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nothing to do with over-feeding, can be caused by like agencies.



I8 a Tarnowska : "Etudes antropometriques sur les prostitutees et les
voleuses," Paris, 1889.



8 Old Age Deferred.



That mental emotions, especially care, grief, sorrow, etc.,
powerfully influence the different ductless glands, and are able
to produce degeneration of the thyroid, adrenals, and sexual
glands, etc., is shown by conclusive proofs in the chapter on the
"Hygienics of the Mind."

Infectious diseases are especially liable to cause change in
the kidneys, and in various infectious diseases, sometimes even
in tonsillitis, we may find an inflamed condition of these organs.

The kidneys can also be damaged by the passage of various
toxic products, which are either produced in the body (auto-
intoxication) or introduced with the food (condiments), or as
stimulants — e.g., alcohol, strong tea, etc. All these toxic agents
are capable of doing damage to the kidneys just as to the thy-
roid gland. We shall treat later on, in separate chapters, of the
action of these stimulants upon the ductless glands.

The condition termed auto-intoxication may be induced by
many different factors, among which may be mentioned the
products of intestinal putrefaction (Senator 19 ) and the waste
products from the processes of oxidation, such as uric acid, for
example. Animal food is more apt to produce intestinal putre-
faction than any of the various other foodstuffs.

There are three important organs which protect us against
such a condition of auto-intoxication; these are the kidneys,
liver, and thyroid, and possibly also the parathyroids.

The kidneys act by promptly eliminating such toxic products
in the urine. They are glands with internal secretion, as shown
by the experiments of Brown-Sequard, 20 E. Meyer, 21 and clin-
ical observations of Senator 22 and H. Strauss.

The liver, which, according to Gilbert, H. Strauss, 23 and
others, is also a gland with an internal secretion, is strongly an-
tagonistic to intestinal poisons. It destroys toxic products



19 Senator: Berliner klin. Wochenschrift, Nu. 24, 1868.

20 Brown-Sequard : Archives de physiologie norm, et path, p. 778, 1893.

21 E. Meyer: Ibid. p. 179, 1894.

22 Senator : hoc. cit.

23 H, Strauss, Senator : Festschrift.



Symptoms of Old Age in Young Persons. 9

brought to it from the intestine through the portal vein, and sev-
eral authors, Professor Adami, Sir Lauder Brunton and Boken-
ham, 24 show that it is also able to eliminate such products with the
bile after previous transformation. We will treat of these pro-
tective functions of the liver in a separate chapter, together with
the hygienics of this important organ; but we will just men-
tion here that the liver plays a great role in the transformation
of the toxic end products of albuminous food into harmless sub-
stances, such as urea.

The third important toxin-destroying organ is the thyroid
gland, which, as shown by the experiments of Dr. Leo Brei-
sacher, 2 ° of Detroit, formerly assistant to Professor Munk, of
Berlin, and of Dr. F. Blum, 26 of Frankfort, as well as Dr.
Chalmers Watson, 27 of Edinburgh, destroys those poisonous
substances produced by the decomposition of proteid food. More-
over, Sajous has shown that this is a prominent function of the
pituitary body, the thyroid and the adrenals, acting jointly as
the "adrenal system."

It will be evident that these various glands can only do their
work to perfection so long as their parenchymatous tissue is not
replaced to any large extent by connective tissue. Of these glands
the thyroid takes the foremost rank, as it governs the other
glands. As we have shown in a communication to the French
Congress of Medicine, in Liege, 1905, the thyroid influences
the liver, and in a paper before the Paris Biological Society,
February 25, 1907, we have shown that the thyroid also influ-
ences the kidneys. In fact, the liver and kidneys are closely
allied to the thyroid, and when this organ is degenerated, the
other two glands follow suit.

Accordingly we may expect that, when the thyroid under-
goes a process of degeneration, such an event may also take place



24 Sir Lauder Brunton and Bokenham : The Journal of Pathology and
Bacteriology, p. 50, Nov., 1907.

25 Breisacher : hoc. cit.

26 Blum: Virchow's Archiv, 1899.

27 Lancet, Feb. 11, 1905.



10 Old Age Deferred.



in these two protective organs, as we have shown in our above-
mentioned two communications. In consequence of the dimin-
ished activity of these organs the development of a condition
of auto-intoxication may be facilitated. Patients showing symp-
toms of old age in early years, also show to a greater or
less extent symptoms of such a condition, as do myxcedematous
persons.

