MENTAL WELFARE.
Mental Welfare
and
the
By Ivo Geikie Cobb,
Author of
"
The
Organs of
63
Endocrine
M.D.,
Organs.
M.R.C.S.
Internal Secretion" Aids to
Organotherapy,"
etc.
Introduction.
It is
in recent years that our knowledge of those small bodies which the Endocrine glands has been sufficient to be of any real practical value to the physician. We are still, moreover, only on the threshold of secrets which these bodies contain; but so fascinating is the study of the ductiess glands and their role in the psycho-physical mechanism of the individual, that We may be forgiven for discussing' in some detail their functions and structure. The gaps in our knowledge are still so wide that we have perforce often to content ourselves with speculation where exactitude should be possible. But it is daily becoming easier to fit fresh pieces in the puzzle, and it gradually becomes plainer that the part played by these organs is of the first importance to bodily health and mental efficiency. Furthermore, it behoves us all to realise that the future holds out hope that the treatment of many disorders of mind and body will be materially helped by the use of preparations manufactured from the glands of animals. are
known
only as
^the
Historical.,
Interest
aroused among physiologists as early as the middle of the last century in those organs of the body, which, while of definite glandular structure, yet appeared to 1 his possess no ducts through which to deliver their secretions. was the period in which scientific interest was aroused in this subject. But if We go back to less enlightened days, we can trace the administration of Preparations of animal organs down to very early times. Shakespeare's " eye " of newt and toe of reminds the reader of an empericism both nasty and frog was
Meaningless.
In 1859,
a physiologist named Schiff discovered that the removal of the led to death. Kocher's work subsequently confirmed and enlarged this while the work of Vassale in Italy, Gley in France, and G. R. in England, turned the attention of the scientific world to the importance of the thyroid gland and the possibility of feeding individuals deficient in the secretion of this gland with the thyroid of the sheep. This was the first positive proof that a deficient thyroid could be replaced per os, and was, in fact, the dawn of modern scientific organotherapy.
thyroid
knowledge; Murray
Previous results of
to this, a physician named Brown-S?quard had published administering organic substances, more especially in senility,
had claimed
decay
that their
use
the and warded off the onset of old age and neutralised the
which accompanied senility. His experiments were not generally accepted, and to some extent, perhaps, his claims were exaggerated. Nevertheless, he is known as the Father of Organotherapy," and it must be conceded that he Was the first to draw attention to the possibility of treating disease by means oi Preparations manufactured from animals. "
Many
other
stand out as pioneers in this field, both as to the role and as to their efficacy in treatment. Enough has been glands said, however, to indicate in general terms how the comparatively recent development of this subject has revolutionised medicine and has placed in the hands of ?f the ductless
names
the clinician fresh weapons with which
to
fight disease.
64
MENTAL WELFARE. General Considerations.
There are several glands in the body which are unprovided with ducts and The chief among which pour their secretions directly into the blood-stream. these are the thyroid, parathyroids, pituitary, and adrenals. Other organs are provided with ducts through which the juice they manufacture can reach its destination. While some?possibly many more than is at present believed?produce both an internal secretion which is absorbed directly into the blood-stream and an external secretion which leaves the gland by its duct. An example of an ordinary gland is the parotid, one of the salivary glands, which manufacture saliva which is poured into the mouth through its duct. Whether all glands possess an internal as well as an external secretion is a point not yet settled. Certain glands, however, are known to be so and perhaps the best example is the pancreas, commonly known as constructed, " the sweetbread." This gland furnishes its external digestive juice and also possesses an internal secretion, whose function is to regulate sugar metabolism. Any damage to the cells in the pancreas which manufacture this secretion results in the appearance of increased amounts of sugar in the blood and sugar in the urine?in other words, diabetes. The production of insulin (the substance obtained from the pancreas of animals) and its use in the treatment of diabetes, is one of the most brilliant and epoch-making achievements in the history of the subject we are now considering. Prior to this discovery, diabetes could be treated only by diet and symptomatic drugs. Other glands possessing both internal and external secretions are to be found among the sexual organs, and probably many of the glands, such as the liver, spleen, etc., whose work is concerned primarily with metabolism. The presence of an internal secretion in both the male and female sexual glands is shown by the mental and physical changes which accompany puberty, the change of life, and extreme old age. When the boy merges into the man, the so-called " secondary sex characters are produced by an internal secretion. The mental development which takes place at such times is due to the sensitising or the reverse of these secretions upon the central and sympathetic nervous systems. Many so-called metastatic effects, i.e., changes in distant organs dependent upon the development of some change in a disordered gland, were thought formally to be dependent upon reflex causes. They are now known to be the result of chemical messages, initiated by the secretions of the endocrine glands. Individual Glands. The corner-stone of the Endocrine system is the thyroid. This gland is situated across the larynx and can be felt at either side of the " Adam's apple." It is composed of two lobes connected with each other by a central lobe or isthmus. The secretion which this gland furnishes to the blood is of the greatest importance to the animal economy; any disturbance of its function is followed by changes in the general metabolism. It is as if one man at the end of a line of soldiers is pushed on by his neighbour, who, in turn, bumps against the next Excess or deficiency of the thyroid hormone leads man, and so on down the line. to changes in the adrenals, to disturbance of the pituitary, parathyroids, and, it may be, several other of the endocrine system. in general terms, the function of the thyroid is to nourish the nails and hair; to regulate the circulation; to act (in conjunction with the adrenals and pituitary) in the sympathetic control of the body; and (in virtue of
skin,
Speaking
MENTAL WELFARE. *ts relation with the
to
the emotional life of sympathetic) the body. As we shall see in a later
play
important
an
65 r61e in the formation of
of thyroid secretion is The disease variously known as exophalmic goitre, Graves's disease, or hyperthyroidism, changes the personality ?f the sufferer From a normal person, the patient becomes to a painful degree. excitable, irritable, and unreliable. That it is not solely due to over-action of the thyroid will appear later in this paper; but that it is partly due to this factor
always
excess
page,
associated with undue emotionalism.
