450 PLURIGLANDULAR DISEASES 



furnishing a basis for a preceding disease of the genitalia. In both cases 

 there was found an almost complete falling-out of hair on the trunk and 

 the extremities, and also that in the axillae and on the pubis. The histo- 

 logical examination of an excised piece of skin showed, in addition to collec- 

 tions of pigmentation, abundant connective-tissue proliferation of the cutis; 

 and in places the sweat-glands and the hair follicles were replaced by 

 connective-tissue strands. Falk believed that this sclerosis was also the 

 cause of the falling-out of the hair. I incline more to the supposition that 

 the involvement of the sexual glands in the general sclerosis had led to a retro- 

 gression of the secondary sexual characters. 



For this assumption I find support in the investigations of Weichselbaum 

 and Kyrle. In individuals, who do not as yet stand under the influence of 

 the senium, Weichselbaum and Kyrle found on account of alcoholism cirrhotic 

 alterations of the testicles, affecting interstitial cells as well as the glands of 

 generation. 



In the broad field of multiple ductless glandular sclerosis belongs perhaps 

 a disease that v. Noorden has described as degeneratio genito-sclerodermica. 

 It affects young, previously healthy, girls, in whom after a previously normal 

 | development the menstrual periods suddenly cease at the termination of an 

 I acute infectious disease. There are marked emaciation and loss of appe- 

 tite, a premature senility occurs, and there develop trophic disturbances 

 of the skin; in some cases in which the condition was looked for, the body 

 of the uterus was found to be atrophic. 



Further I would mention for consideration whether such a multiple duct- 

 less glandular sclerosis does not exist in many cases of pedatrophy. Thompson 

 has described a noteworthy case in which sclerotic processes were found in all 

 the ductless glands. 



Finally I might here mention an apparently rather typical disease picture 

 of which Sir Jonathan Hutchinson, Hastings Gilford and recently Variot 

 and Pironneau have furnished examples. Hastings Gilford designates these 

 cases as "progeria," Variot and Pironneau as "nanisim type senile." As we 

 shall see directly much speaks against our classifying, without other con- 

 sideration, these cases with multiple ductless glandular sclerosis. I would 

 say here, however, that at least an indirect connection with the ductless 

 glandular system is here possible, and that the inclusion of the condition at 

 another place appears to me less to the purpose. 



I will here shortly report the three cases described up to the present. In the case of 

 Hastings Gilford the observation extended between the fourteenth and eighteenth years 

 of life of the individual affected. A photograph of the individual taken at the second 

 year of life shows that the hair of the head was markedly thinned out already at that time; 

 at the later investigations the patient showed a marked remaining behind in growth and in 

 entire development. At fourteen years of age the boy was 113 cm. tall, weighed 16 kg. 

 He was extremely thin, so that the cartilages of the nose and the veins and the tendons of 

 the entire body were very prominent. The head was rather large, the facial skeleton 



