The endocrines

Preface

Heredity is the most profound factor in life. Environment is an ever present influence. Physiological functions have a well recognized normal basis, and deviations therefrom come under the head of the abnormal or pathological. A continuous struggle against bacteria calls into play the protective and defensive mechanism of the body. In this struggle, as well as in the fight against new growths, not only are the principles of physiological chemistry and bio-chemistry to be considered, but likewise the defense and protection supplied by what are known as the ductless glands. Congenital and hereditary deviations in the functions of the ductless glands, altered inter-relations at different physiological periods, the attacks of bacteria, environment, etc., are productive of many physical, mental and psychic abnormalities. Heredity, the effects of environment, and many of the states of mankind can be properly appreciated only by an understanding of endocrine activity and interrelation.

The development of the tissues and structures of the body, the normal development of the cerebro-spinal system, the proper functioning of the various structures and tissues are all intimately connected with the work of the ductless glands. The function of the all important autonomic nervous system depends much, if not entirely, on a proper balance of the endocrine system. Mental states, psychoses, neuroses, abnormal as well as normal behavior, are all quite as closely related to these important

IV PREFACE

ductless structures. If we are, in the final analysis, very much the expression of the activities of the endocrines on the autonomic nervous S3^stem and on our instincts and emotions, and if our instincts and emotions are deeply related to the endocrines, then mens sanis in cor pore sano takes on an added significance. The subconscious state is intimately linked with the instincts and emotions. How much closer to the true and wholesome are we led by these facts than by the aberrations of the theories of Freud.

What is known of the endocrine glands is bearing more than sufficient root to form a working basis for the understanding of these numerous hereditary, physical and psychic questions. Only by therapy and by the use of the extracts of these glands can we be led to definite conclusions. Hence, every practicing physician has in his hands the material with which he may lend aid in the research along these lines.

It is in the hopes of putting the basic principles of endocrinology and many of the questions which hold out promise of solution into the hands of interested medical men that this work has been put into print. I have drawn from the works of Gushing, Biedl, Knauer, Falta, Davenport, Guyer, Gannon, ]\IcDougall and others, giving credit wherever possible. Alany of these authorities were consulted and studied years ago. IMuch of what was originally viewed with skepticism is now generally accepted as current truth. Whatever of theory is printed in these pages represents an attempt at a solution of vexing problems. It would be idle to claim that there may be no change in some of these theories, but a beginning must be made, and while a beginning is made with hesitation, these opinions are offered on the basis of therapy fortified by clinical observation. If in so many

PREFACE V

fields the results of therapy are as favorable as they would seem, this effort too has been worth while. If the factors which suggest the relation of the endocrines. among them adrenal cortex and especially pituitary gland, to fibromyomata prove other than visionary, then the possible solution of the etiology of malignant growths will be hastened.

S. Wyllis Bandler. 134 W. 87th St.,

New York City.

November, ip20.

Chapter I Introductory

Medical training may have its faults on the anatomical and laboratory side of its teaching, in that it demands too much time and attention to these points to the exclusion of sufficient information and knowledge concerning the individual, his instincts, his emotions and his psyche. Too many men are imbued with the notion that the laboratory side is the all important and while histology, pathology, physiological chemistry, the various blood, metabolic and other tests are oi the greatest importance in adding to our knowledge and in aiding our diagnosis, the intensive study of and devotion to these branches are and must remain within the province of men devoted to that particular type of work; and while the physician must understand the importance of these examinations and tests and must of course be able to interpret their meaning, he should not neglect and must not neglect the study of human nature, of psychology, peculiarities of physical, mental and psychic type, the study of the endocrines, etc., the interpretation of which ought to be given to him by no one but himself when applied to each case in his practice, Th€ old-fashioned, kindly physician we recall from our boyhood days, the country practitioner, brought up in a small community, the man whose childhood and environment brought him into close contact with all sorts of people whose past and present he understood, without knowing at the time that he did understand ; the man with the innate power to understand and analyze human beings possesses no mean advantage over the type of physician who is ultra-scientific in the laboratory sense and nothing more. The ideal, of course, is a combination of the two.

