HYPOTHYROIDISM AND HYPERTENSION 151 
through these finest capillary meshes? In this connec- 
tion we recall very well that another of the commonest 
symptoms of hypothyroidism is a tendency to cold 
hands and feet. The circulation of the remoter parts 
of the body is very much below par, and this I believe to 
be due to exactly the same cause as the infiltration that 
already has been mentioned. 
I think that we have reasoned out a relation between 
the infiltration of thyroid insufficiency and a decreasing 
of the size of the precapillary vessels and this I believe 
to be an important mechanical factor in the cause of 
hypertension. It is granted that the other toxic influ- 
ences which would naturally accompany so serious a 
change in the general cellular chemistry must exert 
their influence also, and it is presumed that they do so 
through their effects upon the adrenal mechanism and 
its control of the circulatory muscular tone, including 
that of the heart itself. If we are successful in our 
thyroid therapy of the minor forms of hypothyroidism 
we will notice quite a change in this infiltration and its 
results. Many symptoms of a semimechanical nature 
are reduced. The cells are enabled to throw off a good 
deal of the effete material and there is a consequent in- 
creased chemistry as indicated by the urinary findings 
and a loss in weight due to the removal of much of the 
infiltrated effete material. This being the case there 
is a change in the nutrition of these infiltrated areas, 
and the skin (and other tissues) assumes a more 
healthy appearance; the work of the various organs, 
which heretofore have been puffy, soggy, and infil- 
trated, is more nearly normal; the circulation is in- 
creased and this mechanical factor, which I contend is 
a part of the cause of the high blood pressure, automati- 
cally is reduced. 
In other words, thyroid therapy in cases of hypothy- 
roidism with high blood pressure not merely removes 
a part of the accumulated toxemia but at the same time 
