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There are, too, individuals in whom hyperthyroidism and hypothyroidism are mixed, or rather alternate. At one time they present the phenomena of the one, at another of the other. They are the people who complain of the cyclic quality of their moods and purposes. Their mood will be a heaven of exaltation and exhilaration, and then descend into a slough of despond from which they feel themselves inextricable. They are always talking about the ups and downs of their mental states.
Headache and languor and fatigability, dry skin and lack of appet.i.te for food or exertion on one day or for one week, give way on the next day, or for the next week, to an energetic gayety, and sweaty, flushed skin, a prominent appet.i.te for food and every sort of activity. Driven to be forever on the go, for one period, in the next they feel like lying down most of the day, with no inclination for any life whatever.
The stage of depression may go as far as a melancholia, the stage of stimulation as far as mania. They may simulate manic-depressive or cyclic insanity. Something restrains them, and holds them bound as in a vise in the one cycle. And then they are driven on beyond themselves by some invisible whip in the next.
THYROID AS DIFFERENTIATOR
Besides the action of the thyroid as energizer, lubricator, and growth catalyzer, it has a remarkable power as a differentiator of tissues.
It determines the embryonic etchings of the different organs which in their totality comprise the unique individual. Every multicellular animal must first have existed as a single cell, the impregnated ovum.
With the body and personality of the ovum, the creature is one and continuous, literally something the single cell has made of itself by sub-dividing and differentiating. In the process, the cell ma.s.s often goes through stages which stand out as individualities in themselves, that appear on the surface absolutely unrelated. So the caterpillar and the b.u.t.terfly, to the nave child, seem as far apart as worm and bird. In the case of the frog, the tadpole as a first sketch seems completely an impossible and wild absurdity. Yet we know that there is an orderly progression of events, a propagation of cells, a forward going arrangement of chemical reactions, that results in expansion and intricate complication of the organism. Just what the forces at work in this most mysterious of all natural processes are, has been an intellectual mystery that the best minds of the race have attempted to get rid of with words like pangenesis (Darwin). Words of Black (Mediterranean or Greek and Latin) origin, as Allen Upward has named them, always cover a mult.i.tude of ignorances. The glands of internal secretion, here, as in so many other dark places, provide the open sesame to certain long closed doors of biology. They offer themselves to us as the first definitely tangible agents which are known to keep the process of growth going, and undoubtedly initiate the marvelous unfolding of tissues and functions, organs and faculties summed up as development or differentiation.
Thus by the direct feeding of thyroid at particular points in the differentiating history most curious effects have been elicited. If the gland is made part of the nutriment, the bathing environment, of the tadpole, a hastening of its metamorphosis is attained. The tadpole lives not out its day as a tadpole, but precociously turns into a frog. But such a frog! It is a miniature frog, a dwarf frog, a frog seen by looking through the wrong end of the telescope, a frog not magnified, but micrified. Frogs have been so created the size of flies. There has occurred a splitting of the two reactions which ordinarily go hand in hand: the reaction of growth which is just brute increase of total ma.s.s or weight and volume, and the reaction of differentiation which is the finer process. The picture is a frog, but a frog the size of a tadpole, a frog which has missed its childhood, adolescence and youth, skipping over these transition stages into the adult age, as a pigmy.
It is all as if a baby were suddenly to grow a beard and moustache, evolve and shed teeth, and acquire the manner of an earnest citizen, and yet retain the height and weight of a baby. That the spectacle of such a superbaby is not quite the most fantastic of all improbabilities is shown by the condition of progeria, first recorded by the Briton, Hastings Guilford. A queer spectacle in which a child incontinently grows old without having lived--in the course of a few weeks or months. You look upon him and see senility on a small scale, but with all its peculiarities: wrinkled skin, apathy, gray hair and all the rest of it. All we can say about it is that it is probably due to a paralysis of all the glands of internal secretion, a removal of their influence upon the cells. Contrariwise to the feeding of thyroid, removal of the thyroid of tadpoles will prevent their development into frogs. If iodine is then fed to them, say mixed with flour, normal metamorphosis will occur. If Body is the tool chest which we carry about with us, as Samuel Butler said, then to the thyroid belongs the name of tool-maker.
