TREATMENT OF GOITRE AND NEURASTHENIA 131 



subnormal temperature, slow pulse and relatively 

 low blood pressure and fatigability. However rapid 

 pulse and high blood pressure is not a contraindi- 

 cation to the use of anterior pituitary substance. I re- 

 call a case of pronounced neurasthenia with a systolic 

 blood pressure of 160 mm., pulse 110, and a temperature 

 of 97-48 F. This patient weighed 182 pounds, and I 

 believed that most of her symptoms were due to the 

 same fundamental causes as the obesity. I prescribed 

 small doses of thyroid with sedatives, and she steadily 

 lost in weight, but the neurasthenic symptoms became 

 more pronounced. As soon as anterior pituitary was 

 added to the thyroid, her neurasthenic symptoms 

 promptly disappeared; the systolic blood pressure 

 dropped to 115 and the pulse to 80, while her weight 

 remained at about 180 pounds. 



CLINICAL EXPERIENCES 



Space will permit the report of only a few of the case 

 histories in this series of 75 patients treated with ante- 

 rior pituitary and thyroid. 



Case 1. Mrs. G. W. M., aged 66, for 40 years had 

 had a small goitre of the left thyroid lobe, which had 

 caused no trouble until 1917, when she noticed an in- 

 crease in its size, accompanied by such symptoms as 

 marked tremor, nervousness and insomnia. At exami- 

 nation in January, 1919, her pulse was 120, systolic 

 pressure 150 mm., diastolic 85 mm. There was some 

 dyspnea, loss of weight and the fatigability was 

 marked. I injected quinine and urea into the thyroid 

 gland and prescribed the anterior pituitary prepara- 

 tion, one standard sized dose to be taken daily. One 

 year later the goitre had reduced one half in size, the 

 symptoms of hyperthyroidism had disappeared and she 

 was in good health. 



Case 2. Miss G., aged 23, came under my observa- 

 tion in 1918 suffering from severe exophthalmic goitre 

 of one year's duration. The tumor was large, involving 

 both lobes of the thyroid and the isthmus. The pulse 

 was 140, menstruation was irregular and scanty, and 



