Cachexia reaches its highest degree in severe eases, leading to extreme emaciation and exhaustion.
Pigment changes in the skin are also observed, though not very often in adults. They consist in vitiligo and pigmentation, brownish discoloration, also occasionally urticaria, and in very rare cases transient cedema of the lids and the dorsal surfaces of hands and feet.
Increased respiration explains Vigouroux's symptom, consisting in the decrease of the skin resistance to the galvanic current.
The tlisease lasts from a few- weeks to several years in children. Thus, the cases of Solbig, Demme and Mueller, after having readied their respective climax in two, five and fourteen days, lasted from ten days to six weeks. As a rule, its duration is from six months to three years, with alternating exacerbations and improvements, leading to a cure in 90 per cent. of the eases; slight hypertrophy of the thyroid, palpitation and tachycardia will, however, persist. Total atrophy of the thyroid with the picture of complete athyreosis has been observed three times in childhood.
The prognosis is rather favorable in childhood, the mortality being probably not higher than ten per cent.
of the patient to a mild climate, physical and mental rest, strengthening diet, and systematic application of a weak galvanic current of 2 to 3 M.A., con.stitutes the most hopeful treatment. The anode is placed on the sternum or the base of the neck, the cathode on the front part of the neck or against the goitre, the cur rent being applied for five to ten minutes twice or three times a clay. Plentiful, but easily digestible food containing plenty of carbohydrates ancl vegetables. All physical and mental efforts should be avoided, but slowly increasing physical movements practised in order to fortify the organism. Tepid baths and mild hydropathic measures are also recom mended. Erlenmayer's bromine water, Sandow's effervescent bromine salt, Fowler's solution, and sabromin are often efficacious. The serum of thyrcodectomized sheep, as proposed by Moebius recently, has also done good service in juvenile cases.
Internal treatment is, in my opinion, preferable to surgical ligation of the thyroid artery, partial removal of the goitre, or resection of the sympat hie us.