THE IMPORTANCE OF ENDOCRINOLOGY 937 



taneous removal of the parathyroid glands and of the thyroid. But medi- 

 cal practitioners have been quick' to avail themselves of the work and re- 

 sults of the experimental pathologists and, during the past few years, they 

 have themselves made still further contributions to the pathogenesis of 

 tetany. They have shown us that certain disturbances of metabolism 

 intermediate between the parathyroid insufficiency and the tetany attacks ; 

 and they have brought forward evidence, recently, that indicates that pos- 

 sibly tetany may sometimes develop from similar disturbances of metab- 

 olism that have an origin in conditions other than hypoparathyroidism, 

 (e. g. disturbances of acid-base equilibrium; disturbances of mineral 

 metabolism; or intoxications by guanidin bodies). 



Status Thymicolymphaticus. To clinicians who control their work 

 by postmortem examinations we owe the conceptions of those peculiar 

 states now known clinically as status thymicolymphaticus, dependent upon 

 enlargement and, perhaps, upon overactivity of the thymus gland. These 

 states are characterized by peculiar paroxysms or asphyxia and brief un- 

 consciousness in children, by a tendency to glandular enlargement and 

 hypertrophy of the tonsils and adenoids, and by anomalies of dentition 

 and of hair distribution; they are often associated with congenital hypo- 

 plasia of the cardiovascular system and of the chromaffin system. 



It is in patients presenting the status thymicolymphaticus that we meet 

 with the so-called asthma tliymicum and the so-called mors thymica. Thus 

 children who die in their sleep without apparent cause, or who die sud- 

 denly after an injection of antitoxin, during chloroform anesthesia, or 

 after some minor operation, are often due to a status thymicolymphaticus. 



Though the nature of this malady is still far from clear, its relation- 

 ship to pathological conditions of the thymus would seem to be fairly 

 well established. Recent personal observations have tended to indicate 

 the participation of nucleic and of thymic or lymphatic origin as an 

 etiological factor. 



Diabetes Mellitus, Medical practitioners from the time of Celsus 

 have been acquainted with diabetes mellitus. According to Osier, Aretseus 

 first used the term "diabetes," describing it as a wonderful affection in 

 which the flesh and limbs melted down into urine ; and Willis, as far back 

 as the 17th century, described the condition well, stating that the urine 

 was sweet a,s though it had sugar and honey in it. Before 1800 Rollo had 

 discovered the value of a meat diet in the treatment of diabetes. Our 

 modern conceptions of the disease could not develop, however, until after 

 Claude Bernard had demonstrated in 1857 the glycogenic function of 

 the liver. 



Since Claude Bernard's researches, studies of carbohydrate metab- 

 olism and of acidosis have made enormous strides. Thanks to the studies 

 of the clinician Minkowski and of the pathologist Opie the significance 

 of the failure of the internal secretion of the pancreas, particularly of the 



