ORGANOTHERAPY 
in 
GENERAL PRACTICE 
NO. 3 
ASTHENIA 
HYPOTHYROIDISM 
HYPOADRENIA 
SENILITY 
* G.W.CARNRICK CO. • 
417-421 CANAL ST., NEW YORK.N.Y. 
FftIKTZD IK V. >. A. ASTHENIA, HYPOTHYROIDISM, 
HYPOADRENIA. SENILITY 
The treatment of general debility and of states of lowered vitality 
in which no demonstrable pathologic process is present has always been 
a stumbling block for the general practitioner. Organotherapy now 
offers a solution to this problem in that it introduces substances which 
directly stimulate cell metabolism and raise metabolic rate. The success- 
ful treatment of these conditions has, therefore, become possible. Of 
course, the pathology in these conditions is comparatively unknown — 
that is, there is no structural defect, but a functional derangement due 
to glandular deficiency. Following extended illness, states of exhaustion 
and the infections, and occurring as a result of the burdens and conditions 
imposed by various walks of life, these conditions have been treated by 
“tonics,” “alteratives,” etc. Only too frequently the “tonic” has been 
some substance designed to increase appetite and digestive capacity, 
in the belief that lack of strength results from some primary lack of 
nutrition. The following discussion, it is hoped, will indicate a better 
therapy. 
ASTHENIA 
Asthenia is a symptom characteristic of almost all disease, both 
infectious and metabolic, and may also, and frequently does, manifest 
itself as the principal or only symptom in conditions in which there 
is no demonstrable pathology. It constitutes one of the commonest con- 
ditions that the general practitioner is called upon to treat and includes 
patients recovering from definite illness, prolonged infections and states 
of general lowered vitality. For these reasons a rather extensive investi- 
gation of the causes of asthenia and the general nature of the conditions 
under which it appears is of more than ordinary interest to the physician. 
Asthenia, as here used, is but slightly, if any, more inclusive than the 
term “myasthenia.” It is mere weakness, the “run-down feeling,” for 
which some effective treatment is necessary. The train of associated 
symptoms, undue fatigability, cardiac insufficiency, feeble pulse, 
arterial hypotension, arrhythmia, bradycardia, vasomotor disturbances, 
cold extremities, etc., which together make up a complete clinical picture 
1 of debility, will be considered in the following discussion of hypoadrenia. 
Asthenia may occur, however, as a result of disturbances of both the 
pituitary and thyroid, as well as of the adrenals. In the frequently 
encountered clinical conditions characterized by lowered basal metab- 
olism and lessened functional activity of the acceleratory group of 
endocrine organs, asthenia is conspicuous. The energy production of 
the organism and the cell metabolism are at fault and the subjective 
symptom, asthenia, arises. 
Sejary1 distinguishes between asthenia due to suprarenal insuffi- 
ciency and those due to other causes. The adrenal type is characterized 
by rapid muscle exhaustion and fatigability, whereas other types show 
a diminution of muscular force but not a rapid exhaustion. According 
to Sejary, it is as yet unproved that any other asthenia of endocrine 
origin can present this special type of rapid exhaustion of muscular 
force. Asthenia forming a part of the Erb-Goldflamm syndrome may be 
mentioned as a variety occurring independently of the endocrine system, 
although even this has been suggested as of adrenal origin. Harvier 
says2: 
“Certain cases of myasthenia which are included in the 
syndrome of Erb-Goldflamm, characterized by muscular 
asthenia (weakness of the muscles, tendency to be easily tired), 
either diffuse or limited to certain muscles of the face, are 
probably due to some adrenal disturbance. They improve 
under adrenal medication, alone or combined with thyroid 
or pituitary extract.” 
Sejary, however, differentiates it from the adrenal type by the 
paralysis of the oculomotor and facial muscles, and those of the neck, 
conditions not present in the adrenal type, which shows no especial 
predilection for the muscles innervated by the cerebral nerves. 
A study of the fatigue process gives some aid in 
understanding the nature of asthenia, which is the 
conscious sense of muscle inefficiency. Many experi- 
mental studies of fatigue have been made and at least something is known 
of the conditions in which it arises. It seems fairly well established that 
an accumulation of the waste products of catabolism, “fatigue sub- 
stances,” are directly concerned in the condition. In some cases a 
second possibility is present — that of a too rapid consumption of the 
material necessary for the work of muscle contraction — but this need 
not be considered here. Ranke made the first comprehensive investiga- 
tions of fatigue pathology and suggested the name “fatigue substances” 
for those compounds which, when present in sufficient concentration, 
inhibit muscle contractions. He showed that extracts of fatigued 
muscle, when injected into the circulation of a fresh animal artificially 
produced fatigue, whereas extracts of fresh muscle substance (not 
fatigued) gave no such results. That such substances are actually 
formed and are largely responsible for muscle fatigue seems fairly certain 
from the nature of the various experimental results and from clinical 
Pathology 
of Fatigue 
'A. Sejary, La Presse Medicate, Jan. 28, 1922. 
2Endocrine Glands and the Sympathetic System, 1922. 
2 experience. Such substances produced in one set of muscles affect not 
only that particular set but, diffused through the circulation, definitely 
lower the efficiency of other muscle groups and cause the general malaise 
and psychic dullness incident to fatigue of the organism as a whole. 
Lactic acid appears to be chief among these fatigue substances and in 
muscle preparations fatigue may be produced by bathing or perfusion 
with lactic acid solutions. Aqueous solutions of muscle previously 
exhausted to the point of fatigue also reduce the excitability of the muscle 
preparation and induce the fatigue condition. In experiments in which 
the muscle is not cut off from its circulation and in which the accumula- 
tion of these substances is more difficult, fatigue is much less readily 
produced than in those isolated preparations in which the conditions for 
accumulation are ideal. In either class of preparations the fatigue 
may be relieved by flushing with normal salt solution. 
The action of these fatigue substances may be either in the muscle 
itself or in the myoneural junction — the receptive substance — of 
the nerve ending: less likely does it appear that they act through the 
nerve tracts themselves. 
What conditions permit the accumulation of the toxic wastes 
responsible for asthenia and the fatigue syndrome? Chief among these 
is lack of oxygen and the resulting state of suboxidation and lowered 
metabolism. 
“It seems more probable that we are dealing here with 
two stages of one process and that in the muscle under normal 
conditions (that is, richly supplied with oxygen) the first chem- 
ical change is one of disintegration, leading to the formation 
of lactic acid (and probably other substances), and that this 
is followed by a process of oxidation, in which all the products 
of the first stage are converted into C02, which can be rapidly 
eliminated from the muscle. If the supply of oxygen is deficient, 
the products of the first stage remain in the muscle, giving 
rise to the phenomena of fatigue.1 ” 
The effect of oxygen gas in relieving fatigue and restoring the 
irritability of muscle preparations previously exhausted is evidence of 
the influence of oxygen in preventing the onset of the fatigue syndrome. 
With a free supply of oxygen, the excessive accumulation of lactic acid, 
with its inhibitions to muscle contractions, does not take place. Lactic 
acid is formed as a result of the work performed by the muscles and 
may be an intermediary product of sugar metabolism. A certain acid 
concentration appears to be necessary for contraction, however, and it 
is probable that even in ideal conditions of oxidation the lactic acid 
is not finally and wholly oxidized but rather is synthesized into the 
substances from which it was formed. Suboxidation, therefore, causes 
fatigue through permitting excessive accumulation of the acid. 
“In the process of recovery which follows the activity of 
muscle wdien it is allowed to rest, it is found that the lactic 
acid disappears provided a supply of oxygen is available. Since 
at the same time carbon dioxide is set free from the muscle, 
1 Human Physiology, Starling, 1912. 
3 one might suspect that the disappearance of the lactic acid 
is due to its being oxidized to carbon dioxide and water. This, 
however, cannot be the case, for it is known that after the 
repeated fatigue and recovery of an isolated muscle the total 
quantity of lactic acid which may be extracted from it is 
undiminished. In other words lactic acid does not disappear 
from the muscle during rest, but is restored to the condition in 
which it occurred before contraction took place. Further 
evidence that lactic acid is not oxidized is afforded by the 
fact that the disappearance of 1 gram of lactic acid from fatigued 
muscle is accompanied by the production of 450 calories of 
heat, whereas the oxidation of 1 gram of lactic acid would 
set free 3700 calories. Apparently the oxidation of some other 
substance is necessary in order to restore lactic acid to the 
precursor condition, and to replace the potential energy lost 
in the contractile process, and in the course of the oxidation of 
this substance — carbon dioxide is liberated and heat is given 
off. The nature of the substance oxidized is not definitely 
known, but it is presumed from the high respiratory quotient 
of muscular work that it is chiefly carbohydrate. ”1 
Asthenia is undoubtedly the most conspicuous and 
characteristic symptom of adrenal insufficiency, and the 
function of epinephrin in the maintenance of voluntary 
muscle efficiency is very striking. Cannon, Gruber, Fellows and others 
have shown that epinephrin increases the contractility of the voluntary 
muscles and diminishes the tendency to muscle fatigue. Gruber reached 
the following conclusions2: 
“In the fatigued unaltered nerve muscle adrenalin may in- 
crease the height of muscular contraction by a twofold action, 
by improvement of the blood supply (vasodilation) and by its 
chemical action upon some substances in the muscle. 
“In a muscle in which the nerve is cut and stimulated, 
adrenalin in small doses, however administered, does not 
better the circulation and must therefore produce its effect 
of increasing the height of muscular contraction by its chem- 
ical (specific) action alone. 
“The following three processes which normally go on in 
the muscle may be greatly accelerated by adrenalin and it 
is not improbable that one or all of these will finally prove 
to be the way in which adrenalin produces its effects: 
“1. The conversion of glycogen into sugar. 
“2. The reconversion of lactic acid into sugar (trans- 
formation of fatigue products). 
“3. The oxidizing of lactic acid into carbon dioxide and 
water (destruction of fatigue products).” 
Gruber and Kretschmer3 in experiments upon cats found that: 
Adrenal 
Influence 
and Biochemistry in Modern Medicine,” MacLeod, 1922. 
2American Journal of Physiology, 1917, Vol. 43. 
3American Journal of Physiology, 1918, Vol. 47. 
4 “Adrenalin (0.5 to 1 c. c. of 1:1,000 solution) counteracts 
the induced fatigue produced by the perfusion of fatigue sub- 
stances such as sarcolactic acid, lactic acid and acid potassium 
phosphate, through the muscle in identically the same way as it 
does the fatigue produced normally in active muscles.” 
Hartmann1 investigated the effect of epinephrin upon muscular 
activity and has shown a very definite relationship between epinephrin 
output and muscular response. He finds that in normal animals there 
is an increase in epinephrin output during exercise, which output is 
greater in proportion to the length and vigor of the exercise. This 
increased epinephrin output persists after the exercise ceases, the dura- 
tion depending to some extent upon the amount of work performed. 
