Determination Of Basal Metabolic Rate Research Articles

A SIMPLE RESPIROMETER FOR SMALL ANIMALS

An apparatus for the indirect determination of basal metabolic rate has been described. Representative results using the Swiss albino mouse as an experimental subject are recorded.

A psychiatric evaluation of the problem patient; study of a thousand cases from a consultation service.

• One thousand unselected outpatients who presented puzzling diagnostic features were examined by the Mount Sinai Hospital consultation service. Examining facilities encompassed all the specialties in medicine and included the most comprehensive laboratory support, e. g., determination of basal metabolic rate, electrocardiogram, Kahn test, blood cell count, sedimentation rate, chest fluoroscopy, and stool and urine analysis, with such further procedures as indicated by the original complaint or preliminary findings. After all organic factors could be eliminated, in 81.4% of these diagnostic problems the patients were found to have psychological factors as the basis for their complaints and illnesses. Only 16.6% of the 1,000 patients had organic illness as the sole etiological factor. Emotional illness can and should be a positive diagnosis, not one of exclusion.

Metabolic observations during the forced feeding of patients with cancer

1. 1. Nine patients with growing malignancies were studied on a metabolism ward while nutritional rehabilitation was attempted by forced feeding. Balances of nitrogen, phosphorus, calcium, potassium, sodium and chloride were conducted before, during and after such treatment and repeated determinations of basal metabolic rate and calculations of caloric expenditures were made. 2. 2. Characteristically, large gains in body weight were produced during forced feeding but weight loss was rapid when this was discontinued. An analysis of the weight gain in terms of body compartments revealed that the increase was predominantly due to an accumulation of large quantities of intracellular fluid. 3. 3. Although there was initial retention of a significant quantity of nitrogen and phosphorus during forced feeding, there was a tendency for the nitrogen balance to approach equilibrium rapidly, and during the subsequent control periods a negative balance was uniformly observed. This suggests that in these patients a host repletion process could not be sustained. 4. 4. Transient clinical benefit occurred in a few of the patients studied, while caloric expenditure determinations, basal metabolic and clinical data indicated that in about half the patients forced feeding had a detrimental effect. 5. 5. The significance of the observed changes in nitrogen balance, the basis for the increased caloric expenditure in cancer, and the possible factors responsible for the different responses observed during forced feeding are discussed.

Use of thyroid hormone to differentiate between hyperthyroidism and euthyroidism.

Shortly after radioactive iodine (I 131 ) was made available for general use, enthusiastic reports appeared as to its efficacy as a diagnostic agent. Skanse, 1 using the 24 hour urinary excretion of the isotope, reported that 98% of the hyperthyroid patients and not one of the euthyroid subjects had diagnostically low excretions. In his series of mildly hyperthyroid patients, the radioactive iodine test was 95% diagnostic as compared to an 86% accuracy of the serum protein-bound iodine determination and a 51% accuracy of the basal metabolic rate determination. Similar findings were reported by Jaffe and Ottoman 2 who evaluated the 24 hour thyroid accumulation of I 131 rather than its excretion in the urine. They observed that the radioactive iodine uptake was 95% accurate as compared with an accuracy of 80% for the serum protein-bound iodine test and of 67% for the basal metabolic rate. Thus of these three diagnostic

Studies of the Energy Requirements of Chickens: 1. The Effect of Dietary Energy Level on Growth and Feed Comsumption

THE energy requirement of growing chicks has been studied in two widely different ways. One method is illustrated by the studies of Mitchell, Card and Hamilton (1931) who estimated the net energy requirements for maintenance and growth from the determination of basal metabolic rate and changes in body composition. Data of this kind have been of limited usefulness because of the lack until relatively recently of net energy values for poultry feedstuffs.The other method was used by Robertson, Miller and Heuser (1948) and Panda and Combs (1950). They studied the relationship between productive (net) energy of the ration and early growth rate to determine the minimum energy level per unit weight of the ration necessary to promote the maximum rate of growth. Both of these groups concluded that the minimum productive energy level required for maximum early growth rate was approximately 800–850 Calories per pound of ration on …

Studies in the etiology of chronic desquamative and hyperkeratotic lesions of the oral mucous membranes

