OBESITY. — The selective action on adipose tissues shown to attend the in creased metabolism brought about by thyroid, and the decided increase in the nitrogen excretion sustain the use of this agent in obesity. The effects have been irregular, however, some patients re sponding readily to the influence of the remedy, but others not doing so. The views of the French authors in this par ticular perhaps afford an explanation, namely: young, vigorous, and plethoric individuals, who are good livers, receive little or no benefit from thyroid treat ment, but are benefited by a dietetic regimen. On the other hand, fat per sons that are pale, soft, and flabby, and inclined to (edema, receive benefit from the ingestion of the thyroid gland. They lose weight rapidly, oxidation is in creased, and nutrition is improved. We are again brought face to face with con ditions showing some of the elements of myxcedema.
Besides the dangers attending the use of thyroid in any case, the only source of untoward effects is the giving of large (loses at first, the organs, especially the heart, being thus exposed to the effects of undue reaction. In appropriate cases the remedy is taken without trouble. and the effects soon show themselves. After a time the reduction in weight is propor tionately smaller, and discontinuance of the treatment is followed by recurrence, in the great majority of cases, until the former weight is reached. To maintain the advantage gained, however, dieting and small doses of thyroid at longer in tervals may be utilized with advantage.
Case of obesity treated by thyroid juice, minims daily, either by sub cutaneous injection or by the mouth. In three months weight fell from 292 to 253 pounds. As soon as the treatment was discontinued the loss of flesh also ceased, and when the thyroid extract was re sumed a daily loss of to ounces was observed, this becoming less after a time. A second ease treated showed sim ilar, but less marked, results, while in a third no effect could be noted. The in constancy of results perhaps depended upon the different forms of obesity, upon the insufficiency of the treatment, or upon the extract used, which may not have been genuine. Charrin (La Sem. Mad., Jan. 2, '95).
The thyroid gland of the sheep a spe cific in obesity; free from danger and injurious after-effects, and the beneficial results of which appear within a few months from beginning of treatment. The sole risk is in beginning with large doses, as palpitations and fainting fits are possible until the patient is well ac customed to the drug. Frederick Gutt mann (Amer. Medico-Surg. Bull., May 15, '95).
Case of a man who took a large quan tity of tablets in the hope of reducing his obesity and became maniacal within a few days; oedema of the brain was found at the necropsy. Stabel (Lancet, Mar. 28, '96).
In excessive obesity with tendency to weakness and anremia, in which exercise and diet fail, thyroid extract should be tried. H. C. Wood (Univ. Med. Mag.,
Apr., '96).
Of considerable value to reduce weight in obesity, especially in the anemic, flabby types, and provided the relapse is prevented by diet and exercise. Cabot (Medical News, Sept. 12, '96).
Tabloids of the whole gland-substance disagree in some instances, owing, no doubt, to the fatty matter they contain. Colloid tablets not prepared according to the method advocated by Dr. Hutch inson decidedly disappointing. Of the three sorts of tabloids used, those pre pared according to Dr. Hutchinson's process the most efficacious. P. Jervis (Brit. Med. Jour., Oct. 2. '97).
Unpleasant and even serious symptoms observed after the administration of thy roid extracts; attributed to the presence of toxic decomposition products. By the employment of iodothyrin — an active principle of the gland—these unfavorable symptoms can be practically obviated. Used in seventeen cases of simple obesity, it brought about a reduction of weight without the aid of other treatment. In five cases there was diminution in weight after fifteen days' treatment. Lutaud (Coll. and Clin. Dee., Dee., '97).
Three cases of obesity in which was used a new preparation of thyroid gland known as thyroglandin. One grain was given three times daily for a few days. Dose was then rapidly increased until 0 grains were taken in the course of the day. Decrease in weight was rapid and persistent in all cases and was unaccom panied by the unpleasant symptoms so commonly experienced with other prepa rations used for this purpose. MacLen nan (Brit. Med. Jour., July 9, '98).
The most serious disadvantage lies in the lack of permanency of its action. The most marked results are to be ob served in the first weeks of the treat ment, while after a few months the system may become so accustomed to the remedy that the patient not only ceases to lose his superfluous avoir dupois, but may actually regain much of the flesh lost. After cessation of the treatment there is quite com monly a strong tendency of the body to return to its previous condition. If we wish our treatment of obesity, either by the thyroid or diet, to be permanent, we must insist on a continuance of abstemi ous habits: a point on which the origi nator of the thyroid method. Yorke Davies, lays especial stress. H. B. Wood, Jr. (Merck's Archives, July, '99).
Four cases of juvenile obesity treated with the thyroid extract. One a boy, aged 8 years, weighed before treatment 131 pounds. With purgation, diet, and exercise he was ordered grains of thyroid extract three times a day, with a gradual increase until a 5-grain tablet was taken four times a day. After fourteen months' treatment he weighs 106 pounds and he has developed muscle to a considerable degree. I. N. Love (Jour. Amer. Med. Assoc., Apr. 21, 1900).