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Endocrinology 2 Volume Set Adult and Pediatric 6th
Edition J. Larry Jameson Digital Instant Download
Author(s): J. Larry Jameson, Leslie J. De Groot
ISBN(s): 9781416055839, 1416055835
Edition: 6
File Details: PDF, 107.22 MB
Year: 2010
Language: english
ENDOCRINOLOGY
This page intentionally left blank
 VOLUME I

ENDOCRINOLOGY
ADULT AND PEDIATRIC 6th Edition

Senior Editors
J. Larry Jameson, MD, PhD Leslie J. De Groot, MD
Professor of Medicine, Dean Research Professor
Northwestern University Feinberg School of Medicine Cellular and Life Sciences
Northwestern University University of Rhode Island, Providence Campus
Chicago, Illinois Providence, Rhode Island

Section Editors
David de Kretser, AO, FAA, FTSE, MD, John T. Potts, Jr, MD
FRACP Jackson Distinguished Professor of Clinical Medicine
Emeritus Professor Harvard Medical School;
Monash Institute of Medical Research Director of Research and Physician-in-Chief Emeritus
Monash University Department of Medicine
Clayton, Melbourne, Victoria, Australia Massachusetts General Hospital
Boston, Massachusetts
Ashley Grossman, BA, BSc, MD, FRCP,
FMedSci Gordon C. Weir, MD
Professor of Neuroendocrinology Head, Section on Islet Transplantation and Cell Biology
Endocrinology Diabetes Research and Wellness Foundation Chair
St. Bartholomew’s Hospital Joslin Diabetes Center;
London, United Kingdom Professor of Medicine
Harvard Medical School
Boston, Massachusetts
John C. Marshall, MD, PhD
Andrew D. Hart Professor of Internal Medicine
Director Center for Research in Reproduction Associate Editor
Department of Medicine
University of Virginia School of Medicine Harald Jüppner, MD
Charlottesville, Virginia Professor of Pediatrics
Endocrine Unit and Pediatric Nephrology Unit
Shlomo Melmed, MD Massachusetts General Hospital and Harvard Medical
Senior Vice President, Academic Affairs and Dean of School
the Faculty Boston, Massachusetts
Cedars Sinai Medical Center
Los Angeles, California

With 1317 illustrations and 26 color plates

1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

Endocrinology Part number: 9-9960-7447-1 (vol 1)

Part number: 9-9960-7441-2 (vol 2)
ISBN: 978-1-4160-5583-9 (set)

Copyright © 2010, 2006, 2001, 1995, 1989, 1979 by Saunders, an affiliate of Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval
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Notice

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is the responsibility of
the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to
determine dosages and the best treatment for each individual patient, and to take all appropriate safety
precautions. To the fullest extent of the law, neither the Publisher nor the Authors assumes any liability
for any injury and/or damage to persons or property arising out of or related to any use of the material
contained in this book.
The Publisher

Library of Congress Cataloging-in-Publication Data

Endocrinology / senior editors, Leslie J. De Groot, J. Larry Jameson ; section editors, Ashley Grossman …
[et al.].—6th ed.
    p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4160-5583-9 (v.1 & v.2 : hardback : alk. paper)
ISBN-13: 978-9996074479 (v.1 : hardback : alk. paper)
ISBN-10: 9996074471 (v.1 : hardback : alk. paper)
ISBN-13: 978-9996074417 (v.2 : hardback : alk. paper)
[etc.]
1. Endocrine glands–Diseases. 2. Endocrinology. I. De Groot, Leslie J. II. Jameson, J. Larry.
[DNLM: 1. Endocrine System Diseases. 2. Endocrine Glands. 3. Hormones. WK 140 E5585 2010]
RC648.E458 2010
616.4—dc22
2010001335

Acquisitions Editor: Pamela Hetherington

Developmental Editor: Mary Beth Murphy
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Rachel E. McMullen
Design Direction: Ellen Zanolle

Working together to grow

libraries in developing countries
Printed in China www.elsevier.com | www.bookaid.org | www.sabre.org

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 Contributors
Lloyd Paul Aiello, MD, PhD Lloyd Axelrod, MD Stephen R. Bloom, DSc, FRCP
Director, Beetham Eye Institute, Joslin Diabetes Associate Professor of Medicine Professor
Center Department of Medicine Department of Metabolic Medicine and
Associate Professor of Ophthalmology, Harvard Harvard Medical School; Investigative Sciences
Medical School Physician and Chief of the James Howard Means The Hammersmith Hospital and Imperial College
Department of Ophthalmology, Harvard Medical Firm Medical Services University of London
School Massachusetts General Hospital London, United Kingdom
Joslin Diabetes Center Boston, Massachusetts
Boston, Massachusetts Manfred Blum, MD, FACP
Rebecca S. Bahn, MD Professor of Medicine and Radiology
Erik K. Alexander, MD Professor of Medicine Director, Thyroid Unit
Assistant Professor of Medicine Endocrinology, Diabetes, Metabolism and Nutrition Director, Nuclear Endocrine Laboratory
Department of Medicine Mayo Clinic New York University School of Medicine
Brigham & Women’s Hospital/Harvard Medical Rochester, Minnesota NYU Langone Medical Center
School New York, New York
Boston, Massachusetts H.W.G. Baker, MD, PhD, FRACP
Professor Steen J. Bonnema, MD, PhD
Carolyn A. Allan, MBBS(Hons), PhD, University of Melbourne Department of Obstetrics Associate Professor
DRCOG(UK), FRACP and Gynaecology Department of Endocrinology
Postdoctoral Research Fellow The Royal Women’s Hospital Odense University Hospital
Prince Henry’s Institute; Victoria, Australia Odense, Denmark
Honorary Senior Lecturer
Department of Obstetrics and Gynaecology Randall B. Barnes, MD Diego Botero, MD
Monash University; Associate Professor Attending Physician
Endocrinologist Obstetrics and Gynecology Endocrinology Program
Monash Medical Centre Northwestern University, Feinberg School of Miami Children’s Hospital
Clayton, Victoria, Australia Medicine Miami, Florida
Chicago, Illinois
Bruno Allolio, MD Roger Bouillon, MD, PhD, FRCP
Professor of Medicine Murat Bastepe, MD, PhD Professor of Medicine and Chair of Endocrinology
Deptartment of Endocrinology and Diabetes Assistant Professor of Medicine Experimental Medicine and Endocrinology
Med. Univ. Hospital Endocrine Unit, Department of Medicine Katholieke Universiteit Leuven
University of Wuerzburg Massachusetts General Hospital and Harvard Leuven, Belgium
Wuerzburg, Germany Medical School
Boston, Massachusetts Andrew J.M. Boulton, MD, FRCP
Peter Angelos, MD, PhD, FACS Professor of Medicine
Professor and Chief of Endocrine Surgery John D. Baxter, MD Universities of Manchester, United Kingdom and
The University of Chicago Senior Member, Co-Director Miami, Florida
Chicago, Illinois Diabetes Center Diabetes and Endocrinology
The Methodist Hospital Research Institute; University of Manchester
Sree Appu Chief of Endocrinology Manchester, United Kingdom
Department of Surgery, Monash University The Methodist Hospital
Consultant Urologist Houston, Texas Glenn D. Braunstein, MD
Monash Medical Centre Professor and Chairman, Department of Medicine
Melbourne, Australia Paolo Beck-Peccoz, MD The James R. Klinenberg MD Chair in Medicine
Professor of Endocrinology Cedars-Sinai Medical Center
Richard J. Auchus, MD, PhD Department of Medical Sciences, University of Los Angeles, California
The Charles A. and Elizabeth Ann Sanders Chair in Milan
Translational Research and Professor Fondazione Policlinico IRCCS F. Richard Bringhurst, MD
Internal Medicine, Division of Endocrinology and Milan, Italy Associate Professor of Medicine, Harvard Medical
Metabolism School
The University of Texas Southwestern Medical Graeme I. Bell, PhD Physician, Massachusetts General Hospital
Center at Dallas Louis Block Distinguished Service Professor Senior Vice President for Medicine and Research
Dallas, Texas Departments of Medicine and Human Genetics Management
The University of Chicago Massachusetts General Hospital
Joseph Avruch, MC Chicago, Illinois Boston, Massachusetts
Professor of Medicine
Harvard Medical School; John P. Bilezikian, MD Frank J. Broekmans, MD, PhD
Physician and Chief Professor of Medicine Gynecologist
Diabetes Unit Division of Endocrinology Reproductive Medicine and Gynecology
Member Columbia University University Medical Center Utrecht
Department of Molecular Biology New York, New York Utrecht, The Netherlands
Massachusetts General Hospital
Boston, Massachusetts

v
 Contributors xv

Anne White, PhD Michael P. Whyte, MD Joseph I. Wolfsdorf, MB, BCh

Professor of Endocrine Sciences Professor of Medicine, Pediatrics, and Genetics Clinical Director and Associate Chief
Faculties of Life Sciences and Medical and Human Division of Bone and Mineral Diseases Division of Endocrinology
Sciences Washington University School of Medicine, Children’s Hospital Boston,
University of Manchester Medical-Scientific Director Professor of Pediatrics
Manchester, United Kingdom Center for Metabolic Bone Disease and Molecular Harvard Medical School
Research Boston, Massachusetts
Kenneth E. White, PhD Shriners Hospital for Children
Associate Professor St. Louis, Missouri Bernard Zinman, MD
Department of Medical and Molecular Genetics Director, Leadership Sinai Centre for Diabetes
Indiana University School of Medicine Wilmar M. Wiersinga, MD, PhD, FRCP Mount Sinai Hospital,
Indianapolis, Indiana (London) Professor of Medicine
Professor of Endocrinology University of Toronto
Morris F. White, PhD Department of Endocrinology and Metabolism Toronto, Ontario, Canada
Investigator, Howard Hughes Medical Institute Academic Medical Center
Professor of Pediatrics University of Amsterdam
Division of Endocrinology Amsterdam, The Netherlands
Department of Medicine
Harvard Medical School
Children’s Hospital Boston
Boston, Massachusetts
vi Contributors

Marcello D. Bronstein, MD Robert M. Carey, MD, MACP V. Krishna Chatterjee, MD, FRCP
Professor of Endocrinology David A. Harrison III Distinguished Professor of Professor of Endocrinology
Chief, Neuroendocrine Unit Medicine; Department of Medicine
Division of Endocrinology and Metabolism Dean, Emeritus and University Professor Institute of Metabolic Science
Department of Internal Medicine Division of Endocrinology and Metabolism University of Cambridge
Hospital das Clinicas University of Virginia Health System Cambridge, United Kingdom
University of Sao Paulo Medical School Charlottesville, Virginia
Sao Paulo, Brazil Luca Chiovato, MD, PhD
Esther Carlton, CLS Professor of Endocrinology
Edward M. Brown, MD Project Manager University of Pavia
Professor of Medicine Division of Endocrinology, Clinical Correlations Head, Unit of Internal Medicine and Endocrinology
Diabetes and Hypertension Quest Diagnostics Nichols Institute Fondazione Salvatore Maugeri IRCCS
Department of Medicine San Juan Capistrano, California Pavia, Italy
Brigham & Women’s Hospital
Boston, Massachusetts David Carmody, MB, BCh, BAO, LRCP, SI, Kyung J. Cho, MD
MRCP(UK) Professor
Chuong Bui, MBBS, FRACP, DDU Doctor Department of Radiology
Staff Specialist Department of Endocrinology and Diabetes University of Michigan Medical School
Nuclear Medicine Department Beaumont Hospital Ann Arbor, Michigan
Nepean Hospital Dublin, Ireland
Kingswood, New South Wales, Australia Daniel Christophe, PhD
Jose F. Caro, MD Research Director FNRS and Professor of Molecular
Col. Henry B. Burch, MD Distinguished Professor of Medicine and Vice Chair Biology at the ULB
Chief, Endocrinology for Research, Associate Dean of Clinical Institut de Recherche Interdisciplinaire en Biologie
Walter Reed Army Medical Center; Investigation, Director of the Metabolic Institute Humaine et Moléculaire (IRIBHM)
Professor of Medicine and Chair Department of Medicine Université Libre de Bruxelles (ULB)
Endocrinology Division Uniformed Services Brody School of Medicine, East Carolina University Institut de Biologie et de Médecine Moléculaires
University of the Health Sciences Greenville, North Carolina (IBMM), Charleroi (Gosselies)
Washington, D.C. Brussels, Belgium
Francesco Cavagnini, MD
Henry G. Burger, AO, FAA, MD, FRCP, Professor of Endocrinology Teng-Teng Chung, MBBS, MRCP
FRACP, FCP(SA), FRCOG, FRANZCOG Chair of Endocrinology MRC Clinical Research Fellow
Professor University of Milan; Centre for Endocrinology
Prince Henry’s Institute of Medical Research Chief, Divisione di Medicina Generale ad Indirizzo Barts & the London School of Medicine &
Monash Medical Centre Endocrino-Metabolico, Ospedale Dentistry
Clayton, Victoria, Australia San Luca, Istituto Auxologico Italiano London, United Kingdom
Milan, Italy
Richard O. Burney, MD, MSc John A. Cidlowski, PhD
Chief, Division of Reproductive Endocrinology and Jerry Cavallerano, OD, PhD Chief Laboratory of Signal Transduction
Infertility Director Associate Professor National Institute of Environmental Health
Translational Research Program Department of Ophthalmology Sciences, NIH
Department of Obstetrics and Gynecology Madigan Harvard Medical School; Research Triangle Park, North Carolina
Army Medical Center Staff Optometrist
Tacoma, Washington Beetham Eye Institute Adrian J.L. Clark, DSc, FRCP
Joslin Diabetes Center Professor of Medicine
John B. Buse, MD, PhD Boston, Massachusetts Endocrinology
Chief, Division of Endocrinology Barts & the London School of Medicine &
Department of Medicine Luigi M. Cavallo, MD, PhD Dentistry
University of North Carolina School of Medicine Department of Neurological Sciences London, United Kingdom
Chapel Hill, North Carolina Division of Neurosurgery
Università degli Studi di Napoli Federico II Peter E. Clark
Peter C. Butler, MD Naples, Italy Assistant Professor of Urologic Surgery
Doctor Department of Urologic Surgery
Larry Hillblom Islet Research Shu Jin Chan, PhD The Vanderbilt-Ingram Cancer Center
University of California Los Angeles Research Professional Associate Nashville, Tennessee
Los Angeles, California Department of Medicine
The University of Chicago David R. Clemmons, MD
Paolo Cappabianca, MD Chicago, Illinois Director Diabetes Center for Excellence Kenan
Professor and Chairman of Neurological Surgery Professor of Medicine
Department of Neurosurgery R. Jeffrey Chang, MD Department of Medicine
Università degli Studi di Napoli Federico II Professor University of North Carolina School of Medicine
Naples, Italy Department of Reproductive Medicine Chapel Hill, North Carolina
University of California San Diego, School of
Maria Luiza Avancini Caramori, MD, PhD Medicine Robert V. Considine, PhD
Assistant Professor La Jolla, California Associate Professor
Division of Endocrinology and Diabetes Department of Medicine/Division of Endocrinology
Department of Medicine and Pediatrics Roland D. Chapurlat, MD, PhD Indiana University School of Medicine
University of Minnesota Professor of Rheumatology; Indianapolis, Indiana
Minneapolis, Minnesota Head, Division of Rheumatology;
Director, INSERM Research Unit 831;
Director, National Reference Center for Fibrous
Dysplasia of Bone
Lyon, France
 Contributors vii

