MULTIGLANDULAR SYNDKOMES 885 



thymus, hajdly grew at all, although remaining quite well and active. 

 When it died at over four months old it was like an animal about a fort- 

 night old, and the testes were in size and structure those of an animal of 

 the same age. They had undergone no compensatory hypertrophy, as they 

 usually do, and the result had apparently been the arrest of growth which 

 occurs when thymus and testes are removed together." In other words, 

 removal of one of the endocrin glands is not necessarily followed by the 

 same sequence of events in every case. The realization of this state of 

 affairs accounts for the diversity of opinion and difference of conclusion 

 of various observers pursuing similar lines of investigation. It apparently 

 contradicts the laws of logic and mathematics. But only apparently. 

 For the basic difficulty is that in mathematics one must have two equations 

 to determine two unknown quantities that have functional relations with 

 each other. In experimentation upon the endocrin organs, the gland the 

 function of which is to be determined is balanced against the whole re- 

 mainder of the system all unknown and variable quantities as the 

 second unknown quantity. Here is the error for the remainder of the 

 system is not one constant but many independent variables ; and being such, 

 the value of the gland experimented upon can never be determined in 

 terms of the others, or of any constant. Hence also, the perturbations of 

 one gland, operating functionally in one human being can practically 

 never be accompanied or followed by the same chain of events in the other 

 glands in him, as in a second individual unless in the almost infinitely 

 small chance of two beings having the variables the endosecretory 

 glands varying mutually and respectively alike. 



This gives rise to manifestations, in different individuals with similar 

 original gland disturbance, of clinical pictures which may vary only in 

 degree; or if this degree becomes so great as to be critical, then also 

 in kind. 



As a result, the so-called pluriglandular syndromes are of necessity 

 not clearly demarcated and sharply separated from one another, but merge 

 imperceptibly into one another; and furthermore, within the limits arti- 

 ficially set for any one of these syndromes, there appear frequently single 

 instances of so-called uniglandular involvement such as exophthalmic 

 goiter, acromegaly or Addison's disease. However, within the limitations 

 imposed by any one svndrome it will be found that many individuals can 

 be grouped with much similarity in their symptomatology. As the limits 

 are approached, the number of cases grows larger, the symptomatology 

 gradually changes, many connecting links are either not seen or else not 

 reported and gradually this syndrome merges into another more or less 

 well defined group which again may be designated by the term syndrome. 



Classification. Theoretically, the various pluriglandular syndromes 

 might be classified in a manner which would conform to the following 

 groupings : 



