the observation that in cases of testicular or ovarian insufficiency
intelligence is often diminished. Thus we were consulted by the parents
of a young man of eighteen years who was mentally backward; he could not
remember anything; his arms and legs were abnormally long, but his body
short, thus resembling a eunuch’s—and indeed I found his testicles were
not yet descended. His voice was that of a child, and he also exhibited
the other symptoms of testicular insufficiency described in the second
chapter of this book.
On the other hand we may see a precocious highly developed intellect in
children with a premature sexual development. We know of a boy of six
years who tried to have sexual intercourse with a little girl of the
same age, and who at the age of four and one-half years knew all the
capitals of the world by heart. Hence the education of precociously
bright children should be especially guarded, for they can become great
men but also not rarely, if neglected, great criminals.
As, however, in these days of scepticism we do not believe in anything
until demonstrated by experiments (often forgetting the fact that what
does for dogs or rabbits does not always do for man) which should only
assist our judgment, but not exclusively govern it, we shall have to
prove the correctness of our clinical observations on the influence of
the sexual glands—i.e., on the nervous system and mentality—by
experiment, and we believe we have sufficient facts at hand to do so.
About a hundred years ago it was shown by Gall—who was attacked by
several authors, among them Rieger, as innovations always are, but who
was also successfully defended by the celebrated German nerve specialist
and philosopher, Moebius[93]—that castrated animals or persons have an
alteration in the back part of the skull indicating an impoverishment of
the cerebellum. And, indeed, he produces his own evidence and that of
several other authorities, Darnecy, Rousseau, etc., which gives the
history of several autopsies on castrated persons, all of whom showed an
atrophy of this structure. In cases where only one of the testicles was
destroyed, this atrophy was always present in the hemisphere of the
small brain on the opposite side.
Footnote 93:
Moebius: “Die Wirkungen der Castration,” Halle, 1902.
It has been found by numerous authorities that the skull and brain of
castrated animals and persons is smaller than the normal. Gall[94] noted
this fact, and after him Vimont,[95] from experiments on animals; and,
according to the latter observer castration of both sides produces a
considerable diminution of the cerebellum. Leuret and Hoffmann[96] found
a diminution of the head in horses, sheep, and pigs after such an
operation, and that the other parts of the skeleton are always altered
is a fact recorded by a large number of authorities as stated already.
Footnote 94:
Gall: “Anatomie et Physiologie du Système nerveux,” T. iii., p. 108,
Paris, 1818.
Footnote 95:
Vimont: “Traité de Phrenologie humaine et compareè,” two vols. et
atlas, vol. ii., p. 233, Paris, 1835.
Footnote 96:
Hoffmann: “Ueber die Castration der Hausthiere Schneidermühls Thier
medecin,” Vorträge ii., 12. 1892.
As we have pointed out above, any alteration of the testicles or ovaries
is followed by nervous disturbances, and, consequently, the total
removal of these glands produces far more deleterious effects, and these
will vary according to whether such persons have been castrated at an
early age or later. In these latter cases nervous disorders will be more
acutely felt, and as the celebrated French authority, Dupuytren, states,
melancholia is a common phenomenon in castrated men. According to more
recent observations in cases of enlargement of the prostate that have
been treated by castration, the patients exhibit melancholia. We may
here remark that the testicles and the prostate are in close relation,
the latter always becoming atrophied after castration. There is
experimental evidence to show that a too large amount of testicular or
ovarian secretion may produce toxic effects. Thus, Loisel, by injecting
testicular or ovarian extracts into animals, could produce toxic
symptoms in every instance. This may account for the fact mentioned
previously that persons living for a long time in complete sexual
abstinence, occasionally exhibit symptoms of disorder of the nervous
system.
The marvelous influence of the sexual glands on the mind and character
is at once apparent if we consider the aberration from the normal of the
castrated person. The authorities who have studied the eunuchs in Egypt
and the Skopze in Russia (a religious sect who adopt castration as a
tenet), found typical characteristics in these people that distinguished
them from the normal.
Thus, as a rule (and as stated by Moebius), the biography of remarkable
eunuchs of the old and middle ages shows that they are entirely
deficient in courage, which seems to be dependent entirely on the
possession of testicles, and the same fact may be noted also in the case
of the lower animals. Thus, an ox is a coward compared to a bull, and an
ordinary horseman prefers to ride a mare rather than a stallion. The
best means of taming certain animals is by depriving them of their
testicles at an early age. Intelligence also is much influenced, not
only by the thyroid, as already shown, but by the testicles. Thus
persons of literary or other fame, such as artists and the like, have
become impaired in their capacity after castration: Abelard, for
example.
Moebius, in the history of the world, could find no castrates of great
intelligence. Knowledge gained by diligent labor is not referred to
here. We merely wish to express our conviction that great ideas, such as
are found in men of genius, are impossible in men devoid of their
testicles; and it appears out of the question to imagine such men as
Napoleon, Goethe, or others, as castrates. On the contrary, we are
inclined to believe that such great men had a private life that would
have rendered them unfit for the position of superintendent of an
American Sunday School.
Courage is a specific feature that can only be found in a man who is
still in possession of healthy sexual glands; it is entirely wanting in
eunuchs. Cowardice, superstition, laziness, avarice, vanity, cruelty,
and other bad qualities are typical features in eunuchs. Our friend Sir
Hugh Adcock, formerly physician to the late Shah of Persia, told us that
his own experience with hundreds of eunuchs showed him that they all had
these bad qualities. Capacity for hard work, generosity,
kind-heartedness, and religion may be found in persons who are in the
possession of healthy, vigorous, sexual glands; but by exhaustion, after
sexual excesses, a condition may be created analogous to myxœdema after
previous Graves’s disease. This exhaustion of the sexual glands may
create a condition in which some of the features of the castrated may
appear. This is noticeable in the character of many of the dignitaries
of oriental countries who possess large harems, and also in occidental
countries in many men who lead a life of debauchery. The influence of
the pituitary is shown by changes that invariably occur in the nervous
system and mind after any alteration in it. Thus, in two millionaires
suffering from acromegaly we have observed great stinginess. We do not
intimate that this is a characteristic of millionaires, but these
gentlemen were quite the reverse before becoming afflicted with their
disease. In one case of acromegaly, for the knowledge of which we are
indebted to Dr. Dercum of Philadelphia, there was a great distrust of
anything new, even the most useful of innovations. This caused great
discontent among the gentleman’s business partners, although he himself
showed this disposition only after the symptoms of his disease were
apparent. In acromegaly there exists a hyperactivity of the pituitary;
Renon was able to produce the disease by giving large doses of pituitary
extracts, and Hochenegg obtained good results in his treatment of it by
extirpating the pituitary body.
Extirpation of the adrenals is also followed by important alterations in
the nervous system, as was noted by Jersoni and others. Also, in
Addison’s disease, which is accompanied by a degeneration of these
glands, we notice a diminution of the intellect together with a general
mental depression.
The influence of the ductless glands on character, and the change in the
same after alterations in those glands, may easily lead to crime, as the
two principal barriers against crime are will-power, by which we control
our passions; and sound judgment, by which we distinguish right from
wrong. It is evident that a cretinous or myxœdematous person will have
no great will-power, for this, as already shown, is dependent on the
thyroid secretion; nor do they possess intelligent sound judgment enough
to realize what is right; and, as the possible consequences of their
defective action, castrated persons, as above shown, are more attracted
to crimes due to avarice or cruelty. Those who are interested in this
question may read our lecture delivered before the Medical Jurisprudence
Society in Philadelphia,[97] in which we endeavored to prove in detail
our assertions that the origin of crime is due to nervous changes
succeeding alterations of the ductless glands. As persons of advanced
age often have a complete atrophy of the sexual glands, changes in their
character may be explained on these grounds.
Footnote 97:
Journal of the American Med. Association, May 10, 1907.
------------------------------------------------------------------------
CHAPTER V.
ON THE INFLUENCE OF THE SEXUAL GLANDS UPON VITALITY AND LONG LIFE.
WHEN we study the history of people who present a youthful appearance
late in life, and reach an extraordinary old age,—up to 120 or 140, or
even 160,—we are surprised at the unmistakable evidence of a strong
sexual activity in most of them, which is only possible by being
possessed of healthy and active sexual glands; and thus it would appear
that the possession of such glands may impart a strong vitality and the
best chances for a long life. That such is the case we will endeavor to
show by evidence of an experimental nature, and also by facts gathered
from observation of the long lives of the patriarchs.
When the sexual glands of a person are extirpated, such castrated
people, be it man or woman, soon get old. This we can see in the case of
eunuchs who get wrinkled even in their youth, such also get fat, and
present other symptoms of premature old age; and the same is observable
in women whose ovaries have been removed.
Matthew Paris,[98] the historian, in his description of eunuchs and the
appearance of early old age, tells us that in 1253 Frederick II, Emperor
of Germany, married Isabella, sister of the King of England, and he
presented to his wife several Moorish slaves who were eunuchs, for
servants, who looked like old masks. Pelikan[99] also mentions that the
whole community of castrated Skopze in Russia, has a withered aspect;
and in his book Merschejewski relates that their skin is withered and
wrinkled, and that they look worn out, aged, and senile.
Footnote 98:
Quoted after Moebius, “Die Wirkungen der Castration,” p. 43, Halle,
1907.
Footnote 99:
Pelikan: “Gerichlach Med. Untersuchenger über das Skopzentham in
Russland,” Giessen, 1876.
Besides provoking senility at an early period, castration or a
degenerated condition of the sexual glands, especially in women, is able
to produce alterations in organs, which are of great importance to the
vitality of individuals, and to a long life, such as the heart, stomach,
intestines, and liver. Experienced authorities have noted heart troubles
in dysmenorrhœa and amenorrhœa, and also neurosis of the heart with
long, lasting alterations of the female sexual glands. Professor
Kisch[100] also noted tachycardia in such conditions. Professor
Landau[101] has very often observed a degeneration of the heart after
myoma of the uterus. Lehman and Strassmann, in the Berlin Charité, have
seen such a degenerated condition of the heart in 44 per cent. of
patients with myomas of the uterus.
Footnote 100:
Kisch: “Das Geschlestrlehen der Frau,” second edition, Vienna, 1908.
Footnote 101:
Quoted after Kisch.
It has been shown by experiments that there is a close relation between
the condition of the ovaries and the heart. Professor Hegar[102] has
demonstrated that castration, or simple tugging of the ovaries, is able
to produce a diminution of the heart beats, or even a stoppage of the
heart. Lucas Championnière has also noted the same after a tearing of
the ovaries, and Mariagalli and Negri have also noted tachycardia after
laparotomy.
Footnote 102:
Quoted after Kisch; as also other authors on the relation between
heart and stomach, and the ovaries.
Very important also are the relations between the ovaries and the
digestive organs. Kretschy observed, in a case of fistula in the
stomach, that alterations of the female sexual organs regularly produced
also alterations of the digestive functions; for instance, during
menstruation there is always an increased flow of hydrochloric acid. The
same has been found by Fleischer, who noted during this period a
sluggishness in digestion, which improved after menstruation.
Tanecki found dyspeptic troubles in cases of retroflexion of the uterus,
and Eisenheart has observed the disappearance of acute gastric troubles
after a cure of retroflexion.
P. Muller also declares that there are intimate relations between the
sexual glands and the digestive organs. He also observed dyspeptic
troubles during menstruation; and Professor Leyden has noted neuralgia
and hyperæsthesia of the stomach in young girls after menstrual
troubles.
Habitual chronic constipation, which is so frequent after a degenerated
condition of the sexual glands, points to the existence of close
relations between these organs and the intestines.
Based upon clinical observations, we have advanced the theory that
alterations of the ovaries are able to produce alterations also of the
liver, and the circulation of the bile, with formation of gall-stones.
Castration also produces alterations of the thyroid: first, its
hyperactivity with increase of colloid substance, and, afterward, its
degeneration.
Castrated animals or persons seem to offer less resistance to infection,
which may be on account of the connection, as shown by the experiments
of Metschnikoff[103] and others, that the testicles are altered in
infections, which has been shown to be equally the case with the ovaries
(Professor Cornil). The sexual glands, as the ductless glands in
general, have the duty also of protecting the body against the various
kinds of intoxication and infections, as already emphasized.
Footnote 103:
Metschnikoff: Loc. cit.
From the foregoing there can be no doubt that degenerated conditions of
the sexual glands, by producing alterations in important organs,
diminish vitality and the chances of an advanced old age.
This seems also to apply to males, for there is no evidence showing that
any eunuch has reached a very advanced age, whereas there is plenty of
evidence of persons with strong sexual glands having lived far beyond
100 years. The vitality of persons if totally castrated is, as a rule,
diminished.
