THE THYROID-OVARIAN SYNDROME 109 
should be reduced one half, but it must be kept up con- 
stantly for a period of from three to six months in 
order to have the relief continuous. After the six 
months’ period medication may be reduced to approxi- 
mately one quarter of the intensive dose, and it need 
only be given intermittently, say, for two to three days 
in the week—this, however, must be continued either 
indefinitely or for very long periods. 
It goes without saying that the treatment outlined 
is not a matter of rule of thumb, judgment must be used 
particularly in the administration of the thyroid. A 
rise in the pulse rate, the rapid loss of weight, 
diarrhea and the development of nervousness are all 
indications of toxemia and indicate the need for less 
intensive dosage. When the normal weight has been 
established it is well to allow a further reduction of five 
pounds and then endeavor to hold it at that figure. 
While occasionally the administration of a single gland 
may prove to be effectual, such cases are, in the experi- 
ence of everyone, relatively rare. Success is much more 
uniform when the various glands are combined accord- 
ing to the scheme indicated. The criticism may be 
made that a so-called “shotgun” therapy is advocated, 
however, it is “shotgun” therapy only to those who do 
not understand the altered physiology upon which it is 
based. 
In the body of the article we have purposely re- 
frained from discussing the work of others who have 
considered one or another phase of the syndrome. For 
those who may be interested, the recent literature per- 
taining to the subject in its various phases is appended. 
BIBLIOGRAPHY 
1. Barrett (A. M.): Hereditary occurrence of hypothy- 
roidism with dystrophies of nails and hair, Arch. 
Neurol. & Psychiat. (Chicago), 1919, ii, 628. 
