84 THE THYROID AND 



that the New Physiology has reached. We learn 

 that parenchymatous goitre is an hypertrophy of 

 the thyroid gland, designed to enable it to obtain 

 sufficient iodine from the blood, this element being 

 an essential constituent of its internal secretion. 

 The deficienc}'- in iodine is in some comphcated way 

 connected with the drinking-water. In the early 

 stages, iodides, thyroid feeding, or probably iodo- 

 form will work improvement, and the water should 

 be boiled, or the supply changed. Should operative 

 measures be adopted, we learn that the whole gland 

 must not be removed, or myx oedema may result, 

 and that the four small parathyroids lying behind 

 it must also be respected, or the patient may develop 

 tetany. In some cases the loss of the parathyroids 

 on one side only has caused this unpleasant sequel. 

 An attempt should therefore be made, in removing 

 one lobe of the thyroid for goitre or adenomata, to 

 leave these little glands intact and in situ, and to 

 preserve their blood-supply. They will not be 

 injured if the posterior part of the capsule of the 

 thyroid is left. 



If myxoedema or tetany do follow the operation, 

 they may be remedied by thyroid and parathyroid 

 feeding respectively. There is some evidence that 

 even the medical varieties of tetany are due to loss of 

 the internal secretion of the parathyroids ; according 

 to Kocher, this has been proved in the case of the 

 tetany of pregnancy, and other observations have 

 since been made in which the parathyroids were 

 diseased when tetany was present. Parathyroid 

 feeding should therefore be worth a trial in such 