Again if we study the history of persons who attained the maximum span
of life, we find many evidences of the existence of strong sexual
impulses. Thomas Parr, who lived to nearly 153, has been accused of
having committed a sexual offense in his 102d year, for which he was
found guilty and punished. Reaching even a greater age, his sexual
appetite does not seem to have diminished, for he married, eighteen
years after, a widow, who said she could discover nothing that would
betray his great age.
Drakenberg, a Dane, who is buried in the cathedral in Aarhus, Denmark,
lived 146 years, and reached this advanced age although he was more
often drunk than sober. When he was 111 he married a woman of 60, and
after she died he fell in love in his 130th year with a young peasant
girl; but this blooming flower of the Jutland peninsula, famous for its
fresh and healthy girls, refused her ancient wooer, who, nothing
daunted, tried his luck with several other young maidens but with no
better success; therefore he had perforce to remain a widower, and he
lived an additional sixteen years. Possibly if he had addressed widows
or elderly spinsters, he might have succeeded; but it is very
instructive that this ancient Methuselah insisted on marrying a young
girl, which certainly speaks in favor of strong sexual feelings in so
old a man, and, indeed, we may say it is an object lesson to us to
observe that these ancients were always anxious to marry again so soon
as they became widowers. That it was more than a mere formality, or bond
of platonic affection, was attested to by Thomas Parr’s wife when he was
in his 130th year.
If many children be considered a sign of sexual activity and capacity,
these very old men distinguished themselves in this respect, as most of
them had numerous progeny. Several had a score of children after they
were 80. Peter Albrecht, who lived to be 123, married in his 85th year,
and had 7 children. Another patriarch, Gurgen Douglas, born in
Marstrand, near Gothenburg, in Sweden, who reached to 120 years and 7
months, married in his 85th year and had 8 children, one of which was
born when he was in his 103rd year. This child was an idiot, but as it
is very interesting to note, otherwise physically well developed.
An Italian, Baron Baravicino de Capellis, died in 1770 at Meran, a
climatic resort in the Tyrol (Austria), in his 107th year. He had 4
wives, the first of whom he married when he was 14, and the last when he
was 84. He had 7 children, and it is an interesting fact that his wife
was pregnant when he died.
As an English paper has reported, in 1796 there was a shoemaker, R.
Glan, living near Philadelphia, Pa., who died at 114, and never missed a
Sunday service. At his decease his third wife was but 30, and his virile
powers were normal.
We need not be too skeptical as to the legitimacy of the children of
fathers of such advanced age for reasons we will mention later. Examples
of fathers at ages above 60 or 70 are not so exceedingly rare. A very
good example of this is that of a crowned head of one of the European
countries, married morganatically, who, in his 72nd year, was presented
by his wife with a child, and nobody who is acquainted with the powerful
constitution of this monarch and his predilection for the fair sex will
doubt his happiness as a father. He is noted for his marvelous
intellect, which, again, is so frequently met with in persons with very
active sexual glands.
Several of these ancient patriarchs, at the autopsy, presented a
wonderfully good state of preservation of the various organs. Thomas
Parr died in his 153d year, and his autopsy was made by one of the
greatest physicians in the history of medicine—the celebrated Harvey,
the discoverer of the circulation of the blood. Harvey found every organ
in this wonderful old man in perfect condition. His death was attributed
by Harvey to over-eating, as Parr had always lived a very frugal life.
The King of England invited this astonishing personage to London in his
152d year, as he wanted to know this most interesting of his subjects;
but the rich food he received in the royal household did not prove
beneficial to him, and though his 152 years of frugal life were unable
to kill him, nine months of an opposite style of living succeeded in so
doing.
We should not wish to omit mentioning again the important fact that,
with few exceptions, the persons who lived to such an extraordinary age
were married, and some of them three or four times, which again serves
to show us the great importance of marriage as a means to reach a good,
old age.
We have quoted these instances of longevity from Hufeland,[104] one of
the greatest German physicians of the eighteenth century, of whose
truthfulness there can be no doubt. The great German physiologist,
Pflüger, also quoted some of the above examples of great age in his
address in celebration of the birthday of Emperor William II, at the
University of Bonn. When Parr had been found guilty of a misdemeanor in
his 102d year facts were adduced in the courts which showed that, as
Pflüger says, this “100 jährige durchaus die Eigenschaften eines
Kräftegen jugendlichen mannes besass” (the man of 100 years really had
the qualities of a powerful young man). Pflüger quotes this from
Flourens, and we were pleased to find an account of the autopsy of the
celebrated patriarch in a letter from Harvey, himself, to his nephew,
published by the Sydenham Society[105]: “The body was in such a good
condition in a man of 153 that the cartilages of the chest bones were
not yet ossified.” Harvey put it: “The cartilages were soft and
flexible,” black hair on the forearms, and the organs apparently
healthy. Probably the fact that the testes, as Harvey says, “were sound
and large,” had something to do with it. He was also an affectionate
husband, and to quote Harvey again, “His wife told me that until twelve
years ago he never ceased to embrace her frequently”; that is, when he
was 140 years old! At the autopsy of John Bayley, of Northampton, who
died 130 years old, Dr. James Keill[106] found his testes of large size.
Footnote 104:
Hufeland: Loc. cit.
Footnote 105:
The works of William Harvey, M.D., edition of the Sydenham Society, p.
590, London, 1847.
Footnote 106:
Philosoph. Transactions, xxv., 1706.
We have also knowledge of a very interesting case, that of an Irishman,
an ex-navy man, who, according to the admiralty official statistics, was
113 years old, and whose body was dissected by Professor Cunningham,
Professor of Anatomy of Edinburgh University. As Dr. Cunningham,
himself, told us, the testes were sound and healthy looking, and the
cartilages of the chest bone not yet ossified. Death was not due to old
age, but to a prostate abscess, except for which the body was in good
condition.
Metschnikoff also mentions in his “Etudes sur la Nature Humaine”
examples of old men between 94 and 104 years, who suffered from copious
spermatorrhœa, and in whose semen he has found a great quantity of
spermatozoa. He and Dr. Weinberg observed similar conditions in old dogs
of 18 to 22 years of age, one of whom, just before his death, had shown
marked sexual tendencies.[107] Saverio Spangaro,[108] examining the
testicles of a number of old men, found many of them atrophied, but
others showed microscopically no difference to the testicles of younger
individuals; there were only slight microscopical changes. This again
proves our theory, that old age is not due to the degeneration of one,
but of several glands with internal secretion, similarly to other
diseases of these glands, like diabetes, acromegaly, etc.
Footnote 107:
Essais optimistes, p. 47, Paris, 1907.
Footnote 108:
S. Spangaro: Anatomische, Hefte, Heft lx., p. 630, Wiesbaden, 1902.
The above facts of the preservation of the sexual glands in advanced old
age, proves also the important fact that though the actual age be there,
the symptoms of it may not be very pronounced if but the sexual glands
are in good order. Of course the condition of the other ductless glands
is of importance, for old age must be regarded as the consequence of the
degeneration of the different ductless glands, and not of one gland
alone.
When we consider the splendid health enjoyed by most of these patriarchs
and the good condition of their organs, why should we deny the
possibility that they were disposing of at least one lively
spermatozoön, and thus we shall have no reason to doubt their happiness
as fathers.
We must also add that the truth of the extraordinary age of these
persons has been proved, in most cases, by documents, sometimes even in
courts of law; also by the recollections of very old people who, in
their own early childhood, personally knew them.
That people with strong sexual impulses very often reach a very advanced
old age, we can often observe. There are plenty of examples in the
history of the world. Thus, the greatest debauchery did not prevent
Louis XV becoming very old, and the Emperor Tiberius lived to be 78
after his notorious life. However, in the same way as with alcohol and
tobacco, we would here repeat “Quod licet Jovi, non licet bovi” (or,
“what suits Peter may not suit Paul”).
We may also refer to a few instances coming under our own observation. A
few years ago one of our confrères at Carlsbad died, 96 years of age.
His intellect was perfect, and a few months before his death we had a
consultation together about a patient who was 83, at which he gave
evidence of a wonderfully clear intelligence. In his behavior toward the
fair sex (whom he much admired) he showed a chivalry and gallantry
outvying men of half his age. Up to the last he never failed to attend a
theatrical performance when there was an operetta or a ballet. There was
nothing to prevent his attaining a greater age, but, falling in his
room, he contracted a fracture of the femur, followed by pneumonia,
which put an end to his medical practice, for this wonderful old man in
his advanced years paid his daily visits, which he only intended to
cease, as he said, when he reached 100.
A prominent member of the aristocracy of one of the northern countries
of Europe, who is at present 90 years old, having been reproached
several years ago by his relatives for his amorous advances to the fair
sex, gave the answer, “You do not know what it means to be an old man
with the body of a young man.” This old man still rides on horseback and
still goes shooting. The fact that he looks a handsome man of 60 may be
explained on the basis of our above observation.
In advanced old age the preservation of the sentiments toward the
opposite sex, which allows us to presume the presence, and not yet
extinction, of an internal secretion of the sexual glands, is often
found in combination with a high intellect. This is also proved by the
example of Goethe in his 83d year, for in his old age his intellect
would have been creditable to a man of 30. When he was over 81 he
astonished his audience by the uninterrupted current of his ideas, also
the extraordinary richness of his inventions.[109] Commenting on the
above, Moebius, in an interesting biography on Goethe, says: “From the
physiological standpoint the astonishment evoked by the works of this
old man is almost greater than that about his juvenile activity.” He
finished the second part of “Faust” when he was over 82. As Metschnikoff
says: “It is love that was the greatest stimulant of the genius of
Goethe,” for it is well known that Goethe was an ardent admirer of the
fair sex. When he was 74 he was passionately in love with Ulricke
Lewetzow, who was still in her teens. He danced like a youth when in her
company, and it was at this time that he wrote to his son that he had
never, up to this, felt so well in mind and body. He wanted to marry the
young girl, and the Grand Duke of Saxe-Weimar asked in Goethe’s name for
her hand; but the mother was not willing to allow a marriage between
persons of such divergence in age. So much was Goethe in love with the
young girl that his disappointment contributed to develop a serious
illness (Eckermann). Even when he was much older he again renewed his
relations with Miss Marianne Young, and was then, to a certain extent,
consoled for his disappointment over Miss Lewetzow. He preserved his
admiration for the fair sex until his death, and even in the closing day
of his life in his delirium he called out, “Look at that beautiful
woman’s head with dark curls on a black background!”[110]
Footnote 109:
Eckermann: Quoted after Metschnikoff.
Footnote 110:
Lewes: Vol. ii., p. 372; quoted from Metschnikoff.
A similar retention of the sexual sense we see in the advanced years of
Victor Hugo, whose admiration of the opposite sex continued till his
death. Ibsen, the celebrated Norwegian dramatist, kept up a well-known
correspondence with a young lady whom he met at Marienbad a short time
before he died in advanced old age.
Sometimes in women of extreme age instances are quoted that would seem
to indicate that in them also the activity of the sexual glands may not
have been extinct. It is stated that Ninon de l’Enclos[111] was in her
90th year still so beautiful that a young abbé fell desperately in love
with her. We know an Italian lady of 69 who is still good-looking,
presenting the appearance of 45, and she still menstruates. That she was
sexually active is shown by the fact that she has 12 children. There is
more fire in the eyes of this Italian matron than in many women of half
her age. That the possession of active sexual glands influences the
looks very much can also be proved by the pale, yellow-gray and aged
looks of even young women suffering from serious chronic diseases of the
sexual glands, and also of women who have caused these organs to
degenerate owing to sexual excesses.
Footnote 111:
Quoted from Professor Kisch.
The fact that persons who have attained advanced old age in robust
health and perfect intellect often show signs of preservation of the
sexual glands, permits the inference, especially considering the
foregoing examples, that a perfect condition of these glands is an
important factor toward vitality and long life, for which reason we
devote a long chapter to the best hygiene of the sexual glands (see
Chapter XLIX).
------------------------------------------------------------------------
CHAPTER VI.
ON HEREDITY AND LONGEVITY.
