INFLUENCE OF THE DUCTLESS GLANDS ON THE REGULATION OF METABOLISM I 7 



time that the thyroid gland influences it enormously. In Basedow's disease 

 the protein requirements are increased; the patient must ingest more protein 

 if he does not wish to use up the protein constituents of his body. In 

 myxedema the protein requirements are abnormally low. In hypophysial 

 and suprarenal diseases these disturbances in the protein economy are not so 

 distinctly prominent. Also the severe diabetic ordinarily has no heightened 

 protein requirements. 1 



From these examples it will be seen that the regulatory influence of indi- 

 vidual ductless glands on the different metabolic processes is to a great extent 

 specific. While pancreas and chromaffin tissue govern the carbohydrate 

 metabolism, the thyroid gland is especially important for the protein meta- 

 bolism. For the calcium metabolism the function of the parathyroid would 

 seem to be of especial importance, as in tetany the assimilation of calcium in 

 the nervous system seems to be disturbed, although also other ductless glands 

 would seem to take a part in the regulation of calcium metabolism. Thus 

 the thymus gland seems to be of importance for the assimilation of calcium 

 in young bones. Administration of thyroid-gland substance or of extracts 

 of the posterior lobe of the hypophysis increases chiefly the elimination of 

 calcium ; adrenalin increases that of potassium and sodium, while the elimina- 

 tion of calcium is restricted. The significance of these experiments for 

 clinical medicine is not as yet clear. 



The influence of ductless glands on the purin metabolism has as yet been 

 investigated but little. The observations that in acromegaly the endogenous 

 factor of the uric-acid elimination is raised, that in hypophysial dystrophy it 

 may lie strikingly low, and that also the exogenous factor may show oppo- 

 sitely directed alterations, and that, further, alterations of purin metabolism 

 also occur in the thyroid-gland diseases, as I shall show in Chapter II, make 

 probable the regulatory influences of the ductless glands on the purin met- 

 abolism. I must not off-hand make any statement as to whether the 

 problem of gout will be elucidated by such investigation. 



The study of the respiratory gaseous exchange has furnished a deep insight 

 into the regulation of metabolism in the ductless glandular diseases. Here, 

 too, I will limit myself to certain important facts. In Basedow's disease the 

 fundamental exchange is increased. In thyroprivic or spontaneous myxe- 

 dema the fundamental exchange and the caloric requirements are reduced. 

 In acromegaly a distinct rise of the fundamental exchange is present only 

 when symptoms of Basedow's disease are present at the same time. In 

 hypophysial dystrophy the fundamental exchange is reduced only in espe- 

 cially severe cases. In failure of the sexual glands the reduction of the 

 fundamental exchange is still a moot question and if present is but slight. 



1 Also qualitative alterations of the protein metabolism are observed in ductless glandular 

 diseases; in tetany, for example, there is a heightening of the ammonia, amino-acid, and polypeptid 

 fractions. 



