114 THE INTERNAL SECRETIONS 1920 



laity have come to believe that it is a purely surgical 

 condition. This attitude has arisen through the fact 

 that apparently better and quicker results are obtained 

 by partial thyroidectomy than by medical measures. 

 In the great majority of cases the latter have not been 

 given a thorough trial, consequently results in these 

 have been attended by failure, which always follows 

 insufficient and half-hearted treatment. 



One might question the advisability of considering 

 other means when surgery seems to offer quick relief 

 from symptoms and ultimate cure. Without at this 

 time entering into a discussion as to whether or not 

 surgery really accomplishes this result, let us consider 

 another aspect of the problem. Granting that good 

 results are obtained by operative means, it does not 

 necessarily follow that surgical treatment is the most 

 rational or productive of the greatest ultimate good. 

 The logic of surgical treatment as applied to dysthy- 

 roidism is subject to some criticism. Whatever theory 

 is adopted as to its etiology or whatever term is used 

 in describing it, the pathologic state in every case is 

 one of perverted function. Removal of a gland or part 

 of a gland is hardly justified because it is not function- 

 ing properly. Surgery is not resorted to in any other 

 instances of pure dysfunction of an organ. The un- 

 questioned fields of surgery are removal of malignan- 

 cies, removal and drainage of infected tissues, correc- 

 tion of skeletal defects and repair of soft tissues. It is 

 not the usual procedure to remove an organ for any 

 other cause than malignancy or infection which is so 

 advanced as to make the organ's retention in the body a 

 menace. 



The application of surgery to thyroid disturbances 

 came about through the conception of this condition as 

 one of hyperfunction and the attempt was made to re- 

 move a large portion of the gland, leaving just enough 

 to supply body requirements. 