now
abundantly clear. In close anatomical Pairs of small
proximity to the thyroid gland, there are found two neighbours called the parathyroids. Originally believed to be part of the thyroid and to consist of thyroid tissue which had become separated from the main gland, it is now known that they are independent structures, and, indeed, in many ways antagonistic to the thyroid secretion. Some of the early
experiments
carried out on the thyroid led to conflicting results, because some had removed the parathyroids, while others had left these glands tn situ.. The results varied according to whether the entire thyro-parathyroid had been removed, or solely the thyroid.
observers
Removal of the parathyroids
fatal if
complete; if part only is system of the animal, and a " condition known as In some way, the parathyroids are ensues. tetany concerned in the calcium metabolism, and excessive loss of lime from the body leads to the nervous symptoms encountered in tetany. It is not possible as yet to say that a condition such as Anxiety Neurosis can be attributed to parathyroid or that it is relieved by the administration of extract of the parathyroids. There are, however, instances on record in which thyroid extract has done harm to such a case, while parathyroid extract has been beneficial.
removed,
marked
changes
take
"
is
place
always in the
nervous
deficiency;
The clinical pictures of over-action of the thyroid and under-action of the have certain points in common. This would suggest an antagonism two secretions, and this view is now generally he'd.
Parathyroids between the
Situated
at the base of the
brain, enclosed in a small It consists of an anterior and
bony box, is a gland posterior lobe and a stalk, and its structure is partly glandular, partly nervous. Our knowledge of this gland and its functions is of even more recent acquisition than is our acquaintance with the thyroid and the interstitial tissue of the ovary and testis.
known
as
the
Pituitary.
^
The functions of the pituitary may be regarded from two angles, according whether we are considering the anterior or posterior parts.^ The anterior or glandular portion is largely concerned with metabolism ; and it is believed that failure of this part of the gland results in a disease characterised by obesity and to
deficient development, although
doubt
has been cast upon this
school which believes it is the posterior portion which is responsible
obesity.
view
tor
y
one
pituitary
With the space at our disposal it is impossible to do more than take a general of the main glandular secretions and their functions, and we must be excused for apparent dogmatism if we state the position briefly in order to show that the mentality of the normal and the abnormal is dependent respectively upon glandular efficiency or failure.
survey
It is at least likely that the pituitary gland should be regarded as one_organ rather than from the of two parts, possibly antagonistic or wide y dif ering angle in their functions. The gland is one of the dynamic structures of the body. It works in conjunction with the and adrenals; and we shall refer
thyroid, gonads,
MENTAL WELFARE.
66
a later section to the type which is believed to result when its secretion is the dominant one in the endocrine hierarchy.
in
A few words about the thymus. This gland, which is situated in the thorax, is active principally during- infancy and childhood, and diminishes in importance In some instances it continues its activities into as the sexual activities develop. adolescence and causes delay in normal development or produces a general disturbance of the glandular balance.
The adrenal glands are two small structures found above the upper part of each kidney. They consist of two parts, a cortex and a medulla, the functions The former is much larger than the latter of which are strictly differentiated. and is different histologically. It bears a close and intimate relation with the sexual glands, and tumours of this part of the gland have been shown to be associated with the premature development of sex.
medulla, on the other hand, is the part of the adrenals which secretes This substance, the isolation of which was carried out by Takamine, remarkable and vitally important secretion; its introduction into medicine surgery has marked an epoch in the practical application of the internal
The
adrenalin.
is a and secretions in treatment.
What is of greater interest to us in this connection is the relation of the adrenal glands and their functions to the nervous system, and particularly to It must be remembered that the most that part known as the sympathetic. primitive form in which stimuli were originated and conducted was by chemical Nervous structures were differentiated later in the evolutionary messengers. scale, and were evolved as the organism became more complex and its need for rapid communication became more essential. The central nervous system furnishes this means; the sympathetic, more closely allied in time and function to the
endocrine
glands, developed pari
passu with them.
The adrenal system, with its secretions, is very similar in its work to the sympathetic nervous system. It controls the involuntary muscular system, and in conjunction with the thyroid and pituitary, is responsible largely for the In addition to this, its activities metabolism and circulatory tone of the body. colour, if they do not determine, the mental type of the individual. Further, we now know that changes in the mental outlook?the temporary states known as " moods "?can be correlated with the undue activity or quiescence of the sympathetic nervous system and its colleagues. has now been said to indicate that the mental life of the individual much to the glands of internal secretion. Not only in the determination of the type to which he will belong, but to the changes which will take place from time to time in the endocrine balance, will he owe alterations in his emotional life and in his relations to his environment.
