48 THE INTERNAL SECRETIONS 1920 



this way can this balance be explained. For instance, 

 an increase of the thyroid secretion does not always 

 manifest itself immediately. Some time elapses before 

 clinical signs develop, and even then the basal meta- 

 bolic rate is often maintained. Without increased ac- 

 tion of other glands, stimulated by the presence of 

 thyrotoxin, all cases of thyrotoxic adenoma would 

 show disturbance of metabolic rate immediately and 

 constantly, which is not the case. In such cases an 

 excessive stimulation is given to the adrenals, for in 

 these adenomata the first sign is often a rise of blood 

 pressure (6). This stimulation is kept up until bal- 

 ance is definitely lost, and then the clinical symptoms 

 manifest themselves. The balance is lost only when 

 the other associated glands cannot keep up with the 

 abnormal gland. Then the picture is not only that of a 

 predominating thyrotoxic element, but an augmenta- 

 tion of symptoms through overproduction of other in- 

 ternal secretions, notably the ovaries and adrenals (7) . 



At times this interrelationship is hard to deter- 

 mine except empirically, but the hypothesis is well 

 borne out that in cases of hyperthyroidism the balance 

 is not only kept for some time, but the feeding of co- 

 operative endocrine products, like thymus, adrenal or 

 pituitary extracts, seems to alleviate symptoms (8). 

 After the stage of high blood pressure comes myocar- 

 ditis through loss of muscle tone. Here the stimulus to 

 adrenals and pituitary has been so great that they have 

 become exhausted. This exhaustion of the adrenals 

 makes it ofttimes necessary to give treatment with 

 adrenalin before the operation for thyroidectomy, in 

 order to improve the heart tone. For the same reason 

 after-treatment, this time with adrenal substance, fol- 

 lowing severe cases, has to be long-continued because 

 of this exhaustion (9) . 



That this hormonic action and interaction is constant 

 and necessary, and that development of some glands 



