34 ENDOCRINE THERAPEUTICS 



hormotone. A little thought and experience will 

 show which combination to use. In high-pressure 

 cases it is well to leave out ovarian, orchitic, and 

 post-pituitary, but a moderate amount of supra- 

 renal will help. It may seem foolish to give a 

 pressure- raiser like suprarenal in combination 

 with thyroid, but experience shows it to be 

 most useful ; the troublesome irregular heart 

 action that thyroid often produces can be entirely 

 controlled by suprarenal, and with it full doses 

 of thyroid can be given : this is really of impor- 

 tance, for many patients will not persist with 

 thyroid if the heart trouble be not relieved. In 

 general practice the regular use of the manometer 

 will show many cases in which unexpectedly 

 there is plus or minus pressure, and in which the 

 pressure variation is the cause of trouble ; no 

 ordinary drug can alter these variations. In old 

 age, we often meet cases that complain of vertigo ; 

 in the majority the symptom is due to raised 

 pressure or to actual atheroma of the cerebral 

 arteries, and the indications are clear for thyroid 

 or some other tension depressor, but one occasion- 

 ally comes across a case where the vertigo is due 

 to very low pressure. (I have a case now in a man 

 of 86, whose pressure is only no mm. Thyroid 

 in such a condition would aggravate, while supra- 



