OEGANOTHEKAPY AND HOEMONOTHEEAPY 10i 



percentage of spontaneous recoveries, J. T. EL), stuporous states, and 

 primary dementia. 6. To obtain a favorable result, it is not necessary to 

 cause a high temperature reaction. Y. Physical benefit resulted in most 

 cases even without improvement of mental state. 8. The proportion of 

 relapses was less than in those cases cured by other methods. 



Such optimistic views were for a time shared by many other alienists, 

 Middlemass (quoted by von Jauregg, who appears to agree with him), 

 for instance, having expressed the opinion that it was not justifiable to 

 consider a psychosis incurable until the thyroid treatment had proven 

 unsuccessful. Unfortunately the experience of the years that have passed 

 since this treatment of mental cases was introduced has failed to corrob- 

 orate the opinion that thyroid treatment is so generally applicable or so 

 frequently successful as these earlier observers believed, and it is note- 

 worthy that except in Great Britain and America it was never generally 

 adopted. The consensus of opinion to-day is that thyroid administration 

 is occasionally beneficial 14 in patients with melancholia and stuporous 

 conditions, and that it may be useful and should be tried in cases of 

 insanity of various types if the patients show evidence of hypothy- 

 roidism. 15 The doses used to-day are, however, very much smaller than 

 those of twenty years ago, and are the same as those generally employed in 

 the treatment of hypothyroidism. 



Quite recently thyroid therapy has again been advocated as useful or 

 curative in dementia prcecox, Eaecke and others believing that various re- 

 ports indicate its probable value. 16 



"~ Epilepsy. From time to time it has been thought by various observers 

 that there was a more or less frequent relationship between epilepsy and 

 dysfunction of the thyroid (Claude and Schmiergeld), and that thyroid 

 therapy had produced remarkably beneficial results in the treatment of 

 this disease (Bolten, Leopold-Levi and Eothschild). It would be hard to 

 define the status of thyroid therapy in epilepsy better than has been done 

 by Dercum (a). "In a given number of instances the physiological level 

 of the patient may be distinctly raised by the administration from time to 

 time of small doses of thyroid extract, say from i/ 8 to % grain tnree 

 times a day, seldom more." Naturally there can be no question of the 



"No mention of any such general application of it or of the use of such massive 

 doses as advocated by MacPhail and others has been found in recent text-books or 

 journals. 



15 Post-mortem examination of cases of insanity show a rather large proportion 

 of abnormal thyroids. Peabody's series of 50 autopsies is fairly typical in showing 

 over 22 per cent with marked chronic interstitial thyroiditis and lesser degrees of the 

 same in 32 per cent. 



16 There is some evidence suggesting that dysfunction of this gland may be more 

 or less frequently present in cases of this type of mental disease, Dercum and Ellis 

 having found the thyroids small in 7 out of 8 autopsies of cases of dementia praecox, 

 but, while Peabody found anatomical changes in the thyroid gland of three cases of 

 long standing, he found no demonstrable changes in these glands in two cases of 

 briefer duration. 



