THE SYMPATHETIC SYSTEM 43 



should be limited only to cases of malaria. Tuberculosis 

 sometimes causes endocrine manifestations and this fact 

 may be of value in certain therapeutic indications. 



In spite of all this, etiology does not help us very much in 

 the treatment of these patients and the knowledge that we 

 are dealing with functional disturbances by deficiency or 

 excess, which we must attempt to modify, has done much 

 to bring about a marked improvement in the condition 

 of our patients. 



II. SURGICAL TREATMENT. 



Surgical interference is rarely indicated in endocrine 

 pathology. There are, however, certain definite cases in 

 which it is of great help. We have known for many years 

 the surgery of the thyroid. At first, limited to simple 

 goitre and tumors, it has now extended to exophthalmic 

 goitre and if intervention is still often questionable , be- 

 cause of the danger, it can be considered as rational in 

 certain cases, as for instance, those recently studied by 

 Roussy. The facts established show that while there is no 

 question of the benefit of partial thyroidectomy in Base- 

 dow's disease, it has also its drawbacks. Thymectomy 

 has also been performed with variable success, with or 

 without thyroidectomy. In hypertrophy of the thymus 

 in childhood, for a while surgery of the thymus became 

 popular as a result of the investigations of Veau, but it is 

 now limited to very rare cases. 



The surgery of the pituitary has been even more care- 

 fully studied and we are still far from having perfected it. 

 The recent investigations in France of Lecene, Toupet and 

 Lenormant have shown that the pituitary could be 

 reached through the nasal route and that its removal in 

 man w T as possible. The results are, however, far from 

 what was expected after the first few cases were pub- 



