Even where the goitre is of consider able duration, removal to a non-goitrous region may be followed by rapid dimi nution of the tumor, save where cysts are present; in young people and chil dren such removal may, with fair cer tainty, be depended upon to cure the state. Failing this, the medical treat ment about to be described leads to marked improvement in the majority of cases. While, again, failing this, resort may be had to surgical means, and very little danger need be anticipated of any untoward result.
of the condi tion may be divided into medical and surgical.
MEDICAL.—The use of iodine and the various preparations of the same is quite the most valuable. According to Koenig, this drug is more especially of use in the hypertrophic and follicular forms, not so much in the colloid; especially in re cently-developed goitre is it useful. It may be employed either externally over the goitre or in the form of potassium iodide given in large doses by the mouth. In this use there is some danger that the symptoms of iodism may supervene, but, as Koenig points out, we may not truly be dealing with iodism, but with symp toms of cardiac stimulation and rapid emaciation due to the rapid reabsorption of the colloid material into the blood.
Dangers of potassium iodide referred to in treatment of goitre. Goitrous sub jects are particularly susceptible to iodism. M. Ferrand (Le Progres Med., Nov. 23, '95).
Where cysts are present, iodine is use less and surgical means must be em ployed.
Mosetig-Moorhof has used injections of iodoform with slight constitutional re action and excellent results, more espe cially in the soft varieties of goitre. Kapper, Frey, and Rosenberg all con firm the value of this method.
Soft varieties of goitre treated by author for the past ten years by injec tions of iodoform, with slight constitu tional reaction and excellent results. The following solution was used under the strictest antiseptic precautions:— Iodoform, 1 part. Ether, 5 parts.
01. olivw, 9 parts.
Or 13 Iodoform, I part.
Ether, 01. olivfe, of each, 7 parts.
Beginning injection is I5 V, minims; the author has injected as much as 62 minims at one time, injected in two places. Intervals should be five to eight days. Five to ten injections, according to the size, etc., of the tumor, are neces sary for a cure. Mosetig-Moorhof (Inter. Jour. of Slug., :Mar., '90).
In 65 cases treated by the Mosetig Moorhof method not the slightest bad symptom obtained. Good results noted in cystic and even fibrous goitres. Frey (Wiener med. Presse, Oct. 12, '90).
Fifteen cases of parenchymatous goitre treated with injections of iodoform after the Mosetig-Moorhof method with the most gratifying results. In one hundred and fifty injections there was not the slightest unpleasant symptom. F. Kop
per (Deutsche reed. Koch., July 9, '91).
The following solution, which should be kept in a glass-stoppered bottle, recommended:— 13 Iodoform, 15 grains.
Ether, 105 grains.
Sterilized olive-oil, 105 grains.
The skin of the neck is carefully disin fected, a needle plunged into the goitre, and the injection made.
Half a syringeful may be injected at first, increasing gradually to an entire syringeful. At first the injections should be practiced every fourth day; later, every second or third day.
The injections produce usually a slight sensation of burning, which ordinarily disappears in a few minutes, but some times persists for several hours.
Complete cure experienced in nearly 45 per cent. of cases, and decided improve ment in about 50 per cent. Usually, at least twenty-five injections are required. Rosenberg (Lyon Hied., Jan. 9, '93).
Another treatment which has of late years been tested with promising results in a certain proportion of cases is the administration of preparations of the thyroid gland. Issai, Vas, and Garg found that in three cases the use of thy roid tablets led to diminution in the size. Serapin confirms this observation. Stabel in twenty-six cases of goitre found that thyroid medication was beneficial. The best effects were obtained by the use of the fresh gland. Bad effects were noted in several instances from the use of the tablets, though Ewald came to con trary results, obtaining better results with the tablets than with the fresh gland. The parenchymatous form of goitre in young chlorotic girls was most benefited. Mendel obtained no improve ment by use of tablets, and had to aban don treatment on account of the palpita tion and emaciation which it caused. Perhaps the largest series of cases is that quoted by Angerer of 7S cases treated with raw gland. Only 4 or 5 remained uninfluenced. The hard fibrous growths remained totally unaffected, and, like other observers, he found that it is the small, soft, parenchymatous goitres, more especially in young people, that are most favorably influenced.
On the whole, therefore, the employ ment of fresh sheep's gland would seem to give the best results, and more espe cially in young persons and those suffer ing from the softer parenchymatous forms of the disease, whether diffuse or nodular. What the exact method is in which the thyroid taken leads to favor able results is a matter of doubt. To state that it causes physiological rest to the gland is, perhaps, begging the ques tion. It is further to be noted that only in early cases does it appear to result in complete cure, and where cysts are pres ent these are in no wise reduced in size, although, through the shrinking of the surrounding tissue, they may become more easily enucleated. (See ANIMAL