Hartmann also found that intramuscular injection of adrenalin improved 
the output of work in many normal cats and in cats with epinephrin 
deficiency, and that an animal can go further and travel faster when 
there is an increase in the epinephrin output during exercise. Hartmann 
makes an interesting explanation of the so-called “second wind” of 
athletes, which he relates to the increased efficiency resulting from 
epinephrin. He believes that epinephrin is an important factor in the 
development of “second wind” or that state of increased efficiency which 
takes place after a condition of exhaustion has apparently developed. 
In investigations made by Hartmann, Waite and Powell2 they 
came to the conclusion: 
“Our results seem to indicate that epinephrin plays a 
very important role in increasing muscular work and delay- 
ing the onset of fatigue.” 
The influence of epinephrin seems to be due to a direct specific 
influence upon the muscle cell and this conclusion has been reached 
by various investigators. Gruber3 finds that, while in some of the 
experiments the increased height of the muscular contraction may be 
accounted for by increased circulation through the muscle, there are 
specific effects in eliminating fatigue. The manner in which the specific 
action is accomplished is unknown and may be due to the neutralization 
or destruction of the fatigue products, the rapid formation of more 
available energy, or to some toxic action increasing the excitability of 
the muscle. 
It has been suggested by MacLeod (see above) that the oxidation of 
some substance, presumably carbohydrate, is necessary to prevent the 
excessive accumulation of lactic acid and to restore it to the precursor 
substance, a mode of action also suggested by Hartmann (transformation 
of fatigue products). There has been much evidence to show that the 
adrenals are important factors in sugar metabolism (Bierry, Malloizel, 
Cannon, Porges) and, although such influence is minimized by some, 
the evidence is very suggestive of an action in sugar metabolism which, 
in part at least, accounts for the epinephrin effect in relieving fatigue. 
Endocrinology, July, 1922. 
2 American Journal of Physiology, 1922, Vol. 60, No. 2. 
3Endocrinology, 1919, Vol. 3, No. 2. 
5 “The asthenia which dominates the clinical picture of ad- 
renal insufficiency may be explained by the undoubted fact 
that adrenalin presides over carbohydrate metabolism. As 
for the latter view, it is true that adrenalin regulates the de- 
posit of glycogen in the liver and its transformation into glu- 
cose; if adrenalin is deficient, carbohydrate metabolism is 
interfered with and muscular action is rendered impossible.”1 
It should be mentioned, too, that the effects of the cortex, which 
are important in producing other symptoms of hypoadrenia, may also 
be a factor in producing the asthenia. The evidence, however, points 
strongly to the epinephrin as the essential factor. 
In marked muscle fatigue the quantity of epinephrin in the adrenals 
themselves is much reduced and in the light of Hartmann’s observations 
above this appears to indicate that in the maintenance of muscle effi- 
ciency, following the demands of excessive contraction, all the available 
epinephrin is consumed, and fatigue develops when the store has been 
exhausted and epinephrin is no longer available. Vacuole formation 
in the cortical portion is also noted and indicates some function of this 
portion of the gland in muscle work. 
HYPOADRENIA 
Ilypoadrenia or suprarenal insufficiency has been described under 
various names and divided into various classifications, for the most part 
depending upon the duration, and the extent and character of the symp- 
toms. In 1899 Sergent, in association with Leon Bernard, made what 
appears to have been the first description of a case of suprarenal in- 
sufficiency not Addisonian in character. Addison’s disease is an ex- 
treme example, representing the upper limit of suprarenal insufficiency, 
and the milder cases of clinical hypoadrenia, the existence of which has 
been challenged by some workers in experimental physiology and path- 
ology, represent the lower limit. 
The symptoms of actual extirpation of the adrenals include rapidly 
developing asthenia (myasthenia), convulsions, psychic depression, 
cardiac weakness, lowered temperature and blood pressure, dyspnea, etc. 
In some of the acute forms of suprarenal insufficiency (suprarenal 
hemorrhage) symptoms approximating these may be observed. The 
onset is sudden and the course rapid and fatal. Acute gastrointestinal 
symptoms — vomiting, diarrhea, etc. — may be marked. In Addison’s 
disease the asthenia is an outstanding symptom and there is also another 
perhaps equally characteristic, the discoloration or bronzing of the 
skin, that is not apparent in other forms of insufficiency. The asthenia 
has been described above. Epinephrin appears to play an important 
part in muscle work and fatigue, and there is much evidence that the 
myasthenia at least is due to deficiency of this substance. It should be 
made plain that the evidence in favor of epinephrin deficiency as a 
XG. Fiore, Pensiero Medico, Jan. 1, 1922. 
6 cause of the symptom asthenia is much stronger and generally less open 
to question than as a cause of low blood pressure and other symptoms 
of hypoadrenia, in which physiological research at least seems to have 
shown that epinephrin does not play such an important part. The 
blood pressure is characteristically low. It is not possible to state 
just what defect of the suprarenal glands is responsible for this condi- 
tion, but it forms a fairly constant feature of hypoadrenia and there 
can be no doubt but that the suprarenal medulla or cortex, or both, 
are essential in the maintenance of vascular tone and circulatory effi- 
ciency. Feeble heart action is a concomitant of the low pressure and 
is explicable in the light of the known stimulatory action of epinephrin 
on cardiac muscle and the lack of tonicity resulting in all contractile 
cells as a result of the accumulation of the products of lowered metabol- 
ism. Josue1 described a special type of cardiac affection — cardiac 
asystole — in which suprarenal insufficiency appeared to be the cause. 
There were cases with demonstrable hypertrophy and both systolic and 
diastolic pressures were constantly low, and three of the four cases showed 
marked arrhythmia and auricular fibrillation and the symptoms of dysp- 
nea, pulmonary and hepatic congestion and edema. Although histologic 
examination showed a comparatively normal condition of the cardiac 
muscle fibres, the suprarenals were in all the cases very small, degen- 
erated and giving every evidence of much decreased functional activity 
in life. Metabolism in general is reduced, an effect that may be due 
to either the impaired function of the cortex or medulla. An appreciable 
reduction in the blood sugar takes place. 
The gastric, intestinal and digestive symptoms 
observed in extirpation experiments are evident 
in lesser degree in the milder clinical forms, and 
vomiting, diarrhea, anorexia, dyspepsia, etc., are common. Loeper2 
has described a type of indigestion caused by suprarenal insufficiency, 
characterized by gastric distress and constipation, the pain arising in 
from half an hour to two hours after eating. This is attended by asthenia, 
low blood pressure and general depression, all of which improve with 
the improvement in the suprarenal factor. An interesting and not 
satisfactorily explained association of gastric and gastro-duodenal 
ulcers with disease of the adrenals may be noted. Silvestri3 concludes 
that these are chiefly the result of the predominance of the vagus system 
and that when there is a good balance of the endocrine system these 
ulcers are not formed. The vagus influence may be accentuated by 
stimuli from the sex glands, for castration at pregnancy depresses the 
vagus activity and cures the ulcers, while partial or total removal of 
the suprarenals causes gastric and duodenal ulcers. It would seem 
that the experimental suprarenal insufficiency produced by Silvestri 
may produce ulcers by removing the antagonistic effects of the sympa- 
thetic system ordinarily stimulated by the suprarenals. 
Gastro-Intestinal 
Symptoms 
10. Josue and F. Belloir, Bulletins et Memoires de la Societe MSdicale des Hopitaux 
de Paris, April 9, 1914. 
2Loeper, “Legons de Pathologie Digestive.” 
*Silvestri, II Policlinico, June 28, 1920. 
7 In experimental insufficiency, effects upon the body temperature 
are evident. Scott1 found that in suprarenal insufficiency amounting 
practically to suppression, there is a decrease of heat production and 
death. In less severe injury and consequent lesser insufficiency (in 
cats) there is a “profound effect upon the calorific mechanism, charac- 
terized by a significant increase in heat production.” Probably in the 
clinical types marked variations in temperature are complicated with 
abnormal function of other endocrine glands. 
TYPES OF HYPOADRENIA 
Sajous classifies fiypoadrenia as: 
1. Functional hypoadrenia, 
2. Progressive hypoadrenia, 
3. Terminal hypoadrenia, 
a classification which, for the practical purposes of clinical medicine 
is as good as any proposed, although numerous others have appeared. 
The adrenals show marked changes following 
acute infections, and nutritional disturbances and 
chronic infections as well are accompanied by changes 
in the glands. McCarrison found that the functional 
activity of the adrenal glands is dependent on the 
quality of the food,2 and that in animal experiments 
the adrenal glands enlarge in consequence of qualitatively deficient food. 
He finds as a result of his studies that: “An intimate relationship exists 
between the adrenal glands and the metabolic processes of the animal 
organism.” Particularly following influenza is the involvement of the 
adrenals very common and the pronounced prostration characteristic 
of this condition seems to depend upon this adrenal factor. Hypoadrenia 
is also characteristically found following typhoid fever, pneumonia, 
diphtheria, scarlet fever, malaria, tuberculosis, etc. This is the “termin- 
al” hypoadrenia of Sajous, described by him as due to exhaustion of the 
glands during the acute febrile period of the infection. The adrenals 
appear to be peculiarly susceptible to infection or toxins of any kind, 
and continued irritation of toxic substances may result in a condition 
of permanently lowered functional activity. 
The relation of the adrenals to the emotions, the “emergency” 
theory of Cannon, seems to bear application to certain types of in- 
sufficiency arising as a result of psychic causes — intense emotion, etc. 
A class of cases common during and after the war is of this kind. As- 
thenia, low blood pressure, pronounced psychic symptoms, circulatory 
disturbances and inability to assemble the bodily resources for rapid, 
unusual demands, appear to be due to adrenal insufficiency resulting 
from previous heavy and overwhelming demands upon the adrenal 
apparatus. Satre has described such conditions in soldiers and be- 
lieves the mental and physical overexertion of the soldier leads to ex- 
haustion of the endocrine and other organs. Shock he believes is per se 
largely a condition of adrenal insufficiency. 
Effects of 
Infection, 
Toxemia and 
Defective 
Diet 
1W. J. N. Scott, Journal of Experimental Medicine, Aug. 1, 1922. 
2McCarrison, “Studies in Deficiency Disease,” 1921. 
8 FUNCTIONAL HYPOADRENIA 
Definition 
of Functional 
Hypoadrenia 
“Functional hypoadrenia is the symptom complex 
* of deficient activity of the adrenals, due to inadequate 
development, exhaustion by fatigue, senile degenera- 
tion, or any other factor which, without provoking 
organic lesions in the organs or their nerve paths, is capable of reducing 
their secretory activity. Asthenia, sensitiveness to cold and cold 
extremities, hypotension, weak cardiac action and pulse, anorexia, 
anemia, slow metabolism, constipation, and psychasthenia are the main 
symptoms of this condition.1 
This form of hypoadrenia is encountered at four periods of life: 
infancy, childhood, adult and old age, and includes the asthenias of 
these periods usually described as resulting from “weakness or exhaust- 
ion.” (Sajous.) This type may be due to a congenital underdevelop- 
ment of the adrenal tissue, a conception which has found frequent express- 
ion in the literature and which might account for an adrenal insufficiency 
type. 