Georges Copinschi, MD, PhD Leslie J. De Groot, MD Daniel J. Drucker, MD

Professor Emeritus of Endocrinology Research Professor Professor
Laboratory of Physiology Cellular and Life Sciences Department of Medicine
Faculty of Medicine, Université Libre de Bruxelles; University of Rhode Island, Providence Campus Samuel Lunenfeld Research Institute, Mt. Sinai
Formerly Chief Providence, Rhode Island Hospital, University of Toronto
Division of Endocrinology, Hôpital Universitaire Toronto, Ontario, Canada
Saint-Pierre; David de Kretser, AO, FAA, FTSE, MD,
Formerly Chairman FRACP Michael J. Econs, MD
Department of Medicine, Hôpital Universitaire Emeritus Professor Glenn W. Irwin, Jr. Professor of Endocrinology and
Saint-Pierre Monash Institute of Medical Research Metabolism
Brussels, Belgium Monash University Director, Division of Endocrinology and
Clayton, Melbourne, Victoria, Australia Metabolism
Kyle D. Copps, PhD Professor of Medicine and Medical and Molecular
Department of Endocrinology Ahmed J. Delli, MD, MPH Genetics
Children’s Hospital Medical Doctor Indiana University School of Medicine
Boston, Massachusetts Department of Clinical Sciences/Diabetes and Indianapolis, Indiana
Celiac Disease Unit
C. Hamish Courtney, MD, FRCP Clinical Research Center/Lund University David A. Ehrmann, MD
Consultant Endocrinologist Malmö, Skåne, Sweden Professor
Regional Center for Endocrinology and Diabetes Department of Medicine/Section of Endocrinology,
Royal Victoria Hospital Pierre D. Delmas, MD, PhD† Diabetes, and Metabolism
Belfast, United Kingdom Professor of Medicine The University of Chicago
Claude Bernard University of Lyon; Chicago, Illinois
Leona Cuttler, MD Chief of Department, Rheumatology
William T. Dahms Professor of Pediatric Hôpital E. Herriot; Graeme Eisenhofer, PhD
Endocrinology Chief Director, Research Unit (Pathophysiology of Professor and Chief
Division of Pediatric Endocrinology, Diabetes, and Osteoporosis) INSERM Division of Clinical Neurochemistry
Metabolism Lyon, France; Institute of Clinical Chemistry and Laboratory
Director, The Center for Child Health and Policy at President, International Osteoporosis Foundation Medicine and Department of Medicine
Rainbow Nyon, Switzerland Universitätsklinikum Carl Gustav Carus Dresden
Rainbow Babies and Children’s Hospital Case Dresden, Germany
Western Reserve University Marie B. Demay, MD
Cleveland, Ohio Professor of Medicine Gregory F. Erickson, PhD
Massachusetts General Hospital Professor Emeritus
Melita L. Daley, MD Harvard Medical School Department of Reproductive Medicine
Assistant Professor Boston, Massachusetts University of California, San Diego
Department of Psychiatry LaJolla, California
UCLA Semel Institute Paul Devroey, MD, PhD
Los Angeles, California Professor Barbro Eriksson, MD, PhD
Centre for Reproductive Medicine Professor
Mehul Dattani, FRCP, FRCPCH, MD UZ Brussel Department of Endocrine Oncology
Professor of Paediatric Endocrinology Brussels, Belgium Uppsala University Hospital
Developmental Endocrinology Research Group, Uppsala, Sweden
Clinical and Molecular Genetics Unit Roberto Di Lauro, MD
UCL Institute of Child Health London Full Professor of Medical Genetics Eric Espiner, MBChB, MD, FRACP, FRS
London, United Kingdom Department of Cellular and Molecular Biology and (NZ)
Pathology Professor
Stephen N. Davis, MBBS, FRCP, FACP, University of Naples “Federico II” Department of Medicine
FACE Naples, Italy Christchurch School of Medicine and Health
Theodore Woodward Professor and Chairman Sciences
Department of Medicine Sean F. Dinneen, MD, FRCPI, FACP Christchurch, New Zealand
University of Maryland Medical School and Senior Lecturer in Medicine and Consultant
Medical Center Endocrinologist Felice Esposito, MD, PhD, FACS
Baltimore, Maryland Department of Medicine Department of Neurological Sciences
NUI Galway and Galway University Hospitals Division of Neurosurgery
Oreste de Divitiis, MD Galway, Ireland Università degli Studi di Napoli Federico II
Associate Professor Naples, Italy
Department of Neurological Science, Institute of Jacques E. Dumont, MD, PhD
Neurosurgery Honorary Professor Victoria Esser, PhD
Università degli Studi di Napoli Federico II Iribhm Associate Professor, Internal Medicine
Naples, Italy University of Brussels University of Texas Southwestern Medical Center
Brussels, Belgium at Dallas
Mario De Felice, MD Dallas, Texas
Professor of Pathology Kathleen M. Dungan, MD
Department of Cellular and Molecular Biology and Assistant Professor of Medicine Erica A. Eugster, MD
Pathology Division of Endocrinology, Diabetes, and Professor of Pediatrics
University of Naples “Federico II”; Metabolism Section of Pediatric Endocrinology, Department of
Scientific Coordinator Ohio State University Pediatrics
Biogem Columbus, Ohio Riley Hospital for Children, Indiana University
Ariano Irpino, Italy School of Medicine
Indianapolis, Indiana
Ralph A. DeFronzo, MD
Professor of Medicine/Chief, Diabetes Division
Department of Medicine
University of Texas Health Science Center
San Antonio, Texas
†Deceased.
viii Contributors

Sadaf Farooqi, PhD, FRCP Mark Frydenberg, MBBS, FRACS Harry K. Genant, MD
Wellcome Trust Senior Clinical Fellow Clinical Director Professor, Emeritus
University of Cambridge Metabolic Research Centre for Urological Research Radiology, Medicine and Orthopaedic Surgery;
Laboratories Monash University Executive Director, Osteoporosis and Arthritis
Institute of Metabolic Science Clayton, Victoria, Australia; Research Group
Cambridge, United Kingdom Chairman Department of Radiology
Department of Urology University of California, San Francisco;
Martin Fassnacht, MD Monash Medical Centre Chairman, Emeritus and Member, Board of
Max Eder Senior Research Fellow Melbourne, Australia; Directors
Consultant Endocrinologist Australian Urology Associates Synarc, Inc.
Professor for Medicine Malvern, Victoria, Australia San Francisco, California
Department of Internal Medicine I, Endocrine and
Diabetes Unit Peter Fuller, BMedSCI, MBBS, PhD, FRACP Michael S. German, MD
University Hospital of Würzburg NHRMC Senior Principal Research Fellow, Professor, Clinical Director UCSF Diabetes Center
Würzburg, Germany Associate Director Department of Medicine
NHMRC Senior Principal Research Fellow University of California San Francisco
Bart C.J.M. Fauser, MD, PhD Associate Director, Prince Henry’s Institute of San Francisco, California
Professor of Reproductive Medicine Medical Research
Reproductive Medicine and Gynecology Director, Endocrinology Unit, Southern Health Mohammad A. Ghatei, PhD
University Medical Center Utrecht Adjunct Professor in Medicine and Biochemistry Professor
Utrecht, The Netherlands and Molecular Biology Department of Metabolic Medicine and
Monash University Investigative Sciences
Gianfranco Fenzi, MD, PhD Clayton, Victoria, Australia The Hammersmith Hospital and Imperial College
Professor of Endocrinology University of London
Dipartimento di Endocrinologia e Oncologia Robert F. Gagel, MD London, United Kingdom
Clinica Head, Division of Internal Medicine;
Università di Napoli “Federico II” University of Texas Linda C. Giudice, MD, PhD, MSc
Napoli, Italy MD Anderson Cancer Center Professor and Chair, The Robert B. Jaffe, MD
Houston, Texas Endowed Professor in the Reproductive Sciences
Ele Ferrannini, MD Obstetrics, Gynecology and Reproductive Sciences
Professor of Medicine Jason L. Gaglia, MD University of California, San Francisco
Department of Internal Medicine Instructor in Pathology San Francisco, California
University of Pisa School of Medicine Harvard Medical School;
Pisa, Italy Physician Anna Glasier, BSc, MD, DSc
Department of Endocrinology (Professor) Lead Clinican for Sexual Health NHS
David M. Findlay, PhD Harvard Vanguard Medical Associates; Lothian and Honorary Professor Universities of
Professor of Orthopaedic Research Physician, Adult Diabetes Edinburgh and London
Department of Orthopaedics and Trauma Joslin Diabetes Center Family Planning Service
University of Adelaide Boston, Massachusetts NHS Lothian
Adelaide, South Australia, Australia Edinburgh, Scotland
Gianluigi Galizia, MD
Courtney Finlayson, MD Clinical Research Fellow Francis H. Glorieux, MD, PhD
Instructor, Pediatrics Neurovascular and Autonomic Medicine Professor
Division of Pediatrics Department Departments of Surgery, Pediatrics, and Human
Harvard Medical School Faculty of Medicine, Imperial College London at Genetics
Children’s Hospital Boston St Mary’s Hospital McGill University, and Shriners Hospital for
Boston, Massachusetts London, United Kingdom Children
Montreal, Québec, Canada
Delbert A. Fisher, MD Chuanyun Gao, MD
Professor of Pediatrics and Medicine Fellow, Endocrinology Javier González-Maeso, PhD
David Geffen School of Medicine at University of Division of Endocrinology, Diabetes and Assistant Professor
California Los Angeles Metabolism Departments of Psychiatry and Neurology
Los Angeles, California Beth Israel Deaconess Medical Center, Harvard Mount Sinai School of Medicine
Medical School New York, New York
Maguelone G. Forest, MD, PhD Boston, Massachusetts
Professor Emeritus at INSERM Louis J. Gooren, MD, PhD
Pediatric Endocrinology Thomas J. Gardella, PhD Emeritus Professor of Endocrinology
Hôpital Femme-Mère-Enfant Associate Professor in Medicine Department of Endocrinology
Lyon/Bron, France Department of Medicine, Endocrinology Unit VU Medical Center
Massachusetts General Hospital and Harvard Amsterdam, The Netherlands
Daniel W. Foster, MD, MACP Medical School
John Denis McGarry, Ph.D. Distinguished Chair in Boston, Massachusetts David F. Gordon, PhD
Diabetes and Metabolic Research Associate Professor
Department of Internal Medicine Bruce D. Gaylinn, PhD Department of Medicine/Endocrinology
The University of Texas Southwestern Medical Research Assistant Professor University of Colorado Medical School
School Department of Medicine, Division of Endocrinology Aurora, Colorado
Dallas, Texas University of Virginia
Charlottesville, Virginia Karen A. Gregerson, PhD
Mason Wright Freeman, MD Associate Professor of Physiology
Professor of Medicine Division of Pharmaceutical Sciences
Chief of the Lipid Metabolism Unit James L. Winkle College of Pharmacy
Department of Medicine and Center for University of Cincinnati
Computational and Integrative Biology Cincinnati, Ohio
Massachusetts General Hospital, Harvard Medical
School
Boston, Massachusetts
 Contributors ix

