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of myxœdema. In such cases the symptoms of exophthalmic goître first disappear, and it is only at a later stage that myxœdema is developed. It appears then that the progressing fibrosis is at first really curative in nature, as it lessens the activity of the thyroid gland, and the exophthalmic goître disappears. If the fibrosis progresses too far the functions of the gland become too much impaired, and more or less myxœdema is developed, according to the amount of injury done to the secreting tissue by the fibrosis.
In conclusion I would maintain that in exophthalmic goître there is an excessive formation and absorption of thyroid secretion, which may or may not be normal in character, and that the symptoms of the disease are due to the presence of this excess of secretion in the blood, and to its action upon the tissues and especially upon the nerve centres in the medulla.
The practical conclusion from this is that we should endeavour to improve our methods of treating the diseased thyroid gland. We want to be able to induce a moderate degree of fibrosis, and so imitate the natural process of recovery. Removal of a portion of the gland, though most successful in some cases, has proved to be a dangerous operation in others. Possibly injections of iodine, electrolysis, or some similar means of starting a limited fibrosis, may help us to attain the object we have in view without danger.
