892 WALTER TIMME 



tion to normal health is not usually to be looked for, yet the recovery is 

 more or less complete except for some moderate limitations that prevent 

 excessive activity and energy expenditure. The syndrome was originally 

 described in 1918 by Timme (6). 



From observations and clinical examination of many patients over a 

 period of seven years he came to the conclusion that certain types of 

 endocrinopathies, such as status thymicolymphaticus, giantism, infantil- 

 ism, acromegaly, and many others, are not static states, as one would 

 be led to suppose from descriptions in the literature, but are simply 

 cross-sections taken at intervals in a dynamic, progressive, and wide- 

 spread disturbance of the internal glandular system. The constant 

 repetition of the appearance of patients in his clinic showing similar 

 symptoms and similar physical signs which theretofore had been generally 

 accredited to the asthenias accompanying neurasthenic and psychasthenic 

 states was noteworthy. The patients were usually of the late adolescent 

 period, in the early twenties, and, to neglect for the present the detailed 

 symptoms, the outstanding complaints, overshadowing all others, were 

 headache and muscular fatiguability. Accompanying complaints of these 

 two suggestive symptoms there was an additional statement that they had 

 been growing very rapidly for the preceding few years. Going deeply into 

 their antecedent history and their family history one was able to find many 

 points of resemblance in these various individuals. One case, observed for 

 six years, went through various stages to recovery at the age of thirty-two 

 years. From his early history symptoms were recognizable that are pre- 

 sented by cases in the beginning stages of this syndrome, notably the head- 

 aches, f at igu ability, and the skeletal overgrowth. Cross-sections at various 

 stages of his further progress also resembled clinical pictures in patients 

 that had formerly been somewhat puzzling to analyze. 



During the past few years so many cases of a similar nature had been 

 observed that from past experience it was possible to foretell, to a degree, 

 the progress such cases would make. To add to this assurance, Timme had, 

 seen many patients admitted to the hospital for divers complaints of middle 

 age, in whom he could recognize the final compensatory stages of this syn- 

 drome. Upon close questioning, their antecedent history bore out the 

 facts that his studied clinical types presented in various stages of the 

 syndrome. They were completely compensated cases and their presence 

 in the hospital was due to some entirely adventitious cause. Observation 

 to the present time has disclosed: (a) clinical types presented by single 

 cases at various ages and stages of the syndrome; (b) progressive cases, 

 observed over periods of from one to six years, which showed the changing 

 and probably compensatory nature of the disturbance; (c) completed 

 cases in which the disturbance had come to a definite stop, in which the 

 antecedent history revealed the close relationship to the isolated cases 

 which were still in active progress; (d) uncompensated cases in which the 



