THYROID INSUFFICIENCY 69 



tonics, such as sulphate of spartein, cactus, or 

 convallaria, may be used, but are not as effective 

 as strophanthus. The rapid action of the nitrites 

 is of course most useful in cases of emergency, 

 in which there is threatening heart failure or 

 cerebral haemorrhage, but their influence is only 

 very transient. 



Next to amyl inhalation the most rapid and 

 effective remedy in such cases is the hypodermic 

 use of liq. adrenalin and liq. trinitrin (7 minims 

 of the former and 2 minims of the latter form a 

 good proportion). In the use of the nitrites we 

 should bear in mind that we are only treating 

 symptoms, and those in no lasting manner, 

 whereas with thyroid we are getting at one of 

 the chief root causes. The wise physician will 

 use both methods as circumstances arise. 



Sir Clifford Allbutt, in his inimitable way, 

 settles this question as follows : "In entering 

 upon the discussion of vaso-dilation as con- 

 trasted with agents which bring about this change 

 indirectly by modifying the causes of morbid 

 constriction, we have to consider how far mere 

 dilatation brought about, that is to say, im- 

 mediately and singly serves any good purpose. 



" We are told that to act thus directly upon 

 the vessel is but to treat a symptom, and is 