“There is a very large, not very well defined, but very 
important field, which is characterized by so slight a degree 
of suprarenal insufficiency that it is called myopragia congenita 
of the suprarenals. It is constitutional, hereditary or acquired 
through infection or toxins. This myopragia, whether consti- 
tutional, congenital, hereditary or acquired, may have for its 
pathological basis a hypoplasia or simply a functional insuffi- 
ciency of the suprarenals, which has been caused by some 
dystrophy resulting from a disease in the ascendants, especially 
tuberculosis and syphilis. According to Wiesel, this con- 
dition is caused by the status thymico-lymphaticus and with 
it is often associated the syndrome of constitutional vagotonia, 
eosinophilia, exudative diathesis, and we are led to believe 
that the basis of these conditions is a constitutional suprarenal 
insufficiency.” (Pende.) 
Functional hypoadrenia may be self limited and undergo spontaneous 
recovery. The removal of the excessive demands upon the function is 
usually followed by some improvement in the symptoms. The mental 
attitude is frequently characteristic and one of indecision, lack of in- 
itiative and tendency to melancholia. 
Experimental physiology has not contributed any brilliant results 
in establishing a condition of artificial hypoadrenia, a fact which has led 
to some physiologists adopting a somewhat skeptical attitude toward the 
clinical varieties of adrenal insufficiency. The criticism arising from this 
class of workers has shown such a disregard for the facts of clinical medi- 
cine, and the limitations of the experimental method are so apparent, 
that it fails to carry conviction or bear the importance which properly 
interpreted physiological investigation should. In a reply to criticism 
of this kind, Sergent2 gives a comprehensive review of the clinical views 
xSajous, “The Internal Secretions and the Principles of Medicine,” 10th Edition, 
1922 
2E. Sergent, La Presse Medic ale, Oct. 12, 1921. 
9 of the condition, following the first described case (his own) in 1893. 
Sergent disposes of the criticism that clinicians generally attribute the 
symptoms of suprarenal insufficiency (including Addison’s disease) to 
insufficient epinephrin production by showing that at the time of the 
first description of this condition epinephrin was unknown and that 
clinical views since (including his own) have generally regarded the condi- 
tion as an insufficiency of the whole gland. Pende clearly recognizes the 
influence of the whole suprarenal in giving rise to the symptoms of in- 
sufficiency : 
“The cortex and medulla are so intimately connected 
that it is not possible to imagine functional efficiency of one 
without that of the other. This intimate connection may 
be traced all the way up in the scale of the vertebrates, being 
more and more intimate and complicated as we pass from the 
lower to the higher. In the lower animals, their functions 
are perfectly distinct, but as we approach the mammalia they 
become more and more inseparable. It seems as if we were 
justified in inferring that the syndrome of medullary insuf- 
ficiency is not alone caused by the lack of adrenalin in the blood. 
Rather are we inclined to think that many of the symptoms 
of adrenalin deficiency, which we find in animals that have 
been deprived of their suprarenals, are due to unknown but 
strictly necessary connections between the medulla and the 
cortex.” 
Sajous1 also emphasizes the error of assuming that clinicians attribute 
Addison’s disease to an epinephrin insufficiency. There seems little 
doubt but that the syndrome of suprarenal insufficiency —• asthenia, 
hypotension, feeble and irregular heart action, vasomotor instability, 
gastric and other digestive disturbances, lowered metabolism, psychic 
depression, etc. — is due to insufficiency of both parts, cortex and 
medulla, as it has been shown in convincing manner that death in extir- 
pation experiments is due to loss of the cortex, while total suppression 
of the epinephrin output is followed by impaired metabolism, for, al- 
though numerous observers have shown that the concentration of epine- 
phrin in the circulating blood is normally very small, even physiologists 
who have most critically examined the facts of the role of epinephrin in 
the organism do not deny a physiological function. “Small as the con- 
centration of epinephrin may be in arterial blood, there is evidence 
that it may exert a certain action.”2 
That suprarenal insufficiency is due to an insufficiency of the whole 
gland is suggested by injection experiments using suprarenal extract, 
resulting in effects not obtainable with epinephrin. In the treatment 
of Addison’s disease, an extreme case of insufficiency, the treatment is 
with whole gland and not by epinephrin. “Either the fresh gland or a 
glandular extract or the dried gland, all representing the whole gland, 
must be used to expect beneficial results, as shown by a personal study of 
120 reported cases.”3 
1C. E. deM. Sajous, Endocrinology, March, 1922. 
2Stewart, “Endocrinology and Metabolism,” Vol. II, 1922. 
3Sajous, Endocrinology, Vol. VI, No. 2, March, 1922. 
10 Sergent has pointed out that both physiologists and clinicians agree 
that the suprarenals are indispensable to life, a conclusion reached by 
the methods of both fields of science, and that slowly developing disease 
of the glands is accompanied by well marked symptoms. 
“Alongside the syndrome of acute suprarenal insufficiency 
provoked by sudden and complete destruction of the supra- 
renal glands clinical observation therefore ranges syndromes of 
gradual insufficiency and ascribes them to progressive alter- 
ation of those glands, an alteration insufficient to suppress 
function totally, but quite pronounced enough to diminish it. 
Asthenia and hypotension are its cardinal signs. These tw;o 
classes of syndromes constitute the principal clinical modalities 
of simple suprarenal insufficiency. When melanoderma is 
added, Addison’s disease comes into being — a morbid complex 
formed apparently by a union of the symptoms of suprarenal in- 
sufficiency and those of pericapsular sympathetic irritation.”1 
It seems that the only uncertainty in connection with this syndrome, 
therefore, is in explaining the nature of the effects of the entire supra- 
renal gland, a problem which is as yet hardly touched. 
HYPOTHYROIDISM 
Hypothyroidism is of common occurrence in general practice and as 
in moderately developed cases it presents a picture of general debility, 
rather than distinct and typical disease of the thyroid, it may con- 
veniently be considered in connection with the other common cause of 
debility, hypoadrenia. It is of -value, however, to first consider those 
cases of hypothyroidism which are typically and definitely recognizable 
as thyroid in character, cretinism and myxedema, as an adequate con- 
ception of these conditions, in which the numerous symptoms character- 
istic of thyroid hypofunction are well marked, facilitates recognition and 
understanding of the minor degrees of the condition in which only a 
few of the usual symptoms may be present. 
Hypothyroidism in the young, when well marked, is termed cretinism 
and presents a clinical picture which is unmistakable and differs from 
minor degrees of hypothyroidism in forming a definite, well marked 
clinical type. Some authors distinguish various conditions, such as 
“juvenile myxedema,” and limit cretinism to a congenital condition. 
Thus McCarrison2 states: 
“Cretinism is always congenital, whether endemic or 
sporadic. Cases of thyroid deficiency arising in the individ- 
ual and due to nutritional or infectious causes should be clearly 
distinguished and designated as juvenile myxedema.” 
Cretinism, however, is generally used to designate hypothyroidism 
in the young and myxedema is applied to the same condition in the adult. 
As these are the usual connotations of these terms and as they appear to 
be thus firmly fixed in the literature, it seems wise to retain them. 
’Sergent, La Presse Medicate, Oct. 12, 1921. 
2“The Thyroid Gland,” 1917. 
11 Complete absence of the thyroid is rare (twelve cases were reported 
by Pineles). Cretinism may occur in two characteristically different 
types — sporadic and endemic. 
Sporadic cretinism occurs in all parts of the world. 
Hereditary factors appear to play an important part and 
hereditary defective development of the thyroid apparatus 
has been suggested as explaining many cases of hypothyroidism, just as 
congenital underdevelopment of the adrenals has been described in 
hypoadrenia. Many such cases do not develop the characteristic symp- 
toms of cretinism and, in fact, may exhibit few or no symptoms. They 
develop into the characteristic hypothyroid cases under added demands 
of various kinds upon their functional capacity. Cretinic symptoms may 
be apparent in earliest infancy or may develop during childhood. The 
female sex appears to be more often affected and, following the profound 
physiologic changes in the female organism at puberty and pregnancy, 
there appears to be a greater proportion affected. 
In well marked cretinism and myxedema actual structural change in 
the thyroid is constant, varying from total absence of the gland (thyro- 
aplasia, athyreosis) to varying degrees of degenerative change. The symp- 
tomatology is in general in direct relation to the extent' of the tissue 
change, the fully developed cretin approaching a condition of thyroaplasia 
and the milder cases of hypofunction showing but small thyroid struc- 
tural change. The gland may be enlarged, simple non-toxic hyperplastic 
goiter arising as a result of an effort to compensate for faulty functional 
activity, or the gland may be markedly reduced in size as a result of- 
general atrophy. The growth is affected, particularly the skeletal sys- 
tem, resulting in the dwarfed condition so characteristic of cretinism. 
The low mentality is equally prominent. The cretin in marked cases 
has the mentality of an idiot and in less advanced degrees is stupid, 
“backward,” and obviously below the normal. Facial expression 
is vacant and stupid. They do not behave normally at play. The skin 
is severely affected and may be thickened and wrinkled, and is usually 
dry. Mucous membranes and subcutaneous tissue show the myxed- 
ematous swelling. The fontanelles are late in closing or remain open. 
The skull varies from the normal and appears larger proportionately 
than the rest of the body. Characteristic depression of the root of the 
nose is said to be due to faulty development of the vomer (saddle nose). 
Anomalies of dentition are usual and the deciduous teeth develop slowly 
and may be retained. The myxedematous infiltration of the skin and 
mucosa gives a swollen appearance to the lips and mouth. The mucosa 
of the nasopharyngeal cavity is hypertrophied, the tonsils are frequently 
enlarged, and adenoids are common. The sexual organs are frequently 
underdeveloped. Deafness and partial deafness are common, though an 
explanation of this condition is wanting. The cheek bones are prominent, 
metabolism is depressed, and temperature is low. Constipation is usual. 
The face is sallow, pasty and colorless; the tongue protrudes from 
the mouth and is thickened and furrowed; the nose flattened and 
saddle shaped. Enuresis, possibly due to infiltration of the tissue of the 
neck of the bladder, is a frequent symptom. The abdomen is character- 
istically protuberant. 
Sporadic 
Cretinism 
12 When cretinism occurs as an endemic disease the 
condition varies considerably from the sporadic variety 
and it has been held that endemic cretinism or cretinic 
degeneration is not thyroidal in origin but is a general degenerative 
process involving the thyroid with the other organs of the body. Whereas 
sporadic cretinism is a clinical picture of advanced hypothyroidism, the 
endemic variety presents some symptoms and signs not explicable in such 
terms. Falta1 states: 
“There is as yet no agreement as to the question whether 
the manifold manifestations of the cretinic degeneration are 
called in to existence only by the mediation of the strumous 
degeneration of the thyroid gland, or a part of these are directly 
produced by the strumous noxus and thus are co-ordinate 
with the struma.” 
The general symptomatology of the endemic form shows much 
greater variety and less adherence to type than the sporadic, and in some 
localities individuals affected show the most marked variations in type. 
