108 THE INTERNAL SECRETIONS—1920 
indicated by weakness and often low blood pressure. 
The headache is probably caused by an enlargement of 
the pituitary and this same enlargement possibly also 
causes a partial and temporary paresis of the ocular 
motor muscle by pressure upon the nerves. Further 
evidences of disturbed catabolism are shown by the 
myxedematous condition of the skin, the transitory 
edemas, and the itching. 
Irrespective as to which link in the chain breaks first, 
eventually all are involved, and the pluriglandular 
symptom complex results. A close observation partic- 
ularly of so-called chronic nephritis will reveal a sur- 
prisingly large number of individuals who have this 
condition. 
PRACTICAL THERAPEUTIC DEDUCTIONS 
The therapy of the condition based upon the altered 
physiology is relatively simple. When the evidence 
points to an initial ovarian insufficiency, large doses 
(15 grains) of the ovarian gland substance, with small 
doses of pituitary gland substance (1 to 2 grains), are 
to be tried first. If there is not relief then small doses 
of thyroid gland are added (one-half grain). The 
medication is given three times daily. In those cases 
commencing with thyroid disturbances relatively large 
doses of thyroid substance (2 to 3 grains), and smaller 
doses of ovarian substance (5 grains) are adminis- 
tered. In the latter type pituitary gland is contraindi- 
cated. In the terminal well-developed syndrome a large 
thyroid and small ovarian medication is the proper one. 
The intensive medication should be kept up until there 
is either relief of symptoms or toxic manifestation. It 
has been our experience that ovarian cases must be kept 
under intensive medication for approximately four 
weeks before there is relief, while the thyroid cases 
show improvement in approximately two weeks. When 
there is almost complete relief of symptoms the dosage 
