EXOPHTHALMIC GOITER AND THE ADRENALS. 



163 



exophthalmic goiter an increased excretion of phosphoric acid 

 in the stools amounting to tenfold the normal, as compared to 

 one of only 25 per cent, in a healthy person. He concluded, 

 therefore, that the thyroid gland has an important influence 

 on the metabolism of phosphoric acid. Experimental evidence 

 also bears this out, since Eoos 28 found that, in healthy dogs, 

 feeding with thyroid caused an increased excretion of nitrogen, 

 sodium chloride, and phosphoric acid. This is further confirmed 

 by the beneficial effects obtained empirically with sodium 

 phosphate, which will be referred to when exophthalmic goiter 

 is further analyzed. Again, G-. R. Murray 29 refers to a case 

 examined post-mortem by Dr. Auld as follows: "The state of 

 the pituitary and thymus glands had received considerable 

 notice in connection with morbid alterations of the thyroid, 

 but Dr. Auld suggested a more systematic examination of the 

 suprarenal gland. In a case of fully developed exophthalmic 

 goiter in a young woman, aged 25, in whom death occurred 

 from an intercurrent malady, he had had an opportunity of 

 examining this organ. He was much interested to find that 

 the medullary portion of the gland was much hypertrophied 

 and the nuclei of many of the glandular cells were undergoing 

 division." That "hypertrophy" is the result of overaction of 

 the glands has, as we have seen, been experimentally demon- 

 strated. Finally, the clinical observations of Breuer 30 may be 

 adduced to show that the active factor in the whole process is 

 iodine. Swiss investigators had already noted that even small 

 doses of iodide of potassium were capable of bringing on mild 

 symptoms of exophthalmic goiter. Breuer witnessed nine cases 

 in which the disease could directly be traced to the adminis- 

 tration of iodine. 



If we now endeavor to garner the progress so far made 

 in the present inquiry, a prominent feature soon appears: i.e., 

 that we have transferred to the adrenals a long list of symp- 

 toms that were thought to be associated with abnormal activity 

 of the thyroid gland. We have done more: the signs referred 

 to are no longer incidental elements of the symptom-complex' 



28 Roos: Zeitschrift fur physiol. Chemie, Bd. 21. 



29 G. R. Murray: British Medical Journal, Jan. 20, 1896. 



30 Breuer: Wiener klin. Wochenschrift, July 19, 1900. 



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