WE occasionally witness the peculiar fact that persons who live very
moderately and eat very sparingly, and who totally abstain from alcohol,
nevertheless become old before their time, while, on the other hand,
there are those who, in spite of having been addicted all their lives to
the pleasures of a bounteous table and unstinted quantity of wine or
spirits, yet enjoy a green old age. We had an opportunity of observing
an old gentleman of 76 (some say he was really older) belonging to our
own profession, with whom we had the pleasure of traveling from Lisbon
to Paris in the same small railway compartment. This gentleman,
notwithstanding his age, was in full possession of all his mental
powers, of which he has given remarkable proofs in his recent
publications which might have well been written by a man younger by some
scores of years, and which, in fact, convey that impression. This
gentleman’s age cannot be gauged by his words, neither was it shown by
the hearty appetite with which he partook of the six courses of the
dinner, nor by the enjoyment with which he disposed of his bottle of
claret; and he smoked a large cigar afterward with such appreciation
that we began to envy the old man. We almost believe that he stood the
long-continuous journey of thirty-seven hours much better than we did,
and we were surprised at his fresh appearance the following morning
after the discomforts of a night in a small berth of the Compagnie
Internationale des Wagons-lits, half the size of the ordinary American
Pullman car berth. We must remark, however, at once, that such instances
as these are exceptional. Nature is always just, and even here we have
an illustration of the Golden Rule, for such persons inherit the health
of their fathers.
Even character and appearance may be inherited by offspring. The height
of parents is, as a rule, though not in every case, inherited by their
children, as also are many features of their external appearance. As we
have seen in the previous chapter, the size of an individual and his
outward appearance are dependent on the internal secretions of the
ductless glands; and as these qualities are inherited, so we may presume
that the properties of the ductless glands, which produce these effects,
may also be inherited; and that this is not a vague supposition is
demonstrated, we think, in a paper we read on the subject of heredity at
the German Congress of Internal Medicine at Leipzig, in 1907, in which
we showed that the alterations of the ductless glands are inherited with
remarkable frequency. Thus Graves’s disease can frequently be inherited,
and the children descended from such parents, especially after puberty,
often have a small goiter. In such cases a slight protuberance of the
eyes can also be noticed; they are frequently very nervous, and any
sudden shock will be sufficient to induce a typical case of Graves’s
disease. Oesterreicher[112] found 9 cases of exophthalmic goiter in one
family. The frequent instances of heredity in Graves’s disease are
insisted upon by Brouwer[113] and other authors.
Footnote 112:
Quoted after Moebius, “Die Basedow’sche Krankheit,” second edition,
1906.
Footnote 113:
Quoted after Oppenheim, “Lehrbuch des Nervenkrankheiten,” Berlin,
1906.
Degenerative changes of the pituitary body may also be inherited. Thus
Bonardi and Schwoner and others also showed cases of acromegaly of
hereditary origin.
Diabetes is, as we have said, a disease of the ductless glands, and we
have especially emphasized, on previous occasions, how frequently, if
not invariably, diabetes originates through heredity. We have also shown
in a communication published in the _Practitioner_, of London, in
October, 1903, that the children of diabetic persons have an inherited
tendency to alimentary glycosuria, which occurs very frequently among
them.
Myxœdematous persons, as a rule, have children displaying symptoms of
congenital myxœdema, and cretins have cretinous children. The very
interesting case has been published of a woman who, until the age of 40,
had two normal children. She then acquired a goiter, and the child that
was born later was a cretin with a goiter (Lanz).
Parents suffering from diseases in which the thyroid has degenerated,
such as chronic tuberculosis, malaria, syphilis, and other cachectic
diseases, have children whose growth is slow, and who remain backward
physically and mentally. Such children easily acquire any infectious
disease. Tuberculosis, as we have shown at the International Congress on
Tuberculosis in Paris, in 1905, is remarkably frequent among them. We
can easily appreciate the fact, if we realize that the children of such
parents in whom the thyroid has degenerated through disease are born
usually with a congenital atrophy of the thyroid gland, which has been
proved by Gamier and Perrando. These children have inherited from their
forefathers the bad qualities of their thyroid, and this will also
explain why such children, when fully grown up, will not remain, as a
rule, for so long a time as youthful looking as other persons who have
inherited healthy thyroids; they early become aged-looking and, also, as
a rule, their lives are shortened owing to their tendency to contract
easily all kinds of infections.
Evidence founded on experiments is at our disposal to prove our
assertion that irregularities of the thyroid are inherited by offspring.
Professor Lanz,[114] of Amsterdam, formerly an assistant of Professor
Kocher in Bern, has extirpated the thyroid gland of goats, and he found
that in each case the young of such animals, as compared with normal
kids of the same age, remained backward in growth. There can thus be no
doubt that the qualities of the ductless glands of the parents are
inherited by their descendants.
Footnote 114:
Beiträge zur klin. Chirurgie, xiv., p. 1, 1905.
We often find diseases of the various ductless glands present among
members of the same families. We can trace, not infrequently, diabetes,
Graves’s disease, etc., and acromegaly, occurring in different members
of the same family, and this will be observed most often in the case of
diabetes and Graves’s disease. Thus I have observed in the case of two
fathers (coming from the same city in Hungary, but belonging to
different nationalities) diabetes, and their daughters had protuberant
eyes; they had a small goiter, and the typical fingers characteristic of
Graves’s disease, emaciated and pointed like those of the Madonna of
Perugino, which have been mentioned already by other authors as symptoms
of Graves’s disease. There was no tachycardia as yet in either of these
two cases which had Graves’s disease. Very probably any mental shock, as
in so many other cases, would here have caused sudden development into
Graves’s disease.
We have already noted that in syphilis and other cachectic diseases such
as alcoholism, malaria, tuberculosis, etc., the thyroid gland becomes
degenerated (Garnier, Hertoghe, etc.), and that the fœtuses of such
parents demonstrate congenital atrophy of the thyroid (Garnier[115] and
Perrando[116]). We can thus understand the observations of Hertoghe, who
found that nearly all cases of infantile or congenital myxœdema were
born of parents suffering from the above-named diseases. Of very great
value, also, is the observation of Professor Pel.[117] He diagnosed a
case of syphilis in the father, myxœdema in the daughter and acromegaly
in the son.
Footnote 115:
Garnier: “Les maladies infectieuses,” Thèse de Paris, 1899.
Footnote 116:
Perrando: “Sulla struttura della Tiroide,” Sassari, 1900.
Footnote 117:
Pel: Berl. klin. Wochenschrift, 44^a, 1905.
As shown by many observers, including ourself, the ductless glands stand
together in a very close relationship, and thus we may find that when
one member of a family shows an alteration of the ductless glands, we
may discover in the same family other members affected by alterations of
the same or other ductless glands. The case of Pel is a fine
illustration of this point; the syphilis of the father with its morbid
influence on his thyroid resulting in the hereditary transmission of a
degenerated thyroid to the daughter, and the consequent supervention of
myxœdema. The son had an altered condition of the pituitary body, and
thus developed acromegaly. The altered condition of the pituitary body
may have been secondary to the previous alteration of the thyroid
inherited congenitally, if we take into consideration the fact that, as
I showed in a communication to the International Congress of Medicine in
Madrid, in 1903, acromegaly is due to primary alterations in the thyroid
which, in the same way as is demonstrated by experiments on animals, may
lead secondarily to alterations of the pituitary closely connected with
the former gland. The qualities of the sexual glands can also be
inherited. Thus, there are cases of mothers whose menstruation began
very early, i.e., at the age of 9 or 10, and lasted until the age of 56
to 60, and who had many children, among whom were daughters showing
similar conditions. On the other hand, we may see difficulties of
menstruation in the mother also inherited by the daughter.
If the bad qualities of the ductless glands are inherited, it is only
logical to expect the same for the good qualities also. It stands on
this basis that we may frequently find longevity in the same family.
Longevity, as illustrated by the many facts adduced in this book from
the field of clinical and experimental observations, is closely allied
with a thorough performance of the functions of the ductless glands,
especially of the thyroid gland; if these are in good condition, and
especially if proper hygiene is also observed at the same time,
longevity will follow. The good condition of the ductless glands is
largely dependent upon a life based on hygienic principles, although
when these glands are of the best quality they may stand a good deal and
not degenerate so soon, even after excessive activity following
injudicious or fast living.
But if a long life be dependent on a good state of the ductless glands
and if the qualities of these are inherited—which cannot be doubted
after the foregoing observations on heredity,—it must necessarily follow
that longevity is inherited too, and this is a fact which can be proved
by a large number of observations.
If we study the history of persons who have lived over 100 years, we
shall find in nearly every case that their forefathers, or their
descendants, or other relatives of the same blood have, as a rule, also
lived to a great age. This will be illustrated by a few examples which
we will now give.
In the year 1724 there died in Hungary in a village called Köprös, about
ten miles from Temesvar, a man, Petraz Czarten, who was 185 years of
age. When he died, his son was 95.
We have already referred to the case of a man named Thomas Parr in our
chapter on the influence of the sexual glands upon vitality and long
life. This man died in 1635 in his 153d year, and after death his body
was dissected by the great physician Harvey. That longevity had existed
in his family was shown by the fact that one of his female descendents
died in Cork, in Ireland, at the age of 103.
In the year 1797, in a village near Bergen, there died a man, Joseph
Surrington, in his 160th year. That he left a young widow, after having
been married several times, is not so extraordinary if we consider the
facts in the chapter in this book on the influence of the sexual glands
upon vitality and long life. When this man died his eldest son was 103
and his youngest only 9!
In a Finnish village near St. Petersburg there lived an old peasant
woman, Maria Willamow. She was born in 1692, and died on September 10,
1807, after having lived 115 years, 9 months, and 4 days; her brother
had already died in 1768 at the age of 108. All her relatives and
descendants were remarkable for their longevity.
Jean Thuret was a soldier, and in spite of having been wounded in
several battles, he lived beyond the age of 104. His mother died when
118 and his uncle at 130. The high old age of many of these patriarchs
is proved by legal evidence. Thus, H. Jenkins, from Yorkshire, has
appeared before a court of justice as witness in a matter that happened
140 years ago. He was accompanied by two sons, of whom one had reached
100 and the other 102 years. Again, conclusive proof of the inheritance
of long life.[118]
Footnote 118:
Quoted after Professor Pel.
To the history of these patriarchs I can add a few personal
observations. My mother’s father lived to the age of 104. He never
smoked and could read without spectacles all his life. He had eleven
children, of whom one (an aunt of mine) is 95, and I have every reason
for believing that she will continue to live yet many years in her
present condition. Another daughter is at present 85; a son is 83, and
another 78.
We are acquainted with the history of the family of a physician in
Amsterdam, in which the great grandfather was 96. He had six sons who,
between them, totaled 600 years, one of them living to the age of 102,
some of the others to 80 and 90; and there is a daughter 79 years of
age.
From the foregoing it seems that persons descended from long-lived
families have themselves a good chance of living to a great age; but to
do this it is essential that they should observe the rules of hygiene to
prevent the deterioration of their ductless glands.
That the observance of good hygiene is of the greatest importance to
attain longevity can be best adduced by the fact that persons descended
from short-lived parents may also attain a green old age in robust
health, as I will show by a few examples which have come under my
personal observation.
Sir Herman Weber, the author of a valuable work on the prolongation of
life, is descended from parents who both died at an early age. This
savant has himself followed the excellent advice he gives in his books
on long life, with what result can be best judged by his healthy and
vigorous looks. His appearance is that of a man many years his junior,
yet Sir Herman was 82 a few years ago when we were together climbing a
very steep and high hill in Carlsbad. When we arrived at the summit
nothing could restrain Sir Herman, but he insisted on also mounting a
lofty tower to see the surrounding mountains, without taking any rest
between his exertions, and this in spite of the warmth of the weather.
On the day that we began to pen these lines we were congratulating one
of the multifarious professors of the medical faculty of Berlin on his
73d birthday. He is in perfect and robust health, and is at present
engaged on the third edition of his work, which is well known in medical
circles all over the world. He told us his father was 33 and his mother
48 when they died, and several of his brothers died before reaching old
age. However, his grandfather lived to be 90. This savant has always led
a sober and regular life.
Sometimes chronic diseases, like syphilis, etc., do not prevent people
who come from a long-lived family from attaining to a very old age. Thus
a patient of mine, a French gentleman of 72 years, who still shows
symptoms of the tertiary form of syphilis acquired fifty-two years ago,
is still looking in splendid health, like a man of 60, and was
complaining to me about his too strong sexual feelings. Likewise, the
father of a patient of mine has reached his 96th year in spite of his
syphilis, which he acquired an age ago.
If we now consider the environments where the longest-lived persons are
found, we shall find that those who always live in the open air, and
also moderately, rising early in the morning and leading day by day the
same regular life, have attained the longest lives. A great number of
long-lived patriarchs can be found among the peasants, or at least among
persons living in the country and out in the fresh air all day.
Undoubtedly the greatest number of long-lived people are to be found in
the British Islands, especially in Scotland. The inhabitants of Great
Britain are well known to appreciate fresh air, and on the Continent we
often see them, especially Scotchmen, going about without any overcoat
even on a cold winter’s day.