1. 1. Ten patients presenting with chronic oral mucous membrane lesions characterized by both desquamation and hyperkeratosis, six patients with chronic oral mucous membrane lesions principally hyperkeratotic in character, nine patients with chronic oral mucous membrane lesions principally desquamative in character, and thirty-two control patients were studied in an effort to correlate chronic oral mucous membrane lesions with systemic factors. 2. 2. The scope of this investigation included a comprehensive history, oral examination, physical examination, Kodachrome photographs, intraoral x-rays, blood chemistry, blood counts, Kline test, basal metabolic rate determinations, nutrition study, psychiatric interview, and urinary 17-neutral ketosteroid determination. 3. 3. Although in these tests certain differences were observed between the disease groups and the control group, and although the results of certain of these tests suggest that one or more systemic conditions may be concomitant with the oral lesions in some of the patients studied, we were unable consistently to correlate the chronic oral mucous membrane lesions under consideration with any definite systemic factors.

Pregnancy in myxedema.

MYXEDEMA in women is usually associated with altered menstrual function, infertility, or repeated abortion.¹Parkin and Greene²described the occurrence of pregnancy in one patient with cretinism, in two with juvenile myxedema, and in three with adult myxedema. Their review of the world's literature revealed 10 previously recorded cases of pregnancy in true hypothyroidism, making a total of 16 cases.³Their methods of diagnosis included determinations of the basal metabolic rate and the serum cholesterol, the clinical appearance, and the response of the patient to thyroid extract. Myxedema cannot always be diagnosed unequivocally by clinical findings plus these laboratory aids. In the past, many, varied disorders of the female reproductive function unfortunately have been attributed to hypothyroidism on the basis of a single basal metabolic rate determination. We agree that the 16 previously reported cases represented true myxedema. One might expect that the increased accuracy of diagnosis

Therapeutic Effects in Hyperthyroidism from Repeated Diagnostic Doses of I131

Several repeated tracer doses of I131Sare commonly used to follow the course of hyperthyroidism under treatment of various types. While it is generally assumed that these tracer amounts of the isotope are innocuous, evidence from three directions has suggested the need to test this assumption. The first observation in this clinic in conflict with the commonly accepted concept has been the consistent reporting by occasional patients with toxic goiter that they “felt better” following a diagnostic tracer test. The obvious explanation has been the facile one, that a factor of suggestion is involved. This has not always appeared adequate. The second cause for suspicion of a possible effect from tracer dosage is the finding that there is a wide biological variability in response to therapeutic doses of I131 in hyperthyroidism (1). Extreme sensitivity of the thyroid to internal radiation effect has been noted, as well as extreme resistance. As a consequence, it has appeared reasonable that smaller dosages of I131 than those used therapeutically might have some effect. This lower dosage range has remained unexplored since the failure of Soley and Miller to achieve remissions with doses of 250 microcuries repeated several times (2). Finally, interest in a possible effect from tracer dosage has been aroused by the conflict in results between groups investigating the effect of ACTH upon hyperthyroidism (3, 4, 5). The only apparent difference in procedure has been the number of tracer tests and the size of the dose of I131 used in each test. For these reasons, then, the present investigation was undertaken to determine the effect upon hyperthyroidism of several tracer doses of I131. It has been found that complete remission of thyrotoxicosis may result from as little as 240 microcuries I131, total dosage. The time interval from the beginning of the experiment to the achievement of remission has, in most instances, paralleled that of therapeutic doses of I131. The remissions following smaller dosage generally have been transient. Methods The methods employed by this laboratory for tracer testing with I131 and for direct measurement over the thyroid of uptake of the isotope at twenty-four hours have been described in detail elsewhere (6). In all cases the diagnosis was made and the patient was followed from the clinical and laboratory standpoints as previously detailed (7). Only patients with unquestioned hyperthyroidism due to toxic diffuse or toxic recurrent goiter were used in the present study. It should be pointed out that the series includes several children. These were deliberately treated after an initial observation indicated the possibility, in this age group, of unusual susceptibility of the thyroid to radiation effect. Basal metabolic rate determinations were conducted with the use of a Benedict Roth apparatus. Serum precipitable iodine was estimated by the method of Barker (8).

Studies in the etiology of idiopathic orolingual paresthesias.

