THE SYMPATHETIC SYSTEM 31 



velopment of hairs in certain cases of suprarenal virilism or 

 hirsutism. Teeth easily affected, or absent, belong to this 

 same group of symptoms and in children the persistence 

 of the milk teeth and the superposition of the two denti- 

 tions is sometimes a sign of hypothyroidism as I have 

 observed with Mrs. Long-Landry. The nails can be also 

 altered striated, with many white marks, thin and easily 

 breakable. The examination of the hairs, the nails, the 

 teeth, added to that of the skin, is essential when- 

 ever an endocrine lesion is suspected, particularly a thy- 

 roid disturbance. 



Among the disturbances in nutrition which go hand in 

 hand with changes of the skin and its derivatives, obesity, 

 holds an important place as being one of the most fre- 

 quent signs of endocrine disturbance. Be it associated or 

 not with bone, genital or skin lesions, it has often been 

 caused by an insufficiency of the thyroid. There are also 

 more complex causes; that is, it may be due indirectly to 

 an action on the genital glands by the thyroid. Next to 

 the thyroid in frequency and possibly more often, the 

 pituitary is involved. Occasionally the pineal and the 

 adrenal glands are to blame. Certain syndromes, such 

 as, Dercum's disease appear distinctly as polyglandular 

 syndromes, in which at least three glands are involved: 

 ovary, thyroid and pituitary, and possibly, also the ad- 

 renals. In all cases an endocrine disturbance should be 

 suspected in cases of obesity, particularly if it shows evi- 

 dence of partial obesity, be it painful or not. Obesity 

 associated with thin limbs is very characteristic in certain 

 adiposo genital syndromes of pituitary origin. 



Next to obesity, we must place diabetes mellitus, which 

 often leads the way to the discovery of an endocrine 

 disturbance. Next to pancreatic diabetes, clinically and 

 experimentally, so clearly specific, there are diabetes due 



