43 



hypophysaire, a predominance genitale et sans predominance marquee." 

 Claude and Gougerot have further developed their teaching in that they point 

 out that also conditions of hyperfunction of several ductless glands may 

 exist simultaneously, and that not rarely conditions of hyperfunction of one 

 ductless gland are combined in the clinical picture with manifestations of 

 absence or deficiency of the function of another. They distinguish, of duct- 

 less glandular diseases, seven categories: 



1. Syndromes uniglandulaires avec lesion pluriglandulaire; example, 

 classical myxedema. 



2. Syndromes pauciglandulaires; that is, predominance of the disease in 

 one ductless gland, but distinct alteration in the others. 



3. Syndromes d'insuffisance pluriglandulaire sans predominances. 



4. Syndromes d'hyperfonction pluriglandulaire; example, acromegaly, 

 hyperfunction or dysfunction of the hypophysis with hyperfunction 

 of the thyroid gland, suprarenal glands, etc. 



5. Syndromes pluriglandulaires de balancement; that is, a hyperfunction 

 that developed compensatorily as the result of a primary falling away 

 of the function; for example, Basedow's disease that follows a 

 "hypoovarie." 



6. Syndromes pluriglandulaires disharmoniques ; example, Basedow's 

 disease combined with myxedema and " hypoovarie." 



7. Cas d'attente a syndromes frustes. 



Gougerot goes still further, including the glands with external secretion 

 in the pluriglandular syndrome; for instance, he describes: syndrome 

 Mikulicz, lacrymo-parotidien avec symptomes d'hypoovarie evidente, hy- 

 pothyreoi'die et hypoepinephrie probable. The disciples of Claude and 

 Gougerot have also included the trophoneuroses. Thus Siccard and Rousay, 

 later together with Berkowitsch, explain a case of Dercum's disease as in- 

 suffisance ovarothyreoi'dienne. From these views Renon and Delille have 

 drawn far-reaching therapeutic consequences, in that they propose an 

 "opotherapie associee" in those conditions hr which a trial with simple 

 opotherapy fails. Thus the authors found that in one case of Dercum's 

 disease ovarian substances, and later thyroidin, remained inactive, while 

 on the contrary the combination of these two remedies was effective. A case 

 of myasthenie bulbospinale was improved by the combined administration 

 of ovarian and hypophysial substances, a scleroderma by thyroidin and 

 ovarian substances, a Basedow's disease disappeared on the administration 

 of hypophysial and ovarian substances, a case of acromegaly was essentially 

 improved through ovarian substances and thyroidin, etc. R. Dupuy used 

 polyopotherapy for the development of individuals who had remained be- 

 hind or were at a standstill, and saw a striking improvement after one-half 

 to one year's treatment. The admixture of all nosological unities goes so 

 far that Grasset says: The insufficiency of a ductless gland always becomes 