Z THE ENDOCRINES

Of all men the physician is thrown into closest relations for the study of man and his ills. It is, however, no longer a question of examining the lungs, the heart, the kidneys, taking the blood pressure, examining the blood and then giving his advice; it is no longer a question of combating the various infectious diseases; it is not alone a struggle with the various forms of benign and malignant tumors; it is no longer the practice of surgery with its saving of life and the improvement of health; the physician should be able and must be able to understand the difference between normality and abnormality in the innumerable deviations of body, mind and psyche associated with and due to the ductless glands. They are the underlying factors in heredity; they have to do with growth and development of body and mind; they have to do with instincts and emotions; they have to .do with normal and abnormal psychic and mental states; and from these ills come more torture and suffering than anyone but the physician really appreciates.

The differences between animals of various species are due to the ductless glands. The variations between animals of the same species are due to the ductless glands. Race characteristics are produced and perpetuated by the same factors, and the differences among individuals of the same race likewise depend on endocrine activity; and resemblances in body, mind or psyche, whether the resemblance is that of normality or abnormality, are due to like or similar relations in the activity of the endocrines.

The instincts, the emotions, their relation to the endocrines and, therefore, to behavior will be discussed later ; a very brief reference to these most important questions is in place. Among the more important instincts and emotions are (1) The instinct of flight and the emotion of fear; (2) The instinct of pugnacity and the emotion of anger, as evidenced by fighting; (3) The instinct of self-assertion and the emotion of elation evidenced by the ego and independence; (4) The instinct of subjection and the emotion of subjection, shown by negative self-feeling; (5) The instinct of suggestibility shown by the

INTRODUCTORY 3

readiness to accept or to be taught; (6) The instinct of contrasuggestion, which is one of the most determining factors in human or animal Hfe; (7) The sex instinct, which is quite different from (8) the maternal and the paternal instincts; (9) The gregarious instinct evidenced by hunting in packs, the desire to be in company, in groups, associated with one's fellows.

Chapter II Environment And Heredity

There has always been the problem of the relative importance of heredity and environment. The laws of heredity are to a great extent known, thanks to the untiring efforts and study of our still unrecognized scientists. And these laws are being continually verified and amplified. The laws of heredity as to instincts and emotions are probably quite the same, but since the instincts and emotions are so capable of change, the study of the same presents a more difficult problem. Environment is not the proper term. It is not only the surroundings and the conditions and their character, it is the training or the treatment a baby, child or adolescent receives. Neither is training the proper word, for it calls to mind the circus with its whips and blows and show of power. The better term is treatment. If people imagine that a beautiful home and elegant interior, comforts and luxuries are the heights of environment and that this is all or the most essential, they satisfy themselves and their consciences only too readily. It is the treatment a child receives and the effect on its instincts and emotions that brings out the good or the bad or represses the good or bad. Intelligent treatment can be as well carried out in modest, wholesome surroundings. Even from the midst of poverty the world sees and has seen rise many, if not most, of its best and marvelous products, because difficulties, obstacles, struggles, work and necessity are related not only to the survival of the fittest, but to the success of the strong and the fighter. The effects of environment are important. Children observe and imitate and, however meagre is the artistic or aesthetic on the walls, on the floor or in the furniture there should be surroundings that do not create a lack of respect for the decencies, amenities and courtesies of life.

The chief idea in treatment and education is to prepare the human being for the work and obligations of life and for parenthood. Children should not be taught that the main purpose of life is pleasure and that a path of roses will always be theirs. They should be taught to expect little and whatever more comes to them is, in the current phrase, "velvet."

Girls should be prepared to take life as a long road. Why should they in their earlier years at home, school, or boardingschool center their thoughts too much on dress, social activities and gaieties? The domestic virtues are the best and these should be inculcated. When thought and activity are centered too much on any one phase, they exclude action in other channels. If occupied with too many phases that oppose each other, we develop the jumpy type of individual looking for and desiring change and excitement ; and while the instinct of Wanderlust is strongly inherent in many individuals, faulty treatment may readily develop this instinct into a physical or mental Wanderlust beyond the normal.

When a man and woman marry, are they supposed to train each other, or are they supposed to treat each other according" to their respective instincts and emotions and according to the most sacred principles of community of interest? No one has a right to expect of his partner more than that individual is capable of being. Therefore people should first know themselves and should be taught to understand others, for life in any of its relations is a matter of give and take and to most people it seems to be a question of take.

The treatment a person receives to a great extent determines his behavior and this appHes not only to individuals but to groups, communities, states and nations.