Studies in a comprehensive investigation of the etiology of idiopathic orolingual paresthesia included: extensive history, repeated oral examinations, physical examination, kodachrome photographs, intra-oral x-rays, blood chemistry,blood counts, Kline test, basal metabolic rate determination, nutrition study, psychiatric interview, 17-neutral kestosteroid determination,

SPECIFIC RENAL FUNCTIONS IN HYPERTHYROIDISM AND MYXEDEMA

THE abnormalities of metabolism and blood flow which characterize hyperthyroidism and myxedema have their effect on the kidneys. Urea clearance is depressed during myxedema although maximum specific gravity is not (2). But the kind and degree of renal functional changes in these diseases have not been analyzed by specific clearance methods. These enable the measurement of renal blood flow, glomerular filtration rate, tubular secretory capacity and, by calculation, renal vascular resistance. The purpose of this report is to describe observations before and after treatment in 4 patients, 2 suffering from hyperthyroidism and 2 from myxedema. Brief protocols of each patient are appended to this report. One of the hyperthyroid patients was treated by subtotal thyroidectomy (Dr. Goethe Link) and the other with thiouracil. The two patients suffering from myxedema were treated by oral administration of desiccated thyroid. Routine observations include electrocardiography, cardiac teleroentgenography and frequent determinations of basal metabolic rate. The special studies of renal function were made shortly after admission to the hospital and repeated when the effects of treatment were established. These studies consisted in determination of the renal plasma clearances of diodrast and inulin and measurement of tubular secretory capacity for diodrast (Tmd). The procedures were substantially as described by Smith, Goldring and Chasis (9). The analytical methods were those of Corcoran and Page (4). The values reported are means of three satisfactory periods of urine collection and clearance measurement.

THE BASAL METABOLIC RATE, FASTING BLOOD SUGAR, GLUCOSE TOLERANCE, AND SIZE OF THE SELLA TURCICA IN HOMOSEXUALS

Basal metabolic rate determinations, fasting blood sugar determinations, glucose tolerance tests, and measurements of X-ray films of the pituitary fossae were made on a group of male homosexuals. No significant deviations from the normal were found.

CARDIOTOXIC GOITER—A DISTINCT ENTITY A PRELIMINARY REPORT11

IT is GENERALLY TAUGHT that the cardiac manifestations of thyrotoxicosis occur as a part of and incidental to accelerated tissue metabolism resulting from excessive thyroid secretion. Several cardiologists of repute maintain that, unless there is an underlying pathologic lesion, there is no such thing as a 'goiter heart.' Their views are supported by the observation that no characteristic pathologic alteration is demonstrable in microscopic sections of the myocardium of thyrocardiac patients. Further, it is generally held that the thyroid hormone, thyroxine, is the active principle of the thyroid secretion. Thus, thrytoxicosis, whether associated with a diffuse or with a nodular goiter, results simply from hyperthyroidism. Adherents to the concept of thyroid hypersecretion employ basal metabolic rate determinations for the purpose of a), diagnosing hyperthyroidism, and b), estimating the degree of hyperthyroidism. The foregoing hypothesis is attractive because of its simplicity.

REVERSE OR ‘PARADOXICAL’ BLOOD SUGAR RESPONSE TO INGESTED GLUCOSE A CORRELATION OF LABORATORY AND CLINICAL FINDINGS ON FORTY PATIENTS1

AGLUCOSE TOLERANCE TEST made on Miss V. Z. (Case 1), April 12, 1930, gave results diametrically opposed to the accepted normal, that is, a depression of the blood sugar below the initial or fas ting level for the 3-hour period of the test.2 Since then to August 1, 1939, 38 similar reactions, or 5.6% of a total of 698 glucose tolerance tests, have been studied at the Polyclinic, and 1, Case 24, at the Columbus Hospital (Case 16663),– a total of 40; 10 males and 30 females. The purpose of this communication is to present the laboratory and clinical findings on this series of patients. The glucose tolerance test, hereinafter designated as G. T. T., was conducted as follows. The patient presented himself after a full night's rest and without having had breakfast. After a 30-minute rest in the recumbent position, a basal metabolic rate determination was made, a specimen of urine, and a blood sample per vena puncture, were obtained and the patient given 100 gm. of glucose in water and lemon juice.

Effect of Benzedrine Sulfate on Basal Metabolic Rate.