We shall see in various chapters of this book how essentially important
is a sound hygiene to ensure long life, and we shall demonstrate in
separate chapters the great importance of fresh air and of exercise in
the open air.
If we would inquire where are to be found the greatest number of persons
over 100 years of age, the palm must be given to Bulgaria, if what is
claimed be true, _viz._, that there are 3800 persons over that age, and
all these folk partake daily of “jogurth,” a sour milk containing three
different microbes, the most efficacious among them being the maeja
bacillus. In Germany, with its 61,000,000 of inhabitants, there are but
71 persons over 100 years old, while Bulgaria, with only 7,000,000,
claims to have 3800, and that it is due to the jogurth eaten every day.
We will deal more fully with jogurth in the chapter on the elimination
of toxic products from the intestines.
------------------------------------------------------------------------
CHAPTER VII.
ON MEANS WHICH CAN HELP US TO DETERMINE THE PROBABLE DURATION OF LIFE.
WE have seen in the first chapter of this book that we may find the
symptoms of old age, in quite early years, in persons whose ductless
glands (the thyroid, ovaries, testicles, liver, kidneys, pancreas,
adrenals, pituitary body) are degenerated by disease; nervous
affections; alterations of the mind: grief, sorrow, etc.; chronic
infections; numerous pregnancies, etc., or by faulty hygienics: excesses
in food, alcohol, sexual pleasures, etc. We have also seen in the third
chapter that the immunity of an individual against infections—be it by
bacterial invasion or by poisonous food or drugs, etc.—is dependent upon
the correct functionating condition of these glands. We have seen that
those in whom these glands are degenerated fall easy victims to all
manner of infections, and the previous chapter on heredity shows that
the same happens to children, the offspring of parents suffering from
alcoholism, tuberculosis, or malaria, as the children of these parents
are born with a congenital degeneration of the thyroid, and thus remain
backward in growth, both mentally and physically, and, especially, fall
easy victims to tuberculosis. Their life is generally short. While such
a sad cloud hangs over the head of persons whose glands are damaged,
either congenitally or by disease, much more favorable is the lot of
those who have inherited healthy glands and by careful living have
preserved them intact, or who, though born with ductless glands not
entirely normal, and possibly bordering on a condition of congenital
myxœdema, have, by suitable treatment and hygiene, succeeded in
improving the condition of their glands.
We have seen that the thyroid influences powerfully the production of
those safeguards of our body against infections—the anti-bodies being,
as shown by Prof. Sajous (1903-1907), beyond a doubt products of
ductless glands—and the better the condition of the glands, the more
protective substances will be produced in order to fight down the
murderous microbes, or organic poisons, which continually threaten us
with destruction. In this fight, a person with healthy ductless glands
will always attain a longer life than one with ductless glands of
inferior quality. The better the condition of the thyroid the greater
will be the activity of those organs that are under its direct command
(e.g., the kidneys, liver, skin, and intestines), and by the increased
activity of the main emunctories of the body poisonous products will be
eliminated by means of a greater flow of urine, an abundant
perspiration, and thorough purging. Also the myriads of toxic products
that are brought from the intestine to the liver will be promptly
destroyed, or transformed into less dangerous combinations.
Thus there can be no doubt that a person with healthy ductless glands,
especially the thyroid and testicles or ovaries, will live long
provided, of course, no other vital organ be irreparably diseased.
The question now arises, by what means can we ascertain whether the
ductless glands are in good condition or not? We will now try to answer
this important question.
We can diagnose a healthy condition of the ductless glands either
directly, by the examination of those glands which are available for a
digital examination, as the thyroid, sexual glands or liver, or
indirectly, by the examination of the state of those functions which are
governed by these glands; e.g., the heart’s action, the pulse,
regulation of temperature, defæcation, diuresis, digestion, activity of
the skin and its glands, condition of the nervous system, etc.
Before entering upon the examination of these glands we must first
ascertain whether our patient comes of a long-lived stock, or, if not,
whether diseases that are particularly harmful to the ductless gland,
and are commonly hereditary, like tuberculosis and syphilis, have
occurred in the family. According to our observation boys more
frequently look like their mothers, and girls like their fathers, and
also inherit their qualities. After having ascertained the family
history, we must inquire whether the patient has had any diseases that
are specially harmful to the ductless glands: e.g., infectious
diseases—scarlet fever, diphtheria, typhoid, etc.—and also ascertain his
usual diet and habits, keeping in mind the bad effects of abundant meat
food upon the thyroid, as well as of certain stimulants like alcohol and
tobacco. As these, if of bad quality and taken in quantity for a long
time, have the most damaging influence on the ductless glands, our
prognosis of a long life will be duly influenced, and in particular
unfavorably for those who come of a short-lived stock, or who have been
weakened by previous infectious diseases. If some persons, otherwise
healthy and of good family history, can with impunity indulge till old
age in wine and tobacco, yet this is not a general rule. Individuals are
known who drank and smoked till over one hundred years of age, but such
cases are rare, and we may quote the Latin proverb: “Quod licet Jovi,
non licet bovi.” Everybody will admit that the expectation of life in
those who are moderate in the use of wine and tobacco and also, let us
insist, of tea and coffee, is much greater than in the immoderate. We
will further deal with this question in our chapters on alcohol and
tobacco.
After having given an exhaustive history of the persons whose probable
lifetime we are trying to determine, we next proceed to the examination
of those ductless glands which are available for direct examination, and
first of all, the thyroid.
The examination of the thyroid gland by palpation is a very difficult
undertaking and necessitates a thorough knowledge of the anatomy and
physiology of the gland. We must bear in mind the fact that, in men, we
generally find only two lobes, the lateral ones, which lie on either
side of the trachea, as the median lobe is generally undeveloped in the
male. The right lobe is usually larger than the left. In women the
median lobe is often well developed and can be distinctly seen in
enlargement of the gland, for instance, during puberty, menstruation,
pregnancy, etc., and especially when a goiter exists which, for reasons
we have mentioned previously, is more common in the female.
When the thyroid shows a considerable swelling, as in goiter, it can be
seen and felt easily, but not always, for cases certainly exist where in
life no thyroid could be felt, and yet at the autopsy a large goiter has
been found. Thus, in a case of acromegaly a thyroid of about 130 grammes
was found by Holsti,[119] though during life nothing could be discovered
by palpation. When a large thyroid can be seen and felt, we are
justified in diagnosing a swelling of the gland; but in cases where we
neither see nor feel it, we are not always justified in stating that it
is not enlarged.
Footnote 119:
Holsti: Zeitschrift für klin. Medicin, p. 272, 1892.
When palpating the thyroid we must note whether it is soft or hard. If
soft, the tissue present is probably parenchymatous in nature and so,
probably, entirely secreting tissue, while a goiter that feels hard may
denote excess of connective tissue, and thus, apparently, an inactive
gland. The presence of cystic formations raises the possibility of a
large quantity of colloid substance, either healthy or degenerate.
Thus, inspection and palpation of the thyroid can give us, to a certain
extent, valuable information; we must, however, not rely entirely upon
the results of this external examination but, especially in cases where
no thyroid can be felt, we must add to the external examination an
inquiry into the condition of those functions which are governed by the
thyroid—we must, in fact, examine the condition of those organs whose
function is dependent upon the internal secretion of the thyroid.
Thus, we must examine the skin and note whether it is dry or moist, and
whether the sweat glands are acting normally. A dry skin, with
diminished perspiration, denotes an inactive thyroid, especially when
excess of subcutaneous fat is present. Excess of fat, of the consistence
of bacon, is characteristic of a greater degeneration of the
thyroid—i.e., myxœdema,—and indicates a great loss of function of the
thyroid gland. Pallor of the face, with round red patches on the cheeks,
and dilated capillaries, are also characteristic signs of such a
condition in its early stages, and so are a wrinkled forehead,
especially with two perpendicular folds, and puffy eyelids. Wrinkling of
the skin of the hands, taken in conjunction with other signs, is also a
point of diagnostic value.
The condition of the musculature can also give us some valuable
information. The thyroid and other ductless glands, as the sexual
glands, govern the tonicity of all the muscles. In children, especially
about the age of puberty, the muscles are firm and elastic, but in later
years, or even in young women, consequent upon various conditions which
are harmful to the ductless glands, such as sexual excesses or numerous
pregnancies, the muscles lose their tonicity and become lax and flabby.
This also occurs in myxœdema arising from other causes. The viscera,
deprived of their muscular support, become displaced, and in this way
arise the various forms of visceroptosis.
Premature grayness is an indication of probable changes in the thyroid.
This is confirmed by the fact that, as a rule, such persons are also
very nervous. Premature grayness constitutes a typical symptom of
myxœdema and hypothyroidia, and as such has been described already by
Hertoghe.[120] Falling out of the hair is also a symptom of importance,
if it appears in early years, especially if it is accompanied by falling
out of the eye-brows and the hair on the back of the head. On the other
hand, Sajous found that in appropriate cases, thyroid extract promotes
the growth of hair, while adrenal extract encourages, besides, the
growth of the eye-brows.
Footnote 120:
Nouvelle: Iconographie de la Salpêtrière, Juillet-Aout, 1899.
In examining the circulatory system we must bear in mind the powerful
influence of the ductless glands upon the circulation, especially that
of the adrenals, thyroid, and pituitary body. As shown by Oliver and
Schäfer, the thyroid secretion diminishes blood-pressure, whereas the
adrenal secretion increases it. Thus, these two glands are antagonistic
and it can easily be understood that if there is not sufficient thyroid
secretion to counterbalance that of the adrenals, the blood-pressure
will increase. If this lasts for some length of time, very serious
effects will follow. Atheroma and arteriosclerosis may ensue, both of
which conditions tend to shorten life. The adrenals can be stimulated to
such over-secretion by mental emotions, which act upon the sympathetic
(splanchnic) nerves. Besides mental emotion they can also be stimulated
by various poisons, such as alcohol, tobacco, or infectious diseases
(see Chapter III). We must keep these facts in mind when we examine the
circulatory system, and we must ascertain the condition of the arteries,
whether soft or hard, and of the blood-pressure. Tortuosity of the
temporal artery in young persons is also a sign of some value. The
condition of the coronary arteries is of the utmost importance. We must
also not forget the fact, that even in severe cases of arteriosclerosis
the pulse may be found soft. Everything will depend upon the examination
of the heart, and special attention must be paid to the second sound at
the aortic orifice, and to any accentuation of that sound.
In the examination of the digestive organs we must pay special attention
to the state of the appetite. Very often with a degenerated thyroid this
may be wanting. The appetite, as shown by Pawlow, is under the influence
of the mind as we will see. With a sad melancholic disposition, as is
often found in persons with a degenerated thyroid, there is insufficient
or no secretion of gastric juice. Besides, in myxœdematous conditions
all glandular secretions are more or less checked. Thus food passes into
a stomach with insufficient gastric juice, remains there in stagnation
and causes fermentation. The stomach makes vain efforts to drive the
food into the intestine. Slowly an atonic condition of the gastric walls
arises, and later dilatation of this organ. The fermenting foodstuffs in
the stomach set up a chronic intoxication of the organism.
Concerning the condition of the intestines we should consider the
chances of long life greater in those persons whose bowels act regularly
and who are never constipated. Such persons are able to eliminate toxic
products much better than those who are suffering from chronic
constipation. The function of the intestines is powerfully influenced by
the thyroid gland, chronic constipation being a typical symptom of all
conditions in which this gland is degenerated, whereas in the opposite
conditions, such as Graves’s disease (exophthalmic goiter), diarrhœa is
common. By giving thyroid gland we can treat successfully those
obstinate cases of constipation, which are based etiologically on such
grounds. Besides the thyroid gland, the ovaries also influence, to a
large extent, the intestines, constipation occurring, as a rule, in
diseased conditions of the female sexual organs.
Flatulency and distention of the bowels are very frequently met with in
women with diseased thyroids or ovaries, and are due to an irritated
condition of the nerves of the intestines.
When examining the nervous system we must inquire for headaches,
especially in the occipital region, migraines, and the previous
occurrence of neuralgia, these being very frequent symptoms in persons
with athyroidia or hypothyroidia. Most characteristic are alterations in
the mental condition. Thus, memory for recent events may be gone. There
may be apathy, with hesitation before every movement, such persons
disliking to move about. They may sit indefinitely in the same position.
As already mentioned in the chapter on the influences of the ductless
glands upon the nervous system such people are frequently somnolent.
