104 THE INTERNAL SECRETIONS—1920 
third that previously experienced when in health. The 
patient, a trained nurse and the wife of a physician, 
was very morose and downcast at the prospect which 
confronted her. 
Physical examination showed a large-framed female 
55 lbs. overweight, with a dry, scaly skin, which was 
decidedly boggy. Her blood pressure varied between 
175 and 200 systolic. The cardiac area was enlarged 
a trifle to the left. There were scratch marks on the 
legs and back. 
Laboratory examination: No evidence of nephritis 
in the results of blood chemical examination, a Mosen- 
thal test diet, or a phenolsulphonephthalein test. A 
slight secondary anemia was present. No pathological 
condition of the pelvic organs other than a slight lacer- 
ation. 
While the therapeusis of the condition will be con- 
sidered later, the subsequent course of this case makes 
it necessary to refer to medication. She received ova- 
rian gland substance, 15 gr., and thyroid gland, 3 gr., 
three times a day for a period of ten days. At the end 
of that time she reported that the headaches and double 
vision had gone and that she had lost eight pounds in 
weight. Her blood pressure was 165 mm. systolic. 
This medication was continued for a period of two 
months, during which period she was symptom-free, 
having neither itching, double vision, headaches, nor 
backache. The loss of weight was 35 lbs., blood pres- 
sure 145 systolic. The dosage of thyroid was reduced 
to one half grain and that of ovarian substance to three 
grains. After three weeks of this treatment she re- 
ported that she had felt perfectly well up to ten days 
before her menstruation, when double vision had re- 
turned rather severely for two days. The ovarian sub- 
stance was increased to ten grains and the thyroid to 
one and a half grains. This was continued for two 
months, during which time she was symptom-free and 
