For the purpose of this inquiry, it may be admitted that exophthalmic goiter and the related condition, toxic adenoma, are characterized by an altered function of the thyroid gland, chiefly an increased secretion; and that the reduction of this activity, by operative removal of a part of the gland, is followed in the great majority of cases by a prompt and more or less lasting amelioration of symptoms. It may also be admitted that in spite of the fact that many patients, especially those with exophthalmic goiter, will recover or be improved by medical measures and many more by appropriate irradiation by roentgen ray or by radium, nevertheless, in certain refractory cases operation is much the best and perhaps the only solution of the problem.
The three chief disadvantages of operative treatment are: first, the associated mortality; second, the ordeal of the operative experience, and third, the scar. The two