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CORNELL 
 
 UNIVERSITY 
 
 LIBRARY 
 
 FROM 
 
Cornell University Library 
 Q p 187.H24 1922 
 
 Adventures in endcfcrinology. 
 
Cornell University 
 Library 
 
 The original of this book is in 
 the Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924003689605 
 
Bth Edition— Thin Paper 
 150,«ea Copies 
 
 Adventures 
 
 in 
 
 EMocrinotogg 
 
 Sy 
 
 Hennj R. Harrower, M. D. 
 
 TO THE READER: 
 
 x 
 
 HIS is a reprint of the 159-page book that has 
 made such a stir since its publication last June 
 
 and so many friends for FAIR PLAY in medicine 
 
 and in organotherapy. 
 
The Administration Building of The Borrower Laboratory, Glendolo y California 
 
 THE institution known as The Harrower Laboratory was founded 
 in February, 1918. In September, 1921, the building illustrated 
 above was occupied. From a business with a capitalization of less 
 than $500 it has developed into a nation-wide organization, with seven 
 branch offices, employing nearly ISO people. The success of this insti- 
 tution and of its founder, Dr. Henry R. Harrower, was built upon one 
 big idea: That the endocrine glands are involved in many every-day 
 conditions, and that these glands are closely interrelated and conse- 
 quently that pluriglandular therapy is the logical treatment for endo- 
 crine disorders. 
 
 In keeping with the chief object of The Harrower Laboratory, which is 
 "to Develop Information Pertaining to the Internal Secretions in Gen- 
 eral Practice," a large literary staff is occupied in the study of Amer- 
 ican and foreign journals. A number of periodicals and publications 
 are issued and circulated regularly, and a vast amount of infor- 
 mation kept on file that may be used by members of the medical 
 profession who care to avail themselves of these facilities. 
 
 A research laboratory is maintained, in the Administration Building, 
 with two branches — one in a hospital nearby and the other in the 
 country, where the animals are kept. 
 
 All this is paid for through the sale of organotherapeutic products 
 produced in The Harrower Laboratory. Thus, the "commercialism" of 
 The Harrower Laboratory has been the means of rendering a service 
 to thousands of physicians a»d through them to the people whose 
 sufferings they relieved. 
 
 THE HARROWER LABORATORY 
 
 Clendale, California 
 
 BRANCH OFFICES 
 
 NEW YORK CITY PORTLAND, ORE. CHIC \f)0 
 
 31 P«rli Place 607 PIMooi Black 186 N. La Salle St. 
 
 KANSAS CITY DENVER 
 
 Tll-Tl! K. C. Llfc BUt. Central Ratines Bank Building 
 
 BALTIMORE 
 
 316 Equitable Blcig. 
 
 DALLAS 
 
 IttOfl Insurance Bldg. 
 
 ENDOCRINES LIMITED, 72 Wigmore St., London, W. 1. 
 
The original book was dedicated 
 
 "To my esteemed colleague, GEORGE H. SIMMONS, who, by his opposition through 
 twelve years, has stimulated me more than many a well-wishing friend." 
 
 Adventures in Endocrinology 
 
 By HENRY R. HARROWER, M. D. 
 
 Director of The Harrower Laboratory 
 
 Table of Contents 
 
 Preface to the Fifth Re- V. Harrower's Hypothesis and 
 
 vised Edition 3 Hoskins' Hallucinations 30 
 
 Preface to the Third Edi- VI. Professor Cushing's Alle- 
 
 tion 4 gory 3*6 
 
 Preface to Second Edition.. 6 VII. "The Endocrine Glands — a 
 
 Introduction 7 Caution" 41 
 
 I. The Development of VIII. The Pancreatin Mystery 46 
 
 "Pseudoendocrinology" 11 ' IX. A Pathologist's Peculiar 
 
 II. Hypoadrenia — "The Fourth Viewpoint 49 
 
 Dimension in Medicine" 15 X. "Properly Supervised Con- 
 
 III. The Organotherapeutic trols" 52 
 
 "Wilderness" 22 XI. "The Crucible of the Clinic" 57 
 
 IV. The "Supposititious Pitui- XII. The, nth Power in 
 
 tary Influence" 24 Endocrinology 60 
 
 Fifth Revised Edition 
 
 Reprinted in Pamphlet form 
 
 150,000 Copies 
 
 1922 
 
 The Literary Department of 
 
 THE HARROWER LABORATORY 
 
 Glendale, California 
 
 Copyright, 1922, by Henry R. Harrower, M. D. 
 
PREFACE TO THE FIFTH REVISED EDITION 
 
 No single thing that has been done 
 in connection with the development of 
 the work of The Harrower Laboratory 
 has aroused such a storm of favor- 
 able comment and so many printed 
 complimentary remarks as the publi- 
 cation last June of this book, "Ad- 
 ventures in Endocrinology." Edition 
 after edition was printed; thousands 
 of physicians have read it; and it has 
 been received in certain circles with 
 a greater appreciation than I had 
 thought would be possible. 
 
 Evidently some people like myself 
 are getting tired of being told how to 
 think and what to do and they are sick 
 of the medical automatonism that still 
 is being seen far too frequently in this 
 country. 
 
 Frankly, I became peeved at the 
 continued condemnation of my work 
 and of my ideas by those so obviously 
 unfitted to condemn, and my little ef- 
 fort has struck a responsive chord 
 which has reverberated across the 
 country and its echoes have not yet 
 apparently died down. This revised 
 edition is going to be made in such 
 form that it can be sent to every 
 physician in the country in order that 
 those who wart to read it may do so 
 without further delay, and that those 
 who may not be anxious to buy it 
 may have a chance to look it over 
 and either enjoy themselves a little 
 bit, or gnash their teeth a little more. 
 
 This attempt to show the necessity 
 for fair play and individual thinking 
 is not only dedicated, like the original 
 
 edition, to the illustrious editor of th* 
 Journal A. M. A., who from the pin- 
 nacles of knowledge and the heights 
 of ultra-science, deigns to look down 
 upon so insignificant a person as my- 
 self and cry "bunk," but to many 
 thousands _ of well-minded physicians 
 who by their interest, friendliness and 
 support, have brought affairs to this 
 pass. While I am willing to thank 
 Dr. Simmons for having aroused me 
 by his continued antagonism, I must 
 also give credit where it is equally 
 due — to those who have stimulated me 
 by their kind words. 
 
 This edition contains a new chapter 
 — stimulated by some absurd lucubra- 
 tions eliminated at the last session of 
 the American Medical Association 
 (May, 1922). Perhaps it may add a 
 little weight to the other chapters. 
 It was really too preposterous to be 
 left buried in the files of The Journal. 
 and I find that there is room for mj 
 critique in this pamphlet. 
 
 Special attention also is called to 
 the quotations from various book re- 
 views in current medical literature 
 which form a part of the preface to t 
 previous edition. I take much pleas- 
 ure in extending my thanks to these 
 editors for their attitude and, espe 
 cially, for their willingness to express 
 it so forcefully. 
 
 //Ct^Jt^^J^ /hls*SK+j 
 
 ■J-e*>«/* 
 
 September 28, 1922. 
 
 PREFACE TO THE FOURTH EDITION 
 
 It is gratifying, indeed, to see how 
 encouraging the response to this lit- 
 tle book has been. The letters of 
 commendation keep coming, and the 
 
 reviews still have the same fnendi 
 ring. Surely we have struck a r» 
 sponsive chord, and perhaps, it is tim* 
 something like this was being done. 
 
 H. R. H 
 
ADVENTURES IN ENDOCRINOLOGY 
 
 PREFACE TO THE THIRD EDITION 
 
 Again another edition is needed, and 
 I am surprised^ at, the. amount of in- 
 terest and attention 'prieVioilS edffiions* 
 have aroused. Several of my friends 
 have secured extra books to lend to 
 their eolleagues and a number of li- 
 braries have^writte#for copies.' 1 
 
 'The book reviews and" editorial' re- 
 marks in>: current medical literature 
 have been most pleasing.' The char- 
 acter of these remarks is such^that-I 
 do not> like to have' them- missed ' : an3 
 Iwill submit here : several "ihtereStirig 
 as well asV amusing excerpts' frbifi 
 •these reviews: ■- - v ■ "- ■- ■■''■ i 
 
 .-"We have -already had a 'trifle to 
 say '-relative to". this book and since 
 our previous remarks- were written 
 the volume has been commented on 
 by several of .our, -friends aredrtb.a rrian 
 they. seem> of the.-; opinion that; Hai- 
 rower (jnay ,hav£. started something 
 which ,may end, ina conrplete. revolu- 
 tion withjn the ranks of/jwgamized 
 medicine. It- has been, said that, lijte 
 'Uncle Tom's Cabin,' tjfye-, bopk, now be- 
 fore us may mart? a,n ,, epoch in^medi' 
 cm'e, *' ' ',....",,..'.''*"'.''"' . ' ''' ."'"'" -J- 
 
 ^Artywaly^Harrowe'r his done some 
 things which ' othe'rl "' have seemingly 
 nbt dared do, for he Mas' come but' in 
 the open and' has Wade ; hls "remarks 
 in plain English, that aH -who run ffSj 
 read/ 'awd^JthStt' : with' ^understanding 1 '. 
 He has told-mueh truth, perhaps more 
 than- „he is, aware"- of . ■ " i .-,,- . It is 
 possible that this book will ■opewuthe 1 
 eyes. of many^tctjjvibiat is amd has been 
 going on within the , "©rganization. 
 
 "Harrower's peaceful ( ? ) s sarcasm 
 will go farther than would any abuse 
 and it is possible will bring some out 
 of their clam-like ( shells „ and . cause 
 them to talk. It may not be either 
 nice or proper to criticize the powers 
 that be — those who would tell us what 
 to do — but now and then something 
 of the sort is a good thing to have 
 happen. 
 
 "We found the book so interesting 
 that we were made angry when any- 
 body Came in and caused us to put it 
 down and we read it from cover to 
 cover and found something interest- 
 
 ing in every page." — Western Med- 
 ical,, Times (Denver), ^August, 1922, 
 xlil, 57! l ' : '•"-'- ' 
 
 ,."It is. a pi ever effort .to answer,.crit- 
 ic'^'whohav^ coiisfde'red^ hjjm unduly 
 enthusiastic, "and he' 'beards ''thfe lion* 
 by dedicating tts volume to the Edi- 
 tbf /J bf the" Journal of the' Americdn 
 Medical. Association, .'•".< .' Dir. 
 Harrower is not content with • offering 
 a defenser: On the contrary he carries 
 his war into, -Gaul, and in some- in- 
 stances utilizes what might be called 
 tljie deadly parallel column for f the 
 purpose, of proving that his, critics are 
 in" error. .... . , r ..,, ,, 
 
 ""There 'is t a.' .breezines^s, . about his 
 contribution which is interesting, .and 
 his'' text glves'marked 'e^fdefice o'f Iris 
 ent'husilsrri and his intention to 'pur : 
 sue 1 - his present- course ' whatever may 
 bd 1 'the' attitude 1 of thbse who' are un- 
 friendly -to his work.- Possibly it 
 would have been more telling had he 
 given his^book the title of the motto 
 on the old Col oaiaU flag — ;Don'.t, ; tread -., 
 on #*,"■'— i , 'i* Therapeutic : -Qazette - 
 (Detroit.), .July,-1922,-xjacviij,j,p.-651. 
 
 s'*An altogether different book, and 
 one that should 1 command the closest 
 attention on threpart ofi the rrevtewer, 
 ia Henry Rl tHarroiwei's ^Adventures in 
 En.docrjrtol?ogy, ! for £he- dojnjnant n^te . 
 isra-conrwrianding one,,,and of yalue^p 
 all, , sirtce,, it concerns, itself jWith. the 
 righting, qt a r wrpri^,- Dr. .Harrojv.er 
 -wishes tp .place' hiinseli. before "fii"#, 
 public, in. his proper dress, the dress 
 of.,. ,an honest m^n. who is candid 
 enough to .affirm that he is not 
 ashknied of being commercial, if com- 
 mercialism means to'' make a living 
 out of what he conceiv&s to be an 
 idea' of worth and'value and of benefit 
 to the public. His presentation' of the 
 theory of pluriglandular therapy and 
 the administration of single glandular 
 extracts has been unabating, and de- 
 spite a deal of acrimonious criticisms 
 from the 1 Journal of the American 
 Medical Association and a number of 
 physicians who are opposed to his 
 teachings, his success — non-commer- 
 cial, this time — has been above ques- 
 tion. 
 
PREFACE TO THE THIRD' EDITION 
 
 Bu$ w.e do not, (Jesiire to. lake up ,4^, 
 this review the 'convolutions ^hT invo- 
 lutions, of controversy— the start with' 
 dighityhnd t& "finish with '. bickerings 
 oh the part of detractors? Wtiat in- 
 terests us 'is ,'the 'liveliness' of thfe ' 
 book and its 'Undoubted, literary merit. 
 These 'features are -outstanding, and 
 the reader, if he is the sort we take 
 him to be, will at once^ be held- by 
 them. And for long,, too, : for- in this 
 book are instanced a mental poise 
 despite drastic criticism covering a 
 number of years, an. outlook ,,that 
 breathes sanity, and a desire to. state 
 facts as they .really are, without too 
 much praise for self, or too much" dis- 
 praise df others. And over all the 
 statements there is spread a sense of 
 good feeling" toward others, -an es>- 
 pression that we are all -human, per- 
 haps too* human. And this, sense is 
 eihhodied in a • literary form that is 
 most diverting and robs the. contro- 
 versy of all 1 those sharp edges -which 
 tefar into the amour-propre of oppos- 
 ing factions. Let us add. that if it 
 were only for the Dedication, which is 
 felicity of thought carried to ihe^ *ith 
 decree, this h 00k of 15'9 pages would 
 be' very worths while.-'^MeeKca/ Times 
 (New York), August, 1922, J, p.. 227. 
 
 "Dr. narrower ,--. ';' dbes'-hot re- 
 gard it "as being sinful to depart -from 
 the beaten paths. It is 'said that in 
 the domain' of electrical phenomena 
 certain facts haver been Established, 
 determined and? settled by men learned 
 in such matters., 'A number of .young 
 men throughout the couiitry did not' 
 know 01^ the "determinate factSj and 
 by their effort^ and experiments they 
 have shown that these, supposed- faets 
 were hot fact? at all- So 1 it may be 
 that Dr. Harrowed has stumbled onto 
 Some heretofore unknown and unde- 
 termined facts. At a n y rate, he is 
 interesting and worth considering, if 
 even Dr. George H. Simmons devotes 
 space in the A. M. A. Journal .to cojir 
 demn him."^— Medical Sentiaiel (Port- 
 land, Ore.), August 1922, xxx, p., 425. 
 
 "The man who. has no enemies is 
 dead. The man who has achieved any- 
 thing has enemies. The more success- 
 ful he is, the more enemies he has. 
 Dr. Harrower's antagonists seem to be 
 merely playing with words. He 
 
 answers them splendidly."— Medical 
 World , f (P^il : adelphiaK" August*, ,1922,' 
 
 xl, ,p,, J,2|; / ,, . : . ",.' ',,'.'.' 
 
 "Thfe .book 'Adventures injEndocrin-. 
 ologyf .constitutes" a personal. story , of 
 the development arVthe mark ofcThe 
 Harrower Laboratory , and the pluri- 
 glandular idea, 'peeudoendocrinolpgy,' 
 ag, some have , cabled it, with a special 
 reference, to the .opposition that has 
 developed against certain beliefs that 
 we hold dear! . . . The pi-ice of the 
 cloth-bound edition will be $1.00 post- 
 paid x and it, ought, tp be well worth the 
 money." — International Journal of 
 Surgery (New York), June, 1922, 
 xxxv.p. 24. . ..... i4 _ , 
 
 "The introduction very lucidly, gives 
 a history > of Dr; Harrower's interest 
 in the internal secretions and why he 
 made, this subject a study. Attention 
 is, caljed to the, point tha^ the 1 critic 
 usually, admits that he, has had ho 
 personal experience while .'the "booster 
 is well acquainted with the usefulness 
 of thS ageifts in therapy as advocated 
 by' Dr: Harrower. . . : : J 
 * "The author refers to--quite' a num- 
 ber -of- papers that have been read, 
 which -were' intended to bear- some^rer 
 lation ±0 endocrinology and ..from : the 
 author's-, viewpoint some, are shown 
 conclusively to he ;misfij;s and. |he 
 writers of. some of these; papers are 
 put in the light of an antiquated in- 
 dividual with not even the vestige of 
 a psfeudosciehtist having takfen 'a 1 step 
 backwards, afld fe the thought of Gib- 
 bon wbuld apply, granting the' truth- 
 fulness Of Dr: Harrower's" ,, position; 
 'All that is human must' r^frb'gr'a'deif 
 it does hot advance.' "—Iitdiandpolis 
 Medical Journal, July, 1922, xxv, 
 p. 184. '■ ''"' ■ ' >---' 
 
 "To anyone who ; is everi'a little fa- 
 miliar- with Dr. - Harrower'sTwork dur- 
 ing the past twelve years, along the 
 line of organotherapy and' endocrin- 
 ology this dedication will reveal , an 
 immense fund of humor and .sarcasm. 
 No man outside the homeopathic pro- 
 fession has had more abuse Tieaped 
 upon his head' by the editor of the 
 Journal of the A.M. A. than Dr. Har- 
 rower. This has been because he ha!s 
 dared to work along lines, neither laid 
 down nor approved by the great pro- 
 gressives, G. H. S. and his colleagues, 
 
Missing Page 
 
Missing Page 
 
ADVENTURES IN ENDOCRINOLOGY 
 
 of all the others — the establishment 
 of an institution with facilities for de- 
 veloping the various ideas in this field 
 that seemed likely to be practically 
 helpful, but were difficult of mate- 
 rialization. In short, I wanted to 
 make it possible for physicians other 
 than those who "specialized" in en- 
 docrinology, to derive a degree of 
 clinical knowledge from the things 
 that were being expounded in the cur- 
 rent literature so that they would be 
 brought closer to all that was of in- 
 terest in the study of endocrinology. 
 When I realized the. impossibility 
 of establishing a department in con- 
 nection with some large teaching or 
 research institution and how proble- 
 matic it was to influence any wealthy 
 persons to finance it, I took, the mat- 
 ter altogether iri my own hands with 
 the result that. what is known; as The 
 Harrower Laboratory was established. 
 This laboratory has called forth praise 
 in certain quarters and adverse criti- 
 cism in others. In this respect its 
 career has not been unlike - the careers 
 of .other institutions. The funda- 
 mental idea of this, laboratory is ser 7 
 vice to the profession — a, specialized 
 service to "materialize, ideas pertain- 
 ing to the internal secretions in gen- 
 eral practice." 
 
 ■ Some years ago, by reading of the 
 splendid clinical work of Henri Claude 
 and lujs pupil Gougerot, of Paris, as 
 well as many subsequent papers on 
 various aspects of the subject, I got 
 hold of THE PLURIGLANDULAR 
 IDEA which sounded very good to me 
 and when I investigated it for myself 
 I found that it contained some real 
 gold, though even in these days, one 
 critic calls it "fool's gold." I began 
 to pan for more and have much that 
 can only be considered the real thing. 
 I have been scorned for seeking gold 
 in a locality in which its presence 
 was denied; I have been derided for 
 attempting to pan for it in an unac- 
 cepted fashion, and I have been taken 
 to task by my critics for expressing 
 myself in terms distasteful to them 
 and through media that were unor- 
 thodox. 
 
 The commercialism — that much 
 abused term which like the poor is 
 with us always, though we are 
 ashamed to confess that all of us are 
 more or less "afflicted" with it — which 
 wag a necessary part of the work of 
 my laboratory, sent cold chills down 
 the backs of several of my colleagues 
 in the A. S. I. S., and a few of them 
 have attempted in an aggressive man- 
 ner to shpw the errors of my ways 
 in no mistakable terms. 
 
 As was ito be expected, and in the 
 natural sequence of things as they 
 obtain to-day in these United States, 
 it_was not long before the arbiters, of 
 "therapeutic morals"— The Council on 
 Pharmacy, and . Chemistry of the 
 American Medical Association — had 
 singled me out for a special attack 
 on the score that many of the glandu- 
 lar remedies I used, and recommended 
 were not in the U. S, P. or the N. 
 N. R., hence were not recognized as 
 effective remedies. This meant that 
 any.pf my formulas containing these 
 tabooed products coiild not be ac- 
 cepted by "The Powers That Be." But 
 the criticism did tiot stop here, for 
 what was most reprehensible about 
 my formulas was that the idea of 
 combining glandular extracts was a 
 reversion to the old-time poly- 
 pharmacy. 
 
 I answered their first criticism by 
 saying that no remedy ever could at- 
 tain a place in; the U. S. P. or N. N. 
 R. until it had been shown to be 
 clinically useful. This could only be 
 found out by using it. Hence some- 
 body has to be using non-official prod- 
 ucts, else progress must stop entirely. 
 Their second comment I denied point 
 blank as entirely contrary both to ex- 
 perience and to logic. 
 
 Since then I have consistently held 
 to the fundamental physiological prin- 
 ciple that the glands of internal se- 
 cretion are related, that disturbances 
 in one of them necessarily must be re- 
 flected in the functions of the others 
 which are related to them, and that 
 pluriglandular therapy needs must 
 be a more reasonable procedure than 
 the use of single gland extracts. 
 
INTRODUCTION 
 
 9 
 
 The more I think of the attacks 
 that have been made on my work the 
 more philosophical I am, and though 
 in the beginning my resentment was 
 intense, perhaps too intense, I am so 
 Bure now that I am in the right and 
 that those who are opposed to me are 
 wrong that whether I am correct or 
 not must be; left to my readers. My 
 object in writing this, book is merely 
 to collate . some of the attacks which 
 have been made on me and prove to 
 what lengths narrow prejudice will 
 drive men. In short, I epcpect to pre- 
 sent here facts from which the reader 
 may draw! his own conclusions, and it 
 is my hope that he will draw, his own 
 conclusions unbiased by what, he has 
 beard or read about me. In this book 
 I am gojng to ;stand befpre the med- 
 ical profession unashamed , and - un- 
 abashed, and I am not going to "throw 
 down the glove for a fray. I am 
 through with war and, want j>eace — 
 peace with honor, the only sort of 
 peace that is Worth while. I have no 
 doubt that my opponents are men of 
 worth and I have, no ..doubt that, in 
 their opposition they thought they 
 were helping the . cause of "clean" 
 medicine. 
 
 Let me emphasize, here that the 
 mood that is upon me as I pen these 
 lines is one of peace to my colleagues 
 — without rancor, without malice. But 
 let me also emphasize here that I am 
 not in the least contrite nor regretful 
 for what I have done in the past, nor 
 have I any misgivings as to my future 
 course which will be along the same 
 lines as in the past, with this differ- 
 ence only, that a greater development 
 will be my object. Whether among 
 my harsh critics have figured the 
 editor of The Journal of the Ameri- 
 can Medical Association and other 
 editors, or certain physiologists and 
 physicians in high places, I have only 
 the kindest thoughts for them— 
 thoughts which all right-minded men 
 have for their opponents. 
 
 Since fallibility is a distinctly hu- 
 man attribute, I can not very well 
 say that none can controvert my 
 statements. Bather will I say that I 
 
 have had every reason to believe that 
 I have been and am still right funda- 
 mentally, and have always attempted 
 to pass' my judgment with as many 
 as possible of the facts before me. I 
 shall be very glad if any reader who 
 may be interested, and has any addi- 
 tional facts to submit,- will give me 
 proof either unpublished, or with the 
 reference, to disprove my attitude 
 as it will be outlined in' the following 
 chapters. 
 
 Another matter that may be men- 
 tioned is illustrative of a trait in hu* 
 man nature that has been known to 
 alf from time immemorial. When 
 some of my opponents are asked if 
 they have ever used any of Harrow- 
 er's products; they invariably throw 
 up : their hands and assure their cfues- 
 tioners that they would "never thiifk 
 of using such stuff." This "gesture" 
 on the part of my opponents would be 
 acceptable to me if they had had clin- 
 ical experience with my remedies; but 
 when they have not had any expe- 
 rience, which is invariably the case, 
 their attitude is far irom commenda- 
 tory. How in all reason can one in- 
 sist that a man is fundamentally 
 wrong, and decry the results of his 
 work_ if one has withheld himself 
 through prejudice from the slightest 
 use of his. suggestions, and go even a 
 step further and deny the statements 
 made by those who are in a position 
 to give. a just opinion because of a 
 full knowledge based on the indis- 
 putable fact^that the ideas have been 
 used and have not been found want- 
 ing ? 
 
 To illustrate this strange vagary of 
 human nature I shall cite a conversa- 
 tion between a, friend of mine and a 
 certain Baltimore physician who be- 
 trayed the involved workings of his 
 mentality in the following remark- 
 able manner: 
 
 "Pluriglandular therapy is no good. 
 There are only a few glands that are 
 any good. Harrower has done more 
 against organotherapy than any other 
 -man in the country and I really think 
 he has made a fool of himself. He 
 makes too many claims. Why — he 
 
10 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 doesn't know anything about organo- 
 therapy anyhow. ... Of course 
 it is easy enough to get statements 
 from crossroads doctors to the effect 
 that they have gotten wonderful re- 
 sults with this and that that H&r- 
 rower sells, but it doesn't mean any- 
 thing. . . . Unfortunately, Har- 
 rower came out with his sales work 
 just as the profession was beginning 
 to realize the value of the glands, no- 
 tably the thyroid. . . ." 
 
 I must demean myself, disagreeable 
 as it is to me, to deny categorically 
 several of these remarks. First, 
 "Pluriglandular therapy is no good." 
 This statement in itself is tinged 
 with asininity since the contrary long 
 since has been proved. Secondly, as 
 for Harrower being a fool, would it be 
 immodest in me to deny so distin- 
 guished an allegation? 
 
 Again, "the crossroads doctor" is 
 indeed a despicable character — he 
 knows naught of truth — how can he? 
 And is easily led astray, hence he rep- 
 resents ignorance in the medical pro- 
 fession — in the minds of some who 
 think well of themselves I Our med- 
 ical Main Streets are peopled with 
 quacks and only in cities of a million 
 or more do education and truth abide. 
 
 And, fourth, Harrower did not come 
 out with his sales work "just as the 
 profession was beginning to realise 
 the value of glands, notably the thy- 
 roid." The beginnings of thyroid 
 therapy are thirty years old and the 
 development of my laboratory has 
 taken place in the four years since 
 the beginning of 1918, and I am will- 
 ing to believe what I have been told 
 many times, that I have had some part 
 in arousing medical opinion in regard 
 to the importance of the routine study 
 of the endocrine glands, and, espe- 
 cially, the value of pluriglandular 
 therapy. 
 
 In passing, it is interesting to note 
 that my correspondent who was good 
 enough to send this report to me, re- 
 marks rather sagely: "I note with 
 much interest that these fellows who 
 have so much criticism and advice to 
 hand out against your work have not 
 used your products, and generally are 
 
 the ones whose waiting rooms are 
 empty. The physician who has up to 
 a dozen patients waiting for his ser- 
 vices, invariably is ready to do any- 
 thing to produce results, for he is the 
 man who is carrying the load of sick 
 folks." 
 
 With the above in mind, it certainly 
 is strange how uniformly the kicker 
 has to admit, usually somewhat 
 shamefacedly, that he has had no per- 
 sonal experience, whereas the booster 
 says, "Sure I have been following this 
 thing for three years and would be 
 convinced out of my own personal ex- 
 perience without hearing a word from 
 any source" — or words to that effect. 
 
 It is also a strange thing that every 
 principle of any magnitude, any doc- 
 trine different in the slightest degre* 
 from the orthodox, any invention that 
 is entirely original, has got to gt 
 through the stage of derision by some- 
 body. 
 
 Nothing important that has beet- 
 done in this world has been free from 
 attack of some sort and the work that 
 has been developed out here in The 
 Harrower Laboratory in Glendale, 
 California, certainly has run true to 
 form and has been subjected to con- 
 siderable criticism. Despite this fact, 
 however, it has established itself 
 throughout the United States and in 
 a number of foreign countries as a 
 worth-while addition to those factors 
 furthering progress in medicine, and 
 its phenomenal growth in four short 
 years is tangible evidence of the 
 esteem with which its work and prod- 
 ucts are held by some. 
 
 This book, written in the stress of 
 battle for what I firmly believe to be 
 a fundamentally correct and reason- 
 able principle, is an attempt to di- 
 rect attention both to the criticisms- 
 and to the answers to these criticisms. 
 
 As to what the verdict about my 
 position will be must be left for tht 
 reader to decide, and it is very fortu 
 nate that there is plenty of opportu- 
 nity to verify the decision in an indi 
 vidual manner, for after all, the med 
 ical profession at large must be the 
 final court of appeal. 
 
THE DEVELOPMENT OP "PSEUDOENDOCRINOLOGY" 11 
 
 L— THE DEVELOPMENT OF "PSEUDOENDOCRINOLOGY" 
 
 "Things true and evident of necessity must be recognized by those who would 
 contradict them." — Epictetus. 
 
 "PSEUDOENDOCRINOLOGY" is a term 
 that was born in 1921. Evidently it 
 is a child of the brain of R. G. Hos- 
 kins, at one time Professor of Physi- 
 ology at the Northwestern University 
 and more recently occupying the same 
 chair in the Ohio State University, 
 Columbus, Ohio. Pseudoendocrin- 
 ology, as its name indicates, is this 
 writer's conception of an endocrin- 
 ology which is imaginary or supposed. 
 One of the first statements embodying 
 this term is the editorial by Hoskins 
 entitled "What is Endocrinology?" in 
 Endocrinology, September, 1921, v, p. 
 610. 
 
 "There is a class of writers who 
 affect the term 'so-called endocrin- 
 ology,' the implication seeming to be 
 either that the existence of endocrine 
 organs is doubtful or else that the vol- 
 uminous literature pertaining to them 
 is of such uncertain significance as 
 not to deserve formal recognition. 
 That the literature does include an in- 
 tolerable deal of twaddle, no well-in- 
 formed reader can deny. Such pre- 
 tentious nonsense might well be desig- 
 nated pseudoendocrinology." 
 
 It may be interesting to recall a 
 little history regarding . my relation 
 with Professor Hoskins. Early in the 
 formative stage of the Association for 
 the Study of Internal Secretions in 
 1916, I visited him at the Northwest- 
 ern University on South Dearborn 
 Street, Chicago, and aroused a lively 
 interest on his part in what work had 
 been projected for this embryo or- 
 ganization. As a result of this visit 
 Hoskins' interest was r sufficiently 
 aroused to make him accept a posi- 
 tion on the editorial staff of a pro- 
 jected periodical which has since de- 
 veloped into the position of Editor-in- 
 chief of Endocrinology. 
 