Enough
owes
Inter-Relation There is
of
the
Ductless Glands.
definite balance recognised in the endocrine
hierarchy; that is to glands may be regarded as dynamic or positive; the opposing glands are inhibitory or negative. Excess of thyroid secretion may be associated with excess of the adrenals. The small neighbours of the thyroid, the parathyroids, are even now somewhat of an unknown quantity. That they play a very important part in mental and bodily health, there is no doubt; but it say,
one
a
set of
changes in the health due to these glands can be recognised except perhaps in a very limited manner. Many attempts have been neutralise the excess of one gland by the administration of an extract
cannot be said that
definitely, made to
MENTAL WELFARE.
67
Of one which may be regarded as antagonistic. One of the early examples of these was to endeavour to neutralise excessive thyroid secretion by extracts of the adrenal glands. It is now believed, however, that the symptoms of nervous which are seen in over-action of the thyroid are probably due more excitability to the adrenals than to the thyroid. All the endocrine glands are to some extent concerned in the metabolism of the body. Laboratory tests can tell us whether the thyroid is over-active or whether the pituitary is not doing its share of work. The administration of an extract of the thyroid or pituitary in a suitable case "will often work wonders. The various glands concerned in sex have been studied with great care from the point of view of the internal secretions; and it is known that the thyroid and pituitary, to mention two, are undoubtedly related with the internal secretions of the gonads. The pancreas is equally in inter-relation with these glands, and the mechanism that controls sugar utilisation in the body varies according to the activity of both the thyroid and the pituitary. The changes which may be seen after middle-life in both sexes have their basis in the endocrine supplies. Equally the inter-relation of the various glands depends upon the balance set up by their working adequately and in harmony. What used to be called the mental faculties are unquestionably closely dependent upon the smooth A violent mental shock is capable of of the endocrines. working so upsetting this balance that the emotions may become disturbed for a lengthy
Period.
death which of the
Thus Trousseau describes
a lady who was suffering great grief on the suddenly felt her eyes swell and lift up her eyelids, was accompanied by violent palpitations and throbbing and enlargement thyroid.
of her father and she
The Endocrines
and
the
Emotiohs.
Many such cases were seen during the war where sudden or prolonged strain Produced a disturbance in the endocrine balance. Anyone who observed such cases in the battle areas will agree that the group of disorders variously called neurasthenia,
shell shock, and anxiety neurosis, were very largely dependent on The instincts which were predominant under shell fire resulted in increase in the adrenal activity; and this gland has therefore been called the gland of "fight or flight," because it is the gland which is called upon to activate the reserves of the body in an emergency or crisis. The sympathetic nervous system is the Morphologically it is in close relationship with messenger of emotions. the adrenals, so that undue emotion is likely to produce hyperadrenia. This, in its turn, will produce thyroid changes. One observer has shown that the adrenals have a definite effect upon the thyroid, for it is possible to pioduce marked changes in the cells of the thyroid by repeated injections of adrenalin. Again, adrenalin will alter the metabolism of the body, and a more or less constant disturbance of the adrenal system may lead to such changes as we may group under the generic name of debility.
this
cause.
histological
Personality
and
the
Ductless Glands.
Dr. Louis Berman published a fascinating book in 1922 entitled The Elands Regulating Personality." His object was to show, from the purely Physical standpoint, how the mind and its attributes depended upon the action and inter-action of the The pattern of the personality, so to ductless glands. speak, depends upon w'hat may be called the relative proportion of the different ?nternal secretions. Many of Dr. Berman's types of personality are definitely recognisable, and the interest of the reader is kept up by a chapter describing some historic As an example of his contentions, we may quote personages.
68
MENTAL WELFARE.
" from chapter nine of his book, which is called the Backgrounds of Personality." of methods the of approach which have been adopted There is a brief review here " " nerves and nervous disorders, and the evolution of the present towards on these subjects. Dr. Berman describes the physical basis of the knowledge unconscious and says : *" Another vastly important law that governs the content of the conscious and the unconscious, and resultant behaviour is the fact that the nerves and nerve cells of the vegetative apparatus, the nerves leading to the viscera and the endocrine glands, like the solar plexus, are affected by stimuli of lower value than those which arouse the brain cells. In the metaphorical language of the old psychology, the threshold value, that is the strength or loudness of stimulus sufficient to make itself felt or heard, is less for the vegetative apparatus than for the brain. So we begin to glimpse why an emotion seems to be experienced before the visceral changes that really preceded it, but pressed This gives us a clue to the unconscious their way into consciousness later. as the more sensitive and deeper part of the mind. "
More than that, it supplies us with a physical basis for the unconscious, which will explain much of the observed laws of its workings. It provides a reason for the apparent swiftness, spontaneity and unreasonableness of what is called intuition. And it may show us a source for a good deal of the material of dreams and dream states. "We have said that we think and we remember, not alone with the brain, but with the muscles, the viscera and the endocrines. So do we forget, not alone with the brain, but with the muscles, the viscera, the endocrines and their The utmost importance of muscle attitudes in remembering has been nerves. established in the experimental laboratory." In marked disorders of the endocrines it can often be said which gland is Let us consider for a moment one or two of the types seen due to a disordered endocrine balance. Most people are familiar with the cretin; this is a child suffering from dimunition or absence of the thyroid secretion. Such a child is small, wizened, prematurely senile, and in the complete type an idiot. The analagous picture seen when thyroid deficiency occurs in later life produces a type known as myzoedema. Such people are fat, slow, dull, with a dry skin, sunken eyes and other symptoms dependent upon absence of the dynamic effect of the thyroid secretion. The type is easily recognisable by medical men; the restoration to normal of such an individual when thyroid extract is administered is one of the miracles of modern science.
