Thyroid extract constitutes a means of rapidly reducing weight without caus ing any special disturbance in the, pa tient's general condition or any limita tion of his activities. The extract should be given in doses of 3 grains two or three times a clay after meals, and gradually increased to 7 L/,.. grains. This treatment is continued for months, with occasional intermissions. The benefit proves most lasting in cases in which decrease in weight is slow. 31. Affanas sieff (Klinisch-therap. \Vochen., Feb. 6, '9S).
Patient ordered thyroid extract for obesity. Within five weeks he took nearly 1000 tablets, each containing 5 grains. For the first three weeks noth ing was noticed, except loss of flesh, but after this time dyspncea came on, with swelling of the neck and very rapid loss of weight. Altogether, thirty pounds were lost, and five-sixths of this loss took place in the last three weeks. When examined, the patient had marked exophthalmos, with both Stellwag's and von Graefe's signs; the thyroid gland was enlarged and pulsated, and there was a thrill over it; there was a fine tremor of the fingers and tongue; the cardiac apex-beat was displaced out ward, and the pulse was 120 to the minute; there was cough and severe mental depression; polyuria and gly cosuria also were present. Under the use of Fowler's solution and after the withdrawal of the thyroid extract most of the symptoms rapidly disappeared, only the ocular manifestations and the goitre persisting for nearly six months. A. F. von Notlhaft (Centralb. f. innere Med., Apr. 16, '93).
[The administration of thyroid ex tract should be attended by especial care, particularly at first. The chief editor has witnessed cases in which 2 grains three times a day caused vertigo and fainting-spells.] Thyroidin, the active principle of the thyroid gland, gives results that are, per haps, as good as thyroid feeding (Bau mann and Ross).
Patient successfully treated with thy roidin for a fatty heart. When gland of the of was tried, patient began to make flesh rapidly. This sustains the opinion that the thymus and thyroid glands of the sheep are the most active. Schlesinger (Med. Press and Circular, Mar. 25, '96).
[Jerzykowski treated ten cases of corpulence by thyroidin in doses of from 5 to S grains per diem. In one case more than forty pounds were lost in two months, and in another thirty pounds in three months. J. M. ANDERS.]
The symptoms of thyroidism (tachy cardia, vomiting, renal pain, suffusion of the face, syncope, vertigo, and marked headache) are a signal for a discontinu ance of the remedy. The treatment may be resumed again, cautiously, alternating with intervals of cessation. (See ANI MAL EXTRACTS, volume i.) Fatty Degeneration of the Heart.
Symptoms.—The condition may exist iu an advanced form without the pro duction of symptoms (latent fat-heart). The presence of any causal conditions, however, should be noted, and they afford premises for suspicions, although even when symptoms during life point strongly to the existence of fatty heart it may not be revealed by an autopsy. The characteristic evidence of defective heart-power are generally present, but in pernicious anemia, chlorosis, and in certain wasting affections, the fatty change may be marked and the pulse continuing full and regular while the pa tient is at rest. In such cases, slight provocation or strong excitement lead to palpitation, leaving signs of commencing dilatation (an apical systolic murmur, with feeble, diffuse impulse). The con dition is quite commonly associated with hypertrophy and chronic nephritis; it then gives rise to the phenomena that characterize failing compensation. The process is constantly associated with sclerosis of the coronaries, a clinical type which embraces most of the cases of so called idiopathic fatty heart of the Eng lish writers. I have frequently observed that these cases manifest the same group ing of symptoms as met with in prema ture senility.
Dilatation is apt to supervene early in fatty degeneration of the heart, owing to the weakened state of the cardiac walls; hence it is quite probable that many of the symptoms that have been ascribed to the morbid processes are, in reality, due to secondary dilatation. It is to be re membered that the symptoms pointing clearly to defective heart-power may be in evidence only after great exertion. Among the symptoms pointing to over distension, either constant or tempo rary, of the cardiac chambers, are palpi tation, dyspncea, and a small, irregular, somewhat quickened pulse, and cool and clammy extremities. Great physical ex ertion may produce sudden, marked dila tation, whereupon a canter-rhythm and an apical systolic murmur speedily de velop, although in most instances the symptoms are brought to light in a more gradual manner.