June 30, 1922] 



SCIENCE 



687 



roid gland (goitre) in the neck, a persistently 

 acceleraited pulse rate (say 150 or more to the 

 minute instead of the normal rate of 72), 

 marked nervous s3Tnptoms including fine tremor 

 of the fingers, outspoken protrusion of the eye- 

 balls (exophthalmos), a tendency to profuse 

 sweats and to watery diarrhoea, sensitiveness to 

 heat, a peculiar psychic over-alertness and 

 apprehensiveness, and a tendency to rapid ema- 

 ciation (despite an abundant food intake) 

 associated with demonstrable acceleration of 

 the rate of the basal metabolism. Since simi- 

 lar symptoms can be produced by feeding 

 thyroid gland estraet, it is believed that there 

 is a hyperfunction of the thyroid gland (hyper- 

 thyroidism) in exophthalmic goitre. 



In the idiopathic form of myxosdema (or 

 Gull's disease) the clinical conditions are dia- 

 metrically opposite to those in exophthalmic 

 goitre. The thyroid gland is small, the pulse- 

 rate is usually slow, the eyes look sunlien 

 (enophthalmos), the lid-slits are narrow, the 

 bodily movements are slow and clumsy, the 

 patient is mentally dull, forgetful and apa- 

 thetic, there is sensitiveness to cold and a ten- 

 dency to constipation, the hairs fall out, the 

 skin is dry, thick and wrinkled and there is a 

 tendency to obesity (despite a restricted food 

 intake) associated with demonstrable retarda- 

 tion of the rate of the basal metabolism. Since 

 patients with idiopathic myxcedema rapidly 

 improve if they are fed the thji-oid gland of 

 the sheep, and since a condition precisely sim- 

 ilar to it occurs if the thja-oid gland be sur- 

 gically removed (cachexia thyreopriva), it is 

 believed that mj'xffidema is due to a hypofune- 

 tion of the thyroid gland (hypothyroidism). 



Two similarly contrasting clinical syndromes 

 due to disorders of the hypophysis cerebri or 

 pituitary gland may next be mentioned, namely, 

 (1) gigantism and acromegaly, due to over- 

 function, and (2) Froehlich's syndrome of 

 obesitjf with genital dystrophy, due to under- 

 function. 



When there is overfunction of the pituitary 

 gland in early life before the epiphyses of the 

 long bones have united with the shafts of those 

 bones there is over-stimulation of bony gi-owth 

 and the patient becomes excessively tall (gigan- 

 tism). When the overfunction of the pituitai-y 



gland occurs in later life (after epiphyseal 

 union), bony overgrowth is still stimulated but 

 manifests itself in enlargement of certain parts 

 of the skull and of the hands and feet 

 (acromegaly). There is also enlargement of 

 the tongue and of the internal organs (splanch- 

 nomegaly). The victim presents a very char- 

 acteristic appearance. The face is hexagonal, 

 the nose is broad, the chin is prominent and 

 curved so as to bend sharply upward, the cheek 

 bones are outstanding and the arches above the 

 eyes are prominent. Looked at from the side, 

 the face resembles that of Punch (nut-cracker 

 profile). The hands are spade-like, the fingers 

 are sausage-shaped, and the feet are huge. 



On the other hand, when there is under- 

 funetion of the pituitary gland during develop- 

 ment a condition (Pix)ehlich's syndrome) in 

 marked contrast to gigantism and acromegaly 

 results. The skeletal development is defective, 

 the growth of bone being less than normal. 

 The patient is short in stature, the face re- 

 mains child-like and the hands and feet are 

 small (aeromikria). The subcutaneous fat is 

 markedly increased (obesity), and is distributed 

 in an uneven way over the body, being most 

 abundant on the abdomen, over the buttocks, 

 and in the proximal portions of the extremi- 

 ties. The secondary sex characters either fail 

 to develop or develop in a faulty way. The 

 pubic and axillary hairs do not appear or are 

 scanty. The external genitals remain in an 

 infantile state. In young men the voice is high 

 pitched and there is a lack of normal virility. 

 In young women, the menstrual flow is scanty 

 or absent. 



Next, let us contrast two clinical pictures 

 believed to depend upon disorders of the supra- 

 renal capsules, (1) Addison's disease, met with 

 in destruction of the suprarenals (hyposupra- 

 renalism), and (2) pseudo-hermaphrodism, 

 premature puberty, and hirsutism, met with in 

 association with hyperplasias of the supra- 

 renals (hypersuprarenalism). 



In Addison's disease there is great weakness 

 and prostration, associated with low blood 

 pressure, diarrho3a and other digestive dis- 

 turbances, chronic ana3mia and often a peculiar 

 bronzing of the skin (melanoderma). 



On the other hand, in eases in which there is 



