442 PLURIGLANDULAR DISEASES 



cerned. Mostly, however, we are in a position sharply to differentiate the 

 disease pictures. In the cases about to be described we are dealing with a 

 symptom-complex that already in vivo suffices to let us refer the diagnosis 

 to a more or less generalized sclerosis of the ductless glands and justifies 

 us in picking out this disease-form as an entity. 



Definition. As multiple ductless glandular sclerosis I term that clinical 

 picture which is brought about by a probably infectious, for the most part not 

 as yet more well-defined, disease process a disease process that involves several 

 ductless glands simultaneously, and leads to high-grade sclerotic atrophy and 

 hence to manifestations of deficiency on the part of these glands. Thyroid gland, 

 sexual glands, hypophysis, and suprarenals are mostly involved. Correspond- 

 ingly are found more or less pronounced the manifestations of hypothyrosis, of 

 late eunuchoidism, and hypophysial insufficiency, combined with a syndrome 

 similar to Addison's disease (hypotonia, pigmentations, etc.). Especially 

 brought into prominence is a progressive [i.e., uncontrollable] cachexia, that 

 develops to a high grade. 



Case Histories. Of the cases reported in the literature I regard the fol- 

 lowing as belonging to multiple ductless glandular sclerosis. At all events 

 I must mention that some of these cases are not exactly enough described, 

 so that their membership in the group is not quite certain. 



Observation of Rumpel. Man, thirty-six years old. Great weakness, backs of hands 

 and feet thick and puffy, pronounced cachexia, and considerable anemia, skin dry, weak- 

 ness of memory, frequent chills, temperature abnormally low, penis of normal size, scrotum 

 very small, testicles much atrophied, but still sensitive. Cremasteric reflex weakened, 

 libido absent. Scanty axillary and pubic hair; also the hair of the head is thinned out; 

 subcutaneous fat-tissue increased, especially on mons Veneris; polyuria and polydipsia; 

 gonorrhea at the age of twenty-four years. Beginning of the disease in the thirtieth 

 year of life with gradual loss of the sexual instinct, with thickening of the skin of the dorsa 

 of the hands and feet, lessening of memory, falling out of hair, etc. Thyroid treatment 

 without result. No autopsy. 



Observation ofPonfick. Man, forty-seven years old, cobbler, married since twenty-third 

 year of life, has six children. Since the thirty-second year has had a gradually-increasing 

 fullness of the face, working ability decreased, the cheeks become puffy, the lips swollen, 

 the skin rigid and pale as wax, the hair of the head thinned out, the hair on the cheeks is 

 entirely absent. Also the mustache is thinned out. Mimicry slow, speech scanning, 

 hearing diminished, skin slightly colored cyanotic, scaly, the hairiness of the trunk and 

 extremities has decreased markedly, the genitalia are almost entirely devoid of hair. 

 Hemoglobin 55 per cent. Essential improvement on thyroid medication, gain of weight, 

 8 kg., hemoglobin rises again to 75 per cent. In spite of continuation of the thyroidin 

 treatment, later much puffiness of the face, diarrheas, hemoglobin again falls, hearing be- 

 comes worse (sclerosis of the middle ear), body weight sinks lower, although thyroidin is 

 no longer given. Death from pneumonia. Thyroid 10.2 gm., therefore only a third of the 

 normal weight. The isthmus and the parts bordering on it well retained, however, and 

 show tissue that is entirely capable of functionating. Periarteritis hemorrhagica. 

 Suprarenals generally thinned, cortex somewhat smaller. Hypophysis: in the sella 

 turcica a large cavity, the posterior lobe well retained, the peduncles of the hypophysis 



