The present article will attempt to sketch only the general outlines of the various uni glandular and pluriglandular syndromes. The more radical French school is followed, but at the same time attention should be called to the fact that the French school presentations con tain gross fallacies, and should be read cum grano sails. Still the clinical suggestions of these writers are so rich that it is felt to be a better course to call the attention of the physi cian to possible relationships rather than to take the more conservative attitude of directing at tention only to that which can be indubitably proved. This whole subject is still so largely empirical that the principle of putting the hypotheses to a test will be found to be more advantageous than that of believing only the obvious. The former attitude may result in gaining useful therapeutic truths, the latter be comes monotonous and frequently encourages stupidity.
The more recent suggestive and extreme summaries of Biedl, Faha, Laignel-Lavastine, Levi and Rothschild are therefore here sum marized.
Uniglandular Myxedema. 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 ir regular, at times increased tension. There are constipation, diminished urination, hypothermia and chilliness of the skin. Reflexes diminished. The voice is frequently nasal, slow, monoto nous and raucous. Headache is frequent and at times epileptic attacks occur. These are all symptoms of diminished secretion.
Exophthalmic Goitre. A more or less com plete catalogue of findings for a lot of cases will include tachycardia, arrhythmia, anxiety, pulsa tions In the neck, exophthalmos, epiphora, v. Graef's, Stellwag's, M8bius' sytnptoms, facial paresis, cramps, tremors, neuralgias, 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, albuminuria, polyuria or glycosuria, anorexia, bulimia, vomiting, ptyalism, hyper chlorhydria, diarrhea, dyspnea, amenorrhea, atrophy of mammae, 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, diarrhea, mild tachycardia, no alimentary glycosuria, pilo carpine and oculocardiac reflexes positive. In the sympathicotonic types there are exophthal mos, 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 bulk large in the etiology of the psychogenic cases.
Thyroid insufficiencies, other than those of myxedema, are infantilism, obesity, Dercum's syndromes, pseudolipomata, alopecia, precocious loss of hair, scleroderma, urticana, pruntus,.re curring herpes, transitory edemas, migraine, asthma, constipation, mucous enterocolins, acrocyanosis, Raynaud's syndrome, localized erythemas, rhinorrhea, glucose tolerance, geni tal instability, chilliness, mammary hypertrophy.
Thyroid Instability (Levi and Rothschild). From dyshypothyroidism: chilliness, baldness, headaches, depression, crying, giddiness, passing edemas, neuralgic pains, suffocations, shivering, hot flushes, at menstrual period. With pre dominant dyshyperthyroidism : thinness, in crease of eyebrow development, hot flashes, palpitation, intestinal spasms, irritability, emo tionalism, phobias, inquietudes, migraine, asthma, hyperidrosis dysidrosis, tremors. Mixed cases : chilliness, shivering, migraine, frequent urina tion, neuralgic pains, distractable reddening of eyebrows, catamenia; neuralgias, anxiety, dilata tion of palpebral fissures, swelling of feet, varia tions in volume of the feet, tremors, nervous crises, hysterical attacks.
Parathyroids. Tetany. This syndrome is unquestionably related to parathyroid loss or de ficient Parkinson's syndrome( ?). The view point of Lundborg and of Gauthier is that this syndrome belongs here, and is a hyperf unction disorder, but it rests on very unstable founda tions.
Thymus. Vagotonic Symptoms of Basedow Syndrome( ?) : Profuse sweating, palpitation, lymphocytosis, eosinophilia, sensation of weak ness.
Myasthenia of Erb-Goldflam( ?) : Headache, ptosis, external ophthalmoplegia, fixed or transi tory palsies principally of the face, the neck, myasthenic electrical reaction.