Several children in the same family may have the same environment and if they receive the same treatment, possessed as they probably are of different instincts and emotions, howcan we expect like results ? Not only have they inherited different physical qualities and different endocrine relation, but they have been differently affected by the infectious diseases of childhood, react differently to the same stimuli, and wise are the parents who sense these facts and act accordingly. What right have we, who are full of faults and weaknesses, who in our attitude and relation to others are often petty and ungenerous, to expect in the growing, immature minds those perfections of nature we so fondly desire for them, and what right have we to blame, criticize and condemn the very qualities, weaknesses and faults which we ourselves in all probability have passed on to them?

Earliest Impressions

A baby cries when brought into the world in contact with the air, or it is made to cry by slapping it. This reaction to external stimuli resulting in a cry is really the emotion of anger.' The newly-born child has the sensation of hunger as perhaps the most noticeable urge. All infants are sensitive to pain, and to the sense of the pleasurable. Even in its earliest days it may coo with all the notes of pleasure and contentment. In the earliest weeks it fixes its gaze on the face of the nurse and receives its first retinal impressions. These soon form an outline. The soft and the rough become differentiated, and repetitions of voice and the sight of the face prompt the evidences of recognition. Perhaps the voice rouses the first manifestation of recognition, although the really first habit is connected with suckling. Hearing, the sense of smell, the sense of taste, are continually recording the effect of stimuli and creating paths of experience. The skin, the bath, the powdering, the clothing, irritations, an occasional pin point, the instillations and washings of the eyes are creating new paths. Gradually the ego develops and soon the child begins to assert what amounts to a "yes" or a "no." The emotions of pleasure and anger are aroused extremely early, and fear is among the first of the arousable emotions. Soon the baby crawls, learns to balance itself, to stand, and eventually to walk.

Training as to the habits associated with physical functions may yield really wonderful results at a very early period, though physical states may thwart these attempts, — especially as regards nocturnal enuresis. Discipline, acting on the in-^ stincts and emotions may influence the infant according to the elements of subjection, self-assertion, suggestibility, fear,

ENVIRONMENT AND HEREDITY V

wonder, curiosity, and so on through the whole Hne of the simpler and more complicated or plural combinations.

A child of three years has its instincts and emotions well in evidence; its memory is excellent, it remembers what you promised to bring, asks questions, wants explanations, — and is in most ways a miniature adult. But the recall of this period of its existence is lacking in later life because of the immaturity of the cells receiving the impression. Yet the mechanism of each reaction to stimuli on the part of the instincts or emotions becomes established and sensitized so that fear of one or more sorts may persist as a tendency and be easily roused after one or two, or many repetitions of the original stimulus, even though later the recall of the original stimulus does not exist. But there comes a time after which the recall of incidents, events, and impressions is developed, and though a child may remember one fearsome or pleasurable event as its first recallable one, the same or a parallel impression associated with an emotion of fear may have been made dozens or a hundred times before. Therefore the effect of fear in these earlier unremembered years may be carried on through the remainder of life, even though, as just stated, the first recall may date from a later period. One may remember a book he has read long ago and may express his opinion of it. The impression has been made and the reader may consider it one of the most instructive books he has read, yet he may not connectedly recount the story or remember the names of more than a few of the characters until they are brought to mind by some one else, or by a rereading.

The earliest experiences of a child are the most important because paths are made by stimuli. These paths follow a course involving the psychic, physical, and nerve mechanism, with an associated endocrine reaction. Each path has been created by a peristaltic wave, so to speak. Such paths are naturally the most sensitive since they are the earliest, and the obliteration of the once well established psycho-physical neuro-endocrine path is impossible. The sensitiveness of this may be diminished or overshadowed, or no longer brought into play, but what was once created as a path or groove may still exist. With any such path there may be associated grooves or paths or inlets through allied senses, so that an impression made by any experience may be transmitted by sight, through the skin, the sense of smell, taste, or hearing, or later by thought. Several parallel grooves may be created as the consequence of a stimulus, such as an event or an experience. With each groove that is created there has been and is a connection through nerve paths with an endocrine activity, — so that not only with the great and powerful emotions but with innumerable of the minor ones, and with the innumerable processes not viewed as emotions, there is not only a psychic and a neural path but an associated endocrine process.

