhaustion may be considered responsible for many so-called neurotic conditions, especially when the neuroses disap- pear following glandular therapy. The entire paper manifests a conservative attitude, such as is unfortunately rare in articles along this particular line.-—H. W. Influence of ENDOCRINE SECRETIONS on phloridzin glucosuria (Einflusz von Inkreten auf die Phloridzinglucosurie). Grote, Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. Sympathicotonic persons, especially when thyreotoxic symptoms are present, show a very marked glucosuria after the injection of phloridzin. Patients with cancer or myxedema excrete very little sugar after such an injection. Injection of thyroid extract tends to augment phloridzinglucosuria, injection of thymus to diminish it. —J. K. (ENDOCRINE GLANDS) Epithelial and paraepithelial glands (Glandes épithéliales et glandes paraépitheliales). Bujard (E.), Compt. rend. Soe. de biol. (Paris), 1921, 84, 498-500. A grouping of all glands according to their morphological af- finities. In this classification the endocrine glands are paraepi- thelial.—T. C. B. The ENDOCRINE GLANDS—a caution. Editorial, J. Am. M. Ass. (Chicago), 1921, °76, 1500-1501. This editorial sounds a much needed note of caution against undue enthusiasm and credulity regarding the numerous poorly substantiated claims that are being made in the name .of endocrin- ology. It is pointed out that much of the physiology of the internal secretions is in a state of chaos and that correspondingly it is futile to select bits uncritically from this chaos to bolster up clinical theories. It is suggested that the difficulties in the field and the ABSTRACTS 643 importance of the problems should stand as a challenge to the well- trained clinician to lend his constructive aid toward their solution; also that the solid work of well-trained investigators should be criti- cally differentiated from the specious claims of gullible enthusiasts. The former should be supported, the latter condemned.—R. G. lal (ENDOCRINE GLANDS) Miculicz disease, sympathicotonia and fruste pluriglandular syndrome (Maladie de Miculicz avec état de sympathicotonie et syndrome polyglandulaire fruste). Mery (H.), Girard (L.) & Mercier-Desrochettes, Bull. et mem. Sec. méd. d. hop. de Par., 1921, 45, 406-412. Not endocrine.—F. S. H. (ENDOCRINE ORGANS) Further studies on substances with specific action prepared from single organs. Il. (Weitere Studien iiber die von einzelnen organen hervorgebrachten Substanzen mit Speci- fischer Wirkung. H.). Abderhalden (B.), Arch. f. d. ges. Physiol. (Bonn), 1919, 176, 236-262. Thyroid, thymus, pituitary, gonad, adrenal, and placenta were administered to tadpoles, and the effects compared with those of hydrolysed preparations of these glands. Abderhalden states that the most important conclusion from his experiments is that the same results are obtained whether the organs themselves are administered, or their hydrolysed products, so that the active substances must be of simpler nature. Usually the action is quantitatively the same. ait, AY, (O- (ENDOCRINE ORGANS) Studies on substances with specific action prepared from single organs. IV. (Studien iiber die von einzelnen Organen hervorgebrachten Substanzen mit specifischer Wirkung. IvV.). Abderhalden (E.) & Brammertz (W.), Arch. f. d. ges. ’ physiol. (Bonn), 1921, 186, 265-271. The ‘optone’’ (completely hydrolysed products) of corpus luteum fed to tadpoles produced an increase in their oxygen-con- sumption, that of thymus had no effect, neither had that of ovaries from which the corpus lutea had previously been removed. Optones of testis and pituitary produced an increase, as did all the products obtained from yeast cells——A. T. Cc. (ENDOCRINE ORGANS) Further studies on substances with specific action prepared from single organs. V. (Weitere Studien iiber die von einzelnen Organen hervorgebrachten Substanzen mit speci- fischer Wirkung. V.). Abderhalden (E.) & Gellhorn (B.), Arch. f. d. ges. Physiol. (Bonn), 1921, 187, 243-268. The ‘“optones” obtained by enzymic decomposition of organs possess specific actions which depend entirely on their content of organic substances of simpler nature. Corpus luteum-, testis-, and 644 ABSTRACTS thymus-optones produce on heart-strips (atropinised or not, but not on the whole heart, nor on strips connected to atrium and sinus), slowing of the spontaneous contractions and slight negative-inotropic action, and on the surviving oesophagus (frog) an increase of tonus, with, after a slight inhibition-period, positive-intropic and positive- chronotropic action. Pituitary and thyroid optones produce an oppo- site action on the oesophagus. Anterior pituitary optone excites, posterior pituitary optone inhibits the automaticity of the frog’s oesophagus. These optones, and to a lessor degree those of the thyroid testis, and ovary produce an exciting, tonus-increasing action on the surviving uterus of the guinea pig, while those of corpus luteum and thymus decrease the tonus.—A. T. C. (ENDOCRINE ORGANS) Experiments on the central regulation of carbohydrate metabolism in the medulla oblongata (Experimen- teller Beitrag zur zentralen Regulation des Zuckers‘offwechsels in der Oblongata). Brugsch (T.), Dresel (K.) & Lewy (F. dnls ic, Deutsche med. Wehnschr. (Berlin), 1921, 47, 610. The amount of blood sugar is increased only when the nucleus dorsalis vagus is wounded, because of an increased amount of adre- nalin poured by the adrenals into the blood. No other lesions of the medulla oblongata produces the same effect. When a lesion is made in the nucleus vegetativas vagi the blood sugar diminishes. When the pancreas is removed special cells in the nucleus vegetativus de- generate. In the medulla oblongata there are two centers, one for increasing the blood sugar, via the sympathetic and adrenals and one for diminishing it via the pancreas.—J. K. ENDOCRINE ORGANS and the x-ray (Streustrahlung oder endocrine Driisenwirkung). Frankel (H.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 242-243. The effect of x-ray treatment in malignant tumors may partly be due to endocrine phenomena. Probably the endocrine organs have an influence on the cancer-cells. If in a cancer of the eye X-rays are used, the hypophysis may be stimulated to produce a hormone that acts against the carcinomatous-degeneration of normal cells. In the same way x-ray treatment of tumors of the mediastinum in- volves the thyroid and the thymus. In considering these facts, the author comes to the conclusion that for treating malignant growth smaller doses than are generally used are wanted.—J. K. (ENDOCRINE ORGANS) Chronic colitis with secondary endocrine disturbances and their importance for the constitution (Chronische Kolitiden mit sekundiirer inkretorischen Storungen und ihre Bedeutung fiir die Konstitution). Grote (L. R.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 379-380. ABSTRACTS 645 Three relations between the alimentary tract and the endocrine organs are possible: 1. The endocrine disturbance is primary (diar- rhea in Graves’ disease, hyper- or an-acidity in Graves’ disease, con- stipation in acromegaly, etc.). 2. The endocrine disturbance and the disease of stomach or intestines are due to the same cause (necrosis of the stomach with thyrotoxicosis; constipation due to changes in the tonus of the involuntary nervous system). oe Lhe endocrine disturbance is caused by the changes in the abdominal organs. a. By direct influence: when a chronic enteritis reaches the pancreas and produces glycosuria. Db. Through indirect influence. It is not so rare that in the cause of an intestinal disease symptoms of thyrotoxicosis are observed. This may be seen in + 20% of the chronic postdysenterical colitis. The most constant symptom in these cases is the increased excretion of sugar after injection of phloridzin.—J. K. (ENDOCRINE ORGANS) A case of myasthenia gravis and its im- portance for constitutional pathology (Hin Fall von Myasthenia gravis als Beitrag zur Konstitutionspathologie). Hase (H.), Berl. klin. Wehnschr., 1921, 58, 176-177. Report of a case. Mother had diabetes; father gout. The patient had bilateral exophthalmos, nervous irritability and loss of flesh. Probably in these cases the endocrine symptoms, as well as the neurological symptoms, are due to constitutional abnormalities. hf, ES (ENDOCRINE ORGANS) The effect of pregnancy upon the size and weight of the organs of the body. ‘Herring (P. T.), Brit. M J. (London), 1920, (ii), 886. In the healthy albino rat the occurrence of pregnancy had little effect upon the length and weight of the body, excluding the increase of weight due to the uterus and its contents. The heart, kidneys and spleen were little effected; there was certainly no en- largement of the heart during pregnancy. The liver was greatly enlarged. The thymus had undergone rapid involution and was much diminished in size. The suprarenals were slightly hypertrophied. The thyroids were diminished in size, and there was a notable diminution in weight of the pituitary body, attended by histological changes in its glandular lobe.—L. G. K. (ENDOCRINE ORGANS) A case of myasthenia gravis pseudo-para- lytica, Hutter (A.), Psychiatrische en Neurologischebladen (Amsterdam), 1920, —, 352-356. In this case at post-mortem no changes in the thyroid, adrenals, testicles or hypophysis were found. No trace of thymus tissue could be detected. The patient was 25.—J. K. 646 ABSTRACTS (ENDOCRINE ORGANS) A case of chondrodystrophia in an adult (Ueber einen Fill von Chondrodystrophie bei Erwachsenen). Marum (G.), Inaug. Diss. (Cologne), 1919-1920. Report of a post-mortem examination of a woman of 33 years with chondrodystrophia. She died from influenza. Her height was 108 em. She first menstruated when she was 19. There were fol- licular cysts in the left ovary; no changes in the thyroid, thymic residues, hypophysis or adrenals. Only three parathyroids were found; these were smaller than normal. Microscopically there were no important changes in the parathyroids; they were very rich in blood; colloid was not present.—J. K. (ENDOCRINE ORGANS) Myxedema and pluriglandular insufficiency (Myxédem mit pluriglanduliren Insuffizienz). Meissner (R.), Miinchen med. Wehnschr., 1921, 68, 488-490. In 1920 Meissner described some cases of myxedema. One of the patients died. The post-mortem report is now given. It showed a highly atrophic thyroid with growth of lymphatic tissue in the gland; atrophy of the ovaries and increased pigmentation of the adrenals and hypophysis. The cause of death was a cerebellar dis- ease.—J. K. (ENDOCRINE ORGANS) The endocrine causes of pathological senescence (Die innersekretorischen Ursachen des pathologischen Alterns). Pribram, Berl. klin. Wehnschr., 1921, 58, 366; Deutsche med. Wehnschr. (Berlin), 1921, 47, 459; Miinchen. med. Wehnschr., 1921, 68, 470. A sarcomatous ovary was removed from a girl of 6 with well developed mammae. After this all symptoms of adult development retrogressed. A woman of 32 developed puerperal fever after manual removal of the placenta. She did not get well again, but showed many symptoms of senium praecox. Post-mortem changes were found in the hypophysis, thyroid and adrenals. The ovaries were normal.—J. K. (ENDOCRINE ORGANS) The form of the blood vessels of the nail- wall (Zur Formenlehre der Nagelfalzgefasze). Rosenberger (F.), Zentralbl. f. inn. Med. (Leipzig), 1921, 42, 26-28. The author examined the capillaries of the nail wall with a microscope. He distinguished four different types: hairpin forms, repeatedly winded forms without anastomoses between each other, “crescent” forms and the form of the violin-key (&) in music with anastomoses. The hairpin forms and the violin-key vessels seem to have some relation to the kidney and the blood pressure; repeatedly winded capillaries seem to depend on the thyroid; the “crescent” forms are only seen in sympathicotonia. A patient with a small ABSTRACTS 647 goiter received during some days small doses of iodine. The goiter increased and the capillaries which were not coiled before took on the ‘‘thyroid-type.” This type disappeared when the administration of iodine was stopped.—J. K. (ENDOCRINE ORGANS) Osteomalacia and osteomalacia-like dis- eases (Osteomalazie und osteomalazieartige Erkrankungen). Schlesinger (H.), Wien. klin. Wehnschr., 1921, 34, 213-214. The opinion is expressed that this is a pluriglandular disease. Changes have been found in the thyroid. ovaries, hypophysis, adre- nals and particularly hyperplastic cnanges in the parathyroids. Whether they are affected by a toxin, a micro-organism, a want of vitamines or another cause is unknown.—J. K. Blockade and ENDOCRINE ORGANS (Blockade und innere Sekre- tion). Sehrt (E.), Miinchen. med. Wehnscbhr., 1921, 68, 268-270. Undernutrition during the war has caused a hypofunction of the endocrine organs. The iodine content of thyroids of the sheep is much lower than before the war. Hemorrhages per vaginam are often observed in women which are stopped by the administration of thyroid. Much larger quantities of thyroid are needed now than before the war. In animals the adrenals contain much less adre- nalin; in man often a low blood pressure is observed. After opera- tions hemotomas are often seen, much more frequently than before the war.—J. K. (ENDOCRINE ORGANS) X-ray in epilepsy (Rontgenstrahlen bei Epilepsie). Strausz, Deutsche med. Wehnschr. (Berlin), 1921, 47, 524. Strausz believes that epilepsy is due to a hypofunction of the endocrine glands. He recommends methodical x-ray treatment of the thymus, spleen, liver, and adrenals. Local treatment with x-rays of the cerebral cortex is not to be recommended.—J. K. Mikulicz’s disease and the ENDOCRINE ORGANS (Miculischer Symptomenkomplex und innere Sekretion). Taschenberg (E. W.), Miinchen. med. Wchnschr., 1921, 68, 332. A girl of 21 observed that regularly before the onset of men- struation symptoms of Mikuliez’s disease (swollen salivary glands) appeared. This would make probable a relation between the ovaries and the salivary glands.—J. K. The role of the ENDOCRINE system in internal medicine. Blumen- garten (A. S.), N. York M. J. (New York), 1921, 113, 233-239. A consideration of the relation of the endocrine organs to the general picture of disease. Patients may show endocrine diseases as secondary factors resulting from other lesions.—H. W. 648 ABSTRACTS (ENDOCRINE SYSTEM) The individual factor in disease. Potten- ger (F. M.), Med. Record (N. Y.), 1920, 98, 647-649. Symptoms of disease are produced through either the nerves or the internal secretions, and either from physical or psychical stimuli. A perfect man should be possessed of an anatomically perfect body and physiologically balanced nervous, endocrine and psychical sys- tems; each part is interdependent upon the other. Pottenger then discusses the vegetative nervous system, and notes the symptoms and signs of vagotonia and sympathicotonia. A disease will affect an individual differently if he already be preponderantly vagotonic than if he be sympatheticotonic in type. Likewise, disease will appear differently in an individual exhibiting hypofunction of one or more endocrine glands than in one showing hyperfunction. Clin- ical syndromes will also vary with the psychic status of the patient. —H. L. Homoplastic and heteroplastic ENDOCRINE transplants. Swingle (W. W.), Anat. Record (Phila.), 1921, 20, 195. Various parts of the hypophysis from three species of frogs were ingrafted intraperitoneally into immature larvae of the bull frog. Grafts of the anterior lobe accelerated metamorphosis; those of the pars intermedia caused certain color changes. Grafts of the adrenal glands were negative. Implantation of the thyroid was the most effective means for hastening metamorphosis. It was found possible to ingraft a thyroid into an immature larva, induce metamorphosis, re-ingraft the same gland into another larva, induce metamorphosis, then repeat the procedure on yet a third animal.—W. J. A. ENDOCRINOLOGY and the heart. Satterthwaite (T. E.), Med. Record (N. Y.), 1920, 98, 510-511. Among the prominent signs of hypoadrenia are muscular asthenia, sensitiveness to cold, hypotension, weak cardiae action and pulse, subnormal temperature, loss of appetite, anemia, slow metab- olism, indigestion, constipation, psychoasthenia, perhaps Sergent’s white line, a dry skin, and no capacity for sustained effort. For patients having such manifestations the author has achieved very satisfactory improvement by dried suprarenal extract, giving 2% grain capsules, three times a day and adding 1/10 grain posterior lobe of pituitary to supplement and sustain the action of the former. The endocrine preparations are more effective when given in com- bination with one another. The pituitary usually provides an initial stimulation to activity of other preparations. The beneficial effect upon the circulation would seem to be obtained by direct action of the glandular secretion on the myocardium, and by stimulating the cerebrospinal nerves which govern the muscles of the heart. —H. L. ABSTRACTS 649 Contributions to the physiology of the stomach. LXVII. The response of the stomach glands to GASTRIN before and shortly after birth. Sutherland (G. #.), Am. J. Physiol. (Balt.), 1921, 55, 398-408. In dogs and cats there is a secretory response to gastrin in fetuses a few days before term, and the response increases with age, at least for the first few days.—T. C. B. On a case of GERODERMA GENITODYSTROPHICA with convul- sions (Sopra un caso di geroderma genito-distrofico in soggetto frenastenico con attacchi epilettici). Gadani (Angelo), Riforma med. (Napoli), 1920, 36, 1073-1074. The case reported, while belonging without doubt to the gero- derma syndrome in that the appearance of the skin, the atrophy of the genitals and the feminine voice show the additional symptoms of absence of the right lobe of the thyroid, marked abnormality of the intelligence, epileptic seizures and exaggerated development of the arms (1.87 M. as compared with the legs, 1.14 M.). The author believes this to be a case of a pluriglandular lesion and intends to subject the patient to glandular treatment and later report the result.—G. V. (THYROID) Goitre produced experimentally by waters from the province of Salta (Bocio producido experimentaimente por agua de la provincia de Salta). Houssay (B. A.), Rev. del. Inst. Bacterio- logico del Dep. Nacional de Higiene (Buenos Aires), 1920, May, II, No. 5. Goiter has been produced in rats in Buenos Aires by giving them water from Cerrillos (a northern town affected with endemic goiter) to drink.—B. A. H. (GONADS) Glandular hermaphrodism (Sur Vhermaphroidisme glandulaire). Ancel (P.), Compt. rend. Soc. de biol. (Paris), 1920, 83, 1642-1644. Observations on four pigs in which there were present both ovary and testicle, either on one side or on both sides. Chiefly of embryological interest.—T. C. B. (GONADS) Case of androgenous pseudo-hermaphroditism, with an intra-abdominal tumor consecutive to the ablation of a genital gland. Disappearance of the tumor under the influence of radio- therapy (Un cas de pseudo-hermaphoditissme androgyne avec tumeur intrabdominale consécutive a Vablation d'une glande genitale. Disparition de cette tumeur sous l’'influence de la radio- thérapie). Béclére & Siredey, Bull d’obst. et gynée. (Paris), 1921, 10, 91-99. The title tells the story.—F. S. H. 650 ABSTRACTS (GONADS) The work of Steinach on rejuvenation (Steinach’s Ar- beiten und die Verjiingungsfrage). Boruttan (H.), Ztschr. f. arztl. Fortbild. (Jena), 1921, 18, 129-131. A very short review on the well known work of Steinach.—J. K. (GONADS) Atypical structures of two OVOTESTES in the pig (Structures atypiques de deux ovotestis de porc). Bujord (Eug.), Compt. rend. Soc. de biol. (Paris), 1921, $4, 112-114. Histological.—T. C. B. (GONADS) The genesis of the OVOTESTIS in mammals (De la genése des ovotestis chez les mammiféres). Bujord (Eug.), Histological and embryological.—T. C. B. Compt. rend. Soe. de biol. (Paris), 1921, 84, 114-116. (GONADS) Nervous disturbances of genital origin in the female (De quelques troubles nerveux d'origine génitale chez la femme). Dalché (P.), La Gynécol. (Paris), 1920, 19, 437-468. This article is an extensive general discussion of the association of headaches during puberty, pregnancy and the menopause with disturbances of the endocrine organs and general physical condition. —F. S. H. GONADS and sex development (Keimdriise and Geschlechtsentwick- lung). Halban (Josef), Arch. f. Gynaek. (Berlin), 1921, 114, 289-303. Halban reviews the recent evidence supporting his idea that at the moment of fertilization not only is the sex determined, but also the entire primary and secondary sex characteristics are laid down, whether male or female. A rather vigorous criticism of Steinach’s conclusions is made, which is somewhat weakened by the statement that the ovarian and testicular secretions are identical in nature or effect, and that the placenta is not entirely a female organ, but is a mixed-sex gland, a sort of enlarged ovo-testis.—F. S. H. The fat of the GONADS of Rhizostoma cuvieri (Untersuchung des Fetts der Gonaden von Rhizostoma Curvieri). Haurowitz (F.), Ztschr. f. physiol. Chem. (Berlin u. Leipzig), 1921, 112, 28-37. Chemical studies of the gonads of Rhizostoma cuvieri, particu- larly the lipoid constituents are reported in this paper, the results of which at present have no particular endocrine interest.—F. S. H. (GONADS) The dissociation of the seminal and interstitial gland determined by experimental alcoholism. Sterility without im- potence (Sur la dissociation de la glande séminale et de la glande interstitielle déterminée par l’alcoholisme expérimentale. Sterilité ABSTRACTS 651 sans impuissance). Kostitch (A.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 569-571. White rats were progressively intoxicated by daily doses of absolute alcohol. There was a rapid influence on the genital glands. As an example, one rat was killed after thirty-seven days, having taken 53 cc. of absolute alcohol. It had the appearance of perfect general condition. The penis, vesiculae seminales and prostate were normally developed. Microscopic examination of the testes showed advanced atrophy of the seminal gland, with marked hyperplasia of the interstitial gland. The conclusion is that the spermatogenic tissue is more susceptible to alcohol than the interstitial. The fact that the integrity of the interstitial gland coincides with the integ- rity of the secondary sex characters, and the sexual appetite, confirms the opinion that they are dependent on the internal secretion of the interstitial glands. The hypertrophy of the interstitial gland indi- cates that it plays a role in the defense of the seminal elements against toxic substances. Atrophy of the seminal tissue shows that a certain degree of alcoholic intoxication may provoke sterility with- out determining impotence.—T. C. B. (GONADS) The influence of ligation of the funicules spermaticus on metabolism (Der Einfluesz der Samenstrangunterbindung auf den Stoffwechsel). Loewy (A.) & Zondek (H.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 349-350. If it is true that Steinach’s operation renews sexual charac- teristics it must be possible to prove that the operation produces an increase in metabolism. In some cases this was really so, in some patients this increase was only temporary. The changes in metab- olism and the influence on sexual functions do not go parallel. Some patients are described in whom the operation had no effect on the sexuality but in whom the metabolism was increased.—J. K. (GONADS) Sex glands transplantation and the modifying effect in rats and guinea pigs. Moore (C. R.), Anat. Record (Phila.), 1921, 20, 194. In the white rat testicular tissue grafted into young spayed females will persist for a period of nine months. Associated with the testicle graft the behavior of the animal is decidedly male-like. Ovaries transplanted into young castrated males will persist and grow for several months. In the white rat ovarian grafts will persist for eight months in a male with one normal testicle. There seems to be no deleterious influence of secretions from either sex gland upon the opposite one.—W. J. A. (GONADS) The influence of castration on patients with sexual neurosis (Der Einflusz der Kastration auf Sexualneurotiker). 652 ABSTRACTS Miihsam (R.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 155-156. Report of three cases: two with sexual neurosis and one with homosexuality. Castration had in all three cases a good effect. One patient had a temporary restoration of his sexual desires.—J. K. (GONADS) Eugenic prevention of conception and the biological fundamentals of generative prophylaxis by vasectomy and auto- transplantation of the testicles (Ueber eugenetische Konzeptions- verhinderung und die biologischen Grundlagen generativer Pro- phylaxe durch Vasectomie und Autotransplantation der Hoden). Ottow (B.), Monatschr. f. Geburtsch. u. Gynaik. (Berlin), 1921, 54, 219-227. A review and discussion of the subject in the title.—F. S. H. (GONADS) Implantation of testicles in prostatism (Hodeneinpflan- zung bei Prostatismus). Rohleder, Deutsche med. Wehnschr. (Berlin), 1921, 47, 185-186. One year ago (See Endocrinology, Vol. IV, p. 311) Rohleder stated that the administration of testicle had a good influence on prostatism. In many cases, however, no effect is seen. This may be due to the fact that the artificial extract that is given is not at all identical with the testicular hormone. This may account for the fact that in homosexuality never any result is obtained with testicle preparations. Further, we know that when glandular extracts are taken by mouth they undergo changes in the alimentary tract. Last, but not least, the commercial extracts are made from bull’s testicle and we do not know whether they are absolutely identical with human organs. Then an injection of a hormone can never take the place of its regular excretion by an organ. Therefore, the author recommends the transplantation of slices of testicle in cases of pros- tatism, but only in cases in whom organo-treatment has had at least some effect. It is recommended to administer eryptorchic testicle. No clinical cases are reported. It is even doubtful whether the author has ever tried this operation.—J. K. (GONADS) Hermaphroditismus glandularis. Steindl (A.), Miinchen. | med. Wehnschr. 1921, 68, 412. A bicornate uterus was found ina girl of 9 during a laparatomy. There were two tubes, and on one side an ovary, on the other a testicle. The patient was classed as a female.—J. K. Specific sex action of GONAD-extracts (Geschlectsspezifische Wir- kungen von Keimdriisenextrakten). Weil (A.), Arch. f. d.. ges. Physiol. (Bonn), 1920, 185, 33-41. ABSTRACTS 653 Subcutaneous injections of testicular extracts (cattle) corre- sponding to 30 grams of fresh organ per kilo body-weight produce in guinea pigs specific sex changes in the CO.-curve (measured by a modified Haldane method). With young males, castrated males, and pregnant females there is a sudden fall followed by a steeper rise to above normal; no action is produced in adult males and (non- pregnant) females. In the former cases and in adult females ovarian extracts produce slight fall and slow rise to normal, but they are without action on adult males. Typical nervous symptoms are pro- duced by both extracts, also sex-specific, and connected with rises in temperature. They cannot be evoked after fourteen days, but the influence on gas-metabolism persists.—A. T. C. The effects of transplantation of the several parts of the adult HYPOPHYSIS into tadpoles in Rana pipiens. Allen (B. M.), Anat. Record (Phila.), 1921, 20, 192. Parts of the gland were transplanted into normal tadpoles and into those from which the hypophysis had been ablated. The latter showed a tendency toward metamorphosis and the thyroid glands were restored almost to normal size when the anterior lobe was im- planted. Transplantation of the united intermediate and neural lobes caused the tadpoles to revert to the original black color after having become white as a result of prior pituitary extirpation. Transplantation of the intermediate lobe does not stimulate the development of the thyroid gland; for this reason it likewise has no effect upon metamorphosis.—W. ThA. (HYPOPHYSIS) Acromegaly (Acromegalia). Bellavitis (C.), Ri- forma Med. (Napoli), 1921, 37, 403. Report of a case of complete acromegaly (mandible, nose, tongue, limbs involved, kyphosis and clavicles thickened) lasting nine years in a man 59 years old. The familial and personal history was otherwise negative. Radioscopy showed a normal sella turcica, and there were no intracranial pressure symptoms. Nothing abnor- mal was detected in the other endocrine glands. The only abnor- mality found was in his blood, leukopenia with 15 per cent. eosino- phils. The red cell count was 5,500,000. There were traces of albumin in the urine.—G. V. The HYPOPHYSIS in hypothyreosis and some remarks on the hypophysis in pregnancy (Die Hypophyse bei Hypothyreose nebst Bemerkungen tiber die Schwangerschaftshypophyse). Ber- blinger (W.), Mitt. a. d. Grenzgeb. Med. u. Chir. (Jena), 1921, 33, 92-112. In all textbooks one may find that thyroidectomy is followed by a compensatory hypertrophy of the hypophysis. This is certainly not 654 ABSTRACTS true in all animals. There are animals (goat) in which thyroidec- tomy has no influence on the hypophysis. Berblinger carefully exam- ined the hypophysis in 5 people with hypofunction of the thyroid, dying from intercurrent disease. He found an increased number of chromophobe cells; the cells are richer in protoplasm than nor- mally. The number of eosinophil cells is augmented. In the syncytial cells degeneration of the nucleus was seen. In 3 of the 5 cases the hypophysis was heavier than normal. This increase in weight is only due to the increase in chromophil cells. In one case the hypophysis was much lighter than had been expected. In this gland a great many naked nuclei without protoplasm were found. The increased number of chromophil cells is typical for hypothyroid conditions. This is, however, found also during pregnancy, but it is not regularly seen in myxedema. The author injected into male and female rabbits extracts of placenta or of fetus and always observed that the hypophysis gained in weight and the number of chromophil cells increased—although it never reached the number observed in pregnancy. When other substances were injected no effect was seen, only injection of peptone produced a similar effect. Of course, these changes are only to be observed in the anterior lobe and they are most marked in the female animals. Boiled extracts of placenta and fetus have the same influence as do unboiled extracts. The histology of the hypophysis in a rabbit after thyroidectomy or thyroidectomy+ castration is the same as in the pregnant animal. Berblinger does not believe that the enlargement of a hypophysis after thyroidectomy is compensatory.—J. K. Experimental DIABETES INSIPIDUS and HYPOPHYSEAL opo- therapy (Diabete insipide expérimental et opotherapie hypo- physaire). Camus (J.) & Roussy (G.), Compt. rend. Soc. de biol. (Paris), 1920, 83, 1578-1583. The authors have adduced evidence that the polyuria usually attributed to a lesion of the hypophysis is in reality due to a lesion of the base of the brain. In the present paper they give the results of a study of the effect of different extracts of the pituitary upon diabetes insipidus experimentally induced. The usual lesion was made at the base of the brain, and after polyuria was established, various extracts of the hypophysis (posterior lobe, the whole gland, hypophysine, pituitrin) were injected either subcutaneously or intra- venously. The results obtained were inconstant. Sometimes the quantity of urine was lessened, sometimes it was increased in spite of treatment. When oliguria occurred it was not lasting.—T. C.,. 3B; (HYPOPHYSIS) Dystrophia adiposo-genitalis. Chiari, Wien. klin. Wehnschr., 1921, 34, 42. A woman of 25, who was an alcoholic, became fat, menstruation was regular, no eye-symptoms; infantile sexual-organs, polydipsia, ABSTRACTS 655 polyuria, Wassermann test positive. Improved by antisyphilitic treatment.—J. K. (HYPOPHYSIS) [Acromegaly with myxoedema]. Christoffersen (N. R.), Ugesk. f. Laeger. (Copenhagen), 1920, 82, 794. The author presented the case of a man, aged 48 years, who iS) years ago suffered traumatism of the head. Nine years ago head- ache and vomiting supervened and 3 years later acromegalic symp- toms. Presently the face assumed the typical acromegalic charac- teristics, but the condition of the skin and hair of the scalp indi- cated well marked myxedema. The reactions to adrenalin and to hypophysin were found to be normal. The radiogram showed a dilated sella turcica. The mentality was slow and dull. The metab- olism was depressed. The increase of blood sugar after 100 grammes glucose was strikingly slow.—K. Testy 1S, The effect of feeding the anterior lobe of the HYPOPHYSIS on the oestrous cycle of the rat. Evans (H. M.) & Long (J. A.), Anat. Record (Phila.), 1921, 21, 62. The length of the oestrous cycles was not appreciably altered. Ie dis As (HYPOPHYSIS) Heat polyuria in children (Poliuria estiva infan- tile). Funaioli (G.), Gazz. de osp. (Milano), 1921, 42, 189-190. The author observed in Africa many cases of polyuria in young children. This always began at the beginning of the hot season. Administration of hypophysis had no influence. Only belladonna was useful. Even without treatment the symptoms disappear rather quickly.— J. K. (HYPOPHYSIS) The induction of labor with pituitary extracts. Gallie (J. G.) & Scott (W. A.), Canad. M. Monthly (Toronto), 1920, 4, 143-146. Induction of labor by means of intramuscular injections of pituitary extract can be successfully accomplished in the great majority of cases, especially if the patient is at or past term. The initial dose is % cc., and this is repeated every half hour until regular uterine contractions occur. The administration is then dis- continued, If the contractions begin to die away, the dose is im- mediately repeated. If the contractions are allowed entirely to cease, the whole process has to be repeated. The advantages of this method of induction are that (1) there is no instrumentation, and consequently less liability to sepsis; (2) no anesthesia is re- quired; (3) there is less reluctance on the part of the patient than there is to submitting to the introduction of a bag. A series of 65 cases is reported, in 55 of which labor was successfully induced by the use of pituitary extract.—L. G. K. 656 ABSTRACTS HYPOPHYSEAL syndrome and decompressive craniotomy (Sindrome ipofisaria e craniotomia decompressiva). Gianettasio (N.), Ri- forma med. (Napoli), 1921, 37, 177-179. A report of a somewhat typical case with marked improvement following decompression.—G. V. Action of HYPOPHYSEAL extracts on the bronchial muscles (Action de l'extract hypophysaire sur les muscles bronchiques). Hallion (L.), Compt. rend. Soc. de biol. (Paris), 1920, 83, 1587-1590. The injection of very small doses of extract of hypophysis causes an augmentation of the amplitude of the respiratory movements. This occurs in dogs that have shown a diminished lung volume under larger doses of the extract. It is thought that this effect of small doses is due to a lowering of the pulmonary blood pressure, as the same result is obtained by compressing the vena cava.—T. C. B. (HYPOPHYSIS) The influence of pituitary extract on gastric secre- tion (Der Hinflusz von Hypophysenextrakt auf die Magensaftsekre- tion). Hess (W. R.) & Gundlach (R.), Arch. f. d. ges. Physiol. (Bonn), 1920, 185, 137-140. There is no marked effect. The initial slight decrease in secretion-volume is probably psychic.—A. T. C. Tumor of HYPOPHYSIS (Hypophysentumor). Hirsh (O.), Wien klin. Wehnschr., 1921, 34, 79-80. Demonstration of a man of 27 who had been operated upon for tumor of the hypophysis 4 years ago with splendid success. Three years after the operation the eye symptoms reappeared. It is im- possible to completely remove tumors of the hypophysis when the method of Krause is used. Therefore, this operation must be fol- lowed by a treatment with radium. In two cases of acromegaly the patients were cured by its use. Not all cases end so happily. In 28 cases a splendid result was obtained 5 times.—J. K. The influence of the HYPOPHYSIS on growth (Versuche tiber den Finfluss der Hypophyse auf das Wachstum). Klinger (R.), Arch. f. d. ges. Physiol. (Bonn), 1919, 177, 232-238. Weekly injection of fresh pituitary emulsion, or implantation of anterior pituitary into young guinea-pigs for from two to five months did not produce any definite influence on growth.—A. T. C. Tuberculosis of the sphenoid and its relation to the HYPOPHYSIS (Ueber Tuberkulose des Keilbeins mit Beziehungen zur Hypo- physe). Kurzak (H.), Inaug. Diss. Cologne, 1919-1920. The author reports a case of a patient in whom the clinical diagnosis of empyema of the sinus sphenoidalis was made. Post- ABSTRACTS 657 mortem, a tuberculosis of the sphenoid was found, which had reached the hypophysis. This is one way in which the hypophysis can be- come the seat of tuberculosus changes; it is rare that a tubercular meningitis is the primary cause. Tuberculosis of the hypophysis as the cause of a miliary tuberculosis does not seem to be so very rare. There do not exist typical symptoms of tuberculosis of the hypophysis. In cases in which there are eye symptoms, as they are seen in hypophyseal disorders, without symptoms of acromegaly we must think of the possibility of a tuberculosus infection of the hypo- physis.—J. K. (HYPOPHYSIS) Tumor of the pituitary. McArthur (i. 1.), Surg. Clinics of Chicago (Phila.), 1918, 2, 691-700. The report of a patient 35 years of age who has been suffering from severe headaches at intervals for two years. The diagnosis of pituitary tumor was based upon the symptoms of intra-cranial pressure and the x-ray findings. Operation was carried out through the McArthur frontal approach.—J. F. Remeval of HYPOPHYSIS (Hypophysenexstirpationen) . Oehlecker, Miinchen. med. Wehnschr., 1921, 68, 121. A short note. In a case of acromegaly and ancther one of dys- trophia adiposo-genitalis, a good result was obtained after removal of the hypophysis. In three other cases a tumor of the brain in- vaded the hypophysis. In two of them the outcome was at once fatal, in the third one a temporary remission was seen before death. ——J. KK. Tumors of HYPOPHYSIS (Hypophysentumoren). Oehlecker, Deutsche med. Wehnschr. (Berlin), 1921, 47, 228. The author demonstrated two patients who had been operated upon by the method of Schloffer-Chiari. One with acromegaly has slightly, the other one with dystrophia adiposo-genitalis largely improved.—J. K. (HYPOPHYSIS) Experiments with pituglandol in DIABETES (Hinige Versuche mit Pituglandol bei Diabetickern). Schild, Deutsche med. Wehbnschr. (Berlin), 1921, 47, 611. Injections of pituglandol are followed by a decrease in the quantity of sugar in the urine.—J. K. The influence of the anterior lobe of the HYPOPHYSIS in the de- velopment of the albino rat. Sisson (Warren R.) & Broyles (Edw. N.), Johns Hopkins Hosp. Bull. (Balt.), 1921, 32, 23-30. The desiccated powder of the anterior lobe of the hypophysis of young calves was fed to albino rats of a standard stock. The experi- 658 ABSTRACTS ments were begun when the animals were three weeks old and lasted for periods of 8-10 weeks. Sixty-eight animals were used, one-half serving as controls. They were observed for differences in activity, in the condition of their fur, in their nutrition, and in their skeletal development. Special emphasis has been laid upon differences in external sex characters, changes in body weights and differences in the microscopical findings in the reproductive organs and the endo- crine glands, after hypophysis feeding. Dietary precautions were taken in order to differentiate the effects of food and the gland substance. The hypophysis-fed animals developed normally and showed no significant deviation beyond the normal variation of their species. Careful autopsies revealed no significant differences in organ weight or structure.—J. F. Some modifications induced by parabiotic union of the hypo- physectomized to the normal tadpole. Smith (P. E.), Anat. Record (Phila.), 1921, 21, 838. Hypophysectomized tadpoles were united at an early stage to normal larvae. Both members of four pairs completed meta- morphosis, and several pairs reached a nearly maximal larval size. In every case the pigmentary and endocrine disturbances typical of hypophysectomy were modified. Albinism, though evident, was only partial. The thyroids of the hypophysectomized member, instead of being diminuitive, as would otherwise have been the case, were nearly normal in size, while those of the normal mate exhibited a slight hypertrophy. The adrenal cortex, while reduced, did not ap- pear to suffer the same reduction as that which occurs in the typical albino.—W. J. A. Upon the essentiality of the buccal component of the HYPOPHYSIS for the continuance of life. Smith (P. E.), Anat. Record (Phila.), 1921, 21, 83. When hypophysectomized and normal tadpoles were joined into parabiotic pairs by the tails, both completed metamorphosis. The members of a pair were liberated, when, in metamorphosis, the tails were resorbed. The hypophysectomized members soon died. The separation in no way embarassed the normal members of the pairs; they continued to display their usual activity.—W. J. A. (HYPOPHYSIS) Does the administration of anterior lobe to the tadpole produce an effect similar to that obtained from THYROID feeding? Smith (P. E.) & Cheney (G.), Anat. Record (Phila.), 1921, 21, 84. The evidence indicates that a similarity of response is not evoked by thyroid and hypophyseal administration. The author concludes that the anterior lobe preparation used by Hoskins and ABSTRACTS 659 Hoskins contained an unusual amount of iodine and displayed an altogether unique activity. —W. J. A. (HYPOPHYSIS) On narcolepsy (Zur Narkolepsiefrage). Somer (W.), Wien. klin. Wehnschr., 1921, 34, 132-138, 147-149. A description of two cases of narcolepsy. A cause could not be detected. It is possible that endocrine disturbances, especially of the hypophysis, play an important part. Jolly has described a case of narcolepsy with enlarged sella turecica. In the cases of Somer the sella was normal, but in one of them a calcium-infiltration of the pineal was suspected from the x-ray picture.—J. K. Relations between the various cellular forms of the anterior lobe of the HYPOPHYSIS (Sur les relations unissant entre elles les diverses formes cellulaire du lobe antérior de Ilhypophyse). Stewart (F. W.), Compt. rend. Soc. de biol. (Paris), 1921, S84, 49-50. Histological.—T. C. B. The relation of the pars intermedia of the HYPOPHYSIS and the PINEAL gland to pigmentation changes in anuran larvae. Swingle (W. W.), Anat. Record (Phila.), 1921, 21, 87. Reported in full elsewhere. Previously abstracted. (HYPOPHYSIS) Studies in metabolism. II. The metabolism of a very obese child with a small sella turcica (Typus Fréehlich?). Talbot (F. B.), Am. J. Dis. Child. (Chicago), 1920, 20, 331-336. The boy studied was 2 years and nine months old, had been born at full term and fed for the first nine months on drawn breast milk because his mouth would not open widely enough to permit him to nurse. He was thin and poorly nourished until one year of age, when he commenced to gain. His weight on entering the hos- pital was 54 pounds, 9% ounces. The mentality was that of a 10- month child; he recognized the family, but did not talk, did not feed himself and was unable to stand alone. His voice was hoarse, his skin like satin, hair slightly coarse and great rolls of fat were present all over the body. Total basal metabolism was found to be that of a boy of the same age, that is 631 calories. Total metab- olism in comparison with boys of same weight was found to be 37 per cent. below the average. Heat production per kilogram of body weight when compared with that of boys of same age was found to be 56 per cent. below the average and when compared with boys of same weight was 40 per cent. below the average. Talbot thinks that in children and infants there is a tendency for the fatter indi- viduals to have a lower metabolism both per kilo of body weight and per square meter of body surface than for children of the 660 ABSTRACTS average weight. The child was given pituitary extract and it was found that when he did not receive the extract he gained in weight and presumably put on fat very rapidly, even on a diet containing relatively few calories. After the extract was supplied he lost weight and commenced to develop mentally.—M. B. G. HYPOPHYSEAL anomalies (Hypophysire Stérung). Weggand, Miinchen. med. Wehnschr., 1921, 68, 317. The author demonstrated a mentally deficient girl with dwarfism, adiposity and glycosuria. Menstruation was normal. This disease is probably due to the hypophysis. He also showed a photograph of a very fat giant with atrophy of the genitals, but normal psychical functions. There was a hydrocephalus which certainly had an influ- ence on the hypophysis. In another girl with adiposity and blindness a tumor of the hypophysis was found at autopsy. The photograph of Napoleon during the last period of his life shows adiposity; we know that he had had epileptic fits. Perhaps this was a hydro- cephalus which influenced the hypophysis.—J. K. The excretion of enzymes and the influence of the HYPOPHYSIS in diabetes insipidus (Ueber Fermentausscheidung und Hypo- physenwirkung bei Diabetes insipidus). Wolpe (L.), Berl. klin. Wehnschr., 1921, 58, 101-108. In normal urine trypsin is not regularly found. In a ease of diabetes insipidus trypsin was never found in the urine; pepsin and diastase were found, but not regularly. The influence of pituglandol injections on the quantity proves, according to the author, the im- portance of the hypophysis as the origin of the disease. (The work of Camus and Roussy, Aschner, Leschke and others, proving that the hypophysis has no relation to diabetes insipidus seems to be unknown to the author).—J. K. INTERNAL SECRETIONS as conceived from the point of view of the practical physician, Kaplan (D. M.), N. York M. J. (New York), 1921, 113, 227-230. A characteristic article explaining to the uninitiated the almost unbelievable wonders of “‘the endocrines.’’ The present article, as several previously published, is concerned with the various ‘‘endo- crine tropisms” through which all physical, mental and spiritual peculiarities find an explanation. Indeed, Kaplan would have us believe that the entire purpose of life rests upon a thoroughly estab- lished endocrine basis. The thyroid is the chief equilibrizer of the human organism and is particularly endowed to maintain equipoise among the endocrine organs. The pituitary dominates dimension. The adrenal system is the chief source of energy. The gonads “‘in- sure the preservation of the race, being so endowed by nature and ABSTRACTS 661 through them the ego of’ man is conscious of his immortality.” “Such states as lack of courage, melancholy, suicidal tendencies, dementia praecox, precocious adolescence, and immature senility, sadism and masochism, are all possible manifestations in a gonada- trop individual.” ‘More than one living man has been cured of his so-called incurable and manifold complaints by the judicious administration of ovarian extract.” “We know that measles, typhoid fever, diphtheria, mumps, and even syphilis in a patient does not signify that the infection was contracted by some unexplainable accident. On the contrary, we believe that the ability to contract these infections lies in the makeup of the individual. He selects this or that malady, and it is not the malady that selects him. The in- fectious diseases of childhood determine the tropism of the patho- crine constitution.’—H. W. (INTERNAL SECRETIONS) Obesity following encephalitis lethar- gica (L’obesité consécutive a Vencéphalite léthargique). Livet (L.), Bull. et mém. Soc. méd. d. hop. de Par., 1921, 41, 656-659. Report of a case of obesity following encephalitis lethargica in which disturbances of menstruation occurred. The total syndrome suggests a repercussion of the infectious process to the endocrine organs, particularly: hypophysis, thyroid and ovaries. Hypophyseal therapy was beneficial.—F. S. H. (INTERNAL SECRETIONS) Acrocephaly and scaphocephaly with symmetrical malformations of the extremities. Park (E. A.) & Powers (G. F.), Am. J. Dis. Child. (Chicago), 1920, 20, 235-315. In a consideration of the possibility of disorders of internal secretions as etiological factors in these conditions, Park and Powers state that, although they cannot offer evidence as striking as that contained in the work of Harrison to prove that growth and de- velopment of the limb buds is not determined by any organ or com- bination of organs of internal secretion of the fetus, they can bring forward considerations sufficient to render any such view extremely improbable. All facts at their disposal indicate that the embryo is dependent for its proper growth and development, not on its own, but on the parental organs of internal secretions. Though the medical literature is full of examples of abnormal conditions attributed to disturbances in the fetal organs of internal secretion and abounds in explanations of congenital defects and disease of the basis of insufficiency in the fetus’ own endocrine glands, there is not one single pathologic condition which in the present state of our knowl- edge can be referred to that cause with any justification whatsoever. Furthermore, clinical observation teaches that disturbances in the function of the endocrine glands may give rise to changes in the body as a whole or at least in a variety of tissues (gigantism, acro- 662 ABSTRACTS megaly, dystrophia adioposo-genitalis, myxedema, hyperthyroidism, eunuchism) or to altered metabolic states, such as those seen after removal of the pancreas or parathyroids, but gives no indication that they produce alterations in parts of the body which are com- posites of tissues, such as the head, extremities, etc., to the exclu- sion of other parts. It is impossible to conceive that an organ of internal secretion can cause changes to occur in the bone muscles, connective tissue, fat and integument of certain divisions of the body and not act at all on the same tissues elsewhere.—M. B. G. The organs of INTERNAL SECRETION in anaerobic infections (Les organes a sécrétion interne dans les infectiones a microbe anaé- robies). Van Gehuchten (P.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 459-461. A study of the glands of internal secretion (adrenals, hypo- physis, thyroid) in sixty-five guinea pigs that had died of anaerobic infections. The changes observed were comparable to those occur- ring in other infections.—T. C. B. [Metabolism and internal secretion]. Christoffersen (N. R.), Ugesk. f. Laeger. (Copenhagen), 1920, 82, 838-850; 879-885. The author reports some examinations on the metabolism made on 3 patients with endocrine disturbances. The first case was @ man, aged 45 years, with signs of insufficiency of the thyroid, adre- nals and pituitary glands, hypotonus of the vagus and sympathetic and possibly hyperfunction of the parathyroids. The other patient showed uncomplicated myxoedema. The third patient had acro- megaly and myxoedema. The results of the examinations were as follows: Good renal NaCl-secretion is maintained in thyroid insuffi- ciency when the adrenals are healthy and the pituitary either © normal or diseased. Perturbed secretion is noted when thyroid, pituitary and adrenals are simultaneously affected. In some cases the NaCl-secretion is diminished after thyroid treatment. The secretion can be increased in a single day by pituitrin and hypo- physin. The secretion can be increased very considerably by treat- ment with adrenalin. The data as a whole indicate that the regula- tion of the NaCl-secretion is mediated in man by the adrenals and pituitary.