The reaction following partial thyroidectomy in very toxic cases of hyperthyroidism is well known. The use of various surgical and nonsurgical methods of reducing thyroid activity as a preliminary to thyroidectomy is universal. Various methods of preventing the psychic and operative traumatism inflicted by the operation itself are also in use.
It has seemed to me that the excessive reaction sometimes observed is due not merely to faulty technic but to a basic fault in the scheme of operation, and that the primary mortality can be radically lowered and the ultimate result materially improved by the operative method suggested.
The reaction is essentially an excessive, acute hyperthyroidism. Were it permissible to make a complete extirpation of the gland, the only reaction possible would be due to the manipulation of the gland during its removal, which would be analogous to the administration of so much toxin hypodermically; that is, with the