MULTIPLE DUCTLESS GLANDULAR SCLEROSIS 441 



of the hypophysis. The only disease that perhaps belongs here is gigantism. 

 Later I shall expound in detail that I cannot regard gigantism as simply an 

 acromegaly of child-life, as Launois and Roy assert. The enormously in- 

 creased tendency to growth of the entire body seems to signify to me much 

 more a rendering potent of the entire ductless glandular system, that is mostly 

 followed by a rapid exhaustion, in which some glands, as for example the 

 sexual glands, even at the beginning of the disease, show signs of a decay 

 [of function] or of a remaining backward in development. One aspect of 

 the problem seems to me not as yet explained, namely, whether we are 

 justified in regarding the potentizing of the ductless glandular system as 

 alone the cause of the increased tendency to growth or whether we must not 

 assume that from the beginning there was an abnormal tendency [mapping- 

 out, Anlage] of the entire organism, . including the ductless glands. It 

 seems to me, however, that the inclusion of gigantism among the pluri- 

 glandular diseases seems best adapted for our purpose. 



Multiple Ductless Glandular Sclerosis 



Historical. A number of the cases that I shall group under this term 

 appear in the literature under very diverse designations. In the descrip- 

 tion of late eunuchoidism it was mentioned that the cases of multiple ductless 

 glandular sclerosis all are associated with more or less distinct symptoms of 

 late eunuchoidism, that however' these symptoms constitute only a partial 

 manifestation of the picture, far richer in symptoms, of multiple ductless 

 glandular sclerosis. A uniform conception of this disease picture has not 

 as yet permeated the French literature. Gandy describes as infantilism 

 reversif ou tardif a part of the cases here set forth by myself and ascribes an 

 important etiological factor to a disease of the thyroid gland. Cordier and 

 Rebattu place the sexual glands as the central figure of the pathogenesis and 

 distinguish between dysorchidie and dysorchidie-dysthyroidie. The works 

 of Claude and Gougerot mark an essential advance, these authors in 1907 

 having described this clinical picture under the terms insufrisance pluri- 

 glandulaire endocrinienne. To my mind, however, Claude and Gougerot 

 have lately gone too far, in that they had especially also later French authors 

 have included under this designation cases whose position [thereunder] have 

 seemed to me uncertain. I have already dealt with this in detail in the first 

 chapter. There I have classified together under the term multiple ductless 

 glandular sclerosis those cases in which a primary simultaneous disease, or 

 almost simultaneous disease, of several glands exist, cases that we must re- 

 gard as correlated to the inflammatory sclerosis and atrophy of the ductless 

 glands as found at autopsy. 



There are, of course, cases of spontaneous myxedema or of Addison's dis- 

 ease that likewise depend on inflammatory sclerosis of the ductless gland con- 



