774 PERCY FRIDENBERG 



J ' 



The term idiopathic applied to disease forms has always been a con- 

 fesssion of ignorance, a reproach as well as a testimonium paupertatis in 

 etiological knowledge. Inherent in the word, however, was the connota- 

 tion of idiosyncrasy, of a heightened susceptibility or disposition to certain 

 disease forms depending on a diathesis which might be inherited, con- 

 genital, i. e., communicated in fetal life, or genuinely acquired. The 

 essential character of many if not all diatheses as deficiencies of one or 

 other essential element or better, end-product, of metabolism is now gen- 

 erally recognized. Such deficiencies may be brought about in various ways 

 as by disturbances in the succession or quality of individual metabolic re- 

 actions, resulting in a faulty biochemism, by a predominance of one or 

 other dietary component to the extent of causing intolerance, or, again, by 

 a lack of certain food forms or, more important still, of one or more of the 

 essential vitamins. The hormones are in some respects analogous to the 

 vitamins. These vitamins which have hitherto been isolated and studied 

 relate to the prevention of scurvy, of multiple neuritis, and of rachitis, 

 respectively. Hess has shown that there are certain marked analogies be- 

 tween the clinical manifestations of scurvy and those of exophthalmic 

 goiters, while Pfaundler and others accentuate the similarity in mani- 

 festations and pathcgenesis, of exudative diathesis, lymphatism, and ar- 

 thritis. 



The suggestion arises that the complex metabolic processes and re- 

 actions of the organism may be, in the last analysis, dependent on much 

 simpler factors, such as physiological plus or minus of acid or alkali in 

 tissues and secretions. 



This view would endow vitamins as well as hormones with the eminent 

 faculty of controlling the acid-alkaline balance. It is significant that 

 so many of the symptoms both of vitamin deficiency and of dyscrinism 

 are associated with manifestation in their end states of an excess of acid 

 or of lack of calcium. Cyclical vomiting, gastro-mtestinal irritation, asth- 

 ma, migraine, angioneurotic edema, and not at all improbably, glaucoma, 

 are from the endocrinological standpoint, spasmophile reactions affecting 

 definite regions, or, more properly, organ systems and tissue categories. 

 This spasmophilia is, one might say, a normal expression of vagotonia, 

 and the latter is -invariably the index, of an acid state or dyscrasia, in- 

 herited or acquired and mainly controlled by the vegetative nervous 

 system. 



It seems fair to assume that chemical allergy via foreign protein sen- 

 sitization may be a factor, and in some cases a passive, endogenous, sen- 

 sitization through excess or defect of essential endocrin activators of 

 metabolism. Thus, asthma from ingestion of egg albumen ; the associa- 

 tion of tonsillar and adenoid hypertrophy with hypoplasia of the systemic 

 lymph-glands and acidotic indications of disordered parenteral digestion 



