THYROID INSUFFICIENCY 77 



be, requires the actual support that we get so 

 well from adrenal extract. Again, we must 

 remember that in all acute diseases metabolism 

 is excessive, and that the results may be in them- 

 selves poisonous ; elimination of these is impera- 

 tive, and is largely under the control of the 

 endocrine glands. When mental disease is estab- 

 lished the endocrine failure or error still persists, 

 and much can be done by intelligent use of our 

 gland extracts. For instance, in melancholia, 

 hypothyroidism is the rule with raised blood- 

 pressure ; these two alone bring about a sense of 

 discomfort with mental fatigue and incapacity 

 quite apart from the mental disorder. Here the 

 thyroid, by its action on blood-pressure and on 

 metabolism, helps much towards the cure of the 

 main affection. In maniacal conditions the blood- 

 pressure is generally far below normal and 

 metabolism excessive: here adrenal or pituitrin 

 therapy comes to our aid. In dementia praecox 

 careful investigation will often show endocrine 

 failure or excess, and so give indications for 

 suitable treatment. 



When giving thyroid in brain disease, we must 

 remember that large doses carry off a good deal 

 of phosphorus : the brain-cells cannot spare this 

 loss for long, and we should restore the loss by 



