10 GENERAL PART 



simultaneous affection of thyroid gland and glandular hypophysis is found 

 also in multiple ductless glandular sclerosis. 



Another example concerns the insular apparatus of the pancreas and the 

 thyroid. - In typical myxedema the assimilation limit for carbohydrates is 

 raised. Now there are individual cases of myxedema described in the litera- 

 ture in which alimentary glycosuria may be obtained, and even indeed a 

 spontaneous glycosuria may be present on ingestion of diet somewhat richer 

 in carbohydrates than ordinarily. Such cases have been held up to me as 

 irreconcilable with our theory as to the reciprocal actions of the thyroid gland 

 and pancreas, but incorrectly. In such cases it may be assumed that 

 there is a simultaneous affection of the insular apparatus. I have already 

 mentioned that after simultaneous extirpation of the thyroid gland and the 

 pancreas the oppositely directed effect of the absence of the thyroid on the 

 carbohydrate metabolism compensates for the effect of the absence of the 

 pancreas. It is therefore fully comprehensible that in an affection of the 

 insular apparatus disturbances in the carbohydrate metabolism may occur 

 in spite of the myxedema that is present. 



Finally, further example is afforded by the pancreas and the suprarenal 

 glands. In the cases of cirrhose bronzee dependent upon severe alcoholism 

 there are found extensive sclerotic processes in the liver, the spleen, and 

 eventually in different other organs, with simultaneous deposition of a pig- 

 ment that is at first rich in iron and later free of iron (hemosiderosis). With 

 involvement of the pancreas in the sclerotic process, diabetes mellitus 

 not unusually occurs (diabete bronzee). Now, observations have shown 

 that in such cases the diabetes later disappears, as not rarely the cirrhose 

 bronzee involves also the suprarenal glands in the sclerotic processes and may 

 finally even bring about the condition of symptoms resembling Addison's 

 disease; so that we may readily draw the conclusion that the retrogression of 

 the diabetic disturbances of metabolism stands in connection with a more 

 intense sclerosing of the suprarenal glands that occurs later [in the course 

 of the disease]. 



Question of Dysfunction 



The -study of the pathological correlations seems to me to throw light on 

 the question as to whether we are justified in postulating, in addition to an 

 increase in function and a diminution in function of the ductless glands, also 

 ajdysfunction. I shall in this book try to explain the individual ductless 

 glandular diseases exclusively as due to quantitative alterations in the duct- 

 less glands. I know well full that to-day this opinion is not throughout 

 the generally prevailing one, and I expect to meet with opposition. I believe, 

 however, that I can at least adduce so much evidence for my standpoint 

 that a certain justification for it will not be denied. 



As has been previously stated, the physiologico-chemical basis of the 



