CLINICAL SYNDROMES 371 



the thyroid gland has long been employed, with the hope thereby to reduce 

 the vascularity of the gland and so diminish the excretion of the normal 

 or perverted gland substance. It is still to be recommended in the general 

 medical management of a case of exophthalmic goiter. 



X-rays and Radium. With the same end in view the rontgen rays 

 have been recommended. C. H. Mayo (c) believes that they lessen vascu- 

 larity and induce sclerosis around the gland and so diminish the risk of 

 hemorrhage at operation. Freund, Cook, Seymour, Pfahler, and Grier are 

 among the many who have published their results from this form of treat- 

 ment. Some are very conservative, others extremely radical in their 

 claims. Seymour reports an improvement in seventy-three of eighty cases 

 treated with the target ten inches from the skin and one thickness of 

 sole leather interposed; he recommends the production of only a slight 

 erythema but without skin irritation; the dose is repeated in three to 

 four weeks. 



Pfahler and Zulick believe that the rontgen rays should be given a 

 trial in all cases of Graves' disease, because no harm is done and an 

 operation may thus be avoided. They insist that both the thyroid and 

 thymus glands should be rayed. An increase in body weight and a 

 decrease in pulse rate are the first signs of improvement. The struma 

 and exophthalmos are the last to manifest retrogression and in some 

 cases show no appreciable change. They warn against too prolonged treat- 

 ment because of the possible danger of hypothyroidism resulting. 



Grier claims to have cured 87.5 per cent of sixty-three cases of hyper- 

 thyroidism treated by him. The most favorable results were noted in 

 simple hyperthyroidism, acute and chronic exophthalmic goiter ; the Base- 

 dowized goiter yields much less readily to this form of treatment. Waters 

 (&) reported his results in sixty cases and believes a more liberal use of this 

 form of therapy worthy of trial. Even such a conservative surgeon as 

 Halsted (e) lias tried X-ray treatment of the thymus gland in six cases of 

 exophthalmic goiter refractory to double lobectomy with astonishingly 

 good results. In contrast to the above enthusiasm Mackenzie (c) expresses 

 frank disappointment with the results in Graves' disease but admits that 

 the trend of present experience is decidedly in favor of its further trial. 

 Murray (g) writes that "the application of suitable doses of X-rays to the 

 enlarged thyroid gland has in some of my cases proved to be of great 

 value. The gland gradually diminishes in size and the other symptoms 

 subside. Atrophic changes in the secretory epithelium and both in- 

 terstitial and intracapsular fibrosis appear to be induced by the action 

 of the rays." While fifteen to twenty weekly doses usually suffice, Murray 

 advises in the obstinate cases a persistence with the treatment for a year 

 at least. 



In conclusion we believe that any one who reads Ludin's analysis of 