Meat food especially, if taken in large quantity, is a certain
producer of uric acid, and it is an interesting fact, shown by
several authors and also by the writer, 28 that by thyroid medica-
tion we can augment the elimination of uric acid, and also pre-
vent its formation in large quantity, both in the case of uric
acid formed in the body or introduced from without by the food.

This fact stands in relation to the powerful influence exer-
cised by the ductless glands, and especially the thyroid, upon
the process of oxidation ; and, as we are anxious to prove the as-
sertions we here advance, we shall show in the next chapter how
these wonderful glands influence the processes of nutrition in the
tissues, and at the same time the external appearance. We have
already mentioned a form of obesity that has nothing to do with
overfeeding, as one of the symptoms of precocious old age, and
in the next chapter we will review in detail the agencies which
govern this condition.



28Lorand: Comptes Rendus de la Societe de biologie de Paris, Fevrier
25, 1907.



CHAPTER II.

On the Agencies which Govern our External Appear-
ance and the Nutrition of the Tissues.

As a general rule infants of both sexes look very much
alike, so much so, indeed, that sometimes it is only possible, upon
close inspection, to determine the difference in sex. This, how-
ever, can only be so for a certain period until certain changes
take place in the ductless glands, especially in the sexual glands
and the thyroid.

The latter contains but very little, if any, colloid sub-
stance in infancy, and the colloid increases only gradually until
it is present in abundance at the time of puberty, when also the
changes in the sexual glands reach a climax coincident with the
ripening of the follicles in the ovaries and their rupture at a
menstrual period. This latter process is, as we have mentioned
before, under the influence of the thyroid. Puberty and men-
struation do not take place, as a rule, in persons with a degen-
erated thyroid gland.

With the onset of puberty there is seen, also, a change in
the external appearance of the individual and the attributes of
virility — e.g., moustache, hair in the pubic region, alteration of
the voice, etc., appear. In the female the development of the
breast, hair on the pubis, etc., occurs. At the same time the
features attain the peculiar characteristic which distinguishes
the male face from the female, even without the aid of a mous-
tache.

In those persons in whom puberty has not occurred at the
usual age (fourteen to sixteen years in our climate) the attri-
butes of sex are absent. In these cases the male looks very much
like the female. A similar phenomenon may be seen in women
after castration and the climacteric, when they may even show

(11)



12 Old Age- Deferred.



a tendency to develop a moustache and hair on their face in
places, corresponding to the male beard.

This we can also observe in women whose ovaries have been
altered by disease or by sexual excesses.

These attributes of sex are also called external sexual char-
acteristics, and they are the direct result of the internal secretion
of the sexual glands. They only develop through the presence of
such a secretion, and this is easily demonstrated by the fact that
after castration of the infant, they do not appear at all. Hence,
if we see grown up men with no trace of a moustache it may
indicate an undeveloped condition of the testicles. Again, we
castrate a young cock, he will not grow a comb and spurs, and
other cocks will pass by, too proud to fight with a degenerate
deprived of its male attributes. If we now take the extirpated
testicle of such cock and graft it under his skin, the other cocks
will commence to fight with him, for his comb and spurs will
develop as in other normal cocks.

That the whole external appearance of a castrated animal
or man is changed, is also demonstrated by important changes
in the skeleton and size of such animals or persons.

As Poncet 1 has shown, the extremities of a castrated rabbit
become abnormally long, and it is a well-known fact that
eunuchs have abnormally long arms and legs. This also occurs
in cases of infantilism, which, as we know, is due to a non-devel-
opment of the sexual glands. Moreover, the thyroid of such
individuals is also found to be in a pathological condition, as
was shown by Hertoghe.

Men who have been castrated before puberty or whose tes-
ticles are undeveloped, present such an external appearance. They
have no moustache, as above mentioned; their hair is dry and
brittle and remains short ; their faces are pale, and of a yellowish
hue; their hands are cold and reddish blue. Often the skin of
the face is like parchment and has many wrinkles. Their intelli-



1 Poncet: C. R. de la Societe de biologie de Paris, 55.



External Appearance and Nutrition of Tissues. 13

gence is often diminished, as we will show later oil, and they arc
usually anaemic.