—K. H. K. Mental disturbances at the MENOPAUSE and opotherapy (Troubles mentaux an cours de la menopause et opotherapie). Marie (Eas Bull. gén. de thérap. (Paris), 1921, 172, 215. Advocates opotherapy in combatting the mental disturbances of the menopause. The doses should be increased when the periods are expected and treatment should be carried out for long periods. —F. S. H. ABSTRACTS 663 The white blood picture during menstruation (Ueber das leucocytare Blutbild wihrend der Menstruation). Garling (K.), Deutsches Arch. f. klin. Med. (Leipzig), 1921, 135, 353-357. The blood was examined during menstruation in women who did not show changes in the irritability of the vegetative nervous system. The lymphocytes and monuclear cells had a tendency to increase, though this was by no means constant. A constant rela- tion between eosinophilia and menstruation does not exist.—J. K. Metabolism in vascular hypertonia (Ein Beitrag zum Stoffwechsel bei der vaskuliren Hypertonie). Hitzenberger (K.) & Richter-Quitt- ner (M.), Wien. Archiv. f. inn. Med., 1921, 2, 189-216. In primary as well as in secondary vascular hypertonia there always exists a hyperglycaemia, which is independent of the quantity of carbohydrates ingested. It is not due to a disturbed sugar metab- olism, but to a permanent over-production of sugar. In cases of hypertonia with diabetes the blood sugar is always higher than the amount that would correspond to the quantity of sugar that is ex- creted with the urine. In vascular hypertonia the quantity of uric acid in the blood is often increased. This is not due to a retention, for the quantity of endogenous and exogenous uric acid excreted is often higher than normal and when an increased quantity of purin- bodies are given, they are excreted as usual. Thus this hyperuri- cemia cannot be compared to the hyperuricemia in gout. It is pos- sible, though not sure, that hyperuricemia may be due to increased secretion of adrenalin.—J. K. MONGOLIAN IDIOCY. Pardee (I. H.), Arch. Ped. (N. Y.), 1920, 37, 10. Data published elsewhere. See Endocrin., 4, 662.—M. B. G. (OVARY) The oestrous eycle in the mouse. Allen (E.), Anat. Record (Phila.), 1921, 21, 43. Diagnosing oestrous by the cell contents of the vaginal fluid, it was found that the average duration of the cycle in the mouse is from four to six days. There is little uterine discharge. Not all mice ovulate spontaneously during oestrous.—W. J. A. (OVARY) Ovogenesis in the sexually mature mouse. Allen (E.), Anat. Record (Phila.), 1921, 21, 44. Allen finds that ovogenesis is not complete at birth or at puberty in the mouse, but continues on into sexually mature life. He concludes that the germinal epithelium of the ovary is homologous with that of the testis tubules.—W. J. A. Invagination of the superficial epithelium and neoformation in the transplanted OVARY of the guinea pig (invaginations de l’épi- 664 ABSTRACTS thelium superficiel et néoformation ovulaire dans l’ovaire trans- planté chez le cobaye). Athias (M.), Compt. rend. Soc. de biol. (Paris), 1920, 83, 1647-1649. Histological.—T. C. B. An address on the nature of the OVARIAN function and the medical and surgical methods adopted to secure the benefits of the ovarian secretions. Bell (W. Blair), Lancet (London), 1920, (ii), 879-884. The author advances the view that normally the sex-development of the individual is not primarily dependent on the nature of the gonad, but the character of the sex pervades all the tissues of the foetus, including the sex-gland itself. The primary sex-characteristic is the predominance of maleness or femaleness in the fertilized ovum, and this predominance may be so slight as to be disturbed. This conception is advanced as an explanation of such experiments on the determination of sex, as the influence of nutrition on the final sex-characterization of the frog. All the glands of internal secretion are said to control the sex-functions, sex-characteristics, and sex- metabolism from the beginning as much as do the gonads, and, primarily, all owe their directive tendencies to the predominating sex-potentiality in the zygote. Certain partial hermaphrodites have all the mental and physical aspects of the opposite sex, in spite of their gonads, consequently when the sex-glands are out of co-ordina- tion with the other organs of internal secretion, in regard to sex- characterization, they have little influence in this respect, and should not, therefore, be termed the primary characteristic on which the denomination of sex is based. Removal of the ovaries in a young sexually-active woman of a feminine type may cause very serious results. Consequently, if the ablation is unavoidable, substitution therapy should be undertaken. Ovarian whole gland substance, gr. v-x, with thyroid gland gr. 14, taken 3 times a day after food, is recommended. In cases of pelvic infection autoplastiec ovarian grafting is advised. The ovaries should be implanted into the rectus muscle. This does away with the danger of the ovaries later having to be removed from the normal situation because they had become bound down with adhesions and become cystic. Of the author’s cases menstruation occurred following ovarian grafts in 66.6 per cent of the cases in which menstruation was possible (38 out of 57 cases). —tI,, G. KK Cyclic changes in the OVARIES and uterus of the sow, and their relation to the mechanism of implantation of the embryos. Cor- ner (G. W.), Anat. Record (Phila.), 1921, 21, 52. Oestrous in the sow averages twenty-one days in length. Ovu- lation is found to occur during oestrous; the corpora lutea complete their formation about the seventh day, and remain in full develop- ABSTRACTS 665 ment from the seventh to the fifteenth day, thus surviving just long enough to cover the period of attachment of the embryos. If no embryos are present the corpora lutea degenerate about the fifteenth day. At the same time changes are taking place in the uterus. The results indicate that there is a correlation between the state of the corpus luteum and that of the uterus by which the uterus is prepared, after ovulation, to receive embryos.—W. J. A. (OVARY, THYROID) The effect of thyroidectomy on the oestrous cycle of the rat. Evans (H. M.) & Long (J. A.), Anat. Record (Phila.), 1921, 21, 61. Following thyroidectomy there was a pause in the oestrous eycle of from 6 to 27 days, but this was succeeded by normal cycles. Operations on young animals did not appreciably influence either the time of maturity or the length of the oestrous cycles when these appeared. Regenerated thyroids were found at autopsy in several of the latter group.—W. JeVAS Activity of the OVARY in pregnancy (interstitial cells) [Ueber die Tatigkeit des Ovarium in der Schwangerschaft (interstitielle Zel- len)]. Fellner (O. O.), Monastchr. f. Gebs. u. Gynak. (Berl.), 1921, 54, 88-94. Experiments are reported on rabbits in which the injection of ovarian lipoid material is saown to be more active in producing uterine hypertrophy than is corpus luteum lipoid, from which Fellner concludes that the interstitial cells of the ovary are likewise active as secretory agents, that they produce the same lipoid as the corpus luteum and that the activity of the interstitial cells in preg- nancy is just as marked as is the activity of the corpus luteum. He also is of the opinion that the ovarian activity is increased during pregnancy. His experiments, however, are few and hardly seem sufficient to justify such sweeping conclusions.—F. S. H. OVARIAN influence on blood-sugar (Beitrag zur Frage der Beein- flussung des Blutzuckers durch das Ovarium). Hiirzler (0O.), Monatschr. f. Geburtsh. u. Gynak. (Berlin), 1921, 54, 215-219. Using rabbits as the experimental animals it was found that when that dose of adrenine, which when injected into healthy ani- mals failed to produce a hyperglycemia, was injected into the same animals after removal of the ovaries, there occurred a marked in- crease of the blood sugar.—F. S. H. ‘ (OVARY) The influence of lactation on the sexual cycle in the rat and guinea pig. Loeb (L.) & Kuramitzu (C.), Am. J. Physiol. (Balt.), 1921, 55, 443-449. Ovulation is suspended in the rat during lactation, but it con- tinues to take place in the guinea pig. A possible explanation is that 666 ABSTRACTS in the rat the corpus luteum of lactation functions for a longer period of time than in the guinea pig.—T. C. B. On the rapid maturation of the OVARY by transplantation of the youthful gonad to adults. Long (J. A.) & Evans (H. M.), Anat. Record (Phila.), 1921, 21, 60. Ovaries from immature rats, when transplanted to adults, be- come functional in from six to eight days. The authors think it is apparent that endocrine influences of the adult tissues are respon- sible for provoking this sudden maturation of the sex gland, which normally occurs from one to two months later.—W. J. A. (OVARY) The interstitial gland (‘Ein Mahnwort zum Kapital”’ In- terstitielle Driise). Meyer (R.), Zentralbl. f. Gyn. (Leipzig), 1920, 45, 593-601, The author studied the “interstitial sex gland’? in women and comes to these conclusions: An interstitial gland does not exist. The Pubertitsdriise is a word without any physiological meaning. Some authors have stated that this gland is situated in the cells of the theca, but girls in puberty have no increase in theca cells and these cells are already found in the sixth month of fetal life. A woman does not need ovaries for the development of the secondary female characteristics. A person without ovaries in whom inter- stitial cells of testicles are found may develop perfect female char- acteristics. A function of the theca cells is unknown, but it is high- ly improbable that it has anything to do with sexuality. The inter- stitial uterus gland that has been invented by some authors does not exist.—J. K. (OVARY) The interpretation and clinical significance of uterine hemorrhage. Novak (E.), Med. Record (N. Y.), 1920, 98, 43-46. The underlying cause of menstruation is the ovary, and the corpus luteum the responsible constituent. The author outlines 3 types of uterine bleeding: (1) the purely anatomical type, as in uterine cancer; (2) the combined mechanical and functional group, as in myomata, adnexitis, ete., in which functional disturbance of the ovary is partially responsible, and (3) cases in which hyper- plasia of the endometrium with hemorrhage is due to ovarian endoc- rinopathy.—H. L. ; Grafts of the OVARIES of the goat or sheep (Sur la graffe d'ovaires de chevre ou de brebis). Retterer (Ea.) & Voronoff (S.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 104-106. If an ovarian graft is successful, do all the elements of the ovary continue to survive? Is the ovary capable of producing mature ova and can it furnish an internal secretion? Two experiments on goats ABSTRACTS 667 are described. In one ecdse, after double ovariotomy, one ovary was implanted in the interior of the right horn of the uterus; the other ovary was introduced into the left horn in such a way that one- fourth of the ovary was inside the horn, the other three-quarters outside. The graft was removed after nineteen months. In the second case, after double ovariotomy, half of an ovary taken from another goat was introduced into the right uterine horn, while half of one of its own ovaries was transplanted to the exterior of the uterus at a level with the bifurcation of the cornua. The grafts were removed in thirty-three days. The microscopic appearances are de- scribed. En résumé, all the elements of the graft in the cavity of the uterine horn were the seat of degeneration. In spite of this, the presence of the ovary in the uterus of a spayed goat determined the development of the maternal placenta. There is a brief critique of the work of others.—T. C. B. Evolution of maternal placenta or caruncles after OVARIAN grafts (Evolution des placentas maternels ou caroncules aprés le greffe d’ovaires). Retterer (Ed.) & Voronoff (S.), Compt. rend. Soc. de piol. (Paris), 1921, 84, 187-189. Histological description of the uterine mucosa of the two goats in which the ovaries had been grafted into the cavity of the uterine horn, with a discussion of the results.—T. C. B. (OVARY) The non-atresic graafian follicle in the rabbit (Sur le follicule de de Graaf non atrésique de la lapine). Salazar (A. L.), Compt. rend. Soc. de biol. (Paris), 1920, 83, 1658-1660. Histological.—T. C. B. The Pfliiger’s cords of the adult rabbit OVARY; their atresia (Sur les cordons ovigénes de Vovaire adulte de la lapine: leur atrésie). Salazar (A. L.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 235-237. Embryological.—T. C. B. (OVARY) The concentric corpuscles of the atresic granulosa of the rabbit (Chromatolytic period) [Les corpusules concentriques de la granulosa atrésique de la lapine (période chromatolytique) ]. Salazar (A. L.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 237-239. Histological.—T. C. B. OVARIAN function. Ovulation, corpus luteum and menstruation (tudes sur la fonction des ovaries. Ovulation, corps jaune et menstruation). Schickele (G.), Gynec. et Obst. (Paris), 1921, 3, 170-196. 668 ABSTRACTS Macroscopic and microscopic studies of the ovaries removed from a large number of patients because of one pathological condi- tion and another, accompanied by observations of the menstrual period and uterine condition lead to the conclusions that the corpus luteum can be found in active condition during the week after the completion of menstruation; that the latter part of the menstrual period is accompanied by a hyperemic and secretory metamorphosis of the uterine mucosa, which may persist after cessation of the periods; that in consequence, a developing corpus luteum often is seen to coincide with a uterine mucosa in the state of metamorphosis, but that the degree of development is not necessarily the same for both; in fact, the uterine metamorphosis can take place without corpus luteum, and corpus luteum can develop without uterine transformation. There is accordingly a reciprocal independence of the two, and it is stated as a certainty that menstruation can occur in the absence of corpus luteum.—F. Sin The influence of optones from the OVARY on the secretion of milk (Die Wirkung der Ovarialoptonen auf die Milchsekretion). Weil (A.), Miinchen. med. Wehnschr., 1921, 68, 520-521. Abderhalden has prepared “optones” from different organs, which underwent sterile autolysis. In one case Weil could prove that injections of optones from the ovary increased the secretion of milk in woman.—J. K. Formation of the definitive cortical layer in the rabbit OVARY (Formation de la couche corticale définitive de l’ovaire de lapin). Winiwarter (H. de), Compt. rend. Soe. de biol. (Paris), 1920, 83, 1559-1561. Histological.—T. C. B. (PANCREAS) Carbohydrates in the surviving liver of depancreatized dogs (Sul comportamento degli idrati di carbonio nel fegato so- pravvivente di cane spancreatizzato). Lombroso (Ugo), Riforma med. (Napoli), 1921, 37, 429. After removal of the pancreas the liver content of carbohydrates is very low—less than 1 per cent. During the survival period the liver hardly consumes them as well as the carbohydrates of the cir- culating blood. Upon adding a large amount of glucose to the circulating blood its consumption is remarkable, though a great deal less than that in the liver of a normal dog, during the digestion period. Therefore, the fat of the liver in dogs without pancreas is not used to form glucose, as some authors claim, in explanation of pancreatic diabetes.—G. V. ABSTRACTS 669 (PINEAL) A contribution ‘to the study of the function of the glan- dula pinealis. Zandrén (Sven), Acta med. scand. (Stockholm), 1921, 54, 323-335. A youth of 16 years, 9 months, exhibited a number of abnor- malities in development, namely, a considerable retardation of physical growth, retention of teeth, small testes and the absence of all secondary sexual traits. The anamnesis showed that he had developed normally to the age of ten, but that he had entirely failed to undergo the characteristic changes of puberty, and at the age of nearly 17 presented the appearance of a boy of 12. The clinical ensemble seemed to indicate thyroid insufficiency. But the absence of myxedematous affections of the skin, despite the very marked aberrations in development, may possibly argue against thyroid in- sufficiency. Four days before death ejection of blood occurred and laparatomy was performed on suspicion of ulcus perforans ventriculi; no ulcus nor peritonitis found. Collapse and death followed. Au- topsy disclosed: Thyroid, 19 gm.; hypophysis, 9 gm.; thymus and adrenals, normal; testes hypoplastic with a microscopic appearance which fully corresponds with that of a 1-2 years old baby. Pineal gland missing (proved by microscopical search in serial sections). The function of the pineal gland is without doubt essentially of an internal secretory nature. Its principal task is the initiation of puberty, which probably is effected. by an interaction between the epiphysis and the sexual glands. The granulation of the pineal cells observed by the anatomists at the age of 8 or 9 may possibly be the anatomical basis of the secretion. The absence of complete involution even at mature age argues that the gland has internal secretory functions also after puberty. The described case affords no support for a purely mechanical function, nor for any connection of the symptoms adiposity, cachexia and idiotism with disorders of the pineal gland.—J. A. H. Postoperative tetany and transplantation of PARATHYROIDS (Post- operative Tetanie und Epithelkorpercheniiberpflanzung) . Burk (W.), Zentralbl. f. Chir. (Leipzig), 1921, 48, 10-12. Tetany developed after an operation for goiter in a boy of seven- teen. As organotherapy and autotransplantation were unsuccessful 35 hours after operation a homotransplantation was earried out with temporary benefit. Death occurred in 6 days. However, at autopsy organs which had been transplanted were found to have been lymph-glands. The parathyroid that had been transplanted with autotransplantation had become necrotic.—J. K. (PARATHYROID) Guanidin poisoning in mammals and its physio- pathological importance (Guanidinvergiftung beim Saiigetier und seine physiopathologische Bedeutung). Frank (E.), (Stern (N.) 670 ABSTRACTS & Rothmann (M.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 578. Guanidin causes tetanic contractions of muscles. Still more poisonous is diurethylguanidin. This poison produces all symptoms of tetany. Guanidin and diurethylguanidin do not stimulate but increase the irritability of nerves and muscles. It is a function of the parathyroids to neutralize their influences.—J. K. On the formation of the PARATHYROID immune bodies. Kishi (Isami), Tokyo, Igakkwai, 1920, 34, (No. 9). Correction Endocrinol., 4, 678. The author immunized rabbits with horse’s parathyroid gland tissue and made studies on comple- ment fixation, precipitin, and cytolytic reactions. He found that the immune serum affects not only parathyroid, but also thyroid, pineal, hypophyseal, suprarenal, and lymph glands of the horse, while it was without influence on parathyroid tissue of dogs and rats. The serum, therefore, contained no genuine specific antibody.—Author’s cor- rection. (PARATHYROID) Calcium metabolism and calcium in the blood of a patient with tetania parathyreopriva (Kalkstoffwechsel und Blutkalkunterssuchungen in einem Falle von Tetaniaparathy- reopriva). Klein (C. J. J. G.), Deutsches Arch. f. klin. Med. (Leipzig), 1921, 135, 161-172. Report of a case of tetany after an operation for goiter. There was an enormous retention of calcium in the body. The more calcium was retained, the less intense were the symptoms and the less was the galvanic irritability of the peripheral nerves. When parathyroids were given by mouth the retention of calcium was somewhat increased. When an extract of parathyroids was injected the amount of retained calcium was a bit more. Much more calcium was retained when thyroid tabloids were given, though metabolism was markedly increased. The amount of calcium in the blood was normal and remained normal when parathyroids were given. How- ever, it reached four times its original amount when 8 gr. lactate of calcium was given daily.—J. K. (PARATHYROIDS) Treatment of tetany during the first years of life (Behandeling van de tetanie der eerste levensjaren). de Lange (C.), Neuratherapie (Amsterdam), 1920, —, 30-36. Of no endocrine interest.—J. K. On the internal secretion of Sandstroem’s glands, PARATHYROID hypofunction and eclampsia. Massaglia (A. C.), Am. J. Physiol. (Balt.), 1921, 55, 317-318. After removal of two or three parathyroids (in dogs or cats) there are no nervous symptoms; they are in a condition of ‘latent ABSTRACTS 671 parathyroid insufficiency.” ‘Poxie substances in the blood may bring on tetanic symptoms, for the remaining gland will not be able io function efficiently. This gives a method for determining what poisons are neutralized by the parathyroids. Waste products were increased by means of pregnancy, impairment of kidney function, derangement of the liver, muscular fatigue and lead poisoning. The parathyroids neutralize the toxins from pregnancy, muscular fatigue and from the intestines; they do not neutralize phosphorus or lead poisoning. Hypofunction—especially in pregnancy—causes auto- intoxication which injures the liver and kidneys. Parathyroid hypo- function prodtices symptoms similar to eclampsia. This does not preclude the possibility of other etiological factors. In eclampsia caused by parathyroid hypofunction, prompt treatment with para- thyroidin gives good results.—T. C. B. Transplantation of PARATHYROIDS in_ postoperative tetany (Epithelkérperchentiberpflanzung bei postoperativer Tetanie). Polya (B.), Zentralbl. f. Chir. (Leipzig), 1921, 48, 223-224. The author tried to find at autopsy the parathyroids and exam- ine them histologically. In many cases the organ that was believed to be a parathyroid proved to be a tuberculous lymph-gland. There- fore, he advises the transplantation of a part of the thyroid with its adnexae from a person recently dead. Histological examination is less useful. While the aspect under the microscope may be that of a parathyroid the largest part of the graft may consist of lymph or other tissue.—J. K. (PINEAL) Pubertas praecox. Frank, Miinchen. med. Wehnschr., 1921, 68, 29. A boy of 11 became suddenly stupid, dull and complained of giddiness, headache and vomiting. The sexual organs developed rapidly, hair around the genitalia and on the legs, largely developed and a choked disk (optic neuritis) was observed. An x-ray was nega- tive. The diagnosis is a probable teratoma of the pineal.—J. K. (PINEAL) Pubertas praecox. Huebschmann, Miinchen. med. Wehnschr., 1921, 68, 220. Clinical details are not given. Post-mortem: Tumor of the pineal, large heart and larynx, the testicles were completely devel- oped (age of the patient not given).—J. K. (PINEAL). Lipodystrophia: report of a case (Ueber Lipodystrophie nebst Mitteilung eines Falles). Klien (H.), Miinchen. med. Wehnschr., 1921, 68, 200-208. In this case the atrophy of the subcutaneous fat was combined with nasal hydrorrhea, hypertrichosis, polakiuria and slight polyuria. 672 ABSTRACTS The author believes that these symptoms as well as the lipodys- trophia itself may be due to changes in the pineal.—dJ. K. (PINEAL) Pubertas praecox. Weigeldt, Miinchen. med. Wehnschr., 1921, 68, 220. Report of a case of a girl of 13 years and 8 months with normal female development. The author considers this as a case of hyper- genitalism, because the girl had already menstruated. © (It would be of interest to know what age the author considers as the normal age of puberty).—4J. K. The diuretic action of PITUITRIN. Stoland (O. 0.) & Korb (J. H.), Am. J. Physiol. (Balt.), 1921, 55, 305-306. Experiments were made on large, healthy female dogs with a bladder fistula. The urine was collected in clean flasks packed in ice and determinations made every four hours. The results seem to show that pituitrin acts as a stimulant to the kidney in that it produces such a marked secretion of urine that the nitrogenous con- tent of the blood falls far below normal.—T. C. B. Dangers of injections with PITUITRIN (Gevaren van de inspuiting yan pituitrine). Westerbeck van Eerten (B. J.), Neder}. Tijdschr. y. Geneesk. (Haarlem), 1921, 65, 513-515. In one case a dead child was born after an injection of pituitrin. In another an injection of pituitrin was given, the patient collapsed after the accouchement. The author’s proof that these accidents were due to pituitrin is not very convincing! —J. K. Maternal PLACENTA experimentally produced in the guinea pig (Placenta maternel expérimental de la chévre). Retterer (Ed.) & Voronoff (E.), Bull. d’obst. et gynéc. (Paris), 1921, 10, 32-34. These investigators transplanted ovaries into the uterine cornua and observed that the neighboring uterine mucosa produced tissue analagous to the maternal placenta during the degeneration of the implant.—F. S. H. Action of the PROSTATIC liquid on the contents of the vesicular glands of new born or very young guinea pigs (Action du liquide prostatique sur le contenu des glandes vesiculaires des cobayes nouveau-nés ou tres jeunes). Camus (L.) & Gley (E.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 250-252. It is shown that the coagulating action of “vesiculase’’ (pros- tatic ferment) on ‘‘vesiculine” (vesicular contents) is delayed in very young guinea pigs, due to the minute quantity of ferment present. —— TC LB: ABSTRACTS 67: Oo Endocrinological studies’ of the PROSTATE. Macht (D. I.), Am. J. Physiol. (Balt.), 1921, 55, 311-312. Feeding prostate hastens metamorphosis of frog and salamander larvae, but unlike thyroid it causes no shrinkage of the animals. Extracts of prostate have no particular influence on the contraction of smooth muscle (fallopian tubes, bladder, ete.). Prostatic extracts hasten coagulation of blood, but it is due to kephalin, not to a specific substance. There is no effect on the intelligence (behavior) of albino rats. A study of the innervation of the prostate warrants the state- ment that it is more richly supplied by the true sympathetic system than by the sacral autonomics.—T. C. B. (SEX) Is casiration indicated in pseudo-hemaphroditic males (A propos d’ un cas de pseudo-hermaphrodisme a type androgynoide regulier. La castration estelle indequée chez les pseudo-hermaph- rodites males). Bérard (L.) & Dunet (Ch.), Gynec. et. Obst. (Paris), 1921, 3, 226-232. A description of a case of pseudo-hermaphroditism as given in the title, accompanied by a discussion as to the advisability of remov- ing the gonads in such cases. In view of the possibility of develop- ment of a malignant tumor from the ectopic sex residue, and since the endocrine importance of such abnormalities is not proven, the authors consider total castration justified.—F. S. H. (SEX) The early history of the germ cells in the brook lamprey, Entosphenus wilderi (Gage), up to and including the period of sex differentiation. Okkelberg (P.), J. Morph. (Phila.), 1921, 35, 1-151. The germ cells are segregated very early in the life of the ani- mal even before the germ layers are definitely established. They are first recognizable when the mesoderm separates from the entoderm. The definitive germ cells take their origin from no other source than the primordial germ cells and the germ cells take no part in the production of somatic structures. Numerous germ cells are pro- duced which do not become functional, and these degenerate and dis- appear during the process of development. The germ cells of each germ gland are usually of two kinds, namely, those showing a ten- dency toward rapid division (katabolic) and those showing a ten- dency toward growth (anabolic). The former are regarded as hay- ing a male, the latter a female potentiality. The relative proportion of anabolic and katabolic cells determines whether the larva becomes a male or a female. During this period the larva may be described as a juvenile hermaphrodite. The author feels warranted in con- cluding that each larva of this species carries the potentiality of both sexes, and that sex, therefore, is not irrevocably fixed at fertili- zation. When sex is once established, the germ cells belonging ta 674+ ABSTRACTS the opposite sex disappear or remain in the gland in a rudimentary condition. (SEXUAL GLANDS) Rejuvenation by extirpation of the uterus (Totalextirpation des Uterus und Verjiingung). Leipmann (W.), Zentralbl. f. Gyn. (Leipzig), 1921, 45, 302-303. A short note. In many cases the women made a younger im- pression and showed stronger sexual desires. (It is not told why the patients have been operated. We know how the removal of a tumor, ete., may have an influence on a patient in relieving the symptoms.)—J. K. Treatment of SPASMOPHILIA by calcium chloride and phosphated cod-liver oil (Le traitement combiné des manifestations spas- mophiles par le chlorure de calcium et Vhuile de foie de morus phosphorée). Rhomer (P.) & Vonderweidt (P.), Le Nourrisson (Paris), 1921, 9, 87-95. Feeling that the discontinuous effects of calcium administration in conditions of spasmophilia may in part be due to defective absorp- tion, the authors made several studies of various methods of giving the compound, and checked their results by observations on the changes in the galvanic reactions of the patients treated. Twelve cases in all were studied. Asa result of the investigation the con- clusion is reached that from the first day on, large doses of calcium chloride (5 to 6 grams of the anhydrous salt or 10 to 12 grams of the crystalline salt) should be given accompanied by 5 grams of phosphated cod-liver oil (0.01 gram of Phosphorus per 100 grams of oil) twice a day. This medication is continued without interruption for 12 days. The calcium chloride is then omitted and the oil con- tinued for several weeks. Good results are obtained.—F. S. H. The action of SPLEEN extract on the activity of the frog’s heart in situ and of the isolated perfused mammalian heart [Ueber die Hinwirkung des Milzextraktes (Lienins) auf die Titigkeit des Froschherzens in situ und des isoliert durchstriéimten Siiugetier- herzens]. Rothlin (BL), Arch. £).d. ges: Physiol. (Bonn), 1920, 185, 111-121. Stern and Rothlin’s work on spleen extract (named by them -‘Lienin’’) suggests at least a specific metabolic product if not a hormone (J. de Physiol. et de Path. gén., 1919, 18, 441), having a marked vasoconstrictor action on all surviving vessels. The action of “Lienin’’ on the heart is marked by two phases, the first occupy- ing 10 to 15 seconds. The curarised frog’s heart (in situ) shows first a decrease of tonus, slowing of frequency, and lowering of height of contraction, followed in the second phase by a decrease of frequency, with increase of height of contraction and slow recovery of tonus. The perfused mammalian heart shows at first an increase ABSTRACTS 675 of tonus, with decrease ‘of frequency and extent of contraction, these being followed by increases in the second phase. Repeated injections give the same results, and will produce marked activity in a heart originally scarcely beating or at standstill. “Lienin,”’ histamine, and “Pituglandol” have in these respects qualitatively the same action; quantitatively that of histamine is greater. This suggests that histamine is present as an active principle in ‘“‘Lienin” and ‘“Pituglandol.’’—A. T. C. (TESTES) The existence of secretory phenomena in the vas deferens (Sur l’existence de phénoménes sécrétoires dans le canal déférent). Benoit (J.), Compt. rend. Soc. de biol. (Paris), 1920, 83, 1640-1641. Histological proof that the vas deferens is secretory.—T. C. B. (TESTES) Interstitial gland grafting (Sugli innesti della ghiandola interstiziale). Falcone (R.), Riforma med. (Napoli), 1920, 36, 1177-1180. Falcone, of the University of Naples, reports four cases of graft- ing of ram testicle into the abdominal wall. The subjects were men, 74, 638, 53 and 69 years old, respectively, all of them sexually im- potent. As regards the sexual condition and general health, all of the patients showed a remarkable improvement; in two patients even exaggerated sexual excitability resulted. Psychic influence was excluded since the patients did not know what effect was expected from the graft; and furthermore no psychical effect, the author adds, would explain the increased size of the testicles that followed. With- out trying to draw definite conclusions from cases too recently operated upon, the author believes that from heterologous grafts encouraging results may be obtained as regards the sexual function, general euphoria, psychic condition and organic improvement.—G. V. A ease of transplantation of the TESTICLE (Ein Fall von Hoden- transplantation). Forster (W.), Miinchen. med. Wehnschr., 1921, 68, 106. A testicle of a man of 20 was transplanted without success into a man of 55 with praecox senilis. The patient died 3 months after the operation; both the grafts had become necrotie.—J. K. Quantitative experiments on the endocrine function of the TESTICLE (Quantitative Untersuchungen iiber die innersekretorische Funk- tion der Testikel). Lipschutz (A.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 350-351. In guinea pigs one testicle was completely and the other one partly removed. When in a young animal only one testicle is re- moved the other one hypertrophies. If, however, the second testicle 676 ABSTRACTS is partly removed, the piece left behind does not become hyper- trophied. When about 1/140 part of the normal testicles are left behind the animal develops normally. When still more testicular tissue is removed sexual development becomes slower. The histo- logical examination of the piece, left behind in the body, shows marked changes. Degeneration of the spermatozoa may be found; at last they disappear completely. The same changes are observed after exposure to x-ray, transplantation or cutting of the vasa defer- entia. On the other hand, the interstitial cells in the residues left behind are enormously increased in number and volume. These re- sults are found in guinea pigs; in rabbits no growth of interstitial cells or degeneration of the spermatogeneous tissue could be detected. —J. K. Two remarkable cases of TESTICLE implantation. Lydston (G. F.), N. York M. J. (New York), 1921, 113, 232-233. Case 1. Hypopituitarism was manifested in a subject, age 34; he showed feminine secondary sex characteristics and had sexual organs the size of those of a child of one year. He was inefficient mentally, physically and sexually. Left scrotal implantation of a single testicle was made. The implantation resulted in an im- provement of nutrition, the appearance of frequent and violent erections and the power of coitus, a marked growth of pubic and axillary hairs and an enlargement of the penis and testis. The marked enlargement of the patient’s own testis will probably make permanent the results of the implantation. Case 2. A man, age 36 years, who at the age of 30 lost both testes because of a tubercular condition of these parts. The castra- tion operation was followed by the loss of the beard, the acquire- ment of much fat of feminine distribution, alterations in the voice, loss of sexual power and mental and physical efficiency. Double implantation was made 2 years ago without much improvement. Ten months after first operation a single gland was implanted. This was followed by a decided physical improvement, a loss of 26 pounds in weight, disappearance of the nervous condition and pro- nounced sexual improvement. The author believes the results of this operation can be maintained by repeated implantations.—H. W. The TESTICLE of a glandular hermaphrodite (Der Hoden eines Driisenzwitters). Meixner (K.), Wien. klin. Wehnschr., 1921, 34, 142-144. In a child with female internal sexual organs a part of the left sexual gland was removed and proved to be a testicle. No clinical details are given.—J. K. Further experiences on the transplantation of TESTICLE (Weitere Mitteilungen Uber Hodeniiberpflanzung). Miihsam (R.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 354-355. ABSTRACTS 677 In a case of bisexuality and two cases of homosexuality favor- able ‘results were obtained. These results, however, were not ob- served immediately after the transplantation. In both cases of homosexuality it took 6 and 4 months before heterosexual signs were observed.—J. K. Influence on sexual life of TESTICULAR transplantation (Beeinflus- sung des Geslechtslebens durch freie Hodeniiberpflanzung). Muh- sam., Berl. klin. Wehnschr., 1921, 58, 182. In two cases of homosexuality and in one case of eunuchoidism caused by castration a good result was obtained. No clinical details are given.—J. K. The development of the antlers and its relation to the internal secre- tion of the TESTICLE (Ueber die Geweihentwicklung und ihre Abhingigkeit von der inneren Sekretion der Hoden). Olt., Deutsche med. Wehnschr. (Berlin), 1921, 47, 491-492. In the deer the development of the antlers depends upon the function of the gonads. Normally, when the antlers are full grown they become necrotic. When such an animal is castrated new antlers begin to develop. These show abnormal growth and finally kill the animal through cachexia. These abnormal antlers may be compared to a kind of papilloma.—J. K. The mode of development of tumors of the interstitial gland of the TESTICLE of the horse (Sur le mode de développement des tumeurs de la glande interstitielle du testicule chez le cheval). Peyron (A.), Compt. rend. soe. de biol. (Paris), 1921, 84, 461-464. Of pathological interest —T. C. B. A case of tumor in an ectopic TESTICLE (Un caso di tumore in testicolo ectopico). Pizzagalli (L.), ll Morgagni (Milano), 1921, 64, 133-119. Of no endocrine interest.—J. K. The results of ligation on the TESTICLE with special reference to the question of the puberty-gland (Unterbindungsbefunde am Hoden unter besonderer Beriicksichtigung der Pubertatsdriisen- frage). Tiedje (A.), Deutsche med. Wehnschr., 1921, 47, 352-354. If one testicle is removed in guinea pigs and on the other side the vas deferens is ligated the testicle develops normally in young animals, or in older ones first shows a degeneration, followed by a complete regeneration. If the ligation is made on both sides the results are the same. If only one side is ligated without removal of the other gland the testicle on which the operation is performed becomes atrophic, the other one hypertrophical. According to the author the spermatogenous part of the testicle is the cause of the 678 ABSTRACTS sexual characteristics. It has never been proved that the so-called interstitial cells have an endocrine function. There is not one reason to believe in a Pubertitsdriise’” as described by Steinach. —J. K. Contribution to the anatomical and pathological study of the THY- MUS in infancy (Contributo allo studio anatomico e patologico del timo nella prima eta). Canelli (A.), Pediatria (Napoli), 1920, 28, 1003-1019; 1056-1070; 1108-1122. Canelli reports from Foa’s laboratory at Turin University a study of 119 thymuses, 7 per cent of which were derived from cases of status thymicus or thymico-lymphaticus. From the study of his own cases as well as of those published by others, he draws the following conclusions: In new born children, either premature or not, there may be found status thymicus or thymico-lymphaticus (congenital), as indicated by hyperplasia of the lymphoid elements of the gland. These conditions may be clinically connected with mors thymica, though the anatomo-pathological finding does not always show this. Owing to the cokstant hyperplasia of the lymphatic tis- sue in both varieties we may conclude that in new born there may be either a status lymphaticus or a Ss. thymico-lymphaticus. Nearly all thymus glands in these conditions are above the normal weight (13.8 gm.), but as regards the cortico-medullary index there is no characteristic change, nor is there in the number and size of the Hassel’s corpuscles in the nuclear picnosis, nor in the number of the eosinophiles. Hyperplasia of the lobules is constantly found. There is always augmented development of the follicles of the spleen (number and volume), but neither congestion nor increased weight is characteristic. The peripheral lymphatic glands may be macro- scopically normal, but microscopically, they always show in their cortex many compact follicles. The lymphatic tissue in the rhino- pharynx is always involved; it is doubtful, however, whether the hyperplasia of the palatine and lingual tonsils is due to a lymphocytic proliferation or to diapedesis of lymphocytes through the epithelium. Eventually the vermiform appendix in such cases may be of a con- siderable length (8 cm.), but what is more important, nothing can be stated with certainty about the involvement of the lymphatic intestinal tissue in these cases. There is no lymphoid reaction of the bone marrow. The process of ossification is not influenced. Hyaline degeneration of the renal glomeruli is not found, nor is fetal lobulation of the kidney, such as is frequently seen in status thymolymphaticus of adults. The hematopoietic foci that can be found in the liver are independent of status thymolymphaticus. Hypoplasia of the blood vessels, especially of the aorta, is of doubt- ful occurrence in status thymolymphaticus of the new born. Char- acteristic lesions of the adrenals are not surely demonstrated in such cases, yet in two of Canelli’s cases there was accentuated hypoplasia ABSTRACTS 679 of the medulla and a poor development of the chromaphil elements. This might lead to an imbalance in the interrelational functions of the endocrine glands. Nothing significant was noted in the hypo- physis. Congenital thyroid struma is frequent, though not found in every case. Nothing abnormal was seen in the seminiferous tubules, but increase of fat in the canalicular epithelium was noted. There may be congenital malformations, though no relation can be demon- strated with the status thymolymphaticus. The color and condition of the skin are not characteristically altered. The length of the body is not above normal, but in some cases the weight may be increased. —G. V. Congenital bone fragility and the THYMUS. Contribution to the study of bone dystrophy in relation to the ENDOCRINE GLANDS (Fragilitaé ossea congenita e timo. Contributo allo studio delle distrofie ossee in rapporto con le ghiandole endocrine) . Frontali, Riv. di clin. pediat. (Firenze), 1920, —, —, (May); Abst., Pediat- ria (Napoli), 1921, 29, 334-335. The author reports a case of congenital fragility of bones in an infant three months and a half old, whose skull bones were ofa parchment consistence and whose long bones, all very much reduced in size, had 33 fractures. The calcium metabolism and the calcium content in the blood showed no detectable abnormality. The thymus showed marked atrophy and sclerosis. Frontali thinks that a marked alteration of the thymus in the prenatal life might have influenced the osteogenesis. The other endocrine glands did not show any abnormality. [Park and McClure’s recent eareful studies render very dubious the theory that the thymus has an influence on osteogenesis. ]—G. Vi (THYMUS) A case of status thymolymphaticus with rickets (Un caso die stato timico-linfatico accompagnato a rachitismo). Gemma (G.), Pediatria (Napoli), 1921, 29, 126-130. Gemma of the University of Naples reports a case of rickets in which autopsy revealed parenchymatous hyperplasia of the lymphoid tissue of the thymus with hypertrophy of the spleen. The Wasser- mann reaction was negative in the child, but positive in the mother, hence syphilis might have played ,a part in the abnormality of the thymus and the development of rickets. Usually the condition of status thymolymphaticus is observed in cases of rickets with florid appearance. The marasmatie condition of the present case the author regards as probably due to insufficiency of the thymus with relative atrophy of Hassal’s corpuscles.—G. V. Lymphosarcome du THYMUS. Harvier (P.), Bull. et. mem. Soc. méd. d. hop d. Par., 1921, 45, 374-381. 680 ABSTRACTS A case report of thymic tumor of no particular endocrine inter- est.—F. S. H. Extirpation and transplantation of THYMLI in larvae of Rana pipiens. Hoskins (Margaret M.), Anat. Record (Phila.), 1921, 21, 67. When one thymus is removed there is no compensatory hyper- trophy of the remaining one, and the engrafting of thymic tissue does not affect the thymi of the host. None of the operations affects the spleen in size or appearance. The gonads, thyroids, and para- thyroids remain unchanged. In some instances the hypophysis of the thymectomized larvae appear to be hypertrophied, but this is not always the case. Histologically, the hypophyses of the operated animals are normal.—W. J. A. The effect of the THYMUS and MAMMARY on menstruation. Jacoby, (A.), N. York M. J. (New York), 1921, 113, 243-244. Mammary and thymus extracts alone or in combination, ad- ministered in 5 gr. doses three times a day over a period of 1 to 6 months, resulted in a diminution of both the duration and quantity of blood lost during the menstruation in 53 cases or 75 per cent of those considered. Such changes did not follow the administration of thymus extract alone (4 cases). Inhibition of the ovary aione is not sufficient to influence menstruation as shown by the failure of thymus extract to cause any change in the menstruation. On the other hand, a combination of the thymus and mammary extracts is quite effec- tive in the control of the menstrual flow.—H. W. The developmental topography of the THYMUS, with particular ref- erence to the changes at birth and in the neonatal period. Noback (G. J.), Anat. Record (Phila.), 1921, 21, 75. This is a topographical study in the fetus and new born. —=Wi, eee The results of THYMUS extirpation in the dog, with a review of the experimental literature of thymus extirpation. Park (BE. A.) & McClure (R. D.), Am. J. Dis. Child. (Chicago), 1919, 18, 317-521. Park and McClure summarize the results of a careful and ex- tensive series of experiments on the extirpation of the thymus in the dog as follows: Thymectomy failed to cause death. It did not pro- duce rickets or any disease of the skeleton. It was impossible to be certain that it caused any alteration in the animal. A great minor- ity of experiments suggested the possibility that removal of the thymus had caused a retarded or diminished growth of the skeleton and, therefore, of the animal as a whole; some experiments sug- gested that removal had provoked changes in the thyroid in the nature of hyperplasia, hypertrophy of the suprarenal or retarded ABSTRACTS 681 development of the testes. There is a cogent reason, however, which they wish to emphasize for believing that the changes in the various parts of the body mentioned were actually due to some other cause than deprivation of thymus function; they did not occur in combination in the same animal. It was concluded that the thymus gland is not essential to life in the dog. Extirpation of the thymus produces no detectable alteration in the hair, teeth, contour of the body, muscular development, strength, activity or intelligence of the experimental animal. Extirpation of the thymus does not influence growth or development. The possibility that it may cause retarda- tion in development and delayed closure of the epiphysis, however, cannot be excluded absolutely. Extirpation of the thymus probably produces no alterations in the organs of internal secretion. It is possible that it produces well marked changes in the organs of internal secretion in the period immediately following thymectomy which was not covered in their experiments.—M. B. G. The influence of the administration of THYMUS on weak animals (Die Beeinflussung minder veranlagter, schwiachlicher Tiere durch Thymusfiitterung). Romeis (B.), Miinchen. med. Wehnschr., 1921, 68, 420-422. Romeis has shown that when thymus is given to tadpoles they grow quicker and show metamorphosis before normal control ani- mals. The same influence is observed when the fats and lipoids are removed from the thymus. The fats and lipoids themselves have, on the contrary, an inhibiting influence on the growth of the animals. In each generation of tadpoles many specimens are weak and are less developed than the others. Romeis has examined the influence of thymus on these weak animals, and found a most marked effect, for after some time the weak individuals had reached or even sur- passed the control animals in size and development.—J. K. The influence of x-ray treatment of the THYMUS on the excretion of uric acid (Ueber die Beeinflussung der Harnsauerausscheidung durch Roéntgenbestrahlung der Thymusdriise). Rother & Szego, Deutsche med. Wehnschr. (Berlin), 1921, 47, 578. In some cases of Graves’ disease the excretion of uric acid was largely increased after exposure of the thymus to x-rays.—J. K. (THYMUS) Status thymo-lymphaticus. Stahr (H.), Munchen. med. Wehnschr., 1921, 68, 405-406. An isolated status thymicus is not known with certainty, the existence of a status thymicus has never been proved. Status thymo- lymphaticus plays an important part in fatal diseases of children. —J. K. 682 ABSTRACTS Surgical treatment of hyperplastic THYMUS (Zur operativen Be- handlung der Thymushyperplasie ) . Wirtz (C.), Inaug. Diss. (Cologne), 1919-1920. A hyperplastic thymus from a child 5 weeks old. This organ was partly removed, because of the pressure from an intercurrent disease.—J. K. (THYROID) The influence of specifically formed iodine compounds on the metamorphosis of frog larvae (Ueber den Einfluss spezifisch gebauter Jodverbindungen auf die Metamorphose von Froschlarven und von Axolotl). Abelin (J.), Biochem. Ztschr. (Berl.), 1921, 116, 138-164. Studies are reported of the influence of KI, Nal, NH,I, KIO,, Lugol’s soln., di-iodo-salicyclie acid, di-iodo-phenyl-salicylate, iodo- pyrine, di-iodo-tyrosine, di-iodo-di-thymol, iodo-gallicin, iodized pro- tein, non-iodized proteins, and tyrosine on metamorphosis of tad- poles. The results showed that certain type of organic I, protein derivates such as di-iodo-tyrosine and iodized protein are of im- portance at the beginning and during the course of frog larvae meta- morphosis while the other compounds of non-protein derivative na- ture were ineffective. The active compounds act as does the thyroid substance itself. Their activity is to be taken into account whea thyroid extracts or thyroid decomposition products are used. Similar results were obtained with axolotl.—F. S. H. (THYROID) The presence of pathogenic cryptococci in the lymph- nodules of goitrous goats (Sur la présence de cryptocoques patho- genes dans les ganglions des chevreaux goitreux). Bachmann (A.), Bull Soe. path. exot. (Paris), 1921, 14, 199-202. Noting that the inguinal and axillary lymph-nodes were en- larged in a goat having a goiter, Bachmann examined the glands histologically. There was found to be present an organism which to all appearances was similar to that present in epizootic lymph- angitis of the horse.