The use of benzedrine in narcolepsy has been advocated by several workers.,, The results have been uniformly excellent, the drug affording complete relief from symptoms; no patients have failed to respond to adequate dosage. In the case-records reported, the basal metabolic rates recorded have averaged well below the normal range. It has been stated that the drug can awaken experimental animals from anesthesia produced by barbital given intraperitoneally., In humans, besides its profound effect in narcolepsy, it has produced also marked cerebral stimulation, insomnia, and rise in blood-pressure; this occurs in normal individuals, likewise. One would expect, therefore, that benzedrine would markedly increase metabolism, most probably indirectly through its stimulative action. The following study was undertaken to determine the metabolic activity of benzedrine as shown by the basal metabolic rate. Three subjects were used: T.B.L., a normal white female, aet 28; M.H.S., a normal white male, aet 29; and J.B.L., a normal white male, aet 30. Basal metabolic rates of 2 subjects were determined for 3 successive days, and of the third, for 2 days in order to obtain the true basal levels. Benzedrine sulfate, 20 mg. (2 tablets), was then given for 5 successive days each morning at 9:00′ o'clock, following the basal metabolic rate determinations. Therefore, the basal metabolic rate obtained on any given day during the experimental period showed the effect of the benzedrine taken 24 hours previously. The basal rates were not determined on each day of the experimental period, but at the end of the first, second and fifth days of medication. A post-experimental control-rate was determined on the third day (72 hours) after the last dose.

EMPHYSEMA: REBREATHING, BASAL METABOLIC RATE DETERMINATIONS, VITAL CAPACITY

Article1 November 1936EMPHYSEMA: REBREATHING, BASAL METABOLIC RATE DETERMINATIONS, VITAL CAPACITYHENRY M. THOMAS JR., M.D., F.A.C.P.HENRY M. THOMAS JR., M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-10-5-596 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe classical picture of pulmonary emphysema is accepted without question by physicians, pathologists and roentgenologists. The chest is barrel-shaped and remains in the position of inspiration—moves as a whole—with diminished expansion and calls into play the accessory muscles of respiration. The percussion note is hyperresonant with obliteration of the compensatory spaces and the breath sounds are soft and expiration prolonged and sighing. The descent of the bases may be diminished, abdominal breathing is increased, although in long, narrow-chested individuals the diaphragms may descend freely. The lungs at autopsy are pale and voluminous, do not collapse on standing and microscopically present...Bibliography1. KOUNTZALEXANDER WBHL: Emphysema, Medicine, 1934, xiii, 251-316. CrossrefGoogle Scholar2. RICHARDS DW: Disturbed action of thoracic muscles in dyspnea (personal communication Dec. 7, 1934). COURNAND, A., BROCK, H. J., RAPPAPORT, I., and RICHARDS, D. W., JR.: Disturbance of action of respiratory muscles as a contributing cause of dyspnea, Arch. Int. Med., 1936, lvii, 1008. Google Scholar3. HAMMAN L: Diseases of the lungs (in Oxford Medicine, 1920, ii, 68-81). Google Scholar4. HURTADOFRAY AWW: Studies of total pulmonary capacity and its subdivisions; correlation with physical and radiological measurements, Jr. Clin. Invest., 1933, xii, 807-823. CrossrefGoogle Scholar5. HURTADO A: Studies of total pulmonary capacity and its subdivisions; observations on cases of obstructive pulmonary emphysema, Jr. Clin. Invest., 1934, xiii, 1027-1051. CrossrefGoogle Scholar6. CHRISTIE RV: Lung volume and its subdivisions; methods of measurement, Jr. Clin. Invest., 1932, xi, 1099-1118. CrossrefGoogle Scholar7. MCCANNHURTADOHALTREIDERFRAY WSANLWW: Pulmonary capacity and respiratory function in pulmonary fibroses, Trans. Assoc. Am. Phys., 1934, xlix, 45. Google Scholar8. CHRISTIEMCINTOSH RVCA: Measurement of intrapleural pressure in man and its significance, Jr. Clin. Invest., 1934, xiii, 279-294. CrossrefGoogle Scholar9. NEERGAARD K: Beitrag zur Lehre vom Emphysem, Verhandl. d. deutsch. Gesellsch. f. inn. Med., 1930, xlii, 624. Google Scholar10. BAKER B: Personal communication. Google Scholar11. THOMAS HM: Present status of vital capacity as test of pulmonary efficiency, Med. Clin. N. Am., 1935, xviii, 1685-1695. Google Scholar12. PEABODYSTURGIS FWCC: Clinical studies on the respiration. IX. The effect of exercise on the metabolism, heart rate, and pulmonary ventilation of normal subjects and patients with heart disease, Arch. Int. Med., 1922, xxix, 277. CrossrefGoogle Scholar13. ROBBWEISS GPS: The rôle of the pulmonary circulation in the dyspnea of circulatory failure and of hyperthyroidism, Proc. Am. Soc. Clin. Invest., Jr. Clin. Invest., 1932, xi, 823. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Baltimore, Maryland*Presented in part before the American Clinical and Climatological Association, Oct. 22, 1935. Received for publication July 2, 1936.From the Medical Department of the Johns Hopkins Hospital. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Vital Capacity in Pulmonary EmphysemaGEORGE C. LEINER, M.D., F.A.C.P., SOL ABRAMOWITZ, B.S., MAURICE J. SMALL, M.D., F.A.C.P.Pathophysiologie der AtmungPathophysiologie der AtmungEVALUATION OP PULMONARY FUNCTION TESTS IN DETERMINATION OP RISK PRIOR TO THORACIC SURGERY 1 November 1936Volume 10, Issue 5Page: 596-604KeywordsAutopsyBreathingEmphysemaLungsMusclesPathologistsRespirationThorax ePublished: 1 December 2008 Issue Published: 1 November 1936 PDF downloadLoading ...