Another function of thyroid that must be taken into consideration is what has been spoken of as its ant.i.toxic function--in plainer English, its power to prevent poisoning, or to increase resistance against poisons, including the bacteria and other living agents which cause the infectious diseases. Each molecule of food, ingested for a.s.similation into our substance, acc.u.mulates a history of wanderings and pilgrimages, attachments and transformations beside which the gross trampings of a Marco Polo become the rambling steps of a seven-league booted giant. In the course of its peregrinations, it becomes a potential poison, potential because it is never allowed to grow in concentration to the danger point. The thyroid plays its role of protector like all the internal secretory machines. In an animal deprived of a thyroid the feeding of meat shortens life--a single sample of how it works to guard against intoxication from within. The feeding of thyroid will also raise the ability of the cells to stand poisons introduced from without--intoxications of all sorts. Alcohol and morphine will affect in much smaller doses the subthyroid person than the normal or the hyperthyroid. As regards the infections, which directly or indirectly kill most of us, the injection of thyroid will increase the content in the blood of the protective antibodies which preserve us, temporarily at any rate, against malignant invaders. The opsonins, for example, those substances which b.u.t.ter the bacteria so that the appet.i.te of the white cells for them is properly roused, are mobilized by thyroid feeding or injection. Other substances in the blood which destroy and dissolve bacteria are also increased. The thyroid probably performs these functions by sending its secretion to the cells directly responsible for the immunity reactions, and stimulating them to activity.
A sketch of the thyroid like the foregoing shows it as the wondrous controller of vitality and growth, and indefatigable protector against intoxicants and injuries. When it is sufficiently active, life is worth while; when it is defective, life is a difficult threatening blackness. That would make it out as the gland of glands. It is tremendously important, without a doubt, in normal everyday life. But no more so than the other members of the cast. The position of star it may claim, but in vain. The other glands of internal secretion to be sketched will each, when the marvels of its business in the cell-corporation are considered, present itself as candidate for the honors of the president. Justice should give fair credit to all the organs which fabricate the reagents of individuality, and the regulators of personality.
THE PITUITARY
In the human skull, the pituitary is a lump of tissue about the size of a pea lying at the base of the brain, a short distance behind the root of the nose. It is of a grayish-yellow color, unpretentious and insignificant enough in appearance, and so long neglected by the scientists who boast their immunity to the glamor of the spectacular.
Guesses at its nature date back to Aristotle.
Like most of its colleagues among the glands of internal secretion, it is really two glands in one, two glands with but a single name. At least it consists of two different parts, distinct in their origin, history, function and secretions, but juxtaposed and fused into what is apparently a h.o.m.ogeneous ent.i.ty. They are conveniently spoken of as the anterior gland and the posterior gland.
In the embryo, the anterior gland is derived by a proliferation of cells from the mouth area. The posterior gland represents an outgrowth of the oldest part of the nervous system. When it is traced back along the tree of the vertebrate species, it is found to be present in all of them. An ancient invention, its precursor has been identified in worms and molluscs and even among the starfish. "The pituitary is practically the same, from myxine to man." A trusted veteran, therefore, among the internal secretory organs, its importance can be surmised.
To understand the story of the pituitary, variously acquired bits of information concerning it have been a.s.sembled and fitted together like the fragments of a picture puzzle, as Cus.h.i.+ng has so well put it. Here and there pieces stick out, obviously out of place. The relations of some of them to one another or to the whole design are not at all clear. Parts appear to have been irrevocably lost, or not yet to have turned up. Chance bystanders will select odd figures and articulate them into a new harmony. Yet out of the jumble of fragments, a fairly respectable insight has been gained in less than a half century.
The pituitary is cradled in a niche at the base of the skull which, because of its form, is known as the Sella Turcica or Turkish saddle.
So situated, an operative approach to it is overwhelmingly difficult.
On the other hand, X-ray studies are favored. "Nature's darling treasure" it might be called, since there has been provided a skull within the skull to shelter it.
