MULTIPLE DUCTLESS GLANDULAR SCLEROSIS 449 



mention, although I cannot follow the connection of ideas of these authors 

 when they ascribe to cases of dystrophia adiposo-genitalis, yes even to cases 

 of acromegaly, a tuberculous foundation. 



In many cases the disease picture of multiple ductless glandular sclerosis 

 develops quite spontaneously, without a preceding or an accompanying 

 disease. The opinion of Claude and Gougerot that there exists in such cases 

 a congenital weakness of the ductless glandular system, so that a not well- 

 definable deleterious agent brings this system to degeneration, is not im- 

 probable. In such cases the organism, especially that which is still in a state 

 of development, may come to a temporary manifestation of insufficiency 

 on the part of the ductless glandular system. 



I would regard the following as such a case: 



Observation LIV. J. K., seventeen years old (first medical clinic). One year ago 

 typical tetany, two months ago typical epileptic attacks for the first' time. Now tetany 

 again. Of medium height, pale color of face, skin somewhat dry and exfoliative. Face 

 distinctly myxedematoiis, especially the eyelids. On the backs of the hands slight 

 myxedematous swellings. Hairs of the beard and axillae are entirely absent, as is also the 

 hairiness of the linea alba and the calves. Scanty hairs at the root of the penis. The 

 testicles are very small and soft. As yet no libido, never erections nor pollutions. 

 Finger nails very compact, strongly curved, and ridged longitudinally. Teeth through- 

 out strikingly small and poorly developed, "terrace-like striations on the enamel (whether 

 he had tetany in childhood cannot be elicited). Ossification normal. Blood-pressure 65. 

 On the administration of even 200 gm. dextrose, no glycosuria. Neutrophile cells 54 per 

 cent. Typical tetanic attacks. Slight apathy; on thyroidin medication the myxede- 

 matous symptoms disappear entirely, the blood-pressure soon rises to normal, the blood 

 picture becomes normal. 



After a year the case was examined by Redlich. There were new attacks of tetany, also 

 epilepsy. There was nothing to be seen of the myxedematoid symptoms, the second- 

 ary sexual characters had for the greater part developed, and the sexual life had begun 

 to assert itself. 



Thus in this case there existed, in addition to typical tetany and epilepsy, 

 a simultaneous disturbance of the function of the thyroid gland and of the 

 sexual glands. Perhaps the suprarenals (pronounced hypotonia) were also 

 involved. Probably the inhibition of development of the sexual glands 

 was not occasioned directly by the disease of the thyroid. For this 

 speaks the fact that thyroid-gland therapy immediately brought the mani- 

 festations of hypothyroidism to disappearance, while the insufficiency of 

 the sexual glands gradually disappeared spontaneously. 



Claude and Gougerot believe that also alcoholism may furnish an etiological 

 factor. In this respect two cases of general hemochromatosis, concerning 

 which Folk has reported, are of interest. As is known, there are found in 

 such cases pronounced sclerosis of the liver and mostly also of the pancreas. 

 In both the cases, as I myself had occasion to observe, there was also a pre- 

 mature diminution or cessation of the genital function, without the history 

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