48 GENERAL PART 



ditions that we regard as vegetative neuroses, shows that the vegetative 

 nervous system has a prominent place here. Rapin sees also in a familial and 

 inherited lability of the nervous system the connecting link between the in- 

 dividual diatheses. In this connection we must turn our attention to the 

 ductless glandular system. Actually we find that diabetes and obesity 

 play a prominent part in the great group of arthritism. The connection 

 between gout and the ductless glandular system is, of course, at first hand as 

 yet quite unclear. In the pathogenesis of the spasmophilic diathesis we 

 must, even with the use of the utmost reserve, ascribe some significance to 

 the parathyroid glands. Also for the genesis of lymphatism the observations 

 that status lymphaticus is regularly associated with hypoplasia of the chrom- 

 affin tissue cannot be quite without significance. For the predisposition to 

 the dermatoses the processes in the sexual sphere are of importance, as 

 Block emphasizes, for just at the transitional periods, at puberty and at the 

 climacteric, certain dermatoses are very common, and others, like favus or 

 trichophytina, disappear with the beginning of puberty. Here the ductless 

 glandular system exerts a certain influence on the natural immunity. 



A very much older observation concerns the known inclination of dia- 

 betics for furunculosis, and the great vulnerability of their tissue. This 

 may be shown experimentally: it is known that after extirpation of the pan- 

 creas it is not easy to obtain a reactionless healing of the laparotomy wound. 

 Block infected the skin of dogs with yeast before and after the extirpation 

 of the pancreas and found that the affection was much worse in the dogs 

 without a pancreas. The fact in itself cannot be gainsaid, but as yet we 

 are without any deep insight into the nature of this disease susceptibility. 



As may be gathered from the elucidation of the idea of diathesis through 

 the summarizing "Referate" [references] of His, Pfaundler, and Block, we 

 are dealing in the diathesis not with sharply circumscribed disease pictures, 

 but with an exceedingly manifold disease susceptibility resting on as yet 

 hard to define factors; alterations in the function of the ductless glands 

 constitute only one of these factors; in a theoretical sense I would not, 

 however, estimate this factor as of slight importance, for if we see in the 

 interest that physicians have taken in the question of diathesis a sort of 

 resurrection of the old humoral pathology, and if we seek in an altered blood 

 admixture and the consequent changing of the tissues the cause of the 

 tendency to disease, we find that the little that the study of the ductless 

 glandular diseases has afforded for the knowledge of diathesis has up to the 

 present first furnished" an idea as to the genesis of this alteration of the 

 blood admixture and the tissue changes that follow it. 



Finally a few words as to senility. Horsley first pointed out that the 

 alterations of the skin and other tissues that occur in old age, especially the 

 increase of the connective tissue, have a certain similarity with those that 

 occur after extirpation of the thyroid gland, and that on the other hand 

 localization of the fat deposits in old age is similar to that in eunuchoidism. 



