372 C. P. HOWAKD 



two hundred and eight papers an this subject will agree that the treatment 

 in selected cases is worthy of further trial. We believe that it is a pro- 

 cedure to be recommended in the simple cases of hyperthyroidism and 

 possibly as a preliminary and preoperative measure in the very vascular 

 struma of certain cases of exophthalmic goiter and lastly as a post- 

 operative measure in cases refractory to lobectomy. 



The use of radium was first recommended by Abbe, who introduced 

 it directly into the gland substance but without distinctly beneficial re- 

 sults. However, Turner has applied it externally in fifty cases of Graves' 

 disease with distinct success in all but one case. The patients gained 

 in weight and strength, while the tachycardia^ tremor and dyspnea dimin- 

 ished or disappeared. The thyroid gland, Turner states, becomes harder 

 but usually not much smaller, while the exophthalmO'S is but little affected. 

 Each lobe as well as the isthmus of the thyroid should be treated with a 

 dose for each of 200 to 400 milligram hours, with of course proper screen- 

 ing: this dosage can be repeated in three months. The advantages of 

 radium are, first, a. more exact dosage can be given than with the X-rays, 

 secondly, radium penetrates better and thirdly is not so disturbing to the 

 nervous patient, 



Injections Into the Gland. The injection of boiling water into the 

 thyroid gland has been practiced by Porter and O'Day and C. H. Mayo (0). 

 Porter (a) (&) has been using the method since 1911 and has treated more 

 than one hundred cases ; he considers it indicated in patients with small thy- 

 roid glands and mild hyperthyroidism, or after a lobectomy for recur- 

 rence of hyperthyroidism in the other lobe and in patients with large 

 goiters and extreme symptoms of hyperthyroidism until they become safe 

 surgical risks. O'Day (&) has used this method in seventeen cases of hy- 

 perthyroidism, though he admits that partial thyroidectomy is the proce- 

 dure of choice. For the exact technic we refer the reader to the original 

 articles and to the textbooks of surgery. 



Watson recommends the intrathyroid injection of quinin and urea 

 hydrochlorid, which he has performed in over one hundred cases of goiter 

 without untoward effects. He recommends a preliminary injection of the 

 goiter with sterile saline solution after carefully using novocain as a local 

 anesthetic to overcome the tendency to hyperthyroidism from the pain of 

 the injection. He then injects one to four mills of the 30 to 50 per cent 

 quinin and urea solution every third clay: he has found eight to fifteen 

 infiltrations are necessary. He recommends it only for the relief of the 

 hyperthyroidism and not as a cure of the goiter itself. 



tfuryical Procedures. After carefully reading Halsted's (/) "Opera- 

 tive History of Goiter," it would seem that the first authentic excision of 

 the thyroid gland for exophthalmic goiter was by P. H. Watson, who in 

 1874 reported five thyroidectomies, three of which were for definite cases 

 of Graves' disease. In 1877 Lister, according to Mackenzie (, did a par- 



