CLINICAL SYNDROMES 367 



by an increase in the nervousness, headache, palpitation, etc. The red 

 iodid of mercury which was once so popular as a local application is 

 now discarded. Injections of iodin and iodoform into the gland substance 

 are very dangerous and have been practically abandoned. Breuer of 

 Vienna and Gautier of Geneva (quoted by Moffitt) have reported the de- 

 velopment of exophthalmic goiter after the treatment of simple goiter 

 with iodin preparations, Theodore Kocher (h) has reported a similar case 

 under the title "lod-Basedow," and speaks of its great frequency; he 

 advises against the use of iodin internally or externally even in simple 

 goiter, or, if it be used at all, that it be administered only in small doses 

 for a short period. 



G. R. Murray frankly admits that a the number of drugs that have 

 been recommended in the treatment of this malady is large but as far as 

 my experience goes I have found only a few to be of special service." For 

 many years belladonna, either as the tincture or its alkaloid atropin, had 

 a great vogue because of its well known antagonism to such external secre- 

 tions as the saliva and sweat; ten to fifteen drops of the tincture or one 

 one-hundred-and-fiftieth of a grain of atropin were given three times a 

 day until symptoms of atropin poisoning supervened. It certainly 

 lessens the sweating and appears to soothe the nervous system and to 

 diminish the excitability and restlessness as well as to quiet the heart. 

 In our own experience it has proved of some comfort to the patient, 

 though we are quite skeptical as to its lessening the thyroid secretion in 

 man and know of no animal pharmacological experiments in support of a 

 supposed restraining effect on the thyroid internal secretion. 



Quinin was formerly used by Friedreich. More recently Forchheimer 

 has recommended the exhibition of quinin hydrobromate in doses of two 

 to five grains in combination with one grain of ergotin three times a day. 

 The former should stop when cinchonism appears. It would seem that 

 some benefit is experienced by the patient with mild symptoms of hyper- 

 thyroidism from this combination of drugs. We use it almost as a 

 routine while the patient is undergoing the rest treatment prior to surgery. 



Various preparations of the bromides including the strontium and 

 calcium salts in daily doses of thirty to forty-five grains have been used 

 with some benefit. Some clinicians, following the work of McCarrison (e) 

 on the etiology and treatment of endemic goiter, have given intestinal 

 antiseptics as salol and thymol, in the hope that Graves' disease is the 

 result of a general infection, the portal of entry of which lies in the 

 intestinal tract. However we know of no successful results. 



Before leaving this section we must consider the various measures to 

 combat particularly troublesome symptoms. For the tachycardia and 

 palpitation bed rest is the first essential ; of great assistance is a light ice 

 bag placed over the precordia and kept constantly or intermittently 

 applied, according to the desire of the patient. Rarely are cardiac stim- 



