OKGANOTHEKAPY AND HOKMONOTHEKAPY 97 



the first week, and from 10 to 35 or more pounds in the course of two 

 or three months. Yorke Da.vies found that in patients, previously kept 

 for some time on a restricted (obesity) diet the administration of thyroid 

 increased by two or three times the rate of reduction in weight. While 

 for a time clinical reports of this new method of treatment were unani- 

 mously and unreservedly favorable, before long less favorable reports 

 appeared. Attention was called to unfavorable effects on the general 

 health, to the fact that much of the loss in weight was the result solely 

 of loss of water from increased diuresis, and to a by no means infrequent 

 failure to secure any considerable or permanent reduction in weight. 

 Abuse of the thyroid treatment of obesity by physicians prescribing too 

 large doses, or failing to properly observe their patients, its exploitation 

 by vendors of obesity cures, and self-administration by patients all com- 

 bined to bring the treatment into disrepute, so that many clinicians un- 

 reservedly condemned it as useless or harmful. Following this swing of 

 the pendulum there ensued a period of careful investigation which has 

 made it possible to reach relatively definite conclusions as to the clinical 

 utility and value and also as to the limitations and harmfulness of thyroid 

 treatment of obesity. 



Various investigations of the influence exerted by thyroid feeding on 

 the metabolism of obese patients have given apparently contradictory re- 

 sults. In almost all of Magnus Levy's (&) (c) cases there was a negative 

 effect on the nitrogen balance and no constant increase of basal metabolism, 

 and when this latter effect was produced it was so slight that he concluded 

 that the loss in weight produced was not due to increased oxidation of fat- 

 but chiefly to increased destruction of protein and increased excretion 

 of water. Other investigators also reached similar unfavorable conclu- 

 sions, and attention was called to the occasional production of glycosuria, 

 of marked nervous symptoms and, relatively rarely, of a condition of 

 hyperthyroidism. Opposed to these unfavorable findings and opinions 

 were the demonstrations by Zinn and Schiodte that the nitrogen balance of 

 obese patients may be kept positive, if the diet contains sufficient protein 

 and the thyroid dosage be not too large. As von Noorden and others 

 (notably v. Bergmann) have shown that there is a type of obesity (consti- 

 tutional obesity) in which the basal metabolism is abnormally low, due, 

 according to von Noorden, to hypofunction of the thyroid, the administra- 

 tion of thyroid in these cases appears to be justified, and clinical experi- 

 ence has corroborated this view. 



In using this method it is well to remember that, as shown by v. Berg- 

 mann, the increased protein destruction often does not manifest itself 

 before the second or third week of treatment, and that a sufficient amount 

 of protein in the diet will counterbalance this. Both Locke and Hoyten 

 have found that thyroid is especially useful in reducing the weight of 

 middle aged women, especially in those who have passed the menopause. 



