192 MYXEDEMA 



This secondary condition has been designated tJiyreoidism; the disturb- 

 ances may be separated into the nutritive and the nervous. The urine ia- 

 creases in amount, and its N-containing constituents, as vi^ell as the chlorids 

 and phosphates, are increased. The body-weight decreases and, as was first 

 shown by Wendelstadt, not over J of the loss in weight is of the body albumin; 

 the remainder is a decrease of fat and water, so that the increased combustion 

 of fat may be referred to increased oxidation (Magnus-Levy). In this process 

 oxidation, during and for some time 'after the use of thyreoid, may rise 10 to 

 30 per cent, above the former values; there is therefore an increased metab- 

 olism. As a nervous symptom we note primarily a decided increase in pulse 

 frequency and cardiac palpitation, which may be looked upon as a definite 

 indication that the dose is too large. After this headache, nausea, vomiting, 

 and general debility may occur. Sometimes these symptoms increase to an 

 alarming extent, and formerly, when this condition was not sufficiently under- 

 stood, even fatal cases were observed. Therefore, when these symptoms 

 appear (which may be soon or late, according to individual susceptibility) 

 thyreoid preparations must be immediately stopped, and the treatment be 

 interrupted. These toxic symptoms will then shortly disappear without causing 

 permanent injury. This teaches the lesson that these preparations should 

 not be used except on the advice and under the supervision of a physician, 

 and their sale by an apothecary except upon prescription should be prohib- 

 ited. How far thyreoidism is a phenomenon of specific intoxication, and 

 how far toxic products of decomposition generated during the manufacture of 

 the preparations are concerned in it, is doubtful. Fortunately, we have lately 

 become able to combat these symptoms of thyreoidism, or better, to prevent 

 their appearance ; as Mabille has proposed, we administer simultaneously with 

 the thyreoid preparations small doses of arsenic, either as Fowler's solution or 

 as arsenious acid. As a matter of fact, in my case I administered no less 

 than 962 tablets without any deleterious effects, and during three months I gave 

 3 drops of Fowler's solution, i. e., upon the whole a minimal amount of 0.16 

 gram of arsenious acid. 



We may consider it as definitely settled that we are able by means of sub- 

 stitutiontherapy and only in this way to influence the entire constitution to 

 such a surprising extent, in the pathologic conditions which depend upon 

 atrophic or degenerative changes in the thyreoid gland. We should mention 

 here also the value of thyreoid extract in the abortive forms of myxedema 

 which Hertoghe has described under the designation " myxoedeme fruste." 



The use of thyreoid preparations should also be considered in local dis- 

 ease of the thyreoid gland, namely, in the treatment of goiter. Although suc- 

 cess in treatment is here limited to the so-called parenchymatous goiters of 

 youth, i. e., to that form of goiter which is not so much the result of degenera- 

 tive change as of a hypertrophic condition of the glandular tissue, their use is 

 here of great value, v. Bruns was the first to employ thyreoid gland prepara- 

 tions in simple goiter with the idea of diminishing the labor of the hyperactive 

 gland. For it is self-evident that in such cases there is an increased demand 

 m the organism for the product of the secretion of the gland, either because, 

 from some unknown disturbance of metabolism, more thyreoiodin was required 



