THERAPY 195 



tablets with arsenic— he received during this time 450 tablets which contained 

 0.25 gram of lodothyrm and 0.16 gram of arsenious acid— the eruption 

 almost disappeared, being replaced by small, isolated areas of about the size 

 of a silver three-cent piece, and by natural, smooth, pink skin. Of 154 cases 

 collected by Cabot, 63 were improved, 53 unimproved, and 22 aggravated. 

 This is greatly in favor of my view previously expressed regarding the connec- 

 tion between these diseases of the skin and disturljances in function of the thy- 

 reoid gland; for Wells, in a case of scleroderma in a woman aged fifty-one 

 who had suffered for about one year from the affection, found the thyreoid 

 gland, post mortem, to be greatly atrophied, so that in the fresh condition it 

 weighed only 14 grams and when dried only 3.23 grams. The total amount 

 of iodin was only 2.94 milligrams, i. e., only about one-fourth of the normal. 

 Microscopically the connective tissue was greatly increased, the intima of the 

 glandular vessels was proliferated, the lumen of the acini, for the most part 

 without colloid, changed into small cysts which were filled with colloid mate- 

 rial. The hypophysis was hypertrophied, it weighed 0.7 gram, its acini were 

 distended by colloid masses with uncommonly numerous eosinophile cells in 

 the interacinous tissue. Wells remarks quite properly that if these changes 

 could be determined constantly in scleroderma the fact would greatly favor a 

 thyreogenous origin of this disease. 



Actuated by the same reasons as in the therapy of obesity and psoriasis, 

 etc., physicians have used thyreoid preparations in mental disease, in tetanus, 

 chorea and progressive myopathy. Favorable results in isolated cases have 

 even been reported, particularly by Bruce from the Eoyal Edinburgh Asylum, 

 , by Mabon and Babeock from the St. Lawrence Hospital, and by Eeinhold, 

 Levy-Dorn, Gottstein, and Bramwell in tetanus, etc. ; but invariable and con- 

 vincing results have been obtained more rarely in these affections than in the 

 diseases previously mentioned. Gauthier, Quenu, Eeclus, Ferria and others 

 have employed thyreoid treatment also in fractures with delayed union of 

 bones, on accormt of the fact that the thyreoid gland has a predominant influ- 

 ence upon the growth of bone; the results were apparently most gratifying, 

 and the same reason led to the employment of this remedial agent in rachitis. 

 But here the watchword for the present must be : temporize ! Confirma- 

 tions are wanting ; and from this it may be concluded that the treatment has 

 been tried by others, but without success. 



We cannot close this discussion without referring briefly to an organ 

 apparently in close connection with the functions of the thyreoid gland, and 

 by embryologic and anatomic analogies also histogenetically parallel with it. 

 This is the hypophysis, the pituitary body, the anterior glandular part of 

 which is developed, like the th3Teoid, from the ectoderm, a diverticulum of 

 the posterior pharyngeal wall, the structure of which also consists of acini 

 which unite and form follicles containing more or less of a colloid substance. 



Unquestionably this gland has some relation to osseous growth, for it is 

 almost invariably enlarged in acromegalia and giant growth. In isolated cases 

 it has been known to attain the size of a hen's egg, and the sella turcica is 

 abnormally developed. Nevertheless, this does not yet prove, as most authors 

 too hastily assume, that the hypertrophy of the gland is the caiise of these 



