Mental Welfare and the Endocrine Organs
- Author:
Ivo Geikie Cobb, M.D., M.R.C.S.
Author of ” The Organs of Internal Secretion” Aids to Organotherapy,” etc. Introduction.
It is only in recent years that our knowledge of those small bodies which are known as 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 ^the 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.
Historical.
Interest was 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 possess no ducts through which to deliver their secretions. 1 his 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 frog ” reminds the reader of an empericism both nasty and Meaningless.
In 1859, a physiologist named Schiff discovered that the removal of the thyroid led to death. Kocher’s work subsequently confirmed and enlarged this knowledge; while the work of Vassale in Italy, Gley in France, and G. R. Murray 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.
Previous to this, a physician named Brown-S?quard had published the results of administering organic substances, more especially in senility, and had claimed that their use warded off the onset of old age and neutralised the decay 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 names stand out as pioneers in this field, both as to the role ?f the ductless glands and as to their efficacy in treatment. Enough has been said, however, to indicate in general terms how the comparatively recent develop- ment of this subject has revolutionised medicine and has placed in the hands of the clinician fresh weapons with which to fight disease.
General Considerations.
There are several glands in the body which are unprovided with ducts and which pour their secretions directly into the blood-stream. The chief among 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 constructed, and perhaps the best example is the pancreas, commonly known as 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 man, and so on down the line. Excess or deficiency of the thyroid hormone leads to changes in the adrenals, to disturbance of the pituitary, parathyroids, and, it may be, several other of the endocrine system.
Speaking in general terms, the function of the thyroid is to nourish the skin, 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 *ts relation with the sympathetic) to play an important r61e in the formation of the emotional life of the body.
As we shall see in a later page, excess of thyroid secretion is always associated with undue emotionalism. The disease variously known as exophalmic goitre, Graves’s disease, or hyperthyroidism, changes the personality ?f the sufferer to a painful degree. From a normal person, the patient becomes 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 now abundantly clear.
In close anatomical proximity to the thyroid gland, there are found two Pairs of small 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 observers 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.
Removal of the parathyroids is always fatal if complete; if part only is removed, marked changes take place in the nervous system of the animal, and a condition known as ” tetany ” ensues. In some way, the parathyroids are 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 deficiency; 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.
The clinical pictures of over-action of the thyroid and under-action of the Parathyroids have certain points in common. This would suggest an antagonism between the two secretions, and this view is now generally he’d.
Situated at the base of the brain, enclosed in a small bony box, is a gland known as the Pituitary. It consists of an anterior and 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. The functions of the pituitary may be regarded from two angles, according to 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 deficient development, although doubt has been cast upon this view y one school which believes it is the posterior portion which is responsible tor pituitary obesity.
With the space at our disposal it is impossible to do more than take a general survey 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.
It is at least likely that the pituitary gland should be regarded as one_organ rather than from the angle of two parts, possibly antagonistic or wide y dif ering in their functions. The gland is one of the dynamic structures of the body. It works in conjunction with the thyroid, gonads, and adrenals; and we shall refer in a later section to the type which is believed to result when its secretion is the dominant one in the endocrine hierarchy.
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 as the sexual activities develop. In some instances it continues its activities into 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 of which are strictly differentiated. The former is much larger than the latter 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.
The medulla, on the other hand, is the part of the adrenals which secretes adrenalin. This substance, the isolation of which was carried out by Takamine, is a remarkable and vitally important secretion; its introduction into medicine and surgery has marked an epoch in the practical application of the internal 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 that part known as the sympathetic. It must be remembered that the most primitive form in which stimuli were originated and conducted was by chemical messengers. Nervous structures were differentiated later in the evolutionary 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 metabolism and circulatory tone of the body. In addition to this, its activities 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.
Enough has now been said to indicate that the mental life of the individual owes 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.
Inter-Relation of the Ductless Glands.
There is a definite balance recognised in the endocrine hierarchy; that is to say, one set of 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 para- thyroids, 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 cannot be said that changes in the health due to these glands can be recognised definitely, except perhaps in a very limited manner. Many attempts have been made to neutralise the excess of one gland by the administration of an extract 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 excitability which are seen in over-action of the thyroid are probably due more 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 working of the endocrines. A violent mental shock is capable of so upsetting this balance that the emotions may become disturbed for a lengthy Period. Thus Trousseau describes a lady who was suffering great grief on the death of her father and she suddenly felt her eyes swell and lift up her eyelids, which was accompanied by violent palpitations and throbbing and enlargement of the thyroid.
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 this cause. 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 messenger of emotions. Morphologically it is in close relationship with 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 histological 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.
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 ductless glands. The pattern of the personality, so to 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 personages. As an example of his contentions, we may quote from chapter nine of his book, which is called the ” Backgrounds of Personality.” There is a brief review here of the methods of approach which have been adopted towards ” nerves ” and nervous disorders, and the evolution of the present knowledge on these subjects. Dr Berman describes the physical basis of the 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 their way into consciousness later. This gives us a clue to the unconscious 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 nerves. The utmost importance of muscle attitudes in remembering has been established in the experimental laboratory.”
In marked disorders of the endocrines it can often be said which gland is mainly disturbed. Let us consider for a moment one or two of the types seen and recognised as 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. 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 of this type as ” the syndrome of persistent juvenilityIn between these two 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 personality of any one individual. There are now certain laboratory tests 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.
that the thyroid will sink to a lower level in this scheme. At present, however, we can be more definite in regard 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.
Ihe adrenal personality is a type of individual dominated by his adrenal gland. 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, stubborn, and a highly intelligent being. 1 he two pituitary types 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 jaws, an aggressive, calculating, able character. When the gland is not dominant, small delicate skeleton, adipose and weak muscles, dry, flabby but smooth skin, mentally sluggish, dull and apathetic.
Much that we have written here is, of course, hypothetical, but it is becoming increasingly clear that the types of personality can be correlated to what has been 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.
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 of a failing supply of the adrenal hormone, adrenal substance was administered; to a patient suffering from hypo-pituitarism, extract oi the pituitary was given; and to an individual deficient in the internal secretion of the sexual glands, 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 manu- actured from endocrine organs other than the thyroid, are active and have a definite effect on the individual.
This use of 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.
Still another approach to the therapeutic side of the endocrines is afforded by the attempt to balance the over-action of one g-land by the administration of an antagonistic secretion. This has already been referred to by quoting- the prescription of adrenal substance in pver-action of the thyroid. Attempts have likewise been made to balance over-action of the adrenals by the exhibition of pancreatic substance.
There is not much to be said in favour of either of these examples, but they are quoted to show the lines along which experiments have been made. Combinations of glandular substances have been very popular of late years, and have been dubbed ” shot-gun preparations.” At first sight these may appear unscientific and illegitimate. But it must be remembered that it is very difficult to diagnose accurately in practice the actual gland which must be indicted, whatever it may be in theory. It is better to use a ” mitrailleuse ” than attempt no alleviation.
Finally, we must realise that we are only on the fringe of this subject. As far as we 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.
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