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Nervous and Mental Disease Monograph Series No. 30 
 
 THE INTERNAL SECRETIONS 
 
 AND THE 
 
 NERVOUS SYSTEM 
 
 BY 
 
 DR. M. LAIGNEL-LAVASTINE 
 
 /''/ PARIS 
 
 Authorized Translation by 
 DR. F. T. ROBESON 
 
 New York 
 
 NEW YORK AND WASHINGTON 
 
 NERVOUS AND MENTAL DISEASE PUBLISHING 
 
 COMPANY 
 
 1919 
 
 Reprinted with the permission of the Original Publisher 
 
 JOHNSON REPRINT CORPORATION JOHNSON REPRINT COMPANY LTD. 
 11 1 Fifth Avenue, New York, NY. 10003 Berkeley Square House, London, W1X6BA 
 
L/4- 
 
 First reprinting 1970, Johnson Reprint Corporation 
 Printed in the United States of America 
 
 Copyright, 1919 by 
 
 Nbevous and Mental Disease Publishing Company 
 
 3617 loth St. N. W., Washington, D. C. 
 
sa 
 
 
 I 
 
 03 
 
 TRANSLATOR'S PREFACE 
 
 In the original French " The Internai Secretions and the Nervous 
 System,"^ by Prof. Laignel-Lavastine, is a classic. The translation 
 is crude and without literary merit, and its only virtue is that a 
 sincere attempt has been made to preserve its scientific value. 
 
 As proper innervation of the internal organs is necessary for 
 health, and considering that there is an intimate relationship be- 
 tween the ductless glands and the nervous system, the proper under- 
 standing of the subject is not only of interest to the neurologist but 
 to the general practitioner as well. 
 
 Organotherapy dates back to remote ages, as Dr. Diner has 
 stated in his introduction. The Chinese treated obesity with prep- 
 arations made from canine orchitic extracts and heart disease and 
 epilepsy with dried and powdered frogs and nevrts. It has been 
 shown by Abel's investigations that the skins of these animals con- 
 tain an appreciable amount of adrenalin owing to the presence of 
 cutaneous adrenals. To-day suprarenal extract is used in certain 
 forms of heart disease and epilepsy with excellent results. More- 
 over we have no other adequate treatment for eunuchoid obesity 
 than the administration of orchitic extracts. It would seem that 
 modern medical knowledge is not the only healing art that was ever 
 practiced. Empirics they were perhaps, but be that as it may 
 " There were Kings before Agamemnon." 
 
 If the renewed interest in endocrinology has done nothing else 
 for the art of medicine it has shown the utter futility of regarding 
 physiology and pathology en masse. It is the individual and the 
 study of the individual that is of supreme importance. Everyone 
 has his own proper physiology and his own proper pathology as 
 well. Following along their lines his life takes its course. That 
 there are a broad common physiology and pathology none can deny, 
 but that each individual has his own physiological and pathological 
 variant is also not to be questioned. There is no truer saying than 
 that " what is one man's meat is another man's poison," and it is the 
 disregard of this fact that has hampered the advance of medical 
 
 1 Article written in July, 1914, for the Congress at Berne, which did not 
 take place on account of the War. I here publish the entire text, just as it 
 was given to the Revue de Médecine in July, 1914. 
 
 iii 
 
IV THE INTERNAL SECRETIONS AND 
 
 diagnosis and therapeusis for years. Whether it comes under the 
 heading of mechanistic physiology or vitalistic physiology it is the 
 individual physiology that has to be carefully analyzed and con- 
 sidered before a proper appreciation of health and disease can be 
 arrived at. Endocrinology has taught, and is still teaching us to 
 analyze our cases by close clinical observation and research. In 
 many ways Nature is a kind mistress after all, and even her misfits 
 are frequently granted a modus vivendi which can only be appre- 
 ciated by the right kind of clinical study. In the analysis of endo- 
 crinal disease a slipshod method is worse than useless. The family 
 history, the previous history, the present history, the personal idio- 
 syncrasies, likes and dislikes, physical make-up and appearance, in 
 fact all that concerns the individual must be elicited, weighed and 
 balanced even to the most minute detail. In this way alone can 
 success be arrived at. 
 
 It would be presumptuous in me to enter into detailed descrip- 
 tions of methods of endocrinological research which has been 
 furthered by American observers. When the time is ripe for the 
 publication of well-authenticated facts on the subject they will ap- 
 pear in proper form. I may be pardoned, however, in stating here 
 certain conclusions which have been arrived at, and which have 
 been confirmed time and time again. 
 
 A. Briefly stated the life of every individual is dominated 
 largely if not wholly by his ductless gland chain. 
 
 B. Certain of these glands assume a preponderating influence 
 on the morphology, physiology and pathology of the individual. 
 
 C. Certain tropisms are existent, so that we have the pituitary, 
 thyroidal, adrenal, etc., type of individual. 
 
 D. Certain diseases, both of an acute and constitutional char- 
 acter, are welded, as it were, with the glandular tropisms, and belong 
 to them, and are part of their distinctive pathology, either func- 
 tional or organic. This is not only true of acromegaly, Basedow's 
 disease or Addison's disease, but of many other diseases as well. 
 
 E. The glandular influence having so much to do with morphol- 
 ogy, the physical make-up of the individual gives marked evidence 
 of the glandular constellation under which he lives and has his 
 being, 
 
 F. Within certain limits if the previous history of the individual 
 be accurately known, his physical appearance can be approximately 
 described, and his physiological and future pathological states can 
 be predicted. 
 
THE NERVOUS SYSTEM V 
 
 Some of these conclusions need no defense, and will be acceded 
 to by all who have given the subject even a moment's consideration, 
 while others will not be admitted by all endocrinologists. 
 
 The results obtained in the experimental feeding of tadpoles are 
 very significant. The small amphibia that were fed on thyroid 
 gland developed into tiny frogs described as " petit vieux," and those 
 that were fed on thymus grew into enormous tadpoles or "grand 
 enfants." This experiment proves to some extent at least why 
 taking two individuals of the same age, one may look like a prema- 
 ture old man, and the other have the appearance of unwarranted 
 juvenility. 
 
 The physiology, psychology and pathology of the two will follow 
 the thyroidal and thymic influences that have had such a marked 
 bearing on their morphology. 
 
 Take for example the dominion of the pituitary gland on certain 
 types of body structure. Giantism in youth, acromegaly in adult 
 life and shrinking in old age. There are small pituitary types as 
 well. The dominating influence of the pituitary makes for femi- 
 nism in the male, just as the dominating influence of the adrenals 
 makes for masculinity in the female. The thyroidal individual has 
 his marked personal characteristics — his bright intelligent eye, his 
 good clean teeth, his temperamental attitude toward life, his free- 
 dom from infectious disease except measles and typhoid and his 
 tendency towards intestinal, certain forms of cardio-vascular and 
 neurotic disturbances. The pituitary individual, easily recognized 
 by his structural make-up, has his own peculiarities. He is musical, 
 has an abnormally acute sense of rhythm and is prone to diseases 
 attended by periodicity and to syphilis (Charcot joint — a local 
 acromegaly). The adrenal individual has his strong masculinity, 
 his tendency to hypertrichosis and pigmentosis, his liability to diph- 
 theria, to hyperchlorhydria, to hypertension, to certain forms of 
 pulmonary disease, to hernia and varicocele. These master types 
 have their variants depending upon the influences of the other 
 glands, especially marked in the gonads. The endocrine system has 
 been well described as the ductless gland chain, and it is impera- 
 tive to realize that every link counts. The clinical picture is never 
 a simple one. 
 
 It will be through endocrinological study and investigation that 
 we will come to a better understanding of humanity. We will see 
 how within certain broad lines the life of the individual takes its 
 course. We will understand perhaps what the world calls Fate. 
 
 F. T. Robeson 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons (for the Medical Heritage Library project) 
 
 http://www.archive.org/details/internalsecretioOOIaig 
 
TRANSLATOR'S INTRODUCTION 
 
 "Every man, from the highest to the lozvest station, ought to 
 zvarm his heart and animute his endeavors with the hope of being 
 useful to the zvorld, by advancing the art which is his lot to exercise; 
 and for tftnt end he must necessarily consider the whole extent of its 
 application, and the whole weight of its importance." — Johnson. 
 
 In making the writings of Laignet-Lavastine accessible to those 
 not familiar with the French language, the translator has certainly 
 hearkened to the admonition quoted above. 
 
 The importance of the internal secretions, both as etiological 
 factors and as remedial agents, is being recognized more and more 
 and anything which adds to our understanding of this highly com- 
 plex subject should be welcomed with open arms by the medical 
 profession. 
 
 Organotherapy or the use of animal matter in the treatment of 
 disease is not by any means a new addition to the medical arma- 
 mentarium. It is the intelligent interpretation of the symptom- 
 complexes arising from dysfunction of the endocrine glands and the 
 rational application of the secretions of these glands which anew 
 engages the attention of the medical research worker and clinician 
 alike. 
 
 The indirect appHcation of animal tissues and organs to the 
 treatment of disease finds its first expression at the sacrificial altar. 
 
 In gray antiquity, medicine and religion went hand in hand. 
 God only could cure diseases and those of his representatives who 
 were close to him in his service, the high priests, were empowered to 
 execute his will in this direction as well as in religious matters. 
 History records that as far back as 2000-3000 B.C. the treatment 
 of disease was in the hands of the priests in Egypt. In Greece the 
 Asclepiades, the priests of the temple of Asclepias, were entrusted 
 with this important function. And Moses transferred to the priests 
 the knowledge of medicine which he accumulated in Egypt. 
 
 The Hebrew literature, while replete with medical information, 
 gives but scant evidence of animal therapy. No doubt the term 
 "unclean" which is so frequently employed as a prohibitive injunc- 
 tion with reference to food, hygiene and other matters, comes into 
 play here and accounts for the scant use of animal matter for medic- 
 
Vni THE INTERNAL SECRETIONS AND 
 
 inal purposes. In Joma, VIII, 6, we find that " One bitten by a 
 mad dog was given the liver of the dog as an antidote " and the use 
 of small doses of urine is passingly mentioned in another section, 
 but whether to be taken internally or applied externally is not clearly 
 stated. 
 
 However, if we cast our eye on the medical literature of other 
 nations and peoples, we find no lack of evidences of animal therapy. 
 Without making any attempt at chronological arrangement, I will 
 merely cite a few instances. 
 
 The Papyrus Eberus recommends: human brain, half with 
 honey and half dried, as a remedy against inflammation of the eyes. 
 Dioscorides, first century of present era (II, 21), recommends the 
 fried brain of the hare as a good remedy for the cure of " Tremor, 
 Convulsions, etc." Sextus Platonicus (330 A.D.) recommends the 
 fried brain of the hare given internally to aid dentition in children. 
 Celsus (II, 31, 34) as well as Plinius (XXVIII, 60) suggest the 
 use of brain of the hare for urinary incontinence. And Plinius. 
 Dioscorides and others advise the use of brain of different animals 
 for the treatment and cure of epilepsy. 
 
 The liver also plays an important part in the materia medica of 
 antiquity. Besides the quotation previously mentioned, we find that 
 Hippocrates speaks of the benefit to be derived from the use of 
 sheep's liver and of goat's liver in the treatment of diseases of the 
 uterus. Plinius considers human liver as indicated to combat epi- 
 lepsy ; and Scribonius Largus uses " a piece of liver from a suffo- 
 cated gladiator" for the same purpose (epilepsy). 
 
 Herophilus (300 B.C.) employs liver in cases of dysmenorrhea 
 and metrorrhagia, as does Plinius, who also finds it useful against 
 cough, tachycardia and ascites. 
 
 Bile is employed by Hippocrates in gynecological practice in 
 the form of suppositories to combat sterility, prevent abortions and 
 to ameliorate dysmenorrhea and amenorrhea. Plinius uses bile as 
 a cathartic internally and applies it externally in treating diseases of 
 the eye and to remove warts. Sextus Platonicus treats dizziness, 
 epilepsy and asthma by internal medication with bile. Orchitic 
 substance is mentioned by Susruta (400-600 B.C.) for the treat- 
 ment of obesity. 
 
 Particularly rich in information on the subject of organotherapy 
 are the writing of Dioscorides. Thus we find that the blood of 
 doves and wild hens is a valuable remedy against recent injuries of 
 
THE NERVOUS SYSTEM IX 
 
 the eyes, against hemorrhages and in many other pathological condi- 
 tions. The blood of doves is especially valuable in hemorrhages of 
 the brain, while the blood from other animals, such as goat, sheep, 
 rabbit, etc., fried in a pan and taken internally, cures or stops dysen- 
 tery. Blood from land-turtles is a sure cure for epilepsy. Men- 
 strual blood prevents conception when painted in a circle around the 
 body (abdomen?) or if one steps over it (blood). When rubbed 
 in as a liniment it removes podagra and roseola. Feces of different 
 animals also finds manifold uses. So for instances it is indicated 
 to reduce inflammations, remove scrophula and gland-enlargements, 
 correct prolapsus uteri, chase away mosquitoes, aid menstruation 
 and to promote abortion. 
 
 Frogs prepared with oil and salt are a sure antidote for serpent's 
 bite. Incidentally they cure painful tendons and stop bleeding when 
 applied externally after burning and powdering them. 
 
 Testicle, dried and finely powdered, taken in wine is also used 
 as antidote for serpents' bites but the beaver's testicle is especially 
 valuable to help in bringing on the menstrual flow, aid abortion and 
 promote expulsion of retained placenta. Incidentally it also finds 
 its use in relieving cramps, convulsions and nervousness. Crabs, 
 especially river-crabs, when boiled with honey are recommended for 
 the removal of carcinomatous growths, and when boiled with meat- 
 soup are indicated in the treatment of phthisis pulmonalis. Sea- 
 crabs may be used for the same purposes but are less efficient. 
 Lungs, especially fox's lungs, dried and taken internally cure asthma. 
 And finally Dioscorides recommends urine for a number of diseases. 
 So for instance is one's own urine good against serpents' bites ; that 
 from a mad dog against the bite of the dog, while the urine of an 
 innocent boy, taken internally, cures orthopnea. Urine is also em- 
 ployed in various forms against eruptions, dysmenorrhea, pams in 
 uterus, earache and urinary calculus. 
 
 BIBLIOGRAPHY 
 
 Bcrendes, J. Des Pedonius Dioslcurides Arzneimittellehre. 
 Bcrgel, Dr. Joseph. Die Medizin der Talmudisten. 
 Carmoly, E. History of the Jewish Physicians. 
 Ebstein, W. Die Medizin im Neuen Testamente und im Talmud. 
 Fattaciolli, Joseph. L'Organothérapie humaine en Thérapeutique. 
 Fricdenwald, A. Jewish Physicians and their contributions to Medicine, etc. 
 Fuchs, Lconhard. Hippocrate's siimthche Wcrkc. 
 GriJlingius, Ph. Tractatus Novus, etc. 
 
 Newton, Richard Cole. President's Address. Medical Record, N. Y., IV, 
 7, 1906. 
 
X THE INTERNAL SECRETIONS AND 
 
 Preuss, Dr. Julius. Biblisch-Talmudisch Medizin. 
 
 Sharp, William. Organotherapy. 
 
 Stebbins, Nathaniel D. Scripture Evidence of a General System of Medical 
 
 Practice. 
 Steinschneider, M. Schriften iiber Medizin in Bibel und Talmud. 
 Wolzendorff, Gustav. Gesundheitspflege und Medizin der Bibel. 
 Winkler, L. Animalia als Arzneiraittel. 
 Yellin, David, and Abrahams, Israel. Marmonides. 
 
AUTHOR'S INTRODUCTION 
 
 The relations of the internal secretions and the nervous system 
 constitute an immense subject, which requires to be classified and 
 condensed in as short a report as this to escape the penalty of 
 remaining under vague generalities. 
 
 The most recent and important work issued on this question is 
 the second edition of the remarkable production of Professor Arthur 
 Biedl, " Innere Sekretion, ihre physiologischen Grundlagen und ihre 
 Bedeutung fiir die Pathologie." It contains, perfectly classified, 
 all that has appeared of interest on the internal secretions up to the 
 year 1913.^ The physiological researches and experiments are 
 herein particularly well set forth. 
 
 As I have the honor and the pleasure of having Professor Biedl 
 himself as co-reporter, I would show poor taste in not leaving it to 
 him to demonstrate the physiological part of the question. 
 
 1 shall limit myself then to the pathological part. From a 
 pathological standpoint the relations of the internal secretions and 
 the nervous system are far from being completely cleared up, as 
 one may gather from the recent reports of N, Pende,' G. Ghedini* 
 and Parhon^ at the congress of 1912 and 191 3, and I have no hesi- 
 tancy in stating with the Philalèthe of the Philosophical Dialogues 
 of Renan: " For my part I am accustomed to classify my ideas on 
 the subject in three categories. The first, unfortunately very 
 limited, is that of the certainties; the second is that of the proba- 
 bilities; the third is that of dreams. We will refrain from men- 
 tioning the last if you please, Euthyphron, as in all probability it 
 exists for each one of us as the dearest part of all." 
 
 In fact, since my report of 1908 at the Congress of Dijon, on 
 
 2 I refer here for the bibliography, also to the recent volume of Pr. Gley, 
 Les Secretions internes, Baillière, 1914. 
 
 3 N. Pende, Les secret, int. en rapport avec la clinique, XXII Cong, de 
 la Soc. italienne de med. int., Rome, oct., 1912. 
 
 ♦ G. Ghedini, idem. 
 
 " Parhon, Les gl. à secret, int. dans leurs rapp. avec la psychol. et la 
 pahtol. mentale, rapport. Congrès internat, de Neurol, Gaud, 1913. — Voire 
 aussi: Parhon et Goldstein, Les secret, int., Maloine, 1909; W. Falta, die 
 Erkrankungcn der Blutdrusen, Berlin, 1913; Lucien et Parisot, Gl. surr. el 
 org. chromaffines, Gittler, 1913; Lewandowsky, Uandbuch der Neurologie, 
 Bd. IV, Innere Sekretion und Nervensystem, Berlin, 1913. See more com- 
 plete Bibliography in Jclliffe and White, Diseases of the Nervous System, I, 
 Endocrinology, 2d Edit., 1917. 
 
xii THE INTERNAL SECRETIONS AND 
 
 psychic troubles caused by disorders of the glands of internal secre- 
 tion, where I insisted on the importance of these glands in neurology 
 and psychiatry, the glands of internal secretion, heretofore ignored, 
 have now become the special study of medical men, so that all or 
 nearly all of them, clinicians, anatomico-pathologists, experimenters 
 and therapeutists started investigating and consequently to-day one 
 invokes with too much facility their disturbances as a causative 
 factor each time one is puzzled. Next to the sympathetic, the 
 abnormalities of which were more dwelt upon than was warranted, 
 the endocrine glands have become the maids of all work of physio- 
 pathology. 
 
 It seems wise to me to expostulate against this excess. It has a 
 tendency in effect to prejudice against endocrinology such critical 
 minds which are more impressed by the lack of strict truth and the 
 foundation of vagrant theories than by the biological interest of 
 precise facts, verified over and over again. 
 
 In this question of the relationship of the internal secretions and 
 the nervous system one should be assured above all of the reality of 
 the facts under consideration, then these should be analyzed as to 
 their details in order to grasp their divers elements, and to unravel 
 their component parts, finally one should not extend their reach 
 beyond the conditions that determine them, extrapolation not being 
 generalization. 
 
 From the standpoint of pathology as from the standpoint of 
 physiology the relations of the internal secretions and the nervous 
 system interest us in so much as they are relations of causality. 
 
 My first aim then is to show that in pathology there exist, on 
 the one hand, nervous disorders due to disturbance of the internal 
 secretions, and on the other hand, disturbance of the internal secre- 
 tions due to nervous disorders. 
 
 Before establishing this double relationship it is necessary to 
 define exactly the terminology. Nervous troubles mean to me all 
 the disturbances of the nervous system, the motor symptoms, sen- 
 sory symptoms, trophic and psychic symptoms with their anatomical, 
 physical and chemical correlations. These disorders are divided 
 into three groups according as to whether they pertain to the sen- 
 sory-motor, vegetative or psychic functions. 
 
 The sensory-motor disturbances are above all the expression of 
 the neuraxis, the vegetative of the vago-sympathetic, and the 
 psychic of the cerebral cortex. 
 
 One knows that Langley has differentiated in the vegetative 
 
THE NERVOUS SYSTEM Xlll 
 
 system that which he calls the autonomic from the sympathetic 
 system. This consists of the cephalic portion which proceeds from 
 the mid-brain and the bulb — the oculomotor nerve, the pneumo- 
 gastric and the chorda tympani — and of the sacral portion running 
 from the cord — the pelvic nerves. This system, of which the ruling 
 element is the pneumogastric, presents a functional antagonism to 
 the sympathetic. 
 
 Thus, for example, the sympathetic dilates the pupil, causes the 
 eyeball to protrude, accelerates the heart action, inhibits the move- 
 ments of the intestine, dilates the sphincter ani, produces glycosuria 
 and polyuria. Inversely the autonomic system contracts the pupil, 
 relaxes the zonule of Zinn, slows the heart action, contracts the 
 muscles of the intestine, increases the gastric and pancreatic 
 secretions. 
 
 Eppinger and Hess^ have striven to demonstrate this in man by 
 the aid of pharmacodynamic tests, injections of adrenalin, of pilo- 
 carpine and of atropine. They have given the name of vagotonics 
 to individuals in whom the activities of the autonomic predominate 
 and of sympathicotonics to individuals in whom the sympathetic 
 excels. 
 
 Adrenalin dilates the pupil, contracts the blood vessels, acceler- 
 ates the heart action, increases arterial tension, produces polyuria, 
 glycosuria and reflex excitability. 
 
 Pilocarpine incites salivation, sweating, blushing, increase of in- 
 testinal peristalsis, hypersecretion of digestive fluids and intestinal 
 juice. 
 
