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NEWBURGH, N. Y., U. S. A.

Continuing the Medical Fortnightly and Laboratory News

The Medical Herald n

and Electro - Therapist
The Kansas City Medical Index-Lancet

= Incorporating =

An Independent Alonthly Magazine

Vol. XXXIX.

JANUARY 15, 1920

No. 1

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states. He confirms the opinion that goitre is

more common in Washington and Oregon than
Original Contributions

in the neighboring states. He shows, too, that

this type of goitre enters only casually into the
( EXCLUSIVELY FOR THE MEDICAL HERALD.)

matter of neurocirculatory asthenia. On the
my minimignonnummerburirmining Cameroon other hand, Wearn and Sturgis (Archives Int.

Med., 1919:24:247) show that a large majority
THYROID RESPONSE TO OVERSTRAIN*

of the recruits suffering from NCA respond to
GEORGE H. HOXIE, M. D., Kansas City, Mo. the adrenalin test of Goetsch for thyroid hyper-

1. The Cause of Thyroid Dysfunction-For function. Hence a distinction must be made be-
the last generation the function of the thyroid tween thyroid hyperplasia and thyroid hyper-
has been popularly considered that of the detoxi- function.
cator par excellence of the body. Therefore the Janney (Arch. Int. Med., 1918:22:187) has
invasion of infectious agents and the absorption shown that all cases of exophthalmic goitre are
of toxins (as from drinking water) have been not cases of thyroid hyperfunction. And the now
considered the exciting causes of reactive (com- well known fact that the thymus is frequently
pensatory) thyroid enlargement of hypofunction, (60 per cent) enlarged in exophthalmic goitre,
or even of hyperthyroidism.

makes it necessary to revise our nomenclature
Later, as the complexity of the endocrine bal- and make a new definition of this disease.
ance began to be appreciated, compensatory hy- 3. Observations in France-In France, last
perplasia and hypertrophy because of the activ- year, many cases of thyroid enlargement and thy-
ity of the sex glands was spoken of. Thus the roid hyperfunction appeared among the soldiers
goitres of puberty and pregnancy were regarded as the secondary reaction to exhaustion, and to
as compensatory.

the debilitation resulting from disease. This
Then after Cannon's study of the adrenals and confirms the theory that thyroid hyperfunction
their antagonism to the thyroid, an added con- may be a compensatory phenomenon.
ception of endocrine reaction entered.

The sequence of events in these cases was
Thus Cannon attributed hyperthyroidism to

somewhat as follows: The patient entered the
the lowering of the threshold of thyroid activity hospital with a blood pressure of 70 diastolic
brought on by exaggerated function — by in-

and 90 to 100 systolic. The heart action was not
creased discharge into the bloodstream of the

clear and sharp. That is, one heard systolic
adrenals. Since this result could occur from

murmurs at the second and third left interspace.
excessive emotionalism and nervous overstrain,

The blood and urine were usually negative. The
the theory fitted in well with the facts of every

breath sounds were usually harsh, and there was
day observation. Then the matter of fatigue,

frequently the evidence of enlargement of the
as emphasized by Rogers (Archives Int. Med., peribronchial lymph glands.
1919; 23:498), showed that both the adrenals The blood pressure gradually rose until in
and the thyroid might be involved, in an attempt three or four weeks the diastolic might be 100
to compensate for the exhaustion of the end and the systolic 160. With this there was urin-
plates in cases of prolonged exertion, as well as ary frequency and nocturia but no albuminuria.
from debilitating disease.

The pulse showed a constant tendency to tachy-
2. Exophthalmic Goitre and Thyroid Hyper- cardia. A tremor of the fingers would then ap-
function—The matter of endemic goitre has re- pear. There was generally an increase in the
ceived some illuminations from the work of Kerr size of the thyroid. In the majority of cases
in his studies of the recruits of the northwestern there was an intermittent diarrhea, a tendency to
*Read before the Medical Society of the Missouri Val-

sweating was marked; and frequent rises in tem-
ley at Des Moines, Iowa, Sept. 18, 1919.

perature were noted.
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