Endemic cretinism is well knowm in some localities of the world and an 
appreciable number of the population are affected by it. Practically 
all the symptoms of the sporadic variety may occur. Nervous involve- 
ment is more common and deaf-mutism is usual. “Eighty per cent, of 
all cretins are deaf mutes in greater or lesser degree.2” The cardiac 
involvement, which also occurs in the sporadic form, is also common. 
Goiter is present in a much higher percentage of cases. Many explan- 
ations of the cause of cretinic degeneration have appeared: hereditary, 
chemical through the water supply, geological, bacterial. McCarrison 
has presented much evidence in favor of the bacterial theory. His 
experiments and observations over a long period of time included animal 
experimentation and clinical experience. He says2: 
“No better illustration of the action of the toxic product 
of bacteria could be afforded than that which occurs in ex- 
perimentally produced congenital goiter, congenital parathy- 
roid disease and cretinism, as a result of administering cul- 
tures of fecal organisms to pregnant animals. In this obser- 
vation the cultures were not killed, but there can be little 
question that the effects on the fetal organ were due to toxins 
and not to the direct action of the organisms themselves.” 
And again: 
“This accumulation of facts demonstrates, I believe, that 
the causal agents of goiter, as well as of its congenital mani- 
festations, are micro-organisms inhabiting the alimentary 
tract of sufferers from this disease, and often of other persons 
whose thyroids show no actual enlargement, but which never- 
theless may be in a hyperplastic state. Except in so far that 
all the epidemiological and experimental facts point to anaerobic 
organisms as the causal agents of this disease, they do not 
permit of a more definite conclusion as to the identity of these 
organisms.” 
Endemic 
Cretinism 
'“The Ductless Glandular Diseases,” 1915. 
2McCarrison, “The Thyroid Gland,” 1917. 
13 Application of the rules of general hygiene and 
careful inspection and maintenance of a pure water 
supply. Administration of iodine or iodine salts (.2 to 
.4 grams sodium iodide daily). Thyroid extract is 
particularly advisable in those cases attended with goiter. McCarrison 
has successfully used intestinal antiseptics, iodine, betanaphthol, thy- 
mol and salol, a form of treatment also successfully carried out by others. 
As the ductless glands other than the thyroid may be involved (some 
writers reporting pituitary involvement in as high as 95 out of 112 
cases) a combination of gland substances may be tried. 
McCarrison describes a type of cretinism which he terms “nervous 
cretinism,” in which symptoms referable to the nervous system are pre- 
dominant. “It may be best described as a condition of cretinous idiocy 
with associated cerebral diplegia and tetany, due to congenital fibrosis 
of the thyroid and of the parathyroid glands.” This type presents 
many symptoms in common with the usual type, as protuberant abdo- 
men, dwarfism, etc., but there are added the symptoms referable to 
the nervous system: convulsive seizures, paralysis, tetany, etc. This 
type seems common in India but is practically unknown in Europe and 
America. 
When previously normal individuals of adult age 
develop marked hypothyroidism, the condition is called 
myxedema. The onset is gradual, with symptoms of general asthenia, 
mental instability, disinclination for mental or physical work. When 
the condition arises suddenly, as a result of operative removal of the 
thyroid, the condition is sometimes called “cachexia strumipriva,” a 
name given by Kocher. Thyroid insufficiency is attended by profound 
and constant effects upon general metabolism and the symptomatology 
is fairly constant. Falta1 describes myxedema as follows: 
“This condition, resulting from the absence or insufficiency 
of the function of the thyroid gland in the adult organism, 
is characterized by diminution of all vital processes and by 
certain trophic manifestations. The diminution affects the 
vegetative functions as well as the psychic life. There is 
found slowing of the entire metabolism and diminution of the ex- 
citability of the whole vegetative nervous system. The 
trophic disturbances affect especially the ectodermal tissue, 
the skin, hair, nails and teeth, although almost all organs 
may show regressive metamorphosis, especially the vascular 
system, which tends to be the seat of a premature arterio- 
sclerosis.” 
Leopold-Levi2 stresses the pluriglandular nature of myxedema 
and states that while thyroid insufficiency is the predominating factor 
it is not the only one, and of itself will not account for the complete 
syndrome. 
“Among the endocrine organs alone, roles of varying im- 
portance are played by the hypophysis, the thymus, the tes- 
Treatment 
of Endemic 
Cretinism 
Myxedema 
luThe Ductless Glandular Diseases,” 1915. 
2“Thyroid Insufficiency,” Leopold-Levi, The Practitioner, February, 1915. 
14 tides and ovaries, as well as by the pancreas, liver, etc. De- 
rangement of these organs reacts upon the tone of the nervous 
system and the great sympathetic, as well as upon the con- 
stitution of the blood plasma. A portion of the sympto- 
matology depends upon disturbance of these various glands. 
Briefly put, true myxedema is a pluriglandular syndrome, the 
predominating feature of which is thyroid insufficiency.” 
The dwarfism characteristic of cretinism does not, 
of course, exist if the condition has developed after the 
normal growth process has been completed. The men- 
tal symptoms, however, are almost constantly present 
and may be pronounced in character. There is a characteristic apathy, 
dullness and disinclination for work. Normal interests are lost and 
there is a general slowing of thought processes. In many cases more 
marked symptoms, such as hallucinations and illusions may appear. 
The weight usually increases. The skin and mucous membranes are 
severely affected and surface temperature is low, as a result of the 
lowered metabolism. The lips, nose and cheeks have a puffed, dis- 
torted appearance. The infiltrated areas occur all over the body, 
although especial sites of predilection have been described — cheeks, 
lids, extensor surfaces, ankles, feet, supraclavicular fossae. The infil- 
tration occurs in the mucous membranes as well as the skin and may 
extend to the viscera. The skin appears grayish or waxy white, and is 
infiltrated and furrowed. The hair is dry and brittle, with a tendency 
to fall out. In the case of the eyebrows, there is a tendency towards 
thinning of the outer third (Hertoghe’s sign). The nails are dry and 
tend to split easily; the fingers are clubbed and spade shaped. The 
gums are swollen. The mucosa of the throat and glottis may be affected 
sufficiently to cause marked changes in the voice. The cardiac muscle 
is frequently affected, with resulting slowed circulation, and periods 
of cardiac pain. The vascular endothelium is affected and arterio- 
sclerosis is usual (see Falta, above). 
Symptoms 
of 
Myxedema 
MINOR HYPOTHYROIDISM 
It has been generally recognized by all and specifically mentioned 
by many of the investigators in thyroid disease that the grave, well 
marked types (cretinism, myxedema) of hypothyroidism form a very 
small percentage of the total number of cases found in any locality. 
The great majority are those cases in which the hypothyroidism is one 
of lesser degree and in which many of the grosser signs and symptoms ■— 
dwarfism, idiocy, etc. — are not in evidence. 
“Besides the grave form of thyroid insufficiency, of which 
myxedema is a maximum expression, there is a lesser thyroid 
insufficiency. It is of considerable importance inasmuch as, 
in contradistinction to myxedema, it is very frequent.1’’ 
Janney2 states that in its latent form hypothyroidism is of far 
1L6opold-Levi and de Rothschild, “La Petite Insuffisance Thyroidienne et son 
Traitemente.” 
2“The Diagnosis of Hypothyroidism,” Janney, California State Medical Journal, 
August. 1921. 
15 more frequent occurrence than is generally believed. In a series of 
cases investigated by him, he found that two-thirds showed definite 
hypothyroidism, although only three had been diagnosed. Janney 
notes, as have others, that the greatest diversity of symptoms are en- 
countered in hypothyroidism, which are seemingly unrelated and are 
not explicable except by means of endocrine pathology. The action of 
the thyroid in affecting the metabolism of all types of cells explains the 
diversity of symptoms arising as a result of its diminution or withdrawal. 
Ldopold-Levi accounts in part for the diversity of symptoms as a result 
of the mediation of the sympathetic nervous system. 
“In view of the influence of the thyroid gland upon the 
nervous system, especially the vegetative system, and upon 
the humoral conditions, it is readily conceivable that insuffi- 
ciency of the glandular function is attended by an extremely 
diverse symptomatology, the expression of wdiich is determined, 
in the first instance, by local predisposition, whether inherited 
or acquired. The syndrome includes disturbances in varying 
degree of all the organs the function of which is subordinated 
to the sympathetic system; which is in its turn dependent 
upon the activity of the thyroid gland.” 
An ever larger influence in the causation of a diversity of symptoms 
is given to an inherent predisposition in some tissues to react to the 
thyroid insufficiency. 
“It sometimes happens that accentuation of a local pre- 
disposition leads to the development of an extra-thyroidic 
syndrome, a morbid complex which, in some cases may fitly 
be termed a malady, of which thyroid insufficiency is the 
underlying cause. For example: thyroid insufficiency is 
accompanied by muscular fatigue, partial neurasthenia, an 
ichthyotic condition of the skin, and alopecia. Now the 
degree of neurasthenia, myasthenia, ichthyosis, diffuse alopecia, 
may far exceed that which characterizes the symptoms of 
thyroid insufficiency, yet these signs may be due to thyroid 
insufficiency and in that case will respond to thyroid treat- 
ment.” 
Most of the symptoms described under cretin- 
ism and myxedema may occur in minor degree, 
but seldom are all, and frequently not even a 
considerable number, present in the same case. 
If the condition has existed since childhood, the individual will probably 
be small, poorly developed physically and of low vitality. The signs 
and symptoms of hypothyroidism in children particularly common are: 
constipation, partially closed fontanelles, mental dullness and lack of 
normal incentive and application in play, delayed dentition and re- 
tained and irregular teeth, deficient muscular development and dis- 
inclination for physical effort, enlarged tonsils, adenoids, impairment of 
hearing, pasty infiltrated skin, puffy cheeks, thick lips, scanty, dry, 
brittle hair, thinning of the hair on the outer third of the eyebrows, 
enuresis. The mentality shows all grades of defect from the idiocy of 
the cretin to stupidity or “backwardness.” These conditions may be 
Signs and 
Symptoms of 
Hypothyroidism 
16 evident in school work or be strikingly showm by various mentality 
tests. General nervousness and irritability is a common symptom. 
Due to deficient muscular movements of the bowel, constipation is very 
common in hypothyroidism, although there is also associated deficient 
excretion of the digestive ferments, gastric and intestinal juice, and 
bile, which contributes to this condition. There is a tendency to large 
accumulations in the colon and the intoxication resulting may give rise 
to symptoms which are the most prominent in the clinical picture. The 
condition results in a vicious circuit, for the toxemia resulting adds 
additional work upon the thyroid and depresses it, so that it becomes 
less and less efficient in correcting the intestinal condition. 
In adults the symptomatology is one of general debility and lowered 
vitality. There is general asthenia, disinclination for physical work 
and inability for concentration or mental activity. Listlessness and 
lack of interest are characteristic. The mental symptoms are fairly 
constant and in advanced cases may result in definite psychoses. The 
temperature is subnormal and basal metabolism depressed. In marked 
cases this decrease is constant. Magnus Levy was the first to demon- 
strate this fact (1895), reporting a reduction of 58 per cent, in myxedema. 
