640 THOMAS E. BROWN AND JOHN H. KING 



The suggestion has been put forward that there is an elaboration of ab- 

 normal peristaltic hormones. The state of malnutrition which develops in 

 this disease is due to interference with digestion and absorption. 



Intestinal Disturbances Following Abnormality of 

 the Ductless Glands 



1. The Diarrhea of Exophthalmic Goiter. The diarrhea which may 

 occur in this disease is often so striking that the clinical picture suggests 

 an intestinal disease. Often the fact that the primary disturbance is 

 in the thyroid is entirely overlooked. The movements are fluid, bile 

 tinged and often contain food fragments a few hours after they have 

 been eaten, indicating an increased peristalsis of the stomach and in- 

 testines, in addition to impaired digestion. The diarrhea may be transitory, 

 periodic or permanent and appear at the early or late stages of the disease. 

 Again, it may occur synchronously with the acute exacerbations of the 

 disease and markedly increase their severity. The disturbance to the body 

 nutrition, which can be very great, has two factors. The hyperactive 

 thyroid gland increases the basal metabolism, causing a considerable loss 

 of weight in severe cases. When diarrhea complicates the disease, still 

 greater loss of weight and strength occurs, often reaching extreme grades. 

 While the primary cause lies in the property of the overstimulated gland 

 to accelerate the body metabolism, at least as great, if not, in some cases, 

 greater interference with the metabolism results from the disturbed 

 motility and absorption in the intestinal tract. 



2. The Diarrhea of Addison's Disease. Diarrhea may occur in crises 

 of great severity in this disease, without obvious cause and often associated 

 with spasm in the calves of the legs. In fact the clinical picture suggests 

 a severe intestinal disturbance. The diarrhea takes the form of frequent 

 watery discharges with colicky pains and may lead to collapse, delirium 

 and coma. The abdomen is retracted, tense, the pulse small and the gen- 

 eral picture suggestive of peritonitis. Great loss of weight and strength, 

 amounting to severe grades of emaciation, may characterize the terminal 

 .stages of this disease, whose etiology is not always clear and which may 

 be mistaken for severe intestinal infection. The deleterious effect on 

 the metabolism of the body can to a large extent be due to the disturbed 

 intestines. 



There is then a great similarity in the effects on the metabolism, pro- 

 duced by diseases of the intestines. In the main, the chief disturbance is 

 to the nutrition of the body, caused by interference with secretory, ab- 

 sorptive and digestive processes of the intestines and complicated by in- 

 fective and putrefactive changes. The intestinal tract, which so largely 

 controls the metabolism of the body in health, through its complex physi- 



