6 GENERAL PART 



n ilk a nee for the clinical aspects of the diseases of the ductless glands. This 

 recognition, that was especially furnished by the serviceable work olPineles, 

 (IrjK'nds not only upon the observations of intimate physiological reciprocal 

 relations., but also upon numerous clinical experiences and pathological- 

 anatomical findings that show that diseases very frequently affect several 

 ductless glands simultaneously, and lead not only to simultaneous increase of 

 function, but also to simultaneous diminution in function, or to a combination 

 of increase of function in some of these organs and to diminution of func- 

 tion in others. 



Reciprocal Action of the Ductless Glands 



I would like here to enter a little more fully into the question of the re- 

 ciprocal action of the ductless glands; the phrase has become, as Novak says, 

 a catchword. An immense amount of work in recent years has been de- 

 voted to the study of this reciprocal action, and hypotheses and speculations 

 have grown luxuriantly upon this soil. It is true that up to the present 

 we really know nothing exactly concerning the intimate process in these 

 reciprocal actions, but in a clinical relation such correlations force themselves 

 unmistakably upon the observer; the knowledge of them makes easier the 

 analysis of the often complicated disease picture. Finally, the expressions 

 "reciprocal reinforcement" or "reciprocal inhibition" are in the first place 

 nothing other than circumlocutions for [clinical] observations. If we view 

 the thing from this standpoint it seems to me that the study of these corre- 

 lations is productive. 



For the understanding of these often very complicated processes it seems 

 to me that a separation of physiological and pathological correlations becomes 

 absolutely necessary. Among physiological correlations I mean to include 

 the action that the alteration of function of a ductless gland diminution 

 or increase of function exercises upon the function of another otherwise 

 normal ductless gland. These conditions are fulfilled in an ideal manner, 

 when the ductless gland has been extirpated, for example. This can occur in 

 human pathology. I have reference to the total extirpation of the thyroid 

 gland which, formerly, before we knew about the incurable results of the 

 operation, was also undertaken in human beings; or to parathyroprivic 

 tetany after operations on the thyroid gland; or to castration. Further, 

 an inflammatory process may become established in an isolated ductless 

 gland and cause its destruction. In such cases we must by all means be 

 very careful as to the assumption of a pure physiological correlation, as, 

 according to experience, inflammatory processes affect very commonly other 

 members of the ductless glandular system. Here we often find, therefore, 

 as we shall see later, transitions to pathological correlations. Also the 

 increase in function may be produced experimentally in the pure form as, for 

 example, after feeding with thyroid-gland substance. Again, in many cases 