 I have had many friendly letters 
 and evidences of Hoskins' personal 
 
 interest in my work and the work of 
 the Association in which we are mu- 
 tually interested, but as The Har- 
 rower Laboratory developed, and its 
 promotion department brought its 
 work before the medical profession in 
 a business way, there developed in 
 Professor Hoskins the feeling that he 
 must stand up for what he called pur- 
 ity in endocrinology, as against my 
 "pretentious nonsense" that he has 
 called pseudoendocrinology. Each of us 
 is attempting to add his little bit of 
 service to humanity. Hoskins, still a 
 physiologist, though he graduated as 
 a physician at Johns Hopkins Uni- 
 versity last year (1921) sees things 
 largely as a physiologist, while I, on 
 the other hand, am the same aggres- 
 sively interested ordinary doctor that 
 I was when I first had the pleasure of 
 meeting this gentleman who now 
 seems to be arrayed against me. 
 
 Hoskins, from his editorial chair, 
 feels that the study of the internal 
 secretions is being besmirched by me 
 because of my erring viewpoint, 
 whereas I, on the other hand, feel that 
 I have a right to look at things from 
 a little different angle than Hoskins 
 and, consequently, to disagree with 
 him. 
 
 I cannot help thinking that Hoskins 
 and some of his colleagues are af- 
 flicted with the disease known as 
 misokainia, and therefore should be 
 commiserated with rather than laid 
 open to criticism. This word miso- 
 kainia (miso — hatred; kainos — new) 
 was originated by the lat.e Achilles 
 Rose of New York, as a substitute for 
 the philologically incorrect word "mis- 
 oneismus," which Lombroso applied to 
 the deep-rooted tendency of mankind 
 to combat new ideas and discoveries — 
 one of the great bars to human prog- 
 ress. Rose pointed out that "this 
 
12 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 hatred of the new may become ^ a 
 phrenitis— a distinct type of mania — 
 when the misokainist may resort to 
 contemptible weapons such as delib- 
 erate misrepresentation and interfer- 
 ence and, perhaps, even personal ani- 
 mosity and attack." 
 
 The development of pseudoendocrin- 
 ology, with its sanguine viewpoint, is 
 believed to be "exerting an influence 
 detrimental jto further .progress," as 
 Hoskins puts it, although in almost the 
 next breath he makes the statement 
 that 
 
 "The bverertfhusiastic chass, exerts an 
 unfortunate influence largely by giv- 
 ing point to the strictures, of the first 
 ' mentioned, group [e.g. those who re- 
 fuse to believe at all.H. R. if.]. In 
 the long' run their very' extravagance 
 will serve as its own antidote, but as 
 a passing phenomenon their confident 
 exploitation of systematized delusions 
 is awakening false hope in the minds 
 both of patients and of physicians." 
 
 The above statement, ■ • appearing 
 early in an address by Hoskins en- 
 titled >'Some Current Trends in En- 
 docrinology," read before the Colum- 
 bus Academy of. 'Medicine and pub- 
 lished as the heading article in the 
 Jmrnal A. M. A-, November 5, 1921, 
 lxxvii, p. 1459, is but one of many 
 hints that the. current .trend: • appar- 
 ently, is in the direction of what is 
 called "pseudoendocrinology" and is to 
 the detriment of medicine as a whole. 
 It is possible that, Hoskins is right and 
 in his position, he is joined by a num- 
 ber of other individuals, but it is also 
 equally possible that the opposite may 
 be true, and it is quite interesting to 
 note that another statement in the 
 same article reads as follows: 
 
 "The overenthusiastic group offer 
 in justification of their imaginative 
 daring and therapeutic rashness the 
 plea that it is only by extensive expe- 
 rience that 'we can hope to learn either 
 the possibilities or the limitations of 
 endocrinology as a branch of prac- 
 tical medicine. In this they are, of 
 course, occupying an impregnable po- 
 sition. . . . Recklessly adminis- 
 tering endocrine products to all sorts 
 and conditions of patients, happily 
 
 claiming, as therapeutic triumphs all 
 changes for the better and ignoring 
 failures, is not likely to result in any 
 very substantial progress." 
 
 The above quotations rather smooth- 
 ly indicate that- certain procedures 
 recommended by me (because I have 
 found them frequently recommended 
 by others and after having tried them 
 myself I found them good and was 
 willing to pass them on) are "imagi- 
 native," and when applied are evi- 
 dences of "therapeutic rashness." But 
 it is good to know that Hoskins has to 
 admit that I, with those who agree 
 with me in regard to empiricism — a 
 matter to which I have .given some 
 consideration in a future chapter^, of 
 this book — are "of course, occupying 
 an.impnegnable position" And I feel 
 quite confident that the- position is in- 
 deed impregnable,, and that we never 
 can be ousted from it. 
 
 It will, be' seen in the pages which 
 follow that a very decided assault is 
 being made upon this impregnable po- 
 sition and I purpose to defend myself 
 in it as best I can. '-' t ' 
 
 1 Another statement in Hoskins" pa- 
 per niaybe quoted:' . 
 
 "Any number of absurdities; have 
 appeared, are appearing and, will" ap- 
 pear because men so readily" believe 
 that , which ' they wish to ' believe. 
 There is only one way to circumvent 
 the post hoc fallacy, and that is to 
 maintain adequate and' rigid controls. 
 . . . ' Reports of cures are convinc- 
 ing only when accompanied by ade- 
 quate evidence that suggestion and 
 other accessory therapeutic measures, 
 as well as mere coincidence, have been 
 ruled out as the determining factors. 
 . . . So long as practitioners fail 
 to realize the essential requirements 
 of scientific evidence and to educate 
 their patients along this line, not only 
 pseudoendocrinology but also a multi- 
 tude of other pseudoscientific cults 
 will continue to flourish."' 
 
 Further consideration is given to 
 the subject of suitable controls in 
 Chapter X, and in passing I merely 
 wish to say that the most convincing 
 "adequate evidence" that we can have 
 as to the value of a procedure and the 
 
THE DEVELOPMENT OF "PSEUDOENDOCRINOLOGY' 
 
 13 
 
 correctness of „ the one who recom- 
 mends 'it, "is the patient and 'his 
 changed clinical situation. I have ad- 
 mitted repeatedly in my lectures and 
 publications that it is entirely impos- 
 sible to know just exactly where the 
 value of an organotherapeutic proce- 
 dure begins and where it ends, and 
 my interest in the subject has not 
 permitted me to become so engrossed 
 in this one corner of ' medicine,, that 
 matters which necessarily must be 
 considered, simultaneously are ig/iored. 
 
 In other words, my conscience will 
 not allow me, when confronted with a 
 problem which may be solved by , .the 
 application of some principle . of 
 "pseudoendocrinology" to limit my 
 recommendations: ■ to the organother- 
 apy alone. (A little hint which ex- 
 tends this viewpoint will be found in 
 my reference in Chapter X to^the lec- 
 ture by Dr. John L. Tierney, of St. 
 Louis, at the California State Med- 
 ical Society held last May 1 (1921). 
 Every obviously' needed measure 
 should be added to it. It would be 
 manifestly unfair, and, in fact, it 
 would Clearly constitute malpractice 
 if, when confronted with a compli- 
 cated problem, a physician would ig- 
 nore every contributory factor and 
 treat the most ohvibus condition alone. 
 
 My chief point in establishing my 
 position, which Hoskiris admits is im- 
 pregnable, has been my insistence that 
 the endocrine aspects , of the routine 
 problems of general practice have 
 been ignored persistently by the med- 
 ical profession, and in directing at- 
 tention to them and urging measures 
 calculated to modify them* 1 believe 
 that I have broadened the viewpoint 
 of many a doctor and also made pos- 
 sible results that had not been at- 
 tained previously. 
 
 I grant that my critics can say that 
 if Harrower insists upon detoxication 
 and remineralizatioh and dietetic con- 
 trol and the removal of foci of infec- 
 tion and the regulation of the funda- 
 mentals, that any or all of these 
 measures may be the ones chiefly re- 
 sponsible for any therapeutic prog- 
 ress in a given case; but it must not 
 
 b.e, overlooked, in this connection, that 
 the same reasoning, must apply to the 
 use of any other therapeutic, proce- 
 dure. It is also a fact that the, ma- 
 jority of the cases that have been 
 treated at my Suggestion, and in 
 whose treatment the profession has 
 been interested in applying pluri- 
 glandular therapy, already have been 
 "through the mill," and perhaps may 
 have perambulated from one physi- 
 cian's office to another for months or 
 even years. 
 
 ' A far greater difficulty which I 
 have had to encounter in my work, 
 than the opposition of the scientists, 
 has been the very natural attitude on 
 the part of the general practitioner 
 to apply my recommendations ' when 
 he knows nothing better to . do— in 
 other Words, when he is "'at the end 
 of his rope" and does not know which 
 way to turn — and in spite, of this 
 really tremendous handicap we have 
 made bur mark. This indicates to me 
 that the application of the pluri- 
 glandular idea, even late hi the day 
 and when many other measures had 
 failed, justifies its recommendation 
 and the principles upon whfch it has_ 
 been based. ,,' 
 
 Here is an opportune comparison: 
 We : say'that "America really won the 
 World War." Yet if such a claim is 
 made before a Britisher or a French- 
 man, the Britisher very properly will 
 immediately say, "What would have 
 happened if there had been no British 
 navy?" and the Frenchman, equally 
 right, will say, "What would have 
 happened if our boys had not said at 
 Verdun, lis ne passeront pas du tout,' 
 and given life to their words by their 
 deaths?" 
 
 I think this is a very excellent 
 simile. The French made their ef- 
 forts, succeeded occasionally and 
 failed almost as often. The Canadians 
 at Vimy Ridge made their advances, 
 but had to take their reverses. The 
 British in their sectors, the Portu- 
 guese in theirs, and in fact, every 
 army involved, from Flanders south, 
 made their temporary gains and lost 
 them for four long years. Then a new 
 
14 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 factor was injected, a new alignment 
 took place, and every body said, "Let 
 us, with one accord and as one great 
 whole, get together and go out to 
 win." They did it, tnd they won, but 
 not until they worked TOGETHER. 
 And this is exactly the way that I 
 see it in so many cases. 
 
 Advances are made by the applica- 
 tion of some accepted measure; re- 
 verses come by overlooking a weak 
 point or allied condition. Still further 
 advances may be made in the hands 
 of some other doctor by applying some 
 other measure, and it is only when a 
 new alignment takes place, the pa- 
 tient is considered as a whole, the 
 vital endocrine aspects with the rest, 
 and an altogether concerted effort 
 made 1 , that the "war" is ended. 
 
 What do we care whether the Amer- 
 icans won the war? Or the French? 
 Or the British? Or to put it very 
 frankly, what do I care whether the 
 results are solely due to the advised 
 organotherapy or to the tout ensemble 
 of the treatment ? I could not ignore 
 the other sectors and fight on the or- 
 ganotherapeutic line alone, and appai^ 
 ently in many an instance 1 the best 
 directed efforts upon all the other sec- 
 tors have failed until the broader and 
 more comprehensive view has been 
 taken. 
 
 This may or may not offset Hos- 
 kins' statement: "Reports of cures are 
 convincing only when accompanied by 
 adequate evidence that suggestion and 
 other accessory therapeutic measures, 
 as well as mere coincidence, have 
 been ruled out as the determining fac- 
 tors." 
 
 Nevertheless, I shall make the ut- 
 most use" of suggestion and recom- 
 mend it when called for. It would 
 be altogether wrong to ignore the "ac- 
 cessory therapeutic measures" in or- 
 der that we might see how effective 
 our organotherapy might be alone, 
 and despite the fact that this may ob- 
 scure a decision "as to which factor 
 was the decisive one, or in what de- 
 gree various measures were valuable, 
 the interests of the patient come first, 
 and I shall continue to advise the 
 
 "pseudoendocrinology" which some in- 
 sist on criticizing. 
 
 Further on in Hoskins' address he 
 emphasizes that "endocrine physi- 
 ology is largely in a state of uncer- 
 tainty" and also that "deductive rea- 
 soning can be productive only when 
 the premises are sound." His methods 
 of judging premises do not seem to 
 harmonize with those of others, and 
 then he follows the above statements 
 by the following: 
 
 "A few examples of more or less du- 
 bious premises in current vogue may 
 be cited. We are glibly tolcT of the 
 'complex hormonic equilibrium' of the 
 blood. However probable the exist-' 
 ence of numerous circulating hor- 
 mones, proof of their existence is al- 
 most completely lacking. . . . Much 
 is made by some writers of 'hormonic 
 antagonists.' ... In short, the 
 existence of hormonic antagonism re- 
 mains yet to be proved, however fas- 
 cinating it is to theorize about." 
 
 Presumably acceptable proof in the 
 eyes of this critic will consist in be- 
 ing able to analyze the blood and iso- 
 late from it the varied and almost in- 
 numerable substances which we pre- 
 sume arc circulating therein. This is, 
 of course, hoping too much. It is 
 passing strange that a man who has 
 done so much experimental work with 
 internal secretions should at this late 
 stage question the existence of the 
 hormones and confirm his position by 
 the statement that "proof of their ex- 
 istence is almost completely lacking." 
 
 There is no proof of the presence 
 of amboceptors and receptors, as pre- 
 dicated in the "side chain theory" of 
 Ehrlich, who apparently has explained 
 to the entire satisfaction of both the 
 technical as well as the practical 
 members of the guild, the philosophy 
 of the immunizing response of the 
 body and how the body disposes of 
 toxins by the production of antitoxins, 
 and so on. One might equally say, 
 referring to these antibacterial and 
 antitoxic factors that "proof of their 
 existence is almost completely lack- 
 ing" — in fact, it is entirely lacking, 
 they are figments of Ehrlich's imag- 
 ination. 
 
HYPOADRENIA— "THE FOURTH DIMENSION IN MEDICINE" 15 
 
 Whether Hoskins believes in a 
 "complex hormonic equilibrium" — a 
 term which he happens to be quoting 
 from one of my articles — or not, can- 
 not dispose of the reality of this equi- 
 librium, nor can it lessen its complex- 
 ity; and insofar as normal antagon- 
 ists are concerned, no less an author- 
 ity than Sir Edward A. Schafer, Pro- 
 fessor of Physiology in the University 
 of Edinburgh, insists that the term 
 "hormone," representing the activat- 
 ing principles of certain organs, is a 
 misnomer because not all the internal 
 secretions activate. Some of them 
 have an entirely opposite effect. In 
 fact they are, as Professor E. Gley, 
 of Paris, has called them, "antihor- 
 mones," or as Sir Edward himself 
 calls them, "chalones," from the 
 Greek word meaning to relax — those 
 whose action is of an antagonistic na- 
 ture or inhibitory. 
 
 Then Hoskins refers very gently to 
 my hypothesis of hormone hunger in 
 the following terms: 
 
 "A fantastic theory that has had 
 some currency is that the body cells 
 have a capacity to select from a pluri- 
 glandular mixture any hormones they 
 happen to need and to discard the 
 rest. All the evidence is to the con- 
 trary. Both clinically and experi- 
 mentally it is sufficiently plain that 
 the law of mass action has not yet been 
 repealed. If the blood is flooded with 
 thyroid substance, for example, the 
 subject dies of thyroid intoxication 
 
 quite as would be expected. Many 
 other guesses, masquerading as facts, 
 could be cited, but let these suffice." 
 
 And this particular subject is so 
 interesting that it will be given con- 
 sideration in an "Adventure" all by 
 itself! See Chapter V. 
 
 Whether my endocrinology is of the 
 "pseudo" variety or not, the reader 
 undoubtedly will find in the following 
 pages that I have not merely the 
 courage of my convictions but the 
 added weight of the published state- 
 ments of many an authority whose po- 
 sition has been established as a re- 
 sult of years of clinical study and has 
 been repeated in the literature times 
 without number. 
 
 I would rather be a pseudoendocrin- 
 ologist out in the battle front, fight- 
 ing to acquire better control over dis- 
 ease than to be ever so scientific an 
 endocrinologist who stays at home and 
 criticizes the methods whereby others 
 accomplish their advances. 
 
 As the deathless Thomas Huxley 
 once said, "Sit down before a fact 
 like a little child; be prepared to give 
 up every preconceived notion; follow 
 it wherever and to whatever abysses 
 it may lead you — or you shall learn 
 nothing." Or as his equally famous 
 contemporary Thomas Carlyle said, 
 "Surround truth with • bitter denial 
 and contradiction and you furnish it 
 with the soil for its permanent 
 growth." 
 
 II.— HYPOADRENIA— "THE FOURTH DIMENSION IN MEDICINE" 
 
 "Facts remain such, despite denial, and no amount of opposition can change 
 the character of truth." 
 
 In the May, 1921, issue of Endo- 
 crinology is a paper by Professor 
 George N. Stewart, of the Western 
 Reserve University, Cleveland, Ohio, 
 entitled, "Adrenal Insufficiency." This 
 article consists of a resume (14 
 pages) of. the physiological data de- 
 veloped in the past few years, and 
 "Some Clinical Views" (6 pages) 
 
 which are of very unusual interest 
 to me'. 
 
 Considerable study is given to the 
 literature regarding the influence of 
 the removal of the adrenal glands, as 
 well as to references to measures cal- 
 culated to interfere experimentally 
 with the function of these organs in 
 dogs. Naturally, Stewart emphasizes 
 
16 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 the position taken by himself and 
 Rogoff in the experimental work which 
 he believes has disproved some of' the 
 conclusions made several years pre- 
 viously by Prof. W. B. Cannon, of 
 Harvard University, in regard to the 
 influence of emotional factors ■ upon 
 adrenal functioning, but his opposing 
 position has not been as generally ac- 
 cepted as has that of Cannon, al- 
 though some . of his remarks may be 
 considered as well taken. 
 
 Stewart believes that the experi- 
 mental evidence has tended more and 
 more to show that. the cortex is."t^e 
 part of the adrenal indispensable ifor 
 life. It is the cortical tissue which 
 alone, or at any rate most conspicu- 
 ously undergoes compensatory, hyper- 
 plasia, .when, a deficiency is created 
 by removal of "a considerable part of 
 the adrenal tissue." 
 
 This, of course, undoubtedly is true 
 and probably explains the therapeu- 
 tic advantage of total adrenal sub- 
 stance over the medullary principle, 
 adrenalin, when used in the condi- 
 tions which are termed by so many 
 clinicians "adrenal insufficiency." It 
 is also explainable by the histologist's 
 just claim that approximately 85, per 
 cent of the adrenal tissue is cortex, as 
 compared with only 15 per cent of the 
 chromaffin cells or medulla. 
 
 With this in view, Stewart properly 
 remarks : 
 
 "It is a curious thing that while 
 the great bulk of the experimental evi- 
 dence emphasizes the importance of 
 the cortex . . . the bulk of clin- 
 ical writers seem almost to ignore the 
 existence of the cortex. 'Adrenal in- 
 sufficiency' in nine clinical papers out 
 of ten . . . seems to connote in- 
 terference with the output of epin- 
 ephrin and consequent derangement of 
 functions in which epinephrin is as- 
 sumed to play a leading role. . . . 
 It is very common indeed to find the 
 conclusion drawn that because the 
 epinephrin store was found smaller 
 than the average, perhaps many hours 
 after death, the 'adrenal function' 
 must have been depressed and the pa- 
 tient must have suffered from adrenal 
 insufficiency during life." 
 
 Stewart, apparently pleased to find 
 one writer who partly agrees with 
 him (Rene Porak: J. de Physiol, et 
 path, gen., Paris, Jan. 1919, xviii, p. 
 9*5) refers to Porak's experiments in 
 the Municipal Laboratory at Paris, as 
 follows: 
 
 "He remarks apropos of the innu- 
 merable researches on the condition of 
 the adren'als s in infectionc, and intoxi- 
 cations' prioir to his own work, -that 
 the existence of the 'same histological 
 changes in the adrenals in infection 
 and in immunity 'prdve in a definite 
 fashion the excesses of the theory of 
 adrenal insufficiency in infections and 
 intoxications. It is as welcome as it 
 is unfortunately rare at the moment, 
 to find ina the Ertench .clinical and 
 pathological literature a protest 
 against the fetish .of adrenal insuf- 
 ficiency.-, Gley Slid his, coworkers 
 have given but a cool reception to the 
 complementary doctrine of, what may 
 be "almost, termed 'adrenal all-suf- 
 ficiency' in physiology." 
 
 Then concluding his comprehensive 
 consideration of the large amount of 
 experimental data on this subject, 
 Stewart says : 
 
 "On the, whole, then, it' must be 
 granted , that hitherto , the attempts 
 made to evoke in animals, a well 
 marked syndrome characteristic , . of 
 adrenal deficiency, have been singu- 
 larly disappointing. The contrast .is 
 great when we leave this desert, 
 where the physiologists and experi- 
 mental pathologists have wandered, 
 striking many rocks but finding few 
 springs, and pass into the exuberant 
 land of clinical endocrinology, flowing 
 with blandest milk and honey almost 
 suspiciously sweet." 
 
 These conclusions are not very en- 
 couraging, and I shall have something 
 more to say about this last insinuating 
 phrase a little later. 
 
 Just because it is not easy for the 
 laboratory worker to reproduce the 
 syndrome of adrenal insufficiency in 
 dogs and because the results of many 
 tedious experiments reported "have 
 been singularly disappointing," is no 
 proof to a clinician that such a con- 
 dition cannot exist in human beings. 
 One can produce diabetes mellitus in 
 
HYPOADRENIA— "THE FOURTH DIMENSION IN MEDICINE" 17 
 
 dogs by removing the pancreas in the 
 accepted three-step fashion; one can 
 also produce colitis in animals with 
 great ease by introducing irritating 
 substances in the bowel; and it is 
 possible to produce many other con- 
 ditions in various animals in order to 
 study them and to develop means of 
 controlling them through animal ex- 
 perimentation, but according to Stew- 
 art it is not easy to produce adrenal 
 insufficiency. Either the dog is killed 
 as a result of the ablation of the 
 glands or the healthy out-of-doors ani- 
 mal overcomes the less drastic condi- 
 tions too quickly to permit of the de- 
 velopment of a "well marked syn- 
 drome characteristic of adrenal de- 
 ficiency." 
 
 Without belittling the laboratory, 
 for endocrinology owes much to the 
 painstaking efforts of the laboratory 
 workers, we must not allow ourselves 
 to arrive at conclusions such as Stew- 
 art advises merely because he cannot 
 reproduce in animals certain clinical 
 symptoms which happen to be un- 
 usually common in human beings un- 
 der certain quite usual circumstances 
 which are encountered almost every 
 day in the routine of general prac- 
 tice. 
 
 In his much more brief considera- 
 tion in his paper of the clinical as- 
 pects of hypoadrenia several points 
 are worthy of mention. For example, 
 he refers thus to the work of Claude 
 and Gougerot, who, by the way, were 
 among the first to emphasize the im- 
 portance of pluriglandular syndromes, 
 (they) "put forward in 1908 what 
 they considered as a new conception, 
 that certain complex symptoms are 
 due to primary insufficiency of more 
 than one of the endocrine glands. 
 There is no reason in the world why 
 this should not be true." And in this, 
 at least, I thoroughly agree, for it 
 happens- that this admission by Stew- 
 art is true. 
 
 Again, it is surely not necessary 
 when there is a disturbance of en- 
 docrine function that it should be 
 manifest histologically or pathologic- 
 ally »t autopsy? Functional disor- 
 
 ders need not cause organic changes. 
 It should not be forgotten that a large 
 part of the deductions of a physiolo- 
 gist, based upon animal experimenta- 
 tion, depends upon the histologic 
 study of the tissues supposed to be 
 influenced, whereas, as regards our 
 clinical experiences, we are con- 
 cerned with changes which do not 
 necessarily have to reach a structural 
 degree, nor is the opportunity pre- 
 sented to see such changes either with 
 the naked eye or by the aid of the 
 microscope. 
 
 Pause should be made here to men- 
 tion an experience I had in Indianapo- 
 lis. Sometime ago my friend, Dr. 
 Samuel Earp, hearing that I was in 
 Indianapolis, invited a number of his 
 friends to meet me at the Marion 
 Club, where we had a round-table dis- 
 cussion on the internal secretions. 
 When I was in the middle of a con- 
 sideration of my favorite topic — 
 adrenal insufficiency — Dr. Earp inter- 
 jected the suggestion that one of his 
 colleagues then present, Dr. Edwin 
 Kime, might make some remarks 
 which would be particularly apropos 
 under the circumstances. I had just 
 been emphasizing the importance of 
 adrenal depletion in toxic conditions, 
 especially influenza, and Dr. Kime' 
 made a statement substantially as fol- 
 lows: 
 
 "You may be interested to know of 
 an opportunity I had while in the 
 service to do some autopsy work on 
 over 150 soldiers, all of whom had 
 died of influenza. In our study of 
 the pathological anatomy of the adre- 
 nal glands we found that in quite a 
 generous percentage of cases there 
 were macroscopic changes in the 
 adrenals, whereas upon microscopic 
 study practically every case showed 
 divergencies from the normal." 
 
 In view of the very large number of 
 cases that it was possible to bring to 
 autopsy at Camp Zachary Taylor, and 
 the thorough work done by Kime in 
 conjunction with his associates Lucke 
 and Wight (see their paper: "Patho- 
 logical Anatomy and Bacteriology of 
 Influenza," Arch. Int. Med., Aug. 1919, 
 xxiv. 154) , a report of this kind nat- 
 
18 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 urally was a source of very consider- 
 able encouragement to me, and in the 
 years that have passed no opportu- 
 nity has been found which could add 
 more emphasis to what Kime told us 
 that night. There is, however, a 
 small monograph in Portuguese, 
 written in 1919 by da Ponseca of Rio 
 de Janeiro, entitled "Da Insufficiencia 
 Suprarenal na Grippe," to which I 
 will refer here. Da Fonseca cites a 
 number of autopsy findings indicating 
 that changes in the adrenal structures 
 were not infrequent in patients who 
 had died of grippe. These included 
 microscopical and, occasionally, ma- 
 croscopical phenomena of congestion, 
 especially in tbe cortex; and at times 
 inflammatory and edematous manifes- 
 tations were present with leucocytic 
 infiltration, slight hemorrhages and 
 even foci of necrosis. 
 
 This Brazilian writer urges the im- 
 portance of the adrenal aspects of in- 
 fluenza; and insists that hypoadrenia 
 almost invariably is present and that 
 it is of decided importance as a fatal 
 complicating factor. He emphasizes 
 that the adrenal aspects of influenza 
 deserve to be studied and treated in 
 the less serious cases, and many ex- 
 periences in hospital and private prac- 
 tice in Rio de Janeiro have convinced 
 him that organotherapy opposed to 
 hypoadrenia is a sound therapeutic 
 measure. Quoting from this writer 
 we find that he states: "of the reality 
 of influenzal hypoadrenia, modern 
 clinicians are fully convinced, for in 
 the recent (1918) pandemic which at- 
 tacked humanity as a whole and to 
 which Rio de Janeiro paid such a 
 heavy tribute, the profession was once 
 again made aware of its importance." 
 
 And later, after referring to the 
 paucity of information on the sub- 
 ject, in American and European med- 
 ical reviews, he quotes Ricoldoni of 
 Montevideo. Uruguay, who asserts 
 positively that 
 
 "this adrenal insufficiency is insepar- 
 able from influenza itself" and who 
 further affirms that "the adrenal in- 
 sufficiency of influenza accordingly is 
 more fundamentally significant than 
 
 that which may appear in all or near- 
 ly all of the general infections and 
 many forms of intoxications." 
 
 To return to Stewart's article : Ref- 
 erence is made to many of the articles 
 by various writers, chiefly abroad. For 
 example: Nicola Pende, of Palermo, is 
 said by Stewart to speak "of the 
 hypoadrenal constitution as a clinical 
 and pathological entity first studied 
 in Italy (constitutional angiohypotony 
 of Ferrannini)"; and then he contin- 
 ues: 
 
 "In reading this paper, and many 
 others by 'clinical endocrinologists,' 
 especially the French and the Italians, 
 the physiologist can scarcely escape 
 the feeling that here he has broken 
 through into an uncanny fourth di- 
 mension of medicine, where the fa- 
 miliar canons and methods of scien- 
 tific criticism are become foolishness, 
 where fact and hypothesis are habitu- 
 ally confounded, and 'nothing is, but 
 what is not.' " 
 
 Stewart then refers to the work of 
 Eppinger and Hess of Vienna, with 
 sympatheticotonia and vagotonia, to 
 references by several French writers 
 to a group of cardiopathies in sol- 
 diers which are sometimes called the 
 "hypoadrenal types of Satre," and also 
 to references to the neuropsychic 
 origin of certain adrenal insufficien- 
 cies, and then arbitrarily concludes 
 that "there is no evidence of 'adrenal 
 insufficiency' in these patients which 
 will stand the test of critical exam- 
 ination for a moment." 
 
 The most interesting work done by 
 Prof. Josue of Paris on adrenal asys- 
 tole does not come in for much favor- 
 able consideration. Stewart says that 
 this "is the name given to a sup- 
 posed syndrome in which sudden 
 death from heart failure is apt to oc- 
 cur, associated with the presence of 
 disease or marked diminution in size 
 of the adrenals." And, by the way, 
 it really seems as though Josue's 
 work was backed up very thoroughly 
 by a large clinical experience, verified 
 by numerous colleagues, and still fur- 
 ther verified by a good deal of post- 
 mortem work; and yet, somehow or 
 other, Stewart cannot see it, for he 
 
HYPOADRENIA— "THE FOURTH DIMENSION IN MEDICINE' 1 
 
 19 
 
 decisively ends the matter by saying: 
 
 "There is no real foundation for the 
 view that the heart stops because the 
 adrenals naturally supply a physio- 
 logical stimulus necessary for its con- 
 tractions. But is is very probable that 
 if the adrenals are extremely diseased, 
 the profound changes in the metabo- 
 lism which must be presumed to occur 
 will affect the heart, as well as other 
 organs." 
 
 From my own comparatively limited 
 clinical experience, I really believe 
 that this is exactly what does happen 
 though the changes are not limited to 
 conditions related to "extremely dis- 
 eased" adrenals. The serious outcome 
 of the Addisonian syndrome is both 
 direct in its influence upon the cardio- 
 vascular mechanism and indirect in its 
 influence upon the other endocrines 
 and the metabolism which it is well 
 known that they regulate. We must 
 not forget that Stewart already has 
 admitted elsewhere in this same ar- 
 ticle that "profound changes in metab- 
 olism" are caused by the experi- 
 mental ablation of the adrenals, and 
 in order to come to this conclusion, 
 surely he must have proved these 
 changes to exist beyond the possibility 
 of doubt, since he uses the phrase so 
 confidently. 
 
