MULTIPLE DUCTLESS GLANDULAR SCLEROSIS 447 



such an involvement of the suprarenal cortex in the crassest cases, as in 

 traumatic late eunuchoidism, in which the etiological factor is quite clear, 

 quite severe manifestations of retrogression may occur. In women, however, 

 there may perhaps be ascribed to the suprarenal cortex a greater signifi- 

 cance in this direction, for we see after castration very slightly pronounced 

 the ordinary retrogression of such secondary sexual characters as the hairi- 

 ness of the axillae and of the genitalia. 



The changes in the hair of the head are to be referred to a degeneration 

 of the thyroid gland, as are also trophic disturbances of the nails, probably 

 also of the teeth, and further the apathy, headache, forgetfulness, etc., 

 finally the myxedema of the skin. At all events it seems to me questionable 

 whether the myxedematoid consistence of the skin is always of purely thyro- 

 genic origin, as thyroidin medication very often does not fully control it. 

 Such myxedematoid alteration of the skin is found not infrequently in the 

 hypophysial dystrophia adiposo-genitalis; further such alterations occur not 

 rarely if cachexia develops in Basedow's disease. I refer to the chapter 

 dealing with this subject, and would like only to express the conviction that 

 in such cases the skin changes may be brought into relationship with a 

 (even simultaneous) degeneration of the glandular hypophysis. 



The sclerosis of the hypophysis may also very well play a part in the 

 rapidly progressive cachexia. . That there does not ensue a distinct develop- 

 ment of hypophysial obesity is intelligible when we consider the general 

 cachexia in multiple ductless glandular sclerosis. If individuals who are 

 not yet fully developed were to become the subjects of this disease, the 

 absence of the eunuchoidal tall height would also be intelligible, as the action 

 of the insufficiency of the sexual glands on the development of the skeleton 

 might be compensated by the insufficiency of the hypophysis. I would 

 bring still another symptom into relation with the hypophysis the transi- 

 tory polyuria. As is known we find this symptom quite commonly in 

 diseases of the hypophysis, or in pathological processes at the base of the 

 skull. We may readily conceive that sclerosing processes that have be- 

 come established in the anterior lobe of the hypophysis temporarily act as 

 irritants on the posterior lobes or on the pars intermedia. From this stand- 

 point it seems to me worthy of mention that two of the cases of late eunuch- 

 oidism reported in the tenth chapter, in which we found transitory polyuria, 

 developed after an acute infectious disease or after lues. Here the polyuria 

 may well be regarded as hypophysial. 



Hypotonia, high-grade asthenia and the pigmentations serve as mani- 

 festations of absence or deficiency [Ausfall] on the part of the suprarenals or, 

 much more, the suprarenal medulla. Finally the tetanic spasms that occur 

 point to an involvement of the parathyroid glands in the disease process. 

 Here perhaps it may be thought that the lowering of the thyroidal and 

 suprarenal activities can antagonize the occurrence of distinct tetanic symp- 



