446 PLURIGLANDULAR DISEASES 



part they rather appear prematurely old, and in some cases the face has 

 even a senile appearance. There never occurs the development of an adi- 

 posity of the type of the eunuchoids. For the most part there rather 

 occurs an increasing emaciation, which is associated with a feeling of weak- 

 ness and with chills, and which persists in spite of all attempts at 

 feeding up. Then there occurs more or less pronounced puffiness of the 

 skin of the face, especially of the cheeks, and of the skin of the backs of the 

 hands and feet, in many cases quite pronounced myxedema, which partially 

 but not entirely retrogresses on thyroidin medication. There usually are 

 added to the falling out of the hair on the face, trunk and extremities, 

 thinning out of the hair of the head, eventually falling out of the hairs 

 in spots, such as is seen in true myxedema, also thinning out of the eye- 

 brows, eyelashes, and symptoms that also do not belong to true late 

 eunuchoidism. Also brittleness of the nails was observed in my case. 

 The loosening of the teeth, and especially the marked wearing down of 

 the crowns, as I saw in my case, perhaps too belong to the clinical picture. 

 In many cases are found in addition to the puffiness of the skin, pronounced 

 atrophy of the rest of the skin, and marked dryness and exfoliation. There 

 further develops in the majority of cases pigmentations of the skin, especially 

 in places exposed to light or where the clothing presses, sometimes, too, dis- 

 tinct pigmentations of the mucous membrane as in Addison's disease; in 

 other cases a pigmentation that is more brownish is noticed. Almost in no 

 case are absent asthenia that increases to high-grade prostration of strength, 

 mental sluggishness and apathy, further a feeling of pressure in the head, 

 forgetfulness, insomnia, and eventually transitory rheumatoid pains in the 

 limbs. In addition there exists hypotonia. The sugar content of the blood 

 has not as yet been investigated. In cases in which the blood has been 

 examined have been found in addition to the anemia, slight leucocytosis with 

 mononucleosis and eosinophilia. Temporary polyuria has been reported 

 remarkably frequently (Rumpel, Gandy, Gougerot and Gy). Occasionally 

 also occur tetanic convulsions (Claude and Gougerot), or at least the symptoms 

 of a latent tetany. 



The tracing of the relationship of the numerous symptoms to the diseases 

 of the individual ductless glands often meets, as will be understood, with diffi- 

 culties. It seems to me that the simplest to explain is the syndrome that we 

 learned to know in the exposition of late eunuchoidism, and that comes about 

 through the degeneration of the sexual glands. It should only be mentioned 

 in addition that in the cases that affect women, the retrogression of the 

 genital apparatus and of the secondary sexual characters are present in a pro- 

 nounced manner. At all events we cannot in the cases with pronounced retro- 

 gression of the genital apparatus, and especially of the hair of the mustache, 

 exclude the possibility that a degeneration of the suprarenal cortex does not 

 play a role. In male individuals, it appears to me only necessary to assume 