Milton D. Gross, MD Matthias Hebrok, PhD Hero K. Hussain, MBChB, FRCR

Professor, Division of Nuclear Medicine Professor Associate Professor
Department of Radiology Hurlbut-Johnson Distinguished Professor in MRI/Abdominal Division
University of Michigan Diabetes Research Associate Director Research, Department of Radiology
Ann Arbor, Michigan UCSF Diabetes Center Department of Medicine University of Michigan
San Francisco, California Ann Arbor, Michigan
Ashley Grossman, BA, BSc, MD, FRCP,
FMedSci Laszlo Hegedüs, MD, PhD, DMSc Peter Illingworth, MB, MD(Hon),
Professor of Neuroendocrinology Professor, University of Southern Denmark in FRANZCOG
Endocrinology Odense Associate Professor, Obstetrics and Gynaecology
St. Bartholomew’s Hospital Department of Endocrinology and Metabolism University of Sydney;
London, United Kingdom Odense University Hospital, and University of Director of Reproductive Medicine
Southern Denmark Westmead Hospital
Valéria C. Guimarães, MD, PhD Odense, Denmark Sydney, New South Wales, Australia
Clinical Endocrinologist
Endocrinology Georg Hennemann, MD, PhD, FRCP, J. Larry Jameson, MD, PhD
ENNE FRCPE Professor of Medicine, Dean
Brasília-DF, Brazil Professor of Medicine and Endocrinology Northwestern University Feinberg School of
Department of Internal Medicine Medicine
Mark Gurnell, PhD, FRCP Medical Center Spijkenisse Northwestern University
University Lecturer in Endocrinology The Hague, The Netherlands Chicago, Illinois
Institute of Metabolic Science and Department of
Medicine Maria K. Herndon, PhD Nathalie Josso, MD, PhD
University of Cambridge Postdoctoral Research Associate Research Director
Cambridge, United Kingdom School of Molecular Biosciences Unité de Recherches sur l’Endocrinologie et
Washington State University la Génétique de la Reproduction et du
Nadine Haddad, MD Pullman, Washington Développement
Associate Professor of Pediatrics INSERM
Pediatrics, Section of Pediatric Endocrinology and Peter Hindmarsh, BSC, MD, FRCP, Clamart, France
Diabetology FRCPCH
Indiana University School of Medicine, Riley Professor of Paediatric Endocrinology Harald Jüppner, MD
Hospital for Children Developmental Endocrinology Research Group Professor of Pediatrics
Indianapolis, Indiana University College London, Institute of Child Endocrine Unit and Pediatric Nephrology Unit
Health Massachusetts General Hospital and Harvard
Daniel J. Haisenleder, PhD London, United Kingdom Medical School
Associate Professor Boston, Massachusetts
Department of Medicine Ken K.Y. Ho, MD
University of Virginia Professor of Medicine Jeffrey Kalish, MD
Charlottesville, Virginia Head, Department of Endocrinology, St. Vincent’s Assistant Professor of Surgery
Hospital Section of Vascular and Endovascular Surgery
David J. Handelsman, MB, BS, FRACP, Head, Pituitary Research Unit, Garvan Institute of Boston Medical Center
PhD Medical Research Boston, Massachusetts
Professor of Reproductive Endocrinology and Sydney, New South Wales, Australia
Andrology Edwin L. Kaplan, MD
Director, ANZAC Research Institute, Nelson D. Horseman, PhD Professor of Surgery, Section of General Surgery
University of Sydney Professor Department of Surgery
Head, Department of Andrology, Department of Molecular and Cellular Physiology The University of Chicago
Concord Hospital University of Cincinnati Chicago, Illinois
Sydney, Australia Cincinnati, Ohio
Jeffrey B. Kerr, PhD
John B. Hanks, MD Mara J. Horwitz, MD Associate Professor
C Bruce Morton Professor Chief, Division of Assistant Professor of Medicine Anatomy and Developmental Biology
General Surgery Department of Medicine, Division of Endocrinology Faculty of Medicine, Monash University
Department of Surgery University of Pittsburgh Melbourne, Victoria, Australia
University of Virginia Health System Pittsburgh, Pennsylvania
Charlottesville, Virginia Ronald Klein, MD, MPH
Mimi Hu, MD Professor
Mark John Hannon, MD, MRCPI Assistant Professor of Medicine Department of Ophthalmology and Visual Sciences
Doctor Department of Endocrine Neoplasia and Hormonal University of Wisconsin School of Medicine and
Academic Department of Endocrinology Disorders Public Health
Beaumont Hospital/RCSI Medical School University of Texas M.D. Anderson Cancer Center Madison, Wisconsin
Dublin, Ireland Houston, Texas
Meyer Knobel, MD
Simon W. Hayward, PhD Ieuan A. Hughes, MA, MD, FRCP, FRCP(C), Associate Professor of Endocrinology, Thyroid Unit
Associate Professor of Urologic Surgery and Cancer FRCPCH, F Med Sci Division of Endocrinology, Department of Internal
Biology Professor of Paedaitrics, University of Cambridge; Medicine
Department of Urologic Surgery and Department of Honorary Consultant Paediatrician, Cambridge University of São Paulo Medical School
Cancer Biology University Hospitals NHS Foundation Trust São Paulo, SP, Brazil
Vanderbilt University Medical Center Cambridge, United Kingdom
Nashville, Tennessee Efstratios Kolibianakis, MD, MSc, PhD
Christopher J. Hupfeld, MD Professor
Private Physician Unit for Human Reproduction, 1st Department of
Endocrinology and Metabolism Obstetrics and Gynaecology
Oceanside, California Aristotle University of Thessaloniki
Thessaloniki, Greece
x Contributors

John J. Kopchick, PhD Harold E. Lebovitz, MD, FACE Carl D. Malchoff, MD, PhD
Goll-Ohio Professor of Molecular Biology Professor of Medicine Professor of Medicine
Edison Biotechnology Institute and Department of State University of New York Health Science Division of Endocrinology and Metabolism and
Biomedical Sciences Center at Brooklyn Neag Comprehensive Cancer Center
Ohio University Brooklyn, New York University of Connecticut Health Center
Athens, Ohio Farmington, Connecticut
Paul Lee, MBBS, FRACP
Peter Kopp, MD Endocrine Fellow Diana Mark Malchoff, PhD
Associate Professor Department of Endocrinology Chair
Director ad interim Center for Genetic Medicine St. Vincent’s Hospital and Garvan Institute of Department of Science
Division of Endocrinology, Metabolism and Medical Research Avon Old Farms School
Molecular Medicine Sydney, Australia Avon, Connecticut
Feinberg School of Medicine
Northwestern University Åke Lernmark, PhD Rayaz A. Malik, MBChB, FRCP, PhD
Chicago, Illinois Professor Professor of Medicine
Clinical Sciences Department of Cardiovascular Medicine
Márta Korbonits, MD, PhD Lund University/CRC, University Hospital MAS Central Manchester Foundation Trust and
Professor of Endocrinology and Metabolism Malmö, Sweden University of Manchester
William Harvey Research Institute Manchester, United Kingdom
Barts and London School of Medicine and Laura J. Lewis-Tuffin, PhD
Dentistry Intramural Research Associate Susan J. Mandel, MD, MPH
London, United Kingdom Department of Laboratory of Signal Transduction Professor of Medicine and Radiology
National Institute of Environmental Health Division of Endocrinology, Diabetes, and
Melvyn Korobkin, MD Sciences, NIH, HHS Metabolism
Professor of Radiology Research Triangle Park, North Carolina; University of Pennsylvania School of Medicine
University of Michigan Senior Research Fellow Philadelphia, Pennsylvania
Ann Arbor, Michigan Department of Cancer Biology
Mayo Clinic Christos Mantzoros, MD, DSc
Stephen M. Krane, MD Jacksonville, Florida Associate Professor
Persis, Cyrus and Marlow B. Harrison Internal Medicine
Distinguished Professor of Clinical Medicine Zhi-Liang Lu, PhD Harvard Medical School and Harvard School of
Harvard Medical School; Programme Leader Public Health
Center for Immunology and Inflammatory Diseases MRC Human Reproductive Sciences Unit Boston, Massachusetts
Massachusetts General Hospital The Queen’s Medical Research Institute
Boston, Massachusetts Edinburgh, Scotland, United Kingdom Eleftheria Maratos-Flier, MD
Associate Professor
Knut Krohn, PhD Paolo Emidio Macchia, MD, PhD Department of Medicine
Head of DNA Technologies Assistant Professor Harvard Medical School Beth Israel Deaconess
IZKF Leipzig Dipartimento di Endocrinologia ed Oncologia Medical Center
University of Leipzig, Medical Faculty Molecolare e Clinica Boston, Massachusetts
Leipzig, Germany Università degli Studi di Napoli “Federico II”
Napoli, Italy Stefania Marchisotta, MD
Henry M. Kronenberg, MD Post-Doc in Endocrinology
Chief, Endocrine Unit and Professor of Medicine Noel K. Maclaren, MD Internal Medicine, Endocrinology and Metabolism
Department of Medicine Director and Biochemistry
Massachusetts General Hospital and Harvard BioSeek Endocrine Clinic University of Siena
Medical School New York, New York; Siena, Italy
Boston, Massachusetts Clinical Professor of Endocrinology
Weill Cornell College of Medicine Michele Marinò, MD
John M. Kyriakis, PhD Manhattan, New York Assistant Professor of Endocrinology
Investigator Department of Endocrinology and Metabolism
Molecular Cardiology Research Institute Carine Maenhaut, PhD University of Pisa
Professor of Medicine Assistant Professor Pisa, Italy
Tufts University School of Medicine Institute of Interdisciplinary Research (IRIBHM)
Boston, Massachusetts Faculty of Medicine John C. Marshall, MD, PhD
Free University of Brussels Andrew D. Hart Professor of Internal Medicine
Sue Lynn Lau, MBBS(Hons), FRACP Brussels, Belgium Director Center for Research in Reproduction
Research Fellow Department of Medicine
Diabetes and Transcription Factors Laboratory Christa Maes, PhD University of Virginia School of Medicine
Group Senior Postdoctoral Fellow Charlottesville, Virginia
Garvan Institute of Medical Research Department of Experimental Medicine
Sydney, New South Wales, Australia K.U. Leuven Thomas F.J. Martin, PhD
Leuven, Belgium Wasson Professor of Biochemistry
John H. Lazarus, MD, FRCP, FACE, FRCOG Department of Biochemistry
Professor of Clinical Endocrinology Katharina M. Main, MD University of Wisconsin
Centre for Endocrine and Diabetes Sciences Clinical Associate Research Professor, Consultant in Madison, Wisconsin
Cardiff School of Medicine Paediatric Endocrinology
Cardiff, Wales, United Kingdom Department of Growth and Reproduction T. John Martin, MD, DSc
Rigshospitalet and University of Copenhagen, Professor of Medicine
Diana L. Learoyd, MBBS, PhD, FRACP Faculty of Health Sciences St Vincent’s Institute
Associate Professor Copenhagen, Denmark University of Melbourne
Department of Endocrinology Melbourne, Victoria, Australia
Royal North Shore Hospital and Sydney Medical
School
University of Sydney
St. Leonards, New South Wales, Australia
 Contributors xi

Gabriel Á. Martos-Moreno, MD, PhD Boyd E. Metzger, MD David M. Nathan, MD

Pediatrician Tom D. Spies Professor of Metabolism and Director, Diabetes Center and Clinical Research
Assistant Professor of Pediatrics Nutrition Center
Edison Biotechnology Institute Medicine Massachusetts General Hospital
Ohio University; Northwestern University Feinberg School of Professor of Medicine
Department of Pediatric Endocrinology Medicine Harvard Medical School
Hospital Infantil Universitario Niño Jesús; Chicago, Illinois Boston, Massachusetts
Department of Pediatrics
Universidad Autónoma de Madrid; Robert Millar, PhD Maria I. New, MD
CIBERobn Professor Professor of Pediatrics
Instituto de Salud Carlos III MRC Human Reproductive Sciences Unit Professor of Genetics and Genomic Sciences
Madrid, Spain Edinburgh University Director, Adrenal Steroid Disorders Program
Edinburgh, Scotland Department of Pediatrics
Christopher J. Mathias, DPhil, DSc, FRCP, Mount Sinai School of Medicine
FMedSci Walter L. Miller, MD New York, New York
Professor Distinguished Professor of Pediatrics
Neurovascular and Autonomic Medicine Unit, Chief of Endocrinology Carolyn Nguyen, MD
Faculty of Medicine University of California San Francisco Fellow in Child and Adolescent Psychiatry
Imperial College London at St Mary’s Hospital San Francisco, California UCLA Semel Institute for Neuroscience and
London and Autonomic Unit Human Behavior
National Hospital for Neurology and Neurosurgery Madhusmita Misra, MD, MPH Los Angeles, California
Queen Square, Institute of Neurology Assistant Professor of Pediatrics, Harvard Medical
University College School Lynnette K. Nieman, MD
London, United Kingdom Pediatrics Senior Investigator
MassGeneral Hospital for Children and Harvard Intramural Research Program on Reproductive and
Michael Mauer, MD Medical School Adult Endocrinology
Professor Boston, Massachusetts The Eunice Kennedy Shriver National Institute of
Division of Pediatric Nephrology Child Health and Human Development
Department of Pediatrics and Medicine Mark E. Molitch, MD (NICHD), National Institutes of Health
University of Minnesota Professor of Medicine Bethesda, Maryland
Minneapolis, Minnesota Division of Endocrinology, Metabolism and
Molecular Medicine, Department of Medicine John H. Nilson, PhD
Elizabeth A. McGee, MD Northwestern University Feinberg School of Edward R. Meyer Distinguished Professor, Director,
Associate Professor, Medicine School of Molecular Biosciences
Director Division of Reproductive Endocrinology Chicago, Illinois School of Molecular Biosciences
Department of Obstetrics and Gynecology Washington State University
Virginia Commonwealth University David D. Moore, PhD Pullman, Washington
Richmond, Virginia Professor
Molecular and Cellular Biology Jeffrey A. Norton, MD
Neil J. McKenna, PhD Baylor College of Medicine Professor of Surgery
Department of Molecular and Cellular Biology and Houston, Texas Stanford University
Nuclear Receptor Signaling Atlas (NURSA) Stanford, California
Bioinformatics Resource Damian G. Morris, MBBS, PhD, FRCP
Baylor College of Medicine Department of Diabetes and Endocrinology Robert H. Oakley, PhD
Houston, Texas The Ipswich Hospital Laboratory of Signal Transduction
Ipswich, Suffolk, United Kingdom National Institute of Environmental Health
Robert I. McLachlan, MD, PhD Sciences
Professor, Obstetrics and Gynecology Allan U. Munck, PhD National Institutes of Health, Department of Health
Monash University; Emeritus Professor of Physiology and Human Services
Deputy Director, Endocrinology Department of Physiology Research Triangle Park, North Carolina
Monash Medical Centre; Dartmouth Medical School
Director of Clinical Research Lebanon, New Hampshire Kjell Öberg, MD, PhD
Prince Henry’s Institute of Medical Research Professor of Endocrine Oncology
Clayton, Victoria, Australia Jon Nakamoto, MD, PhD Chairman Center of Excellence Endocrine Tumors
Laboratory Medical Director Department of Endocrine Oncology
Geraldo Medeiros-Neto, MD, MACP Quest Diagnostics Nichols Institute Uppsala University, Uppsala University Hospital
Senior Professor of Endocrinology, Thyroid Unit San Juan Capistrano, California; Uppsala, Sweden
Division of Endocrinology, Department of Internal Associate Professor (Voluntary) of Pediatrics and
Medicine Endocrinology Jerrold M. Olefsky, MD
University of São Paulo Medical School University of California, San Diego Professor of Medicine
São Paulo, Brazil San Diego, California Department of Medicine/Endocrinology and
Metabolism
Juris J. Meier, MD Anikó Náray-Fejes-Tóth, MD University of California, San Diego
Assistant Professor Professor of Physiology La Jolla, California
Department of Medicine I Department of Physiology
St. Josef-Hospital, Ruhr-University Dartmouth Medical School Stephen O’Rahilly, MD
Bochum, Germany Lebanon, New Hampshire Professor of Clinical Biochemistry and Medicine
University of Cambridge Metabolic Research
Shlomo Melmed, MD Ralf Nass, MD Laboratories
Senior Vice President, Academic Affairs and Dean Research Assistant Professor Institute of Metabolic Science
of the Faculty Division of Endocrinology and Metabolism Addenbrooke’s Hospital
Cedars Sinai Medical Center University of Virginia Cambridge, United Kingdom
Los Angeles, California Charlottesville, Virginia
xii Contributors

