194 MYXEDEMA 



have stated before that the employment of thyreoid preparations increases 

 metabolism, and causes a decrease in the fat of the organism; this has been 

 experimentally proven. What was more natural than to attempt a cure of 

 obesity by this means? Y. Davies in America, Leichtenstern and Ewald in 

 Germany, were the first to publish favorable results of this kind. They ob- 

 tained in obese persons reductions in weight of 5 kilograms and more in a 

 few weeks without any special restriction of the food, and without producing 

 marked debility, restlessness, fatigue, etc. This condition is due, as already 

 remarked, to an increased combustion of carbohydrates and fat, while albumin 

 decomposition is but little affected. Schrodt has lately published a case in 

 which a loss of 16 kilograms of weight occurred in an obese person, and, as 

 was shown by carefully conducted investigations of metabolism, this was almost 

 wholly due to combustion of fat. The results are even better if the diet is 

 regulated simultaneously, i. e., the fats and carbohydrates limited to a certain 

 extent without, however, insisting on a dietetic cure for the reduction of fat 

 in the strict sense of the word. Cabot has collected 145 cases of this kind, 

 and reports favorable results in all but 6 cases, v. ISToorden, who is not well 

 disposed to thyreoid treatment in obesity, nevertheless observed among 14 

 patients, who, in the course of four or five weeks, had taken upon the average 

 3 to 4 tablets per day, a reduction in weight of 5.4, 6.0, and 7.8 kilograms, 

 and had only one complete failure. In thyreoiodin we should, therefore, pos- 

 sess an almost ideal remedy for obesity if only it were always effective. Ee- 

 ports of failure are, however, not wanting, and in several cases, instead of the 

 desired loss of weight, symptoms of thyreoidism have appeared. This latter 

 condition, with or without a simultaneous reduction of body fat, has been apt 

 to supervene when the laity, without professional advice, have used the thyreoid 

 preparations either too long or in too large doses. In another article, in re- 

 ferring to a case of psoriasis treated by the thyreoid preparations, I have dis- 

 cussed the question asked by Hertoghe, whether success or failure in these cases 

 does not depend upon the condition of the thyreoid gland of the affected indi- 

 vidual ; i. e., the treatment is only successful in cases in which the obesity 

 (or the skin disease) is one of the manifestations of an affection produced by 

 disturbance of the function of this organ, as the gland certainly has a decided 

 influence upon metabolism. 



There can be no doubt, as has been determined from observations in myx- 

 edema, of the effect of thyreoid in trophic processes of the shin. Hence thyreoid 

 preparations are administered in various skin diseases, lichen planus, prurigo, 

 adenoma sebaceum, ichthyosis, xeroderma, lupus, and, above all, in psoriasis; 

 of course here also the success is varying and uncertain. In some quite chronic 

 cases I have seen conspicuous improvement, and it is not too much to say a 

 cure; in others there was no result in spite of treatment for several months. 

 In the last case successfully treated, a spare man, aged fifty-three, whom I 

 showed at the meeting of the Berlin Medical Society on July 18, 1900, the 

 thyreoid gland could not be palpated. This man had a persistent, freely 

 desquamating eruption, appearing in large blotches upon the trunk and ex- 

 tremities, for the cure of which various remedies had been unsuccessfully 

 employed for years. After the administration for three months of thyreoiodin 