If this be true, we might imagine every impression from the earliest to the latest, though they number millions and billions, to have created a path from without inward; and associated with these paths were all possible degrees of emotions up to the degree evidenced by the facial, physical, and functional responses. Therefore the reverse of this would be an antiperistalic wave, where by endocrine activity of any sort, produced by digestive, metabolic or other natural systemic causes, might reproduce the emotion and the psychic and mental phases of the original impression. This might account for phobias and fears which persist, for inexplicable feelings of danger and impending events, troubles or disasters, — and for dreams and their associated emotions, whether pleasurable or fearful, co-ordinate, fantastic, and chaotic, sexual, or otherwise.

One should take into consideration the factors of heredity in considering the questions of instincts, emotions, disposition and character and their relation to the endocrine system and the psyche. It is of the utmost importance to realize the effect of stimuli, pleasant or otherwise, on the emotions, the mental state, and the associated endocrine reaction; for it is as certain that psychic shocks are injurious as it is that inflammations produce, — for instance, — a thyroiditis after influenza. A child is born with instincts, emotions and endocrines of a type contributed by its parents and inherited from them and their ancestors. Its emotional experiences are evidence of, and are associated with, endocrine activity. The type of mentality and mental development are evidences of normal function, hypofunction, or excessive function, — for instance, of the thyroid and pituitary. Its preference for certain forms of play evidences not only its psychic and instinctive makeup, but often its physical adaptability. This is, of course, susceptible to modification through education.

Some children have a remarkable sense of balance ; others have this function to a lesser degree, and are therefore more timid in activities requiring its function. The experiences in the aviation service show that only those with a well-developed sense of balance are qualified for flying. This qualification rests on a physical basis, having to do with the well-recognized cerebellar mechanism. Many adults cannot look down from a great height or follow a dangerous trail without recoiling, this lack of balance resulting in a sensation of apprehension. Thus their apparent fears rests solely on a defective physical mechanism.

Of all the emotions which are injurious, fear stands at the head. Its effects in children are most pronounced, and if any fear becomes fixed it may have a lasting effect throughout life. The instinct of flight, associated with the emotion of fear, has inlets through the various senses; many of these inlets or paths are performed, but may be blocked, shifted or modeled into a more pleasurable or less fearful emotion by experience, or through explanation, or by play.

We must recognize the relation of physical states and Instincts to fears. The development of inhibition or of switching may be exemplified as follows :

A little boy two years old was taken to Van Cortlandt Park during a field day and was held in his father's arms on the summit of a hill overlooking the parade grounds. A field gun boomed with its noise, its flame, and its smoke. The

10 'HE ENDOCRINES

little child clung to his father and said : "I want to go home." The father replied: "All right, but let's hear just one more of those lovely sounds and watch that beautiful smoke." At the next report, the father said: "Isn't that lovely? Let's watch another," — and he jumped up and down, repeating the words, "lovely, fine, beautiful," — and soon the child also jumped up and down, repeating these words, watched the whole performance, and was taken home with fear changed to an emotion of pleasure by the shunting or shifting process which interposed a switch between the stimulus given through the eye and ear and the first instinctive reaction. The same method was applied to thunder, and the child now regards thunder as the talk of the clouds telling the raindrops to fall. One day this child screamed out with a note of fear in his voice when his older sister, growling like a lion, asked him to hide under his bed-clothes for the sake of play. When asked why he cried out and why he refused to play, he replied that he was afraid to go under the bed-clothes because there might be a lion there. ISPow, for hours he had played with his father, hiding under the bed-clothes, while the indulgent parent pretended to seek him elsewhere, and he would continue this play without let-up on innumerable occasions had his wish been followed. But hearing the growl, with his sister impersonating a lion, meant something different to him. The next day when his father carried him upstairs on his back, he said : "I am going to be a big lion and you are the baby lion; you know lions don't talk as we do, they growl, but they understand each other. Now I am going to growl real loud, and that means T love you' ; and then you'll growl back, and I'll know you are saying that you love me. Now, when I am going upstairs, if you want me to go faster, growl louder still, and I will know what that means." As a result, the lion play, with the bed-clothes, is a source of pleasure to this three and a half year old boy.

One summer, a five year old child, — a little girl brought up without any element of fear, protected from stories in which death was mentioned, a child to whom no fairy tales were read because it was seen that she did not hke them, — began, several nights in succession, on going to bed, to call repeatedly for her mother or nurse, making requests of all sorts as an excuse to bring them into her presence. She was questioned carefully and finally informed her parents that several little girls with whom she had been playing recently, for the first time, had spoken about kidnappers and kidnapping and had been warned by their paernts not to go out of th^ park in which they lived. Here was the explanation of the fear of this five year old child, one who at the age of nine enjoys reading but does not care for Grimm's fairy tales. Every call of that child was responded to, and the light was left burning in her room or in the hall ; and with the simple explanation that the story of the kidnappers was an old tale of the long ago and had nothing to do with modern days, she now sleeps without a light, goes into the bathroom at any hour of the night, and presses the electric button without calling any one.