mainly disturbed. and recognised as
At the opposite pole personalities are encountered, the most striking feature of which is an excess of thyroid secretion ; perhaps it would be more accurate to say in excess of the needs of the body. Such a type is the exact opposite of the myxedematous subject; instead of being heavy, fat and lethargic, such an individual will be lively, emotional and unreasonable. The French have spoken " the syndrome of persistent juvenilityIn between these two of this type as extremes there is a range of almost indefinite nature in which the thyroid may be slightly in excess or slightly deficient. It is interesting to try and estimate what part the thyroid is playing in the There are now certain laboratory tests personality of any one individual. depending upon the rate of wear and tear in the body, and these indicate, although not necessarily arbitrarily, the condition of the thyroid apparatus. I think it may be said that the thyroid stands out pre-eminently in considering personality and the endocrines. It may be that as our knowledge progresses and we know more about the part which others of the endocrine hierarchy play, *
pp, 194-195.
MENTAL WELFARE.
that the
69
At present, however, lower level in this scheme. to this gland than we can to any other ol the endocrine organs. The following are a few brief points in connection with the influence of other glands on the personality.
thyroid
will sink to
we can be more definite in
a
regard
Ihe adrenal personality is a type of individual dominated by his adrenal According to Dr. Berman, these types are normal individuals, enjoying good health and comfortably adapted to their environment. The skin is always more or less pigmented, and areas of darker nature than the surrounding skin are said to be related to past illnesses. In Addison's disease, where there is deficiency of the adrenal secretion, the general bronzing of the skin is found in like manner. It is presumed that the dark areas seen in the adrenal type point to past deficiencies. The adienal personality is a dark-skinned type with thick, coarse and dry hair, the canine teeth are well marked, the line of the hair on the forehead is low, and such People do not, as a rule, run to fat. Mentally, it is believed that an individual whose adrenals are pre-eminent, is a good fig'hter, persevering, impeiious, 1 he two pituitary types stubborn, and a highly intelligent being. can^ be summarised as follows : When the gland is adequate and dominant, there is a large spare frame, eyes wide apart, broad face, large teeth, square-featured When the gland is not jaws, an aggressive, calculating, able character. dominant, small delicate skeleton, adipose and weak muscles, dry, flabby but smooth skin, mentally sluggish, dull and apathetic.
gland.
Much that
we have written here is, of course, hypothetical, but it is becoming clear that the types of personality can be correlated to what has called the endocrine pattern. In any case, it is interesting to try and estimate (even though at present we lack the necessary data to be dogmatic) how our minds depend upon the physical strata. Before leaving this subject, we might just mention how interesting it is to trace the effect of past illnesses uPon the individual's endocrine glands. The thyroid deficiency, for example, may commence after an acute childish infection such as measles, scarlet fever, and influenza. On the other hand, it is believed that over-action of this gland is always due to the presence of irritating poisons somewhere or other in the body, and medical science has laid it down in the treatment of such cases that all septic or toxic sources must be eradicated.
increasingly been
The Theory of Organotherapy. The brilliant results which followed tne administration of thyroid substance to cretins and the subjects of myxoedema led to the attempt to supply to the ?rganism any secretion presumed to be missing. Ihus, in a case showing
symptoms
a failing supply of the adrenal hormone, adrenal substance was to a patient suffering from hypo-pituitarism, extract oi the pituitary given; and to an individual deficient in the internal secretion of the sexual the appropriate remedy was prescribed. In many cases, however, the brilliant results anticipated failed to materialise, possibly because the extiact Was destroyed in the stomach or otherwise interfered with by the process of digestion. In some instances there can be no doubt that preparations manuactured from endocrine organs other than the thyroid, are active and have a
of
administered; was glands,
definite
effect
This
on
the individual.
organotherapy?the substitutive?is not the only method employed. Some of the secretions are employed for their pharmacological effect, lust as drugs are so utilised. Chief among these are adrenalin and pituitrin. ?th of these substances have found a very definite place in surgery, a place, moreover, that could scarcely be filled by any other substance. use
of
70
MENTAL WELFARE.
Still another approach to the therapeutic side of the endocrines is afforded the attempt to balance the over-action of one g-land by the administration of by This has already been referred to by quoting- the an antagonistic secretion. in pver-action of the thyroid. substance adrenal of Attempts have prescription likewise been made to balance over-action of the adrenals by the exhibition of pancreatic substance. are
There is not much to be said in favour of either of these examples, but to show the lines along which experiments have been made.
they
quoted
Combinations of glandular substances have been very popular of late years, " have been dubbed shot-gun preparations." At first sight these may But it must be remembered that it is very appear unscientific and illegitimate. difficult to diagnose accurately in practice the actual gland which must be " mitrailleuse " indicted, whatever it may be in theory. It is better to use a than attempt no alleviation. and
As we must realise that we are only on the fringe of this subject. have got, the achievements are considerable. The future seems to promise well; and it may be that to endocrinology?and its therapeutic companion, organotherapy?we shall look for the rectifying of many of the disorders met with in civilised life, and for the neutralising of many of the abnormal states, both of mind and body. far
Finally,
as
we
Mental Welfare
and
the
By Ivo Geikie Cobb,
Author of
"
The
Organs of
63
Endocrine
M.D.,
Organs.
