106 THE INTERNAL SECRETIONS 1920 



legs edematous up to the knee; hands edematous ; heart 

 enlarged to the left, no murmurs ; abdomen large and 

 pendulous ; skin dry ; eyes and ears negative. 



Laboratory examination: No evidence of nephritis 

 by special examination. Urine, 1975 c.c. in 24 hours; 

 sp.gr., 1020 to 1023, trace of albumen and moderate 

 number of hyalin and granular casts. 



Subsequent course under organotherapy of 3 grains 

 of thyroid and 5 grains of ovarian substance (ovarian 

 gland was given because commercial testicular extracts 

 have, in our experience, not been effective), and later 

 reductions in the thyroid dosage showed at the end of 

 six months a loss of 38 Ibs. in wight. Blood pressure, 

 147 mm. systolic ; edema, itching and headaches, as well 

 as double vision, gone. A course of four grains of pitui- 

 tary gland substance three times daily for four days 

 brought a prompt return of the double vision. 



DIAGNOSTIC CONSIDERATIONS 



The differential diagnosis of the ovarian complex 

 is not difficult. Static conditions, such as flat feet, 

 lacerated perineum, etc., must be eliminated as a cause 

 of backache, and the general complaint of weakness 

 must not be attributed to neurasthenia, whatever that 

 term may mean. 



A carefully-taken history is essential and a careful 

 search for evidence of loss of secondary sexual charac- 

 teristics, i. e., development of hirsuties, is essential. 

 The thyroid group present a difficulty in diagnosis, in 

 that the condition of chronic nephritis is very closely 

 simulated. This difficulty may be eliminated either by 

 the special tests which have been mentioned, i. e., the 

 Mosenthal test and blood chemistry, or they may be 

 eliminated by therapeutic tests, i. e., treating the case 

 as if it were an endocrine deficiency, and if no improve- 

 ment occurs changing the diagnosis to a chronic ne- 

 phritis. 



