420 THE DISEASES OF THE SEXUAL GLANDS 



cases, in which the typical distribution had not been noted especially, it 

 could be recognized in the illustrations that accompany the reports. 



In the majority of cases it is furthermore stated that the voice which had 

 previously been mannish, altered in the course of the disease. A falsetto 

 voice did not develop, as in eunuchs and early eunuchoids, but the voice 

 placement was high and the voice shrill. 



In the pure cases there is no alteration of the intelligence. The apathy, 

 [mental] heaviness, forgetfulness, that are stated to have occurred in indi- 

 vidual cases, may well be referred to the general prostration following several 

 general infectious diseases or perhaps to a slight myxedematous component. 

 We shall again see such manifestations under multiple ductless glandular 

 sclerosis. In pure cases the statements as to alterations of the moral and 

 psychical attitude are on the contrary very frequent; statements that such 

 individuals like early eunuchoids, are psychically more easily excited, and 

 given to sudden anger and to lying. In two cases also has been noted tem- 

 porary polyuria {Gougerot and Gy, and Dalche). In the first case the late 

 eunuchoidism came after an acute infectious disease, in the second after lues. 

 We shall often meet with these symptoms in the consideration of multiple 

 ductless glandular sclerosis. Perhaps it is of hypophysial origin. 



Are we now justified in separating out these cases as an especial clinical 

 formation and giving it the name "late eunuchoidism?" As has been men- 

 tioned, Gandy regards them as " dysthyreodie + dysorchidie." Gallavardin 

 and Rebattu express themselves more in favor of [in affection of] the sexual 

 glands, Cordier and Rebattu distinguish between an " inf antilisme regressif 

 myxedemateux et non myxedemateaux." Claude and Gougerot finally group 

 all these cases under "insuffisance pluriglandulaire." The confusion can, I 

 think, readily be overcome if we place in the foreground the classification of 

 these cases according to their etiological factor, and separate out, before 

 everything else, those cases which have the value of experiments, namely, 

 the traumatic. Where acute infectious diseases or noxi of a more general 

 nature have led to degeneration of the sexual glands it is very well intelligible 

 that also other ductless glands can suffer damage, and that other features 

 often hard to define become associated with the picture of a disease that is 

 due to falling-out of the sexual gland. 



As to the significance of thyroid insufficiency in this disease picture, we 

 can become clear on this point, if we have recourse to the experiments. If 

 in an individual who has attained complete maturity, the thyroid gland is 

 completely extirpated, there come about disturbances of the genital function, 

 but never any such retrogression of the genitalia as has been just described. 

 The thyroprivic disturbance of the genital function can be promptly over- 

 come by thyroidin medication, while all statements are in accord that 

 thyroid medication does not improve the disturbance of sexual glandular 

 function in late eunuchoidism. In spontaneous myxedema of adults the 