Under the most highly magnifying lenses of the microscope, three kinds of cells have been distinguished. The anterior gland is a collection of solid columns of cells, surrounded by blood s.p.a.ces into which their secretion is undoubtedly directly poured. A gelatinous material, presumed to be the internal secretion of the gland, has, in fact, been observed emerging from the cells into the blood s.p.a.ces. The posterior lobe, or gland, consists of secreting cells producing a gla.s.sy substance which finds its way into the spinal fluid that bathes the nervous system. The spinal fluid itself is a secretion of another gland at the base of the brain, the choroid. Nerves and internal secretion are a.s.sociated here with a closeness symbolic of their general relations.
From each portion of the gland (to stick to the accepted nomenclature of speaking of the two glands as one) an active substance has been isolated. Robertson, an American chemist, separated from the anterior lobe a substance soluble in the fat solvents, like ether and gasoline, which he christened tethelin. But P.E. Smith has shown that the active material is soluble neither in boiling water nor in boiling alcohol, the typical fat solvent. A number of facts favor the idea of the anterior lobe cells as stimulants of growth of bone and connecting and supporting tissues generally. From the posterior lobe, pituitrin, believed its internal secretion, has been obtained in solution.
Pituitrin is a substance of many marvelous functions. In general, it controls the _tone_ of the tissues, of involuntary or smooth muscle fibres of the blood vessels and the contractile organs of the body like the intestines, the bladder and uterus. When injected, it will slowly raise the blood pressure and keep it raised for some time, and will increase the flow of urine from the kidneys and of milk from the b.r.e.a.s.t.s. It will also cause an intense continued contraction of the bladder and the uterus. It is also said to control the salt content of the blood upon which its electrical conductivity and other properties depend. Normally, there is a certain fixed ratio of the salts in the blood, which keeps them like the ratio in sea-water. Again, we have an example of the curious atavism of the internal secretions. The thyroid, remember, keeps the iodine concentration of the blood like that of the ocean, our original habitat. Pituitrin likewise does its part to maintain our internal environment as near as possible to what was once the surrounding medium. A substance somewhat similar has been found in the skin glands of toads.
The extraordinarily well protected position of the pituitary, its persistence throughout life, and its abundant blood supply, emphasize its vital importance. No other gland of internal secretion can adequately subst.i.tute for it. Complete expiration means death, in two or three days, with a peculiar lethargy, unsteadiness of gait and loss of appet.i.te, emaciation, and a fall of temperature, so that the animal becomes cold-blooded, its temperature the same as that of the atmosphere it occupies. If only part of the anterior lobe is taken away, there occurs a remarkable degeneration of the individual. The degeneration is not a mucinous infiltration of the skin and the internal organs which occurs with thyroid deprivation, but a fatty degeneration, with a tendency to inversion of s.e.x. A singular somnolence, a dry skin, loss of hair, a dull mentality, sometimes epilepsy, and a noticeable craving for and tolerance of sweets appear.
These are but a few of the observations obtained in experimental sub-pituitarism, that is, underaction or insufficient secretion of the pituitary, produced by removing part of the anterior gland.
If such an experimental sub-pituitarism is started in infancy, for instance in puppies, there is a cessation, or marked hindering and slowing of growth. That is, dwarfs are artificially created. Apropos, pathologists have shown that in several true human dwarfs the gland is rudimentary or inadequate. All of which goes hand in hand with the evidence that the skeleton stands directly under the domination of the pituitary.
REGULATOR OF ORGANIC RHYTHMS
There are certain other singular by-effects of the gland in its relation to the periodic phenomena of the organism like hibernation, sleep, and the critical s.e.x epochs of both s.e.xes. In hibernation, or winter sleep, the animal in cold weather pa.s.ses into a cataleptic state in which it continues to breathe, more deeply but more slowly than when awake, but shows no other signs of consciousness or life.
