HUMAN INFERTILITY 325 



ments, the significance of which has been established by the many years of 

 earlier study. Each has been standardized by application both to the 

 proven normal and also to those exhibiting with certainty the conditions 

 under consideration. My own discussion will be limited to these methods 

 of approach. 



Another point that may not be ignored is the frequent simulation of 

 endocrine disorders by conditions unassociated with the ductless glands. 

 These too must be investigated and eliminated by test and observation — 

 not opinion — before the interpretation of the evidences in terms of aberrant 

 endocrine function is warranted. While a detailed analysis would far 

 exceed the modest limits of this presentation, a few of the more significant 

 points of the differential diagnostic procedure may be offered as illustrations. 

 Discussion is limited to the pituitary, thyroid and ovary as principal endo- 

 crine structures. The elimination of the testicle rests upon the fact that 

 in adult years the incretory activity of this gland, if indeed there be any, 

 is relatively unimportant. Pancreatic diabetes rarely needs so elaborate 

 a diagnostic approach ; the partial control of the level of blood calcium is the 

 only function, capable of objective demonstration, that is certainly asso- 

 ciated with parathyroid activity. The participation of the pineal, the 

 thymus and the spleen in the endocrine concert is too uncertain to warrant 

 their inclusion. 



In the following discussion, states of hypofunction are considered pri- 

 marily. General trends only will be reported with just recognition of the 

 fact that any individual case may depart from custom in any one of many 

 of the tests recorded. To facilitate discussion, a few simple tables have 

 been prepared. Certain of the physical data are collected in table 2. 



But few matters call for additional comment. The pituitary obesity 

 both occurs more frequently and to a greater degree than with the other 

 two glands. Thyroid failure may be associated with obesity or less fre- 

 quently in patients without myxedema with definite underweight. These 

 latter depart sharply from the classical picture of hypothyroidism, cannot 

 be diagnosed without the clear-cut objective data, and gain weight on 

 replacement therapy with thyroid substance. The significant loss in lung 

 volume is typical of thyroid failure and does not derive from obesity. In 

 the main, the pituitary is normal or approaches it, the thyroid shows a 

 general lowering of the physical data, and the ovary one that is selective. 

 The low alveolar CO2 of hypogonadism is characteristic and, like the same 

 finding in pregnancy, not associated with acidosis. 



The more striking urine findings are collected in table 3. 



The urine of the thyroid failure presents a general picture of lowered 



