114 THE INTERNAL SECRETIONS—1920 
laity have come to believe that it is a purely surgical 
condition. This attitude has arisen through the fact 
that apparently better and quicker results are obtained 
by partial thyroidectomy than by medical measures. 
In the great majority of cases the latter have not been 
given a thorough trial, consequently results in these 
have been attended by failure, which always follows 
insufficient and half-hearted treatment. 
One might questien the advisability of considering 
other means when surgery seems to offer quick relief 
from symptoms and ultimate cure. Without at this 
time entering into a discussion as to whether or not 
surgery really accomplishes this result, let us consider 
another aspect of the problem. Granting that good 
results are obtained by operative means, it does not 
necessarily follow that surgical treatment is the most 
rational or productive of the greatest ultimate good. 
The logic of surgical treatment as applied to dysthy- 
roidism is subject to some criticism. Whatever theory 
is adopted as to its etiology or whatever term is used 
in describing it, the pathologic state in every case is 
one of perverted function. Removal of a gland or part 
of a gland is hardly justified because it is not function- 
ing properly. Surgery is not resorted to in any other 
instances of pure dysfunction of an organ. The un- 
questioned fields of surgery are removal of malignan- 
cies, removal and drainage of infected tissues, correc- 
tion of skeletal defects and repair of soft tissues. It is 
not the usual procedure to remove an organ for any 
other cause than malignancy or infection which is so 
advanced as to make the organ’s retention in the body a 
menace. 
The application of surgery to thyroid disturbances 
came about through the conception of this condition as 
one of hyperfunction and the attempt was made to re- 
move a large portion of the gland, leaving just enough 
to supply body requirements. 
