TREATMENT OF GOITRE AND NEURASTHENIA 129 
quency of the occurrence of thyroid enlargements as the 
individuals approach “the goitre age.” When goitre 
already has developed, the adniinistration of an iodide 
will cause it to diminish in size, in over half of the 
cases, and in many instances the glandular enlargement 
will disappear entirely. 
The recurrence of a goitre after operation is be- 
lieved to be due to compensatory hyperthrophy of the 
remaining portion, which enlarges in its effort to fur- 
nish sufficient of its hormone to supply the demands of 
the system. Patients who have submitted to partial 
thyroidectomy will be less liable to recurrence when 
kept under prolonged observation and iodide or thyroid 
extract given when indicated, to prevent the secondary 
hypertrophy and hyperplasia, just referred to. 
QUININE AND UREA INJECTIONS 
A majority of the goitre patients mentioned in this 
report came to me suffering with the usual symptoms 
of hyperthyroidism. To control the hyperthyroidism 
and lessen the abnormal amount of thyroxin that is 
entering the blood, a portion of the hyperactive gland is 
destroyed, by making several injections of quinine and 
urea directly into the anterior portion of the tumor. 
The strength of the quinine and urea solution varies, 
depending on the type of the goitre and character of the 
symptoms. Only one injection is given at a treatment, 
which is repeated at two to six-day intervals. Ten to 
twenty infiltrations usually are required to produce 
marked improvement in the general symptoms. It is 
important that only a few minims of the concentrated 
solution be injected at a time. The changes in the 
thyroid at the point of injection are the phenomena of 
inflammation followed by swelling, hyaline degenera- 
tion, and finally necrosis of both epithelium and stroma. 
As soon as sufficient thyroid has been destroyed, which 
is shown clinically by a gain in weight, slowing of the 
