TREATMENT OF GOITRE AND NEURASTHENIA 133 
diastolic 70 mm., and temperature 100 deg. F’., marked 
insomnia, nervousness and tremor, diarrhea most of 
the insomnia, and anterior pituitary compound one 
gland lobes. I injected quinine and urea into the thy- 
roid and prescribed small doses of sodium bromide for 
the insomnia, and anterior pituitary compound one 
capsule daily. Three months later the patient had 
gained 10 pounds in weight, the pulse was down to 108 
and the general symptoms had improved as the goitre 
was reduced in size. 
Case 6. Mrs. J. F. M., aged 23, had had goitre for 
two years, evidently caused by pregnancy. Examina- 
tion May, 1920, disclosed symptoms of severe exoph- 
thalmic goitre, including scanty menstruation, loss of 
weight, marked insomnia, nervousness, diarrhea and 
tremor, pulse 160, systolic pressure 150 mm., diastolic 
85 mm., temperature 100 deg. F. There was a moderate 
edema of the ankles. Quinine and urea injections were 
made into the thyroid gland and the patient received 
the anterior pituitary preparation, one capsule daily. 
She improved rapidly. Now, four months after treat- 
ment, the symptoms have disappeared and she has 
gained 15 pounds. 
Case 7. Mrs. S. M. H., aged 29, suffered from severe 
exophthalmic goitre for two months previous to exami- 
nation May, 1920. During this time she had lost 20 
pounds in weight. Marked insomnia, nervousness and 
tremor. Pulse 130, temperature 99 deg. F. I injected 
quinine and urea into the thyroid and prescribed the 
same anterior pituitary formula, one capsule to be 
taken daily. In four months this patient has gained 18 
pounds, 7 pounds in the last three weeks. The goitre 
has reduced in size, the symptoms of hyperthyroidism 
are ae much better and she is again doing her house- 
work. 
Case 8. Miss E. B., aged 19, examination April, 
1920. Complained of fatigue, nervousness, loss of 
weight, insomnia, fatigability and other symptoms of 
neurasthenia following scarlet fever two years previ- 
ous. Pulse 90, systolic pressure 100 mm., diastolic 
65 mm., temperature 97%4 deg. F. I prescribed the 
anterior pituitary formula, one capsule to be taken 
twice daily. She gained steadily for one month when 
her weight became stationary and she was instructed 
