THE THYROID APPARATUS. 1 07 



to repress a suspicion that the " remnants of the thyroid gland ' 

 left in situ were not thyroid tissue at all, but were the actual para- 

 thyroids themselves. 



Blum also claims that he was able to cure, or at any rate very 

 much ameliorate, acute tetany by means of a milk diet. In the 

 chapter on tetania parathyropriva, instances were given of the 

 effect upon this condition of certain forms of diet ; a more careful 

 investigation of this point is very desirable. As far as we can 

 see, however, Blum's observations do not furnish grounds for 

 the assumption of an auto-intoxication. They may add to our 

 knowledge of the function of the parathyroids, but they cannot 

 be said to supply any evidence as to an antitoxic activity on the 

 part of the thyroid gland. 



The pathological conditions which follow affections of the 

 thyroid gland result, according to Blum's theory, from the 

 interruption of the steady procedure of the process of 

 neutralization. As soon as, owing to suppression of the thyroid 

 gland, the fixing of the free poison ceases, tetany, cachexia, 

 strumipriva, myxcedema, and other thyroid affections make their 

 appearance. If the entero-toxins are fixed, but are not sufficiently 

 quickly, or not completely, neutralized, the thyroid becomes over- 

 loaded". This gives rise to those forms of goitre which are favour- 

 ably influenced by iodine the neutralizing agent of the thyroid 

 gland. 



If, however, the fixation of the toxin continues uninter- 

 ruptedly, but the toxin, as thyrotoxalbumin, passes into the blood 

 before it is completely neutralized, a partial thyroid insufficiency 

 results, similar to that produced experimentally by the exhibition 

 of thyroid gland or by ligature of the vessels and lymphatics, and 

 identical with the clinical picture presented by Graves's disease. 

 Blum advances this as the clinical ground for the treatment of 

 Graves's disease by means of an absolutely flesh-free diet, as 

 opposed to operative treatment. 



It must be evident from the preceding pages, that Blum's 

 theories concerning the thyroid gland are not only insufficiently 

 grounded, but that they are not adequate either to explain the 

 physiological and pathological phenomena with which we are 

 already acquainted, or to pave the way for further knowledge. 

 Blum's theories offer no explanation of the undoubted effects of 

 "substitution' 1 in conditions arising from thyroid insufficiency, 

 and he himself must admit the possibility of the neutralizing pro- 

 cess being performed by the thyroid substances themselves. For 

 the increased oxidation, by which Blum explains the beneficial 

 effects obtained with thyroid extract in myxcedema, is the result of 

 an activity on the part of the thyroid substance, which takes 

 place externally to the gland, and is not, therefore, dependent 

 upon the presence of the thyroid cells. Moreover, Blum takes no 

 account of the significance of the suppression of the parathyroid 



