THE THYROID AND PARATHYROID. 343 



although at the present time the iodothyrin seems to be regarded 

 as the most active ingredient. 



Thyroid extract has also been recommended as a means of 

 treating obesity, on the ground that it increases metabolism ; 

 there is undoubtedly a diminution of fat in its use. 



The thyroid gland has been used in the treatment of goiter, 

 myxedema, etc., in various ways. Thus Schiff and Esselsberg, in 

 1884, made grafts both in the abdominal cavity and in the cellular 

 tissue. Birch, on the advice of Horsley, transplanted the thyroid 

 of a sheep into the peritoneal cavity of a woman suffering with 

 myxedema. For a time she was benefited, but the gland was 

 absorbed and the symptoms returned. In 1890 Pisenti extracted 

 the juice from the thyroid and injected it into the tissues ; Gley 

 was the first to use this method on the human subject and cured 

 his patient. Horwitz, in 1892, demonstrated that the gland itself 

 could be given by the mouth with equally good results as when 

 its extract was injected, and later the extract was given by the 

 mouth. At the present time tablets containing the fresh gland 

 of the sheep are used for goiter, myxedema, obesity, etc. 



H. O. Nicholson reports the case of a child cretin in which 

 the effects of thyroid treatment upon the bodily and mental con- 

 dition were remarkably rapid and complete. At the age of two . 

 years and eight months the child Avas in the condition of well- 

 marked cretinism. The initial dose of thyroid powder was 2^ 

 grains, once daily ; but after three days, on account of diarrhea, 

 this was reduced to 1^ grains for several weeks, when the original 

 dose was given. After four months of treatment a photograph, 

 with which the article is illustrated, showed "a bright, happy, 

 pretty child, to all appearances normal, both physically and 

 mentally" (Figs. 184, 185). A few months later death occurred 

 during a malignant attack of measles, but an autopsy could not be 

 obtained. In the etiology the author lays stress on the fact that 

 the child seemed normal for the first four months of life, at the 

 end of which it contracted whooping-cough lasting four months, 

 and then it was seen to be abnormal. He attributes the origin of 

 cretinism to the attack of pertussis. 



We are indebted to M. A. Flourens, of Bordeaux, for a very 

 interesting resume of thyroid medication, and the following case 

 is taken from his pamphlet : 



This was a girl of twelve years, suffering from myxedema, in 

 whom there was a question as to the presence of a thyroid. She 

 came under treatment in February, 1893. The disease began 

 when she was nine years old. 



The child began to be inattentive, flighty, and especially in- 

 different. Her memory became weakened and study fatiguing. 

 She developed a state of torpor and did not care to play with her 

 brother and sister. Her movements were slow and lazy, a laziness 

 more moral than physical, especially of the will, for if compelled 