 Atropine dilates the pupil, stops secretion, and sometimes ac- 
 celerates the heart. 
 
 Eserine, introduced by Mougeot,' vago-excitant, slows the pulse, 
 raises pressure, and contracts the intestine. 
 
 One speaks of adrenalin as exciting the sympathetic, of pilo- 
 carpine and eserine as exciting the autonomic, and of atropine as 
 paralyzing the latter. 
 
 When a subcutaneous injection of one milligram of adrenalin 
 produces a glycosuria in excess of 5 grams, when the quantity of 
 urine is doubled and the pulse has a rhythm one third above normal, 
 one speaks of sympathicotonia. 
 
 « H. Eppinger et L. Hess, Zur Pathologie des vegetativen Nervensystems, 
 Deutsch. Arch. f. klin. Med., 1909, LXVIII, 3-4, P- 231. See Monograph No. 
 20, this series. Translated by Kraus and Jelliffe. 
 
 ^ Mougeot. A., Lc réflexe oculo-cardiaque, Soc. de Med. de Paris, 28 mars, 
 1914, pp. 277-287. 
 
xiv INTERNAL SECRETIONS AND NERVOUS SYSTEM 
 
 When a subcutaneous injection of one centigram of nitrate of 
 pilocarpine produces a salivation and sweating more abundant than 
 normal one speaks of vagotonia. 
 
 When a subcutaneous injection of one milligram of the neutral 
 sulphate of atropine produces a rapid and prolonged dilatation of 
 the pupil with considerable increase of the pulse rate one speaks 
 again of vagotonia. 
 
 When finally a subcutaneous injection of a quarter of a milli- 
 gram of hydrobromate of eserine does not produce an appreciable 
 slowing of the heart nor contractions of the intestines one speaks 
 either of hypovagotonia or sympathicotonia. 
 
 The oculo-cardiac reflex, discovered by Aschner, allows one also 
 to take notice of the respective activities of the sympathetic and 
 pneumogastric 
 
 In the normal state and in the recumbent position, pressure on 
 the eyeballs with the pulp of the fingers softly for 30 seconds with- 
 out pain, determines after the lapse of a few seconds a slowing of 
 the pulse, lowering of arterial tension, slowing of the respiration 
 and sometimes a feeling of nausea. 
 
 The reflex is positive when the slowing of the pulse is in excess 
 of 12 beats per minute. 
 
 It is normal when the slowing is at least 4 and less than 12 
 beats per minute. 
 
 It is negative when there is no reaction or one of less than 4 
 beats per minute. 
 
 It is inverted when, without excitement or pain, the slowing of 
 the pulse is replaced by acceleration. 
 
 When the reflex is positive, one speaks of vagotonia; when it is 
 negative or inverted, of sympathicotonia. 
 
 Thus, thanks to these researches, two clinical types among the 
 vegetative neurotics are clearly determined. 
 
CHAPTER I 
 
 The young girl, who complains of palpitations and precordial 
 pains with slight tachycardia, burning pains in the stomach, diar- 
 rheas and sweating attacks, in spite of being chilly and having cold 
 feet; who has profuse lachrymation, who is often nauseated, and 
 who has tendencies to be sick especially before her periods, who is 
 easily seasick, who dislikes to ride backwards in a carriage or rail- 
 road car ; who with a large palpebral fissure has a slight exophthal- 
 mos ; who has a clear von Graef e's sign without the sign of Mobius ; 
 who has an abnormally low arterial tension, with perhaps an eosino- 
 philia; whose overcontracted pupils are not dilated by adrenalin, 
 and which contract with expiration (Samogyi's sign); who has an 
 alimentary glycosuria with adrenalin ; who has secretory crises with 
 pilocarpine ; and finally who is benefited marvellously by atropine as 
 regards dyspeptic troubles, and whose constipation disappears at 
 once — she is a vagotonic. 
 
 The woman with a well-marked tachycardia and few subjective 
 symptoms; with exophthalmos and no von Graefe's sign, but with 
 a clear sign of Mobius; with a large pupil and scanty lachrymal 
 secretion ; who has no sweats or diarrheas ; with very marked loss of 
 hair, with a tendency towards fever; who is always too warm; 
 whose pupil dilates with adrenalin, who also has an alimentary 
 adrenalin glycosuria; who does not react to pilocarpine, and stands 
 atropine badly — she is a sympathicotonic. 
 
 This differentiation, true in general, has aroused many criticisms 
 from the very first, especially from Fleischmann,^ Potzl, Eppinger 
 and Hess themselves,» Falta, Newburgh and Nobel,^" Falta and 
 Kahn, " Petren and Thorling,^- Burstein^^ ^^^ Bauer," etc., the 
 justice of which has been admitted by myself and my interne Mile. 
 Romme at Eeaujon Hospital. 
 
 It is thus that we have seen intense reactions to pilocarpine at 
 the same time that adrenalin shows an exaggerated excitability of 
 
 8 Fleischmann, Med. Klinik, 4 fev., 1910. 
 
 » O. Potzl, H. Eppinger et L. Hess, Wien. klin. Woch., 22 dec, 1910. 
 10 \v. Falta, L.-H. Newburgh et E. Nobel, Zeitschr. f. klin. Med., 1914, 
 LXXII, 1-2. 
 
 " VV. Falta et F. Kahn, Zeitschr. f. klin. Med., 1912, LXXIV. 
 
 "K. Petren et I. Thorilng, Zeitschr. f. klin. Med., 1912, LXXIII, 1-2. 
 
 '''M. Burstein, Med. Obozr., 1912, LXXII, 10. 
 
 "J. Bauer, Deutsch. Arch. f. klin. Med., 1912, CVII, i. 
 
2 THE INTERNAL SECRETIONS AND 
 
 the vegetative system, the same individual presenting at intervals 
 of some days different reactions, and adrenalin glycosuria has no 
 value until the hepatic element is eliminated. 
 
 Finally I wish to state that the term tonic or tone does not seem 
 to me well chosen, because it deals more with an exaggeration of 
 the excitability of the nerve rather than an increase of its tonicity, 
 and these two states are far from being always parallel. 
 
 Be that as it may, I differentiate in nervous disorders in addition 
 to sensory-motor troubles and psychoses, the disorders of the vege- 
 tative system, and these sympathetic and autonomic abnormalities. 
 We shall see later on that these disorders do not separate them- 
 selves into parallel series as simply as the theory would have them 
 do. Then again many trophic disorders observed in endocrine syn- 
 dromes are not actually trophoneuroses. It seems quite often that 
 endocrine commotions reecho on the morphology through a humoral 
 intermediary and not through a nervous one. Nevertheless, as I 
 can not dissociate in the actual enumeration of the trophic dis- 
 orders those that have a nervous intermediary from those that have 
 none, I will discuss them all, later on indicating how they may be 
 distinguished. 
 
 Commotions of the internal secretions should include the dis- 
 turbances of all the internal secretions, that is to say, all humoral 
 pathology not to say all the pathology, because every cell from a 
 cytological standpoint is a gland of internal secretion, and following 
 Renault, who showed the secretory value of the cells of the con- 
 junctivae, Nageotte, just recently by mitochondrial methods, has 
 demonstrated the secretion of the neuroglia, which was thought 
 formerly to be a simple tissue of support.^*^ 
 
 In order to be brief, and admitting the three distinctive condi- 
 tions, histological, chemical and physiological, of the glands of in- 
 ternal secretion, claimed by Gley^^ at the recent Congress of London, 
 I will only picture among the internal secretions those that depend 
 upon definite glands, in the front ranks of which I will place the 
 classical hemato-vascular glands: thyroid, parathyroids, pituitary, 
 suprarenals, ovaries and testicles. 
 
 I will add to this group the pineal, which in the infant, histo- 
 logically as well as physiologically, is an endocrine gland ; the choroid 
 plexus, of which the secretion diffused in the cerebro-spinal fluid 
 has been demonstrated by Pettit and Girard; the prostate, whose 
 
 1*^ See Translation of Achucarro, Jl. Nervous and Mental Disease, Oct., 
 1918, p. 333. 
 
 '^^ E. Gley, Relat. entre les organes à sécrétion int. et les troubles de ces 
 secret, Rapport, sect, de Physiol., Congrès internat., Londres, 1913. 
 
THE NERVOUS SYSTEM 3 
 
 elective action on the genital organs has been brought in evidence 
 by Hallion, Papin and MoreP® and the paraganglia of the sym- 
 pathetic, which are chromaffin organs apart from the suprarenals. 
 
 In addition among the glands of external secretion, certain ones 
 have at the same time an internal secretion of such importance that 
 I must at least mention them; such are the liver, the kidney, the 
 pancreas, the salivary glands, the mammary glands and the in- 
 testinal glands of which the endocrine action has been grasped 
 histologically by P. Masson." Among these I will retain only the 
 pancreas on account of its participation in the mechanism of 
 glycosurias. 
 
 Finally among the lymphoid glands, ganglia, thymus and spleen, 
 the thymus at least plays a secretory rôle. 
 
 I will consider then the nervous disorders linked with disturb- 
 ances of the thyroid and parathyroids, the thymus, the suprarenals 
 and paraganglia of the sympathetic, the pancreas, the pituitary, the 
 pineal and the choroid plexus, the ovary, the testicles and the 
 prostate. 
 
 In this clinical analysis I shall recapitulate at first in a critical 
 review as briefly as possible the nervous disorders existing in the 
 syndromes, that one as a rule places among the disturbances of the 
 endocrine glands, that I have just mentioned, and reciprocally the 
 endocrine disorders observed in the nervous syndromes. 
 
 In this critical review I will bring out the elements of an endo- 
 crino-neurological scheme, in which by the choice of certain nervous 
 symptoms, certain endocrino-vegetative syndromes, certain tradi- 
 tional nervous syndromes, certain temperaments, certain characters, 
 I will attempt to show by the method of double weighing, that some 
 among them are determined by an endocrine commotion in certain 
 cases, and that in others they are the expression of a nervous up- 
 heaval of different origin reacting secondarily on the internal 
 secretions. 
 
 And I will gather from this rather suggestive study of a subject 
 so complex and so obscure some conclusions which I will advance 
 for your discussion. 
 
 ^^ Hallion, Morel et Papin, Act. vaso-dilatatrice péniesme de I'extr. 
 prostateq., Soc. de biol., 28 fev., 1913, p. 401. 
 
 " Masson, P., La gl. endocrine de l'intestin chez l'homme, Acad, des Se, 
 5 janv., 1914. 
 
4 THE INTERNAL SECRETIONS AND 
 
 A. Critical Review 
 
 The endocrino-neurological clinical relationships form, a priori, 
 two big groups : 
 
 1. Nervous disorders in the endocrine syndromes. 
 
 2. Endocrine disorders in the nervous syndromes. 
 
 Before discussing these I must explain the value of the methods 
 of investigation which are permissible for proof. I will be very brief 
 as regards the neurological methods and a little more explicit as 
 regards the endocrinological procedures. 
 
 (a) Methods of Neurological Investigation 
 
 I skim over the current clinical methods employed for unravel- 
 ling the motor, sensory, lisso-motor, secretory, trophic and psychic 
 disorders of the nervous system to pause at the more complex ex- 
 perimental tests in clinical use to establish the so-called states of 
 vago- and sympathicotonia. These tests are at the starting point 
 chemical or mechanical. The first are the injections of adrenalin, 
 of atropine, of pilocarpine, of eserine; the second are the ocular, 
 auricular or solar ganglion tests permitting the consideration of the 
 oculo-cardiac,^^ auriculo-cardiac and cœliac hypotensory reflexes.^" 
 
 Now each of these tests determines a series of reactions already 
 quoted. 
 
 In order to judge of their diagnostic bearing on the neurological 
 status one makes three hypotheses. 
 
 The first, that the antagonism between the sympathetic and the 
 autonomic is complete. 
 
 The second, that just one of the results of each of the tests, 
 which one regards as characteristic, is representative of the general 
 orientation of all the results of that test. 
 
 The third, that the orientation of the test so determined is of 
 use for deciding not only the state of the function thus investigated, 
 but the state of the whole sympathetic or autonomic nervous 
 system. 
 
 Now as regards the first hypothesis one can reply that if phar- 
 macodynamics bring the innervation of the sweat glands under the 
 control of the autonomic, there is nothing in anatomy or physiology 
 to permit it to be separated from the sympathetic. 
 
 To the second one can answer that the results so often dis- 
 
 18 For the recent French bibliography, see : Vernet et Petzetakis, Le réflexe 
 oculo-cardiaque, Gaz. des hop., 2 mai, 1914. 
 
 19 André, Thomas, et J., Ch. Roux. Soc. de biol., 23 mai, 1914, p. 857. 
 
THE NERVOUS SYSTEM 
 
 sociated of adrenalin or atropine, raised blood pressure without 
 glycosuria or vice versa, dilatation of the pupil without acceleration 
 of the heart or vice versa, show clearly that one can not draw con- 
 clusions from the character of the physiological reaction, consider- 
 ing from the same standpoint the character of all the other possible 
 reactions that one has neglected. 
 
 In a stronger way one should respond to the third hypothesis 
 that the frequent confirmation of reactions in an inverse sense, 
 of the vagotonic and sympathicotonic classification shows that one 
 can not judge of such states from one single reaction, but further 
 that the frequent confirmation of reactions in an inverse sense, 
 sympathicotonic or vagotonic, that I have often observed as a re- 
 sult of diflferent tests and even of the same test, shows at least the 
 association or the succession of these two states of the vegetative 
 system, and in consequence diminishes, if not the importance of the 
 doctrine, at least the practical interest of this classification, of 
 which the clear-cut outlines and the antagonism seem to have been 
 exaggerated. 
 
 (b) Methods of Endocrinological Investigation 
 
 These methods are clinical, anatomical, organotherapeutic, phys- 
 iological and chemical. In my report of 1908 I have shown the 
 inherent causes of error in the first three. 
 
 Clinically one must not in an endocrino-neurological complex, 
 of which the groupings may be more or less defaced, pick out as an 
 element of causality that which perhaps is nothing more than a 
 co-result of the same cause or which has nothing but a contingent 
 relationship with the nervous or endocrine disorder. 
 
 In anatomo-morphological pathology one gathers facts of in- 
 contestable value, and that is why I have continued^» to examine 
 systematically the endocrine glands of my nervous and mental 
 cases, but as I said in 1908 one must always know how to read, 
 and how to interpret these data; to read them, that is to say, ob- 
 
 20 Laignel-Lavastine, Hyperplasias glandulaires de l'hypophyse. Congrès 
 de Neurol., Amiens, 191 1. ^ ' c j 
 
 Laignel-Lavastine et Duehm, Les parathyroïdes chez les aliènes, Soc. de 
 biol., 20 janv., 1912; 30 mars, 1912; Annales de Méd. (sous presse); Les 
 parathyroïdes chez les déments seniles, Soc. de psychiatrie, avril, 1912; M. 
 Labbé, Laignel-Lavastine et Vitry, Diabète et lésions du pancréas, Soc. 
 anatomique, 8 mars, 1912. 
 
 Laignel-Lavastine et V. Jonnesco, L'hypophyse des psychopathes, Soc. 
 anatomique, 30 nov., 1912; Encéphale, janv., 1913, pp. 25-45- Trois planches 
 couleurs. 1. a j 
 
 Laignel-Lavastine, Anat. pathol. de la pinéale, Mem. couronné par 1 Acad. 
 de Méd., 1913, Arch, de Méd. exp. (sous presse). 
 
6 THE INTERNAL SECRETIONS AND 
 
 serve the physiological, ethnic or geographical^^ variations, the 
 errors of technique, the post-mortem lesions, in order to dis- 
 tinguish the normal from the pathological; to interpret, that is to 
 say, to distinguish in the pathological lesions those which are con- 
 tingent, and are recent alterations due to terminal accidents, or 
 which are but a co-effect resulting from the same cause as the 
 nervous disorders, or results of a previous infection or intoxication, 
 in order to be able with these lesions to establish beyond criticism a 
 causal relationship between endocrine disorders and nervous symp- 
 toms. 
 
 Besides a last difficulty which is considerable renders these re- 
 searches sufficiently rare under ideal conditions. The glandular 
 disorders, which for the sake of argument one supposes to have 
 reacted on the mental condition, are seldom severe enough to re- 
 sult in death. 
 
 A long time elapses between the onset of the trouble and the 
 autopsy. Thus on the one hand additional lesions due to the path- 
 ological overcharge can render old glandular lesions unrecognizable, 
 and on the other hand nervous and psychic symptoms born of a 
 glandular disorder, which is often transitory, may outlast this dis- 
 order indefinitely. 
 
 These examples of nervous and above all mental sequelœ of a 
 functional upset, which has ceased for a long time, are relatively 
 very frequent illustrations of the great law of habit. 
 
 In organotherapy^^ when it is a question of establishing a re- 
 lationship of causality between a nervous disturbance and an en- 
 docrine disorder, because the administration of the extract of an 
 incriminated gland has been followed by the disappearance or at 
 least the attenuation of the nervous syndrome under consideration, 
 it behooves one to be even more careful than in any other thera- 
 peutic induction, being aware already of the many fallacies of such 
 because here the causes of error are particularly numerous: coin- 
 cidence; general action on the organism and its metabolism by 
 simple pharmaco-dynamic effect; suggestion; variability of the or- 
 ganotherapeutic extracts according to the method of acquisition, 
 of preparation, of conservation, their age, the mutation of effect 
 according to dosage, the avenue of introduction, the frequency of 
 dosage, the difference between their action and that of the normal 
 
 2111 en est ausi pour la thyroïde. V. Parhon, Mile. Mateesco, Tupa, 
 Nouv. recherches sur la thyr. des aliénés, Encéph., aôut-sept., 1913, pp. 139 
 et 235-55. 
 
 22 Hallion, L., La pratique de l'apothérapie, 191 1. 
 
THE NERVOUS SYSTEM 7 
 
 gland, the uncertainty indeed of the nervous syndrome being in 
 Hne with the endocrine disorder, which in other respects may not 
 have induced the nervous syndrome except through the agency of 
 giandular commotions in one or many other of the endocrines, ob- 
 serving as well other intermediaries such as mechanical, physical, 
 chemical, humoral, nervous or psychic causes. 
 
 In his report of 19 13, Gley reiterated the causes of error in 
 insisting upon the general toxicity of organic extracts and their 
 variations, depending upon the method of preparation, autolysis, the 
 production, the manner in which they are used, the heating and the 
 quickness of injection. In addition he has drawn attention to a 
 new cause of error : tachyphylaxis,^' rapid immunization character- 
 ized by the fact that successive injections of organic extracts in 
 small doses gives rise to an immunization that is produced in a 
 few minutes. This phenomenon of tachyphylaxis for one organic 
 extract can be aroused by the extract of another organ and vice 
 versa. This crossed tachyphylaxis of Gley and Champy should be 
 taken into consideration in the interpretation of such complex re- 
 sults as the effects of treatments by simultaneous or successive as- 
 sociations of glandular extracts. From this standpoint the theory 
 of treatment by hormones^* is guarded from such causes of error 
 because the hormones entail neither anaphylaxis nor tolerance. In 
 the above we have an instance of one of the differences between 
 the action of adrenalin and that of extracts of the suprarenal gland. 
 
 Finally the new physiological methods, methods of Abderhalden, 
 methods followed by Gley and Claude, etc., are themselves no longer 
 shielded from causes of error. 
 
 The Abderhalden method has already been applied by numerous 
 autliors, Urechia,^^ Pesker,-® Parhon,^^ Obregia and Pilulesco," 
 Marinesco and Papazolu,^^ Mutermilch,'° etc., to induce from their 
 results an endocrinological origin for numerous nervous and mental 
 syndromes. 
 
 Only recently, following his researches on the relations of the 
 
 2s Gley et Champy, Soc. de biologie, 1911, 22 juillet, p. 159; Gley, Livere 
 jubilaire du Pr. Richet, 1912, pp. 11 1-29. 
 
 2* Hallion, L., Sur la part attribuable aux hormones dans les effets de 
 l'opothérapie, Soc. de thérapeutique, 26 nov., 1913, pp. 472-77. 
 
 23 Urechia et Popeia, Soc. de biol., Bucarest, 20 dec, 1913, p. 591. 
 
 2« Pesker, Ass. scientif. des med. de l'Ass. psychiatrique Saint Nicholas a 
 Saint Petersbourg. 10 janv., 1914. 
 
 " Parhon, et Parhon, M., Soc. de biol., 25 avril, 1914. 
 
 28 Obregia et Pitulesco, Soc. de biol., Bucarest, 31 janv., 1914, p. 316. 
 
 *" Marinesco et Papazolu, Soc. de biol., Bucarest, 29 mai, 1914, p. 1419. 
 
 20 Mutermilch, S., L'applicat. de la react. d'Abderhalden au diagnostic et 
 à l'état des mal. nerv. et mentales. Arch, de Neurol., avril, 1914, pp. 205-219. 
 Bibliographie. 
 
8 THE INTERNAL SECRETIONS AND 
 
 internal secretions and the psychoses, Parhon, with Odobesco," 
 started to trace a psycho-endocrine syndrome characterized from 
 the psychic viewpoint by great irascibility and ideas of persecution 
 poorly systematized, and from a somatic viewpoint by ovarian dis- 
 turbances, irregular menstruation or amenorrhea and especially 
 thyroidal disturbances, congestion of the face, hot flashes, mono- 
 nucleosis and a positive Abderhalden reaction for the thyroid. 
 
 Now Plant has shown that in Abderhalden's reaction, kaolin 
 talc, sulphate of barium produce dialyzable sustances which react 
 with ninhydrin just as the protein does which has served in the 
 preparation of the animal,^^ and H. de Waele concluded after a 
 series of experiments that this ferment is unique : it is antithrombin. 
 It is not the fragments of organs or proteins that undergo pro- 
 teolysis but really the globulins of the serum. The specificity will 
 simply arise from the preparatory injection which has created con- 
 ditions favorable to the action of the protein on the globulins of 
 the serum, and it appears probable that this bears a close relationship 
 to the phenomena of agglutination and precipitation. 
 
