150 THE INTERNAL SECRETIONS—1920 
precursors of the nitrogenous wastes of the body and 
there is good evidence to prove this physiologically and 
clinically. 
At all events, this accumulation of cellular wastes 
brings about the condition which Hertoghe has called 
“thyroid infiltration” on well-known physical princi- 
ples. We will presume that a given cell located in any 
part of the body—for the thyroid influence extends to 
every corner of the human organism—is not maintain- 
ing its normal chemical activities, that it is suffering 
with the condition which I have named ‘“‘chemasthe- 
nia.” The cellular activities are lessened and, as a 
result of this, the wastes of that cell are not prepared 
for elimination and remain behind. Asa result of this 
there ensues an actual swelling of the cell due to the 
effort on the part of the body to maintain a normal 
osmotic tension. In other words, this increased osmotic 
tension in the cell draws fluids from other parts of the 
body, including the blood, lymph, and tissue juices, 
which evens up this tension and, therefore, extends the 
confines of the cell wall. Weare in the habit of expect- 
ing an infiltration of the skin in myxedema—the very 
name of this condition indicates that there is an edema 
of the skin—and this edema or process of swelling or 
infiltration, as it is preferably called, is not limited by 
any means to the superficial tissues of the body. 
It will be recalled that in Barker’s paper,? from 
which a quotation already has been made, he believes 
that high blood pressure appears to depend chiefly on a 
narrowing of the lumina of the arterioles in the pre- 
capillary areas. What is the chief reason for the nar- 
rowing of these lumina? May it not be that the 
infiltrated cells which surround these prearteriolar 
canals or vessels are pressing upon the channels 
through which the blood usually flows, thereby reduc- 
ing the circulation and also increasing the activity of 
the heart muscle which is necessary to force the blood 