Therefore we must inquire about the hours of sleep. Besides sleeping
long, such persons are apt to awake in the night after dreams of a
terrifying nature. Our diagnosis of a condition of athyroidia or
hypothyroidia has often been helped, by inquiring whether such persons
have seen little animals (rats or mice) creeping through the room while
sitting quiet, or before going to sleep. Such a symptom has been
described by Murray,[121] in his book on myxœdema, in the early stages
of this disease; the mind being then so much altered that even manias of
persecution and suicide may arise.
Footnote 121:
Murray: “Disease of the Thyroid Gland,” p. 72, London, 1901.
Neurasthenia is a disease which, as we have tried to show, is very often
based upon changes in the ductless glands, especially the thyroid,
sexual glands, and pituitary body. The same holds good for hysteria.
Therefore the presence of such conditions will influence us in our
judgment as to the future of such persons. In cases of great
nervousness, especially when associated with mental depression, there is
less resistance to infection, for causes already mentioned (see Chapters
III and L). Great mental excitability may predispose to certain diseases
which shorten life, like diabetes, and in people in whom, owing to an
unstable nervous system, there is a frequent increase in the
blood-pressure, the possibility of apoplexy is to be feared, if such
persons are of a plethoric build. The wear and tear of life is certainly
far more felt by persons whose minds are very easily impressed and
excited by events of little importance; and, considering the great
influence of mind upon body, persons, who like a weak tree are easily
beaten down by the smallest storm, will have less chance of long life
than persons who have a better control over themselves and stronger
will-power (see “Hygienics of the Mind,” Chapter L).
Having thus briefly described the principal functions governed by the
thyroid gland: shown how, by observing changes in these functions, we
can judge as to the healthy condition of this gland, let us now see if
any means exists by which we can ascertain the functionating condition
of the other ductless glands.
After the thyroid the sexual glands claim our attention, as these glands
are of the utmost importance on account of their enormous influence upon
the processes of metabolism and the maintenance of life (see Chapter V).
We must first call to mind that their work is essentially under the
influence of the thyroid, changes in which invariably produce changes in
the sexual glands. Thus, in degenerated conditions of the thyroid, we
find impotency in men and sterility in women. In such conditions atrophy
of the testicles, or of the ovaries, can often be found. These clinical
observations can be confirmed by experiments. Thus Lanz[122] found
sterility common in goats whose thyroids had been extirpated. In cretins
an atrophic condition of the testicles, or of the ovaries, is present as
a rule, and such patients very frequently show lack of sexual desires.
Footnote 122:
Lanz: Loc. cit.
Direct examination of the sexual glands can be more easily carried out
in men than in women.
The presence of varicose veins is of great importance, as varicoceles
are generally accompanied by great disturbances of the nervous system,
sometimes even going as far as insanity. Suicide is not unfrequently
committed in such a condition.
After the testicles the prostatic gland must be examined. As direct
examination of this gland is only possible by a painful examination
through the rectum, we shall have to inquire into the condition of the
functions of this gland. We must find out whether there is a flow of
prostatic liquid and semen (frequency of pollution). It must be
remembered, however, that the flow of a little semen in constipation and
sexual abstinence has no importance.
We must specially inquire about previous attacks of gonorrhœa. Examining
the urine in two fractions, we must ascertain whether the first fraction
is as clear as the second. The presence of a few filaments tells a tale
of previous gonorrhœa, but is of no consequence for the prognosis. It
may be, however, that they possibly indicate the presence of gonococci
in the deeper lying glands of the urethra which, after sexual excesses,
can again come to the surface even after years.
Inquiring for gonorrhœa in the past, we must find out whether the
patient was treated by local applications with instruments to the
posterior part of the urethra, this being the only radical treatment of
chronic gonorrhœa. As a rule, every chronic gonorrhœa invades the
posterior part of the urethra and, usually, inflammation of the
posterior part of the urethra involves also the prostatic gland.
The presence of strictures and hypertrophy of the prostate, unless they
occur in connection with a gonorrhœa, are indicative of a faulty
activity of those glands which influence the formation of fatty or
connective tissue in the body, as will be shown. It may indicate changes
in the thyroid, after extirpation or degeneration of which the
connective tissue in the body is increased, to which fact is also
largely due the occurrence of prostatic hypertrophy.
We must inquire as to the passage of urine. An interrupted stream with
pain on micturition may indicate, in elderly persons, a hypertrophy of
the prostate, especially if these pains are more frequent in cold
weather. The bladder must be examined for the presence of stone. The
presence of stone, as also of long-standing gleet and strictures that
are not cured, lessen the chances of a long life, the dangers of
cystitis, and ascending pyelonephritis, and nephritis, hanging, as the
sword of Damocles, over the heads of their unfortunate possessors.
Gonorrhœa, if it occurs frequently and attacks the prostate, is a great
danger both to the mental stability and sexual powers. The presence of
great sexual desires, with more or less impotence, must also be taken
into consideration when we are collecting evidence to find out the
chances of long life in an individual.
Regarding the examination of the female sexual organs and of their
functions, it cannot be the object of these lines to describe how to
conduct a thorough gynæcologic examination. We must limit ourselves to
those points by which we can ascertain the condition of those functions
which are under the control of the ovaries, with special reference to
their internal secretion. Thus, we need merely observe whether the
external sexual characteristics (e.g., breasts, hips, etc.) are well
developed, since these are under the direct influence of the internal
secretion of the ovaries.
A chlorotic condition allows us to draw the inference that a faulty
condition of the ovaries exists (ovarian origin of chlorosis—v.
Noorden), and also of the thyroid, as this gland often shows change in
chlorosis. The extirpation of these glands is followed by a diminution
in the number of red blood-corpuscles and in the percentage of
hæmoglobin. Both of these elements of the blood can be increased by the
use of thyroid or ovarian extracts, as has been noted by several
authorities.
The condition of menstruation can give us valuable information. The late
appearance of the first menstrual period, irregularities of
menstruation, its appearance at irregular intervals, and frequent
disappearance for months, will give us an unfavorable idea of the
ovarian activity, especially when each menstrual period is accompanied
by pain. So will sterility, as this condition is common, not only in
association with ovarian inactivity (if not due to malpositions of the
uterus or impotency of the husband), but also with thyroid deficiency.
On the other hand, too frequent pregnancies or miscarriages will also
unfavorably influence our judgment, as these agencies have, as a rule, a
deteriorating effect upon these important glands, causing their
exhaustion and, at the same time, that of the thyroid. In women with
thyroid insufficiency and general loss of muscular tone, prolapse of the
uterus may be frequent, and also metrorrhagia. As Hertoghe found, we can
stop uterine hæmorrhages in women with thyroid insufficiency by the
administration of thyroid extracts. The history of previous gonorrhœal
infection must be specially investigated, as this disease, if not
treated, which is unhappily so often the case, will always involve the
ovaries, causing their destruction and often their obliteration.
Gonorrhœa in women is far oftener overlooked than in men, as it so often
passes for a simple discharge, until by microscopical examination
gonococci are found, and the ovaries already injured. It is a sad fact
that a large majority of the cases of pelvic disease in married women
are due to infection by the husband, for an enormous number of men enter
upon marriage with gonorrhœa that is imperfectly cured, or not cured at
all. Let us hope that there will come a time when a law will be passed
obliging every man to be examined thoroughly before entering upon
marriage, especially for gonorrhœa and syphilis. Such legal precautions
would soon check the transmission of these diseases to the wife and of
syphilis to the innocent descendants. It may be that thus, to a large
extent, the propagation of some of the greatest scourges of humanity can
be checked, viz.: of tuberculosis, alcoholism, and crime[123] which, as
shown previously, flourish on the soil prepared for them by hereditary
syphilis.
Footnote 123:
Arnold Lorand: “Pathogeny of Crime,” Address to the Philadelphia Med.
Jurisprudence Society. Monthly Cyclopædia of Practical Medicine, 1907.
A total lack of sexual desire in women is not normal, and may indicate
changes in the ovaries. On the other hand, there is an increase of
sexual desire at the period of augmented ovarian activity, as in the
days preceding menstruation. We have had the opportunity of hearing
praise of ovarian treatment from husbands of women with tendencies to
sexual frigidity.
Very valuable information about the activity of the ovaries can be
gained from the examination of the breasts. It must be borne in mind
that the ovaries and the breasts stand in very close relation. Changes
in the ovaries are always followed by changes in the breasts, and it is
a very interesting fact that cases of cancer of the breast have been
cured by extirpation of the ovaries.
Comparing the breasts of an innocent young girl between sixteen and
twenty years with those of women of the same age leading an immoral
life, or of women after many pregnancies or in advanced age, we notice
at once the great difference between the large flabby breasts and the
firm tissue of a young girl leading a moral life. According to our
observations we have described[124] cases of fatty enlargement of the
breasts, following all those agencies which are hurtful to the ovaries,
as masturbation, sexual excesses, many pregnancies, etc. On the other
hand, in degenerated conditions of the ovaries and thyroid, especially
if these conditions are congenital, we may find the breasts quite
undeveloped.
Footnote 124:
International Congress of Medicine, Lisbon, 1906, reported in Presse
médicale, 1907.
After the thyroid and ovaries we will direct our attention to the
pituitary body. Direct examination of this ductless gland being out of
question, owing to its position on the base of the skull, in the _sella
turcica_, we have to judge of its vitality by indirect methods. We know
that by the alterations of this gland a condition is produced, called
acromegaly, characterized by enlargement of the toes, fingers and nose,
prominence of the lower jaw, sinking in of the temple and of the _fossa
canina_ in the cheek-bones, prominence of the occipital bone, etc. As
with all diseases of the ductless glands, besides the extreme form just
described, which constitutes the highest degree of such a degeneration,
there are also marked cases where all of the above deformities are only
slightly pronounced. We must inquire whether the features of such
persons have changed, or the nose, hands, and feet become larger. This
is best determined by comparison of old and recent photographs.
A history of headache, especially nocturnal, of mental change, e.g.,
great susceptibility or symptoms of neurasthenia, taken together with
the external appearances, may aid our diagnosis. The simultaneous
discovery of an ocular lesion (hemianopsia) will confirm our suspicions
beyond doubt.
The pancreas, also, can only be examined by indirect evidences of its
activity. A history of frequent or occasional epigastric colic, of large
quantities of unformed shapeless stools of a yellow or yellow-gray
color, containing undigested fat, together with loss of weight, will
make us think of the possibility of disease of the pancreas. The most
exact proof of such change can only be obtained by microscopical
examination of the fæces.
Examination of the urine for sugar can also tell us whether there is
disease of the pancreas, especially of those parts of the pancreas which
constitute a ductless gland, independently of the rest of the viscus,
namely, the islands of Langerhans.[125]
Footnote 125:
Langerhans: Thèse, Berlin, 1869; G. Lange.
As Mering and Minkowski[126] first showed, every dog whose pancreas is
extirpated invariably becomes diabetic, and this diabetes is similar to
that of man. In many cases of diabetes changes in the pancreas have been
found at autopsy; and although a good number of cases without any
apparent change in the pancreas have been recorded, the cause of these
has been revealed by an American author, Dr. Opie,[127] then of the
Johns Hopkins University in Baltimore. This author has found in a few
cases of diabetes alterations in the islands of Langerhans in the
pancreas. This fact has been confirmed by a good many authors, of whom I
may mention Sobolew,[128] Weichselbaum[129] and Stengel, Sauerbeck, and
others. As is invariably the case, the statements of these authorities
have been attacked by others, as Hanseman, who have found no such
changes in the islets in diabetes. We must, however, state here, that an
apparently perfect anatomical condition of glandular structure after
death need be no proof of a perfect secretory activity during life.
Every epithelial formation, and the islands of Langerhans are of this
nature, must furnish a secretion, and this flows in every gland only
under a nervous stimulation. As Pawlow has shown, the pancreas secretes
under nervous impulse. Therefore the findings of pathological anatomy
cannot show us whether these glands have been secreting properly during
life or not, especially in a nervous disease such as diabetes.
Footnote 126:
Mering und Minkowski: Archiv für exper. Path. und Pharm., xxvi, 1889.
Footnote 127:
Opie: Journal of Experiment. Medicine, p. 827, 1901.
Footnote 128:
Virchow’s Archiv, clxviii, p. 1.
Footnote 129:
Wiener klin. Wochenschrift, 1901-1902.
According to the experiments of Diamare and Kuliabko, the islands of
Langerhans furnish a secretion which aids in the inversion of grape
sugar. We have shown at meetings of the Biological Department of the
Hamburg Medical Society (Germany), and of the London Pathological
Society, specimens of the pancreas of diabetic persons where there were
changes only in the islands of Langerhans and none in other parts of the
pancreas while, in one case, nearly the whole of the pancreas was
destroyed by cirrhosis, but without any diabetes, for in this case the
islands of Langerhans were not changed at all. It is interesting to note
that these changes in the islands of Langerhans were also present in
mild cases of diabetes.
