366 C. P. HOWARD 



patient with exophthalmic goiter will be most comfortable; the patient's 

 own expe/ience is of greater importance. Tight lacing and tight collars 

 should be taboo. 



Hydrotherapy and Electricity. Both these physical therapeutic meas- 

 ures have been used, but with varying results. However, exhausting and 

 depressing baths should be avoided. A daily warm bath at 98 to 100 F. 

 should be insisted upon. Warm sea water or salt baths are sometimes 

 useful but bathing in the open sea is generally to be forbidden. 



Electricity has been much used in the past with excellent results if 

 the reports can be believed. Some, as Benedict, von Dusch and Chvostek, 

 prefer galvanism ; others, as Vigouroux and Murray, f aradism ; still others 

 recommend static electricity, while a few recommend the high frequency 

 current. It would seem to us that the chief benefit in these procedures 

 is through mental suggestion. Nevertheless such a well known clinician 

 as Murray (I)} believes that he has "observed steady improvement and 

 practical recovery take place in several cases in which this treatment has 

 been systematically carried out." 



Diet. The diet should be as varied and as palatable as possible to 

 encourage the patient to increase the body weight or at least to regain 

 weight lost through the increase of the metabolic processes inherent in 

 the disease. As overfeeding is to be carefully avoided frequent small 

 meals are to be preferred to three large ones. All indigestible food and 

 condiments must be prohibited, and tea and coffee allowed only in very 

 small quantities. Alcohol and tobacco had best be excluded. 



The majority of the older writers and more recently Ochsner favor the 

 use of a low protein diet namely milk, cream, buttermilk, cooked veg- 

 etables, stewed fruits and eggs. Jaimey's (&) few metabolic experiments 

 made on patients with exophthalmic goiter do not substantiate this view. 

 He believes that this point is clearly brought out by the experiments of 

 Pribram and Forges, who found the respiratory quotient of the disease 

 unchanged by a low protein diet ; on the other hand, a high protein diet 

 with restriction of the carbohydrates but of the same caloric value, pro- 

 duced an increase in the basal metabolism and a loss of weight, The best 

 results were obtained with a mixed diet. Janney believes that a certain 

 but not necessarily a predominant amount of carbohydrate in the diet is 

 useful in combating the nitrogen loss; he found that the most favorable 

 diet was one in which the protein, fat and carbohydrate are present in 

 the usual proportions but in increased amounts. 



Medication, Galenical. Various preparations of iodin as the syrup of 

 hydriodic acid, iodipin and the iodids were formerly much in use and 

 were believed to reduce the size of the thyroid gland. However, a 

 diminution in the size of the gland, even if it did occur, did not mean a 

 reduction of the hyperthyroidism ; therefore while a small minority of the 

 patients were improved, the great majority were made worse as shown 



