The present résumé, largely following the author's summary in Stedman's 'Reference Handbook of the Medical will attempt to sketch only the general outlines of the various uniglandular and pluriglandular disease pictures. The more radical French school is followed, but at the same time attention should be called to the fact that the French school presentations contain gross fallacies, and should be read cum grano salis. Still the clinical sug gestions of these writers are so rich it is felt to be a better course to call the attention of the intelligent layman to possible relationships rather than to take the more conservative atti tude of directing attention only to that which can indubitably be proved. This whole sub ject is still so largely empirical that the prin ciple of putting the hypotheses to a test will be found to be more advantageous than that of recording only the obvious. The former atti tude may result in gaining useful therapeutic truths, the latter becomes monotonous and fre quently encourages stupidity.
The more recent suggestive and extreme summaries of Biedl, Falta, Laignel-Lavastine, Levi and Rothschild are therefore here sum marized.
Uniglandular Syndromes. Thyroid.— Myx edema.— The chief symptoms are arrest of development, dwarfism, infantilism, infiltration of skin and mucous membranes, mental torpor, slow ideation, defective memory, apathy, lazi ness, slowness, sleepiness, taciturn, awkward ness. The pulse is usually small, rapid and irregular, at times increased tension. There are constipation, diminished urination, hypo thermia and chilliness of the skin. Reflexes diminished. The voice is frequently nasal, slow, monotonous and raucous. Headache is frequent and at times epileptic attacks occur. These are all symptoms of diminished secre tion.
Exophthalmic Goiter. —A more or less com plete catalogue of findings for a lot of cases will include tachycardia, arrhythmia, anxiety, pulsations in the neck, exophthalmos, epiphora, v. Graef's, Stellwag's, Mobius' symptoms, facial paresis, cramps, tremors, neuralgtas, chiefly frontal and ocular, colic, hot flashes, profuse sweats, thermophobia, engorgement of the skin, dermographism, transitory edemas, pigmenta tion, urticaria, alopecia, diminution of electrical resistance, albuminuna, polyuria or glycosuria, anorexia, bulimia, vomiting, otyalism, hyper chlorhydria, diarrhoea, dyspncea, amenorrhoea, atrophy of mamma, loss of flesh, agitation, emotional instability, volubility, insomnia, anxiety, excessive anger or reverse, maniacal excitement, marked depression, cyclothymic variations, confusion, epileptic attacks. Ep
pinger and Hess have endeavored to separate a vagotonic and sympathicotonic type.
In the vagotonic type the more prominent signs are decreased lacrymation, less exophthal mos, with enlargement of the palpebral fissures, v. Graef's sign, abundant sweating, diarrhoea, mild tachycardia, no alimentary glycosuria, pilocarpine and oculocardiac reflexes positive. In the sympathicotonic types there are exoph thalmos, dryness of eyes, violent tachycardia, glycosuria, oculocardiac reflex reversed or ab sent, increased reaction to adrenalin. Most cases are mixed in type. In all save infectious forms psychical influences are striking and psychotherapy is extremely valuable in the early, stages, less so in chronic cases. Money worries are of great importance in the caus ation of the psychogenic cases.
Thyroid insufficiencies, other than those of myxedema, are infantilism, obesity, Dercum's syndromes, pseudolipomata, alopecia, precocious loss of hair, scleroderma, urticaria, pruritus, recurring herpes, transitory edemas, migraine, asthma, constipation, mucous enterocolitis, acrocyanosis, Raynaud's syndrome, localized erythemas, rhinorrhcea, glucose tolerance, geni tal instability, chilliness, mammary hypertrophy.
Thyroid Instability (Levi and Rothschild). — From dyshypothyroidism: chilliness, bald ness, headaches, depression, crying, giddiness, passing edemas, neuralgic pains, suffocations, shivering hot flushes, at menstrual period. With predominant dyshyperthyroidism: thinness, in _ crease bf eyebrow development, hot flashes, palpitation, intestinal spasms, irritability, einotionalism, phobias, inquietudes, migraine, asthma, hyperidrosis, dysidrosis, tremors. Mixed cases: chilliness, shivering, migraine, frequent urination, neuralgic pains, distractable reddening of eyebrows, catamenia; neuralgias, anxiety, dilatation of palpebral fissures, swell ing of feet, variations in volume of the feet, tremors, nervous crises, hysterical attacks.
Parathyroids.— Tetany.— This syndrome is unquestionably related to parathyroid loss or deficient Parkinson's syndrome( ?). The view point of Lundborg and of Gauthier is that this syndrome belongs here, and is a hyperfunction disorder but it rests on very unstable founda tions.
Thymus.— Vagotonic Symptoms of Base dow Syndrome( ?) : Profuse sweating, palpita tion, lymphocytosis, eosinophilia, sensation of weakness.