Many theories have been advanced with regard to the special secretion and function of the thyroid gland. The various glands of the body can be classified into three groups; protective, digestive and eliminative. The thyroid is classed among the protective glands. From investigations which have been made to the present time, it would seem that in association with the parathyroid the thyroid gland is an important factor in the control of calcium metabolism; that in asscociation with the hypophysis, it is concerned in the development of the body; and that together with the adrenals and the hypophysis, it serves to control blood pressure and circulation through the so-termed internal secretion.

While a relationship is thought, by some, to exist between the thyroid and the pancreas, yet that connection is not well understood.

That the thyroid is a sex gland is indicated by the fact that, in some invertebrates, it empties by a duct into the uterus.

*Abstract of address of guest of honor at the 46th annual meeting of the Michigan State Medical Society Detroit, September 27, 28, 1911.

No. I

The ductless glands in the neck can be demonstrated in embryos of 4 mm. The thyroid develops from three anlage, a superior median in the tongue-bulb, and two lower in the fourth branchial groove. Failure of complete descent leaves the superior portion as lingual, sublingual or suprahyoid thyroids. The developing hyoid, by its entanglement with the thyroid may cause the central part to string out into a pyramidial lobe. The midline cysts in this region are due to the thyroid's drawing embryonic mucosa into an anomalous situation.

The thymus gland forms in two buds in the third groove and in its descent may draw a portion of the thyroid into a substernal position, as an accessory or aberrant thyroid.

the activity, or lack of it, in the vesicles. When in excess, it means simple or colloid goiter as retention cysts, and in great quantities it may, by pressure, destroy the secreting cells. The area of arterial supply to the thyroid is approximately that from the circle of Willis to the brain.

The thyroid gland is found in all animals, and its study in them has thrown considerable light upon the subject in general. The young of animals, without this gland, fail to develop and are called cretins.

The simple, watery, colloid goiters of adolescence are probably physiological, to a degree with the sex development. The goiters of this period are responsive to medical treatment, seldom requiring operative relief.

The glands of the body are normally over-sized so that they may respond to excessive demands, or still be able to secrete in sufficient amounts should they be partially impaired at birth, or by disease.

They

The four epithelial bodies or parathyroids, although very small, are to be considered as a part of the thyroid group. are located behind the thyroid, developing in the third and fourth grooves of the embryo. They are apparently often injured at birth by hemorrhage, yet seldom develop tumors in later life. When operating, these glands should be preserved to prevent tetany.

Hydatid cysts, tuberculosis and malignancy, both carcinoma and sarcoma, are occasionally seen.

Morgagni's disease, Flajani's disease, Parry's disease, Grave's disease, Basedow's disease, exophthalmic goiter, etc., are merely terms to describe a group of irregular

symptoms. Moebius' disease would be a better term since Moebius first suggested, in 1886, that the disease was caused by thyroid change and secretion. Hyperthyroidism seems a reasonable term. It is a condition which can be present without sickness, yet which may become essentially toxic and cause death as a primary or chronic condition.

The medical treatment of the disease for the past 100 years has made little impression on the medical profession the world over. All forms of treatment, climatic, rest, internal and external medication, have been and are still employed by men who are contemporaneous with the older period of medicine, that is, before we had any pathologic entity or knowledge of the real changes in the gland.

The early operation of ligation cures many cases. Early as well as advanced cases can be cured by partial thyroidectomy. Very late cases, with degeneration of the heart, kidney, and liver, can be improved but not completely cured by partial thyroidectomy. The mortality in these cases will vary from 1 to 4 per cent. Combined operations are often indicated in bad cases; first ligating one or both superior vessel areas, and, later, doing a partial thyroidectomy.

Local anesthesia is indicated in most ligations. Local or combined, or straight ether anesthesia, are the methods used for thyroidectomies, according to the preference or experience of the individual operator.

In 900 operations performed on the thryoid in St. Mary's Hospital during the first ten months of 1911, the mortality was I per cent.

In reviewing the literature of prostatectomy, it is interesting to note that among the different methods of attacking the prostate that have been practiced by different surgeons, practically equally good results are reported by most diverse methods when used by men who have become specially skilled in their application. The great relative frequency of obstructive prostatic dysuria, and the general recognition of the possibilities of operative relief, will compel the frequent attempt on the part of the general surgeon to supply it, "So that the question is no longer what is possible in the hands of the specially expert, but what, in the light of our present knowledge of the anatomical relations and the pathological changes of the prostate gland will, in the hands of the average surgeon, most certainly and safely, wholly and permanently, relieve the obstructive dysuria that the prostatic disease has produced." (L. S. Pilcher).

Any careful surgeon will probably have a considerable series of favorable cases without a death, but, sooner or later, he will meet with cases which demand surgical relief and, despite the skill of the physician, terminate fatally, so that we must content ourselves with recovery in from 95% to 95% of our cases. This is, indeed, a magnificent record, when we realize that the disease affects chiefly men between the ages of 65 and 80, and the disease,

*Read at the forty-sixth annual meeting of the Michigan State Medical Society, Detroit, September 27, 28, 1911.

if not relieved by surgical operation, would not only condemn the unfortunate owner of the prostate to a miserable and filthy invalidism, but most certainly, in a relatively short period of time, would bring about the death of the patient.

Sometimes I fear that the general practitioner is still swayed in his judgment by his experiences of a previous decade, but let me assure him that the advances made in this branch of surgery have been among the most tangible and brilliant, not only in the relief of the urinary obstruction, but also in bringing about permanent relief from the mental and physical degenerations associated with chronic prostatism. It is not alone the urinary obstruction which must be considered in these patients but also that which, to my mind, is equally important, the rehabilitation of the patient's self-respect, the rejuvenation of one prematurely aged, and the rekindling of a mind clouded by the incomplete elimination of toxic products, disordered by the constant call for relief from his bladder, and degraded and isolated from intellectual intercourse and association with his fellows on account of the unpleasant odor which clings to his clothing, his irritable temper, and the constant or frequent desire to urinate.

If the patient survives his operation, the mental relief is sure to follow. As to the complete and permanent cure of his dysuria, we have found that in the great majority of cases that have been subjected