148 THE DISEASES OF THE THYROID GLAND 



Fonio's experiments have shown that when thyroid or colloid goiter or 

 Basedow's struma preparations are administered to myxedemics there 

 occurred an increased elimination of nitrogen, increased diuresis, and de- 

 crease of the body weight, and that the nitrogen elimination varied directly 

 as the iodine content of the preparation administered. In the two cases 

 he worked on, he was unable to substantiate a hyperleucocytosis or an 

 eosinophilia. 



In passing, the editor would state that in America the condition myxe- 

 dema seems to be relatively rare. 



So far as the pathology of the thyroid gland is concerned, MacCarty, 

 from a study of over 2500 thyroid glands removed at operation, divided these 

 into the symmetrical and the asymmetrical or nodular. The symmetrical 

 glands contain various combinations of an adult and a fetal type of tissue 

 element or of hypertrophied acini containing colloid, or of acini that contain 

 little or no colloid material, but that possess lumina almost completely filled 

 with large hypertrophic or hyperplastic cells. The simple nodular or simple 

 symmetric thyroids contain nodules with a fetal type of cell, while the re- 

 mainder of the parenchyma of the thyroid gland possesses various combina- 

 tions of the tissue elements described under the symmetric thyroids. The 

 complex nonsymmetric thyroids may show, in addition, various combina- 

 tions of the tissue-element types in the nodules. 



Still more recent studies on the pathology of the thyroid gland have been 

 made by Wilson and byPlummer, who base their conclusions on the enormous 

 material of the Mayo Clinic. These authors divide goiters with symptoms 

 of intoxication into, clinically, the exophthalmic and nonexophthalmic 

 forms. In the first form only is there a true hypertrophy and hyperplasia 

 of the gland tissue. The pathology of toxic nonexophthalmic goiter is one 

 of increased parenchyma through regenerative changes in atrophic paren- 

 chyma, or the formation of new parenchyma of the fetal type with an increase 

 in each instance of secretory activity and of absorption. The process is a 

 chronic one, but one sufficiently active to cause the patient to consult a 

 surgeon earlier than do the true exophthalmic goiter patients, in whom the 

 disease is acute. 



Gilbride has examined the thyroids in six cases of exophthalmic goiter 

 bacteriologically, and isolated a bacterium in one case only micrococcus 

 tetragenes. 



With regard to the treatment of Basedow's disease, internists and 

 surgeons occupy hostile camps. More and more has the opinion gained 

 ground that the condition is an affection demanding surgical attention. 

 Nevertheless border-line cases should first be given the benefit of properly 

 directed medicinal dietary and physiotherapeutic measures. 



5. Solis-Cohen has a strong conviction that surgical measures are indicated 

 only in a small minority of the cases of exophthalmic goiter that come under 



