172 FKANCIS M. POTTENGER 



of the digestive and urogenital tract (McCarrison; Barker (&)) influence 

 this gland. We can further see that a source of the loss of weight in these 

 conditions may be an increased metabolism produced by the increase in the 

 thyroid secretion, which hastens the catabolic processes in the tissues by 

 acting as a catalytic agent in the tissue cells themselves, and, according to 

 Plummer, controlling the energy output. Thyroid substance, however, not 

 only increases catabolism, but, as Janney (&) shows in case of cretins, it 

 has an anabolic action as well. 



The Goetsch Test for Hyperthyroidism. The thyroid secretion is a 

 sympathicotropic secretion, and, as Oswald (&), Cannon and Levy have sug- 

 gested, has the property of sensitizing the sympathetics ; in other words, 

 it makes the sympathetic nerve cells respond to stimuli more readily than 

 is normally the case. Goetsch (&), taking advantage of this fact and the 

 further fact that epinephrin selectively stimulates the sympathetic system, 

 has suggested that hyperirritability shown on the part of the sympathetic 

 nervous system to a comparatively small dose (one^half a cubic centimeter) 

 of epinephrin may be taken as evidence of hyperthyroidism. 4 From the. 

 standpoint of visceral neurology, this test must be considered as an indica- 

 tion of sympathetic hyperirritability; since the thyroid hormone is sympa- 

 thicotropic, its presence in excess should be accompanied by such sympa- 

 thetic hyperirritability, and, if other sympathicotropic stimuli can be 

 ruled out, hyperthyroidism should be suspected. 



The secretion from the thyroid, when discharged in excess, produces 

 a train of symptoms which affect the entire organism the nervous sys- 

 tem, both voluntary and vegetative, other endocrin glands, and the entire 

 psychical and physical being. 



Sympathetic and Parasympathetic Hyperirritability in Graves' Dis- 

 ease. In the discussion of Graves' disease, von Noorden, Jr., describes 

 two types, according to whether the symptoms are predominantly those 

 of sympathetic or parasympathetic stimulation. The presence of a group 

 of the following symptoms is characteristic of the parasympathetic (vago- 

 tonic) type; a relatively slight degree of tachycardia, with, however, 

 markedly pronounced heart oppressions, distinctly marked v. Graefe's 

 sign, and wide palpebral fissures, absent Moebius sign, slight protrusion of 

 the eyeballs, marked secretion of tears, outbreaks of sweat, diarrhea, dis- 

 turbances in respiratory rhythm, and absence of alimentary glycosuria. 

 Some of the following symptoms are characteristic of the sympathicotonic 

 type: marked protrusion of eyeballs, greatly increased cardiac activity 

 with slight accentuation of subjective disturbances, absence of sweats and 

 diarrhea, marked falling out of hair, inclination to increase of tempera- 



4 Hyperthyroidism is frequently used in the clinical literature to include, not only 

 tlu- condition resulting from so-called toxic adenomata in the thyroid, but also ex- 

 ophthalmic Boiler, .lanney and others have emphasized the possibility that, in the 

 latter condition, the term hyperthyroidism is a misnomer that the condition is 

 dysthyroidism. Tlte Goetsch test is positive in both conditions. R. G. H. 