 Even more recently Flatow^^ happened to show that it con- 
 sists of simple variations of the proteolytic ferments of the serum. 
 This study of antiferments for the diagnosis of endocrino-nervous 
 relationships is, therefore, to my mind, extremely dangerous. In 
 eflfect the recent criticisms of the Abderhalden reaction, in spite of 
 the recognition of the gross chemical interest, put one justly on 
 guard against its pretended specificity towards the extracts of or- 
 gans employed. 
 
 I will then consider that the new investigations are not entirely 
 conclusive relative to the existence of an endocrine factor, based 
 solely on the Abderhalden reaction. 
 
 The physiological method advocated by Gley in his report for 
 judging of the functional capacity of the affected organ consists 
 of injecting into animals the altered tissue in order to see if it 
 still manifests the physiological properties of normal tissue. 
 
 A priori, this method seems of value, and, as Gley says, "this 
 type of study seems to recommend itself in a general way to 
 pathologists. The anatomo-pathological research which allows cer- 
 tain lesions to be authenticated should be amplified." And as an 
 
 31 C. J. Parhon et Gr. Odabesco, Encéphale, lo juin, 1914, pp. 489-582. 
 
 32 H. de Waele, Soc. de biol., 25 avril, 1914, p. 627, et Zeitschr. f. 
 Immunitatsf. 
 
 33 Flatow, A propos de la spécificité des soi-desant ferments protecteurs, 
 XXXI Cong., allemand de med. int., Wiesbaden, mai, 1914. 
 
THE NERVOUS SYSTEM 9 
 
 example he has cited his experiences with the cardiovascular action 
 of adrenal extract from thyroidectomized dogs compared with that 
 obtained from normal canine glands. He did not note any differ- 
 ence. Porak, who has followed this route, has arrived at unex- 
 pected results. Suprarenal extracts obtained under conditions of 
 activity clearly greater than normal have given cardio-vascular re- 
 actions of less intensity than those that were obtained under normal 
 conditions. As the cardio-vascular effect is proportionate to the 
 richness in adrenalin one must conclude that not only is the richness 
 in adrenalin of the suprarenals not in proportion to their activity, 
 but that taken at a given moment they are less charged with adrenalin 
 than are less active suprarenal glands. 
 
 Thus because function wears itself out with persistence, and by 
 fault of having overlooked the time factor, one has been exposed 
 to erroneous deductions, in conclusions drawn from the physiolog- 
 ical method, which a priori is valuable in itself. 
 
 It is good because, contrary to precedent, it is capable of fur- 
 nishing answers during the life of the individual. Better yet be- 
 cause it seems to be the method followed by Claude and his pupils. 
 
 It consists of injecting divers glandular extracts into patients, 
 and observing their reactions systematically, and deducing from 
 these reactions the probable endocrine disorders. Thus it permits 
 the acquisition of individual indicators of physiological endocrine 
 reactions, which, counting on the complexity of the cases, by the 
 comparison of a large number of facts, may allow the formation 
 of hypotheses if not of conclusions. Claude with his pupils, 
 Baudouin and Porak, has already used this method with success 
 in the study of acromegalics, Addisonians and just recently of 
 Basedowians." 
 
 The many criticisms summed up by Biedl and Falta and Porak" 
 have done full justice to the serological methods, such as that of 
 Meltzer-Ehrmann, based upon the supposed fact that dilatation of 
 the enucleated eye of the frog, in the presence of any serum in- 
 dicates the existence of adrenalin in that serum. Mydriasis can 
 be brought about by other causes than the presence of adrenalin. 
 It is useless to argue further. 
 
 There remains the need of knowing how to interpret the results 
 of the clinical, organotherapeutic, anatomo-pathological and phys- 
 iological methods (Claude type). 
 
 '* Claude, H. Baudouin, R. Porak, L'épreuve des extr. hypophysaires chez 
 les bascdowiens, Soc. méd. des hop., 19 juin, 1914, 11 12. 
 
 3'^ Porak, L'épreuve de l'hypophyse dans les maladies des glandes à 
 sécrétion interne., Thèse, 1914. 
 
10 THE INTERNAL SECRETIONS AND 
 
 I will now sum up the nervous disturbances in the endocrine syn- 
 dromes and the endocrine disturbances in the nervous syndromes as 
 rapidly as possible, because one finds them to-day explained at length 
 everywhere. 
 
 I. Nervous Disturbances in the Endocrine S5mdromes 
 
 Endocrine syndromes are increasing every day, perhaps because 
 one finds definite endocrinal lesions in a syndrome till now con- 
 founded with an analogue, perhaps because one now erects at 
 pleasure endocrine theories for divers affections of unknown 
 origin. The first way is legitimate, although of a rather delicate 
 interpretation — in fact we are all familiar with the frequency of 
 lesions in the endocrine glands in all sorts of autopsies. The 
 second is singularly fallacious when it depends only on experi- 
 mental or clinical analogies or on debatable anatomical, humoral 
 or therapeutic authentications. The syndrome of dystrophia 
 adiposo-genitalis due to a pituitary lesion and precocious macro- 
 genito-somatosis due to a pineal lesion are examples of the first. 
 The endocrine theories as to the origin of seasickness, hysteria, 
 Paget's disease, cholera are, in their turn, examples of the second. 
 
 In the beginning, in the period which might be called the uni- 
 endocrine, each syndrome was connected with a lesion of one single 
 gland, Basedow's with the thyroid, Addison's with the suprarenals, 
 acromegaly with the pituitary, and in each gland only disorders of 
 increase or decrease of secretion were seen (quantitative period). 
 
 In the meantime, after many others, I had shown with Thaon in 
 1905 a case of Basedow's disease in a woman with myxedema, 
 which the simple quantitative theory could not explain. 
 
 Meanwhile, in 1904, in reference to a case of acromegaly with 
 hypertrophy of the pituitary, the thyroid and the suprarenals, I 
 and M. Ballet^^ attempted to explain these glandular reactions by 
 claiming functional correlations among the endocrines, and I ad- 
 vanced the hypothesis of a humoral process. 
 
 Shortly after, Claude^'^ insisted upon the existence of several 
 endocrine reactions in acromegalics. 
 
 After this quantitative, uniendocrine organic period there fol- 
 lowed the polyendocrine period, which is rendered memorable by 
 the ringing memoir of Claude and Gougerot^^ on the pluriglandular 
 
 3« G. Ballet et Laignel-Lavastine, Soc. de Neurol., juillet, 1904, R. N., 
 p. 793- 
 
 2'' Claude, Soc. de biol., 28 oct., 1905, p. 362. 
 
 38 Claude et Gougerot, Soc. de biol., dec, 1907, p. 785. Journ. de physiol. 
 et path, gén., juin, 1908. 
 
THE NERVOUS SYSTEM 1 1 
 
 syndromes pertaining to a tuberculous case with a testicular-adreno- 
 thyroidal insufficiency. 
 
 Subsequently on June 24 at my course at Laennec on the medical 
 anatomy and physiology of the secretions I delivered a lecture, 
 published afterwards,»» on the correlation of the glands of internal 
 secretion and their pluriglandular syndromes, and M. Renon" 
 established a clinic at Necker. 
 
 Following this one spoke of nothing but pluriglandular syn- 
 dromes, because really the disorders are hardly ever, if ever, limited 
 to one gland exclusively. But after having been too limited, we 
 exaggerated in the opposite sense. It is not logical, because the 
 endocrinal disorders in the pathological state have many glandular 
 echoes, as in the normal state the functional correlations run along 
 in humoral harmony, to speak of pluriglandular syndromes when 
 but two glands are involved. 
 
 In addition if classical endocrine syndromes such as Basedow's 
 syndrome, Addison's syndrome and diabetes insipidus are often 
 allied to a microscopical lesion of the thyroid, the suprarenals or 
 the pancreas, sometimes these lesions lack emphasis, and one is 
 forced to admit a nervous disorder reacting on these glands. It is 
 this that I endeavored to demonstrate in my theses on the solar 
 plexus," where side by side in Addisonian syndromes with micro- 
 scopic lesions of the suprarenals I published others without such 
 lesions. As I have stated, a syndrome being the clinical expression 
 of a disturbance of function, it is brought about either by a glandular 
 lesion which controls that function or by a lesion of the nervous 
 system, which regulates that gland. To the lesional contingency is 
 opposed the functional necessity. All the cases which are not ex- 
 plained by the organic theory place themselves easily, on the con- 
 trary, in the physiological theory, which is much more compre- 
 hensive. Hence one must know how to substitute the single phys- 
 iological or the qualitative or quantitative polyendocrine explana- 
 tion for the quantitative organic uniendocrine interpretation which 
 is the oldest and simplest. 
 
 To sum up, endocrine syndromes may depend not only on a 
 lesion of a corresponding gland or of its regulating nervous mech- 
 anism, but indeed upon an upset of one or the other of an infectious 
 or toxic origin; the glandular trouble may be not only quantitative 
 but qualitative; it may depend not only on one gland but upon 
 
 •■"o Laignel-Lavastine, Gaz. des Hop., 14 nov., 1908, pp. 1563-71. 
 <°Renon, Journ. des practiciens, 25 juill., 1908. 
 *^ Laignel-Lavastine, These de Paris, 1903. 
 
12 THE INTERNAL SECRETIONS AND 
 
 many, and in the latter case with predominance on one or on several 
 of them, sometimes without appreciable clinical ascendancy, I will 
 therefore enumerate the uniendocrine syndromes and the polyen- 
 docrine syndromes, and I will divide the latter into two groups 
 according as to whether a preponderance in the disorders of cer- 
 tain glands can be differentiated or not. 
 
 From this enumeration of the endocrine syndromes it will be- 
 come evident that endocrinogenous nervous disorders exist. The 
 interpretation of facts is more delicate from the viewpoint of the 
 Viennese School, which, in a parallel manner to the division of the 
 vegetative system into sympathetic and autonomic systems, and 
 after having admitted the relationship of excitation and inhibition 
 of the divers glands, one on the other (the triangular schema of 
 Eppinger, Falta and Rudinger reproduced everywhere), divides 
 these same endocrine glands into two groups, of which one formed 
 especially of the suprarenals, the thyroid and the pituitary excites 
 the sympathetic, while the other formed especially of the pancreas 
 and parathyroids excites the autonomic. 
 
 'A. Uniendocrine Syndromes 
 
 The ensuing is the enumeration of nervous disorders noted 
 in the divers syndromes as depending on the following endocrine 
 glands: thyroid, parathyroids, thymus, suprarenals, paraganglia of 
 the sympathetic, pancreas, pituitary, pineal, choroid plexus, ovary, 
 testicle and prostate. 
 
 I. Thyroid 
 
 1. Myxedema: Arrest of development, dwarfism, infantilism, in- 
 filtration of the skin, mental torpor, dull ideation, defective memory, 
 apathy, laziness, sluggishness, somnolence, taciturnity, awkwardness, 
 slow, monotonous, raucuos, nasal voice; small pulse, rapid and 
 irregular, sometimes with hypertension; constipation, scanty urine, 
 subnormal temperature, chilliness, headaches, slight knee jerks; no 
 alimentary glycosuria ; sometimes epilepsy. 
 
 2. Basedow's syndrome: Tachycardia, arrhythmia, anxiety, pulsa- 
 tion of the arteries of the neck: exophthalmos, lachrymation. Von 
 Graefe's sign (lack of synergy in the movements of the upper eye- 
 lid and the globe), Stellwag's sign (lengthening of the palpebral 
 fissure and incomplete closure of the eyes), Mobius's sign (diffi- 
 culty in convergence) ; facial paresis, a giving way of the legs, 
 epilepsy, transient attacks of tetany, cramps, tremblings, ocular 
 frontal headaches; colics, hot flushes, profuse sweats, intolerance of 
 
THE NERVOUS SYSTEM 13 
 
 heat, vasodilatation of the skin, meningitic skin reaction, dermo- 
 graphia,*- transient attacks of edema, pigmentations, urticaria, 
 alopecia, diminution of electrical resistance, polyuria, albuminuria, 
 glycosuria, anorexia, insatiable hunger, vomiting, ptyalism, hyper- 
 chlorhydria, diarrhea, rapid respiration, Bryson's sign (lack of deep 
 inspiratory power), suffocation, amenorrhea, atrophy of the breasts, 
 emaciation, agitation, emotional instability, volubility, insomnia, 
 emotional stress, susceptibility, inquietude, anxiety, rage and some- 
 times anxiety neurosis, obsessions, anxious melancholy, cyclic in- 
 sanity, restless excitement, depression, mania, melancholia, mental 
 confusion, epilepsy. 
 
 Sainton*^ found among Basedowians sometimes signs of sym- 
 pathicotonia: exophthalmos, adrenalin mydriasis, lack of lachrymal 
 secretion, violent tachycardia, glycosuria, adrenalin reaction, an 
 absent or inverted oculo-cardiac reflex; at other times signs of 
 vagotonia: slight exophthalmos with enlargement of the palpebral 
 fissure. Von Graefe's sign, increased lachrymation, abundant sweats, 
 diarrhea, slight tachycardia, no alimentary glycosuria, positive oc- 
 ulo-cardiac reflex and a pilocarpine reaction ; and at still other times 
 a mixture of the two series. 
 
 He therefore admits of three forms : sympathicotonic, vago- 
 tonic and mixed.^^ 
 
 This seems to me to be the rule. Especially as I have had oc- 
 casion to see a case where the oculo-cardiac reflex was at various 
 periods sometimes positive, sometimes normal, negative and even 
 inverted. 
 
 3. Thyroidal insufficiencies other than myxedema: Infantilism, 
 obesity, Dercum's syndrome, pseudo-lipomatosis, alopecia, prema- 
 ture grayness, scleroderma, urticaria, pruritus, relapsing herpes, 
 transitory edemas, migraine, asthma, constipation, muco-membra- 
 nous entero-colitis, blueness of the extremities, Raynaud's syndrome, 
 localized erythema, nasal asthma, carbohydrate tolerance, genital 
 irritability, hypertrophy of the mammae, chilliness. 
 
 4. Thyroidal instability of Leopold Levi and Henri de Roth- 
 schild: (a) With dyshypothyroidea predominating: chilliness, fall- 
 ing of the hair, headaches, despairs, weeping fits, giddiness, tran- 
 sient edemas, pains, spells of suffocation, shivering fits, hot flushes 
 at the periods; {b) With dyshyperthyroidea predominating: 
 
 *2 Alquier, Rev. Neurol, 30 mars et 30 juin, 1914, pp. 393-401 et 795. 
 *2 Sainton, P., Journ. méd. français, 15 mars, 1914. 
 
 ** B. Guillaumont, Le réflexe oculo-cardiaque dans le syndrome de Base- 
 dow, Th., 1914, p. 74. 
 
14 THE INTERNAL SECRETIONS AND 
 
 emaciation, heavy eyebrows, flashes of heat, feverishness, palpita- 
 tion of the heart, intestinal spasms, irritability, emotivity, phobias, 
 inquietude, overwhelming migraines, asthma, hyperidrosis, dysi- 
 drosis, tremblings; (c) Without preponderance: chilliness, chills, 
 migraines, repeated trips to the toilet, migratory pains, " diffuses," 
 " hemmage," redness of the eyebrows, catamenial neuralgias, anxie- 
 ties, large palpebral fissure, swelling of the feet, variability in the 
 size of the extremities, tremors, nervous crises, hysteria. 
 
 2. Parathyroids 
 
 1. Tetany. -^^ Tingling and stifïness of the fingers, tonic intermit- 
 tent spasms of the flexors of the extremities; flushings, temporary 
 edemas of the joints, normal or increased tendinous reflexes, dysp- 
 nea, tachycardia, fever, salivation, vomitings, diarrhea. Trousseau 
 sign (hand of the accoucheur on compression of the arm), 
 Chvostek's sign (brisk and fleeting contraction of the skin muscles 
 of the face on light percussion of the facial nerve, over the auric- 
 ulo-labial course) and Weiss's sign (brisk contraction of the 
 muscles of the forehead, eyebrows and eyelids on light percussion 
 of the temporal branch of the facial at the level of the external 
 angle of the eye) ; hyperexcitability of the nerves to the galvanic 
 current, particularly to the closure of the negative current and the 
 opening of the positive current. 
 
 2. Parkinson's*^ syndrome?: Trembling, muscular rigidity, pro- 
 pulsion, rheumatoid pains, sensations of heat, increased tendinous 
 reflexes, vaso-dilatation, sweats, edemas, cerebral retardation, 
 psychic depression, vertigoes. 
 
 3. Thymus 
 
 1. Vagotonic symptoms'^'' of Basedow's syndrome ( ?) : Profuse 
 sweats, palpitations, lymphocytosis, eosinophilia, sensation of 
 weakness. 
 
 2. Myasthenia*^ of Erb-Goldflam ( ?) : Headaches, ptosis, ex- 
 
 ■*^ Tétanie, résultante d'une insuffisance parathyroidienne latente, con- 
 génitale or acquise, qui s'aggrave brusquement et devient manifeste à l'occa- 
 sion d'une traumatisme, d'une infection or d'une intoxication surajoutée. 
 Thèse de R. Lifschitz, 1914, inspirée par Babonneix. 
 
 *^ Le syndrome de Parkinson serait hypoparathyroidien et s'opposerait a 
 la myasthénie, syndrome hyperthyroïdien ? (Lundborg). Deutsche Zeitsch. 
 f. Nervenheilk., Bd. XXVII, 1904, p. 217; voir de plus: Gautier, J., Th., 
 Lyon, 1913. 
 
 *J Rose, Le thymus et la mal. de Basedow, Sem. med., 21 janv., 1914, 
 d'après Capelle et Bayer, Biedl, Klose, Lampe et Liesegang. 
 
 *8 La coincidence très fréquente d'une gros thymus chez les myasthéniques 
 est certaine, Claude (Acad. de méd., juin, 1914) admet a l'origine de certains 
 cas des lésions thymiques. 
 
THE NERVOUS SYSTEM 1 5 
 
 ternal ophthalmoplegia, changing and fleeting paralyses confined 
 mostly to the head and neck, myasthenic electrical reaction of 
 Jolly (muscular fatigue by tetanizing stimulation). 
 
 3. Thymoprivic Idiocy (Klose and Vogt).** 
 
 4. Tetany?? (Basch).5° 
 
 4. Suprarenals 
 
 1. Addison's syndrome and suprarenal insufficiency: Asthenia, 
 arterial hypotension, morning nausea, morning vomitings, lumbar 
 pains, melanoderma, white skin reaction of Sargent, amyotrophia,'^ 
 aboulia, sadness, sometimes: tetany, epilepsy, myoclonia^^ convul- 
 sions, periodic paralyses, delirium, mental confusion, coma, sudden 
 death. 
 
 2. Genito-suprarenal syndrome: Feminine external pseudo-her- 
 maphrodism with virile secondary sexual characteristics ; suprarenal 
 masculinism : amenorrhea, gynecomastia (excessive size of the male 
 mammary glands), adiposity with discolorations of the skin, all 
 signs of feminine maturity; in addition: hypertrophy of the clitoris, 
 hypertrichosis wtih masculine distribution, masculine voice, increased 
 muscular and nervous tonicity, violent character, " disorders of the 
 mental state and afïectivity may go as far as sexual inversion "®' 
 (Gallais); increased arterial tension, arteriosclerosis; glycosuria. 
 " At the same time," adds Gallais,^* " bizarre nervous and mental 
 phenomena set in, near neighbors to maniacal excitement. The 
 sexual instinct deviates : the character changes and becomes violent, 
 authoritative, and crises of anxiety appear. Along with these 
 crises and in the interim one notes vaso-motor phenomena." 
 
 5. Paraganglia of the Sympathetic 
 
 Chromaffin cells in the solar plexus, Zuckerkandl's aortic para- 
 ganglia, the cardiac paraganglion of Wiesel and Wiesner, Luschka's 
 carotid gland, Luschka's coccygeal gland, the tympanic paragan- 
 
 *^ Klose. H., et Vogt, H., Klinik und Biologie der Thymusdruse mit 
 besonderer Beriicksichtigung ihrer Beziehungen zu Knochen- und Nerven- 
 system, Beitrage klin. Chir., 69, p. I, et Monographie, Tubingen, 1910 (505). 
 
 5° Basch, K., Ober die Beziehung der Thymus zum Nervensystcm, Jahr- 
 biJcher fur Kinderheilkunde, 68, 1908. 
 
 ^"^ Sézary, Syndromes surréno-musculaires, Sem. méd., 5 fev., 1913. 
 
 ^2 Laignel-Lavastine, Les formes cérébrales de l'insuffisance surrénal, 
 Presse méd. d'Kgypte, 15 mars, 191 1, p. 89. — Frette, Th., 1913. 
 
 *' A. Gallais, Le syndrome génito-surrénal. Thèse, Paris, 1913. 
 
 ** A. Gallais, Diagnostic anatomo-clinique du syndrome génito-surrénal, 
 Revue de gynécologie, janv., 1914. — Voir aussi : Truffier, Virilisme surrénal, 
 Ac. de med., 27 mai, 1914. 
 
l6 THE INTERNAL SECRETIONS AND 
 
 glion, are for the most part^^ chromaffin organs, and in this respect 
 pertain to the suprarenal sympathetic system. Their disturbances, 
 from the standpoint of nervous echoes, have not, as far as I know 
 at the present time, recognized aspects which are peculiar to them- 
 selves. 
 
