DUCTLESS GLANDS.- Besides the glands which possess ducts opening into canals of the body (e.g., liver, pancreas) there are a number of glands whose secretions (hence called Internal) pass direct into the blood stream. Of these the most important are, thyroid, adrenal, pituitary, para-thyroid, and it must further he noted that the liver and the pancreas and the ovaries and testicles possess internal as well as external secretions.
These internal secretions influence life profoundly. One or more of them is liable to be affected in almost any sickness, and there are certain diseases which can be associated definitely with failure or excessively function of some one or other gland. The most important of these diseases are briefly discussed in the following pages.
187.- Myxoedema and Cretinism- (Hypo-thyroidism).
There are certain circumstances of unknown origin by reason of which the Thyroid gland ceases to function. The result is Myxoedema of Cretinism, the first being a disease of advanced life, the second of early years.
Cretinism may be congenital, the gland being absent. More commonly it atrophies after one of the fevers. Where goitre (q.v.) is epidemic, cretinism occurs; the gland is enlarged in these cases, but not functioning.
SYMPTOMS OF CRETINISM.- The child (in a congenial case) is mentally slow or deficient. The tissue is thin and the skin dry. The face is pale and the eyelids are puffy, the whole body gradually acquires a swollen appearance. The fontanelles remain open; there is great muscular weakness. Imbecility is the rule in regard to the mental condition. If Cretinism follows fever or goitre these symptoms appear in individuals who may till then have been bright and well developed. The words stunted growth and feeble mind sum up the condition.
SYMPTOMS OF MYXOEDEMA.- This is a disease of adults, much more common in women then in men, but not related to menstruation or pregnancy. The general bulk of the body increases, the skin is swollen in a firm inelastic way, which does not pit on pressure, and is dry, rough and non-perspiring. The hair falls off. The features become thick and shapeless, and the gait heavy and slow. Temperature is often subnormal and patients feel the cold excessively. The mental condition is one of stupidity and slowness, with slow, hesitating, toneless speech and defective memory. Dementia with delusions may supervene. The sufferers are very liable to tuberculosis, which generally kills untreated cases. Post mortem the thyroid gland is found atrophied. The whole bodily energy is reduced by twenty to forty per cent. It is a slow progressive disease and may last for years. It may follow Exophthalmic Goitre (q.v.).
Treatment is as certain and successful as in any known disease. The absent gland secretion can be supplied by giving the sheep. One grain three times a day is enough at first, and the dose can be increased if necessary, but is as well not to be in a hurry to increase it. Under its use improvement is rapid and a return to normal bodily and mental health almost invariable. If cases are recognised early, before the gland is quite atrophied, the renewed vigour seems to stop the atrophying process nd after health is restored only small doses are needed to maintain it. But it is virtually never possible to do without occasional supplies, and congenital cretins cannot do without regular dosage.
Patients with tendency to myxoedema or Cretinism should be kept warm. Massage is useful. The drugs most likely to be to service are Calcarea Carb., Arsenicum, and Tuberc. Bovista These are not likely to do much without Thyroid, but can supplement its action efficiently.
188.- Hyperthyroidism-Exophthalmic Goitre.
In this disease the thyroid is over active. Cases of all degrees may be met with. Acute infection, worry, shock, nerve strain, all seem to play a predisposing part and the tendency to this disease runs in families.
SYMPTOMS.- Acute cases are known but are rare. Usually the onset is gradual. The pulse rate rises to 120, 140 or more, with visible pulsation of vessels. The face is flushed and erythema is common. The thyroid gland enlarges as a rule; the swelling is firm and elastic. A double murmur may be heard by the stethoscope placed not he gland The eyeballs protrude, and the eyelids retract (Exophthalmus). Tremor is an early symptom affecting the hands chiefly. Anaemia, emaciation, occasionally fever, vomiting and diarrhoea, are all possible symptoms. Myxoedema may follow this disease. The body output of energy is increased.
TREATMENT.- The disease may disappear spontaneously, even after lasting for months.
When advanced cases have resisted medicine it is night to consider removal of part of the gland, which is often a successful procedure. X-ray applications have helped now and then. Simple diet without stimulants and a very quiet, restful life are essential, Medicinally, in acute and recent cases Belladonna, Glonoin, Veratrum Viride, Lycopus Virg., give great relief to symptoms and sometimes permanent amelioration. In more chronic cases, Spongia, Spigelia, especially when heart symptoms (pain and palpitation) are prominent, should be thought of, but cure has more often resulted from careful case working-our with single doses sand high potencies.
The drugs oftenest used in chronic cases in this way are Natrum Muriaticum. Sulphur and Sepia.
This is a chronic enlargement of the Thyroid Gland, attacking women more often than men and occurring about puberty generally. The cause is obscure; it has been considered as due to excess or deficiency of some mineral constituents in the drinking water, or to a specific micro-organism as yet unidentified. Possibly the last is the essential and the other a contributory cause. Goitre is very common in certain districts, Oxfordshire, Derbyshire, parts of Switzerland, Pyrenees, etc., and in all goitrous districts water tends to the hard, rich in lime and magnesia, and poor in iodine.
The enlargement of the gland in simple goitre does not mean over activity as in exophthalmic goitre. Generally, indeed, the gland secretion seems lessened and enlargement may sometimes be compensatory. There are few symptoms beyond the enlargement, and occasionally, pressure symptoms, cough and dyspnoea. Many cases spontaneously recover. Large tumours or those causing pressure can be sent to the surgeon if medicinal measures fail, but Iodine, Kal.- Iodium and Spongia (i.e., Iodine in some form) are very often successful, and this suggests that failure to absorb Iodine or (less likely) Iodine deficiency, is a cause of this disease. Apart from Iodine, Lapis Albus has a well deserved reputation, and if any symptoms can be obtained pointing to a deep-acting remedy, it should be given. Perhaps Lycopodium is the most likely to help. X-rays have been successfully used.