 Now, comes one of the most remark- 
 able of all of Stewart's statements. 
 Immediately following the discussion 
 of Josue's presumed misapprehensions, 
 he refers to a syndrome of hypoadre- 
 nia that has been described in sol- 
 diers suffering from infectious icterus 
 in Italy by certain writers, including 
 Frugoni and Gardeghi; also to a sim- 
 ilar adrenal syndrome that Frugoni 
 has connected with typhoid fever; and 
 that several French writers, includ- 
 ing Riviere, Fillerval and others, con- 
 nect with the toxic alimentary dysen- 
 teries; as well as an adrenal insuf- 
 ficiency believed to accompany various 
 indefinite infections by Carles and 
 Satre of Bordeaux, and then, mirabile 
 dictul Stewart says the opinions of 
 these men "can scarcely be more at 
 present than the product of an undis- 
 ciplined imagination!" 
 
 I have never tired of re-reading the 
 above quotation, for it always brings 
 home to me the thought that Stewart 
 has small regard for clinicians, espe- 
 cially Italian clinicians. No small 
 wonder, indeed, it must be to all in- 
 telligent physicians who know any- 
 thing of Italian medicine to read the 
 above "inspired" lines which indicate 
 beyond dispute that Stewart classes 
 the Italian clinician with the usual 
 "dago" one meets in this country — the 
 man who never rises above the lowly 
 state into which fate and lack of op- 
 portunity have thrust him. That there 
 is a difference between an Italian 
 street laborer and an Italian physician 
 need not be expatiated on here; the 
 facts are too evident. 
 
 Not belonging to the class of "in- 
 telligent" critics to which Stewart just 
 referred, I am "weak" enough to be- 
 lieve that these Italian writers are 
 men of probity and also of acumen 
 and that their statements are the re- 
 sult of powers of observation which 
 are not despicable. 
 
 As if Stewart's low opinion of those 
 mentioned in the quotation were not 
 enough, he follows this up with a fling 
 at Sergent of Paris, a man who, in 
 my opinion, is at the head of all who 
 have developed a clinical knowledge 
 in this line and whose book "Etudes 
 Cliniques Sur l'lnsuffisance Surrenale" 
 is indisputably of so high a quality 
 that he must be purblind who is not 
 won over by his exposition of adrenal 
 insufficiency. But Stewart is among 
 those who are obdurate — perhaps the 
 most obdurate, for his bull of excom- 
 munication reads thus: 
 
 "There is no experimental evidence 
 whatever that fatigue diminishes the 
 output of epinephrin, and of course, 
 no evidence that the function of the 
 adrenal cortex, whatever it may be, 
 is diminished in that condition. Un- 
 til we have such evidence, what is 
 the use of a clinical observer looking 
 at a sick man and saying *No doubt 
 he is suffering from capsular exhaus- 
 tion due to excessive war fatigue,' or 
 to so-called shell shock (Carles) ?" 
 
 The above quotation is fortified by 
 a jocular simile to the effect that 
 
so 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 since there have been certain clinical 
 reports of pharmaco-dynamic or ther- 
 apeutic effects from adrenal therapy 
 "Hoskins [a clinician of less than a 
 year's standing— H. R. H.], for in- 
 stance, asks very pointedly whether 
 because cascara is efficacious in re- 
 lieving constipation we ought to con- 
 clude that this is because the patient 
 is_suffering from hypocascarism?" 
 
 Can it be gainsaid by any fair- 
 minded person, after reading the 
 above quotations, that the statements 
 emanating from Hoskins and Stewart 
 have a puerility and inanity which 
 condemn them at first blush? 
 
 Emile Sergent, of Paris, whose pio- 
 neer work has been a large factor in 
 initiating and maintaining my inter- 
 est in hypoadrenia and whose writings 
 were among those criticized by Stew- 
 art, made reference to his article in 
 a communication published last Octo- 
 ber ("L'Insumsance surrenale devant 
 les recentes critiques des physiolo- 
 gistes," La Presse Medicale, Oct. 12, 
 1921, xxix, p. 813), and his very 
 kindly worded criticism of Stewart is 
 subjoined : 
 
 "Acquisitions derived from clinical 
 observation cannot be regarded as 
 nonexistent. I may be permitted, in 
 this connection, to raise my voice 
 against the somewhat excessive criti- 
 cisms made by Stewart in his recent 
 article (loc. cit.). I think that the 
 best and most courteous rejoinder 
 which I can make to this eminent 
 physiologist is that he does not know 
 French sufficiently well to have thor- 
 oughly grasped the thought of the 
 French clinicians. By way of proving 
 this statement I have ascertained that 
 he attributes to us, quite gratuitously, 
 the view that adrenal insufficiency is 
 insufficiency of the secretion of adren- 
 alin. This was never our thought, 
 and by way of assurance on this point 
 I will state, once again, that, with L. 
 Bernard, I described the syndrome of 
 acute adrenal insufficiency in 1899 and 
 that adrenalin was discovered in 1901, 
 two years later. 
 
 "Moreover, recently I had the priv- 
 ilege of chatting with Prof. E. Gley 
 upon this question which interests us 
 both so vitally, for varying reasons, 
 
 and I had the satisfaction of ascer- 
 taining that he shared my view. I 
 was too well acquainted with his 
 scientific mind to doubt for one mo- 
 ment that he attached no value to 
 facts rigorously observed by clin- 
 icians." 
 
 I fear, however, that Stewart's 
 knowledge of French is better than 
 Sergent gives him credit for, for I 
 am quite sure that this distinguished 
 physiologist is clinically blind, and, I 
 think I may add, wilfully so. 
 
 Stewart concludes his article in the 
 bravura style so dear to all writers 
 who stand foursquare on their pedes- 
 tals of self-conceit: 
 
 "Mankind can apparently be divided 
 into sheep and goats in regard to this 
 matter, that is to say into sympa- 
 theticotonics and vagotonics, and the 
 vagatonics have the better chance of 
 escaping seasickness — if vagotonia 
 and sympatheticotdnia exist in ordi- 
 nary, tri-dimensional medicine, and if 
 seasickness is due to hypoadrenalism. 
 But by my troth, as Mrs. Quickly has 
 it, 'these are very bitter words' for 
 the physiologist or the experimental 
 pathologist — words like vagotonia and 
 sympatheticotonia, hypo- and hyper- 
 adrerialism, hypo- and hyper-adrena- 
 linemia and all their cousins and con- 
 nections. For he knows that in most 
 cases they are but words, and in sci- 
 ence words which conceal or even dis- 
 tort the facts do not leave a sweet 
 savor in the mouth." 
 
 The writers whom Stewart takes to 
 task and attempts to cover with rid- 
 icule have not distorted facts — they 
 have merely reported occurrences as 
 they encountered them. Nor has my 
 effort to emphasize the importance of 
 adrenal insufficiency in routine clin- 
 ical experiences and correspondingly 
 to attempt to mitigate both the fac- 
 tors which cause this depletion as 
 well as to support the played-out or- 
 gans, been based upon a distortion of 
 facts. 
 
 There is nothing "suspiciously 
 sweet" in the clinical consideration of 
 this subject. Just because a certain 
 person believes in a certain thing, 
 and believes firmly, is no reason to 
 advance the accusation that he is the 
 
HYPOADRENIA— "THE FOURTH DIMENSION IN MEDICINE" 21 
 
 victim of an "undisciplined imagina- 
 tion." But granting that Stewart is 
 somewhat in the right when he says 
 the disease of the clinicians in en- 
 docrinology is undisciplined imagina- 
 tion — I am granting the truth of this 
 charge only for argumentative rea- 
 sons — the same cannot be said in any 
 attack on him, for he is the victim of 
 a decidedly disciplined imagination- — 
 disciplined so thoroughly that it does 
 not require any deep thinking to ar- 
 rive at the conclusion that his article 
 and Frank's article and several of 
 Hoskins' articles and a number of un- 
 signed editorials in the J. A. M. A, 
 are expressions of such striking simi- 
 larity of thought that a family re- 
 semblance is quite evident and the 
 motive underlying them has all the 
 noble qualities of a secret pact and 
 understanding. 
 
 Since this was published a masterly 
 critique of the position of physiolo- 
 gists in general and Stewart in par- 
 ticular was published in Endocrinol- 
 ogy (May, 1921, p. 283) in which the 
 writer, Dr. Charles E. de M. Sajous, 
 of Philadelphia, takes Stewart to task 
 for his position and pertinently asks, 
 "May there no,t be another side to this 
 question?" He then adds, 
 
 "An experience of over forty years 
 as a physiologist (my first chair), 
 clinician, encyclopedist and editor has 
 only served to emphasize the fact that 
 physiology will become a 'great white 
 light' when physiologists will fully 
 realize that its true worth lies in con- 
 structive synthesis along with con- 
 tributions from all other branches of 
 medical science. . . . Apparently 
 discordant data, always considered 
 with due respect, often prove not to 
 be such, for, if based on sound obser- 
 vation they usually find in the other 
 branches of knowledge one or more 
 links which convert them into valuable 
 assets. As examples, I might men- 
 tion the 'obsolete' tonus theory of 
 Oliver and Schafer, the 'obsolete' an- 
 titoxic theory of Abelous and Lang- 
 lois, and the much, questioned emer- 
 gency theory of Cannon, which 
 though severely assailed by physiolo- 
 gists, are to me brilliant and invul- 
 
 nerable contributions to our knowledge 
 when regarded as manifestations of 
 the function I have attributed to the 
 adrenals, and when they are eluci- 
 dated by the many side-lights it af- 
 fords." 
 
 It will be recalled that Stewart 
 does not merely not believe in the 
 clinical importance of hypoadrenia but 
 stigmatizes those who believe in it as 
 having disordered imaginations. I 
 have already expressed quite forcibly 
 my opinion of his position and it is 
 good to know that a much older, a 
 much broader and a much better 
 posted man like Sajous agrees with 
 me. 
 
 After several pages devoted to an 
 extensive review of the literature, Sa- 
 jous continues: 
 
 "In the face of all the above evi- 
 dence, Stewart's condemnation of hy- 
 poadrenia as this syndrome is inter- 
 preted by clinicians does not appear 
 justified. His argument based on the 
 survival of experimental animali 
 after removal of both adrenals and 
 the absence of symptoms during that 
 period are invalidated if, in addition to 
 the numerous accessory or aberrant 
 adrenal tissues in the body, there ex- 
 ists a large systemic supply or re- 
 serve of adrenin from which a normal 
 animal deprived of both adrenals can 
 draw for a time, i. e., as long as its 
 reserve will last, then show the symp- 
 toms of adrenal failure and die. The 
 presence of such a reserve has been 
 indicated by the widespread distribu- 
 tion of hematoidin and of melanin, 
 both hemoglobin bodies of which 
 adrenin forms part, after removal of 
 both adrenals in rats and in advanced 
 Addison's disease, and the connection 
 of adrenin with hemoglobin in the re- 
 spiratory process. 
 
 "The suddenly produced morbid 
 process which double removal of the 
 adrenals entails differs entirely, we 
 have seen, from that recognized a* 
 hypoadrenia by clinicians. For them 
 hypoadrenia means a gradual failure 
 of the adrenals, which renders these 
 organs uniable to supply to the body 
 at large the stock of adrenin it needi 
 to carry on, from my viewpoint, iti 
 respiratory functions, i. e., tissue oxi- 
 
22 
 
 ADVENTURES IN ENDOCRINOLOGY. 
 
 dation. Whether due to local lesions, 
 or to conditions such as an acute fe- 
 brile process, which drain the reserve 
 beyond the restitutive efficiency of the 
 adrenals, the result is the same: there 
 comes a time when in addition to 
 symptom complex of the causative 
 disease, there appear certain specific 
 symptoms which are those of gradual 
 adrenal failure. Now what are these 
 
 symptoms? They are precisely those 
 observed in animals deprived of both 
 adrenals, when the function I have 
 attributed to the latter, tissue oxida- 
 tion, is taken into account, to wit: 
 anorexia, muscular weakness pro- 
 gressing to paralysis, loss of tension 
 of the eyeballs, gradual fall of the 
 blood-pressure and steady fall of the 
 temperature' until death ensues." 
 
 III.— THE ORGANOTHERAPEUTIC "WILDERNESS" 
 "Where there is no vision, the people perish." — Proverbs xxix, 18. 
 
 An asseveration characteristic of 
 old-fashioned physicians is to the ef- 
 fect that imagination has no legiti- 
 mate place in medicine. Certain en- 
 docrinologists seem to be of a like 
 opinion, asserting that imagination is 
 fraught with danger since it may run 
 away with the physician. Empiricism 
 and unscientific medicine — its dele- 
 terious attributes — are emphasized in 
 their arguments, especially when these 
 undesirable "medical outsiders" ob- 
 trude themselves with suggestions re- 
 garding pluriglandular therapy. A 
 matter to attract notice is the fact 
 that during the last year it has hap- 
 pened frequently that the articles of 
 some of my opponents have contained 
 unmistakable insinuations coupled 
 with their denials. 
 
 I am reverting he^e to George N. 
 Stewart, of Cleveland — and I ask the 
 reader's indulgence because of this 
 since I am sure he must be a bit 
 weary of my criticism of Stewart's 
 attitude — merely to illustrate how 
 blurred his clinical vision is and how 
 unfortunate it would be if every phy- 
 sician would believe him and thereby 
 deny the clinical evidence reported by 
 many physicians of standing in regard 
 to the adrenal aspects of many toxic 
 conditions. 
 
 "Where there is no vision, the peo- 
 ple perish" is indeed a true saying, 
 and applies just as well to medicine 
 as to literature and the other arts. I 
 would that Stewart were the posses- 
 sor of enough vision to take an in- 
 
 terest, a lively interest, in some of 
 the possibilities of organotherapy. 
 My desire for him to be thus dowered 
 is born of the desire I hold toward 
 every man of intelligence so that no 
 longer may it be said of him that he 
 walks in darkness. Were Stewart 
 among those with a real vision, would 
 he be guilty of the following? 
 
 "On the whole, then, it must be 
 granted that hitherto the attempts 
 made to evoke in animals a well- 
 marked syndrome characteristic of 
 adrenal deficiency, have been singu- 
 larly disappointing. The contrast is 
 great when we leave this desert, 
 where the physiologists and experi- 
 mental pathologists have wandered, 
 striking many rocks but finding few 
 springs, and pass into the exuberant 
 land of clinical endocrinology, flowing 
 with blandest milk and honey almost 
 suspiciously sweet." 
 
 Merely because Stewart and his col- 
 leagues have no encouragement to 
 offer is no reason, as I see it, why 
 everybody else who does offer some 
 encouragement should be wrong; and 
 his statements remind me of an atti- 
 tude which has not been uncommon in 
 medicine, and for that matter in other 
 sciences, the attitude of subtle criti- 
 cism by those who when their atten- 
 tion is directed to some progress, have 
 no good word for it or for the one re- 
 sponsible for it because they did not 
 happen to think of it first. 
 
 Stewart's reference to a "suspi- 
 cious" sweetness of the milk and honey 
 of this endocrine land of promise im- 
 
THE ORGANOTHERAPEUTIC "WILDERNESS" 
 
 23 
 
 mediately was taken up by the editor 
 of the Journal A. M. A. who used 
 this for the basis of another attack, 
 which in turn was reproduced again 
 by Hoskins in still another editorial in 
 Endocrinology — forming a sort of 
 vicious circle of opposition. 
 
 The criticism meted out to those 
 who choose to believe in clinical adre- 
 nal insufficiency seems to agree with 
 the editor of The Journal, for, in still 
 another editorial, after having quoted 
 the "wilderness" statement he con- 
 cludes: 
 
 "How much longer will our profes- 
 sion continue to merit such criticism? 
 Just so long as our profession contin- 
 ues to give serious consideration to 
 pseudoscientific rubbish promulgated 
 by exploiters of organic extracts." 
 
 In passing, be it remembered, that 
 none of these writers admit that they 
 have given careful clinical trial to the 
 suggestions or preparations they so 
 slightly malign. They have not ven- 
 tured out of this wilderness, as did 
 the Israelitish spies, into the promised 
 land, and they cannot return with their 
 proofs of the riches and fruitfulness 
 of the land. They merely are sure 
 that the grapes are too big to have 
 any flavor and that the tales -told 
 are the products of "undisciplined im- 
 aginations." 
 
 No discovery has yet been made 
 that has not had its opponents in the 
 beginning — its pessimistic critics who 
 have cried aloud at the innovation. 
 And no new note has been introduced 
 in literature, music, painting or sculp- 
 ture that has not fared in the same 
 manner. To cite only a few instances, 
 I would mention the brutal criticism 
 of The Edinburgh Review in connec- 
 tion with Keats' immortal poem "En- 
 dymion"; the hissings and derisions 
 that arose against Wagner's first op- 
 eras; the laughter visited on Whistler 
 and the shouts of denunciation against 
 Rodin, France's immortal sculptor. 
 
 A like attitude obtains in medicine 
 every time a new idea is put forward 
 by a well-meaning man attempting to 
 further our knowledge of these prob- 
 lems which are still in the land of 
 
 shadows. Lord Beaconsfleld had a 
 poor opinion of critics, for he was the 
 father of a clever epigram on the 
 tribe; namely, that "critics are men 
 who have failed in literature and art." 
 Would it be unwise to say of the un- 
 kind critics whose criticisms are dis- 
 played in this little volume, that they 
 too are embittered because they have 
 failed in medicine — failed in keeping 
 up with its progress ? Or would it be 
 less cruel to attribute their exceed- 
 ingly unfriendly attitude to the fact 
 that, being human, they are a bit 
 jealous because the ideas "did not come 
 to them fir^t? I leave this problem to 
 those who have more leisure time to 
 solve it than I, and who also have a 
 more penetrating mentality than is 
 mine. 
 
 But this "wilderness" visualized by 
 Stewart, fortunately is of a transi- 
 tional nature'; the Promised Land is 
 no longer a fiction but an actuality. 
 From Mount Pisgah it was s,een more 
 than ten years ago by ' Dr. Leonard 
 Williams, of London, in an introduc- 
 tion prepared at my request for a 
 special "Hormone Therapy" issue 
 (April 1913) of The Prescriber, Edin- 
 burgh, which I had the honor to sug- 
 gest and assist" in preparing: 
 
 "Yesterday was the day of the path- 
 ologist, more especially of the bac- 
 teriologist. The day before yesterday 
 witnessed the triumphal progress of 
 surgery. Physiology and medicine, 
 all wrung in the withers and quite 
 chapfallen, contented themselves, per- 
 force, with the crumbs that fell from 
 the rich microbic tables of these oth- 
 ers. But the whirligig of time brings 
 in his revenges. To-day and to-morrow, 
 and the day after, are foreordained 
 to the physiologist, the physician and 
 the therapeutist. Their hour has 
 come through the agency of the in- 
 ternal secretory glands, which already 
 unfold before the astonished view of 
 the seeing eye, a land of promise be- 
 side which the vast territories con- 
 quered by Lister and Pasteur are des- 
 tined to pale into honorable insignifi- 
 cance. The ductless glands and their 
 hormones come to us as peaceful con- 
 querors who brook no denial. They 
 
14 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 lighten our darknesses and show us 
 miracles. In studying them and en- 
 deavoring to unravel their intricate 
 »nd esoteric mysteries, one seems ever 
 and anon to be on the trail of the 
 Great Secret, and in danger of losing 
 one's mental perspective." 
 
 This "transition" is a matter that 
 rests with him whose faith is such 
 that he is dissatisfied with the "wil- 
 derness" and who, brooking no denial, 
 longs to extricate himself from its 
 paths that lead nowhere and get out 
 into the open where all is sunshine, 
 and he who runs may read. It does 
 not require a superior intellect to rid 
 oneself of the tangles which beset all 
 who still live in the "wilderness." Any 
 
 physician of average intelligence can 
 enter this Promised Land at once and 
 profit by the experience of those 
 whose words are not written small in 
 the annals of pluriglandular therapy. 
 And it is not only the experience of 
 others which will count in the Prom- 
 ised Land; ere long his own expe- 
 rience will be of such value to him 
 that no regret will be his for having 
 "foolishly" and "heedlessly" entered 
 a province which has been tabooed by 
 all those who are closely related to 
 the "din" and "noise" makers who 
 clamorously have denied, from time 
 immemorial, worthiness and value to 
 anything new in medicine. 
 
 IV.— THE "SUPPOSITITIOUS PITUITARY INFLUENCE" 
 "All that is human must retrograde if it does not advance."- — Gibbon. 
 
 In this chapter an exceedingly 
 pleasant undertaking devolves on me 
 in the matter of telling the reader a 
 thing or two about Dr. Robert T. 
 Frank's interesting studies in regard 
 to the ovary and the internal secre- 
 tion of the sex organs: Let me em- 
 phasize here that Frank is considered 
 by many to be an authority on the sub- 
 ject. 
 
 Considerable original research work 
 characterizes Frank's papers and the 
 clinical and experimental applications 
 of organotherapy are both interesting 
 and novel. Witness thereof is his pa- 
 per on "The Ovary, and the En- 
 docrinologist" in the Journal A. M. A. 
 of January 21, 1922, p. 181. 
 
 Frank's article starts bravely in the 
 following manner: 
 
 "The ovary exerts a powerful influ- 
 ence on both the primary delevop- 
 ment of the female sex organs and 
 their function during sexual life. 
 Whether other glands of internal se- 
 cretion affect the sexual sphere, ex- 
 cept secondarily, that is, by interme- 
 diation of the ovaries, is more than 
 doubtful. For example, the claims 
 of Goetsch that anterior lobe pituitary 
 extract stimulates the growth of the 
 
 sex organs was disproved by me in 
 1919 and more recently again by Sis- 
 son and Broyles. Yet this supposi- 
 titious pituitary influence continues to 
 crop out in the literature and in the 
 'therapeutic advertising pamphlets 
 with which the medical profession is 
 bombarded.' " 
 
 It is open to considerable doubt 
 whether this "disproving" of the work 
 of Goetsch, and a score of other in- 
 vestigators, by the way, will be ac- 
 cepted by a majority of the profes- 
 sion, even though, according to Frank, 
 his work published in 1919, appar- 
 ently has been supported later by that 
 of Sisson and Broyles working in the 
 same laboratories at the Johns Hop- 
 kins Hospital where Goetsch did his 
 splendid work. It must be remem- 
 bered in this connection, however, that 
 the work of these two writers con- 
 cerns "The Influence of the Anterior 
 Lobe of the Hypophysis on the Devel- 
 opment of the Albino Rat." And 
 while it is perfectly true that 
 Goetsch's claims concern the stimula- 
 tion by organotherapy of the sex or- 
 gans in animals and that Sisson and 
 Broyles also have done their work 
 with animals, we are only interested 
 
THE "SUPPOSITITIOUS PITUITARY INFLUENCE" 
 
 21 
 
 incidentally in the influence of the pit- 
 uitary on the sex glands in animals, 
 for our chief interest is in regard to 
 the effect the pituitary gland exerts 
 upon the ovaries in women in a clin- 
 ical way. 
 
 The three words — "supposititious 
 pituitary influence" (upon ovarian 
 function) are talismanic and should 
 be remembered as such, for by writ- 
 ing them Frank declares himself at 
 odds with the numerous statements 
 which have been made connecting pit- 
 uitary dysfunction with dysovarism, 
 as well as pituitary therapy as a pos- 
 sible means of regulating functional 
 ovarian difficulties. In short, he has 
 the temerity to discredit them as fig- 
 ments of the imagination. 
 
 The second paragraph of his- article 
 yields nothing in interest to the first 
 — in fact, is an improvement over it 
 in that he declares himself before the 
 public the victim of a degree of humor 
 of which he is not conscious: 
 
 "No matter how often a plausible 
 appearing claim is shown to be wrong, 
 if it appeals to the imagination or 
 meets with the desire of the therapeu- 
 tist for new and dramatically effec- 
 tive agents, the falsity continues to be 
 accepted. The results of incomplete 
 experiments, isolated empiric observa- 
 tions and fantastic hypotheses are 
 thrown together to form a glittering 
 and ever changing kaleidoscopic pic- 
 ture. A new terminology is being 
 coined. Shotgun mixtures containing 
 the 'fifty-seven varieties' are being 
 circulated. What is to be the end of 
 this seemingly uncontrolled wave of 
 mysticism, hysteria, commercialism 
 and credulousness ? Does it betoken 
 the birth of another medical cult, to 
 be controlled by the charlatan and 
 self-seeker and which, at least for the 
 moment, will carry along with it the 
 overoptimistic, the uncritical ana the 
 untrained members of the profession? 
 If this must be the outcome, the 
 sooner the break occurs the better; 
 then all hail to the 'endocrinopractor I 
 The profession is well rid of him, but 
 let us at least try to save the un- 
 wary, whom he is at present deluding 
 and perverting." 
 
 It is evident that Frank has a bur- 
 den quite similar to that of some of 
 the gentlemen whose names are re- 
 ferred to in other "adventures," and 
 that the reason for the publication of 
 his article is not so much his desire 
 to analyze or elucidate the influences 
 exerted by the ovaries on the genital 
 sphere and on the body as a whole, 
 as to serve as propaganda, for the 
 large part of the remainder of 
 Frank's paper consists of a repetition 
 of a number of things, most interest- 
 ing things too, that he has written 
 previously, and refers to work which 
 he has done quite some time ago, 
 which is none the less splendid and 
 entirely creditable. Incidentally no 
 further consideration is given in 
 Frank's remarks to the influence that 
 the pituitary is supposed not to play 
 upon the sex glands. In other words, 
 he does not find any opportunity t» 
 establish the veracity of his statement 
 that the pituitary influence upon the 
 sex glands is, as he calls it, "supposi- 
 titious." 
 
 A few comments are really neces- 
 sary here so that the reader may b» 
 able to draw a heavy line between 
 what is "fustian" in writing and what 
 is expressed thought born of a com- 
 manding degree of mentality. Ne 
 doubt you have been impressed in the 
 theatre or in your reading by speeches 
 which dripped with blood, which tore 
 deep rents into your sense of right, 
 which have brought tears to your eyas 
 because you felt that the hero or hero- 
 ine was so greatly the victim of Fate 
 as Fate was spun by the machina- 
 tions of the villain. This dire state of 
 mind is "the sort that every intelligent 
 man is ashamed of afterwards — he 
 feels that it was unmanly for him to 
 have been moved to heights of enthu- 
 siasm or plunged into depths of de- 
 spair — he cogitates just why the thing 
 affected him the way it did. And he 
 forgets that deep down in his heart 
 thefre is a "soft spot" for the melo> 
 dramatics of life. No doubt, Frank 
 is no better and no worse than the 
 man who has just been pictured, and 
 no doubt when he wrote the lines 
 
26 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 quoted he was in the fierce clutch of 
 the "melodramatics," was fascinated 
 for the moment by what he had in 
 mind to write, and afterwards was 
 heartily ashamed that he had ever al- 
 lowed himself to be guilty of such a 
 travesty of literature. "He wrote 
 from his heart," we can hear his 
 friends exclaim directly they read the 
 article and were still under its spell; 
 but a few days later a few may have 
 said: "He wrote from his liver." And 
 sometimes the minority are right. 
 
 One more quotation from Frank's 
 paper should suffice to illuminate the 
 reader so thoroughly as to his preju- 
 diced attitude that all further ex- 
 cerpts are superfluous. Here are the 
 last paragraphs : 
 
 "This leads me to state that to-day 
 we have no better ovarian extract on 
 the market than we had in 1910 when 
 I first discussed this subject. The 
 commercial preparations are 'de- 
 greased' or 'defatted' and therefore 
 deprived of such minute doses of- the 
 active principle as they originally 
 contained. Pharmacologically they 
 are inert. This includes the ovarian 
 extracts, corpus luteum extracts, ova- 
 rian residue and ovarian substance, 
 etc., of which we read they cure amen- 
 orrhea, sterility, dysmenorrhea, men- 
 orrhagia, metrorrhagia, pernicious 
 vomiting, climacteric disturbances and 
 mental confusion in women, etc. 
 
 "The near future may supply us 
 with an at least partially potent liquid 
 extract. In the meantime, it seems 
 likely that we shall continue to re- 
 ceive ecstatic reports from the com- 
 mercial laboratories of the marvelous 
 cures obtained with ovarian extracts, 
 especially if combined with a pinch of 
 thymus, spleen, bone-marrow and pan- 
 creas. . . . The ovarian extracts 
 now in use have been deprived of the 
 small amount of active substance that 
 they have contained when fresh. Their 
 pharmacologic effect on the sexual 
 tract is nil. This does not imply that 
 a total extract cannot be elaborated." 
 
 So all commercial ovarian prepara- 
 tions are "pharmacologically inert"! 
 A mountain was in labor and brought 
 forth a mouse. And in this case the 
 mouse is a sickly animal and cannot 
 
 thrive, for only truth is nutritious. 
 The "ecstatic reports from the com- 
 mercial laboratories" is an empty 
 phrase for the man in the stalls of our 
 medical theatre and a sweet morsel 
 for the gallery. Of course, the gal- 
 lery will applaud with hands and feet, 
 will shout "Bravo" — and will carry 
 home fond recollections of this jumble 
 of words and repeat them verbatim. 
 The gallery "loves" attacks on com- 
 mercialism; its simplicity of thought 
 always bespeaks a friendly reception 
 for the word. But who would want to 
 sit in the gallery knowing its compo- 
 nent parts ? How about the intelligent 
 spectator? Would he crave a change 
 from the stalls ? I doubt it. 
 
 It happens that a short time ago I 
 was talking about Frank's article to 
 the editor of the Journal A. M. A. in 
 his office when his associate, Doctor 
 Fishbein, who was also present, in- 
 formed me that they had had several 
 letters criticizing this particular state- 
 ment in Frank's paper, but that they 
 could not be responsible for it because 
 it was in an original article; and 
 Fishbein then informed me that there 
 was in the Correspondence Depart- 
 ment of the current issue of The 
 Journal an article coming out and op- 
 posing Frank's attitude; and since I 
 had been traveling and had not seen 
 The Journal (for March 11, 1922), 
 on my return to the office I found a 
 clipping from it awaiting me on my 
 desk, and here it is: 
 The Ovary and the Endocrinologist 
 
 "To the Editor: — May I comment 
 on an article entitled 'The Ovary and 
 the Endocrinologist,' by Dr. Robert 
 T. Frank, which appeared in The 
 Journal, January 21? I have been 
 hoping that someone interested in the 
 subject and realizing the benefit from 
 certain types of organotherapy, might 
 answer Dr. Frank's rather scathing 
 remarks anent the subject of ovarian 
 organotherapy. I will agree that the 
 rank commercialism which has envel- 
 oped the field of endocrinology has 
 done much to discredit it. I have no 
 use for the exploiter of the 'shotgun 
 mixtures,' or the pluriglandular 
 products, put upon the market and 
 
THE "SUPPOSITITIOUS PITUITARY INFLUENCE" 
 
 27 
 
 foisted upon the profession by means 
 of 'therapeutie' advertising pamphlets, 
 postcards, etc. Dr. Frank's allusion 
 to the 'endocrinopractor' is well made. 
 I must take issue with him, however, 
 in regard to ovotherapy of a rational 
 and common sense type. I cannot un- 
 derstand his pessimism. When he 
 says that corpus luteum extracts, ova- 
 rian extracts and ovarian residue are 
 inert, and shows his disbelief that 
 beneficial results are obtained in the 
 functional amenorrheas, certain types 
 of dysmenorrhea and in the treatment 
 of the symptoms of the artificial and 
 physiologic menopause, I believe that 
 the products he used have either been 
 of poor preparations, not fresh, or 
 that his therapy has been incomplete. 
 Ovarian organotherapy must be pro- 
 longed, continuous and regularly ap- 
 plied to obtain results, and fresh 
 glandular products must be used. The 
 miraculous effect of luteum extract in 
 amenorrhea of the functional type, 
 combined with thyroid extract where 
 obesity is coexistent in dysmenorrhea, 
 not referable to mechanical causes and 
 in the early symptoms of the meno- 
 pause, is too well known to me and 
 many others to allow Dr. Frank to 
 discredit it without a word of pro- 
 test. 
 
