42 THE INTERNAL SECRETIONS 1920 



tion showed a decreased output of urea (1 per cent.). 

 Otherwise, it was negative. 



s It was evident that the destruction of tissue wastes 

 in the patient's organism, or the catabolism, was very 

 much below normal, as compared with the formation of 

 tissues, or anabolism, in consequence of which the pa- 

 tient keeps on storing up materials, which normally 

 should be destroyed in the processes of energy produc- 

 tion. 



Remembering the function of the thyroid gland in 

 balancing the relation between destruction and recon- 

 struction of the tissues, it was assumed that this patient 

 was suffering principally from a decrease in thyroid 

 secretion. On this ground, thyroid gland was adminis- 

 tered. The diet was not reduced or changed. No 

 change in pulse rate, blood pressure, or nervous irrita- 

 bility was noted with six capsules, amounting to \y 2 gr. 

 of thyroid extract a day for a period of four weeks, and 

 this fact was thought to be of importance, indicating 

 that the patient's organism was in need of, at least, that 

 much more thyroid secretion. However, when the dose 

 was increased to 1% gr. per day, the pulse rate rose 

 from 76 to 90 per minute, and the blood pressure from 

 130 to 135. The patient is now taking only 1 gr. a day. 

 Altogether, the patient has been under thyroid treat- 

 ment for six weeks and has lost twenty-one pounds. 



CASE No. 4. A man 40 years of age with a negative 

 family and previous medical history, consulted me the 

 first time for pain in his arms, which had bothered him 

 for several weeks. He is a tailor by occupation. The 

 physical examination revealed a man 5 feet 5 inches tall 

 and weighing only 110 pounds; evidently very much 

 underweight and undernourished, with some enlarge- 

 ment of the right lobe of the thyroid gland. Examina- 

 tion of the chest revealed a very active apex beat, not 

 displaced, but very rapid and irregular. A murmur 

 was heard at the apex only and was not transmitted. 

 This unusual character of the heart murmur was con- 

 firmed by several of my colleagues. The lungs were 

 negative. A fine tremor of the fingers was noticed. 

 Pulse rate was 105 per minute, and very irregular, as 

 shown in the accompanying sphygmographic tracing: 