M.R.C.S.
Internal Secretion" Aids to
Organotherapy,"
etc.
Introduction.
It is
in recent years that our knowledge of those small bodies which the Endocrine glands has been sufficient to be of any real practical value to the physician. We are still, moreover, only on the threshold of secrets which these bodies contain; but so fascinating is the study of the ductiess glands and their role in the psycho-physical mechanism of the individual, that We may be forgiven for discussing' in some detail their functions and structure. The gaps in our knowledge are still so wide that we have perforce often to content ourselves with speculation where exactitude should be possible. But it is daily becoming easier to fit fresh pieces in the puzzle, and it gradually becomes plainer that the part played by these organs is of the first importance to bodily health and mental efficiency. Furthermore, it behoves us all to realise that the future holds out hope that the treatment of many disorders of mind and body will be materially helped by the use of preparations manufactured from the glands of animals. are
known
only as
^the
Historical.,
Interest
aroused among physiologists as early as the middle of the last century in those organs of the body, which, while of definite glandular structure, yet appeared to 1 his possess no ducts through which to deliver their secretions. was the period in which scientific interest was aroused in this subject. But if We go back to less enlightened days, we can trace the administration of Preparations of animal organs down to very early times. Shakespeare's " eye " of newt and toe of reminds the reader of an empericism both nasty and frog was
Meaningless.
In 1859,
a physiologist named Schiff discovered that the removal of the led to death. Kocher's work subsequently confirmed and enlarged this while the work of Vassale in Italy, Gley in France, and G. R. in England, turned the attention of the scientific world to the importance of the thyroid gland and the possibility of feeding individuals deficient in the secretion of this gland with the thyroid of the sheep. This was the first positive proof that a deficient thyroid could be replaced per os, and was, in fact, the dawn of modern scientific organotherapy.
thyroid
knowledge; Murray
Previous results of
to this, a physician named Brown-S?quard had published administering organic substances, more especially in senility,
had claimed
decay
that their
use
the and warded off the onset of old age and neutralised the
which accompanied senility. His experiments were not generally accepted, and to some extent, perhaps, his claims were exaggerated. Nevertheless, he is known as the Father of Organotherapy," and it must be conceded that he Was the first to draw attention to the possibility of treating disease by means oi Preparations manufactured from animals. "
Many
other
stand out as pioneers in this field, both as to the role and as to their efficacy in treatment. Enough has been glands said, however, to indicate in general terms how the comparatively recent development of this subject has revolutionised medicine and has placed in the hands of ?f the ductless
names
the clinician fresh weapons with which
to
fight disease.
64
MENTAL WELFARE. General Considerations.
There are several glands in the body which are unprovided with ducts and The chief among which pour their secretions directly into the blood-stream. these are the thyroid, parathyroids, pituitary, and adrenals. Other organs are provided with ducts through which the juice they manufacture can reach its destination. While some?possibly many more than is at present believed?produce both an internal secretion which is absorbed directly into the blood-stream and an external secretion which leaves the gland by its duct. An example of an ordinary gland is the parotid, one of the salivary glands, which manufacture saliva which is poured into the mouth through its duct. Whether all glands possess an internal as well as an external secretion is a point not yet settled. Certain glands, however, are known to be so and perhaps the best example is the pancreas, commonly known as constructed, " the sweetbread." This gland furnishes its external digestive juice and also possesses an internal secretion, whose function is to regulate sugar metabolism. Any damage to the cells in the pancreas which manufacture this secretion results in the appearance of increased amounts of sugar in the blood and sugar in the urine?in other words, diabetes. The production of insulin (the substance obtained from the pancreas of animals) and its use in the treatment of diabetes, is one of the most brilliant and epoch-making achievements in the history of the subject we are now considering. Prior to this discovery, diabetes could be treated only by diet and symptomatic drugs. Other glands possessing both internal and external secretions are to be found among the sexual organs, and probably many of the glands, such as the liver, spleen, etc., whose work is concerned primarily with metabolism. The presence of an internal secretion in both the male and female sexual glands is shown by the mental and physical changes which accompany puberty, the change of life, and extreme old age. When the boy merges into the man, the so-called " secondary sex characters are produced by an internal secretion. The mental development which takes place at such times is due to the sensitising or the reverse of these secretions upon the central and sympathetic nervous systems. Many so-called metastatic effects, i.e., changes in distant organs dependent upon the development of some change in a disordered gland, were thought formally to be dependent upon reflex causes. They are now known to be the result of chemical messages, initiated by the secretions of the endocrine glands. Individual Glands. The corner-stone of the Endocrine system is the thyroid. This gland is situated across the larynx and can be felt at either side of the " Adam's apple." It is composed of two lobes connected with each other by a central lobe or isthmus. The secretion which this gland furnishes to the blood is of the greatest importance to the animal economy; any disturbance of its function is followed by changes in the general metabolism. It is as if one man at the end of a line of soldiers is pushed on by his neighbour, who, in turn, bumps against the next Excess or deficiency of the thyroid hormone leads man, and so on down the line. to changes in the adrenals, to disturbance of the pituitary, parathyroids, and, it may be, several other of the endocrine system. in general terms, the function of the thyroid is to nourish the nails and hair; to regulate the circulation; to act (in conjunction with the adrenals and pituitary) in the sympathetic control of the body; and (in virtue of
skin,
Speaking
MENTAL WELFARE. *ts relation with the
to
the emotional life of sympathetic) the body. As we shall see in a later
play
important
an
65 r61e in the formation of
of thyroid secretion is The disease variously known as exophalmic goitre, Graves's disease, or hyperthyroidism, changes the personality ?f the sufferer From a normal person, the patient becomes to a painful degree. excitable, irritable, and unreliable. That it is not solely due to over-action of the thyroid will appear later in this paper; but that it is partly due to this factor
always
excess
page,
associated with undue emotionalism.
