224 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



ensue, but they distinctly point to the fact that the entire list 

 of conditions collectively considered under the term "intoxica- 

 tions" of intrinsic or extrinsic origin is brought into action. 

 Indeed, there seems to be no line drawn, no particular morbid 

 field common to these operated cases except the one vast source 

 of suprarenal insufficiency represented by poisons in general, 

 bacteria and their toxins, toxic products of metabolism, etc. 



The operation brings the cardiac action down to a remark- 

 able degree 10 pulsations in a case reported by Combemale 

 and Gaudier. 66 Berry, 67 in a review of the literature of the 

 subject, refers to a case in which the patient died a few hours 

 after operation after having shown an "extremely rapid pulse." 

 That we are dealing with weakened and finally overpowered 

 suprarenal glands in post-operative cases is not only suggested 

 by the class of disorders witnessed, but it is also shown post- 

 mortem by the pulmonary congestive phenomena referred to: 

 a normal result of the vasodilation which marked reduction or 

 arrest of the suprarenal secretion entails. 



The few other general affections in which sympathectomy 

 has been resorted to are all, if the views advanced in this work 

 are exact, expressions of excessive suprarenal activity. Exoph- 

 thalmic goiter, therefore, can serve as a type to illustrate the 

 course of events when the suprarenal glands are not able, 

 through inherent or acquired debility, to continue their func- 

 tions when separated from their center, the anterior pituitary 

 body. Peugniez's case of this disease, in which sympathectomy 

 was performed on both sides, being one of this kind, it can 

 serve as example. The patient, a girl 20 years of age, presented 

 the typical signs: goiter, exophthalmos, tachycardia, and ex- 

 ceedingly profuse sweating. The operation on the left side 

 was performed on October 28th; that on the right on Novem- 

 ber 20th. Less than two weeks after the latter operation the 

 goiter had completely disappeared; exophthalmos had become 

 greatly reduced; the pulse likewise; and the sweating had 

 ceased. The patient left the hospital on December 12th in a 



68 Combemale and Gaudier: Gazette Hebdom. de M6decine et de Chirurgie, 

 April 24, 1898. 



67 Berry: Trans. Edinburgh Medico-Chirurgical Society, Jan. 17, 1900. 



