44 GENERAL PART 



more and more a rarity or a "creation artificielle," the group of insuffisance 

 pluriglandulaires crowds the others more and more and perhaps in time will 

 quite replace them. With all this, who does not feel foundations wavering 

 under him? 



I must not leave unmentioned the fact that voices, even in France, 

 have been raised against these extreme overdrawings. Roussy maintains a 

 very reserved attitude. He believes that they are an ingenious hypothesis, 

 but [regards] methodical sections as lacking. 



The question seems to me to gain clearness if we distinguish between 

 pluriglandular insufficiency or pluriglandular syndromes on the one hand 

 and multiple ductless glandular sclerosis on the other, for the existence of a 

 pluriglandular syndrome does not signify the existence of a multiple ductless 

 glandular disease. On the basis of what I have already written, I must 

 assume that the pluriglandular syndrome comes about: 



1. Through physiological correlation. 



2. Purely functionally through influencing on the part of the vegetative 

 centers. 



I have gone more intimately into the question of the latter factor in the 

 consideration of the vegetative neuroses. As far as the physiological corre- 

 lation is concerned, it seems to me that it affords no ground for a confusing 

 of the sharply delimited disease pictures of the individual ductless glandular 

 diseases. Let us first consider the diseases due to deficiency. That in 

 myxedema the activity of the glands of generation is diminished or that 

 in hypophysial dystrophy there occurs even marked degeneration of the 

 sexual glands belongs to the disease pictures themselves. On account of 

 this no doubt is cast on the view that in the first case the thyroid gland is 

 the central figure of the pathogenesis, in the second the hypophysis. The 

 disease pictures which, however, we assume as the result of a pathological cor- 

 relation already belong to multiple ductless glandular diseases: I refer once 

 more to the simultaneous degenerative lesions of the thyroid gland and the 

 glandular hypophysis, of the thyroid gland and the insular apparatus of the 

 pancreas, etc. The pathological correlation finds its most complete ex- 

 pression in that clinical picture, well characterized in a symptomatological 

 respect, which I have termed multiple ductless glandular sclerosis. 



Undoubtedly more complicated are the relations in the hyperfunctional 

 diseases not so very much in Basedow's disease. Although in this condi- 

 tion we may acknowledge a functional increase of the chromaffin tissue, 

 this is secondary and well enough explained by physiological correlation. 

 That long-continued oversaturation of the body with thyroid gland secretion 

 may give rise to disturbances of the functions of the sexual glands is not 

 at all remarkable, only the significance of the thymus hyperplasia is as yet 

 unclear. But on this account, not to wish to consider Basedow's disease 

 as a clinical entity seems to me incomprehensible. Sooner could aero- 



