TREATMENT OF ATHYROSIS AND HYPOTHYROSIS 141 



on bone growth was the same. According to this it is not at all likely that, as 

 Pick and Pineles state, in young thyroprivic dogs the symptoms of deficiency 

 are not fully combated by iodothyrin, but that they are combated by the 

 English tablets. 



Thyroantitoxin, potassium iodide, and hypophysis substance are, as 

 shown by the experiments of Magnus-Levy, entirely actionless. 



As far as the dose is concerned, it is well in every case to begin with small 

 doses and gradually to increase. In adults we give one to two English tablets 

 daily and can gradually increase to from three to five. If we have attained 

 a favorable result, we may again decrease the dose to two or one tablet. 

 Children are usually first given one-half tablet, which may be increased to 

 from two to three tablets. In my cases of sporadic cretinism I went transi- 

 torially as high as seven tablets, in one case indeed to nine. Kassowitz recom- 

 mends thyreoid elixir (Allen H anbury, London), of which one coffee-spoonful 

 represents about one-sixth of a sheep's thyroid gland. Children under a half 

 year should be given one-half coffee-spoonful daily, later increased to one 

 coffee-spoonful. Only in children over twelve years of age did Kassowitz 

 order up to two coffee-spoonfuls per day. 



The result of thyroid-gland medication in myxedema adultorum is in the 

 most cases an immediate one. The myxedematous swellings may undergo 

 an appreciable reduction even in a few days. Together with this there goes 

 for the most part, a loss of the body protein, that for the most part depends 

 on the rapid melting down of the myxedematous tissue. In the cases in 

 which very marked swellings have occurred, the skin is lax and wrinkled. 

 It acts very rapidly on the secretion of sweat, in that the previously dry 

 skin becomes moist; then too, the marked scaling ceases. The action on 

 the trophic disturbances naturally takes a long time, but are no less striking. 

 The bald spots on the head cover again with new hair ; the hair on the axillae 

 and on the genitalia become thicker, the hairs again feel soft and pliable. 

 The pulse becomes more rapid, the protein exchange and the fundamental 

 exchange rise to normal, the appetite increases, the beginning loss of weight 

 supersedes the gradual increase in weight. The diuresis becomes more abun- 

 dant, the lowered temperature rises at first somewhat above the normal, and 

 then remains normal. The action on the blood is usually slower; usually 

 a medication of several weeks' or several months' duration is required 

 before the red cells and the amount of hemoglobin come back to normal and 

 before the differential counts of the white cells show normal values. The 

 mental condition improves much more rapidly. The apathy may appreci- 

 ably improve after only a few days, the patients become more active, they 

 take a more active interest in their environment, and the memory improves. 

 Also the mental disturbances accompanying the myxedematous condition 

 show a pronounced improvement and under the thyroid medication may even 

 become entirely normal. In the case of Pilcz already mentioned the illusive 