 6. Pancreas 
 
 Diabetes mellitus: glycosuria, polyuria, polyphagia, polydipsia, 
 neuralgias, pruritus, impotence, constipation, scant salivation, scant 
 perspiration, dry skin, testicular atrophy, amenorrhea, loss of tendon 
 reflexes, increased arterial tension, asthenia, headaches, lessened 
 resistance to cold, perforating ulcer, syncopes, attacks of apoplecti- 
 form coma, paralyses, vertigoes, asthmatic dyspnea, pseudo-an- 
 gina pectoris, sommolent disorders of sleep, depression, apathy, hy- 
 pochondria, coma. 
 
 7. Pituitary 
 
 1. Froelich's dystrophia adiposo-genitalis syndrome: Adiposity, 
 arrest of development or retrogression of the genital glands, geni- 
 tal organs and the secondary sexual characteristics corresponding 
 thereto; somnolence. 
 
 2. Renon and Delille's^^ syndrome of pituitary insufficiency: 
 Tachycardia, instability of the pulse, lessened arterial tension, in- 
 somnia, anorexia, painful sensations of heat, increase in the secre- 
 tion of perspiration. 
 
 3. Acromegaly: "Marked hypertrophy, not congenital, of the 
 upper and lower extremities and of the head," pain in the head, 
 amenorrhea, tendinous reflexes never exaggerated, arrhythmia, syn- 
 cope, sweats, polyuria, glycosuria, lessened resistance to cold, 
 neuralgias, acroparesthesias, cramps, lancinating pains, lassitude, 
 irritability, sadness. 
 
 4. Giantism: " Acromegaly in individuals in whom the epiphyseal 
 cartilages are not yet ossified," impotence, amenorrhea, effeminacy, 
 puerility, aboulia, asthenia, glycosuria, polyuria. 
 
 5. Diabetes insipidus (???) :^^ Polyuria, polydipsia. 
 
 .^5 Voir sur ce point les réserves de N. Pende, Patologia de l'apparecchio 
 surrénale, Milan, 1909; de C. Frugoni. La gl. carotidienne possède-t-elle une 
 secret, int. propre? Sem. méd., 9 oct, 1912, p. 481 ; de Lanzillotta, Archiv. de 
 Fisiologia, i sept., 1913 ; et de Laignel-Lavastine, Pathologie du sympathetique 
 (sous presse). 
 
 58 Rénon et Delille, Congr. de méd., act., 1907, et Delille Thèse, 1909. 
 
 S'' Il tiendrait à un trouble du lobe intermédiare de l'hypophyse et de 
 l'infundibulum. Harvey Gushing, The Pituitary Body and Its Disorders, Lip- 
 pincott Co., Philadelphia et Londres, 1912; mais Camus et Roussy, Soc. de 
 biol., 1914, passim, l'ont reproduit expérimentalement par lésions de la sub- 
 stance grise du tuber cinereum au voismage de l'infundibulum. Il desire chez 
 le chien tout rôle à l'hypophyse dans la détermination du diabète insidipe, 
 Presse méd., 8 juill., 1914, pp. 517-521. 
 
THE NERVOUS SYSTEM I7 
 
 8. Pineal^^ 
 
 1. Macrogenitosomatosis:^^ Abnormal increase in growth or size, 
 premature genital and sexual development with secondary sexual 
 characteristics, hypertrichosis, precocious exaggerated mentality. 
 
 2. Pineal adiposity :^° Diffuse obesity. 
 
 9. Choroidal Plexus 
 
 I. Hydrocephalus: Increased tension of the cerebro-spinal fluid, 
 rapid reproduction, nervous and mental syndrome of ventricular 
 hypertension, clouded mentality, idiocy. 
 
 10. Ovaries 
 
 1. Infantilism: Amenorrhea, absence of secondary feminine 
 sexual characteristics, obesity, scanty hair, puerility. 
 
 2. Acquired ovarian insufficiency: Peripheral vaso-dilatation, 
 crises of subjective sensations of heat, sweats, continuous or par- 
 oxysmal tachycardia, palpitations, increased arterial tension, in- 
 somnia, headaches, facial neuralgias, lumbago, neuro-muscular 
 asthenia, uncertain memory, irritability, nervous debility, hysterical 
 crises, exaggeration of the sexual instinct?, which is more often 
 absent or inverted; obesity, inquietude, anxiety, phobias, impulses, 
 gastro-spasm, constipation, vomiting, vertigoes, syncopes. 
 
 "Vagotonic crises," before the periods and at the beginning of 
 pregnancy : pallor, tendency to syncope, spells of nausea, vomiting, 
 constipation, lessened arterial tension, rather slow pulse, positive 
 oculo-cardiac reflex, Samogyi's sign, psychic depression, related 
 especially to the evolution of the corpus luteum. 
 
 One must not confound these premenstrual crises or crises ot 
 the beginning of pregnancy with the reactional dyshyperthyroidism 
 of the menopause, characterized by hot flashes, sweats, hyperten- 
 sion, paroxysmal tachycardia, palpitations and anxiety. 
 
 3. " Hyperovaria" (Dalché) i"^ Precocious puberty, abundant 
 menses, pain during and before the first day of the periods, inter- 
 menstrual leucorrhea, developed sexual instinct, variability of de- 
 
 ^* Dana et Berkeley, W., Med. Record, 10 mai, 1913; L. J. Kidd, Review 
 of Neurology and Psychiatry, janv.-fev., 1913, pp. 1-24 et 55-75- 
 
 '^ Ce syndrome de Pellizi, Ogle, Oestreich et Slavyk, Frankl-Hochwart, 
 Gutzeit, Hudovernig, Raymond et Claude, Alarburg, A. Collin et Hcuycr, R. 
 Neurol, 30 mai, 1914, p. 729, serait lié à la destruction de la pinéale par une 
 tumeur chez les enfants. Au contraire, par Gallais, la pineale semblerait 
 avoir une rôle fonctionnel analogue à cclesi de la cortico-surrénalc, loc. cit. 
 
 •° L'adiposité pinéale de Marburg serait liée à un " hyperpinéalisme "? 
 
 «* Dalché, L'hyper, et l'hypovaric, Gaz. des hôp., nos. 75 et 78, 1906. Je 
 préfère dire dyshypcrovarie. 
 
1 8 THE INTERNAL SECRETIONS AND 
 
 sire depending on the menstrual period, well-developed eyebrows, 
 thinness, pallor, large hips, rounded contour of the lower extrem- 
 ities, th-ï size of which contrasts with that of the upper, lessened 
 arterial pressure, uneasiness causing movement and action, nervous 
 debility, tendency to loquacity, erotic crises. 
 
 11. Testicles 
 
 1. Infantilism: Lack of development in the male genital organs, 
 absence of secondary sexual characteristics, obesity, little hair, in- 
 creased length of the lower extremities, smallness of the cranium, 
 puerility. 
 
 2. Acquired testicular insufficiency:^^ Increase in size, decreased 
 hairiness, rotundity of the figure, tendency towards obesity, in- 
 creased size of the breasts, loss of desire, impotency, senility, in- 
 creased arterial tension?, asthenia. 
 
 The types of testicular insufficiency are, according to Rebattu 
 and Gravier:^' 
 
 1. The sterile. 
 
 2. Eunuchoid giantism, because the internal secretion of the testicle 
 
 was of late appearance. One notes in such a case a prolonged 
 infancy. 
 
 3. Eunuchism by castration, characterized by giantism and a youth- 
 
 ful aspect. The secondary sexual characteristics do not appear. 
 
 4. Revertive infantilism of Gandy, or the known asexual sort of 
 
 state, with attenuation of the secondary sexual characteristics 
 and a certain degree of obesity, due to delayed testicular dis- 
 order in the adult. 
 
 5. Dyshyperdiastematosis : short lower extremities, large head, 
 
 plenty of hair, especially heavy moustaches, thinness, persist- 
 ence of youth, no arterial hypertension, activity, moral and 
 physical energy. 
 
 12. Prostate 
 
 I. Prostatic insufficiency: Asthenia, diminished potency, neu- 
 rasthenia, sometimes suicide. 
 
 _^2La gerodermie génito-dystrophique de Rumno et Ferrannivi serait au 
 testicules ce que le myxoedème acquis est a la thyroïde. 
 
 ^3 J. Rebattu et L. Gravier, Étude des troubles de la sécrétion interne du 
 testicule. Dissociation des secret int. et ext. du testicule. Retard de l'étab- 
 lissement de la secret int. Nouv. Iconographie de la Salpêtrière, juill.-août., 
 1913, pp. 257-271. 
 
THE NERVOUS SYSTEM 1 9 
 
 2. Prostatic hypertrophy:^* Increased arterial tension,^^ slowing 
 of the heart action, cerebral hemorrhage, genital excitement. 
 
 B. POLYENDOCRINE SYNDROMES 
 
 (a) With Predominance of the Thyroid 
 
 1. Basedovians, with hypertrophy of the thymus and vagotonic 
 symptoms; scleroderma and tetany, amenorrhea; Addison's syn- 
 drome ; acromegaly, etc. 
 
 2. Myxedematous cases with hypertrophy of the thymus, tetany, 
 acromegaly, Addison's syndrome, amenorrhea, infantilism, hyper- 
 trophy of the breasts, etc. 
 
 3. Acromegalics or ovarian insufficients with varied disorders 
 either psychic, nervous, vaso-motor, or trophic, entering sometimes 
 into the myxedematous series and sometimes into the Basedovian. 
 
 (b) With Predominance of the Ovary^^ 
 
 1. Thyroidal reaction to the ovarian insufficiency: tachycardia, 
 palpitation, sweats, nervous irritability, vertigoes, scanty urination, 
 tremors, anxiety, etc. 
 
 " One can no longer fail to notice," said I in 1908, " that the 
 differences are very slight between these nervous manifestations 
 and the picture of the attenuated forms of exophthalmic goiter. 
 This pathogenetic idea allows of important therapeutic conse- 
 quences. One can ask if it would not be of interest to institute an 
 antibasedovian therapeusis, hemato-ethyroidin for instance, against 
 the nervous and psychic disorders of the natural menopause, which 
 recall trait for trait the symptoms of the Basedovian series." 
 
 Since then numerous successes of the sort have confirmed the 
 justice of the idea. 
 
 2. Dyshyperovaria among cases of hypothyroidism:^^ antici- 
 pation, prolonged abundance of the menses, menorrhagia, metror- 
 rhagia. 
 
 3. Thyro-ovarian disorders taken in the same sense: be it the 
 ovarian insufficiency in the myxedematous series, or the dyshy- 
 perovaria in the Basedovian series, in all cases the nervous dis- 
 
 8* Elle coïncide souvent avec l'insuffisance. 
 
 ^= L'extrait prostatique est hypotenseur et cardio-modérateur, Thaon. Soc. 
 de biol., 1.3 juillet, 1907. Son injection est suivie de vaso-dilatation cérébrale. 
 Ch. Dubois et L. Boulet, Soc. de biol., 19 avril, 1913, p. 811. 
 
 *^ Schickcle, G., Kongrcss f. innere med., 191 1. 
 
 ''^ Leopold, Levi et H. de Rothschild, La petite insuffisience thyroïdienne, 
 1913, p. 153- 
 
20 THE INTERNAL SECRETIONS AND 
 
 orders, whatever they may be, of the dysthyroidal women are mod- 
 ified by the ovarian rhythm at all times 
 
 (c) With Predominance of the Pituitary 
 
 1. Infantile giants with their clinical varieties : feminism, 
 eunuchism, crytorchidism, pseudo-hermaphrodism of the feminine 
 type, mental puerility. 
 
 2. Acromegalics with deficiency syndromes, myxedema, infanti- 
 lism, amenorrhea, obesity, asthenia, 
 
 3. Acromegalics, who on the contrary have syndromes of hy- 
 peractivity, more or less vitiated either of cooperation or supply: 
 simple or exophthalmic goiter, arterial hypertension and atheroma, 
 lacteal secretion. 
 
 (d) With Predominance of the Suprarenals 
 
 1. Addisonians with amenorrhea, impotence, chilliness, tetany or, 
 on the contrary, exophthalmic goiter. 
 
 2. And very often Basedovians, acromegalics, giants, with 
 spontaneous glycosuria of alimentary or adrenal type, this latter 
 being able in certain cases to cause one to presuppose a certain 
 degree of suprarenal activity. 
 
 {e) Without Marked Predominance 
 Take the case of Claude and Gougerot : loss of sexual character- 
 istics, senile face, thick skin, wrinkles, pigmentations, chilliness, 
 absence of perspiration, asthenia, lowered arterial tension, tetany, 
 atrophy of the testicles, of the prostate, of the suprarenals, thyroid 
 and possibly of the parathyroids. 
 
 In order to include these nervous disorders revealed in the 
 endocrine syndromes in one complete aspect, I have grouped them 
 together under five headings, motor, sensory, vegetative, and psy- 
 chic disorders, to which I have added the results of the sympatho- 
 vagotonic tests. 
 
 These are: 
 
 1. Motility (tonus, sthenic, reflex, voluntary) ; 
 
 2. Sensibility (special, general) ; 
 
 3. Vago-sympathetic : 
 
 1. The sense of conscious existence (general, hunger, thirst, 
 
 genital) ; 
 
 2. Lisso-motility (pupil, vaso-motor, pilo-motor, chromato- 
 
THE NERVOUS SYSTEM 21 
 
 motor, lisso-motor properly speaking, arterial tension) ; 
 
 3. Cardiac rhythm ; 
 
 4. Digestive secretions (salivary, gastric, hepatic, pancreatic, 
 
 intestinal), cutaneous (sweats), urinary (water, sugar) ; 
 endocrinal. 
 
 5. Eutrophia. General good nutrition. 
 
 4, Psychism : rhythm, response, emotion, attention, memory, in- 
 
 telligence, activity, sleep, instinct (sexual). 
 
 5. Sympatho-vagotonic tests : adrenalin, atropine, eserine, pilocar- 
 
 pine, oculo-cardiac reflex. 
 
 Now, if I set aside the sympatho-vagotonic tests, then although 
 it is very easy to answer plus or minus to different questions con- 
 cerning the nervous state just analyzed, when one considers the 
 thyroidal syndromes, it is impossible to do the same clearly for the 
 other syndromes. Those which furnish most of the definite an- 
 swers after the thyroidal syndromes are the ovarian syndromes. 
 One single functional whole is affected by all, that is a sense of 
 well-being (eutrophia) ; but I have indicated correctly that many 
 of the disorders allied to endocrine dysfunction may be independent 
 of the nervous system. Whence comes this first affirmation, that 
 it is above all the thyroid syndromes and in the second place the 
 ovarian syndromes that are most frequently accompanied by 
 nervous disorders? 
 
 There is therefore an enormous difference between the endocrine 
 glands viewed from the nervous consequences resulting from their 
 disturbances. 
 
 Moreover the importance of the thyro-ovarian relations ex- 
 plains the differences according to sex of one portion of the neu- 
 rology and especially of the psychiatry. 
 
 If, on the other hand, one classifies the divers groups of nervous 
 disorders, psychic disorders appear to predominate in the thyroidal 
 syndromes, the vago-sympathetic disorders in the thyroidal and 
 ovarian syndromes, and finally the disorders of neuro-striated 
 muscle motility predominate in the thyroidal, parathyroidal, thymic 
 and suprarenal syndromes. Not only then are the endocrine syn- 
 dromes far from being equal as regards wealth of nervous ele- 
 ments, but in addition they involve a relative election amidst these 
 elements. 
 
 It remains to discover the reasons for these varieties of coin- 
 cidence in delving further into the probable mechanism of their 
 production. 
 
22 THE INTERNAL SECRETIONS AND 
 
 After this very summary account of the facts, let us consider 
 their interpretation. 
 
 Among the nervous symptoms — ^motor, sensory, vaso-motor, 
 secretory, trophic and psychic — revealed in the enumerated endo- 
 crine syndromes, all the world admits that there are some that are 
 caused by endocrine disturbances ; thus tachycardia and active 
 vaso-dilatation are caused by thyroidal disorders in Basedow's syn- 
 drome, as are asthenia and lowered arterial tension by suprarenal 
 disorders in Addison's syndrome. These glandular disorders 
 themselves may be in their turn secondary to a nervous disturbance. 
 I will bring to your notice such cases in the succeeding chapter. 
 This is not really the question. The endocrino-nervous relation- 
 ship is demonstrated: endocrinogenous nervous disorders do exist. 
 
 Such is my first conclusion, universally admitted. This does 
 not mean to say that in other respects all the nervous symptoms 
 existing in individuals afflicted with an endocrine syndrome are 
 attached to this syndrome and dependent upon the glandular dis- 
 turbance of which it is the expression. In addition, among the 
 nervous disorders which depend upon the disturbance, one must 
 differentiate two groups according as to whether they are related 
 directly or only indirectly. 
 
 The direct endocrino-nervous relationships have numerous ex- 
 amples, both clinical and experimental: tachycardia in Basedovians, 
 hypotension in Addisonians, mydriasis following the conjunctival 
 instillation of adrenalin, etc. 
 
 The indirect endocrino-nervous relationships are often extremely 
 difficult to outline precisely, and it is in their study that one part 
 of the difficulties of the question lies. 
 
 I will also divide these relationships into four categories. 
 
 The first category includes the indirect endocrino-nervous re- 
 lationships through evolutional morphological intervention. Thus 
 a lesion of the thyroidal body sustained in early infancy, even in 
 utero,^^ arrests the general development of the organism, and thereby 
 interferes with the appearance of secondary sexual characteristics 
 with all their consequences. 
 
 The glandular disorder, appearing in utero, in infancy or 
 adolescence reacts on the development of the organism. The re- 
 lationship comes essentially under the domain of ontogenesis and 
 morphology. The secondary nervous disorders result from struc- 
 
 ^s J. Parhon, " Quelques considérations sur l'importance des fonctions 
 endocrines, pendant la vie embryonnaire et foetale et sur leur rôle dans 
 l'organogenèse," Presse med., i*" oct., 1913. 
 
THE NERVOUS SYSTEM 23 
 
 tural anomalies, which are themselves secondary to the glandular 
 lesion. 
 
 The second category, near neighbor to the first, includes in- 
 direct endocrino-nervous relationships through humoral morpho- 
 logical intervention. Thus normally the suppression of the ovarian 
 function at the menopause entails well-known modifications of the 
 female organism, the exaggeration of which determines, among 
 other disorders, trophic symptoms such as a subcutaneous adiposity 
 and development of hair. This example may also serve for the 
 comprehension of a third category: the indirect endocrino-nervous 
 relationships through a humoral intervention. The latter are ex- 
 tremely frequent; they are explained very naturally by the func- 
 tional correlations under the influence sometimes of the hormones 
 and sometimes, and perhaps more often, of the general modifica- 
 tions of metabolism (loss of calcium for example^^) set free by 
 the glandular disturbance or even directly by the cause of the latter. 
 
 For example increased arterial tension among Basedovians seems 
 to be allied to the fact that their blood contains more adrenalin than 
 that of normal individuals. Asher and de Rodt explain it by the 
 fact that thyroidal hypersecretion reinforces the action of adrenalin ; 
 by an indirect route the terminal organs of the sympathetic may be 
 in a state of excitation, and as the secretory nerves of the supra- 
 renals belong to the sympathetic, an increased secretion of adrenalin 
 may result. 
 
 Per contra, to explain the tachycardia, one must invoke another 
 factor besides the experiments, experience teaches only that the 
 products of normal thyroidal secretion augment the excitability of 
 the autonomic nerves. 
 
 A fourth category is established by indirect endocrino-nervous 
 relationships through nervous intervention. This intervention is 
 excited at times physiologically and at other psychically. In the 
 first case it consists for example of headache due to a meningo- 
 encephalic vascular disturbance under the influence of a cervical 
 sympathetic disorder of thyroidal origin. 
 
 In the second case it consists for example of a phobia (fear of 
 dying, of having heart disease, of becoming insane, etc.) determined 
 by a diffuse anxiety allied to a menopausal tachycardia from excita- 
 tion of the sympathetic of thyroidal origin, and the accuracy of this 
 mechanism is shown by the cure of such cases with hemato-ethyroid- 
 ine (unpublished personal observations). 
 
 •«Chiari et Frohlich, Arch. f. exp. Pathol, u. Parmak., ign, P- 214. 
 
24 THE INTERNAL SECRETIONS AND 
 
 One can consider this last group, which is very important in 
 psychiatry, as a fifth category, and speak of indirect endocrino- 
 nervous relationships, through psychic intervention. These rela- 
 tionships simply dogmatize the facts. They do not explain them. 
 The Viennese school in a series of remarkable studies has attempted 
 to interpret them. I will leave to my co-worker, Professor Biedl, 
 the honor and pleasure of explaining these researches, which he 
 partly instigated, and which he has had the wisdom to publish 
 already with his collaborators and pupils, showing admirable com- 
 mand of the subject. 
 
 At the end of this analysis I will only remark that if the 
 pharmacodynamic division of Langley, Eppinger and Hess of the 
 vegetative system into the autonomic and sympathetic systems in- 
 troduces in its own interest a new standard in the nomenclature of 
 the nerves, up to now based on anatomy, and that if it is better now 
 to think in terms of physiology rather than of anatomy, neverthe- 
 less the pharmacodynamic idea is not the whole of physiology, and 
 the three present divisions of the vegetative system into the anatom- 
 ical, physiological and pharmacodynamic do not fit their valencies 
 together with any precision. 
 
 In a parallel manner to this division of the vegetative system 
 Eppinger, Hess, Falta and Rudinger have divided the endocrine 
 glands into two groups, one vagotrope and the other sympathi- 
 cotrope. As I have already stated the vagotropes are the pancreas 
 and parathyroids, and the sympathicotropes are the thyroid and the 
 adrenals, to which Falta and Berterelli have added the infundibular 
 portion of the pituitary. Now the analysis of nervous disorders in 
 the endocrine syndromes shows moreover that the vagotonic and 
 sympathicotonic disturbances, far from being always opposed to 
 each other, exist at times in the same individual, not only con- 
 secutively but simultaneously, and accordingly there is not a simple 
 and constant relationship between the endocrinal disturbance and 
 the nervous disorder of one or the other group. 
 