now
abundantly clear. In close anatomical Pairs of small
proximity to the thyroid gland, there are found two neighbours called the parathyroids. Originally believed to be part of the thyroid and to consist of thyroid tissue which had become separated from the main gland, it is now known that they are independent structures, and, indeed, in many ways antagonistic to the thyroid secretion. Some of the early
experiments
carried out on the thyroid led to conflicting results, because some had removed the parathyroids, while others had left these glands tn situ.. The results varied according to whether the entire thyro-parathyroid had been removed, or solely the thyroid.
observers
Removal of the parathyroids
fatal if
complete; if part only is system of the animal, and a " condition known as In some way, the parathyroids are ensues. tetany concerned in the calcium metabolism, and excessive loss of lime from the body leads to the nervous symptoms encountered in tetany. It is not possible as yet to say that a condition such as Anxiety Neurosis can be attributed to parathyroid or that it is relieved by the administration of extract of the parathyroids. There are, however, instances on record in which thyroid extract has done harm to such a case, while parathyroid extract has been beneficial.
removed,
marked
changes
take
"
is
place
always in the
nervous
deficiency;
The clinical pictures of over-action of the thyroid and under-action of the have certain points in common. This would suggest an antagonism two secretions, and this view is now generally he'd.
Parathyroids between the
Situated
at the base of the
brain, enclosed in a small It consists of an anterior and
bony box, is a gland posterior lobe and a stalk, and its structure is partly glandular, partly nervous. Our knowledge of this gland and its functions is of even more recent acquisition than is our acquaintance with the thyroid and the interstitial tissue of the ovary and testis.
known
as
the
Pituitary.
^
The functions of the pituitary may be regarded from two angles, according whether we are considering the anterior or posterior parts.^ The anterior or glandular portion is largely concerned with metabolism ; and it is believed that failure of this part of the gland results in a disease characterised by obesity and to
deficient development, although
doubt
has been cast upon this
school which believes it is the posterior portion which is responsible
obesity.
view
tor
y
one
pituitary
With the space at our disposal it is impossible to do more than take a general of the main glandular secretions and their functions, and we must be excused for apparent dogmatism if we state the position briefly in order to show that the mentality of the normal and the abnormal is dependent respectively upon glandular efficiency or failure.
survey
It is at least likely that the pituitary gland should be regarded as one_organ rather than from the of two parts, possibly antagonistic or wide y dif ering angle in their functions. The gland is one of the dynamic structures of the body. It works in conjunction with the and adrenals; and we shall refer
thyroid, gonads,
MENTAL WELFARE.
66
a later section to the type which is believed to result when its secretion is the dominant one in the endocrine hierarchy.
in
A few words about the thymus. This gland, which is situated in the thorax, is active principally during- infancy and childhood, and diminishes in importance In some instances it continues its activities into as the sexual activities develop. adolescence and causes delay in normal development or produces a general disturbance of the glandular balance.
The adrenal glands are two small structures found above the upper part of each kidney. They consist of two parts, a cortex and a medulla, the functions The former is much larger than the latter of which are strictly differentiated. and is different histologically. It bears a close and intimate relation with the sexual glands, and tumours of this part of the gland have been shown to be associated with the premature development of sex.
medulla, on the other hand, is the part of the adrenals which secretes This substance, the isolation of which was carried out by Takamine, remarkable and vitally important secretion; its introduction into medicine surgery has marked an epoch in the practical application of the internal
The
adrenalin.
is a and secretions in treatment.
What is of greater interest to us in this connection is the relation of the adrenal glands and their functions to the nervous system, and particularly to It must be remembered that the most that part known as the sympathetic. primitive form in which stimuli were originated and conducted was by chemical Nervous structures were differentiated later in the evolutionary messengers. scale, and were evolved as the organism became more complex and its need for rapid communication became more essential. The central nervous system furnishes this means; the sympathetic, more closely allied in time and function to the
endocrine
glands, developed pari
passu with them.
The adrenal system, with its secretions, is very similar in its work to the sympathetic nervous system. It controls the involuntary muscular system, and in conjunction with the thyroid and pituitary, is responsible largely for the In addition to this, its activities metabolism and circulatory tone of the body. colour, if they do not determine, the mental type of the individual. Further, we now know that changes in the mental outlook?the temporary states known as " moods "?can be correlated with the undue activity or quiescence of the sympathetic nervous system and its colleagues. has now been said to indicate that the mental life of the individual much to the glands of internal secretion. Not only in the determination of the type to which he will belong, but to the changes which will take place from time to time in the endocrine balance, will he owe alterations in his emotional life and in his relations to his environment.