Thus, the finding of sugar in the urine usually indicates the
probability of changes in the pancreas. Even small quantities of sugar,
such as appear only after starchy meals (alimentary glycosuria _ex
amylo_) may be brought into connection with changes in the pancreas; for
Wille[130] found in Hamburg from a large series of autopsies, that in a
considerable number of cases with alimentary glycosuria, there were also
changes in the pancreas.
Footnote 130:
Quoted after Professor Oser: Deutsche klinik., vol. v, p. 158.
We must not forget the very important fact, that even when we find no
sugar we cannot at once exclude diabetes. There are many cases of mild
diabetes which do not show any sugar on an ordinary diet. To recognize
these cases we must give them a test meal of either about three ounces
of grape sugar two hours after a light breakfast of coffee and a roll,
or, as we have recommended in our book on the rational treatment of
diabetes,[131] we must give a test meal of much starchy food, such as
rice and cakes, and examine the urine two hours later. If then no sugar
is found, or not exceeding 0.2 per cent., diabetes may be excluded.
Persons with 0.1 per cent. to 0.3 per cent. of sugar after such a
starchy test meal may be considered as on the border line of diabetes.
Such persons show a diminished tolerance of carbohydrates, and they have
lost the power to consume all the sugar they introduce into their body.
Therefore, especially if they come of diabetic parents, they should
avoid eating much starchy food so as not to develop further this
dangerous tendency.
Footnote 131:
Second edition, Berline, 1909.
Diabetes, in the majority of cases, considerably shortens the patient’s
life. Mild cases of diabetes may however live for fifteen or twenty
years, or often even longer. In predicting the chances of longevity in
diabetic subjects everything depends on the question whether diacetic
acid has been found in the urine or not. This can be easily ascertained
by putting a few drops of a solution of perchloride of iron into a test
tube with the diabetic urine. If diacetic acid is present, the liquid
will become Burgundy red in color, and the deeper this red color, the
greater is the percentage of diacetic acid present. In such cases the
chances are very bad, such patients living on an average for only one to
two years. Exceptions to this rule, however, are not infrequent, and we
know of a case of acromegaly with severe diabetes, who has passed large
quantities of diacetic acid for the last fourteen years.
Cases of severe diabetes, with diacetic acid, can often be easily
recognized by their appearance. They are thin, the cheeks are often
flushed, and they show nearly all the signs of a myxœdematous condition,
as already described, whereas cases of mild diabetes present often
symptoms of hyperactivity of the thyroid gland, as in exophthalmic
goiter. As we have shown, diabetes is often due to an overactivity of
the thyroid gland,[132] as well as to degeneration of the pancreas,
these glands being antagonistic to one another. This is confirmed and
amplified by Sajous, who ascribes one form of diabetes to overactivity
of the adrenal system, which includes the thyroid gland. Overactivity of
the latter organ may also be followed by its exhaustion, with symptoms
of myxœdema, as is the rule in severe diabetes.
Footnote 132:
“Die Entstehung der Zuckerkrankheit,” Berlin, 1903, and its French
translation, Maloine, Paris, 1904.
Patients with mild diabetes often have a fresh look and a rosy face, and
very frequently look much younger than they are. We believe that the
healthy working condition of their thyroids has something to do with
this fact.
The pancreas is a very important organ for the maintenance of life as it
produces certain bodies (enzymes) which are of enormous importance in
the assimilation of food. One of these bodies (they are three in
number), helps the assimilation of albuminous products and is called
trypsin. It also plays an important rôle in the treatment of cancerous
growths. Besides this the pancreas produces an enzyme that helps the
assimilation of the carbohydrates (amylopsin) and another that is
indispensable for the perfect assimilation of fat (steapsin).
As we have shown by experiments made in the laboratory of Professor
Minkowski (then in Cologne), the pancreas stands in definite relation to
the thyroid. These two glands seem to be antagonistic to one another,
for on extirpation of the pancreas of three dogs, thus rendering them
diabetic, in every case the thyroid showed a condition of hyperactivity,
whereas in one case, after previous extirpation of the thyroid, the
pancreas showed an enormous number of islands of Langerhans—(thirty-six
to forty in one field).[133]
Footnote 133:
Comptes-Rendus de la Société de biologie, Paris, 25 Mars, 1904.
It was also of great interest, that each diabetic dog ceased to
eliminate sugar two days after extirpation of the thyroid.
As with the thyroid, the pancreas has also very important relations with
the liver. Dr. Steinhaus found, in a research conducted in the
laboratory of Professor Minkowski, that in a large number of cases of
hepatic cirrhosis there were also similar changes in the pancreas.
Similar observations have also been made by Opie, Amato, Kliffel and
Lefas,[134] and others. This may be the reason that in diseases of the
liver we have had good results from the administration of pancreatic
extract. In every case we have found a better assimilation of food, and
especially a better appetite. This stomachic effect of pancreatic
extracts we have found in nearly every case and even when the patients
were not suffering from pancreatic or hepatic disease. (See also Chapter
LIV.)
Footnote 134:
Revue de médecine, 23, 1903.
Still more than the pancreas is the liver indispensable for the
maintenance of life. It destroys the deadly poisons which are conveyed
to it by the portal vein for neutralization. Besides this it produces
certain bodies which help to destroy poisons arising from the
decomposition of albuminous food. (See also Chapter XIII.)
The liver also produces certain bodies, as urea, which play a very
important part in metabolism, and it also serves as a large depot for
glycogen, the stored sugar of the body. The liver forms a large amount
of glycogen, and stores it up for the wants of the body. By a ferment,
also produced by the liver cells, the glycogen is transformed into
sugar, and in this form is given off to the body. If the liver were
extirpated the blood would contain no more sugar, as was found by
Minkowski through experiments on animals.
Besides sugar, the liver also produces, as just mentioned, another very
important substance, and this is urea. This body is produced in the
liver from ammonia, which, as the final product of decomposition of
albuminous substances, is brought to the liver by the blood. From
carbamic acid, also, the liver forms urea. Ammonia and carbamic acid are
poisonous products which arise from the decomposition of albuminous
material, and, by transforming them into urea, the liver saves our body
from continuous intoxication. Thus we can see that in diseases of the
liver the quantity of urea falls and the elimination of ammonia
increases. A normal man eliminates about thirty to forty grammes of urea
in a day. Much smaller quantities per diem would thus indicate
diminished activity of the liver.
Besides glycogen and urea, the liver also produces another substance,
which is indispensable to the perfect process of digestion and
assimilation. This is the bile. The bile transforms fat in the intestine
into an emulsion, and thus makes it possible for the fat-splitting
ferment of the pancreas to act upon it, and to split it up into glycerin
and fatty acids, and thus make it serviceable for the uses of the
organism. The bile augments the action of the pancreatic ferments; it
stimulates the movements of the intestine, and is a powerful antiseptic
to the contents of the intestine, as it hinders to a certain extent
their putrefaction. Another important action is that it increases the
water content of the fæces, and thus materially helps an easy evacuation
of the bowels.
After having thus briefly passed in review the important functions of a
healthy active liver, let us now say a few words about its examination.
The liver is one of the few ductless glands which are available for
manual examination by percussion and palpation. We must ascertain if it
extends considerably below the costal margin, and by palpation we must
ascertain whether the enlarged liver is soft or hard and cirrhotic. In
the former condition we can diagnose hyperactivity of the liver,
probably due to its efforts to safeguard the body against a
long-continued intoxication, as may be the case in those who overeat,
and also in long-continued digestive troubles, especially with
dilatation of the stomach, chronic constipation, etc. Following on this
hyperactivity, as is the case with all organs, there may come an
exhaustion, more especially after long-continued intoxications. Thus in
chronic alcoholism a simple hypertrophy of the liver may go on to
cirrhosis, and later the hypertrophy may be followed by an atrophy, with
all its harmful consequences, as ascites, etc.
On examining the liver we must not forget the sclerotics, and must note
whether, on looking upward, there is any yellow discoloration.
While palpating the liver we must specially note whether it is tender,
and also if the gall-bladder is tender. This is a typical symptom of
chronic inflammation of the gall-bladder, or cholecystitis, which is so
frequently associated with gall-stones. We find such a tender
gall-bladder very frequently in elderly women, in whom gall-stones are
particularly common. In fact, they occur so frequently that Halck[135]
in Copenhagen, found them in 29 per cent. of 4140 autopsies on persons
above 50 years of age. However the mere presence of gall-stones does not
constitute gall-stone disease, the essential point being an inflammation
of the gall-bladder and bile-ducts. Such an inflammation of the
gall-bladder is revealed by tenderness on pressure with the examining
hand. It is a frequent symptom of all those conditions (as we have found
and communicated to the French Congress of Medicine, 1905) in which the
thyroid or sexual glands are diseased. For instance, after pregnancies,
after infectious diseases in old age, etc., it is often accompanied and
preceded by obesity, which is also a consequence of inactivity of the
thyroid and sexual glands. Frerich, many years ago, observed enlargement
of the liver and a tender gall-bladder in women at the climacteric, and
many other authors have made similar observations. Hertoghe found such
conditions common in women suffering from inactivity of the thyroid or
hypothyroidia.
Footnote 135:
Quoted from Hoppe-Seyler in Nothnagel’s “Practice,” p. 548, 1904.
It has been found by experiments, made by Blumenthal and Jacobi, that
extirpation of the thyroid is followed by a dilation of the
gall-bladder, and many authors have noted the presence of biliary
constituents in the urine of animals whose thyroid has been extirpated.
We can readily understand why women with changes in the thyroid and
sexual glands are so often attacked by gall-stone disease. In these
women there is, as a rule, atony of the intestines, with habitual
constipation. This intestinal atony is also accompanied by an atony of
the gall-ducts, and so the bile is more or less stagnant in these ducts.
As shown by Morat and Doyon,[136] the gall-ducts contract rhythmically
every ten to twenty seconds, and the bile is thus expressed. The
periodical compression of the liver by the diaphragm at each inspiration
also helps this expression of the bile. Thus it flows under a certain
pressure through the choledochus, and it is easy to understand that the
billions of microbes which infest the intestines, will have great
difficulty in passing the narrow and tortuous passages of the bile-ducts
through which bile is circulating at great pressure. And this is of the
utmost importance, for if microbes are able to pass the common duct and
thus enter the bile-ducts, they will set up inflammation, as was shown
by several French authors: Gombault, Charcot, Gilbert, etc.
Footnote 136:
Traité de Physiologie.
Inflammation of the bile-ducts plays a most important part in the origin
of gall-stone disease, for, as Naunyn and his pupils have shown,
inflammation of the bile-ducts leads to a precipitation of cholesterin,
and so to the formation of gall-stones.
In women gall-stone disease is more frequent than in men. This depends
upon the greater frequency of diseases of the thyroid and sexual glands
in women. Changes in the sexual organs produce an irritation of the
splanchnic with checking of the peristaltic movements of the intestine
and, at the same time, relaxation of the muscular coat of the
bile-ducts. Thus there arises a deficient expression of bile, and
stagnation follows, with invariable immigration of bacilli producing
inflammation and precipitation of cholesterin and gall-stones. For the
above-mentioned reasons constipation is far more frequent in the female,
and constipation, being always accompanied by atony of the bile-ducts
with stagnation of the bile, directly exposes to the risk of gall-stone
disease.
In men gall-stone disease may often be considered a manifestation of old
age. It appears, as a rule, after the fortieth year, and is often
brought about by previous infectious diseases. In such cases obesity
often develops first, and later gall-stone disease. For those who are
interested in this subject we would refer to our communication[137] on
the origin of gall-stone disease following changes in certain ductless
glands. Considerable, sometimes enormous, loss of weight is a very
frequent symptom of gall-stone disease, and is probably due to
pancreatic alterations.
Footnote 137:
Archives générales de médecine, Octobre, 1905, and Monthly Cyclopædia
of Practical Medicine, 1906.
Gall-stone disease may be regarded as of great importance in estimating
an individual’s prospects of longevity, and at the same time as a
pathological manifestation of an inactive thyroid, or deficient sexual
glands in women. This applies equally well to the cause of renal colic,
gravel, which was found by Professor Sajous to be prevented by thyroid
preparations and a suitable diet.
Constipation, an important predisposing cause, has been shown to be an
expression of such conditions. The truth of these assertions is proved
by experimental evidence.
Extirpation of the thyroid provokes important changes in the liver. In
myxœdema there is a condition of hepatic cirrhosis, as shown by
Prun-Hudden, Vermehren,[138] and others. Two years after we had shown
that the thyroid and liver stand in close relation to one another,
Professor Neusser, of Vienna, brought forward the same conclusion at the
German Congress of Internal Medicine in 1906.
