Nine cases of section of the cervical sympathetic for exophthalmic goitre re ported. The results were good, both with respect to the exophthahnos and to the goitre and palpitations. The best effect was obtained in young people in whom presumably the accelerator sys tem of the heart was less developed and more thoroughly modified by the divi sion of the sympathetic. In cases of failure of the treatment an explanation might be found in the existence of two sympathetic cords in the neck: a not infrequent anomaly. Jaboulay (Pro gees Med., July 31, '97).
Section of the sympathetic pronounced as resultless and unnecessary, thyroi dectomy as successful and safe, while the after-occurrence of myxcedema need not be feared, as, out of a large number operated on, only two or three developed this disease. Nan (Bull. Acad. de Med., Tome iii, p. 31, '97).
If a portion of the thyroid gland be removed, the vesicles of the remainder enlarge, and become altered in shape from round or cubical to oblong or branched; the lining membrane becomes convoluted, the lining secreting cells columnar instead of cubical, and the col loid contents of the vesicles become less viscid and more watery. These changes appear to be identical with those found in the enlarged thyroid of Graves's dis ease; hence it may be inferred that the typical change in the enlarged thyroid in Graves's disease is of the nature of a compensating hypertrophy. Previous division of nerves has no effect upon these changes, and hence the enlarged thyroid of Graves's disease is not pri marily of central origin. A number of experiments were performed upon dogs, with a view to further determining the function of the parathyroid glands. If a single parathyroid and a minute piece of thyroid proper were left, no symp toms of any kind appeared, whereas death followed if the parathyroid were subsequently excised, although the small piece of the thyroid proper was left. The excision of the parathyroids would thus appear to be the cause of the acute symptoms (tremors, rigidity, convulsive attacks of dyspncea, and death) which follow the total excision of the thyroids, and that the excision of thyroid proper causes only the symptoms of myx cedema. Edmunds (Jour. Path. and Bact., Jan., '98).
Cases of Graves's disease may be com pletely cured both by thyroidectomy and bilateral section of the sympathetic. In view of the fact that some cases are cured by internal medication, there must be a certain proportion in which the affection does not induce structural changes in any organ. No theory can be regarded as adequate without taking into consideration the functions of the thyroid gland. Three factors must be considered in the production of the dis ease: (a) the central nervous system; (b) the connecting fibers,—sympathetic and vagus; (c) the thyroid gland. A lesion of one of these parts may produce a specific alteration in the others, the consequence of which, together with the exciting cause, may give rise to the symptoms of Graves's disease. J. A. Booth (Jour. of Nervous and Mental Dis., Sept., 1902).
The surgical treatment of the thyroid and removal of one or both cervical sympathetic ganglia seems unquestion ably to be a treatment of great value, and to be applicable not only in the class of cases called "secondary," where an indo lent goitre has been present for some years, but in the "primary" cases as well. The objection to it, as may be stated once for all, is the fact that a large proportion of the cases have ended fatally, for some unknown reason, so that it should not be adopted without an expressed willing ness on the part of the patients and their friends to take a real risk.
Any operative treatment of exoph thalmic goitre is likely to be attended by serious and quite special risk. Lejars (Bull. et Mem. de la Soc. de Chir. de Paris, Mar., '97).
When we leave these two methods of treatment we come to quite a number which, in my opinion, owe their effi ciency, as I have indicated, not to their specific effect, but to their general effect. The treatment of this class which I have found most valuable is persistent fara dization or galvanization of the thyroid gland with strong currents. It is, per Imps, going too far to deny a beneficial local action to this sort of treatment of the gland. Certainly it is useful, what ever its mode of action. Through this means a great proportion of the patients presenting themselves at the Massachu setts General Hospital have been treated with marked benefit.