 Things then seem much more complicated than one would have 
 believed, and the classifications of the Viennese School, even if 
 they have rendered, and still render, great service in arranging the 
 phenomena, do not seem as yet sufficiently adequate in real truth 
 to act as a basis for new systematizations. 
 
THE NERVOUS SYSTEM 2$ 
 
 2. Endocrine Disorders in Nervous Syndromes 
 In all individuals suffering vi^ith nervous diseases endocrine dis- 
 orders may coexist ; but I will only outline the cases in which these 
 endocrine disorders may be under the direct or indirect influence 
 of the nervous syndromes, or which play a rôle in determining the 
 nervous symptoms, although their clinical manifestations are not 
 evident. Following this point of view I will divide these syndromes 
 into three large groups : sensory-motor, vegetative and psychic. 
 
 A. Sensory-Motor Syndromes 
 
 Among these syndromes there are a great number that can have 
 nothing but a relationship of casual coincidence or a more or less 
 mediate attachment. That is why I eliminate the hemiplegias, 
 paraplegias, ataxias, muscular atrophies, vertigoes, tremors, athe- 
 toses, choreas, spasms, myoclonias, contractures, convulsions, myo- 
 tonias, hypotonias, myatonias, neuralgias, distributed pains, mi- 
 graines, paresthesias by evident organic affections of the nervous 
 system, with known lesions of the nerves, of the spinal cord or 
 brain, even though endocrinogenous toxic functional nervous dis- 
 orders often exist coincident with nervous symptoms of an organic 
 nature. Certainly as bearing on the subject, for example, are the 
 hemiplegias due to hemorrhage of the optic thalamus, often allied 
 with suprarenal hypertrophies (Frouin), and which readily appear 
 to be due to increased arterial tension secondary to dyshyperfunc- 
 tion of the adrenals; in like manner the cerebral hemorrhages of 
 the menopause, allied also to ovarian insufficiency by the interven- 
 tion of sudden hypertensive shocks in the vasomotor ataxia of that 
 critical period; as well as, although inversely, increased suprarenal 
 secretion by excitation of the splanchnic in the course of tabetic 
 crises (there are endocrine secretory crises just as there are exo- 
 crine) ; also aspongiocytosis in these same suprarenals subsequent 
 to the incessant motor agitation in cases of chronic chorea or mania 
 (unpublished personal notes) ; also those tabetics or cases of syphilis 
 of the nervous system with myxedema, infantilism, tetany, etc., 
 caused by concomitant syphilitic lesions of the nervous system and 
 the glands. In the first two cases the relationhip is too indirect and 
 mechanical ; in the two following the relationship is inverse, neurog- 
 enous, direct and indirect; in the last the coincidence arises from a 
 co-effect of the same cause, namely syphilis, acting on two different 
 parts of the bodv. One could multiply such examples without 
 profit. 
 
26 THE INTERNAL SECRETIONS AND 
 
 I will retain among the sensory-motor syndromes only those 
 whose pathology is still disputed, and which appear sufficiently often 
 in coincidence with endocrine disorders for the hypothesis of a 
 relationship between cause and effect to be at least worthy of 
 discussion. 
 
 Such are 
 
 1. Certain intermittent paraplegias: thyroid, parathyroids, thymus, 
 
 suprarenals. 
 
 2. Periodic paralysis (Westphal). 
 
 3. Pseudo-paralytic myasthenia gravis (Erb-Goldflam) :''° thymus, 
 
 parathyroids. 
 
 4. Myopathies:''^ thyroid. 
 
 5. Certain vertigoes : pituitary, suprarenals, ovaries. 
 
 6. Certain tremors: thyroid. 
 
 7. Certain choreas : thyroid, suprarenals. 
 
 8. Certain spasms. 
 
 9. Certain myoclonias. 
 
 10. Tetany: parathyroids. 
 
 11. Parkinson's syndrome :''2 parathyroids, thyroid(?), pituitary( ?), 
 
 ovary ( ?). 
 
 12. Epilepsy: thyroid. 
 
 13. Eclampsia: parathyroids. 
 
 14. Myotonias. 
 
 15. Congenital myatonia. 
 
 16. Hypotonia. 
 
 17. Acroparesthesia. 
 
 18. The cephalalgias: thyroid, ovary. 
 
 19. Migraine: thyroid. 
 
 20. Certain paresthesias. 
 
 In this résumé I wish to state that the sensory-motor syndromes 
 coming under the precise heading of the chapter: endocrine dis- 
 orders in the nervous syndromes have not been described, so to 
 speak, but I have nearly always indicated nervous syndromes in 
 which endocrine disorders should be looked for in order to under- 
 stand them. I have been guided therefore more by the relative 
 symptomatic importance of the nervous and endocrine manifesta- 
 tions than by the causal relationship. From this last point of view 
 
 '■o Tobias, Neurol. Centralbl., May i, 1913, pp. 551-62. 
 
 ^1 Oppenheim, H., Congrès de Londres, 1913. 
 
 '^^ Sainton et Barré, Soc. de Neurol., 26 juin, 1913. R. N., 15 juill., p. 55. 
 Parhon et Goldstein, Soc. des se. mèd., Bucarest, 1909, 1910; Encéph., cet., 
 1912, p. 228. 
 
THE NERVOUS SYSTEM 27 
 
 I must distinguish at first the cases, few in number, where the endo- 
 crine symptoms are caused by nervous disorders, such as the endo- 
 crine insufficiencies described recently by Claude, in the train of 
 the crises of Erb-Goldflam myasthenia, and later on the more 
 numerous cases where the nervous symptoms are caused by endo- 
 crine disorders. 
 
 This subgroup is not to be confounded nevertheless with that 
 of the nervous disorder in the endocrine syndromes, because in the 
 latter there is a clearly outlined endocrine syndrome, while in the 
 former there is merely an endocrine commotion. If they are con- 
 founded owing to their relationship of pathological causality, they 
 are to be distinguished clinically in definite types, with, in addition, 
 all their intermediates between them. 
 
 This having been stated, two remarks arise from the preceding 
 résumé. It deals especially with syndromes having paroxysmal 
 manifestations and with disorders bearing on qualitative variations 
 of motility. 
 
 This rôle played by the endocrine glands in paroxysmal nervous 
 manifestations did not escape a clever clinician like Leopold Lévi,'^* 
 and he has proposed the name of endocrinolepsies for such paroxys- 
 mal syndromes, because they burst forth of a sudden, like an ex- 
 plosion (lepsy, XaiJL^aveiv to seize) and they are subordinated to an 
 endocrine disturbance. 
 
 The principal endocrinolepsies are, according to Leopold Levi, 
 ordinary migraine and ophthalmic migraine, ordinary asthma'^* and 
 nasal asthma, muco-membranous enteritis, urticaria, relapsing 
 edemas, periodic hydarthrosis, acute exacerbations in chronic rheu- 
 matism, paroxysms of gout, crises of grayness of the hair, crises 
 of anxiety, acute paroxysmal goiter. 
 
 I feel that I can add certain convulsive, tetanic, paralytic and 
 asthenic crises. 
 
 These crises, sudden, variable, relapsing, subject to disappear- 
 ance through the use of simple organotherapy (most often thy- 
 roidal, sometimes adrenal) or complex, are as a rule dominated 
 by the feminine sexual life. 
 
 According to Leopold Levi the endocrine disorder is the patho- 
 logical mordant which sensitizes centers already predisposed. In 
 
 ^3 Leopold Levi, Endocrinolepsies, leurs characters généraux, Soc. de 
 méd. de Paris, 9 janv., 1914, pp. 44-47. 
 
 ''* La crise hémoclassique initiale découverte par Widal et ses collabora- 
 teurs dans l'asthme. Rev. méd., juill., 1914, comme dans l'urticaire et 
 l'hémoglobinurie paroxystique, Sem. méd., 1913, n'élimine pas le facteur 
 nerveux réactionnel et ses connexions endocaines. 
 
28 THE INTERNAL SECRETIONS AND 
 
 thyroidal endocrinolepsies, he claims a hyperthyroidal paroxysm 
 which activates the nervous centers by a local vaso-motor blast. I 
 might state with equal reason that it is a general law of the nervous 
 system to respond in intermittent fashion to continuous stimulation. 
 
 Be that as it may I have continued to insist on the paroxysmal 
 character of sensory -motor syndromes, such as tetany, myasthenia, 
 migraine, which seem allied with endocrinal disturbances. 
 
 Secondarily I recall that the schema of Lundborg,''^ open to 
 discussion from certain viewpoints, has the merit of synthesizing 
 the physio-pathology of the thyroid and parathyroids and of show- 
 ing the rôle played by the parathyroids in the neuro-muscular regu- 
 lation. It is in this way that he connects tetany, paralysis agitans, 
 myoclonia (myoclonus, epilepsy), myotonia, with a parathyroid in- 
 sufficiency, and pseudo-paralytic myasthenia and periodic myatonia 
 with a hyper or dysfunction of the parathyroids. 
 
 Tetany is alone to-day no longer in doubt, as far as the other 
 afïections are concerned — it is nothing but an hypothesis as yet. 
 The most firmly established hypothesis appears in relation to Park- 
 inson's syndrome. In this instance as Roussy and Clunet^® state 
 the parathyroids may be found in a condition of hyperplasia. As 
 to the relation of this condition with the syndrome, it is ignored. It 
 is quite possible, according to Claude,''^ that it consists of a simple 
 reaction of defense in the organism. 
 
 B. Vegetative Syndromes 
 
 In this enumeration I will follow the plan of my Pathology of 
 the Sympathetic''® now being published. 
 
 (a) Tegumentary Syndromes 
 
 1. Local syncope of the extremities: thyroid, suprarenals, kidney. 
 
 2. Acrocyanosis: thyroid, thymus. 
 
 3. Erythromelalgia : ovaries, thyroid, suprarenals.^^ 
 
 4. Acroparesthesia: suprarenal. 
 
 5. Erythema: thyroid. 
 
 6. Urticaria: thyroid.®" 
 
 ^5 Lundborg, Deutsche Zeitschr. f. Nervenheilk., Bd. XXVII, 1904, p. 217. 
 
 ''^ Roussy et Clunet, Arch, de méd. exp., 1910, no. 3. 
 
 '''" H. Claude, Soc. de Neurol., fev., 1910. 
 
 [^ M. Laignel-Lavastine, Pathologie du Sympathique. Esquisse d'anatomo- 
 physio-pathologie clinique, i vol. in-8 de 600 p., Paris, Alcan, 1915? 
 
 ^9 Moleen, G., Journ. Amer. Med. Ass., 17 août, 1912. 
 
 ^^ Les modifications sanguines qui précèdent la crise d'urticaire, ses 
 rapports avec l'anaphylaxie, sa cause déterminante ramenée par Widal et ses 
 
THE NERVOUS SYSTEM 2g 
 
 7. Dermographia : thyroid. 
 
 8. Purpura : liver. 
 
 9. Pruritus: liver, kidney, thyroid. 
 
 10. Melanoderma: suprarenal, thyroid. 
 
 11. Vitiligo. 
 
 12. Hyperidrosis : ovaries. 
 
 13. Chromidrosis. 
 
 14. Seborrhea: thyroid(?), testicles( ?), ovaries(?). 
 
 15. Goose flesh: thyroid (?). 
 
 16. Premature grayness of the hair: thyroid. 
 
 17. Alopecia : thyroid.^^ 
 
 18. Hypertrichosis: thyroid, suprarenals, testicles, ovaries. 
 
 19. Zona and herpes. 
 
 20. Scleroderma: thyroid. 
 
 21. Raynaud's gangrene: thyroid(?). 
 
 22. Acute angioneurotic edema : thyroid. 
 
 23. Trophedema: thyroid (?), pituitary ( ?). 
 
 24. Adiposity: pituitary, thyroid, ovary, pineal. 
 
 (b) Osteo-articular Syiidrov.ics 
 26. Acromegalia : pituitary. 
 
 (c) Syndromes of the Neuraxis 
 
 29. Syndromes of the cervical sympathetic: thyroid (?), suprarenal. 
 
 31. Mydriasis: thyroid. 
 
 32. Myosis: suprarenal ( ?). 
 
 33. Glaucoma. 
 
 34. Glittering eye: thyroid. 
 
 35. Exophthalmos : thyroid. 
 
 36. Migraine: thyroid, ovaries. 
 
 37. Cephalic vaso-dilatation : ovaries (?). 
 
 38. Epilepsy: thyroid, ovaries. 
 
 39. Vertigoes: suprarenals, ovaries, thyroid. 
 
 40. Euphoria : thyroid. 
 
 41. Melancholia: thyroid, suprarenals, ovaries. 
 
 42. Anxiety: thyroid, ovaries. 
 
 élèves (Widal, Abrami et Et. Brissaud: L'auto-anaphylaxie, Sem. méd., 24 
 dec, ÎQ13), à un conflit entre colloïdes, n'excluent pas l'importance de la 
 thyroïde dans les prédispositions réactionnelles et les manifestions ncuro- 
 cutantes. 
 
 " Sabourand, Ann. de dermatol., mars, 1913. 
 
30 THE INTERNAL SECRETIONS AND 
 
 (d) Circulatory Syndromes 
 
 43. Vascular spasms : suprarenals. 
 
 44. Increased arterial tension : suprarenals, pituitary. 
 
 45. Vaso-dilatations : thyroid, ovaries. 
 
 46. Arterial hypotension : suprarenals, pituitary. 
 
 47. Palpitations : ovaries, testicles, thyroid. 
 
 48. Tachycardia :®2 thyroid, ovaries. 
 
 49. Bradycardia: pituitary ( ?). 
 
 50. Arrhythmia. 
 
 51. Cardiac neuralgias. 
 
 52. Syncope: thymus, suprarenals. 
 
 (e) Respiratory Syndromes 
 
 54. Asthma: thyroid. 
 
 56. Acute edema of the lungs: suprarenals. 
 
 57. Rhinorrhea. 
 
 (/) Digestive Syndromes 
 
 58. Hypersalivation. 
 
 60. Gastric crises. 
 
 61. Enteralgic crises; thyroid. 
 
 65. Digestive atony. 
 
 66. Digestive spasms. 
 
 71. Diarrhea. 
 
 72. Glycosuria: thyroid, suprarenals, pancreas, liver, pituitary. 
 78. Constipation : thyroid, pituitary. 
 
 80. Muco-membranous entero-colitis : thyroid. 
 
 (g) Urinary Syndromes 
 
 84. Polyuria: pituitary ( ?). 
 
 85. Albuminuria. 
 
 89. Too frequent urination : thyroid. 
 
 (h) Genital Syndromes 
 
 95. Impotency : prostate, testicles. 
 
 96. Priapism: suprarenals. 
 98. Ovarian crises. 
 
 ICI. Frigidity. 
 
 104. Menstrual troubles : thyroid, ovaries. 
 
 _^2 La théorie endocrine de la tachycardie paroxystique a été exposée par 
 Savini (Arch, des mal. du coeur, nov.-dec, 1912). J'en ai confirmé l'au 
 dernier l'exactitude chez une femme à la ménopause qui quérit par opothérapie 
 ovarienne. 
 
THE NERVOUS SYSTEM jj 
 
 (i) Endrocrine Syndromes 
 
 105. Basedow's syndrome: thyroid, thymus. 
 
 106. Addison's syndrome: suprarenals. 
 
 107. Poly endocrine sympathetic syndromes. 
 
 (;') General Trophic Syndromes 
 
 108. Hyperthermia : thyroid. 
 
 109. Hypothermia: thyroid. 
 
 111. Diabetes mellitus: pancreas, suprarenals. 
 
 112. Emaciation: ovaries, testicles, thyroid. 
 
 113. Obesity: thyroid, pituitary, pineal, ovaries, testicles. 
 
 114. Herpetism: thyroid. 
 
 All these vegetative nervous syndromes are the functional results 
 of very different causes. Such glands as I have marked opposite to 
 them simply indicate that in certain cases the endocrine disorders, 
 which have been noted in coincidence with the nervous disorders, 
 have played a rôle in the determination of these nervous syndromes, 
 or that inversely the endocrine disorders are secondary to the 
 nervous commotions. 
 
 In fact it is often very difficult clinically to keep from confusing 
 the angio-tropho-neuroses and their endocrinal consequences with 
 the endocrinopathies and their vegetative nervous consequences. 
 
 Quite often the symptomatic intricacy and the paucity of chrono- 
 logical and established data are such that one is forced to have re- 
 course to a synthetic expression, such as sympathosis,^^ which I 
 have proposed, and which simply indicates a vegetative nervous 
 syndrome. Among the univocal sympathoses, the sensory, circula- 
 tory, lisso-motor, secretory and trophic sympathoses constitute the 
 framework for the preceding facts. I must call attention to the 
 considerable rôle that these vegetative nervous syndromes play in 
 dermatology in their vaso-motor, secretory and trophic types and in 
 psychiatry in their cenesthetic and vaso-motor types. 
 
 It is here that one grasps the closeness of the connections be- 
 tween the internal secretions and the vegetative nervous system, 
 and one understands thereafter the interest of the study of the 
 sympathetic and the vascular glands in domains like dermatology 
 and psychiatry,^'' where taken clinically they still conform partly to 
 a botanical classification. 
 
 83 Laignel-Lavastine, Les sympathoses, Presse méd., sept. 20, 1913. 
 ♦ Laignel-Lavastine, Le sympathique et les viscères dans les affections 
 mentales, Traite mternat. de Psychol.-pathol. Dans ce travail je montrais 
 1 importance de ce que Munzer nomme très hereusement " la decentralization 
 de la psychiatrie. 
 
32 
 
 THE INTERNAL SECRETIONS AND 
 
 Just as I have laid stress elsewhere^' on the rôle of the sym- 
 pathetic in that which I have called the pathology of the border 
 made up of those humoral reactions or reflexes saddled on neurology, 
 dermatology, psychiatry, visceral medicine and the pathology of 
 metabolism, one can claim that there is a whole endocrino-vegeta- 
 tive chapter still to be written in dermatology, as in digestive, cir- 
 culatory, respiratory, urinary and mental pathology. 
 
 C. Pyschic Syndromes 
 
 My report^^ in 1908 at the Congress of Dijon on psychic dis- 
 orders due to disturbances of the glands of internal secretion, the 
 excellent report of Professor Parhon^^ at the Congress of Gand in 
 1913 on the glands of internal secretion in their relationship to 
 psychology and mental pathology and the recent article of M. Van 
 der Scheer®^ have outlined and brought out the question. 
 
 In order to avoid criticism I refer to their works and enumerate 
 the results which are the least doubtful. 
 
 (a) Syndromes of Cerebral Debility 
 
 1. Anencephalia : suprarenals. 
 
 2. Idiocy and cranial malformations:^^ thyroid, parathyroids, 
 
 suprarenals.®" 
 
 3. Imbecility. 
 
 4. Backwardness:®^ thyroid, pituitary, ovaries, testicles, thymus. 
 
 5. Mental debility. 
 
 6. Psychic imbalance.®^ 
 
 (b) Syndromes of Delirium 
 
 7. Mania :®^ thyroid, suprarenals, ovaries. 
 
 8. Melancholia: thyroid, ovaries, liver, suprarenals, kidneys, pitui- 
 
 tary. 
 
 ^'' Laignel-Lavastine, Définition du sympathique, Gaz de Hop., 1912. 
 
 88 Laignel-Lavastine, Congrès des aliénistes et neurologistes, Dijon, 1908. 
 
 ^'^ C. I. Parhon, III* Congrès internat, de Neurol, et de Psychiatrie, 
 Gand, 1913. 
 
 S8 W. M. Van der Scheer (de Meerenberg), Die pathogenetische, Stellung 
 der Blutdrusen in der Psychiatrie, Jahresversammlung der Nederlansche 
 Vereeniging voor Psychiatrie en Neurol., 3 juill., 191 3. 
 
 8^ Bertolotti, Presse méd., 2 mai, 1914, p. 334. 
 
 ^° Guilorowsky, Influence d'hypoplasie surr. sur ce cas d'idiotie, Congr. 
 assist, des aliénés, Moscow, janv., 1914, Arch, de Neurol., mars, 1914, p. 163. 
 
 31 Hastings-Gilford, Influence des glands a secret, int. sur le developp., 
 Congr. internat, de Londres, 1913, sect, de Psychiatrie, rapp. 
 
 32 Cot. Ch. et Dupin, Insuff. glandul. et anormaux, Enceph., mars, 1913, 
 pp. 223-34. 
 
 "3 Lafora, G. R., Folie manique depressive et hyperthyroidisme, Revista 
 clin, de Madrid, 15 oct., 1913, pp. 294-301. 
 
THE NERVOUS SYSTEM 33 
 
 9. Mental confusions: liver, kidneys, thyroid, parathyroids, pan- 
 creas, pituitary, suprarenals, ovaries, testicles. 
 ID. Systematized hallucinatory deliria. 
 
 11. Systematized deliria without hallucinations. 
 
 12. Genital perversions: ovaries, testicles, prostate, suprarenals. 
 
 (c) Syndromes of Dementia 
 
 13. General paralysis: suprarenals, thyroid, pituitary, etc. 
 
 14. Dementia prsecox:®* testicles, ovaries, pituitary. 
 
 15. Cerebro-arteriosclerosis : suprarenals, testicles. 
 
 16. Senile dementia: parathyroids, thyroid, testicles, ovaries. 
 
 17. Epileptic dementia. 
 
 {d) N euro-psychic Syndromes 
 
 18. Epilepsy: thyroid, parathyroids, testicles, ovaries. 
 
 19. Nervosism : thyroid. 
 
 20. Hysteria: thyroid, ovaries. 
 
 21. Neurasthenia: suprarenals, testicles, ovaries. 
 
 22. Psychasthenia : thyroid, ovaries, testicles, suprarenals. 
 
 This analysis of endocrine disorders investigated, discovered or 
 supposed, in the psychic syndromes allows in the first place the 
 conclusion that just as psychic symptoms are met with frequently 
 in endocrine syndromes, so are endocrine disturbances indicated 
 very often in the psychic syndromes. Moreover one should state 
 that the value of the indicated endocrine disorders is very uncer- 
 tain, and the confirmation of a clinical endocrine sign or glandular 
 test is vastly more important than an organotherapeutic result and 
 above all more important than the existence of endocrine lesions, 
 because we know the utter banality of all these. 
 
