410 



GEOEGE H. HOXIE 



tachycardia, but also an increased metabolic rate as shown by the calo- 

 rimeter, and which present also a diffuse enlargement of the thyroid gland. 

 Cases of adenomata with hyperthyroidism belong,, in his judgment, to an- 

 other syndrome and offer a different prognosis. 



Further studies in different localities of the rate of basal metabolism, 

 of the sugar tolerance, of the adrenalin sensitization, will be needed before 

 we can safely state that the thymus and other glands do not play a role in 

 exophthalmic goiter, and do not need attention when treating the disease. 

 Certain it is~that there is something besides pure hyperthyroidism in 



Fig. 9. Shadow in case of exophthalmic goitre where a thyroidectomy gave only 

 partial relief (age 30). 



exophthalmic goiter. This something is being interpreted by many observ- 

 ers as the participation of the sympathetic nervous system in the syn- 

 drome. 



If now we accept myasthenia, breathlessness, low blood pressure, dry 

 skin, relaxed intestinal tone, etc., as the common symptoms attending 

 thymic hyperplasia, we must admit that they are the same as those present- 

 ed by sympatheticotonia. 



Naturally then, we would conclude that thymic hyperplasia is an accom- 

 paniment of sympathetic overbalance, and that, therefore, the hyper- 

 plasia of the thymus in exophthalmic goiter is simply one evidence of the 

 reaction of the vegetative nervous system, of exhaustion of the parasympa- 

 thetic l system due to continued overstimulation. 



a Much confusion in terminology could well be avoided by the use of Langley's 

 original terms sympathetic and parasympatlietic as subdivisions of the autonomic 

 nervous system proper. R. G. H. 