IODINE TOLERANCE TEST FOR THYROID INSUFFICIENCY

Up to the present time the test for determination of the function of the thyroid gland is far from being specific. In order to elaborate a specific test for the function of this gland we based our investigations on iodine metabolism as being closely associated with the function of the gland. Veil and Sturm (1) and other authors have already shown that in hyperthyroidism there exists an increase and in hypothyroidism a decrease of total blood iodine. These observations give a certain basis on which we may obtain a picture of the function of the thyroid gland which may be more exact if we make the determination of blood iodine simultaneously with the examination of the basal metabolic rate. Together with Scheps (2) we have demonstrated that inasmuch as the statement of the increase of these two values proves without doubt the overfunction of the thyroid gland and that the normal blood iodine level (not examined during treatment) excludes the presence of hyperthyroidism, the investigations which concern the detection of thyroid insufficiency are deceiving. Particularly in atypical hypothyroid forms (forme fruste), of which our experiments mainly consist, neither the clinical examination nor the determination of the basal metabolic rate and of the blood iodine give sufficient basis for the detection of these forms. It is known that the clinical picture of atypical hypothyroid forms may be so varied and at the same time so atypical that this fact may easily mislead the clinician. The basal metabolic rate determination, important as it is, may also be misleading. In atypical hypothyroid forms the basal metabolic rate frequently shows values which are near the low normal limit. This masking of the reduction of the basal rate may be noticed most easily in those cases of atypical forms that are followed by disturbances of other glands of internal secretion which are apt even to level the decreased basal metabolism. And if in cases of the above mentioned forms the values of the basal metabolic rate should be even markedly decreased, it is not known whether they may be ascribed, to the thyroid or to other gland insufficiency (hypophysis, adrenals, ovaries, etc.).

