162 THE THYROID, THE THYMUS, AND THE ADRENALS. 



justice be taken to the author's diagnosis. Both cases had 

 weak adrenals, and to this weakness were mainly due the signs 

 witnessed, and it is owing to this, as well as in all cases of a 

 similar kind, that thyroid extract proved efficacious. 



To illustrate the solidity, of these deductions, the follow- 

 ing selection from A. J. Hutchinson's 20 review of an article 

 by Maurice Faure may be adduced: "A woman, aged 32, began 

 to develop symptoms of Graves's disease, and by the end of 

 six years presented a complete picture of exophthalmic goiter. 

 During the seventh year cardiac insufficiency supervened; during 

 the eighth year the signs of exophthalmic goiter retrogressed, 

 and the cardiac condition improved; then during a period of 

 about three years, during which the signs of Graves's disease, 

 especially the tachycardia, still persisted, myxcedema appeared. 

 During these three years the treatment was at times directed 

 against the myxcedema, viz.: thyroidin or thyroid gland; at 

 others against the cardiac condition, viz.: digitalis, with suit- 

 able diet, etc. During the eleventh year cardiac insufficiency 

 became very serious, the myxcedema increased, and finally the 

 patient died in asystole." . . . "Exophthalmic goiter and 

 myxcedema co-existed in this case during at least two years. 

 It is therefore impossible that the former should be due to 

 increased secretion, while the latter should be due to dimin- 

 ished secretion by the thyroid gland. ..." A number of 

 cases have been reported by Baldwin, Gowan, L. Gautier, 

 Jeffrey and Achard, and others in which myxcedema followed 

 exophthalmic goiter. 



That this conception of the pathology of exophthalmic 

 goiter and its close connection with suprarenal functions is 

 able to bear close scrutiny may also be illustrated by the re- 

 searches of Scholtz. 27 If the first stage of the disease, that 

 of overactivity of the adrenals induced by excessive thyroid 

 secretion, is really characterized by hyperoxidation, rapid 

 tissue-waste must occur, and the products, being oxidized as 

 fast as formed, must also be eliminated as highly oxidized end- 

 products. Scholtz, seven years ago, found that there was in 



26 A. J. Hutchinson: British Medico-Chirurgical Journal, from La Presse 

 M^dicale, Sept. 23, 1899. 



87 Scholtz: Centralblatt fur innere Med., Nos. 43 and 44, 1895. 



