42 GENERAL PART 



dermographism, and the trophic disturbances, abnormal pigmentations, 

 mal perforant du pied, etc. If here I look around for symptoms on the part 

 of the ductless glands, I find almost only the degenerative changes in the 

 sexual glands that have been demonstrated by Marchand and others; these 

 may be conditioned by the syphilis, but it might also be conceived that they 

 exist on a trophic degenerative basis. I could regard any of the other 

 symptoms as ductless glandular, only in the sense that they might be second- 

 ary. R. Stern regards as the basis of the fact that only a percentage of persons 

 infected with lues become affected with metasyphilis the vulnerability 

 of the ductless glandular system in the mapping out [Anlage] of such persons. 

 According to this view, the affection of these glands furnishes the impulse for 

 the development of the tabes or the paralysis. Even though in my dis- 

 sertations I arrive at a standpoint that is almost the opposite of Stern's, I 

 would nevertheless recognize the ingenious character of Stern's work. 



I would here summarize briefly the facts arrived at from the above exposi- 

 tion. Even though we may be inclined to refer to functional alterations of 

 the ductless glandular system changes in metabolism in the course of neuro- 

 ses of the vegetative nervous system or in the course of nervous diseases in 

 which manifestations on the part of the vegetative nervous system become 

 prominent, we are not on this account justified in regarding these diseases 

 as true ductless glandular affections. At all events it must be acknowledged 

 that it is not yet possible to draw a clear line of demarcation between certain 

 ductless glandular affections and the vegetative neuroses; the neurosis theory 

 of Basedow's disease has not as yet been fully rejected, nor is the supposition 

 that in the pathogenesis of diabetes mellitus there is the admixture of a 

 marked component of neurosis. But a sufficiently firm foundation has been 

 built by experimental pathology, in the majority of ductless glandular 

 affections, to justify a sharp demarcation from the vegetative neuroses, at 

 least nosologically. 



Pluriglandular Disturbances 



Proceeding from this standpoint, we now go on with a consideration of 

 the question of the pluriglandular disturbances. Of late this question has 

 been especially discussed in France. Claude and Gougerot, on the basis of 

 clinical observations and certain pathologico-anatomical findings, first 

 conceived the idea of an insuffisance pluriglandulaire. Proceeding from the 

 observation that under circumstances certain ductless glands may become 

 diseased simultaneously, they attempted to furnish the demonstration that 

 in the most diverse ductless glandular diseases symptoms are found almost 

 regularly that point to the affection of another ductless gland. The authors 

 have found many disciples. The direction of this is characterized by the 

 classification of Laignel-Lavastine. Laignel-Lavastine distinguishes "syn- 

 dromes pluriglandulaires a predominance thyreoidienne, a predominance 



