342 C. P. HOWAKD 



.lacrimatroy, sweats, diarrhea, gastric hyperacidity, eosinophilia, lymphy- 

 cytosis, pulsus irregularis respiratorius and normal or increased carbo- 

 hydrate tolerance, they assume the existence in the thyroid excretion of 

 a compound that in its pharmacological action resembles the vagotropic 

 drugs pilocarpin and muscarin, and that has an especial affinity for the 

 craniosacral autonomic nervous system and which can be neutralized, in 

 part at least, by an antagonistic vagotropic drug namely atropin. 



Their findings and theories received the approval of Barker and 

 Sladen. Meltzer and many other physiologists are opposed to such specu- 

 lations and especially to the use of diagrams, from the fear that those 

 unfamiliar with the subject will take hypotheses for facts. Nevertheless 

 we cannot but feel that just as Ehrlich's side-chain theory of immunity 

 and its bizarre diagrams have helped to stimulate investigation of many 

 of the abstruse problems of infection, so will the theories and diagrams 

 of the Vienna School aid in the investigations of the equally obscure 

 field of endocrinology. We further agree with Barker that an analysis 

 in every case of Graves' disease of the symptoms with reference to the 

 functions of the pancreas, the suprarenals, the gonads, the thymus, the 

 hypophysis and the chromaphil system, is always instructive and may 

 often lead to the discovery of anomalies and relationships that might 

 otherwise be entirely overlooked. 



Thymus Disorders. Markham, in 1858, was the first to call attention 

 to the thymus hyperplasia of exophthalmic goiter ; since then it has 

 been confirmed by many other observers. While Matti believes the 

 frequency of thymic hyperplasia has been exaggerated, he found it in 

 70 per cent of all fatal cases of exophthalmic goiter, but especially in 

 those dying following the operation of tliyroidectomy. Hb believes there 

 is no experimental evidence that the pathological changes in the thymus 

 and thyroid are the results of correlative reactions. Capelle and Bayer 

 found that 05 per cent of all autopsies on subjects of Graves' disease dying 

 from the immediate effects of the malady or the operation showed some 

 hyperplasia. Mackenzie (r) reports that at twenty-six necropsies in which 

 the condition of the tlivmus was noted it was described as greatly enlarged 

 in six, large or hypertrophied in sixteen and persistent but not large in 

 four: i. e., a definite hyperplasia was found in 77 per cent. It was noted 

 that in some eases, although the gland was enlarged, it showed the his^ 

 tological changes of degeneration or some degree of fibrosis. In Black- 

 ford and Freligh's series of thirty-seven patients under forty years of 

 age that came to autopsy, the thymus was found hypertrophied in all, 

 while it was absent in nineteen of thirty-six patients who died of Graves' 

 disease after the age of forty; in other words, a hypertrophic thymus was 

 present in 73 per cent of seventy.four carefully studied cases. 



In some cases even a thymectomy without a tliyroidectomy may be 

 followed by a marked subjective and objective improvement. The Graves 7 



