Henry Harrower and the turbulent beginnings of endocrinology.

The emergence of new medical science in the mid-19th century was usually greeted with derision by "practical men" who saw their academic colleagues as elitist intellectuals whose work bore little or no relation to the rough-and-tumble aspects of patient care. This schism, which was nowhere greater than in the field of endocrinology, widened in 1891 when a myxedematous patient was dramatically restored to health after the administration of a thyroid extract. On the one hand, academicians-who saw this result as a triumphal example of the transference of laboratory studies to the bedside--were encouraged to pursue further studies in endocrine pathophysiology and pharmacology. On the other hand, medical practitioners began to believe that crude extracts from glands or other organs, when prescribed as orally administered mixtures, were effective for the treatment of most human ailments. The organotherapeutic forces were ably championed by Henry R. Harrower, MD, a manufacturer as well as a dispenser of organotherapeutic products. For some years, the claims of the organotherapists remained unchallenged. Finally, in 1921, Harvey Cushing, pioneer neurosurgeon and endocrinologist, launched a crushing assault on the purveyors of pluriglandular therapy. These attacks continued over ensuing years, and organotherapy fell into disrepute. Nevertheless, the assertions of "practical men" have not subsided; rather, we are now confronted by insistent claims for a bewildering array of herbal remedies, over-the-counter hormonal products, and alternative therapies.

How to learn from patients: Fuller Albright's exploration of adrenal function.

Fuller Albright (1900-1969) was acknowledged as the preeminent clinical and investigative endocrinologist of his day by many of his contemporaries, but his many achievements are all but unknown to the present generation of physicians. This article describes how he used his clinical knowledge and a few tools--the measurement of urinary 17-ketosteroid excretion and the administration of methyltestosterone--to elucidate the major hormonal functions of the adrenal cortex and to clarify the pathophysiology of the Cushing syndrome. In addition, in a tour de force of clinical reasoning, he predicted, 5 years before the event, the discovery of a hormone that would reverse the endocrinologic abnormalities of congenital adrenal hyperplasia. Fittingly, he and pioneer pediatric endocrinologist Lawson Wilkins were the first to treat this disease successfully with cortisone.

Benign metastases from thyroid malignancies.

Two patients harbouring cervical lymph node metastases from papillary carcinoma of the thyroid have remained free of symptoms after treatment with suppressive doses of thyroid hormone for 25 and 34 years, respectively. There is evidence that these local metastases are relatively innocuous and may even exert a protective effect in the course of this low-grade malignancy. It is suggested that currently accepted modes of treatment may be unnecessarily invasive and should be reassessed.