This is readily conceivable when we remember the great importance of 
the thyroid effect in stimulating metabolism, and determination of the 
basal rate by the convenient apparatus now available has become an 
important aid in diagnosing borderline cases. The assimilation limits 
for glucose are raised as a result of the deficient thyroid hormone, which 
is essential to a normal carbohydrate metabolism. As a result of the 
lowered metabolism and temperature there arise the subjective symp- 
toms of chilliness, cold extremities, etc. Joint symptoms resembling 
chronic rheumatism have been described (Kocher). Leopold-Levi 
and de Rothschild have used thyroid therapy in such cases with con- 
stant success, although Falta cautions that this does not necessarily 
point to a thyrogenic origin of these conditions but may be the result 
of the beneficial effects of thyroid medication on general metabolism. 
The muscles are, however, definitely affected and become fatty, and 
fatigue products accumulate, giving rise to asthenia and muscular weak- 
ness. In males, impotence, and in females amenorrhea, menorrhagia 
and sterility are common. 
The involvement of other glands described as occurring as a part 
of myxedema may also be present in the various grades of milder insuffi- 
ciency. 
“Other symptoms are frequently associated with those of 
thyroid insufficiency and certain among these depend for 
their manifestations upon the derangement of other ductless 
glands. The important are these: 
“1. The symptoms in question are not necessarily 
associated with thyroid insufficiency. 
“2. They may form part of the clinical complex, not of 
subthyroidism but of hyperthyroidism. 
, “3. They are associated with lesions or derangements 
of other endocrinic glands, and these lesions or de- 
rangements are capable, on their side, of primary or 
17 secondary reaction upon the thyroid body, giving rise 
either to thyroid insufficiency or to secondary thyroid 
instability.” 1 
Certainly it would appear that the association of other glands, 
either as a result of thyroid disturbance or preceding it, is as a rule 
not sufficiently considered either in diagnosis or treatment. Thyroid 
therapy alone, or thyroid administration for purposes of diagnosis may 
be unavailing and lead to no conclusive results through neglect of this 
point. The hypophysis and gonads which are commonly associated in 
endocrine disease are frequently involved in a syndrome in which the 
major symptoms are those of hypothyroidism. Likewise the low 
blood pressure and asthenia, described above as characteristic of hypo- 
adrenia, may be conspicuous in hypothyroidism and point to an asso- 
ciated suprarenal involvement. 
GENERAL CONSIDERATION OF THE SIGNS AND 
SYMPTOMS OF HYPOTHYROIDISM 
1. Infiltration 
Infiltration is perhaps the most characteristic 
sign of hypothyroidism and in advanced cases gives 
rise to changes in practically all tissues. The pathology of many diverse 
signs in hypothyroidism, therefore, is the same — thickened lips, lids, 
skin, mucous membranes, etc. The condition is most marked in the skin 
and mucous membranes but may extend to practically all of the viscera. 
The peculiar substance which infiltrates these tissues is of unknown 
chemical constitution and described as mucoid. It infiltrates the con- 
nective tissue of the skin layers and muscle tissue of various organs. 
There is no pitting on pressure such as is seen in true edema. In minor 
hypothyroidism Leopold-Levi describes a transitory infiltration appear- 
ing for brief periods and even for part of a day. 
“A white indolent edema, which does not pit on pressure, 
makes its appearance in the vicinity of the eyelids, the fore- 
head and the cheeks; occasionally there is transitory swelling 
of the feet, and the subject finds that his boots are temporarily 
too tight for him. Or the fingers may become sufficiently swollen 
to render the removal of the rings a matter of difficulty.” 
Leopold-Levi’s description of this type serves to emphasize the 
fact that even in marked hypothyroidism the infiltrated material may 
vary from time to time and in some cases may even disappear. 
Symptoms referable to the nervous system and 
defective mental development are of constant oc- 
currence. In congenital cretinism and marked 
hypothyroidism in the young, definite structural 
change in the brain and central nervous axis are present. The normal 
functioning thyroid is indispensable for the development of normal 
mentality. In the marked condition of cretinism typical “cretinic 
idiocy” is present. In lesser grades of subfunction, all gradations of 
mental retardation are encountered. While in total absence of the thy- 
roid with idiocy, there is brain structural defect, in the less advanced 
2. Mental and 
Nervous 
Symptoms 
Leopold-Levi, 77 e Practitioner, February, 1915. 
18 cases and those developing in childhood this probably does not exist, as 
these children can be restored to almost normal mentality by thyroid 
therapy. Children are usually dull and stupid in the milder cases and 
lack the spontaneity and interests of the normal child. Definite psychoses 
may appear. Falta states (quoting from statistics of the English myxe- 
dema commission) that in one series studied there were found 18 cases 
with illusions, 16 with hallucinations and 16 with psychoses. Defects of 
hearing are usual, the explanations for this being numerous. General 
tendency to somnolence, apathy, melancholic temperament and “neuras- 
thenia” is characteristic. 
The hair is typically dry, scanty, brittle and with a 
tendency to fall out and turn grey early. The thinning 
of the outer third of the eyebrow is regarded as particu- 
larly significant. The nails are brittle, split easily and show evidence of 
faulty formation. 
The metabolism is lowered m marked degree 
and is more characteristic of thyroid disturbance 
than of any other endocrine disease. As a result of the depressed chemical 
changes of the body the temperature is lowered and the skin feels cold. 
The patient feels chilly and is never warm. The reaction of chilliness 
found in hypothyroidism is characteristic and very common. The 
tolerance for sugar is raised.- 
As noted by Falta, arteriosclerosis is a character- 
istic of subfunction of the thyroid. The heart may show 
the infiltration common to other tissues and may develop 
degenerative changes. One type of chilliness is described by Leopold-Levi 
as due to vasomotor disturbance. “Chilliness is associated with vaso- 
motor derangement of which aero-asphyxia, cyanosis and chilblains 
are the manifestations. The pulse is usually small and slow.” Organic 
heart lesions are frequently found. 
“The subthyroidic temperament is associated 
with tendency to obesity; in other words, the subject 
possesses a nutritive orientation which, under the influence 
of exogenous conditions, such as an overabundant dietary 
coupled with insufficient exercise, predisposes to the formation 
of fatty deposits.” (Leopold-Levi.)1 
The tendency to a uniform deposition of fat is present in all cases 
and all ages of hypothyroidism, and seems to be bound up with the slowed 
metabolism and imperfect oxidation of the organism. Owing to the 
marked effect of thyroid therapy in these cases in reducing the fat, thy- 
roid extract has been improperly used in the treatment of all types of 
obesity. Owing to its powerful action if given in sufficient dosage, fat 
may be burned by the organism and the weight reduced, but this is an 
unjustifiable and dangerous use of thyroid which should be limited to 
those cases which are clearly thyrogenic in origin. 
Constipation is a very common symptom of 
•hypothyroidism. Colonic stasis may become severe 
and the resulting intoxication a grave complication. The rmiscle layers 
3. Skin 
Appendages 
4. Metabolism 
5. Vascular 
System 
6. Obesity 
7. Constipation 
Leopold Levi, The Practitioner, February, 1915 
19 of the intestine exert an imperfect, inefficient action, probably due to 
the lack of normal thyroid sensitization of the vegetative nervous system. 
In children constipation should always suggest a subfunctioning thyroid. 
Fatigue, disinclination for mental and physical 
work, particularly in the morning, is characteristic. The 
infiltration of the muscle tissue, the slow oxidation and 
the imperfect detoxication of the body create a condition 
unfavorable for either mental or physical activity. 
8. Asthenia 
and 
Fatigue 
TREATMENT 
The clinical picture of hypoadrenia is that usually described as “gen- 
eral debility.” It has been shown how intimately it is related to the infec- 
tions, acute and chronic, to the lowered vitality following prolonged nervous 
and emotional strain, to convalescence, and to those individuals of 
constitutionally lowered vitality. Asthenia, low blood pressure and sub- 
oxidation are the conspicuous symptoms. The treatment, following the 
known facts of the interrelationship of the endocrine glands (considered 
elsewhere) and the constant involvement of the associated glands, makes 
a pluriglandular combination of particular value in these conditions. The 
particularly well established pituitary-thyroid-adrenal-gonad relation- 
ship, the effects of thyroid administration in the stimulation of the ad- 
renals, and the relationship between the gonads and the adrenal cortex 
make Hormotone a rational and effective treatment for these conditions. 
Hormotone, as a combination of thyroid, pituitary and gonad substance, 
stimulates the functional activity of these glands and the adrenals (thyroid 
administration alone causes adrenal hypertrophy in experimental work). 
The effect of the suprarenals in maintaining the tonicity of the tissues 
innervated by the sympathetic doubtless contributes considerably to 
the efficiency of this formula through its stimulatory action on suprarenal 
function, as lessened irritability of the sympathetic appears to be char- 
acteristic of states of failing suprarenal function. Thyroid itself stimu- 
lates, sensitizes or in some manner creates a condition of greater reactivity 
of the sympathetic nervous system to epinephrin. 
In asthenic conditions arising as a result of functional disturbance 
of the thyroid and pituitary, as well as the adrenals—that is, in conditions 
in which these are the glands predominantly at fault — it is sometimes 
advisable to supplement Hormotone with additional dosage of the sub- 
stance of the gland to which the major symptoms appear to be referable: 
thus, in well marked hypoadrenia whole suprarenal substance and in 
hypothyroidism thyroid substance. The following case of hypoadrenia 
reported by Tom Williams1 and treated with adrenal substance supple- 
mented by small doses of thyroid, pituitary and gonads, is typical of the 
successful results of this form of pluriglandular therapy. Hormotone, a 
combination of thyroid, pituitary and gonads, when supplemented by 
adrenal substance in such cases of hypoadrenia, has proved its value 
through years of clinical trial by the ablest in the profession. 
“ Vagotonic Hypoadrenia. A young lawyer was referred last 
winter by Dr. Wilmer, to whom he had been sent because of 
1Tom Williams, Medical Record. April 14, 1917. 
20 distress during prolonged use of the eyes. There were no physi- 
cal abnormalities sufficient to account for this, so Dr. Wilmer 
referred the patient to me for neurological survey, partly 
because of an apprehensiveness which the patient had 
developed as a boy and because of an increasing lack of stamina, 
indigestion and paresthesiae. Examination showed a low 
blood pressure, 110 and 72, decreasing on standing, the follow- 
ing day falling to 90 and 62, increasing to 102 on standing. 
Pulse 102; positive Ascher phenomenon, positive Trousseau 
sign, Chvostek sign however absent, and history of tetanic 
cramp and paresthesiae in the legs after prolonged sitting. 
The reaction to pilocarpine was excessive, there being chills, 
nausea, weakness, and urethral dragging pain. Treatment of 
the hypoadrenia alone by adrenal substance caused considerable 
improvement. This was later augmented by small doses of 
thyroid, pituitary, and gonads, when great improvement fol- 
lowed.” 