 "Adam P. Leighton, Jr., M. D. 
 "Portland, Maine." 
 
 In passing let the reader take note 
 of the pregnant phrase about the pos- 
 sibility that Frank's pessimism apout 
 ovarian organotherapy is because "his 
 therapy has been incomplete," as I 
 have taken the liberty of italicizing 
 it. That is just the point! 
 
 It may be noted here that the con- 
 science of the editor of The Journal 
 was soothed a little because Leighton 
 makes use' of his opportunity to hand 
 out another "slam" to those whose 
 ideas and methods differ from his. 
 He could not help, however, slipping 
 in a couple of hints about the pluri- 
 glandular idea! 
 
 Perhaps it will be well at this time 
 to call attention to some of the state- 
 ments that have been made emphasiz- 
 ing the relation that the pituitary 
 gland bears to ovarian function, be- 
 cause I do not think that any physi- 
 
 cian, no matter how intelligent and 
 highly placed, can with one statement 
 dispose of all the clinical experiences 
 of literally hundreds of investigators. 
 
 The pituitary gland most certainly 
 exerts a very decided and clear-cut 
 influence upon sex gland develop- 
 ment and functioning. The individual 
 who has pituitary insufficiency inva- 
 riably manifests a genital phase, so 
 much so that the so-called "Froehlich 
 syndrome" is known in other terms as 
 the "adiposo-^ewitaZ dystrophy." Ev- 
 ery book bearing upon the pituitary 
 gland and practically every compre- 
 hensive article on the subject calls at- 
 tention to the indubitable fact that 
 disorders of pituitary functioning 
 very often are made manifest through 
 derangement of the function, and even 
 the development and structure, of the 
 sex glands and adnexa. It is a fact, 
 too, that this is one of the early mani- 
 festations and, consequently, is of 
 prime diagnostic value. And it is a 
 source of great satisfaction to me to 
 have been able to emphasize the pitui- 
 tary aspects that so commonly are 
 present in ovarian dysfunction, there- 
 by broadening the possibility of treat- 
 ing an ovarian syndrome by ovarian 
 extract or corpus luteum, to which 
 pituitary therapy is added. 
 
 In other words, since Frank does 
 not agree with me that a "shotgun" 
 combination of thyroid and pituitary 
 and ovary, with corpus luteum is e 
 more suitable remedy than the ad- 
 ministration of ovarian substance 
 alone, he must needs attempt to dis- 
 credit me scientifically and he at- 
 tempts to do so by referring to this 
 "supposititious pituitary influence," 
 and also insists that all commercial 
 ovarian products are inert, while as a 
 matter of fact in both instances he is 
 absolutely wrong. 
 
 I have gone into this matter quite 
 a bit since this remarkable statement 
 came to my attention and find that 
 there are at least forty-five papers by 
 various authors in half a dozen differ- 
 ent languages, and thirteen books' in 
 my library in which this pituitary- 
 ovarian relationship is taken up quite 
 
26 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 fully, and in which information is 
 given both of an experimental labora- 
 tory character — animals being used 
 in the work — as well as of a clinical 
 and hospital nature (in the treat- 
 ment of disease) which indicates that 
 the influence of the pituitary gland 
 upon the gonads in both sexes is as 
 definitely proved as that of the thy- 
 roid, which, by the way, is an equally 
 important factor in any endocrine 
 gonad dysfunction. 
 
 Still greater emphasis can be added 
 to this if necessary, because there are 
 a number of articles by this same 
 Frank indicating that his experience 
 with organotherapy — "ovotherapy" as 
 he calls it — is both interesting and in- 
 structive. He has been in the habit 
 of using organotherapy for some 
 years and has not hesitated to say so. 
 How inconsistent then is his present 
 attitude ? 
 
 This same R. T. Frank read a pa- 
 per on "The Clinical Manifestations 
 of Disease of the Glands of Internal 
 Secretion in Gynecological and Ob- 
 stetrical Patients" at the meeting of 
 the American Gynecological Society, 
 May 21, 1914. His complete article, 
 supplemented by a bibliography of 136 
 items, was published in Surpery, 
 Gynecology and Obstetrics, November 
 1914, xix, p. 618. In the seventh sec- 
 tion of this article entitled "Clinical 
 Manifestations: Local and General" 
 the author commences by making the 
 statement that 
 
 "The interrelation of the glands of 
 internal secretion, the detailed de- 
 scription of the physiological and 
 pathological genital function of the 
 ovary . . . were described in de- 
 tail because, without this preliminary, 
 intelligent discussion of the clinical 
 manifestations is impossible." 
 
 He then divides this subject into 
 several headings, each with several 
 subheadings. We are interested par- 
 ticularly in the first heading, "Geni- 
 tal Inactivity (Hypof unction)" and a 
 few quotations from Frank's remarks 
 will be made. Under the subheading 
 "Congenital Conditions," he states 
 
 that the true infantilism must be 
 placed in a class by itself "Because 
 the defect . . . may be multiple, 
 affecting different glands of internal 
 secretion simultaneously, in such a 
 way as to defy analysis and detec- 
 tion." 
 
 Under the second heading, "Ap- 
 parently Primary" he admits that 
 upon careful consideration the, ex- 
 perienced gynecologist must realize 
 that he has seen few cases . . . 
 which do not show abnormalities 
 pointing fo disturbance in other 
 glands of internal secretion . . . 
 Whether the disturbance is primary 
 in the ovary or secondary to distant 
 troubles does not always become ap- 
 parent." 
 
 Again under the subheading "(c) 
 Secondary Sex Characters," it is 
 stated that 
 
 "Defects or changes in the secondary 
 sex characters occur frequently. They 
 take the form either of the adult 
 eunuchoid type (hypophyseal?), or 
 show a tendency toward male charac- 
 teristics (species type of Tandler and 
 Grosz) (adrenal or hypophyseal over- 
 activity?) " 
 
 and the writer then divides these into 
 several classes, indicating the usual 
 clinical findings and referring the 
 reader for further details to the books 
 by Tandler and Grosz ("Die biolo- 
 gischen Grundlagen der sekundaren 
 Geschlechtscharaktere") and Falta 
 ("The Ductless Glandular Diseases"). 
 
 Admittedly, thus far Frank is not 
 very decided in his assurance that 
 there is a hypophyseal or pituitary in- 
 fluence upon the genital function and 
 dysfunction, but he seems to be thor- 
 oughly convinced at least about the 
 importance of considering the rela- 
 tions of the glands of internal secre- 
 tion, which is worth something. 
 
 In considering the third division 
 of the clinical manifestations, "Surely 
 Secondary," Frank continues: 
 
 "The local genital findings are as 
 in the previous class, but unmistak- 
 ably secondary to thyroid disease 
 (Graves' disease . . . cretinism, 
 myxedema), hypophyseal disturbances 
 
THE "SUPPOSITITIOUS PITUITARY INFLUENCE' 
 
 29 
 
 (acromegaly, Froehlich's syndrome — 
 dystrophia adiposogenital ), destruc- 
 tion of the adrenals (Addison's dis- 
 ease), or thymus persistence (status 
 thymolymphaticus and infantilism). 
 The symptoms of the primary affec- 
 tion usually overshadow the secon- 
 dary genital changes completely." 
 
 I feel justified in presuming from 
 the quotations that I have made that 
 Frank admits that there is indeed a 
 pituitary influence upon ovarian func- 
 tion and dysfunction and, therefore, 
 that he was wrong in referring to this 
 reality as "supposititious." 
 
 In passing, another statement made 
 in one of Frank's later articles 
 ("Symposium on the -Relation of the 
 •Glands of Internal Secretion to Gyne- 
 cology and Obstetrics," Surg. Gyn. 
 ic Obst., September, 1917, xxv, p. 228) 
 indicates a possible reason for his 
 •weeping criticism of the suppositi- 
 tious inertness of commercial ovarian 
 preparations. He writes: 
 
 "All those commercial extracts (and 
 these are the extracts which are em- 
 ployed in the clinical articles re- 
 ported), which the writer has examined, 
 nave proved inactive biologically, 
 tising the growth effect exerted on the 
 rabbit uterus as a test." (Italics 
 mine.— H. R. H.) 
 
 A brief explanation is necessary 
 here. We do not test commercial ova- 
 rian preparations in clinical practice 
 by trying their effects upon the 
 growth of the rabbit uterus. They 
 are administered for therapeutic pur- 
 poses to sick people! 
 
 I do not doubt that there will be 
 a good deal more discussion of this 
 particular subject. However, Frank 
 is not the only one who has been in- 
 terested in the development of or- 
 ganotherapy and the preparation of 
 remedies from the ovaries and I am 
 afraid that in addition to impugning 
 the veracity of the opinion of our un- 
 willing friend, Adam P. Leighton, Jr., 
 whose opposition to Frank's .attitude 
 has been referred to above, he will 
 have to undo the entire clinical work 
 with ovarian therapy of many scores 
 ef workers including sueh American 
 
 writers as Kelly and Burnham of 
 Johns Hopkins, Hirst of Philadelphia, 
 Osborne of Yale, Graves of Boston, 
 Bandler of New York and Engelbach 
 of St. Louis, as well as a very much 
 larger list of authorities abroad. 
 Those men are not staking their repu- 
 tations for the sake of a figment, a 
 crotchet or a desire to achieve the 
 sensational. Their probity is un- 
 doubted and their written words are 
 not negligible. Whose opinion in all 
 truth should take precedence — that of 
 the unbiased investigator or that of 
 the biased? I leave this "riddle" to 
 the reader for solution. 
 
 As the MSS. for this book is being 
 completed I have received from my 
 Paris agents a new book by Leopold- 
 Levi entitled "Opotherapie Endocrin- 
 ienne: Ses applications journalieres" 
 (1922). In chapter three (page 57) 
 there appears the following: 
 
 "Pituitary organotherapy is ad- 
 missible, too, in pluriglandular en- 
 docrine syndromes in which the pitui- 
 tary is involved. Developmental and 
 functional disorders of the sexual sys- 
 tem should also direct attention to the 
 pituitary gland, as also to the thy- 
 roid. In man, there is agenesia, ab- 
 sence of puberty, developmental in- 
 fantilism or reappearance of infantil- 
 ism, return of puberty. In woman, 
 there is amenorrhea which, according 
 to Hofstatter, can be classified accord- 
 ing to whether there is genital apla- 
 sia, infantile uterus, hypoplasia in 
 multiparas, or whether the amenor- 
 rhea is consecutive to toxi-infections 
 or manifold and prolonged lactation. 
 In these cases the therapeutic effect 
 of pituitary organotherapy is indi- 
 rect (Renon and Delille) but at the 
 same time excitatory." 
 
 The author of this book has been 
 clinically interested in this subject for 
 many years, and his new book hap- 
 pens to be his fifth on endocrine sub- 
 jects. His opinions evidently also dis- 
 agree with some of those under dis- 
 cussion in this chapter. 
 
 In closing this chapter a statement 
 might be made in partial justice te 
 Frank, certain of whose opinions I 
 have taken so decidedly to task. 
 
30 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 A colleague, who like myself was 
 astounded at his article, wrote 
 him a letter. (So did I, but he 
 did not answer it.) He answered 
 the colleague, however, and in 
 the course of his letter which 
 has been shown to me, he says, "The 
 pituitary gland has a very marked 
 influence on ovarian function. What 
 I have shown is that pituitary ex- 
 tracts as now available and used have 
 not the effect ascribed to them." 
 But that is not what Frank says in 
 his article and he does not give any 
 evidence to show that pituitary ther- 
 
 apy with the "extracts as now avail- 
 able" does not measure up to the use- 
 fulness claimed for it. He makes spe- 
 cific statements regarding the suppos- 
 ititiousness of the pituitary influence, 
 and then to add insult to injury he 
 denies absolutely the therapeutic 
 value of commercial ovarian prepara- 
 tions even though in the quotation 
 from my friend's letter he now fully 
 admits that "the pituitary gland has 
 a very marked influence on ovarian 
 function" — as I think has been shown 
 very clearly both here and elsewhere. 
 
 V.— HARROWER'S HYPOTHESIS AND HOSKINS' HALLUCINATIONS 
 
 "Error of opinion may be tolerated where reason is left free to combat it," — 
 Thomas Jefferson. 
 
 As indicated in the Introduction, 
 the fundamental principle upon which 
 the work of The Harrower Labora- 
 tory has been builded, is what is 
 sometimes called "the pluriglandular 
 theory." This is fully outlined in Sec- 
 tion 2, Chapter 4, of my book "Prac- 
 tical Organotherapy," the third edi- 
 tion of which has recently come from 
 the press.* 
 
 Briefly, this idea involves the im- 
 portance of the relations of the 
 glands of internal secretion. It does 
 not seem possible that any general- 
 ized influence for harm that may 
 come about in the course of disease 
 can be limited in its effects to a single 
 endocrine organ. Again, if there is a 
 decided disturbance in one of the 
 glands of internal secretion, as for 
 example, the thyroid gland in myx- 
 edema, there 1 cannot but be a reflex 
 fluence as a result of this upon the 
 other endocrine glands which are re- 
 lated to it physiologically. 
 
 I believe that the glands of internal 
 secretion are in so intimate a relation 
 
 * While the edition lasts a copy of the 416- 
 pp, cloth bound, reference book will be Bent 
 on approval to any physician on request. The 
 price, if acceptable, is only one dollar. 
 
 with each other that, as I have often 
 said, "there never was a purely uni- 
 glandular endocrine disorder," and 
 that much of the success that has 
 come to those who have followed the 
 ideas which we have developed, has 
 come about because of the fact that 
 pluriglandular therapy was used in- 
 stead of single gland extracts. 
 
 In my publications I have dwelt on 
 pluriglandular therapy so fully that 
 mfere mention of it here is all that is 
 necessary. But a more extensive ac- 
 count should be given of a hypothe- 
 sis which I devised so as to make clear 
 to myself certain clinical experiences 
 which I had noticed very frequently 
 following the use of pluriglandular 
 remedies. 
 
 This "Hypothesis of Hormone Hun- 
 ger," as I called it, was worked out 
 by me, and first discussed in an ar- 
 ticle in the New York Medical Record, 
 August 16, 1919. The philosophy of 
 this hypothesis is as follows: 
 
 "Each organ of the body that is de- 
 pendent upon hormone influences 
 must have some subtle capacity to 
 pick up the hormones from the blood 
 as they float by. This cannot but be 
 true, else how could the passing 
 
HARROWER'S HYPOTHESIS AND HOSKINS' HALLUCINATIONS 31 
 
 'chemical messengers' bring about the 
 influence upon the organ or cell that 
 they are supposed to affect? Not only 
 must there be a definite capacity to 
 pick up these hormones as they are 
 Drought to the cell by the blood, but 
 there must be a selective capacity, for 
 the blojod contains all the hormones 
 that we know of as well as probably 
 a good many more that we do not 
 know at present. I do not feel that 
 the imagination has to be stretched 
 very much to presume that there is a 
 remarkable 'cellular judgment' or se- 
 lective capacity to pick out the hor- 
 mones which are needed — and in the 
 amount they are needed. 
 
 "It is with this particular selective 
 power in mind that I have developed 
 ,this hypothesis of hormone hunger. I 
 contend that under varying circum- 
 stances these cells must be more ac- 
 tive in their picking up of the passing 
 hormones than at other times. In 
 other words, at times a condition of 
 hormone hunger actually must be 
 present. Let me explain: Take as an 
 example the thyro-ovarian interrela- 
 tionship — this is, perhaps, the most 
 thoroughly established and most eas- 
 ily understood. It is well known that 
 there is a principle produced in the 
 thyroid gland which "exerts a very 
 marked influence upon ovarian func- 
 tion. (It will be recalled that in 
 myxedema there are definite func- 
 tional ovarian disorders, that girls 
 with goitre very often have serious 
 menstrual difficulties and, finally, that 
 the cretin, who has no thyroid gland, 
 does not develop sexually.) Surely it 
 is fair to believe that there is a prin- 
 ciple made in the thyroid which stim- 
 ulates ovarian function, and that this 
 must necessarily reach the ovaries 
 through the blood, and of course, that 
 the ovaries must have some means of 
 getting hold of this hormone. If, then, 
 this thyroid hormone passing through 
 the ovaries in its blood supply hap- 
 pens to be deficient, after as much of 
 it as can be found is taken up by cells 
 of the ovary, and the demand is 
 ereater than the supply, there will re- 
 main a need for that which is not 
 present, i. e., the ovarian cells will be 
 fhunerv' for more of the thyroid stim- 
 ulus Furthermore, this 'hunger' will 
 vary, depending upon the degree to 
 
 which the thyroid is functioning and 
 the hormone needs of the ovary." 
 
 The foregoing statements have 
 aroused considerable comment, mostly 
 favorable. A gratifying feature has 
 been that several editorials in ap- 
 proval of my theory have been pub- 
 lished and that an encouraging num- 
 ber of writers have referred to it in 
 the course of their articles. Of course 
 not all the comments in regard to this 
 idea have been favorable. Perhaps one 
 of the most active opponents of this 
 idea is the editor of Endocrinology, 
 Dr. R. G. Hoskins, who, in a number 
 of original articles and signed edito- 
 rials, has attempted to throw cold 
 water on my enthusiasm, and to pre- 
 vent some of his colleagues from being 
 "misled" by me. Hoskins credits me 
 with having had much to do with the 
 development of the science which he 
 calls "pseudoendocrinology," and feels 
 that I am leading the medical profes- 
 sion astray, and should be stopped in 
 some way, even if it is necessary to 
 plow up the entire field of endocrin- 
 ology in order to start over again, un- 
 trammeled by so many of the mis- 
 statements with which I am credited. 
 In a signed editorial published in 
 Endocrinology entitled "What is 
 Endocrinology?" Hoskins has this to 
 say: 
 
 "There is a class of writers who af- 
 fect the term 'so-called endocrinology,' 
 the implication seeming to be either 
 that the existence of endocrine organs 
 is doubtful or else that the volumi- 
 nous literature pertaining to them is 
 of such uncertain significance as not 
 to deserve formal recognition. That 
 the literature does include an intoler- 
 able deal of twaddle, no well-informed 
 reader can deny. Such pretentious 
 nonsense might well be designated 
 pseudoendocrinology. 
 
 "The proponents of this sort of lit- 
 erature are coming in for criticism on 
 all sides. A recent editorial in The 
 Journal of the American Medical As- 
 sociation concludes: 'How much 
 longer will our profession continue to 
 merit such criticism? \ Just so long as 
 our profession continues to give se- 
 rious consideration to pseudo-scientific 
 
32 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 rubbish promulgated by exploiters of 
 organic extracts.' The writer might 
 well have added: 'and by clinical in- 
 competents seeking easy paths to 
 fame.' 
 
 "Upon the members of the Associa- 
 tion for the Study of Internal Secre- 
 tions a special responsibility devolves 
 lest a long-suffering medical profes- 
 sion in disgust with the rank growth 
 of weeds in our fertile field in reform- 
 atory zeal uproot wheat and tares 
 alike. 
 
 "It fortunately happens that the 
 pseudoendocrinologists have developed 
 such a characteristic array of meth- 
 ods that they are relatively easy to 
 identify. They are strikingly ad- 
 dicted to theorizing. If, in a given 
 article, the 'explanatory' portion bulks 
 larger than ten or twenty per cent 
 of the original data adduced, one is 
 rarely in error in classifying it as 
 'pseudoscientific rubbish.' As Elliott 
 has sagely remarked: 'Medicine owes 
 no thanks to him who, without proof, 
 would formulate her theories.' Those 
 who are attempting to elicit our grat- 
 itude in this way often put forth the 
 specious plea that they are pointing 
 the way to research, — as though the 
 competent investigators in this field 
 were not beset with an almost bewil- 
 dering array of problems. 
 
 "The pseudoendocrinologists are 
 much given to appeals to 'physiology.' 
 But the physiology cited, one seeks in 
 vain in any first-class treatise on that 
 subject. The guesses of novices and 
 the deductions of shallow thinkers are 
 habitually quoted as on a par with 
 substantial facts. Gross distortion of 
 the evidence is constantly encountered. 
 Such data as support the preconceived 
 theories of the writer are cited while 
 opposing data are ignored. This is not 
 infrequently carried to the point of 
 actual mendacity. Systematicized de- 
 lusions masquerading as the 'teach- 
 ings of experience' are not uncommon. 
 Marvel mongering is also an ear- 
 mark, though this is going out of 
 style. 
 
 "Examples could be cited by the vol- 
 ume. One recent paragraph, and it by 
 no means the worst available, may be 
 quoted: 'I have frequently been asked 
 why adrenal gland and pancreas can 
 be given together in hyperthyroidism. 
 
 . . . This is readily explained. 
 Adrenal extract is a cardiac tonic 
 and slows and strengthens the heart. 
 Further, when administered in this 
 form, its influence upon the adrenal 
 glands and the factors controlled by 
 them is supportive rather than stim- 
 ulative. ... In the complex hor- 
 monic mixture in the blood all the 
 hormones, both antagonists and stim- 
 ulants, are to be found and the re- 
 markable selective capacity of the or- 
 ganism to avail itself of those which 
 are needed, and in proportion as they 
 are needed, explains why, when an- 
 tagonists are given simultaneously, 
 benefit may accrue in both directions 
 represented by the opposing princi- 
 ples. Suffice it to say that . . . 
 the antagonistic value of pancreas 
 over adrenal medullary irritability, as 
 well as the thyroid itself, makes the 
 pluriglandular idea not so unreason- 
 able after all.' 
 
 "Space and patience are lacking for 
 a full analysis, but a few of the vio- 
 lations of sound physiology may be 
 indicated. That adrenal extract 
 given by mouth has any effect on the 
 circulation is without evidence that 
 competent pharmacologists can now 
 accept. 'Its influence is supportive 
 rather than •stimulative'' is only 
 verbalism that obscures rather than 
 clarifies. The 'complex hormonic mix- 
 ture of the blood' is quite possibly 
 nonexistent. In few cases has it been 
 proved that the endocrine organs con- 
 tribute anything to the blood stream. 
 They may function by a process of 
 subtraction rather than addition. 
 Hormonic 'antagonists' are, so far as 
 proof is concerned, largely mythical. 
 That epinephrin is rapidly destroyed 
 in alkaline media and that pancreas 
 extract is alkaline comprise the 6um 
 total of clean-cut evidence on the 
 point. The 'remarkable selective ca- 
 pacity of the organism' is, so far as 
 can now be determined, a mere fig- 
 ment of the imagination, which is be- 
 ing grossly overworked as an excuse 
 for haphazard, pluriglandular dosing. 
 If the body cells were possessed of 
 any such critical acumen as postu- 
 lated, why should we ever encounter m 
 case of acromegaly or hypothyroid- 
 ism? It is definitely proved that the 
 cells will take up thyroxin or epin- 
 
HARROWER'S HYPOTHESIS AND HOSKINS' HALLUCINATIONS 3S 
 
 ephrin in lethal quantities, when ex- 
 posed to excess of these substances, 
 Finally, the 'value' of pancreas ex- 
 tract as a source of hormone is, ac- 
 cording to reliable evidence, nil. 
 
 "That given endocrine gland sub- 
 stances may be valuable in given clin- 
 ical conditions may or may not be 
 true, as a matter of empirical obser- 
 vation. That enlightened empiricism 
 may lead to further valuable thera- 
 peutic deductions is not improbable. 
 Such results are to be expected, how- 
 ever, not from promiscuous dosing 
 with hit-or-miss mixtures, but from 
 carefully controlled experiments care- 
 fully analyzed. Rigid critique and 
 rigid logic are indispensable. Any 
 data adduced must stand on their own 
 merits as data. Confusing the issue 
 by the introduction of impressionistic 
 physiology is deplorable. 
 
 "In the endocrine field, as in all 
 other fields of medical science, prog- 
 ress depends upon intelligent discrim- 
 ination. Sound workmanship deserves 
 every support, mere tinkering, none. 
 Pseudoendocrinology will disappear as 
 soon as it ceases to be profitable. The 
 medical profession at large can alone 
 determine when this time will ar- 
 rive." 
 
 It is difficult to know what to say 
 when confronted with so much abuse. 
 Hoskins' criticism that the pseudo- 
 endocrinologist is 'much given to ap- 
 peals to physiology' but 'one seeks in 
 vain in any first-class treatise on that 
 subject' is unfair, for clinical physi- 
 ology is surely a real thing. There is 
 plenty of proof also that this is not 
 true, but it really seems that those 
 who feel with Hoskins are not so 
 much concerned about physiological 
 reactions in sick persons, but rather 
 are interested more in laboratory ex- 
 periments, which occasionally they are 
 unable to duplicate, as for example, 
 the experiences outlined by Stewart 
 elsewhere, and previously considered 
 in another adventure. We are looked 
 uvon as "novices and shallow think- 
 ers" (Chap. II), and as "constantly 
 and grossly distorting the evidence. 
 And if by any chance we choose to 
 quote some clinical experience of an 
 
 unusual character, then we are called 
 "marvel mongers." 
 
 A few of Hoskins' statements in- 
 vite attention. He indicates that 
 adrenal extract given by mouth is 
 without effect on the circulation, sim- 
 ply because competent pharmacolo- 
 gists cannot accept the evidence of the 
 clinician. Fortunately, the patient* 
 who come to us for treatment do not 
 expect us to treat them as though 
 we were pharmacologists, and there ii 
 plenty of evidence in a hundred dif- 
 ferent papers that adrenal therapy, 
 that is to say, the administration of 
 desiccated adrenal substance by 
 mouth, not merely has an effect upon 
 the body, both in health and disease — 
 chiefly in disease! — but that its chief 
 influence is upon the circulatory mech- 
 anism of the body, as manifested on 
 the blood-pressure in particular. 
 
 The "verbalism that obscures rather 
 than clarifies," which refers to my 
 statement that the influence of 
 adrenal substance "is supportive 
 rather than stimulative," deserve* 
 consideration for a moment. (And, by 
 the way, the criticized pluriglandular 
 formula containing adrenal and pan- 
 creas substances which is used in th« 
 hope of controlling a part of the ex- 
 treme sympathetic irritability and 
 heart hurry was first suggested by 
 Andre Crotti, of Columbus, Ohio, an 
 old time assistant of the famous 
 Kocher of Berne and a real clinician. 
 Our preparation Pancreas Co. (Har- 
 rower), which has been used success- 
 fully in many cases of hyperthyroid- 
 ism, is a slight modification of Crotti't 
 original formula.) 
 
 If an individual is suffering with as 
 asthenic state, strychnin is very often 
 recommended as a means of stimula- 
 tion, and under certain circumstances 
 it is of decided therapeutic value. Thig 
 influence is conceded by the pharma- 
 cologist as well as the clinician, t« 
 be of a stimulative character. On the 
 other hand, if an individual is asthenic 
 and tired out in conjunction with a 
 serious degree of adrenal insufficiency, 
 and we administer the indicated or- 
 
34 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 ganotherapy, or "adrenal extract," 
 e. g., the total gland, it is not very 
 difficult to conceive that such stimula- 
 tion is not to be compared with that 
 which we get from strychnin. In 
 other words, it is not really stimula- 
 tion, because stimulation involves a 
 sort of an irritation. As a matter of 
 fact, when the body reacts to strych- 
 nin it is in a well-intentioned effort to 
 dispose of a poison which the body has 
 discovered to be present, whereas 
 when we give adrenal substance to a 
 person with hypoadrenia, we are not 
 stimulating him, but supporting him, 
 just as we "support" a tired-out horse 
 with a bag of oats, instead of whip- 
 ping him. I think that there is a real 
 difference; and so do others who have 
 been willing to make a similar com- 
 parison in a clinical way. 
 
 Attention should now be concen- 
 trated on Hoskins' reference to "the 
 remarkable selective capacity of the 
 organism" — a quotation, by the way, 
 from one of my articles. He insists 
 that this is "so far as can now be 
 determined, a mere figment of the 
 imagination which is being grossly 
 overworked for haphazard plurigland- 
 ular dosing." 
 
 He then attempts to explain the ab- 
 surdity of this position by saying, 
 
 "If the body cells were possessed 
 of any such critical acumen as postu- 
 lated, why should we ever encounter 
 a case of acromegaly, or hyperthyroid- 
 ism? It is definitely proved that the 
 cells will take up thyroxin or epin- 
 ephrin in lethal quantities, when ex- 
 posed to excess of these substances." 
 
 First of all, in pluriglandular ther- 
 apy and even in the administration of 
 single glandular extracts we do not 
 offer "lethal quantities" of these prod- 
 ucts. The conditions which are present 
 in hyperpituitarism or even hyperthy- 
 roidism, do not happen to lend them- 
 selves particularly to any kind of 
 glandular therapy, much less to pluri- 
 glandular therapy; and while without 
 a doubt excessive amounts of thy- 
 roxin or adrenin can cause serious 
 symptoms, indicating that the cells 
 can take up "lethal quantities" when 
 
 exposed to an excess of them, as 
 Hoskins indicates, he is introducing a 
 factor which is not germane to the 
 subject. 
 
 This would seem the proper place 
 to republish a letter received by me 
 late in 1919 from Hoskins, which is 
 really a comment on the reprint of my 
 article referred to above, which I sent 
 to him as editor. This letter was 
 originally published with his acquies- 
 cence in The Organotherapeutic Re- 
 view (January 1920, vi, p. 62) : 
 
 "Thank you for your interesting re- 
 print of your 'Hormone Hunger' pa- 
 per. So far as I can see, it is per- 
 fectly good biology; it is rather de- 
 monstrated fact, however, than the- 
 ory. You are somewhat too modest 
 in applying it merely to hormones. 
 Precisely the same mechanism — 
 whatever it may be — comes into play 
 when a young bone cell has to pick 
 out calcium or an active muscle, glu- 
 cose, from the blood. One can call it 
 'hunger,' 'specific affinity' or whatnot. 
 Your term has the advantage of 
 graphicness." 
 
 We all know what "the whirligig of 
 time" may effect, but my casual read- 
 ings have failed to bring home an- 
 other instance in which there is such 
 a diversity of opinion from the same 
 source in the course of so very few 
 years. Perhaps after all Hoskins 
 was not strong enough to hold out 
 against "the word from above." 
 