A lowered blood pressure and a marked insensitivity to painful and emotional stimuli go with it. There is a preliminary storage of starch in the liver, and of fat throughout the fat depots of the body. These are so like what happens after part of the pituitary is removed, that a comparison of the two becomes inevitable. Common to both conditions is a drop in the rate of tissue combustion or metabolism, which can be relieved by injection of an extract of the pituitary, a rise of temperature occuring simultaneously. Moreover, examination of the glands of internal secretion of hibernating species, like the woodchuck, during the period of hibernation, shows changes in all of them, but most marked in the pituitary, the shrunken cells staining as if they too were asleep, or in a resting stage. The characteristic alive qualities of these cells return, without relation to food or climate, when the animal comes to in the spring, at the vernal equinox. Hibernation may, perhaps, be put down to a seasonal wave of inactivity of the pituitary gland.
Now winter sleep may be looked upon as an exaggeration of ordinary night sleep, the latter differing from the former only in its brevity.
In the natural sleep of non-hibernating species there occurs, too, a fall in temperature. Moreover, they all, even man, have a certain capacity for winter sleep, as the experiences of travellers and explorers in the arctic regions indicate. In certain parts of Russia, where there is a scarcity of food during the winter months, the peasants pa.s.s weeks at a time in a somnolent state, arousing once a day for a scant meal. Just as the s.e.x glands influence the body and mind profoundly with a certain cyclic periodicity of activity and inactivity (rut, heat, menstrual period and so on), which has been demonstrated to have a very close functional relations.h.i.+p with the pituitary, so sleep and hibernation will bear interpretation as products of a temporary dormancy of the same gland. We have, then, to set up in the place of Morpheus and Apollo, the new G.o.ds of the internal secretion of a chemical-making bit of the brain, as an explanation of the rhythms of sleep and wakefulness.
There are individuals who go about outside of hospital walls, quasi-normally, who are semi-hibernators or partial hibernators, and who are really in a state of subpituitarism. They are people who may have something wrong or inferior with their pituitary, but not to the extent of interference with their daily life. They go about with their type stamped upon them for the seeing eye. The cla.s.sical type is obese, with fat distributed everywhere, but more so in the lower abdomen and the lower extremities. They are slow and dull, and s.e.xually inactive, often impotent. They are sometimes tall, but most often dwarfish, and may be subject to epileptic seizures. They recall the picture of what happens to young dogs partially deprived of the pituitary. d.i.c.kens delivered a perfect likeness of an extreme degree of the condition in the Fat Boy of the "Pickwick Papers," whose employment with Mr. Wardle consisted in alternate sleeping and eating.
WHEN THE PITUITARY OVERACTS
All grades of overaction of the pituitary exist. Then its peculiar power to act as a stimulant to the growth of bone and the soft supporting and connecting tissues like tendons and ligaments comes into play. If the overaction or excess of secretion begins in childhood or adolescence, that is, before p.u.b.erty, there results a great elongation of the bones, so that a giant is the consequence. Now giants have always appealed to the imagination of the little man, and have had all kinds of wonderful abilities ascribed to them by him. The giants and ogres of folk-lore and fairy tales are favored with the most extraordinary mental advantages. Direct and a.n.a.lytic acquaintance with the giants of our own day, as well as a probing of their conduct in the past, has shown that normal giants--persons of exceptional size free from physical or mental deformities--are rare. There are people with _hyper_-pituitarism who exhibit the highest mental powers. In them is an increased activity of the posterior lobe in a.s.sociation with enlargement and hyperfunction of the anterior, overgrowth is not so marked, and the individual is lean and mentally acute. But the ordinary giant is one in whom there is degeneration of the pituitary after too much action of the anterior and too little of the posterior glands. A tumor or disease process in the gland is most often responsible.
If the overaction of the anterior happens after p.u.b.erty, when the long bones have set, and can not grow longer, a peculiar diffuse enlargement of the individual occurs, especially of his hands and feet and head. The nose, ears, lips and eyes get larger and coa.r.s.er.
