Chemico-Functional Integration 115 



apparatus, and from the non-glandular a portion of the 

 alimentary mucous membrane, namely, that of the duo- 

 denum. 



Effects of Removing the Human Thyroid for Curative 



Purposes 



As definite knowledge of the great physiological impor- 

 tance of internal secretions begins with human surgery 

 with operations on the thyroid apparatus we may well 

 begin our study here. This is the better starting point 

 in that there is no more striking illustration of how great 

 a part of the whole organism may be implicated in the 

 action of internal secretions than is afforded by the prod- 

 ucts of the thyroids and parathyroids. 



The subject first came into clear light in the early eighties 

 of the last century through the experiences of Swiss sur- 

 geons, Theodor Kocher and J. L. Reverdin especially, who 

 removed the thyroids to cure goitre, this disease being spe- 

 cially prevalent in some parts of Switzerland. The patients 

 operated on were found to improve rapidly for a time after 

 the operation, but later untoward symptoms began to mani- 

 fest themselves. Because the variety and pervasiveness of 

 these symptoms in a typical case are highly instructive for 

 us we present them in detail, selecting a description from 

 Human Physiology by Luciani : "Patients who have under- 

 gone total thyroidectomy . . . experience the initial symp- 

 toms of glandular deficiency either at once or at latest some 

 weeks after the operation. They feel weak, complain of 

 heaviness of the limbs, and more or less diffuse dull pains, 

 particularly in the legs, which may become acute and assume 

 the character of pains in the bones. 



"Other more serious symptoms are gradually associated 

 with the preceding. After four or five months the face 

 and the extremities swell and become cold, the muscles are 



