ATHYROSIS OR HYPOTHYROSIS 103 



extremely poor in iodine, thus bringing the stored secretion into the cir- 

 culation on account of the greater need. I refer once more to the experi- 

 ments of Rudinger carried out on the basis of these convictions, which 

 showed that on almost protein-free diet, very rich, however, in carbohy- 

 drates, we can depress the increased exchange to the normal. When there- 

 fore we administer abundant nitrogen-free energy carriers, we do not have 

 to fear a loss of protein. From such a diet should be expected not only 

 a favorable influencing of the body weight, but also a certain mitigating in- 

 fluence on the hypersecretion of the thyroid gland; to which must be added 

 that such a diet oppresses the least the gastrointestinal tract. As important 

 as must be our endeavors to increase the body weight in Basedow's, not the 

 less important is the avoidance of overfeeding (v. Noorden), as the improvement 

 of the cardiac activity does not keep pace with the increase of weight, and 

 cases are known in which the increased demands on the heart, in consequence 

 of the increase of weight, led to a sudden collapse. 



b. Athyrosis or Hypothyrosis 



Historical. The first experiments as to the influence of extirpation 

 of the thyroid gland on the animal organism originated with Schijj. To 

 about the same time belong also the first clinical descriptions of myxedema 

 on the part of Gull, Ord, and Char cot. Gull, in 1873, described five cases of 

 "A Cretinoid State supervening in Adult Life in Women." Ord, in 1878, 

 was the first to designate such cases as "myxedema." ' Charcot, in 1879, 

 called the attention of the French to this clinical picture, terming it "cachexie 

 pachydermique." The demonstration of the connection of this disease with 

 the absence of thyroid function was furnished in 1882 and 1883, by Th. 

 Kocher and Reverdin. In the period that followed this, thought was rendered 

 confused by the fact that the symptoms following upon the removal of the 

 parathyroids together with the thyroid were attributed to the absence of the 

 thyroid. Investigation distinguished between acute and chronic cachexia 

 thyreopriva. Only at the end of the nineteenth century did the clinical 

 pictures of athyrosis assume stabile forms, through the detachment of the 

 symptoms due to the absence of the parathyroids (Gley, Vassale andGenerali, 

 Erdheim, Pineles, Biedt). About this time, too, Hertoghe called attention 

 to the mitigated forms of athyrosis. To-day one of the hardest problems 

 is the relation of myxedema to cretinic degeneration. Although the fact that 

 congenital absence of the thyroid as well as a severe disease of this organ 

 in early life (infantile myxedema) had been established by animal experi- 

 mentation and the recognition of the significance of thyroaplasia by Pineles 

 in 1902, the careful analysis of the clinical manifestations between sporadic 

 and endemic cretinism permit a recognition of far-reaching differences. 

 Among these is the fact that in the first condition thyroid therapy is always 