Footnote 138:
Over Myxœdemet, Kjöbenhavn, 1895.
Another important gland that has a very close connection with the
thyroid is the kidney. A direct examination of this organ is not
possible, but we have means of readily judging of its efficiency by
observing how it performs its function. This is to eliminate waste and
poisonous products from the body by means of its secretion—the urine.
Thus from the examination of the urine we may gather all the information
necessary about the activity of the kidneys.
In examining the urine we must first pay attention to its appearance,
the daily amount, and its specific gravity. Less than about two pints a
day of a light colored urine, with a specific gravity below 1020,
indicates a faulty action of the kidneys, and the possibility of a large
amount of toxic products being retained, instead of being eliminated.
Such a urine can often be seen in cases of thyroid insufficiency, as
this condition of the thyroid causes a diminution in the activity of the
kidneys. As we have shown in a communication to the Paris Biological
Society,[139] the thyroid and the kidneys are very closely related,
changes in the thyroid always being followed by changes in the kidneys.
Thus it was found by Albertoni and Tizzoni, by Blum and others, that
extirpation of the thyroid is followed by fibrosis of the kidneys.
Interstitial nephritis is the rule in myxœdema, and is very frequent in
all conditions with insufficiency of the thyroid. In such patients the
quantity of urine is diminished, and also its specific gravity, as well
as the quantity of urea and uric acid, which in consequence are retained
in the body.
Footnote 139:
Loc. cit.
The quantity of the eliminated uric acid being diminished, its retention
in the body explains why gout is so frequent in people with thyroid
insufficiency, and why these persons so often complain of rheumatic
pains. As we have shown in our above-mentioned communication, gout is
due to a degenerative change in the thyroid and kidneys, with retention
of uric acid as a sequel.
The presence of albumin in quantities greater than 0.5 gramme to the
liter is of grave import, and denotes important change in the kidneys.
Smaller quantities, or just a trace, may not be of great importance.
Traces of albumin occur from a great number of causes, and are often due
to the passage of toxic products through the kidney which this organ
eliminates, as one of its main functions is to eliminate toxic products
from the body.
More serious than small quantities of albumin is the appearance of casts
and renal epithelium. These, if present, indicate a destructive process
in the kidneys. Even the occasional occurrence of hyalin casts is not
without danger, for, according to Professor Senator,[140] of Berlin,
hyalin casts are formed by degeneration of the epithelium of the
convoluted tubules, which play an important rôle in the separation of
solid products from the blood into the urine. The loss of these
structures means a hampering of the most important function of the
kidneys. Even when we find only one such cast in one or two specimens,
we must not forget that a pint of the urine may contain a very large
number, and thus every day large quantities of valuable kidney elements
are wasted and one of the most important functions in our body is
hindered. Therefore we must not pass by such a condition of things
without serious thought for the future of such persons. The length of
their lives will largely depend upon their diet, just as in cirrhosis of
the liver. If these persons are addicted to an abundant meat diet, their
chances of longevity will certainly be smaller than with milk and
vegetable food. As we have seen, the liver is constantly dealing with
poisons arising from the decomposition of albuminous food, especially
meats. The kidneys are destined to eliminate such products from the
blood and pass them out with the urine. We will treat of this subject
later in a separate chapter.
Footnote 140:
Die Erkrankungen der Nieren, second edition, Berlin, 1906.
In patients with diseases of the kidneys, the condition of the skin is
of the utmost importance, as the skin is our second kidney. Therefore
patients with thyroid insufficiency have less chance of a long life if
their kidneys are in any way incapacitated.
Besides the above-named vital organs, there are certain portions of our
anatomy which are also of importance in the determination of our chances
of life. Take, for example, the nose. In the children of parents with
degenerated thyroids there is a great tendency to adenoid vegetations.
These are, strictly speaking, not a disease of childhood alone, for
often they may be met with in adults, even in middle age. If large they
necessitate breathing through the mouth instead of through the nose,
especially at night. Such children are liable to frequent catarrhs, and
what is more serious, to pulmonary troubles. They are also liable to
suppurative otitis media and frequent attacks of tonsillitis. These
frequent attacks of tonsillitis may constitute a serious danger, as they
may induce an inflammation of the kidneys. As a rule, in such cases the
nephritis passes off in a few days, often without being recognized, the
symptoms being ascribed only to the tonsillitis. Although the acute
symptoms may have disappeared and nothing remain but a few red
blood-corpuscles in the urine and occasionally a few casts and
epithelial cells, yet under the ashes the fire may still creep on and
chronic nephritis develop. In fact, a good number of cases of chronic
nephritis whose origin is wrapped in mystery are due to such a
tonsillitis.
The condition of the teeth must also be inspected, for people without
sufficient teeth cannot chew their food properly, and thus gastric and
intestinal catarrhs may arise.
Just as important, if not more so, than the condition of the
above-mentioned vital organs, is the mental state. Thousands of years
ago it was a manifest truth that the mind governs the body. In judging
an individual’s chances of long life, we cannot omit the importance of
his mental character. As a rule a man with a well-balanced mind, who is
not disturbed by the smaller worries of life, has more chances of a
green old age than a man whose easily impressionable mind exposes him to
continual agitation and anxiety, and who is overwhelmed by the slightest
untoward event. A man who is a born optimist and who views everything in
a rosy light, has got far more chance than a pessimist who sees
everything in a cloud. A man who is ambitious and never satisfied is
more liable to mental and physical change than one who asks for little
and easily gets it. Being disappointed in his ambition, as so often
happens, he becomes despondent, especially if he is lacking in
will-power, which depends on the activity of the thyroid as previously
mentioned. In this condition he may not only lose his appetite and
become ill-nourished, but he is also more liable to succumb to the
incessant attacks of microbes, among which he lives, and which gain easy
access to the body in melancholic conditions. Sorrow may act in the same
harmful manner.
The chances of a bachelor or spinster for a long life are always less
than those of a married person. Single people are more subject to
nervous change and digestive troubles, and have a greater tendency to
become despondent and melancholic. In bachelors, also, the acquisition
of contagious diseases is a continual danger, and when they get older
after their former merry lives, if merry it was, gloom invariably
follows. Married life is the best guarantee for a long life and happy
old age (see Chapter XLVIII).
Before closing this chapter we would state that it was not our intention
to give a description of the physical examination of a patient from the
point of view of life insurance, but to indicate certain points which
must guide us in forming an opinion on a person’s chance of longevity.
All vital phenomena are under the influence of the internal secretions
of the ductless glands, which govern every organ of our bodies.
Therefore everything depends upon finding out the condition of these
glands. Any well instructed physician can make a thorough examination of
the different organs of the body for the purposes of life insurance;
therefore we did not think it necessary to describe here the examination
of the heart or lungs, etc.
By such examination of the ductless glands we are not only able to
forecast the approximate length of life, but we are able to judge a
patient’s power to withstand disease when we are called to his bedside.
If we find the ductless glands of such a patient (especially the thyroid
and adrenals, kidneys and liver) in good working order, we can predict a
successful and rapid termination to the malady. It is easy to understand
that any one with a healthy skin, normally acting bowels, and plentiful
urine, will more readily eliminate poisonous products than a person with
a dry skin, constipation, and scanty urine. Also his tissues will be in
better condition, and in the case of wounds granulations will more
quickly form and fractures heal readily with firm callus.
Such an examination as the above can, however, also help us, as we
readily shall understand, to foretell the chances of a person as to the
prolongation of youth and the retardation of old age.
------------------------------------------------------------------------
CHAPTER VIII.
ON THE CAUSATION OF OLD AGE.
WE have seen in the first chapter of this book that the symptoms of old
age may appear in quite young persons after changes in the ductless
glands, especially the thyroid, ovaries, testicles, etc. We have also
shown how these glands influence the condition of the tissues, and our
external appearance, our immunity from infections and intoxications, and
the condition of our nervous system and mind. We have also seen how
these wonderful glands influence the length of our life and our
prospects of a green old age, and thus it is evident that these glands
are in close relation with the origin of old age. It is justifiable,
therefore, to enter fully into a discussion as to whether old age is
really due to degeneration of the ductless glands, which supposition
must have occurred to anyone who has read the previous chapters of this
book.
Sir Victor Horsley, of University College Hospital, London, was the
first to bring old age into causal relation with degeneration of the
thyroid, and after him Vermehren and Ewald of Berlin.
In a communication we made to the Biological Society at Paris, December
4, 1907, we showed that old age is not alone due to degeneration of the
thyroid, but to changes in several ductless glands, of which the chief
are the thyroid, ovaries, testicles, adrenals, and pancreas. In a
communication to the International Medical Congress in Lisbon, in 1902,
we added to these glands the liver and kidneys, which also possess an
internal secretion.
Let us now see if there is any evidence in support of such a statement.
As we shall show, such proofs do exist and they are of a pathological,
anatomical, experimental, and clinical nature. To begin with, it is a
well-established fact that at a certain age the different ductless
glands show important changes, notably an increase of connective tissue,
with subsequent degeneration of the secreting tissue.
Sir Victor Horsley[141] found that the thyroid gland, after a certain
age, shows an increase of connective tissue, with fatty degeneration of
the epithelium and shrinking (concentration) of the contents of the
follicles. Hale White[142] also, examining at autopsy seventy thyroid
glands, found an atrophic condition in old subjects, an atrophy which is
more marked the older the subject, and that these changes are already
present in the thyroids of persons fifty years old.
Footnote 141:
“On the Thyroid and Pituitary Bodies,” British Medical Journal, 1890,
and Proceedings of the Royal Society, 1886.
Footnote 142:
Hale White: Med.-Chirurg. Transactions, vol. lxxi, 182.
The thyroid, together with the parathyroids, have been found degenerated
in old age by Erdheim.[143] Bauman found only very little iodine in the
thyroid of aged persons.
Footnote 143:
Beiträge zur path. Anatomie, xxxiii, p. 158, 1903.
Let us add that, luckily, not every thyroid shows important changes
after the age of forty or fifty, although there is usually a slight
increase of connective tissue at that age. On the other hand there are
thyroids in subjects of advanced age which show no important
degenerative change. This, however, is, according to our experience at
autopsies, a very rare occurrence. The point of main importance is the
amount of colloid substance present. A thyroid with much colloid, if it
is of normal quality (which can be recognized by the way it stains with
eosin), is a thyroid of good activity. As we know, the thyroid contains
more iodine than any other part of the body. The main bulk of the iodine
in our body comes from the thyroid. It follows from the investigations
of Docent Oswald,[144] in Zurich, that the quantity of iodine in the
thyroid depends upon the amount of colloid substance. Hence a thyroid
with much colloid substance contains much iodine, and a large goiter
composed of connective tissue alone and containing no colloid, cannot
contain any iodine.
Footnote 144:
Oswald: Zeitschrift für physiolog. Chemie, 1899, and Virchow’s Archiv,
169, p. 444, 1902.
Differing with a famous French physician who said that the age of a man
depended upon his arteries, we would state that it depends upon the
quality of his thyroid. For the condition of the arteries, as we have
shown in different parts of this book (Chapters II and VI), depends very
much upon the condition of the thyroid gland, which governs the whole
circulatory system.
The parathyroid glands, which are in relation with the thyroid, and
changes in which may produce cramps, as shown by Jeandelize,[145]
Pineles,[146] etc., also present an increase of connective tissue, with
fatty degeneration of the epithelium, in old age, as was shown by
Erdheim,[147] of the Vienna Pathological Institute.
Footnote 145:
L’insuffisance thyroidienne et parathyroidienne, Paris, 1904.
Footnote 146:
Grenzgebiete f. Med. Chirurg., 1905.
Footnote 147:
Erdheim: Loc. cit.
As is well known, the ovaries also, between the ages of forty-six and
fifty, undergo important changes and involution, with consequent
cessation of the menses. There is an increase of connective tissue with
degeneration of the epithelial structure. There is also a retrograde
metamorphosis of the Graafian follicles into fibrous tissue. The
testicles have been found atrophied in old age by Professor
Langhans,[148] but there are many exceptions, as shown by S.
Spangaro.[149]
Footnote 148:
Langhans: “Hoden Atrophie,” Handbuch der Deutschen Chirurgie,
Stuttgart, 1887.
Footnote 149:
Spangaro: Anatomische Hefte, lx, 1902.
As Sajous[150] and we[151] also have shown in our already cited
researches, that the various ductless glands are closely related, and
thus changes in the thyroid are always accompanied by changes in the
other ductless glands. This rule applies to the present case and after
senile changes in the thyroid, with increase of connective tissue, the
other ductless glands also show similar changes. These are found in the
pituitary body, the adrenals, the liver, and kidneys. We have several
times insisted upon this fact in various chapters of this book.
