EXOPHTHALMIC GOITER AND THE ADRENALS. 155 



in producing exophthalmos in this way." That such cases do 

 occur may be shown by the following instance reported by 

 Notthaft 12 : His patient, a man 43 years of age, had, on his own 

 responsibility, taken thyroid extract for obesity. Not content 

 with the slow progress witnessed at first, he increased the dose, 

 and within five weeks took nearly 5000 grains of the extract. 

 "For the first three weeks nothing was noticed, except loss of 

 flesh, but after this time dyspnoea came on, with swelling of 

 the neck and very rapid loss of weight. Altogether, thirty 

 pounds were lost, and five-sixths of this loss took place in the 

 last three weeks. When examined, the patient had marked 

 exophthalmos, with both Stellwag's and von Graefe's signs; the 

 thyroid gland was enlarged and pulsated, and there was a thrill 

 over it. A fine tremor of the fingers and tongue was quite 

 evident; the cardiac apex-beat was displaced outward, and the 

 pulse was 120 to the minute; there was cough and severe 

 mental depression; polyuria and glycosuria were also present. 

 Under the use of Fowler's solution and after the withdrawal 

 of the thyroid extract, most of the symptoms rapidly disap- 

 peared, only the ocular manifestations and the goiter persist- 

 ing for nearly six months." We have here, not only the stage 

 of suprarenal overactivity, including the cramped heart, as 

 witnessed by the displacement of the apex, but also the earlier 

 manifestations of insufficiency: mental depression, glycosuria, 

 Stellwag's and von Graefe's signs all features to which the 

 gradual recovery, after withdrawal of the thyroid extract, con- 

 tributes the necessary complementary evidence. 



A mass of testimony could furthermore be deduced from 

 the results of thyroidectomy. How could we account, for in- 

 stance, for the cases reported by Doyen, 13 in which, after 

 removal of the gland, followed by recovery, all the symptoms 

 returned when they were given thyroid extract, then disap- 

 peared as soon as its administration ceased, without implicating 

 oversecretion of the thyroid as the primary pathogenic factor 

 of the disease? This also invalidates all the theories in which 

 the thyroid is credited with the power of reducing toxic sub- 

 stances in loco, since the glands are absent in these cases and 



12 Notthaft: Centralblatt fur innere Med., April 9, 1898. 



13 Doyen: Semaine Medicale, July 29, 1897. 