Beside the Thyroid gland are two pairs of small glands called Parathyroids. They control the dealings of the body with Calcium (lime). When this is interfered with by disease of these glands, the nerve muscular system becomes over-excitable, and spasms of muscles of the extremities occur. This condition is Tetany.
The disease may be epidemic, may follow infections. In adults gastro-intestinal symptoms are common, and the fundamental cause may be an intestinal toxaemia acting specially on parathyroids. In children it is common with rickets (q.v.), and other nutritive disorders (see Laryngismus Stridulus).
SYMPTOMS.- The spasms are the characteristic feature. The arms are flexed across the chest, the two last finger-joints extended and the first joints flexed. The thumb is flexed into the palm. There is planter flexion of feet and toes, and the legs are extended. Other groups of muscles may be involved in face or elsewhere; spasm of the larynx is possible; pain is rare. The liability to spasm may persist for days or weeks.
Children generally recover. In adults peri-nuclear cataract has followed a prolonged attack.
TREATMENT.- During the attack, cool baths or cold sponging, or sometimes very hot sponging relieve, and Belladonna or Nux Vomica should be given. Between attacks the remedy most likely to help is Calcarea Carb. Rare doses of high potencies should be tired, for although non-homoeopathists prefer five to fifteen grains of Calcium Lactate frequently and persistently, the disease seems associated, not with Calcium deficiency, but with inability to handle Calcium, and the stimulus of a potentized drug is more likely to be effective than that of massive dose.
In the skull, beneath the brain, lies the Pituitary Body. It has an anterior and a posterior portion. The secretion of the anterior influences growth and development, and is essential to life; the posterior influences the body’s dealings with carbo- hydrates and fats. Extracts of the gland rise blood pressure greatly.
When the gland secretion is in excess (hyper-pituitarism) gigantism or abnormal growth of long bones occurs if the epiphyses have not become ossified before the disease occurs. In adult life the condition resulting is that known as acromegaly. It is rare, more common in women, and is often associated with large size.
SYMPTOMS.- The bones enlarge-hands and feet become huge, and the involvement of bones of the face gives a characteristic appearance. Headache (Frontal) is usual, and somnolence and often glycosuria (early). Pressure symptoms affecting the base of the brain may occur. Later there is apt to be decrease of the internal secretion (hypo-pituitarism), and this (however caused), leads to deposit of fat, subnormal temperature, slow pulse, and a very high tolerance for sugars. Mental symptoms are not uncommon; goitre may be seen. It should be observed that the secretion of the posterior part of the gland passes into the cerebro-spinal fluid, so that any cause interfering with the movement of this may cause pituitary symptoms.
TREATMENT.- Gland extracts have proved a failure.
If any deep acting remedy is indicated, that will be the most hopeful line of treatment. Phosphorus should be tried if no clear symptoms of other drugs are found.
192.- Primary Spleno-Megaly-(Bantis Disease.)
This is a primary disease of the spleen, leading to enlargement, anaemia, haemorrhage, and later to enlarged liver, jaundice and ascites (fluid in abdomen). The cause is doubtful; malaria or syphilis may predispose to it.
SYMPTOMS.- It is a very chronic disease. The enlarged spleen is the first symptom to appear. Little or no pain is present; no glands are enlarged. Anaemia follows; red corpuscles may sink below half of the normal, and white corpuscles are diminished. There are no cell changes in the blood. Bleeding (especially vomiting of blood) sets in and later the liver enlarges and jaundice and ascites appear.
TREATMENT.- Carduus Marianus in tincture, and Ceanothus should be given a good trial, unless any drug is clearly indicated. Phosphorus is likely to help and Crot. is the haemorrhagic stage. Removal of the spleen has been successfully performed, and unless medicinal treatment is remedial, it should not be too long delayed. (There are other causes of spleen enlargement, but they are nearly all cases so severe as to demand early professional treatment.
193.- Addison’s Disease.
Above the kidneys lie the adrenal glands. When they are destroyed or diseased (generally by tuberculosis) Addison’s disease occurs. It is rare.
SYMPTOMS.- Great debility, feeble heart action, pigmentation of skin, and vomiting. The secretion of the gland helps to maintain the tone of arteries, so in its absence, low tension occurs. Loss of appetite and diarrhoea are usual as well as vomiting. The pigmentation is peculiar, giving rise to dark patches on face, hand, or elsewhere. The disease is seldom very prolonged, and recovery is rare.
TREATMENT.- Adrenalin should be tried, but seldom helps much. Tuberc. Bovin. should be given, and Arsen., Argentum-Nit., Natr.- Mur. seriously studied for symptoms. In non-tubercular cases, intestinal toxaemia should be considered, as a cause, and vaccine tried.
194.- Status Lymphaticus.
The thymus gland is a gland of childhood and should disappear after puberty. Its function is obscure, though related to development of the sexual glands, when it persists or is enlarged, the Status Lymphatics is present. In it patients are liable to sudden death (there is especially danger from anaesthetics), susceptibility to acute infection is increased, and there is a psychical instability with tendency to drug habits.
Children with increased thymus are fat, with enlarged tonsils and adenoids. The enlarged thymus may cause a shadow under X- rays. Later the symptoms are soft, delicate skin, slender general growth (of feminine type in boys), poor hair development of sex glands.
TREATMENT.- Sugar and starch should be cut down in diet; green vegetables and fruit are important. X-ray may be tried. Medicinally Calcarea carb. in young children and Phosphorus and Tuberculinum- Bovista later would seem the best indicated, but each case should be studied for its own symptoms.