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Syndromes

structures, secretions, lobe, thyroid, chemical, glands and special

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SYNDROMES, Endocrinous. The con ceptions concerning the push that lies behind the metabolism of the human body even in recent years have been all too elementary and simplistic. They have, however, slowly and gradually undergone modification until the im portance of a number of overlooked structures have forced themselves within the past 10 years (1910-20) almost with a rush upon the medi cal horizon. These structures are the endo crinous glands or the hormonopoietic system. Their study now constitutes an enormous specialty.

As early as 1828 Parry called attention to the relationship between enlarged thyroid and rapid heart beat, since which time the works of Johannes Muller, Addison, Gull, Brown-Sequard, Marie and many others have served as starting points for the building up of a rich structure which is amply recorded in a score of mono graphs. The chief of these are Biedl, 'Internal Secretions' (bibliography of 4,000 titles, 1913) ; Falta, 'Ductless Glands) (1915) ; Parhon et Golstein, 'Les Secretions Internes> (1909) ; Levy and Rothschild, 'Endocrinologie> (1913) ; Gley, 'Les Secretions Internes> (1914) ; Sajous, 'Internal Secretions); Pende, 'Endocrinologia,) and the special articles in Lewandowsky's 'Handbuch der Neurologie> (1913). In addi tion to these a large number of special mono graphs upon the individual organs have been written all of which may be found in the works here quoted in the Bibliography.

Out of this prodigious development, much of which is evanescent and hastily constructed, a large amount of solid substance remains and a number of permanent acquisitions have been made. The net result has been to show much more essentially than ever before the funda mental physicochemical foundations of biological metabolic processes as they are utilized in the upkeep of the animal machine. The viewpoint has been attained that a marked degree of chemical interrelationship takes place between the different organs of the body. That this is automatically regulated through the vegetative nervous system (the old sympathetic) chiefly, apparently in some cases, though this is by no means clear, solely through chemical regula tion. The disorders of this adjustment now constitute a special department of vegetative neurolog.y, and are most conveniently grouped

under the terms endocrinology, or the endo crinopathies.

In the earlier period of the study of these endocrinopathies individual disease groups, uni glandular syndromes, were isolated. Among the most accentuated of these were Addison's disease, diabetes mellitus, myxedema, cretinism and acromegaly, but of recent years it has been increasingly emphasized that whereas a certain group of symptoms, which may be linked to plus or minus activities of one or another gland may be most prominent, nevertheless other glandular modifications are bound up in them and are not to be neglected. Hence has arisen the viewpoint that most of the endocrinopathies are, strictly spealcing, poly- or pluri-glandular syndromes.

For many years, even back to the earliest days of primitive animistic magic, it has been held that every living tissue yields a chemical product which will act upon other tissues. The early alchemistic studies, those of Paracelsus, to the latter work of Hahnemann, and the iso therapists, are all attempts to co-ordinate a host of empirically observed facts. They are all worth rereading if the reader will put himself in sympathy with them through a comprehen sion of the now strange symbols then used.

Endocrinous glands for the present purposes are those structures which yield products termed hormones and chalones having some definite or specific action related to, yet different from, enzyme activities. These structures are de veloped from different embryological forma tions. The hypophysis (posterior lobe) and chromaffin tissues (suparenal chiefly) are nervous; the thyroid and pituitary (anterior lobe) come from the buccal cavity; the pan creas and mucosa of the sniall intestine from the intestine, the parathyroids and thymus from the branchial arches (old gill slits of fishes), the gonads (testes and ovary) and the inter renal bodies from the genital ridges. Some of these, in humans, merge into one structure, as thyroid and parathyroid, as chromaffin and in terrenal cells in the suprarenals, as hypophysis (posterior lobe) and pituitary (anterior lobe).

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