 This hypothesis of hormone hunger 
 is a well-intentioned attempt to ex- 
 plain how it is that various parts of 
 the body are able to utilize certain 
 hormones when it is presumed from 
 the symptoms that these hormones 
 are deficient, and I assert without any 
 fear of contradiction that clinical ex- 
 perience shows that in these persons, 
 the capacity of the cells to avail them- 
 selves of the previously missing and 
 artificially replaced substances indi- 
 cates that there must be some sort of 
 a hunger, as I have called it, to fa- 
 cilitate their appropriation. Now what 
 might be called an excess, that is to 
 say, the organotherapeutic adminis- 
 tration of just a little more than the 
 body may need at the time of its ex- 
 
HARROWER'S HYPOTHESIS AND HOSKINS' HALLUCINATIONS 35 
 
 hibition — not the persistent adminis- 
 tration of undue amounts of thyroid 
 extract, as has been done many times 
 unfortunately, and which causes thy- 
 roidism, nor "lethal quantities" — is 
 permitted to remain in the circula- 
 tion until oxidized, or disposed of in 
 the usual manner. 
 
 Just because we cannot explain the 
 whole of the factors involved in or- 
 ganotherapy and endocrinology, is no 
 reason why we should cast aside the 
 whole theory until we are perfectly 
 informed regarding all the details. 
 
 The fact does remain that there 
 must be varying degrees of interest 
 on the part of the various cells of the 
 body for certain endocrine products 
 which we may offer to them in the 
 course of our therapeutics, and pro- 
 vided we are reasonable in the extent 
 and character of our pluriglandular 
 menu, without a question we are go- 
 ing to accomplish a great many re- 
 markable things with our "haphazard 
 pluriglandular dosing," even though 
 it may be based upon what Hoskins 
 chooses to call "impressionistic physi- 
 ology." 
 
 The patients are not concerned in 
 regard to the impressionism, nor are 
 they always interested in the tech- 
 nical duplication of experiences in the 
 laboratory, and if they can get some 
 satisfaction from the service of a doc- 
 tor who is willing to give them the 
 benefit of the possibilities of organo- 
 therapy, and especially pluriglandu- 
 lar therapy, they are going to give 
 what credit comes to the one to whom 
 credit is due and not to the one or 
 ones who are heaping ignominy on the 
 heads of those who know that they 
 are rendering help to their patients. 
 
 In order to emphasize his point, 
 Hoskins states that the value of pan- 
 creas extract as a source of hormone 
 "is according to all reliable authori- 
 ties nil." Is it possible that the edi- 
 tor of Endocrinology has turned his 
 back on the French literature on the 
 subject as well as on the reports of 
 such men as Combe of Geneva, 
 Lepine of Lyons, Zuelzer of Berlin, 
 
 Crofton of Dublin, Pochon, Carnot 
 and H6don of Paris, Biedl of Prague, 
 and others ? As a matter of fact, the 
 possibilities of pancreas therapy in 
 functional high blood-pressure, sym- 
 pathetic irritability, diabetes mellitus 
 and, perhaps, in other conditions, rep- 
 resents a phase of endocrinology 
 which deserves very much more study 
 than has been given to it as yet, and 
 there are at least two hundred papers 
 having a bearing on this subject, 
 many of them concerned with the ex- 
 perimental aspects of pancreectomized 
 dogs, as well as the clinical aspects of 
 individuals with glycosuria. 
 
 No editor of a journal devoted to 
 endocrinology should lay himself open 
 to the charge of not being versed in 
 what the European profession is doing 
 in the realm of endocrinological in- 
 vestigation, for no matter how limited 
 his knowledge of the French language 
 may be, his editorial acumen should 
 be of so high a degree that no litera- 
 ture is excluded from his survey. 
 
 Then Hoskins also refers somewhat 
 slightingly to what he calls, "empir- 
 ical observation." He says "that 
 given endocrine gland substance may 
 be valuable in given clinical condi- 
 tions, may or may not be true" — he 
 hesitates to admit it point blank — "as 
 a matter of empirical observation." 
 He then continues, "that enlightened 
 empiricism may lead to further val- 
 uable therapeutic deduction is not im- 
 probable," and this is exactly the 
 point that I have always contended. 
 That is to say, while empiricism still 
 may be reprehensible in the minds of 
 some, it is the only way in clinical 
 practice, to apply ideas which have 
 been developed in the laboratory, or in 
 the clinical experience of others. The 
 duplication of a procedure because it 
 has been recommended highly by a 
 certain investigator or group of clin- 
 icians, is simon-pure empiricism — 
 "the. practice of medicine founded on 
 mere experience" (Webster), or do- 
 ing what one has done previously is 
 the hope that sin-.ilar experiences may 
 be obtained. Hoskins is averse to ad- 
 mitting that empiricism can be of any 
 
36 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 advantage, nevertheless it is my opin- 
 ion that progress in medicine has been 
 based more upon empiricism than it 
 has been upon the special brand of sci- 
 ence which Hoskins seems to believe 
 in. 
 
 No doubt by now the reader has a 
 very clear conception of Hoskins' 
 strictures on pluriglandular therapy 
 and on those who believe in it. The 
 
 rather detailed account that I have 
 given was necessary so that the great- 
 est light could be thrown on the sub- 
 ject. It is only by this method that 
 results can be achieved — by which I 
 mean, it is only by going into the de- 
 tails of a subject that the reader is 
 benefited in that he gets into close 
 grips with the views and opinions of 
 the contending forces. 
 
 VI.— PROFESSOR CUSHING'S ALLEGORY 
 
 'It is not enough to know; ive must turn what we know to account. It is not 
 enough to will; we must do." — Goethe. 
 
 Ten years ago Dr. Harvey Cush- 
 ing, then connected with the Johns 
 Hopkins Medical School, wrote a 341- 
 page book entitled, "The Pituitary 
 Body and its Disorders" (J. B. Lip- 
 pincott Co., 1912), which has been a 
 source of very considerable encour- 
 agement to many physicians includ- 
 ing myself, who have been interested 
 in this mysterious subject. 
 
 The other day, when in Boston, I 
 had the pleasure of meeting Cushing 
 for the first time, and after I had 
 asked him why he did not get out a 
 second edition of his book, after so 
 long a lapse of time, he gave me to 
 understand that he was not going to 
 get out another edition, and seemed 
 to me to be somewhat sorry for ever 
 Having published the book. 
 
 I then asked him if he would answer 
 two questions for me, for reasons 
 which will be found in Chapter IV of 
 these "Adventures." I asked him 
 first if he had any information con- 
 firming the relation between the pit- 
 uitary gland and the ovaries, and was 
 informed that he "could not answer 
 that question" ; and, second, if he had 
 had any experience indicating that 
 pituitary therapy exerted any influ- 
 ence upon ovarian functioning, and, 
 naturally, I received a similar unsat- 
 isfactory answer. 
 
 While Cushing was intensely cour- 
 teous, it was very easy to see that wo 
 live in different spheres, think dif- 
 
 ferent thoughts, and express them in 
 widely differing ways. In the course 
 of our conversation, he referred to the 
 ease with which the medical profes- 
 sion "could be made to believe most 
 anything" that was told them and 
 happened to mention the large emol- 
 uments which came to a certain doc- 
 tor who promoted a remedy called 
 "Peruna," and also made some re- 
 marks regarding the remarkable fa- 
 cility with which the strange views of 
 a certain defunct Bostonian were ac- 
 cepted by so many apparently intelli- 
 gent persons throughout the country. 
 Cushing was kind enough to assure 
 me that he was not comparing the 
 success of my work with that of the 
 maker of "Peruna," but none the less 
 it was apparent to me that he thought 
 of me as one of the same class. 
 
 All of which is introductory to a 
 consideration of an allegory which 
 Cushing prepared as a presidential 
 address which was delivered before 
 the Association for the Study of In- 
 ternal Secretions last June (1921). 
 The whole trend of this allegory, 
 which is entitled, "Disorders of the 
 Pituitary Gland, Retrospective and 
 Prophetic," and which was pub- 
 lished both in the Journal A. M. A. 
 (June 18, 1921, lxxvi, p. 1721), and 
 also in Endocrinology (May, 1921, v, 
 p. 283) is distinctly in line with the 
 remarks which he made to me. He is 
 clearly a pessimist about organother- 
 
PROFESSOR CUSHING'S ALLEGORY 
 
 37 
 
 apy; he also feels that my interest in 
 the subject and its manifestations are 
 a decided detriment to the profession 
 and to this particular branch of med- 
 icine, and that if the blind should lead 
 the blind both will fall into the ditch 
 — although he did not particularly re- 
 fer to this Biblical simile. 
 
 I have great respect for Cushing's 
 surgical acumen. also have believed 
 in his experiences as reported in his 
 book, referred to above, and have du- 
 plicated one or two of them (espe- 
 cially with pituitary therapy) a num- 
 ber of times. If he has changed his 
 mind, as indeed I believe he has done, 
 I do not feel justified in changing mine 
 as well. Years ago he helped to con- 
 vert me to the remarkable possibili- 
 ties of clinical organotherapy and the 
 fact that he has now "changed his re- 
 ligion" certainly is not going to be 
 sufficient ground for me to aposta- 
 tize also. 
 
 At all events, I am going to quote 
 a number of statements from Cush- 
 ing's allegorical address in order to 
 direct attention to his present atti- 
 tude and to draw a conclusion or two 
 therefrom: 
 
 "We find ourselves embarked on the 
 fog-bound and poorly-charted sea of 
 endocrinology. It is easy to lost our 
 bearings for we have, most of us, lit- 
 tle knowledge of seafaring and only 
 a vague idea of our destination. Our 
 motives are varied. Some unques- 
 tionably follow the lure of discovery; 
 some are earnest colonizers; some 
 have the spirit of" missionaries and 
 would spread the gospel; some are at- 
 tracted merely by the prospect of gain 
 and are running full sail before the 
 trade wind. Traders, adventurers, 
 even pirates are certain to follow on 
 the heels of exploration. In every 
 profession, even ours, are to be found 
 those who gather up beads of infor- 
 mation of little intrinsic value which 
 are exchanged for the property of 
 credulous people, as gullible as the 
 natives of the new»found land. Thus 
 do discoveries become exploited and 
 there were discreditable chapters in 
 the histories of all the Great Com- 
 panies of days gone by. . . - 
 
 "To our present short sight it would 
 appear that this sudden enthusiasm 
 to put to sea under the pennant of the 
 ductless glands was largely influenced 
 by the chance discovery in 1909 that 
 certain hitherto uncharted though 
 easily recognizable disorders are due 
 to a state of pituitary insufficiency. 
 
 "If this organization [the A. S. I. 
 S.] is to play its proper role, it should 
 act as a much-needed stabilizer 
 which, by proper recognition, will en- 
 able the profession and the public to 
 distinguish the Cooks from the 
 Pearys of our profession; for though 
 imagination is a desirable quality, in 
 research as well as in exploration, it 
 must be disciplined and, even so, can- 
 not be drawn upon in making out of- 
 ficial reports. . . . 
 
 "What is more, in many disorders 
 showing a polyglandular participa- 
 tion there is an obvious hypophyseal 
 influence at work, whereas this is far 
 less, if at all, apparent in those mala- 
 dies which seemingly originate in the 
 thyroid. 
 
 "These are but a few of the influ- 
 ences which have led us in such num- 
 bers to embark glandward hoi and a 
 good many of us, I fear, have com- 
 pletely lost our bearings in the thera- 
 peutic haze eagerly fostered by the 
 many pharmaceutical establishments. 
 For this, however, a credulous profes- 
 sion is largely responsible. . . . 
 
 "Never before has there arisen such 
 an opportunity for polypharmaceuti- 
 cal charlatanism. The subject has fired 
 the imagination of the stay-at-homes 
 as did the Mississippi Company and 
 the South Sea Bubble, and there is 
 likely to be the same final crash and 
 then ridicule when common sense be- 
 gins to breed a proper skepticism. 
 . . . I know of nothing similar un- 
 less it was the furore over phren- 
 ology. 
 
 "The thyroid colony has, in other 
 words, been longest established and 
 though it has been a far cry from 
 Schiff's experimental thyroidectomies 
 in 1856 to Kendall's synthetic produc- 
 tion, in 1914, of thyroxin, yet how lit- 
 tle do we really know of the back- 
 ground of thyroid disorders, of their 
 relation to the emotions and the sym- 
 pathetic nervous system, and their 
 pluriglandular interplay. 
 
38 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 "With the pituitary gland we are 
 still far behind all this. . . . We 
 must exercise patience and expect 
 even slower progress, for we are deal- 
 ing with a far more complicated struc- 
 ture and one whose problems evidently 
 cannot be solved without consideration 
 of their relationship to other glands. 
 Of its great importance to the econ- 
 omy, particularly in its influence upon 
 growth and reproduction, 
 there can be little doubt; but these 
 speculative theories are not for the 
 practising physician. He must await 
 the tedious accumulation of facts 
 which the experimental laboratory 
 and clinic alone can supply. 
 
 "It is very easy to say that when 
 the metabolism is low, give thyroid 
 extract, and when high give a counter 
 extract, possibly some lutein. This 
 is a good deal like the hypertension 
 bugaboo, the outcome of the blood- 
 pressure apparatus which encourages 
 the attempt to lower tension if it is 
 too high or to raise it if it is too low. 
 We ought to be beyond this variety 
 of pure symptomatic treatment, for 
 hypertension is not a disease any 
 more than is tachycardia or brady- 
 cardia, discussions of which flooded 
 the literature after the introduction 
 of the pulse watch. When our clinical 
 tests get too far in advance of our 
 powers of interpretation, theory is apt 
 to elope with practice. . . . 
 
 "The physician or surgeon, mean- 
 while, even 'if incapable of partici- 
 pating in these underlying studies, 
 must do the best he can with the mere 
 recognition and classification of clin- 
 ical types, and should he venture to 
 try glandular therapy, he must be 
 slow to draw conclusions from the ap- 
 parent effect of glandular extracts 
 given by mouth, particularly when 
 more than one is given at a time. It 
 has been claimed that the body picks 
 out the substance it needs and dis- 
 cards the others, but this has the fa- 
 miliar sound of the gunshot doses of 
 earlier days. The experience with pit- 
 uitary extract in diabetes insipidus 
 shows that the substance oialy acts 
 when given hypodermically, and we 
 have very little evidence that other 
 glandular extracts have any action 
 when given by mouth. . . . 
 
 "And so, if I may return again to 
 my underlying allegory, if this so- 
 ciety wishes to play a useful role in 
 furthering advances in endocrinology, 
 it must . . . keep such an exact 
 almanac that those pursuing the sub- 
 ject in the proper spirit may be able 
 to avoid unfavorable winds, currents 
 and counter currents. It must dis- 
 countenance the exploitation of the 
 few discoveries which have already 
 been made by those who recklessly un- 
 der full sail plow through a fog bank 
 of therapeutics, their horns tooting. 
 
 "Surely nothing will discredit the 
 subject in which we have a common 
 interest so effectively as pseudoscien- 
 tific reports which find their way from 
 the medical press into advertising 
 leaflets, where cleverly intermixed 
 with abstracts from researches of 
 actual value the administration of 
 pluriglandular compounds is promis- 
 cuously advocated for a multitude of 
 symptoms, real and fictitious. The 
 Lewis Carroll of to-day would have 
 Alice nibble from a pituitary mush- 
 room in her left hand and a lutein in 
 her right and presto! she is any 
 height desired. 
 
 "Endocrinology as a special subject, 
 if it wishes to survive and come to be 
 a factor in medical practice, must 
 look out for the character of its clin- 
 ical advance agents lest it come to 
 be utterly discredited. We have noth- 
 ing as yet, in the treatment of pitui- 
 tary insufficiency comparable to what 
 Victor Horsley and his pupil Murray 
 accomplished for myxedema, and we 
 are still further behind in the case of 
 the other glands. Indeed, no Magel- 
 lan or Balboa for ductless gland ther- 
 apeutics in general has yet appeared, 
 though let us hope he may be on the 
 way. Meanwhile, there is many an 
 imitator of Cortez or Pizarro to trade 
 on the superstitious awe of the na- 
 tives, who will soon come to be fully 
 disillusioned." 
 
 Having read and reread these re- 
 marks several times, I find myself 
 wondering what might have hap- 
 pened if Columbus had not been an 
 explorer— or Cushing had not written 
 his book? It is admitted that there is 
 still much to be attained in the way 
 
PROFESSOR CUSHING'S ALLEGORY 
 
 39 
 
 of accurate knowledge regarding en- 
 docrinology and its twin sister organ- 
 otherapy, and that the idea is indeed 
 "poorly charted," but to my way of 
 thinking, it is hardly fair to insinuate 
 that those who are attempting to add 
 something to the knowledge along 
 these lines are those who "gather up 
 beads of information of little intrinsic 
 value which are exchanged for the 
 property of a credulous people, as gul- 
 lible as the natives of a new-found 
 land." 
 
 In my conversation with Cushing he 
 criticized me and some of those in- 
 terested in the same things that I am, 
 for having too much imagination, and 
 I countered with the suggestion that 
 perhaps he and some of the others 
 had too little. I now recall in his 
 published remarks the following state- 
 ment: "For though imagination is a 
 desirable quality in research as well 
 as in exploration,it must be disciplined 
 and even so cannot be drawn upon in 
 making our official reports." And, 
 pray, how is the ordinary doctor to 
 discipline his imagination if he reads 
 Cushing's book ? Perhaps by so doing 
 he has attained an impression that 
 there might be a pituitary basis for 
 certain epileptic manifestations, and 
 then attempts to apply the idea by re- 
 course to organotherapy and finds 
 that under certain circumstances very 
 considerable benefits accrue. Should 
 he, therefore, acquire the negating at- 
 titude of the Christian Scientist who 
 by constant repetition to himself as- 
 sures himself that "there is no pain," 
 "there is no pain"? What can he do 
 if, perchance, he may have seen some 
 return for having allowed his imagi- 
 nation to presume that statements 
 such as the following which appear in 
 Cushing's book, "The Pituitary Body 
 and its Disorders," have indeed a scin- 
 tilla of truth? 
 
 "Particularly important is the rela- 
 tionship of convulsive seizures to the 
 states of glandular deficiency. The 
 possibility that an undue excitability 
 of the cerebral cortex may be a con- 
 sequence of posterior lobe insufficiency 
 
 is novel to the subject of epileptiform 
 
 convulsions (p. 282). 
 
 "Thus, all told, thirteen patients in 
 the series, with existent hypopituitar- 
 ism, have shown epileptiform tenden- 
 cies — a percentage too large to be 
 purely coincidental. . . . With- 
 out further observations it would be 
 unwise to lay too great stress on these 
 few experiences, though they are un- 
 doubtedly suggestive of a hypophy- 
 seal insufficiency. It has been a 
 source of comment by many students 
 of epilepsy that the terminal stage of 
 certain types is often accompanied by 
 an extreme lowering of temperature 
 and slowing of the pulse. Moreover, 
 many of these unfortunates, as is well 
 known, are obese and have ravenous 
 appetites, just as is the case with 
 many of the patients with demon- 
 strable hypopituitarism. We have 
 shown that in some instances there is 
 a high sugar tolerance" (p. 319). 
 
 Speaking of the very empirical pro 
 cedure of pituitary feeding in the 
 treatment of epilepsy, Cushing also 
 says, "Comment has been made also 
 on the amelioration of symptoms in 
 certain cases of epilepsy which were 
 suggestive of hypophyseal origin." 
 
 You will note by reading the quota- 
 tions previously made from Cushing's 
 address that it was impossible for 
 him not to refer to the pluriglandu- 
 lar idea, not merely in critical terms 
 of the work of one who has attempted 
 to popularize its study, and make it 
 readily available by the profession, 
 but in a favorable way, for instance: 
 "We are dealing with a far more com- 
 plicated structure [referring to the 
 pituitary gland] and one whose prob- 
 lems evidently cannot be solved with- 
 out consideration of their relationship 
 to other glands"; and later, in a foot 
 note on p. 1724, first column, report- 
 ing his series of 255 cases of pituitary 
 disease, 190 of whom were operated 
 upon, he said: 
 
 "Only a few of the 190 surgical 
 cases were acromegalics. The others 
 showed many and varied forms of dys- 
 pituitarism. A great number of these 
 patients have been induced subse- 
 quently to follow out prolonged 
 courses of glandular treatment. I 
 
40 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 cannot say that I have ever seen any 
 definitely beneficial results of so do- 
 ing except when there has been some 
 concomitant thyroid want indicating 
 the coincidental use of thyroid ex- 
 tract." (Italics mine.— H. R. H.) 
 
 AND THAT IS JUST THE 
 POINT 1 I am criticized for daring to 
 presume that when a person has a 
 pituitary dystrophy sufficiently ad- 
 vanced to show itself clinically, that 
 there is also a thyroid aspect to it, 
 and probably that this was present 
 long before signs of either of them 
 were noted. It is for this reason that, 
 in spite of criticism, I prefer to treat 
 functional pituitary dystrophies which 
 are likely to be amenable to organo- 
 therapy, with something more than 
 pituitary substance alone, because I 
 contend that the associated glands in- 
 variably are involved also as a system 
 or closely related whole. 
 
 It is a very interesting coincidence 
 that in the very same issue of the 
 Journal A. M. A. in which Cushing's 
 paper appears (see p. 1795), there is 
 an abstract of an article by Dr. 
 George H. de Schweinitz (originally 
 published in the Archives of Ophthal- 
 mology, May 1921, i, p. 203) in which 
 the following is stated: 
 
 "All patients, therefore, with pitui- 
 tary body disorder, who also have con- 
 stitutional syphilis, or from whom the 
 suspicion of such an infection cannot 
 be eliminated, should have the advan- 
 tage of a full trial of this therapeutic 
 test. In stages of glandular insuf- 
 ficiency the efficacy of organotherapy 
 is probably enhanced by simultaneous 
 administration of mercury (prefer- 
 ably by inunctions) and the gland ex- 
 tracts, even though the presence of 
 syphilis is not demonstrable by the 
 usual methods. DeSchweinitz sug- 
 gests the probability that a combina- 
 tion of thyroid and pituitary gland 
 extracts is more efficient than either 
 of the extracts alone, and that this 
 combination, associated with mercury, 
 is more effective than is an extract of 
 one gland, even though given in con- 
 junction with unguentum hydrargy- 
 rum." 
 
 Now, a word or two in regard to 
 the finale of the Cushing allegory. 
 
 He says in it: "The experience with 
 pituitary extract in diabetes insipi- 
 dus shows that the substance only acts 
 when given hypodermically, and We 
 have very little evidence that other 
 glandular extracts have any action 
 when given by mouth." This is Cush- 
 ing's complete sentence: but I think 
 it is most incomplete, for he should 
 have added, "when given by mouth 
 in diabetes insipidus." Other glandu- 
 lar extracts have a therapeutic action 
 when administered orally; further- 
 more, the foregoing statement is con- 
 trary to many of Cushing's state- 
 ments in his own book, which it would 
 appear he is now repudiating. 
 
 It may be possible that some of the 
 failures with pituitary therapy by 
 Cushing and others, in cases which it 
 was hoped would be responsive to such 
 treatment, were due to the fact that 
 the associated conditions were ig- 
 nored, for it is absolutely certain that 
 many a failure with monoglandular 
 therapy has been chalked up against 
 endocrinology as a whole when failure 
 might have been turned into success 
 had the treatment been pluriglandu- 
 lar, or exactly as Cushing says: 
 
 "I cannot say that I have ever seen 
 any definitely beneficial results of so 
 doing [prolonged pituitary therapy] 
 except when there has been some con- 
 comitant thyroid want indicating the 
 coincidental use of thyroid extract." 
 
 It is obvious that there are two 
 sides to this question. Cushing has 
 expressed himself to many as a pes- 
 simist. I prefer to be an optimist. He 
 tries to poke fun at the pluriglandu- 
 lar idea by imagining a dystrophic 
 Alice in an endocrine Wonderland, 
 "nibbling from a pituitary mushroom 
 in her left hand and a lutein one in 
 her right and presto! she is any 
 height desired." In our efforts tcf 
 further a practical interest in pluri- 
 glandular therapy we do not suggest 
 "nibbling" any kind of endocrine 
 mushroom and, unfortunately, there 
 is no "presto" about it, for any re- 
 sults from organotherapy only come 
 after persistent and prolonged treat- 
 ment. And the mariner in this un- 
 
"THE ENDOCRINE GLANDS— A CAUTION' 
 
 41 
 
 charted sea who is not willing to 
 "plow through a fog bank of thera- 
 peutics," as Cushing puts it, will never 
 get to the other side of the ocean and 
 the land of promise never will be dis- 
 covered. 
 
 Since the above was published my 
 attention has been called to an article 
 which seems particularly apropos in 
 view of the fact that it refers to the 
 comparative value of glandular prod- 
 ucts when given by mouth and hypo- 
 dermically, and in diabetes insipidus 
 — the very thing that was discussed 
 by Cushing in his article. Recall for a 
 moment that Cushing stated that 
 "The experience with pituitary ex- 
 tract in diabetes insipidus shows that 
 the substance only acts when given 
 hypodermically," and that he then 
 adds, "and we have very little evi- 
 dence that other glandular extracts 
 have any action when given by 
 mouth." 
 
 In a recent issue of Endocrinology 
 (March, 1922, vi, p. 230) there is an 
 original article by Rees and Olmsted 
 reporting clinical experiences with the 
 use of pituitary extracts by mouth in 
 the treatment of diabetes insipidus, 
 which were carried on under careful 
 control at the Washington University 
 School of Medicine in St. Louis. 
 
 These authors, in an attempt to les- 
 sen the physical and financial burden 
 placed upon patients who are treated 
 with intramuscular injections of the 
 extracts of the posterior lobe of the 
 pituitary, endeavored to find a suc- 
 cessful method of giving pituitary ex- 
 tract by mouth, and it seems that they 
 
 have satisfactorily protected the pos- 
 terior pituitary principle, which is of 
 value in modifying the polyuria of 
 diabetes insipidus, by the use of a 
 salol-coated capsule. 
 
 A quotation of the summary which 
 is found at the close of their interest- 
 ing article may be quite in order: 
 
 "The possibility of finding a satis- 
 factory method of administering post- 
 pituitary extract by mouth was in- 
 vestigated. Reduced expense and in- 
 creased convenience for the patient 
 were the principal factors considered. 
 The history, physical and laboratory 
 findings in a case of diabetes insipi- 
 dus are given. The progress of the 
 patient under various types of treat- 
 ment is recorded. It was found that 
 by giving desiccated posterior lobe 
 substance in salol-coated capsules the 
 polydipsia and polyuria were as ef- 
 fectively controlled as with hypoder- 
 mic injections of pituitary extract." 
 
 It seems unquestioned that Cushing 
 made his somewhat conclusive state- 
 ment without all the facts before him, 
 and bearing this in mind, it seems 
 hardly fair for ignorant "authorities" 
 to point their finger at and criticize 
 the ignorance of those with whom they 
 disagree. 
 
 It is certainly good to know that, 
 despite the darkness which it is be- 
 lieved by some covers the endocrine 
 earth and the gross darkness which 
 certain "authorities" insist is cov- 
 ering certain of the people, we are 
 groping along nevertheless and find- 
 ing something worth while at every 
 turn. 
 
 VII.— "THE ENDOCRINE GLANDS— A CAUTION" 
 
 "Be thou chaste as ice, as pure as snow, thou shalt not escape calumny."- 
 Shakespeare. 
 
 The belittlement of pluriglandu- 
 lar therapy has attained considerable 
 proportions during the past year, and 
 as the enthusiasm engendered by the 
 clinical results of this method grows, 
 so do those wiio previously have said, 
 
 "It can't be done," shout the louder 
 in their derision. Without exception, 
 agitation has always been rife against 
 advances in any field. But there is at 
 least some consolation in the fact that 
 "things true and evident must of ne- 
 
42 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 cessity be recognized by those who 
 contradict them," as Epictetus said a 
 good many hundred years ago. A 
 friend of mine recently said to me: 
 "You should be encouraged because 
 you and your work are worthy of the 
 damnation given to you." 
 
 Further evidence of this opposition 
 is found in the leading editorial in the 
 issue of the Journal A. M. A. (May 
 28, 1921, lxxvi, p. 1500). This edito- 
 rial which carries the title used to 
 head this chapter, is worthy of com- 
 ment because it directs attention to 
 several points which I have been at- 
 tempting to emphasize for several 
 yemrs, even though the editor's views 
 differ decidedly from my own. By re- 
 printing this editorial, I am availing 
 myself of the opportunity to interline 
 several pertinent remarks which I be- 
 lieve are decidedly to the point. 
 
 I am perfectly willing to admit that 
 there is still much to be learned in 
 regard to the internal secretions. 
 From the clinical experience which I 
 have personally had, and from many 
 things which have been told me by 
 many physicians, I am confident that 
 I am on the right track. Mistakes are 
 not improbable, but these are always 
 part and parcel of the human make- 
 up; possibly others may err occa- 
 sionally I 
 
 Several thousands of reputable 
 practicing physicians have seen fit to 
 speak kindly of my efforts. Have 
 their experiences been developed upon 
 a foundation wobbly from corroding 
 untruths? Have they been the vic- 
 tims of exploitation? Have they been 
 unduly credulous ? Have they come to 
 their knowledge as a result of acci- 
 dent? 
 
 The reason for the great develop- 
 ments along these lines, is that we are 
 right in our premises that the en- 
 docrine glands indeed deserve consid- 
 eration much more often than the 
 profession previously has been in the 
 habit of giving them. Furthermore, 
 these organs should be studied to- 
 gether, rather than as has been the 
 custom for many years, from the clin- 
 
 ical standpoint of the most obviously 
 affected organ. If this is correct, 
 then pluriglandular therapy should be 
 a great advance over the older mono- 
 glandular method, as, indeed, it is. 
 The whole method has exceptional 
 value, because often such organothef- 
 apeutic procedures are as valuable as 
 a diagnostic means as they are for 
 their prospective therapeutic help. 
 
 The following is the entire editorial 
 from the Journal A. M. A., with some 
 comments as they occurred to me, and 
 as published originally in the July, 
 1921, issue of our little house-organ, 
 The Organotherapeutic Review. 
 
