ORGANOTHERAPY AND HORMONOTHERAPY 91* 



occasionally cause serious results. It is undoubtedly safest and best 

 to start with small doses, which can be increased if necessary. 



As a general rule there should be little difficulty in determining by 

 trial and by observation of the mental and physical status of the case, the 

 amount of the drug necessary at the different stages of the treatment. 

 Determination of the effect produced on the basal metabolism is probably 

 the most accurate means of determining the correct dose, but for obvious 

 reasons this method will be available only occasionally. Signs of over- 

 dosage in myxedematous patients (and in cretins) are a rise of temperature 

 above normal, too great acceleration of the pulse, too rapid and excessive 

 loss of weight, headache, pains in the limbs, flushing of the face, feelings of 

 weakness, profuse sweating, tremors, loss of appetite, vomiting, diarrhea, 

 and, of more serious portent, attacks of palpitation of the heart, anginal at- 

 tacks or cardiac failure. In not a few instances death from cardiac failure 

 has occurred during treatment. Skin affections, such as urticaria and fur- 

 unculosis, have also been attributed to the thyroid medication. In view of 

 the occasional occurrence of such disagreeable and, more rarely, of really 

 serious effects, these cases must be kept under close observation in the first 

 months of treatment and under no circumstances should a patient be 

 allowed to take any but small doses unless frequently seen by his physician. 

 Especial caution must be exercised in the treatment of more advanced 

 cases, for whom the initial dosage should be small, and it is best that such 

 patients should be confined to bed, or at least to one room, until the 

 correct dosage has been determined and until there is a decided improve- 

 ment in health and strength. 



In cases both of myxedema and of cretinism attempts have been made 

 to overcome the thyroid deficiency by implantation of thyroid tissue, one 

 of the first of these (that of Bettencourt and Serrano) having been the 

 inspiration for Murray's institution of thyroid therapy in his historical 

 case. While often the grafts take and for a longer or shorter period cause 

 and maintain a more or less satisfactory improvement quite comparable 

 to that obtained by thyroid feeding, experience has shown that after a time 

 the grafted tissue is absorbed or loses its specific powers so that the patient 

 suffers a relapse. Kocher (a), in 1914, concluded that experience has 

 shown that, while grafting gives prompter and better results than thyroid 

 feeding in myxedema, it is not possible to obtain permanent results from 

 one grafting. 



The first of these transplantations was performed by H'. Bircher in 

 1889, and following the report of his two cases thus treated with tem- 

 porarily beneficial results, transplantation has been fairly frequently 

 performed by other surgeons with similarly temporary results. In 1907, 

 Christiani reported 28 cases of myxedema (spontaneous and post-oper- 

 ative), cretinism, faulty development, dwarfism, and infantile obesity, in 

 which he implanted thyroid tissue with very great improvement in 60 per 



