130 THE INTERNAL SECRETIONS 1920 



pulse, and lessening of the tremor, insomnia and nerv- 

 ousness, the injections are stopped, and the patient is 

 placed on a modified rest cure and a lacto-vegetarian 

 diet. Anterior pituitary is given to improve the gen- 

 eral symptoms of exhaustion that accompany toxic 

 goitre, and the addition of small amounts of thyroid 

 tends to prevent secondary compensatory hypertrophy 

 of the untreated portion of the thyroid gland. 



SOME REMARKS ON NEURASTHENIA 



The symptom complex that we call neurasthenia, or 

 nervous prostration, was known to the ancients, and is 

 well described by Hippocrates. In few diseases is the 

 treatment more unsatisfactory, because of the multi- 

 plicity of misleading symptoms and the difficulty of con- 

 trolling the patient. 



The typical neurasthenic almost always has a dis- 

 turbance of the function of the thyroid gland. The 

 blood pressure usually is low and the circulation poor. 

 Frequently the activities of the internal organs are 

 impaired, although there may be no discoverable or- 

 ganic disease. Mental exertion, even of the simplest 

 character, often causes so much weariness and exhaus- 

 tion as to be prohibitive. A vasomotor paralysis, some- 

 times present, allows chillings, flushings, cold or burn- 

 ing hands and feet, drowsiness when patient is up, 

 wakefulness on lying down, hence insomnia. The nu- 

 trition may be fair, or good, and the weight may be nor- 

 mal. There may be more or less tingling and numb- 

 ness of the extremities. Thymus disturbance is man- 

 ifested by weakness, dyspnea, nervousness and obsti- 

 nate constipation, and deficient calcium metabolism 

 as in conditions like rickets, marasmus, etc. 



The indications for the administration of anterior 

 pituitary substance, according to the recent studies of 

 Engelbach and others, are undergrowth of bones, 

 amenorrhea, metorrhagia, dysmenorrhea, sterility, 



