426 KELSON W. JANNEY 



In untreated myxedema the prognosis as to life is fairly good but poor as 

 to mental and physical efficiency. A few cases of spontaneous recovery 

 have been reported. Although the most marvelous cures known to medi- 

 cine are frequently made in hypothyroidism when treated skillfully, a 

 perfect restoration to physical and mental normality is seldom attained. 

 In children, growth often remains tardy ; in adults some of the hypothy- 

 roid bodily and psychic changes usually persist. 



Social environment affects the prognosis. The poor and ignorant fre- 

 quently neglect treatment or its proper control and suffer accordingly. 



The prognosis of hypothyroidism can certainly be regarded as better 

 since the clinical introduction of basal metabolism studies which permit 

 of a more accurate control of treatment. 



Treatment 



The therapeutical results obtained in hypothyroidism through, the 

 extraneous introduction of thyroid preparations are among the most bril- 

 liant and ideal in modern medicine. The rudiments of the science of 

 organo- or opotherapy at present in our possession have been largely elabo- 

 rated as a result of the stimulus given to enclocrin research by the success 

 of thyroid therapy. On account of the practical and historical importance 

 of this discovery, the following is quoted from Geo. R. Murray's (/) de- 

 scription of the first use of the thyroid gland in treatment. 



"The symptoms of the disease having thus been traced to loss of the 

 thyroid gland, the next advance was in the direction of supplying the 

 deficiency. Schiff had already shown that the usual fatal result of thy- 

 roidectomy in the dog could be averted by a preliminary transplantation 

 of another thyroid gland into the abdomen of the animal, and von Eisels- 

 berg proved that the same result could be obtained in the cat, provided the 

 graft was successful. Quite independently, 1890, thyroid grafting was 

 suggested by Sir Victor Ilorsley as a method of arresting the disease in 

 man. This suggestion was acted upon by several surgeons, especially by 

 Bettencourt and Serrano, who noticed that in their case the operation was 

 immediately followed by improvement, which they attributed to absorp- 

 tion of the juice of the transplanted thyroid gland. This observation ap- 

 peared to me to be extremely important, as it indicated that the thyroid 

 gland carried on its function by means of an internal secretion. I, there- 

 fore, concluded that if this was the case the regular use of the secretion, 

 obtained in the form of an extract of the gland, would remove the symp- 

 toms of inyxedema, and suggested this line of treatment at a meeting of 

 the Northumberland and Durham Medical Society in February, 1891. 

 In order to test this a glycerin extract of the sheep's thyroid gland was 

 prepared, and injected at intervals beneath the skin so as to ensure its 



