194 FRANKLIN C. McLEAN 



Very doubtful, or practically negative results, have been observed in 

 ascites associated with cirrhosis of the liver. Eppinger, however, does 

 not regard this as a definite contraindication for the employment of 

 thyroid therapy. 



Eppinger uses thyroid extract only in such cases as have been found not 

 to respond to the usual method of therapy. He finds that the maximal 

 effects are obtained after two or three weeks of administration of 0.9 

 gram of dried thyroid substance daily. Further administration is without 

 beneficial effect, and can be followed by very unpleasant complications. 



The greatest care must be used in the treatment of edema associated 

 with any form of heart failure. At the beginning not more than 0.3 gram 

 daily of the dried thyroid substance should be given. In renal disease 

 larger doses are permissible, but Eppinger prefers to begin with small 

 doses in every case, until the reaction of the patient has been observed. 

 He usually begins with doses of 0.3 gram daily, but advises doses of 0.1 

 gram daily in cases where extreme caution is advisable. After it has been 

 determined that the general condition of the patient has not been adversely 

 influenced by the therapy, having given special attention to diarrhea and 

 the frequency of the pulse, the dose may be increased to 0.9 gram daily. 

 Larger doses, up to 1.2 grams daily are used rarely. In some cases of 

 renal disease increase of albuminuria and hematuria followed the institu- 

 tion of thyroid therapy. 



Intensive thyroid therapy should not be continued for more than 

 three weeks. If the frequency of the pulse, the general effect of stimula- 

 tion, or of the number of stools are greatly increased within this time, 

 thyroid therapy must either be discontinued or the doses reduced to the 

 minimum. In certain cases, after the maximum beneficial effect has been 

 obtained, it is advisable to continue with small doses over longer periods 

 of time, in order to prevent the recurrence of symptoms. In such cases, 

 not over 0.1 to 0.3 gram daily should be given, and especial attention 

 should be given to the signs of intoxication noted above. In some instances 

 it may be necessary to give opium together with the thyroid, to counteract 



the diarrhea. 



Baths. Hot baths, in order to increase the loss of fluid through the 

 skin, are often beneficial, either in the form of tub baths at 97 F., for 

 about half an hour daily, or an electric light bath, with the patient in 

 the recumbent position. In all cases such therapy should be begun cau- 

 tiously, in order to avoid unfavorable reactions. In the edema of heart 

 failure it is doubtful whether the results justify the risk involved, but 

 very good results are sometimes obtained in acute nephritis. 



