108 THE INTERNAL SECRETIONS 1920 



indicated by weakness and often low blood pressure. 

 The headache is probably caused by an enlargement of 

 the pituitary and this same enlargement possibly also 

 causes a partial and temporary paresis of the ocular 

 motor muscle by pressure upon the nerves. Further 

 evidences of disturbed catabolism are shown by the 

 myxedematous condition of the skin, the transitory 

 edemas, and the itching. 



Irrespective as to which link in the chain breaks first, 

 eventually all are involved, and the pluriglandular 

 symptom complex results. A close observation partic- 

 ularly of so-called chronic nephritis will reveal a sur- 

 prisingly large number of individuals who have this 

 condition. 



PRACTICAL THERAPEUTIC DEDUCTIONS 



The therapy of the condition based upon the altered 

 physiology is relatively simple. When the evidence 

 points to an initial ovarian insufficiency, large doses 

 (15 grains) of the ovarian gland substance, with small 

 doses of pituitary gland substance (1 to 2 grains), are 

 to be tried first. If there is not relief then small doses 

 of thyroid gland are added (one-half grain). The 

 medication is given three times daily. In those cases 

 commencing with thyroid disturbances relatively large 

 doses of thyroid substance (2 to 3 grains) , and smaller 

 doses of ovarian substance (5 grains) are adminis- 

 tered. In the latter type pituitary gland is contraindi- 

 cated. In the terminal well-developed syndrome a large 

 thyroid and small ovarian medication is the proper one. 

 The intensive medication should be kept up until there 

 is either relief of symptoms or toxic manifestation. It 

 has been our experience that ovarian cases must be kept 

 under intensive medication for approximately four 

 weeks before there is relief, while the thyroid cases 

 show improvement in approximately two weeks. When 

 there is almost complete relief of symptoms the dosage 



