THE IMPORTANCE OF ENDOCRINOLOGY 935 



renal capsule. Since his time we have learned to add low blood pressure 

 and certain other clinical phenomena to this syndrome. 



Many years ago I drew attention to the similarity of certain clinical 

 pictures that develop in acute infections, notably in Asiatic cholera, 

 to the symptomatology of Addison's disease, and since then I have repeat- 

 edly laid stress upon the development of "hypoadrenia" in such acute 

 infections. This view, it would seem, has met with general acceptance by 

 the medical profession. During the recent war, especially, the recogni- 

 tion of these hypoadrenias that develop in association with acute infectious 

 diseases or after-war traumata became general and was of practical value 

 in treatment. 



Exophthalmic Goiter. The group of phenomena constituting the 

 well known syndrome now known as exophthalmic goiter was early recog- 

 nized by general practitioners of medicine in different countries (Parry, 

 Graves, Basedow, Flajani). 



The pulsating struma, the tachycardia, and the protrusion of the eye- 

 balls made a triad of symptoms that could scarcely fail to be recognized 

 by acutely observing practitioners. Later on, fine tremor of the fingers 

 was recognized as a fourth cardinal symptom; and, still later, the sweat- 

 ing, the paroxysms of unmotived diarrhea, certain peculiar nervous and 

 mental states, and other phenomena, particularly a whole group of peculiar 

 eye signs, were found often to be present when the syndrome is well 

 developed. 



The recognition that this syndrome of exophthalmic goiter is related 

 to disturbance of function of the thyroid gland gave an enormous impetus 

 to endocrin studies. The results of carefully planned medical treatment 

 and, in certain cases, of surgical intervention in exophthalmic goiter are 

 now well known to every practitioner of medicine. 



Myxedema. Equally interesting and stimulating have been the dis- 

 coveries that cachexia strumipriva, idiopathic myxedema of adults, and 

 sporadic cretinism are due to insufficiency of activity of the thyroid gland. 

 The results of the administration of thyroid substance in the treatment of 

 these states are among the great triumphs of modern medicine ; they 

 constitute one of the best examples of so-called "substitution therapy." 



General practitioners are now learning to recognize hypothyroidism of 

 mild grade, the so-called thyreopenia (with its clinical manifestations of 

 chronic constipation, a tendency to obesity, sensitiveness to cold, slowing 

 of thought and motion, etc.), with corresponding benefit to their patients. 



Gigantism and Acromegaly. Of somewhat later date was the recog- 

 nition that giants and acromegalics develop because of overfunction of the 

 hypophysis cerebri, or pituitary gland. The giant and the dwarf have 

 long been known to both lay and medical writers ; and even acromegalics, 

 with their remarkable conformation of the head and peculiar skeletal fea- 

 tures, were pictured by the older clinicians. It was, however, the clinical 



