116 THE INTERNAL SECRETIONS 1920 



quotation from a recent report on one hundred thyroid- 

 ectomies is interesting in illustrating this point. The 

 author (Mason 10 ) in speaking of the best time for oper- 

 ation in exophthalmic goitre says, "The patient oper- 

 ated upon before the first crisis is eventually much bet- 

 ter off than the one who is carried through the crisis 

 by medical treatment and operated on later. However, 

 the patient who is operated on early in the disease will 

 have a slight wave of toxicity at the time of the first 

 crisis; but the severity of this wave will be reduced in 

 proportion to the fraction of the gland removed." 



Advocates of early operation urge that procedure in 

 order to prevent damage to vital organs, which fre- 

 quently occurs in long-standing cases. Just how this 

 damage to heart and kidneys is produced is one of the 

 mysteries in the pathologic physiology of the thyroid. 

 Means of combating it rationally are not yet at hand, 

 so the knife is appealed to, and the temporarily diseased 

 organ is removed permanently from the body. 



A moment's reflection on this phase of the subject 

 raises a question as to the nature of a secretion which 

 produces such changes in vital organs. It seems logical 

 to suppose that a normally constituted secretion which 

 is non-toxic in small amounts should not be so toxic in 

 larger amounts as to cause serious damage to vital or- 

 gans. The body has adequate means of ridding itself 

 of its own excess secretions. Its ability to oxidize 

 adrenin after a short time and render it inactive is a 

 well-known clinical fact. Consideration of this point 

 makes it more reasonable to suppose that the damage 

 which we know is done to vital organs is produced by 

 an abnormally constituted product, a physiologically 

 imperfect secretion. Such a chemico-pathologic hor- 

 mone would be foreign to the organism and as harm- 

 ful in its effects as an exogenous toxin. 



This explanation of the damage to vital organs adds 

 more strength to the conception of these conditions as 



