TREATMENT OF GOITRE AND NEURASTHENIA 129 



quency of the occurrence of thyroid enlargements as the 

 individuals approach "the goitre age." When goitre 

 already has developed, the administration of an iodide 

 will cause it to diminish in size, in over half of the 

 cases, and in many instances the glandular enlargement 

 will disappear entirely. 



The recurrence of a goitre after operation is be- 

 lieved to be due to compensatory hyperthrophy of the 

 remaining portion, which enlarges in its effort to fur- 

 nish sufficient of its hormone to supply the demands of 

 the system. Patients who have submitted to partial 

 thyroidectomy will be less liable to recurrence when 

 kept under prolonged observation and iodide or thyroid 

 extract given when indicated, to prevent the secondary 

 hypertrophy and hyperplasia, just referred to. 



QUININE AND UREA INJECTIONS 



A majority of the goitre patients mentioned in this 

 report came to me suffering with the usual symptoms 

 of hyperthyroidism. To control the hyperthyroidism 

 and lessen the abnormal amount of thyroxin that is 

 entering the blood, a portion of the hyperactive gland is 

 destroyed, by making several injections of quinine and 

 urea directly into the anterior portion of the tumor. 

 The strength of the quinine and urea solution varies, 

 depending on the type of the goitre and character of the 

 symptoms. Only one injection is given at a treatment, 

 which is repeated at two to six-day intervals. Ten to 

 twenty infiltrations usually are required to produce 

 marked improvement in the general symptoms. It is 

 important that only a few minims of the concentrated 

 solution be injected at a time. The changes in the 

 thyroid at the point of injection are the phenomena of 

 inflammation followed by swelling, hyaline degenera- 

 tion, and finally necrosis of both epithelium and stroma. 

 As soon as sufficient thyroid has been destroyed, which 

 is shown clinically by a gain in weight, slowing of the 



