CLINICAL ASPECTS OF ENDOCRINOLOGY rH f 
which form an intermediary class, the neurochemical 
correlations or functional manifestations provoked by 
the nervous system, this nervous action determining a 
chemical excitation, which is carried to some other 
part of the nervous system.” 
To illustrate: A patient of 26 years was married 
two years ago, and during the first six months she 
gained fifty pounds in weight, reaching 196 pounds. 
Her skin was coarse and rough, her hair brittle and 
thinned. She had practically no complaints except that 
she was getting too fat. Her blood pressure was 120, 
systolic. Her cardiovascular system was apparently 
negative. Her voice became harsh and cracked at 
times. Her blood sugar was 76 mg. It was very evi- 
dent that she was not metabolizing her carbohydrates, 
for it mattered little what she ate she would gain in 
flesh. This high carbohydrate tolerance, and yet an 
accompanying hypoglycemia, indicated what would 
seem to be a loss of sympatheticotropic impulses, which 
might be supplied by the administration of thyroid. 
Such was done, and within seven days a second blood 
sugar showed a rise to 88 meg., with a coincident loss of 
eight pounds in weight and a complete change in the 
appearance of her skin. It became soft and moist, and 
she said with regard to herself, “I feel so much differ- 
ent.” 
Could this increase in catabolism not go on until the 
sugar content reached beyond the threshold of normal- 
ity, and produced a hyperglycemia with a concomitant 
glycosuria? Over-determination undoubtedly can exist 
in an endocrinopathy as well as in a psychopathy; and 
should be kept before one’s attention in regulating 
metabolic functions. No doubt symptom-complexes 
directed towards the various glands do occur sponta- 
neously at different times in the same case (Farnell”’), 
but this is an inherent phvsiological adjustment. The 
former, however, is probably the over-determination of 
the clinician and the pleadings of the patient to be thin. 
It is quite evident that thyroid feeding for the purpose 
of reducing weight should be governed by the blood 