Enough
owes
Inter-Relation There is
of
the
Ductless Glands.
definite balance recognised in the endocrine
hierarchy; that is to glands may be regarded as dynamic or positive; the opposing glands are inhibitory or negative. Excess of thyroid secretion may be associated with excess of the adrenals. The small neighbours of the thyroid, the parathyroids, are even now somewhat of an unknown quantity. That they play a very important part in mental and bodily health, there is no doubt; but it say,
one
a
set of
changes in the health due to these glands can be recognised except perhaps in a very limited manner. Many attempts have been neutralise the excess of one gland by the administration of an extract
cannot be said that
definitely, made to
MENTAL WELFARE.
67
Of one which may be regarded as antagonistic. One of the early examples of these was to endeavour to neutralise excessive thyroid secretion by extracts of the adrenal glands. It is now believed, however, that the symptoms of nervous which are seen in over-action of the thyroid are probably due more excitability to the adrenals than to the thyroid. All the endocrine glands are to some extent concerned in the metabolism of the body. Laboratory tests can tell us whether the thyroid is over-active or whether the pituitary is not doing its share of work. The administration of an extract of the thyroid or pituitary in a suitable case "will often work wonders. The various glands concerned in sex have been studied with great care from the point of view of the internal secretions; and it is known that the thyroid and pituitary, to mention two, are undoubtedly related with the internal secretions of the gonads. The pancreas is equally in inter-relation with these glands, and the mechanism that controls sugar utilisation in the body varies according to the activity of both the thyroid and the pituitary. The changes which may be seen after middle-life in both sexes have their basis in the endocrine supplies. Equally the inter-relation of the various glands depends upon the balance set up by their working adequately and in harmony. What used to be called the mental faculties are unquestionably closely dependent upon the smooth A violent mental shock is capable of of the endocrines. working so upsetting this balance that the emotions may become disturbed for a lengthy
Period.
death which of the
Thus Trousseau describes
a lady who was suffering great grief on the suddenly felt her eyes swell and lift up her eyelids, was accompanied by violent palpitations and throbbing and enlargement thyroid.
of her father and she
The Endocrines
and
the
Emotiohs.
Many such cases were seen during the war where sudden or prolonged strain Produced a disturbance in the endocrine balance. Anyone who observed such cases in the battle areas will agree that the group of disorders variously called neurasthenia,
shell shock, and anxiety neurosis, were very largely dependent on The instincts which were predominant under shell fire resulted in increase in the adrenal activity; and this gland has therefore been called the gland of "fight or flight," because it is the gland which is called upon to activate the reserves of the body in an emergency or crisis. The sympathetic nervous system is the Morphologically it is in close relationship with messenger of emotions. the adrenals, so that undue emotion is likely to produce hyperadrenia. This, in its turn, will produce thyroid changes. One observer has shown that the adrenals have a definite effect upon the thyroid, for it is possible to pioduce marked changes in the cells of the thyroid by repeated injections of adrenalin. Again, adrenalin will alter the metabolism of the body, and a more or less constant disturbance of the adrenal system may lead to such changes as we may group under the generic name of debility.
this
cause.
histological
Personality
and
the
Ductless Glands.
Dr. Louis Berman published a fascinating book in 1922 entitled The Elands Regulating Personality." His object was to show, from the purely Physical standpoint, how the mind and its attributes depended upon the action and inter-action of the The pattern of the personality, so to ductless glands. speak, depends upon w'hat may be called the relative proportion of the different ?nternal secretions. Many of Dr. Berman's types of personality are definitely recognisable, and the interest of the reader is kept up by a chapter describing some historic As an example of his contentions, we may quote personages.
68
MENTAL WELFARE.
" from chapter nine of his book, which is called the Backgrounds of Personality." of methods the of approach which have been adopted There is a brief review here " " nerves and nervous disorders, and the evolution of the present towards on these subjects. Dr. Berman describes the physical basis of the knowledge unconscious and says : *" Another vastly important law that governs the content of the conscious and the unconscious, and resultant behaviour is the fact that the nerves and nerve cells of the vegetative apparatus, the nerves leading to the viscera and the endocrine glands, like the solar plexus, are affected by stimuli of lower value than those which arouse the brain cells. In the metaphorical language of the old psychology, the threshold value, that is the strength or loudness of stimulus sufficient to make itself felt or heard, is less for the vegetative apparatus than for the brain. So we begin to glimpse why an emotion seems to be experienced before the visceral changes that really preceded it, but pressed This gives us a clue to the unconscious their way into consciousness later. as the more sensitive and deeper part of the mind. "
More than that, it supplies us with a physical basis for the unconscious, which will explain much of the observed laws of its workings. It provides a reason for the apparent swiftness, spontaneity and unreasonableness of what is called intuition. And it may show us a source for a good deal of the material of dreams and dream states. "We have said that we think and we remember, not alone with the brain, but with the muscles, the viscera and the endocrines. So do we forget, not alone with the brain, but with the muscles, the viscera, the endocrines and their The utmost importance of muscle attitudes in remembering has been nerves. established in the experimental laboratory." In marked disorders of the endocrines it can often be said which gland is Let us consider for a moment one or two of the types seen due to a disordered endocrine balance. Most people are familiar with the cretin; this is a child suffering from dimunition or absence of the thyroid secretion. Such a child is small, wizened, prematurely senile, and in the complete type an idiot. The analagous picture seen when thyroid deficiency occurs in later life produces a type known as myzoedema. Such people are fat, slow, dull, with a dry skin, sunken eyes and other symptoms dependent upon absence of the dynamic effect of the thyroid secretion. The type is easily recognisable by medical men; the restoration to normal of such an individual when thyroid extract is administered is one of the miracles of modern science.