 "The bearded lady, the giant, the 
 fat boy, and the midget — those 'mar- 
 velous freaks of nature' of the dime- 
 museum days — we have learned to re- 
 gard as the victims of disordered en- 
 docrine glands. So profound are the 
 effects which these remarkable organs 
 can produce in the body, upsetting 
 such essential processes as sexual de- 
 velopment, growth and metabolism, 
 that the imagination of both labora- 
 tory worker and clinician has been 
 greatly stimulated." [And, fortu- 
 nately, the results of a good many of 
 these dreams have been made avail- 
 able to ordinary doctors and the clin- 
 ical experiences that they have come 
 to depend upon from the application 
 of some of these materialized dreams 
 have stimulated a good deal more than 
 their imaginations!} "No wonder that 
 hopes have been stirred that these 
 processes may be placed under con- 
 trol, that old mysteries of disease 
 will be explained, and that hitherto 
 hopeless cases can soon be satisfac- 
 torily treated. Unfortunately, we are 
 still deeply ignorant of many import- 
 ant aspects of endocrinology." [While 
 this is all too, true, it is getting a bit 
 monotonous to hear so continually "we 
 still know very little about this," "the 
 fathomless depths of this science," or 
 "our deep ignorance." Believe me or 
 not, as you wish, we are much more 
 intelligent about the endocrines and 
 organotherapy to-day than we would 
 have been had we conceded the depth 
 of our ignorance and given up our 
 clinical work along these lines as some 
 seem to have done.~\ 
 
"THE ENDOCRINE GLANDS— A CAUTION" 
 
 43 
 
 "The conditions of the body which 
 control the glands of internal secre- 
 tion are still almost wholly unknown. 
 There is evidence that the suprarenal 
 medulla and the thyroid are subject 
 to sympathetic stimulation, but what 
 of, the others?" [Undoubtedly those 
 chemical and nervous factors which 
 stimulate the adrenals or thyroid are 
 such that they influence other tissues 
 — endocrine or otherwise — -and their 
 cells are not so indifferent to these 
 subtle factors that they are immune to 
 hormonic influences.} "The glands 
 are probably complexly interrelated, 
 but in only few cases has satisfactory 
 proof of mutual influence among them 
 been demonstrated. [I am glad the 
 word "probably" was slipped in here. 
 If this editorialist had left it out en- 
 tirely he would have been telling the 
 unadulterated truth — for there is no 
 whit of a probability about the inter- 
 relationship of the ductless glands. 
 We may not understand why these in- 
 terrelationships exist, nor may we 
 have learned all that there is to 
 know about their extent, but I do dif- 
 fer most emphatically with this writer 
 as to "the satisfactory proof of mu- 
 tual influence among them," even 
 though he indeed admits that this re- 
 lationship has been proved in "a few 
 cases." I do not think I am overstat- 
 ing by saying that I could quote a 
 round hundred articles or abstracts 
 emphasizing the pluriglandular as- 
 pects of endocrinology from the Jour- 
 nal A. M. A. itself.} 
 
 "Though we glibly talk of 'hoi> 
 mones,' only two endocrine products 
 are known chemically, thyroxin and 
 epinephrin, and there are physiolo- 
 gists who do not concede a hormone 
 function to epinephrin. [The editor 
 overlooks Brailsford Robertson's work 
 with tethelin at the University of Cal- 
 ifornia, or the references to hypoph- 
 ysin sulphate, a chemical, by H. 
 Ftihner, possibly because the latter is 
 German. As a matter of fact, hor- 
 mones do not have to be chemically 
 isolated to be therapeutically effica- 
 cious, else more than twenty-five 
 years' experience with thyroid therapy 
 is nullified, or thousands of clinical 
 experiences with ovarian products 
 are put inix. the editorial limbo.} 
 "The nature of the supposed active 
 
 agents of most of the glands, e. g., 
 the ovary, the corpus luteum, the 
 suprarenal cortex, the anterior pitui- 
 tary, the parathyroids, the thymus, 
 and the endocrine cells of the pan- 
 creas, has not been determined. Nor 
 has it been demonstrated that most 
 of these organs contribute any 
 specific internal secretion." [The 
 editor seems to be reverting 
 to the attitude of those who 
 deny realities because they are unable 
 to regulate control of them, or of the 
 ignorant individual who belittles a 
 thing because he is ignorant about it. 
 There is absolutely no need to demon- 
 strate that "most of these organs con- 
 tribute any specific internal secretion." 
 We are satisfied to presume it if our 
 presumption will enable us to get any- 
 where in our treatment of disease.} 
 "They may, conceivably, exert their 
 influence by removing toxic sub- 
 stances from the blood stream and 
 metabolizing them to inert forms. 
 Epinephrin, the nature of which is un- 
 derstood [though the editor has just 
 stated that even yet some "do not con- 
 cede a hormone function to epin- 
 ephrin"}, is known to disintegrate 
 rapidly in an alkaline medium, and 
 though highly potent in many 
 directions when injected intra- 
 venously or subcutaneously, is 
 without physiologic effect when 
 taken by mouth." [Here the editor 
 forgets, wilfully or ignorantly, several 
 published clinical reports as well as an 
 article of my own — "The Oral Admin- 
 istration of Adrenalin," New York 
 Medical Journal, November U, 1916 — 
 in which, after bringing report after 
 report to confirm this opinion, I dared 
 to invite such armchair critics to 
 "swallow just one bottle of 1:1000 
 adrenalin chloride solution, for it con- 
 tains only about 1/2 a grain of the 
 real active principle."} 
 
 "Until we learn more about the 
 character of the essential elements of 
 the ductless glands and their precise 
 effects, we cannot be sure that they 
 also are not altered or destroyed in 
 the alimentary canal." [But why 
 should we stop our successful clinical 
 experiences with oral organotherapy 
 while our ultra scientific friends 
 "learn more about . . . their pre- 
 cise effects?"} "And to what degree 
 
44 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 is substitution therapy possible? Its 
 value has been proved in thyroid de- 
 ficiency, but it is useless in pancre- 
 atic diabetes." [Not so, if R. Lepine of 
 Lyons, J. H. Pratt of Boston, W. M. 
 Crofton of Dublin, G. Zuelzer of Ber- 
 lin, and many others are to be be- 
 lieved. Mind you, the word "useless" 
 is very explicit, and by making refer- 
 ence to the reports of the above clin- 
 icians, I do not say that the Langer- 
 hansian principle is as comparatively 
 valuable as the thyroid principle in 
 corresponding circumstances, but 
 I do deny that < "substitution 
 therapy is useless in pancre- 
 atic diabetes."] Too often or- 
 ganotherapy is justified by the pa- 
 tient's 'feeling better,' or by the dis- 
 appearance of subjective symptoms — 
 criteria of very uncertain quality. 
 [Here are the same old arguments 
 again — akin to those of the Eddyite — 
 "might have happened anyway," 
 "probably due to suggestion," "no tell- 
 ing how much of the presumed benefit 
 was coincidental," and so on. I wish 
 the editor would change chairs with 
 me and read my letters for just one 
 week/] 
 
 "The normal role of the endocrine 
 factors in the organism is largely un- 
 known. Much of the general opinion 
 is based on faulty inference." [What 
 criteria determine whether your judg- 
 ment is faulty or mine? Maybe it is 
 wrong to infer altogether. Anyway, 
 I prefer to leave it to the patients — 
 they know, they believe in you, they 
 tell their neighbors about your work, 
 they don't give a continental for any- 
 body's inferences — faulty or scientific. 
 What they want is results and they 
 get it many more times when their 
 physician thinks for himself and is 
 willing to give them the benefit of a 
 known-to-be effective measure.] 
 
 "Injected epinephrin raises blood- 
 pressure. The inferences have been 
 drawn, therefore, that the suprarenal 
 medulla is essential to the mainten- 
 ance of normal blood-pressure, and 
 that hypotension means 'hypoadren- 
 alism,' and hypertension 'hyperadren- 
 alism.' No conclusive evidence exists 
 to support these inferences; indeed, 
 there is excellent evidence that the 
 suprarenal medulla has nothing to do 
 with maintaining the natural blood- 
 
 pressure level." [Believe it or not, as 
 you wish. I have as much right to bs- 
 lieve that the adrenals are a part of 
 the pressor mechanism as you have to 
 think otherwise. If Cannon is wrong, 
 if Sergent has been fooled ever since 
 1898, and if Sajous, Carnot and scores 
 of others are mistaken, then I prefer 
 to be with the "few" who disagree 
 with such self -constituted authorities 
 whose clinical inexperience is so ob- 
 vious.] "The idea that the posterior 
 lobe of the pituitary is active in labor 
 and in lactation is based on the same 
 fallacy of assuming that the pharma- 
 codynamic action of a powerful drug 
 indicates the physiologic role of the 
 organ from which it is derived." [Not 
 by any means. Fortunately, my skirts 
 are clear in this respect, for I have 
 repeatedly called attention to the fal- 
 lacy of believing that a woman in la- 
 bor was suffering from the insuf- 
 ficiency of the posterior lobe of the 
 pituitary gland, because an injection 
 of liquor hypophysis stimulated the 
 inert uterine muscles and precipitated 
 the much desired event.] "Again, 
 there is no satisfactory clinical test 
 for any assumed internal secretion, 
 as such." 
 
 "Altered metabolism in thyroid dis- 
 orders permits a certain amount of 
 insight into the type of disturbance 
 present. And, of course, when condi- 
 tions are extreme, fairly definite in- 
 ferences can be drawn in such diseases 
 as acromegaly and myxedema. Minor 
 clinical changes, however — headaches, 
 flushes, unstable blood-pressure — are 
 commonly attributed to endocrine dis- 
 orders on no definite evidence what- 
 ever, often on the basis of the thera- 
 peutic fallacy mentioned above. The 
 facts should be faced that much of 
 endocrine physiology is in a state of 
 chaos, and that selection of bits from 
 this chaos bolster up clinical theories 
 is sheer futility." [Of course a "scien- 
 tific" gynecologist cannot possibly be 
 persuaded to believe that the head- 
 aches, flushes, and unstable blood-. 
 pressure related to the menopause are 
 in any way connected with the re- 
 moval of an endocrine factor to which 
 the body has been accustomed for 
 thirty years or more. Undoubtedly 
 the experiences resulting from th* 
 clinical application of these unscien- 
 
"THE ENDOCRINE GLANDS— A CAUTION" 
 
 4* 
 
 tific methods of organotherapy are 
 merely coincidence. I think, however, 
 that I have had enough personal ex- 
 perience to deny flatly that "minor 
 clinical changes such as headaches, 
 flushes,' and unstable blood-pressure 
 are commonly attributed to endocrine 
 disorders on no definite evidence," on 
 the very best of clinical premises — the 
 fact that the endocrine or organother- 
 apeutic regulation of the real or fan- 
 cied dyscrinism causes a mitigation 
 or removal of the headaches, flushes, 
 and pressor vagaries. Again it is the 
 patient that decides — not the editor!] 
 "Confronting our real ignorance of 
 many important features of endocrin- 
 ology are positive statements of facts 
 when the facts have not been estab- 
 lished, large assumptions of assurance 
 when there is no clear certainty, and 
 a formulating of laws for diagnosis 
 and treatment when no respectable 
 basis for either exists. Illustrations 
 of these charges can be found on all 
 sides in books and articles and, espe- 
 cially, in widely, scattered advertising 
 matter." [/ have been expecting it for 
 nearly two columns. It had to come, 
 for here, doubtless, is the text for this 
 long hypercriticism, and all of this 
 stuff purporting to deny our state- 
 ments and decry our work invariably 
 includes a "slam" of this type, in or- 
 der to be true to form! Suppose I 
 happen to be mistaken about my own 
 relation to this — I am having a lot 
 of fun in what we are doing here; 
 the results we are getting satisfy me 
 and my customers and their patients 
 often enough to make it thoroughly 
 worth wTiile. What do I care whether 
 the facts have been established to the 
 scribe's satisfaction, or not, so long 
 as we are getting real results every 
 day? IT IS ACHIEVEMENT THAT 
 DETERMINES THE 'WORTH OF 
 ANY METHOD OR THEORY. Fur- 
 ther, I should be glad to see as much 
 proof on the part of the critic as I 
 can muster up against him. What are 
 the "positive statements of facts" that 
 "have not been established?" That 
 adrenalin "is without physiological 
 effect when taken by mouth?" That 
 "the adrenal medulla has nothing to 
 do with maintaining the natural blood- 
 pressure level?" Or that "minor clin- 
 ical changes — headaches, flushes, un- 
 
 stable blood-pressure — are commonly 
 attributed to endocrine disorders on 
 no definite evidence whatever?" If so, 
 have I not as much right to deny the 
 conclusions of the editor of The Jour- 
 nal of the American Medical Associa- 
 tion as he has to class me with the 
 prevaricators and the charlatans?"] 
 
 Credulity, under these circum- 
 stances, has evil consequences. It 
 helps to fix a sense of security, a sense 
 of being satisfactorily informed, when 
 there is little, if any, justification." 
 [Too bad! Here I have been hoping 
 that we were learning something; 
 that we were really beginning to get 
 somewhere, and now suddenly we art 
 thrust back into the endocrine Stom 
 Age and have to find some incontro- 
 vertible facts, the incontrovertihility 
 of which is acceptable to the editor 
 or printer's devil, who wrote this state- 
 ment. The encouraging remarks of 
 visitors to The Harrower Laboratory, 
 the numerous unsolicited _ letters of 
 commendation from physicians, and 
 even the statements of patients them- 
 selves whom we are so fortunate as t» 
 meet personally — all seemingly must 
 be classed with "mortal error." How 
 credulous we have been!] "It hinders 
 medical progress by substituting sim- 
 ple faith and enthusiasm for the care- 
 ful, critical study that is sorely 
 needed. It opens the door for exploita- 
 tion of the medical profession by char- 
 latans and quacks and unscrupulous 
 manufacturers. [Sic!] Medicine is hu- 
 miliated rather than served when we 
 swarm with the crowd after the latest 
 therapeutic fad, accepting as gospel 
 every claim that is made, if only it is 
 made with sufficient positiveness." 
 [Not so, only if such claim makes 
 good clinically after we have been rea- 
 soned with, converted sufficiently t» 
 make the effort, and, finally, have 
 been satisfied at the unusual results 
 that frequently are secured.] 
 
 "We appeal, however, not for gen- 
 eral condemnation of endocrinology, 
 as a subject of interest, but for a 
 proper scientific attitude toward the 
 data that are advanced." [What is 
 the proper definition of the word 
 "proper" in the proper kind of dic- 
 tionaries?] "Quite as numerous, per- 
 haps, as the group that throngs heed- 
 lessly after each new interest is the 
 
46 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 group that will have none of it, good, 
 bad or indifferent." [As represented 
 by a certain editorial writer for The 
 Journal of the American Medical As- 
 sociation, issue of May 28, 1921, page 
 1501.'] "This is merely throwing out 
 the baby with the bath. Although 
 less vociferous than the impressionis- 
 tic school, there are groups of clinical 
 and laboratory investigators who are 
 bending their best efforts toward the 
 solution of the numerous and baffling 
 problems that the field presents. The 
 efforts of these men are deserving of 
 the whole-hearted support of their 
 colleagues." [But those who dare to 
 differ with "authority" may be 
 damned!] "To the well-trained clin- 
 ician, the existing chaos in this field 
 may well stand as a challenge to his 
 constructive attention. Interest in the 
 ductless glands was initiated by clin- 
 ical study." [And will be developed 
 by persistent clinical study — not by 
 armchair philosophy.] "Addison, 
 Oliver, Parry, Graves, Kocher, Lan- 
 cereaux, Marie — the names of these 
 clinicians mark the steps of our prog- 
 ress." [The writer probably and with 
 purpose has left out the names of the 
 great materializers of knowledge 
 along these lines — the men who have 
 made practical the fundamental sug- 
 gestions of those mentioned in the il- 
 lustrious list just named. I refer to 
 
 Elliott of London, Sajous of Phila- 
 delphia, Carnot and Sergent of Paris, 
 Lorand of Carlsbad, dishing of Bos- 
 ton, Engelbach of St. Louis, and oth- 
 ers whose names I need not mention.] 
 "But these men helped to advance 
 medical knowledge by careful study of 
 their cases, by correlation of similar 
 conditions, by cautious and limited in- 
 ferences." [What is the proper defini- 
 tion of the word "cautious?" Is it 
 "Be sure you're right, then go 
 ahead," or is it, "Be sure that 
 the other fellow has some good 
 reasons behind his remarks, and 
 then proceed to prove or disprove 
 them?"] "The clinic still provides 
 disturbances, probably endocrine in 
 origin, [not absolutely but only "prob- 
 ably"] — that the laboratory cannot 
 duplicate. [And it also provides a 
 kind and amount of truth that the 
 laboratory cannot duplicate, either.] 
 "The opportunity to contribute to pro- 
 fessional knowledge in this field is 
 still great. The situation calls not for 
 the gullible enthusiast but for the crit- 
 ical clinical investigator, not for a 
 stampede but for cautious progress. 
 And so far as the well-tried methods 
 of careful observation, careful record, 
 careful test, and careful inference are 
 employed, they may reasonably be ex- 
 pected to yield useful information." 
 
 VIII.— THE PANCREATIN MYSTERY 
 
 "Assertion does not become proof by mere reiteration — a statement of opinion 
 is as nothing when compared with a report of experience." 
 
 Some yeaks ago there appeared in 
 The Journal A. M. A., under the 
 heading "Propaganda for Reform," 
 some comments sponsored by the 
 Council on Pharmacy and Chemistry 
 of the A. M. A. regarding the thera- 
 peutic efficacy of pancreatin. 
 
 I refer to this particularly because 
 while pancreatin is used clinically 
 chiefly for its tryptic ferment value it 
 is none the less an organotherapeutic 
 product, and the conclusions drawn 
 were quite at variance with the truth. 
 
 This past history is revived here to 
 illustrate the fallibility of human 
 
 judgment and to call attention to the 
 grace with which criticism is accepted 
 when it is inevitable, and also to point 
 out the lack of apologies in cases 
 where wrong has predominated and 
 right has been thoroughly neglected. 
 
 For many years tablets consisting 
 of pepsin, pancreatin and certain 
 other remedies — carminatives, char- 
 coal, etc. — have been put out by lead- 
 ing pharmaceutical houses and many 
 millions of them have been used by 
 many thousands of physicians. In 
 fact, several years ago when I was 
 talking about this with a certain man- 
 
THE PANCREATIN MYSTERY 
 
 47 
 
 ufacturer of digestive ferments he re- 
 ferred to a contract that his firm had 
 with a manufacturer which involved 
 about $25,000.00 worth of pancreatin 
 per annum, and I could not help re- 
 marking, "It is funny how so much 
 of this stuff is used right along and 
 yet the profession does not get the 
 idea of the Council that pancreatin 
 by mouth is useless!" 
 
 Memory is an excellent adjunct in 
 writing and I remember a number of 
 statements of no mean importance 
 which have a decided bearing on "the 
 pancreatin mystery." 
 
 In 1907 and again in 1915 the Coun- 
 cil on Pharmacy and Chemistry of the 
 American Medical Association had a 
 good deal to say regarding this matter 
 and in a critique of lactopeptin they 
 committed themselves quite definitely 
 in regard to their opinion of the 
 therapeutic value of pancreatin given 
 by mouth. 
 
 In an editorial in the Journal A.M.A. 
 (October 23, 1915, lxv, p. 1466) 
 entitled "A Therapeutic Absurdity," 
 in referring to this preparation they 
 say that lactopeptin is supposed to 
 contain . . . pepsin and pancrea- 
 tin "and this, in the light of present- 
 day knowledge, brands these products 
 as therapeutic absurdities." The 
 statement is then made that 
 "it is axiomatic that pepsin and pan- 
 creatin are never indicated at one and 
 the same time and it is practically im- 
 possible for the two substances to act 
 together." 
 
 Later on, a preparation of this kind 
 is again called "an indefensible ther- 
 apeutic and pharmacologic absurdity." 
 In the same issue of The Journal, un- 
 der the subheading "Propaganda for 
 Reform" (p. 1477) there appears the 
 following statement: 
 
 "Mixtures of pepsin and pancreatin 
 are therapeutically irrational . . . 
 under pharmacologic conditions such 
 mixtures are chemically impossible. 
 . . . As stated at the outset, what- 
 ever the tryptic activity of the mix- 
 ture (lactopeptin) it is therapeutic- 
 ally useless. A demonstration of 
 tryptic activity in a mixture contain- 
 
 ing both pepsin and pancreatin is of 
 merely theoretical interest." 
 
 Further on in the Council's actual 
 report we read the following: 
 
 "It is a commercial impossibility to 
 make mixtures of pepsin, pancreatin 
 and lactic acid so that they can dis- 
 play any material tryptic activity." 
 
 "It should be reaffirmed that mix- 
 tures combining peptic and pancreatic 
 activities are not feasible, because 
 pepsin cannot act except in the pres- 
 ence of acid, and pancreatin is de- 
 stroyed by acid and by peptic activity. 
 Theoretically, as well as 
 practically, however, pepsin and pan- 
 creatin cannot exist together in so- 
 lution." 
 
 Incidentally, these final statements 
 — not hints, not suggestions, but posi- 
 tive and unqualified remarks: "Pan- 
 creatin is destroyed by acid and by 
 peptic activity" — are based upon 
 laboratory experiments for tryptic 
 activity by several investigators, who, 
 by the way, had arrived at quite dif- 
 ferent conclusions. The final remark 
 in the secretary's summary is that 
 "even if tryptic activity were con- 
 ceded, the preparation, like all prepa- 
 rations containing pepsin and pancre- 
 atin, would still be, as previously 
 stated, therapeutically irrational." 
 
 The evidence seems to show that 
 liquid preparations of this type, es- 
 pecially those containing acid, are not 
 stable, and even this is open to ques- 
 tion; but since the use of pancreatin 
 is far more common in dry form the 
 criticism above is not well taken. 
 
 In another item, published some 
 months later in the same journal (De- 
 cember 11, 1915, lxv, p. 2108), ap- 
 pears the unsigned statement: "It is 
 doubtful if the pancreatin used in this 
 mixture could ever enter into a di- 
 gestive process in the intestine." 
 Note that there is now an element of 
 doubt! 
 
 There seems to be no possible chance 
 of misunderstanding these statements. 
 Not merely are these "authorities" 
 sure that pancreatin is destroyed in 
 the stomach and consequently inef- 
 fective as a remedy under these cir- 
 
48 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 eumstances, but they are impugning; 
 the honesty and integrity of those 
 who have been "foisting them upon 
 the profession." 
 
 But here is another side of this his- 
 tory. Prof. J. H. Long, in charge of 
 the Department of Physiological 
 Chemistry in the Northwestern Uni- 
 versity, and his associate, Mary Hull, 
 published several papers in the Jour- 
 nal of the American Chemical Society 
 and in Science, to which reference will 
 be made. The first of these is 
 a paper entitled "On the Assumed 
 Destruction of Trypsin by Pepsin and 
 Acid" (J. Am. Chem. Soc. 1916, 
 xxxviii, p. 1620) which is the report 
 of a comprehensive series of re- 
 searches done with the assistance of a 
 grant from the American Medical As- 
 sociation and in an attempt to assist 
 the Council to come to some conclu- 
 sions — after they apparently already 
 had reached their hard-and-fast con- 
 clusions ! 
 
 At the beginning of this paper ,the 
 writers state that they were attempt- 
 ing to determine whether pancreatin 
 was destroyed in the stomach and 
 whether the administration of pan- 
 creatin by mouth was a therapeutic- 
 ally active procedure. 
 
 The conclusions of a large series of 
 carefully worked-out experiments in 
 individuals as well as animals are of 
 special interest: 
 
 "If sufficient protein is likewise 
 present, the acid, in combining with 
 it, is unable to destroy in the same 
 degree. When the acid concentration 
 is reduced in this manner . . . 
 tryptic activity persists, even though 
 •everal hours at the temperature of 
 the body. This is a practical condi- 
 tion which very commonly obtains in 
 the human stomach. An active tryp- 
 tic ferment would unquestionably pass 
 with the chyme . . . into the duo- 
 denum . . . and there be able to 
 produce a normal proteolytic diges- 
 tion of some degree." 
 
 And later, in a second paper on the 
 same subject, referring especially to 
 observations in animals (J. Am. 
 Chem. Soc, 1917, xxxix, p. 162) these 
 writers conclude further : 
 
 "In all the animals the secretion of 
 pepsin and acid was abundant, and 
 from this point of view the conditions 
 for the persistence of trypsin were 
 not favorable. Yet, in the larger 
 number of the experiments, this lat- 
 ter ferment was not destroyed by the 
 other combination where sufficient 
 protein was present to bring the con- 
 centration of the free acid down to a 
 certain value. Trypsin seemed to be 
 destroyed or greatly weakened only 
 when the acid was in excess with pep- 
 sin." 
 
 To state the matter simply, the 
 statements of the Council on Phar- 
 macy and Chemistry were disproved 
 as the result of experimental work 
 made by a capable man, of their own 
 selection and at their own expense. 
 As yet I have not read of any apolo- 
 gies to the New York Pharmaceutical 
 Company, the makers of lactopeptin, 
 nor have I seen any extensive retrac- 
 tions in The Journal in regard to their 
 position. 
 
 The moral to be drawn from the 
 above recital of facts is that so-called 
 "authority" is not always character- 
 ized by impeccable truth, and that 
 when the clinic indicates the feasi- 
 bility of a measure — pancreatin has 
 been given successfully these many 
 years by mouth and its oral adminis- 
 tration still continues to be a reme- 
 dial procedure — in all probability it 
 is likely to be in close proximity to 
 what is right even though exact ex- 
 planations are not forthcoming. 
 
 What has just been said reminds 
 me of still another instance of the fal- 
 libility of "authority" which may be 
 reported here to substantiate my pre- 
 vious remarks in this chapter. There 
 is a book published some years ago 
 by the American Medical Association 
 entitled "Useful Drugs" which is in- 
 tended to serve as a vade mecum to 
 physicians and students. It is sup- 
 posed to be authoritative, yet I note 
 that so common a remedy as cod liver 
 oil is held up to question as a thera- 
 peutic agent by the suggestion that 
 its value as a remedy depends prob- 
 ably entirely upon its nutritive prop- 
 erties. It has been used as a real 
 
A PATHOLOGISTS PECULIAR VIEWPOINT 
 
 49 
 
 nutrition-influencing remedy — not 
 merely as a food — for more than a 
 hundred years; but just because the 
 authors of this compendium did not 
 know just how the smelly stuff could 
 serve as a remedy, gave no warrant 
 for their criticism in the face of the 
 accumulation, during scores of years, 
 of clinical evidence of its therapeu- 
 tic^not dietetic — value. 
 
 More recently, however, in another 
 publication from the very same office 
 — The Journal of the American Med- 
 ical Association — we find the recently 
 disclosed reason for the empirical 
 clinical conclusions of thousands, of 
 physicians for 100 years! A certain 
 Doctor Hess (Newer Aspects of Some 
 Nutritional Disorders, Jour. A. M. A., 
 March 12, 1921, lxxvi, p. 693) em- 
 phasizes the well-known facts, regard- 
 ing the value of cod liver oil jn the 
 
 cure of rickets and makes the asser- 
 tion that this disease could be prac- 
 tically abolished in New York City 
 for the paltry sum of $100,000.00 a 
 year— figuring the cod liver oil at its 
 current price. Reference is also made 
 to the researches of Zilva and Miura 
 at the Lister Institute in London, 
 which showed thai; crude cod liver oil 
 may be 250 times as rich in the vita- 
 mine-A, as butter. 
 
 In other words, vital therapeutic re- 
 sults of unquestionable character now 
 known to he due to mtamines, but hot 
 attributable, to them • through ignor- 
 ance of. their character at that time, 
 were decried or belittled in the book 
 "Useful Drugs." 
 
 Might, not. these same "authorities" 
 be mistaken regarding some other 
 matters, and misled by their technical 
 advisers ? 
 
 IX.— A PATHOLOGIST'S PECULIAR VIEWPOINT 
 "Censure is the taa; a man pays to the public for being eminent." — Dean Swift 
 
 JOHNS.HOPKINS University is an in- 
 stitution out -of Which nothing but 
 truth should come — it ought not to be 
 otherwise. In its very laudable effort 
 to add to the world's supply of knowl- 
 edge the faculty of this university re- 
 cently instituted a series of medical 
 lectures by members of its staff, to 
 which the medical profession and the 
 public are invited. 
 
 The first of these lectures was given 
 in Baltimore by Dr. William G. Mac- 
 Callum, Baxley Professor of Path- 
 ology at Johns Hopkins University, on 
 April 6, 1922. According tO (< the 
 newspaper report before me, "The 
 Cult of the Monkey Gland" may have 
 been the title, and in the course of his 
 remarks the speaker harpooned with 
 ridicule the claims of those who have 
 believed in this idea. 
 
 I have had a few things to say 
 about the monkey gland craze and 
 have compared it with what followed 
 the well-intentioned and caretully- 
 W orked-out reports of Brown-Sequard 
 
 in. 1889. The effect of Brown-Se- 
 quard's work r and for that matter the 
 whole procedure of organotherapy, 
 was set back many years by the char- 
 latans of Paris who saw in the an- 
 nouncement a chance to separate their 
 especially susceptible patients from 
 still more money. I believe that the 
 same kind of "black eye" has been 
 given to the well-intentioned efforts of 
 many an endocrinologist because of a 
 good deal of unwarranted notoriety 
 about the monkey gland idea. (Paren- 
 thetically, monkey glands contain no 
 more therapeutic virtue than any 
 other kind of animal glands, and nei- 
 ther do goat glands.) 
 
 Professor MacCallum did not limit 
 his remarks to a consideration of 
 Voronoff and other transplantation 
 enthusiasts, but attacked pluriglandu- 
 lar therapy very vigorously: it was 
 clear that he considered my work in 
 exactly the same light. Early in his 
 remarks he explained that if he could 
 succeed in injecting a certain degree 
 
50 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 of skepticism into his hearers he 
 would have succeeded at least par- 
 tially in his effort. He referred to 
 certain manufacturers who "were ex- 
 ploiting organotherapy for personal 
 profit" and told of "a regular flood of 
 literature which is going through the 
 mails daily, some of which has just 
 come to me this morning." He re- 
 marked that some of these people even 
 "had written whole books on the sub- 
 ject" which he felt had been done "un- 
 der the influence of autohypnotism." 
 
 He then made some interesting 
 statements which are accepted by the 
 majority of the profession in regard 
 to the remarkable usefulness and clin- 
 ical availability of thyroid prepara- 
 tions, but went on to state his belief 
 that so far as there being any thera- 
 peutic advantage in the use of 
 adrenal, orchic or ovarian therapy, it 
 was "all bunk." 
 
 I have before me a full report of 
 this meeting and a clipping from a 
 Baltimore newspaper which came out 
 the next morning. It was clear that 
 MacCallum not only was conservative, 
 but as the newspaper reporter states, 
 "he was more than skeptical, he was 
 scornful" of certain attempts that are 
 being made to materialize the good to 
 be found in various phases of glandu- 
 lar therapy. Near the close of his 
 remarks he produced from his pocket 
 some literature and letters which came 
 from The Harrower Laboratory, and 
 from the latter read "Why not pre- 
 scribe Antero-Pituitary Co.. and give 
 the patient the benefit of the doubt?" 
 and added some comments perfectly 
 in harmony with his previous state- 
 ments. 
 
