ORGANOTHERAPY AND HORMONOTHERAPY 89 



but where medication has been delayed such results cannot be expected. 

 Not infrequently the very rapid growth resulting from thyroid treatment 

 is attended by the undesirable result that the rapidly growing bones are 

 too soft, bowlegs or deformity of the spine resulting. The delay in denti- 

 tion, so regular a feature of cretinism, is also corrected. Even patients 

 of relatively mature age may develop new teeth, Sinkler having seen 

 this in a patient of thirty. The abnormal conditions of the skin, hair 

 and nails, the tendency to obesity, the pseudolipomata, the swollen tongue, 

 the goiter, the hypoplasia of the genitals and other physical features of 

 cretinism also yield more or less completely and promptly to the treat- 

 ment, and coincidently with these physical results there is an improver 

 ment or return to normal of various functions, the metabolism becoming 

 normal, the appetite and digestion being improved, and the constipation 

 (almost regularly present in cretins) corrected, while in patients suf- 

 ficiently mature the genitalia develop, menstruation is established and 

 the other sexual functions become more normal. Such effects on the de- 

 velopment of the genitalia and on their functions may be obtained even 

 at a relatively advanced age, as in Murray's patient, aged 27 years. Im- 

 provement in the hearing may or may not be obtained, depending on the 

 cause of its impairment, but in a very large percentage of cases this 

 function is also favorably influenced. 



While thyroid feeding almost invariably brings about at least some 

 improvement of the mental condition of the cretin, there are great differ- 

 ences in the results obtained. Promptness in inaugurating treatment is 

 of preeminent importance for securing the best results. Cases in which 

 there is only a delayed mental development, especially if they are treated 

 early, usually respond with a prompt and marked improvement, so that 

 after a time their mental and psychic status approximates if it does not 

 equal that of normal children. Unfortunately, even in the apparently 

 milder cases such gratifying results are not always attainable, for not 

 infrequently the improvement in the physical status far exceeds that in 

 the mental. Although, as has been intimated, complete return to a 

 normal mental state does not always ensue even in the milder cases, the im- 

 provement is almost invariably so great that the lot of the patient is greatly 

 ameliorated and his ability to care for himself markedly increased. In 

 those cases in which there is a true weakmindedness or idiocy, as is often 

 the case in congenital cretinism, one may not hope for more than an 

 improvement in the mental condition sufficient to render the subjects less 

 helpless and more amenable to control and care. 



It is thought by many that in some cases at least of myxedema and 

 cretinism the thyroid feeding brings about favorable changes in the con- 

 dition of the more or less atrophied thyroid glands. Against the correct- 

 ness of this view is the fact that practically always cases of true myxedema 

 relapse if the treatment is abandoned. An argument for it is seen by some 