As these people are rather big and tall to begin with, the effect produced is that of a heavy-jawed, burly, bulking person, with bushy overhanging eyebrows, and an aggressive manner. For there is, too, something distinctive about their mentality which has been as often portrayed as those of the pathologic giant. Rabelais' most famous character, Gargantua, belongs to the group. We recruit more drum-majors than prime ministers from among these people. They often suffer much from torturing boring headaches, and a consequent despondency and feeling of hopelessness which colors gray the entire spiritual spectrum. Up to a certain point these sufferers have a remarkable alertness and capacity. When conscious of the malady, they often meet it with a doggedly courageous optimism, which is another characteristic, although women occasionally commit suicide.
In both the semi-hibernators who remind one of cattle, and in the giant or acromegalic types who remind one of the anthropoid ape, there develops a distinct diminution of s.e.xual life. An abnormal process in the anterior gland, whether of oversecretion or of undersecretion, may interfere with the proper functioning of the posterior gland, the secretion of which is tonic not only to the brain cells, but also to the s.e.x cells. Thus, young animals deprived of the pituitary will not, if male, grow spermatozoa, nor ripe ova in the female. Moreover, the feeding of pituitary increases s.e.xual activity. In the case of hens, this has been demonstrated to be about thirty per cent by a pretty experiment. At a time of the year when eggs diminish, six hundred and fifty-five hens laid two hundred and seventy-three eggs upon an ordinary diet. When pituitary was added to their food for four days, the number of eggs rose to three hundred and fifty-two, an increase of seventy-nine. In addition, the fertility of the chicks born of these eggs was augmented, especially if both parents had been fed on pituitary. There are other aspects of the relation of the pituitary to s.e.x, which will be treated in another chapter.
THE BONY CRADLE OF THE PITUITARY
Always, in attempting to understand the pituitary, it is necessary to remember that it is tightly packed in the bony cradle, the Turkish Saddle or Sella Turcica. Should some stimulus, local, or in the blood, arouse the gland to growth, a good deal will depend upon whether it has room to grow in, or it will make room by eroding the bone. With s.p.a.ce for the formation of a large anterior and posterior pituitary gland, there will be created the long, lean individual, with a tendency to high blood pressure and s.e.xual trends, great mental activity, initiative, irritability and endurance. An outstanding trait of these favorites of fortune is that they remain thin no matter how much food they consume, and they have the best of appet.i.tes. They often are subject to severe headaches because of intermittent swelling of the gland against the bone of its container.
If the bony container is or becomes too small for its contents, it is interesting that along with the other signs of pituitary insufficiency, such as undersize, obesity, and asymmetry, there developes conspicuous moral and intellectual inferiority. The unfortunates suffer from compulsions and obsessions and lack inhibitions. They are the pathological liars with little or no initiative or conscience--amoral, not merely theoretically, but instinctively and unconsciously, with all the cert.i.tude and perfection of the unconscious accomplishment.
THYROID AND PITUITARY
The thyroid and the pituitary have often been compared. The anterior gland and the thyroid arise from almost the same spot in the embryonic oesophagus, the thyroid being an outgrowth in front, the anterior pituitary an outgrowth behind of the same soil. They both control growth marvelously, also the differentiation, the ma.s.s and intricacy of the tissues. But they differ in the site of their control. The thyroid bears more directly upon the inner and outer coverings of the body, the skin, the skin glands and the hair, the mucous membranes, and the irritability and the preparedness for response of the nerves.
The pituitary acts more upon the framework of the body, the skeleton and the mechanical supports and movers. Bone and ligament, muscle and tendon seem to be within its immediate sway. The secretion or secretions of the pituitary diffuse directly into the fluid bathing the nervous system, supplying beneficent stimulants and aiding in the abstraction of harmful waste. So while the thyroid raises the energy level of the brain, and the whole nervous system, as a byproduct of its general awakening effect upon all the cells of the body, the pituitary probably stimulates the brain cells more directly, perhaps in the manner of caffeine or cocaine.
The difference between the thyroid and the pituitary might be put this way: that while the thyroid increases energy evolution and so makes available a greater supply of crude energy, by speeding up cellular processes, the pituitary a.s.sists in energy transformation, in energy expenditure and conversion, especially of the brain, and of the s.e.xual system. In short, the thyroid facilitates energy production, the pituitary its consumption. The pituitary appears therefore as the gland of continued effort. Hence fatigability, an inability to maintain effort, is one of the prominent complaints when there is destruction or an insufficiency of it for one reason or another. As such, it contrasts with the glands of emergency effort, known as the adrenals.