Umut Ozcan, MD Aldo Pinchera, MD Samuel Refetoff, MD

Assistant Professor Professor of Endocrinology Frederick H. Rawson Professor in Medicine
Medicine/Endocrinology University of Pisa, Medicine, Pediatrics, and Genetics
Children’s Hospital Boston, Harvard Medical Chief, Division of Endocrinology The University of Chicago
School University Hospital of Pisa Chicago, Illinois
Boston, Massachusetts Pisa, Italy
Ravi Retnakaran, MD, MSc, FRCPC
Karel Pacak, MD, PhD, DSc Frank B. Pomposelli, MD Assistant Professor and Clinician-Scientist
Professor of Medicine Chief, Division of Vascular and Endovascular Department of Medicine, Division of Endocrinology
Senior Investigator Surgery University of Toronto;
Chief, Section on Medical Neuroendocrinology The CardioVascular Institute Leadership Sinai Centre for Diabetes
NICHD Beth Israel Deaconess Medical Center Mount Sinai Hospital
NIH Boston, Massachusetts Toronto, Ontario, Canada
Bethesda, Maryland
John T. Potts, Jr, MD Rodolfo A. Rey, MD, PhD
Furio Pacini, MD Jackson Distinguished Professor of Clinical Researcher with the National Research Council
Professor of Endocrinology and Metabolism Medicine (CONICET)
Department of Internal Medicine, Endocrinology Harvard Medical School; Centro de Investigaciones Endocrinológicas
and Metabolism and Biochemistry Director of Research and Physician-in-Chief (CEDIE)
University of Siena Emeritus Hospital de Niños Ricardo Gutiérrez;
Siena, Italy Department of Medicine Professor
Massachusetts General Hospital Histology, Cell Biology, Embryology and Genetics
Shetal H. Padia, MD Boston, Massachusetts School of Medicine, University of Buenos Aires
Division of Endocrinology and Metabolism, Buenos Aires, Argentina
Department of Medicine Charmian A. Quigley, MBBS
University of Virginia School of Medicine Senior Clinical Research Physician Christopher J. Rhodes, PhD
Charlottesville, Virginia Department of Endocrinology Professor
Lilly Research Laboratories Department of Medicine
Ralf Paschke, MD, DMsc Eli Lilly and Company Sections of Endocrinology, Diabetes, and
Professor Indianapolis, Indiana Metabolism
Medical Department The University of Chicago
Leipzig University Marcus Quinkler, MD Kovler Diabetes Center
Leipzig, Germany Doctor Chicago, Illinois
Department of Clinical Endocrinology
Adam Pawson, PhD Charité Campus Mitte E. Chester Ridgway, MD, MACP
Human Reproductive Sciences Unit Charité University Medícine Berlin Frederic Hamilton Professor of Medicine, Senior
Medical Research Council Berlin, Germany Associate Dean for Academic Affairs, Vice Chair
Edinburgh, Scotland, United Kingdom Department of Medicine
Christine Campion Quirk, PhD University of Colorado Denver School of Medicine
Alison C. Peck, MD Human Biology Program Aurora, Colorado
Clinical Practice Indiana University
The Fertility Institutes Bloomington, Indiana Gail P. Risbridger, PhD
Encino, California Associate Dean, Research Centres and Institutes
Miriam T. Rademaker, PhD Director
Francesca Pecori Giraldi, MD Associate Professor Centre for Urological Research
University Researcher Department of Medicine Monash University
University of Milan Divisione di Medicina Generale Christchurch School of Medicine Clayton
ad Indirizzo Endocrino-Metabolico, Ospedale Christchurch, New Zealand Melbourne, Victoria, Australia
San Luca,
Istituto Auxologico Italiano Ewa Rajpert-De Meyts, MD, DMSc Robert A. Rizza, MD
Milan, Italy Senior Scientist Executive Dean for Research,
Department of Growth and Reproduction Earl and Annette R McDonough Professor of
Luca Persani, MD, PhD Copenhagen University Hospital (Rigshospitalet) Medicine
Associate Professor of Endocrinology Copenhagen, Denmark Division of Endocrinology, Diabetes and Nutrition
Dipartimento di Scienze Mediche, Istituto Department of Internal Medicine
Auxologico Italiano Eric Ravussin, PhD Mayo Clinic
Università degli Studi di Milano Professor Rochester, Minnesota
Milan, Italy Nutrition Obesity Research Center, Director
Pennington Biomedical Research Center Bruce Robinson, MD, MSc, FRACP
Richard L. Phelps, MD Baton Rouge, Louisiana Professor and Dean
Assistant Clinical Professor of Medicine Sydney Medical School
Northwestern University Feinberg School of David W. Ray, MB, ChB, FRCP, PhD University of Sydney
Medicine Professor of Medicine and Endocrinology Sydney, New South Wales, Australia
Chicago, Illinois School of Medicine
University of Manchester, and Manchester Pierre P. Roger, PhD
Louis H. Philipson, MD, PhD Biomedical Research Centre Senior Research Associate
Professor Manchester, United Kingdom Institute of Interdisciplinary Research (IRIBHM)
Departments of Medicine and Pediatrics Université Libre de Bruxelles
The University of Chicago Nancy King Reame, MSN, PhD, FAAN Brussels, Belgium
Chicago, Illinois Mary Dickey Lindsay Professor of Nursing
Irving Institute for Clinical and Translational Michael G. Rosenfeld, MD
Kevin Phillips, PhD Research HHMI, Department of School of Medicine
Research Scientist Columbia University UCSD
Diabetes Research Center New York, New York La Jolla, California
The Methodist Hospital Research Institute
Houston, Texas
 Contributors xiii

Robert L. Rosenfield, MD Richard J. Santen, MD Carolyn L. Smith, PhD

Professor of Pediatrics and Medicine Professor of Medicine Associate Professor
Section of Adult and Pediatric Endocrinology, Department of Internal Medicine Division of Molecular and Cellular Biology
Diabetes, and Metabolism Endocrinology and Metabolism Baylor College of Medicine
The University of Chicago Pritzker School of University of Virginia Houston, Texas
Medicine Charlottesville, Virginia
Chicago, Illinois Philip W. Smith, MD
Nanette Santoro, MD Chief Resident
James H. Rosing, MD Professor and Director Department of Surgery
Chief Resident Division of REI University of Virginia
General Surgery Albert Einstein College of Medicine/Montefiore Charlottesville, Virginia
Stanford University Hospital and Clinics Medical Center
Stanford, California Bronx, New York Roger Smith, MB, BS, PhD, FRACP,
FRANZCOG
Peter Rossing, MD, DMSc Virginia D. Sarapura, MD Professor of Endocrinology
Manager of Research, Chief Physician Associate Professor of Medicine Director, Mothers and Babies Research Centre
Steno Diabetes Center Department of Medicine, Division of Endocrinology University of Newcastle
Gentofte, Denmark University of Colorado Health Sciences Center Newcastle, New South Wales, Australia
Aurora, Colorado
Robert T. Rubin, MD, PhD Steven R. Smith, MD
Chief, Department of Psychiatry Stuart C. Sealfon, MD Scientific Director
VA Greater Los Angeles Healthcare System, Professor and Chairman Translational Research Institute
Distinguished Professor and Vice Chair Neurology Florida Hospital/Burnham Institute for Medical
Department of Psychiatry and Biobehavioral Mount Sinai School of Medicine Research
Sciences New York, New York Orlando, Florida
David Geffen School of Medicine at UCLA
Los Angeles, California Patrick M. Sexton, BSc(Hons), PhD Peter J. Snyder, MD
NHMRC Principal Research Fellow Professor of Medicine, University of Pennsylvania
Neil Ruderman, MD, DPhil Professor of Pharmacology School of Medicine
Professor of Medicine, Physiology, and Biophysics Monash Institute of Pharmaceutical Sciences Department of Medicine
Boston University School of Medicine Department of Pharmacology University of Pennsylvania
Director, Diabetes Research Unit Monash University Philadelphia, Pennsylvania
Boston Medical Center Parkville, Victoria, Australia
Boston, Massachusetts Richard Stanhope, BSc, MD, DCH, FRCP,
Gerald I. Shulman, MD, PhD, FACP FRCPCH
Irma H. Russo, MD, FCAP, FASCP George R. Cowgill Professor of Physiological Consultant Paediatric Endocrinologist
Chief, Molecular Endocrinology Section Chemistry, Medicine and Cellular and Molecular The Portland Hospital Consulting Rooms
Breast Cancer Research Laboratory Physiology London, United Kingdom
Fox Chase Cancer Center Internal Medicine
Philadelphia, Pennsylvania Yale University School of Medicine René St-Arnaud, PhD
New Haven, Connecticut Professor and Senior Investigator
Jose Russo, MD Genetics Unit
Professor Paolo S. Silva, MD Shriners Hospital for Children;
Breast Cancer Research Staff Ophthalmologist, Assistant Chief of Professor of Medicine, Surgery, and Human
Fox Chase Cancer Center Telemedicine Genetics
Philadelphia, Pennsylvania Beetham Eye Institute Department of Human Genetics
Joslin Diabetes Center McGill University
Wael Antoine Salameh, MD, FACP Boston, Massachusetts Montreal, Québec, Canada
Medical Director
Department of Molecular Endocrinology Shonni J. Silverberg, MD Donald F. Steiner, MD
Cardiovascular and Metabolism Division Professor of Medicine Professor, Biochemistry and Molecular Biology
Quest Diagnostics Nichols Institute Division of Endocrinology and Metabolism Department of Medicine
San Juan Capistrano, California; Columbia University College of Physicians and The University of Chicago,
Associate Clinical Professor of Medicine Surgeons Senior Investigator
Department of Endocrinology New York, New York Howard Hughes Medical Institute
David Geffen School of Medicine Chicago, Illinois
University of California Los Angeles Frederick R. Singer, MD
Los Angeles, California Director, Endocrine/Bone Disease Program Adam Stevens, PhD
John Wayne Cancer Institute Research Associate
Isidoro B. Salusky, MD Santa Monica, California; School of Clinical and Laboratory Sciences
Distinguished Professor of Pediatrics Clinical Professor of Medicine University of Manchester
Pediatrics David Geffen School of Medicine at University of Manchester, United Kingdom
David Geffen School of Medicine at UCLA California Los Angeles
Los Angeles, California Los Angeles, California Andrew F. Stewart, MD
Chief, Division of Endocrinology, and Professor of
Mary H. Samuels, MD Niels E. Skakkebaek, MD Medicine
Professor of Medicine Professor Division of Endocrinology, Department of
Division of Endocrinology, Diabetes and Clinical University Department of Growth and Medicine
Nutrition Reproduction University of Pittsburgh School of Medicine
Oregon Health and Science University Rigshospitalet Pittsburgh, Pennsylvania
Portland, Oregon Copenhagen, Denmark

Dorota Skowronska-Krawczyk, PhD

HHMI, Department of School of Medicine
University of California San Diego
La Jolla, California
xiv Contributors

