88 INTERNAL SECRETION 



is continued for a sufficient length of time, the improvement will 

 be maintained. In the severer forms, where the cases do not 

 come under treatment until very late, the improvement is confined 

 to certain symptoms. The administration of over-doses of 

 thyroid may, however, be a cause of failure (W. Scholz). The 

 state treatment of cretinism in Styria by means of thyroid extract 

 has been followed in every case since 1907 by satisfactory results 

 (v. Kutschera). In 85.7 per cent, of the cases, the growth was 

 in excess of the normal growth proportionate to the age ; in 

 42.8 per cent, there was a considerable improvement in all the 

 cretinous symptoms ; and in 48.6 per cent, there was a distinct 

 improvement in certain symptoms. 



Thyroid treatment has also been employed in the manage- 

 ment of a large number of pathological conditions which are be- 

 lieved, frequently upon no very clear grounds, to have an 

 etiological connection with insufficiency of the thyroid. Such 

 are : Trophic oedema, scleroderma, several skin affections, 

 osteomalacia, obesity, &c. 



THE METABOLIC CHANGES IN HYPOTHYROSIS 

 AND THE MANNER IN WHICH THEY ARE 

 INFLUENCED BY THE EXHIBITION OF THYROID 

 EXTRACT. 



The metabolic changes in hypothyrosis in man are minutely 

 described by Magnus-Levy. In this condition, the entire energetic 

 output (Kraftwechsel) of the organism is reduced, and patients 

 increase in weight, even with a very small amount of nourish- 

 ment. The diminution of the energetic output (Gesamtumsatz) 

 is not entirely due to physical indolence, but is largely the result 

 of the enormous reduction in the amount of the physiological 

 turnover (Grundumsatz) the physiological expenditure of the 

 resting body. This falls to 50 to 60 per cent, of the normal, 

 a figure unknown in any other chronic condition. The low 

 metabolism of myxcedema is accompanied by a proportionate 

 decrease in assimilation and in the metabolism of albumin. The 

 daily excretion of nitrogen amounts to only 8 or 9 grammes. An 

 increase in the amount of nourishment, and especially in the 

 amount of albumin, may add to the amount of nitrogen. 



This remarkable reduction of metabolism in myxcedema 

 disappears as soon as the condition yields to treatment with 

 thyroid gland. The gas metabolism reaches the normal and may, 

 indeed, exceed it. Under the ordinary treatment, with one to 

 three tabloids a day, this change is completed in three to four 

 weeks. If the treatment is then suspended, the expenditure of 

 oxygen will be again reduced, only to increase again as soon 

 as the treatment is recommenced. In slight cases of myxcedema, 