Footnote 150:
Sajous: Loc. cit.
Footnote 151:
Loc. cit.
The adrenals of old people have been examined by Minervini,[152] and he
found a true cirrhosis of these glands which had included nearly the
whole gland. He also found drops of fat in the cells of the medulla.
Dellamare[153] found a hypertrophic condition of this gland in old age.
Footnote 152:
Minervini: Journal d’anat. et de physiol., p. 449 and p. 639, 1904.
Footnote 153:
Dellamare: Soc. de biologie, 17 Octobre, 1903.
In nature every cause has a sequel. Therefore, when we see such
important changes in glands with internal secretions, there logically
must be sequels to the alterations in these important organs. And these
exist. When the thyroid is degenerated, to a greater or less extent all
those symptoms appear which are characteristic of changes in the
functions governed by the thyroid, and of which we have spoken in
previous chapters.
Therefore, when the thyroid is degenerated, symptoms appear which are
characteristic of myxœdema. And, indeed, Sir Victor Horsley was the
first to draw attention to the fact that in old age we find all the
symptoms of myxœdema; and after him, Vermehren[154] and Ewald.[155] They
have compared the symptoms of myxœdema with those of old age, and found
the two conditions very similar. According to our own observations the
most prominent of these corresponding symptoms are:—
Footnote 154:
Studier over Myxœdemet, Kjöbenhavn, 1895.
Footnote 155:
Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch,
Vienna, 1896.
The wrinkles on the face and the drooping of the lower eyelids, in
extreme cases amounting to ectropion. Then the great number of wrinkles
on the hands of myxœdematous people, even at an early age, and the
feeling of cold in the hands and feet and their bluish color.
With advancing age, obesity is often the first symptom, just as in
myxœdema, and, as we have said above, obesity can be caused by
degeneration of the thyroid and sexual glands.
The hair in both conditions is very often gray, and there is atrophy of
the papillæ of the hair and of the sebaceous and sudorific glands, with
dryness and falling out of the hair.
Constipation or irregularity of the bowels is also common. There is
often great fatigue, slow speech, and an apathetic condition in both
these states. The memory shows the same typical deficiency, events of
long ago being more easily remembered than those of quite recent date.
The character of the patient becomes egotistical and avaricious. There
is great sensibility to cold and difficulty in keeping warm. The urine
is generally below the normal quantity; often it is scanty and of low
specific gravity, with retention of solid constituents. The processes of
oxidation are diminished both in typical myxœdema and in advanced old
age. There is a diminution of the blood-corpuscles and of hæmoglobin in
both conditions.
After the initial obesity in early myxœdema and old age, there comes as
a second stage a loss of fat, characteristic of the advanced stage of
myxœdema (the cachectic stage) and advanced old age.
There is an increase of fatty tissue after extirpation of the thyroid
gland, and later of connective tissue, just as in myxœdema and old age.
This increase of connective tissue is typical of old age. It first
appears in the arteries, leading to atheroma, and the typical symptoms
of arteriosclerosis. In myxœdematous persons, although they may still be
young, we find atheromatous arteries and arteriosclerosis. Impotence is
common in myxœdema, especially in advanced cases, and is also found in
senility, being more marked the greater the patient’s age.
There is no denying the fact that in old age we find, besides
degeneration of the thyroid, symptoms of degeneration in various other
tissues and functions, and the question now arises, whether these
changes in the tissues are really the sequel of previous degeneration of
the ductless glands, or whether both are only accidental and in no
causal relation We have already answered this question four years ago in
our communication to the Paris Biological Society, showing that old age
is due to degeneration of the ductless glands, and stating that these
glands govern the tissues and not _vice versa_. Still, we shall enter
here more fully upon this question, showing by experimental and clinical
evidence that the changes in the ductless glands are primary, and
followed by a degeneration of the tissues as a consequence.
We can produce experimentally typical symptoms of old age in young
animals by extirpation of the ductless glands, more especially the
thyroid, ovaries, and testicles.
When we extirpate the thyroid gland of an animal we get an increase of
fat in the subcutaneous tissue, or an increase of connective tissue. We
know of the case of a young bull which, two months after extirpation of
the thyroid, gained about thirty kilos in weight, due to an increase in
fat. The same thing occurred in a colt. We are indebted for our
knowledge of both these cases to Dr. Hertoghe, of Antwerp, the
well-known authority on the thyroid gland.
After extirpation of the thyroid gland prominent writers have found a
diminution in the processes of oxidation; and by thyroid gland feeding
we can augment these processes, as was shown by Vermehren, Magnus-Levy,
Thiele, Nehring, and many others. This property of the thyroid gland is
made use of in the medicinal treatment of obesity. Since writing these
lines we have observed a loss of forty pounds in a man, a patient of
Professor Launois, of Paris, who, after this loss, felt better. We
treated him in Carlsbad for six weeks with thyroid extracts, and the
average loss was about a pound a day. True, this patient was also taking
Carlsbad water, but we have never seen so considerable a loss due to
this water alone. The diet of this patient had not been strict. This
loss of weight, then, is mainly to be ascribed to the thyroid treatment.
This treatment is dangerous, however, unless carefully regulated by a
physician.
Thus extirpation of the thyroid is undoubtedly in causal relationship to
obesity, which, as already mentioned, is often the first symptom of old
age. But it also can produce another sign of old age, and this is the
increase of connective tissue in the various organs and tissues. That
connective tissue formation is an attribute of old age has been clearly
shown by Demange and Oettinger, who found at every autopsy on old
persons an increase of connective tissue in the walls of the
capillaries. Ord and Mahomet found exactly the same thing in the
capillaries of persons suffering from myxœdema. This has been proved
experimentally by Professor Eiselsberg,[156] of Vienna, who found
atheromatosis of the aorta and other blood-vessels in dogs whose
thyroids he had removed.
Footnote 156:
“Die Krankheiten der Schilddrüse,” Stuttgart, 1901.
This increase in connective tissue has been found in various viscera
after removal of the thyroid; thus it was found by Kishi[157] in the
liver of one hundred and fifty dogs and monkeys. Rosenblatt and
Jeandelize[158] also described an interstitial hepatitis in similar
cases.
Footnote 157:
Virchow’s Archiv, p. 260, 1904.
Footnote 158:
Loc. cit.
The same change has also been noted in the kidneys after extirpation of
the thyroid (e.g., Blum[159] found an interstitial nephritis), and in
the brain an increase of neuroglia occurs, as observed by Blum, Walter
Edmunds, and others.
Footnote 159:
Blum: Loc. cit.
Increase of connective tissue in the skin is a common occurrence after
thyroid extirpation, and the name “myxœdema” is probably derived from
the fact that in some cases, as the disease advances, the connective
tissue is transformed into a mucinoid substance. The name “cachexie
pachydermatique,” as suggested by Charcot, seems to be far more
adequate.
Formation of fat and of connective tissue is not only seen after removal
of the thyroid, but can also be observed after extirpation of the sexual
glands, the ovaries and testicles.
As mentioned in Chapter II, Loewy and Richter,[160] of Berlin, observed
that removal of the sexual glands always produced a diminution of the
oxidation processes.
Footnote 160:
Archiv für Anat. u. Physiol., Supplement, 1899; and Ergebnisse der
Physiologie, ii, 1902.
The experiments of Prof. Loewy and Prof. P. F. Richter are not
invalidated, in our opinion, by the experiments of Lüthje, who did not
find an increase in metabolism after ovarian feeding. The reason for
this may be that he was not in possession of active extracts. Anyone who
works with animal extracts knows what a great difference there is
between various organo-therapeutical preparations, some being more
efficacious than others.
As a rule castrated animals take on fat, and this fact has for many
years been made use of by farmers. At the same time the flesh of such
animals acquires a better flavor, the pronounced flavor of the meat of
non-castrated animals being objectionable to some consumers. This
demonstrates the very instructive fact that the internal secretion of
the testicles has its effect on all parts of the body.
Castration in man is very frequently followed by obesity and symptoms of
old age. Thus the eunuchs of eastern countries are very often fat and,
at the same time, look much older.
The influence of the ovaries upon fat formation can also be shown by
their therapeutical action in obesity. Although not so active as thyroid
extracts, we have found that by the combined use of thyroid and ovarian
extracts, we could produce a considerable loss in weight, when, by
thyroid treatment alone, we could not obtain it. This, however, is only
in the case of women. We will treat of this subject more fully in the
chapter on ovarian treatment.
Besides the above-mentioned experimental facts, which show that these
attributes of old age—obesity and increase of connective tissue—can be
produced by removal of the thyroid or sexual glands, we also have to
deal with facts gained by clinical observation, which show that any
cause inimical to the ductless glands, especially the thyroid and
ovaries, may bring about old age. Take, for example, infectious
diseases. They have a very damaging effect on the various ductless
glands, especially so if they are of long duration. Their influence upon
the thyroid has been clearly shown by various observers. (Roger and
Garnier, Crispino, Torri, Bayon, de Quervain, and others. See Chapter
III.)
Not only the thyroid gland, but other ductless glands, are affected by
infectious diseases, and in the third chapter of this book we have shown
that the adrenal glands show alterations indicating hyperactivity in
infectious diseases.
The pituitary gland is also altered in infections, as shown in the same
chapter.
Changes in the pituitary body may also be a factor in producing
premature old age. It is a fact that all people suffering from
acromegaly appear much older than their age. In fact, one of the first
symptoms that arouses the anxiety of the relatives of such a patient is
that he looks so much older, and it is only later that they notice the
overgrowth of the nose, the hands, and feet. Since, in many people who
are getting older, the head and nose may increase in size, we may
suppose that this is the clinical expression of senile changes in the
pituitary body. There is a condition known as “acromegalie fruste,” in
which the symptoms are only slightly pronounced and which is often
unrecognized. As we have already said, all diseases of the ductless
glands may be only partially developed. This is due to the fact that
only a proportion of the thousands of follicles, of which such a gland
is composed, need be affected.
The ovaries and testicles also show changes as an evidence of their
fight against infections, and we have mentioned the findings of
Professor Metschnikoff with regard to these glands.
In every severe infectious disease the liver shows great change in its
parenchymatous tissue, with a subsequent increase of connective tissue.
The increase of connective tissue in various organs, and especially in
the blood-vessels, after infectious diseases, can be regarded as an
illustration of our remarks on these same changes following
degenerations of the thyroid. It is a well recognized fact that atheroma
can be caused by various infectious diseases, and can also be
artificially produced by several infectious agents.
The kidneys, through their rôle as eliminative organs, usually suffer,
even more than the other glands, in the course of infectious diseases.
Even a slight angina may produce an acute parenchymatous nephritis, and
the more virulent the infection, the more will the kidneys suffer.
Not infrequently, unknown to us, important parts of the renal tissue are
lost after such infections, and a chronic nephritis may creep on
insidiously. After such loss there may be proliferation of connective
tissue, and the kidneys thus become unable to fulfill the most important
eliminative functions in the body. Owing to this incomplete elimination,
toxic substances may be retained in the body.
From the above considerations we can see how important it is to guard
against the risk of infection. This is often impossible, considering the
billions of microbes by which we are surrounded day and night. The best
precaution is to keep those organs in good working order which safeguard
us against infections—i.e., the ductless glands.
Even more potent than infectious diseases in producing old age are the
results of degenerative changes in the ovaries. The effects of
castration have already been mentioned. Much in the same way do those
causes act which exhaust the internal secretion of the ovaries, e.g.,
many pregnancies, or sexual excesses. We must take into consideration
the fact that, as shown by many authors, the different ductless glands
are altered during pregnancy (Launois,[161] Guieysse, etc.). Many
mothers of large families look old before their time, as do also many of
those who lead a professedly immoral life. Even in young girls we can
see the consequences of such deteriorating agencies in hypertrophy of
the mammæ, developing in very short time, and also a tendency to
deposition of fat on the abdomen, which becomes pendulous in women who
have had many children. The features of women who indulge in sexual
excesses undergo a striking change even in early life. They become
coarse, bloated, less sharply defined, and the cheeks and chin become
fat and flabby. Indeed we have often been struck by the great
resemblance of such a face to that of an early stage of myxœdema, a
condition due to deficiency of thyroid secretion, which in turn, as
shown by Sajous, influences other ductless glands. The effects of
numerous pregnancies are far more marked if lactation is prolonged.
Footnote 161:
Launois et Mulon: “Hypophyse et femme enceinte,” Société de biologie,
p. 448, 21 mars, 1903; and Thèse à la Faculté des Sciences, 30 juin,
1904.