 The frequency of pathological endocrino-psychic associations 
 are not explicable alone by fortuitous coincidences and more or less 
 mediate attachments. It seems to me necessary to admit, in cer- 
 tain cases at least, a relationship of casuality. This conclusion 
 which I advanced in 1908 has been confirmed by numerous authors, 
 and recently by M. Parhon in 1913. This relationship of casuality 
 varies moreover according to the case. Eliminating fortuitous 
 coincidence I will sum up in a few lines my ideas on the more or 
 less mediate bonds between endocrine and psychic disorders, on the 
 causal rôle played by the psychic syndromes in endocrine disorders 
 
 •* Dercum et Ellis, J. of Nerv. and Mental Disease, fev., 1913, pp. 73-90. 
 
34 THE INTERNAL SECRETIONS AND 
 
 and on the causal rôle played by the endocrine disorders in the 
 psychic syndromes. 
 
 I. Relationships of Connection between Endocrine and 
 Psychic Disorders 
 
 In this heterogeneous group I place the cases in which the fre- 
 quency of association between endocrine and psychic disorders 
 makes one think that it consists of something more than a coin- 
 cidence, and in which nevertheless one can not demonstrate a clear 
 relationship of casuality. 
 
 Thus psychic excitations give rise to fits of rage or anxiety. In 
 a similar way to psychic changes, modifications of endocrine secre- 
 tion, thyroidal for example, appear to me to be among the factors 
 that make up that physio-psychic complex called emotion. Some 
 think that the psychic factor is causal, others like Redmond and 
 Sauvage®' think that "the phenomenon of emotion is the result of 
 auto-intoxication, due to a sharp destruction of endocrine equilib- 
 rium." I consider that the mechanism is a triple one : at times the 
 psychic act releases the secretory act, at others the endocrine act 
 releases the psychic act, and at still others the endocrine and psychic 
 action are both the coresults of the same cause. It consists of a 
 proximate adherence. 
 
 Take for another example a given case of juvenile general 
 paralysis with infantilism. The meningo-encephalitis like the 
 atrophic thyroidal sclerosis, being the results of hereditary syphilis, 
 are both coeffects of the same cause. The two syndromes, psychic 
 and endocrinal, are therefore bonded by a relationship of mediate 
 adherence. 
 
 2. Causal Rôle of the Psychic Syndromes on the Endocrinal 
 
 Disturbances 
 
 In the normal state one can not deny that psychic excitations 
 determine disorders of secretion. The experiences of Dumas and 
 Malloizel and the results of Cannon, where emotion has increased 
 the quantity of adrenalin in the blood, like the classic case of 
 Trousseau of exophthalmic goiter caused by a fit of rage, are in- 
 stances of the kind. 
 
 In the pathological state the results are the same : motor agita- 
 tion caused by delirium may bring about almost complete aspongio- 
 cytosis of the suprarenals, as I have had occasion to observe in the 
 insane. It is therefore plain to me that the psychic factor may 
 
 *' Redmond and Sauvage, Soc. de psychiatrie, lo f ev., 1913. 
 
THE NERVOUS SYSTEM 35 
 
 bring about the endocrinal result. INIoreover the psychogenic 
 mechanism of endocrinal disorders is not uniform, and if in cer- 
 tain cases it is directly psycho-secretory, it is much more frequently 
 indirectly psycho-physio-secretory, the intermediary perhaps being 
 the physico-chemical modifications of divers viscera of life of rela- 
 tionship or of nutrition. 
 
 3. Causal Rôle of Endocrinal Disorders on the Psychic 
 
 Syndromes 
 
 This rôle, by far the most important, is not always uniform. 
 One can diflferentiate three large divisions as I have already shown 
 in 1908. 
 
 1. Sometimes the endocrinal disorder arising in utero, in in- 
 fancy or adolescence reacts on the development of the organism 
 and the brain: the psychic disorders result from anomalies of 
 structure. 
 
 2. At others the endocrine disorder, compatible with existence 
 and a relative functionating of the organism, brings about in organic 
 as well as psychic life more or less reciprocal modifications of 
 various modalities. 
 
 3. At still others the endocrine disorder no longer moderate but 
 massive produces, along with grave disorders of the organism, in- 
 tense cerebral reactions, which reveal themselves always in the 
 same way by classical toxic psychoses of the mental confusion type. 
 
 These three divisions seem to me to explain the facts of the 
 third group with sufficient connection. 
 
 1. The first is the most simple. It remains essentially in the 
 domain of ontogenesis and morphology. The mental puerility of 
 infantilism is an example. 
 
 2. The second is on the humoral order. The internal organs 
 being specifically modified by the elective disturbance of one or 
 many of the selected internal secretions, the anatomical elements 
 which they bathe are by such modified in their vitality. There 
 result accordingly pathological changes along with somatic, anatomic 
 and functional alterations. The former like the latter, reflexes of 
 a like humoral disorder, present a debased series of a frank pathol- 
 ogy or normal model. 
 
 With greater precision, one can differentiate with Parhon three 
 varieties in the humoral action of the endocrine glands on the 
 psyche. 
 
 In the first place these glands directly influence the nervous 
 
36 THE INTERNAL SECRETIONS AND 
 
 system itself, and one can distinguish, with Munzer, sympathico- 
 tonic, vagotonic (or better autonomotonic) and poly tonic glands, 
 these last being able to affect, for example, the cerebral cortex, 
 the autonomic system and the sympathetic. The tonicity of one 
 or many cortical centers being influenced, their psychic function 
 will thus remain the same. However, this psychic function will 
 respond equally to changes in the cerebral circulation, the state of 
 the respiration, the oxidation of the body, and the chemical com- 
 position of the blood — for example the richness or poverty in cal- 
 cium salts, etc. Now one or the other of these influences, if not all, 
 are affected by the sympathicotonic or autonomotonic action of the 
 endocrine glands. 
 
 Side by side with this action, more or less directly central, 
 Parhon claims a peripheral action " which moreover may be itself 
 partly the consequence of a central action " ; it is the action of the 
 endocrine glands on the sense of conscious existence. 
 
 He adds that " the action of the genital glands must acknowledge 
 partly at least a similar mechanism." Finally the endocrine glands, 
 by their action on the general metabolism, bring about modifica- 
 tions of different tissues, which affect the psyche through humoral, 
 nervous reflex or psycho-cenesthetic means. 
 
 3. " Finally, I claimed, the third mode of action, the massive, of 
 the endocrine disorders on the mental life, which is characterized 
 by toxic psychoses, is often very complex in the sense that the 
 cerebral intoxication is not only the result of the disturbance of 
 the incriminated gland, caused by the concomitant syndrome, but 
 the result of a series of associated or secondary functional in- 
 sufficiencies. It is thus that in cases of Addison's disease with 
 delirium the discovery of azotemia by Sicard and Haguenau^" 
 might give rise to the hypothesis that renal insufficiency may have 
 been added to the suprarenal insufficiency in the mechanism of 
 delirium, but the statement must be made that the determination 
 of azotemia has no interest unless such is not terminal, because of 
 its known frequency immediately before death.^^ 
 
 In a word the endocrine disorders in nervous syndromes, 
 whether they have been established by clinical or anatomical methods 
 or induced by physiological or therapeutic proofs, are face to face 
 with the nervous syndromes. 
 
 1. It may be a relationship of simple fortuitous coincidence. 
 
 2. It may be a relationship of more or less mediate adherence. 
 
 88 Sicard et Haguenau, Soc. méd des Hop., 15 mai, 1914, p. 902. 
 »7D. Dumitresco et A. Popesco, Presse méd., 27 juin, 1914, p. 487. 
 
THE NERVOUS SYSTEM 
 
 37 
 
 3. It may be a relationship of causality: at times the nervous 
 disorder has determined the endocrine disturbance, at others and 
 inversely it is an endocrine disturbance which has determined the 
 nervous syndrome, but the frequent clinical latency of the former 
 may interfere with the comprehension of the cause of the latter. 
 
 It is necessary to remember that to a patent nervous disorder 
 there is frequently attached a latent endocrine cause. One should 
 therefore look for an endocrine cause in any nervous syndrome of 
 an unknown or obscure origin. But one must not be determined 
 to find such in spite of everything, and to accept contingencies for 
 necessities. 
 
 In conclusion, all the facts gone over in this critical review are 
 explained aside from coincidence and coefifects of the same cause, 
 at times by a direct or indirect endocrino-nervous relationship 
 through a morphological intermediary (evolutional or humoral) 
 or a physiological intermediary (humoral or nervous) or a psychic 
 intermediary, at others by a direct or indirect neuro-endocrinal 
 relationship through a direct morpho-evolutional, physiologic reflex 
 or psychic intermediary or through the same indirectly (motor ac- 
 tivity, general nutrition), and at still others by recurring endocrino- 
 neuro-endocrinal relationships and neuro-endocrino-psychic rela- 
 tionships. 
 
 This is explained in the following table. 
 
 Coincidence. 
 
 Connection. 
 
 Causality. 
 
 Endocrino-nervous Relationships 
 fProximate. 
 
 LMediate. 
 
 I. Simple. . . - 
 
 2. Double 
 
 ...{ 
 
 Endocrino-nervous. 
 (i) Direct. 
 
 (2) Indirect through _ 
 intermediaries. 
 
 Neuro-endocrinal. 
 (i) Direct. 
 
 Morphologic evolutional. 
 Morphologic humoral. 
 Physiologic humoral. 
 Physiologic nervous. 
 Psychological. 
 
 (2) Indirect through 
 intermediaries. 
 
 Morphologic evolutional. 
 Physiologic reflex. 
 Psychologic. 
 Motor activity. 
 General nutrition. 
 
 Endocrino-neuro-endocrinal. 
 Neuro-endocrino-nervous. 
 
38 THE INTERNAL SECRETIONS AND 
 
 B. Endocrino-Neurological Sketch 
 
 In practice, that which matters is less the neurogenous endo- 
 crine disorders than the endocrinogenous nervous disorders. 
 
 Of course the endocrine disorders secondary to the nervous 
 disorders are very interesting theoretically and practically. Theo- 
 retically they show the unity of human personality and not only 
 the influence of nervous disorders on the secretions and nutrition, 
 but in addition, to use an old expression which illustrates the pic- 
 ture, the mastery of the soul over the body. 
 
 Practically their interest is twofold, because attenuated and 
 masked by the nervous syndrome, they may nevertheless modify 
 and complicate it, as can be seen in certain tabetics and general 
 paralytics. Inversely when very marked they may mask more or 
 less through their symptomatic richness the clinical expression of 
 the nervous disorders which cause them, and thus effect a change 
 with an endocrine syndrome which is clinically primitive. This is 
 the case in certain Addisonian and Basedovian syndromes, which 
 are not originally endocrinogenous but neurogenous. 
 
 Endocrinogenous nervous disorders, which are infinitely more 
 frequent than neurogenous endocrinal syndromes, form altogether 
 an extremely important group, which, unburdened with morphologic 
 and endocrinogenous trophic syndromes in which a nervous factor 
 is not constant, constitute the greater part of functional neurology. 
 
 I intend in this sketch, as a practitioner, to limit myself almost 
 entirely to that which functional neurology owes to endocrinology. 
 
 I will take my illustrations from certain ordinary symptoms, 
 endocrino-vegetative syndromes, traditional psychoneuroses, temper- 
 aments and characters. 
 
 I. Ordinary Symptoms 
 
 Among the ordinary symptoms I retain arbitrarily asthenia, 
 headache, insomnia, anxiety, sweats, constipation, arterial hyperten- 
 sion and obesity in order to show that there are for each of these 
 symptoms certain cases which arise from an endocrinal cause, and 
 that daily one should give an endocrine factor consideration in 
 pathogenic diagnosis. It should be considered but not determined 
 upon except on the authentication of well-marked signs, that is to 
 say, clean cut and frank. Moreover most frequently such con- 
 sideration ends in elimination. 
 
THE NERVOUS SYSTEM 39 
 
 (i) Asthenia 
 
 Asthenia is abnormal fatigue. It is either general or more espe- 
 cially motor or psychic. 
 
 Motor asthenia is an extremely commonplace symptom, due to 
 various causes, either infectious, toxic or psychic. 
 
 Among the motor asthenias of endocrinal origin, the first to be 
 recognized was the asthenia of Addison's disease. It is connected 
 with adrenal insufficiency, and is accompanied by arterial hypo- 
 tension. 
 
 In addition there are motor asthenias allied with adrenal insuffi- 
 ciency, which are not Addisonian. This fact is well known to-day. 
 They are very common and are usually but not always accompanied 
 by arterial hypotension. 
 
 Their recognition and consequently their organotherapeutic treat- 
 ment will permit the cure of a large number of sick, ticketed as neur- 
 asthenics, cyclothymics, melancholies and even hypochondriacs. 
 Certain cases of arteriosclerosis with hypotension enter into this 
 category. The interesting point is that they were often asthenics 
 already at the beginning of their arteriosclerosis, while they still 
 had hypertension. This asthenia of hypertensive arteriosclerotics 
 existing from the beginning is well understood to-day. Maurice de 
 Fleury among the first has shown its frequency. In such cases there 
 is often a dyshyper functionating of the suprarenals. This asthenia 
 of hypertension through dyshyperfunction may be recovered from 
 completely through a simple regime. It can after a period of years 
 border on asthenia due to adrenal insufficiency, an insufficiency itself 
 secondary to the old glandular hyperf unction and without mechanical 
 participation of cardiac insufficiency ; I have followed a lot of such 
 cases in the last ten years. 
 
 The majority of endocrinogenous muscular asthenias are supra- 
 renal, but there are others which are thyroidal, thymic, parathyroidal, 
 pituitary, ovarian, testicular and polyglandular. 
 
 Dejerine and Gauckler^» have brought the weight of their au- 
 thority to the support of these data. 
 
 The endocrinal origin of a muscular asthenia having been recog- 
 nized, diagnosis is not complete. The cause must be determined. 
 In the simple cases it is sometimes an infection (a beginning tuber- 
 culosis, convalescence from grip or diphtheria, etc.), at others an in- 
 toxication. In the more complicated cases it is a vascular, nervous 
 or psychic disturbance, under the subjection itself of a previous endo- 
 
 »« Dejerine et Gauckler, Les asthénies périodiques crises de fatigue. Presse 
 méd., 17 juin, 1914, PP- 457-459- 
 
40 THE INTERNAL SECRETIONS AND 
 
 crinal disorder. It is often like this in the hypophysics of Martinet/^ 
 a typical case of which I have actually seen, which merits publica- 
 tion by itself. 
 
 An important fact is that the asthenia may be not the result but 
 the cause of an endocrinal insufficiency. Claude^"'' believes this to 
 be the case in the paralytic myasthenia of Erb-Goldflam. According 
 to him the endocrine glands are normal or rather increased in size, 
 but they are exhausted by an effort truly excessive. This is brought 
 about by the entrance into the circulation of poisons to the nerve and 
 muscle cells of inconstant origin, but which, in certain cases, arise 
 from a disordered thymus. In the Erb-Goldflam syndrome the mul- 
 tiple insufficiency of the endocrine glands by functional exhaustion 
 is therefore secondary, just as the disappearance of spongiocytes in 
 the suprarenal cortex is secondary to an intense or prolonged mus- 
 cular agitation. I have had occasion to confirm in eight cases this 
 fact grasped experimentally by Mulon"^ and clinically by Porak.^"^ 
 
 (2) Headache 
 
 Not only migraine,^"^ but the most ordinary headache may be of 
 endocrinal origin. Many of the headaches called neurasthenic come 
 under this heading. The most frequent of the endocrinogenous 
 headaches are those of thyroidaP°* origin. As a general thing slight 
 concomitant signs of hypothyroidism, such as palpebral edemas, 
 anorexia, constipation, somnolence, chilliness, muscular and articular 
 pains assist the diagnosis ; but sometimes the thyroidal disorder does 
 not reveal itself except by the headache, which of itself and through 
 causal elimination should possess an indicative value. These head- 
 aches are very frequent among women; are more or less governed 
 by genital life, improved by sexual relations^"^ and cured by preg- 
 nancy. I have gathered typical cases of the kind in my practice. 
 
 ^^ Martinet, Syndrome hyposphyxique, Pr. méd., 21 dec, 1912. S. 
 hyposphyxie et insuff. plurigland., Ac. de méd., 22 avril, 1913, et Pr. méd., 2 
 août, 1913. 
 
 i°<* H. Claude, La myasthénie paralytique et les syndromes asthéniques 
 par insuffisance surrénal, Acad. de méd., 9 juin, 1914, et Soc. de Neurol., 28 
 mai, 1914. R. N., 15 juin, p. 786. 
 
 101 Mulon, P., Soc de biol., 26 juill., 1913, p. 189. 
 
 i°2 Porak, Mém. inéd. 
 
 103 Leopold Levi et H. de Rothschild, Acad. de méd., 14 nov., 1911, p. 22; 
 Répertoire de méd. int., mars, 1912; Goett, La migraine thyroïdienne. Th. 
 Bordeaux, 1909. Flatau, La migraine, Berlin, 1912; A Véron, id.. Th. Lyon, 
 1914. 
 
 ^°* Gaujoux, Céphalée hypothyroïdienne et opothérapie, Soc. des Se. méd. 
 de Montpellier, 14 mars, 1913; Bilancioni, G., Il Policlinico, sez. pratica, 23 
 mars, 1913, pp. 401-6. 
 
 105 Migraines de jeunes filles guéries par le mariage, migraines de jeunes 
 femmes absentes le lendemain de l'accomplissement des devoirs conjugaux. 
 
THE NERVOUS SYSTEM 4I 
 
 After the thyroidal types, the ovarian, testicular, pituitary, supra- 
 renal and polyendocrinal headaches are to be noted. 
 
 (3) Insomnia^°^ 
 
 Among the insomnias those of Basedow's syndrome and the 
 menopause, which come under the heading of dyshyperthyroidism, 
 show the existence of endocrinogenous insomnias. 
 
 The most frequent of these is the dyshyperthyroidal, seen clearly 
 in the cases that I have just cited. It is probably present in many 
 of the psychoses, where one knows that thyroidal excitation is fre- 
 quent. It is to be suspected at least in the " nervous " where no other 
 appreciable cause justifies its presence. 
 
 The insomnia of acquired ovarian insufficiency seems to contra- 
 dict this precedent. 
 
 Perhaps it conforms to the same lines as the insomnia of certain 
 cases of hypertension of the fifties, where the genital functions are 
 lessened. 
 
 (4) Anxiety 
 
 The anxiety of Basedovians and of many women at the meno- 
 pause and its cure by hematothyroidin, confirmed many times by 
 Alquier, Rose, myself and many others, show the existence of endo- 
 crinogenous anxiety due to dyshyperthyroidism. This anxiety seems 
 really to be that of the anxious melancholias. It is already known 
 that the works of Parhon tend to show the rôle played by the thyroid 
 in what he calls the affective psychoses.^"'' 
 
 The anxiety frequently noted in acquired ovarian insufficiency 
 seems to be controlled by the same mechanism. 
 
 Clinically considered, all anxiety that does not possess warrant 
 should make one suspicious of an abnormal excitation of the thyroid. 
 
 (5) Sweats 
 
 A vagotonic reaction, released by pilocarpine, arrested by atro- 
 pine, the sweats which come on in crises at the menopause, are asso- 
 ciated in the hot flushes with active vaso-dilatation, but may be pres- 
 ent alone. Symptomatic in this instance altogether of acquired 
 ovarian insufficiency and of thyroidal reaction, they are seen in the 
 two conditions. We are all familiar with the frequent sweats of 
 Basedovians. 
 
 ^0" A. Salmon, La fonct. du sommeil, Vigot, iQio. 
 
 "^^ Cette voie permettra peut être de trouver des raisons aux intermit- 
 tences de toutes des syndromes d'excitation et de dépression, maniaques et 
 mclancholiques. 
 
42 
 
 THE INTERNAL SECRETIONS AND 
 
 According to this there are endocrinogenous sweats due to 
 dyshyperthyroidism. This vagotonic expression referable to thy- 
 roidal excitation is associated very often with sympathicotonic mani- 
 festations of a similar origin. It is thus in the classical hot flushes 
 of the menopause. 
 
 (6) Constipation 
 
 Spastic constipation, "vagotonic," which yields to belladonna, is 
 a nervous symptom. 
 
 Its recognition in cases of hyperchlorhydria, in certain neu- 
 rasthenics, in women at the menopause or at the beginning of preg- 
 nancy, permits of cures as easy and complete as they are brilliant, 
 through the use of the well-known belladonna pillule of Trousseau 
 and Pidoux. 
 
 Then again it is frequently caused (by ovarian or testicular in- 
 sufficiency with abnormal excitation of the thyroid, as seen in the 
 observations of Maranon.^"^ 
 
 This constipation must be carefully distinguished from the con- 
 stipation of myxedema, from the general type of constipation, such 
 a common sign of hypothyroidism, and which is cured by organo- 
 therapy. 
 
 Thus the same symptom in its gross clinical expression may be 
 of thyroidal origin, and point nevertheless to two different mechan- 
 isms, excitation or insufficiency of thyroidal secretion. This instance 
 of thyroidal constipations is not the only example o^ endocrinogenous 
 constipations that can be given. There appears to be one also of 
 pituitary origin, although the cure of certain atonic constipations by 
 the extracts of the posterior lobe of the pituitary does not demon- 
 strate the nature of this, inasmuch as these extracts act as excitants 
 of unstriped muscle tissue by virtue of their pharmaco-dynamic 
 properties, and not on account of their elective vicarious or stimu- 
 lating^"^ action on the pituitary. 
 
