1922 DISEASES OF THE DUCTLESS GLANDS 



valent vaccine made from the bacilli found in the faeces of persons 

 suffering from the disease. Iodine therapy is strongly recommended. 

 The syrup of the iodide of iron in 5-minim doses combined with 

 5 grains of iodide of potash is advised as an initial dose, and this 

 may be gradually increased to three or four times this quantity. 

 The liquor thyroidei of the British Pharmacopoeia is excellent, 

 or fresh tabloids in doses of 2-5 grains combined with 10 grains of 

 bicarbonate of soda and taken at night. The sour-milk treatment 

 has also been recommended. 



Prophylaxis. — The most important prophylactic measure is to 

 filter and boil the drinking-water when compelled to visit or live 

 in an endemic region. The patient must also lead a life free from 

 emotion, if possible. 



Congenital Goitre. 



McCarrison has pointed out that this is extremely common in 

 certain Himalayan villages. Nearly every man and woman in these 

 situations is goitrous, and congenital goitre may be present in 

 60 per cent, of the infants at the breast. The mothers of these 

 children are often myxoedematous. The condition rarely calls for 

 treatment, as the victims usually die at or shortly after birth or 

 r ecover spontaneously, but the mother and child may be given the 

 British Pharmacopoeia liquor thyroidei, of which i to 2 minims 

 may be given to the child at night. 



Endemic Cretinism. 



According to McCarrison, the cretinism of the Himalayas, which 

 does not show itself until about six months after birth, may be 

 divided into: — 



1. The myxoedematous type. 



2. The nervous type. 



Myxoedematous Type. — There is failure in growth, dwarfism, 

 skeletal deformities, persistent infantile condition of the sexual 

 organs, and a lack of intellect, and deafness or deaf-mutism, as well 

 as impai ment of the sensory and muscular systems. 



Nervous Type. — This is a state of cretinous idiocy associated with 

 cerebral diplegia and tetany. 



The treatment of these conditions is the fresh liquor thyroidei 

 (B.P.) in doses of 1-2 minims at bedtime, combined with grey 

 powder and bicarbonate of soda during the first fortnight. The 

 dose of the liquor is gradually increased until 5-10 minims are given 

 in a day. If the liquor is not available, the dried gland in powder 

 may be given in l-k grain doses, working up to 5-7 grains per diem. 



Endemic Tetany. 



This is found in goitrous districts in the Himalayas, where it is 

 called ' hatti fallategen,' or turning of the hands. It is characterized 

 by bilateral, intermittent, and usually painful spasms of the hands 