—F. S. H. (THYROID) Diagnostic methods in exophthalmic goitre, with special reference to quinine. Bram (1.), Med. Record (N. Y-), 1920, 98, 887-891. Bram stresses the importance of early diagnosis in this disease before all four cardinal symptoms have necessarily appeared. This is the period when treatment is most beneficial. Marked hyper- thyroidism may occur without goitre or without exophthalmos. At this time differential diagnosis may be difficult. Kocher’s blood picture of leukopenia with relative lymphocytosis is not a positive diagnostic test of exophthalmie goitre. Harrower's thyroid extract test is condemned because it may aggravate the disease and is not ABSTRACTS 683 always reliable. Administration of digitalis for diagnostic purposes is of no value. Complement fixation tests are still in the experi- mental stage. The hyperglycemia test is also not reliable, being positive in other endocrine diseases. Basal metabolism observations are valuable aids in diagnosis, but not always available and require intricate, costly apparatus with highly trained technicians. Bon- douin and Porak’s posterior lobe pituitary injection test is valuable. The Goetsch adrenalin hypersensitiveness test has lately been ques- tioned as to accuracy, having been found positive in 48 per cent of, 103 soldiers with the effort syndrome. Furthermore, it depends on aggravation of the symptoms. The author then describes a quinine test which he has employed in 160 cases, 67 of which were instances of thyroid toxemia. It is simple of application and harmless. Most normal individuals react to large doses of quinine by fullmess and roaring in the head, tinnitus, impaired hearing, etc. Subjects of thyrotoxemia, on the other hand, are exceptionally tolerant to qui- nine, almost “immune’”’ to it. The patient is given a dozen capsules, each containing ten grains of the neutral hydrobromide of quinine. He is instructed to take one capsule four times a day, to be washed down by an ample quantity of lukewarm water, an hour or two after meals and at bedtime. Patients susceptible to the drug com- plain after the first or second dose; normal individuals, as a rule, after thirty, forty, fifty grains, whereas the hyperthyroid subjects will not only not complain after over a hundred grains, but feel definitely improved. Bram thinks there may be a 5 to 10 per cent error in the use of his quinine test, but believes its simplicity and harmlessness offsets this——H. L. (THYROID) Epilepsy, anaphylaxis and dysthyroidism (Epilessia, anafilassi e distiroidismo). Buscaino (V. M.), Arch. Suisses de Neurol. et de Psych. (Zurich), 1920, 7, 304-315. Buscaino refers to a previous publication, in which he cited evidence that in genuine epilepsy as well as in epileptic crises. as found in paresis, and arteriosclerotic dementia, there is a form of dysthyroidism, characterized by formation by the thyroid of octa- hedric crystals of protein, which by entering into the circulation determine the epileptic seizure. The author especially insists on the participation of the endocrine action on epileptic fits, as demon- strated by the unbalance of the leucocytic formula and vagotonia. In his research on protein crystals in the thyroid he found their presence in 15 per cent of patients supposed not to be epileptic and in 84 per cent of epileptics or patients affected with epileptiform seizures, in cases of paresis, arteriosclerotic dementia, idiocy, cerebral tumor and urema presenting epileptiform convulsions. —G. V. 684 ABSTRACTS The comparative effects of THYROID and of iodide feeding on growth in white rats and rabbits. Cameron (A. T.) & Carmichael (J.), J. Physiol. (Lond.), 1921, 54, lxxiv-lxxvi. The conflicting results of thyroid feeding on growth are due to inaccurate dosage; results depend on the proportion of thyroid to body weight. The method was, therefore, to base the amount of thyroid on the daily weight of the rat fed. Continual small doses of desiccated thyroid lead invariably to a decrease in the rate of growth, and hypertrophy of the organs concerned with increased ‘metabolism—heart, liver, kidneys, adrenals. Sodium iodide has no effect on the rate of growth, and there is no hypertrophy. Full de- tails are promised.—T. C. B. Action upon the THYMUS of the ingestion of THYROID gland (Action sur le thymus de l'ingestion de glande thyroide). Cour- rier (R.), Compt. rend. Soc. de biol. (Paris), 1921, 84, 226-228. A study of the functional correlation between the thymus and thyroid. The experiments were made on white rats and on eats. From 0.5 to 5 gms. of fresh thyroid were given daily. In one set of experiments the animals were kept on a diet that was insufficient to compensate for the augmentation of metabolism; they were in negative balance. In another series the diet was sufficient to keep the animals in positive balance. In the case of negative balance it is found that there was atrophy of the thymus caused by general lack of nutrition, but a comparative examination of all the organs showed a selective action on the thymus. In the case of positive balance, there was hypertrophy of the thymus, apparently due to a specific action of the thyroid. The author expects to show later that the above results confirm the theory that the thymus is the principal reserve organ for nucleoproteins.—T. ‘C. a: Morphology of THYROID (Morfologia della tiroide). Castaldi (L.), Jazz. de osp. (Milano), 1920, 41, 1115-1116. The author compared the weight of thyroids (found post- mortem) in Italians from different regions. All thyroids with abnor- malities were excluded. The thyroid of people living in the moun- tains had a higher average weight than in people living on the plain. Goiter and hyperthyroidism are frequently observed on the mountains. A well developed pyramid of the thyroid and a large isthmus are much more found on the mountains than in the plain. These differences become clear after some years, at birth no constant differences are found.—J. K. (THYROID) The blood in myxedema (Blutuntersuchungen beim Myxédem). Deusch (G.), Miinchen. med. Wehnschr., 1921, 68, 297-298. ABSTRACTS 685 Data have been reported in Deutsche Arch. f. klin. Med., Vol. 130.—J. K. (THYROID) Should the wound after operation for goiter be closed at once or drained? (Primiarer Wundschlutz oder Drainage nach Strumectomie)? Dorn (J.), Zentralbl. f. Chir. (Leipzig), 1921, 48, 111-114. Of technical surgical interest.—J. K. The effect of THYROID feeding on the oestrous eycle of the rat. Evans (H. M.) & Long (J. A.), Anat. Record (Phila.), 1921, 21, 61. In all cases thyroid feeding was accompanied by an increased consumption of food, but by a decrease in body weight. On the one hand, when the doses were very large, the cycle was lengthened or inhibited. With moderate doses, on the other hand, the oestrous eycles were usually not greatly disturbed. There consequently do not appear to be specific effects of thyroid substance on the oestrous eycle.—W. J. A. (THYROID) Hereditary goitrous cretinoid degeneration (Sulla de- generazione g0zzo cretinica ereditaria). Ferrara (M.), Riforma med. (Napoli), 1921, 37, 117. An interesting study of endemic thyropathy. Ferrara has ob- served thats the children born of cretinous parents from Lavanone (Val di Sabbia) may be healthy, whereas the offspring of healthy parents who have migrated to Lavanone tend to be cretins. There seems to be no doubt of the endemicity of cretinism in this region, but there is no recognized difference between the condition of this and surrounding non-cretinous territory, as regards either water sup- ply or terrain. Consanguinity of the parents was found to play an important role; with successive generations from affected parents the degenerative condition progresses from goitrous cretinoid to a true cretin state-—G. V. (THYROID) Role of basal metabolism in diagnosis and treatment of hyperthyroidism. Freund (H. A.), J. Mich. M. Soc. (Grand Rapids),.1921, 20, 35-37. Discussion of the value of basal metabolism tests in diagnosis, especially in borderline cases in which the pulse may be normal. Report of five cases of hyperthyroidism with basal metabolism determinations.—C. M. W. Carcino-sarcoma of the THYROID (Contributo alla conoscenza dei carcino-sarcomi della _ tiroide). Giavotto (G.), Pathologica (Genova), 1921, 13, 95-98. 656 ABSTRACTS ‘A case of carcino-sarcoma of the thyroid is described and illus- trated.—R. G. H. Creatinuria. III. The effect of THYROID feeding upon creatinuria. Gross (E. G.) & Steenbock (H.), J. Biol. Chem. (Balt.), 1921, 47, 45-52. The feeding of sheep’s thyroid to a pig on a nitrogen-free diet calls forth a marked stimulation of creatine formation. This is accentuated when creatine precursors from exogenous sources are available. It is suggested that creatine formation is primarily de- pendent upon the balance that obtains between the arginase and oxidative systems whereby arginine is destroyed. Furthermore, it is suggested that the thyroid principle may be active in causing creatine formation by accelerating the oxidative system of arginine destruction at the expense of the effect of arginase and that in the thyroid mechanism is to be sought the variable responsible for the difference in reaction of men and women in protein feeding. —F. S. H. (THYROID) Strumitis (Beitrag zur Kenntnis der Strumitis). Hagenbuch (M.), Pitt a. d. Grenzgeb. der. Med. u. Chir. (Jena), 1921, 33, 181-195. A tedious description based on 47 cases, without novel data. —J. K. The THYROID gland and thyrotoxicosis. Hammer (A. W.), N. York M. J. (New York), 1921, 118, 245-247. Review of general interest; nothing new.—H. W. Studies of the THYROID apparatus. I. The stability of the nervous system as a factor in the resistance of the albino rat to the loss of the PARATHYROID secretion. Hammett (Fe (S:)) Amis Physiol. (Balt.), 1921, 56, 196-204. At the Wistar Institute there are maintained, among others, two colonies of albino rats which are descended from the same orig- inal pair. One of these, the ‘Experimental Colony,” has been “gentled” and gives a uniform picture of placidity. Their threshold of neuromuscular reactions is very high. The other colony, the “Standard” stock, has come into only such human contact as is inci- dent to cage cleaning and feeding. The picture as a whole is one of high irritability and ‘neuromuscular tension. The author noticed that, following parathyroid ablation, not all animals died of tetany, and that the greater percentage of survivals occurred in animals from the “Experimental” colony; hence the present report. In all, 304 rats were operated upon. Complete thyro-parathyroidectomy result- ed in a mortality from acute parathyroid tetany of 79 per cent in ABSTRACTS 687 the “Standard” rats, but only 13 per cent in the ‘‘gentled’’ rats. The same ratio was found when parathyroidectomy alone was done. “Gentled” rats of the third generation, when put from weaning under conditions exactly similar to those of the “Standard” stock, still showed a mortality of only 14 per cent. “Standard” rats had their mortality reduced to zero, when ‘‘gentled.’”’ There were no signifi- cant sex, size, weight or dietary variations. It is concluded that sta- bility of the nervous system induced by petting produces a marked resistance to the loss of parathyroid secretion. The reason for this is briefly discussed.—T. C. B. Acute hyperplasia of the THYROID with dyspnea. Harger (John RD, Surg. Clinics of Chicago (Phila.), 1919, 3, 1417-14238. Report of the case of a girl of 12 years who complained of marked dyspnea upon exertion associated with rapid enlargement of the thyroid gland of three months duration.—J. F. (THYROID) Hypothyroidism, infiltration and hypertension. Har- rower (H. R.), Med. Record (N. Y.), 1920, 98, 854-856. The occasional successful reduction of hypertension by thyroid extract is the basis for a theory that essential hypertension may be due to an infiltration of the tissues, “myxedeme fruste,”’ with re- sultant pressure on, and narrowing of, the lumina of the arterioles in the precapillary areas, which cellular infiltration is a charac- teristic of hypothyroidism. Harrower considers this mechanical factor important in the production of hypertension. With this cel- lular clogging there is chemical stagnation, elaboration and absorp- tion of toxins which in turn affects the adrenal mechanism. “In other words, thyroid therapy in cases of hypothyroidism with high blood pressure not merely removes a part of the accumulated toxemia, but at the same time favors a change in this mechanical obstruction in the circulation in these so-called ‘precapillary areas.’ ”’ [It seems difficult to reconcile this theory with the hypertension not infrequently met with in cases of hyperthyroidism. ]—H. L. (THYROID) Diffuse colloid goiter (Die diffuse Kolloidstruma). Hellwig (A.), Deutsche med. Wehnschr. (Berlin), 1921, 47, 324-325. The surgery of goiter generally accepts two principles: Opera- tion is wanted when the pressure on other organs is too marked or when there are toxic changes as in Graves’ disease. It is generally believed that the ordinary goiter only acts in a mechanical way by pressure. This is not true. The author examined about 20 colloid goiters. Degeneration with atrophy as described by Liicke, W6lfler and others was never observed. A retention of colloid could never be detected. This proves that Breitner’s theory that the colloid 688 ABSTRACTS goiter is produced by a retention of colloid and in this way gives rise to a hypothyreosis is not right. Always there were histological signs of hyperplasia with hypersecretion of colloid. Clinical symptoms are always symptoms of hyperthyreosis or of “formes frustes’’ of Graves’ disease (perspiration, marked intelligence, tremor of hands and feet, goiter heart). On the other hand, the goiters of patients with Graves’ disease prove to develop from a diffuse colloid goiter. The author considers patients with colloid goiter as very apt to get Graves’ disease; operation may be desirable even when there are no symptoms of pressure.—J. K. The effect of THYROID-feeding and of thyro-parathyroidectomy upon the pituitrin content of the posterior lobe of the pituitary, the cerebro-spinal fluid, and blood. Herring (P. T.), Proc. Roy. Soc. (London), 1921, B. 92, 102-107. Six adult cats were fed with large quantities of fresh ox thyroid for from 2 to 3 weeks in addition to their ordinary diet. Six other cats were subjected to thyro-parathyroidectomy and then killed in from 3 to 6 days after the operation. The pituitrin content of the posterior lobes of the pituitary bodies of these two series of animals was found to be unchanged from that of a series of normal cats, when tested by the action of the extracts upon the contraction of the rat’s uterus and the blood pressure of the pithed cat. There was no evidence of the presence of pituitrin in the cerebrospinal fluid of the fourth ventricle in normal, thyroid-fed or thyro-parathyroidec- tomized cats. The defibrinated blood of the three series of animals showed no appreciable differences in its action upon the rat’s uterus. The blood of the thyroiq¢-fed eats had a greater depressor action upon the circulation than had that of the normal animals. The blood of the thyro-parathyroidectomized cats exercised a pressor effect upon the circulation, accompanied by a contraction of the kidney and a diminution in the secretion of urine. It is suggested that this might have been due to the presence of guanidin, or allied bodies, in the blood of these animals.—L. G. K. (THYROID) How to stop bleeding after operation for goiter (Zur Stillung von Blutungen aus dem Kropfrest nach Strumentomien). Hilgenberg (F. C.), Zentralbl. f. Chir. (Leipzig), 1921, 48, 366. Of technical surgical interest.—J. K. THYROID removal from the horse (La tiroidectomia en los caballos) . Houssay (B. A.) & Hug (E.), Rev. del Inst. Bacteriologico del Dep. Nacional de Higiene (Buenos Aires), 1920, May 11, No. 5. Thyroidectomy in young horses determined an evident delay in body growth (size of body, sexual organs, teeth, ete.) and sometimes it produced cachectical death in a few months. Adult horses did not ABSTRACTS 689 present any apparent perturbation. Nearly every thyroidless horse experienced passing hypothermy. In some cases there appeared very prominent edema; and generally a depression in normal vitality was noticed. —B. A. H. (THYROID) Does x-ray treatment of goiter produce adhesions (Ex- perimentelles Beitrag zur Frage der Vewachsungen nach Sirumen- bestrahlung). von der Hutten, Deutsche med. Wehnschr. (Berlin), 1921, 47, 284. The experiments prove that x-ray treatment of goiter produce adhesions which make an operation much more difficult. There- fore, it is advised not to use X-rays in treating goiter.—J. K. (THYROID) Recent studies on the Flajani-Basedow’s disease (Studi recenti sulla malattia di Flajani-Basedow). Japelli (A.), Riforma med. (Napoli), 1921, 37, 82-84. A review of recent literature and theoretical discussion of well known data. The author ascribes considerable importance to syphilis and tuberculosis as etiologic factors. Radiations of the thyroid and thymus are favored as therapeutic proceedure.—G. V. The action of the THYROID on tadpoles (Ueber die Wirkung der Schilddriise auf Kaulquappen). Jarisch (A.), Anehenien damees: Physiol. (Bonn), 1920, 179, 159-176. The well known stimulating effect of thyroid substance on the development of tadpoles was proven on larvae of Bufo vulgaris by the use of differential diets. The effect was particularly marked in fasting animals with those running a close second which were fed protein, egg-yolk or starch plus the thyroid substance. The process by which the animals are hastened in their development is in fact a hastening of the disintegration of the larval form, not a hastening of the formation of the adult stage. This is attributed to the meta- bolic stimulating properties of the active principle of the thyroid. =i, (Sh. 1BL [Standardization of THYROID preparations by use of Axolotl]. Jensen (C. O.), Hosp.-Tid. (Copenhagen), 1920, 63, 505-515. Standardization of thyroid preparations by measurements of the iodin content is not satisfactory, since the iodin content does not correspond to the therapeutic effect. Neither is the Reid Hunt acetonitrile method adequate on account of the varying resistance of the mice to the poison. Jensen investigated further, therefore, the availability of the tadpole metamorphosis method. He has continued Gudernatsch’s experiments, especially on axolotls, and found that thyroid feeding and injection brought about metamorphosis. The experiments showed that injection of inorganic and some organic 690 ABSTRACTS iodin compounds (starch-iodin, iodized albumin) had no effect on the development; iodo-thyrosin had some influence, but not so much as thyroid preparations. Various of these preparations (iodothy- rine, thyreoidine, etc.) were investigated. It was found that the effect was constant in any given preparation, but varied in the dif- ferent preparations and was not dependent on the iodin content. Thyroidine of Vermehren had the same effect as the iodothyrine from Friedr. Bayer, although its iodin content is only 1/10 that of iodo- thyrine.—K. H. K. Laryngeal function in THYROID cases. Judd (Edward Starr), Ann. Surg. (Phila.), 1921, 73, 321-327. The author concludes that the functional results following thyroidectomy, as concerns both phonation and respiration, are ex- tremely good; that the disturbances which sometimes follow im- mediately after operation are temporary and normal functions will be restored in from a few days to a few weeks; that there is a very small group of patients who, following thyroidectomy, have a bi- lateral abductor disturbance which is slow in onset but very per- sistent. Its cause is not known.—J. F. The action of THYROID and THYMUS on frog larvae (Zur Frage der Wirkung von Schilddriise und Thymus auf Froschlarven). Kahn (R. H.), Arch. f. d. ges. Physiol. (Bonn), 1916, 163, 384-404. Aqueous solutions of fresh thyroid or thyroid tablets are ther- mostable and produce the same effect on frog larvae as thyroid gland. Thyroid and thymus tablets have the same action as fresh gland. Partial separation of the active constituent of thyroid can be made by extraction with 96 per cent alcohol, evaporation nearly to dry- ness, and removal of the “lipoid’’ substances which separate. The cloudy aqueous solution which remains is very active.—A. TG: (THYROID) Idiocy (Idiotie). Kellner, Berl. klin. Wehnschr., 1921, 58, 424. In some cases of idiocy thyroid therapy gave good results. No details are given.—J. K. Extirpation of uterus and REJUVENATION (Totalexstirpation des Uterus und Verjiingung). Lahm (W.), Zentralbl. f. Gyn. (Leip- zig), 1920, 45, 601-602. Leipmann has stated that rejuvenation may.take place after extirpation of the uterus. He considers the ligation of the vas deferens as the same operation as extirpation of the uterus, for in both operations the natural excretory duct of the sexual gland is taken away. This is not at all true, for after ligation of the vas deferens histological changes occur in the testicle. The function of ABSTRACTS 691 the ovary is not changed after removing the uterus. It is, of course, possible that women with diseases of the uterus feel younger after removing this organ, but this has nothing to do with real rejuvena- tion.— J. K. (THYROID) Eserine sulfate in the treatment of tachycardia (Le sulfate d’ éserine dans le traitement des tachycardies). Lian (Camille) & Welti (H.), Bull. et mem. Soc. méd. d. hép. de. Par., 1921, 45, 559-566. Favorable report from the use of 1 mg. of eserine sulfate after meals in the relief of tachycardias of thyroid origin.—F. Sy Ee (THYROID) Healing by first intent or drainage after goiter surgery (Primarer Wundschlusz oder Drainage nach Strumectomie). Lotsch (F.), Zentralbl. f. Chir. (Leipzig), 1921, 48, 589-590. Of technical surgical interest.—J. K. (THYROID) Myxedema. McGraw (T. A.), J. Mich. M. Soc. (Grand Rapids), 1921, 20, 27-30. Complete report of a case of myxedema with secondary involve- ment of pituitary and gonads. Trouble began five years ago. The first symptom noticed was oedema around the eyes. Menses became irregular and profuse, with occasional severe hemorrhages. Symp- toms of myxedema gradually increased. The patient showed an unusual feature for myxedema, namely, pulse of 112 and temperature of 98.6. Physical examination showed the ordinary signs of myxedema plus prominent malar bones and chin with spacing of the upper teeth, all suggestive of acromegaly. She was given four grains of thyroid daily and began to improve, but in two weeks started to develop symptoms of hyperthyroidism. When by mistake in directions, ten grains of pituitary extract were combined with the same dose of thyroid, the symptoms of hyperthyroidism disappeared and did not return. After two months treatment all the symptoms of myxedema disappeared, menstruation became normal, and the patient later gave birth to a healthy full term child.—C. M. W. (THYROID, TESTIS, HYPOPHYSIS) Researches on complement deviation in dementia praecox (Richerche sulla deviazione del complemento nei dementi precoci). Magauda (P.), Riforma med. Napoli), 1920, 36, 908-909. Following the negative results of Pellacani, Magauda chose as antigens testis, thyroid and hypophysis extracts from the glands of 8 patients. The material was obtained 12 to 14 hours after death. The sera were taken from cases of dementia praecox, choosing sub- jects preferably at the initial stage of the disease and showing para- noid and catatonic symptoms. Disregarding instances of incomplete 692 ABSTRACTS hemolysis, the author obtained with 20 sera deviation of the comple- ment eight times with testis antigen and seven times with thyroid antigen. As regards the subjects affording antigens two showed complement deviation with both testis and thyroid antigens, one with testis antigen and two with thyroid antigen. Notwithstanding all the possible causes of error (more or less fresh antigens, period of the psychosis at the moment of death, the acuteness or chronicity of accompanying sickness, apt to determine endocrine disturbances) the results, though not all positive, are certainly such as to encour- age further researches.—G. V. Differential diagnosis between perichondritis laryngis and THY- RIDITIS or strumitis (Zur Differentialdiagnose zwischen Peri- chondritis laryngis und Thyreoiditis bzw. Strumitis). Maier (M.), Berl. klin. Wehnschr., 1921, 58, 230-232. Of no endocrine interest.—J. K. (THYROID) The emotional factor in the pathogenesis of hyper- thyroid states (Le facteur émotionnel dans la pathogénie des états hyperthyroidiens). Maranon (G.), Ann. ad. Méd. (Paris), 9, 81-93. Maranon reports and discusses his observations on some 48 cases of hyperthyroidism in connection with the emotional conditions present. He comes to the conclusion that the emotions have an indisputable influence in the pathogenesis of Basedow’s disease; in general in all cases of hyperthyroidism. In the majority of cases emotion acts on subjects having a predisposition to hyperthyroidism and consequently sensitized to emotional shocks. In a much smaller number of cases emotion acts as a first cause in normal subjects from the thyroidal point of view. This pathogenetic action of emotion on the thyroid is well explained on the basis of our actual knowledge of the intervention of the endocrine glands in the emotional act and does not contradict the generally accepted idea of the thyreogenous origin of Basedow’s disease. These facts explain the great etiologic importance of prolonged emotion; and the great frequency of cases of Basedow’s disease of emotional origin at the critical age and particularly in women.—F. S. H. (THYROID) Exophthalmic goiter: removal of the right lobe and the isthmus. Moorhead (Edward Lewis), Surg. Clinics of Chicago (Phila.), 1919, 3, 1205-1214. Report of a case in a seamstress of 20 years with goiter, promi- nent eyes, and a rapid heart. The differential diagnosis and treat- ment are discussed. Emphasis is placed on the surgical cure of the disease.—J. F. ABSTRACTS 693 Multiple tumors of the THYROID. Moorhead (BH. L.), Surg. Clinies of Chicago (Phila.), 1920, 4, 1051-1054. A case report of a woman of Austrian descent, aged 53, who had a swelling in the region of the right lobe of the thyroid for 32 years. She was the mother of four children. One daughter had been operated upon at 26 years for exophthalmic goiter.—J. F. (THYROID) Graves’ disease and x-ray treatment (De ziekte van Basedow en Rontgenbestralingen). Orbaan (C.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1921, 65, 1576-1578. Careful x-ray treatment may be useful.—J. K. (THYROID, HYPOPHYSIS) Biddy and the coal bin. A case of polyglandular disease. Pitfield (R.), Med. Record (N. Y.), 1920, 98, 351-352. A picturesque sketch of a pathetic, gloomy, shrivelled woman of 42, evidently an example of infantile myxedema, with added path- ological conditions due to oophorectomy, magically transformed, as it were, by administration of thyroid and pituitary.—H. L. (THYROID) Specific dynamic action of thyroxin. Plummer (H. 5.) & Boothby (W. M.), Am. J. Physiol. (Balt.), 1921, 55, 295-296. The specific dynamic action produced by intravenous injection of varying amounts of thyroxin in sixty-nine cases of myxedema and hypothyroidism is reported, with tables. Thyroxin undoubtedly has a specific dynamic action, increasing the metabolic rate in proportion to the quantity actively present in the body.—T. C. B. Organ therapy in THYROID and allied disorders. Rogers (J.), Med. Record (N. Y.), 1920, 98, 631-639. Rogers finds the nucleoproteins of thyroid glands less toxic and more beneficial than the dried entire organ extracts. The pig had a higher iodine content than the sheep thyroid, and beef thyroid was not satisfactory. Standardizing by iodine content, 1 per cent, 2, 5 or 10 per cent, corresponded to 1/100, 1/50, 1/20, or 1/10 grain pig or sheep thyroid nucleoproteins, which clinically and for dosage is equivalent to %, %, % or 1 grain of the dried powder from the entire gland. Nucleoprotein preparations of pituitary, parathyroid, adrenal, ovarian substances, etc., were then made and found more efficacious than any desiccated entire gland. Hypodermiecally, nucleoproteins or coagulable portions of aqueous thyroid extract excited no immediate response, but the residue given subcutaneously or intravenously excited prompt and vigorous reactions. Alcoholic extracts of thyroid were found to have the same physiological action as the non-coagulable hydrolyzed aqueous extract or residue. The thyroid nucleoproteins seemed more efficacious in typical myxede- 694 ABSTRACTS matous conditions; the residue, which is a vigorous vasodilator and stimulant, seemed most useful in chronic hypothyroid disturb- ance accompanied by high blood pressure or deficient gastrointes- tinal function. The varying types of hyper- and hypo-thyroidism and mixed states, and the manner in which one often merges into the other, are discussed. If thyroid is administered (injection of alcoholic extract or hydrolyzed residue) to voluntary muscles the end plates of which are fatigued but not exhausted, muscular vigor is immediately restored. The flow of gastric secretion, pancreatic secre- tion, urine, saliva, and involuntary peristalsis is similarly accen- tuated. The tachycardia of hyperthyroidism is not due to direct stimulation of the cardiac accelerator nerve by the thyroid product, but is an accompaniment of increased metabolism. Adrenal extract acts exactly opposite to thyroid—it will stop the stimulation pre- viously induced by thyroid extracts. The adrenal nuceloprotein will inhibit gastric secretion more than 1:1000 solution of adrenalin. These adrenal extracts act upon the terminal filaments of the sympathetic system (‘‘check’’ system, the vagus being termed the “drive’’ system). A case of myxedema with high blood pressure is presented; sufficient desiccated thyroid to relieve symptoms produced more troublesome signs of hyperthyroidism. When thyroid nucleo- protein was used no unpleasant symptoms appeared. Another pa- tient, diagnosed as having forme fruste of hyperthyroidism, but in reality hypofunction, who had formerly been made worse by thyroid tablets, improved on thyroid nucleoprotein. Several other interest- ing case histories are added with observations on therapy with thy- roid nucleoprotein of varying iodine strength, thyroid residue, and alcoholic extracts. Rogers claims to have seemingly saved life in some acute post-operative toxemias following thyroid extirpation by prompt administration of thyroid residue. Peculiar neuralgias and subjective dyspnoea are curiously relieved by the alcoholic extract of thyroid, but not by the nucleoproteins or residue. These peculiar- ities are not explained. Typical hyperthyroid cases are sometimes improved by adrenal therapy, since the latter checks the former through the sympathetic check mechanism. Several illustrative cases accompany the discussion. Some cases of gastric hyperirrita- bility with high acid values and vomiting are remarkably improved by adrenal nucleoprotein; cases of gastric hypofunction and hypo- secretion are improved by thyroid residue.—H. L. A note on the relation between the weight of the THYROID and the weight of the THYMUS in man. Scammon (R. E.), Anat. Record (Phila.), 1921, 21, 25-27. The writer has utilized the recent data of Dustin and Zunz on the weight of the thyroid and the thymus in young adults who died within forty-eight hours after receiving wounds in battle. These ABSTRACTS 695 data have been compared with other figures on the weight of these glands in the new born, and the standard of deviation, the co- efficient of variation and the coefficient of correlation between the two organs determined. These figures indicate that any correlation which may exist between the weights of the thyroid and the thymus is inconstant in postnatal life, and they offer little if any support to the theory of a direct functional relation between the two organs. —wW. J. A. Hyperplasia and hypersecretion of the THYROID in the young (Hyperplasie und Hypersekretion der Schilddriise bei Kindern und Jugendlichen). Schlesinger (E.), Miinchen. med. Wehnschr., 1921, 68, 531-532. Hyperplasia of the parenchyma of the thyroid in countries with goiter may begin in newborn infants. It begins most frequently at the age of 6 in girls or 9 in boys. Then the number of cases rapidly increases with the age: % of the number of boys and % of the number of girls with hyperplasia of the thyroid have cardiovascular disturbances and often symptoms of hyperthyroidism. They are mostly very intelligent and show sexual precocity. Often the cases are complicated with a scoliosis and myopia.—J. K. (THYROID) Graves’ diséase, its pathogenesis and treatment (De Ziekte van Basedow, haar pathogenese en Behandeling). Schulte (J. B.), Nederl. Tijdschr. v. Geneesk. (Haarlem), 1921, 65, 1243- 1251. A general review.—J. K. [A case of THYROGENOUS edema]. Scheel (V.), Ugesk. f. Laeger. (Copenhagen), 1920, 82, 369. A woman, aged 61 years, showed an ordinary edema (not myxedema) of her face and arms, but none on the lower limbs. The skin was dry and desquamating. There was no albuminuria or other signs of heart disease. Thyroid treatment was without effect on the edemata, but it made the patient, nervous and tachycardia ap- peared. The patient died of bronchopneumonia. Autopsy showed atrophy of the thyroid gland, no abnormality of the heart and the kidneys, nor thrombosis of the veins.—K. Val LES [Cases of papillomatous tumors of the THYROID gland]. Sennels (A.), Hosp.-Tid. (Copenhagen), 1920, 63, 337-341. Sennels describes two cases of papillomatous tumors of the thyroid gland. In one of the cases there had been slight symptoms of Graves’ disease, but they had disappeared; after that the papil- lomatous tumor had developed. Such tumors seem to be rare; only 17 cases have been published before. The tumors seem ordinarily 696 ABSTRACTS to be malignant. The author mentions that corresponding tumors of the thyroid are found commonly in certain American salmon, caused by a nematode (Gayland and March). —K. H. K. THYRO-PARATHYROIDECTOMY in the sheep. Simpson (Suther- land), Am. J. Physiol. (Balt.), 1921, 55, 281. Five animals, four of which were pregnant ewes, over five years of age were operated upon. A sixth was kept as control.’ The chief point of interest is that no manifestations of acute tetany were observed, even in the pregnant state, to follow removal of the para- thyroids, except in one case, after many months. Autopsy on two of the sheep showed no accessory parathyroids, but some thyroid tissue. —T. C. B. (THYROID) Changes in the muscles in myxedema (Muskelveran- derung bei Myxoedem). Slauck, Deutsche med. Wehnschr. (Ber- lin), 1921, 47, 172. Heidenheim has found that in myotonia atrophica there are so- called circular fibers; these are fibers that surround the ordinary muscle-fibers. Slauck found these circular fibers still more dis- tinctly in myxedema with hypoplasia of the ordinary muscle-fibers. In cachexia strumipriva this was seen too. It was not possible to get these circular fibers in an animal by removing the thyroid. In dystrophia musculorum progressiva or myasthenia these fibers are not seen.—J. K. (THYROID) The management of toxie goiter with radiation. Stevens (J. T.), N. York M. J. (New York), 1921, 113, 247-248. Metabolism tests show that at least 90 per cent of toxic goiters can be cured by proper rontgen therapy.—H. W. (THYROID) A study of the correlation of the basal metabolism and pulse rate in patients with hyperthyroidism. Sturgis (C. CH Tompkins (Edna H.), Arch. Int. Med. (Chicago), 1920, 26, 467- 476. This report shows that there is a fairly constant relation between the resting pulse rate and the basal metabolism in hyperthyroidism. Determinations were made on 154 patients with hyperthyroidism. A tachycardia of 90 or more was found associated with a plus basal metabolism of 15 per cent or more in 84 per cent. When the metab- olism fell to normal there was a drop in the pulse rate in 78 per cent of the cases studied. This is of practical importance in dif- ferentiating nervous conditions from hyperthyroid conditions. —F. S. H. ABSTRACTS 697 (THYROID) Surgical treatment of Graves’ disease (Chirurgische Behandlung der Basedowschen Krankheit). Sudeck, Munchen. med. Wehnschr., 1921, 68, 499. There are three forms: 1, the classical Graves’ disease, which is a typical dysthyroidism and has a typical bloodpicture; 2, thy- roidism; 3, formes-frustes. The best treatment of the classical disease is resection of both lobes of the thyroid with ligation of the 4 arteries. In some cases the whole thyroid is removed and thyroid tablets are given the patient. From these last cases he reports 100 per cent cases. Removal of the thymus is not necessary. In thyroidism the effect of surgical treatment is not so good. Perhaps the thymus plays a certain part in these cases.—J. K. (THYROID) Endemic goiter as a public health problem. Tolman (Mayo), Am. J. Pub. Health (Concord, N. H.), 1920, 10, 434. This paper presents briefly the results of a survey of the state of West Virginia made by its Health Department to ascertain the frequency and distribution of goiter within this commonwealth. —J. F. (THYROID) The MAMMARY glands of thyroidectomized goats (Die Milchdriise thyreopriver Ziegen.) Trautmann (A.), Arch. f. d. ges. Physiol. (Bonn), 1919, 177, 239-249. Thyroidectomy produces harmful effects of a degenerative na- ture on the lactating mammary gland.—A. T. C. (THYROID) Thyreo-tuberculosis or pseudo-Basedowian pulmonary tuberculosis (Thyreotuberculose ou tuberculose pulmonaire pseudo-Basedowique) . Vanowski (W.), Ann. de méd. (Paris), 1920, 8, 418-4384. This paper presents an extended discussion of the sign-posts and frequent concurrence of thyroid disorders and tuberculosis. The similarity of the symptomatology in its gross manifestations is noted both from the subjective and the objective points of view, and the literature on the subject is well covered. The opinion is expressed that prognosis is favorable in 90 per cent of the patients coming under observation providing a proper orientation between patient and physician is obtained.—F. S. H. (THYROID) A case of erysipelas terminating in acute thyroiditis. Weeks (L. M.), Brit. M. J. (Lond.), 1920, (ii), 476-477. A case is described in which, following recurring attacks of erysipelas on the face and buttocks, a long standing swelling of the thyroid gland increased in size and became very tender and hard. There was pain on swallowing, and within a few days fluctu- ation was felt. An incision was made and a cupful of pus evacu- 698 ABSTRACTS ated. From this a pure culture of streptococcus was obtained. The wound did not heal for three months, and during this period signs of myxoedema were noticed. The hair fell out, the skin became dry, the pulse was slow and mental depression was present. These signs as well as the original swelling disappeared with the closure of the sinus. About six months later a similar swelling was opened and a pure culture of streptococcus again obtained. Vaccine treat- ment is now being carried out.—L. G. K. Acute malarial THYROIDITIS (Tiroiditis aguda de origen paliidica). Wieland (F.), Cron. méd. (Lima), 1920, 37, 259-262. Wieland cites a case of inflammatory process of the thyroid, presumably due to weak circulation or loss of blood in the cap- illaries of the glands as it was characterized by sphygmothermic dissociation and diarrhea. The former may be regarded as the ex- terior manifestation of lack of equilibrium in the sympathetic nerv- ous system due to perturbations in the production of the thyroid hormones which also causes tachycardia. The diarrhea, according to the author, is a predominant sign of the sympathetie activity which is always constant in functional hyperthyroidism.—l. oO. The abstracts in this number have been prepared by the staff, assisted by Cc. M. Wilhelmj, St. Louis. With the permission of the editors, certain abstracts have been quoted from “Physiological Abstracts,’ ‘“‘Chemical Abstracts” and from “Surgery, Gynecology and Obstetrics.” Vol. V. No.6. Serial No. 22. November, 1921. Endocrinology The Bulletin of the Association for the Study of Internal Secretions CONTENTS CLINICAL REPORT OF A CASE OF GRAVES’ DISEASE WITH RAPID IMPROVE- MENT FOLLOWING THE ORAL ADMINISTRATION OF FRESH OX SUPRARE- NAL GLAND. S. Shapiro and Dayid Marine, New York.......-.-.++++-+++-- TESTICULAR SUBSTANCE IMPLANTATION. L. L. Stanley, San Quentin, Calif... THE IMPORTANCE OF VISUALIZING ESTABLISHED SCIENTIFIC DATA WITH REFERENCE TO THE SIZE OF THE BODY CELLS AND THEIR CHEMICAL SUPPLIES IN THE CIRCULATING BLOOD. Georgine Luden, Rochester, Minn. SOME NOVEL EFFECTS PRODUCED BY STIMULATING THE NERVES OF THE LIVER. W. B. Cannon, J. E. Uridil and F. R. Griffith, Boston.........-.+.-- THE NEW VIEWS AS TO THE MORPHOLOGY OF THE THYMUS GLAND AND THEIR BEARING ON THE PROBLEM OF THE FUNCTION OF THE THYMUS. (Concluded.) J. Aug Hammar, Upsala, Sweden.......-.--+++se seer ere cerees EXPERIMENTAL DIABETES INSIPIDUS AND GENITAL ATROPHY. Percival Bailey and Fritz Bremer, Boston........-.--++ee+e settee etree teeter eres EXTIRPATION AND TRANSPLANTATION OF THE THYMI IN LARVAE OF RANA SYLVATICA. Margaret Morris Hoskins, FEU CHINON Grogs cares erste is pels ited oie ENDOCRINE THERAPY IN CASES OF LOW BLOOD PRESSURE. George H. Elie oe iat ri SASICC TE Vie ats ewegersicr eta oleate evah. nd sy stm hed enn tagae: als ta) skew for nae Meu et=ppuanh mperiel sal aol BOOK REVIEWS: LA GLANDE GENITALE MALE ET LES GLANDES ENDOCRINES. Edouard Retterer AMG) Sree VOLOWOLE. ate maspapele ese eee enim emis mem = sgh ilshs solr inenaere alos (ei) oles aia HtuMAN Bruavior, Stewart Paton..... Pe Aili An er RT RSE. BS ti ceo Doan DIaAPETES : A HANDBOOK FoR PHYSICIANS AND THEIR PATIENTS. Philip Horowitz. ABSTRACT DEPARTMENT, Containing 181 Titles and Articles Reviewed......... : INDEX FOR VOLUME Y. 699 708 Entered as second-class matter March 12, 1921, at the postoffice at Los Angeles, California, under the Act of March 3, 1879. Acceptance for mailing at special rate of postage provided for in Section 1103, Act of October 3, 1917, authorized September 17, 1920. —_—— THE ASSOCIATION FOR THE STUDY OF INTERNAL SECRETIONS Presidente ax.5 3 et tee a a ee eas WALTER B. CANNON First Vice-President.....:02..+eesceeeeceres ...EmiIL GoETSCH Second Vice-President.......+++++++++++:> Watter M. BoorHsy Secretary-Treasurer ..cseeeee eee ee eee eres F. M. PorrENGER COUNCIL WALTER TIMME, Chairman, New York L. R. DeBuys, New Orleans GiLBErt Horrax, Boston G. H. Hoxtz, Kansas City Jno. B. Porrs, Omaha L. F. Barker, Baltimore C. E. pe M. Sajous, Philadelphia F. A. Hartman, Buffalo - Emit Novak, Baltimore Ex-Officio Members Water B. Cannon, Boston R. G. Hosxrys, Columbus F. M. Porrencer, Los Angeles ANNOUNCEMENT HE object of this Association is to correlate the work and inter- | ests of many physicians and students throughout the world who are engaged in the study of the internal secretions and organotherapy, and by concerted effort to broaden knowledge in this field. This Association is not limited to specialists. It includes in its membership physiologists, pathologists and other investigators in addition to a large number of physicians in active practice—leading men in this field in the United States and thirty other countries. Every branch of medicine is represented. The orthopedist recognizes the importance of the internal secretions in relation to the physiology and pathology of bone development. The opthal- mologist realizes the relation of the pituitary and the thyroid glands to his field; the pediatrician is especially interested because growth and development are controlled by hormones and many disorders of childhood are due to, or aggravated by, disturbances of the endocrine glands. Many disorders seen by the gynecologist are brought about by endocrine defects and there is a large and increasing literature dwelling upon the diagnostic and therapeutic phases of this subject. In internal medicine and surgery the endocrine glands figure con- stantly. Endocrinology, in short, is a matter of concern to the medical profession as a whole. Reputable physicians and investigators are eligible for member- ship. The annual dues are $6.00, payable in advance. This includes a subscription to ENDOCRINOLOGY, the Association’s bi-monthly bulletin. The subscription price of ENDOCRINOLOGY to non-members is $6.00. Further information and application blank may be secured by addressing the secretary, F. M. Pottenger, M.D., 1100-1103 Title ‘surance Bldg., Los Angeles, California. ENDOCRINOLOGY EDITORIAL STAFF R. G. Hoskins, Editor-in-Chief, Columbus ane Ns Nath oa bebo bs. coe amore Northwestern University ,Chicago LEWELLYS F. BARKER.....--- Johns Hopkins University, Baltimore WALTER B. CANNON......------ Harvard Medical School, Boston DW Conners cooseuoboone Peking Union Medical College, China EAR VE) ©USELINGH een seis Harvard Medical School, Boston ih, (Gitiinvaed Goon hos ude.colom 6o copie meme mraor University of Paris Joun T. HALsEy.......-------- Tulane University, New Orleans FREDERICK S. HAMMETT.......--.-- Wistar Institute, Philadelphia ee AMIE OMSSAMS ate usta os Ohta = lave University of Buenos Aires DANhiny IMPNaINISS oehooeco 206 sao bse oO UUeRO DUOOnomc New York Epwarp SHARPEY SCHAFER.....---+-+++ University of Edinburgh Spawn. WAINIGINNNS ggo0dcepoenocuoddE Middlesex Hospital, London FRANK A. HARTMAN:..---5-¢-00-+2+- 5025 University of Buffalo iD. (QU TSeIS OYTO Pa Ain ies o So ieieaoutior ye Mayo Clinic, Rochester, Minn. Wi, TEL Wont, ono bop clade aoe co-op Do eioomp occ Pontiac, Mich. COLLABORATORS Wi SAI dle Gunwalieneeonor oppo anueooc DCO snDcCOOCKDGe University of Buffalo i>. THON Sa qeanoone cos onon ee CUD OuON Co nO eR DOU ORCO tS aIIOIo Madrid, Spain 4b (C, Bish its on gnomes a noosoUcuraDo~ oK University of California, Berkeley AN IS; CRMEROINI5 boacbondncoposcOseOmOODG University of Manitoba, Winnipeg FPONUADIEUAING BOR MIAN ste clotelsfefe ciclelo1steiefer= nieve tele elefnverar =)ernfeleinimsveiciein slo Columbus iDANiian (Guo Gerbp 55 uo poeo omen pon ORR paper oO UU UGE OD CoonOD ICD Des Moines (@. PD (GONNUON Sng spa booo sop Jeneeen 7s cosmo oadcNs Buenos Aires, Argentine Mim ine 1By (GOING. 5 pole ced ee as cog Opn OUdUN DoD OM oDOUpmOGICnInoD Brooklyn fs ANUS IEINMICINSE 6 oo db epomso8 pop oD on a> OUOos UO CHGDYDE Upsala, Sweden Witiiam Harrison (Bibliographer)....-..---+--+++ee0eeeee reset Ann Arbor MarGARET M. HOSKINS....----- 200-2 secre cette eee teers r seme es Richmond If, ISGGRMUNTS Baas Oboccocenonbinp oo SnarcoceuaBroMHor - The Hague, Holland IKENUDPEI KRABBES cris riei leis =e ols eis ol ole ee vies tin een Copenhagen, Denmark JOSE TRG TUDES R55 oer ove nosy appmObesSonpegss Sour um GIP Doro New York Wer S TEM Go ISIDBORINE IA = Pre eis eletetciern cl vote tale n)e/-t=refaro! oTalitota\= na! obernteueraver~lole Toronto Si, IRGHR 5600 kdoc blo Hee donb BRAD eSB eco bao ocgoc ol scocs OG h Ono. San Francisco (GL IW IARARGINS oo dA pons aobeead nocd dua ochono codanGo, unpoan Madrid, Spain AG AVA Gl CHOMERAN DAG ie iotencte es o7e) stele ela icatn els segey slice secehe +) suse oleae nlvlolssniearncse Mexico Jor Ropiquez P........---+0- +e ere sees University of Chile, Santiago HIECTOR AROSELLOL es ees ieee lee ne Bh OE PRE ona Montevideo, Uruguay J. P. Srmonps........---- Northwestern University Medical School, Chicago STO ADS GI EXOINdn ad eane @aaris soangenen spe Coubo mE gCsOCUCoLOn Opt Buffalo PAR TETCIR Gs: GVATUMG ayere ni <2 = ale) ajo sess .......University of Chicago FIGNTERD WWILTEETIONS nico, etter cucia citer is [ate = ioies=/e cen )2 i oy nmaioans.s mipae St. Louis G. VERCELLINI......- Be 2 anes oie See cart St. Paul ENDOCRINOLOGY is the official bulletin of the Associa- tion for the Study of the Internal Secretions. It is published in volumes of 600-800 pages. At present it appears as a bi- monthly. It comprises original articles, authoritative reviews, critical abstracts of the endocrine literature and editorial dis- cussions of timely topics. Manuscripts of three types of original work are desired for publication : a. Clinical studies of endocrine diseases and the part played by the endocrine organs as contributing factors in other diseases ; b. Systematic studies on endocrine therapy ; ce. Laboratory investigations of endocrine problems. Articles are accepted for publication with the understand- ing that they will appear in this journal only. Manuscripts may be submitted in any modern language, and if found suitable for publication will be translated into English without expense to the authors. To imsure a version, however, satisfactory to the author, it is desirable that the article be sub- mitted, when feasible, in English. Readers who encounter articles of endocrine interest in unusual periodicals or under captions not indicating such interest are requested to submit abstracts for publication. Bibliographic form: Since ENDOCRINOLOGY is to a con- siderable extent a bibliographic journal, it is desirable that references should be given in complete form, quoting title of article, author, periodical, year, volume number and page. The references should be segregated on separate sheets for publica- tion at the end of the article. Footnotes should be used sparingly and included with the text. Illustrations: A reasonable number of illustrations suitable for zine line reproduction may be included. Half-tone repro- ductions will ordinarily necessitate a reasonable charge to the author. Reprints: One hundred will be furnished gratis. For larger quantities price list and order blank will be sent with galley proof. Subscriptions and remittances should be sent to the Secre- tary-Treasurer of the Association, Dr. F. M. Pottenger, 1100- 1103 Title Insurance Bldg., Los Angeles, Cal. Manuscripts may be addressed to the Editor, Prof. R. G. Hoskins, Ohio State Univ., Med. School, Columbus, Ohio, or to any of the members of the staff. Correspondence relating to advertising and business matters should be addressed to Dr. W. H. Morley, Managing Editor. Pontiac, Mich. COMPLETION OF VOLUME V This number of ENpocrINoLocy completes its fifth volume. You will observe that there is a total of 828 pages exclusive of the annual index. This is 114 pages more than the preceding volume, which was the largest to that time. In this volume there have appeared thirty-nine original papers and editorials. The abstract department has contained 1174 items. The annual index in this issue makes all of this material readily accessible for study or reference. For those individuals and libraries who bind their jJour- nals, a Title Page and Table of Contents will be found just preceding page 699 of this issue. This is a separate signature and may be removed by the binder and transferred to the be- ginning of the volume. We wish to thank all who have contributed to the suceessful year just closing, and assure you that your co-operation is ap- preciated. On another page will be found the titles of some of the papers which will appear in the early numbers of Volume Six. We wish you all a Merry Christmas and a Prosperous New Year. 1917 NUMBERS WANTED We are very anxious to get hold of one or more sets of ENDOCRINOLOGY Vol. I (1917). If any of our readers wish to sell their set, or any single numbers of it, we would be glad to have you write us. BACK VOLUMES FOR 1918, 1919 AND 1920 These back volumes can now be furnished complete at $5.00 per volume. If you have not secured these back volumes and wish them to complete your reference library on this subject we would advise ordering early as there are but a few sets of some years available. VOL. V, NO. 1 (January-March, 1920) Early this year we sold a number of sets for 1920 without the first number. We have recently secured additional copies and have been supplying this number to those who bought the broken sets. If you have been overlooked, send us $1.25 and we will send this number by return mail. IN FUTURE NUMBERS The following manuscripts are in the hands of the edi- torial department and will be published in early numbers of ENDOCRINOLOGY : Effect of tissues other than thyroid upon the basal metabolic rate. J.C. Aub, Boston. Spontaneous tetany following epidemic encephalis. L. F. Barker and T. P. Sprunt, Baltimore. Early observations bearing wpon pituitary function. Har- vey G. Beck, Baltimore. Some factors modifying the epinephrin reaction. J.B. Collip, Toronto. Pathological and clinical significance of diffuse adenomatosis of the thyroid. Emil Goetsch, Brooklyn. Childhood myxedema in North America. Murray B. Gordon, Brooklyn. Water and salt metabolism in diabetes mellitus. J. Koopman, The Hague. Hypopituitarism and its treatment. H. luisser, San Francisco. Influence of adrenal feeding upon the iodine content of the thyroid. J. Rogers, New York. Studies on the cortical substance of the suprarenal capsule. Y. Tokumitsu, Igakushi, Japan. Adrenal enlargement in rabbits. T. L. Squier and G. P. Grabfield, Ann Arbor and Boston. Diabetes insipidus, pathogenesis and therapeutics. T. Sten- strom, Lund, Sweden. Effect of iodothyrine and iodine on metamorphosis. HE. Uhlen- huth, New York. To Administer to the Physical Ills Successfully, You Must Understand the Psychic Ills PSYCHO- — PATHOLOGY By EDWARD J. KEMPF, M.D. Clinical Psychiatrist to St. Elizabeth’s Hospital (formerly Government Hospital for the Insane), Washington, D. C.; author of ““The Autonomic Functions and the Personality.” 