Paul M. Stewart, MB, ChB, MD, FRCP, Michael O. Thorner, MB, BS, DSc, MACP Eric Vilain, MD, PhD
FMedSci David C Harrison Medical Teaching Professor of Professor of Human Genetics, Pediatrics and
Professor Internal Medicine Urology, Chief of Medical Genetics
University of Birmingham Medicine Human Genetics
Queen Elizabeth Hospital University of Virginia David Geffen School of Medicine at University of
Edgbaston, Birmingham, United Kingdom Charlottesville, Virginia California Los Angeles
Los Angeles, California
Donald L. St. Germain, MD Henri J.L.M. Timmers, MD, PhD
Professor Clinical Endocrinologist, Assistant Professor Theo J. Visser, PhD
Department of Medicine and Physiology Endocrinology Professor
Dartmouth Medical School Radboud University Nijmegen Medical Centre Department of Internal Medicine
Lebanon, New Hampshire; Nijmegen, The Netherlands Erasmus MC
Director Rotterdam, The Netherlands
Maine Medical Center Research Institute, Jorma Toppari, MD, PhD
Associate Vice President of Research Professor of Physiology Michael P. Wajnrajch, MD
Maine Medical Center Departments of Physiology and Pediatrics Senior Medical Director
Scarborough, Maine University of Turku Specialty Care
Turku, Finland Pfizer, Inc;
Jim Stockigt, MD, FRACP, FRCPA Associate Professor
Professor of Medicine Cristina Traggiai, MD Department of Pediatrics
Monash University, Pediatrician New York University
Consultant Endocrinologist Department of Neonatal Intensive Care Unit, New York, New York
Epworth Hospital, University of Genoa
Emeritus Consultant Endocrinologist IRCCS G. Gaslini Gary Wand, MD
Alfred Hospital Genoa, Italy The Alfredo Rivière and Norma Rodriguez de
Melbourne, Australia Rivière Professor of Endocrinology and
Michael L. Traub, MD Metabolism Director, Endocrine Training
Jerome F. Strauss, III, MD, PhD Assistant Clinical Professor Program
Executive Vice President for Medical Affairs Island Reproductive Services Medicine
VCU Health System; Staten Island University Hospital The Johns Hopkins University School of Medicine
Dean, Virginia Commonwealth University of Staten Island, New York Baltimore, Maryland
Medicine
Professor of Obstetrics and Gynecology Yolanda Tseng Paul Webb, PhD
Virginia Commonwealth University Howard Hughes Medical Institute Research Scientist/Associate Member
Richmond, Virginia Division of Endocrinology Center for Diabetes Research
Children’s Hospital Boston The Methodist Hospital Research Institute
Lillian Marie Swiersz, MD Harvard Medical School Houston Texas
Reproductive Physician Boston, Massachusetts
Portola Valley Women’s Health Center Anthony P. Weetman, MD, DSc
Palo Alto Medical Foundation Fred W. Turek, PhD Professor of Medicine
Portola Valley, California Charles E. and Emma H. Morrison Professor of Department of Human Metabolism
Biology University of Sheffield
Lyndal J. Tacon, MBBS, FRACP Director, Center for Sleep and Circadian Biology Sheffield, United Kingdom
Department of Endocrinology, Royal North Shore Department of Neurobiology and Physiology
Hospital Northwestern University Nancy L. Weigel, PhD
Cancer Genetics Unit, Kolling Institute of Medical Evanston, Illinois Professor
Research Department of Molecular and Cellular Biology
Sydney, Australia Eve Van Cauter, PhD Baylor College of Medicine
Professor Houston, Texas
Shahrad Taheri, BSc, MSc, MB, BS, PhD, Department of Medicine
MRCP The University of Chicago Gordon C. Weir, MD
Doctor Chicago, Illinois Head, Section on Islet Transplantation and Cell
Heartlands Biomedical Research Centre (HBMRC) Biology
and School of Experimental Medicine Greet Van den Berghe, MD, PhD Diabetes Research and Wellness Foundation Chair
Birmingham Heartlands Hospital and University of Professor of Medicine Joslin Diabetes Center;
Birmingham Intensive Care Medicine Professor of Medicine
Birmingham, United Kingdom Catholic University of Leuven Harvard Medical School
Leuven, Belgium Boston, Massachusetts
Rajesh V. Thakker, MD, FRCP, FRCPath,
FMedSci André C. Van Steirteghem, MD, PhD Roy E. Weiss, MD, PhD
May Professor of Medicine Emeritus Professor Rabbi Esformes Professor
Nuffield Department of Medicine Reproductive Medicine Chairman (interim), Department of Medicine
University of Oxford Vrije Universiteit Brussel Chief, Section of Adult and Pediatric
Oxford, Oxon, United Kingdom Brussels, Belgium Endocrinology, Diabetes, Metabolism and
Hypertension
Chris Thompson, MB, ChB, MD, FRCPI Gilbert Vassart, MD, PhD The University of Chicago
Professor of Endocrinology Professor Chicago, Illinois
Academic Dept of Endocrinology IRIBHM
Beaumont Hospital/RCSI Medical School Faculty of Medicine Katherine Wesseling-Perry, MD
Dublin, Ireland Free University Brussels Assistant Professor of Pediatrics
Brussels, Belgium Department of Pediatric Nephrology
David Geffen School of Medicine
University of California Los Angeles
Los Angeles, California
 Contributors xv

Anne White, PhD Michael P. Whyte, MD Joseph I. Wolfsdorf, MB, BCh

Professor of Endocrine Sciences Professor of Medicine, Pediatrics, and Genetics Clinical Director and Associate Chief
Faculties of Life Sciences and Medical and Human Division of Bone and Mineral Diseases Division of Endocrinology
Sciences Washington University School of Medicine, Children’s Hospital Boston,
University of Manchester Medical-Scientific Director Professor of Pediatrics
Manchester, United Kingdom Center for Metabolic Bone Disease and Molecular Harvard Medical School
Research Boston, Massachusetts
Kenneth E. White, PhD Shriners Hospital for Children
Associate Professor St. Louis, Missouri Bernard Zinman, MD
Department of Medical and Molecular Genetics Director, Leadership Sinai Centre for Diabetes
Indiana University School of Medicine Wilmar M. Wiersinga, MD, PhD, FRCP Mount Sinai Hospital,
Indianapolis, Indiana (London) Professor of Medicine
Professor of Endocrinology University of Toronto
Morris F. White, PhD Department of Endocrinology and Metabolism Toronto, Ontario, Canada
Investigator, Howard Hughes Medical Institute Academic Medical Center
Professor of Pediatrics University of Amsterdam
Division of Endocrinology Amsterdam, The Netherlands
Department of Medicine
Harvard Medical School
Children’s Hospital Boston
Boston, Massachusetts
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 Preface
Endocrinology is now in its fortieth year and Sixth Edition, and synthesize and prioritize subject matter. We are proud to work
it continues to evolve. After all, evolution to fit a changing envi- with the most accomplished international authorities in the prep-
ronment is a law of nature that applies equally well to medical aration of this text. Armed with electronic means to write, revise,
publishing as it does to the biological systems we seek to under- edit, and update topics, this group of authors has succeeded in
stand. Indeed, the rapid changes in information dissemination keeping pace with the latest advances in their specialty areas.
are necessary to keep pace with progress in science and medi- We also aspire to make the text interesting to read, relevant,
cine. In this Sixth Edition, we have retained the founding goals and accessible in clinical practice settings. We have streamlined
of this text while responding to the innovative means by which the book noticeably, so that it now fits within two sets of covers
students, practicing clinicians, and researchers now acquire of reasonable weight. There is a hard-cover version for those
information. who feel most comfortable with the book in hand, perhaps idyl-
As in the five prior editions, we provide a comprehensive, lically relaxing in a comfortable chair, and an online version
contemporary textbook that spans basic and clinical aspects of for more “contemporary” readers who prefer the immediacy of
endocrinology. In addition to the traditional gland-based struc- online access to www.expertconsult.com between patient visits.
ture, readers will recognize a focus on the clinical presentations The online version also provides direct links to original reference
of disease, and an emphasis on multi-hormonal integration sources and monthly sectional updates so that important new
of endocrine function, perhaps a prime example of “systems ideas can be presented during the lifetime of this edition to keep
biology.” Another change in this edition is more complete cover- it current.
age of pediatric endocrinology because the division of pediatric In closing, the editors express their gratitude to the several
and adult endocrinology is largely arbitrary and many physicians hundred authors who have balanced their many other obliga-
care for patients from all age groups. tions to prepare truly masterful presentations for this Sixth
A striking feature of our field is the explosion of knowledge Edition.
ranging from the discovery of new hormones and drugs to the
impact of genomics, proteomics, and metabolomics on how we J. Larry Jameson, MD, PhD
classify diseases and conceptualize signaling pathways. These
Leslie J. De Groot, MD
advances are all the more reason to seek information sources that

xvii
Other documents randomly have
different content
 3. Repressive and Punitive Agencies.
The various instrumentalities falling under this head appear
deserving of separate consideration, and cannot therefore be
appropriately included under either of the previous divisions, being
neither curative in their character, nor preventive to any appreciable
extent. They evidently presuppose the existence of crime, and
merely seek to diminish its influence, or curtail its power by the
application of legal provisions and compulsory measures, intended
on the one hand to indemnify society against the infraction of its
rights, and on the other to intimidate or restrain the criminal
offender. The absolute reformation of the viciously disposed can
hardly be expected to result from the use of such means, and
belongs properly to another class of agencies. It may indeed be
achieved by punitive measures, but in this case reformation of
character is rather a startling accident than an essential property of
the system pursued. Experience has abundantly established the
utility of legal provisions as a “terror to evil doers;” but the statistics
of our police-courts will by no means warrant the assumption that
penal measures have per se been successful in reclaiming the
offender. It is not intended, however, while speaking of repressive
and punitive agencies, to include in this category the strictly legal
efforts employed by the State to deter and correct the criminal who
renders himself amenable to justice. This subject will be found fully
and distinctly treated by Mr. Mayhew, in a work now in the press,
entitled “Prisons of London, and Scenes of Prison Life.”
The inquiry pursued in the course of this Essay is not designed to
comprehend such constitutional measures as are employed by either
Church or State, for the suppression of vice and crime; but rather to
draw from their obscurity, and to give prominence to those resources
and expedients which society itself adopts, for the defence and
preservation of its own interests.
The Society for the Suppression of Vice, which was established in
1802, has for its objects the repression of attempts “to spread
infidelity and blasphemy by means of public lectures, and printed
publications.” The operations of the Society have also been directed
to the suppression of disorderly houses, the punishment of fortune-
tellers, and other important objects. “It is represented that by means
of this Society many convictions have taken place, and persons have
been sentenced to imprisonment for selling obscene publications and
prints,” while their works have been either seized or destroyed. With
such admirable intentions and useful objects, to commend it to
benevolent support, and with the entire voice of public opinion in its
favour, the only wonder is that this Society does not carry on its
operations with greater publicity, vigilance, and efficiency. Unhappily
the loathsome traffic in Holywell Street literature is still carried on
with bold and unblushing effrontery, and its existence, although
greatly diminished in the country, is too notorious and too patent, in
certain portions of the metropolis, to need any extraordinary efforts
to promote exposure and punishment.
The demoralizing influence of low theatres, and the licentious
corruptions of the Coal Hole, and Posés Plastiques, might surely
afford scope for vigorous prosecutions under the Society’s auspices;
and yet these dens, in which the vilest passions of mankind are
stimulated, and every sentiment of religion, virtue, and decency
grossly outraged, or publicly caricatured, are allowed to emit their
virulent poison upon all ranks of society without the slightest let or
hindrance! Only let a man smitten by the plague or with any other
infectious disease, obtrude himself by unnecessary contact upon the
public, and his right to free agency would be summarily disposed of,
by speedy incarceration within the walls of a hospital; but provided
only the disorder be a moral one—and therefore far more to be
dreaded, in its pestiferous influence and baneful effects upon society
—it is forsooth to be tolerated as a necessary evil! Proh tempora et
mores!
The Associate Institution, formed in 1844, has been in active
operation fifteen years, and has been instrumental in effecting a
large amount of good, by improving and enforcing the laws for the
protection of women. It has maintained a strenuous crusade against
houses of ill-fame, and has since its establishment conducted
upwards of 300 prosecutions, in most of which it has been
successful in bringing condign punishment upon the heads of those,
who have committed criminal assaults upon women and children, or
who have decoyed them away for immoral purposes.
Important as these results have been, a larger amount of good has
probably been achieved by means of lectures and meetings held in
various parts of the country by Mr. J. Harding, the Society’s travelling
secretary, whose faithful and stirring appeals and bold denunciations
of vice have contributed not a little to the spread of sounder and
more wholesome views on social questions, and to the removal of
that ignorance of profligate wiles and artifices, which, in so many
cases, proves fatal to the unsuspecting and unwary.
Two Bills prepared by this Association, one for the protection of
female children between 12 and 13 years of age, and the other to
simplify and facilitate the prosecution of persons charged with
keeping houses of ill fame, were this year submitted to parliament,
but unhappily without success, having been lost either on technical
grounds, or for want of support. It is refreshing to turn from the
supineness of statesmen to the energy and decision manifested by
private associations in resisting the encroachments of vice. The East
London Association, composed of a committee partly clerical and
partly lay, and including most of the influential parochial clergy in the
district, was instituted four years ago for the purpose of checking
“that class of public offences, which consists in acts of indecency,
profaneness, drunkenness, and prostitution.”
Its modes of action are as follows:—
1. To create and foster public opinion in reprobation of the
above-named acts.
2. To bring such public opinion to bear upon all exercising
social influence, with a view to discountenance the
perpetrators and abettors thereof.
 3. To secure the efficient application by the Police of the
laws and regulations for the suppression of the class of
public offences above named; and to obtain, if necessary,
the institution of legal proceedings.
4. To procure the alteration of the law, wheresoever
needful to the object contemplated, and especially to the
obtaining further restrictions in granting Licenses for Music
and Dancing to houses where intoxicating liquors are sold.
5. To find Houses of Refuge and means of restoration for
the victims of seduction by honest employment,
emigration, &c.
It is satisfactory to state that already, and with the very limited funds
placed at the disposal of this Association, no fewer than “seventy-
five houses in some of the worst streets in the east of London,
hitherto devoted to the vilest purposes, have been cleared of their
inmates; one of these houses having had thirty rooms, which were
occupied by prostitutes; that more than one house ostensibly open
for public accommodation, but really for ensnaring females for
prostitution, has been closed; and that in one instance of peculiar
atrocity, the owner of the house has been convicted and punished.
Handbills have also been issued, containing extracts from the Police
Acts, to show the power of remedy for offences against public
decency, such as swearing, the use of improper language, and the
exhibition of improper conduct in the streets.”
Such are the objects and results of this Association, and such the
praiseworthy example set to other London districts, which if
vigorously followed would result, at least, in the repression of vice,
and in a marked diminution of crime.
“It is chiefly from the reserve which, rather by implication than by
compact, has so long been preserved in those influential quarters
where the power to correct and guide public opinion is maintained,
that the crying social evil of our day has attained such dimensions,
and exhibited itself in such dangerous and revolting forms as we
have referred to. Preachers, moralists, and public writers have been
deterred by the difficulty and delicacy of the subject from their
obvious duty of protecting the social interests, and a sluggish
legislature, ever inert in introducing such measures as are calculated
to foster and conserve the public virtue, has thus lacked the external
pressure which might have aroused it to vigilance and forethought in
the discharge of its duties. Recently, however, there have been clear
indications that a distrust of the old plan is spreading. With manifest
reluctance, but not without interest, has public attention fastened
itself on a subject in which not merely the happiness of individuals,
and the peace of families, but the national prosperity and the
concerns of social life, are felt to be bound up. Inquiries as to the
best mode of doing something to stem the tide of immorality which
is coursing onwards are made in quarters where indifference, if not
acquiescence, was formerly manifested. Public opinion is ever slowly
formed, but is seldom wrong at the last in detecting the true source
of generic evils, and in applying to them the best remedies.
Example, also, is as contagious on the side of virtue as of vice; and
where an initiative step, taken by another, appeals to our intuitive
sense of right and duty, it is seldom that the courageous right-doer
has to wait long for the expression of sympathy and the proffer of
aid.
“It is only recently that the great sin of our land has received a
measure of the attention it has long and loudly called for.
“First in one quarter, and then in another, has the subject been
discussed with tolerable delicacy, and with an approximate fidelity.
“The discussion has done good. Men have thought about the
subject, have been led to measure the fearful dimensions of this evil,
to observe its progress and influence within their own
neighbourhoods, and have come at last to deplore the existence of
that which they have too long tolerated or connived at. Where
remedial measures have been attempted, they have not lacked for
countenance and support; and, in some quarters, at least, there
have been indications of a desire to pass from the feebler stage of
alleviation to the more potential remedy of prevention. Whilst it
seems to be admitted on all hands, that to aim at the forcible
extinction of immorality would be Utopian and disappointing, the
repression and diminution of crime is felt to be an imperious
obligation upon all who are vested with any power and influence for
that end.
“We cannot help regarding the measures which have been recently
adopted by certain parochial authorities in the metropolis as at once
a proof of the benefit which has arisen from the partial discussion of
this subject in the various public channels into which it has gained
admittance; and we regard it, further, as a cheering sign that a
deepening conviction is spreading on all sides respecting the
absolute necessity of a well-organised antagonism to evil, in place of
our former supine indifference, or more culpable acquiescence.
Some of the most influential metropolitan vestries have commenced
a crusade against the keepers of bad houses in their respective
parishes, and, by the vigour and promptitude characterizing their
prosecutions, seem determined to hunt down the hosts of
abandoned householders who are mainly concerned in extending
and facilitating immorality.
“Aristocratic St. James’s, and more plebeian Lambeth, have alike
joined in these laudable measures; and it is to be noticed, with
extreme satisfaction, that the steps thus taken have been almost
invariably successful, and that severe punishments have been
inflicted upon the wretches who were the objects of these
prosecutions. Such a movement cannot be sufficiently applauded,
and fervently is it to be trusted that the example thus shown in
these influential centres may not only reach to every other parish in
the metropolis, but may also stir up the parochial authorities in every
city and town in the land to a like course of procedure. This is to
strike at the main root of the evil. In vain are all our Reformatories
and Refuges, in vain the endeavours of Christian people to repress
the evil by exertions for the rescue even of a large number of its
victims, if the floodgates of vice be allowed, by public neglect, to
remain open, ever to pour out into our streets fresh streams of
wickedness and pollution. There are, no doubt, persons who think
that measures, such as those now under consideration, will not
materially check the traffic in vice, but will only lead to its being
more subtly and secretly practised. Even that result, if brought
about, would be something gained, something as a protest on the
side of public purity and virtue, and something in the amount of
warning and terror brought home to guilty breasts, leading them to
dread retribution in future, whenever offended justice could detect
them in their malpractices. But in truth there is no limit to the
amount of good which would result from these repressive measures
becoming universal and well-sustained.
“Many persons would be saved from future ruin, a manifest check
would be given to the further development of iniquity, and the
example of authority thus generally exercised in aid of the cause of
virtue, would greatly tend to the spread of sounder views of social
duty in regard to this matter.”[7]
One of the greatest scandals on a country professedly Christian, is
the extent to which Sabbath desecration pervades the metropolis.
Although the traffic now openly pursued in the streets, or carried on
with impunity in shops, is strictly illegal, yet the technicalities which
are too often allowed to obstruct the ends of justice, and the
smallness of the fines inflicted, even where summary conviction
follows, concur to render the law, in this particular, a mere dead
letter.
The permission to sell on Sunday, originally extended only to
vendors of perishable articles, is now claimed by whole troops of
costermongers, who, presuming upon the license they have so long
enjoyed, no longer hesitate to ply their usual calling in the most
public and offensive manner, frequently pursuing their traffic in the
open streets during the hours of divine service, and disturbing whole
congregations by their noisy vociferations around the very doors of
our churches.
These evils call loudly for more stringent legal measures, and it is to
be hoped the time is not far distant when some improvement will
take place.
As one means of directing public attention to this subject, by the
circulation of appeals and tracts, and of promoting the introduction
of salutary legal provisions for the repression of such acts of
desecration, the Society for Promoting the Due Observance of the
Lord’s Day is entitled to a large measure of support. The efforts
made by the Society to awaken public opposition to the obnoxious
provisions of Lord Chelmsford’s Sunday Trading Bill, were probably
mainly instrumental in securing its rejection.
One of the noblest repressive agencies within the metropolis is the
Royal Society for the Prevention of Cruelty to Animals, established in
1824, which employs a number of agents to frequent the markets
and public thoroughfares, for the purpose of bringing to punishment
persons detected in the commission of acts of cruelty to animals. It
seeks, moreover, by means of suitable tracts, to diffuse among the
public a just sense of the duty of humanity and forbearance towards
the lower orders of creation. Allusion was made during the present
year to the objects embraced by this Society from upwards of two
thousand London pulpits, which will doubtless have the effect of
directing the attention of the benevolent public to an instrumentality
which has already achieved a large amount of good; and only
requires to be better known to enjoy a corresponding measure of
support.

