170 THE THYROID, THE THYMUS, AND THE ADRENALS. 



for the Insane, 39 may be adduced to show that it is as active 

 here as in myxcedema: 



"The case was that of a cataleptic who had lain immovable 

 in bed for over three years; there was an absence of motor 

 and sensory activities; the feeding was by means of the nose- 

 tube. Under increasing doses of gland constantly increasing 

 activities resulted, until finally the patient 'returned to life' 

 and was able to speak and walk. At a time when 75 grains WITI? 

 given daily, symptoms of exophthalmic goiter appeared, and 

 the remedy had to be discontinued temporarily, the pulse going 

 up to 160. In the course of a few days the patient relapsed 

 to his usual condition, but 'revived' on again receiving the 

 remedy, with a return of the symptoms mentioned. A similar 

 case recovered promptly in a few weeks on small doses." 



It thus seems conclusively shown that, to the long list of 

 symptoms ascribed to the suprarenal glands, as represented by 

 the first stage of exophthalmic goiter, we can now add another 

 equally long list of phenomena: i.e., those represented by 

 myxcedema and infantile myxcedema, but due to suprarenal 

 insufficiency instead of overactivity. It also appears that, as 

 is the case with the signs of the latter, those observed in both 

 forms of myxcedema, whenever they occur, are also invariably 

 traceable to insufficiency of the adrenals. We have also estab- 

 lished the connection between myxcedema and the second stage 

 of exophthalmic goiter, and realized that thyroid extract is 

 efficient in this stage of the disease because of the latter's 

 identity as myxcedema in some cases and as simple suprarenal 

 insufficiency in others, the thyroid gland in the latter case 

 remaining active and therefore obviating the cutaneous symp- 

 toms, through, perhaps, the arsenic it furnishes these struct- 

 ures. On the whole, it thus becomes apparent that: 



1. Myxcedema and infantile myxocdema (cretinism) are due 

 to insufficiency of the adrenals, the result, in turn, of absence 

 or diminution of the secretion supplied to the blood ly the thyroid 

 gland. 



2. All individual symptoms witnessed in the course of these 

 diseases should be ascribed to reduced activity of the adrenals. 



39 R. Hessler: Jour. Amer. Med. Assoc., and Dublin Jour, of Med. Science, 

 March, 1897. 



