120 THE INTERNAL SECRETIONS 1920 



they show any improvement or even remain stationary. 

 A better understanding of the interrelation of the endo- 

 crine glands will undoubtedly reveal means of treating 

 these cases rationally without resort to surgery. 



The rationale of medical treatment consists in carry- 

 ing the patient over the period of abnormal thyroid 

 activity with as little damage to vital organs and the 

 nervous system as possible. To do this, rest in bed is 

 prerequisite with the use of sedatives if indicated. This 

 gives the heart a minimum of work and invariably is 

 accompanied by a satisfactory decrease in the pulse 

 rate. Stimulation of the thyroid also is avoided by 

 making no demands upon it. The diet should be high 

 in caloric value to prevent loss of weight, which is con- 

 sequent upon increased metabolism. A reduction of 

 proteins is desirable as tachycardia is diminished on a 

 protein low diet. Alkalinization to combat the usual 

 tendency to acidosis is advisable. 



Basal metabolism estimations should be made at reg- 

 ular intervals of about two weeks in order to determine 

 the rate of improvement. This is rapid at first but 

 gradually declines till it remains stationary. At this 

 stage Roentgen irradiations may be tried if thought 

 advisable, depending upon the type of dysthyroidism. 

 Scott 11 advises strongly against Roentgen therapy be- 

 lieving there is danger of altering the thyroid's func- 

 tion to such an extent that return to normal is impos- 

 sible, thus accomplishing the undesirable effect of irre- 

 parable loss comparable to operative results. The ex- 

 cellent results obtained, however, by this form of treat- 

 ment recommend it highly. Care should be taken to 

 check the result of each irradiation by careful clinical 

 observation and basal metabolism estimations. (Means 

 and Aub 21 .) 



Although, according to Hoskins, 22 the function of 

 the thymus is unknown, still the frequent association 

 of a persistent and hypertrophied thymus with dysthy- 



