370 C. P. HOWAKD 



increase t^e dosage as rapidly as possible to a point where there is either 

 a marked improvement in the symptoms or signs of intolerance on the 

 part of the patient when one should stop altogether, continue or decrease 

 the dose according to the result. Rodagen and antithyroidin are not 

 well borne, the former on account of the odor, the latter on account of 

 the phenol used as a preservative. Thyroidectin is less disagreeable to 

 the patient. Further, all these preparations are expensive and the results 

 as yet are not very encouraging. 



Mackenzie states that Merck's serum and thyroidectin are inert and 

 expresses the belief that casein would have the same effect as rodagen. 

 However, after an extensive trial of rodagen, Mackenzie admits that it 

 was of distinct benefit in some cases of exophthalmic goiter. 



Various attempts to produce thyrotoxic sera have been made by Portis, 

 MacCallum (a) and Yates but without success. A different method from 

 any of the above was used by Murray (e) and subsequently by Beebe (a). 

 The latter obtained a cytotoxic serum by injecting into rabbits the nucleo- 

 protein and the thyreoglobulin precipitated from the thyroid gland of ex- 

 ophthalmic goiter patients obtained at first from the autopsy room, but later 

 from the operating room. Beside this "pathological serum," a "normal" 

 cytotoxic serum was prepared in the same way from the normal human 

 thyroid. Rogers believes that Beebe's serum has a twofold function: 

 (1) a late and cumulative effect in suppressing the action of the thyroid 

 secreting cells and (2) an antitoxic or nullifying action against the ex- 

 cessive thyreoglobulin. They do not believe that this serum will cure 

 all cases and were very cautious at first in promising results. "Technical 

 difficulties make the preparation of the serum on a commercial scale im- 

 probable. A very skillful chemist experienced in biologic work is a neces- 

 sity." This form of serum therapy is of course based on the theory that 

 exophthalmic goiter is a toxemia and that the toxin in question is the 

 thyroglobulin. lingers and Beebe state that there are two types favor- 

 able for treatment: (1) cases in the early stage of the disease, whether 

 of the mild, severe or the acute toxemic type; (2) long standing cases 

 of the suhacute variety with occasional exacerbations but without marked 

 secondary changes. After the injection of the serum in the usual dose 

 there may bo a local as well as a general reaction with increase in the 

 temperature and pulse rate, restlessness, nausea and vomiting. Though 

 in several cases there were severe and even alarming reactions, the authors 

 have never known of a fatality from the use of the serum. Beebe (a) and 

 Rogers in !!)(){) had treated more than five hundred cases of exophthalmic 

 goiter, of which 20 to 25 per cent of the patients were cured, 30 to 40 

 per cent were distinctly improved, 30 per cent somewhat improved and 

 10 per cent quite unaffected. 



Local Measures. Cold. Application of cold either in the form of 

 cold compresses wrung out in ice-water, a Leiter coil or an ice-bag to 



