In India an ointment of mercury is used. It is made by melting 1 pound of lard or mutton suet, which, when melted, is cleaned, strained, and then allowed to cool. When it is. nearly cold, 1F0 grains of the biniodide of mercury, ground into a very tine powder, are mixed with it in a mortar till the red powder is uniformly distributed through the lard and no grains are visible. The ointment is kept in pots, protected from the light. It is used in the following away At sunrise the ointment is applied to the swelling by means of an ivory spatula, and is well rubbed in for at least ten minutes. "The patient then sits with the goitre held up to the sun as long as lie can endure it. In six or eight hours there will probably be some pain from the blistering action of the application." The application is repeated at about two in the afternoon, the ointment being lightly rubbed in this time, and is allowed to remain for several days. In ordinary cases one treatment of this kind is sufficient, but if neces sary it may be repeated in six or twelve months. When a strong sun is not obtainable a very hot fire may act as its substitute, the patient sitting before it. The same ointment may be employed by rubbing it in, morning and even ing, for several days.
It is not considered. justifiable to have the tumour removed by an operation, and that for various reasons, among them because of the extensive blood supply to the gland, and the way in which this is increased in enlargement of the gland. Cysts, abscesses, &c., that may form in the gland are opened, often with great relief to the patient.
Exophthalmie Goitre (Graves' Disease, Base cloals Disease) is a disease in which enlargement of the thyroid gland, great prominence of the eyeballs (e.z•ophthalmos, from Greek ex, out, and ophthalmos, the eye), palpitation of the heart, and a fine general tremor over the body are the special features. The disturbance of the heart and the protrusion of the eyeballs may, however, exist without the thyroid enlarge ment, though the symptoms are due to exces sive activity of the gland—hyperthyroidism. It occurs usually in young women after pu berty, and commonly in pale, nervous subjects. Indeed, sonic believe the disease is at first due to some bad condition of the sympathetic ner vous system (see p. 152). The symptoms some times develop suddenly after a fright or pro found emotional disturbance.
The symptoms are chiefly those already mentioned connected with the heart, the eyes, and the thyroid gland. Other symptoms are common—disturbances of the digestive system, irritability of temper, feverishness, sleepless ness, and irregularity of the monthly periods. The person's eyes are easily fatigued, and motes are seen passing before the sight.
The disease is essentially a chronic one, last ing for many years. • The treatment need only be indicated, for it should be under careful medical direction. It is certain that, if at the very outset systematic treatment is undertaken, a much greater hope of recovery exists than if the patient struggles ' on for a long time, trying merely the effect of drugs.
If the patient were taken to a nursing insti tution at the outset, put to bed, shut off from everything and everyone, having no letters, writing none, seeing no visitors, being nursed carefully, and being permitted such reading and occupation as will interest without exciting, there is a much better chance of rapid improve ment than is likely to occur at her own home. She should, of course, be under medical care, and in such an institution there is the oppor tunity of trying the various drugs that have been advocated in this disease, and of pushing them as far as possible. Such drugs are arsenic and iron, belladonna, phosphate of soda ; ex tract of thymus gland has also been used with benefit. Electrical treatment has been found very useful, the constant current applied to the neck ; and the author has seen excellent results from the Nauheim treatment. In many cases by an operation on the enlarged gland a cure can be effected, and X-ray treatment is equally effective in suitable eases.
Myxoedema is a disease associated with degeneration of the thyroid gland. It is much more frequent in women than in men, and more usual in elderly women, at least the commonest age is about forty years. Cretinism may be regarded as an infantile form.
Its development is slow and insidious, so that it is often already of considerable duration be fore it is recognized.
Symptoms.—The chief symptom is due to an alteration of the character of the skin and connective tissue under it, by which a kind of dropsy is produced. This dropsical condition, however, differs from ordinary dropsy in that it does not " pit " on pressure; it is a solid swelling, not a watery one. It affects the whole body ; the face becomes puffy, swollen, coarse; the eyelids are baggy, and the upper lids droop over the eyes, the forehead being wrinkled in the effort to keep them raised ; the lips are large and coarse ; the nose is broadened ; the ears large and swollen. The patient notices that gradually she requires larger gloves and larger boots and wider clothing. The podgi ness of the hands interferes with some kinds of work, sewing for instance, and the touch for the piano or violin is lost. The skin has a dirty yellowish hue, but below the eyes there is a peculiar waxy, translucent appearance and often a high colour of the cheeks. The hair is dry, brittle, and scanty, and the scalp may be covered with dirty-yellowish or brown patches. The patient may be compelled to wear a wig. The voice is muffled, and the person speaks as if her tongue were too large for her mouth, or as if she had not control of her lips, and the speech is s,ow. The skin is dry and wanting in sweat, and easily affected by cold. There is a feeling of weakness and lassitude, and a de gree of mental sluggishness. The heart's action is feeble, and the circulation weak, but the kidneys are not affected.