160 THE THYROID, THE THYMUS, AND THE ADRENALS. 



deficient oxidation, the immediate consequence of suprarenal 

 insufficiency. A vicious circle is thus created; the toxic prod- 

 ucts of metabolism engender further insufficiency of the ad- 

 renals, while this condition, in turn, allows the toxics to ac- 

 cumulate in the organism. Finally, marasmus appears, if 

 some intercurrent pulmonary or cardiac acute disorder does 

 not cause death before this stage is reached. This stage of 

 the disease includes the cases in which exophthalmic goiter 

 and myxoedema appear jointly, since in a small proportion of 

 instances the thyroidal secretion becomes reduced below the 

 needs of the suprarenal glands. 



It seems evident that these advanced, not necessarily 

 grave, cases of exophthalmic goiter, should be assisted by a 

 supply of the very agent which they now lack: i.e., their nor- 

 mal suprarenal stimulus. A case reported by Silex 20 and char- 

 acterized by Kroenig, who had seen it, as "very grave," was 

 thus cured after taking 1200 grains of thyroid extract. All 

 the typical signs had been present, and so advanced was the 

 muscular weakness that the patient, a woman aged 42 years, 

 could hardly walk. A case cured by K. Cox 21 also showed 

 "general prostration," but the thyroid extract used was doubt- 

 less greatly assisted by the intestinal irrigations simultaneously 

 employed. Another case successfully treated by 0. Martin 22 

 "could not rise without experiencing great fatigue" when first 

 seen. Another case greatly benefited by C. L. Lang 23 presented 

 "an emaciated, tremulous, dusky countenance" and "was con- 

 fined to bed," etc. 



Another class of cases that clinical evidence shows to be 

 benefited includes those which, through acquired or inherited 

 suprarenal weakness, promptly yield to the primary hyper- 

 oxidation. Such cases often show signs of a quasi-myxcedema 

 during their earlier years of life. An example of this class is 

 afforded by Kerley. 24 The father of the patient had suffered 

 from epilepsy and a sister had died of tubercular meningitis: 



20 Silex: Berliner klin. Wochenschrift, No. 6, 1896. 



21 R. Cox: Montreal Medical Journal, August, 1899. 



22 O. Martin: La Presse M6dicale, August 27, 1898. 



23 c. L. Lang: Medical Council, April, 1900. 



24 Kerley: Pediatrics, June 1, 1897. 



