116 THE INTERNAL SECRETIONS—1920 
quotation from a recent report on one hundred thyroid- 
ectomies is interesting in illustrating this point. The 
author (Mason’’) in speaking of the best time for oper- 
ation in exophthalmic goitre says, “The patient oper- 
ated upon before the first crisis is eventually much bet- 
ter off than the one who is carried through the crisis 
by medical treatment and operated on later. However, 
the patient who is operated on early in the disease will 
have a slight wave of toxicity at the time of the first 
crisis; but the severity of this wave will be reduced in 
proportion to the fraction of the gland removed.” 
Advocates of early operation urge that procedure in 
order to prevent damage to vital organs, which fre- 
quently occurs in long-standing cases. Just how this 
damage to heart and kidneys is produced is one of the 
mysteries in the pathologic physiology of the thyroid. 
Means of combating it rationally are not yet at hand, 
so the knife is appealed to, and the temporarily diseased 
organ is removed permanently from the body. 
A moment’s reflection on this phase of the subject 
raises a question as to the nature of a secretion which 
produces such changes in vital organs. It seems logical 
to suppose that a normally constituted secretion which 
is non-toxic in small amounts should not be so toxic in 
larger amounts as to cause serious damage to vital or- 
gans. The body has adequate means of ridding itself 
of its own excess secretions. Its ability to oxidize 
adrenin after a short time and render it inactive is a 
well-known clinical fact. Consideration of this point 
makes it more reasonable to suppose that the damage 
which we know is done to vital organs is produced by 
an abnormally constituted product, a physiologically 
imperfect secretion. Such a chemico-pathologic hor- 
mone would be foreign to the organism and as harm- 
ful in its effects as an exogenous toxin. 
This explanation of the damage to vital organs adds 
more strength to the conception of these conditions as 
