CLINICAL ASPECTS OF ENDOCRINOLOGY 33 
There was a thyroid enlargement and cessation of men- 
strual function. Mentally she was slow, inactive, lacked 
initiative and rapport. She lost weight, and her skin 
was oily and wet. She ate little, and her bowels were 
constipated. She had been a bright and active child, 
had stood well in her studies at school and had plenty 
of chums and social duties. This was all changed. 
There were no shut-in symptoms prior to the fright. 
She was looked upon as a case of adrenal dysfunction, 
brought about through a “conditioned” sympathetic 
system exaggerated by an emotional trauma. Within a 
few months, during which suitable measures were insti- 
tuted to spare and support the adrenals, adjustment has 
taken place with a return of all normal physiological 
activities ; but the emotional life, which was considered 
normal before the trauma, is now somewhat over-deter- 
mined, with a tendency to exaggerate social contact. 
One may observe in his clinical work the many fac- 
tors involved in arriving at a diagnosis of a qualitative 
disorder referable to the endocrine system. It is com- 
mon to be asked if such and such a case is not a pitui- 
tary or a thyroid case, and to be told that mixed glandu- 
lar products have been tried without avail. When the 
case is investigated a disturbance in instinctive de- 
mands may be of primary importance, or an emotional 
maladjustment, or even an environmental maladapta- 
tion. These endogenous and exogenous factors do in- 
deed play a part in disturbing the neurogenic control 
and do undoubtedly bring about disturbances in func- 
tion not only referable to the skin and mucous mem- 
brane, to the cardiovascular system, but also to the 
endocrine system, and disturb their function with possi- 
bly a resultant disorder in metabolism. Many such 
cases undoubtedly adjust themselves, others require aid, 
as organotherapy, and some even go on to actual tissue 
loss and cessation of function with its concomitant in- 
terrelative disharmony. 
It is hardly within the power of a clinician to be able 
to go deeply into all factors in all cases, as they pass 
