10 4 JOHJST T. HALSEY 



themselves refractory to the usual mercury and iodid therapy, treatment 

 with mercury, iodid, and thyroid be given a trial. 



While according to our present views iodids do not owe their value in 

 the treatment of syphilis to their action on the thyroid there is at least one 

 established fact which lends support to the view that thyroid therapy may 

 be a useful adjuvant, at any rate occasionally, to other antiluetic therapy. 

 This is that syphilis by no means rarely attacks the thyroid gland and that 

 in such cases there may develop hypothyroidism with its various conse- 

 quences, among which a lessening of the power of resisting infections 1 

 is perhaps of especial moment in this connection. These views of von 

 Jau read's certainly appear worthy of remembrance, and thyroid therapy 

 would seem Avorthy of trial in recalcitrant cases of syphilis, especially if 

 there be any evidence that the thyroid has been affected. 



Nephritis. Remarkably beneficial results from thyroid therapy in 

 cases of nephritis have been claimed by Percy (a) (&), who in 1912 and 

 1013 reported a considerable number (35 in bis first communication) of 

 severe cases all of whom were strikingly benefited. I cannot find any later 

 article containing further reports with greater detail as promised by him, 

 but in 1016 Phipps reported that in several cases of severe nephritis 

 (but not in all) lie had obtained marked improvement, due in his opinion 

 to the administration of thyroid. Percy's average doses of 20 grains per 

 day, and those of Phipps of from 5 to 15 grains daily are so large that it is 

 surprising that Percy observed hyperthyroidism develop in only one case. 



The reports as made by these two writers are not such as to compel 

 acceptance of their views, for, without medicinal treatment, very sick 

 neplirities often show surprising changes for the better, even such diminu- 

 tion in blood-pressure as reported by Percy and such improvement of renal 

 function as Phipps observed. For me the known facts as to the effects 

 of thyroid feeding on renal function and metabolism in no 1 way explain 

 the results claimed. Consequently, I must await further reports before 

 acknowledging the connection between the thyroid therapy and the im- 

 provement reported. 



Affections of the Skin. The abnormality of the skin and other epi- 

 dermal structures in myxedema and other types of hypothyroidism and the 

 milliner in which this is benefited by thyroid therapy naturally suggested 

 that thyroid dysfunction might bo at least partially responsible for, and 

 that thyroid therapy might prove of value in the treatment of various skin 

 diseases. To a limited extent at least clinical trial has justified these 

 views. 



/W/W.s- was the disease in which such trial of thyroid therapy was 

 first; made and numerous cases of cure by it have been reported, but 

 dermatologists to-day are well agreed that this treatment is successful in 

 only a small pro|>ortion of cases of psoriasis and that the affection is not 



"See discussion of use of thyroid in infectious diseases (p. 103). 



