130 THE INTERNAL SECRETIONS—1920 
pulse, and lessening of the tremor, insomnia and nerv- 
ousness, the injections are stopped, and the patient is 
placed on a modified rest cure and a lacto-vegetarian 
diet. Anterior pituitary is given to improve the gen- 
eral symptoms of exhaustion that accompany toxic 
goitre, and the addition of small amounts of thyroid 
tends to prevent secondary compensatory hypertrophy 
of the untreated portion of the thyroid gland. 
SOME REMARKS ON NEURASTHENIA 
The symptom complex that we call neurasthenia, or 
nervous prostration, was known to the ancients, and is 
. well described by Hippocrates. In few diseases is the 
treatment more unsatisfactory, because of the multi- 
plicity of misleading symptoms and the difficulty of con- 
trolling the patient. 
The typical neurasthenic almost always has a dis- 
turbance of the function of the thyroid gland. The 
blood pressure usually is low and the circulation poor. 
Frequently the activities of the internal organs are 
impaired, although there may be no discoverable or- 
ganic disease. Mental exertion, even of the simplest 
character, often causes so much weariness and exhaus- 
tion as to be prohibitive. A vasomotor paralysis, some- 
times present, allows chillings, flushings, cold or burn- 
ing hands and feet, drowsiness when patient is up, 
wakefulness on lying down, hence insomnia. The nu- 
trition may be fair, or good, and the weight may be nor- 
mal. There may be more or less tingling and numb- 
ness of the extremities. Thymus disturbance is man- 
ifested by weakness, dyspnea, nervousness and obsti- 
nate constipation, and deficient calcium metabolism— 
as in conditions like rickets, marasmus, etc. 
The indications for the administration of anterior 
pituitary substance, according to the recent studies of 
Engelbach and others, are undergrowth of bones, 
amenorrhea, metorrhagia, dysmenorrhea, | sterility, 