CHAPTER III
THE ADRENAL GLANDS, THE GONADS, AND THYMUS
Like the pituitary, each adrenal gland is a double gland, that is, consists of two distinct portions, united together, one might say, by the accident of birth. It would be confusing, however, to speak of each as two glands, because there are, as a matter of fact, two separate adrenal glands, one in the right side of the abdomen, and the other in the left. Each gland is composite, or duplex. How the two parts came to be united is a long story, interesting but too long to be recounted here. In fishes they are apart and independent.
Each adrenal is a c.o.c.ked hat shaped affair, astride the kidneys, easily recognized because of its yellowish fatty color. Indeed, for centuries the glands were not given a separate status as organs, but were pa.s.sed up as part of the fat ensheathing the kidney. In childhood and youth, in common with the other glands, they are relatively larger and more prominent than in the adult. Also, at every age, the amount of blood pa.s.sing through them is very large compared to their size.
Their tremendous importance in the body economy accounts for their being so favored.
The two parts of which each gland is composed, are known as the cortex or outer portion (literally the bark) and the medulla or inner portion (literally the core). No clean-cut boundary sharply delimits the two, as strands and peninsulas of tissue of one portion penetrate the other. In the history of their development in the species and the individual, and in their chemistry and function, a sharp difference contrasts them.
In the embryo, the cortex is derived from the same patch that gives rise to the s.e.x organs, the ovaries in the female, and the testes in the male, described as the germinal epithelium. How intimately the two sets of glands are connected is neatly pointed by this fact of a common ancestor. All vertebrates possess adrenal glands. In the lowest of the vertebrates, Petromyzon, the two parts are distinct, the cells of the cortex-to-be are situated in the walls of the kidney blood vessels, projecting as peninsulas in the blood stream, the blood sweeping over and past them. The medulla-to-be consists of cells accompanying the vegetative nerves. Among reptiles, the two become adjacent for the first time, and among birds one part occupies the meshes of the other. The size of the cortex varies directly with the s.e.xuality and the pugnacity of the animal. The charging buffalo, for example, owns a strikingly wide adrenal cortex. The fleeing rabbit, on the other hand, is conspicuous for a narrow strip of cortex in its adrenal. Human beings possess a cortex larger than that of any other animal.
No definite chemical substance has as yet been isolated from the cortex. That remains a problem for the investigator of the future. But certain observations, especially concerning the relation between the development and behaviour of the so-called secondary s.e.x characteristics, those qualities of skin, hair and fat distribution, physical configuration and mental att.i.tudes, which distinguish the s.e.xes, and the condition of the gland, indicate clearly that an internal secretion will be isolated, and that it will in its activity furnish certain predictable features.
Three different layers of cells, arranged in strings, that interpenetrate to form a network directly bathed by blood, that breaks in upon them from _open_ blood vessels, compose the cortex. Most remarkable is this method of blood supply for it is exceedingly common among the invertebrates and rare among the vertebrates.
In certain disturbances of these glands, especially when there are tumors, which supply a ma.s.sive dose of the secretion to the blood presumably, peculiar s.e.x phenomena and general developmental anomalies and irregularities are produced. If the disease be present in the fetus, taking hold before birth, and so brought into the world with the child, there evolves the condition of pseudo-hermaphroditism. The individual, if a female, presents to a greater or less extent the external habits and character of the other s.e.x. So that she is actually taken for a man, although the primary s.e.x organs are ovaries, often not discovered to be such except when examined after an operation or death. How closely such an occurrence touches upon the problems of s.e.x inversion and perversion comes at once to mind.
If the process involving the adrenal cortex attacks it after birth, the symmetrical correspondence and harmony of the primary s.e.x organs and the secondary s.e.x characters are not affected. But there follows a curious hastening of the ripening of body and mind summed up in the word p.u.b.erty, a precocious p.u.b.erty, with the most startling effects.