ADDENDUM 149 



the eye of the alert physician. He recognizes the following indications for 

 treatment. 



1. When the disease has persisted and, despite proper medical and hy- 

 gienic care, is advancing. 



2. When the disease is progressive or far advanced. 



3. When the patient's means or social status is such that rest is im- 

 practicable, and the disease, although slight, has persisted under treat- 

 ment for a year or more without signs of yielding. 



This author estimates the number of cases in which surgical intervention 

 is necessary at about 5 per cent, of the total number. He recommends in- 

 dividualization in treatment, the keynote of which is rest. Correction of 

 the eye conditions, fresh air, proper diet, the drinking of hot water for its 

 diuretic and eliminative action, intestinal antiseptics, neutral quinine hydro- 

 bromide (5 gr. or more thrice daily), ergot, picro toxin, calcium chloride, digi- 

 talis, strophanthus, and even cactus all have their place in the medicinal 

 therapy. In addition hydrotherapeutic measures, electricity (ionic appli- 

 cation of iodine to the gland or to the cervical sympathetic, or the high- 

 frequency discharge to the neck or to the vertebra prominens) and the ice- 

 bag or ice-coil to the heart or gland or spine. Among organic extracts the 

 author recommends especially thymus extract (0.5-3 g m - P er diem) or a 

 combination of thymus gland with adrenalin. 



Falta has in the text cited the fact that in many cases of Basedow's the 

 thymus gland is enlarged. The use of thymus extract in BasedoVs disease 

 had better be dispensed with. The editor would advise against the employ- 

 ment of adrenalin on account of the tendency to glycosuria in Basedow's 

 disease. 



Musser summarizes the results of consideration of medical and surgical 

 treatment in the dealing with goiter, especially exophthalmic goiter, as 

 follows : 



1. "Endemic goiter should not be treated surgically until proper general 

 treatment has been employed for a long time. 



2. Surgical intervention should not be advised in cases of goiter associated 

 with functional or organic disturbances of other secretory organs 

 until the associated disorders are removed or relieved. 



3. If relapses occur in spite of general treatment, or in spite of treatment 

 directed against the disorders of other organs, a goiter should then be 

 treated surgically. 



4. Medical treatment should be continued from six to twenty-four months. 

 Favorable results should not be promised unless the patient is under 

 the absolute control of a physician, so that treatment by rest, diet, 

 bathing, physical therapy and so forth may be carried out with pre- 

 cision and continuity. 



