PATHOGENESIS AND ETIOLOGY OF DUCTLESS GLANDULAR DISEASES 35 



With this agrees the fact that in many nervous diseases that have in- 

 volved especially or partially the vegetative nervous system, as especially 

 in the vagal neurosis, there have been found mononucleosis and eventually 

 hypereosinophilia, while in the initial stage of the hypertonic diathesis, for 

 example, the count of neutrophilic cells lies at the upper boundary of the 

 normal or even exceeds this. 



On long continuance, however, there are found in many ductless glandular 

 diseases morphological alterations in the hematopoietic apparatus. The 

 alterations in the blood pictures that are observed are at first hand very hard 

 to interpret. It may be stated that in acromegaly there is very frequently 

 found mononucleosis and eventually slight eosinophilia. We have seen 

 mononucleosis in chronic tetany (in this disease under the influence of acute 

 exacerbation there may occur rapid reversals of the blood picture). Mono- 

 nucleosis (without status lymphaticus) may be observed even in severe 

 diabetes. I agree with Borchardt, who has likewise studied these relations, 

 that in general in most of the ductless glandular diseases there is observed 

 a tendency to mononucleosis and neutropenia, and in many a slighter or 

 severer grade of status lymphaticus. 



Pathogenesis and Etiology of the Ductless Glandular Diseases 



On turning our attention to the consideration of the pathogenesis and 

 etiology of the ductless glandular diseases, we find that the idea we have de- 

 veloped as to the influencing of the function of these glands by the nervous 

 system is not without significance. However, the etiology of a great number 

 of ductless glandular diseases is to be sought in an entirely different direction. 

 Let us first consider the diseases due to absence or deficiency. Here we meet 

 with congenital aplasia or marked hypoplasia, as, for instance, in thyro- 

 aplasia. A defective development [of a "rudiment" or "Anlage"] often 

 seems to be a favorable soil for a later infection. Wiesel, for instance, assumes 

 that a tuberculosis infection very frequently becomes established in the 

 suprarenals on hypoplasias of the chromaffin tissue. But on such a defective 

 mapping out, an insufficiency may become manifest, temporary, or perma- 

 nent, even without the addition of an infectious process, if larger demands 

 are made on the ductless gland in question; for example, glycosuria may occur 

 on marked alimentary overloading with carbohydrates if a (often heredi- 

 tary) weak mapping out of the insular apparatus is present. In addition, 

 we should mention trauma. This, for example, may affect the testicles 

 and lead to eunuchoidism or late eunuchoidism; in operation on goiter too 

 much of the functionating thyroid glandular tissue may be extirpated, or the 

 parathyroid glands may be injured. A very great role in the pathogenesis 

 of the disease due to absence is played by infection. Tuberculous, luetic, or 

 other bacteriological processes, most as yet not investigated, may temporarily 

 damage the ductless glands or lead to permanent destruction or sclerosis. 



