286 PHARMACEUTICAL BACTERIOLOGY 



mortification is intensified by the fact that unlike that of the other types, 

 his mind is as alert as that of the normal individual. His large head, saddle 

 nose, short and bowed legs, prominent abdomen, and marked lordosis, 

 bespeak little indeed in favor of a medical science which cannot check the 

 development of such deformities in their incipiency. 



Myxedema, cretinism, and other classic disorders of the various duct- 

 less glands obviously belong to the field of the hemadenologist. It should 

 be borne in mind, however, that in their larval or mild forms they con- 

 stitute in many instances, the so-called rebellious cases met with in general 

 practice. The sufferer of larval hypothyroidism, for example, may show 

 little else than occipital or interscapular pain and cold extremities and yet 

 resist all the antirheumatic or antineuralgic measures that a century may 

 have suggested. Unrecognized, such patients sometimes contribute to 

 their physician's diagnostic acumen by becoming frank cases of myxe- 

 dema when organotherapy arrest both the latter and the rheumatism. 

 Lying behind tetany, paralysis agitans, and osseous disorders are, it is 

 believed, lesions of the para thyroid glands which thus become, as does the 

 thyroid, elucidative factors in obscure though relatively commonplace 

 disorders. 



Much the same remarks apply to larval Addison's disease. While 

 more or less bronzing characterizes the latter, we often meet in pale children, 

 neurasthenic adults, and premature seniles, the typical signs of this con- 

 dition, asthenia, sensitiveness to cold, cold extremities, hypotension, weak 

 cardiac action and pulse, anorexia, anemia, constipation, etc., but without 

 bronzing. Acute febrile diseases, pneumonia, diphtheria, typhoid fever, 

 etc., may bring on a similar state by exhausting the adrenals, the patient 

 dying after a period of weak heart, low blood pressure, asthenia, a tend 

 ency to fainting, prostration, etc., an issue which a few timely doses of 

 adrenaline in saline solution would have prevented. Excessive activity 

 of the adrenals is another cause of death in children seldom recognized. 

 Here the work of the hemadenologist will become elucidative and life 

 saving. 



Goitre and exophthalmic goitre, the bulk, as it were, of the cases 

 witnessed by the hemadenologist, need his special intervention, to elimi- 

 nate at the earliest moment, that of the surgeon. While in no way dis- 

 crediting the value of operative procedures in appropriate cases, my own 

 experience confirms that of Leonard Williams in condemning promiscuous 

 resort to the knife. This applies also to many cases of ordinary goitre. 

 Many patients subjected to operation could have been cured by medical 

 treatment, thus preserving for them a useful organ. We must not lose 

 sight of the fact, however, that much work remains to be done to establish 

 the precise limitations between operable and inoperable cases a line 



