QUESTION OF DYSFUNCTION II 



hormone teaching is still insufficient. Up to the present only a single hor- 

 mone, adrenalin, has been denned chemically. A dysfunction of the chrom- 

 affin tissue would then signify that a qualitatively altered, faulty, adrenalin 

 is obtained from the chromaffin tissue and given off into the blood-path. 

 But every ground for this opinion has, up to the present, been lacking. As 

 a principal argument for dysfunction is adduced the variability of the clinical 

 pictures that may be expressed by the disease of a definite ductless gland. 

 The study of the pathologic correlations teaches us, however, that often the 

 pure picture of a functional increase or deficiency may be set aside and 

 concealed if other ductless glands become affected at the same time. 

 Thus it not rarely happens that trophoneuroses accompany the diseases of 

 the ductless glands, the combination seeming to me only a loose one. For in- 

 stance, special stress has been laid on the observation that in the later stages 

 of Basedow's disease sometimes signs of myxedema occur, while the signs of 

 hyperthyrosis are still present. In the description of Basedow's disease 

 I shall dwell at length on these cases, and I believe that in no case is the evi- 

 dence for the existence of a myxedema absolutely convincing. In common 

 with Newburgh and Nobel, I have further shown, in connection with this 

 question, that the great multiplicity of syndromes in conditions of func- 

 tional increase of a definite ductless gland are for the most part to be explained 

 through diversities of constitution. We have attempted to justify this 

 experimentally. The individual hormones or ductless glandular extracts 

 have very different kinds of action throughout. As I shall come to speak of 

 adrenalin in this connection later, I shall choose as example at this place 

 the thyroid-gland substance. By peroral administration of large amounts 

 of thyroid-gland substance, we can see the following symptoms make their 

 appearance: 



1. Tachycardia. 



2. Great depression in the blood pressure from center to the periphery. 



3. Increase of the fundamental exchange. 



4. Increase of the protein exchange. 



5. Increase of the elimination of salts. 



6. Lowering of the assimilation for carbohydrates, and finally spon- 



taneous glycosuria. 



7. Sweats. 



8. Mononucleosis. 



9. Tremor. 

 10. Diarrheas. 



n. Psychic agitation, etc., etc. 



Thus there are produced almost all the symptoms of a Basedow's disease. 

 We almost never, however, succeed in obtaining all these symptoms in a 

 single individual, but do note the regular appearance of tachycardia as the 

 cardinal symptom. To this other symptoms group themselves to form definite 



