132 THE INTERNAL SECRETIONS 1920 



there was some loss of weight. I injected quinine and 

 urea into the thyroid gland and prescribed anterior 

 pituitary compound, one capsule to be taken daily for 

 one week in each month. Taking the even small dose 

 of thyroid (one twelfth of a grain) more frequently 

 aggravated the symptoms and caused loss of weight, 

 while using it intermittently with the pituitary had a 

 beneficial effect. In six months the general symptoms 

 were relieved, and the goitre reduced one third. She 

 had gained 14 pounds in weight. 



Case 3. W. T. C., aged 50, had a small goiter of 

 eight years' standing. It had caused no symptoms and 

 had remained stationary in size until following an at- 

 tack of influenza in January, 1919. At this time she 

 came to my attention, suffering with toxic goitre, 

 aggravated by the symptoms of the menopause. The 

 pulse was 130, systolic pressure 150 mm., diastolic 

 100 mm., temperature 100 deg. F., pains over both ovar- 

 ies, marked insomnia, tremor, nervousness and loss of 

 weight. Quinine and urea injections were given into 

 the thyroid and the patient was placed on small doses 

 of posterior pituitary and thyroid. This increased her 

 symptoms and shortly after had to be discontinued. 

 The thyroid alone was then tried, and this had to be 

 abandoned also. Finally the anterior pituitary combi- 

 nation was prescribed, one capsule to be taken daily, 

 and she has gained in weight, her symptoms are re- 

 lieved and the goitre has been reduced one third. 



Case 4. Mrs. B. F. M., aged 34, noticed that she was 

 developing a goitre following parturition in 1914. She 

 came to my attention in May, 1920, when she presented 

 a small toxic goitre involving both lobes, together with 

 symptoms of neurasthenia, headache, loss in weight, 

 and fatigability. I prescribed posterior pituitary and 

 thyroid. This aggravated the symptoms and I substi- 

 tuted anterior pituitary compound, one dose to be taken 

 twice daily. Under this treatment she has noticed a 

 reduction in the goitre, and decided improvement in her 

 general health, her headaches have disappeared and she 

 has made a slight gain in weight. 



Case 5. Mr. D. C., aged 31, noticed goitre with severe 

 exophthalmic symptoms four months previous to exam- 

 ination March, 1920. During this time he had lost 35 

 pounds in weight. Pulse 140, systolic pressure 145 mm., 



