THERAPY 



191 



in those obtained elsewhere, while, on the other hand, Eositzki's rescarclies in 

 Styria confirmed Banmann's reports. 



No matter how diverse the manufactured preparations may be, their use 

 evidently checks the previously described symptoms of myxedema, which give 

 place to complete or almost complete health; therefore all must contain the 

 active substance, though perhaps some more than others. The skin becomes 

 soft, smooth and elastic; the edematous infiltration — the myxedema — disap- 

 pears ; the hair which has fallen out is renewed. The general health returns 

 to the norm, vigor and activity take the place of the preceding debility and 

 indolence — ^briefly, so complete a transformation in the condition of the patient 

 takes place that anything more extraordinary can hardly be imagined. The 

 same is also true, mutatis mutandis, in the conditions previously described, 

 viz.: infantile myxedema, cachexia thyreopriva, an abortive form of myx- 

 edema which has been designated " myxoedeme fruste," and to some extent 

 also in cretinism. To enter minutely into this subject would carry us too 

 far, hence we will only remark that the influence of thyreoid preparations 

 upon the length and caliber of the bones in infantile myxedema has been ob- 

 served, and to a certain extent demonstrated, ad oculis, by means of radioscopy. 



We noted the curative effect of this remedy upon myxedema in my patient. 

 As time has gone on the preparations of various English and G-erman firms 

 have been administered, as well as thyreoiodin pastilles, all with good results 

 which, however, lasted only as long as the drug was given. 



After discontinuing the administration of the remedy for some time — in 

 my case for a few months — we must always return to it, as signs of myx- 

 edematous cachexia always recur. These usually consist of chilliness, malaise, 

 and slight swellings in the face ; occasionally, however, severe symptoms of de- 

 pression appear, particularly of a psychic nature. This is not to be wondered 

 at, as our substitutiontherapy does not root up the evil, but only re-supplies 

 some necessary products for metabolism, and for this reason the medication 

 must be persistently carried on. At times the remedy becomes unneccesary, 

 and it may be discontinued for a considerable interval, because a certain 

 reserve accumulates, which, after the cessation of the specific therapy, is only 

 gradually utilized and consumed by the organism. The same is also true, 

 according to our present experiences, in cachexia strumipriva, while in infan- 

 tile myxedema and cretinism this effect does not occur, and from the begin- 

 ning we must carry on the thyreoid therapy almost continuously. 



One of my patients, a highly cultured woman, who has been taking thyreoid 

 extract for five years, wrote me as follows : " I may say that (inconceivable 

 as it may appear) under organotherapy the system becomes decidedly accus- 

 tomed to the taking of thyreoid gland, so that its therapeutic efliect is weak- 

 ened, and the doses must be constantly increased if improvement is to be 

 expected. On the other hand, when we consider the toxic action, the debility 

 and tiring of the heart, the damage to the stomach, etc., it appears that one 

 does not become accustomed to it; the longer the drug is administered the 

 greater the susceptibility." The latter remark points to the secondary effects 

 of thyreoidtherapy, effects which, after prolonged use of the drug, appear to be 

 more or less severe. 



