300 C. P. HOWAED 



adiposity and sexual infantilism of the reversive type when it originates 

 in the adult. Gushing, by his brilliant experiments on dogs, has been able 

 to reproduce a similar picture. 



Further, feeding the human or laboratory animal suffering from 

 operative or acquired forms of hypothyroidism with either the whole 

 thyroid gland or the thyroid extract or its active principle thyroxin, will 

 cause all the symptoms to disappear and the subject to return to normal. 

 Somewhat similar, if less striking, results can be obtained when one feeds 

 the hypopituitary patient or animal with full doses of the extract of 

 the whole pituitary gland. 



In marked contrast to the almost complete case that has been estab- 

 lished for the hypof unction of both thyroid and pituitary, is the state of 

 our knowledge of hyperfunction of these two glands. Gushing himself, 

 as well as other workers in experimental physiology have failed to repro- 

 duce hyperpituitarism in the laboratory animal. Further, clinical hyper- 

 pituitarism as represented by gigantism or acromegaly (according as to 

 whether the syndrome began in childhood or adolescence) sooner or later 

 develops symptoms of hypofunction, so that Gushing prefers to speak 

 of the condition as dyspituitarism and not hyperpituitarism. Might it 

 not be safer, until our knowledge of the physiology and pathology of the 

 thyroid gland is more accurate, to speak of the clinical syndrome of exoph- 

 thalmic goiter, whether larval or complete, as one of dysthyroidism? This 

 idea is not original with me, but has been suggested by personal conversa- 

 tions with Gushing and the reading of much of the voluminous endocrin 

 literature. 



The usual meaning that is intended for dysthyroidism is, however, 

 not to indicate a confession of ignorance like that given above, but rather 

 to call attention to certain larval and atypical forms of exophthalmic goiter 

 which present evidences of an alternative hypo- and hyperthyroidism or a 

 peculiar combination of the two at the same time. This is the sense of 

 the term in the articles by Bram (b) and Bertine. The latter noted in a 

 series of one hundred and thirty-four patients suffering from various 

 types of thyroid disease thirty-three who combined the elements of a 

 partial Graves' disease with a suggestion of myxedema in a way that no 

 mere variation in the quantity of the thyroid active principle will account 

 for; for instance, nervousness, tremor, more or less emaciation and irrita- 

 bility of the pulse may be associated with lassitude, inertia, emotional de- 

 pression and headaches ; or again there may be on the one hand tachycardia 

 and sweating and on the other obesity, constipation and asthenia. We 

 have all seen such cases each year and most of us have considered them as 

 originally cases of mild hyperthyroidism due to hyperplasia of the gland 

 which gradually gives way to a more evident hypothyroidism as the de- 

 generation of the gland tissue progresses and the active principle is 

 secreted in insufficient quantity. This explanation still seems logical for 



