adolescence is considered sufficient in itself to indicate treatment directed toward the anterior pituitary lobe. Confirmation of the anterior lobe deficiency could be made by X-ray studies of the osseous system. Dr. Alphonse McMahon and I, in comparison studies of the normals with various ductless gland disorders (Endocrinology, vol. 8, no. 1, January, 1924), have shown that even in the infantile and early juvenile ages the diagnosis of disorder of the various ductless glands affecting the osseous growth may be made by X-ray studies of the appearance of

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the age of eleven, in the center picture (fig. 10 B), it is easy to diagnose from the photograph a juvenile adiposity, which, taken with the type of pituitary head, or "Gibson" head, and the mammary and mons adiposity, would be sufficient at this age to suspect that he had, with the posterior lobe insufficiency, a decreased function of the anterior lobe of the hypophysis. This is the age (11) at which this individual should have been treated. At that time, three years before the age of maturity, there were very good prospects not only of over

of educating the public concerning a number of diseases acquired late in adult life, when the individual should be capable at least of taking care of himself. On the contrary no attention has been given to the great factors which govern the growth and development of our children during their helpless ages. This indifference of parent and medical adviser permits these unfortunates to drift into tragic conditions in later life.

In order to show the benefits of ductless gland treatment unaided by diet, hydrotherapeutics, exercise, etc., we wish to present this photograph (slide 3, fig. 11) of a boy nearly eighteen years of age before and after treatment. The marked reaction seen in this patient is often credited to the natural changes occurring during adolescence. We chose this case particularly to refute this contention. This boy was seventeen, already two years beyond the age of adolescence. You can see that he had no development of his generative organs, associated with the classical posterior lobe pituitary adiposity before treatment (fig. 11 A). Yet frequently physicians assure the juvenile obese that as soon as they reach maturity they will change and be restored to normal proportions, development, etc. We have had an opportunity of seeing so many of these cases through this epoch that we can assure you that in any marked pituitary disorder adolescence does not have this favorable effect. This picture (fig. 11 A) demonstrates this conclusively. His physician in Kansas gave him the treatment we suggested and was kind enough to send him back to us one year afterward, showing the changes presented in figure 11 B. You

hypophyseal deficiency is not as constant as in myxedema. This is due to three causes: (1) late diagnosis and consequently institution of treatment, many years after the function of the hypophysis has been absent; (2) inadequate treatment; and (3) incomplete diagnosis, which does

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not take into consideration additional ductless glands involved with the pituitary deficiency. Yet in over third of cases personally observed early and complete diagnosis, with proper treatment, has been productive of very positive and enduring results.

PHYSIOLOGY OF REST AND EXERCISE

THE

HE physiologic principles which underlie the treatment of pulmonary tuberculosis by rest are the same as those which under

lie the treatment of any disease by this measure. Innumerable remedies have been suggested for the treatment of tuberculosis, but only a few have established themselves as being able to produce outstanding and permanent benefit; of these, rest unquestionably holds first place.

There is no such thing as absolute rest for the human organism. Rest, as we know it, is but a relative degree of exercise. The body may be divided into the somatic or skeletal and the visceral systems. The somatic is under control of the will. The visceral system is not under direct control of the will. It is made up of the vegetative structures upon which the life processes themselves depend. We cannot rest the vegetative or visceral system. It is active from birth until death. We can, however, reduce its activity to the lowest possible point. The voluntary system,

Read before the American Congress of Internal Medicine, Eighth Annual Clinical Session, St. Louis, Mo.. February 18 to 23, 1924.

on the other hand, can be largely put at rest. When we speak of rest, we mean a relative inactivity in the voluntary muscular system and a reduction of the demands upon the vegetative system to a low point.

Remembering that man is a dual organism, consisting of a psychical as well as a physical being, and realizing that physical activity can be materially enhanced or materially decreased by different psychical states, it is necessary to take the psychical state of the patient into consideration in dealing with this subject. Putting the patient in the best condition for the cure of his disease consists in bringing him to a state in which his physiologic balance is best preserved. Consequently, there are certain fundamental factors which must be considered, among which are relative rest both of the voluntary and vegetative systems when the disease is active; exercise suited to each patient's condition after activity has ceased; open air; good food; cheerful surroundings, a suitable psychic attitude, and guidance of the patient's whole life by one who understands tuberculosis and the tuberculous patient.

I shall endeavor to discuss the question of physical rest in such a manner