In asthenia with marked suboxidation and lowered metabolism and 
evidence of general hypothyroidism, the addition of thyroid may be 
exceedingly valuable. The general results of thyroid therapy are among 
the most striking observed in medicine and in definitely diagnosed, un- 
complicated hypothyroidism the administration of thyroid extract 
alone may be sufficient. In cretinism and myxedema the improvement in 
the mentality and physical symptomatology may result in a return to 
a close approximation to normal. This improvement is usually prompt, 
a few days sufficing to bring an easily discernible change. The dosage 
is from 1 to as much as 5 grains daily, the greater number of cases requir- 
ing low dosage — from 1 to 2 grains daily. In minor hypothyroidism 
the effects are most gratifying and low dosage is advisable. 
It will be noted that in “general debility” with asthenia, suboxida- 
tion, low blood pressure, mental and physical lassitude, lack of “drive,” 
etc., as the cardinal symptoms, there is usually defect of cell metabolism 
itself. In hypoadrenia and in hypothyroidism there is accumulation of 
the catabolic products, fatigue substances, and (in hypothyroidism) 
definite infiltration of the tissues of the body. The effect of Hormotone 
is one of stimulation of the entire group of glands described by Falta as 
the acceleratory or dissimilatory, and is attended by stimulation of the 
lowered metabolic processes, increase in respiratory quotient, stimu- 
lation of the tissues innervated by the sympathetic, correction of sub- 
oxidation and the resulting accumulation of fatigue substances, and 
increase in adrenal function, which has been shown to be so essential in 
the maintenance of muscle efficiency and the prevention of fatigue and 
asthenia. 
The frequent association of functional disturbances of the thyroid, 
hypophysis, suprarenals and gonads, with the resulting clinical picture 
that is not characteristic of pure type disturbance of any single gland, 
has been described. These complex involvements account for the great 
majority of the cases of general debility and “run-down” conditions, which 
certainly form one of the most numerous groups met with in general prac- 
tice. In the treatment of these cases it is unnecessary to relate the in- 
21 sufficiency of the usual “tonic” drugs or to note the fact that the endo- 
crine substances used in medicine are the only ones which definitely 
raise lowered basal metabolism. The advisability and even necessity 
of combined therapy has been shown. 
“Where thyroid insufficiency is associated with other 
endocrine insufficiencies, the glandular therapy should be 
equally complex; ovarian, testicular, suprarenal and pitui- 
tary extracts may all be employed with advantage in suitable 
cases.” (Leopold-Levi.) 
In simple asthenia, without disproportionate in- 
volvement of any particular gland, Hormotone, in a dosage 
of 1 or 2 tablets three times daily. 
In cases of determinable involvement of the supra- 
renals1—hypoadrenia—in which the adrenal factor is predominant, 
Hormotone in a dosage of 1 or 2 tablets three times daily, supplemented 
with 1 tablet (2 or 5 gr.) of Entire Suprarenal Substance. 
In cases with involvement of the thyroid, 1 or 2 Hormotone Tablets 
three times daily, supplemented with 1 tablet (1/10 to 134 grs.) of Thy- 
roid Substance, the thyroid dosage depending upon the extent of the 
symptoms of hypothyroidism. 
Summary 
of 
Treatment 
SENILITY 
The similarity in general appearance of cases of well marked hypo- 
thyroidism and senility has frequently been noted, in both the psychic 
and physical features of the two conditions. The characteristic mentality 
of the aged, with its loss of memory, tendency to somnolence and lack of 
gras$ of difficult or complex matter, has its counterpart in the mentality 
of marked hypothyroidism. The impaired hearing, dry and scanty hair, 
lowered or lost sex function, and arteriosclerosis, of the one are likewise 
characteristic of the other. Horsley, in particular, and others follow- 
ing him, noted the increase in connective tissue and the alteration in 
the skin as common to both conditions. 
In senility, however, and particularly in pre- 
mature senility, considerations of clinical obser- 
vation, as well as the physiological correlation of 
the endocrine glands, warrant the belief that pre- 
mature senility is not due to subfunction of the thyroid alone, diverse and 
widespread as these effects are. 
“For reasons less obvious and in a manner less dramatic 
than the menopause, the conditions surrounding the mere 
advance of years tend to produce inadequacy of the thyroid 
function. It is not that the thyroid gland declines more rapidly 
than the other internal secretory glands, for all of them, even 
including the spleen, tend to diminish both in size and activity as 
the years advance. It is that the thyroid gland is so impor- 
tant to the economy that any diminution in its activities reflects 
itself unmistakably in a great many directions.”1 
Senile Changes 
Pluriglandular 
In Origin 
Leonard Williams, “Minor Maladies,” 1918. 
22 Certain symptoms and signs indicate the involvement of other 
endocrine tissues and the condition of senility very probably arises as a 
result of a gradual pluriglandular hypofunction. “Besides the thyroid 
there are also different other ductless glands whose degeneration pro- 
duces old age. These are the sexual glands, the pituitary body and the 
adrenals.”1 Falta is in accord with this opinion in so far as it is applied 
to premature senility. He says: 
“In a detailed study Lorand has upheld the idea that the 
degeneration of the ductless glandular system is chiefly the 
cause of senility. I would not concur with this, so far as physio- 
logical old age is concerned, but believe much more, as does 
also Ewald, that the ductless glandular system like every other 
organ participates in the involution of old age. There is on 
the other hand a pathological, old age, setting in prematurely 
or associated with distinct accentuation of the cachexia. The 
premature senility which develops in most of the diseases due 
to giving out of function, and especially in multiple ductless 
glandular sclerosis, makes intelligible to me the fact that degen- 
eration in the ductless glandular system may be one of the 
causes of pathological age.”2 
The conception of autointoxication as a con- 
tributing factor in old age has also been brought 
into relation with pluriglandular endocrine involvement by many authors 
and such intoxication seems to follow as a necessary part of the glandular 
disturbance. Both the adrenals and thyroid, which play an important 
part in the antitoxic mechanism of the body, fail to exert their normal 
antitoxic action and the widespread systemic effects of the intestinal 
toxins proceed unhindered. 
“In true senescence, normal decline, the outstanding 
phenomena have to do with degeneration of the ductless glands. 
Since these glands regulate the effects of self poisoning, when 
they fail of their integrity, autointoxication progresses almost 
unhindered.”3 
The effects of adrenal insufficiency in establishing a premature 
senility have been noted and these effects may be found in the diverse 
symptomatology of senility. Sajous assigns an important place to the 
adrenals in this condition. 
“In the light of the data I have submitted, however, it is 
clear that the lesions to which the adrenals are subjected 
during infection and autointoxication, from birth to the last 
day of life, do greatly shorten it by limiting the functional 
area of the organs through the fibrosis they entail. It is quite 
probable, in fact, that centenarians owe their prolonged lon- 
gevity mainly to integrity of their adrenals.”4 
Autointoxication 
1Lorand, “Life Shortening Habits and Rejuvenation,” 1922. 
2Falta, “The Ductless Glandular Diseases,” 1915. 
3J. Madison Taylor, Medical Record, Nov. 3, 1917. 
4Sajous, “The Internal Secretions and the Principles of Medicine,” 10th Edition, 
1922. 
23 The effects of prolonged and intense emotional and 
psychic activity have been stated to contribute to pre- 
mature senility by many physicians and the idea is current 
among the laity as well. If the reservation is made that a moderate nor- 
mal mental activity is necessary to the prolongation of life, the im- 
portance of excessive emotional and psychic activity in causing senile 
changes will probably be doubted by none. Taylor says: 
“Conditions of fierce, frantic competition, breeding as they 
do envy, hatred and malice; inviting to indiscretions in act, 
in amusements, in food, in drink, irregularity in hours of sleep, 
inadequate forms and kinds of rest and exercise, form the foun- 
dation of and supply favorable conditions for presenility. Hence 
it comes to pass that when these unfortunates reach early middle 
age they show the earmarks of overcombustion, disintegration, 
cellular decline.”1 
Having important bearing upon the mechanism of these emotional 
states would appear to be the work of Cannon, who demonstrated the 
effects of the strong emotions, fear, rage, etc., in causing a great increase 
in adrenal activity and epinephrin output. It seems probable that an 
individual whose mental life has been filled with a succession of such states 
develops an early functional incapacity of the adrenals and a consequent 
early appearance of the signs of senility. 
The influence of the sex glands in maintaining physi- 
cal and mental vigor has long been known and the develop- 
ment of signs and symptoms of senility following castra- 
tion is of constant occurrence. This relationship has 
within the last few years been emphasized by the experiments of Stein- 
ach, both by transplanting sex glands and by effecting a stimulus to 
the individual male gonad by vasectomy. In these experiments upon 
old and decrepit animals (male and female) the transplantation of ovaries 
and testes made the most remarkable change in the animal. Animals 
previously feeble, decrepit and unfit for breeding purposes gained in 
physical vigor and appearance, and became sexually potent. In com- 
menting upon these experiments Lorand says: 
“It is interesting to note that at the autopsy of these re- 
juvenated old rats the sexual organs, including the ovaries, 
mammary glands, and uterus, were found in the same condi- 
tion as would have been expected in young rats. 
“Thus, upon transplantation of the ovaries of young rats 
into old ones, the new ovaries made up for the lost functions of 
the former ovaries which had undergone degeneration by reason 
of advanced age. Along with this came the remarkable trans- 
formation into a young animal, with all the attributes of a 
young female, again proving the truth of what the great Belgian 
physician, Jean Batiste Helmont, said several centuries ago, 
viz., that a woman is made what she is by her ovaries.”2 
Emotional 
Factors 
Influence 
of the 
Sex Glands 
1Taylor, Medical Record, Nov. 3, 1917. 
2Lorand, “Life Shortening Habits and Rejuvenation,” 1922. 
24 The gonad influence on the organism is very marked and in young 
adult life affects not only the physical but the mental development as 
well. 
“Nearly all the great men of present and past times, in- 
cluding great writers, artists, famous generals, etc., have had 
highly developed sexual proclivities. Their high grade intellect 
offers an enormous contrast to the inferior mental qualities 
and feeble intellect of castrates.”1 
The onset and development of the condition of premature senility 
seems to be intimately connected with the endocrine glands, even such 
factors as autointoxication, emotional strain, etc., acting through them. 
Various observers have placed emphasis upon this or that gland, all, 
however, recognizing the pluriglandular nature of the process. The 
thyroid and gonads appear to be central figures in the causation, although 
it is by no means believed that they are the only ones. The thyroid 
element has been discussed and is of such a nature that premature senil- 
ity has been likened to hypothyroidism. The influence of the thyroid 
upon all tissues of the body makes its importance in this connection easily 
understood. The influence of the gonads is scarcely less striking, and the 
experimental work has served to emphasize the function of this tissue in 
maintaining and restoring the vital processes characteristic of youth. The 
part of the adrenals, while not so strikingly apparent as the thyroid and 
gonads, seems to be important. Premature senility, then, is a condition 
the establishment of which involves a definite group of glands and is not 
wholly dependent upon any one of them. 