762 pages + xxiii, 634x934, with 97 illustrations. Printed on beautiful India Tint paper, and bound in silk cloth binding, with gold stamping. Price, $9.50. N “Current Opinion” for December, André Tridon, author and lecturer on psychoanalysis, asserts that “Freud will always be revered as the founder of psycho- analysis, but that the scepter has already passed out of his hands. His disciples, Jung and Adler, were the first to break his authority; and now a third figure, EDWARD J. KEMPF, is rising to supremacy.” PARTIAL TABLE OF CONTENTS The Physiological Foundations of the Per- ology of Paranoia; The Psychopathology of sonality; The Psychology of the Family; the Acute Homosexual Panic; Acute Perni- The Universal Struggle for Virility, Good- cious Dissociation Neuroses; The Psycho- ness and Happiness; Influence of Organic pathology of Chronic Pernicious Dissocia- and Functional Inferiorities upon the Per- tion of the Personality with Defensive Ha- sonality; Mechanistic Classification of Neu- tred, Eccentric Paranoid Compensations and roses and Psychoses Produced by Distortion Pernicious Deterioration; The Psychopath- of Autonomic-Affective Functions; The ology of Chronic Pernicious Dissociation of Mechanism of the Suppression or Anxiety the Personality with Crucifixion and Cata- Neuroses; Repression or Psychoneuroses, tonic Adaptations to the Repressed Crav- Their Mechanisms and Relation to Psycho- ings; The Psychopathology of Chronic Per- ses Due to Repressed Autonomic Cravings; nicious Dissociation of the Personality with Benign Compensation or Regression Neu- Hebephrenic Adaptations; Predominance of roses, with or without Dissociation of Per- sonality; Manic-Depressive Psychoses: Elim- ination or Simulation for Wish-Fulfillment in Affective Crises: Pernicious Repression Compensation Neuroses; The Psychopath- havior; Psychotherapeutic Principles. Excretory Erotic Interests; Reconsideration of the Conditioned Autonomic Affective De- terminants of Abnormal Variations of Be- A complete book on phychopathology, elaborating the new epoch in the study and treatment of the adjudicated insane. Abnormal behavior is one of the most interesting topics for study. When the principles underlying it are mastered many mysteries that have perplexed medical men, criminologists, and lawyers are solved. Doctor Kempf has rendered a real service to physicians in the writing of “PSYCHOPATHOLOGY.” It is a record of his observation and study made during years spent in St. Elizabeth’s Hospital. Its perusal will clear up much in human behavior that has heretofore proven to be a sealed book to physicians, and with the clearing up of these mysteries better service can be rendered to patients. ee Sn nr @EE-Order your copy Today through your Bookseller, or direct from the Publisher. The C. V. Mosby Co., Publishers, St. Louis, U.S.A. Ask for a copy of our catalog. STATEMENT OF THE OWNERSHIP, MANAGEMENT, CIRCULATION, ETC., REQUIRED BY THE ACT OF CONGRESS OF AUGUST 24, 1912, Of Endocrinology, published quarterly at Los Angeles, California, for October 1, 1921. State of California . ss. County of Los Angeles § Before me, a notary public in and for the State and county aforesaid, personally appeared Paul C. Mason, who, having been duly sworn according to law, deposes and says that he is the Business Manager of The Endocrinology, and that the following is, to the best of his knowledge and belief, a true statement of the ownership, management, etc., of the afore- said publication for the date shown in the above caption, required by the Act of August 24, 1912, embodied in section 443, Postal Laws and Regu- lations, printed on the reverse of this form, to wit: 1. That the names and addresses of the publisher, editor, managing editor, and business managers are: Name of Post office address The Association for the Study of Internal Secretions, 1100-1103 Title Ins. Bldg., Los Angeles, Cal. R. G. Hoskins, 710 N. Park St., Columbus, Ohio. Managing Editor, W. H. Morley, R.F.D. No. 3, Pontiac, Mich. Business Manager, Paul C. Mason, 625 No. Maryland Ave., Glendale, Cal. 2. That the owner is The Association for the Study of the Internal Secretions (incorporated), a co-operative organization of physicians, etc., of which the following are the officers: President, Walter B. Cannon, Harvard Medical School, Boston, Mass. Ist Vice-President, Emil Goetsch, L. I. College Hospital, Brooklyn, N. Y.- 2nd Vice-President, Walter M. Boothby, Mayo Clinic, Rochester, Minn. Secretary-Treasurer, F. M. Pottenger, 1100-1103 ‘Title Insurance Bldg., Los Angeles, Cal. Council: Walter Timme, 2 W. 67th St., New York, INAY: L. R. DeBuys, 1776 State St., New Orleans, La. F. A. Hartman, University of Buffalo, Buffalo, NL: Emil Novak, 26 E. Preston St., Baltimore, Md. ae Gilbert Horrax, Peter Bent Brigham Hospital, Boston, Mass. Jno. B. Potts. Brandeis Bldg., Omaha, Nebr. L. F. Barker, 208 Stratford Rd., Guilford, Baltimore, Md. C. E. de M. Sajous, 2043 Walnut St., Philadelphia, Pa. Geo. H. Hoxie. 3719 Pennsylvania Avenue, Kansas City, Mo. Walter B. Cannon, Harvard Medical School, Boston, Mass. R. G. Hoskins, 710 N. Park St., Coumbus, Ohio. F. M. Pottenger, 1100-1103 Title Insurance Bldg., Los Angeles, Cal. 3. That the known bondholders, mortgagees, and other security holders owning or holding 1 per cent. or more of total amount of bonds, mortgages, or other securities are: none. 4. That the two paragraphs next above, giving the names of the owners, stockholders, and security holders, if any, contain not only the list of stockholders and security holders as they appear upon the books of the company but also, in cases where the stockholder or security holder ap- pears upon the books of the company as trustee or in any other fiduciary relation, the name of the person or corporation for whom such trustee is acting, is given; also that the said two paragraphs contain statements em- bracing affiant’s full knowledge and belief as to the circumstances and con- ditions under which stockholders and security holders who do not appear upon the books of the company as trustees, hold stock and securities in a capacity other than that of a bona fide owner; and this affiant has no rea- son to believe that any other person, association, or corporatoin has any interest direct or indirect in the said stock, bonds, or other securities than as so stated by him. PAUL C. MASON. . Business Manager. Sworn to and subscribed before me this 30th day of September, 1921. (Seal) ELIZABETH F. HILLMAN. (My commission expires October 6, 1921.) The Abstract Department Beginning with January, 1916, the periodical literature on the internal secretions is abstracted exhaustively. The mor- phology, physiology, pharmacology and pathology of the thy- roid, parathyroid, pineal and adrenal glands, the chromaffin tissues, the pancreas, gonads, hypophysis and thymus are in- eluded. Articles on the spleen, mammae, prostate, stomach, liver and intestines are dealt with only as they are of endo erine interest. Especial attention is given to diseases of known or sup- posed endocrine origin, as diabetes, acromegaly, exophthalmic goitre, Addison’s disease, the various dystrophies, scleroderma, ete. Articles on growth, menstruation and other functions sub- ject to hormone control are included when they are of explicit or implicit endocrine interest. Organtherapy is treated in detail. The literature on the physiology, pharmacology and path- ology of the autonomic nervous system is included as of pre- sumptive endocrine interest. In general contributions on surgical technique and on the spleen are omitted and those of highly technical interest are merely indicated as such. Articles which include nothing new either in the way of data or of significant viewpoint are ordi- narily treated very briefly with a notation as to their general character. The material is fully cross indexed. The index is checked with ‘‘Chemical Abstracts,’’ ‘‘ Physiological Abstracts,’’ ‘‘ Index Medicus’’ and other special bibliographies to insure complete- ness. Readers who chance to note omissions of articles of en- docrine interest, and especially any which appear in unusual publications or under captions which do not indicate such in terest, are requested’ to notify the editor. SS MTITITTIM CCC CC CCC CCC THE AMERICAN ANATOMICAL MEMOIRS Edited by GEORGE S. HUNTINGTON With the Collaboration of CHARLES R. STOCKARD and HERBERT M. EVANS No. 11 will appear in February, 1920, with a memoir entitled: “The Pigmentary, Growth and Endocrine Disturb- ances induced in the Anuran Tadpole by the Early Ablation of the Pars Buccalis of the Hypophysis’’ By P. E. SMITH Anatomical Laboratory, University of California 140 pages of text, 28 pages of illustrations, including two colored plates and eight heliotype plates. Price, postpaid, $3.00 Subscriptions to this Memoir should be sent to The Wistar Institute of Anatomy and Biology Thirty-sixth Street and Woodland Avenue PHILADELPHIA, PA. iil PHTTTTTTTTTTTTTeTTTTITITTTTTTITT TLL Quarterly Journal of Experimental Physiology EDITORS Sir Edward Sharpey Schafer, Edinburgh W. D. Halliburton, London C. S. Sherrington, Oxford E. H. Starling, London A. D. Waller, London Vol. XII No. 4 ——=— LIM, R. K. S. The Histology of Tadpoles fed with Thyroid. KILBORN, L. G. and J. J. R. MACLEOD. Observations on the Glycogen Content of Certain Invertebrates and Fishes. LANG, R. S. and J. J. R. MACLEOD. Observations on the Reducing Substance in the Circulating Fluids of Certain In- vertebrates and Fishes. BURRIDGE, W. Researches on the Perfused Heart: Its Mode of Working. HEWITT, JAMES ARTHUR. The Effect of Administration of Small Amounts of Thyroid Gland on the Size and Weight of Certain Organs in the Male White Rat. BURRIDGE, W. A Survey of Some Elements of Cardiac Ex- citability. SCHAFER, EDWARD SHARPEY. Note on Cats With Double Vagotomy. WALLER, A. D., and M. KOJIMA. Measurements of Emo- tivity in a Japanese Subject. SCHAFER, E. SHARPEY. The Influence of the Depressor Nerve on the Pulmonary Circulation. SCHAFER, EDWARD SHARPEY. The Influence of the Res- piratory Movements upon the Blood-Pressure in the Pulmo- nary System. Papers for publication may be sent to any of the Editors. The price of this number is ten shillings. CHARLES GRIFFIN & CO., Limited Exeter Street, Strand, London, W.C., 2 Glandular Deficiency “The potency of the glandular extracts in the market varies enormously, according to the manufacturer, and probably the age of the preparation when dispensed.”’ Dr. C. H. LAwRENCE Boston Medical and Surgical Journal Page 160, August 5, 1920 Specify WILSON’S Thyroid Ovary Thymus Orchic Suprarenal Mammary Pituitary Placenta Corpus Luteum Spleen Brain Spinal Cord Prostate Duodenum Prepared from fresh U. S. inspected glands, dried at low temperature under carefully controlled conditions. We supply the above autacoids singly or in combinations. Our facilities are offered for the preparation of any pluri-. glandular compound that you may desire. ee SG, “ay: ‘Thid mank youn quonamtee” 4209 South Western Boulevard. Chicago, Ill. Manufacturers of Standardized Animal Derivatives, Ligatioes and Digestive Ferments Subsidiary to WILSON & Co., Packers May we place you on our mailing list for “The Autacoid and Suture, “* our house Write for Catalog journal devoted to Glandular Therapy? Endocrinology The Bulletin of the Association for the Study of Internal Secretions November, 1921 CLINICAL REPORT OF A CASE OF GRAVES’ DISEASE WITH RAPID IMPROVEMENT FOLLOWING THE ORAL ADMINISTRATION OF FRESH OX SUPRARENAL GLAND S. SHAPIRO and DAVID MARINE From the Laboratories of Montefiore Hospital, New York. The following clinical report of a case of exophthalmie goiter presents several unusual features in addition to the classical manifestations of profound asthenia, emaciation, tachyeardia, thyroid hyperplasia, tremor and exophthalmos. The more impor- tant of these were: (1) Periods of pyrexia for which no assignable cause could could be found ; (2) Very low systolic blood pressure ; (3) Purpura with prolonged bleeding time, decreased platelet count, swollen and bleeding gums and a his- tory of profuse menstrual hemorrhage; and, (4) A rapid gain in weight and muscular strength, rise in blood pressure and decrease in bleeding time associated with administration of fresh ox suprarenal gland, but without any noteworthy changes in the pulse rate, exophthalmos or thyroid gland. Case History: R. B., the patient, is a female, age 30 years, single, and a stenographer by occupation. Family History: This is unimportant. Past History: Aside from measles and diphtheria, the patient has never had any serious illness, 700 SUPRARENAL THERAPY IN GRAVES’ DISEASE Habits: The appetite is always good. The bowels were regular until about two years ago. Since then she has been irregularly con- stipated. Weight: Her average weight before the present illness was about 125 pounds. Menstruation: Began at the age of thirteen and has been regular up to August, 1919. Present Illness: During June of 1919 the patient first noticed the occurrence of irregular large and small black and blue spots on her thighs. She consulted her physician, who treated her without improve- ment. Soon the spots spread so that they were present on the abdomen and chest. These purpuric spots continued to develop for more than a month when, early in August of 1919, the patient developed a sudden profuse menstruation which lasted for sixteen days. She became so exsanguinated that a blood transfusion was performed. She also be- came very nervous, complained of palpitation of the heart, persistent dryness of the mouth, and increased muscular weakness. Nocturia two or three times each night developed about this time. A second uterine hemorrhage occurred at the time of the next menstrual period and is said to have ceased following the administration of thrombo- plastin. At this time abnormal prominence of the eyes was noted, her nervousness became more marked, the palpitation of the heart and dry- ness of the mouth persisted. She was losing weight steadily in spite of a good appetite. Physical weakness became profound. Purpuric spots covered her chest, abdomen, upper and lower extremities. Her case was now recognized as one of exophthalmie goiter and she was advised to go to the mountains for a rest. She remained in the mountains two months and returned home in December of 1919 feeling better. Her menstrual periods during October and November of 1919 were within normal limits. In December of 1919 she had another profuse menstrual hemorrhage lasting fifteen days, which is said to have been controlled by the administration of thromboplastin. She then went to the country and remained until March, 1920. During these three months the menstrual periods appear to have been normal. However, her exophthalmos had increased so that her ability to read was impaired. There was further loss of weight and muscular strength. Her pulse rate averaged about 150 at that time. There has been amenorrhea since May of 1920. Early in June of 1920 she went to a western sanitarium, where she remained for four months. Examination of the blood at that time revealed: Red cells, 3,300,000; white corpuscles, 12,700; hemoglobin, 73 per cent. The blood pressure was 150-60. The Wassermann reac- tion was negative; non-protein blood nitrogen was 25.3; and blood sugar, 100. The urine showed no albumin, sugar, casts or blood cells. The basal metabolic rate in June was + 68. Soon after her arrival at the sanitarium she had, according to her physician, a hemorrhage into the medulla, causing paralysis of the muscles innervated by the 7th, 9th and 12th cranial nerves on the left side. In the course of a few weeks the paralysis cleared up entirely. The purpuric condition, i i SHAPIRO AND MARINE 701 however, persisted, so that she had considerable oozing from the gums and purpuric spots over the body. X-ray and radium applications to the thyroid were followed by violent reactions. Ligation of the left superior thyroid artery was performed September 1, 1920, and of the right superior thyroid artery on September 25, 1920. Following this, she improved sufficiently to return to New York about October 15th, at which time her metabolic rate was —- 49. She entered Montefiore Hospital October 20, 1920, complaining of nervousness, palpitation of the heart, profound muscular weakness and marked loss in body weight. Physical Examination: General: The patient is a female adult, white, markedly emaciated and so weak that she is scarcely able to stand long enough to have her weight taken. The weight is 70 pounds. She perspires freely. The Head is normal in size and shape. The Hair is very thin and dry. The Eyes show marked bilateral exoph- thalmos. The pupils are equal and react sluggishly to light and accommodation. Von Graefe’s and Stellwag’s signs are present. Iritis is present in the left eye. The left fundus shows a petechial hemorrhage near the center of the disc. The right fundus is nor- mal. Ears: The hearing is good. No tophi, no discharge, no mas- toid tenderness are found. Nose: There are scab-like crusts of old and recent hemorrhages on the mucous membrane just within the external nares. Mouth: The teeth are fairly well kept, the gums are swollen and spongy; there is oozing of blood from the gum margins The tongue protrudes in the mid-line, is markedly tremulous and dry. Facial muscles show no abnormalities. Neck: A transverse scar is seen just above the level of the ericoid cartilage. The thyroid gland is symmetrically enlarged; a thrill is felt and bruit heard over each lobe. Carotid pulsations are forcible and visible. The cervical lymph glands are not enlarged. The Chest is of the flat type. The mammary glands are atrophic. The ribs are very prominent. Pur- puric spots are seen over the chest. Marked suprasternal pulsations are visible. The lungs are clear and resonant throughout. Heart: The cardiac rate is 128. The beat is regular. The apex is in the fifth interspace in the mid-clavicular line; the apex beat is diffuse but forcible. The area of cardiac dulness is not increased. A soft, blow- ing, systolic murmur is heard over the apex; it is not transmitted. The Abdomen is seaphoid. Purpuric spots are seen chiefly over the lower portion. The abdominal wall is very thin. The liver, spleen and kidneys are not palpable. No masses are felt; no tenderness is de- tected. Eatremities: No abnormalities are palpable in the long bones. There are a few purpuric spots on the arms and legs. The out- stretched fingers show fine tremor. Reflexes: The knee jerk and ankle jerk are active. The abdominal reflexes are present. Temperature: The temperature of the patient has been ranging between 100° and 102° since admission. Subsequent Notes: October 26. The patient’s temperature still varies between 100° and 102°. She perspires readily, although kept 702 SUPRARENAL THERAPY IN GRAVES’ DISEASE quiet in bed. Bleeding along gum margins is seen; calcium lactate, 1 gram t. i. d., is prescribed. Blood examination on this date showed: red cells, 3,800,000; white cells, 9,000; neutrophils 64%, lymphocytes 30%, mononuclears and transitionals 4%, eosinphils 2%; bleeding time eight minutes. The blood pressure was 95-60, the weight, 7244 pounds. Urine had a specifie gravity of 1010, was acid, showed a very faint trace of albumin, with no sugar and no casts. October 27. Glucose tolerance test using 50 grams of glucose gave no glycosuria in three hours. October 31. The tolerance test was repeated, using 100 grams of glucose. No glycosuria appeared in three hours. November 1. Started desiccated suprarenal gland, 0.3 grams t. ind. The bleeding time was eight minutes. The weight was 70% pounds, November 4. The patient still complains of persistent dryness of the mouth. The temperature is normal for the first time since admis- sion. The blood pressure is 100-60. November 9. The patient is on a full diet. She is out of doors most of the day, but still unable to walk. Her weight is 73 pounds. November 13. The blood pressure is 105-65. November 16. The weight is 74 pounds. November 18. Dryness of mouth and sweating persist. Coarse tremor of fingers is apparent. November 22. Fresh ox suprarenal gland, 10 grams, t. 1. d.,/18 substituted for the desiccated suprarenal. The weight is 75% pounds. The blood pressure is 115-75. November 23. The patient had nausea and vomiting associated with cramp-like pains in the abdomen, probably due to the excessive administration of fresh suprarenal gland. This is discontinued. November 27. Desiccated whole suprarenal gland, 0.3 gram, t. i. d., is started. The blood pressure is 110-70. November 29. Desiccated suprarenal gland is discontinued and the administration of fresh whole ox suprarenal, 5 grams daily, begun. The weight is 75 pounds. December 2. Temperature has remained normal since Novem- ber 28. Between November 6 and November 28 the temperature has fluctuated between normal and 102°. The bleeding time is four min- utes. The patient no longer complains of dryness of the mouth nor of sweating—symptoms that have been present since admission. She is now able to walk from bed to porch. New growth of scalp and axillary hair is visible. Urine examination shows: specific gravity, 1012; acid, very faint trace of albumin; no sugar; no casts. December 6. The weight is 77 pounds. The blood pressure is 110-70. December 12. Blood examination shows: red cells, 4,000,000; white cells, 7,500; neutrophils, 62%; lymphocytes, 30%; mononuclears and transitionals, 6%; eosinophils, 2%. December 13. The weight is 83 pounds. The blood pressure is 115-70. SHAPIRO AND MARINE 703 December 21. The weight is 87% pounds. The blood pressure is 115-70. December 27. The exophthalmos seems slightly increased. The outstretched fingers show marked lessening of tremor. The patient is able to walk about the ward without dyspnea. The purpuric spots have disappeared. The weight is 94 pounds. The blood pressure is 115-70. January 1. Temperature arose to 100.2° today. The abdomen is distended with gas. Nausea is complained of. Colonic irrigation and light catharsis are administered. January 3. The temperature is normal. The abdomen is soft. January 4. The weight is 99% pounds. The blood pressure is 120-70. January 9. Fresh suprarenal gland is discontinued (for a con- trol period). The patient still receives calcium lactate. January 11. The weight is 101% pounds. January 15. The blood pressure is 125-70. January 18. The weight is 108 pounds. The temperature has remained normal since January 3. The patient feels quite comfortable. Palpitation and tremor are improved. The blood pressure is 120-70. The bleeding time is four minutes. Urine examination shows: specific gravity, 1010; very faint trace of albumin; no sugar; no casts. January 25. The weight is 113 pounds. January 31. The weight is 117% pounds. The bleeding time is five minutes. February 1. Purpuric spots reappear over chest and thighs. Feeding 5 grams of fresh ox suprarenal cortex daily is begun. Blood examination shows: red cells, 4,150,000; white cells, 4,500; platelets, 40,000; neutrophils, 64%; lymphocytes, 26%; mononuclears and tran- sitionals, 10% The bleeding time is 4% minutes. February 5. The patient is menstruating for the first time in nine months. February 6. The temperature is elevated to 101.4°. The patient complains of headache and diarrhea. February 7. The temperature is 100.8°. February 8. The temperature is 101.8°. Diarrhea is still pres- ent. The blood pressure is 125-70. February 9. The temperature is 102.4°. February 10. The temperature is 102.8°. A severe chill was experienced during the night. The blood pressure is 125-70. The abdomen is distended. Tenderness is elicited over both ovaries. The bleeding time is four minutes. February 11. The temperature is 102.8°. The stools are nor- mal. The purpuric spots have disappeared. February 13. The temperature is 99.4°. Desiccated ox supra- renal cortex, 0.3 grams, t. i. d., is substituted for the fresh suprarenal gland. 704 SUPRARENAL THERAPY IN GRAVES’ DISEASE February 14. The weight is 112% pounds. The temperature is normal. February 21. Purpuric spots have returned. Desiccated whole suprarenal gland is substituted for the desiccated cortex. The weight is 115% pounds. February 24. The blood pressure is 125-80. March 1. Purpuric spots are still present on the chest. The patient feels quite comfortable and is able to take considerable exer- cise without fatigue. She leaves the hospital today. May 12. The patient returns for observation after having spent approximately 2% months in the country. The temperature is 98.2°; the pulse, 112; blood pressure, 120-76; weight, 133 pounds. There is no tremor of the outstretched fingers. Muscular strength is excellent. Exophthalmos is possibly slightly less. There is no abnormal sweat- ing. She sleeps well. Her appetite is good. A thick coat of scalp hair has grown. The skin is normal. The neck measures 34 cm. in circumference; the thyroid gland is vascular. The menstrual function has been regular. Purpura is absent. Subjectively the patient is quite comfortable and able to take considerable exercise daily without fatigue. Since leaving hospital the patient has taken one gram desiccated whole suprarenal gland daily. DISCUSSION Fever in uncomplicated exophthalmie goiter is rare, although patients suffering from this disease frequently complain of hot flushes and of feeling warm. If fever is present, it usually manifests itself as a very slight and fairly constant elevation of the temperature above normal. The febrile reaction in this case suggested a focal infection, but we were unable to find such a focus, and moreover there was no leukocytosis, nor did the pulse vary with the temperature. Extensive studies on blood coagulation in exophthalmie eoiter have been made in Kocher’s clinic. These have uniformly shown a prolongation of the coagulation time in frank cases. Pur- pura is a rare complication. In our case exacerbations and remis- sions were observed which coincided with the withholding and administration of suprarenal gland. The bleeding time likewise increased and decreased with the appearance and disappearance respectively of the purpura. The patient showed a marked and rapid gain in weight, which began with the administration of desiccated suprarenal gland, and became more rapid after the fresh gland was substituted. Others, ineluding Solis-Cohn and Crary, have observed rapid increases in the weight following the 706 SUPRARENAL THERAPY IN GRAVES’ DISEASE administration of suprarenal gland. Oppenheim and Hoppe have reported similar rapid gains following the use of desiccated ovary and corpus luteum. Quite recently, Obregia has reported a series of twenty-one cases of exophthalmie goiter, including classical types as well as the so-called ‘‘formes frustes,’’ in which he ob- tained a marked and rapid amelioration of the symptoms, except- ing exophthalmos and tachycardia, by the administration of from 10-50 drops of a glycerol extract of whole fresh pig suprarenal gland by mouth. This author also claims that adrenalin alone seemed to have some beneficial effect, but negligible as compared with the glycerol extract of whole fresh gland. He was aware of the voluminous literature now available dealing with the un- toward effects of adrenalin in exophthalmie goiter, and of the alleged hypersecretion of epinephrin in this disease. Unfortunately, we were unable to make metabolic rate deter- minations during the period under observation, although in June a rate of + 68, and in September, a rate of + 49 were obtained in another institution. The right and left superior thyroid arteries were ligated September 1st and 25th, respee- tively. While inerease in weight and general improvement fre- quently oceur within two or three weeks after ligation, it is quite unusual to see such marked gains in weight unaccompanied by pulse and thyroid changes beginning after an interval of two months without improvement. The systolic blood pressure remained relatively constant at 95 mm. for the first ten days after admission, and during the next 214 months rose gradually to 125 mm. This like- wise was coincident with the gain in weight and the adminis- tration of suprarenal gland. We do not believe there is any direct relationship between the administration of the suprarenal gland and the rise in blood pressure, and are inclined to believe that the improved vascular tone is more readily explained as a part of the general improvement. Other striking evidences of improvement were the return of the menstrual function and the new growth of sealp and axillary hair, the disappearance of the asthenia, the lessening of the tremor, the disappearance of abnor- mal sweating and dryness of the mouth, although the thyroid gland, as regards size, consistency, bruit and expansile pulsation, remained unchanged, as did also the pulse rate and exophthalmos throughout her stay of over four months in the hospital. 9 ; a d SHAPIRO AND MARINE 70 = Very rapid and striking improvement in the general nutri- tion of a case of exophthalmie goiter has been observed following the use of suprarenal gland. This improvement occurred during the administration of fresh ox suprarenal cortex, rather than during the administration of desiccated suprarenal gland. The observation contains an additional suggestion from the clinical viewpoint of a possible relative functional insufficiency of the suprarenal cortex as one of the underlying factors in exoph- thalmie goiter. Our experience suggests that fresh suprarenal cortex may be administered in five gram doses daily by mouth without untoward effects. Larger doses, especially of whole fresh suprarenal gland, caused nausea and vomiting, probably from direct irritation of the gastric mucosa by epinephrin. These doses are equivalent to much larger amounts of desiceated suprarenal gland than had been administered by the authors of the reports above referred to. Evidence, both experimental and elinieal, is now rapidly accumulating that the suprarenal gland, and particularly its cortical portion, plays an essential and fundamental role in the etiology of exophthalmie goiter. BIBLIOGRAPHY Solis-Cohen, S.: The treatment of exophthalmie goiter and other vaso- motor ataxias with preparations of the thymus gland and of the adrenals. J. Am. M. Ass, (Chicago), 1897, 29, 65-67. Crary, G. W.: The use of extract of suprarenal capsules in exophthalmic goiter. Tr. Soc. ‘Alumni Bellevue Hosp. (N. Y.), 1897-98, p. 101-105. Oppenheim, H.: Lehrbuch der Nervenkrankheiten. Karger, Berl., 1905, Ba. ii, S. 1379. Hoppe, H. H.: The medical treatment of Graves’ disease with special reference to the use of corpus luteum. J. Nerv. & Ment. Dis. (Lan- caster, Pa.), 1918, 47, 254-261. Obregia, A.: Action de lopothérapie surrénale chez les Basedowiens. Compt. rend. Soc. de biol. (Paris), 1921, 84, 1024-1026. TESTICULAR SUBSTANCE IMPLANTATION DR. L. L. STANLEY, Resident Physician, California State Prison, SAN QUENTIN, CALIFORNIA Brown-Séquard (1) in 1889 made a number of experiments with an extract produced from the testicles of various animals. He became so convinced of the beneficial effects of this material when injected into older animals, that he determined to experi- ment with it upon himself. On May 15, with the assistance of his co-workers, he excised one of the testicles from a vigorous dog two years of age, cut it into pieces, ground it in a mortar with a small amount of water, and expressed the fluid. By filtration about 41% c.c. of extract was obtained. He injected 1 ¢.c. of this extract subcutaneously into his own leg, repeating the injection about every five to ten days, until he had received ten treatments in all. The last five were made from the extract of guinea pig tes- ticles, which was injected under the skin of the abdomen and arm. At this time Brown-Séquard was 72 years old, and so feeble that it was necessary for him to sit down after only half an hour’s work in his laboratory. Although seated, he became very much fatigued after a few hours, and it was necessary to return home in a carriage, and immediately go to bed after a sparse and hurried supper. For the preceding ten years his weakness had been so great that he was unable to sleep, and arose exces- sively tired. The day after the first injection, and still more after the others, he claimed that a radical change took place in him, and by the first of June he had regained all the foree which he pos- sessed a number of years before. A considerable amount of work in the laboratory scarcely tired him, and, to the astonishment of his principal assistants, he was able to experiment for many hours, and in walking about had no need for help. On May 23rd, after three and one-quarter hours of very fatiguing experi- mental work, he was so slightly tired that after dinner he was 708 STANLEY 709 able to begin work on the report of some very difficult problems. It had been twenty years since he had done any work after supper. Because of a natural impetuosity, Brown-Séquard had the habit, up until he became sixty years old, of running up and down stairs. This gradually lessened, and it became necessary for him to hold to the balustrade, but after the second injection he regained his lost propensities, and without realizing it regained his old habit. His limbs showed a very noticeable increase in strength. The flexors of his right arm registered 34 kilograms before, but after the treatments increased to 41. Partieular attention had been paid for many years by him to the registering of this strength by the dynamometer. He observed the force of the jet of urine, and affirmed that the greatest length of the stream during the six days preceding the first injection was at least a quarter less than that which followed during the next twenty days. He commented, moreover, that perhaps the most distressing misfortune of old age consists in the inability to defecate. With him the expulsion of fecal material had become most laborious during the preceding twelve years, and had become almost impos- sible without the aid of purgatives and artificial means. During the two weeks which followed the first injection, a radical change took place in the reflex of defecation. He had less use for laxa- tives, and the expulsion of feces equally as large and hard was accomplished without mechanical assistance or lavage. There had been a return to normal state of many years before. He added that intellectual effort had become easier than for many years, and that many other forces not lost, but decreased, had been notably increased. Subsequent to his experiments upon himself, Brown-Séquard reported other cases which were benefited. He believed that the testicular extract had an influence particularly on the spinal cord, Brainard made injections in over two hundred people, using extracts from the testicles of healthy young ras. He tied the spermatic veins and vasa of the ram as far away from the tes- ticle as possible, and then expressed the fluid. Mixing this with distilled water, and filtering, he injected from 15 to 60 minims 710 TESTICULAR SUBSTANCE IMPLANTATION in the deltoid muscle. After the first injection in many cases of weakness without definite disease, he noticed a beneficial effect. In three cases of locomotor ataxia, Brainard states, more favor- able and pronounced effects resulted than im any others. Five cases of muscular rheumatism and four of sciatica were relieved or entirely cured of pain. Some of the cases of Brainard reported as not improved, were thought by Brown-Séquard to have re- ceived insufficient injections. In cases of tuberculosis, Brown-Séquard noticed beneficial effects, as increase in appetite, strength, and a fall in tempera- ture. He gave daily injections of 1 ce of testicular material. He also reports cases of other diseases in which conditions of mental depression, hemiplegia, and myopathies were greatly relieved. In the latter part of 1918, the first experiments of engraft- ing human testicles from recently executed prisoners to senile recipients were begun at San Quentin Penitentiary, and to date twenty-one such cases have been tr eated. In 1920, animal glands were substituted for the human, and were not grafted to the recipients testes, but were merely laid | in the pampiniform plexus of the scrotum. Many of these sloughed out, for too large a piece was used. After a time, varying from three days to as many weeks, the site of operation would open up and discharge a quantity of yellowish necrotic material, usually devoid of bacteria. Later smaller pieces were used. A cross section of a ram’s testicle about the size of a dollar was cut and placed in the scrotum. Many of these remained without sloughing, and very gradually were absorbed. As the scrotum is subject to considerable trauma, and is difficult to keep clean, it was determined to imbed the section of ram’s testicle on the fascia, overlying the rectus muscle of the abdomen. With the skin injected with 14 per cent novocain, an incision was made down to the rectus; closed eurved Mayo’s scissors were then run along on top of the fascia at right angles to the incision, opened and withdrawn, leaving a tunnel between the fascia and fat. This was held open with retractors, and the section of testicle carefully inserted. The incision was closed with two silkworm gut sutures. With this procedure there were —— CE eel STANLEY 711 very few sloughs, but it was necessary for the patient to ‘‘go easy’’ for a week, until the wound had healed. A number of these implants were removed after a variable time, and it was found that they were not alive, but were necrotic, and were being gradually absorbed. Believing that all the testicular substance would undergo the same process, however placed in the system, it was determined to inject it by syringe without undue maceration. The syringe employed is one devised by Joseph Beck, for paraffin. It holds about 4 grams. The barrel of the syringe is filled with strips of the fresh testicle. The piston is attached and the substance slowly injected through a large needle, the skin being first infiltrated with a few drops of novoeain. About one gram of the testicle is injected in each of four places, radially from the single point of entrance. | With this method the danger of slough is reduced to a mini- mum. The patient does not have to “oo easy’’ for a week, but may continue with his work. There is usually no inconvenience, although there may be some redness for the first few days about the site of injection on the abdomen, and later on a sense of itching. The injected sub- stance may be felt under the skin for weeks and months, until it is all absorbed. The material used is best taken from a ram, goat, or boar which has reached maturity, preferably a year to eighteen months old. As soon as the animal is killed, the whole scrotum is resected between clamps and brought to the hospital. Here the external hair is clipped off, the skin painted with iodine, and with abso- lutely aseptic technic the skin incised. The edges are grasped with hemostats and held back. The next layer is likewise grasped and retracted. There are many coverings before the tunica is reached, and each may be carefully and aseptically opened. The tunica vaginalis is then opened and the testicle caught with a large hemostat and removed to a sterile towel or basin. Here it is opened, and the strips cut for filling the syringe. The abdomen or site of injection of the patient is cleaned with aleohol. After the operation the needle hole in the skin is covered with Tincture Benzoin Compound, and a little cotton. This may be in turn covered with a small strip of adhesive tape. 712 TESTICULAR SUBSTANCE IM PLANTATION Because it is not always possible to obtain testicular mate- rial just when it is wanted, a plan for preserving was devised. As soon as the testicle is removed aseptically, it is immersed in pure vaseline, warmed to liquid state. This keeps out all air. Then the container is placed in the refrigerating vats of the ice plant and kept frozen at —12° F. When ready for use the testicle has the consistency of an iee eream brick. Glands preserved in this way have been used as long as thirty days after death of the animal. Refrigeration does not seem to affect the potency. Up to the present time over three hundred eases have been treated with animal testicular material. These were not selected but were taken in order of their application. After the first twenty or thirty prisoners had’received the glands and reported among their fellow prisoners the good results they had obtained, many applications were received. As there is very little pain, and no inconvenience to the process, many were willing to test it. Among those treated were cases of neurasthenia, senility, asthma, paralysis agitans, epilepsy, dementia precox, diabetes, locomotor ataxia, impotency, tubereulosis, paranoia, gangrene of toe, atrophied testicles, rheumatism, and, in fact, many other illnesses of chronic character not amenable to treatment. Finding that the injection of animal testicular substance caused no ill effects, and at most only a slough, it was thought worth while to try it on any case which presented. From these experiments it may be said that animal testicular substance injected into the human body does exert decided effects. Some of those receiving this treatment claim that their eye- sight is improved, the appetite is increased, that there is a feel- ing of buoyancy, a joy of living, an increased energy, loss of tired feeling, increased mental activity and many other beneficial effects. These results are not easy to demonstrate, and one must rely to a considerable extent on the patient’s statements. However, when the psychology of a prisoner is considered, one may be assured that if no beneficial effects were derived, the news would rapidly spread among the inmates and it would be impossible to induce others to take the treatment. As a STANLEY 713 matter of fact, applications come in every day from the convicts for the ‘‘glands’’ and the demand is very great. Some even want a second and third injection, feeling that if one does good, more will do better. In the series, eight cases of asthma have been treated. All have been helped, and four claim that they have had no re- currences. If it be true that there is an inter-relation between the various glands of internal secretion, the theory might be ad- vanced that the injection of testicular substance so acts upon the adrenal glands, that an increase of adrenin is thrown into the system, thereby influencing the asthmatie attacks. In four cases of acne, young men from 18 to 25 years of age have received injections. The eruptions have been markedly decreased. As acne is usually a disease of early manhood, may it not be possible that the maturing interstitial tissue has less influence on the sebaceous glands than that which the patient acquires as he grows older? Aene generally disappears when the patient enters manhood. In tuberculosis in the various stages and conditions, eleven patients were treated. Most of them showed a temporary gain in weight, appetite, sexual manifestations, and general well-being. Three advanced cases, however, died. The injections were made only as a last resort, with little hope of their being of any value. This procedure has been carried out in about sixteen mental cases, ranging from neurasthenia to manic-depressive insanity. Most of the subjects showed some change. One case of paranoia has apparently lost his delusions of persecution, improved physi- eally, and works very well. Almost all the subjects report increased sexual activity. Many who have not had erections for years claim that their virility has been restored. One melancholiac, who would not talk or show any activity whatever, was observed to have an erection a few days after an implantation. He died several months later from inanition due to refusal to take food. Experimentation is now under way with six white rats in separate revolving cages, to compare the amount of work done before and after implantation of testicular substance. 714. TESTICULAR SUBSTANCE IMPLANTATION Further work will also be done on prisoners, testing the effects of single and multiple injections. These observations were undertaken with an unbiased mind, and with the endeavor to pursue the truth, wherever it may lead. BIBLIOGRAPHY Brown-Séquard: Expérience démontrant la puissance dynamogénique chez homme d’un liquide extrait de testicules d’animaux. Arch. de physiol. (Paris), 1889, 5 s., 1, 651. : Nouveaux faits relatifs & l’injection souscutanée chez VYhomme d'un liquide extrait de testicules mammiféres. Arch. de physiol (Paris), 1890, 5 s., 2, 204. Du role physiologique et thérapeutique d’un suc extrait de testicules d’animaux d’aprés nombre de faits observés chez l'homme. Arch .de physiol. (Paris), 1889, 5 s., 1, 738 THE IMPORTANCE OF VISUALIZING ESTABLISHED SCIENTIFIC DATA WITH REFERENCE TO THE SIZE OF THE BODY CELLS AND THEIR CHEMICAL SUPPLIES IN THE CIRCULATING BLOOD GEORGINE LUDEN, M.D., Ph.D. First Assistant in Cancer Research, The Mayo Foundation, ROCHESTER, MINNESOTA Knowledge only becomes our mental property after it has been visualized. Scientific data can be visualized only by cor- relating them to familiar conceptions, quantities or measures. An attempt has been made in this paper to form a clearer con- ception of well-known data concerning the size and the numbers of certain body cells and of the chemical supplies in the cireula- tion. The information thus obtained proved to be interesting and instructive: it gave food for thought in connection with great medical problems. It revealed unsuspected elements of humor in sober scientific facts and showed that ‘‘relativity’’ is by no means restricted to Einstein’s famous theory. The data which have been considered are (1) the size of the body cells; (2) the total blood volume in relation to the total number of erythrocytes and leukocytes in the circulation ; (3) the total amounts in which im- portant chemical blood constituents (iodin, urea, sugar, choles- terol, natrium chlorid, and so forth) are present in the total blood volume; (4) the relative size of electric ions or electrons with reference to the hydrogen-ion concentrations of the blood, and (5) the concentration in which epinephrin is physiologically active. The size of the body cells—It is well-known that in normal blood counts the number of cells contained in 1 ¢.mm. ranges from 4,000,000 to 5,000,000 for the erythrocytes and from 6,000 to 10,000 for the leukocytes. It is less well known that the actual size of a millimeter may be visualized by merely pressing the point of a fairly soft pencil on paper: the resulting dot will be found to measure 1 mm. To form a mental picture of objects, 5,000,000 of which find room in a mere dot of three dimensions, is by no means easy. However, microscopic measurements have 715 716 VISUALIZING SCIENTIFIC DATA proved that the size of the cells in the human body ranges from 5 to 40 microns, micromillimeters, one micron being equal to the one-thousandth part of one dimension of the aforementioned dot or to the one twenty-five thousandth part of an inch. The larg- est cell in the body, the ovum, measures 40 microns; the erythro- cytes vary from 5 to 8 microns, and the leukocytes from 10 to 15 microns (Nichols and Vale). While it is impossible to form a very definite mental picture of even the largest body cell, it will help our imagination considerably to recall that this cell covers the same area as five of the largest erythrocytes, of which 5,000,000 practically fill 1 ¢.mm. The total blood volume.—Various methods have been used to determine the total blood volume. MacCallum mentions the method of Haldane-Smith as the most accurate; it consists in administering a known amount of carbon monoxid and in esti- mating the concentration of the gas in several blood samples.* By this method the total blood volume was found to represent from 5 to 5.3 per cent of the total body weight. The recent in- vestigations of Ashby (1), based on the injection of a known quantity of Group IV blood serum followed by numerous blood counts, seem to indicate that the total blood volume is likely to be higher, from 7.5 to 8.5 per cent of the body weight. Accord- ing to Haldane-Smith the total blood volume of an adult, weigh- ing 154 pounds (70 kg.) is 3500 em., that is, 3.5 liters or slightly less than 1 gallon; according to Ashby (2) the blood volume of this adult would be approximately 5900 em., that is, practically 6 liters or 1.5 gallons. The latter amount only half fills an aver- age pail or bucket, of the type used for household purposes. t The figures given in the following ealeulations are based on the total blood volume of an adult weighing 154 pounds, with a blood volume of 5000 gm. (a compromise between the data of | Haldane-Smith and Ashby) ; erythrocytes 5,000,000, leukoeytes 6,000 per 1 ¢.mm. The total number of erythrocytes and lewkocytes in the total blood volume.