150 THE DISEASES OF THE THYROID GLAND 



5. Surgical intervention requires the same rigid and prolonged after- 

 treatment to give permanent results." 



Musser believes that the surgeon does too much, the internist too little, 

 in the treatment of goiter. 



Abrams recommends for exophthalmic goiter stimulation of the vagus 

 nerve by direct percussion or concussion over the seventh cervical spine. 

 In addition, he recommends pilocarpine, hypodermically or in doses of Y\ 

 gr. three times daily by mouth. With regard to this treatment it may 

 be said that Abrams uses it to give tone to the vagus nerve. If it is granted 

 that this method of procedure really does stimulate the vagus nerve, the 

 treatment is certainly not indicated in the so-called vagotonic forms of the 

 disease. 



Stoney reports forty-one cases of exophthalmic goiter (various types) 

 treated by X-rays. (The anode is 6 in. from the skin, which is protected with 

 four layers of blankets. One-half to i milliampere of current is run through 

 the secondary.) Of the forty-one cases fourteen were completely cured, some 

 of these remaining well for over two years after the treatments, twenty-two 

 more have improved very much, four were somewhat better, only one did not 

 do well. Snow in a discussion of Stoney 's report stated that he had seen good 

 results from the application of the static wave current, and from the use of 

 Abram's percussion method. 



Lewi reports a series of thirty-four cases of exophthalmic goiter and 

 perverted thyroid secretion [?] that he treated with high-frequency currents, 

 with results that he considers exceptionally good. 



The editor believes that no harm is done by expectant treatment with high- 

 frequency currents, combined with rest and other rational methods of physio- 

 therapeutics ; and that such currents might be used as an alternative for the 

 X-rays, or as a substitute for them before they are used. Temporizing with 

 such methods should not, however, supersede surgical procedures in appro- 

 priate cases. The use of radium is mentioned by Marine in a review, and 

 Turner reports that results from local irradiation with radium were as favor- 

 able as those of the X-ray. 



After hearing what these internists and physiotherapeutists have to say 

 let us turn our attention to the surgical side of the question. According 

 to Mayo, the early operation of ligation cures many cases. Early as well as 

 advanced cases can be cured by partial thyroidectomy. The mortality in 

 these cases will vary from i to 4 per cent. Combined operations are often 

 indicated in bad cases: first ligating one or both superior vessel areas, and, 

 later, doing a partial thyroidectomy. 



Local anesthesia is indicated in most ligations. Local or combined or 

 straight ether anesthesia are the methods used for thyroidectomies, according 

 to the preference or experience of the individual operator. 



In 900 operations performed on the thyroid in St. Mary's Hospital, 



