12 GENERAL PART 



syndromes; for example, tachycardia, sweats, mononucleosis, or tachycardia, 

 mononucleosis, tremor, etc. We can therefore obtain in miniature almost 

 all the syndromes that we find in cases of Basedow's disease. As thyroidin 

 is always the same, the cause of this dissociation must be ascribed only to the 

 various constitutions of the persons tested. The question as to why this is 

 so in the individual case is naturally hard to answer, as the sum of the partial 

 constitutions (to use an expression of Marlins's) that go to make the total 

 constitution is enormous. In many respects it seems most reasonable in 

 experimental hyperthyroidism to seek the explanation in the different reac- 

 tion activities of the ductless glandular system.- When, for example, we see 

 that administration of thyroid substance produces glycosuria in one in- 

 dividual and in another does not alter the carbohydrate metabolism, we 

 may readily infer that, on account of the known physiological correlation 

 between thyroid and pancreas, in the first case the insular apparatus has not 

 kept pace with the demands that the hyperthyroidism has made upon it, 

 while in the other case the functional capacity of the pancreas is sufficient. 

 In other cases entirely different constitutional factors appear more strongly in 

 the foreground. For example, in neuropathic predisposition, the symptoms 

 on the part of the nervous system and the mind occur more markedly and 

 have other features. This, ceteris paribus, holds just as good for the [diseases 

 due to] functional increases as [for those due to] deficiencies. 



Our standpoint as to dysfunction is important not only theoretically but 

 practically. If we discard dysfunction, the therapeutic indications are much 

 clearer. The results of substitution therapy are thus readily made intelli- 

 gible, and the operative treatment of conditions due to hyperfunction 

 properly receives its justification only in this way. It appears to me that 

 the study of the pathologic correlations is important for the explanation of 

 many a therapeutic failure. In symptoms due to lack of a gland, a complete 

 result as the consequence of substitution therapy is not to be expected when 

 other parts of the ductless glandular system are involved at the same time. 

 Perhaps in such cases more can be achieved through combined organotherapy. 

 Pertinent contributions in the French literature appear to me to be in part 

 very optimistic. A similar consideration of the pathological correlations is 

 perhaps due in the position of the indications for the operative treatment of 

 the hyperfunctional disease. One would perhaps take exception to a resec- 

 tion of the thyroid when at the same time other manifestations are present 

 that point to exhaustion of another ductless gland, for instance, the chrom- 

 affin tissue. In this connection still another factor is important, namely, the 

 relations between the ductless glandular system and the central nervous 

 system. I shall speak about this subject later. 



Only a few words yet as to the intoxication theory that plays so great a 

 role in the study of the internal secretions. The expression "poisoning" is, 

 according to my opinion, well adapted in many diseases due to hyperfunction; 