mainly disturbed. and recognised as
At the opposite pole personalities are encountered, the most striking feature of which is an excess of thyroid secretion ; perhaps it would be more accurate to say in excess of the needs of the body. Such a type is the exact opposite of the myxedematous subject; instead of being heavy, fat and lethargic, such an individual will be lively, emotional and unreasonable. The French have spoken " the syndrome of persistent juvenilityIn between these two of this type as extremes there is a range of almost indefinite nature in which the thyroid may be slightly in excess or slightly deficient. It is interesting to try and estimate what part the thyroid is playing in the There are now certain laboratory tests personality of any one individual. depending upon the rate of wear and tear in the body, and these indicate, although not necessarily arbitrarily, the condition of the thyroid apparatus. I think it may be said that the thyroid stands out pre-eminently in considering personality and the endocrines. It may be that as our knowledge progresses and we know more about the part which others of the endocrine hierarchy play, *
pp, 194-195.
MENTAL WELFARE.
that the
69
At present, however, lower level in this scheme. to this gland than we can to any other ol the endocrine organs. The following are a few brief points in connection with the influence of other glands on the personality.
thyroid
will sink to
we can be more definite in
a
regard
Ihe adrenal personality is a type of individual dominated by his adrenal According to Dr. Berman, these types are normal individuals, enjoying good health and comfortably adapted to their environment. The skin is always more or less pigmented, and areas of darker nature than the surrounding skin are said to be related to past illnesses. In Addison's disease, where there is deficiency of the adrenal secretion, the general bronzing of the skin is found in like manner. It is presumed that the dark areas seen in the adrenal type point to past deficiencies. The adienal personality is a dark-skinned type with thick, coarse and dry hair, the canine teeth are well marked, the line of the hair on the forehead is low, and such People do not, as a rule, run to fat. Mentally, it is believed that an individual whose adrenals are pre-eminent, is a good fig'hter, persevering, impeiious, 1 he two pituitary types stubborn, and a highly intelligent being. can^ be summarised as follows : When the gland is adequate and dominant, there is a large spare frame, eyes wide apart, broad face, large teeth, square-featured When the gland is not jaws, an aggressive, calculating, able character. dominant, small delicate skeleton, adipose and weak muscles, dry, flabby but smooth skin, mentally sluggish, dull and apathetic.
gland.
Much that
we have written here is, of course, hypothetical, but it is becoming clear that the types of personality can be correlated to what has called the endocrine pattern. In any case, it is interesting to try and estimate (even though at present we lack the necessary data to be dogmatic) how our minds depend upon the physical strata. Before leaving this subject, we might just mention how interesting it is to trace the effect of past illnesses uPon the individual's endocrine glands. The thyroid deficiency, for example, may commence after an acute childish infection such as measles, scarlet fever, and influenza. On the other hand, it is believed that over-action of this gland is always due to the presence of irritating poisons somewhere or other in the body, and medical science has laid it down in the treatment of such cases that all septic or toxic sources must be eradicated.
increasingly been
The Theory of Organotherapy. The brilliant results which followed tne administration of thyroid substance to cretins and the subjects of myxoedema led to the attempt to supply to the ?rganism any secretion presumed to be missing. Ihus, in a case showing
symptoms
a failing supply of the adrenal hormone, adrenal substance was to a patient suffering from hypo-pituitarism, extract oi the pituitary given; and to an individual deficient in the internal secretion of the sexual the appropriate remedy was prescribed. In many cases, however, the brilliant results anticipated failed to materialise, possibly because the extiact Was destroyed in the stomach or otherwise interfered with by the process of digestion. In some instances there can be no doubt that preparations manuactured from endocrine organs other than the thyroid, are active and have a
of
administered; was glands,
definite
effect
This
on
the individual.
organotherapy?the substitutive?is not the only method employed. Some of the secretions are employed for their pharmacological effect, lust as drugs are so utilised. Chief among these are adrenalin and pituitrin. ?th of these substances have found a very definite place in surgery, a place, moreover, that could scarcely be filled by any other substance. use
of
70
MENTAL WELFARE.
Still another approach to the therapeutic side of the endocrines is afforded the attempt to balance the over-action of one g-land by the administration of by This has already been referred to by quoting- the an antagonistic secretion. in pver-action of the thyroid. substance adrenal of Attempts have prescription likewise been made to balance over-action of the adrenals by the exhibition of pancreatic substance. are
There is not much to be said in favour of either of these examples, but to show the lines along which experiments have been made.
they
quoted
Combinations of glandular substances have been very popular of late years, " have been dubbed shot-gun preparations." At first sight these may But it must be remembered that it is very appear unscientific and illegitimate. difficult to diagnose accurately in practice the actual gland which must be " mitrailleuse " indicted, whatever it may be in theory. It is better to use a than attempt no alleviation. and
As we must realise that we are only on the fringe of this subject. have got, the achievements are considerable. The future seems to promise well; and it may be that to endocrinology?and its therapeutic companion, organotherapy?we shall look for the rectifying of many of the disorders met with in civilised life, and for the neutralising of many of the abnormal states, both of mind and body. far
Finally,
as
we
