144 THE DISEASES OF THE THYROID GLAND 



Under the influence of the medication the umbilical hernias disappear, 

 not rarely in a few weeks, sometimes] after a month. These are almost 

 constant in infantile myxedema, and often appreciably large. 



Finally, just as significant is the influence on the genitalia and the second- 

 ary sexual characters. Magnus-Levy reports the case of a forty-five-year-old 

 cretin, in whom at the beginning of medication the pubic hair began to 

 develop and the penis began to increase in size. In a case of cachexia 

 strumipriva, in whom the struma had been totally extirpated at the age of 

 fourteen, thyroid medication was begun in the twenty-eighth year. Al- 

 ready after two years there was noticed a certain sexual development, after 

 seven years all sexual characters were present and sexual maturity was at- 

 tained. In the fully developed form of sporadic cretinism it is not, of course, 

 to be expected that a late-introduced treatment is able to bring about pro- 

 creative capacity. 



Also the mental development takes part in this general impetus. 



In the severe cases of infantile myxedema permanent administration of 

 thyroid substance is necessary; when the therapy is discontinued relapses 

 occur, even when the administration of the larger doses have transitorially 

 brought about symptoms of hyperthyroidism (Knopf elmacher) . In slight 

 cases the result is mostly a permanent one; in such cases we assume that 

 under the stimulating influence of the therapy the thyroid gland has held 

 fast to its development, or the less altered parts have recovered. 



Thyroid therapy has been tried in a great number of disease conditions that 

 have nothing directly to do with myxedema and is often very much valued. 

 I shall speak of its value in obesity in the consideration of the various forms 

 of obesity at the end of this book. Its influence in diseases of the hypoph- 

 ysis, the sexual glands, infantilism, and multiple sclerosis of the ductless 

 glands, I shall refer to in the appropriate chapters. Very much under dis- 

 cussion is the use of thyroidin in the treatment of scleroderma. Since 

 Singer first reported as to the favorable results a series of good results have 

 been published. In other cases there were soon manifested symptoms of 

 thyroidism with only slight improvement of the sclerodermic symptoms, in 

 still other cases, finally, the treatment failed entirely. The literature as to 

 this subject is found in detail in Cassirer's communication, v. Notthaft is 

 of the opinion that favorable results, where they have been obtained, 

 depend only on the stimulation of the general metabolism (consult also the 

 statements as to the ductless gland theory of scleroderma in the first chapter). 

 As to therapeutic results in endemic cretinism see the next chapter. 



Addendum 



With regard to inflammations of the thyroid, cases of acute idiopathic 

 thyroiditis have been reported by Dutrow and others. In Dutrow's case, 

 which was accompanied with a leucocytosis of 12,000, prompt relief was ob- 



