TREATMENT OF GOITRE AND NEURASTHENIA 131 
subnormal temperature, slow pulse and relatively 
low blood pressure -and fatigability. However rapid 
pulse and high blood pressure is not a contraindi- 
cation to the use of anterior pituitary substance. I re- 
call a case of pronounced neurasthenia with a systolic 
blood pressure of 160 mm., pulse 110, anda temperature 
of 97-48° F. This patient weighed 182 pounds, and I 
believed that most of her symptoms were due to the 
same fundamental causes as the obesity. I prescribed 
small doses of thyroid with sedatives, and she steadily 
lost in weight, but the neurasthenic symptoms became 
more pronounced. As soon as anterior pituitary was 
added to the thyroid, her neurasthenic symptoms 
promptly disappeared; the systolic blood pressure 
dropped to 115 and the pulse to 80, while her weight 
remained at about 180 pounds. 
CLINICAL EXPERIENCES 
Space will permit the report of only a few of the case 
histories in this series of 75 patients treated with ante- 
rior pituitary and thyroid. 
Case 1. Mrs. G. W. M., aged 66, for 40 years had 
had a small goitre of the left thyroid lobe, which had 
caused no trouble until 1917, when she noticed an in- 
crease in its size, accompanied by such symptoms as 
marked tremor, nervousness and insomnia. At exami- 
nation in January, 1919, her pulse was 120, systolic 
pressure 150 mm., diastolic 85 mm. There was some 
dyspnea, loss of weight and the fatigability was 
marked. I injected quinine and urea into the thyroid 
gland and prescribed the anterior pituitary prepara- 
tion, one standard sized dose to be taken daily. One 
year later the goitre had reduced one half in size, the 
symptoms of hyverthyroidism had disappeared and she 
was in good health. 
Case 2. Miss G., aged 23, came under my observa- 
tion in 1918 suffering from severe exophthalmic goitre 
of one year’s duration. The tumor was large, involving 
both lobes of the thyroid and the isthmus. The pulse 
was 140, menstruation was irregular and scanty, and 
