Therapy.— Many contradictions may be found in the literature concerning the use of thyroid substance in cretinoid degeneration. Among the best reported results are those of v. Wagner who obtained a diminution in the myxedematous swelling of the skin, rapid de velopment of the genitals, diminution in size of the tongue, disappearance of the umbilical her nia, development of new hair, hastening of den tition, closure of the fontanelles, increase in bony development. The psyche was less hope fully modified, but there was a diminution in the apathy and slight increase in intellectual ca pacity.
Early therapy is naturally the main feature. According to v. Wagner, small doses of iodine in addition seemed to stimulate the thyroid ac tivities still further. Magnus Levy, v. Eysselt and others also report excellent results, complete cure resulting in some patients still in their teens.
A widespread state experiment carried out by v. Kutscheras in Styria treated 1,011 cretins. A large number were neglected by the parents, i.e., treatment was not kept up. In 2.4 per cent the thyroid tablets could not be well borne. All idiots and severe grades of deafness and dumb ness were left alone. Of 440 of the cases 10.2 per cent showed slight increase in bony devel opment, 4 per cent showed definite change, 85 per cent showed an increase well above the average. The increase in bony growth was marked with the younger individuals, but also persisted into the third decade.
A careful revision of 677 cases showed 42.8 per cent marked improvement, 48 per cent some definite improvement, 8.6 per cent no improve ment.
Iodothyrine has also been utilized. One gram contains three milligrammes of active substance representing the iodine content of one gram of fresh sheep's thyroid. It would seem that the iodine content is not the only factor in the ac tivity of the thyroid substance and it is not as yet definitely demonstrated what the combina tion is that is effective. The result of the use of implanting of glandular substance would be the ideal therapy and experiments directed to this end have been attempted since 1889 when Bircher was one of the first to attempt it. The gland has been implanted in different portions of the body— the neck, under the breast, in the spleen, even in the bony substance. As a rule, however, the implantation has not been as suc cessful as was hoped, the gland itself under going retrograde changes. Furthermore it
would appear from the studies by Enderle and Borst that thyroids from other animals possi bly are not the best things to use as the bio chemical composition of the human and animal types varies so widely as to render degeneration of the implanted gland likely. Implantation of human glands has not been successfully brought about as yet, but with the newer work on or ganic transplantation as inaugurated through the researches of Carrel it would seem that this technical difficulty might be overcome in the very near future.
One is compelled, therefore, to resort in most cases to the dried or liquid preparations of the thyroid itself or to such biochemical products as laboratory research has provided through the utilization of the glandular substance itself or that portion of it which presents its chief hor mone activity.
The general results of thyroid medication in typical cases is fairly constant. Especially is it of value in the aberrant and minor forms of the disease of which one of the most chronic of symptoms is the persistent anaemia. This may be in part overcome by the simultaneous use of small doses of arsenic, which have been recommended by a number of experimenters. Alcohol and morphine work disadvantageously and should be carefully avoided. The use of small doses of sodium bicarbonate and bismuth work advantageously in diarrhceal states.
Thyroid medication for the sporadic cases varies somewhat from its use in the endemic cases. In the sporadic cases of the light or mild type the action is quite similar to that seen in the endemic ones, but as a rule, sporadic cases by reason of their longer involvement and the less rapid development of the symptoms, the more hidden or obscure nature of the same, with their great mixture of syndromes, make such cases less responsive to the therapy. Nev ertheless, many of them respond very kindly to it, the same dosage being utilized. Consult Bircher, F.,