118 THE INTERNAL SECRETIONS—1920 
well or improve markedly without operation. This has 
led many surgeons to the conclusion that such cases 
should be treated and observed medically for six 
months before being submitted to operation. 
As mentioned earlier in this paper, there are certain 
known indirect or predisposing causes of dysthyroid- 
ism. It is helpful to consider the relation of these 
causes to the therapy of the disease produced. Emo- 
tional causes as fright, grief, anger, etc., cannot be re- 
garded as producing great anatomic changes in the 
thyroid. Alterations of function must be the prevailing 
type and these are undoubtedly associated with func- 
tional changes in other endocrine glands, especially the 
adrenals. Cannon” has shown the effect which these 
“major emotions” have upon the chromaffin system and 
the marked functional changes which the whole organ- 
ism undergoes as a result of such adrenal stimulation. 
The thyroid, in all probability, also plays an important 
role in this widespread reaction to emotional stimula- 
tion. It is possible that this gland in some cases is un- 
able to meet the demand made upon it and reacts by 
elaborating a physiologically imperfect hormone with 
resulting dysthyroidism. 
The late war has given an excellent opportunity of 
studying these cases and a considerable literature on 
the subject is available (Bérard'*, Findlay**). Dys- 
thyroidism, resulting from such a cause, is usually self- 
limited and yields to medical treatment. 
Infections, both focal and general, produce a type of 
dysthyroidism which also is inclined to self-limitation, 
improving with removal of the infection. The follow- 
ing brief history of a case developing after severe in- 
fluenza pneumonia is illustrative. 
A young marriea woman of twenty-eight had always 
had a moderate thyroid enlargement since puberty. In 
January, 1919, she had influenza and developed double 
pneumonia, which ran a very severe course with tem- 
