120 THE INTERNAL SECRETIONS—1920 
they show any improvement or even remain stationary. 
A better understanding of the interrelation of the endo- 
crine glands will undoubtedly reveal means of treating 
these cases rationally without resort to surgery. 
The rationale of medical treatment consists in carry- 
ing the patient over the period of abnormal thyroid 
activity with as little damage to vital organs and the 
nervous system as possible. To do this, rest in bed is 
prerequisite with the use of sedatives if indicated. This 
gives the heart a minimum of work and invariably is 
accompanied by a satisfactory decrease in the pulse 
rate. Stimulation of the thyroid also is avoided by 
making no demands upon it. The diet should be high 
in caloric value to prevent loss of weight, which is con- 
sequent upon increased metabolism. A reduction of 
proteins is desirable as tachycardia is diminished on a 
protein low diet. Alkalinization to combat the usual 
tendency to acidosis is advisable. 
Basal metabolism estimations should be made at reg- 
ular intervals of about two weeks in order to determine 
the rate of improvement. This is rapid at first but 
gradually declines till it remains stationary. At this 
stage Roentgen irradiations may be tried if thought 
advisable, depending upon the type of dysthyroidism. 
Scott"? advises strongly against Roentgen therapy he- 
lieving there is danger of altering the thyroid’s func- 
tion to such an extent that return to normal is impos- 
sible, thus accomplishing the undesirable effect of irre- 
parable loss comparable to operative results. The ex- 
cellent results obtained, however, by this form of treat- 
ment recommend it highly. Care should be taken to 
check the result of each irradiation by careful clinical 
observation and basal metabolism estimations. (Means 
and Aub”'.) 
Although, according to Hoskins,” the function of 
the thymus is unknown, still the frequent association 
of a persistent and hypertrophied thymus with dysthy- 
