EXOPHTHALMIC GOITER AND THE ADRENALS. 157 



ments led him to the conclusion that the bodies referred to 

 "were continuously poured in small quantities in the lym- 

 phatics and in the blood to play therein the role of vitality 

 stimulants and to enhance cell-reproduction." This thought 

 is quite in accord with the views herein recorded, particularly 

 those pertaining to the increased oxidation which suprarenal 

 overactivity procures, since, after all, to increase oxidation 

 is to enhance all manifestations of vital energy. 



Yet the presence of arsenic in the thyroid introduces a 

 source of confusion, since, as we have seen, all the toxic phe- 

 nomena ascribed to poisons are of suprarenal origin, and 

 arsenic might therefore as well be the source of the supra- 

 renal phenomena of exophthalmic goiter as iodine, to which 

 we have traced them. The question reduces itself to this, 

 however: does the arsenic offset iodism as we have suggested, 

 or does it also act as a suprarenal stimulant? 



As to the connection between arsenic and exophthalmic 

 goiter, Notthaft's case, produced by thyroid extract, suggests 

 that a combination of these agents does not produce the dis- 

 ease. Since thyroid extract was used, we can assume that all 

 active constituents took part in the production of the effects 

 witnessed. With the extractives, iodothyrin, thyreoglobulin, 

 etc., however, it would seem, in view of their mode of prepa- 

 ration and the smaller dose administered, that in the undoubt- 

 edly active effects obtained the arsenic should count for prac- 

 tically nothing: a fact which would relegate all the phenomena 

 to the action of the iodine. That such is actually the case is 

 sustained by chemical and experimental evidence. 



Mabille has observed that the untoward symptoms caused 

 by iodothyrin, when used in the human subject as a remedy, 

 or in experimental animals, could be reduced to a great extent 

 and even prevented by the simultaneous use of arsenic. Ex- 

 periments in dogs showed that the toxic effects of large doses 

 did not appear when arsenic was used simultaneously, while 

 they could be arrested by it when iodothyrin had been given 

 alone. In the case of a goitrous woman 42 years of age, he 

 administered this preparation in doses varying from 3 to 10 

 grains daily. Marked palpitations, lumbar pains, and tremor 

 having appeared, the dose was reduced and the untoward 



