Case of advanced cretinism in Hindoo boy treated by thyroid extract. Thyroid treatment was begun by administration as the thyroid extract. After a fort night signs of the reflex returned; pa tient became much stronger on his legs. II. E. Drake-Brockman (Lancet, Oct. 2, '97).
Case of a child who presented a typ ically cretinoid appearance when first seen in February, 1896, then 5 years old. Mentally deficient. Given one 5-grain tabloid of thyroid extract (Burroughs, Wellcome & Co.) daily, which raised the temperature to 102° F.: close reduced to of 3 grains of the dry extract by the mouth daily. Thyroid enlargement di minished fully two inches in the space of one month; the lad, both physically and mentally, had shown marked im provement. Dose increased to 5 grains daily. Marked and steady improvement continued, but marked absence of patel lar reflex: a prominent symptom in tabes dorsalis, in which Brown-Sequard has used orchitic fluid. Administered to patient 5 grains of didymin daily, as well one-half. Gradual improvement. Weight. fell at first to twenty pounds, and then slowly increased, the cretinoid aspect dis appeared, and the intelligence steadily improved. Continued to take smaller quantities of the extract, and has de veloped into a healthy child, weighing thirty-seven pounds, and measuring thirty-seven and one-half inches in height. No thyroid gland could be de tected on palpation. W. Carr (Brit. Med.. Jour., Nov. 13, '97).
Case of a girl, aged 10 years, who first came under observation in June, 1897, and had not previously been treated with thyroid gland. She was then 9 '/, years old, weighed thirty pounds, and was two feet and ten inches in height; legs short, with lordosis and prominence of the ab domen. She was in the second standard at school. During four months of thy roid treatment grew two and one-half inches, fatty masses disappearing from her neck. Expression lively and intelli gent. W. S. Coleman (Brit. Med. Jour., Nov. 13, '97).
Case with numerous abscesses which healed as soon as the child was put under the thyroid treatment.. Themoglobin in creased from 25 to 75 per cent., child not having done well on the daily doses of from to grain of the thyroid ex tract, this attributable not only to the small doses of the thyroid, but to the use of a had preparation.
Case, in which cold hands showed weak circulation, greatly improved when the preparation was changed. It seemed that the dose must be increased as the child grew older. These children should be kept upon the largest doses of thy roid they will stand without having an elevation of temperature. H. Koplik
(Pediatrics, Nov. 15, '97).
Case of cretinism, after two years of treatment, very remarkably improved. During the first year of treatment an attempt was made to keep the child on as large a dose of the thyroid extract as possible. It was found after trial that the child did best on 1 grain a day. After nine months grains (Parke, Davis & Co.), twice a day. During the first year of treatment she grew eight and one-fourth inches and gained four teen pounds: i.e., nearly doubled her weight. After she had been under treat ment a year the thyroid was stopped, and during that time the peculiar ap pearance of the cretin returned and she became much more stupid. She was then put back on 1 '/, grains a day, and this was kept up until the first of this year. Since then she has had 1 V, grains twice a week, on alternate weeks. J. P. West (Pediatrics, Nov. 15, '97).
In sporadic cretinism the fresh thyroid gland, the desiccated gland, and even the colloid substances have been found al most equally efficacious. The preparationn used should be free from decomposition products. half a grain of the desiccated' gland may be at first given two or three times a day, the dose increased in a week or two to 1 grain, and later this may be increased if improvement is not satis factory. If unpleasant effects result, the dose should be lessened or a fresh prepa ration tried. A. McPlied•an (Canadian Jour. of Med. and Surg., vol. iv, p. 275, '98).
Mental Development Following Treat ment with Thyroid. — The alteration in the mental condition is noticed within a couple of months. The patients look much brighter and the face is not ab solutely expressionless. As a rule, the younger the case, the more marked is the mental change. Young cretins who have not learned to speak a word soon begin to talk in their play. In children between six and ten the effects are even more remarkable, and with the loss of the myxoedematons condition there is a corresponding awakening of the mental faculties. In older patients the treat ment is not so efficacious. (Osler.) A grain of the desiccated gland three times a day in young cretins is the dose preferred by Osler, but, as already stated, its effects should be carefully watched and the amount reduced if the pulse becomes more rapid or if there is fever. Older patients may take as much as 5 grains in the day, and the amount may be diminished as the symptoms indicate_ Young patients bear the remedy very well, and in a few months, if no im provement is noted, larger doses must be tried, without, however, relinquishing watchful care.