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OFFICIAL JOURNAL MEDICAL SOCIETY OF THE MISSOURI V.

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Why Club a Cough

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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 Der Mondrummummatutunannining temammamu. 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 bethe last generation the function of the thyroid tween thyroid hyperplasia and thyroid hyperhas 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 thyity 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 urinplates 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 tachy2. Exophthalmic Goitre and Thyroid Hyper- cardia. A tremor of the fingers would then apfunction—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 temley at Des Moines, Iowa, Sept. 18, 1919.

perature were noted.

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