SCIENCE 



[Vol. LV, No. 1435 



believed to be overfunction of the suprarenals, 

 tlie clinical picture is markedly different thougli 

 it varies somewhat with the time of onset of the 

 assumed hyperfunction. Should this occur 

 during fcetal life, a pseudo-hermaphrodite ap- 

 pears, the person presenting the external gen- 

 ital appearances of one sex while possessing 

 the internal sex organs of the other sex. When 

 the overactivity exists soon after birth rather 

 than before birth, puberty appears premature- 

 ly, a little girl of three or four menstruating 

 regularly and exhibiting the bodily and mental 

 attributes (sexually) of an adolescent, or a 

 boy of seven presenting the external genitals 

 and the secondary sex characters of an adult. 

 Should the overactivity of the suprarenals not 

 occur until adult life, it may reveal itself in a 

 woman of middle age by the rapid develop- 

 ment of hairiness over the body (hirsutism) 

 and by the exhibition of masculine character- 

 istics (virilism). 



Other examples of clinical pictures might be 

 mentioned but these few will suffice to illus- 

 trate the extraordinary mental and physical 

 changes that may become manifest when there 

 are disturbances of function of the endocrine 

 organs. 



COXSTITUTION AND THE ENDOCEIKE OEGANS 



Biologically considered, a developed human 

 being, like all developed higher organisms, 

 must be looked upon as the resultant of a long 

 series of reactions between the zygote (fer- 

 tilized ovum) and its environment. The ger- 

 minal type or genotype, reacting with the sur- 

 roundings, becomes the developed type or 

 phenotype, in the case of human beings, the 

 "realized person." The germ plasm provides 

 the determining factors, the environment the 

 realizing factors. Everything in the phenotype 

 attributable to inheritance may be spoken of 

 as "constitution," everything attributable to 

 environment as "condition." Medical men as 

 well as biologists must, then, when studying a 

 person or a single organism, be interested in 

 differentiating, when they can, what is "consti- 

 tutional" from what is "conditional" in origin. 

 In experiments upon animals and plants such a 

 differentiation may be relatively easy; in 

 studies of human beings it is always extremely 



difficult and, as regards many features, as yet 

 wholly impossible. 



The importance of constitution wUl need no 

 emphasis among biologists who are predom- 

 inantly students of heredity. Among medical 

 men, too, throughout the centuries, especially 

 among practitioners, there have always been 

 those who have been fully aware of the sig- 

 nificance of constitution and of its relation to 

 disease-disposition. During the past fifty 

 years, however, under the spell of bacterial 

 and protozoan etiology, medical men have been 

 so absorbed by studies of influences arising in 

 the environment that they have, too often, for- 

 gotten to continue their investigation of influ- 

 ences of endogenous origin. For a time, it was 

 almost taboo to speak of "constitution," or of 

 "disposition," owing to a justifiable reaction, 

 perhaps, against the earlier prevalent tendency 

 to use these words as a mask for ignoi-ance. 

 Recently, however, there has been a welcome 

 revival of studies of constitution. Now that 

 facts that supply a scientific basis for a general 

 pathology of constitution have been accumu- 

 lated, we may look forward to a greatly 

 increased interest among physicians in the part 

 played by inheritance in disease. Indeed, 

 during the past five years, several treatises 

 upon this and allied subjects have been pub- 

 lished; and we may expect, I think, during the 

 period just ahead of us, many attempts to 

 present, more systematically than hitherto, the 

 role plaj'ed by constitutional disposition in 

 the pathogenesis of a whole series of diseases. 



The chemical consideration of endocrine dis- 

 orders, has in my opinion, given a strong im- 

 petus to this movement toward a revival of 

 studies of the physiology and the pathology of 

 constitution. For though the endocrine organs 

 are, in some instances, accessible to trauma and 

 to poisons and parasites that reach them 

 through the blood-stream, diseases of these 

 organs, especially those "idiopathic" chronic 

 diseases that develop insidiously and give rise 

 to the classical endocrine syndromes, appear 

 to be, usually, of endogenous rather than of 

 exogenous origin, that is to say, they develop 

 as the results of special anomalies of constitu- 

 tion. This accounts for the fact that endo- 

 crinopathies tend to run in families, and the 



