CHAPTER LXXXIV 



DISEASES OF DUCTLESS GLANDS AND 

 METABOLISM 



General remarks — The thyroid system — The suprarenal system — The thymus 

 , system — Other ductless glands — ^Diabetes — Macies perniciosa — References. 



GENERAL REMARKS, 



Of late years much work has been performed with regard to the 

 ductless glands, their functions, and their part in the production 

 of disease. In the tropics McCarrison has been the pioneer with 

 regard to the thyroid gland; and it is hoped that as years pass the 

 other systems will be equally well studied. We are only able to give 

 these important subjects a passing reference, but they deserve much 

 fuller attention, and for this purpose we offer the reader references 

 at the end of this chapter. 



THE THYROID SYSTEM. 



The thyroid system consists of the thyroid gland and the para- 

 thyroids, with probably the addition of the pars intermedia of the 

 pituitary gland. The action of these organs has been the object of 

 much study in Europe and America, as can be noted by a reference 

 to Biedl's writings, while McCarrison in the tropics has opened up 

 the way to the solution of many diseases in an excellent manner. 



The various pathological phenomena associated with this system 

 may be divided into two classes — viz., those associated with hypo- 

 thyroidism or insufficiency of functional activity, and those connected 

 with hyperthyroidism, or excess of functional activity, and each of 

 these, again, may be applied to the thyroid gland or to the para- 

 thyroids. 



Thus insufficient activity upon the part of the gland itself may 

 produce benign chronic hypothyroidism of Hertoghe, myxoedema, 

 and cretinism, while exalted activity is believed to be responsible for 

 goitre. Graves' disease, and psychic exaltation. The parathyroid 

 glands when working insufficiently may cause tetany, myoclonia, 

 myotonia, myotonia periodica, and paralysis agitans, but when in a 

 condition of hyper- or dysactivity may be responsible for myas- 

 thenia or myotonia periodica. 



With regard to the factors which produce these changes in the 



1919 



