CLINICAL ASPECTS OF ENDOCRINOLOGY 27 



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 mg., 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 20 ) , 

 but this is an inherent physiological 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 