On the Determination of Basal Metabolic Rate Without Special Apparatus

On the Determination of Basal Metabolic Rate Without Special Apparatus

Osseous Development as an Index of Metabolism

THERE was a time when clinical medicine paved the way for biochemical research: of late years the reverse has been true. The laboratory, long looked upon as merely an adjunct in the elucidation of disease, now assumes an importance second to none. The change came about through the gradual recognition that a living organism is essentially a biochemical machine. Man is no exception. This tardy discovery opened new avenues of thought and brought to light many new and hitherto unsuspected disorders. As a consequence, medicine is, at present, in a state of flux. It has not been long since metabolic disorders went undiagnosed, even in extremis. At present, many are unrecognized beyond a chance of rehabilitation. In the main, this is due to improper evaluation of the chemico-regulating mechanism in the body economy. The nomenclature, as well, tends to defeat a more clear understanding. It is not unusual to hear physicians make a sharp distinction between metabolic and endocrine disorders when, as a matter of common knowledge, the endocrine system plays a significant rôle in body metabolism. Every endocrine disorder is, therefore, a metabolic disorder, although the reverse is not necessarily true. A classic endocrinopathy, upon which the popular conception of the subject is erroneously based, is the end-result of a long-standing metabolic imbalance. Metabolic disorder, as all chronic disorders, must have a beginning: like many another, the origin is frequently in childhood. Because of the fact that in many instances we are dealing with the mechanism essential to normal growth and development, one should, in disruption of this mechanism, expect to find some alteration of the soma. One does, but the discovery is often late. The reflection of a mild degree of metabolic imbalance on the soma is as insidious as development itself. To wait until all the classic features are reflected in the physical and mental make-up, before suspecting such a disorder, is to lose irreparably the most plastic period of the child's existence. It is evident that, in order to preclude such an error, one should attempt to make a diagnosis as early as possible. Unfortunately, this is not easy. Laboratory methods, including the biochemical tests available, are unreliable, except in those conditions affecting carbohydrate metabolism. Basal metabolic rate determinations are discouraging in children below the age of eight. Anthropometric measurements, unless carefully interpreted, mean little. If we must, in final analysis, depend upon some alteration of the soma, the roentgenogram probably affords us the earliest and most conclusive evidence of the change. Roentgenologists may observe the bone changes in hyperparathyroidism long before the patient is incapacitated; and yet, through improper clinical correlation, the diagnosis is rarely made until the patient is badly demineralized. I believe that chronic hypervitaminosis may ultimately be found to be as evident.

The Metabolic Rate in Emotional Moods Induced by Suggestion in Hypnosis

The purpose of this communication is to report some observations concerning the relation between emotion and metabolism. Those who have had practical experience in the determination of basal metabolic rates are familiar with the difficulty in getting reliable figures on excitable persons. It is, indeed, not uncommon to find, even with quite normal subjects, that the metabolic rate is higher on the first test, when the subject is somewhat apprehensive, than on later occasions. There is probably little doubt, therefore, among those familiar with such tests, that a person’s metabolic rate is related in some way to his or her emotional state. Yet the voluminous literature on basal metabolism includes very few studies bearing directly upon this relationship, probably because few laboratory workers have cared to write for publication on a matter so vague and unmeasurable as emotional states. Patients in a mental hospital are not, as one might suppose, good subjects for such a study, because the very factor which one wishes to investigate usually precludes a basal metabolic rate determination, i. e., the emotional state prevents such subjects from keeping quiet for a period long enough to make proper tests. One of us has, however, occasionally made satisfactory observations on a patient in a state of considerable anxiety and apprehension, but able to keep physically quiet, whose metabolic rate was about 2o per cent higher than when emotionally calm. Even in such instances, however, the interpretation is not quite clear, for the emotional state and the metabolic rate may have undergone a simultaneous alteration by a third factor.

The Endocrinology of Tuberculosis

It is suggested that the endocrines hold the key position in the mechanism of resistance to all infection. In man the glands of internal secretion are divided into two counterbalancing groups. It is the function of the "katabolic" group-or glands of emergency-to react to acute infections. It is the function of the "anabolic" group-or glands of conservation of energy-to counterbalance the prolonged over-action of the katabolic group in chronic infections. In chronic pulmonary tuberculosis improvement is dependent on the predominance of the anabolic group. Clinical and biochemical evidence to this effect is brought forward. The individual ductless glands are discussed with a view to summarizing the known tests for detecting their functional variations during life. It is suggested that present methods for the determination of basal metabolic rate are inaccurate and cumbersome. An alternative biochemical method is described and illustrated, which, it is claimed, is both more simple and more accurate. Slides of the thyroid and parathyroid are shown indicating that the histological criteria of function correlate with these biochemical findings during life. The classification of cases of pulmonary tuberculosis according to the mode of reaction rather than to the extent of lung invasion, is advocated. A terminology and the clinical, endocrine, and applied biochemical tests by which the groups can be recognized are described.Emphasis is laid on the necessity for research into the hereditary and environmental factors which lead to injury of the ductless glands, and hence lowered resistance to disease.