—In order to estimate the total number of erythro- *The determination of the carbon monoxid concentration in blood by the carmin method, used by Haldane, has not proved satisfactory : a new method is in elaboration at the U. S. Bureau of Mines, according to information received from Dr. A. C. Fieldner. +The accuracy of this comparison has been verified by pouring 6 liters into an average bucket; all the other “visualized” data have been similarly controlled by measure or weight, whenever this was possible. “| LUDEN 71 cytes and leukocytes in the blood of the adult, the following facts must be borne in mind: the specific gravity of blood and of water is practically identical; 1 gm. of blood represents the content of 1 cc. or 1000 e-mm. Hence a total blood volume of 5000 gm. is equal to 5000 x 1000 = 5,000,000 ¢.mm. The figures for the total number of erythrocytes and leukocytes per 100 ¢.c. and in the total blood volume are given in Table 1. TABLE 1 BLOOD CELLS IN CIRCULATION Per 100 c.e. | Per total blood volume Erythrocytes 500,000,000,000 | Erythrocytes 25,000 000,000,000 | (five hundred billion) | (twenty-five trillion) Leukocytes 600,000,000 Leukocytes 30,000,000,000 (six hundred million) | (thirty billion) Adult, weight 154 pounds; blood volume 5000 c.c. Figures which contain from nine to twelve zeros are likely to convey little information. It may be advisable to recall a certain unseientifie conundrum, when an attempt is made to visualize ‘the countless hosts’’ of blood cells in the circulation. Question: If a fortune of seven billion silver dollars were to become the personal property of any one who finished counting the coms, when would the prospective owner be entitled to enjoy the fruits of his labors? Answer: At the end of 400 years, assuming that the aspirant had counted day and night without any intermission whatsoever. The relative proportions and the total amounts of important blood constituents—The work of numerous investigators (Folin and Wu, McLean and Van Slyke, Benedict, Menten, Bloor, Grigaut, Chauffard, Laroche and Grigaut, Kendall (25, 26), and Hawk, to name but a few) has furnished definite data concerning the proportions in which important chemical constituents are present in the blood. Tt has become customary in this country to express the values obtained by blood analyses in milligrams per 100 c.c. of blood; in other countries, France for instance, they are usually expressed in terms of milligrams per liter, whereas Italian and German research workers generally give their 718 VISUALIZING SCIENTIFIC DATA findings in terms of percentage. The presentation of an analysis in milligrams per 100 e.c. is clear and convenient and its universal acceptance would undoubtedly further the progress of science; neither the American nor the foreign mode of expression, how- ever, gives a very definite idea of the total amounts found in the circulation for the use of the whole body. A far more vivid con- ception of the (often ludicrously small) quantities with which the body works may be obtained by correlating the number of milli- grams per 100 e.c. to the total blood volume and by visualizing the values thus found through comparison with familiar quanti- ties. This has been done in Table 2. It need hardly be pointed out that the figures given in this estimate only apply to the chem- ical supplies of the body which are in cireulation in the blood, and not to the reserve deposits in organs and tissues. To form even an approximately correct idea of, for example, the urea or ereatinin content of all the tissues might prove a difficult task. The relative size of different organs in different persons and many other factors would have to be taken into consideration, and large series of determinations, such as have been made of the blood, have not been made of the majority of organs. An amusing, if not very precise, estimate of the total chemical composition of ‘the average man’”’ has recently been published by a big indus- trial ecompany*; it may be summarized as follows: fat enough for seven bars of soap; iron enough for medium-sized nail; sugar enough to fill a shaker ; lime enough to whitewash a chicken coop ; phosphorus enough to make 2.200 match-tips ; magnesium enough for a dose of magnesia; potassium enough to explode a toy can- non; sulphur enough to rid a dog of fleas. Many items in this estimate are left largely to the imagination, such as the size of the dog and the number of his tormentors, but the total cost of the ingredients is given as ninety-eight cents, which is neither expen- sive nor calculated to foster megalomania. The total amounts of the blood constituents presented in Table 2 are based on Hawk’s data, with the exception of the values for iodin (Ken- dall, 25, 26) and for cholesterol (Luden). Kendall proved that the total quantity of thyroxin, the thyroid hormone containing 65 per cent of iodin, present in the tissues (exclusive of the thy- roid gland) is approximately 14 mg., that is, roughly, 14 gr. of hormone and slightly more than 1 gr. of jodin; these values are *The Marathon Paper Mills Company. 28) LUDEN RELATIVE AND TOTAL AMOUNTS OF IMPORTANT CHEMIC TABLE 2 AL CONSTITUENTS IN NORMAL BLOOD (Adult, body weight 154 pounds) Per 100 c.c. Per total volume (5000 c.c.) Equivalents Milligrams Milligrams Grains lien nxcobocosano0 5 0.013 0.65 0.01 Average dose atrophin or hyosin. @xreavinin’ =... soon! dams 20) 50 to 60.0 Wie) 2240) Average dose ferrous lactate, Ne HOGlossccoosvo) UOw 6H 50 to 150.0 Lim — Bt caffein or aloes. Acid Phosphorus... 2.0to 6.0 100 to 300.0 5.0 Small dose acetylsalicylic acid (aspirin). Lipoid phosphorus...| 6.0 to 12.0 300 to 600.0 10.0 Large dose acetylsalicylic acid (aspirin). Milligrams Grams Grains White Gooooocpec Re 20.0 to 40.0 Lig 2 15 to 30.0 Average dose sodium bromid or quinin ; (malaria). SIERO avoncca00 is 80.0 to 120.0 4to 6 60 to 80.0 1 teaspoonful. Cholesterol ......---| 10.0 to 140.0 4to 6 60 to 80.0 24 egg yolks. Sodium chlorid...... 650.0 32 480.0 (1oz.) | 1 tablespoonful. LAG) eeteicessercre> .......+{100.0 to 720.0 5 to 36 60 to 480.0 (10z.) | 1 tea to 1 tablespoonful. — 720 VISUALIZING SCIENTIFIC DATA comparable to the ‘‘average doses’? in which morphin is given hypodermiecally after operation. The iodin content of the total blood volume, according to Kendall’s findings, is equal to the average 1/100 gr. dose of atropin sulfate, hyoscine bromid or nitroglycerine (Bastedo, Bethea). Plummer’s determinations of the basal metabolic rate show that ‘“‘the average daily exhaus- tion of thyroxin in the tissues is 0.5 to 1 mg.’’ approximately 1/120 to 1/60 grain or the usual dosage of physostigmin salicylate (Bethea, Powell). ‘“‘A shift of 1 mg. of thyroxin in the tissues is accompanied by a corresponding rise or fall of between 2 and 3 per cent in basal metabolism’? (Plummer). I determined the cholesterol values shown in Table 2 according to the Bloor I and II methods for blood and for egg yolk (28, 29, 30). The yolk of eggs contains no ‘‘split cholesterol’’ (Luden), the Bloor I and Dt values being identical, its cholesterol content is roughly nine times that of normal human blood: the normal Bloor I cholesterol value of whole blood, upper limit, is 100 mg. per 100 ¢.c.; that of egg yolk is 888 mg. per 100 c.c. The sugar concentration in the total blood volume is especially worth considering. The fact that there is but one medium-sized teaspoonful of sugar in the one-half bucketful of blood, which represents the entire circulation of an adult weighing 154 pounds, may even help us to take a lenient view of certain acrimonious traits which we sometimes encounter in fellow human beings. The hydrogen ion concentration in the blood and the rela- tive size of electrons —The terms ‘acidosis’? and ‘‘alkalinosis”’ are familiar because of their frequent use in modern medicine. The clinical conditions to which they refer are of great im- portance: ‘‘A rise in the hydrogen ion concentration of the blood is significant because it indicates failure on the part of the pro- tective mechanism to preserve the proper reaction’’ (Hawk). Yet the statement that in clinical acidosis the hydrogen ion con- centration values range from P), 7.3 to P; 7.1; that the normal values are from P, 7.6 to P;, 7.4, and that the extreme alkalinosis observed by Menten in a case of gastric cancer was 8.44, conveys anything but a clear picture of these values to the majority of physicians. Rowntree’s admirable comparison on the other hand: “ 0.00001 Number of people counting electroms......---+--+-+++-- 3,000,000.0 Rate of counting per second......------++-++++see00> 2.0 Time required in yeaYrs...--..--++--++-2+serett tere 20,000.0 electron. According to this estimate it would take 3,000,000 per- sons no less than 20,000 years to count the electrons contained in the electric current of a 16 candle-power lamp, when the cost of the current amounted to one one-hundred-thousandth part of one cent (Howard). The concentration in which epinephrin is physiologically active-—The numerous and interesting experiments of Stewart and Rogoff (8) have furnished conclusive data concerning the concentration of epinephrin in the blood. They proved that “‘the range of epinephrin output per kilogram (body weight) per 722 VISUALIZING SCIENTIFIC DATA minute is surprisingly narrow, not only for animals of the same species, but of different groups. Cats, dogs, baboons, monkeys (M. rhesus), and rabbits were used in these experiments. The epinephrin output ‘‘worked out at 0.0002 mg. per kilogram per minute’’ (42). According to this estimate the total epinephrin output in twenty-four hours of the adult weighing 154 pounds (70 kg.) would not exceed 20.16 mg., that is, slightly less than \% grain. The test objects, by means of which Stewart and Rogoff secured demonstrable evidence in the form of tracings, were segments of the intestine or of the uterus of rabbits. The delicacy of the method (bio-assay) is shown by the fact that the intestinal and uterine segments ‘‘gave a distinet reaction with 1: 330,000,000 epinephrin in indifferent blood, a stronger reaction with 1: 160,000,000, and a marked effect with 1: 80,000,000’” (46). In other words, the tiny strips of animal tissue detected and recorded the presence of epinephrin even in a dilution of 1: 330,000,000 (one in three hundred thirty million). Bio-assay proved further that ‘“‘adrenalin in the concentration of a 1/500,- 000 molecular solution’’ is equal to ‘‘a normal concentration in adrenal vein blood’’ (44). It should be recalled in this connection that the blood of the adrenal vein contains the highest concentra- tion of epinephrin and that, after dilution of the blood of the adrenal vein in the total blood volume, the concentration in the peripheral cireulation will be even less than 1:500,000. That not- withstanding the almost inconceivably small amount of epine- phrin in the blood, ‘‘the steady, spontaneous discharge of epine- phrin is of sufficient magnitude to cause definite physiologic effects in the organism,’’ was shown in an experiment on a cat (45). The customary ‘‘vena cava pocket’? which Stewart and Rogoff employed in all of their experiments, was made by “tying off the lumbar and renal veins and all the small branches which enter the cava from the liver to the bifurcation of the iliaes; thus, a clamp adjusted just below the liver and one just above the iliaes completes a blind pouch into which only the adrenal veins are emptied. Blood collected in such a pocket is released by remov- ing the upper clamp (42). As the amount of blood which col- lects in the cava pocket is only ‘‘about 1 to at most 2 cc. the results obtained’’ could have nothing to do with any effect which the abstraction of such a small quantity of blood as was col- LUDEN 723 lected in the pocket could have had on the filling of the heart’’* (45). By way of preliminary experiment an injection of 1:500,000 epinephrin was made into the eat’s jugular vei: a marked cardiac arrythmia was immediately produced within a few seconds. One minute after the injection the cava pocket was elosed off, and after a latent period of six or seven seconds the cardiac irregularity completely disappeared. ‘‘During the two minutes for which the pocket was closed, no trace of irregularity could be discerned.’’ The pocket was then opened by releasing the upper clamp, the accumulated blood of the adrenal vein entered the circulation, and in seven or eight seconds the irregu- larity reappeared. During the experiment the cava pocket was opened and closed repeatedly at suitable intervals. At first, while the animal was still in good condition, the releasing of blood from the adrenal vein into the circulation produced arrythmia after a short latent period, whereas the closing of the pocket eaused re-establishment of the normal rythm. Towards the end of the experiment, however, when the heart had become weary and the muscle had begun to deteriorate, the reverse effect was obtained ; closing the pocket now produced arrythmia, which van- ished when the pent-up blood in the adrenal vein was released into the circulation. Stewart and Rogoff (45) point out that there is ‘‘nothing really puzzling’’ in these dissimilar results, as they merely resemble the effects produced ‘‘by flogging an ex- hausted and a fresh horse.’’ The experiment proves conclusively that the minute, spontaneously liberated amounts of epinephrin entering the circulation at the normal rate produce a demon- strable effect on the heart. The concentration of epinephrin in the blood in the adrenal vein, 1:500,000, may be visualized by diluting a small glass of whisky (10 ¢.¢.) with the combined eontent of two standard city sprinkling carts. A standard sprinkling eart holds 625 gallons of water. The lowest concen- tration in which epinephrin was detected by the intestinal or uterine segments in bio-assay, 1 :330,000,000, is comparable to the dilution of the same small amount of whisky in the combined eontent of 1320 sprinkling carts, that is in 826,000 gallons, or, *If the weight of the cat be taken at 2 kg., its total blood volume computed at 8 per cent of the body weight would be approximately 160 c¢.c. The temporary exclusion of 1 ¢.c. from the circulation would therefore be only the one hundred and sixtieth part of the total blood volume, or comparable roughly to the loss of 30 ¢.c. of blood by a man with a blood volume of 5000 e.c., a negligible quantity since often more than ten times that amount is withdrawn for a single transfusion, 724. VISUALIZING SCIENTIFIC DATA roughly, 13,000 ‘‘hogshead’’ of water. It might be mentioned, incidentally, that a procession of 1320 sprinkling carts would be about six miles long. The practical value of visualized scientific data lies not only in the stimulation of memory through the imagination, but also in the food for thought which they offer and in their bearing on great medical problems. If mental pictures of the billions and trillions of blood cells crowding, jostling, and possibly struggling for a share of the mere teaspoonful of sugar in the total blood volume of a full-sized man, or the endless procession of sprink- ling carts representing the epinephrin concentration to which animal tissues respond, appeal to one’s sense of humor, they also do much more than this. They bring home (1) the delicacy of the adjustment by which the human body mechanism is regu- lated; (2) the extent to which this fine adjustment may be dis- turbed by seemingly trivial factors; (3) the obligation of both laymen and physicians not to ignore the ‘slight’? tokens of dis- tress of the body engine; and (4) the value of comparing the quantities used in the body chemistry with the ‘‘dosage’’ im therapeutics. 1. Langfeldt has furnished evidence suggesting that the hydrogen ion concentration of the blood together with the pan- ereatic hormone play important parts in regulating the sugar concentration in the blood; Henderson, Haggard, and Coburn have devised means by which the post-operative depression result- ine from a decrease in the blood alkali may be combatted sue- cessfully : yet even in extreme “alkalinosis’’ the alkalinity of the blood is no greater than that of tap water. 2. Hamilton (15, 16), in her admirable survey of industrial diseases, has shown that minute amounts of lead and arseni¢ may produce severe clinical symptoms. The effects of prolonged in- halation of imperceptible quantities of carbon monoxid have been discussed by Wilmer, Harris, McGurn, Luden (31) and others. Haldane mentions that in his first series of experiments the in- halation of 0.06 per cent (6:10,000) of carbon monoxid ‘‘pro- duced no symptoms except shortness of breath on exertion’? in several hours: that the blood saturation did not exceed 28 per cent, and that no further absorption occurred up to five hours.”’ But he adds: ‘‘About a year later we tried a similar experiment and found that 0.06 per cent was far too much for us ;’’ and LUDEN 725 when the experiment was again repeated, later at Oxford, it was found that ‘‘even with 0.03 per cent the saturation gradually erept up during four or five hours to over 30 per cent.’’ Find- ings which show that the body did not handle one-half the con- centration of the ‘‘toxic’’ gas quite as successfully in the later experiment as it had handled the greater concentration in the first series of experiments, suggest hypersensitization as much as previous acclimatization ; they also tend to show that the oxygen deficit created by the inhalation of the ‘‘toxic’’ gas had been ‘‘registered’’ by the body as a whole, and had been resented. Ibe the body works with and animal tissues respond to ‘‘home prod- ucts,’’ such as iodin and epinephrin, in concentrations compar- able with 0.01 grain or to 10 c.c. diluted with the volume content of six miles of sprinkling carts, is it to be expected that the body cells should be entirely indifferent to far greater concentrations of a gas, the action of which is admittedly highly toxic, even though no immediate or grossly demonstrable changes may be produced? The investigations of Green show that the cancer incidence is influenced by the amount of combustion products in chimney smoke. The increase of cancer throughout the world has been proved by Hoffman’s (21, 22) statistics; that such an increase exists is now generally admitted. May not the carbon monoxid content of combustion products be a factor, though not the only one, promoting the admitted inerease of cancer by furthering the chemical disbalance which un- derlies malignant proliferation (ILuden, 30). This idea may not prove to be as far-fetched as it may at first appear, for the work of Teague has proved that the exhaust gas of a smoothly running automobile contains 4 per cent of carbon monoxid and that of a truck with ‘‘racing’’ engine as much as 9 per cent; the numerous and recent investigations of Henderson, Haggard, Teague, Prince and Wunderlich have demonstrated that the air near the taxi-stand of the New York Grand Central station con- tains, under ordinary circumstances, a considerable amount of exhaust gas. Henderson says in this connection, ‘“It appears from these data that the air is occasionally vitiated for a time with as much as two parts of carbon monoxid in 10,000, but that with the ventilation provided by large fans the concentration soon falls again decidedly below one part in 10,000.’? But what about the concentrations in narrow streets lined by sky-serapers, 726 VISUALIZING SCIENTIFIC DATA on windless days and in the absence of large fans? Are the severe headache lasting for from five to seventy-two hours, the dizziness. nausea and faintness, or weakness, which inhalation of from six to nine parts of carbon monoxid in 10,000 during one hour produced in Henderson’s heroic volunteers, entirely ‘‘for- given and forgotten’’ by the organism as a whole, after the symp- toms themselves have passed off? The statistics of the Auto- motor Industries show that the number of motor-driven vehicles in America alone increased from 1,000,000 to close to 9,000,000 between 1912 and 1920* (41). 8 Mackenzie, in ‘‘The Future of Medicine,’’ urges that the consideration which small details deserve should be given them in clinical observation, in order to insure ‘‘the recognition of the diseased state before it has produced gross structural changes and of the condition that predisposed to, or indeed induced the dis- ease.’? Cushing (51) has recently repeated this warning and suggested that ‘‘we are prone to lose sight of the patient as a whole.’”’? In an automobile the faint ‘‘knock’’ indicating lack of water or of oil receives prompt attention. The delicate human engine should deserve as much consideration. If this were borne in mind the number of ‘‘hopeless’’ eases that physicians encoun- ter would be diminished greatly. 4. In modern therapeutics, fortunately, the ‘“horse-power’’ dosage of fifty years ago has been discredited. The era of mod- ern medicine is characterized by a growing interest in the activi- ties of the glands of internal secretion. Organotherapy still re- sents innumerable problems, but it ean also point to unquestion- able victories (Kendall, 24, Timme, 48, 49, 50). It is in connee- tion with this new type of therapy, with the preparations of the pharmacopeia and with the great problems of medicine that the diminutive size of the body cells and the infinitesimal quantities with which the body works, and to which organs and tissues respond, are well worth remembering. SUMMARY 1. Established scientifie data may be visualized, that is, transformed, into vivid mental pictures by comparison with familiar conceptions, weights and measures. *These figures are based on “the revised total registrations after careful checking with the final records of the various secretaries of state.” LUDEN 727 2. Visualized data stimulate memory by appealing to the imagination. Visualized data concerning the size of the body cells, the number of erythrocytes and leukocytes in the total blood volume, the hydrogen-ion concentration in the blood, the size of electrons, and the concentrations in which epinephrin is physio- logically active, are presented in this paper. 3. The practical value of visualized data lies chiefly in the food for thought which they offer in connection with great medi- eal problems. Illustrations are given showing the bearing of visualized data on the cancer problem and on other subjects of medical interest. BIBLIOGRAPHY Ashby, Winifred: Some data on the range of life of transfused blood corpuscles in persons without idiopathic blood diseases. Med. Clin. N. Am. (Phila.), 1919, 3, 783-799. Ashby, Winifred: The determination of the length of life of trans- fused blood corpuscles in man. J. Exper. M. (Balt.), 1919, 29, 267-281. Bastedo, W. A.: Materia medica; pharmacology; therapeutics pre- scription writing for students and practitioners. Philadelphia, Saunders, 1915, 602 p. Benedict, S. R.: A modification of the Lewis-Benedict method for the determination of sugar in the blood. J. Biol. Chem. (Balt.), 1918, 34, 203-207. Bethea, O. W.: Practical materia medica and prescription writing. 2 ed., Philadelphia, F. A. Davis Company, 1917, 562 p. Bloor, W. R.: The determination of cholesterol in blood. J. Biol. Chem. (Balt.), 1916, 24, 227-231. Chauffard, A., Laroche, G., and Grigaut, A.: [The cholesterin cycle]. Ann. de méd. (Par.), 1920, 8, 149: Abstr.: J. Am. M. ASSs., 1921, 76, 273. Collected papers from the H. kK. Cushing Laboratory of Experimental Medicine, 1918-1920, Vol. 6. Cushing, H.: Disorders of the pituitary gland. J. Am. M. Ass. (Chicago), 1921, 76, 1721-1726. Folin, O., and Wu, H.: A system of blood analysis. J. Biol. Chem. (Balt.), 1919 38, 81-110. Green, C. E.: The cancer problem. London, W. Green and Sons, 1914, 98 p. Grigaut, A.: [Colorimetric determination of cholesterol in the organ- ism]. Compt. rend. Soc. de Biol. (Par.), 1916, 68, 827-829; Chem. Abstr., 1910, 4, 2514. Grigaut, A.: [Colorimetric procedure for the estimation of choles- terol in the organism]. Compt. rend. Soc. de Biol. (Par.), 1916, 68, 791-793; Chem. Abstr., 1910, 4, 2513. Haldane: Quoted by Henderson, Haggard, Teague, Prince and Wunderlich. Hamilton, Alice: Women in the lead industries. Med. Woman's J., 1921, 28, 1-7. Hamilton, Alice: A discussion of the etiology of so-called aniline tumors of the bladder. J. Indust. Hyg. (Cambridge), 1921, 3, 16-28 Harris, L. I.: Clinical types of occupational diseases; study of mnetboes for their prevention. J. Am. M. Ass. (Chicago), 1919, 73, 0- - Hawk, P. B.:__ Practical physiological chemistry. Philadelphia, Blakiston’s, 1919, 661 p. Henderson, Y., Haggard, H., and Coburn, R. C.: The acapnia theory, now. J. Am. M. Ass. (Chicago), 1921, 77, 424-426. Henderson, Y., Haggard, H. W., Teague, M. C., Prince, A. L., and Wunderlich, R. M.: Physiological effects of automobile exhaust gas and standards of ventilation for brief exposures. J. Indust. Hyg. (Cambridge), 1921, 3, 79-92, 137-146. Hoffman, F. L.: The mortality from cancer throughout the world. Newark, Prudential Press, 1915, 826 p. Hoffman, F. L.: Some new aspects of the problem of cancer control. Minnesota Med. (St. Paul), 1921, 4, 124-132. Howard, R.: Counting electrons. Scient. Am., 1921, 124, 465. VISUALIZING SCIENTIFIC DATA ‘ Kendall, E. C.: The active constituent of the thyroid; its isolation, chemical nature, and physiologic action. Coll. Papers of the Mayo Clinic, Philadelphia, Saunders, 1916, 8, 513-527. Kendall, E. C.: Determination of iodine in connection with studies in thyroid activity. J. Biol. Chem. (Balt.), 1920, 43, 149-159. Kendall, E. C., and Richardson, F. S.: Determination of iodine in blood and in animal tissues. J. Biol. Chem. (Balt.), 1920, 43, 161-170. Langfeldt, E.: The regulation of the blood sugar content. J. Am. M. Ass. (Chicago), 1921, 77, 466. Luden, Georgine: Studies on Cholesterol. III. The influence of the bile derivatives in Bloor’s cholesterol determination. J. Biol. Chem. (Balt.), 1917, 29, 463-475. Luden, Georgine: Study V. The blood cholesterol in malignant dis- ease and the effect of radium on blood cholesterol. J. Lab. & Clin. M. (St. Louis), 1918, 4, 849-864. Luden, Georgine: Study VI. The value of blood cholesterol deter- minations and their place in cancer research. J. Lab. & Clin. M. (St. Louis), 1919, 4, 719-735. Luden, Georgine: Chronic carbon monoxid poisoning—its immediate and subsequent manifestations. Modern Med. (Chicago), 1921, 3, 102-106; 167-170. MacCallum, W. G.: A text-book of pathology. Philadelphia, Saun- ders, 1919, 1049 p. McGurn, W. J.: Chronic gas poisoning—a brief but comprehensive es on fourteen cases. Interstate M. J. (St. Louis), 1917, 24, 497-487. Mackenzie, J.: The future of medicine. London, Frowde, Hodder and Stoughton, 1919, 238 p. McLean, F. C., and Van Slyke, D. D.: A method for the determina— tion of chlorides in small amounts of body fluids. J. Biol. Chem. (Balt.), 1915, 21, 361-370. Menten, Maud L.: The alkalinity of the blood in malignaney and other pathological conditions; together with observations on the relation of the alkalinity of the blood to barometric pressure. J. Cancer Res. (Balt.), 1917, 2, 179-211. Millikan: Quoted by Howard. Nichols, J. B., and Vale, F. Pp.: In: Gallandet, B. B.: Histology and pathology, Philadelphia, Lea Bros., 1899, 458 p. Plummer, H. S.: Interrelationship of function of the thyroid gland. J. Am. M. Ass. (Chicago), 77, 243-247; 475. Powell, W. H.: Saunder’s pocket medical formulary. 9 ed., Phila- delphia, Saunders, 1914, 261 p. Revised registration figures show trend of sales. Automotive Ind... 1921, 44, 301-308. Rogoff, J. M.: On the liberation of epinephrin from the adrenal glands. J. Lab. & Clin. M. (St. Louis), 1918, 3, 209-219. Rowntree, L. G.: Personal communication. Stewart, G. N.:_ A note on some obvious consequences of the high rate of blood flow through the adrenals, Am. J. Physiol. (Balt.), 1918, 45, 92-95. Stewart, G. N., and Rogoff, J. M.: Demonstration that the spon- taneously liberated epinephrin can exert an action upon the heart. J. Pharmacol. & Exper. Therap. (Balt.), 1919, 13, 397-406. Stewart, G. N., and Rogoff, J. M.: Further observations showing that epinephrin from the adrenals is not indispensable. Am, J. Physiol. (Balt.), 1919, 48, 397-410. Teague, M. C.: The determination of carbon monoxide in air con- ace with motor exhaust. J. Indust. & Eng. Chem., 1920, 12, Timme, W.: A case of pluriglandular disturbance; organotherapy, cure. Arch. Pediat. 1917, 34, 901-909. Timme, W.: Dyspituitarism with limitation of the visual fields; symptoms disappearing under the use of internal glandular therapy, with a return of the visual fields to normal. Arch. Ophthal. (New York), 1917, 46, 151-153. Timme, W.: A new pluriglandular compensatory syndrome. Endoc- rinology (Los Angeles), 1918, 2, 209-240. Wilmer, W. H.: Effects of carbon monoxid upon the eye. Am. J. Ophthal. (Chicago), 1921, 4, 73-90. SOME NOVEL EFFECTS PRODUCED BY STIMULATING THE NERVES OF THE LIVER W. B. CANNON, J. E. URIDIL and F. R. GRIFFITH After removal of the adrenal glands, splanchnic stimulation will cause a faster beat of the denervated heart. Since this occurs when the inferior cava and the portal vein are closed below the liver, and since it does not occur when the hepatic nerves are cut, the inference is drawn that some agent arising in the liver is the occasion of the faster beat. Stimulation of the hepatic nerves will cause an increased rate of the denervated heart, an effect appearing later than the similar adrenin effect and lasting for a longer time. Stimulation of the hepatie nerves will cause a rise of blood pressure. The following evidence is adduced to show that this is not the consequence of a retarded blood flow through the liver. It does not occur on closure of the hepatic artery and vein; it occurs on hepatic stimulation though all abdominal viscera have been removed except the liver, and, unlike stimula- tion of splanchnic blood vessels alone, it long outlasts the period of stimulation. Asphyxia is very promptly depressive in its influence on the effectiveness of hepatic stimulation. The increments of heart rate vary widely. They are slight, if the animal has been fasting, or is in poor condition; they are much greater if the animal is digesting meat. These differences “ean aecount for the discrepancies in Cannon’s and Stewart and Rogoft’s results of splanchnic and reflex stimulation after adrenal ablation. The inference is drawn that a substance is given off by the liver into the blood stream which, carried to the denerv- ated heart, raises its rate. None of the known or supposed products of hepatic activity —glucose, urea, catalase—when injected into the blood stream have the effects produced by exciting the hepatic nerves. Watery extracts of the liver are ineffective. Liver extracted by boiling acid and nearly neutralized augments the heart rate, but so do extracts of other organs. 729 730 STIMULATION OF HEPATIC NERVES The efficiency of hepatic stimulation in causing a faster heart rate, when meat is being digested, is not seen if an animal is digesting carbohydrate, or fat, or has been fed for several days on either of these foodstuffs. On the other hand, stimulation is more effective after amino acids have been injected into the intestines. The tentative conclusion is drawn that the effects noted are probably not due to a true internal secretion produced by the liver, but to a discharge from its cells of amino acids, or amines, which are sympatho-mimetie in character. THE NEW VIEWS. AS TO THE MORPHOLOGY OF THE THYMUS GLAND AND THEIR BEARING ON THE PROBLEM OF THE FUNCTION OF THE THYMUS By J. Auc. HAMMAR UPSALA (This paper was begun in the September, 1921, issue.) 4. \ CLEAR DISTINCTION MUST BE MADE BETWEEN THYMUS ASTHMA DUE TO THE EFFECT OF PRESSURE AND DEATH CAUSED BY THIS AND SO-CALLED ‘“THYMUS DEATH’’: THERE IS NOTHING TO INDICATE THAT ‘THYMUS DHATH’’ IS PRIMARILY DUE TO AN AB- NORMAL CONDITION OF THE THYMUS. Before proceeding to put forward a view of the functional conditions of the organ, based on the facts given here, IT must touch a little upon the question of the so-called *‘thymus death,’’ as it is obvious that if there are cases in which changes in the thymus are direetly harmful to the organism, even, as has been stated with regard to ‘‘thymus death,’’ causing apoplectiform death, not only can such cases not be disregarded in judging of the function of the organ, but they might almost be expected to be more fitted than others to afford information about this. A perusal of the exceedingly abundant literature dealing with cases coming within this field soon shows that these cases, far from always present the same clinical features, and, as re- gards the cases that are best observed and described, there is little difficulty in referring them to two distinct groups: cases with thymus asthma and cases without the symptoms char- acteristic of this. Thymus asthma is characterized, above all, in most cases by attacks of inspiratory dyspnoea, inspiratory stridor and the so-called Rehn’s symptom, the expiratory swelling of a tumour —the cranial thymus end—in the jugulum. In an attack of this kind, possibly even in the first, death may occur, under the form of so-called suffocation death. It seems to be proved quite conclusively that in certain eases of this kind it really is the thymus that has produced the fatal symptoms by pressure on the air-passages. Not only has thymectomy led to a recovery in certain cases; in others it seems 731 732 MORPHOLOGY OF THYMUS to have been sufficient merely to carry out ectopexy, to sew the organ forward and fix it in the jugulum. In some eases it has been possible to observe at the operation itself that merely by pulling the thymus forward towards the jugulum the breath- ing was made easy, while the symptoms of stenosis appeared once more when the organ was allowed to take up its original position (Purrucker 1899, Rehn 1906, Ollivier 1911, Schu- macher 1913). That under such circumstances the obstruction cannot have been situated in the upper thoracic aperture, as has been generally assumed, but farther down, az the tracheal bifurcation or probably still more frequently at the very root of the lung, and that a continuance or a reappearance of the broad shape of the thymus that occurs towards the end of foetal life plays a part in this, are special matters which I have tried to explain in a special paper (1915 :2), with reference to the topographical conditions of the thymus. But it is by no means in every case that deatn oceurs in immediate connection with difficulties in respiration. Death has frequently occurred quite suddenly and unexpectedly in an apo- plectiform manner. Pott (1892) gives a graphic deseription based upon the observation of no less than four eases that oc- eurred before his eyes. Owing, on the one hand, to the im- portance of the matter, and on the other to the circumstance that these deaths happen mostly unobserved during sleep and seldom under the notice of the physician, I think I ought to give an extract of this account of Pott’s. He says: “Die Erscheinungen, unter denen der Tod erfolgte, waren stets die gleichen. Plétzlich biegen die Kinder den Kopf nach hinten zuriick, machen eine lautlose, nach Luft schnappende Inspirations- bewegung, verdrehen die Augen nach oben, die Pupillen erweitern sich. Das Gesicht, namentlich die Lippen, werden blitzblau und schwellen an. Die Zung2 zeigt sich zwischen die Kiefer eingeklemmt, schwillt um das Doppelte im Dickendurchmesser an, ist ebenfalls stark cyanotisch, etwas nach oben umgerollt und fest an den harten Gaumen angepresst. Dic Halsvenen, stark geschwellt vnd prall ge- fiillt, treten als dicke Strange deutlich hervor. Die Hinde werden mit eingeschlagenen Daumen zur Faust geballt, die Finger cyanotisch. Der Unterarm steht in krampfhafter Pronations—und Adductions- stellung. Die unteren Extremitaten sind gestreckt, die grosse Zehe etwas abducirt und dorsal flectirt. Die Wirbelsiiule wird in Bogen stark nach hinten gekriimmt. Einige blitzartige Zuckungen der Ge- sichtsmuskeln und einige vergebliche schnappende Inspirationsbe- wegungen erfolgen, aber kein Laut, kein zischendes Eindringen von Luft dvrch die Stimmritze wird geh®rt. Auf einmal lést sich der Krampf, das Gesicht verfarbt, sich, wird aschgrau, die Cyanose lasst nach. die Zunge und die Lippen werden livide, und nach héchstens 12 Minuten ist das Kind eine Leiche.” i 4 mal 2% * aie SEE BD 6 OOS Oe HAMMAR 733 “Urin und Faces gingen jedesmal bei den ersten kiinstlichen Atembewegungen unwillkirlich ab. Die Herztitigkeit hérte mit Ein- tritt des Anfalles sofort auf. Herzténe sind nicht mehr zu héren, ebensowenig ist ein Puls fiihlbar. Die Refl=xerregbarkeit ist ganzlich erloschen. Auf das Einfiihren des Fingers in den Mund und auf die Bertthrung des Kehldeckels, resp. der Stimmbiinder, welche ich in Medianstellung, fest aneinanderliegend, gefiihlt zu hiben glaube, erfolgen weder Wtirgbewegungen noch Hustenreiz. Ebenso bleibt der Lidschluss bei Beriihrung der Cornea aus. . . - Meine Ueber- zeugung nach wird der Tod durch einen plozlichen Stillstand des Her- zens bedingt.” I think that anyone who reads Potts’s account must agree with his conclusion that in these cases it was not a question of death from suffocation, but death from heart failure. This fact, that two quite different syndrumes, cases of death from suffocation and death from heart failure, have been grouped under the heading ‘““thymus death,’’ was clearly pointed out by Ganghofer in 1902. Christeller (1919) has also recently assumed both a thymus death due to autointoxication ‘‘hyperthy- misation’’ and one produced mechanically. As a rule this has not been sufficiently taken into consideration. It is obvious, how- ever, that this is what lies behind and explains the long pre- vailing difference of opinion as to the cause of ‘‘thymus death,”’ whether it is to be considered as due to mechanical causes or constitutional or endocrine factors [lymphatism (Paltauf), hy- perthymisation (Svehla) ]. It is also obvious that the former of these syndromes, whieh might be called death in and through thymus asthma and in which the part played by the thymus is, of course, apparently a purely mechanical one, cannot be expected to afford any real information as to the function of the thymus. It is only deaths of the second kind that can be taken into consideration in deal- ing with this question. The proof that in deaths of the latter type the thymus has really been the cause of death has been chiefly sought in the fact that in autopsies of such cases an abnormally large thymus has been found, while in other respects the post-mortem finding has been negative. In many cases, however, the presence of a capillary bronchitis has also been verified, in addition to the large thymus, and in such eases it has certainly depended to some ex- tent on the subjective view of the pathologist whether the one or the other part of the findings has been registered as the cause of death. 734 MORPHOLOGY OF THYMUS In two papers (1915-1, 1917) I have reported the results of a microscopic analysis of a total of 37 cases of sudden death from internal causes in children, the majority of which cases ean with good reason be considered to belong to the category referred to here. Comparisons made with thymi of equal age from children who had died from accidents while in good health showed that the organ exceeded the normal limits with regard to size in only four eases, and with regard to the amount of parenchyma in only five. A comparison with the cases—un- fortunately not very numerous—in which the weight of the or- gan is mentioned in the literature shows that it, too, was as a rule normal. The idea of an abnormally large thymus in these cases of death is obviously due to a great extent to insufticient knowledge of the normal conditions of size in the organ and a misleading comparison between those glands that have not, as a rule, undergone accidental involution and those that have undergone such involution and are usually found post-morten after a preceding illness. The structure, the amount of cortex, medulla and inter- stitial tissue, respectively, the index and the relative and ab- solute amount of the Hassall’s corpuscles were all as a rule within normal limits also. In six cases, however, the absolute number of Hassall’s corpuscles was subnormal, in relatively many—15—it was below the average without being subnor- mal. In two eases small Hassall’s corpuscles (10 to 25 uw) were entirely absent, in two others their number was subnormal. It is quite evident that an anatomical finding of this sort does not afford any support at all for the view that in these cases of death the primary cause of death was to be sought for in the thymus. Nor was the above-mentioned depression of the number of Hassall’s corpuscles so regular that any certain conclusions could be based on it, as there were in the material three cases with a supranormal number of these corpuscles with- out any apparent cause. It is, however, conceivable, with the really negative characteristics that distinguish these sudden deaths. that in the three cases mentioned there was present an- other cause of death than in the rest—a latent infection or something similar. But even if, excluding such cases, one were to consider it possible to say that the deaths in question were characterized by a decrease in the number of the Hassall’s eor- HAMMAR : 735 puscles, the fact remains that it is only in exceptional cases that this decrease exceeds the normal limits. If, nevertheless, I consider that we cannot quite exclude the possibility that in “thymus death’’ there is present in the organism a state of increased vulnerability, which is reflected in the thymus by a less than average number of Hassall’s cor- puscles, it is because I have also observed a reduced re-forma- tion of Hassall’s corpuscles in some cases of sudden death in elderly people, among them two in which the diagnosis was “naralysis of the heart.?? In order to prevent any misunder- standing I must state emphatically here that the reduction in the number of Hassall’s corpuscles cannot in either case be reasonably supposed to be the cause of death, but only an ex- pression of a state produced by other parts of the organism, possibly by other endocrine organs. It is useless at present to discuss the nature of sueh factors as counteract the formation of Hassall’s corpuscles im these eases, of the ‘‘cH-depressory factors’’; our knowledge on this point is still too incomplete. When we consider, however, the well-known fact that it is especially well-nourished children that are subject to these deaths, it is, at any rate, not the most common factor of this sort that is present, the one that is oper- ative in starvation, ete. I shall only mention here in passing that even in some other cases the possibility of a cH-depression must be considered. Thus a comparison between the thymus in cases of suicide and in other cases of persons of equal age who have died from ex- ternal causes (Hammar 1917:3) shows the possibility that in the majority of suicides there are less than the average number of these corpuscles present. Similarly the analysis of the thy- mus in some cases of epilepsy and eclampsia has given ground for the suspicion that in these forms of disease a cH-depression is present. Both these series of observations, however, need to be supported by a far greater material before they can be considered to constitute proofs. The same is true of the above- mentioned cH-depression in pregnancy. 5. THE FUNCTION OF THE THYMUS; DIFFERENT CH- AND LC- EXCITATORY AND -DEPRESSOR FACTORS RESPECTIVELY; ANTAGO- NISTIC FACTORS OF BOTH KINDS CONTINUALLY OPERATIVE; THE LC- EXCITATORY AND LC-DEPRESSOR AFFECT THE NUMBER OF ALL THE 736 MORPHOLOGY OF THYMUS LYMPHOCYTES IN THE ORGANISM, THE THYMUS ONLY INDIRECTLY ; THE CH-EXCITATORY FACTORS ARE OF A TOXIC NATURE; THE AC- TIVITY OF THE THYMUS IS ANTI-TOXIC. When we have to try to work out a view as to the function of the thymus on the basis of the morphological and experi- mental data present, it is worth while first to mention the fact that in the case of the thymus we have no morphological obser- vation that could justify the idea that the thymus carries out any secretory activity in the real meaning of this term. The thick, milky juice that often runs out when a volum-. inous thymus gland, normal or pathological, is cut through in its fresh conditions, has not infrequently, not only in older works but even of late, been called a thymus secretion. The microscopical examination of the livuid that has teus run out shows, however, that it consists chiefly of lymphocytes in large numbers, a fact which has been known for a very long time. And if corresponding places in the fixed organ are investigated in sections, one finds that the lymphoeytes are collected in certain, generally rather circumscribed, regions of the medulla, as a rule corresponding to the central parenchymatous cord. It will be seen that in doing this they have dispersed and broken asunder the ordinary medullary elements. The significance of these local surpluses of lymphoeytes in the medulla and what has produced them is an unsolved problem. They do not seem to be purely post-mortal phenomena—due to post-mortal autolytie changes. One thing, however, is certain: they cannot be considered as products of any real secretory process in the organ. Nor can any signs of a secretory function in the Hassall’s- corpuscles be proved, contrary to the statements of some in- vestigators (Livini, Mensi, Magni, Dustin, ete.). The prod- ucts that arise in connection with the degeneration of the cen- tral cells in the somewhat larger corpuscles vary in nature, being sometimes horny, sometimes hyaline products of an in- determinable nature; no signs are to be found of these degen- erative substances being transferred into the blood. And it is furthermore, not to be forgotten that in by far the greater number of corpuscles, namely those that never attain great dimensions, these degeneration products are quite absent. In the lower vertebrates, in which, as a rule, there are no typical Hassall’s corpuscles, there is certainly an analogous local hy- “g q . t 4 HAMMAR 737 pertrophy of cells in the medulla, but very seldom anything corresponding to the degenerative processes in the larger Has- sall’s corpuscles. And it is obviously the former factor, the hypertrophy of certain groups of medullary cells, and not the degeneration, that is the constant and functionally important one in the case of the Hassall’s corpuscles. The negative attitude that already in 1910 I considered I must adopt with regard to the statement that there is a real secretory process in the thymus has only been more and more justified during the years that have since elapsed. E. R. Hos- kins (1918) has recently taken up a similar position in a paper in this periodical. Dustin (1920) has also recently expressed the opinion that the thymus does not function by means of secretion and that in this respect the organ occupies a special position compared with other glands with internal secretion. As, how- ever, he considers that the function of the organ is characterized ‘pyar fixation ou déstruction de matiére sous forme d’éléments figurés’’ and he points to the small thymus cells as the medium for this function, it seems to me open to question whether this function is carried on by the thymus to any very much greater extent than by various other organs of the body. In searching for functional changes in the thymus there are chiefly two facts that attract special attention: the varla- tions in the number of lymphocytes in the parenchyma, espe- cially the cortex, and the variations in the number of the Hassall’s corpuscles. With the variations in the number of the lymphocytes are connected, as IT have previously shown, changes in the reticulum cells (fat granulation of varied char- acter, mitotic and reductive processes), so that both the pri- mary parenchymous components may in this way be consid- ered to take part in these variations. The changes in the retic- ulum cells are, however, not at all so striking as those in the number of the lymphocytes. The significance of the changes in the fat-granulation or the successive reduction of the reticulum cells that takes place in involution is not well enough known for these phenomena to be discussed at present. I limit myself accordingly to pointing out how these changes in the reticulum take place as a rule at the same time as those in the number of the lymphocytes. ioe! | oo MORPHOLOGY OF THYMUS The variations, both in the number of the Hassall’s cor- puscles and in the amount of the cortex, may be considerable. Only in exceptional cases, however, is their occurrence parallel ; as a rule they appear independently of each other, a fact that scarcely fits in with the assumption of common causative fac- tors. On the contrary, everything supports the idea that one has to take into account independent excitatory and depressor factors in the case of each category of these structure elements. Thus in hyperplasia in Graves’ disease both cH-excitatory and le-excitatory factors exert their influence, but in a mutual re- lation that varies considerably from one case to another, so that sometimes the one, sometimes the other influence sets its special stamp on the case. In the earlier stages of infection in- volution, on the other hand, cH-excitatory factors are apparent at the same time as le-depressor. In acute infectious illnesses like poliomyelitis anterior acuta, which may cause rapid death before the general nutrition has suffered any reduction to speak of, cases may occur in which, under the conditions men- tioned, only the cH-exeitatory factor is perceptible, but the em- igration of the lymphocytes has not yet assumed greater pro- portions than normal. In advanced eases of infection in- volution, on the other hand, with a specially marked involve- ment of the general condition the cH-excitation is gradually sueceeded by a cH-depression. Thus we have so far conditions that agree with those prevailing in inanition involution, 1. e., both cH-depression and le-depression. Finally, in certain cases of sudden death it seems as if we may assume a cH-depression, either alone or connected with a le-excitation. The independence of the cH-excitatory and the le-excita- tory and the corresponding depressor factors which is empha- sized here has been illustrated in an interesting way by the comparison between the structure of the thymus in mother and foetus in certain cases of illness in pregnant women. One ex- ample may be mentioned. In a case of pregnancy in a woman with Graves’ disease the size of the organ in the foetus was at the upper limit of what is normal for the age; the number of Hassall’s corpuscles, on the other hand, was at the lower limit. The le-excitatory factor characteristic of Graves’ disease seems here to have shown its influence even on the foetus, but not the cH-excitatory one. HAMMAR 739 Tt has already been pointed out above how the mention of an excitation or depression affecting the Hassall’s corpuscles or the lymphocytes, respectively, must not be taken to mean that in the concrete case factors exclusively of a certaim sort, excitatory or depressor, are in activity against this component of the structure. Thus lIc-depressor factors injurious to the general nutrition are connected with the majority of illnesses. Tf, nevertheless, in certain cases, as In most cases of Graves’ dis- ease, these factors do not make themselves perceptible, this is certainly due to the fact that antagonistic factors of superior potency then affect the organ. Tf these are weakened, le-depres- sory influences become visible even in the hyperplastic organ, i. e., an accidental involution is brought about. It is only from the point of view of an interchange of potentialities of this sort that we can explain the individual variations of a quantitative nature that occur from one case to another, even where, judg- ing from external evidence, we may suppose quite similar con- ditions with respect to age, state of nutrition, ete., to be present. What is the present state of our knowledge as to these excita- tory and depressor factors? Tn the case of the Hassall’s corpuscles the question is easiest to answer as regards the excitatory factors. An increase in the number of the small Hassall’s corpuscles has been shown be- yond all doubt in Graves’ disease, in the great number of acute infections of various sorts that have been subjected to inyesti- gation, and in the above-mentioned ease of death from snake- bite. A common characteristic of all these cases of disease is that in all of them a toxic factor is operative in the organism ; in the case of bacterial and snake poison it is well known that this toxie factor causes the formation of an antitoxin, in the ease of thyroid poison it may possibly do so. On the other hand, it has been impossible to establish any abnormal cH-exci- tation in investigated cases of poisoning by lye, hydrochloric acid, phosphorus, carbon monoxide and other substances that do not cause the formation of antitoxin, and this is true even when the intoxication has taken a somewhat protracted course. As cH-depressor factors we have in the first place inanition and other comparable conditions that disturb the nutrition. Such influences appear so commonly in disease that one may say that there are comparatively few cases in which an illness of 740 MORPHOLOGY OF THYMUS Jong duration does not, at least in its final stages, cause an abatement or a stoppage in the new formation of Hassall’s cor- puscles, and this is also the case when the earlier stages of in- yolution are characterized, as in acute infections, by a supra- normal formation of such corpuscles. It is obvious that a eH- depression of this sort may be the result of a reduction in the power of reaction of the reticulum cells against cH-excitatory factors. Below, I shall discuss how in certain cases this re- duction may possibly be supposed to be caused directly or in- directly by the rarefication of the lymphocytes in the organ. It is not probable, however, that this method of explanation ean be used in all cases. If it turns out to be correct that a cH- depression can appear even in cases where the number of lym- phocytes in the organ is normal (as in certain eases of suicide or sudden death), or even where there is hyperplasia of the thymus, then the reduction in the reaction of the thymus reti- eulum must be considered to be caused, most probably, by other factors (changes in other endocrine organs?) or else it must be presumed that a weakening of the cH-excitatory factors them- selves has taken place. The most common of the factors that reduce the number of lymphocytes in the organ—the amount of eortex—are also dis- turbances in the general metabolism. In certain illnesses, how- ever, such as Spanish influenza, one often finds a very marked involution of the thymus even in cases in which the fat and the musculature still seem to be normal or very slightly reduced. In these cases the question arises whether special le-depressor factors have not exerted an influence by the side of the disturb- ances in the general nutrition. But these phenomena are too little known to be discussed here. Apart from these exceptions, which are in any case relatively rare, it is true of the le-depres- sion in general, as has already been mentioned, that there is no question at all here of conditions, special in principle, for the thymus, but of conditions that occur at the same time in the genuine lymphoid tissue and are also reflected in the number of lymphocytes contained in the blood. As has previously been indicated, the same may be said to be also true in the case of the more chronically operative le-depression that begins with puberty, principally under the influence of the sexual glands. ee ae ee ee Lh Ce HAMMAR 741 This, too, has its correspondence in the real lymphoid tissue and in the blood. A similar parallelism, but in the direction of a le-excitation, is perceptible in Graves’ disease, as we have already seen. The hyperplasia of the thymus in this illness, which is chiefly a hy- perplasia of the cortex, is often associated with hyperplasia in the real lymphoid tissue and with lymphocytosis. The question as to whether the same thing is true in castration seems at pres- ent to have been scarcely sufficiently investigated. As far as the present deficient state of our knowledge per- mits us to judge, the lymphocytes thus seem in their conditions in the thymus to obey the same rules as usually regulate the total lymphocyte constituent in the organism. And therefore, it seems as if their variations in the thymus, no matter how great and striking, ought seareely to be taken as direct expres- sions of the function of the organ. This does not at all mean that this function is independent of the lymphocytes of the organ, but I shall return to this question below. Nor can the parallelism between the conditions of the lym- phocytes in the thymus and in the organism in general lead to the idea that the thymus can, without reserve, be subordinated functionally to the lymphoid tissue. On the contrary, all the attempts made by v. Braunschweig (1891), Petrone (1904), Rud- berg (1909) and Holmstrom* to produce in various ways an increased mitotie reaction in the thymus lymphoeytes corre- sponding to that which takes place in the lymph glands show a negative result. Nor, as far as we can judge, is the regenerative activity of the thymus parenchyma increased in diseases of the blood. Basch (1906) looked in vain for a compensatory hyper- trophy of the lymph glands in his thymectomized animals. The attempt made by v. Hansemann (1905) to explain the thymus as a regional lymph gland to the thyroid has not been con- firmed, either. It is also very frequently found that the changes in the lymphocytes in the thymus, especially in accidental in- volution, are more far-reaching and occur more promptly than the corresponding processes in the real lymphoid tissue. And finally, as Hellman’s investigations (1904) clearly showed, one has constantly to take into account differences of a purely local nature in the real lymphoid tissue, differences which appar- ently have no parallel in the thymus. 