158 THE THYROID, THE THYMUS, AND THE ADRENALS. 



symptoms vanished. lodothyrin was then administered in in- 

 creased doses, 12 grains daily, but simultaneously with 12 

 drops of Fowler's solution. Not a single sign of thyroidism 

 showed itself; but, when the use of the arsenic was discon- 

 tinued for three days, the toxic symptoms recurred, and again 

 disappeared when the use of arsenic was resumed. This re- 

 markable property of arsenic was confirmed by Ewald. 16 This 

 investigator was not only led to grant it all the properties 

 referred to by Mabille, but he found it to exert its antagonistic 

 action against thyroidism far more promptly than atropine 

 when administered to attenuate or prevent the noxious effects 

 of potassium iodide. On the whole, we can fairly conclude that 

 iodine is the most active factor of the thyroidal constituents and 

 that it is through its effects that the adrenals are directly or in- 

 directly over stimulated in exophthalmic goiter. 



There is another feature of the problem which demands 

 elucidation. Overaetivity of the thyroid being accepted as the 

 cause of exophthalmic goiter, how can we account for the 

 undoubted cases of recovery that have occurred as the result 

 of treatment with thyroid extract and other thyroid deriva- 

 tives? When some years ago Owen reported that he had wit- 

 nessed marked improvement after this treatment, it was tried 

 on all sides, generally with unfavorable results. Since then, 

 however, quite a number of successful cases have been reported. 



These contradictory results are easily accounted for when 

 we consider the part played by the suprarenal glands in the 

 process, and particularly the fact that overactivity and insuffi- 

 ciency of these organs give rise to different, though co-related, 

 symptoms. Interesting in this connection is a clinical ob- 

 servation of Solomon Solis-Cohen's, quoted as given by a 

 reviewer 17 : 



"Dr. Cohen remarked that his experience went to show 

 that in exceptional cases thyroid preparations might benefit 

 goitrous patients, both those with simple goiter and those with 

 Graves's disease; but that, as a rule, the effect was nil or not 

 good. He could give no definite rule for discrimination, al- 



16 Ewald: Die Therapie der Gegenwart, No. 9, 



17 Alienist and Neurologist, Oct., 1896. 