 I am willing to admit that the the- 
 ory of cellular rejuvenation advanced 
 by Voronoff and others does not ap- 
 peal to me; and I am also glad to 
 give MacCallum credit for a greater 
 degree of intelligence regarding the 
 internal secretions than some of his 
 colleagues apparently have, for about 
 ten years ago MacCallum published 
 some very interesting reports of his 
 work in New York City regarding the 
 
 parathyroid glands and calcium 
 metabolism. He is one of the men who 
 really have added something to en- 
 docrinology. But because a man has 
 attained a position of eminence in his 
 line does not make him an authority 
 in all other lines, and while MacCal- 
 lum's word may be valuable regarding 
 matters with which he is acquainted- 
 pathology, for example — I am not at 
 one with him as regards his remarks 
 about pluriglandular therapy-; first, 
 because apparently it is not in his 
 line; and, second, because it was 
 clearly evident during this lecture 
 that the speaker was not intelligent 
 on the subject. As a matter of fact, 
 he referred to Adreno-Spermin Co., a 
 product of The Harrower Laboratory 
 regarding which he had received some 
 literature which he flourished heforo 
 his hearers, and stated in so many 
 words that he did not know what the 
 preparation contained, but in the 
 same breath gave the impression that 
 he thought it had six or seven differ- 
 ent ingredients, which happens not to 
 be the case for there are three gland- 
 ular ingredients— thyroid, adrenal and 
 spermin— and a useful adjuvant ex- 
 cipient. 
 
 It is within the bounds of possibil- 
 ity that even MacCallum is a victim 
 of the same variety of autohypnotism 
 which he suggests has influenced me 
 or others. Autohypnotism spares 
 neither the high nor the-low. 
 
 At all events, the scorn of the good 
 professor, like pepper, served to 
 "bring out the flavor" in the minds of 
 several Baltimore friends from whom 
 I already have heard in somewhat 
 satirical strain. 
 
 A question which is pertinent and 
 which always occurs to one when 
 "commercialism" is flung in one's 
 teeth is this— why all this "fuss" 
 about commercialism, why this utter 
 deprecation of it, when it is a fact 
 that all of us are "commercial" 
 enough to see that we make a living, 
 and a "good" living at that. There 
 may be a few individuals who are so 
 opposed to commercialism that they 
 
A PATHOLOGIST'S PECULIAR VIEWPOINT 
 
 51 
 
 refuse to work and would rather be 
 supported by their friends; but who 
 would want to be classed with them? 
 Who would want to wear their laur- 
 els ? I think even though MacCallum is 
 "wedded" to science — any my regard 
 for him as a scientific man is above the 
 ordinary, — he too, would consider it a 
 stricture on his ability to be accused 
 of being above making a living. He 
 also wants the just returns for his 
 labors and I suspect that he also 
 thinks highly of his labors — believes 
 in them despite what others may say. 
 If this is not the case always, the 
 man who seeks fame and fortune soon 
 deteriorates into something not worth 
 while, and I am sure MacCallum 
 would not want me to do this, just 
 as I would not want him to do it. 
 
 The letter to which the professor 
 refers was sent out from Glendale at 
 a time when it would be likely to 
 reach all the physicians in Baltimore 
 early in April. This is not a confes- 
 sion on my part or a boast — it is 
 merely the statement of a fact of 
 which I need not be ashamed. To 
 prove that I consider this letter only 
 in the light of an act that carries with 
 it no regret, I am reprinting it here: 
 My dear Doctor: 
 
 Give the epileptic "the benefit of the 
 doubt" — for, of course, there is some 
 doubt — is the fair way to recommend 
 Antero-Pituitary Co. (Harrower) in 
 the treatment of this strange disease. 
 
 While epilepsy is not always of en- 
 docrine origin, many times there is a 
 large endocrine aspect, especially in 
 children. Organotherapy has cured 
 epilepsy entirely. In other cases it 
 has changed its character, and in still 
 others has increased the intervals be- 
 tween the attacks — for example, from 
 25 a day to 1 a week! 
 
 This pluriglandular formula, ante- 
 rior pituitary in generous dosage, thy- 
 mus, and a small dose of thyroid, 
 
 originally was and still is used in de- 
 velopmental defects in children. It 
 has accomplished wonders. Its use in 
 epilepsy came from noting frequent 
 beneficial results in this disease when 
 it was accompanied by backwardness 
 of endocrine origin. 
 
 A physician in Georgia refers to this treat- 
 ment in the following words: "Regarding 
 Mrs. Y„ whose history I gave you some months 
 ago, I am glad to report that she has had no 
 more 'grand mal' attacks, since the end of the 
 first week's treatment with Antero-Pituitary 
 Co., and no return whatever of the seizures. 
 Her temper and general disposition have im- 
 proved greatly, and she is less nervous and 
 more normal than for many years past. Mira- 
 bile dictul" 
 
 The following comes from a physician in 
 Montreal : "This is the third hundred I have 
 ordered for patient with epilepsy (grand mal 
 and petit mal) fifteen years standing. Result: 
 He has never felt so well for years — no at- 
 tacks since starting treatment." 
 
 Another physician in Brooklyn, N. Y., in re- 
 ferring to his experiences with my products 
 writes: "The first case of epilepsy about whom 
 I wrote you will pass the year mark this 
 month without a single attack." 
 
 Since the prospects in epilepsy are 
 poor, and bromides really do not get 
 us anywhere, why not give some of 
 these patients the benefit of the 
 doubt! The enclosed booklet gives 
 one or two more points, and I will 
 gladly send on approval a copy of 
 Harrower's Monographs on the Inter- 
 nal Secretions, the third 92-page issue 
 of which is devoted to "Epilepsy: An 
 Endocrine Disorder," and contains a 
 consideration of the literature estab- 
 lishing this position. 
 
 From my own personal point of 
 view, I cannot see anything deserv- 
 ing of scorn in an attitude of this 
 kind, nor do I see anything repre- 
 hensible in attempting to broaden our 
 knowledge in a particular field which 
 happens to interest me especially. 
 There are more ways than one of 
 learning something worth while, even 
 though opinions may differ about 
 them. 
 
52 
 
 ADVENTURES IN _ ENDOCRINOLOGY 
 
 X.— "PROPERLY SUPERVISED. CONTROLS'* 
 
 "He who seizes the right moment ia the right man." — Confucius. 
 
 Every so often a cultured medical 
 writer, usually connected with one of 
 the more or less important institu- 
 tions of learning, makes some remark 
 about a published statement by a col- 
 league indicating that he does not 
 agree with it, and from his superior 
 position he looks down upon his fel- 
 low members and insists that clinical 
 deductions are of no value unless they 
 have been made under circumstances 
 agreeable to him. "Properly super- 
 vised controls" are essential and with- 
 out them clinical observations can 
 have little dependability or value. 
 Hence the "ordinary doctor" can have 
 no facilities for passing correct judg- 
 ment upon matters of clinical import- 
 ance because of the limitations of his 
 professional circumstances. 
 
 The only way to establish a thera- 
 peutic procedure would be" "to get it 
 tried out in some of the large hos- 
 pitals," as one critic expresses him- 
 self. None but the leading men have 
 the necessary intelligence to draw 
 clinical deductions and the work of 
 investigation necessarily must be done 
 in a hospital — and preferably a "large 
 hospital." 
 
 There is a very obvious and unfor- 
 tunate tendency in medicine to make 
 invidious comparisons. On the other 
 hand, it is admittedly a difficult thing 
 to pass judgment on the reports ob- 
 tained for a series of physicians 
 working under widely varying cir- 
 cumstances and, as one physician, 
 who already has been quoted in the 
 introduction, says: "It is very easy 
 to get a statement from some cross- 
 roads doctor to the effect that he has 
 gotten wonderful results with this 
 thing or that, but such reports do not 
 mean anything. I agree, but only, 
 however, if such reports are rare or 
 occasional. 
 
 In conversation with a prominent 
 medical teacher the other day he said 
 to me that he believed there was a 
 
 tendency to mass action on the part 
 of the medical profession — that their 
 enthusiasm for new things was wave- 
 like and that they "believed anything 
 they were told." This particular au- 
 thority in discussing some of my own 
 work tried to make me believe that the 
 reports given to me and upon which I 
 am basing my opinions and state- 
 ments were not based on proper cri- 
 teria, and that these doctors were be- 
 ing fired by some of the sparks of the 
 enthusiasm with which I am carry- 
 ing on my own work. 
 
 Either clinical reports are valuable 
 or they are not. We must either be- 
 lieve or disbelieve; and I, and many 
 thousands of other physicians, have 
 chosen to believe certain things re- 
 garding the internal secretions and 
 especially that there are decided ad- 
 vantages in pluriglandular therapy in 
 the treatment of quite a wide range of 
 functional disorders, and that the nu- 
 merous reports gathered from so many 
 sources — even, occasionally, from the 
 crossroads — constitute a true indica- 
 tor of the inherent value of the 
 method and the remedies based 
 thereon. 
 
 It has always been my rule in my 
 study of the literature on this sub- 
 ject, when I encountered some point 
 of prospective value which at that 
 time was new to me, to attempt to find 
 corroborative evidence in the writings 
 of others — it is surprising very often 
 how a seemingly "new" thing is not 
 new at all but has been written about 
 many times previously — and also 
 when I have had clinical opp6rtunity 
 I have attempted to reproduce clin- 
 ical experiences similar to those of 
 which I. have recently read. This pro- 
 cedure is exactly what any responsible 
 and progressive physician would fol- 
 low who has no other opportunity to 
 verify every single thing that he 
 hears or reads. Somebody refers to 
 something that has happened and 
 
"PROPERLY SUPERVISED CONTROLS" 
 
 53 
 
 when an opportunity to repeat the ex- 
 perience presents, itself, he does his 
 best — he is an empiricist, if you will. 
 Soon he develops opinions of his own 
 based uppn experience and comes to 
 know, and knows that he knows! 
 
 If an unbiased physician applies a 
 presumably reasonable remedy in a 
 number of instances the results ob- 
 tained soon convince him of the real- 
 ity of its value as well as of the rea- 
 sonableness of the remarks which niay 
 have prompted his original interest 
 in the procedure. Such clinical expe- 
 riences, to my way of thinking at 
 least, are worth' a very great deal 
 more to, the physician himself than all 
 of the written and spoken" statements 
 of another, simply because "the other 
 fellow is not treating your patients, 
 and you are responsible to your "pa- 
 tients and to no other." 
 
 Now it. is perfectly true that there 
 should be some discounting of all sorts 
 of clinical reports, for both the tem- 
 perament and judgment of various 
 physicians do not .follow certain stand- 
 ards; but to say that all clinical ex- 
 periences that, are worth anything 
 must be in the work of a certain, lim- 
 ited'class of men with specially fine 
 facilities, does not agree with my 
 own opinion and I have not. hesitated 
 to say so despite 1 the fact that it has 
 brought down upon me the criticism 
 (see Journal A. M.A., Nov. 5, 1921, 
 lxxvii, p. 1499), that "scientific medi- 
 cine is systematically belittled as un- 
 practical" in my publications. I think 
 it depends a great deal on what is 
 understood by "scientific medicine." 
 
 It must be remembered that the im- 
 pressions that I have gained about 
 the internal secretions and plurigland- 
 ular therapy, and which I have suc- 
 ceeded in combining into the tangible 
 and valuable remedies produced in 
 The Harrower Laboratory, were se- 
 cured from the statements of other 
 clinicians who certainly were intelli- 
 gent enough to make reasonable re- 
 ports. Much of this work has been 
 done abroad, and I firmly believe that 
 the conclusions of these foreign phy- 
 
 sicians are just as dependable as the 
 conclusions of any physicians here. 
 In 'fact, this subject of organotherapy 
 and the internal secretions has been 
 given far more consideration and is 
 better understood in Prance, Italy and 
 England than it is . in the United 
 States, and most of the really great 
 advances along this line have orig- 
 inated abroad, although in the last 
 decade or so I will admit that Ameri- 
 can investigators have added mate- 
 rially to the sum of knowledge along 
 these lines. 
 
 The idea of "properly supervised 
 controls" has become a shibboleth 
 which is being quite seriously over- 
 worked by some physicians who desire 
 to belittle certain clinical reports 
 about organotherapy and especially 
 pluriglandular therapy. For in- 
 stance, the possibilities of organo- 
 therapy in the treatment of epilepsy 
 were developed upon clinical expe- 
 rience, and I -think I can very prop- 
 erly mention here how I became en- 
 thusiastically interested in this mat- 
 ter. 
 
 Organotherapy is an accepted meas- 
 ure irj the treatment of development- 
 ally defective children, and knowing 
 that no cretin, mongol or less serious- 
 ly affected child was suffering solely 
 from a thyroid insufficiency, and pre- 
 suming very properly that certain of 
 the <$ther glands , also must be in- 
 volved, I devised a pluriglandular 
 formula — Antero-Pituitary Co. ( Har- 
 rower) for the treatment of the large 
 hypoplastic class which MacCready 
 calls "children requiring special atten- 
 tion." Its use certainly had broad- 
 ened the organotherapy of such cases 
 very wonderfully and made possible 
 results that . previously had not been 
 secured with long periods of thyroid 
 therapy alone, even though this was 
 definitely indicated and obviously val- 
 uable. Now it happens that epilepsy 
 is not uncommon in this particular 
 class of children, and it was not long 
 before a number of developmentally 
 defective children who also had epi- 
 lepsy had been given the benefit of 
 this pluriglandular formula. 
 
54 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 In the course of time a number of 
 clinical experiences supplementing my 
 own were reported to me from various 
 physicians, indicating that not merely 
 had there been benefit from the stand- 
 point of growth, development, men- 
 tality, walking, talking, etc., but that 
 in some of the cases the epilepsy ap- 
 parently had been cured; whereas, in 
 other cases with many attacks a day, 
 the seizures were reduced to one a 
 week or to still longer intervals. Very 
 soon it was clear that this was more 
 than a coincidence, and I began to 
 study the possibilities of the endo- 
 crines in relation to epilepsy and dis- 
 covered in my files references indi- 
 cating that there are many reports in 
 the literature suggesting endocrine 
 base's for epilepsy, as for example, the 
 statements in Cushing's book "Disor- 
 ders of the Pituitary Body" already 
 quoted on page 39. 
 
 Naturally, I began to tell physi- 
 cians, somewhat timidly at first I ad- 
 mit, that there were possibilities in 
 this organotherapeutic formula in the 
 treatment of epilepsy, especially, in 
 children and still more especially in 
 developmentally deficient children 
 where there were other obvious endo- 
 crine disorders. Some of them took 
 me at my word and tried the formula 
 clinically with enough success to en- 
 courage both them and me, untii now 
 I could cite a hundred cases or more 
 in which Antero-Pituitary Co. (Har- 
 rower) has been used successfully as 
 a remedy in epilepsy, and, too, not al- 
 together in children that were devel- 
 opmentally defective and had obvious 
 endocrine disorders. 
 
 This is empirical, it is true — or was! 
 — and it is rational empiricism I be- 
 lieve, as do hundreds of physicians 
 and parents who have been concerned 
 in problems of this character that 
 have been solved partially or com- 
 pletely by recourse 1 to this "unscien- 
 tific method." 
 
 At this point it may be proper as 
 well as interesting to report an ex- 
 perience I had at the last meeting of 
 the California State Medical Society 
 
 as published shortly after in The Or- 
 ganotherapeutic Review for July 1921. 
 
 A well delivered and splendidly il- 
 lustrated talk had been given by Dr. 
 John L. Tierney, of St. Lotus, en- 
 titled "Diagnostic Signs of Ductless 
 Gland Disorders." In the course of 
 his remarks he mentioned a number 
 of cases treated by one form of or- 
 ganotherapy or another, and one of 
 them in particular, illustrated on the 
 screen, was treated with pituitary 
 therapy and later with thyroid ther- 
 apy — in each instance with unsatis- 
 factory results — and, finally, accord- 
 ing to the speaker, a combined ther- 
 apy accomplished what had been de- 
 sired. When this statement was made 
 a physician sitting next to me in the 
 dark nudged me very strenuously, and 
 said, "Why in thunder didn't he start 
 in with pluriglandular therapy?" 
 And so in the lobby of the Hotel del 
 Coronado, immediately following this 
 meeting, I had an interesting discus- 
 sion with a certain internist about his 
 views of mono- and pluriglandular 
 therapy, and he said to me, and a 
 little crowd of others, in substance : 
 
 "In our work we are attempting to 
 get exact information. We treat a 
 given case with the most obviously 
 needed glandular extract. If we fail 
 then, we try another, and so on. If 
 we should give a mixture of these, as 
 you are advising, we would not know 
 which endocrine factor was the most 
 important, or which part of the rem- 
 edy was doing the work." 
 
 I promptly said that I was perfectly 
 willing to forego this exact informa- 
 tion if it involved either failure or 
 temporary failure, and consequent ex- 
 pensive, and perhaps painful, delay 
 to the patient. While new knowledge 
 is to be sought with avidity, and while 
 progress is ever so desirable, the pa- 
 tient's interests always must come 
 first. "Medicine is the patient and his 
 care; not his disease and its study" — 
 and I believe that it is wrong to spend 
 long periods (for organotherapy in- 
 volves months and months of treat- 
 ment) in getting technical informa- 
 tion by the patient's response or lack 
 
"PROPERLY SUPERVISED CONTROLS" 
 
 55 
 
 of response to first one form of treat- 
 ment and then another, and then still 
 another. 
 
 The business of a doctor is to cure 
 his patients as quickly and as satis- 
 factorily and as cheaply as possible. 
 If he wants to use them as means to 
 diagnostic ends, then he should treat 
 them for nothing and tell them so at 
 the beginning. It is wrong to take a 
 patient with a pluriglandular dys- 
 trophyT— and one really can not have a 
 monoglandular dystrophy — and give 
 him a single extract for a while, say 
 a couple of months, then when it 
 doesn't do the work as one might wish, 
 give him another for another couple 
 of months, and so on until the patient 
 either has lost confidence in your or- 
 ganotherapy, or has gone to some 
 other doctor. Frankly, I am aston- 
 ished at some of the excuses for 
 monoglandular therapy. They may be. 
 "scientific," but they are hardly fair 
 to the patient 1 
 
 One of the organotherapeutic 
 measures that has interested me very 
 much, is the use of various glandular 
 desiccations for their galactagogue 
 effect. It happens that desiccated pla- 
 centa substance contains a certain 
 hormone-like principle which clinical 
 experience has proved to favor milk 
 production. Now placenta substance 
 is not in the U. S. P., and is ignored 
 by so-called "authorities." For in- 
 stance, a galactagogue formula 
 containing placenta substance — 
 Placento-Mammary Co. (Harrower) 
 with several other pluriglandular 
 preparations, was denied admission to 
 the list of New and Non-Official Rem- 
 edies (Journal A. M. A., January 18, 
 1919, lxxii, p. 213) because 
 
 "Each of the mixtures contains one 
 ingredient or more, which is neither 
 recognized in the U. S. Pharmacopeia 
 nor admitted to New and Nonofficial 
 Remedies, namely: 'Spermin Extract' 
 
 . . . 'Desiccated Placenta,' 'Liv- 
 er Parenchyma,' . . . 'Pancreas 
 Substance' . . . For obvious rea- 
 sons the Council does not accept a 
 mixture containing an indefinite in- 
 gredient and hence it would be neces- 
 
 sary as a preliminary for the consid- 
 eration of any one of the mixtures 
 that their unofficial ingredients be 
 made eligible for New and Nonofficial 
 Remedies by the submission of evi- 
 dence that such ingredient is of uni- 
 form composition and that it is thera- 
 peutically valuable when given by 
 mouth. There is no evidence that 
 many of these organs have any value 
 whatever when administered by the 
 mouth or in any other way." 
 
 Now it happens that opportunities 
 for applying the principle of "proper- 
 ly supervised controls" can be very 
 conveniently established with the use 
 of -a preparation of this character. 
 This has been done with placenta sub- 
 stance and there are a number of re- 
 ports in the literature indicating that 
 a certain number of nursing mothers 
 were treated with this form of organo- 
 therapy and compared with a certain 
 similar number of apparently simi- 
 lar cases that were treated in the 
 usual manner in different wards of a 
 maternity hospital. The clinical im- 
 pressions were backed up by figure's 
 gained from a study of the amount of 
 milk, its chemical quality and, espe- 
 cially, the weight curve of the in- 
 fants. These figures proved beyond 
 a peradventure that this particular 
 form of unofficial organotherapy can 
 stand the test of "properly super- 
 vised controls." This is not the place 
 to give extensive consideration to re- 
 ports that prove my remarks but I 
 will give one or two brief items: 
 
 In the Journal A. M. A. (Dec. 1918, 
 lxxi, p. 1861) there is an abstract of 
 an article published originally in Sur- 
 gery, Gynecology and Obstetrics 
 (Nov. 1918, 1 xxvii, p. 535) which has a 
 bearing upon the matter under dis- 
 cussion: 
 
 "E. L. Cornell of Chicago reports 
 some experience's with placental ex- 
 tract as a galactagogue. He is de- 
 cidedly in favor of this measure and 
 backs up his opinion with quite a 
 number of figures. He reports that 
 87 per cent of the infants whose 
 mothers received this form of galacta- 
 gogue treatment began to gain oil the 
 fourth or fifth day, as against on 
 
66 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 per cent of those whose mothers' did 
 not take the extract. Of the former 
 class (the treated ones) 44 per cent 
 regained their birth weight before 
 leaving the hospital against 24 per 
 cent of the latter." 
 
 Again Bertha Van Hoosen, also of 
 Chicago (III. Med. Jour., Jan. 1920, 
 xxxvii, p. 22), continues a previously 
 published report on the value of pla- 
 cental feeding as a means of stimu- 
 lating mjlk production. In this more 
 .recent article she gives tables of S3 
 cases in which placental extract was 
 administered before, delivery, and of 
 .36 in which none of this, treatment 
 was given. In the first series the ba- 
 bies began to gain at an earlier date 
 and a larger percentage regained 
 their birth weight, about the "tenth to 
 -the fourteenth day as compared with 
 the infants of those mothers who 
 were not treated in this manner. 
 
 The point that I want to make, and 
 that I think is perfectly justified, 
 concerns the criticism that the devel- 
 opment of organotherapy has not 
 stood the test of "properly supervised 
 controls," and that the practising 
 physician is misled when his attention 
 is directed to the clinical experiences 
 of "ordinary physicjans." The great- 
 est progress in medicine has come 
 from the experiences of the "ordi- 
 nary" doctors. Clinical experiences 
 with the. posterior pituitary principle 
 have been of very great value to med- 
 icine and through it to humanity, but 
 its clinical value was developed in 
 practice by a gynecologist, W. Blair 
 Bell of Liverpool. Although it is ob- 
 vious that the uterotpnic influence of 
 this pituitary principle has a clinical 
 reaction that can be and is routinely 
 tested in experimental work, and quite 
 dissimilar from the suggestion recent- 
 ly made regarding the possibility of 
 organotherapy in epilepsy. 
 
 The physician who, is confronted 
 with a clinical problem must not be 
 denied the opportunity to serve his 
 patient to the utmost _ no matter 
 whether the physician is going to 
 have an opportunity to check up ohe 
 results in a "proper" clinical manner 
 
 with suitable controls, or not. He has 
 no patients that are clinically and 
 physiologically similar to serve as 
 controls to the one to whom he in- 
 tends to apply a certain measure; 
 and to my way of thinking even if he 
 had the opportunity it would be 
 wrong if one patient is given the ben- 
 efit of a certain measure and another 
 is denied it in order that the latter 
 , may serve as' a control so as to fur- 
 ther the physician's knowledge. In 
 other words, the strictest application 
 of the principle of "properly super- 
 vised controls" in clinical practice 
 means depriving, certain individuals 
 of a prospectively helpful measure 
 while, using them as control cases for 
 the benefit of the profession. ' ' 
 
 To revert ^ for- < a moment to the 
 problem of endocrine epilepsy: If I 
 have two .girls under my care whose 
 .epilepsy originated hi connection with 
 a difficult puberty and.whbse attacks 
 gave hints of an ovarian origin, I cer- 
 tainly would not feel l justified in of- 
 fering, one of the giris Thyro-Ovarian 
 Co. (Harrower) in the hope of modi- 
 fying, the -underlying dysovarism pre- 
 sumed to be present, and to deny this 
 same treatment to the other case and 
 let her get along as best she could on 
 bromide's and other sedatives, so that 
 I could make suitable comparisons. 
 To my mind, this is reprehensible, for 
 it has been proved times- without 
 number that plurjglandular ther- 
 apy in the type just mentioned also 
 has a diagnostic value. This means 
 that the treatment is given not 
 merely with the hope that there may 
 be a salutary modification of the un- 
 derlying trouble 1 , but that we may 
 learn so much the more regarding the 
 responsiveness of this individual to 
 Such stimuli. Thus we develop a few 
 additional hints regarding the possi- 
 bilities of an endocrine etiologic fac- 
 tor from the clinical response to the 
 organotherapy which is given as much 
 for the diagnostic value as for the 
 therapeutic results. 
 
 Surely under such circumstances 
 there is an aspect to the idea of 
 "properly supervised controls" that is 
 
"THE CRUCIBLE OF THE CLINIC 
 
 57 
 
 not even humanitarian and I have 
 been encouraged in this view many 
 times by the clinical results that have 
 followed; and I believe that these re- 
 sults were not brought about by co- 
 incidence or as one man jocularly put 
 it "by a favorable conjunction of the 
 planets." 
 
 The general practitioner is not in a' 
 position to follow out the routine de- 
 manded in great scientific, institutions, 
 and I, believe that it is impossible for 
 him to expect to develop in his own 
 work a system whereby he can con- 
 trol his clinical results properly. He 
 has to take things as they happen 
 and are referred to him, and his im- 
 pressions of the value of therapeutic 
 
 measures are built upon the constant 
 reiteration of statements by patients 
 which have a similar ring and the re- 
 peated discovery of clinical findings 
 which stimulate one another. 
 
 In other words, if a physician can 
 be led to believe that a certain form 
 of pluriglandular therapy is valuable 
 as a galactagogue he must depend 
 upon what the mothers tell him and 
 upon the resultant findings; and, 
 when these things are proved to his 
 satisfaction, he will use such a rem- 
 edy routinely irrespective of the com- 
 ments of, the critics and regardless of 
 its failure in some instances, as it is 
 undoubtedly bound to do occasionally. 
 
 XI.— "THE CRUCIBLE OF THE CLINIC" 
 
 "Nothing in medicine is -Worth tiidre than its yield m practice. Laboratory 
 data and ; theories as applied to medicine must take the crucible of the clinic 
 where truth and, falsehood are separated." — G. W. Crile. 
 
 No doubt the reader will have no- 
 ticed tthat through all the articles 
 which have been quoted here there 
 runs a similar and characteristic 
 thread — each and- every writer uses 
 mild or trenchant words • express- 
 ing a hope that no longer will the 
 profession have faith in certain clin- 
 ical findings. He will also notice in 
 several instances that statements pre- 
 viously made have been contradicted; 
 but what is most obvious in the ar- 
 ticles is the indubitable fact that all 
 are directed against one individual, 
 and that individual's unswerving atti- 
 tude. 
 
 Just why this concerted action 
 against me should obtain, is beyond 
 my comprehension and would indeed 
 be flattering (I am thinking now that 
 anyone who receives the attention I 
 have received should feel flattered!) 
 were it not that so many misstate- 
 ments have been made. Am I too sen- 
 sitive? Am I too willing to believe 
 that the attacks have . been directed 
 against me? Let me assume that my 
 
 opinion was born of outraged feelings 
 that had no foundation in fact, that I 
 topk unto myself too much "honor." 
 How then is the following article to be 
 explained, which appeared in the de- 
 partment "Current Comment" of the 
 Journal A. M. A. for Nov. 5, 1921, 
 and in which the editor refers to me 
 quite specifically (he admitted to me 
 personally that. I was the object of the 
 complimentary (?) remarks) in the 
 following terms: 
 
 "This, gratuitous postal-card advice 
 to physicians is reenforced by refer- 
 ence to 'monographs' and a trade 
 journal in which scientific medicine is 
 systematically belittled as unpractical. 
 Stripped of their pseudoscientific pro- 
 tective coloration, the 'suggestions' 
 are essentially pleas for gross com- 
 mercial empiricism. The advertising 
 campaign is ostensibly under the di- 
 rection of the enterprising Mr. Hyde, 
 the merchant of the firm. Mr. Hyde 
 is a profound admirer of the eminent 
 Dr. Jekyll, the medical director. Dr. 
 Jekyll's principles of physiology are 
 constantly extolled though profes- 
 
*8 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 eional physiologists remain in ignor- 
 ance of them. Dr. Jekyll, the path- 
 ologist, is cited as one speaking with 
 authority, though one seeks in vain 
 his name in the accepted literature of 
 pathology. Dr. Jekyll, the pharma- 
 cologist and therapeutist, is much to 
 the fore, though his work so far fails 
 to appear in the reliable monographs 
 and textbooks on these subjects. 
 Reciprocating, Dr. Jekyll misses no 
 opportunity to say a favorable word 
 for the commercial products of Mr. 
 Hyde. Unfortunately, the relation of 
 endocrinology to sound therapeutics is 
 still largely undetermined. The obli- 
 gation that rests on competent thera- 
 peutic specialists to further work in 
 this field is obvious. But until the 
 truth is determined, common honesty 
 as well as prudence demands circum- 
 spect discrimination." 
 
 This criticism is the sort that is 
 thrown off by a greatly prejudiced 
 person who refuses stubbornly to see 
 any good in something that is not to 
 his liking. Moreover, it is unfair be- 
 cause it is divorced from truth; it is 
 anfair because it purposely hides 
 facts; it is unfair because it assumes 
 a superior attitude toward me for the 
 reason that I am not telling the truth, 
 when the article itself states clearly 
 that the truth is not yet determined! 
 
 I am told that I am "consistently 
 trying to belittle scientific medicine." 
 This is a wrong conception of my 
 "gesture" toward scientific medicine, 
 for my motives always have been to 
 further its cause, not by methods 
 which a small coterie may think the 
 proper methods, but by those which 
 rest on a broad basis and necessarily 
 must appeal to broadminded men. 
 
 When taken to task by me about 
 all this in his office in Chicago, in the 
 hour between 11 A. M. and 12 M., 
 Monday, March 13, 1922, Dr. Simmons, 
 titular editor of the Journal A. M. A., 
 stated in substance: 
 
 That I was indeed the one referred 
 to in the offensive editorial, even 
 though my name was not mentioned; 
 
 That I should not set myself up as 
 a physician and manufacture reme- 
 dies as well — it was unethical; 
 
 That I was "not a scalawag," but 
 that my statements, if not actually 
 dishonest, were too enthusiastic and, 
 consequently misleading; 
 
 That I was building far too great a 
 superstructure upon a very flimsy 
 foundation which would very soon fall 
 to the ground, and bring me and 
 members of the A. M. A. who believe 
 in me down into disrepute; 
 
 That at a recent meeting in Balti- 
 more it was decided that my work 
 was detrimental to the best interests 
 of real scientific medicine (or words 
 to that effect); 
 
 That the editorial was not written 
 in the house but was submitted from 
 without, and 
 
 That there was not malicious intent, 
 libel or whatever it might have been 
 considered by some to be. 
 