742 MORPHOLOGY OF THYMUS All these facts thus contain as many confirmations, from the point of view of the function, of the fact, well substantiated by the peculiar development and structure of the organ, that the thymus is not or does not consist of lymphoid tissue. But they do not alter the fact that the essential variations of the lympho- eytes in the thymus are by no means anything special for the thymus, but obey laws that are applicable to the lymphoeytie economy as a whole in the organism. In spite of the far-reaching influence, morphological and functional, that both age involution and accidental involution undoubtedly have on the thymus, the question as to the signifi- cance of these variations is thus by no means a special thymus problem, but one that in a certain sense has a far wider scope. It passes into the problem of the importance of the lymphoeytes to the organism in general, and a decisive answer to it has cer- tainly not been given. But I wish, in passing, to mention the significance that, according to the investigations of Poulain (1902), Bergel (1909), Stheemann (1910), and others, may possibly be assigned to these cells in regard to the fat meta- bolism in the body. Tf the view I have arrived at is correct, the two groups of functional changes that occur in the thymus parenchyma and leave their mark on it during different phases of the existence of the organ, namely, the changes in the number of THassall’s cor- puscles and of lymphoeytes, thus have a rather different signifi- cance with regard to the thymus function, and it is of prior importance to pay attention to the former kind of change in trying to explain this function. From what has already been said with regard to the fune- tional variations in the number of the Hassall’s corpuscles, the conclusion may be drawn that the enlargement of cells or cell groups in the thymus reticulum which causes the formation of such corpuscles may be brought about by certain toxie sub- stances that are produced by the organism itself or have entered into it. As these substances, as far as they are known, are of such a nature that they bring about the formation of antibodies, while toxic substances of other sorts have no effect in this diree- tion, it is tempting to assume that this enlargement of cells is connected with an antitoxie activity in the cells concerned ; this, of course, does not necessarily mean that these cells produce just HAMMAR 743 the antitoxie substantes that have been proved serologically to exist in eases of this sort. The cell degeneration oceurring 1 the Hassall’s corpuscles, especially in the central cells, which are affected first and probably most strongly, has an analogy in other eases in which cells die away under the influence, for instance, of a bacterial toxin in a greater concentration than is compatible with cell life. It is then also easy to understand that the form of degeneration is not always the same, but that it may vary even in the same species, just as, of course, the nature of the factor that produces the degeneration varies considerably. A fact shown even by histological and histogenetie investi- cation of the organ and strongly confirmed by its numerical analysis is that the Hassall’s corpuscles are started as small formations and that only quite a small number of those so begun attain a greater diameter than 50-100 ; the number of these larger forms is also less according as their dimensions are greater. Iie one tries to find the reason why the power of growth in different Hlassall’s corpuscles thus seems to be rather different, there is one especially important fact that is clearly shown as the result of the investigation of material from diseases. In no case™ have I come across conditions indicating that the new toxie fae- tor that affects the organ in and through disease can lead to an enlargement of already existing corpuscles, but in every case we have a formation of new small forms, which, if circumstances permit of it, seem in their turn to be able to some extent to as- sume greater dimensions, while the previously existing larger corpuscles not infrequently show regressive forms even at an early period of the disease. This state of affairs seems to me to indicate a certain specificity in the cells that are involved in the composition of the Hassall’s corpuscles: they do not react to an additional toxie factor of another sort than that which orig- inally caused their formation. Tf this conclusion is correct, there are, as far as I can see, in the main two possible ways of explaining the fact that dif- * A reservation may perhaps be necessary on this point with regard to typhoid fever, as in the few cases of this disease that I have had an opportunity to investigate there has been no increase in the number of small corpuscles, but certainly one in the number of large ones. The cases investigated are, however, from a late stage of the disease, when it may be assumed that the formation of fresh corpuscles has upon the whole ceased, and that a number of those formed earlier may have grown into larger forms. It is thus by no means necessary that the finding in question, which is practically unique in my material, should con- note a deviation in principle from the other results, but it demands, of course, continued investigations with regard to the disease in question. 744 MORPHOLOGY OF THYMUS ferent Hassall’s corpuscles in the same thymus attain to dif- ferent degrees of development before they fall into regression. One is that toxie factors, which may be thought to be of a simi- lar or heterogeneous nature, have ab initio affeeted one place in the parenchyma more strongly and with a greater area of extension, another place more slightly and to a less extent. The second possibility, which of course by no means excludes the first, is that a summation of similar stimuli may take place and proceed to a different extent at different places. Without wishing to adopt a decided standpoint in this matter, I shall only point out that certain cases in which there has been a re- lapse in an acute infectious illness without any observable in- crease of growth in the Hassall’s corpuscles rather disfavour the latter alternative. What has been said above shows quite well that Hassall’s corpuscles do not arise everywhere in the parenchyma, nor under all cireumstances, when a toxie factor of the kind indi- eated above is present in the organism. In trying to form a more detailed view as to the conditions under which these cor- puscles arise, a fixed peint of departure is afforded us by the fact that they originate only in the medulla, never in the cortex. It seems to me that we may all the more certainly consider it a fixed point, as the same is true of the different form of cell hypertrophy—‘ ‘unicellular Hassall corpuseles,’ ‘‘myoid cells,’’ epithelial cell groups of non-conecentrie ar- rangement—which apparently form an equivalent to Hassall’s corpuscles in lower vertebrates. The medulla is now characterized by a hypertrophy of the reticulum cells. This medullary hypertrophy of’ the reticulum cells thus seems to be an indispensable qualification if the lat- ter are to show, against toxie substances, a group reaction of the sort that is expressed in the formation of Hassall’s cor- puscles. It is only after the formation of the medulla that these corpuscles arise, and this is the case both at the first develop- ment of the organ and at its regeneration. If the hypertrophy of the medullary cells regresses at accidental involution, the re- eruiting of the Hassall’s corpuscles ceases, and this is also the case even when, as sometimes happens, the reticulum cells take up their position once more, side by side, in close epithelial union, which might seem to form a more than usually favorable mor- HAMMAR 745 phological condition for the origin of such formations. To use an expression borrowed from serology, one might say that only with the formation of the medulla are the reticulum cells sensibilized for the formation of Hassall’s corpuscles. Of course this ex- pression by no means contains any statement to the effect that this ‘‘sensibilization’’ in this connection is of the same nature as is usually denoted by this term. With this view the medulla becomes the most peculiar part of the organ from a functional point of view, an opinion to which Shimizu (1913) was also led by the thymolytic experiments car- ried out by him, as in these the thymolytic changes were chiefly localized in the medulla. But these last-named investigations certainly need further confirmation before we can venture to build upon them. Weyermeersch (1908) seems to have found only ordinary accidental involution in corresponding experi- ments. Even Ogata’s results (1917), to judge from the ab- stract, do not seem to have afforded morphological guarantees that the effect of the serum on the organ was anything but an indirect one. : xm lf the cell hypertrophy that leads to the medullary differ- entiation is of such importance for the genesis of the centers of functional reaction constituted by the Hassall’s corpuscles, it 1s especially to be regretted that our knowledge of the conditions under which medullary differentiation arises and is maintained is particularly slight and uncertain. As a matter of fact the actual question has only arisen quite recently in the literature. A case of thyreoaplasia (dystopic thyreohy poplasia) published by Hellman and myself (1920), in which the only noteworthy change that could be established in the thymus was a subnormal amount of medulla, gave rise to the question whether the secre- tion in the embryonal thyroid gland might be one of the fac- tors producing differentiation of the thymus medulla. An in- vestigation quoted in the same place, showed that in ontogenesis of amniota of different kinds, not only the oviparous but also the viviparous, the first traces of a secretion in the thyroid gland occur in a fairly fixed time relation both to the first appear- ance of the thymus medulla and to the appearance of the en- chondral ossification or the starting of the medullary cavity in the larger cylindrical bones. These changes in the thyroid gland seem everywhere to belong to a period just before the above- 746 MORPHOLOGY OF THYMUS mentioned changes in the thymus and during ossification, so that to this extent we actually have the first condition for sup- posing that the function of the foetal thyroid gland may pos- sibly influence the last-named processes. But we are still a long way from proving any real causality. If under these circumstances we are confined chiefly to assumptions with regard to the factors that cause the forma- tion of the thymus medulla, it is rather tempting to think in the first place of a chemical correlation, an endocrine influence. On the other hand, the occurrence of lymphocytes in the organ does not seem to be without significance for the medullary dif- ferentiation, if we are to judge from the fact that both in de- yelopment and in regeneration the medullary differentiation does not take place until a considerable number of lymphoeytes have infiltrated the organ. Likewise, in both accidental and age in- yolution, when the number of lymphocytes in the organ has been reduced to a somewhat great extent, the hypertrophy of the medullary cells also undergoes regression. That the lymphocytes are indispensable for the function of the organ is also shown by those cases in which, as sometimes in congenital lues, the parenchyma has partly assumed an epi- thelial character and is partly still infiltrated with lymphocytes. It is then solely the places infiltrated with lymphocytes that form Hassall’s corpuscles, whereas the epithelial regions have no such newly-formed corpuscles. It is certainly an open ques- tion whether the influence of the lymphocytes is exerted directly on the formation of Hassall’s corpuscles or only indirectly through their importance for medullary differentiation. It may possibly be considered that the latter alternative is supported by some cases in which, during convalescence after an acute infectious illness, the patient has fallen ill again with the same or another disease of an infectious-toxie nature. In some such cases the thymus has been found to be in reconstitution, with a relatively abundant infiltration of lymphocytes, but without any medullary differentiation. Under these cireumstances it was impossible to establish any reaction on the part of the organ against the new illness in the form of an appearance of fresh Hassall’s corpuscles. Before the formation of medulla has taken place the regenerating organ seems to be refractory to cH-excita- tory factors. HAMMAR 747 At present no details can be given as to the nature of this influence of the lymphocytes on the antitoxie activity of the thymus. I shall only call to mind in passing that the presumed co-operation between the proper cells of a tissue and leucocytes is by no means without analogies in other cases in the theory of immunity. Tf one starts out from the idea that the presence of the lymphocytes in the organ is of importance, directly or indi- rectly, for the antitoxic function of the organ, then certain phe- nomena in accidental involution become less difficult to under- stand. As, according to the laws otherwise governing the con- ditions of the lymphocytes in the organism, these cells are rare- fied and disappear more or less completely in the thymus, the function of the organ also seems to be weakened and finally ceases altogether. The fact that this disappearance of the lym- phocytes and the cessation of the function of the organ takes place especially during a reduction of the general state of nu- trition does not fit it at all badly with our experience that dur- ing a reduction of this sort the power of resistance of the organ- ism against infectious-toxic and other similar influences is ac- tually reduced. This is, of course, not intended to be any ex- pression of opinion as to how much of this deerease in the power of resistance is to be ascribed to the thymus and how much to other, synergistic organs. For it is of course quite certain that the thymus cannot sustain more than a part, more than some side that at present we are unable to define more closely, of the antitoxie activity in the organism. The conclusion thus arrived at by my analysis of the mor- phological and experimental material put forward here is that the lymphocytes in the thymus are necessary postulates for the function of the organ, but that the essential functional changes take place in the epithelial thymus reticulum in the form of an enlargement of separate cells or cell growps, causing in mammals the formation of the concentric cell complexes known as Hassall’s corpuscles. These originate under the influence, direct or indi- rect, of the lymphocytes in the medullary reticulum, which is prepared and ‘‘sensibilized’’ by special influences (the thy- roid?), and they form the morphological expression of an anti- toxic activity. 748 MORPHOLOGY OF THYMUS This view of the function of the thymus is the result of more than 20 years’ study of this organ in different kinds of animals. In its most general features it has been indicated in an earlier essay (Hammar, 1918:2), but is put forward here for the first time in a somewhat more detailed form, after being tested, with a result that seems to me satisfactory, against a background of a total of between 200-300 normal and 400-500 pathological cases of human thymus, all subjected not only to a purely histological investigation but also to an analysis according to a numerical method. I hope to be able to make this material more accessible in print and so to help to form a conerete idea of the morphology of the human thymus, both under normal conditions and under the influence of different sorts of diseases. Here the observa- tions gained from this material could only be mentioned as far as they were necessary for the present task. It will certainly have been noticed that the detailed nature I have here tried to give to my exposition of the thymus fune- tion has caused me to enter on certain points into the sphere of working hypotheses. If, in spite of this, I considered that I could and ought to enter upon details of this sort, it was not only be- eause my view seemed on the whole suited to contain all the not inconsiderable fund of assured knowledge with regard to the organ that we possess at present, but also and especially in the hope of facilitating in this way the experimental testing of the ideas developed here. To a certain extent a testing of this sort is already possible now, namely with regard to the considerable experimental ex- perience recorded in the literature, which, as it was arrived at without any close attention to the morphology of the organ, has not been taken into consideration in my exposition above. A detailed investigation of this point would, however, require much space and cannot be carried out here. But a few words must be said about the matter. I may at first quite briefly call attention to the paucity of the positive results obtained from the attempts to incorporate more than a normal amount of thymus substance within the organ- ism, whether in the form of an extract, by transplantation or by feeding. In this view I agree very much with what E. R. Hos- kins (1918), among others, has stated in relation to this. In HAMMAR 749 all these attempts at hyperthymisation there has searcely been one that indicates, still less proves, an internal secretion in the proper sense of the term. The lowering of the blood pressure that was shown, first by Svehla (1896-1900) and then by a num- ber of other investigators, to be the effect of an intravenous injection of thymus extract seems, as far as it is not entirely due to intravascular coagulation, not to be any special characteristic of the thymus, but also belongs to other organs containing lym- phocytes. And, according to Parisot and Lucien (1908) this effect is absent in the thymus from athrepties and is thus ap- parently connected with the presence of the lymphocytes. And when Hedvig Miiller (1917) and Del Campo (1918) state that by intravenous injection of thymus extract they have shown the existence of a specific capacity in the thymus to inhibit the occurrence of or even neutralize fatigue, such phenomena point rather to a fixation of poison than to a specifically secretory activity in the organ. An explanation of the saine sort seems to be indicated by the cases, not very numerous up to the present, in which thymus medication has been employed in myasthenia (A. M. Hamilton, 1912). On the other hand the disappearance of myasthenie symptoms in patients with Graves’ disease after thymectomy (Schumacher and Roth, 1912; Sauerbruch, 1912) seems to be compatible with the previous mentioned observations only if we may assume that here we are concerned with a dysfunctioning thymus. Nor does there seem to be anything specific for this organ in the marked growth and delayed metamorphosis of thymus- fed amphibian larvae observed by Gudernatsch (1913-1914) and many others after him. It must be admitted that Uhlen- huth (1919) is correct in his view that the experiences gained on this point most probably indicate that the feeding of such larvae entirely on thymus is not likely to supply them with the substance necessary for metamorphosis. On the contrary, there seems to be no reason for assuming that there is present in the thymus any substance that has a positive inhibitory effect on the metamorphosis. When, on the other hand, the last-mentioned writer is of the opinion that by proving “that the calf’s thymus contains a specifie toxin which is capable of producing tetany in sala- mander larvae and which can be antagonized by the parathy- 750 MORPHOLOGY OF THYMUS roids’? he has shown “that the thymus actually does produce an internal secretion,’’ I cannot agree with him. The observa- tions in question show at the very most that a substance of this sort is present in the thymus; whether it has been formed there or perhaps only absorbed and possibly accumulated there must be considered as quite undecided. The state of affairs with regard to the effect of the extirpa- tion of the thymus may at first sight seem different. Ever since Restelli’s experiments in 1845 until Klose’s and Vogt’s monu- mental investigations in 1910, as well as since that time, there is a whole series of works—by Basch, Soli, Matti, Hart and Nordmann, ete.—that can give us information about positive results of such interferences; not a few of these experimenters even come to the conclusion that the thymus is a vital organ. If one examines more closely the nature of the changes that are observed, which may consist in disturbances in the bone sys- tem and the lime metabolism, changes in the irritability of the nerves, delay in the occurrence of puberty, incomplete somatic and psychical development (‘‘idiotia thymopriva’’)—to men- tion only some of the most important—one must admit that none of them is of such a nature that it cannot equally well be ex- plained by assuming that the thymectomized animals are af- feeted by injuries of a toxic nature which are neutralized in the intact animal. We must also note that against these experiences there are experimental results that are entirely or partly negative. I may mention the results obtained by Ver Eecke (1899:1, 2), Pari (1905, 1906), Vincent (1904), the author (1905:2), ete., with regard to the frog by Allen (1920) in the earliest stages of tadpoles; those of Nordmann (1914), Pappenheimer (1914) Tangu (1916, 1917), Park (1917), etc., in mammals, in which thymectomy was carried out without any lasting disturbance in the condition of the animal. Park and McClure (1919) arrive: at essentially the same negative results, on the basis of their own comprehensive experiments, in their large recently published monograph on this question. The detailed and careful historical and critical exposition in this work is well fitted to serve as a guide to this part of the thymus problem, and I refer the reader to it on this point. HAMMAR 751 If one starts out from the view of the disappearance of a specific organic function it seems comparatively difficult to ex- plain this variation in the result of otherwise successful ex- periments that is actually present in thymectomy; on the other hand it is easy to explain it as the result of a reduced resist- ance against external injurious factors, which differ oecasion- ally in occurrence and potency. In one ease the correctness of the latter explanation has been proved in an apparently convincing way by Pari’s demon- stration that the fatal syndrome that Abelous and Billard (1896) found in their thymectomized frogs and that they took to be a direct result of the operation, is really caused by the invasion of a bacterium against which animals without thymus are less resistent than those which are intact. Cosentino (1900) and Paton and Goodall (1904), among others, seem. to have had similar experiences with mammals. And Park and MeClure also suggest unfavorable conditions of milieu as the explanation of the disturbances in the condition of the animals, caused by thymectomy in so many of their predecessors’ experiments. As a matter of fact, several previous investigators, starting out from their experiments, have arrived at conclusions very similar in the main point, the antitoxie activity in the thymus, to those indicated by me from the point of departure of the structure of the organ and its variation. These statements, more or less firmly established, will be found collected in the book of Barbara (1918). Here I shall mention two which have a broader experimental basis. In the first place there is Brieger, Kitasato and Wasser- mann’s work of 1892. They found that certain bacteria showed a reduced virulence when cultivated in thymus extract or when this extract was added to the culture medium. Thymus ex- tract also appeared to possess the power of neutralizing bac- terial toxin. In this the authors see an indication of an anti- toxie activity of the organ; in the cases in which a comparison was instituted it turned out that the lymph glands had the same power. In the case of the tetanus toxin, however, the power of the thymus to prevent poisoning was not confirmed in a test carried out by Alfred Petterson (1911). The conditions of both the thyroid and the thymus during infection have been recently submitted to a thorough clinical 752 MORPHOLOGY OF THYMUS and experimental investigation by Barbara (1918). He records positive results for both organs. In the case of the thymus he comes to the conclusion that in this organ substances are formed that stimulate the phagocytes; they can be shown in an extract of the organ. In addition the thymus either forms complement or stimulates, by the formation of hormones, other organs to form complement. It also forms or increases the formation of opsonines, but it is uncertain whether it plays any part in the formation of agglutinins. The lack of equilibrium in the im- munization apparatus that is at first brought about by thy- mectomy is gradually counterbalanced, except as regards the opsonins, in which ease it seems to be permanent. * * * * % It is obvious that in all experiments on the function of the thymus we cannot disregard the very varied conditions that the organ may be in, on account of difference in age, different conditions of nutrition in the animal, ete., in each special case. It is also extremely desirable that more attention than hitherto should be paid to each of the different structural com- ponents of the thymus separately, if our knowledge of the fune- tion of the organ is to be properly deepened. It would certainly be some gain if the detailed account of the problem of the fune- tion that I have tried to give above were to contribute to this. In addition our lack of comprehensive knowledge of the factors of an excitatory and depressor nature that affect the thymus is especially noticeable. The filling of this gap seems to me one of the most important tasks that thymus investiga- tion has to carry out in the immediate future. But it is obvious that this task cannot be accomplished by work directed merely toward the thymus. For it we certainly need, above all, a more extensive and a more profound knowledge of other endocrine organs and of the real lymphoid tissue. Thus the special interests of thymus investigation result in a plea for the investigation of these last mentioned parts of the organism along the lines that not long ago (1920) I ven- tured, on more general grounds, to indicate, by ways of sugges- tion to the readers of this journal. SEY HAMMAR 753 EDITORIAL SUMMARY “Thymie asthma’’ due to pressure and ‘‘mors thymica’’ should be sharply differentiated. There is no reliable evidence that the latter is due to abnormality of the thymus. The Hassall’s corpuscles (ec. H.) and the lymphoid cells (1. e.) vary independently. C. H. - excitatory and - depressor as well as l. ¢.- excitatory and - depressor factors can be recog- nized. L. c.-excitatory and-depressor factors affect the lymphoid tissues throughout the body. The ec. H.- excitatory factors are of a toxic nature. The function of the thymus is antitoxic. Much more study of these excitatory and depressor factors is needed as well as careful morphological analysis of the endo- erine glands generally. BIBLIOGRAPHY Abderhalden, BE. & Kashiwado, T.: 1912. Studien tiber die Kerne der Thymusdriise und Anaphylaxieversuche mit Kernsubstanzen, Ztschr. f. physiol. Chem. (Berlin), $1, 285-293. Abelous, J. E. & Billard: 1896. Recherches sur le fonction du thymus eee grenouille. Arch. d. physiol, norm. et path. (Paris), 47, Aimé, P.: 1912. (1). L’évolution périodique du thymus des chéloniens. Compt. rend. Soc. d. biol. (Paris), 72, 115-116. 1912. 2. Note sur le thymus chez les chéloniens. Ibid., 889-890. Allen, B. M.: 1920. The results of earliest removal of the thymus glands in Rana pipiens tadpoles. J. exper. Zool. (Phila.), 30, 189-200. Ankarsvard, G., & Hammar, J. A: 1913. Zur Kenntnis der Ganoiden- thymus (Amia calva, Lepidosteus osseus). Zool. Jahrb. Abt. Anat. Ont. (Jena), 36, 293-306. Barbara, M.: 1918. La fisiopatologia della tiroide e del timo nei rap- porti colle infezioni. Milano, 1-260. Bardetscher, J. A.: 1920. Eosinophilic Leucocytes in the Thymus of postnatal Pig. Anat. Rec. (Phila.), 18, 23-34. Basch, K.: 1906. Beitrige zur Physiologie und Pathologie der Thymus. 1. Ueber Ausschaltung der Thymusdriise. Jahrb. d. Kinderheilk. (Leipzig), 64, 285-335. ——-: 1908. 2. Die Beziehung der Thymus zum Nervensystem. Ibid. 6S, 668-690. ——-: 1913, 3. Die Beziehung der Thymus zur Schilddriise. Ztschr. f. ex- per. Path. u. Ther. (Berlin), 12, 2-28. Bauer, J.: 1913 Ueber den Nachweis organabbauender Fermente im Serum mittels des Abderhaldenschen Dialysierverfahrens. Wiener klin. Wehnschr., 25, 1109-1115. . Bergel, S.: 1909. Fettspaltendes Ferment in den Lymphozyten. Min- chen. med. Wehnschr., 56, 64-66. Bergstrand, H.: 1919. Tva fall of parathyreoideaforstoring kombinerad med. thymus-hyperplasi. Sy. likiresallsk:'s forhandl. (Stockholm), 401-404. Bompiani, G.: 1914. Der Einfluss des Siugens auf die Restitutionsfihig- keit des Thymus nach der Schwangerschaft. Centralbl. f. allg. Path. u. path. Anat. (Jena), 25, 931-935. y. Braunschweig, R.: 1891. Experimentelle Untersuchungen liber das Verhalten der Thymus bei der Regeneration der Blutkérperchen. Diss. Dorpat., 1-55. Brieger, Kitasato & Wassermann: 1892: Ueber Immunitéit und Gift- eeu euue: Ztschr. f. Hygiene u. Infektionskrankh. (Leipzig), 12, 137-182. To4 MORPHOLOGY OF THYMUS Calzolari, A.: 1898. Recherches expérimentales sur un rapport prob- able entre la fonction du thymus et celle des testicules. Arch. ital. de biol. (Pise), 30, 71-77. Castellaneta, V.: 1913. Sulla questione del timo in “Ammocoetes.” Mo- nit. Zool. ital. (Firenze), 24, 161-174. Castellaneta, V.: 1917. Aproposito di aleune particolarita di sviluppo del timo, in Amia calva_e Lepidosteus osseus. Arch. ital. Anat, e Embryol. (Firenze), 15, [Abstr. Endocrin.] Chiari, H.: 1894. Uber Cystenbildung in der menschlichen Thymus zugleich ein Beitrag zur Lehre von den ‘Dubois’schen Abscessen.” Ztschr. f. Heilk. (Prag.), 15. Christeller, E.: 1919. Entspricht dem sog. Thymustode ein einheitliches Eerame peltepiige Virchow’s Arch. f. path. Anat. [ete.] (Berlin), 226, T- : Collin, R., & Lucien, M.: 1905. Nouveaux documents relatifs 4 l’évolution pondérale du thymus chez le foetus et chez l'enfant. Compt. rend. Soc. d. biol. (Paris), 59, 716. - 1906. Sur l’évolution pondérale du thymus chez le foetus et chez enfant. Bibliographie anat. (Paris and Nancy), 15, 24-38. Cosentino: 1900. Iperleucocitosi e potere battericida negli animali timectomizzati. Gazz. d. Osp. e d. Clin. (Milano). Courrier, R.: 1921. Action sur le thymus de l'ingestion de la glande thyroide. Compt. rend. Soc. de biol. (Paris), 84, 226-228. Couti@ére: 1913. Sur Vablation du thymus chez les trés-jeunes oiseaux. Bull. Acad. de méd. (Paris), 70, 321-322. Crémieu, R.: 1912. ftude des effets produits sur le thymus par les rayons X. Lyon, 1-333. Dantschakoff, Vera: 1908. Untersuchengen von Blut und Bindegewebe bei Végeln. Arch. f. mikr. Anat. (Bonn), 73, 117-181. : 1910. Ueber die Entwicklung der embryonalen Blutbildung bei Reptilien. Verhndl. d. Anat. Gesellsch. (Jena), 70-75. Dantschakoff, Vera: 1916 (1). Ueber die Entwicklung des Blutes in den Blutbildungsorganen bei Tropidonotus natrix. Arch. f. mikr. Anat. (Bonn), 87, 497-584. Dantschakoff, Vera: 1916 (2). The differentiation of cells as a criterion for cell identification considered in relation to the small cortical cells of the thymus. J. Exper. Med. (Balt.), 25, 87-105. Del Campo, E.: 1918. Reitriige zur Physiologie der Driisen. MORSE: Fortgesetzte Untersuchungen tiber eine neue Funktion des innern Eas der Thymusédriise. Z. f. Biol. (Miinehen and Berlin), 68, 5-300. Deutsch, Helene: 1913. Erfahrungen mit dem Abderhaldenschen Di- alysier Verfahren. 1. Mitteilung. Abbau von Thymusgewebe durch normales Serum. Wiener klin. Wehnschr., 26, 1492-1494. Dustin, A. P.: 1909. Contribution a Vétude du thymus des Reptiles. Arch. de Zool. expér. (Paris), 42, 43-227. _: 1911, Le thymus de l’Axolotl. Arch. de biol. (Liége), 26, 557-616. —-: 1913. Recherches d’histologie normale et expérimentale sur le thymus des Amphibiens anoures. Tbid, 28, 1-110. __: “1914. Nouvelles contributions 4 l'étude du thymus des Reptiles. ‘Arch. de Zool. expér. (Paris), 54, 1-56. ____: 4920. Recherches d'histologie normale et expérimentale sur le thymus des Amphibiens anoures. Arch. de Biol. (Liége), 30, 601-693. Dustin, A. P. & Baillez, G.: 1914 (1). L’origine des corps de Hassall et des formations kystiques du thymus des mammifeéres. Bull. Soc. R. se. méd. et nat. Bruxelles., 44-46. - 1914 (2). Sur l’existence de cellules myoides dais le thymus des mammiféres. Ibid., 193-195. Eggers, H.: 1913. Experimentelle Beitrige zur Einwirkung der Rént- genstrahlen auf den Thymus und das Blut des Kaninchens, mit be- sonderer Beriicksichtigung der therapeutischen Verwertbarkeit in Fillen von Thymushypertrophie des Menschen. Ztschr. f. Réntgen- kunde (Leipzig), 15, 1-54. Fellinder, J.: 1912. Beitriige zum Studium der anaphylaxieerregenden Substanzen. Stockholm, 1-164. Fiore, G. & Franchetti, U.: 1911. Richerche sperimentali sul timo. Con- tributo allo studio dell’ involutione del timo. Riv. di Clin. Pediat. (Firenze), 9, 823-826: Fischl, R.: 1913. Zur Analyse der Thymusextractwirkung. Monatsschr. f. Kinderheilk. (Leipzig and Wien), 12, Orig. 515-532. Fraser, BE. A.: 1915. The development of the thymus, epithelial bodies, pi) and thyroid in the Marsupialia. P. 2. Phascolarctes, Phascolomys, and Perameles. Phil. Trans. (Lond.), B. 207, 87-112. V Fraser, B. A. & Hill, J. P.: 1915. The development of thymus, epitheMa bodies and thyroid in the Marsupialia Trichosurus Vulu pecula. Phil. Trans. (Lond.), B 207, 1-85. Friedleben, A.: 1858. Die Physiologie der Thymusdrtise in Gesundheit und Krankheit. Frankfurt a/M., 1-336. HAMMAR 795 Fritsche, E.: 1909. Die, Entwickelung der Thymus bei Spinax niger. Zool. Anz. (Leipzig), 35, 85-93. Fulci, Fr.: 1913 (1). Die Natur der Thymusdriise nach Untersuchungen iiber ihre Regenerationsfahigkeit bei Siugetieren. Deutsch. med. Wehnschr. (Berlin), 39, 1776-1780. Fulci, Fr.: 1913 (2). Die Restitutionsfihigkeit des Thymus der Sauge- tiere nach der Schwangerschatft. Cntribl. f. allg. Pathol. u. pathol. Anat. (Jena), 24, 968-974. Ganghofner, F.: 1902. Uber plézliche Todesfalle im Kindesalter. Verh. Deutsch Naturf. u. Arzte 74 Vers. (Karlsbad), G:2, 288-290. Gedday hs: W92le saz Altersanatormie de Kaninehenthymus. Upsala Lakaref. Foérh. N. S., 26. Gellin, O.: 1910. Die Thymus nach Exstirpation bezw. Réntgenbestrah- lung ger Geschlechtsdriisen. Ztschr. exper. Path. u. Ther. (Berlin), 8, 1-21. Goodall, A.: 1905. The postnatal changes in the thymus of guinea pigs and the effect of castration on thymus structure. J. physiol. (Lond.), 32, 191-198. Griper, L.: 1920. Die anatomischen Verdanderungen kurz nach der Geburt. Anat. Hefte (Wiesbaden), 59, 45-75. Gudernatsch, J. F.: 1912. Feeding experiments on tadpoles. 1. Arch. f. Entwicklungs mechan. (Leipzig), 35, 457-483. _-: 1914. Feeding experiments on tadpoles. 2. Ue nee 806 —chromaffin content of in ex- perimental puncture dia- Petes: Shoo, Neues Ceasers 337 —congenital lack of, and Addi- SOM 8 ISGASOes een eveiats 94 — cortex, studies of, after death from ACAlGINE we. wie = we 243 — —relation to Graves’ disease and myxedema ........ 781 —w—relation to pancreas and GIADCLES, cneiteints seni 785 — deficiency in secondary syphi- TG Stone afdrspereh eee bs eli 780 —— GYBDEDSIA, . fee lm epatest sys toes 301 —early human development... .341 — effect of, removal of on poison susceptibility. 6 oicculs cians 78 — — on chromaphil substance of Fetterink. .:-.< ssi eke eaters 618 —embryology of ..........--- 781 — emotional hypertension...... 126 — enlargement of, in diabetes. ..339 Adrenal, extirpation for epilepsy. 783 — — — spasms 8 —w—in epilepsy ............ — extract in Addison’s disease. .241 —function and under-nutrition. 622 — glycosuria, effects of route of administration on ........ 617 — grafts in tadpoles .......0-. — hemorrhage in children...... 90 ——— man of 64............ 94 ——— newborn ......... 623, 785 —histopathology, and _ tetanus intoxication |... .a-s se 94 —hyperglycemia ............ 90 —hypernephroma of ..... 244, 619 — hypo- or dys-function of..... 244 —in Addison’s disease: tuber- CULAR s fois s5eus, 2s Sac ee et — anaerobic infections ..... 662 —= infarction ce. <6 eh = eee 240 —— 1AM ANILLON), +> ots: ose ee 624 —w—relation to the action of hypophysis extract .....783 ———.spasmophilia, ©... 4-1 eens 480 —— insufficiency ....-.-«- =. 283, 335 —-—and gastric ulcers..... C 779 —— acids and alkalies.....--- 627 — hyperglycemia ....-..-------> 786 —hhypertension .....--+.--+-+-:: 628 —hypophyseal extract and his- tamine on blood-pressure. .363 ——influence of, on calcium me- ‘iciyohpisienl Loo oo omOoO UC O mAs 787 -_~ —~- on bile secretion....--.... 484 te ES Yleloys! Rooocesagnseoce 626 ___ __-—_ reactions following ars- phenamine adminis- PENH (Ac on Gen od oc 345 7 Adrenin in Graves’ disease...... 127 — inhibitory effect antagonized by, tissue extracts. <0 >. 343 — injections, action .......... 625 — — and blood pressure changes.607 — -—in dementia precox....... 97 — -— influence of, on blood pic- WOES Bao sie S dio SAB ADS —-—in hemorrhoids —-—into heart as therapy for narcotic poisoning ..... 96 —in spasm of the oesophagus. .357 —w—tachycardia ............ 786 — intratracheal injections in chronic bronchitic and bronchial asthma ........ 96 —in treatment of corneal ulcer of exophthalmic goiter..... 154 —-— —-—dystrophia adiposo- PSU ALIS We rote lepers ers 25 — ——w— otosclerosis ....... 342 —— — — vertigo ........... 343 —w— vomiting of pregnancy....344 — lethal dose in man.......... 95 — medication in asthmatic crises 89 — mydriasis in chronic nephritis.344 —not detectable in blood in COC IET A oc G on co AO 626 — output, influence of atropine and pilocarpine on........ 486 —papaverin in blood pressure BEL ITU ATN ows les altel xe doutmoret rae tote ke 626 — peroral administration of.... — pressor effect of augmented by thyroidin and hypophysin. .825 — prophylactic effects of....... 483 — reaction in bronchial asthma. .481 —-—of adrenal to............ 783 — restorative effect of, in chloro- forms poisoning (miei on 485 — role in intestinal disturbances.111 —test of cardiopathies........ 627 — therapy in Graves’ disease. ..699 — vegetative nervous system.... Adrenalism, acute Agglutinins, increase of, due to endocrine organ preparations. 253 Aikins, W. H. B.: Radium in goiter’ shinier ee 382 Albadalejo, L.: Endocrine dis- turbances of syphilitic origin. .109 Alcoholism, dissociation of semi- nal and interstitial glands by.651 — effect of, on spermatogenesis. .809 Alexander, H. L. (Paddock, R.): Bronchial asthma; response to pilocarpine and adrenine..... 481 Allen, B. M.: Experiments in the transplantation of the hypo- physis of adult Rana pipiens to tadpoles Allen, B. M.: Parathyroid glands of thyroidless Bufo larvae... .806 — Results of removal of thymus in tadpoles — Transplantation of the several parts of the adult hypo- physis into tadpoles Allen, E.: Oestrous cycle in the mouse — Ovogenesis in the sexually ma- ture mouse . 663 Allen, F. M.: Control of dia- betes in dogs, experimental. ..487 — Experimental studies in dia- betes 504 — Fever and intoxication on dia- betes —Influence of cold, age and pregnancy on experimental diabetes -488, 489 — The role of fat in diabetes . ..346 — (Mitchell, J. W:): Heredi- tary diabetes de Almaida, M. O.: of adrenin apnoea Alveolar tension in diabetes... Ambrozic, M.: nal Observations 637 Tumor of adre- a lnitepe [o ’eus Jevehn ty ait Cee 239 Macrogenitosomia precox and adrenal tumor in 3 year old/cirlhe = ose rls) Amenorrhea, endocrine factors in etiology and treatment.....641 Amenta, F.: Diabetes mellitus and infantilism Amsler, C.: ACtION. Vorete skeen oe Anaerobie infections, " adrenal, hypophysis and thyroid in....662 Anaphylactiec shock and adrenin .337 —w—epinephrin in ....... 2s eee Anaphylaxis, adrenin content....486 — (thyroid) as factor in epileptic. convulsions: ....5):.e eRe .. 683 Ancel, P.: Glandular hermaph-~ TOCISM. _ wsexs os tenet eee eee ..649 Anders, J. M.: Diagnosis of myxedema” 4... see +2 882 Anemia and diabetes....... 2. 490 Anomalies of menstration.... Anterior lobe of hypophysis and renal function: +2. 22 eeee 125 — pituitary deficiency ......... 538 Antibody production in guinea pigs after partial adrenalec- GODLY sso co cle sete oie oon 90 Anklesaira, B. N.: Personal equa- sions and pathogenic coeffi- cients in: diabetesi.2..-<\-1e 100 Apert, E.: Organotherapy in childhood 2. %ij2.72o.n- eee 2512 Apnoea, adrenin =. OER ROIS ue EAR esd Arai, H.: Hypertrophy of sur- viving ovary after semispay- Hae 5 o ge ogo Bp pom eG aio clom 267 — On the post-natal development of the ovary and the num- DersOl OVaec cele cl se = 130 Arai, M.: Pancreatic stimula- tion by amino acid hydro-_ chlorides Armand-Delille, P. F.: Thyroid dysfunctioning resulting in nanism and infantilism...... 383 Arnold: Case of endogenous AGITOSIAT 6d 6.0 oO GIO Ol OmIccIC Ios 132 Arnoldi: Physiology and pathol- ogy of carbohydrate metabo- lisms Arnoldi, W.: Hereditary endo- genous adiposity Aron, M.: Development of pan- creas 5 — Degenerative changes in the pancreas during gestation. — Embryology of the interstitial FSIOGL 5-6 cverorbia 0 eS. ren oO —Hematie formation in the Is- lands of Langerhans, in the embryonic pancreas — Isles of Langerhans and liver Gdevelopmient «-.....--.-.- 504 Artom, ©.: cf Lombroso, U..... 345 Ascoli, M. (Fagiuoli): X-ray treatment of the hypophysis in bronchial asthma .........-- 259 Asher, L.: Present knowledge of internal secretions —Thyroidectomy and thymec- tomy, effect of, on reaction Honea PUNCLULe =r. cl «i 823 — (Hauri): Carbon dioxide and water excretion in thyroid- ectomized and_ splenecto- mized rabbits in relation to external temperature Asthenia, hypophyseal, treatment (Cie Jalciere 6c.) che DICER NCR 261-262 .132 Asthma, adrenin and pituitrin fii” Son. o oon e plato caer ore —pbronchial, and intra-tracheal adrenin injections ........ — pituitary treatment of...107, 108 Athias, M.: Neoformation in transplanted ovary .......--.- 664 Atwell, W. J.: An anatomical consideration of the hypo- physis cerebri ..........--- moun — Further observations on the pigment changes following removal of the epithelial hypophysis and pineal gland in frog tadpole...........- 221 Atropine, influence of, on epine- jaa Cups scoeocoobesosoodd Aub, J. C. (Forman and Bright): Effect of adrenalectomy upon metabolism Auderodias: Auer, John: cf. Meltzer, S. J....629 Auricular tonus, action of epine- Miidhy Ci aooagdsoasooone ace 482 Ausenda, C.: Adrenal tumors. .479 Autonomic nervous system; anat- CME, WRIA, Gaooode snd 246 as factor in symptoma- HOLGER Vice a letteie neces 6 Axolotl] tadpoles as test, objects for thyroid preparations ..... 689 Baar, H.: cf. Ambrozic, M.....77 Macrogenitosomia precox- MRAGENL Ne Sagoo cena > 806 Babonneix, L.: Clinical notes of adrenal insufficiency ........ 33 Bachmann, A.: Pathogenic or- ganism in lymph nodes of goats Twila, FXopnetd O eigineooly doco ol oe 682 Bailey, P. (Bremer): Experi- mental diabetes insipidus and genital atrophy .........-.--- 761 Balint, A.: cf. Schiff, H........ 825 Bandler, S. W.: Placental gland AMM RERAC UP elels| cle life! usr eile) ellslieeiiare 374 == ThewendOCLiMeS) oclcls + «Nae + + 1 332 Barber, H. W.: Case of urticaria of eight years’ duration with hyperthyroidism .........-.-- 142 Barbosa, R.: . Internal secretions.266 Bardier, E. (Leclere and Still- munkes): Adrenin glycosuria and caffein poisoning.......- 779 — (Stillmunkes): Effect of ad- renin after chloralose ....-. 785 Barlow, H. C.: Healing of tro- phic ulcer of great toe in an aged glycosuric patient.....- 346 Barnewitz: Tumor of the sym- pathetic adrenal metastase. eee) Barker, L. F.: Classical endo- crine syndromes .....---++--- 790 Barker, W. C.: Roentgen ther- apy in hyperthyroidism 5 eas 14 Barron, M.: Relation of the is- lets of Langerhans to diabetes with special reference to cases of pancreatic lithiasis........ 346 Bartlett, W.: Emergency technic for thyroidectomy ....-.---- 142 Basal metabolism and pulse rate in hyperthyroidism .......-- 696 —_ — clinical measurement 345 ——_— jn diseases of thyroid..... 827 ———_—— hyperthyroidism ...... 685 4°" \ Basal metabolism in thyroid dis- QUQOES Fe ier.ses Ge = hs 154, 386, 401 —-——thyrotoxic adenomata.. 1 —_—— LOXIC LOLLGr. wi «sie aie 816 Basedow’s disease, adrenal opo- EHOTADY Fil h ocl et Geen ceabeasuers 784 —-—and tuberculosis ......... 152 — — dyspepsia of ............ 391 — -—humoral symptoms of..... 398 —w—opotherapy ............. $20 Bates, L. B.: Diabetes compli- eated with lipemia and xan- thoma Baiimler, Ch.: Treatment of in- fantile myxedema with thyroid and iodothyrin Bausch, W.: Blood-sugar before and after reduction in spasms.335 Becht, F. C.: Changes in fluid volume under adrenalin and DICWIETIN Fon ceere toned ose = ee mena nla 624 — (Gunnar): Effect of pituitrin and adrenin on _ cerebro- Spinal “wide a. aw haee Seeks 786 Becker, W. H.: Epiglandol in dementia precoxis 2. 5.2 cc sn 37 Béclére (Siredey): Androgenous pseudo-hermaphrodism with abdominal tumor iemeee cts <= 649 van Beek, W. F.: Anatomy of COWS OVAIY occcte Ss ccc owetere res 614 Beguier: Syphilitic diabetes ...2 Behse, E.: Case of tumor of hypophysis, acromegaly and bitemporal hemianopsia...... 259 Beilby, G. E.: Acute thyroid- itis — Surgical treatment of hyper- thyroidism relation between amount of gland removed and permanency of relief. .142 Bejaram, J. (Covira): Syphilis and adrenals Bell, W. B.: Ovarian cree lettl and medical and surgical meth- ods to secure ovarian secretion. 