118 THE INTERNAL SECRETIONS 1920 



well or improve markedly without operation. This has 

 led many surgeons to the conclusion that such cases 

 should be treated and observed medically for six 

 months before being submitted to operation. 



As mentioned earlier in this paper, there are certain 

 known indirect or predisposing causes of dysthyroid- 

 ism. It is helpful to consider the relation of these 

 causes to the therapy of the disease produced. Emo- 

 tional causes as fright, grief, anger, etc., cannot be re- 

 garded as producing great anatomic changes in the 

 thyroid. Alterations of function must be the prevailing 

 type and these are undoubtedly associated with func- 

 tional changes in other endocrine glands, especially the 

 adrenals. Cannon 12 has shown the effect which these 

 "major emotions" have upon the chromaffin system and 

 the marked functional changes which the whole organ- 

 ism undergoes as a result of such adrenal stimulation. 

 The thyroid, in all probability, also plays an important 

 role in this widespread reaction to emotional stimula- 

 tion. It is possible that this gland in some cases is un- 

 able to meet the demand made upon it and reacts by 

 elaborating a physiologically imperfect hormone with 

 resulting dysthyroidism. 



The late war has given an excellent opportunity of 

 studying these cases and a considerable literature on 

 the subject is available (Berard 13 , Findlay 14 ). Dys- 

 thyroidism, resulting from such a cause, is usually self- 

 limited and yields to medical treatment. 



Infections, both focal and general, produce a type of 

 dysthyroidism which also is inclined to self -limitation, 

 improving with removal of the infection. The follow- 

 ing brief history of a case developing after severe in- 

 fluenza pneumonia is illustrative. 



A young married woman of twenty-eight had always 

 had a moderate thyroid enlargement since puberty. In 

 January, 1919, she had influenza and developed double 

 pneumonia, which ran a very severe course with tern- 