 I spent the rest of that hour assur- 
 ing Drs. Simmons and Fishbein that 
 I had as much right to my opinions 
 as they or my critics in Baltimore, 
 that I absolutely believed I was in the 
 right, and that not a single line of the 
 criticism either in the editorials or the 
 original articles was constructive — 
 they are not offering something bet- 
 ter; and that negative criticism was 
 exactly in line with what has been 
 meted out to others who happened to 
 be a bit ahead of the times and of 
 others who were not sure of them- 
 selves. 
 
 And until some really constructive 
 criticism is available and my results 
 to date can be shown to be unreal, I 
 shall keep on — what else could I do? 
 — and shall expect those who are not 
 biased and who think for themselves, 
 to remain on my side. 
 
 The information in the foregoing 
 chapters has been collated largely to 
 show that certain physiologists evi- 
 dently are not capable of passing ulti- 
 mate judgment upon therapeutic pro- 
 cedures and that the best intentioned 
 of them are liable to err, both in 
 judgment and in their statements. 
 
 To become proficient in the practice 
 of medicine it is necessary to practice 
 medicine. Useful information should 
 
"THE CRUCIBLE OF THE CLINIC" 
 
 59 
 
 not be discarded just because it is 
 not popular with some physicians; it 
 should be acquired and put to the 
 test. When a physician is thus forti- 
 fied he is in a position to defy criti- 
 cism and be strengthened in a knowl- 
 edge that is fuller than it had been. 
 He can look the whole world in the 
 face, and not falter. His convictions 
 are his strength; his misgivings would 
 be his weakness. And it is only 
 through convictions that he arrives 
 on a higher plane — a plane that gives 
 him hope that he is not altogether in 
 the wrong. 
 
 In concluding this book of "adven- 
 tures" I should like to leave an impres- 
 sion which I gained some time ago by 
 reading some lengthy, correspondence 
 in the Journal A. M. A. during the 
 year 1916 between certain physicians 
 and physiologists regarding an im- 
 portant aspect of the internal secre- 
 tions first emphasized by Dr. G. W. 
 Crile, of Cleveland, Ohio. 
 
 Doctor Crile delivered an epoch- 
 making address before the New York 
 Academy of Medicine entitled "The 
 Kinetic Drive," which was published in 
 the Journal A.M.A. for December 18, 
 1915, lxv, p. 2129. Later he was taken 
 to task regarding some physiological 
 aspects of his opinions in a long com- 
 munication by a physiologist named 
 A. J. Carlson, who hinted at "forced 
 assumptions and misapplications of 
 experimental data necessary to ex- 
 plain the modus of the kinetic drive." 
 Crile's reply was published simulta- 
 neously and my recollection of his last 
 paragraph has prompted me to look 
 up this matter in order to be able to 
 quote his excellent conclusions. After 
 giving several additional reasons for 
 his deductions and defending his po- 
 sition, Crile writes: 
 
 "In closing, I may repeat that 
 nothing in medicine is worth more 
 than its yield in practice; that labora- 
 tory data and theories as applied to 
 medicine must take the crucible of the 
 clinic where truth and falsehood are 
 separated. The kinetic theory has 
 been tried on a large scale. Up to 
 the present time, in my clinic, the 
 
 kinetic theory has proved true, as is 
 evidenced (a) by the prevention and 
 control of surgical shock; (b) by the 
 treatment of peritonitis or other infec- 
 tions; (c) by the interpretation and 
 increased control of acidosis and (d) 
 by the operative and non-operative 
 control of exophthalmic goitre and in 
 general, the course of more than ten 
 thousands surgical cases. The kinetic 
 theory harmonizes the phenomena of 
 many diseases and relates them to 
 physical chemistry rather than to 
 physiology." 
 
 Are a clinician's words of so little 
 value that they should be entirely 
 neglected ? Is his experience based on 
 hundreds of cases of no value? How 
 about the physiologist without this ex- 
 perience ? Are his words golden while 
 the clinician's are pinchbeck? The 
 physiologist has an important role to 
 play — a very important one. But by 
 admitting this, I am not at all con- 
 vinced that his dicta are always ten- 
 able. Guinea-pigs and rabbits inside 
 the laboratory have become gods to 
 the laboratory worker, but to the clin- 
 ician they are often little tin gods on 
 wheels. And, I think, rightly so. 
 
 I am modest enough to admit that 
 I am not the equal of Crile and that I 
 should resent anyone pushing me for- 
 ward into a position similar to the 
 one which he occupies to-day in the 
 medical world. But there is something 
 about my own experience which re- 
 minds me of Crile's difficulties some 
 years ago, which took the form of at- 
 tacks on his opinions and reputation 
 quite similar to those criticisms that 
 are being meted out to me o-day. 
 
 "The crucible of the clinic," as Crile 
 says, is the place where the real and 
 useful are separated from the false 
 and ephemeral. This sort of crucible 
 is quite to my liking and also to my 
 way of thinking, hence it is just the 
 sort of test to which I am willing to 
 subject my "medical philosophy" and 
 my products. On the other hand, I 
 would be loath to abide altogether by 
 what issues from the physiologist's 
 laboratory, since I am convinced that 
 clinical experience is the most en- 
 
60 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 lightening '•experience that the med- 
 ical man can have. 
 
 Let me add that' it was J necessary 
 in writing this book to make all state- 
 ments personal, for which unusual act 
 I hereby ask the reader's kind indul- 
 gence'. The personal note in all books 
 is to be deprecated when it is not ab- 
 solutely necessary, but, as just inti- 
 mated, in this instance it could not 
 ,he avoided. References and quota- 
 tions were just as necessary, but here 
 no apology is needed. They are com- 
 ponent parts of books which lack the 
 personal note. , 
 
 Another matter which should be 
 mentioned here concerns my object in 
 writing this book. No doubt I shall 
 
 be , criticized by'somfe; no'diftubt I; 
 shall be praised by others. This fs the 
 fate of all men who put their thoughts 
 on japef. But I believe ' that ' it is 
 wrong to repress .one's innermost 
 thoughts; especially 1 vvhen these de- 
 mand some form of expression 1 ; and 
 though I "cannot agree with'him who 
 thinks it wise always to rush' into 
 print, I certainly cannot agree with 
 him who thinks that- silence is always 
 the best policy. - Hence my object in 
 writing this book is not a bid for fame, 
 or as my detractors no doubt will put 
 it, for notoriety,, but to place before 
 all unbiased readers -the trials and 
 tribulations of a .^'commercial" en- 
 docrinologist. ; .'; 
 
 XII.— THE NTH POWER IN ENDOCRINOLOGY ' 
 
 "After long lucubration I have hit' upon' such' an expedient."— Oliver Gold- 
 smith. , 
 
 This chapter did not appear in the 
 previous editions of this little book, 
 but since we have packed the rest of 
 the copy into the space available so 
 well that there is a page or two left, 
 I propose to use it to the best advan- 
 tage in directing attention to a very 
 remarkable symposium on endocrin- 
 ology which was enjoyed by the sec- 
 tions on Practicebf Medicine, Phar- 
 macology and Therapeutics, and Path-- 
 ology and Physiology, at the Seventy- 
 third Annual -Session of the American 
 Medical Association, St. Louis, May, 
 1922. 
 
 I have space only for comment on 
 one paragraph but T should like" to 
 preface it with the first few words of 
 Engelbach, of St. Louis, who opened 
 the discussion of the five papers, con- 
 stituting this symposium. He" said: 
 
 "As a whole, the symposium im- 
 presses one with the hypercriticism of 
 those men who are seriously, taking up 
 the study of internal secretions." 
 
 Ever since the days of the patriarch 
 Job, peculiarly constituted mental 
 types have been cursed with a faculty 
 for darkening counsel with words, for 
 giving out heat rather than light with 
 
 the flickering flame of their remarks ^ 
 but the ; world has' waited untitithis-r- 
 should'w-e" say "enlightened.?"— t wen- ' 
 tieth century to produce a -. type_ that 
 darkens counsel with mathematics. " 
 
 "This new type" finds' its'. .best, and 
 perhaps its ;only example in, the 
 Editor-in-Chief <>f the periodical 
 "Endocrinology," Dr., R. G. Hoskins, 
 whose paper in the above symposium 
 was entitled "Some Principles of En- 
 docrinology Applicable to Organother- 
 apy." It included the following 
 "principle": 
 
 'it is widely assumed that perturbed 
 function in any : one gland is charac- 
 teristically followed by changes in 
 others. It fs presumed that any. en-, 
 docririe gland- may show a condition 
 of normality, hyperfunction, hypofunc- 
 tion, dysfunction, dysfunction plus 
 hypof unction, or dysfunction plus 
 hyperfunction; that is, one normal and 
 five abnormal states. Theoretically 
 there exists, therefore, five uniglandu- 
 lar syndromes for each endocrine or- 
 gan. The more enthusiastic endocrin- 
 ologists assert the existence of at 
 least nine endocrine organs, each of 
 which presumably can assume any one 
 of the six states. The possible num- 
 
THE ttTH POWER IN ENDOCRINOLOGY 
 
 61 
 
 bei- of basic combinations, then, is six 
 to the ninth pbwer, or i.0,077,696. One 
 of these combinations is normality of 
 the glands; hence the theoretical num- 
 ber of endocrinopathies is 10,077,695: 
 If one is more modest and assumes 
 the existence of only six glands, there 
 are but a paltry 46,655 possible en- 
 docrinopathies."— Journal A. M. A 
 July 8, 1922, lxxix, p. 105. 
 
 Polemicists and controversialists 
 take note. Observe how the learned 
 doctor administers a dose of mathe- 
 matics sufficient to benumb the rear 
 soning faculties of the average reader, 
 or, to change the metaphor, how he 
 throws out a.fogbank,of figures, dark 
 and mysterious, behind which he hopes 
 to make his get-away. 
 
 You who would succeed- in battles 
 of words, add to your ' long list of 
 weapons those of higher algebra and 
 calculus'. If you are one of the 
 strange few who are still incredulous 
 of the findings of astronomy, you can 
 revive your waning cause, and baffle 
 your enemies, at least most of them, 
 by explaining glibly, for example, that 
 there are so many librations; pertur-' 
 bations, oscillations and gyrations to 
 the moon, all of which act and react 
 on €*ach. other to the nth power, that 
 it= is preposterous .for astronomers to 
 make' statements with any assurance 
 regarding eclipses.' You need not be 
 troubled • over the insignificant point 
 that could 'be advanced, namely, that 
 astronomers nevertheless have been 
 successful to an astonishing degree', 
 for your adversary, unless he be the 
 exception, will be so hypnotized by the 
 evil genius of the nth power that he 
 will still be-in a comatose state long 
 after you have gone on your way re- 
 joicing. 
 
 Whatever may be your hobby, de- 
 fend it with higher mathematics, and 
 your success is sure. 
 
 And might not the possibilities of 
 this unique method of argumentation 
 be cited, ad libitum, ad infinitum et 
 ad nanseum? 
 
 Far be it from me, however, to in- 
 sinuate that the respected doctor has 
 gone about mastering the art of fig- 
 
 ure-juggling with the idea of adding 
 another arrow to his polemical quiver. 
 There is a pathetic little footnote 'in 
 which he confesses that he isindebted 
 to anpther for his. mathematical argu* 
 ment.. The one to whom he is so m*- 
 debted is not.:a physician, though a 
 professor, which causes me to remem- 
 ber that professionals in one line sel- 
 dom are gifted in another — 4hat doc- 
 tors, for example, rarely ever are 
 shining mathematicians. This ex- 
 plains how the average practitioner — 
 which, unfortunately, does not include 
 those who dispense only the theory of 
 things — proceeds with a certain feelr 
 ing of assurance in diagnosing a dis- 
 ease or prescribing a remedy; for if 
 his brain experienced a mathematical 
 tantrum every time he approached the 
 bedside of a patient troubled with a 
 complication of diseases, would he not 
 soon despair of hitting the right com- 
 bination? If his mind were like that 
 of the famous Sir Isaac, he would 
 quickly realize that a person troubled 
 with a digestive and nervous ailment 
 presented, a case with a paltry few 
 million possible combinations; for this 
 common variety of affliction may be 
 due to dysfunction of any one of the 
 seventeen parts of the digestive' Sys- 
 tem, acting and reacting fa the va- 
 rious complicated parts of the nervous 
 system. The nemesis of the nth power 
 would pursue him like the cranes of 
 Ibycus, screaming out a charge of 
 murder against him for every patient 
 he had failed to save from death. 
 Waking or sleeping, he would be tor- 
 tured by the horrible, unanswerable 
 question, "Dicl I make the right guess 
 in 10,000,000,000?" 
 
 But fortunately, we never find the 
 average practitioner so tortured men- 
 tally. Whether -it is a seared con- 
 science, a lack of mathematical acu- 
 men, or an absurd notion of infalli- 
 bility that is really responsible for the 
 nonchalant assurance with which the 
 physician goes about his daily task of 
 diagnosing and prescribing for every 
 affliction from neurasthenia to pain in 
 the stomach— Either one of which may 
 
62 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 present causes, symptoms and com- 
 plications of sufficient number to be- 
 wilder even a mathematician — certain 
 it is that none, save the ignorant, and 
 least of all the aforementioned physi- 
 ologist, would accuse him of unscien- 
 tific empiricism, or indict him as a 
 quack, even though his diagnosis 
 and prescriptions sometimes — often- 
 times — fail to bring the desired help- 
 ful results. 
 
 Yet this eimient physiologist en- 
 deavors, with borrowed wisdom, to 
 laugh out of court the specialist in 
 endocrinology because he goes about 
 with a certain assurance to treat, not 
 the complicated ailments of all the 
 multitudinous parts of the human 
 frame, but simply the dysfunctions 
 of a paltry half dozen of the body's 
 organs! I am almost tempted to be- 
 lieve that there is lacking from the 
 
 intellectual diadem that encircles the 
 braw of this Doctor of Medicine at 
 least one jewel — the rare one, con- 
 sistency. 
 
 My only counsel to the occupant of 
 the Chair of Physiology of the Medical 
 Department of the University of the 
 State of Ohio is first, to master for 
 himself the mysteries of mathemat- 
 ics; and then having discovered the 
 dangers of the two-edged sword he 
 has grasped, to remember, second, the 
 ancient axiom of logic: "That which 
 proves too much proves nothing." 
 
 I really believe that such counsel, if 
 heeded, would prove the salvation of 
 his logical soul. At least as Robbie 
 Burns has it: 
 
 "It would from many a blunder free 
 him, 
 
 And foolish notion.'' 
 
 APPENDIX 
 
 'Wo pleasure is comparable to the standing upon the vantage ground of truth." 
 — Francis Bacon. 
 
 Several persons, all of them dis- 
 interested, some of them with no pre- 
 vious knowledge of this controversy, 
 and at least one of them a non-med- 
 ical man, have read the manuscript 
 for this book. There seems to be quite 
 a unanimity of opinion that I have 
 not defended myself as thoroughly as 
 possible in regard to the criticized 
 commercial aspects of my work. 
 
 Of course it is very evident that the 
 "big noise" that I have been making 
 has contributed largely to this ruf- 
 fled state of mind on the part of the 
 men whom I have taken to task, for 
 every one of them has heard or even 
 seen, on this hand and on that, evi- 
 dences of our progress. 
 
 The editorial yriter in the Journal 
 A. M. A., it will be remembered, in 
 his editorial "Endocrinology and 
 Pseudoendocrinology" (Journal A. M. 
 A., November 5, 1921, lxxvii, p. 1499) 
 stated that — 
 
 "Those who purpose acting as pur- 
 
 veyors to the medical profession must 
 accept the status of ^purveyors. The 
 only legitimate means' by which they 
 properly can aspire to success are skill 
 in production and acumen in market- 
 ing. Equally well established is the 
 principle that the physician or labora- 
 tory investigator in the medical sci- 
 ences shall not exploit for commercial 
 gain the results of his studies." 
 
 The same impression was gained 
 from MacCallum's lecture and just as 
 I have stated already, I can only reit- 
 erate here that the work that I had 
 hoped might be done by others and 
 which I found would have to be done 
 by myself, conuld only be financed by 
 the establishment of a business on a 
 profitable basis. We have done this 
 in spite of early assurances regarding 
 its soon and certain failure, and hence 
 the criticism. 
 
 "Now,I have yet to find a physician 
 who is entirely disinterested in mat- 
 ters concerning "profit." Doctor Sim- 
 
APPENDIX 
 
 63 
 
 mons himself receives a good salary 
 and some of the best men in medicine 
 to-day are those who have the facili- 
 ties for developing information and 
 surrounding themselves with a halo 
 of progress, thus making themselves 
 more obvious to their colleagues and, 
 invariably, to their bankers. 
 
 Medicine assuredly is a science, but 
 all those who practice it must realize 
 that it is just as much a business, and 
 I disagree with those who say that a 
 man cannot be a physician and at the 
 same time "exploit for gain the re- 
 sults of his studies." Doctor E. R. 
 Squibb, of New York, was an honor- 
 able physician and his memory is still 
 respected highly. He went into the 
 drug manufacturing business and re- 
 mained a physician, and his medical 
 identity has never been submerged 
 from that day to this. Doctor Wallace 
 C. Abbott, of Chicago, with whom I 
 had the honor to be associated for 
 some years, was first, last and all the 
 time a physician, and he developed a 
 manufacturing business of very re- 
 spectable proportions. While he had 
 to put up with a good deal of igno- 
 miny from the very sources where I 
 have encountered it, he forged ahead 
 and has left a monument to his illus- 
 trious memory — The Abbott Labora- 
 tories. 
 
 Doctor G. H. Sherman, of Detroit, 
 a man who has done more than any 
 other single physician to develop bac- 
 terial vaccine therapy in this country 
 and who, I understand, has quite the 
 largest business in this line in the 
 United States, was a physician, and 
 still is. When I was in Detroit a 
 while ago, the president of the 
 Wayne County Medical Society was 
 an employee of the scientific depart- 
 ment of Parke, Davis & Co. There is 
 plenty of precedent for me to follow. 
 
 I recall a little incident that hap- 
 pened at the State Medical Society 
 meeting held in the Hotel Ambassador 
 in Santa Barbara two or three years 
 igo. A friend of mine was talking 
 vith a certain laboratory worker from 
 
 Los Angeles. Not having seen this 
 friend for some months I went up to 
 hi mand shook hands and learned that 
 him and shook hands and learned that 
 and heard some nice things about it. 
 The laboratory worker, on the other 
 hand, expressed disdain, and in the 
 course of his remarks said that "Har- 
 rower is an advertiser." I promptly 
 defended myself and said that it 
 wasn't fair to make such a compari- 
 son, because when the word "adver- 
 tiser" is applied to a physician, ordi- 
 narily it means a physician who be- 
 lieves in newspaper and other trade 
 methods of publicity — "an advertising 
 doctor," or, as some have it, "a quack 
 doctor." 
 - 1 was not then and am not now do- 
 ing anything of the kind and I do not 
 expect to, for my advertising is lim- 
 ited to the medical profession and we 
 have no dealings whatever with the 
 laity, save only at the request of in- 
 terested physicians. 
 
 My friend then gave the laborato- 
 rian a good jolt by asking him first 
 if he had a paper on the program, and 
 on receiving an affirmative answer 
 asked, "And what is the idea of your 
 coming to this meeting? Aren't you 
 an advertiser? Are you not inter- 
 ested in securing as much referred 
 work as possible from those who may 
 be interested by your remarks? And, 
 really, isn't the whole proposition of 
 State medical meetings, incidentally, a 
 splendid advertising scheme for those 
 who manage to get their names on 
 the program so routinely each year?" 
 And then he finished by saying, 
 "Shame on you ! You're as bad an ad- 
 vertiser as Harrower!" 
 
 Now I am not saying whether my 
 friend was entirely right or not, but 
 I do know that this laboratory worker, 
 and Simmons, and MacCallum, and 
 Frank, and any others who oppose 
 are absolutely wrong when they ques- 
 tion my right to do as I have done. 
 
 We have built up an effective, hon- 
 est, business organization. We have 
 built it upon the ground principles of 
 
64 
 
 ADVENTURES IN ENDOCRINOLOGY 
 
 service to the profession, the very 
 best kind of products possible, and 
 then more service to the profession. 
 In fact, the slogan which I started 
 with and which I adhere to most con- 
 scientiously, is "At YOUR Service," 
 see it below — and just because in the 
 course of my work it is necessary on 
 
 sound business principles to arrange 
 for a reasonable profit in return for 
 the effort, is this especially worse 
 than to charge $100 or $500 or $1,000 
 for an operation, or for that matter 
 any kind of a fee for any kind of 
 medical service? 
 
Ei6ht\*)rth-while Therapeutic Hints 
 
 NEURASTHENIA" Many canes labeled neuras- 
 thenia" really are endocrine insufficiencies re- 
 sulting fr»m some serious toxemia, focal in- 
 fection or emotional difficulty Adrenal dys- 
 function is at the bottom of many cases of low 
 blood- pressure, with marked asthenia and the 
 "run-down condition.' Adrenal support, as rep- 
 resented by Adreno-Spermin Co. (Harrower), 
 sometimes is a surprising wav out of vear-old 
 difficulties. 
 
 n.uouiM. a pluriglandular formula calcu- 
 lated to reduce pelvic congestion, antagonize 
 ovarian irritability and lessen menorrhagia and 
 metrorrhagia, consists of mammary substance, 
 pituitary glund and a very small dose of ergotfn 
 i the latter in sensitize the uterus to the asso- 
 ciated organotherapy). Mamma-Pit ultary Co. 
 (Harrower) has proved its styptic and regu- 
 latory value when other usual measures have 
 failed. 
 
 ANLMIA. The most satisfactorv form of assimilable organic iron is hemoglobin made (rum 
 red blood cells. When reinforced with nucleinic acid (to stimulate white call production and ac- 
 tivity) and spleen substance (for its well-known hematinic and nutritional effects), it makes 
 an unusually efficacious oral hematinic. Hemoalobin Co. (Harrower) given one or two. three or 
 Tour times a dav has been used in all stages of anemia and frenuentlv has wrought wonders 
 
 I 
 
 JO 
 
 i ree or U 
 mders. I 
 
 S* 
 
 Price List of Harrower's Plurigl 
 Air-Tight Packing 
 
 alar Formulas in 
 
 Waxed Sealed Strips 
 
 4 Sani tablets' 
 
 1— Adrsno-Spermln So. (IM's) 
 Aathonia. SubnxHation. Hysotenaii 
 
 ■ t— Airtwo-Prhiltary Co.. , KZt 
 
 Defective Children. Mongolism, EpHeyay 
 
 3.00 13— Hemoftlsbin Co ... . $3.60 40— Mamma-Pit ultary Co.. ... $4.75 
 
 Anemia. Malnutrition, Chlorosis, etc. Menorrhagia, Me Irorrhagia.UterineOosine' 
 
 
 3— Ptaeertfo- Mammary Co.. $4. 
 
 Oalaciagogiie. Post-partu m Involutant. 
 
 4— Thyro-Ovarlan Co. 
 
 Amenorrhea, DysmcB 
 
 09f( 5— Secretin Co. $3.00 
 
 IndigeaPon, Pancreas and Biliary Iruuff. 
 
 S4.0C 
 
 rhjta, Neurasthenia 
 
 9-;Hesat»-S»len.le Co. $3.50 
 
 Toicmia. Hepatobiliary InaufT 
 
 6— Pancreas Co. 
 ■ Hy par t byro idiai 
 
 -Thyroid Co. (Gr. >£)•■ 
 Hypothyroidism. 
 
 10— Thyroid Test Capsules (3 tests) $1.26 
 Differentiation af Thyroid Pis. (Coitre). 
 
 14— Nueleo-LecJthlnCb.. .. $5.00 
 
 _ Malnutrition. Cachexia. Maraaaufc 
 
 41-Uydla CeTeo." $U0 
 
 Prostatic Hypertrophy. Senility, etc. 
 
 43— Lymphatic Co. 
 Lymphatiare. Hemophilia 
 
 1 6-Lrt)uorHypophysis.U.S.P.(1 5m**.)S2.60 47 
 
 Obstetrics. Surgery. Shock, Collapse. 
 
 18— Iodized Thyroid Co. J3.75 
 
 Simple Goitre, Hypothyroidism, etc 
 
 . Pituitary Co. .. H.S0 
 
 Hvpopituitary, Infantilism , Hypogonadism 
 48— Prostale Co. 94.50 
 
 Prostatic Disease, Neiiraathtnia, etc- 
 
 22— Eire Salts Co. . . $3.08 
 
 iff. Mucous Colitis, Constipation. 
 
 23— Poncreatln-Blle Co.. _S3.5S 
 
 Intestinal Indigestion, Biliary " 
 
 24— Parathyroid Co. . . $4.50 
 
 Paralysis Agitaas, Hypoparathyroidism. 
 
 29— Thyro-Pancreas Co. w Spermln $4.50 
 
 Functional Hypertension in Men. 
 
 ■rises. Menorrhagia. 
 
 48— PtaoontaCo.. $4J0 
 
 Vomitiag and Nausea of Pregnancy. 
 
 68— Spermln-HsmoolobUi Co. $3.90 
 
 Asthenic Anemia. Suhoti dation. Msloutn. 
 
 TO— Gonad Co. $5. 
 
 Impotence. Aseinialisai. Senility, 
 
 79— Adreno-Ovarlan Co. R£0 
 
 DysoParum lace No. i) trith Ag* bep<a. 
 
 ttJM 
 
 J 1 
 
 $4.25 85— Renal C 
 
 Nephritis. Albuiauuru, Renal Insuff. 
 
 1 1— Ajjiyto-Trypsm Co. 
 Indnteatisn, Flatulence, Gastric Ini 
 
 The Harrower Laboratory I Heme Oft ice: Glendale, Gal. 
 
 HYPERTENSION: Functional high blood-pressure, especially in women approaching, during or 
 uast the menopause, sometimes Is purely an endocrine difficulty and for this reason Thvro- 
 Pancreos Co. with Ovary (Harrower) has been used and recommended by thousands of physi- 
 cians because of encouraging reductions In the systolic blood-pressure. This formula, of course 
 is used in conjunction with other detoxicative and hygienic measures. Full information Is 
 found in the reprint "Reducing High Blood- Pressure." sent to the profession on request. 
 
 HYPERTHYROIDISM: The sympathetic irri- 
 tability, heart hurry and nervouB tension of 
 hyperthyroidism frequently is controlled by 
 the use of Pancreas Co. fHarrower). one of 
 the most decidedly useful of the "antagonist" 
 hormone preparations. Many encouraging re- 
 ports have been received from physicians 
 who have prescribed this formula. Patients 
 have gained decidedly in weight, the thvroid 
 has decreased In size and many of the dis- 
 concerting symptons have been lessened. 
 
 IMPOTENCE. PRESENILITY: The hormone 
 treatment of hypogonadism in the male of- 
 fers prospects of better results if in addition 
 to the Levdig cell principle (spermin) the an- 
 terior lobe of the pituitary and the thyroid 
 are given simultaneous homo-stimulation. 
 Gonad Co. (Harrower) is an efficient sex 
 stimulant when functional (not organic or in- 
 fective) disorder is present. A physician 
 savs: "A case of post-influenzal impotence 
 that I and others had treated unsuccessfully 
 for IS months was entirely cured following 
 300 of your Gonad Co." 
 
 OVARIAN DYSFUNCTION: Manv indetermi- 
 nate disorders are associated with menstrual 
 imbalance, amenorrhea and the menopause. The 
 re establishment of this balance, the main- 
 tenance of menstruation or the mitigation of 
 tne nervous and circulatory disorders of an 
 ovarian Insufficiency often is possible through 
 the administration of Thvro-Ovarlan Co. (Har- 
 rower) a combination of the principles from 
 the corpus luteum and ovary, associated with 
 thvroid and pituitary gland. Clinical experience 
 shows that it is better than ovarian products 
 alone 
 
 VOMITING OF PREGNANCY. It Is believed 
 that much of the discomfort in the early months 
 of pregnancy which may culminate in real hy- 
 peremesls gravidarum, is in the nature of a pro- 
 tein sensitization. At all events, based on this 
 idea. Placenta Co. (Harrower) has been given 
 la a large number of prospective motherB and 
 this particular symptom has been decidedly 
 controlled in manv instances when conditions 
 had been extreme and various other (anus 
 of treatment had failed altogether. 
 
PfTfWTmMiwMiitfTn 
 
 Publications of The Harrower Laboratory 
 
 The object of The Harrower Laboratory being "to 
 develop information pertaining to the internal secre- 
 tions in general practice," a number of books, pam- 
 phlets and periodicals are produced by its literary 
 department. Among these are : — 
 
 "Practical Organotherapy" 
 
 A 416-page, cloth bound work of reference containing a 
 large amount of information which is the more easily ap- 
 plicable because, where convenient, the ideas are material- 
 ized into some laboratory product which can be easily 
 secured and made therapeutically available. Sent to inter- 
 ested physicians on approval. $1.00, postpaid. 
 
 Harrower's Monographs on the Internal Secretions 
 
 A periodical, each issue of which consists of a comprehen- 
 sive consideration of the endocrine aspect of the subject. 
 To date the following have appeared: 
 
 No. 1. "Hyperthyroidism, Medical Aspects/' 120 pp. 
 
 Price, postpaid $1.58 
 
 No. 2. "Neurasthenia: An Endocrine Syndrome," 
 
 92 pp. Price, postpaid 1.25 
 
 No. 3. "Epilepsy as an Endocrine Disorder," 78 pp. 
 
 Price, postpaid 1.25 
 
 No. 4. "Endocrinology in Pediatrics," 110 pp. Price, 
 
 postpaid 1.25 
 
 No. 5. "The Adrenals in Everyday Medicine." Price, 
 
 postpaid 1.25 
 
 The subscription price for four issues (a "year") is 
 $3.00, postpaid. 
 
 The International Digest of Organotherapy 
 
 A monthly review of the literature on the internal secretions 
 as it applies in clinical medicine. A generous share of each 
 issue consists of translations of appropriate material from 
 foreign journals. Subscription price $2.00 a year. 
 Specimen copies will be sent to physicians who desire them. 
 
 The Organotherapeutic Review 
 
 A small, pocket sized monthly periodical emphasizing the 
 progress in organotherapy in general and the work pf The 
 Harrower Laboratory in particular. 
 
 Sent to any physician without charge on request. 
 
 "Adventures in Endocrinology" 
 
 A virile, interesting defense of the work and ideals of the 
 author, Dr. Henry R. Harrower. 159 pages, 12 mo. Cloth 
 binding. Price, postpaid, $1.00. 
 
 The Literary Department 
 
 THE HARROWER LABORATORY 
 
 920 East Broadway (Box 68) GlendaU, California 
 

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