TREATMENT 
The effects of organotherapy in bringing about an amelioration of 
the symptoms, and as a preventive measure in delaying their appearance, 
has been thoroughly demonstrated. The correction of vicious modes of 
living and habits is of prime importance and excessive indulgence in 
food, alcohol, tobacco, work and stimulants of any kind should be avoided 
in any treatment looking toward the rejuvenation of the individual. 
Organotherapy should be used in conjunction and the prognosis is most 
favorable. 
“Old age being caused by degeneration of the endocrine 
glands, especially the thyroid and sexual glands, all that is 
necessary to secure rejuvenation is to improve the condition of 
these glands. The best and easiest way to do this is to ad- 
minister by the mouth extracts of these glands, after their 
extirpation from healthy animals. As long as thirty or more 
years ago it was proved that when one of these glands, such as 
the thyroid, is degenerated, all of the normal functions of 
this gland can be reproduced by ingesting extracts of the thyroid 
of sheep. The diseased gland is thus successfully replaced by the 
ingestion of the animal gland. 
“To bring about rejuvenation I have given to old men and 
women, and also to persons suffering from premature old age, 
extracts of the thyroid and sexual glands of animals. As al- 
25 ready mentioned, marked success attended the procedure. 
The persons treated looked considerably younger after it, to 
the extent of ten or fifteen years and sometimes even more. 
The wrinkles in the face already began to disappear four or 
five weeks after the treatment, and at the same time, pre- 
viously corpulent persons, losing their excess of fat, were 
made to look slender, thus imparting a youthful impression.”1 
In a discussion of the neurotic and neurasthenic conditions arising 
in elderly women Leonard Williams says: 
“Of polyglandular therapy I have not had very much exper- 
ience but since I have been using a mitrailleuse called Hormo- 
tone I have had considerable success in those cases just referred 
to as benefited by pituitary.”2 
Plormotone in a dosage of 1 or 2 tablets t. i. d. is usually sufficient 
and the effects in restoring physical and mental vigor are most encour- 
aging. The added strength and sense of well-being and the maintenance 
of the physical and mental vigor are not only satisfying to the individual 
himself but are of interest and value to society as well, for at a time when 
the maximum of intellectual efficiency, through education and years 
of experience, has been reached, the retrograde changes of senility ordi- 
narily remove in large measure the productive and creative capacity and 
the value of the individual is lost to society. Any system of treatment, 
therefore, which will add, by rejuvenation effects, any considerable 
period of vigor and usefulness to the period of life in wrhich the highest 
attainment is possible, is of more than ordinary interest to the physician 
and to society. 
CLINICAL REPORTS 
, Miss. 
“I have a case of hypothyroidism that I have had taking your 
Hormotone for two weeks (2 tablets three times a day before meals) 
with the most satisfactory results so far. Pulse reduced from 120 to 108 
per minute, nervous symptoms much improved, and has gained 9 pounds 
in weight (in two weeks). It is too early of course, to be sure, but it 
looks like she is going to get well, and is taking nothing but Hormotone.’ 
, N. Y. 
“Some time ago your representative left with me a sample of Hor- 
motone, and you later sent me a bottle of same. Shortly after this I 
had a case of chronic gastrointestinal toxemia with very weak heart 
action and blood pressure systolic 120, diastolic 100. The case was 
a man 50 years of age. He was put on Hormotone, the sample of same 
coming in very handy. He was given nothing else but this and castor 
oil, and animal food was withheld from diet. There was marked improve- 
ment in this case in a couple of days and continued improvement. He 
“Life Shortening Habits and Rejuvenation/’ 1922. 
2“Discussion on the Therapeutic Value of Hormones”, at a meeting of the 
Therapeutic and Pharmacological Section of the Royal Society of Medicine, Lon- 
don, January 20, 1914. 
26 was perfectly well in a week, and it was surprising to me to see the quick 
improvement in heart action and rise in the blood pressure. I am taking 
increasing interest in organotherapy, and desire literature and list of 
your products.” 
, N. J. 
“I have given a two weeks’ treatment of your Hormotone to a cretin, 
age 18 months, and the mother is delighted with the improvement. I 
wish to continue treatment. I enclose check for $1.00. I have no price 
list. Please send me a dollar’s worth by parcel post, and oblige.” 
, Maine. 
‘‘I have a patient, a lady, who had been operated upon for thyroid- 
ectomy and was continually losing flesh, impaired digestion, nervous 
and unable to do her household duties, but some relief from thyroid 
gland tablets. I advised Hormotone, and the treatment still continues, 
with complete recovery and a gain of some 15 pounds in weight.” 
Detroit, Mich. 
“In neurasthenic conditions I have obtained unvarying success 
through the administration of Hormotone. I obtained remarkable 
results recently in administering in tablet form three times daily to an 
octogenarian on the verge of complete senile debility. I unhesitatingly 
employ it wherever I deem it is indicated.” 
, Arkansas. 
‘‘Inclosed you will find $4.90 for which please send me 500 Hormo- 
tone Tablets. I have used all I could get from our retail druggist. They 
are the finest medicine for old people that are suffering from indigestion 
and senility that I have ever found. Please send them as soon as you 
can.” 
, Maine. 
‘‘I am pleased to say I secured some very satisfactory results with 
the two bottles of Hormotone you sent me some time ago. I tried them 
in a neurasthenic of advanced years and he reported that he felt at least 
ten years younger after taking the last bottle.” 
, Vermont. 
‘‘My patient has received the most excellent results from the Hormo- 
tone Tablets you so kindly forwarded. He was suffering from a low 
asthenic condition, blood pressure only 120, as a result of a severe attack 
of stomach grippe two years ago. Blood pressure is now 132, general 
condition much better. No fainting spells in past six weeks. Attacks 
previously occurred every ten or twelve days, rendering him almost 
helpless for a few days following. Enclosed find one dollar for another 
bottle.” 
27 in 
"|j ~^y|** p*-jj J~~P^j|'P f" "|"P 
and 
OLD AGE 
Stimulates metabolism 
Increases muscle 
tonicity 
Raises respiratory 
exchange 
Effects marked sub- 
jective improvement 
Dose: 1 or 2 tablets 
three times daily 
G. W. CARNRICK C08 
417-421 Carnal Street 
New York, N. Y. 
28 SPECIAL FORMULAE 
Each formula is sold in bottles of 40 
and 100 capsules or tablets. 
No. I Pluriglandular Comp. Male 
Hypoadrenia, Asthenia, Low Blood 
Pressure, Fatigue Syndrome 
Thyroid grs. 1/10 
Pituitary “ 1/40 
Suprarenal “ If 
Orchic “ If 
Physiological Salts Comp. “ if 
Dose: 1 or 2 cap- 
sules 3 times daily. 
No. 2 Pluriglandular Comp. Female 
Hypoadrenia, Asthenia, Low Blood 
Pressure, Fatigue Syndrome 
Thyroid grs. 1/10 
Pituitary “ 1/40 
Suprarenal “ if 
Ovarian “ If 
Physiological Salts Comp. “ If 
Dose: 1 or 2 cap- 
sules 3 times daily. 
No. 3 Pineal Comp. Male 
Backward Children, Mongolism, Re- 
tarded Mental or Physical Develop- 
ment 
Anterior Pituitary grs. 1/5 
Thyroid “ 14 
Suprarenal “ 1 
Orchic “ 114 
Pineal “ 1/30 
Physiological Salts Comp. “ If 
Dose: 1 or 2 cap- 
sules 3 times daily. 
No. 4 Pineal Comp. Female 
Backward Children, Mongolism, Re- 
tarded Mental or Physical Develop- 
ment 
Anterior Pituitary grs. 1/5 
Thyroid “ Vs 
Suprarenal “ 1 
Ovarian “ 114 
Pineal “ 1/30 
Physiological Salts Comp. “ If 
Dose: 1 or 2 cap- 
sules 3 times daily. 
No. 5 Orchic-Prostatc Comp. 
Enlarged Prostate, Sexual Neuras- 
thenia,Vesical Irritation 
Orchic grs. 1 
Prostate “ 2 
Calcium Glycerophosphate “ 2 
Dose 2 or 3 cap- 
sules 3 times daily. 
No. 6 Corpus Lutcum Comp. 
Vomiting of Pregnancy (Hypereme- 
sis Gravidarum), Menstruation Psy- 
chosis, Mild Manic Depressive In- 
sanity (Females) 
Corpus Luteum grs. 1 
Thyroid “ 1/10 
Physiological Salts Comp. “ If 
Dose: 1 to 3 tab- 
lets every 3 or 4 hours, 
which may be in- 
creased to 5 tablets 
in unusually severe 
cases. 
No. 7 Parathyroid Comp. 
Tetany, Uremia, Epilepsy, Paralysis 
Agitans, Nervous Tremor of Chil- 
dren 
Parathyroid grs. 1/20 
Orchic “ 1 
Calcium Lactate “ 2 
Dose: 2 or 3 cap- 
sules 3 times daily. 
No. 7 N. P. Parathyroid Comp. 
Tetany, Uremia, Epilepsy, Paralysis 
Agitans, Nervous Tremor of Chil- 
dren 
Parathyroid Nucleo Protein grs. 1/20 
Orchic “ 1 
Calcium Lactate “ 2 
Dose: 2 or 3 cap- 
sules 3 times daily. 
No. 8 Thymus Comp. 
Chronic Arthritis, Rheumatoid Ar- 
thritis, Arthritis Deformans 
Thymus grs. 3 
Thyroid “ 1/10 
Pituitary “ 1/20 
Dose: 1 or 2 tab- 
lets 3 times daily. 
No. 9 Mammary Comp. 
Menorrhagia, Metrorrhagia, Sub- 
involution, Prolonged Menses, Ute- 
rine Oozing 
Mammary grs. 2 
Posterior Pituitary “ 54 
Calcium Lactate “ 2 
Dose: 1 tablet 3 
times daily. 
No, 10 Suprarenal-Pituitary Comp. 
Asthma, Bronchial Asthma 
Suprarenal grs. 2 
Pituitary Entire “ 1 
Thyroid “ 1/10 
Anterior Pituitary “ 114 
Physiological Salts Comp. “ ' if 
Dose: 1 or 2 tablets 
3 times daily, which 
may be increased 
when asthmatic aura 
appears. 
No. II Ovarian Comp. 
Amenorrhea, Ovarian Hypof unction, 
Menopause. 
Ovarian Substance grs. 3 
Thyroid “ 1/10 
Physiological Salts Comp. “ % 
Dose: 1 or 2 tablets 
3 times daily, which 
may be increased to 
3 or 4 tablets from 5 
to 10 days before the 
expected menstrual 
period. 
No. 12 Renal-Pancreas Comp. 
Nephritis, Prevention of Uremia. 
Kidney Substance grs. 2 
Pancreas Sub. “ 2 
Physiological Salts Comp. “ If 
Dose: lor2tablets 
3 times daily. 
29 TRYPSOGEN 
Diabetes mellitus; 
glycosuria and defec- 
tive carbohydrate me- 
tabolism. Also useful 
in certain pancreatic 
disorders, and as an 
adjunct in hyperten- 
sion. May be had with- 
out gold and arsenic at 
same prices. 