4. Reformative Agencies.
Must be understood as referring solely to individuals, and include all
such measures as are employed to effect an external change of
character, and render those, who are vicious and depraved, honest
and respectable members of society.
While, however, agencies of this kind are reformative in their relation
to persons, they have also a preventive aspect, when viewed in their
bearings upon the entire community; for the reformation of every
vicious man is a social boon, inasmuch as it removes one individual
from a course of vice, and thus diminishes the aggregate of crime.
As a nucleus of reformatory operations, and a “centre of information
and encouragement,” the Reformatory and Refuge Union was
established in 1856. It seeks to diffuse information respecting the
various agencies at present in existence, and to encourage and
facilitate the establishment of new institutions. In connection with
the Union is a “Female Mission” for the rescue of the fallen. The
Mission maintains a staff of female missionaries, whose business it is
to distribute tracts among the fallen women of the metropolis, to
converse with them in the streets, and visit them in their houses, in
the hospitals, or in the workhouses. These missionaries, “as a rule,
leave their homes between eight and nine o’clock at night, remaining
out till nearly twelve, and occasionally till one in the morning. They
are located in different parts of London, near to the nightly walks
and haunts of those they desire to benefit. They have the means of
rescuing a large number who have been placed in the Homes or
restored to their friends.”
There are upwards of fifty metropolitan institutions for the reception
of the destitute and the reformation of the criminal, or those who
are exposed to temptation, capable of accommodating collectively
about 4,000 persons of both sexes.
Nine of these institutions are designed especially for the reception
and training of juvenile criminals, sentenced under the “Youthful
Offenders’ Act,” and two for vagrants sentenced to detention under
the “Industrial School Act.” Three are exclusively appropriated to the
benefit of discharged prisoners, and the rest are chiefly employed in
the rescue and reformation of destitute or criminal children.[8]
Most of these institutions, with the exception of such as are certified
by Act of Parliament, and aided by Government subsidies, are
supported entirely by voluntary contributions and by the earnings of
the inmates, who are either admitted free on application, or by
payment of a small sum towards the expense of maintenance.
Such is the benevolent machinery now at work within the metropolis
for the reformation of our criminal population, and for the
preservation of those who are in a fair way of becoming the moral
pests and aliens of society.
The results, both in a religious, social, and sanatory point of view,
achieved by these different agencies, are beyond all human
calculation; and it is mainly to their beneficial and restraining
influence that the peace, safety, and well-being of society may be
attributed.
The other Reformative Agencies are those adapted to the rescue and
reformation of fallen women, or such as have been led astray from
the paths of virtue.
There are twenty-one institutions in London devoted to these
objects, and unitedly providing accommodation for about 1,200
inmates. Ten of these are in connexion with the Church of England,
and in the remaining eleven the religious instruction is unsectarian
and evangelical. Three, viz., The Female Temporary Home, The
Trinity Home, and The Home of Hope, are designed for the reception
of the better educated and higher class of fallen women. One, viz.,
The London Society for the Protection of Young Females, is limited
to girls under fifteen years of age; and another, The Marylebone
Female Protection Society, affords shelter exclusively to those who
have recently been led astray, and whose previous good character
will bear the strictest investigation.
It may be fairly assumed that the objects of all these institutions are
substantially the same, viz., the reformation of character, and the
restoration of the individual to religious and social privileges. While,
however, the end is in most cases one and the same, the methods
and subordinate means adopted to insure its attainment, are often
strikingly dissimilar, and present distinctive and almost opposite
features. Thus one class of institutions, in imitation of our Lord’s
merciful forbearance towards the sinner, make their treatment pre-
eminently one of love, and seek by means the most gentle and
attractive to win back the stubborn wills and depraved natures of
those entrusted to their care. Kindness is the only instrument used in
laying siege to the hard heart, and in mollifying the seared
conscience. Stern discipline, irritating restraints, and rigorous
exactions, form no part of a system which is built up on the model
prescribed by Him, who “spake as never man spake.”
That a mode of treatment which affords such a remarkable
coincidence, and such a striking parallel to the divine method of
dealing with the sinner, so eloquently taught under the parable of
the Prodigal Son, should be found by experience to be the only really
efficacious one, can hardly be a matter of surprise. The fact is too
notorious to require any proof that in numberless instances

‘Law and terrors do but harden’