664 Bellavitis, C.: Acromegaly..... 653 Benedict, F. G. (Collins): Clin- ical apparatus for measuring basal metabolism ...........% Benedict, W. L.: Early diag- nosis of early pituitary tumor with ocular phenomena...... 116 Benoit, J.: Secretions of epi- didymus and vas deferens....809 — Secretory phenomena in the vas deferens a! Bensaude (Hallion): Medica- tion in asthmatic crises and the pathogenic considerations sug- POSted ac .. active Gracia ee 89 Bentley, J.: Ductless therapy in the insane........ 80 Berard, L. (Dunet): Pseudo-her- maphroditism and castration. .673 Berblinger, W.: Hypophysis in hypothyreosis and pregnancy. .653 — The interstitial cells of the POSEICIO. «0s sac,« cayenne ee 807 Berger: Some rare consequences of influenza 21.0... 2h 381 Bergeret (Botelho): Epithelial sarcoma of the mammary GAM. | ociacsae 3 'a.s Sarat 127 Bergstrand, H.: Case of phaeo- chromocytoma (paragangli- oma) of the suprarenals with hypertrophy of the left heart.336 — Case of tumor of the adrenal with hypertrophy of the left myocardium wena — Parathyroids and Bright’s “dis- ease 5 Beriberi and adrenals.......... 621 Berlinger: Anatomical changes in and insufficiency of the thy- roid Bertschi, H.: Respiratory metab- olism of castrated rabbits..... PIM Beth, H.: Case of peripheral pressure neuritis in tetany. ..269 Beumer: X-ray treatment of ad- renals in diabetes Beumer, H.: Effect of adrenal radiation on metabolism in diabetes — Simultaneous oral administra- tion of adrenalin and glu- COSC: <é dos le cleus ouch ean 625 Biedl, A.: Diagnostic use of the internal secretions in diseases of nutrition and digestion... .365 — Significance of internal secre- tions in disturbances of metabolism and digestion. .523 Bihlmeyer, G.: Exanthema in juvenile diabetes .........-- 101 Bijlsma, U. G.: Adrenalin and antibody formation ......... 625 Bile secretion . <<<... 4... sticks bree eee 112 slood after operation for Graves’ GHEES® ooosgobpoouogood Uo 7 —ealcium in tetany.....---- 670 —changes after parathyroidec- ONY 4d. bbt aoeupdo y eGo OG 507 —-—— produced by adrenin..... 246 —chemistry, clinical application eater ole ieleueneisie" eles +795 —count and adrenaline....... 630 —in myexdema .....--+-++-+:: 684 —lipoids in diabetes.......--- 103 STETISCLUC wicis) ele os cies se os ol = 502 —pictures, influence of adrenin jnjections on .....-.+-++--+ 95 ____in disorders of involuntary nervous system .......246 —— post-operative tetany..... oot — pressure, abnormal, endocrine PACLOTS OAM, co. cee le oe cles 640 and adrenalin in dementia PLECOM occ scl enn 7 ____ changes caused by injection OUPAGTENIM, cree wir =! olin mec 607 __— effect of pituitary injection in febrile patients...... 125 ____ endocrine therapy in low. .773 —serum phosphate and calcium in guanidine tetany....... 134 SS (HUET 55 og Glo GolbaeCIc ONC S 633 ———— adrenalin effect........-. 625 ___ __ after oral administration of PUUCOSE) cies ies Bouveyron: Hypophyseal extracts in headaches of syphilis and Other OLifins =<... 2 2 is 360 Brain changes in diabetes......- 633 —growth hormone in......--- 247 Bram, I.: Diagnostic methods in exophthalmic goiter with spe- cial reference to quinine..... 682 — Exophthalmic goiter and its non-surgical treatment.... 613 —— —- — jin surgery — Some pitfalls in the diagnosis of exophthalmic goiter..... 143 Brammertz, W.: ef. Abder- THMValeine: Db oiglac dO cio OIODO 643 Brandis, G.: Infantilism and REIS IM eo ci eie, vies allele t= «ella! wise 801 Brayton, H. W. (Heubelin): En- larged thymus gland in infancy and its treatment with radium.139 —-— Thymus reduction by ra- dium Bremer, F.: cf. Bailey, P...... 761 Brigham, F. G.: Observations on various types of diabetes under the present methods of treat- VITUS ee an cok ea sae Been eee 101 Bright, E. M.: cf. Aub, J. C....617 Brock S. (Kay) Endocrine dis- TUPDANCES ss 22% fit). wai oe eee 493 Brodin, P.: Chauftard, A:..479 Bronchial ee and adrenin TEACLIOU es tetne sic ciel el tenner ee 481 Bronchitis, chronic and intratra- cheal adrenin injections...... 96 Brooks, Harlow: Physiological hyperthyroidism ............ i Geir Brown, E. J.: Diabetes, initial fast and tolerance testing....101 Brown, N. W.: Determination of relative activity of thyroid lobes S Jocts Sew se eee 29 Brown, W. L.: Diabetes in rela- tion to the ductless glands... .347 — Sympathetic nervous system in) GISSSsS ” crepes else 85 — The principles of internal se- CTELLONS® 507 ardiac insufficiency and goiter cured by x-ray treatment of GEES) 4c oo BO OOD Oto cid bom 143 Cardio inhibitory center, action OLadrenins OD. ci cls )- 01> o> 481 ‘arrelli, H. H. (Sordelli): Injec- tion of gas to outline kidney. Silty ‘armichael, J.: ef. Cameron, PAW Tieetciecsicy sive #3) 384, 514, 684, 815 ‘arotid body, tumor of......- 100 —gland, tumor .....------+:: 631 Jarrara, M.: Homosexuality and hermaphroditism ...----+--+-+ 359 ‘astaldi, L.: Thyroid morphology. 684 Jastex, M. R. (Waldorp): De- layed hereditary lues... Seley, el! ___ Endocrinopathic nanism...353 ——— Hypogenitalism, etc...... 380 Yastration and its effect on hy- perthyroid prostate .......-- 136 — effects in hen-feathered Cam- pines eee 8 ha ee aoe aN) = [OI Sd GORD nD 0 CROTON CACC oLcuci 307 followed by enlargement of hypophysis ....-.-+----:-: 174 == (MG! 55 cog ooo apbS OIRO DS 810 —_____ changes in testes after... 809 —poles of testes in....------:- 809 — in pseudo-hermaphroditism ..673 Castro, A. de,: Acromegaly and THSGe eoce aoc oso p Ol pees 260 —— Recklinghausen’s disease with .. acromegaly .....--.+++++> 260 — Thyreo-hypophyseal syndrome.260 Castronuovo, G.: Diffuse neuro- fibromatosis (Recklinghausen’s disease) Catan, M. A. (Houssay and Maz- zoceco): Carbohydrate metab- olism in animals........---- 618 Catz, B. F.: Pituitrin in obstet- rical practice .....-.+.+-+++> 117 Biratet ei njielie) ole, ax wretagee) wwii. 's 9° Caussade, L.: cf. Hamant, A....262 Cavengt, G. S.: Endocrinology in infant pathology 791 Cavengt, S.: Mongolism.....--- 805 — Two cases of achondroplasia. 89 Cawadias, A.: Continued fever of sympathetic origin.......----- 126 Cerebro-spinal fluid, effect of ad- renin and pituitrin om....... 786 —_-——in diabetes insipidus, role Oi pHooo Sooo DOr DoD 170 —_—elation of hypophysis to formation of ........--- 798 —___—— yascular reactions to; pres- ence of hypophyseal se- cretion im .....----+-- 121 —_——yolume, effects of adrenin and pituitrin on.......-. 624 Cervello, V, (Levi): Action of iodine and adrenin on living surviving cellS ....--.+-+++e- 245 Cevera, L.: cf. Houssay, B. A....4838 Cervical ganglia, superior and Aye > Gite on Gid.b o.crcroolclo gio o 512 Chantraine, H.: Blood sugar in narcosis and diseases of nerv- ous System ....-:---s sees 99 Charbanier, H.: Critical glyce- 249 “nik! BAG eo pao S ODOR Ono o.0 DmC 2 Chatton, E. (Courrier): Endemic FIG os heocdoor onode gto OOD 815 Chanftard, A. (Brodin): Neuro- fibromatosis with adrenal in- SIMICIEN CY! cxcye lel miatelebeten ses varae = 479 — (Laroche and Grigaut): Cho- lesterinemia in normal and pathological conditions..... 359 Cheney, G.: cf. Smith...... 448, 658 Chiappori, R. (Gonzalez): case of acromegaly Chiari: Dystrophia adiposo-gen- TEALISCS. plcdcrstste tere! cdeken cl ebehste ene 654 Chidister, F. E.: Hermaphrodit- ism in fundulus........-.--- 497 Chloride metabolism and men- : StEnWaAtlOM.) Seles selec cis eral 801 Chloroform, action of, and ad- renin on heart........-..--:- 482 — poisoning, adrenin in........ 485 Cholelithiasis and involuntary nervous system ......--++++- 487 Cholesterol, corpus luteum..... 63 — feeding and the adrenals. ...620 Sin) AGTENAIS! crccete © wise eaeinre oe 242 Cholesterinemia in diabetes..... 248 Cholin as peristaltic hormone... 247 Chondrodystrophy, endocrine or- gans in; etiology of.....--- 787 —“inizpheaniiel, 45 og ooco0 Dect tig cod 256 Chondrodystrophia in an adult. 646 Chorea, hysteric and hyperthyroid- ABI Vite iene A hlow «micro ptelatemere 145 Christoffersen, N. R.: Acrome- galy with myxedema........ 655 — Metabolism and internal se- PEGEION cio ieavet-h tusteuaeitere 662 Circulatory system, relation of EVibdsybbel Mine) Be et SGN A Betis 245 Citelli, S.: Acute febrile epidemic myxedema with tracheal sten- DSIS oct s ameraetaasyeken oe enasce ts 385 Clerc, A. (Pezzi): Antagonism of adrenin and quinine....... 245 Glimacteric wn man. So. ee eee « 137 Climate and internal secretions. 267 Clough, P. W.: Study of the car- diovascular reaction to epine- DHL tyre oie i tekelsh es oie et 245 Colitis, chronic and the endo- CLINGS uepave aise eee eet aed 644 Collar y Jimenez, J.: Thyroid in- sufficiency Collins, W. E. cf. Benedict, F. G..345 Collip, J. B.: Antagonism of in in- hibitory action of adrenin and depression of cardiac vagus by a constituent of certain tissue BRUTACUS ose 6 ce al ee it oe 343 — Antagonism of depressor action of small doses of adrenin by tissue extracts......... 343 — Depressor action of adrenalin. 626 Comby, J.: Adrenal hemorrhage iv SCHUVATSR fcslsw. 102 — threshold value of glycosuria. 491 transitory hypermetrophia in.351 —treated with novarsenobengol. 639 — treatment .350, 634, 635, 636, 637 apy yOSMULE....----7 23: 349 of, by diet, exercise and hygiene ....-.-.--:-++- 100 complicated by pulmon- ary tuberculosis ..- .102 __ _ __ with eucalyptus......-- 105 —with exanthema, juvenile; TEGO, pop od Come On —_— goiter and Graves’ disease. 399 —xanthosis in me Nes ne teio O —_ x-ray treatment of adrenals. .617 Diabetic gamgrene ..-.-+---+-+:: 636 DAN GNOIMA es ee eles ss 302 Diabetics, preparation for opera- ROMO Cie ees eee se ces 349 Diagnosis, goiter ..-....-- 383, 384 —of hyperthyroidism .....--- 387 —-——_ myxedema ......---+---- 382 ——— hyperthyroidism .....-:-- 389 Diagnostic value of basal me- PDINNUISNTN, Bigte loo io CiGko oneal Orica 386 Diarrhea of endocrine, origin. . sa lalal Dias, A.: Influence of the glands of internal secretion on gastro- intestinal pathology Dickinson, G. K.: Man and the ei atetet etal iete= a eEngdOcrines’ 22... -22 essen = 791 Diet in diabetes mellitus. . POT, Zac —— hyperthyroidism ........-- 142 Differential cell count after ad- renal reduction .:..--..-.+--- 244 Digestion, internal secretions in disturbances of ....-...---+--- 523 Digestive disturbances and in- ternal secretions .....-.--:- 365 Diphtheria, experimental, hypo- physeal changes in.......--- 115 Diseases of ductless glands; re- view 2 Ditelli, S.: Acute febrile epidemic myxedema ......---+:- ZT nee tes Diuresis after hypophysectomy. .799 —and hypophyseal extracts... .378 —caused by pituitrin......--- 672 — effect of hypophyseal.....-.- 272 Ponath, J. (Lampl): Case of plur- iglandular sclerosis with elin- ical picture of Addison's dis- ESS ESI force, 2 och oestair = - 255 —___ relation of vitamines to...804 —origin of some intestinal GiGi Gaara no umeo. o 110 — literature, review of for 1919.112 — problems in pelvic surgery. . Seresitl — relationship of epilepsy...--.- 441 —stimulation of agglutinin for- TITAULOMM ele t ce ete) ceacrie sesier ote 253 — syndromes, classical ......-- 790 —system, role of in internal TEE UIME LEGS eens ails: «lel eurncu! oT aes 8 —— secretions on phloridzin glu- SUNT Umer ters fa ect eh colt tec) se 642 — therapy in cases of low blood PICSSUFE 22-0. eee es 773 eee QZCIAL vice = ss = 2) ee ait — transplants in the tadpole... .648 Endocrines, the ....----++++-:: 329 Endocrinology and infant path- GlGEA/ 15 Genieroes ono Orie, = oN Oe 791 —_— its practical application. . 192 ———opotherapy .--------+-+:: 355 tte DOATU!. « - sel. + ss eens 648 = se iP Endocrinology in relation to in- RANIUV Mra teat te ere eo 112 —— practical points in......---- 795 —_ Retterer and Vornoff on...-- 777 SVEN? Ole) bee cota Oe IOEOND CIN STOO 795 SO ane TG) byo ola a oO oboe O10. 080.9 610 Endocrinopathic nanism ....---- 353 Endocrinopathies, Bloch’s syn- Gbeonn\s) Gog gus d.o conc co eOan DIC Oop 112 Endocrinopathy following infec- Myre) gacca uo C00o bd om Ucn ONS 794 Engelking, E.: hereditary disorder of the in- ternal secretions ...---+--:-->: 267 Enzyme treatment of diabetes. . .349 Epididymus, secretions of...--- 809 Epilepsy, adrenal removal in.... cnet te velar tere 239, 337, 784 —anaphylaxis and dysthyroid- Tilsen Cho ortLe ye ame ouwora dO 683 ——and_ adiposo-genital dystro- jhe cagaeooassuaom ano ODS 123 = FiGhtmenk: Sodooobo 5000224 617 —_ —— hypophyseal adiposity....- 499 —of menopause ..-.-+--+-+:-5 805 — suggestive of endocrine rela- TiOMSEUP) | — hyperglycemia ....----- 630, 787 —— hypersensitiveness test in hy- perthyroidism and tubercu- losis differentiation .....-- 46 ——liberated from adrenals and relation to spinal cord..... 93 — output and laparotomy....-.-- 623 — post-operative depletion Of. . 62/3 Escudero, P.: Thyroid dyspep- 14 STAG ecto Mae wayne monet tous? poe kar 5 Etiology of endocrine syndromes (Smplllts)) GoosaooseogdggueS 12 Bunuchoidism ....--+++-+-+-:: 380 Evans, H. M. (Long): Effect of feeding anterior lobe of the hypophysis on the oestrous cycle of the rat.....----:--- 655 ___ __ Effect of thyroid feeding on the oestrous cycle.....-- 685 __ __ Effect of thyroidectomy on oestrous cycle of rat... .665 =r, ISG ee co Cio ao SOI OO 666 Exanthema in juvenile diabetes. eeu Exophthalmic goiter and its non- surgical treatment .....----- SVMS eye ee stellar 281-282 = Sint ony Oe Wee CoG oat 5 O85 158 _____ jndications for surgery in. .814 + Exophthalmie goiter, recent SLUGICS ON) Fone cikc si ee eee 689 —-—removal of right lobe and ASEH MUS EAs e057. ees Oh tee 692 —w—report of case........... 699 ————BUTZery, Of « .-4. 5c urd eters 158 ——— THESES! WOT) faynys}nestsrePoycesin etanets 682 Faber, K.: Case of acromegaly.361 (Norgaard): Relations be- tween glycosuria and gly- Cemian se yx She. area ee 490 — Studies on threshold for PIF COSUTIA eit ee oe ae 634 Fagiuoli, A.: cf. Ascoli, M......259 Fahr: Graves’ disease and goi- ter with heart complications..145 — Heart in goiter and status thy- MOM PHatiCuss —ela eee 817 — Heart in Graves’ disease and Foiten . Wesker ee 278 Falcone, R.: Interstitial gland PTARUINE sf. eee eee ene ii Falta: Case of thyreoaplasia...515 Graves’ disease and unilateral exOopHthal mis erences) cee lea — “‘“Mehlfriichte” treatment of diabetes mellitus ........233 —— VMenIinucht kin) = 2)-i-eeieeer 634 Farnar, E. (Klinger): Experi- ments’ on ‘tetany 4.2.0... see eco: —-— Experimental studies on COCA Y. -ocao cei eege. sree 375 Faroy, G.: Opotherapy of dia- betes and pancreatic insuffi- BIQNCY Tec aie SR ee 348 Fat diet in diabete§S mellitus... .637 Fatigue and gastric ulcers...... 91 —w—thyroidism ............. 154 — endocrine weariness ........ 793 Febrile patients, effect of pitui- tary injection on _ blood-pres- BUG OL cere ein ctete rela selena 125 Feit, H.: Hypophyseal cachexia; syphilis of the pituitary...... iti ly Fellner, O. O.: Ovary in preg- nancy. Interstitial cells..... 665 — Specific hormone of the ovary. 268 BSMUNMIGM "55 pier hiss ce eye be eens 380 Ferment changes in serum on thyroparathyroidectomy ..... 153 Fernandez Sanz: Hysteric chorea and hyperthyroidism ........ 145 Ferranni, A.: Acromegaly..... 479 Ferrara, M.: Hereditary goi- trous cretinoid degeneration. .685 Fettering, hyperglycemia and gly- COSUTIA, dieltos a. oe eee 618 Fever and diabétes............ 488 —-of sympathetic, origin (en- docrine) ici avs (Pende): Hirsch- sprung’s syndrome and diffuse Spinalieliosisiax shosssis.sdocte exer 139 Finney, J. M. T., Jr.: cf. Sisson, Wi RSS, as, estes) eceton nears oe 08 Fischer, A. W.: Pathology and surgery of the prostate with reference to Steinach’s experi- ments — The lethal dose of adrenin in STUGUT se ss ang! eos) br UCR ee 95 Fischer, H.: Adrenals in spas- MODDUIA «25 ws sc se coeetetet cence 480 Fitz, R.: Relation of thyroid to diabetes mellitus °...0) sos 492 Flaecher, F. (Reuter): Products from hypophysis ........ 259-260 Flajani-Basedow’s disease, ther- ADV OF Mercy uve, sissoselshane ea ee 396 Fleischmann, O.: Relation of cerebro-spinal fluid and hypo- DEYVSISE. osc. «cena oihexoceneo ene 798 Fliess, W.: Diagnosis of hypo- physeal asthenia ........ 261-262 Forcada, F.: Embryology of the AGTeENATS? oo, 5. 5.6,6 eysn-kes suse 781 Florecken, H. (Fritzche): Trans- plantation of parathyroids in post-operative tetany ........ 270 Foerster: Dystrophia adiposo- SeONUALIS. oc sas sees sae hee eee 117 Rorman, J::) | Ci. Amb en Ga oe 617 Forssman, J.: Cause of anaphy- lactic: shock, «)....1-sicnscreneienet 337 Forster, W.: Testicle transplan- TATIONS «6 oees.s, ses tye ae 675 Forsythe, J. A. C.: cf. Cam-= MiIGSe: os: Foe c, sscktes eee 372 Fraenkel, M.: Connective tissue in defense against cancer and as endocrine structure....... woes Fraenkel, L. (Geller): X-ray application to hypophysis....799 Frank: Pineal tunior:.. 5.00 269 — Pubertas praecox .......... 671 Frank, E.: Renal diabetes..... 635 — Vagotonia; a review........ 827 — (Stern and Rothmann): Guan- idin poisoning, .....)-ieeee 669 Frank, M.: Pseudohermaphro- Gitisms SUrZeEry ini. . cee 795 Friinkel, H.: Endocrine organs anid) the? X-ray. ;s.«.... sioner 644 Frantz, M. H.: Hyperthyroid- ism. in: a-child...;..-i. eee 817 Frazier, C. H.: Management of toxic goiter from surgical point Of VIEW ae 65% © wale. cha ee 46 Freeman, L.: Tourniquet opera- fion: in.” goiter.) ak .2 eee 146 Freudmann: Adrenal infarction. 240 Freund, H. A.: Basal metabo- lism in hyperthyroidism .....- 685 Frey, H. (Orzechowski): Rela- with otosclerosis .....-- 270-271 Friedman, E. D.: Internal secre- tions Friedman, G. A.: Relation of adrenal cortex to Graves’ dis- ORR cic aly ol te ae Ononaiees noi outa 781 Fritzch, G.: cf. Florcken, H... .270 Frohlich adiposity, basal metabo- hismianecase OL... 2-6 se ses 659 TA ITULANESTYLL wich aie che whe eS = we 364 — disease, report of case......- 325 PEECVGMOMUG) =) 4+ icin cies oe 361 == and diabetes insipidus....160 —— due to midbrain, not hypo- physeal lesions ......-- 128 Frontali: Congenital bone fra- gility and the thymus........- 679 Fugii, I.: Chromaffin content of adrenals in experimental punc- FUME VOHADECEES! |. scien ee a 337 — Fetter hyperglycemia and gly- MERQSUE UD ccs yc weet oe heist in eel 618 Fiihner, H.: Hypophysis and its active principles .........--- abil) Fulchero, A.: Reactions of hu- man heart to adrenin........- 627 Fulton, J. F., Jr.: Controlling factors in amphibian metamor- PINOHIEY G60 o> polo o Gus worn Funaioli, G.: Heat polyuria in GLMITHAS 3 Gro-Bpo oli cere Oporochas 655 Furth, O. (Lieben): Colori- metric studies of tryptophan. .387 Fussell, M. H.: Diagnosis and treatment of hyperthyroidism. 387 Gadani, A.: Case of geroderma genitodystrophica with convul- SHORE 5 go acy eo meommoe lo coo. 649 Gagstatter, K.: Hypernephroma.619 Galan, J. C.: Action of hypo- physis extract on gastric con- PACENGH) ie ucicie dares ere) hsieual ona 798 Galan, J. S. (Houssay and Ne- grette): Action of hypophyseal extracts on diuresis in dogs and SEPT eae cee ot oo oo 20 Gallavardin, L.: Tachycardiac neuroses and abortive Graves’ ANSE AS ED Ge o.scers ios oye) wins maphehewnuepetons 146 Gallie, J. G. (Scott): Introduc- tion of labor, with pituitary 2559 REND Cae SRS em eo, ae cone mean 55 1° Gamero (Gutierrez and Acosta): Adrenin, injections intralaryn- geally in the treatment of chronic bronchitis and bron- chial asthma ..-.-.-..------:; 96 Garcia Guijarro, F.: A goitrous region in High Maestrazgo....817 Garcia Lagos, C.: Case of Froh- lich’s syndrome Garibaldi, G.: Alterations in the Adee) goon oo une DOM OU G 338 Garin, G.: Case of chronic troph- edema in hypothyroid subject .817 Garling, K.: The white blood pic- ture during menstruation..... 663 Garnier, M. (Schulmann): Saline hypertension following adre- bith i OU onc COCDO UO DONS 628 Gastric juice in pancreatic dia- iA ein Oe Oi Oc e AUS 789-790 —secretion, effect of adrenin (Siren, Sener onmenc oe cr Cao mpc cet 628 __— _____ pituitary extracts on. 656 — superacidity, adrenal therapy Fae MEE Blatter oe mae OS —uleers and adrenal insuffi- CICNC YAM et eee 91 Gastrin, response of stomach glands to —_——to, before and after birth. .64 Gastro-intestinal pathology as in- fluenced by the glands of inter- nal secretion .....----+-:+:-> 266 Gatti, O.: Simple hypertrophy of the thymus 512-513 Gayler: Abnormal growth in dia- betes insipidus ........-+--:- 798 van Gelderen, D. N.: Trauma and diabetes Geller: Experimental radiation of hypophysis Geller, F. C.: cf. Fraenkel, L.. SDE) —— Influence of x-ray on the hypo- MAE Goboconagoedeoude 362 Gellhorn, E.: cf. Abderhalden. . SA ee a OO oe bed 500, 643 Gemma, G.: Case of status thy- molymphaticus with rickets. . OMS) Genital causes of nervousness in > rs own the female, oem eles Sal: 5 Gerhardt: Three cases of dia- REN y einiee s cicis ia sGeGeNeu-euausuene ola 2 Germ cell history in the brook (GOREN, 5 o coool OOo oO 673 yf NTNIE ARIS) cle ae 6! ps) e =) =2 9 796 Geroderma genitodystrophica with convulsions, case of.....---- 649 Giacinto, G.: Cure of tubercu- IONE) Fah” Booonocods cumoo 387 Gianettasio, N.: Hypophyseal syndrome and craniotomy (case MENON) Seaaecooeneuonnaecot 656 Giavotto, G.: Case of thyroid CaLrcino-SaveCOMa cas oa ealer ae 685 Gibson, A.: Muscular infantil- ISMN ae Cee See sete o Goer 499 Gibson, R. B. (Martin, F. T.): Pituitary extract and histamine in diabetes insipidus......... 510 Gipantism: Casas Of). 7s. sees 640 Gilbride, J. J.: Undescended testi- cle in inguinal canal......... 807 Girand, G.: cf. Hedon, E.......505 Girard, J.: cf. ’de Massary..... 636 Girard, lie: ef: Mery, Beet... 643 Giraudeau, R.: Addison’s dis- ease; case of: ‘cured: =4.3-)..--. - 241 Giusti, L.: Adrenal removal in frop and wtoad air. chee cee 782 — Effect of poisons in capsulec- tomy and hypophysectomy. .782 Glandula insularis in woman of SA eesyanat sievche Se cen yaa OES 113 Gley, E. (Quinquaud): Relation between splanchnic nerve func- tion and adrenal secretion... .338 —-— Salivary reflex after adre- mM atlectOmy sae. cake teen 783 —=of- GAMUSAss tee peers ays ais ens 672 Givcemia critica). pcrse on ein oe 249 Glycosuria and hyperglycemia. .633 — during pregnancy ...... al TPS ies} —pphloridzin, endocrine secre- GLOTIS MON Memes saunas seem st © 642 ——= PON al phaCLOTsitl).t< ene © sen, sere 101 — studies on threshold in...... 634 Goddard, T. R.: Hypertrophy of the interstitial tissue of the testicleiniman). aces ae 138 Goetsch, E.: Diagnosis and treat- ment of hyperthyroidism..... 818 Epinephrin hypersensitiveness test in hyperthyroidism and tuberculosis differentiation. 146 ——a01,, INICHOISON, (Ne... en ae oe 394 Goetsch test, blood in.......... 486 —w— for hyperthyroidism ..... 818 — — of little aid in toxic goiter.146 Ober) Re A eee tee eee 280, 391 — case of — and cardiac insufficiency cured by x-ray treatment of OVATICS oc fara tog Oicts cue seeaane 147 — -— dystrophia myotonica ....273 — -— Graves’ disease with heart complications >...) mee 145 —— —— FORBI ae elo udliegs Melua os eRe 271 —-—tuberculosis ............ 514 — apical percussion of lungs in. .144 — classification for — clinical study of 139 cases...153 —cystic hemorrhage in........ 278 OLA SN OSA creo cee es nate tie 383-384 Goiter, diffuse colloid...... 389, 687 ——"BMASMIG tacts we wee eea soe 697, 815 —— prevention of............ 516 —— prophylaxis ............ 516 — epidemic increase of, in Buda- pest; infections etiology pos- tulated sas. sen. cee 156 — etiology; prevention; relation Of Sodin’ 't0:. Si.00 6 preieees 820. — exophtnalmic 1 5 settle 521 —— and corneal ulcer......... 154 —-associated with Addison’s disease, opotherapy of.. 92 — — case of in boy of 14....... 158 — hereditary and familial. ..398 —— — non-surgical treatment of. .151 ——— relation of adrenal) jcor GOX. tO) lS oysters pees eae 781 — — — — to cardiac neuroses. .146 — — results of surgery of...... 150 —-some pitfalls in the diag- NOSIS:OL f=. auis «yn eens 143 — -— special consideration of ade- noma in relation to..... 143 —— ——Isurgery” Of 2) -)- = «paren 158 —-with adenoma, results of operations for » 2.22... 150 =—CXPCLIMONCAl <0). - steele een 649 —experimentally induced by water from Cerrillos...... 149 — hereditary, cretinoid degenera- CiON IN, = tice eee SE eee 685 — heart, in Aiea eae 156, 817 — improvement in the surgical . treatment (Of 2. =<. ate 148 —imcidence .........++-.ss08 518 —indications for and _ surgical treatment, Of (-i.0.tcne mene 94 —in Graves’ disease and dia- betes! hss sishan cits Oe 399 —— = OTIEN bal Sir eee et eee 396 —jintrathoracic diagnosis and management Of © 5-2 -e 152 — ligation of arteries in....... 152 SSSCWievechhy Reo nad. S oo 277, 399 — medical treatment of........ 395 — operation, ligation of thyroid arteries: iM)... « .s.-s.seeenene 280 ——_= fechnic. Of w.c.-y-nek Ree 386 — pathogenic organism in lymph NOGCS> .45 525+ 5: += 682 —— preyention | = :.. «5 + ,usilsinene 520 =——ProbDleM 6.0. osc ssh ee 819 === PAT DTN es Soe tok eee 382 — efion of, in Catalan’ .2.o- 824 — ——/jin high Maestrozgo....817 — remarks on — substernal — surgery...143, 520, 685, 688, 691 — — involving ligation of supe- rior pole of thymus..... 140 ' Soiter, surgical ....----+-+-+-+-> 278 Be FASPEGUS OL ~~ ole =) eh oe ir 820 a fechnic iM «2.2.6 eee es 278 me treabment OL «) «0 cn os 814 —_ three cases of surgery Olsens 394 — tourniquet operation Taietek ersten 146 toxic, basal metabolism in... 816 __ —- management of, from surgi- cal point of view....--- 146 —radiotnerapy in ..-..5 +5: 696 eee SUTeery OL .- -. 2 es 155 — treatment by x-rayS....----- 275 Sear various LOrms:. =...) - 823 — tuberculous cure ...--------: 387 — x-ray treatment....... 58831, Gss) — with acromegaly ....-----:- 260 Goldschmidt, R.: Sex determina- TIMBER) 6 lela 5b © 6 losoae nena Na 613 Gonads and metabolism .....-- 651 —__ —-sex development .....-.-- 650 — castrated rabbits, respiratory metabolism of ..-.------:- PHY TI —changes in, after removal of panereaS ..---+-+-+-+-::: 806 —— developments of, as influenced by endocrine factors in metamorphosis ...---+--:> 80 — dissociation of seminal and in- terstitial glands by alco- Tag |G yap 6 O)arneero olor eoiois 651 — disturbance of endocrine func- RELGHTAEV OTe ne ao ot oye, ct 5s"o.

354 Graves’ disease and diabetes, goi- chao hil Ee, Ga CAPR tar) Ee ORCA cACuG ene 99 SS = diabetes! imsipidusy = 3). 162 — — — goiter with heart compli- SCatlOUSieeiaeat einen 5 —_—_— the autonomic nervous EAA Bing oon ooo oo 246 —S HOI Hoon ook soe e 279 _____ — treatment with adrenin.127 tub erculosismns-icinr an 397 _____ __ unilateral exophthalmus.515 __ + plood presstire’ im). .- <==. 388 —_— developing into myxedema after treatment with TENENIS Aocnooacouse0m os 143 —_—— effect of operation for, on HlOOUE Me ae cee sete tas 397 — — glucose mobilization in... .825 SSG. AN ab coonomao meen Ho 388 — improvement after infec- LiOTM oe ook ee = medicalsaspects Of... «1 - 393 ——— —— aiilal aioe Cite n 6 ooo Oe mo 181 —_—_ myxedema after operation LOLA Er eier ache aboeehonsnc: = 152 — — pathogenesis and treatment.695 ___—_ relation of thyroid to. . 276-277 — —suprarenal therapy in... .699 — = HIPAA ocoedaonboobudoD 697 x-ray treatment... = 9 <==). 693 Gray, H. (Bloor and Joslin): Blood lipoids in diabetes..... 108 — (Joslin): Diabetes in chil- dren Griffith, F. R.: ef. WeT Bitte cans ele ins sates ne hoes 729 Griffith, J. P. C.: Infantilism. ..364 Grigaut, A. (Chauffard and La- roche): cf. Chauffard, A.....359 Grimm, G.: Influence of subcu- taneous adrenin injections on blood! picture Fo. 2h. Gee 95 Grimmer, W.: Abnormal goat WH 1s. Seeks ee Pore he eats ets ee Groedel: Cure of goiter and car- diac insufficiency by x-ray treat- Ment (Of (OVATIGS > . nth, -1es-ts =! 2b 147 Gross, A.: Corpus luteum of preg- nancy and cholesterol........ 632 Gross, E. G. (Steenbock): Effect of thyroid feeding on crea- tinuria Grote: Endocrine secretions on phloridzin glucosuria ........ 642 Grote, L. R.: Chronic colitis and the endocrines Growth affected by thymus feed- INES Sey aioe cee oie es eke ae 140 —and endocrine hypofunction. .495 — endocrine factors in......... 267 — hormone from nerve tissue. ..247 — in diabetes insipidus........ 798 — influence of hypophysis on.. .656 —of pelvis and ovarian hor- UOMC Eile ec hatol cls wt NCreeenn 371 — thymus function in...<..... 140 — thyroid extracts on.........521 Gruber, C. M.: Antagonism of epinephrin and nicotine, digi- talis and barium chloride..... 628 — Effect of adrenlain on tonus in terrapin heart — Epinephrin on auricular tonus.482 Grunenberg, K.: Involuntary nervous irritability in hyper- thyroidism Guenther, A. E.: Antibody pro- duction after partial adrenalec- tomv in guinea pigs......... 90 Guelielmetti, J.: Effect of adre- se) whe alee a; 8! ss. o2 ualin on muscular fatigue in BIENTOCACES VIS: se spay cco vauene eee 96 Guleke: Sporadic cretinism....389 Gund'lach. R.: cf. Hess. ...628, 656 Gunnar, H.: cf. Becht, F. C....786 Gunther: Dystrophia myoton- OS Re eee bee ets DANES) Gutierrez (Gamero and Acosta): Intratracheal adrenin injections in the treatment of chronic bronchitis and bronchial asth- TUB Sov.) elelicnchols pore ect Dues tours Guttmann, E.: Treatment of ovarian dysfunction with “‘ovo- DEO Fo isles Io Rone eee 268 Gynecology, endocrine glands in. 354 96 Haag, M. D.: Case of encepha- litis lethargica in a pregnant woman, QUtODSY . siesta 362 Haas, O.: Case of dwarfism....799 Haas, W.: Blood picture in case of post-operative tetany...... 271 Haberer: Graves’ disease and thy MUWAs? oss ohie-in we erat eee 279 Hagedorn, H. C.: Threshold value for elycosuriay.....« sone eee 490 Hagenbuck, M.: Strumitis..... 686 Halban, J.: Gonads and sex developmricent: »...:-.cies & vets elem 650 Hallez, G. L.: Anemias and splen- omegaly in infants.......... 511 Hallion, L.: Action of hypophy- seal extracts on the bronchial MUSCLES Hes «ss seis eye eLereeaene eee 656 —Action of sympathetic on suprarenaly: jc.%5. 2: eee 619 — Reaction of adrenal to adre- TD ssh ahed ons totais Se ee 83 — (Bensaude): Medication in asthmatic crises and the pathogenic consideration suggested ii. 3:.. joshi eee Hamann, O.: Etiology of cryto- plastic osteitis Hamant: Galactorrhea, cure by CuUret*taLe. b. aeouni a eee 28 Hamant, A. (Caussade): Late acromegaly aii. . oer ee 262 Hammar, J. A.: Analysis of thy- mus in 14 cases of thymus death ... sc sais |e ee ee 139 — New views as to morphology of thymus gland and_ their bearing on problem of the function of the thymus. 5438, 731 Hammer, A. W.: Thyroid gland and thyrotoxicosis Hammerli, A.: Hyperplasia of the salivary glands and endocrine disease Hammett, Frederick S.: Changes in the endocrine glands of a tumor-bearing female albino TEE.» csscnceansee nel ates dhs Seen 216 Stability of nervous system and resistance to loss of para- thyroids — (Tokuda): Thyroid extract and thyroxin on intestine. .818 Hanke, M. T. (Koessler): Hista- mine normal constituent of hypophysis cerebri Hannema, lL. S.: Case of xan- thosisdiabetica<. = -)..: «m+ see 250 Hansell, H. F.: Case of suspect- ed tumor of the pituitary ....262 Hanzlik, P. J. (Karsner, 13h Mee Epinephrin in anaphylactic Mile gco obo 0 UOC. ola Oro mOmES 83 Harber, J. R.: Acute hyperplasia of thyroid with dyspnea...... 687 Harrower, R. Harrower’s monographs on the internal se- eretions. Hyperthyroidism: medical aspects ...--++-++:: 613 — Hypothyroidism, infiltration and hypertension .....--- 687 — Principles of adrenal support.619 —_ Tests for hyperthyroidism... 819 Hart, C.: Endocrine organs... atrial Hart, G.: Status thymolymphat- icus Sco o Oe Eon Sener Hartert: Improvement in the surgical treatment of goiter... .148 Harvier, P.: Lymphosarcoma of PPEUVAIMAUNS|) yey ere) i= t=p's)2) oe tenie era 679 Hase, H.: Case of myasthenia STA noo omar aale.e enogwers 645 Hashimoto, H.: Heart in experi- mental hyperthyroidism ..... 579 Hastings, A. B. (Murray, H. A., cre Parathyroidectomy on dogs eae Clee pee Hauptmann: Dystrophia myo- tonica EEE Be be ec es ee Hauri, O.: cf. Asher, lite oe ee) Haurowitz, F.: Fat of gonads of Rhizostoma Cuvieri .....---- 650 Hautner, H.: Relations between the interstitial gland and tuber- ROVUGSSLS Pais cesk oh cycles layed ist Suciel m= 807 Hayes, W. W.: Gastric super- GKOKGHIN? somo DO Depo Cres oo moe 338 Heart, action of adrenin and chioroform OM: .). 2. 4-66-25: 482 — —-spleen extract on...... 674 —complications in Graves’ dis- CERIN” 5 Ge Ooo omd oy 5 bla on dD 145 — excitability, relation of adre- TANG! THOM SloucrOlciS Gales Biol th o.oONuySc. © 5 —jin experimental hyperthyroid- ism 3 oe a. Were ie au) — — goitre and status thymolym- phaticus ....---+---+:-: 817 Maes = GISCASC. mo wus +1 miei 388 —-——myxedema . Be ie ee TOI —_——yarious endocrine dis- (in| CLaS beni oot he — myocardial hypertrophy with adrenal tumor .....------- 239 — perfused, action of adrenin on. 95 —ryeaction of, to adrenin, in cardiopathies Hecht, E.: The cause of diabetes 9 MMOS on gb eoeadeatc og oe 261 Hedon, E. (Girand, G.): Rela- tion between pancreas and ad- renals et aOASe epee EAD OO Heiberg, K. A.: Behavior and structure of pancreas in dia- betes, in children.....-.-.--:-; 132 —__ Diabetes mortality in different pranches of trade in Danish towns ‘ Heinekamp, S. adrenin and heart Action of chloroform on Heissen, F.: Vagotonal diseases in their hereditary aspects... 402 Heitz, J.: Arterial permeability in VGIaDEtESy emis er eee ers 635 Hellier, J. B.: Case of osteo- malacia treated by oodphorec- tomy e Hellwig, A.: Diffuse colloid goi- eee ee rape Men er teie)y WEG Hemopathies and internal secre- TOMS: c efosticeo mide 5 ©, Oh tek aed 804 Hemorrhage of adrenal in man of 64 —pituitrin in Hemangiectases and adrenals. . 243 Hemianopsia, bitemporal, in hypo- physeal tumor and acromegaly. 259 Hemorrhoids treated by adrenin Tht{onOnMise Boe ec ouneecomobS: 344 Henderson, E. H.: cf. ING Wife Sige Sor Cons tio fe ori Oc? 915 Hendrix, B. M. (Crouter): Alka- li reserve in pancreatic dia- Tc ee Rem eee clots aor jo omer Henke, FE Modern view of status thymico-lymphaticus; relation to other diseases.....273 Hereditary diabetes.....-- 488, 639 Heredity and diabetes mellitus. 105 —-in exophthalmic goiter (See Endocrinology 4, 180).....- 398 Herman, G. J.: Therapeutics of pituitary extract ......-.--- 362 Hermaphrodite, Chinese......-- 498 a HaSticlerOlia crater tier) isle 676 Hermaphroditism ........----- 673 —and homosexuality ..-.-.-.-.-: 359 ==y-qosypuakerie)l Se ao oomds sooo O° yal == salennaliiehe 6 46% ace pe Bo OOS 649 Sin, Cities 8 sac clowbp acme co C 497 ae eS ORTGE Sh ela enna een oes ore 497 == == HOEI, CESS Os mug ae wiotos 114 —— = hinksha eoapieio sue oo cect dhal £ 498 == jG). Sonopdu due oleD wm cot 649 — pseudo and castration....... 673 =— the skeleton ims... ii. . sl ke 25§ Hermaphroditismus glandularis. 652 Hernandez, J.: cf. Bosch, B....360 Hernando, T.: Adrenal insuffi- ciency and gastric ulcers....- 91 —Endocrine origin of some in- testinal changes Herring, P. F.: Effect of preg- nancy upon size and weight of organs — Effect of thyroid feeding and thyroparathyroidectomy ...688 Herrmann, E.: Corpus luteum and placenta lipoids in men- Strual conditions... . oe 632 — (Stein, H.): Corpus luteum and placenta as specific sex MOWHOVSS i retetenste see rate 487 Hess, W. R. (Gundlach): Influ- ence of pituitary extract on PAasiric, SeCreLcion. seis ter 656 — — Influence of adrenin on gas- trie secretion) .<.% 2. :/=: 628 Hesselberg, Cora (Loeb): Suc- cessive transplantation of thy- roid tissue into the same host.148§ Heubelin, A. C. (Brayton): En- larged thymus gland in infancy and its treatment with ra- CRW 2p he sare ees cee ee 139 — cf. Brayton; EW... os ee eo Heudorfer, K.: Epithelial pig- mentation and Addison’s dis- CNS Aes Am ha GS VERO OG 619 Heuer, G. J.: Case of gigantism in) Siri vot: 2". +245 eee 262 le Heux, J. W.: Cholin as peris- talticshormone: 2.25... eee 247 Hewitt, J. A.: Effect of adminis- tering thyroid on organs in rat.148 Heydloff, E.: Studies on recovery from narcotics through injec- tious into ‘the heart...4-7. 5... 96 Hibernation, effects of, on hypo- DAVSIS MEE Fs ae ae Se 33 Hildebrand: Kidney premeabil- ity in adrenin diabetes....... 629 Hildebrandt: Diminished renal permeability in experimental adrenin diabetes ............ 344 Hilgenberg, F. G.: Bleeding after goiter removal......... 688 Hinz, ©C.: War diet and hypo- UNVTOIGISM occ ee se eee Hirsch, 0O.: Tumor of hypo- LTS AS RA A ae et NNR 2 656 Hirschsprung’s syndrome and dif- HUAG HPINAl PUOSIS \. coke. Bevo 159 EAU DIB IED 50ers kaha se) yn) has can areas be 354 — and diabetes mellitus........ 491 Histamine and hypophyseal ex- tract on blood pressure......363 —as gastric stimulant..... 496-497 —in diabetes insipidus........510 —w—the pituitary ...........509 Hitchock, C. W.: Glycosuria during, pregnaticy ...2°70%. 20. 113 Hitzenberger, K. (Richter-Quitt- ner, M.): Metabolism in hy- PHrlonia. Tats vse + hee 663 Hoffman: Dystrophia adiposo- genitalisee OC 8 ie tee eee 263 Hofmann, A.: Scissors for goiter SUTEERY. Sos sek eee Re ee Hogben, L. T.: Influence of the ductless glands upon amphibian metamonphsis® ©). vase pees 353 Hollenberg, M. S.: cf. Vincent, Six Piya ota sca eg ok tice eee Hollister, Gi: ck. Stier! 2. es 795 Homosexuality and hermophro- ditism) 2S oes ou “cher S.. cee 359 Hood, C. T.: Hypertension and arterial Dbprosis.".).. > ucts 339 Hormone of the ovary and pla- COntais aes 265s Ses ote eee 268 Hormones and emotions....... 197 Horowitz, Philip: Diabetes.... . 778 Horrisberger, W.: Effect of thy- roid on phlorizin diabetes....819 Hoskins, Margaret M.: Extirpa- tion and transplantation of thy- mi in larvae of Rana pipiens. . 680 — Extirpation and transplanta- tion of the thymi in larvae of Ranavysylvatica. . =. 552/28 763 Hoskins, R. G. (Ebaugh): A case of dystrophia adiposogenitalis. 21 Hotz, G.: cf. Enderlin, 2.2. ou. 386 Houssay, B. A.: Action of hypo- physis extracts <. [eicweree oe 799 — Adrenals in relation to the ac- tion of hypophysis extract. .783 —Adrenalin discharge of splanchnic nerve ......... 483 — Adrenin discharge and splanch- nic stimulation j2:-..=-.-- 483 — Experimental goiter ........ 649 — Experimental goiter induced by water from the Cerrillos.149 ef; ‘Catan; Mi. JAS Se 2 cee 618 — (Cevera, L.): Puncture of bulb and adrenin discharge. 483 — (Galan and Negrette): Ac- tion of hypophyseal extracts on diuresis in dogs and rabbits: .,... 05 ).see ee 120 — (Hug): Diuresis after hypo- DHYSCCtOMY ... <'s opens 799 —w— Thyroid removal from OTSA ce mie seae eer ors 68 — — Thyroidectomy in the horse.149 Howard, H. A. H.: cf. Cam- pei tot ee eee Bo AIA Bosh tous Howard, W. F.: Toxic thyroid.&19 Howland, J.: Idiopathic hyper- trophy of heart in young chil- dren Hoxie, G. H.: Endocrine exhaus- (OIG) Dl Cage Ole Ronan tro eeero rena ree 642 —— Endocrine therapy in cases of low blood pressure....---- 773 Huebschman: Pubertas praecox.671 Hug, E.: cf. Houssay, Buds J688., 7919 Hug, H. (Houssay) : Thyroidec- tomy in the horse...-...------ 149 Hiirzler, O.: Ovarian influence on NOG ehY neo ood oo co Ob OO 665 Hutchinson, W.: Our internal sugar shortage ....-.---- * po a0) von der Hiitten: X-ray treatment Gn EGiGe Sognceng se ooe ce amp 689 Hutter, A.: Case of myasthenia arog} 50-5 cen eos DoD IO es oR 645 Hydrocephalus and atrophy of Phe adremalsie .. c0- che 240 Hyperglycemia, ALAS OEN 5 aoc oe 90 ——fibiulil eos Or oo ome oe ooicoK 786 — and glucosuria ....------:- 633 —— glycosuria due to fetter- ike apdouncoosceu nooo 618 — produced by epinephrin.....-- 630 Hypergonadism - vicarious men- struation eee To ten etree os) Hypermetrophia in diabetes.....3al Hypernephroma of adrenal..... 244 — symptomatology and treat- nian Ol shoommnooo doco mG 784 Hypernephromas, results of sur- Oa OF po cp ooo Ob eo mee ao OOr 243 Hyperpituitarism, report of case. 800 Hyperplasia of interstitial cells. .190 Hypersomnia and thyroid insuffi- CUBA aod oe aoecoRc ceo eb poe 399 Hypertension reduced by thyroid ANOTADY) Pers -t= ili: seen yuo 687 Hyperthyroid emotional tachy- comb Sapo rees.o ce Oeuben ocd 126 Hyperthyroidism and exophthal- mie goiter, results of operation TO pe rel che cbene) ekehensitene Ce kee 150 —_ — hysteric chorea ..--.---:-- 145 a ental disOlders) ..-- =~ = - 156 —_ — pseudo-hysteria ....-.--- 149 Se ALD ELCULOSIS! +. rele ee 824 — associated with urticaria and tonsillar infection .....--- 142 ——pasal metabolism and pulse MEANS), G eon sob Gloucs GOie ono ooea 696 a Sele Sl osoid obi Oe ees 0 685 __ differentiated from tubercu- Werte! ecloc scl OO u > noma 394 — etiology and treatment.....- 822 ——favorable influence of iodide in two cases Of........--- 144 ——heart in experimental...... pong. — involvement of hypophysis and Aishwsoeiin’ Goadaoogodey so 825 =—— medical aspects .....----2.55 613 [iyperthyroidism physiological. . pe berier? — related to emotion and adre- aise CBee mene er 0 98 — surgical treatment, amount re- moved and permanency of TOC hus sekePa eco.) c cncacens 142 GE OID Esigd aes TaD toe 819 —_ treatment by quinine urea in- amon) Bgeacde boned Ore 157 — (toxic adenoma) ; history, sympomatology with basal metabolic rates ....------ il Hypertonia, metabolism .....--. 663 Hypertrichiasis in childhood... .792 Hypertrophy of interstitial gland ya al COON Cy eye tay e-em 651 Hypogenitalism .-...---;-+---- 380 Hypopituitarism and diabetes in- SULCUS! yee -) = > i) oes sel dep eel 160 = TepOGt Ol GAS CH -i-)-neen ese 3215 Hypophyseal abnormalities..... 660 —— adiposity and epilepsy....--- 499 —_—— with poliomyelitis .....- eili22 ——and pineal extirpation... 221 — cachexia te Pee tS eer eee ee a eo disturbance diagnosed early by opthalmic examination. . S01 SHON ARISTD cee eyeteeys) ord n cies 799 — extract in diuresis......-.-- 3202 —_. __ —- Raynaud’s disease. 264-265 TA CULOM MOL spalemaiciebsder oly © mien ne 329 _______ —_o9n bronchial muscles.656 —_ and water absorption from the small intestine.....- 378 = therapeutics Ol «si er ~ oe = jWeuhbits graoconovomope a=c OD 448 _ insufficiency and diabetes in- iil) op aneoocus= > -< 159 —__ —— due to syphilitic lesion . 109 ——opotherapy in diabetes in- Syonsbts! Goon ooceo os 56 135, 654 — syndrome and (case report) ....--:.- . 656 Nera Vere ake 499 —— tu berewlOSisi gate 5 3 oye .656 Se HIMOTS EE ich aero e Hao ———_ report of case. =... =. sat Hypophysectomized tadpoles unit- ed to normal individuals... - 658 Hypophysectomy, diuresis after. .799 —_ effect of poisons after......-.- 782 Hypophysin, sensitizing action of for adrenalin Hypophysis, acromegaly of acute fa fOMNIAR coocodod dss 2 owls 363 —achondroplasia ....-.--- By kes) action on renal function. 125 — iMoleroray Olio ogc one ooo: 108, 109 ——and blood sugar regulation. ..494 ____ diabetes insipidus....86, 364 PS aniGLsi Fo aabist ace eee Co Hypophysis and its active prin- Hypophysis Extracts and _ hista- ciples” se Se ee ine te See 117 mine on blood pressure....... 363 —w—pigmentary, growth and —— of, effects on gastric secre- endocrine disturbances in TOR. |S RE erates 656 PAG DOIES Fore Sat ates ran eee 234 —-—jin diabetes ............. 657 — — pineal in pigmentation — — influence of, on peristalsis. 800 ehanres').)- elise). fer o etere 659 —-—titration by the islodate — PN OSEALE. (ails oie) ) 1) 11-57 oe EEC? oe 461 —-— present knowledge of..... 125 -——significance of in disturb- ances of metabolism and GIPESHION. 2. onic scpey bees: — -—the principle of..........365 —-—tissue extracts ..........§ 00 PNDCTANIAT) COMB in, 2 Sec cated Soe 615 — — after ligation of vas Geferensel es... viet exe 795 — — hematopoietic processes in gonads, of birds)... ..< 5257 — —of ovary in pregnancy..... 665 — — — testis and vital dyes....138 — gland and secondary sexual charactersy . Shine acer 808 —-— embryology of .......... 808 — — Of bOar> .).i2\sedtn ses, s 02 a aes 809 —-— (testis) grafting ........ 675 — -—relation to tuberculosis. ..807 —-——tumor of, their develop- IMMEDI aaa eens aie 677 —-— what it is and its supposed PUN CLIO) 43 Slo cste rere 808 — tissue, changes in in mam- malian testis! .-: ccf. .-6o.<0s sexe 190 — — effect of radiation of hypo- physis ‘on se Somes % 798 — — hypertrophy of, in testis...138 Intestinal changes of endocrine OLIPUH : See ers, teeta 110 —— toxemia and thyroid changes.155 Involuntary nervous system, blood picture in, and disorders of...246 lodide of sodium, effect of feed- ing, compared with those of EO YROMG! ote ccs ous ete eerece 684 lodine compounds on metamor- ONOBIB | sei se Scone, oro aie 682 — distribution in thyroid......399 ———— of in thyroid............ 826 — effect of on ovary...........268 — feeding and growth compared with thyroid effect........ 384 — in prevention of goiter......516 — relation of, to amphibian meta- morphosis and to thyroid ULVICY © \as.5.'0 fo Goo a eto wuts 67, 2 — treatment of thyrotoxicosis. ..281 lodothyrin treatment of infantile MV RCOCIN A. shaseaste, ani peer eunmees 814 Irwin, H. C.: Goiter problem...819 Isaac, S.: Treatment of dia- MGUES cece ates cecche a trays ies chu ke eae 635 Isola, A. (Butler and Musio- Fournier): Oxcephalia and PSUSUTREA MINS «sites es 61's) tae 'o) eeect aioe 129 Izar, G.: Hypophysis and sclero- SUTIN a oo, a neh v, iso, a scp oop TS 120 Izard (Lereboullet and Mouton): ef. Lereboullet Izquierdo, J. J.: Changes in blood pressure in case of hyper- vagotonia caused by _ intra- venous injection of adrenalin. . 607 Jacobson, C.: Study of hemody- namic reaction of cerebrospinal fluid and hypophyseal extracts. 127 Jacobson, T. B.: Cases of dia- betes Jacoby, A.: Effect of thymus and mammary on menstration....680 Janney, N. W. (Henderson): Di- agnosis and treatment of hy- POUNYLGIOISM «26 2s. eee 515 — (Newell): Treatment of dia- betes complicated by pul-~ monary tuberculosis ...... 102 Janzen, E. (Brockman): Heredi- tary diabetes insipidus....... 639 Japelli, A.: Recent studies on Flajani-Basedow’s disease ...689 Jarisch, A.: Action of thyroid on ta@Moles® 6s /.u5,.. 6. sys ieee eee OMe Jastram, M.: Influence of iodine On “Che OVARY. « ..03.< scresr eee 268 Jelliffe, S. E.: Hypothyroidism and tabes/idorsalis. «>; .. eee 819 — Parathyroids and convulsive States: «.scscps,4n5 = Sie 376 Jemma, G.: Case of status thy- micolymphaticus and rickets. .811 Jensen, C. O.: Standardization of thyroid preparations by use of axolotl Jewesbury, R. C.: tonia Jobling, J. W. Case of myo- (Peterson and Egegstein): Serum changes following thyroparathyroid- ectomy ferment action....... 153 Johns, F. M.: Blood sugar estima- tion’ in’ ‘diabetesin.-. a. . sere 788 Johnson, C. H.: Diagnosis of hyperthyroidism Johnson, W.: Hyperthyroidism in exhaustion 2.2.5. .2<, 3. eee Josephson, A.: Distortions of the visual fields in cases of pitui- tary tumors Josephy: Syphilis of the brain with changes in the hypophysis....362 Joslin, EK. P. (Bloor and Gray): Blood lipoids in diabetes..... 1038 — (Gray): Diabetes in children.102 Judd, E. S.: Laryngeal function in’ thyroid CASH so 00. 1. «ts stone 690 — Results of operations for ade- noma with hyperthyroidism.150 Judd, E. S$: Results of surgical treatment of exophthalmic goi- SRE Reicione Ce aor Gee ee 150 Juarros, C.: Hyperthyroidism and pseudohysteria .....-------- 149 —— Peculiar variation of Bloch’s syndrome ......--+-+---:: 112 Kiigi, Adrienne: Blood changes produced by adrenin.......-- 246 Kahlmeter, G.: Histological struc- ture of the hypophysis and hypophyseal adenomas in rela- tion to acromegaly......---- 263 Kahn, M.: Pre-operative prepara- tion of diabetic patients and their subsequent treatment. . .349 Kahn, R. H.: Action of thyroid and thymus on frog larvae... .690 Kaiser, A. D.: Use of atropine in the treatment of the hypertonic Wait. 4 ope Geers Mies cee DO oipeceto 402 Kalmus: Seven cases of nocturnal head eshakinig 2/05... ce iss 150 Kaplan, D. M.: Endocrinology and its practical application...... 792 —— Internal secretions from point of view of practical physi- Gui erohsestchoayalokiegs Saeio auciOwdn 660 Karsner, H. T.: cf. Hanzlik, P. J.. 483 Kaspar: Myxedema......------ 280 Kastan: Hypophyseal adiposity with poliomyeletis 12 Kato, T. (Watanabe): Adrenin mydriasis in chronic nephritis. 344 Katz, J.: Pathological conditions of the female reproductive or- gans and gastro-enteric dis- PAID ANCES Garb ale ers OS Kay, M. Boyd: Hypopituitarism- TRAN Lolal TAA OYE 5 o Once Ourn Sueec om Oro 5 325 Kay, W. E.: cf. Brock, So a 493 Keith, A.: Studies on anatomical changes in certain growth dis- ONGOLS MI Nebr cieh oie) alee = Met okehant 127 Kelker, G. D. (Stanley): Testicle transplantation .....-----+:- 138 Kellaway, C. H.: Effect of dietary deficiency on suprarenals....-. 620 Kellmer: Idiocy .....-.---++-:: 690 —_ Four cases of cretinism..... 280 Kepinow, L.: Correlation between vasodynamie action of pituitrin Pisislyoldeevee 5 Soro om 2 5 Ge 122 Kestner, O.: Internal secretions. 267 Ketone production, amount of carbohydrate necessary to pre- Vishohth otc. fees. GARD Oko ROE 2 DEC tO 788 Kidney permeability diminished in experimental adrenin dia- BOCES ee Ck oan i emar cee ue 344 Kidneys and hypophysis in dia- betes insipidus ...-.-------:- 86 ——in diabetes insipidus.....--- 261 Kimball, O. P.: ef. Marine, ID YS Minict Beoas csicnc Daan 520, 820 Kishi, I.: Formation of parathy- roid immune bodies....----- 670 idtsne Ch d& Ae eee Calcium metabolism in parathyroid WEA woke ooba shane Ds oN’ 670 Kleinschmidt, H.: Spasmophilla. 376 Klempere, G.: Yoghurt cure of Gites ooidoeosdnmoeueuo as 349 af Klercker, Kj. O.: Relation be- tween diabetes insipidus and disturbances of hypophyseal GMO) Gooooew cone Uo oc 263 Klessens, J. J. H. M.: Double pa- ralysis of the plexus femoralis simulating Addison’s disease caused by an abdominal tumor. 241 Klewitz, F.: Non-surgical treat- ment of Graves’ disease....-- imal Kein, H.: Lipodystrophia: Case WANA BHaoceoprosuoe cece oc 671 Klinger, R.: Antagonism between spleen and thyroid........-- 390 Influence of hypophysis on Faqs B pipe Golo oo ome oI oS 656 __ prevention of simple goiter. .516 — Prophylaxis of endemic goiter .516 —_ (Farner): cf. Farner, E..269, 270 SP iote Marner w)cr-elel eis) sien 375 Klinkert, H.: Myxedema......- brie Oy —— Tumor of hypophysis.....--- 499 Knabbe, K. H.: Morphology of NCE a enc oUMoommE DOr OH OE 507 Knowlton, F. P.: Carbohydrate metabolism and diabetes....- 788 Knowles, F. C.: Hypertrichiasis in childhood 7 Koch: Abortive forms of osteo- malacia Koessler, K. K. (Hanke): Hista- mine normal constituent of hy- pophysis cerebri ....-------- 119 tion —— (Ojrstea labor Kolm, R. (Pick, E. P.): Adrenin action and vagus stimulation... 484 Koltonski, H.: Osteomalacia...570 Kondoléon, E.: Enlargement of mammary gland after pros- tatesotomy Korb, J. H.: cf. Kostitch, A.: Dissociation of seminal and interstitial glands by alcoholism extracts as aids in \o =) Kostitch, A: Effect of alcoholism on spermatogenesis Krabbé, K. H.: Infantilism..... 354 — The pineal gland in mammals.377 Krasemann, E.: Precocious men- SUNG tale, hee, nisl oie int ee ol ee 805 Kraus, E. J.: Acromegaly......263 —Changes in ductless glands after removal of pancreas. .806 Kraus, E. T.: Acromegaly......362 Kraus, W. M.: Pituitary tumor in two cases of nanism...:..... 122 Kredit, G.: Case of hermaphrodit- ISMN) LOACT WV -1 6 rectum and stomach........- 96 Lessing, Oscar: Internal secre- tions in dementia praecox... 233 Leucocytes, changes in numbers of, after injections of iron and HlmAcoicl Sopa an cco > Uomo no 402 phagocytic properties of, in iehiaieyeitesn Gaokala UO cro cioeioe Oho 352 Leupold, F.: Relation between the adrenals and male gonads... .236 Levi, G. (Cervello): Action of iodine and adrenin on living surviving cells ....---++-+:-:: 245 Levins, S.: Goiter incidence in over one thousand individuals.518 Levy, F. H.: cf. Dresel, Keane es 787 Lewis, F. O.: Pituitary tumor operation by transphenoidal THOUS ooo ob Gn Oe.o b.wbO i D.C GoDe 363 Lewis, J. T.: Sensibility to toxic substance of rats without ad- renals Lewy, F. H.: cf. Brugsch....... 