It should be generally recognized that fear tends to become fixed in a child's consciousness and thus readily becomes a permanent impression. In adult life, the physician sees these fears or phobias in varying degrees, up to obsessions. In adult life experience, shocks, — such as frights, worries, disappointments, financial upsets, loss of a dear one, etc.. — may cause psychic injuries which produce lasting harm.

With a child, the infectious diseases may produce a temporary or lasting effect on any one or more of the glands in the endocrine chain and thereafter fear may be more readily aroused. At puberty, when the ovarian function is established, the ovary, — the interstitial portion of which has been active up to this time. — evidences the entrance of the glandular portion into more or less rhythmical play ; so to speak, a new endocrine has been introduced into the circle of endocrines engaged in the development of body and mind and associated with the play of the instincts, the emotions, and the psyche. One of the normal sex functions has appeared, and from this time on it must be expected that its action and the action of the associated glands and their inter-relation are continually more and more centered on the preservation of the sex organs, and this aside from any consciousness of this function or aside from any interpretations or views which the child may acquire. This akered glandular activity must of necessity exert a differing trophic stimulus upon the brain and the vegetative nervous system, with a consequently to-be-expected possible variation both on the instincts, the emotions, and the psyche.

And the reverse of this action is also to be expected. At any period such as this, the life of the individual, his books, plays, teachers, associates, and parents may markedly, — especially in the more sensitive, — rouse, stimulate, or inhibit the various emotions in innumerable ways and degrees. During this period, as well as later, any of the infections or the infectious diseases may play an important part, especially upon the endocrines ; and this period of adolescence is the critical period during which the psychoses, — especially dementia praecox, — manifest themselves.

Influenza undoubtedly exerts its play upon the endocrines, and I have held and still hold that the mental changes resulting therefrom, which are of course evidenced to us by the psychic alterations, are not only toxic in character but in all probability are the result of injuries produced in the various endocrines, resulting in plus, or minus or dys.

Happiness or the pursuit of happiness is the factor of greatest interest in our existence. The real purpose for each and every one of us is to carry on the physical existence of our ancestors. In our children, fear and worry are the greatest deterrents to happiness. No one can fully appreciate the horrible and lasting effects of fear unless he thoroughly reviews the events of his own life ; for everyone knows that experience is the best teacher. We should try to make of every parent the psychologist who can teach himself more by a review of his or her life than can be learned from all the books that were ever written, even though they are and should be the greatest aid to teaching. And here let me say that if books, plays, biographies, the cinema, history, etc., were used to explain psychology, and if they were properly interpreted, then their lessons would be considered the essential points rather than the passing interest or diversion which they create, however wholesome these may be. Here follows an experience of a friend of mine :

"When I was a boy we had a cook called Katrina. She was most devoted to six children in her care and attention ; and her subsequent married life and the career of her children has been a matter of interest to all of us. But Katy in her desire to stop the nightly pillow-fights and the conversation indulged in after we were tucked in bed, informed us repeatedly of the dragons and little dwarfs which she would call to her aid to punish us for our disobedience, and many is the night that I have lain with my face to the wall unable to turn around because Katy's goblins were standing there with hatpins and sharp-pointed instruments biding their time till it suited them to do their nefarious work. My childhood dreams were along lines of fear. Only one who has gone through such experiences can appreciate the possibility of the play of fears on the child's mind and of all this and with all her care and devotion, my mother knew nothing about it.

"Yet very early in my life my mother spoke to all her children concerning what she termed self-abuse. She warned us of the various things we might see or be told, of the false impressions that might be created, and informed us that it was totally within our power to be perfectly clean and sweet and that in every way we would be the better in guarding ourselves. She said that four-footed animals had their heads so placed that they looked to the ground, for that was the source from which they obtained their food. God had put man on two legs so that he could look forward or backward mostly forward, but that the main purpose was to enable him to hold his head high and to look upward where dwelt the Almighty who created and governed the world. She said that for this reason we should not look downward, so far as our persons were concerned, nor should our thoughts or actions turn in that direction."