MYXCEDEMA. — With very few excep tions, cases of myxcedema are always attended by well-marked atrophy of the thyroid gland. That the disease is a result of the absence from the blood of the secretion of the thyroid is a logical conclusion which the use of the gland as a remedy has amply verified. Again, the fact that absence of the gland is the primary factor in the etiology of the disease also makes it plain that unless the secretion which it furnishes the sys tem is replaced continuously the disease will recur after recovery: another fact verified by practical experience, which has shown that small doses of the gland must be administered for years if the recurrence of the myxcedemie symptoms is to be prevented.
As originally recommended by Mur ray, the treatment should be divided into two stages: (1) removing the symptoms of the disease; (2) maintaining the con dition of health attained. The first stage must be carried on gradually, and with care, as the alteration in the patient's condition is so great that, in many cases, it is not safe to bring it about rapidly. This caution applies especially to cases which show signs of cardiac or vascular degeneration. Several such patients have died of syncope brought on by overexer tion, after the symptoms of myxcedema had been much improved. Ten to 15 minims of the extract, twice or thrice a week, may be slowly injected. If flush ing of the face or pain in the lumbar region occur, the injection should be stopped. When taken by the mouth from the beginning, daily doses of 5 to 15 minims two or three hours after breakfast have been found best. The changes which take place in the tem perature, pulse, weight, appearance, and sensations of the patient are all impor tant in governing the dose. In the sec ond stage, the smallest dose which keeps the temperature up to the normal, or above 97° F., is sufficient. The remedy is given preferably by the month in this stage.
When cardiac disorders are present, the dose should be small and the patient kept in the recumbent position, as ad vised by Bramwell.
Two deaths, under treatment, of pa tients with weak heart. F. Vermehren
(Centralb. f. Derv. Psy., etc., July, '93).
The dose should be much smaller when cardiac disorders are present than the usual one. Complete rest in the recum bent position should be enforced from the commencement of the treatment. B. Bramwell (Practitioner, July, '93).
Effect of thyroid extract in myxce dema complicated by angina pectoris beneficial. No discomfort until the twelfth day, when extract discontinued. H. C. L. Morris (Lancet, Sept. 2S, '95).
Statistics of one hundred and sixteen cases, with absolute failure to secure im provement in only three, show the value of the thyroid treatment. Reports vary in regard to the degree of improvement from "cure" to "slight improvement." The latter cases, however, were few in number. (Eskridge.) Case of myxm_dema placed on a diet regulated so that its different elements should be as far as possible, the same each day. At the end of a week treat ment with thyroid extract was begun. the diet remaining the same. During treatment the urine was increased in volume; the nitrogen excreted in the urine exceeded the total quantity of nitrogen in the food, and appeared in the urine chiefly in the form of urea. Phosphoric acid and chlorine elimination was practically unaffected. The body weight was diminished rapidly and the temperature raised. Mental improve ment in myxcedematous patients under the thyroid treatment has generally been as marked as the physical. W. M. Ord and E. White (Brit. Med. Jour., July 29, Eleven cases of myxcedema treated by thyroid grafting. Improvement in six and failure in five cases. Kinnicutt (Med. Record, Oct. 7, '93).
Case of a boy, about 5 years of age, who, in the early part of the treatment, took one-fourth of the thyroid gland of a sheep each twenty-four hours. Later on the gland was given him in a desic cated form. In fourteen months the boy grew four inches: an unusual increase. At the time of the report he walked and ran about, and had gained so much men tally that few would think him abnor mal in this particular. Osler (Med. Record, July 21, '94).