644 — Ce, IDE TAGS Rio op croseenD ood Leydig’s cells of testis and vital GER on Oe OOD Ob eo OOD 138 Lian, C. (Welti): Hserine sulfate in treatment of tachycardia. . 691 Lichtenstein: Steinach’s opera- ion) Yona) ike oo oo mon oo ooo 257 Lichenstein, R.: Transplantation OLPCSULGIG) Me alc giles ceta re coe gs ws 807 Lichenstern: Abnormal sexual de- RATES 1 eee AE Me Tele ie. le sites es ile Die Lhieben, F.: cf. Furth, O...:.... 387 Liek, E.: Steinach’s studies on rejuvenation .......-.----++: 257 Lim, R. K.S.: Brown granules in endocrine organs ......---> 495 — Histology of tadpoles fed with (Dav sHONGL a col Nooo ace Oh 152 Thyroid gland .....--»--; 390 ew ip Bey 5 bas Oa. a b-amioEe Ging ic olor 498 Lindblom, S.: Case of severe dia- betes with multiple endocrine disturbances ....--.+--+++-:> 250 Linhart: Goiter ......+-+-+-:: 280 Lipemia complicating diabetes. .101 Lipodystrophia, case Oferta te 671 — p©rogresSiva .....--+++:25-> 369 ee ENCASCHONe thane ancenens oleh ot Tons 804 Lipodystrophy, symmetrical, case of 9 Lipschitz, A.: Endocrine func- tion of the testes.......---- 675 — (Ottow and Wagner): Changes in testes after partial castra- tion 809 _* = Partial castration’ 92-0... 810 —_—_ — Testes in partial castration. 809 Liquor folliculi, enzymes in the. .372 Litchfield, W. F. (Little): En- largement of the adrenals ina fatal case of diabetes........- 339 Little, E.M.: ef. Litchfield, W. F.. 339 Lisser, H.: Influence of pituitary secretion on prostate.....--- 800 Liver, action of adrenin on stored Moen CM BoogodousogoRs a2 —and pancreas development. . FeO — stimulation of nerves of.....- 129 Livet, L.: Obesity following en- cephalitis lethargica .....--. 661 Llosa, J. B.: Comparative action of histamine and hypophyseal extract on the blood pressure associated with adrenin...... 363 Lobenhoffer: Ligation of thyroid arteries in goiter operation. . .280 Loeb, C.: Deep x-ray therapy in tumors of hypophysis.....-- 3863 Loeb, J.: Internal secretions as a factor in the origin of tumors.367 Loeb, L.: Heterotransplants of the thyroid 5 — Organ transplantation: ovary, testes 5 — (Hesselberg) : Successive trans- plantation of thyroid tissue into the same host....... 148 — (Kuramitzu): Influence of lactation on the _ sexual ONG | Seatoo do agen ooo0 ae 665 Loeper, M.: Flatulent dyspepsia of Basedow’s disease....---- eal Loewe, S. (Simon): Peroral ad- ministration of adrenin...... 340 Loewenberg, S. A.: Case of acro- megaly of acute onset...... 363 Loewy, A. (Zondek): Ligation of spermatic cord on metabolism. 651 Loffler, W.: Addison’s disease. . .340 — Blood sugar of old age..... 636 a Lottier, W.: Internal secretions and nervous system......... 808 Lombroso, Ugo: Carbohydrates in surviving liver of depancrea- GIZMOS. ociels crs «5,55 slae eee 668 — (Artom); Glucose metabolism in surviving organs....... 345 — (Luchetti): Glucose metabol- ism in surviving organs. ..345 Lommel: Endocrine disturbances. 356 Long, J. A. (Evans): Rapid maturation of the ovary by transplantation of the youthful gland to the adult.......... 666 Ss, hss Sas oS 655, 665, 685 Léning, K.: Organotherapy in Giabeles? a. ne) - cc wees ees 636 Lopez Albo, W.: Is there a hy- pophyseal form of adiposis Golorosa! 2 eo eeeeee 800 Lopez, J. A.: Internal secretions And tupberculosish.. s+ - ie 368 Lotsch, F.: Goiter surgery...... 691 Lowrey, L. G.: The effects upon the blood pressure of the injec- tion of adrenalin in dementia MPCCOKGa ss )-ciea re era i i 97 Lowenthal, K.: Interrenal and ad- renal system as one organ with homogenous function. ..242 ——Status thymicolymphaticus as independent disease ...... 812 Lubarsch, O.: Diabetes accom- panied by generalized xan- HHOMIALONIC = eer taeie: cian eiear an 350 2) — Diabetic xanthoma 5 Luchetti, C.: cf. Lombroso, U...34 Luden, Georgine: Importance of visualizing established scien- tific data with reference to the size of the body cells and their chemical supplies in the circu- lating DIGORNs siete. mete = + abeta a tae 715 Ludwig, E.: Development of liver, pancreas and fore-gut in the duck and the mole.......... 374 Luelmo, A.: Hormonic correla- Honvin Cmovion i. aioe el 796 Luengo, E.: Encephalitis lethar- gica and pituitrin........... L273 Lues, hereditary, retarded...... 143 Luksch: Glandula insularis (of Pende) in woman of 34...... 113 Lundsgaard, C.: Determination of carbohydrate tolerance in pa- tients with diabetes mellitus. .492 Lydston, G. F.: Two remarkable _eases of testicle implantation. 676 Lymphatic constitution, abnormal blood picture reaction to ad- renin in Lymphatism and internal secre- tion io. taste oe rok nearer aL Maas, O. (Zondek): Case of dystrophia myotonica ....... 254 McArthur, L. L.: Tumor of pitui- tary) (casesreport),. oe. «cite 657 McCarrison, Robt.: Dietetic de- ficiency and endocrine activity. 356 — Edema and beriberi......... 621 McOlure, BR. Di: ck Parkes. 680 McCready, B. E.: Delicate child as a medical sproblem).. -1)- iene 792 McGraw, T. A.: Myxedema...... 691 Macht, D. I.: Study of the pros- tate McKendree, C. A.: Dystrophy and loss of vesical control....... 493 Mackenty, J. E.: Surgical treat- ment..of goiter 4.5 .))--. 2. ae McLean, A.: Thyroid metastasiz- ing. CHECIS Cis ahvotehsee she. aehetenee 391 McNulty, J.: Fatigue endocrine WEALINGSS: PP fae eee oe eee 793 McNulty, J. J.: Biological sense OL Therapy ye 0 ene ee eee 793 Macrogenitosomia precox and ad- renal tumor in three year old toh 9 Mares WO Sate eR OeC NT SO S78 779 — -—with tumor of the adrenal, in a girl of three..... 239 — — pineal tumor Madlener, M.: Ligation of the four thyroid arteries in goiter opera- tions Magauda, P.: Complement devia- tion in dementia precox...... 691 Mahnert, A.: Endocrine dyfunc- tions in pregnancy.......... 356 Mahon, F. F.: Case of early MYXCMOMA <5 sit. 5.0556 NPs eee 391 Maier, J.: Differential diagnosis perichondritis laryngis and THYTOWMitis (i 2s seen 692 Malamud, TT.: Adiposo-genital dystrophy accompanied by epi- leptic attacks 2 cer eets 123, 499 Malaria and thyroiditis........ 698 Mammae, galactorrhea, cure by curettage 1 Mammary change following pros- tatectomy —gland enlargement moval Of Prostate. ois wie eee 136 —eglands, effects of thyroid- ectomy on Manley, O. T.: cf. Marine, D.....511 Mann, F. O.: Accessory pancreas in dog 7 Mansfeld, G.: Physiology of thy- roid ee ane e aon ces OO == (eR aE Physiological heat regulation a Ge RNS OIE Maranon, G.: Case of lipodystro- phia progressiva ....--.---: 804 —— Diabetes insipidus as a hypo- pituitary syndrome ......-. 159 — Emotional factor in hyper- hy TOLGISIM) ete yes 692 — reaction to adrenin...... Sti ——New orientations on diabetes mej HwEy Geblogeo apo oe eer 86 — The glands of internal secre- tion and disease of nutri- {iu bcos ca oOo como Otc 237 P= NHeLeCMOCLONS .- 0c: so le: 640 Maresch, R.: Musculature of ad- MN GWE atria eel tna 621 Marie, A.: Opotherapy in Base- RAS WUT SIRA tet one, een Reet eye yi =) a fan 820 Marie, P.: Mental disturbances at menopause; opotherapy .....- 662 Marine, D. (Kimball): Prevention of goiter se ere ee ee ee pes oy) __._ __ __—__ simple goiter in man. 820 — (Lenhart): Adrenin in normal and thyroidectomized rab- ES eee U0 — (Manley): Transplantation of spleen ee SRO re OL —= He, Sinan. She dobomoane omen 699 Marsh, P. L.: cf. Newburgh, L. OMe ie eee ee a lemehe tuslis. spats 493, 637 Marum, G.: Titi Ayal FHOGO YE peoes culo cacmoNo is, Gupeonoy Ons 646 Mason, E. H.: Treatment of dia- Hetes mews Wess wees ee Se 350 Mason, J. T.: Mistakes in 100 thyroidectomies ......--- 280-281 — Surgical aspect of goiter..... 821 Massaglia, A. C.: Internal secre- tion of parathyroids ...-..-.- 670 — Parathyroid hypofunction and eclamipsiaenies seas rie de Massary, E. (Girard, J.): Dia- betic gamgreme ....-.-...+---: 636 Mathers, A. T.: Case of myx- BGI Sask ooo eo eo awe oo om ae 391 Matthews, A. A.: Goiter.......-.- 391 Mauriac, P.: Circumscribed ede- mas. Disease of lymphatic sys- tem Soh vn eR RMR. ROO: Mayo, GC. H.: Adenoma with hyperthyroidism .........--- 152 Mazzocco, P.: cf. Catan, M. A..... 618 “Mehlfriichte”’ treatment of dia- Neh) cle S Sle OL ole ninco Beanch oles 234 Meissner, R.: Myxedema and pluriglandular insufficiency. ..646 Meissner, R.: Pathology of the heart in myxedema..........392 Meixner, K.: Testicle in a glandu- lar hermaphrodite ........-. 67 Mellanby, E. (Mellanby): Experi- mental hyperplasia of thyroid. 822 — -— Thyroid hyperplasia ...... 822 Mellanby, M.: cf. Mellanby, E....8 Meltzer: Mongoloid idiocy.....281 Meltzer, I. J.: Superior cervical ganglia essential to life?.....512 Meltzer, S. J. (Auer): Constric- phrin Mendelson, J. A. (Oliensis): Case of Addison’s disease ........- 91 Menopause and diabetes insipi- GINS 6 oie Spe Ba Soe aig Ora 16%, 163 SSQGATIG) WN peo A eS Ce os 6 805 —=yoleysay Ce or acedoachodgne 805 — mental disturbances ......-. 662 Menstrallsblood) sce ae a career Menstruation a factor in rupture OL Graaiam Olle. om a acer 131 —and chloride metabolism..... 801 —— tuberculin reaction ......502 SS Pinon iis) wie eleomia ns dae teas 370 == lHOIOAAP OH Boahnacaadomeaso 130 — corpus lutem and ovulation. . .498 — endocrine problems in_ vVi- earious 537 — precocious Fag SW REA NRENA Seb loaner) —— With) Ovarian CUMOL 130 —thymus and mammary in... .680 thee) COONS A eo eee es 663 Mental disorders and hyperthy- TOLGUSIy cee. reel eed a 156 —— disturbances at menopause. ..662 Mercier-Desrochettes: cf. Mery, 1 3 (ERE oat eStonHEG oica eo SEY O'S 643 Mery, H. (Girard and 'Mercier- Desrochettes): Miculicz dis- (EE TSTSlwhis onto ail hor EG cs CARO IONE IS LCS © 643 Metabolism after adrenal abla- ET OT ett siseee sas eh care Po oaariete 617 <= uo rhe, MEIN a 5 ooo peo oo 670 — carbohydrate and spleen.....379 ——— ——IMNOUADECESIe ne) 5 os a sicleas sien 788 —— physiology and pathology Oh Rete oe onthe: aetoneeens 632 = SMAI En aobooo domo co 644 — (diabetic, effect of adrenal ra- QigtHON RON er tices) eee 780 Sey (CL Mich 5 0 aud, Hiei eatin hc 498 —in diabetes: insipidus. ...2..- 798 ——=— NypertOnia. © as. seston 663 —— influence of gonad extracts on. 652 —inorganic, in diabetes..-.--- 639 ——intermediate carbohydrate... .251 — internal secretions in dis- CUP DANCES TOL cioes ae) coke moans 523 Metabolism (Na Cl) and internal RECTENON rin ceils wns ie d= cases 662 —of fat in diabetes.........-.- 491 —w—glucose in surviving or- FEN AS eh RETO RTIN OLCOTT NS 345 —w—nucleins, relation of thy- THUS UO snort ese eee 811 — — obese child with small sella CUTCICA | Aelets cae eee 659 —purine and adrenals........ 623 — respiratory, of castrated rab- Bits Ao wee hos eke eter ee eee Oat) Metamorphosis and ductless PLANS hee aecieks ce sacnsose Geir ees gA 353 ts ENYNOI OX PRACUS sacle ca irnelel = 396 —jin amphibia, relation of en- docrine organs and iodine OL octets eteas ee ticket ones Cee 67 —of Cyclops and thyroid ex- PAG scat seen aus ale ee 400 —thyroid extracts on.........- 521 Meugny, B.: cf. Launoy, L...... 485 Meyer, R.: Interstitial gland... .666 tion and the related uterine DIOCESES leroy =. opeurrs Bia eae cco near 130 Michaelsson, E.: Results of opera- tive treatment of hypernephro- Pit: Re PREM ees 242, 243 Michon, L. (Porte, P.): Histology of ectopic testicle...........& pL2 Miculicz disease... 2c 1. e 643 bepere tis 647 Midbrain, clinical pathology of..128 Mieres, J. F.: Basedow’s syn- drome and tuberculosis....... 152 Milber, H. H.: Diabetes mellitus. 492 Milk, composition of, as affected by thyroidectomy cies Miller, G. T.: Splenectomy re- port of two cases. [5.7.6 2..--7- 379 Mills, A. E.: A case of hyper- ano ICUCCAN ISIN odes) -iene tees okay kta eon 800 Milojevic, B. D.: Sex character BLLBLCE «ve Getetan subire, bes crouse 810 Minkowski: Old and new in the treatment of diabetes ....... 36 de Mira, M. F.: Thyreo-parathy- roidectomy and _ parathyroid- ectomy in the guinea pig..... 392 Mitchell, J. W.: cf. Allen, F. M..488 Moise, T. S.: Origin of heman- BICCUASES SA. ys) ois. aloha es ele 243 Molnar, B.: Thyroid treatment Df BdemMaM stews -eisnucreurate 93 vy. Monakow, P.: Pathology of the Ry DOPNYAIG! oe sa, 9) Siepel ete 2 cepatens 800 Mongolian idiocy ...........-.- 663 Mongolism, three cases of...... 805 A ae 280 Mongoloid idiocy .............281 Moore, C. R.: Sex gland trans- plantation in rats and guinea DIGS y feretier Oetnes oye eee 651 Moorhead, E. L.: Exophthalmic goiter; removal of right lobe BUG) ASHEINUS ©. caeunte |<) cererer eee 692 — Multiple tumors of thyroid. .693 Moose, M.: Lymphatism with dis- turbed internal secretions.... . 501 Morgan, T. H.: Effects of castra- tion of hen-feathered campines.359 — Effects of ligating the testes of hen-feathered cocks....380 Morley, W. H.: Corpus luteum of pregnancy, review of mono- graph — The interstitial gland—what it is and its supposed function. 808 Morphine, adrenin as antidote to.786 Morphology of thymus......... 731 Morris, M. F.: Hyperthyroidism .$22 Morris, S. J.: Relation of thymus to criminology Morsman, C. F.: Medical aspects of Graves’ disease........... 393 Mosenthal, H. O. (Lewis, D. S.): The D:N ratio in diabetes mel- litus Mosse: Case of symmetrical lipo- dystrophy 2 Moutard-Martin, R.: Tubercu- losis of adrenal capsules in man twenty-six. Death by cachexia 91 Mouton, (Izard and Lereboullet): ef. Lereboullet Mouzon, J.: cf. Lereboullet, P... Mozota, R.: Thymus in accidents of anesthesia 8 Miihsam: Testicular transplanta- tion and sexual life.......... 677 Miihsam, R.: Castration in sexual NEUTOSIS have see Sexseee es Ce 52 — Testicular transplantation... .676 Miiller, L. R.: Influence of vegeta- tive nervous system on fatty tISSILGS: cfs 0 s-censetore eels eee 827 — Involuntary nervous system. .615 Multiple sclerosis of the en- Gocrine organs ......:4.5.00 253 Munk: Case of myxedema after operation for Graves’ disease. .281 — Myxedema after operation for Graves’ disease .........-. 152 Murray, G. R.: Diagnosis and treatment of some diseases of the endocrine glands........ 3857 Murray, H. A., Jr.: cf. Hastings, BOMB Pious oc vcieteraaiee eeeereioas 507 Muscle, carbohydrate decomposi- TOT be one ercsa Fase ora eee 636 Mussio-Fournier, J. C. (Isola and Butler): Oxycephalia and nan- (GHD |G. SRE 6 Bint coo roraioes Leyoueucirs 129 Myasthenia accompanied by changes in dental maxilla....355 == SRDS fo 009 Gouna omic alo 645 Mydriasis by adrenin in chronic ME PH TIGIS Mate «| sie) stele) else es 344 Mye, H. W.: Exophthalmic goiter.521 Myotonia, case of......-----+-- 370 with PH SAnthinee ese ace sass 208 Myxedema PAP Pon ere t 5 DLT — accompanying thyroid aplasia.395 acute, febrile, epidemic with tracheal stenosis .....---- 385 — after operation for Graves’ dis- GPGVE «, choos IGISIOCo.0 ORO ncia aaucae 152 — and pluriglandular insuffi- CIERTAT Gis toin bro on cuca koe 646 eT ROU WAL ctelicts stete aun ive = ilee 21 280 EP IOOG! AM shee ucts ote tel ecu iellemel= = 684 pee NEM MMI TIL = ai ae eee ee 386 CASON OL cx. cust c) Gelete ls cmdea Hee eee 280 ——report, thyroid and hypo- physis therapy .....-..-- 691 — developed from diabetes.... 266 — developing from x-ray treat- ment of Graves’ disease....1438 — differentiation of from ovarian MehClenGyie dae: = cielelenske == 820 — ford) Seis coaeroe iors oa orc oens 391 — endocrine extracts in 255 —epidemic acute febrile. . .277-278 EP HEATE IIL eet ete s leliensyetnier anes 256, 369 — infantile, case of......-.--- 693 ——thyroid therapy in....... 697 —_— treatment with thyroid and TOEVNABV A og od oom dae 814 = TINESCIES Ml .c ih chavepetets| eieu = ins 696 — pathology of heart rh ence 392 — relation of adrenal cortex to..781 —spontaneous infantile eas —thyroxin injection in........ 693 —— with acromegaly case report.655 mental derangement and gastro-intestinal atony. Sagi! Naccarati, S.: Hormones and emo- ‘ ROT Syne, Se ote Cee CRE if Nachtsheim, H.: Studies on sex in Dinophilus, etc.......--- » 9360 Naegeli, O.: Diseases of blood and endocrine organs ....-+++++: 614 —Osteomalacia of endocrine OMS Geese eee cerns Nagayama, T.: cf. Abel, J. Js dese OS) NeEjaicisl «id occ oe o.oo cece cons 353 —and oxycephalia ..¢...--+--- 129 Nanism, infantilism resulting from thyroid dysfunction..... 383 —two cases of endocrine condi- tions in Narcolepsy Nasso, I.: Pathogenesis and ther- apy of diabetes insipid ws). sen 364 Nather, K.: Pathology of thyroid tUbeKrculOSsisies | «1 < «ele lel kee 822 Neel, A. V.: Two cases of lipody- strophia progressiva 3 Neff, Mary Lawson: Case of hypo- physeal tumcr .....-.--+---- By Fir Negrette, J. (Houssay and Galan): Action of hypophyseal extracts on diuresis in dogs and rab- Ditsee Sot cuneber ap onetar. nllete ng 7-9 120 Neisser, E.: Treatment of thyroid- toxicosis with iodine......... 281 Nerve tissue, growth hormone of. 247 Nervous system, relation of in- ternal secretions to..........- 803 Neubauer, E.: Bile secretion... .484 Neumann, W.: Surgery in en- docrine disturbances ........- 793 Neuritis, peripheral pressure, in IDI? oc oid hd oo Mcrae ome OU Neuro-arthritis and thyroid in- Siloti s oo ome oOo come eed 390 Neurofibromatosis with adrenal TMSUMLCLOM CY) Bele che ysie s teite one e 79 Neuroses, cardiac, relation of, to Graves’ diSeases. a. . 2 = = ae 146 Newburgh, L. H. (Marsh): The use of a high fat diet in the treatment of diabetes mellitus PEE Ra he, oe eke 493, 637 Newell, R. R. (Janney): Treat- ment of diabetes complicated by plumonary tuberculosis... .102 Nicholson, N. C. (Goetsch): Dif- ferentiation of early tubercu- losis and hyperthyroidism by the adrenin test............394 Nicholson, S. T.: cf. Blau, N. F.. .491 Nigay, J.: Diet in diabetes. .,... aD) Noback, G. J.: Topography of the thymus Nonidez, J. F.: Hematopoietic processes in gonads of birds. .257 Nonne, M.: Dystrophia adiposo- genitalis and hereditary lues. .499 von Noorden: Treatment of dia- WEL GR ae cues een erect ree isles eben a eo 5o7 Nonohay, U.: Syphilis and the en- docrine glands ....... 254 Nordmann, O.: sory thyroid 2 Norgaard, A.: cf. Faber, K..490, 634 Northrop, H. L.: Goiter......-- 823 Cancer of acces- Novak, E.: Interpretation and clinical significance of uterine hemorrhage — Relation of hyperplasia on en- dometrium to _ functional uterine bleeding Nutrition disturbances diagnosed | by internal secretions Nyffenegger, W.: Thyroidectomy and thymectomy, effects of, on reaction to heat puncture....823 Oberndorfer: Hypophyseal and adjacent tumorsi.. =... None 124 Obregia, A.: Adrenal opotherapy in Basedow’s disease......... 784 Obesity and hypophysis, nervous OTIPINGOL. can eee ae eee 160 — following encephalitis lethar- PCR Maes aii hai ce acn eaten 661 Ochsner, A. J.: Indications for and technic of surgical treatment fo) tet 400K) By eychoets Clea a Deke ce Ae 394 Ocular phenomena as early diag- nosis in pituitary tumor....... 116 Oedema and adrenals.......... 620 — caused by excessive adrenalin. 621 Oehlecker: Tumors of hypophy- hte OE e Coe O08 Foot 657 — Removal of hypophysis...... 657 Oestrous cycle, effect of thyroid- GRLGINY VOM) ya6 = oer ee cate a 664 — — — —thyroid feeding on. .685 —-—jin the mouse............ 663 Ohara, H.: cf. Sekiguchi, S....: 397 Ohno, S.: Adrenin content of suprarenals in various diseases 9% Okkelberg, P.: Germ cell history in the brook lamprey........ 673 de Olavarria, L.: Endocrine ther- EADY AN WOE Are ol peers totes sane eens 111 Old age, thyroid factor in.......282 ——and pituitary organs ther- hth) (Ae en oe cece or 127 Oliensis, A. EK. (Mendelson): Case of Addison’s disease ........ 91 Olleuri2, and pitiiurin onan ne 169 Olt: Antler development and testicular secretion .......... 677 Opotherapy and endocrinology. ..355 — hypophyseal, in diabetes in- RIPICLUB. econ) or haere asain rele seme 67 — in Basedow's disease........ 820 —.—— diabetes insipidus, hypo- Hhyseal oo. oe ce. eae 135 — menopause ....-.-.-.+-ceee 662 —of Addison’s and Graves’ dis- BHNOS yoerecsct co a cuslitan © cameieie 92 Gptoness action” Of. ai se sls 643 SS TrOMUOVALY 1. oes eee. ate 668 — specific action of;...:.22%.. 643 Orbaan, C.: Treatment of large malignant growths of the male and female generative organs WER ery ecepeiee cane = 257, 258 —kX-ray treatment of Graves’ WISCASE? ye ae chic ke ime ete) Seek 693 Orchitis; AnyemumMps 789 — new facts on islets of Langer- hans in human ........-. 333 —— removal and blood-sugar.....506 —_studies of the internal secre- CiOUM OL! Leora ack siepee eos ——yitamine content of........- 256 Y% Pancreatic function, disturbance Ol) I VOMPELES 21.) 1-14- 0s wet atte 249 — insufficiency, test for........ 374 —— treatment ...........06. 348 — lithiasis and diabetes........ 346 —stimulation by amino acid hydrochlorides, i... =) <= 785 Pancreatitis and thyroid changes.155 ——=EWOUCASGS: OLE piconets -chuteeiekcts 1338 de Paoli, N.: Tetany in adults. .271 Pap, L. V.: cf. Mansfeld, G.....520 Parabiosis, heterosexual, repro- MTICLIV.G OLE ANS pallu cs onsen caer 796 Paraepithelial glands, endocrine SIAnNGS) BS) «case tops uke. s taeere one 642 Paraganglioma, of the adrenals. .340 Parasympathetic system, special services rendered to human OTEADISIO Yes «cose can See ae 205 Parathyroids and Bright's dis- GABE) So eeee see eee Tea EES OLN — — convulsive states.........376 — — guanidine tetany, phos- phate and calcium of the BLUE «occ tees orator se acts 134 —— pituitary preparations ....127 ——tetany .........++..-. 269-270 —— tetany in children....... 109 —calcium metabolism ........ 670 — ). << «cee 112 Peristalsis, influence of hypo- physeal extracts on.........-. 800 (Jobling and Egg- stein): Serum changes follow- ing thyroparathyroidectomy: ferment action Peyron, A.: Adrenal paragan- elioma 7.04 WVen Ns. ee mene By — Development of tumors of in- terstitial gland of testis....677 Pezzi, C. (Clerc): Antagonism of adrenin and quinine....... 245 Pfeiffer, C.: Exophthalmie goiter andesyphilisis23 eer ekes 281-282 Pfeiffer, R.: Dystrophy adiposo- genitalis, case of.....caru 264 Pharmacology and therapeutics of ductless gland preparations. ..108 Phelip, J. A.: Two cases of pan- Creatitlsin wi. cccpursdasteu ee aan 133 Peterson, W. Physiological hyperthyroidism. . malirer! Physiology of the emotions... .- ial o- Physostigmine, effect of on epinephrin output ....+----- 622 Pick, E. P.: cf. Kolm, itis catuabarcns 484 Pick, R. (Elias): Apical percus- sion of lungs in goiter.....-- 144 Pilocarpine, influence of, on epine- phrin output ....--+--::-+: 8 Pinard, M. (Velluot): Syphilitic origin of diabetes ....----+--- 637 Pineal and hypophysis in pigmen- tation changes ....-+--++-+-+:>: 659 ———lipodystrophia ..--.----:- 671 —pody, changes in, after re- moval of pancreas....-.-- 806 — comparative morphology... - 507 — development in man.....---- 13'5 — dysfunction in pregnancy... .306 — embryonic, man .....---:-: 135 — extract and feeble minded fAlmioimeuh Go goeoendoo Deo D 34 ___——in Vineland experiment. . .134 — feeding to ratS....--+----:- .508 — gland, function of....-.-.--- 669 —— — morphology and evolutional significance Of.......-- 87 — in dementia precoOx......--+:- 376 AMX TAGLS, sjste sins ein ee SSE — medication increases excita- bility in mania.......---- 806 pemarcolepsy -.- += =: 2a" - 50° 659 —pubertas praecox.....-- 671, 672 —removal pigment changes fol- Thanks Golo on coe code ONO 22 PE arAtOmeds (Ol cs se el tayey eS 269 —tumor and macrogenitosomia THROES geodon a oi WO COIOIOIG 806 —vitamine content of......--- 256 Pirig, W.: Influence of hypo- physeal extracts on peristalisis . 800 Pistocchi, G.: Influence of spleen, kidney and thyroid on anaphy- RET gid wie dre ob oitnomcne aang mde 357 Pitfield, R.: Case of polyglandu- jar disease ..0--86 e268 68+ a 93 Pittaluga, G.: Hemopathies and glands of internal secretions. .804 TMA, of aac vop oC oO OR tao 357 —early symptoms of......---- 357 —— extract for induction of labor.655 ___ —— (whole gland) in treatment of .dystrophia adiposo- BOGS Aolda op como doo 25 ee istamimenint «5c sje OOS — in diabetes insipidus. .377, 510 —hyperfunction of......----:: Bua —hypofunction of.....----+-: Son —-jin Graves’ disease.....---+»- 127 — injection, effect on blood pres- sure of febrile patients... ~b25 Pituitary, pressor compound in. .509 — therapy in asthma and food anaphylactic attacks. .107, 108 —tumor, early diagnosis of... lal Pituitrin, action of.....-.----- 672 ______—_jn diabetes insipidus... SO Oe oo tee orD 167, 168 —_ as a stimulant to parturition. BAL == damsensie Oliers 0) Guia Oo 08 794 Roentgenotherapy in thymus en- largement ....------ 273-274-275 Roger, H.: Recent studies on the functions of the adrenal cap- PTI VA=t acy Ghats Lear Ceci eet S40, O40 92 Rogers, J.: Carcinoma of the DAAC!) Goo GOO S HOMO INOI DO. 153 —_ Corneal ulcer of exophthalmic SOMSTs ele che) ved Veni ered oe 154 — Organ therapy in thyroid and allied disorders ....----- 693 —_The signs and treatment of thyroidismy 7... --- 22 154 Rogers, L.: cf. Goodall, jiSi. Jaoc8 Rogoff, J. M. (Stewart): Rela- tion of spinal cord to spon- taneous liberation of epine- phrin from adrenals......--- 93 __ ef. Stewart, G. N....486, 622, 623 Rohleder: Testicular implanta- tion in prostatism........--- 652 Rohmer, P. (Vonderweidt): Spas- mophilla treatment with cal- cium Chlorides. leo ee 674 IRN Cy IPR eos on aoc ood 784 Romeis, B.: Influence of various thyroid extracts on meta- morphosis and growth....... 521 ——Rejuvenation hypothesis of Stemachiarmictere orn serene-n 795 — Steinach’s experiments on re- WOPHEONVOM yoo sgeshoaanese — Thymus administration to weak animals (4 Romme, M.: Action of hy- pophysis on renal function.... Roénne, H.: Transitory hyper- metropia in diabetes......... 851 Roorda-Smit, J. H.: Syphilis thyroid Rose, E. L. (Davis, L. H.): of pancreas in ether hyper- glycemia Rosenberger, F. L.: sels of nail-wallls siheciee © cee 646 Rosenbloom, J.: Lipins of human corpus luteum — Relation between diabetes mel- litus and clinical syphilis. ..102 Rosser, Curtice: Endocrine prob- lems in pelvic surgery with spe- cial reference to vicarious men- StTUALIONE Sve Beye WS aices: Nene ets 537 Rossle: Myxedema with complete thyroid) aplasia’ oc. anise 395 Roth, G. B:: ef. Edmonds, CSW ee tee. Se eee ne 481 Roth, N.: A case of tetania gravi- darum cured by parathyroid® implantation Rother (Szego): X-ray treat- ment of thymus and uric acid CXCTELIONS s.s.2is. scutes art es 681 Rothlin, E.: Action extract, on thearti.. 22.<.7 sn 674 Rothlin, F.: Properties of sur- viving vessels Rothmann, M.: cf. Frank...... 669 Rouquier (Worms and _ Rever- chon): Adiposo-genital syn- drome, tumor of hypophysis, radiotherapy, regression of symptoms Roussy, G.: cf. Camus....654, 797 Rowe, A. H.: Basal metabolism in thyroid diseases as an aid to diagnosis and treatment with notes on the utility of the modified Tissot apparatus....154 Ruggieri, E.: Idiopathic osteop- sathyrosis Riulf: Myotonia combined with CY RULO DEVS b. ceersicee aya is » 268-269 Russell, W. B.: orientals Rutting in relation to luteal cell formation Sabrazés, J. (Dupérié): Thymo- thyroid polyglandular syndrome with hydrocephalus — — Thyro-ovarian insufficiency .825 Sabucedo, G.: Histopathology of adrenals and tetanie intoxica- tion Saguchi, S.: Langerhan’s islets, their relation to the pancreatic acinus tissue Sajous, C. E. de M.: Pharma- cology and therapeutics of the ductless gland preparations. ..108 Salazar, A. L.: Atresic granulosa oOfrabpit evaryin.> = 70k). seen eae 667 —Pfliger’s cords of ovary — The non-atresic Graafian folli- clevine the rabbits 14 24a 667 Salivary glands, hypertrophy of, associated with endocrine dis- eases Salomon, H.: Differentiation be- tween diabetes and glucosemia of prepnancyys hese eee 637 — Therapeutical importance of acidosis in diabetes....... 638 Sammartino, U.: cf. Elias, H...627 Sanchez Conira y Mejarano, J.: Tuberculosis and hyperthyroid- ism Sanchez Garcia, C.: Case of hypo- thyroid intantilismy, .- seer 825 Sanchis Benus, J.: Climacteric @pilepsy, 2arak-s.c/s tno oe eee 805 Sand, K.: Experimental her- maphroditisnr .... 498 — characters altered by tubercu- ON os 6 Sy ab OOO a ho Gate apoio 810 —— development and gonads....-- 650 — gland transplantation ...-.-. 238 aad guinea pigs.651 =~ in Dinophilus ~. «= 5 ---2 360 — organs, comparative anatomy Chi ioc his Eh OMOROMEL OL Ih oneOnneh Hid, .0 oud —— reactions influenced by gonad EPUMANAISS oo uomu ase oso e 652 —stimulation and the endo- erines ancy sy en eR eee Sexual differentiation and thy- TOLUG «coe secre terete ey stats) tented =) Usk 510 —— disturbances in wounded sol- GETS) attite uct at-) eel takenarene 379 —life and testes transplanta- ELODIE Sidea vw ay tection «eee to 9 677 — neurosis and castration.....- 652 Seyfarth, C.: New facts on the islets of Langerhans in the human pancreas .....--+-+-: 333 Shapiro, 8. (Marine): Suprare- nal therapy in Graves’ disease. 699 Sheppard, H.: Hermaphroditism air TAAL ener May eel oe seems ais 114 Shock and adrenal insufficiency. 302 Shuman, J. W.: Dwarfism and gigantism, case of GEV vend 640 Sicilia, E.: Climacterie disturb- ances and dermapathies...... 805 Siciliano, L.: Humoral symptoms of Basedow’s disease......-.- 398 Siegel, A. E.: Thymic disease. .813 Siegmund: Tumors of squamous epithelium of the infundibulum, structure and position in onco- logical system .......-...--: 265 Silvestri, T.: Diabetes insipidus EhaalHMWAY coGgakanogOuboos 789 df : ’ Simmonds: The closure of the vas deferens by the formation Simon, M.: Simonton, T. G.: Syphilis as a factor in disease of the thy- TOG) caseoel enero este eeek> See es 155 Simpson, S.: Thyroparathyroid- ectomy in sheep ..........-- 696 Siredey: cf. Béclére.........- 649 Sisson, W. R. (Broyles): Influ- ence of anterior lobe of hy- pophysis in development of WHILG TAG). oun ops a ania eeaien 657 — (Finney, J. M. T., Jr.) Ef- fect of pineal feeding to Tats’ sn See Eee Skin diseases, endocrine factors in etiology and treatment of. .109 —relation of thyroid to....... 282 Slauck: Muscles in myxedema. .696 Slaymaker, S. R.: Pernicious anemia and diabetes......... 490 Smith, M. I. (Ravitz): Adrenin content in anaphylaxis....... 486 Smith, P. E.: Essentiality of buceal component of the hy- pophysis to the continuance of life — Parabiotic union of hypophy- sectomized to normal tad- Nik) BYPg eo anwe go toc oa — The pigmentary, growth and endocrine disturbances in- duced in the anuran tadpole by the early ablation of the pars bucealis of the hy- DODUVSIS este tora 234 — (Cheney): Anterior lobe and thyroid feeding .......... 658 —. — Hypophyseal feeding to tad- DOLGS caisie soe laces eta 448 Solanillo, J.: Relation of vita- mines to organs of internal se- CORRE TOTEES lc pay os eothc be ce oat ae, = ees 804 Solis-Cohen, S.: Association be- tween diabetes mellitus and TMB STCUIOSIS si%5 5.0: oc eat eo = sri cle 104 Somer, W.: Narcolepsy......-- 659 Sordelli, E.: cf. Carelli, H. H...779 Souques, A. (Lermoyez): Exoph- thalmic goiter; hereditary and PAMILITEL aa, atetere rs. + sussotelel s spa eenere 398 Spasmophilla SMe Ges eREs Sony —adrenal extirpation ......... 618 —— — reduction and blood sugar.335 = MATENAIS: ATW joreriensvaloinienmin :steuans 480 —and the blood picture....... 622 —ealcium treatment of........ 674 Speed, K.: Carcinoma of the 907 pancreas Spermatogenesis, effect of alco- NOMS TONY cps escn- tls os ee 809 — following closure of vas GSTCYENS] oath ae Ere 808 ——of blind! sworm): <%\. =<: «cus 511 — relation of adrenal to....... 783 Spiegel: Anatomy and pathology ‘of autonomic nervous system. .246 Splanchnie stimulation and heart. (cy) eve: SM Serre A. 5 - 729 Splanchnics and adrenin........ 483 Spleen and anaphylactic crises. ..357 — carbohydrate metabolism. .379 — -—thyroid antagonism....... 390 — effect of thymectomy upon. ..769 — extract, action of, on heart...674 —in a fatal case of diabetes TNEIIGCUS oo c. eusnenote shee amen 107 —— internal secretion) Of. -)-- ees 461 — removal and CO. and H.O ex- CLCUIONY nae os ane eee 8138 ———— TWOMCASOS) oe ene eu cteued nus cnons 379 — transplantation ............ 511 Splenomegaly and anemias in in- EaNtS” cn kore cei So eee 511 Squier, T. L.: Improvement in Graves’ disease after infection. 522 =—— cr. Graptela@e G. Py. mreueiees 480 Stahr, H.: Status phaticus Stanley, L. L.: Experiences in testicle transplantation — Testicular substance implanta- tion 7 — (Kelker): CALTON. eyec5 cpus 138 Starr, M. A.: Relation of thy- roid secretion to the condition of the skin and to old age... .282 Starr, F. N. G. (Graham and REODINSOM) | eos eee oe eee 398 Status hypoplasticus with Hirsch- sprune’s; disease’ 20-)-\-..)-aomeae 139 —thymolymphaticus ..... 513, 681 — -—and rickets, case of....... 811 — -—as independent disease....812 — — ease of, with Hirschsprung’s disease ——heart in; goiter — — in relation to primary car- diac -hypertrophy in childhood ..... oS LCR —— modern view of.......... 273 — — morphological findings in. .678 — — with rickets, case of...... 679 Staub, H.: Blood sugar after oral administration of glucose....790 Steenbock, H.:. ci. (Grossiise.st 686 Stein, H.: ef. Herrmann, E..... Steinach, K.: Sex glands and in- ternal secretions: 3.0. 245 555 238 Git 5 Chaka vere aleieyeroiciomtan ooo b Steinach’s operation, value of.258-25! rejuvenation experiments... .25 —— studies on rejuvenation......2: Stein, A.: Pituitrin as a stimu- lant to parturition.......--. 22 Steinberg, M. E.: Gastric juice in pancreatic diabetes......- 789, 790 Steinert: Hypo- or dys-function arithoemadrenals. Onc 615 .-—— The skeleton in hermaphrodit- TSIM eitles cha cl-ie aite) cueateoelle 258 Stillmunkes, A.: cf. Bardier, E. St iro la eerie ere te 617, C19, @S8o Stoland, O. O. (Korb): Diuretic action of pituitrin.......-.. 672 Stone, R. S.: Atypical male sex- ensemble in the goat......... 498 Stragnell, G.: Relationship of psychopathology to endocrines. 794 Strauss, H.: Congenital lack of both adrenals and Addison’s GISCASCi eel criets cue cheer nies demauiens s Strausz: X-ray in epilepsy..... 647 Strausz, L.: Case of diabetes changed to myxedema.....-. 266 Streiszler: Struma maligna... .399 Strickler, A. A.: Reactions fol- lowing intravenous adminis- tration of arsphenamine as in- fluenced by adrenin.........945 Satine eee Ine orice cSt s 686 Stiibel, H.: Action of adrenin on stored protein of liver......-. 630 Sturgis, €. C. (Tomkins, Edna 1s ))e Basal metabolism and pulse rate in hyperthyroidism. 696 Stutzin, J. J.: Practical value of Steinach’s operations ....258-259% Stuurman, F. J.: Review of endo- crine literature for 1919..... Tavs Sudeck: Surgical treatment of Graves’ disease .......++.-+: 697 Sugar regulation, relation of nervous system tO.........-- 787 Suprarenal, action of sympathetic on Suprarenals, carbohydrate metab- olism in animals without..... 618 = Toi se heleCOsSts) cits osen-nelaie => 622 — sensibility to toxic substances of, rats’ withouts <5. 3.55 621 Surgery of exophthalmic goiter. -1b8 a SHINS HE Cac GonS 150 SS HOM, Scooogacoeoe 280-281 Surgical treatment of goiter... .814 Sutherland, G. F.: Response to gastrin before and after birth. 649 Sweet, J. E. (Tatum): Changes in the thyroid following intoxi- cation by toxic protein deriva- Liye ce eaeoees ced Old aS orb ineo 155 Swingle, W. W.: Experiments with feeding thymus gland to ors IENEK] Sonaooona me oon 140 -— Germ cells of Anurans....... 796 ——Homoplastiec and heteroplastic endocrine transplants ..... 648 ta Swingle, W. W.: Relation hypo- physis and pineal to pigmenta- tion changes in anuran larvae.659 Swoboda, F. K.: Quantitative method for the determination of vitamine in glandular and other tissues Sympathicotonia, clinical aspects Th hee Mepee ehS.¥ LOr nC Ota ap tech 402 Sympathetic, action of, on supra- Pe) ts afive acehstegh sate oc haere 619 —nervous system in disease.... 85 —_— — relation of to endocrine functions —_ —- — special services rendered to human organism DYs oc Seer sis cheval eee 205 — system, aplasia of, with hydro- cephalus and adrenal atro- RZ eich ich OG ced aaron 240 — — irritability of in thyroid dis- Base eyelets ware erem eet 818 Syphilis and adrenals.......--. 780 we = diabetes Vessco sae sae 347 ne llitusy Ste ee © Ste 102 — —endocrine glands.......-- 254 — — hypophyseal infantilism. . .362 —as a factor in thyroid disease. 155 —— etiologic factor in endo- erine alterations ......-. 790 — delayed hereditary ....-.--- 514 — headache treated by pituitary 36 BRETAGNE ay bis a) aera heater —jin etiology of endocrine syn- GroOmes) sc sai eae eh 112 —-of brain and changes in the hypophysis .......--.+--- 362 aie pies ttl) scion GckOscLc is ated an 522 —relation of, to emotional ex- ophthalmic goiter ... . 281-282 ——thyroid and hypophyseal in- sufficiency ....+-:.-- Soa Ny —— with diabetes insipidus...... 251 ——_— hypophyseal cachexia 265 Syphilitic diabetes ........---- 248 Szego: cf. Rother...........-- 681 Tabes and acromegaly.........260 — dorsalis and hypothyroidism. .819 Tachycardia, adrenin in........ 786 — emotional and internal secre- TAGDS oss at oe wad < oR 2 Tadpoles, thyroid on.......-.-- 689 Talbot, F. B.: Metabolism of very obese child with small sella PARE CAUCE to sino) nichols seas: cael. o4 se a 65 Tanaka, K. ( Adachi): Hypophy- seal changes in diphtheria.... an By Taschenberg, E. W.: Mikulicz’s disease and the endocrines....647 Tatum, A. L.: Epinephrin hyper- SLY COMI ansrae ce «cis cacteei= 9 630, 787 — (Sweet): Changes in the thyroid following intoxica- tion by toxic protein deriva- ELVES: Gio eec.ccs texetoteh vie = seen se 155 Taylor, J. M.: Critical epochs in the reproductive cycle, ete....137 Teratoma due to endocrine anom- AlIOS? hl er rat letese = ci reece . 802 == Of Pineal, wicbsis ete el ee ee 269 Terry, W. I.: Surgery of toxic BOWS 6 Sain 6c 1s te ede oe 155 Testes and adrenal, relation be- LNVOOM dete teie tea ys! Gale eee 236 —-—dystrophia myotonica..... 273 — — the reproductive cycle..... 137 — —vyital staining .-.......5% 138 —appearance following vasec- COMUWO rico cheaters ec eres 307 — atrophy of, in dystrophia myo- CONIGH eevee teeta ae 272-273 —endocrine function ........-- 675 —hypogenitalism ........-.--- 380 — in partial castration......... 809 Nig ating) fail see eee ee 380 == UTS eters os ete Neen ee 380 —— removal and rejuvenation.258-259 —transplantation....138, 503, 677 —vitamine content of........-. 256 Testicle, auto-transplantation .. 652 —ectopic tumor .-... 3.7 -.4>. 677 — grafting, two cases of....... 676 — histology of ectopic.........- 512 — ina glandular hermaphrodite. 676 — internal secretion and antler development ....:...:-=2:% 677 —— interstitial cells of; hormone produced by sperm cells. ..807 —removal, implantation, and sexual’ desire’ .. ... Joe me 273 — transplantation ........- 675, 807 Saheb wile Orergna eae rey so 137 — undescended, case of......-- 807 Testicular implantation in pros- tatismil ls. & odot eis, slee eo 652 = igationy oe alsisc oe Siete eter eee 677 ——substance implantation...... 708 — transplantation <= .i.5)t-iner 676 Testis and endocrine glands, Ret- terer and Voronoff on........ Ti bre —as antigen in dementia precox complement deviation test. 691 —changes in, after ligation of vas deferens —__ —_—_ — partial castration. ..809 — degenerative changes in mam- TN ALLAT vice prneloy sta, ae aar enters 190 — development of tumors of in- terstitial gland of.........- 677 — embryology of interstitial gland , bs Ee rn IAT a5. 808 Testis, formation of hormone in. 808 — function of puberty gland of. . 796 == Schiihne 5 o oon © on brcrornonten 675 —hormone function of..+..--.- 808 — hypertrophy of interstitial iGEMIGY Ci Whole o cola Comp 3 —— influence of temperature on. .791 — interstitial gland of......--. 809 — transplantation in man......- PARE oii CERCA UBS. EMDR ET Tetania gravidarum cured by parathyroid implantation... Bettas Tetanus intoxication, effect in ad- METI Sy segeiasi cba) cliche ceusaeliu- Bede) oer b= 94 Tetany, blood-picture in post-op- Se, Giiate) oo pocmoooo Sono no ceed 71 —ealcuim metabolism .....--- 670 —ease of peripheral pressure TMeiiiAis) ha eooo soos oe od 269 — experimental studies on...... Suite ECUONALHIC)- = 0 en a 422 eer TTA ELC AES) toy-a m Va joven te ras! wens) eS 271 == ini nein Agee eo moe cae omen 109 CALI YA Le) ete aie een 670 — parathyroid deficiency caus- ives boeonoomoecamacs 269, 270 ——transplantation in ......- 375 — post-operative, parat hyroid transplantation in.270, 669, 671 —— relation of otosclerosis to.270, 271 — symptoms and treatment..... 424 E=treatment Ole «s-ecs- 55% 0s 269 — Trousseau’s symptom in..... 134 Theories as to mode of action of thyroid adrenals and hypo- DIMAS base Vb otootoems codae 10 Therapeutics and pharmacology of ductless gland preparations. 108 Therapy, endocrinology and; bi- ological sense of........---- —of diabetes mellitus.......-.- Thierry, H.: Symptomatology and treatment of hypernephroma..784 Thompson, A.: Ripe human Graa- fian follicle and its mode of rupture Thomson, J. 0.: Perithelioma of Pains! IERNG! 4 Go co es common 631 Thormington, J. M. (Addison) : Behavior of the interstitial cells of the testis towards vital dyes.138 Thymectomy, effects of, on heat 793 TINCTURE G ead h to. O aid ee o oMcuocanr 823 Thymo-lymphaticus status ..... 681 Thymus action on frog larvae. ..690 TAA MIS CA tLOM © iawcs) weasel © 681 — anatomy and pathology of, in AUNTS CS). aleitel nt or elaatodiasefe: pcer Sheik 381 —and Graves’ disease.......-- 279 —an epithelial organ........ 544 a Z Thymus as factor in accidents of AMECSUMESTAN ojsceie sts) robe rene 81 Snes 6 em oma one © 731 —eondition of, in idopathic hy- pertrophy of heart in young CHildven! aepaeas sie “ysl: 136 Se eather eavaeacics cio eicee sacneus ale {(eis! — developmental topography of .680 SSSR GT 6 Etediceolnnrc- 0 Cech home 813 — extirpation and transplanta- Ovi key (co phd ecole mere Coma 763 —— —— FAs) Chi, They COE Goon coc 680 SNH og. ovoomsnod oa 543, 735 — tha) FALCON oeooowoue Jo00n 140 —gland enlargement in infancy and its treatment with ra- GO ya cai oO Cee oO Ie Onn 139 —_ — feeding to frog larvae... .140 —of mammals, feeding to am- phibians 1 —Hirschsprung’s syndrome and diffuse spinal gliosis...... 139 — hyperplasia eee tre ireteach ences DING —hypertrophied in thyro-ovar- ian insufficiency .......-.- 825 — hypertrophy a pene se Oe —-— congenital bone fragility. olta SEATS AEN ISB Is Beier aus om O eentg 0 811 —-— diseased subjects not TUM Ls cuees ceo a. tee) a) oe bit —_-——infaney; normal and in status thymolymphaticus.678 — influence of thyroid ingestion THOM Boboodgo ncn amo Kiac 684 — ligation of superior pole of in surgery of goiter....... e140 —lymphosarcoma of ........--- 679 — modern view of status thy- mico-lymphaticus .........27 — morphology of 543,73 — not a transitory organ.......94 —on thyroid OE Faraone ey eie cree: ONL — pathology of; danger of thera- peutic destruction of...... 810 —_ — with congenital cataract bi- nocular 273-274-275 — reduction by radium........513 —relation of, to amphibian met- amorphosis 78 —_ —__ —_ weight of, to thyroid. ..694 —— relationship of, to criminology.812 — results of removal in tadpoles. 810 —— status thymolymphaticus ....513 Sita, gadoWocoupdocooeos 682 — thyroid syndrome with hydro- cephalus Nias Wd emit ote, OR ee — vitamine content of.........- 256 — x-ray treatment and uric acid roto! Sobeo done mkosads 68 “a 65 1 m 7/4 Thymus, x-ray treatment of per- SIntenbses ae eioee Nie cae 273-274-275 Phyreoaplasia 2. . <6... ++. «---0Lo TV TOM wee e. ttescicis aieeeanierat knee 356 —aberrant and_ intrathoracic, treatment of goiter ....... 823 — ablation in treatment of de- rAentia PLACOK)« ses cheer 803 ——— parathyroid glands, follow SN ON I sso its LOSE. crt S155 806 ——ACEESSOTY. (CANCER Olmos serene 823 — aceto-nitrile reaction ....... 827 — action on frog larvae........ 690 — —— — heart 5 sei e ss 815-816 —— Tad polenta eerie Dla Dod ——- — '[NEDTYNOls sarees es Se 108, 109 — active principle, discovery of. .276 — activity, influence of tempera- ture on 7 —acute hyperplasia of, dyspnea — adenoma, special considera- tions of, in relation to ex- ophthalmic goiter......... 143 —-— with hyperthyroidism; his- tory of recognition of dis- ease; symptomatology * with basal metabolic rates — — — — results of tions for — administration, effect on or- FPA, (OE TEN iy ic ee oie eee 148 — — in dementia precox....... 155 ——aleoholic extract of in poly- ¢ neuritis and metamorphsis. 396 —amphibian physiology ......5138 —and anaphylactic crises...... BD — -— blood sugar regulation. ...494 —— ——“GTADELES ihe os siep tyes = ais = me eae 492 == =— heat reenlation) 2-7 -ee DO — — hypophysis therapy in myx- COSINE on. cee tena Sods 691 tN OCHIONS |) cic eecs see ae — —sexual differentiation ....510 ——spleen antagonism ....... 390 — —tuberculosis ...........- 697 — aplasia in myxedema........ 395 —as antigen in dementia pre- cox complement deviation EBD: ce cote cabins ined ie aed?) onan eal 691 — — factor in mongoloid idiocy.281 —arteries, ligation of in stru- THOCLOMIY aeciets cists «ob iaeas 152 — atrophy in simple edema, case PEDOL tric fe eee lo) puso Peon 695 — basal metabolism....... 386, 401 —-—— —in diseases of......... 827 — biochemistry of.............255 — blood in myxedema......... 684 — cancer of, case report....... 144 Thyroid carcinoma... - 2...) ssats a3 — carcino-sarcoma, case of..... 685 —cases, laryngeal function in. .690 — changes in, after removal of PANCTOAS! Sissel occ erento 806 ———jindicated by toxic protein.155 — compensatory hypertrophy of, effect of desiccated thyroid, thymus, tethelin and meat diet in guinea pigs....... 518 — deficiency and infantilism, case (3) Dae ray Ae MCN PaO aie Soc. = 825 ——jin children ..--....5.-c.6 357 ——-— chronic trophedema 817 — — — oto-laryngology ....... 815 — — with obesity ...........- 538 — depression and tabes dorsalis. 819 —diagnosis and treatment of Hy pPerackivity, Ol. 5... eee 818 — diffuse colloid goiter....389, 687 — — syphilis as a factor in..... 155 — — basal metabolism in...... 154 — distribution of iodine in..... 826 — — — — — the, after stimula- 100) te A ce 3c 826 —dysfunctioning nanism and INPantilism” Se <- crs oe 383 —— GVSDEDSIAS de . 2. ec eee eee 145 — -—in Basedow’s disease..... Si) — dystrophy and retarded heredi- eae NUNS he oy arash e ea oS 143 ——(early SYDUDtONIS) OW arco aya — — — — hyperthyroidism .. — effect of hypophysis grafts on. 653 — — Won phlorizin diabetes. ..819 —_ — — — the leucocytic picture.402 — —-— thymectomy upon ..... 769 — emergency technic for extirpa- THR Op CTO pT wo CREAN Cacradis <2 Als o.~ 142 = endemic goiter =. -- i 516-697 ——-—p prevention and_ treat- ment 5.54 << oneeee 7 — exophthalmic goiter ......-. 52. —— — — and corneal ulcer...... 154 — ——in boy. of 14.0 >. eee 158 —experimental hyperplasia of; relation (of fat to... aac 822 — extirpation, effect of, on mam- mary -etands: .<. 6. )-yo spe 697 —— effect on composition of Milk ees cits eee 279 — extract in treatment of dystro- phia adiposo-genitalis ..... 25 —-—-— metamorphosis of Cy- CLOPE Mc eee eee ete 400 SON TOW re a ee on a21 —factor in symptomatology of fivbercwlOsis: = -u.0- ne ee sree 397 — feeding and growth compared with iodide effect......... 384 Thyroid feeding and removal in rats; effect of and upon reac- tion to oxygen deficency....-. 276 Ne PIGULGaLy -)-tepe 2 687 ___ __ effect of on oestrous cycle. 685 a JOncreatimucia) <--> <1 686 influence of on axoloth...791 Sin rat and) rabbit... « 684 ——— of tadpoles and histology OE EISSITOS elesevalen © =e) hele n= 152 ——functional relation to hypo- WARE cocodunooco vomope 362 — gas in a cystic adenoma of... 56 — gland een Ve ae cer SOOO a and thy rovuOxiGOsis, 30-11 - 686 —_-—— determination of relative activity of two lobes of.. 29 — grafts stimulating metamor- phosis in tadpoles.......- 648 FOU wean abe dado Bt oo os 6 391 — == eG) iidememilOnis) 55555005 ale: its medical treatment. .395 == == GE SIOH “Gonesouncso aoe 384 =—==— experimental 2-2-2. ..--% 649 =n) Graves’ Disease. -..--. - 399 = = = OMISNBIE, 5 oo 6 cc boee oS 396 == == [eV | oooudeo coor 920 == == erie) UN 6 oo op wo Oe coo 382 = = Sissel soeoooo 394, 685, 688 — ———jnvolving ligation of su- perior pole of thymus.140 = s-ray treatment. |... .: 383, 689 — Graves’ disease, pathogenesis IMG) treatment = 146 ese ily COL: AT. lynteie lit) = he 385 ———jnternal secretions ......- 368 = = TN VEOIG) ois alo aie manic, aeb 0 Op 697 — differentiation from hyperthy- POFLCIIS IM gos yeh) Hisense ecmuaner eae y= 394 —jin etiology of Basedow’s dis- BEI) BS clnlbs (0 Olbic.b DG senO leo nOND 152 —— relation to the interstitial rallehasl 9 Greco cnn.o Gro cee Ola 807 —of adrenals, case report..... 91 = = THEO US ub idol gn buchonibathaiong 822 —thyroid factor in symptoma- tology of Tucker, H.: Comparative anat- omy of the genito-urinary or- gans of the lower animals... soe) Tumor and hypoplasia.........- 360 — of adrenals in relation to blood iDIRSHHOURE, 6.5 o 6 oom peceeue LS 341 = hy POPHYSIS).).". -- 262, 263, 264, 265, 266 Sand) distortion of the Viswall feld |...) -i00- 261 —— infundibulum, structure and oncological position ....265 — origin as influenced by internal SECTEUIONS (eis -pcie ekecene se ae let 367 Turro, R.: Emotion.........-- 110 Udaondo, C. B.: Thyroid insuf- ficiency and hypersomnia..... 399 Uhlenhuth, E.: Does the thy- mus gland of mammals when fed to amphibians exert any specific influence on the or- ganism Uhimann, R.: Acidosis and fat administration Ulcer, corneal and exophthalmic goiter Ullman, H.: Nervous regulation of purine metabolism.......- 624 Underhill, F. P.: Relation of the acid-base equilibrium of the body to carbohydrate metab- alism and its application to human diabetes Urban: Goiter in Graves’ ease = Tiheheartein Olver: % wt. sr 1 Uridil, J. E.: cf. Cannon, W. Bea Uterine hemorrhage, endocrine factors in Uterus, congenital absence of. 38) Urticaria and hyperthyroidism associated with tonsillar infec- tion Utley, F. B.: Treatment of hyper- thyroidism 25 Vagina, congenital absence of. 5 Vagotonia, a review.....------ y —and atropine — clinical BEDE) 08 SARS aio dis- Vagus, effect of thyroid secretion CTT) ees RR Re OR con Rene Ds 391 Van den Berg, H. J.: Epilepsy suggestive of endocrine rela- Hams oasnepoebr vos ae oose 441 “van der Heide, C. C.: Diabetes TN SEDUGUSS ae eens el eel e 491, 639 Van Dyke, H. B Distribution of iodine between cells and colloid in dog and human thy- ) SiGY peor opoceaeon ols wade ms 399 Wan Dyke, H. B.: Distribution of iodine in the thyroid’..... 826 Van Gehuchten, P.: Organs of internal secretions in anaerobic infechions aor cl estes ee = 662 Van Leeuwen, T. M.: Xanthelas- ma diabeticorum ...........250 Vanowski, W.: Thyreo-tubercu- TOSIS? 4. Perea eau ache: causes Nabe 369 TOKgeNsts Wel Soi wee pico oo 660 —__The heart in endocrine dis- Worms (Reverchon and Rou- GASES oe ciate telretesite prin) ais 359 quier): Adiposo-genital syn- Sis IDG AL ia 0 Cos nce dg Om 6 bAD 651 drome, tumor of hypophysis, Seeks, Naas (Obrarc ce. : Aout) UGA AMEN oh ce ay cL aces) Ghiehs: eiatiay slew 827 Zambusch, H.: cf. Stepp, W...- 251 ERRATA Vol. V, No. 2, March, 1921, page Line 5, read: mm. for cm. Line 6, read: mm. for cm. Line 15, read: 22.1 for 82.1. 218. Line 17, read: —100.0 for 100.0. Line 21, read: —49.9 for 49. Line 22, read: —16.7 for 16. Line 23, read: —14.2 for 14. Line 25, read: —19.3 for 19. Line 26, read: —29.5 for 29. Standard values obtained from; Donaldson, lel, Jal4e co co bo =1 bo The Rat. Memoirs of the Wistar Institute of Anatomy and Biology, Phila- delphia. No. 6. 1915. Corrections calculated according to; Donaldson, inte Jkigg dk 12> vision of the percentage of water in the brain and spinal cord of the albino rat. J. Comp. Neurol., Phila., 1916, 27, a 7-115. 469 QP Endocrinology 187 A1E5 v.5 Biological & Medical Serials PLEASE DO NOT REMOVE CARDS OR SLIPS FROM THIS POCKET UNIVERSITY OF TORONTO LIBRARY Seen niwaeoe se hyn TIP PeSseew ite ~ —— Pent Pw oR ON proces) Se es ae AS SI ELIE etre amr aapenrne ae AOE POE Ae OS get hens wee