 (7) Arterial Hypertension 
 
 To Vasquez belongs the credit for having described in man " ar- 
 terial hypertension due to hypersecretion of the suprarenals," which 
 Josué confirmed by experiments. In advance of this permanent 
 hypertension, hyperadrenal secretion may show itself through hyper- 
 tensive crises, which have been classical since the time of Pal. More- 
 over, there are other hypertensive crises besides the endocrinogenous, 
 
 los Maranon, G., Hyperchlorhydrie et hyperthyroidism, Revue de méd., 
 10 mars, 1914, pp. 161-83. 
 109 Hallion, loc. cit. 
 
THE NERVOUS SYSTEM 
 
 43 
 
 and among the latter others besides those due to hyperadrenal secre- 
 tion. Those which are alHed with disturbances of the pituitary, 
 ovary, testicles, prostate, thyroid and parathyroids, have been recog- 
 nized. In like manner there are permanent arterial hypertensions 
 which are not endocrinogenous, and among the latter some which 
 are not of suprarenal origin. 
 
 There is no need to continue. I have simply tried to show that 
 there are arterial hypertensions which are nervous endocrinal syn- 
 dromes, because they depend upon a vascular spasm, of endocrinal 
 origin. 
 
 (8) Obesity 
 
 The existence of endocrinogenic obesities is no longer a matter 
 of dispute. Mouriquand"" has described them well recently in 
 children. 
 
 I have reported several cases myself this last year.^^^ 
 The only point of interest is the demonstration of a nervous 
 factor in the determination of these endocrinogenic obesities. In 
 the majority of cases I do not think that this exists, but believe that 
 such obesities arise through humoral disturbance of endocrinal 
 origin. Nevertheless a nervous factor is present in the cases noted 
 where a cerebral tumor gives rise to obesity through pressure on 
 the pituitary. One might also suspect, if not prove, a nervous factor 
 in those cases of segmentary^^- or paraplegic disposition of adipose 
 tissue. I have with Viard reported a case of this type, which corre- 
 sponding to a trophedema of Henry Meige, studied previously with 
 M. Sicard,"^ caused me to view in their entirety "the variations of 
 the panniculus adiposis, according to the divers physiological condi- 
 tions — of infancy, puberty, pregnancy, lactation, castration, and of 
 the menopause — and to pathological conditions — of the simple or 
 associated endocrinal syndromes, thyroidal, pituitary, ovarian, tes- 
 ticular, suprarenal, and parathyroidal— pursuant to their relations 
 with the trophedema of Henry Meige, the adiposis dolorosa of Der- 
 cum, the intermédiate afïections between these two syndromes, to 
 
 '»" Mouriquand, Congres de Pédiatrie, Rapp., 1913. 
 
 "/ Laignel-Lavastine et L. Boudon. Obésité par sarcome juxta-hypo- 
 physaire. Soc. méd. des hop., 13 fev., 1914; Laignel-Lavastine et Pitulesco, 
 Obésité familaile avec perturbations endocrines, id. 
 
 "2 Sicard et Berkowitsch, Adipose doul. par insuff. ovarienne, Gaz. des 
 Hop., 1908, p. 848; Claude ct Sézary, Adip. doul aet remarquable de I'opoth. 
 rhyr.. Gaz. des Hop., 1Q13, No. 86, p. 69; Ivanoff, Mai de Dercum, R. russe 
 de Psychiatrie, mars, 1913; Wcbcr, Parks, Lipodystrophie progressive; R. 
 Hirschfeld, in Handbuch dcr Neuro. de Lewandowsky, Bd. IV, pp. 455-71. 
 
 "■' Sicard et Laignel-Lavastine, Un cas de trophoedcme acquis. Soc. de 
 Neurol., 15 janv., 1903, Nouv. Iconographie de la Salp., janv., 1903. 
 
44 THE INTERNAL SECRETIONS AND 
 
 certain states of hardening of the skin associated with various affec- 
 tions of the central nervous system, or of the sympathetic or of the 
 ductless glands, and the part which relates in their genesis to dis- 
 turbances of nutrition in general and the endocrine system and the 
 sympathetic in particular."^^* 
 
 2. Endocrine-sympathetic Syndromes 
 
 I will only retain from among the above-mentioned syndromes 
 exophthalmic goiter, Addison's syndrome, scleroderma and diabetes 
 mellitus by reason of their double interest, which is both doctrinal 
 and practical, and of the large number of studies that they have oc- 
 casioned, and are still causing every day. 
 
 (i) Basedow's Syndrome 
 
 I have nothing to say concerning the immense bibliography of 
 exophthalmic goiter, for which I refer you to Biedl's work on the 
 subject and the recent report of Roussy at the Congress of Luxem- 
 bourg (August, 1914). I will simply state that instead of taking 
 sides for the thyroidal theory whose last favorable pleading v/as 
 sustained with excellent arguments by Roussy and Clunet,^^^ or for 
 the sympathetic theory defended by Gley and Cleret,^^^ with the aid 
 of arguments drawn from experimental and anatomo-clinical facts, 
 one^^^ of which is personal to myself, I prefer to say that it is the 
 same with Basedow's syndrome as with all the endocrino-sympathetic 
 syndromes, that they are all the expressions of a disturbance of 
 function, and that this function is disordered as well by a glandular 
 lesion as by a disturbance of its nervous regulating mechanism. 
 
 From a physiological viewpoint I reiterate, therefore, the unity 
 of the Basedovian syndrome in its divers clinical modalities.^^® 
 
 The cases due to thyroidal lesions are certain. I argue no more. 
 The cases due to nervous disorders appear no less often. 
 
 Curschmann^^^ has seen in a woman tabetic an intermittent Base- 
 
 ^^* Laignel-Lavastine et Viard, Adipose segmentaire des membres in- 
 férieure, Soc. de Neurol., 11 juill., 1912; Nouv. Iconographie de la Salpétrière, 
 1912, No. 6. 
 
 115 G. Roussy et J. Clunet, Les les du Corps thyroide dans la mal de 
 Basedow, Annales de med., t. i, No. 4, avril, 1914, pp. 395-438. 
 
 11^ E. Gley et Cleret, Recherches sur la pathogenic du goitre exoph- 
 thalmique, J. de Physiol, et de Pathol, gen., 191 1, p. 928, et Cleret, These, 
 1912. 
 
 ii'^ Laignel-Lavastine et Bloch, Syndrome de Basedow chez une tuber- 
 culeuse. Arch. gen. de med., sept, 1904, pp. 2456-61. 
 
 lis L'épreuve de l'hypophyse (ralentissement du pouls chez les Base- 
 dowiens, découverte par Claude et ses élevés (Soc. de med, des hop., 19 juin, 
 1914) permet de limiter, dans le même esprit, le syndrome de Basedow. 
 
 11® Curschmann, Sur des symptômes basedowiens intermittents (dans les 
 tabes et l'asthme bronchique). Zeitschrift f. klinische medizin, 1912, LXXVI, 
 3-4. 
 
THE NERVOUS SYSTEM 
 
 45 
 
 dovian syndrome coincident with gastric crises. He saw in this a 
 sympathicotonic sign, and he was not far from siding with the opin- 
 ion of Morat and Abadie, who saw in the lesion of the thoracic 
 sympathetic the starting point of the Basedovian syndrome. 
 
 The beneficial influence exercised by adrenalin on the crises is 
 to be noted. 
 
 This fact is contrary to the theory of Gottlieb-O'Connor, ac- 
 cording to which the thyroidal secretion sensitizes the terminal 
 organs of the sympathetic. 
 
 It is explained on the other hand by the researches of Elliot and 
 Durham, who established the fact that after an injection of ad- 
 renalin excitation of the splanchnic nerve caused a lowering of the 
 blood pressure instead of the normal elevation, and this exists also 
 in gastric crises. 
 
 Being more synthetic than analytic, looking at things physio- 
 logically and not anatomically or etiologically, I conclude that the 
 Basedovian syndrome in its fundamental mechanism is an endocrino- 
 sympathetic syndrome, whose divers clinical types arise from various 
 lesions, at times endocrinal (always thyroidal, sometimes thymic, 
 ovarian, parathyroidal, etc.), at others nervous (cervical or bulbar 
 sympathetic) under the dominance of intoxications or infections 
 acute or chronic, either general or local, of which the most frequent 
 are acute articular rheumatism and tuberculosis. 
 
 (2) Addison's Syndrome 
 
 Thus from a case of Addison's syndrome without appreciable 
 gross lesions of the suprarenals (1899) I wrote my thesis^^** in an 
 endeavor to demonstrate that there were Addisonians in whom noth- 
 ing was to be seen except lesions of the sympathetic, in whom the 
 suprarenal disturbances were secondary to nervous changes, and who 
 showed all the intermediary signs of the melanodermic^^^ tuberculosis. 
 To the anatomical theory of the Addisonian discoloration I put in 
 opposition a more comprehensive physiological theory and to the 
 lesional contingency the functional necessity. 
 
 The recent observation of N. Pende and Varvaro^-- came to the 
 support of this point of view. They have seen in a man of thirty- 
 six years of age an Addisonian syndrome secondary to a rapid pul- 
 monary tuberculosis. At autopsy the suprarenals were normal in 
 their make-up. In the cortex the spongiocytes were rare, and pig- 
 ment was almost completely lacking in the reticular zone. 
 
 '20 Laignel-Lavastine, Recherches sur le plexus solaire, Thèse, 1903. 
 p. 420. 
 
 121 Laignel-Lavastine, La mélanodermie des tuberculeux, Soc. méd. des 
 hôp., 29 janv., 1904, et Arch. gén. de méd., oct., 1904, pp. 2497-2520. 
 
46 THE INTERNAL SECRETIONS AND 
 
 At the level of the solar plexus there were two aberrant supra- 
 renals of normal structure. The ganglia of the solar plexus were 
 free from tuberculous lesions, but they were of notable size, and ex- 
 amined histologically they appeared poor in sympathetic nerve cells 
 and rich in new-formed connective tissue. The nervous elements 
 still seen presented pigmentary atrophy. 
 
 To-day one differentiates the primitive Addisonian syndrome of 
 slow and progressive evolution from the secondary Addisonian syn- 
 drome, which is seen in the already more or less advanced tuber- 
 culous cases, and which has a less clearly defined symptomatology. 
 
 Pende and Varvaro think that in the first case the anatomical 
 substratum has its seat in the suprarenal, and in the second in the 
 region of the solar plexus. Their reported case is a type of the 
 secondary Addisonian syndrome. 
 
 Porak and myself have observed a case which anatomo-clinically 
 was quite similar. 
 
 Thinking physiologically^^^ one can conclude that the Addisonian 
 syndrome is the expression of a certain degree of chronic suprarenal 
 insufficiency with a disturbance of adreno-sympathetic pigmentary 
 regulation. 
 
 In this adreno-sympathetic syndrome one can differentiate two 
 anatomo-clinical forms : one form with predominance of the supra- 
 renal lesions, it is the most frequent, and in general is clinically 
 primitive, the second form with predominance of the sympathetic, 
 periadrenal, solar or splanchnic lesions. It is less frequent, often 
 fruste, and in general is clinically secondary to a pulmonary pthisis. 
 
 (3) Scleroderma 
 
 The absence of the thyroidal sign of Vincent in acute articular 
 rheumatisms followed at first by Basedow's syndrome, and later on 
 by evidences of thyroidal atrophy with the appearance of sclero- 
 derma, which sometimes is apparently arrested by thyroidal medica- 
 tion, has caused a belief in the existence of a scleroderma due to 
 thyroidal disturbances of rheumatic origin. 
 
 This endocrinogenic form of scleroderma is not to be ques- 
 tioned. It is quite possible that it is not the only one, and that other 
 
 122 N. Pende et Varvaro (de Palermo), Maladie d'Addison avec in- 
 tégrité apparente des glandes surrénales et avec hypertrophie des glandes 
 surrénales accessoires, La Riforma medica, Nos. 40 et 41, 4 et il cet., 1913, 
 pp. 1093 et 1124. 
 
 123 La communication récente de Hirtz and Debre (Addisonien observe 
 en 1902 considère comme guéri, retrouve en 1913, autopsie), a la Soc. med. 
 des hop., le 26 juin, 1914, et la discussion que suivit entre L. Bernard, Netter 
 et Sergent (3 juillet, 1914, p. 20), ne contredisent pas mes conclusions. — Voir 
 de plus Fayolle, Thèse, 2 juillet, 1914. 
 
THE NERVOUS SYSTEM 47 
 
 endocrinal disturbances are capable of producing scleroderma or add 
 their action to that of the thyroid^24 j^ its causation. 
 
 In addition, in spite of Touchard,^^^ it seems very difficult to do 
 away with a sympathetic factor in certain cases. 
 
 Referring to an association of Basedow's syndrome and sclero- 
 derma, G. Marinesco and Goldstein^^® say that it is "evident that 
 the sclerodermic syndrome does not depend entirely on a disturbance 
 of thyroidal function, but that this disturbance exercises a certain 
 action on the sympathetic system, and brings about in this way the 
 appearance of the scleroderma." There are cases, as they say, which 
 confirm all the pathogenetic theories : the trophoneurotic, the angio- 
 trophoneurotic, the sympathetic, the vascular, the pituitary, the thy- 
 roidal and the pluriglandular. However none of these theories can 
 be applied to these cases as a whole. 
 
 Gauthier^^^ distinguishes two forms of scleroderma, the ordinary, 
 depending upon hyperthyroidism, and a special type, with a less 
 parchment-like skin and having subcutaneous fat, depending upon 
 hypothyroidism. 
 
 Cassirer^-^ puts in the list of the vegetative syndromes the vaso- 
 motor and trophic neurosis, among which he classifies scleroderma. 
 
 Marinesco and Goldstein consider that the thyroidal secretion 
 acts in the cases accompanied by Basedovian symptoms, as well as 
 in those with other thyroidal manifestations, through the sympa- 
 thicotrope action of that secretion. 
 
 The connections and even the associations of certain sclerodermas 
 with Basedovian and Addisonian syndromes compel me to admit 
 that if in the first place scleroderma is an endocrinal syndrome, it is 
 also sometimes a vegetative syndrome, and that consequently it has 
 the right to be quoted among the group of endocrino-sympathetic 
 syndromes. 
 
 (4) Diabetes Mellitus 
 
 Diabetes arises from a disorder in the regulating mechanism of 
 the sugar function. Glycosuria, the most frequent disorder of this 
 function, is at first heading an endocrino-sympathetic syndrome. 
 
 ^2* Voir à l'appui : Laignel-Lavastine, Sclerodermic mélanodermique, 
 Soc. med. des hop., 31 janvier, 1908; Dupré et P. Kahn, Sclérodermie et mal. de 
 Raynaud, Soc. méd. des hop., 11 juin, 1909; Chantemesse et Coureoux, Scléro- 
 dermie avec atrophie thyroïdienne et mélanodcrmie, Soc. méd. des hôp., 3 
 juin., 1914. 
 
 ^25 Touchard, Thèse, 1906. 
 
 ^2« Marinesco et Goldstein, Syndrome de Basedow et Sclérodermie, Nouv. 
 Iconographie de la Salp., juill.-aout., 1913, pp. 272-290. 
 
 i2î Ch. Gauthier, Fonct. du corps thyroïde, R. de Méd., 1900, p. 442. 
 
 *28 Cassirer, Die vasomotorich-trophischcn Ncurosen, 2° éd., 1912, pp. 
 536-700. 
 
48 THE INTERNAL SECRETIONS AND 
 
 Without going into the secretion of sugar by the liver, which was 
 the first internal secretion known, or into the influence of the in- 
 ternal secretions of the pancreas on sugar metabolism, it suffices to 
 mention adrenalin glycosuria as well as suprarenal diabetes to show 
 the existence of glycosuria of endocrinal origin. 
 
 In addition McLeod, after Cavazzini, has laid stress on the gly- 
 cosuria following excitation of the great splanchnic and on the fact 
 that puncture of the bulb in the normal dog is without efïect after 
 section of the splanchnic nerves. 
 
 There is need therefore of a sympathetic factor in the production 
 of certain glycosurias. 
 
 Finally in the decapsulated dog puncture of the fourth ventricle 
 (Mayer), as well as stimulation of the splanchnic (Gautrelet and 
 Thomas), does not produce glycosuria. This proves the need of a 
 double endocrino-sympathetic factor in certain glycosurias. 
 
 One can conceive, therefore, the possibility of diabetic cases, 
 endocrino-sympathetic syndromes, in which sometimes either the 
 endocrinal factor or the sympathetic factor seems to predominate. 
 
 3. Psycho-neuroses 
 
 I indicated in 1908 the importance of endocrine disorders in the 
 psycho-neuroses. Facts published since then in the literature and 
 my personal practice have confirmed me in my opinion. One part 
 of functional neurology comes under the heading of endocrino-neu- 
 rology to-day. 
 
 This subject will be found worthy of great elucidation. I can 
 not go into it here, and will say but a word regarding endocrine dis- 
 orders among the "nervous," the neurasthenics, the hysterics, the 
 psychasthenics and the epileptics. 
 
 (i) Nervousness 
 
 It will be interesting clinically, said I in 1908, not to stop at a 
 simple sémiologie diagnosis in the presence of a neurosis, but to in- 
 quire into the reasons for the irritable weakness of the nervous sys- 
 tem in the general functionating of the organism, and from this point 
 of view not to neglect the examination of the internal secretions. 
 
 The Viennese School, especially Eppinger and Hess,^^^ in the 
 neurosis of Oppenheim, have distinguished the two clinical types of 
 vagotonics and sympathicotonics, the relationships of which they 
 
 1-9 H. Eppinger et L. Hess, Die Vagotonie, Sammlung klinischer Abhand- 
 lungen iiber Pathol, u. Therap. der Stoffwechsel u. Ernàhrungsstôrungen, f. 
 9-10, Berlin, 1910. Tr. Kraus and Jelliffe, Neurological Monographs. 
 
THE NERVOUS SYSTEM 49 
 
 have striven to connect with such and such disturbances of internal 
 secretion. Their remarkable description of vagotonics, which is 
 classic to-day, has been translated or recapitulated in all languages. 
 I refer you to these works.^^° 
 
 Before that Leopold Levi and H. de Rothschild^"^ had prepared 
 the way with their excellent study on thyroidal neuroses. 
 
 In a number of cases the clinical types of neuroses, such as the 
 vaso-motor habitus of Savini^^^ or the emotional constitution of 
 Dupré,^^^ come under the heading of thyroidal neuroses, and from 
 a diagnostic standpoint the joining of a simple clinical type to an 
 endocrino-nervous syndrome is a step forward, because one enters a 
 little further into the understanding of the morbid mechanism. 
 
 Moreover a good many vagotonics, like a good many sympathico- 
 tonics, also come under the heading of dyshyperthyroidal neuroses, 
 and these different effects arising from the same endocrine disorder 
 — supposing that it always is the same — should not cause amazement. 
 
 They are on the same order as the facts which were noted by 
 Asher and de Rodt^^* in their experiments on the thyroidal secre- 
 tions. According to the individual peculiarities of the animals, it 
 was sometimes the action on the vagus and sometimes the action on 
 the sympathetic that predominated. In addition the effect of an 
 injection of thyroidal extracts depended in great measure on the 
 degree of excitability of the nerves of the animal experimented 
 upon. 
 
 This observation seemed to me as being of extreme importance 
 and of a general application. In pointing out more or less marked 
 reactional phenomena in the nervous system as being hand in hand 
 with certain secretions with which they are for the moment more 
 or less in accord, evidence is given of the dangers of too hasty in- 
 ductions relative to the action of the endocrine secretions on the 
 separate parts of the nervous system and to their specific elective 
 action, which are to a certain extent antagonistic. 
 
 There are not only thyroidal neuroses allied with all the modali- 
 ties of stimulation or insufficiency of thyroidal secretion, but dis- 
 
 ^"° Cheinisse, Sem. méd., 20 nov., 1912, pp. 553-556; W. M. Kraus et S. 
 E. JelliflFe, J. of Nerv. and Ment. Disease, mars, avril, mai, 1914, p. 164. 
 
 ^•■'1 Leopold Levi et H. de Rothschild, Etude sur le corps thyroïdien. 
 
 ^32 E. Savini, Le type constitutionnel sympathique ou vaso-motor. Progrès 
 médical, 15 fév., 1913, pp. 82-85. 
 
 ^•■2 E. Dupré, La constitution émotive, Paris méd., 7 oct, 191 1, p. 404. 
 
 ^'* L. Asher et M. de Rodt, Innervât, des gl. à secret, int. et act des 
 produits de secret, int. sur le syst. nerv., Soc. suisse de Neurol., 11-12 
 nov., iQii, 
 
 Rcv méd. de la Suisse romande, XXXII, No. 2, p. 183, 20 fév., 1912. 
 
50 THE INTERNAL SECRETIONS AND 
 
 turbances of the ovaries, testicles, suprarenals and the pituitary may 
 be the origin of beginning neuroses. 
 
 This idea of an attempt to discover the endocrinal disturbance 
 before the neurosis becomes sufficiently marked to be morbid allow- 
 one perhaps to restore an equiUbrium to these nervous tempera- 
 ments through an organotherapy, which is to a certain extent 
 prophylactic. 
 
 They are helped in this way before, to use a vulgarism, they 
 have had a chance to get the habit of the disease. 
 
 Finally among " the nervous " endocrine disorders may be in 
 their turn secondary to nervous disturbances. These secondary 
 neurogenous endocrinal symptoms must not be confounded with 
 primitive endocrine disorders — the causes of the nervous disorders. 
 This intricacy is common among the hyposphyxics of Martinet; I 
 have under observation at the present time a nervous woman with 
 hyposphyxia and hypothyroidism, whose extremely low arterial 
 tension is improved more by small doses of thyroid than by supra- 
 renal, and I believe that it is through a nervous influence that the 
 thyroidal insufficiency of scarlatinal origin reacts upon the supra- 
 renal. 
 
