14 GENERAL PART 



X, I do not regard as warranted.) We may therefore assume that there is 

 exercised by the sexual glands, especially at the time of puberty, an influence 

 upon the zone of ossification in the sense of a definite bone formation. This 

 influence is exercised on the part of the interstitial glands. 



2. Absence or high-grade diminution of the function of the thyroid gland 

 at an early age leads to dwarf growth; that is, to inhibition of growth. The 

 skeleton retains in general the childish dimensions. The epiphysial closure 

 is to a marked degree delayed. The fontanelles remain open for a long time, 

 the root of the nose is drawn in, the development of the bone-nuclei is very 

 much retarded. The bones already formed show a slight degree of sclerosis. 

 The bones are thick. In youthful individuals with Graves' disease there is 

 found on the contrary a slightly accelerated growth in the length, and a 

 somewhat premature closure of the epiphyses. The eunuchoid distribution 

 of fat is absent. The genitals remain backward in development, but not so 

 markedly as in eunuchoidism. Under the influence of the insufficiency of the 

 thyroid gland the endochondral and periosteal ossifications are to a slight 

 degree retarded. 



3. Absence of the hypophysis in early years also leads, as clinical and 

 recently, also, experimental observations show, to an inhibition of growth. 

 Closure of epiphysial junctures and development of the bone-nuclei are like- 

 wise delayed, perhaps not so markedly as in the thyrogenic inhibition of 

 growth; this, however, is hard to decide, at least in the clinical observations, 

 as the observations on the disturbances do not seem to deal with cases at 

 such an early age. The hypoplasia of the genitalia and especially of the 

 interstitial glands is very much more marked, also when the disturbance sets 

 in later. Correspondingly there is found a eunuchoidal distribution of fat 

 and even a (secondary) influencing of the body proportions which approxi- 

 mate more or less closely the eunuchoid type. 



In cases of youthful acromegaly the relations are very much more com- 

 plex. The typical cases appear to me, as I shall treat of in greater length in 

 Chapter VI, to be those with a marked accentuation of the functions of the 

 interstitial glands. We find then premature closure of the epiphysial junc- 

 tures, more emphatic pronunciation of the secondary sexual characters, 

 and premature thickening of the bones with exostosis formation and thicken- 

 ing of the soft parts. In other cases we find, however, inhibition of develop- 

 ment in the genital sphere, together with a marked eunuchoidal tendency 

 in the proportioning, with tall growth. 



4. In disorders of hyperfunction of the sexual glands, of the suprarenal 

 cortex, or of the epiphysis in youthful life, we find premature development of the 

 whole body, accelerated growth with potentized childish dimensions, prema- 

 ture development of the genitalia, and then later premature epiphysial closure ; 

 in short, a transitory gigantism. Whether these vegetative disturbances can 

 be the direct outcome of those of the organs mentioned, or whether they are 