Presents the homo- 
stimulative principles 
that excite the produc- 
tion of the internal 
secretion of the pan- 
creas when the gland 
is functionally defi- 
cient; contains proteo- 
lytic and lipolytic fer- 
ments; also 1/200 gr. 
each of gold bromide 
and arsenic bromide. 
Dose: 2 to 7 tablets 
or 1 to 3 capsules after 
meals. 
IN ONE BOTTLE 
100 
500 
1000 
100 
100 
SECRETOGEN 
A physiologica1 
treatment of gastroin- 
testinal insufficiencies 
and constipation, in- 
testinal stasis, infan- 
tile diarrheas, maras- 
mus and inanition. 
Tablets. A homo- 
stimulative extract 
from the duodenum. 
Dose: 1 to 3 tablets 
before or after meals. 
Elixir. A homo- 
stimulative extract 
from the stomach and 
duodenum; contains 
1/10 of 1% HC1. 
Dose: l to 3 tea- 
spoonfuls before or 
after meals. 
IN ONE BOTTLE 
100 
500 
1000 
Tablets 
Tablets 
Capsules 
Caps. Dble. St’ngth 
Elixir 
>2 Pt. 
lpt. 
5 pts. 
1 gal. 
KINAZYME 
An aid to metabolism 
in tuberculosis and 
other wastingdiseases; 
especially valuable in 
undernourished and 
backward children. 
Contains 1/60 gr. 
whole pituitary in ad- 
dition to pancreas,liver 
and spleen substance 
with calcium'phos- 
phate. Kinazyme(01d 
Formula) contains the 
same without pituita- 
ry. Same price as Kin- 
azyme. 
Dose: 2 to 4 tablets 
•or capsules after eat- 
ing. 
100 
500 
1000 
100 
T ablets 
HORMOTONE 
Neurasthenia; “run 
down conditions”; sub- 
oxidation; neuroses; 
' menstrual and climac- 
teric disorders; cardiac 
asthenia; hypotension, 
etc. A combination of 
tonic hormones from 
thyroid, pituitary, ad- 
renal and gonads. 
Dose: 1 or 2 tablets 
3 times daily before 
meals. 
Capsules 
Tablets only 
100 
500 
1000 
HORMOTONE 
w/o Post-Pituitary 
In neurasthenia 
associated with hyper- 
tension. 
Dose: 1 or 2 tablets 
3 times daily before 
meals. 
100 
500 
1000 
FEROVARIN 
To increase red cor- 
puscles and hemoglo- 
bin content of blood in 
anemia and chlorosis. 
Contains 1/30 gr. of 
desiccated thyroid 
combined with desic- 
cated entire ovary 
and the salts of the 
blood plasma in physi- 
ological proportions. 
Dose: 1 or 2 tablets 
or capsules 3 times 
daily after meals. 
Tablets 
50 
100 
500 
1000 
50 
VIRILIGEN 
Indicated in lowered 
virility andsexual neu- 
rasthenia of functional 
origin. 
Presents desiccated 
extracts of anterior 
pituitary, suprarenal 
cortex, lymph, brain 
and spinal cord sub- 
stance, testis and 1/10 
gr. thyroid. Not sold 
in bulk nor sampled. 
Dose: 1 or 2 tablets 
or capsules 3 times 
daily before meals. 
Tablets 
100 
Capsules 
Capsules 
100 
Alkaline Tablet 
(G.W.C.Co.) 
A coated tablet con- 
taining salts of sodi- 
um potassium and 
calcium in physiologi- 
cal proportions. 
A valuable medica- 
ment in hypo-alka- 
linity. 
200 
500 
1000 
Ampoules 
Yz doz. 
MAMMAGEN 
T ablets 
To increase lactation 
in deficient milk sup- 
ply in the nursing 
mother. Each tablet 
contains Ys grain des- 
iccated entire pitui- 
tary substance with 
the hormones and vita- 
mines of corpus lu- 
te um, placenta and 
mammary glands. 
Dose: 1 or 2 tablets 
or capsules 3 times 
daily after meals. 
50 
100 
500 
1000 
50 
PERISTALSIS 
COMP. 
(G.W.C.Co.) 
A combination of the 
pens'aiHc principles 
of he duodenum, pylo- 
rus and spleen, togeth- 
er vv;th % grain of 
pu-ified ox gall and % 
grain pituitary. 
Dose: 1 to 3 tablets 
after supper and at 
ibedtime. 
40 
100 
Capsules 
Coated Tablets 
30 SINGLE GLAND PRODUCTS 
Our organotherapeutic products are made from fresh glands of healthy food animals, 
in our own laboratory, under the supervision of competent chemists. All moisture has 
been removed from these gland products and they will keep indefinitely if contents 
are not exposed to moisture and bottle is kept tightly corked. 
In one bottle 
Albuzyme caps. 75 
Amylzyme Powder oz. 
caps. 40 
100 
Brain Powder oz. 
Brain & 2-gr. tabs. 100 
Spinal Cord 
Corpus Luteum Powder X oz. 
oz. 
2-gr. tabs. 50 
100 
5-gr. tabs. 50 
* 100 
5-gr. caps. 50 
100 
1 c.c. ampoules, 20$ V2 doz. 
Duodenal Sub. Powder oz. 
Epinephrine Powder 1 grain 
Chloride Sol., 1-1000 oz. 
1 c. c. ampoules, 1:10,000 X doz. 
Glycogen Powder 1 gram 
X oz. 
X oz. 
1 oz. 
2 c. c. ampoules (box of 6) 
Kidney Powder oz. 
2- tabs. 100 
5-gr. caps. 100 
Lecithin X oz. jars 
“ Commercial 1 oz. jars 
Liver Powder oz. 
3- tabs. 100 
5-gr. caps. 100 
Lymphatic Gl. Powder oz. 
3-gr. tabs. 100 
Mammary Powder oz. 
Sub. 3-gr. tabs. 100 
5-gr. caps. 100 
Marrow—Red X Pt- 
Bone Glycerole 1 pt. 
Orchic Sub. Powder oz. 
2-gr. tabs. 100 
5-gr. caps. 100 
Ovarian Sub. Powder oz. 
2-gr. tabs. 100 
5-gr. tabs. 50 
100 
5-gr. caps. 50 
100 
In one bottle 
Ovary w/o Powder oz. 
Corpus Lut. 5-gr. caps. 100 
Ox Gall Powder oz. 
Pancreas Powder oz. 
5-gr. caps. 100 
Pancreatin Powder oz. 
(U.S.P.) 2-gr. tabs. 100 
5-gr. caps. 100 
Pancreatin & Tablets 100 
Soda 
Parathyroid Powder X ®z- 
1/20-gr. tabs. 100 
Parotid Powder oz. 
Pepsin (U.S.P.) Powder oz. 
Pineal Gland • Powder X oz. 
1/10-gr. tabs. 100 
Pituitary Powder X oz. 
1 oz. 
V2-gr. tabs. 50 
100 
1-gr. tabs. 50 
100 
2-gr. tabs. 50 
100 
Pituitary, Ant. Powder X oz. 
1 oz. 
1- tabs. 50 
100 
2- tabs. 50 
100 
Pituitary, Post. Powder X oz. 
1/10-gr. tabs. 100 
V2-gr. tabs. 100 
(Liquor Hypophysis) 
X c. c. ampoules, Ob., X doz. 
1 “ “ “ X doz. 
1 c. c. ampoules, Surg., X doz. 
Placenta Powder oz. 
3- tabs. 100 
5-gr. caps. 50 
100 
31 In one bottle 
Prostate Powder oz. 
2- tabs. 100 
3- caps. 100 
Spleen Powder oz. 
3-gr. tabs. 100 
5-gr. caps. 100 
Steapzyme caps. 75 
Suprarenal Powder oz. 
Gland (U.S.P.) 1-gr. tabs. 100 
3-gr. caps. 100 
Suprarenal Powder % oz. 
Cortex 1 oz. 
1- tabs. 50 
100 
2- tabs. 50 
100 
3- caps. 50 
Suprarenal Medulla Powder X oz- 
2- tabs. 100 
Thymus Powder oz. 
3- tabs. 100 
5-gr. caps. 100 
Thyroid (U.S.P.) Powder oz. 
1/10-gr. tabs. 100 
tabs. 100 
In one bottle 
Thyroid (U.S.P.) (cont.) %-gr. tabs. 100 
1- tabs. 100 
2- tabs. 100 
1- caps. 100 
2- caps. 100 
3- caps. 100 
5-gr. caps. 100 
Tonsil Powder oz. 
3-gr. caps. 100 
Nucleo-Protein Products 
Ovarian Nucleo-protein 10$ 
100 Tablets 
Parathyroid Nucleo-protein 5$ 
20 Tablets 
Pituitary Nucleo-protein 10$ 
20 Tablets 
Suprarenal Nlicleo-protein 10$ 
100 Tablets 
Thyroid Nucleo-protein 1$ 
100 Tablets 
“ Nucleo-protein 5$ 
100 Tablets 
Nucleo-protein 10$ 
100 Tablets 
Residue Yz oz. 
Overseas Distributors of 
Go Wo Carnriek CcPs Products 
BRITISH ISLES-American Drug Supply Co. 
40-42 Lexington St., Lon- 
don, W. 1 
CANADA —Lymans Limited 
Stocked by all 344 St. Paul St., W., Montreal 
wholesalers in 
Canada 
MELBOURNE —Ayers & James Pty, Ltd. 
122 Flinders St., E. 
SYDNEY —Elliott Bros. Ltd., 
O’Connell St. 
AUCKLAND —Connelly Bros., 
Foresters’ Bldgs. 
JOHANNESBURG—Sive Bros. & Karnovsky, 
Ltd. 
CAIRO —New British Drug Co. 
3 Sh. Maghraby 
SINGAPORE —Muller & Phipps (Malaya) Ltd. 
4 Cecil St. 
HONG KONG —Kwong Sang Hong 
246 Des Voeux Rd. Central 
SHANGHAI —Muller & Phipps (China) Ltd 
1 B Jinkee Rd. 
BOMBAY —Muller & Phipps (India) Ltd. 
14 Greene St. 
MADRAS —Muller & Phipps (India) Ltd. 
21 Sunkurama Chetty St. 
CALCUTTA —Muller & Phipps (India) Ltd 
21 Old Court House St. 
COLOMBO —Cargill’s Ltd. 
RANGOON —E. M. De Sousa & Co., Ltd. 
MANILA —Muller & Phipps (Manila) Ltd 
Pacific Bldg. 
HONOLULU —Muller & Phipps (Hawaii) Ltd 
1122 Union St. 
BANGKOK —The Jawarad Co., Ltd. 
Products are also carried by retailers and wholesalers in Penang, Durban, Cape 
Town, Karachi, Wellington, Barcelona and in the important cities of 
Central and South America. 
British Isles—Requests for literature and general information will receive prompt 
attention if addressed to 
S. C. Ritchie, 40-42 Lexington St., London, W. 1. 
32