xii FOREWORD 



tions have been welded together into a single compact organ. Thus the 

 i hromaffin medulla of the adrenals is clothed with the functionally distinct 

 cortex; and the pituitary body, small as it is, appears to be even more 

 complex. 



That certain morbid states result from loss of function of particular glands 

 of internal secretion is a fact so clearly established as to admit of no two opin- 

 ions. As regards the thyroid gland, if the effects of its removal left any room 

 for doubt, the striking results of the administration of the gland substance in 

 cases of myxedema and cretinism would remove that doubt. Nor is evi- 

 dence lacking that such cases of athyroidism are but the extreme examples of 

 series of cases of gradations of thyroid defect which bridge over the gap 

 which separates myxedema from normality. To describe such conditions, 

 of impaired but not abolished function, there have come into use such terms 

 as hypothyroidism and hypopituitarism. 



Concerning diseases of another kind, of which exophthalmic goiter may 

 be selected as the type, there is no such unanimity. It is widely held that 

 such conditions present the reverse of the picture, and that they result from 

 overactivity of the gland involved, and excessive production of its secretory 

 products. 



Many facts may be adduced in support of this theory, such as the effects 

 of partial removal of the thyroid gland in exophthalmic goiter, and of liga- 

 ture of its arteries, and the results of administration of thyroid extract in 

 excess. Moreover, there are certain less obvious symptoms which suggest 

 a converse to myxedema. For example the exalted tolerance of carbohy- 

 drates, which is a feature of myxedema, as contrasted with the so frequent 

 lowering of tolerance in exophthalmic goiter. Such evidence is fully set 

 forth by Professor Folia in this work, for he is a staunch upholder of the view 

 that all the morbid symptoms which result from diseases of the glands of 

 internal secretion, so far as they can be ascribed to their secretory functions, 

 are attributable either to depression or exaltation of the function of the gland 

 concerned. 



However, there are some, who are entitled to speak with authority, who 

 are unable to accept this interpretation, and who hold that the maladies so 

 often ascribed to excessive functional activity are rather due to perversion 

 of function, and the production by the gland concerned of an abnormal secre- 

 tion. Such terms as dysthyroidism and dyspituitarism are used to express 

 this conception. 



The arguments adduced in its favor are of several kinds. It must be 

 acknowledged that the administration in excess of the active principle of the 

 thyroid gland, although it brings about exaltation of the metabolic processes 

 in strict contrast to the depression of those processes observed in myxedema, 

 and produces some of the symptoms of exophthalmic goiter, does not repro- 

 duce the picture of that disease so exactly as to place its origin in excessive 