the heart which can be easily subdued by the exhibition of Christian

kindness. Here is the omnipotent weapon which has achieved such
moral victories, when wielded by gentle and loving women, like Miss
Marsh, Mrs. Wightman, and Mrs. Sheppard.
The opposite mode of treatment, however successful it may be in
the restoration of external character, or in the subjugation of
turbulent passions, is defective, inasmuch as it fails to influence the
heart, and therefore at best contributes only to an incomplete and
partial cure. The almost penal character of the system pursued in
many of the older penitentiaries is founded on the misconception,
that the injury sustained by society in the departure from virtue of
her female members, can only be atoned for by some personal mulct
inflicted on the offender. While, therefore, the ultimate object is the
reformation of lost character, this is too often overlooked or rendered
subsidiary to the proximate one of propitiating society; and the
austere regimen by which the latter point is secured, is generally
found to be subversive of the other. When, however, as is too
frequently the case, society is the tempter, the offence may surely
be condoned by a less rigorous process! Society may indeed well
waive the right to compensation for supposed damages, when it can
be proved that she is at least particeps criminis, and when,
moreover, she has a personal interest in the speedy restoration of
her unhappy prodigals. The retributive suffering, which, in the
majority of cases, so surely overtakes the female delinquent, may be
urged as another reason for dealing leniently with the erring; but the
strongest justification of such a method is undoubtedly derived from
the success attending it, and from the Divine sanction which it has
received.
The impediments which the old penitentiary system of close
confinement, criminal fare, and hard labour, have unfortunately
presented to the rescue of fallen women is too well known to those
who are accustomed to deal with this class. Frequently are the
urgent entreaties of the missionary to forsake an abandoned course
of life, and seek shelter in some institution, met with either
rancorous denunciations against the penal system, or by polite but
firm refusals to submit to the discipline, which is supposed to extend
to all reformatory asylums.
Gradually, however, this prevailing opinion is being cleared away, and
the fallen women themselves are not slow to distinguish between
the two opposite methods of treatment, a fact which is rendered
clearly apparent by the overwhelming number of applications for
admission into those Homes which are characterized by a more
humane and gentle regimen.
The oldest reformatory institution in the metropolis for the reception
of fallen women is The Magdalen Hospital, founded in 1758. During
the last 100 years of its existence nearly 9,000 women have been
admitted, about two-thirds of whom have been restored to friends or
relations. At the time when this charity was first instituted “the
notion of providing a house for the reception and maintenance of
‘Penitent Prostitutes’ seems not to have suggested itself to the public
mind. Even good and actively benevolent men appear to have been
startled at the novelty of the proposition, while they doubted the
wisdom, and still more the success of such an attempt. The
newspapers of that period contained both arguments against, and
ridicule of the plan and its promoters. God, however, blessed the
undertaking, and raised up friends and supporters in every
direction.”
So that eighteen years after its incorporation its friends were able to
use the following cheering language.
“We see many fellow-creatures, by means of this happy asylum,
rescued from sorrow in which they had been involved by all the
iniquitous stratagems of seduction; in which condition they had been
detained by a species of horrid necessity; from which they had no
probable or possible retreat; and in which they must, therefore,
according to all human appearance, have perished. We see them
restored to their God, to their parents, to their friends, their country,
and themselves. What charitable heart, what truly Christian hand
can withhold its best endeavours to promote an undertaking so
laudable, so beneficent? Who would not desire to add to the number
of souls preserved from the deepest guilt—of bodies rescued from
shame, misery, and death? Who would not wish to wipe the tear
from a parent’s eyes—to save the hoary head from being brought
down with sorrow to the grave?”
An interval of half a century elapsed after the foundation of the
Magdalen Asylum before the establishment of any similar institution.
Within the last ten years, however, public attention has been
directed with increasing interest to this subject, and numerous
efforts have been made to provide more ample accommodation for
those who are desirous of escaping from their wretched mode of life.
The London by Moonlight Mission, inaugurated some years ago by
Lieutenant Blackmore, has been followed in our own day by the
Midnight Meeting Movement, which has excited a world-wide
sympathy and interest, and has been very generally approved even
in quarters where encouragement could be least expected. The
commencement of these meetings in London was the signal for
similar experiments in Manchester, Liverpool, Nottingham,
Edinburgh, Glasgow, Dundee, Dublin, and other large towns.
Twenty-two of these meetings have now been held, and attended by
upwards of 4,000 women, more than 600 of whom have been
rescued, and either restored to friends, or placed in situations,
where they are giving satisfactory evidence of outward reformation,
and many of them of a thorough change of character.
The largest association in London for the reformation of fallen
women, is the Society for the Rescue of Young Women and Children.
The Society has at present eleven homes in various parts of London,
and one at Dover. Four of these are “Family Homes” for the
reception of preventive cases, or young girls who have not strayed
from the path of virtue, but are addicted to crime, or are in
circumstances of danger. One is a Home for orphan children, from
nine to thirteen years of age; and the remaining seven are for fallen
cases.
Upwards of 2,700 women and children have been admitted into
these Homes since the Society’s formation in 1853, the greater part
of whom have given satisfactory proof of having been reclaimed and
permanently benefitted. The Society’s income for the past year
amounted to £6,789 17s. 2d. The Homes are under the care of pious
and experienced matrons, who labour incessantly to promote the
spiritual and social welfare of their charges.
Another institution of recent origin, but of rapidly increasing growth,
is the London Female Preventive and Reformatory Institution, which
already numbers four Homes, and has admitted, during the past
year, upwards of 250 inmates.
The following are the objects embraced by the Institution:—
“I. To seek the destitute and fallen by voluntary missionary effort.
“II. To afford temporary protection to friendless young women,
whose circumstances expose them to danger; also to effect the
rescue of fallen females, especially those decoyed from the country,
by admitting them to the benefits of this Institution.
“III. To restore, when practicable, the wanderer to her family and
friends, whether in town or country.
“IV. To qualify those admitted into the Institution for various
departments of domestic service, to obtain suitable situations for
them, and provide them with clothing.
“V. To aid such as for approved reasons wish to emigrate.
“VI. Above all, to seek the spiritual welfare of the inmates.”
The two last-named Societies and the Home of Hope, which is
another Refuge identical in character and spirit with that last named,
have received most of the cases rescued by the midnight meetings.
Great and encouraging as are the results effected by these
institutions, and wide as the sympathy is which they have awakened,
it is clear that the means of rescue are as yet wholly disproportioned
to the numbers claiming assistance.
Calculating the number of fallen women in London at eighty
thousand, which is probably not far wide of the truth, and computing
the number at present in the different institutions to be 1,000, the
chance of rescue through the only recognized medium for female
reformation is offered to one woman in every eighty!
This is the high-water mark of public charity, and the utmost
provision made by Society for the rescue of these 80,000 outcasts!
And yet there are special reasons which seem to give them a strong
claim upon the sympathy and compassion of the benevolent public.
The brief term of their existence, the average length of which is at
best but a few years, and the fact that large numbers of them are
driven upon the streets by a stern necessity, and compelled to live
by sin as a trade, while everything contributes to prevent their
escape from the mode of life into which they have been involuntarily
forced, are surely considerations calculated to stimulate Christian
effort on their behalf. But more than this,—it is well known that they
are hanging as it were over the mouth of the bottomless pit.
“Their life-blood is ebbing at a fearful rate, and their souls are
drifting madly to eternity. Their fate is certain; their doom impends:
and, for their death-bed, there is not even the faintest glimmer of
hope which charity can bequeath to the dying sinner. All others may
find peace at last; but these, suddenly overtaken by death, and
perishing in and by their sins, must be irrevocably lost. And who are
they on whose warm vitals the ‘worm feeds sweetly,’ even on this
side the grave, and around whose heads the unquenchable fire
prematurely burns? Who are those whose souls, in countless
numbers, are now glutting the chambers of hell? Not swarthy
Indians nor sable Africans, whose deeds of violence and superstition
have spread horror and astonishment among civilized nations, but
delicately-nurtured Saxon women, who in infancy were lovingly
fondled in the arms of Christian mothers, and received ‘into the ark
of Christ’s Church’ in baptism, before a praying congregation; young
girls, for whom pious sponsors promised that they should be
‘virtuously brought up to lead a godly and a Christian life,’ and who,
in the faithful discharge of this promise, were trained in our
Sabbath-schools, and ‘taken to the Bishop to be confirmed by him.’
They have sung the same hymns which we now sing; our
congregational melodies are still familiar to them. They have read
the same Scriptures which we now read, worshipped in the same
temple in which we assemble, offered up the same prayers, listened
to the same exhortations, and looked forward to the same glorious
fruition of future blessedness. But where are they now? What are
their hopes and expectations, and what the probable end of their
existence? Let those answer these questions who sneeringly ask why
such prodigious efforts are made to rescue the fallen.
“It not unfrequently happens, however, that the benevolent
promoters of such schemes are perplexed and disheartened by those
who assume a tone of expediency and argue thus: ‘Yes, it is all very
true; and we can sympathise with your efforts, and pity the poor
unhappy objects of your solicitude; but, then, this is a necessary
evil, and any attempts to remove it are altogether mistaken, and are
sure to end in failure, or to produce greater mischief. Besides, the
demand will always create the supply, and for every fallen woman
you snatch from the streets, an innocent, and hitherto virtuous girl,
must be sacrificed. No, we are sorry for them, but better let them
perish than save them at the sacrifice of other victims.’
“First then, this is a ‘necessary evil.’ Falsehood is sufficiently patent
upon the face of this foolish and monstrous assertion. Could the
Creator have pronounced his work ‘very good’ with such an
inseparable appendage to social life? Again, how comes it that a
‘necessary evil’ only exhibits itself in certain localities, and under
particular circumstances, disappearing altogether in uncivilized
countries, and gathering strength and virulence in the most refined
states of society? Will any modern philosopher favour us with a
solution of this difficulty?
“But ‘the demand will always create the supply.’ Inexorable logic
apparently, and incontrovertible if the supply were limited to the
demand. This, however, we deny. Thousands are driven to
prostitution as the only alternative from starvation. Necessity, and
not the demand, here creates the supply, and it is well known that
the supply suggests the demand. Is, then, the balance of vice so
exact and undeviating, that the gap occasioned by the removal of
one victim must be speedily filled by another? Is the equilibrium of
profligacy so nicely adjusted, that it would be dangerous to assert
the prerogative of virtue; and shall we desire its unhappy votaries to
continue in sin that virtue may abound? Shall we drive back anxious
souls, striving to ‘flee from the wrath to come,’ with the cold-blooded
assurance that, ‘for the good of society, they had better remain
where they are?’ Will it satisfy an immortal spirit, to be told that she
helps to maintain the proper equilibrium of vice; or that, by standing
in the gap, she is a benefactor to the innocent of her own sex, who
would otherwise be sacrificed? Shall we assign as our reason for not
preaching the Gospel to ‘every creature,’ that the state of society
would be unhinged by curtailing a necessary evil, or that greater
injuries would result from any attempt to rescue perishing souls?
Shall we mock Him who has said ‘All souls are mine,’ by elevating a
doctrine of human expediency above the authority of a distinct
command? Let us be sure that, in a case so intimately affecting the
honour and glory of God, to ‘obey is better than sacrifice, and to
hearken than the fat of rams.’ In vain may we plead political
necessity as a plausible pretext for disobedience.
“We are not afraid, however, to meet this argument on philosophical
grounds; and we affirm, confidently, that the rescue of every fallen
woman is a social boon. Admitting the possibility that, eventually,
her place will be supplied by another—for we can approach no
nearer to the truth—is it not better to remove a present evil than to
provide for a remote contingency? Supposing that in the long vista
of future years, the immolation of a fresh victim is the price of every
individual rescue, do we overlook the fact, that in the mean time a
powerful temptation is removed, and that not merely units, but
probably hundreds, of the young of the opposite sex are delivered
from the toils of the strange woman? Is nothing achieved by the
temporary removal of one tempter from the streets, and is society a
loser in the end, by the reformation of one whose sole occupation is
to waylay and ruin the youth of the opposite sex? Let our moral
economists escape from this dilemma if they can; the philanthropist
and the Christian need no further arguments to convince them that
they have not only the law of God, but the inexorable logic of
common sense on their side.
“Who can tell the pestiferous influence exercised on society by one
single fallen woman? Who can calculate the evils of such a system?
Woman, waylaid, tempted, deceived, becomes in turn the terrible
avenger of her sex. Armed with a power which is all but irresistible,
and stript of that which can alone restrain and purify her influence,
she steps upon the arena of life qualified to act her part in the
reorganization of society. The lex talionis—the law of retaliation—is
hers. Society has made her what she is, and must be now governed
by her potent influence. The weight of this influence is untold: view
it in the dissolution of domestic ties, in the sacrifice of family peace,
in the cold desolation of promising homes; but, above all, in the
growth of practical Atheism, and in the downward tendency of all
that is pure and holy in life! One and another who has been
educated in an atmosphere redolent of virtue and principle, and has
given promise of high and noble qualities, falls a victim to the
prevalence of meretricious allurements, and carries back to his
hitherto untainted home the noxious influence he has imbibed.
Another and another, within the range of that influence, is made to
suffer for his sacrifice of moral rectitude, and they, in their turn,
become the agents, and the originators of fresh evils. Who, in
contemplating this pedigree of profligacy resulting from a solitary
temptation, will venture to affirm that the temporary withdrawal of a
single prostitute is not a social blessing? Surely for such immediate
results we are justified in dispensing with considerations of future
expediency; and, acting upon the first principles of Christian ethics,
may help to reform the vicious and profligate, leaving it in the hands
of a merciful God to avert the contingency of ruin overtaking the as
yet unfallen woman.”[9]
In reference to all such Christian efforts to reclaim the fallen, it has
been truly said that “You may ransack the world for objects of
compassion. You may scour the earth in search of suffering
humanity, on which to exercise your philanthropy; you may roam the
countless hospitals and asylums of this vast city; you may penetrate
the dens and caves of all other profligacy; you may lavish your
bounty upon a transatlantic famine, or dive into Neapolitan
dungeons, or scatter the Bible broadcast throughout the great moral
wildernesses of heathendom: but in all the million claims upon your
faith, upon your feeling as a man, upon your benevolence as a
Christian, you will never fulfil a mission dearer to Christ, you will
never promote a charity more congenial to the spirit of this gospel;
you will never more surely wake up joy in heaven, and force tears
into the eyes of sympathising angels, than when you can bring a
Magdalene face to face with her Redeemer, and thrill her poor heart,
even to breaking, with the plaintive music of that divine voice,
calling her by name—Mary.”
 LONDON LABOUR
AND THE

LONDON POOR.

THOSE THAT WILL NOT WORK.

INTRODUCTION.
I enter upon this part of my subject with a deep sense of the misery,
the vice, the ignorance, and the want that encompass us on every
side—I enter upon it after much grave attention to the subject,
observing closely, reflecting patiently, and generalizing cautiously
upon the phenomena and causes of the vice and crime of this city—I
enter upon it after a thoughtful study of the habits and character of
the “outcast” class generally—I enter upon it, moreover, not only as
forming an integral and most important part of the task I have
imposed upon myself, but from a wish to divest the public mind of
certain “idols” of the platform and conventicle—“idols” peculiar to
our own time, and unknown to the great Father of the inductive
philosophy—and “idols,” too, that appear to me greatly to obstruct a
proper understanding of the subject. Further, I am led to believe that
I can contribute some new facts concerning the physics and
economy of vice and crime generally, that will not only make the
solution of the social problem more easy to us, but, setting more
plainly before us some of its latent causes, make us look with more
pity and less anger on those who want the fortitude to resist their
influence; and induce us, or at least the more earnest among us, to
apply ourselves steadfastly to the removal or alleviation of those
social evils that appear to create so large a proportion of the vice
and crime that we seek by punishment to prevent.
Such are the ultimate objects of my present labours: the result of
them is given to the world with an earnest desire to better the
condition of the wretched social outcasts of whom I have now to
treat, and to contribute, if possible, my mite of good towards the
common weal.
But though such be my ultimate object, let me here confess that my
immediate aim is the elimination of the truth; without this, of course,
all other principles must be sheer sentimentality—sentiments being,
to my mind, opinions engendered by the feelings rather than the
judgment. The attainment of the truth, then, will be my primary aim;
but by the truth, I wish it to be understood, I mean something more
than the bare facts. Facts, according to my ideas, are merely the
elements of truths, and not the truths themselves; of all matters
there are none so utterly useless by themselves as your mere
matters of fact. A fact, so long as it remains an isolated fact, is a
dull, dead, uninformed thing; no object nor event by itself can
possibly give us any knowledge, we must compare it with some
other, even to distinguish it; and it is the distinctive quality thus
developed that constitutes the essence of a thing—that is to say, the
point by which we cognize and recognise it when again presented to
us. A fact must be assimilated with, or discriminated from, some
other fact or facts, in order to be raised to the dignity of a truth, and
made to convey the least knowledge to the mind. To say, for
instance, that in the year 1850 there were 26,813 criminal offenders
in England and Wales, is merely to oppress the brain with the record
of a fact that, per se, is so much mental lumber. This is the very
mummery of statistics; of what rational good can such information
by itself be to any person? who can tell whether the number of
offenders in that year be large or small, unless they compare it with
the number of some other year, or in some other country? but to do
this will require another fact, and even then this second fact can give
us but little real knowledge. It may teach us, perhaps, that the past
year was more or less criminal than some other year, or that the
people of this country, in that year, were more or less disposed to
the infraction of the laws than some other people abroad; still, what
will all this avail us? If the year which we select to contrast criminally
with that of 1850 be not itself compared with other years, how are
we to know whether the number of criminals appertaining to it be
above or below the average? or, in other words, how can the one be
made a measure of the other?
To give the least mental value to facts, therefore, we must
generalize them, that is to say, we must contemplate them in
connection with other facts, and so discover their agreements and
differences, their antecedents, concomitants, and consequences. It
is true we may frame erroneous and defective theories in so doing;
we may believe things which are similar in appearance to be similar
in their powers and properties also; we may distinguish between
things having no real difference; we may mistake concomitant
events for consequences; we may generalize with too few
particulars, and hastily infer that to be common to all which is but
the special attribute of a limited number; nevertheless, if theory may
occasionally teach us wrongly, facts without theory or generalization
cannot possibly teach us at all. What the process of digestion is to
food, that of generalizing is to fact; for as it is by the assimilation of
the substances we eat with the elements of our bodies that our
limbs are enlarged and our whole frames strengthened, so is it by
associating perception with perception in our brains that our intellect
becomes at once expanded and invigorated. Contrary to the vulgar
notion, theory, that is to say, theory in its true Baconian sense, is not
opposed to fact, but consists rather of a large collection of facts; it is
not true of this or that thing alone, but of all things belonging to the
same class—in a word, it consists not of one fact but an infinity. The
theory of gravitation, for instance, expresses not only what occurs
when a stone falls to the earth, but when every other body does the
same thing; it expresses, moreover, what takes place in the
revolution of the moon round our planet, and in the revolution of our
planet and of all the other planets round our sun, and of all other
suns round the centre of the universe; in fine, it is true not of one
thing merely, but of every material object in the entire range of
creation.
There are, of course, two methods of dealing philosophically with
every subject—deductively and inductively. We may either proceed
from principles to facts, or recede from facts to principles. The one
explains, the other investigates; the former applies known general
rules to the comprehension of particular phenomena, and the latter
classifies the particular phenomena, so that we may ultimately come
to comprehend their unknown general rules. The deductive method
is the mode of using knowledge, and the inductive method the mode
of acquiring it.
In a subject like the crime and vice of the metropolis, and the
country in general, of which so little is known—of which there are so
many facts, but so little comprehension—it is evident that we must
seek by induction, that is to say, by a careful classification of the
known phenomena, to render the matter more intelligible; in fine,
we must, in order to arrive at a comprehensive knowledge of its
antecedents, consequences, and concomitants, contemplate as large
a number of facts as possible in as many different relations as the
statistical records of the country will admit of our doing.
With this brief preamble I will proceed to treat generally of the class
that will not work, and then particularly of that portion of them
termed prostitutes. But, first, who are those that will work, and who
those that will not work? This is the primary point to be evolved.