Women with undeveloped ovaries have flat breasts and hips*,
their faces are often irregular in structure, and their jaws are
often prominent ; their gums are shrunken and their teeth are
long and soon fall out. Some cases may show a colossal obesity,
but in the partial forms of ovarian insufficiency they may be
remarkably thin. They also are, as a rule, anaemic or chlorotic.

In some parts of the Orient, as in India, there are female
eunuchs, such as Roberts has seen on the way from Delhi to Bom-
bay. Such eunuchs had no bosom ; the pubic hair was absent, and
their buttocks were like those of men; but the rest of the body
was stouter. Of course these women had been castrated during
their childhood.

If we make a Roentgen-ray examination of the skeleton of a
person castrated in childhood, we shall find that the epiphysial car-
tilages remain unossified for a long time after puberty.

It is a very interesting fact that, both after castration and
in myxoedema, the same persistence of the epiphysial cartilages
and retardation of ossification have been observed by means of
the Roentgen-rays: by Hertoghe in 1896; Springer and Ser-
banesco in 1897; Gasne and Laude in 1898; Legry and Renault
in 1902; Jeandelize in 1903. The same thing has also been
observed by Hertoghe in "Infantilism of the Type of Lorraine."

The influence of the thyroid upon the skeleton and size of
the body is easily shown by simple observations.

Children of parents with cachectic diseases like chronic tuber-
culosis, syphilis, alcoholism, etc., in which the thyroid gland is,
as a rule, found degenerated (Gamier, 2 Hertoghe 3 ), are (as
shown by Prof. Perrando 4 and Gamier) born with a congenital
atrophy of the thyroid. Just as young animals with an extir-



2 Gamier : "La Thyroide dans les maladies infectieuses," These de Paris,
1899.

3 Hertoghe: Loc. cit.

4Perrando: "Sulla struttura della Tiroide," Sassari, 1900.



14 Old Age Deferred.



pated thyroid, so these children will not grow, and we know
that cretins (degeneration of the thyroid) remain as a rule dwarfs
all their life long. We can now produce in such persons certain
and very curious changes by feeding them with thyroid extract,
and we can see them, as Hertoghe has shown, grow inch by inch
in a short period ; their mental faculties improving at the same
time in an incredible manner.

The influence of the thyroid upon the skeleton is also shown
by the fact, established by Gauthier, 5 that in a fracture with but
little tendency to the formation of a callus, union takes place
much more quickly after administration of thyroid extract.

In Graves's disease, with exaggeration of the thyroid activ-
ity, there is, on the other hand, an increased elimination of the
most important constituent of the skeletal tissues : calcium car-
bonate, and this occurs also in acromegaly and diabetes, in which
conditions the thyroid is very frequently altered (Lorand 6 ).

Osteomalacia, which is associated with an enormous elimi-
nation of calcium carbonate is, as we at present consider, due to
an exaggerated ovarian activity (Fehling), and can be favor-
ably influenced by castration or, by what would be more reason-
able, thyroid treatment.

No less powerful than that of the thyroid is the influence
of the pituitary body upon the skeleton, especially upon the
hands, feet, and skull. And if we wish to demonstrate how much
the ductless glands influence the looks of a person, it is suffi-
cient to point out the great changes that take place in the face
of a patient with acromegaly. This disease makes such persons
look very much as "Punch" is depicted.

The skin and complexion of persons suffering from changes
in the ductless glands are also very different from normal. Thus
Addison's disease, due, as well known, to a degeneration of the
adrenals, makes a white man look more or less like an Indian,
and there is a pigmented skin also in persons affected by the



5 Les Medications thyroidiennes, 1902.

6 Lorand : Loc. cit.



External Appearance and Nutrition of Tissues. 15

partial form of that rare disease. We can also easily show that
changes in the thyroid are followed by changes in the condition
of the skin. Thus, with thyroid degenerations, as in myxoedema,
the skin is pale with a yellowish tinge. In Graves's disease pig-
mentation of the skin can often be observed, and not rarely
cutaneous eruptions.

In affections of the sexual organs in woman similar condi-
tions of the skin can occur. Such persons often present wrinkles
at a very early age, and certainly look older than their years.
Infants suffering from congenital degeneration of the thyroid
gland often look withered and present a face as wrinkled as a
sexagenarian. We see this also in congenital syphilis (atrophy
of the thyroid).

The hair also very often shows alterations in diseases of
the thyroid, or ovaries. Thus, in myxcedema there is an atrophy
of the follicles of the hair, which falls out, even in the case of
the eyebrows.

