MULTIPLE DUCTLESS GLANDULAR SCLEROSIS 453 



features of ductless glandular sclerosis, and which may play the chief role 

 in the enormous cachexia and the senilism of these individuals. 



In the clinical picture of progeria are some features that seem to me 

 hardly compatible with the assumption of a ductless glandular sclerosis. 

 In the three typical cases the intelligence was fairly well developed, which 

 rules out a strong involvement of the thyroid gland. Especially, however, 

 does it seem to me that the premature ossification points to a sclerosing 

 process independent of the ductless glandular system, as otherwise we would 

 expect considerable retardation of ossification. The severe disturbance in 

 the development, or the retrogression of the hair, can indeed very well be 

 brought into relation with an involvement of the suprarenal cortex; it is, 

 however, conceivable that it has its foundation in a severe atrophy of the 

 skin. It was already in the first chapter pointed out that we must not re- 

 gard old age, as Lorand does, simply as a gradual degeneration of the ductless 

 glandular system; but consider that the ductless glandular system, like 

 the rest of the organs takes part in a general involution of old age. It 

 seems to me that the same thought can be applied also to premature and 

 to childish senility. 



Differential Diagnosis of Multiple Ductless Glandular Sclerosis. The 

 cases out of the literature that I have quoted show a remarkable agreement 

 with each other, so that for the most part the diagnosis does not meet with 

 difficulty, especially so in that the retrograde processes in the genitalia and 

 the secondary sexual characters constitute especially striking symptoms. 

 The delimitation from pure late eunuchoidism may indeed become difficult. 

 Marked puffiness of the skin, thinning of the hair of the head in patches, 

 and of the hair of the lashes and eyebrows, speak against late pure eunuch- 

 oidism, as do also marked emaciation and cachexia. For the delimita- 

 tion from pure myxedema I regard as important the partial or extremely 

 deficient results attending thyroid-gland therapy. Concerning the diagnosis 

 from pure Addison's disease nothing further need be said. As far as diag- 

 nosing it from hypophysial dystrophia adiposo-genitalis is concerned, I 

 do not known that in this disease such a high-grade atrophy of the genitalia 

 of adults occurs as was described under late eunuchoidism; naturally the 

 absence of symptoms of brain tumor is also important, although it must 

 be remembered that in the case of Sainton and Rathery there was found at the 

 same time a malignant cystic degenerated tumor of the hypophysis. There- 

 fore it seems that a combination of multiple ductless glandular sclerosis and 

 hypophysis tumor may occur. 



Up to the present the treatment has been of little avail. In the cases of 

 Rumpel and of Djeinil Pascha the use of thyroid gland was negative, and in 

 Gouilloud's case doubtful. French authors have tried a combined ductless 

 gland therapy (thyroidin, hypophysis substance, sexual gland substance, and 

 suprarenal substance), and have sometimes seen temporary improvement of 