Of the Workers and Non-Workers.

The essential quality of an animal is that it seeks its own living,
whereas a vegetable has its living brought to it. An animal cannot
stick its feet in the ground and suck up the inorganic elements of its
body from the soil, nor drink in the organic elements from the
atmosphere. The leaves of plants are not only their lungs but their
stomachs. As they breathe they acquire food and strength, but as
animals breathe they gradually waste away. The carbon which is
secreted by the process of respiration in the vegetable is excreted by
the very same process in the animal. Hence a fresh supply of
carbonaceous matter must be sought after and obtained at frequent
intervals, in order to repair the continual waste of animal life.
But in the act of seeking for substances fitted to replace that which
is lost in respiration, nerves must be excited and muscles moved;
and recent discoveries have shown that such excitation and motion
are attended with decomposition of the organs in which they occur.
Muscular action gives rise to the destruction of muscular tissue,
nervous action to a change in the nervous matter; and this
destruction and decomposition necessarily involve a fresh supply of
nitrogenous matter, in order that the loss may be repaired.
Now a tree, being inactive, has little or no waste. All the food that it
obtains goes to the invigoration of its frame; not one atom is
destroyed in seeking more: but the essential condition of animal life
is muscular action; the essential condition of muscular action is the
destruction of muscular tissue; and the essential condition of the
destruction of muscular tissue is a supply of food fitted for the
reformation of it, or—death. It is impossible for an animal—like a
vegetable—to stand still and not destroy. If the limbs are not
moving, the heart is beating, the lungs playing, the bosom heaving.
Hence an animal, in order to continue its existence, must obtain its
subsistence either by its own exertions or by those of others—in a
word, it must be autobious or allobious.
The procuration of sustenance, then, is the necessary condition of
animal life, and constitutes the sole apparent reason for the addition
of the locomotive apparatus to the vegetative functions of sentient
nature; but the faculties of comparison and volition have been
further added to the animal nature of Man, in order to enable him,
among other things, the better to gratify his wants—to give him such
a mastery over the elements of material nature, that he may force
the external world the more readily to contribute to his support.
Hence the derangement of either one of those functions must
degrade the human being—as regards his means of sustenance—to
the level of the brute. If his intellect be impaired, and the faculty of
perceiving “the fitness of things” be consequently lost to him—or,
this being sound, if the power of moving his muscles in compliance
with his will be deficient—then the individual becomes no longer
capable, like his fellows, of continuing his existence by his own
exertions.
Hence, in every state, we have two extensive causes of allobiism, or
living by the labour of others; the one intellectual, as in the case of
lunatics and idiots, and the other physical, as in the case of the
infirm, the crippled, and the maimed—the old and the young.
But a third, and a more extensive class, still remains to be
particularized. The members of every community may be divided
into the energetic and the an-ergetic; that is to say, into the
hardworking and the non-working, the industrious and the indolent
classes; the distinguishing characteristic of the anergetic being the
extreme irksomeness of all labour to them, and their consequent
indisposition to work for their subsistence. Now, in the circumstances
above enumerated, we have three capital causes why, in every
State, a certain portion of the community must derive their
subsistence from the exertions of the rest; the first proceeds from
some physical defect, as in the case of the old and the young, the
super-annuated and the sub-annuated, the crippled and the
maimed; the second from some intellectual defect, as in the case of
lunatics and idiots; and the third from some moral defect, as in the
case of the indolent, the vagrant, the professional mendicant, and
the criminal. In all civilized countries, there will necessarily be a
greater or less number of human parasites living on the sustenance
of their fellows. The industrious must labour to support the lazy, and
the sane to keep the insane, and the able-bodied to maintain the
infirm.
Still, to complete the social fabric, another class requires to be
specified. As yet, regard has been paid only to those who must
needs labour for their living, or who, in default of so doing, must
prey on the proceeds of the industry of their more active or more
stalwart brethren. There is, however, in all civilized society, a farther
portion of the people distinct from either of those above mentioned,
who, being already provided—no matter how—with a sufficient stock
of sustenance, or what will exchange for such, have no occasion to
toil for an additional supply.
Hence all society would appear to arrange itself into four different
classes:—

I. Those that Will Work.

II. Those that Cannot Work.
III. Those that Will Not Work.
IV. Those that Need Not Work.

Under one or other section of this quadruple division, every member,

not only of our community, but of every other civilized State, must
necessarily be included; the rich, the poor, the industrious, the idle,
the honest, the dishonest, the virtuous, and the vicious—each and
all must be comprised therein.
Let me now proceed specially to treat of each of these classes—to
distribute under one or other of these four categories the diverse
modes of living peculiar to the members of our own community, and
so to enunciate, for the first time, the natural history, as it were, of
the industry and idleness of Great Britain in the nineteenth century.
It is no easy matter, however, to classify the different kinds of labour
scientifically. To arrange the several varieties of work into “orders,”
and to group the manifold species of arts under a few
comprehensive genera—so that the mind may grasp the whole at
one effort—is a task of a most perplexing character. Moreover, the
first attempt to bring any number of diverse phenomena within the
rules of logical division is not only a matter of considerable difficulty,
but one, unfortunately, that is generally unsuccessful. It is
impossible, however, to proceed with the present inquiry without
making some attempt at systematic arrangement; for of all scientific
processes, the classification of the various phenomena, in connection
with a given subject, is perhaps the most important; indeed, if we
consider that the function of cognition is essentially discriminative, it
is evident, that without distinguishing between one object and
another, there can be no knowledge, nor, indeed, any perception.
Even as the seizing of a particular difference causes the mind to
apprehend the special character of an object, so does the discovery
of the agreements and differences among the several phenomena of
a subject enable the understanding to comprehend it. What the
generalization of events is to the ascertainment of natural laws, the
generalization of things is to the discovery of natural systems. But
classification is no less dangerous than it is important to science; for
in precisely the same proportion as a correct grouping of objects into
genera and species, orders and varieties, expands and assists our
understanding, so does any erroneous arrangement cripple and
retard all true knowledge. The reduction of all external substances
into four elements by the ancients—earth, air, fire, and water—
perhaps did more to obstruct the progress of chemical science than
even a prohibition of the study could have effected.
But the branches of industry are so multifarious, the divisions of
labour so minute and manifold, that it seems at first almost
impossible to reduce them to any system. Moreover, the crude
generalizations expressed in the names of the several arts, render
the subject still more perplexing.
Some kinds of workmen, for example, are called after the articles
they make—as saddlers, hatters, boot-makers, dress-makers,
breeches-makers, stay-makers, lace-makers, button-makers, glovers,
cabinet-makers, artificial-flower-makers, ship-builders, organ-
builders, boat-builders, nailers, pin-makers, basket-makers, pump-
makers, clock and watch makers, wheel-wrights, ship-wrights, and
so forth.
Some operatives, on the other hand, take their names not from what
they make, but from the kind of work they perform. Hence we have
carvers, joiners, bricklayers, weavers, knitters, engravers,
embroiderers, tanners, curriers, bleachers, thatchers, lime-burners,
glass-blowers, seamstresses, assayers, refiners, embossers, chasers,
painters, paper-hangers, printers, book-binders, cab-drivers,
fishermen, graziers, and so on.
Other artizans, again, are styled after the materials upon which they
work, such as tinmen, jewellers, lapidaries, goldsmiths, braziers,
plumbers, pewterers, glaziers, &c. &c.
And lastly, a few operatives are named after the tools they use; thus
we have ploughmen, sawyers, and needlewomen.
But these divisions, it is evident, are as unscientific as they are
arbitrary; nor would it be possible, by adopting such a classification,
to arrive at any practical result.
Now, I had hoped to have derived some little assistance in my
attempt to reduce the several varieties of work to system from the
arrangement of the products of industry and art at “the Great
Exhibition.” I knew, however, that the point of classification had
proved the great stumbling block to the French Industrial
Exhibitions. In the Exposition of the Arts and Manufactures of France
in 1806, for instance, M. Costaz adopted a topographical
arrangement, according to the departments of the kingdom whence
the specimens were sent. In 1819, again, finding the previous
arrangement conveyed little or no knowledge, depending, as it did,
on the mere local association of the places of manufacture, the same
philosopher attempted to classify all arts into a sort of natural
system, but the separate divisions amounted to thirty-nine, and were
found to be confused and inconvenient. In 1827 M. Payon adopted a
classification into five great divisions, arranging the arts according as
they are chemical, mechanical, physical, economical, or
“miscellaneous” in their nature. It was found, however, in practice,
that two, or even three, of these characteristics often belonged to
the same manufacture. In 1834 M. Dupin proposed a classification
that was found to work better than any which preceded it. He
viewed man as a locomotive animal, a clothed animal, a domiciled
animal, &c., and thus tracing him through his various daily wants
and employments, he arrived at a classification in which all arts are
placed under nine headings, according as they contribute to the
alimentary, sanitary, vestiary, domiciliary, locomotive, sensitive,
intellectual, preparative, or social tendencies of man. In 1844 and
1849 attempts were made towards an eclectic combination of two or
three of the above-mentioned systems, but it does not appear that
the latter arrangements presented any marked advantages.
Now, with all the experience of the French nation to guide us, I
naturally expected that especial attention would be directed towards
the point of classification with us, and that a technological system
would be propounded, which would be found at least an
improvement on the bungling systems of the French. It must be
confessed, however, that no nation could possibly have stultified
itself so egregiously as we have done in this respect. Never was
there anything half so puerile as the classification of the works of
industry in our own Exhibition!
But this comes of the patronage of Princes; for we are told that at
one of the earliest meetings at Buckingham Palace his Royal
Highness propounded the system of classification according to which
the works of industry were to be arranged. The published minutes of
the meeting on the 30th of June, 1849, inform us—
“His Royal Highness communicated his views regarding the
formation of a Great Collection of Works of Industry and Art in
London in 1851, for the purposes of exhibition, and of competition
and encouragement. His Royal Highness considered that such a
collection and exhibition should consist of the following divisions:—

Raw Materials.
Machinery and Mechanical Inventions.
Manufactures.
Sculpture and Plastic Art generally.”
Now, were it possible for monarchs to do with natural laws as with
social ones, namely, to blow a trumpet and declaring “le roi le veut,”
to have their will pass into one of the statutes of creation, it might
be advantageous to science that Princes should seek to lay down
orders of arrangement and propound systems of classification. But
seeing that Science is as pure a republic as Letters, and that there
are no “Highnesses” in philosophy—for if there be any aristocracy at
all in such matters, it is at least an aristocracy of intellect—it is
rather an injury than a benefit that those who are high in authority
should interfere in these affairs at all; since, from the very
circumstances of their position it is utterly impossible for them to
arrive at anything more than the merest surface knowledge on such
subjects. The influence, too, that their mere “authority” has over
men’s minds is directly opposed to the perception of truth,
preventing that free and independent exercise of the intellect from
which alone all discovery and knowledge can proceed.
Judging the quadruple arrangement of the Great Exhibition by the
laws of logical division, we find that the three classes—Raw
Materials, Machinery, and Manufactures—which refer more
particularly to the Works of Industry, are neither distinct nor do they
include the whole. What is a raw material, and what a manufacture?
It is from the difficulty of distinguishing between these two
conditions that leather is placed under Manufactures, and steel
under Raw Materials—though surely steel is iron plus carbon, and
leather skin plus tannin; so that, technologically considered, there is
no difference between them. If by the term raw material is meant
some natural product in its crude state, then it is evident that
“Geological maps, plans, and sections; prussiate of potash, and
other mixed chemical manufactures; sulphuric, muriatic, nitric, and
other acids; medicinal tinctures, cod liver oil, dried fruits, fermented
liquors and spirits, preserved meats, portable soups, glue, and the
alloys” cannot possibly rank as raw materials, though one and all of
these articles are to be found so “classified” at the Great Exhibition;
but if the meaning of a “raw material” be extended to any product
which constitutes the substance to be operated upon in an industrial
art, then the answer is that leather, which is the material of shoes
and harness, is no more a manufacture than steel, which is placed
among the raw materials, because forming the constituent
substance of cutlery and tools. So interlinked are the various arts
and manufactures, that what is the product of one process of
industry is the material of another—thus, yarn is the product of
spinning, and the material of weaving, and in the same manner the
cloth, which is the product of weaving, becomes the material of
tailoring.
But a still greater blunder than the non-distinction between products
and materials lies in the confounding of processes with products. In
an Industrial Exhibition to reserve no special place for the processes
of industry is very much like the play of Hamlet with the part of
Hamlet omitted; and yet it is evident that, in the quadruple
arrangement before mentioned, those most important industrial
operations which consist merely in arriving at the same result by
simpler means—as, for instance, the hot blast in metallurgical
operations—can find no distinct expression. The consequence is that
methods of work are arranged under the same head as the work
itself; and the “Executive” have been obliged to group under the first
subdivision of Raw Materials the following inconsistent jumble:—Salt
deposits; ventilation; safety lamps and other methods of lighting;
methods of lowering and raising miners, and draining; methods of
roasting, smelting, or otherwise reducing ores; while under the
second subdivision of Raw Materials chemical and pharmaceutical
processes and products are indiscriminately confounded.
Another most important defect is the omission of all mention of
those industrial processes which have no special or distinct products
of their own, but which are rather engaged in adding to the beauty
or durability of others; as, for instance, the bleaching of some textile
fabrics, the embroidering of others, the dyeing and printing of
others; the binding of books; the cutting of glass; the painting of
china, &c. From the want of an express division for this large portion
of our industrial arts, there is a jumbling and a bungling throughout
the whole arrangement. Under the head of manufactures are
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