DYSTHYROIDISM 117 
being due to dysthyroidism, rather than to hyperthy- 
roidism. 
Operative procedures constitute one form of treat- 
ment and must be applied in some cases, but surgery 
should not be regarded as the only rational therapy. 
It is difficult to agree with Mason’s"! conclusions that 
“all patients suffering from toxic adenomas or ex- 
ophthalmic goitre are surgical cases.” Nor is it agree- 
able to subscribe to the stand taken by Scott,’ who ob- 
jects to the removal of any thyroid tissue whatever. 
The resort to surgery, though necessary at times, is a 
frank admission of our inability to completely control 
thyroid function by medical measures. Too much re- 
liance upon surgical aid, however, is conducive to a 
complacence which tends to reduce further endeavor 
along lines which will ultimately reveal means of re- 
storing the thyroid to its normal function. 
Those who advocate other methods often claim that 
there is no medical treatment for dysthyroidism. But 
it must be remembered that treatment consists in more 
than the administration of specifics. It includes every- 
thing which pertains to the patient’s care and this can 
only be given intelligently when the patient and his 
case are closely studied. The attitude of indifference 
unfortunately assumed by some practitioners towards 
diseases pronounced incurable, or thought to be purely 
surgical, has resulted in loss of valuable clinical infor- 
mation on these conditions. Just such an attitude is 
exhibited too often toward dysthyroidism and the pa- 
tient is turned over to surgery at once as though he had 
acute appendicitis or chronic cholecystitis. Clinical ob- 
servation and rational medical treatment for a few 
months would not unfrequently make operation un- 
necessary and be productive of valuable information 
on the subject of thyroid dysfunctions. 
The foundation of the theory of self-limitation is the 
observed fact that many cases of dysthyroidism get 
