THE THYROID APPARATUS 87 



According to Pick and Pineles, the secondary peptones 

 obtained from pig's thyroid after a forty-eight hours' digestion 

 by pepsin and hydrochloric acid, have very little influence upon 

 the pathological symptoms of suppression. The primary 

 albumoses, and the products of prolonged pepsin and trypsin 

 digestion, are also inactive. They found, moreover, that 

 iodothyrin was inactive, which appears to contradict the view 

 that iodothyrin is the only active principle of the thyroid secretion. 



There is a large amount of evidence in favour of the clinical 

 value of substitution. Since the really surprising results obtained 

 in myxcedema by Murray (1891) with subcutaneous injections of 

 sterile glycerine thyroid extract, and by Howitz, Mackenzie and 

 Fox with thyroid gland given by the mouth, thyroid extract has 

 become an indispensable factor in the management of certain con- 

 ditions. The thyroid substances are specific remedies in all 

 those pathological conditions which arise from absence or 

 insufficiency of thyroid function. 



Brilliant results were obtained by Kocher in cachexia 

 strumipriva. The uninterrupted administration by the mouth of 

 thyroid extract will prevent the appearance of cachexia, and may 

 for years completely replace the function of the absent thyroid. 

 Moreover, the treatment may be continued for any length of 

 time without fear of ill-effects. Such subjects are as capable of 

 work as those who are " the happy possessors of a thyroidin 

 factory in their own bodies." But pathological symptoms make 

 their appearance if the treatment is suspended, even for one day. 



The results of thyroid extract are no less striking in myx- 

 cedema ; sometimes the symptoms disappear almost immediately, 

 sometimes not until after months of treatment. As a general 

 rule, the exhibition of thyroid extract is followed by a reduction 

 of the cuticular swelling and the patients lose their puffy appear- 

 ance. The sweat-glands begin to secrete and the hair grows 

 again upon the proper places. The temperature rises to the 

 normal, sexual activity is renewed, and, in women, menstruation 

 returns. The apathy and lack of interest disappear, and the 

 whole personality changes to such an extent that the patient 

 seems to be a different person. In infantile myxcedema and in 

 cretinism, there is a remarkable promotion of the vertical processes 

 of growth, and this may be seen in cretins even at a comparatively 

 advanced age. Suspension of the treatment is followed, first, by 

 a cessation of improvement, and, later, by a return of the 

 pathological symptoms. 



The systematic treatment of endemic cretinism by thyroid 

 extract is warmly advocated by v. Wagner. His experiments 

 extend over a period of at least five to six years, and the results 

 show that every degree of cretinism is favourably influenced, 

 even at an advanced age, by thyroid treatment. The slighter 

 forms may completely recover and, provided that the treatment 