It is particularly interesting that, by thyroid medication, a
new growth of hair has been observed in places where it had
fallen out years previously, as we have observed, with other
authors, in several cases after thyroid medication. And, very
strange to say, this newly-grown hair was quite dark while the
hair that had previously been in its place was gray in color.
It has been authentically stated by several authorities that old
persons of sixty or seventy have acquired black hair under thy-
roid treatment.

On the other hand, in much younger persons, perhaps under
thirty, who are suffering from complete or partial degeneration
of the thyroid gland, the hair very often turns gray ; so much so
that Hertoghe considers this to be one of the typical symptoms
of such a condition.

The falling out of hair, or its turning gray, after acute
infectious diseases or after grief and sorrow, may have some
connection with the well-known changes in the ductless glands,
especially in the thyroid, in these conditions. This is made quite



16 Old Age Deferred.



clear by Sajous's demonstration that these glands collectively
govern the activity of general oxidation, that is to say the vital
process itself.

As we have previously mentioned, a moustache or whiskers
may grow in women suffering from disease of the ovaries, just
as after castration or the climacteric. It is also very interesting
that a premature grayness often occurs in cases of insanity, and
can be attributed to the frequent changes in the thyroid and
sexual glands in these conditions.

The nutrition of the skin is entirely under the influence of
the thyroid. After extirpation or degeneration of the thyroid,
there occurs atrophy of the sebaceous and sudorific glands.

In myxcedema the skin is dry and never perspires. On the
contrary, in Graves's disease, or after thyroid medication in
large doses, there is abundant perspiration.

Deposits of tartar are common symptoms in all forms of
thyroid degeneration. Retraction of the gum follows and the
teeth loosen and fall out. This is also a common symptom in
diabetes, but here only in advanced cases. In such cases there
is, as we 6a have shown, an exhaustion of the thyroid gland, which
develops as a consequence of the previous hyperactivity of the
thyroid gland in the early stages of the disease. As a rule the
teeth of a diabetic only fall out in the severer form of the disease,
generally after acetone has begun to show itself in the urine.

Important changes take place in the subcutaneous tissue
after extirpation of the thyroid gland. In such cases there is
either augmentation of connective tissue or of fat. Thus, in
the case of a young bull, whose history we followed, there has
been an increase of thirty pounds of fat within a few months
after extirpation of the thyroid. The same thing happened in the
case of a young horse, whose thyroid was also extirpated.

There are, however, still more facts which show the great
influence of the thyroid upon the metabolism of fat. Thus we



6 a Lorand: "Die Entstehung der Zuckerkrankheit," Berlin, 1903, and in
French translation, Paris, 1904.



External Appearance and Nutrition of Tissues. 17

know very well that by thyroid medication we are able to reduce
fat considerably. This is due to the action of the thyroid which,
as shown by many authors, increases the process of oxidation.
In Graves's disease these processes are augmented. In the oppo-
site condition (myxcedema) they are diminished. By giving
thyroid extract we are able to augment, positively, the processes
of oxidation in the tissues, as shown by Professor Magnus-Levy, 7
of Berlin, and many others.

As we have shown in our previous researches, there is an
abundant formation of fat in the early cases of degeneration of
the thyroid gland, which sometimes progresses to a colossal
obesity, which obesity has nothing to do with overfeeding.
Such individuals have, as a rule, but poor appetites, and eat
very little. Therefore, in a communication to the French Con-
gress of Internal Medicine in Paris, 1904, we differentiated
two kinds of obesity: 1. Exogenous obesity — i.e., arising by
agencies coming from without by the food we introduce into
our body. 2. Endogenous obesity, having its origin within our
economy, and depending on changes in certain glands which
govern the processes of oxidation — e.g., thyroid sexual glands,
pituitary body. This second form is independent of our feeding.
As we have shown, this latter can be produced by any of those
agencies which are harmful to the ductless glands, especially the
thyroid and sexual glands, as, for example, infectious diseases,
frequent pregnancies, certain toxic products (alcohol), sexual
excesses, climateric. All these conditions may have the effect
of producing obesity, which can be explained by an exhaustion
of the thyroid and ovaries following a pre-existing hyperac-
tivity.