 After what I have said concerning endocrinogenic asthenias 
 I will be very brief as regards neurasthenia of endocrinal origin. 
 Since attaching the importance to it that I did in 1908, I have 
 searched for it regularly in my practice, and have often found it. 
 The forms connected with adrenal and genital insufficiency (dia- 
 stematic and prostatic) seem to me to predominate in the male, and 
 the forms connected with ovarian and thyroidaP^^ insufficiency to 
 predominate in the female. Certain neurasthenias of infectious 
 origin, such as the tuberculous, syphilitic, and gonorrheal, result as 
 much if not more from the endocrinal insufficiency caused by the 
 microbes than from the toxines produced by them directly. 
 
 These endocrine disorders which cause neurasthenia must not 
 be confounded with the secondary neurogenous endocrinal symp- 
 toms, which are often seen in neurasthenias, and which bear mostly 
 on the vegetative nervous system. 
 
 The two disorders — endocrinogenic neurotic and neurogenic 
 endocrinal — often coexist, and by their intricacy complicate the 
 clinical picture. The analysis can be gotten at through the thera- 
 peutic results. 
 
 ''■■'•^ Allen Starr, Neuroses depend upon errors of inter, secret, of the 
 ductless glands, Med. Record, 20 juin, 1912. 
 
the nervous system 5 1 
 
 (3) Hysteria 
 
 Hysteria, whatever the idea may be that one holds in regard 
 to it,"^ is observed among "the nervous." 
 
 I have shown the frequency of neuroses of endocrinal origin. 
 I beheve that I can class the disorders of internal secretion among 
 the predisposing causes of hysteria through the intermediary of 
 nervosity. As a matter of fact I have often found endocrinal dis- 
 turbances, especially of the thyroidal or ovarian type, among 
 hysterics, 
 
 (4) Psychasthenia"^ 
 
 Etymologically psychasthenics should be classed among the 
 neurasthenics in whom the asthenia bears especially on the psychic 
 
 sphere. 
 
 But following along with Raymond and Janet we class espe- 
 cially as psychasthenics those who, on the whole, are obsessed. 
 
 When one follows these cases one sees that their paroxysmal 
 blustering syndromes are nothing but the morbid oflfshoots of deeper 
 variations of nervous tonus or psychic tone. These changes in 
 women are nearly always connected with the sexual life. In man 
 one finds them running parallel with such symptoms as headache, in- 
 somnia, hyper- or hypotension, tachycardia and constipation, which 
 frequently can be connected with endocrinal disorders. 
 
 Thus among the predisposed, obsessions, which might be re- 
 garded as a mental autonomic syndrome, are often nothing but the 
 psychic expression of a more or less difïuse anxiety which in itself 
 is the result of a disturbance of the sympathetic system of endo- 
 crinal origin. Thyroidal excitation particularly, by increasing the 
 irritability of the peripheral sympathetic centers which it controls, 
 predisposes to these dissociations of personality. The thyroid, so 
 to speak, is an anarchistic emancipator. 
 
 Be that as it may, the variations in nervous and psychic tone 
 thus determined may react secondarily on all the vegetative func- 
 tions not forgetting the ductless glands, and can thus establish a 
 vicious circle. 
 
 (5) Epilepsy 
 It is always wise in the diagnosis of an epilepsy after becoming 
 advised as to the causes explaining the cortical changes to pass in 
 
 i3« Laignel-Lavastine, Les réactions anti-sociales des hystériques, Paris 
 
 Médical. 30 mai, 1914. ^ . , t u . 1 • c t? 
 
 '"Schnyder, L., R. méd. de Suisse romande, oct., 1913; Lubetzki, b., K. 
 
 de méd., août, 10^3- 
 
52 
 
 THE INTERNAL SECRETIONS AND 
 
 review the reasons for the organic poisoning and among these not 
 to overlook the glandular disturbances. The search for the minute 
 signs of these disturbances may thus institute the use of one glan- 
 dular therapy rather than another. It is most often the thyroidal 
 disturbances that are revealed in endocrinal disorders among epi- 
 leptics. 
 
 Many subsequent works^^^ have confirmed this conclusion in my 
 report of 1908. 
 
 Sometimes they are hypothyroideal in type and sometimes 
 dyshyperthyroideal. This is not contradictory. The endocrinal dis- 
 order, according to the statement of Leopold Levi, " is the patho- 
 logical mordant that sensitizes centers already predisposed." The 
 endocrinolepsy,^^^ whatever form the crisis may take, is set free by 
 a complete rupture of the endocrinal equilibriimi. The incidental 
 causes alone are different. Thus in a still unpublished lecture"* 
 on the thyroid body and epilepsy pertaining to a confusional epileptic 
 stupor seen in a tuberculous heredo-alcoholic Basedovion, I showed 
 that the crisis coincided with and followed her menstrual periods, 
 while with her hypothyroidal sister they preceded them as a rule, 
 and were absent during pregnancy. 
 
 In the epileptic seizures of thyroidal origin, therefore, I wish to 
 differentiate the dyshypothy roi deal crises from the dyshyperthy- 
 roideal^*^ crises; these latter discharges moreover possibly surviv- 
 ing in all three forms of thyroidal instability. 
 
 4. Temperaments 
 
 Temperament, as I said at Dijon in 1908, is the dynamic char- 
 acteristic of the organism, just as constitution is the static character- 
 istic. Following this conception of Professors Bouchard, Landouzy 
 and Roger it can be stated that what one is to physiology the other 
 is to anatomy. Now it appears to me that among the various innc- 
 
 138 Sicard, Journ. de med. de Paris, 1912; Gelma, Rev. de med., 10 janv., 
 
 1913, PP- 26-39. Guilton, Contrib. à l'ét des symp. épileptiques dans les états 
 thyroïdiens, Th., Montpellier, 1913, No. 58; Enzière et Margarot, Soc. de se. 
 méd. de Montpellier, 2 mai, 1913; Silvestri, Opothérapie surréno-médull. et 
 épilepsie. Il Policlinico, 29 juin, 1913, pp. 917-922; Dufour et Legros, Syn- 
 drome hypo-ovarien et hypo-thyroïdien. Crises épileptif ormes (vagotonic). 
 Soc. méd. des hôp., 27 mars, 1914; Bolten G., Monatsch. f. Psych. u. Neurol., 
 33, No. 2, fév., 1913; Claude et Schmiergeld, Encéph., 10 janv., 1909. 
 
 13» Leopold Levi, Les endocrinolepsies, Soc. de méd. de Paris, 9 janv., 
 
 1914, p. 44; 
 
 i**' Laignel-Lavastine, Clinique psychiatrique, 22 mars, 1914. 
 1*1 Ces crises me paraissent vraiment rythmées par les règles quoi q'en 
 disent Toulouse et Marchand (R. de Psychiatrie, mai, 1913). 
 
THE NERVOUS SYSTEM 53 
 
 tions, the individual varieties of which have to do with tempera- 
 ments, those of the internal secretions should not be neglected, and 
 when one decides to take up the long-forsaken study of tempera- 
 ments in accordance with the classical types — the sanguinary, the 
 nervous, the lymphatic and the bilious, one might discern perhaps 
 the thyroidal, the pituitary, the adrenal, the ovarian and dias- 
 thematic, etc. 
 
 This view of the question is but the application to the internal 
 secretions in relation to temperament, of the masterly conception of 
 Prof. Charles Richet expressed at the Congress of Vienna in 1910: 
 " We are as yet but at the portal of that chemistry of the imponder- 
 able, founded on the analysis of biological functions, and although 
 we can already foresee some of the results, we are soon led into a 
 region in the study of the physiology of the individual, which until 
 to-day was almost unexplored," that physiology which, in my lecture 
 at the opening of the course on medico-legal psychiatry in 1910, I 
 called the differential psychology, and I linked diflferential psychol- 
 ogy with the knowledge of character and differential anatomy with 
 the knowledge of constitution. 
 
 Since then the idea has been greatly amplified, and Prof. N. 
 Pendé"^ has allotted a chapter to it in his remarkable report ot 
 1912 on the internal secretions. As a clever clinician he has related 
 the constitutional vascular hypotonia of Ferrannini with the thymo- 
 lymphatic state of Paltauf or the asthenic or hypoplasic constitu- 
 tional state characterized by hypoplasia of chromaffin and genital 
 tissue combined with hyperplasia of lymphatic and thymic tissue. 
 
 Then again he believes that he can connect the vagotonia of 
 Eppinger and Hess with the exudative diathesis of Czerny. 
 
 He considers the lymphatic and thymo-lymphatic states to which 
 he adjoins the chlorotic state as an organic immaturity of the endo- 
 crinal system in its chromaffin and genital parts contrasting with 
 excessive development in the same system of its lymphatic and 
 thymic parts. He recalls the antithesis established by Viola between 
 the apoplectic or short or megalosplanchnic habitus with the phthis- 
 ical or long or microsplanchnic habitus. He adds that very fre- 
 quently hypothyroidea coincides with the megalosplanchnic habitus 
 and hyperthyroidea with the microsplanchnic. Remarking also that 
 
 ^■•2 Rapin, Angioneuroses familiales, R. med. de la Suisse romande, 1907, 
 p. 196. — G. Maranon, R. de med., mars, 1914, p. 180. — Falta, loc. cit., p. 39. — 
 Leopold Levi, Families thyroïdiennes et dysendocriniennes- 
 
 ^♦^ N. Pcndé, Le secrezioni interne nei rapporte con la clinica XXII* 
 Congresso di Medicina Interna in Roma, oct., 1912. 
 
54 THE INTERNAL SECRETIONS AND 
 
 he has often seen signs of vagotonia among the megalosplanchnics 
 and of sympathicotonia among microsplanchnics he deducts this 
 double equation : vagotonia-megalosplanchnia-hypothyroidea ; sym- 
 pathicotonia-microsplanchnia-hyperthyroidea. 
 
 Pende very prudently does not advance these considerations 
 except as a means of indicating the road to follow, and in fact this 
 classification seems to me to err through too great a desire for sym- 
 metry and by too static a conception of the notions regarding vago- 
 tonia and sympathicotonia. 
 
 These predominances as a rule only express the evolutional mo- 
 ments of the individual. Thus when asleep at night we are all 
 vagotonics. The adult and the aged differ more from the child 
 than the sleeping man from the awakened. Their vegetative 
 nervous formula has therefore the chance of not remaining the same 
 all during life. 
 
 If I criticize the too sharply drawn lines of the theoretical elucida- 
 tion I share, as I have already said, in the directing idea. It is 
 moreover essentially French. Leopold Levi and H. de Rothschild 
 have been the first to deserve the credit for connecting the classical 
 neuro-arthritic diathesis with hyperthyroidism.^** It is true that 
 prior to that time Hertoghe classed adenoid cases as among the 
 hypothyroidal, and opened the way for the classification of many 
 lymphatic temperaments among cases of hypothyroidism. 
 
 Another step along the trail brings us to the diatheses of Bazin — 
 a masterly conception and a very true one, which the fancies of the 
 pastoral era had caused to be forgotten, but to which we bring back 
 the analysis of temperament in the light of endocrinology. 
 
 Finally I must recall that Lancereaux, when he saw in the 
 sympathetic the principal factor in herpetism, had in advance the 
 intuition of the ties which unite endocrino-sympathetic disturbances 
 with temperaments. 
 
 To-day I believe it possible to enlarge and clarify the question a 
 little, thanks to what I have called, in a clinical lecture, the endo- 
 crino-diagnosis of temperaments; an endocrino-diagnosis which 
 must be worked out according to the method of glandular tests of 
 Claude and his pupils, and which will allow one to depict a series 
 of types. This series of types will depend on thyroidal or ovarian 
 or testicular or pituitary or suprarenal temperaments more or less 
 clearly defined, according to the more or less marked predominance 
 of one or of several of the glands of internal secretion in the endo- 
 
 1** Leopold Levi, Neuro-arthitisme et gl. endocrines, Mouv. méd., mai, 
 1913- 
 
THE NERVOUS SYSTEM 
 
 55 
 
 crinal equilibrium. I expect to publish in the near future a de- 
 scription along these lines of the principal temperaments. 
 
 5. Character"^ 
 
 Character, to my mind, as I said in 1908, is nothing but the 
 psychological expression of temperament. Constitution, tempera- 
 ment, character are thus but three expressions— anatomical, physio- 
 logical and psychological— of the reactional coefficient of the in- 
 dividual. 
 
 "The importance of individual varieties of internal secretions 
 will be seen again therefore in characters. The laity have long 
 spoken of good or bad humor in their spontaneous psychology and 
 also of humor in medical parlance. This identity of terminology 
 seems to me to conceal a profound meaning, which the study of 
 the internal secretions uncovers. These secretions by their varia- 
 tions react on the mental life as well as on the rest of the organism, 
 and manifest themselves at first and above all by changes of humor, 
 modifications of aflfective life, because the latter rather than motor 
 or especially intellectual activity depends on organic life from 
 which it can scarcely be separated. 
 
 For a long time my observations have done nothing but confirm 
 me in my opinions. The choleric are such only through the thy- 
 roidal temperament, just as the lazy are such only through supra- 
 renal hypoplasia. 
 
 Nevertheless, even if an endocrinal factor often enters into the 
 formation of character, I do not claim that it always does so, and 
 many other elements play a primordial rôle in such formation. In 
 addition the law of constancy allows the establishment of rela- 
 tionships between morphological and psychological series which are 
 by no means causal. This is what Bergson has caught a glimpse of 
 in his Creative Evolution, when he says that each physiological dis- 
 position is a necessary but not a sufficient condition for each psychic 
 state, and that it is possible to have many psychic states from the 
 same physiological state of the cerebral gray matter. 
 
 Conclusions 
 
 I. From a morphological standpoint there exist clearly defined 
 connections between the nervous system and certain glands of in- 
 ternal secretion, especially between the sympathetic and the chro- 
 maffin systems. 
 
 "= Kollarits Jeno, Charakter und Nervositat, Budapest, 1912. 
 
5'ô 
 
 THE INTERNAL SECRETIONS AND 
 
 2. From a physiological standpoint experimentation has shown 
 that stimulation or predetermined sections of the central or periph- 
 eral nervous system modify certain internal secretions and con- 
 versely that changes produced in these secretions or the injection of 
 their hormones, where such are known and isolated, modify the 
 nervous functions, particularly the excitability of the vegetative sys- 
 tem, with predilection sometimes for the autonomic and sometimes 
 for the sympathetic. The School of Vienna deserves the credit for 
 having shown the importance of these elective relations. 
 
 3. From a pathological standpoint much less is known as yet 
 than one would suppose. The truth of the endocrino-nervous rela- 
 tionships should not be admitted without a critical analysis bristling 
 with facts. Nevertheless it can be said that 
 
 I. Nervous disorders exist due to disturbances of internal secre- 
 tion, and disturbances of internal secretion exist due to nervous dis- 
 orders. 
 
 Endocrino-nervous Relationships 
 
 A. 
 B. 
 C. 
 
 Coincidence. 
 
 Association 
 
 Causality 
 
 •{ 
 
 I. Simple. 
 
 1, Proximate. 
 
 2. Mediate. 
 
 '. Endocrino-nervous. 
 (i) Direct. 
 
 (2) Indirect through 
 intermediary. 
 
 . Neuro-endocrine. 
 (i) Direct. 
 
 (2) Indirect through , 
 intermediary. 
 
 2. Double 
 
 ...{ 
 
 1. Morphological evolutional. 
 
 2. Morphological humoral. 
 
 3. Physiological humoral 
 
 4. Physiological nervous. 
 
 5. Psychological. 
 
 1. Morphological evolutional. 
 
 2. Physiological reflex. 
 
 3. Psychological. 
 
 4. Motor activity. 
 
 5. General nutrition. 
 
 Endocrino-neuro-endocrine. 
 Neuro-endocrino-nervous. 
 
 2. The two-fold critical analysis of the neurological and par- 
 ticularly the endocrinological methods of investigation permits, in 
 the midst of the unknown, the redemption of certain definite rela- 
 tionships between the endocrinal and the nervous disorders. 
 
 3. Until more ample investigation it seems to me that these rela- 
 tionships might be expressed in the following table. 
 
 In practice the great aid that endocrinology brings to the study 
 of neurology and especially functional neurology manifests itself 
 particularly in the clinical study of 
 
THE NERVOUS SYSTEM 
 
 57 
 
 1. Ordinary symptoms, such as asthenia, headaches, insomnia, anx- 
 
 iety, sweats, constipation, arterial hypertension and obesity. 
 
 2. Endocrino-sympathetic syndromes, such as Basedow's syndrome, 
 
 Addison's syndrome, scleroderma and diabetes mellitus. 
 
 3. Psycho-neuroses. 
 
 4. Temperaments. 
 
 5. Characters. 
 
 Endocrino-diagnosis of temperaments, particularly through 
 glandular tests and sympathico-vago-tonic examinations, in pene- 
 trating the familial heredity, will allow us to use prophylactic meas- 
 ures in combating diatheses and in combating certain of the factors, 
 the humoral and neuro-vegetative factors for instance, which are 
 formative of character. 
 
INDEX 
 
 ABDERHALDEN, 7 
 Acrocyanosis, 28 
 Acromegaly, 16-20 
 Addison, 45 
 
 Addison's Syndrome, 15 
 Anxiety, 29, 41 
 Arterial hypertension, 42 
 Asthenia, 39 
 Autonomic, xi 
 
 B 
 
 BASEDOW, 12, 44 
 Bony Syndromes, 29 
 
 Endocrinous-nervous syndromes, 10 
 Epilepsy, 26, 51 
 Erythema, 28 
 Erythromelalgia, 28 
 Eunuchoid, 18 
 
 FROEHLICH, 16 
 
 GENITAL, 30 
 
 Genito-suprarenal syndrome, 15 
 Glaucoma, 29 
 
 Glands of internal secretion, 2 
 Giantism, 16 
 
 CERVICAL SYMPATHETIC, 
 
 Character, 55 
 
 Chinese Organotherapy, iii, vii 
 
 Choreas, 26 
 
 Choroid, 17 
 
 Circulation, 30 
 
 Classical syndrome, 11 
 
 Conclusions, 55 
 
 Constipation, 42 
 
 Delirium, 32 
 Dementia, 33 
 Dermographia, 29 
 Diabetes hisipidus, 16 
 
 mellitus, 47 
 Digestur, 30 
 Dioscorides, viii 
 Double relationship, xi 
 Dyshyperdiastematosis, 18 
 Dyshyperovaria, 19 
 
 E 
 
 ENDOCRINE neurological, 38 
 Endocrine sympathetic, 44 
 Endocrino-nervous, 23 
 
 29 
 
 H 
 
 HEADACHE, 40 
 Hydrocephalus, 17 
 Hypertension, 42 
 Hyperovaria, 17 
 Hysteria, 51 
 
 INFANTILISM, 17, 18 
 Insomnia, 41 
 
 LANGLEY, xi 
 
 M 
 
 MACROGENITOSOMATOSIS, 17 
 Methods by Examination, 4 
 Melancholia, 29 
 Migraine, 29 
 Mitochondrea, 2 
 Myasthenia, 14 
 
 gross, 26 
 Myexedema, 12 
 Myoclonias, 26 
 Myotonia, 26 
 
 58 
 
INDEX 
 
 59 
 
 N 
 
 NERVOUS Endocrine, 37 
 
 symptoms, 20 
 Nervousness, 48 
 Neurasthenia, 33 
 Neuroglia as secretory, 2 
 Neuropsychic, 33 
 
 OBESITY, 43 
 Oculocardiac reflex, xiii 
 Organatlierapy of Ancients, vii 
 Organic extracts, 7 
 Ovarian insufficiency, 17 
 Ovary, 17 
 
 RENON, DELILLE, 16 
 Respiration, 30 
 
 SCLERODERMA, 46 
 
 Sensory-motor syndromes, 25 
 
 Skin Syndromes, 28 
 
 Spasms, 26 
 
 Sterile, 18 
 
 Suprarenal predominance, 20 
 
 Suprarenals, 15 
 
 Sweating, 4 
 
 Sympathetic, xi 
 
 Sympathetic-endocrine, 44 
 
 Sympathicotonic, i 
 
 PANCREAS, 16 
 
 Paraganglia, 15 
 
 Paralysis Agitans, 14 
 
 Paraplegia, 26 
 
 Parathyroid, 14 
 
 Parkinson's Si'ndrome, 14 
 
 Periodic paralysis, 26 
 
 Pineal, 17 
 
 adiposity, 17 
 
 Pituitary, 16 
 
 Pharmacodynamic tests, xii 
 Pharmacodynamics, 24 
 Phobias, 23 
 
 Physiological method, 8 
 Pluriglandular period, 11 
 Polyendocrine Syndromes, u 
 Prostate, 18 
 Psychasthenia, 51 
 Psychic Syndromes, 22 
 Psychoendocrine, 34, 35 
 Psychoneuroses, 48 
 
 QUANTITATIVE period, 10 
 
 TEMPERAMENTS, 52 
 Testicles, 18 
 Tetany, 14 
 Therapy, 9 
 
 Thymopryvic Idiocy, 15 
 Thymus, 14 
 Thyroid, 12 
 
 Instability, 13 
 Thyro-ovarian, 19 
 Tremors, 26 
 Trophic, 31 
 
 U 
 
 UNIENDOCRINE syndromes, 12 
 Urinary, 30 
 Urticaria, 28 
 
 VAGOTONIC. I 
 Vagotonic Crises, 17 
 Vegetative System, 24 
 Vertigoes, 26 
 
QP18T 
 
 LlU 
 
 1919 Laignel-Lavastine 
 
 The internal secretions and 
 the nervous system.