The influence of the ovaries upon the production of obesity
can be demonstrated by the sequels of castration, and also by
the fact that women, after one or more, especially several preg-



7 Magnus-L6vy : "Der Stoffwechsel bei Erkrankungen einiger Drusen ohne
Ausfiihrgang," in v. Noorden's "Handbuch der Pathologie des Stoffwechsels"
vol. ii, Berlin, 1907.

2



18 Old Age Deferred.



nancies, or after sexual excesses, may become very fat. In such
women this obesity may be only partial and limited (as we have
shown in a recent communication to the International Congress
of Medicine in Lisbon, 1906) to certain parts — e.g., the mam-
mary glands or hips.

There can be no doubt that the sexual glands influence the
nutrition of the tissues in a powerful manner, and this has also
been shown, experimentally, by the researches of two Berlin
experimenters, Professors Loewy and P. I. Richter, 8 performed
in the physiological institution of Professor Zunz. These savants
have shown that after castration there is a diminution of oxida-
tion. By giving extracts of dogs' testicles to castrated male
dogs, they were able to augment the processes of oxidation.
These processes, however, were still more increased after the
administration of female extracts to these castrated male dogs.
The administration of ovarian extracts to the spayed bitch has,
of course, given still better results. Thus there was here an
increase of 67.7 per cent, after castration, and 37.6 per cent, of
the original value. The increase of the oxidation in male dogs
was 44.5 per cent, after castration, by the treatment with ovarian
extracts, and 24.8 per cent, above the normal value. If the
results after feeding with male extracts were not so successful,
it must be attributed to the circumstance that we are at present
unable to produce testicular extracts of the same efficacy as
ovarian extracts.

The action of the pituitary body upon metabolism has been
shown by Narbuth, who found a diminution of oxidation after
degeneration of the pituitary body, and an increase after medi-
cation with extracts of the same organ. This fact is also shown
clinically by cases of obesity after degeneration of the pituitary
body in acromegaly, and by the interesting fact (shown by a
great number of authorities and recently by Frohlich, 9 Berger, 10

8 Loewy and Richter: Archiv fiir Anat. u. Physiologie, Supplement, 1899,
and Berliner klin. Wochenschrift, 1899.

9 Wiener klin. Rundschau, p. 78, 1901.
10 Zeitschrift fur klin. Med., liv, p. 5, 6.



External Appearance and Nutrition of Tissues. 19

and Erdheim 11 ) that cases of pituitary tumor may be met with,
associated with obesity, and without any of the symptoms of
acromegaly. Especially interesting is the case of Madelung 12
showing a colossal obesity in a girl aged 9 years, after a gun-
shot injury of the pituitary body. This observation sustains, and
is clearly explained by, Sajous 13 who showed that the posterior
or neural lobe of the pituitary body contained a nerve center
which governed the functional activity of the thyroid, and that
the secretion of the latter insured the catabolism of fats by in-
creasing their vulnerability to oxidation.

The external appearance of such cases of obesity, which we
have described before the French Congress of Medicine in 1904,
and the London Pathological Society, February 21, 1905, as
endogenous obesity, is also clinically different from the appear-
ance of those caused by over-feeding. As we have shown, per-
sons addicted to rich food, with little exercise, are often red in
the face, and are plethoric; they easily become overheated and
perspire freely. They seldom complain of constipation. On the
other hand persons suffering from endogenous obesity generally
look pale, always complain of cold and dry skin, and perspire
very seldom, if at all. As a rule they are also very constipated.

There is still another ductless gland which influences metab-
olism in a powerful way. This is the pancreas which, by its
three enzymes, brings about the assimilation of the proteid car-
bohydrate and fatty materials. To these may also be added its
production of labferment. By its internal secretion, which is
probably produced by the islands of Langerhans, it aids in the
oxidation of the sugar, introduced into our alimentary canal in
the shape of starchy food, or contained in the carbohydrated
radicle of the albuminous molecules, as demonstrated by Pavy.
The entire degeneration of the pancreas, especially of the part
containing the islands of Langerhans, produces a disease that is,



11 Ziegler's Beitrage, 1903.

l2Archiv fur klin. Chirurgie, p. 1066, 1904.

13 Sajous: "Internal Secretions, etc.," vol. ii, 1907.



20 Old Age Deferred.



as a rule, characterized by loss of weight and the production of
emaciation often to an astonishing degree — i.e., diabetes.

Persons suffering from the milder form of this disease often
present a rosy and healthy appearance, and as we have pointed



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