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pending on the administration of the thyroid extract to a case of exophthalmic goitre.

McKenzie records many cases treated by thymus gland extract, and fails to find any specific effect.

The same facts are proven in a surgical manner and early in the history of operations for this disease, the entire gland was removed with the effect that the patients, if they withstood the operation at all were cured of one condition only to be confronted by a worse one, that of myxedema. A few such results taught the profession that the proper thing to dɔ was to remove only a part of the gland, so that now all a neurologist will advise is to remove a half of the gland at the most, ligating the isthmus. Out of one hundred and ninety cases operated upon by the partial removal of the gland, that have been collected and reported, as quoted by Starr, there were twenty-three deaths, seventy-four cases nearly 40 per cent. claimed as cures, forty-five cases claimed to be improved, and thirty cases not improved, and the others not followed. up to a final issue. Of the cases that the result was finally known in, there were cured fifty-one per cent and thirty-one per cent. improved. In all the deaths following operation there were peculiar symptoms, such as a sudden rise of temperature to 105°, 106° or 107°, rapid pulse, extreme nervous excitability, restlessness, anxiety, distress, profuse sweating, collapse, and death from heart failure.

Of course we have no knowledge of any means of absorption of the thyroid secretion except through the lymphatics and blood vessels; and when it is recalled that any handling or manipulation of the organ will produce an increase of the secretion we would think that this extra secretion promoted by the operative procedure, being absorbed would produce, in a system that was already suffering from the effects of hypersection, the symptoms above noted and death. Some one designed an operation of throwing the gland forward and leaving it exposed for a few days before completing the operation, and in performing this he noted a free secretion of a colloid-like material that exuded from the surface. After some operations where only a part of the gland was secured there was an outpouring of a similar substance from the wound.

The histological study of the organ is of some value, through no very constant lesions have yet been demonstrated.

These latter facts show that the secretion of the thyroid may be very materially increased and that such an increase

may be responsible for an acute and fatal condition following the operation. So why should we not attribute the chronic symptoms to a similar cause?

These facts seem to demonstrate that the thyroid gland secretion, altered in quantity or quality, is responsible for the state known as exophthalmic goitre.

The treatment has been very varied and equally unsatisfactory. The result, as it usually is in disease, depends more on the individual case than on the skill of the attendant.

Electricity has been much extolled and thought to possess some special influence on the heart's action through the effect on the vagus nerve. Definite rules for the direction of the current are made by some, though one writer will tell us that the positive pole must be applied at one place, and the other says in just the opposite place, and each writer claims good results from his method. In the cases in which I used it there was no result though the cases probably ceased attendance at the office before a fair test had been made. Many drugs are recommended. Those that appear most useful are belladonna and its congeners and tonics. Rest in bed for a long period with massage and general electricity, associated with the administration of the above drugs seems to have given more good results than any other reported proceedings.

I have had two cases that have become stationary at the result of the above method that I want to report.

Case I-Miss J., aged about 24, has an ancestry of a maternal grandfather dead of locomotor ataxia, and a maternal uncle of paresis, while one sister has had nervous prostration. She attributes her trouble to a weakened general condition from imperfect alimentation and an attempt to do three years work in two while at college. Her first symptoms were rapid and heavy breathing after slight exertion and a year later she noticed a rapid and tumultuous heart action and an increase of dyspepsia. About a year after that the enlargement of the thyroid appeared. Three years after her first symptoms were noticed she was ordered to bed and lost eighteen or twenty pounds in ten days. When I saw her first her eye-balls were prominent, the thyroid was much enlarged, her heart was beating at the rate of 120, the pulse was full, bounding, rapid, easily compressed, the vessel seemed large, there was a pulsation and bruit in the thyroid, a hæmic murmur in the heart, a marked tremor on any attempt to act either physically or mentally and very profuse

off her neck.

sweating. The day I first saw her the sweat seemed to pour She flushed easily and frequently, and was altogether a very nervous individual. She had not menstruated for a year. She was put to bed on modified rest treatment with massage, farradism, baths, limited diet and no company, and kept on that regime for two months, when she gradually assumed her ordinary life. Her other treatment was, reduced iron with extract of belladonna pushed to the point of dryness in the mouth, and dilatation of the pupils continued for three months, and the application of belladonna ointment to the thyroid for twelve hours out of the twenty-four. When she left my care I ordered her to take belladonna for a month at a time periodically. Much to my surprise the size of the thyroid decreased very much, the pulse gradually fell in rate so that when her mother wrote me before Christmas she reported a pulse averaging 64 in the morning and 66 in the evening, and the latter after being out and around all day long. The other symptoms have also disappeared. Of course I know that the time having elapsed is too short to have any conclusion as to the condition of the patient ultimately, yet the improvement was so marked that I desired to report it now.

Case II. This woman was aged twenty; a music teacher by occupation, working very hard, eating irregularly, being of a nervous make-up, or, as she expressed it, she was always irritable, impatient, and in a hurry. Outside of a goitre that her mother had there is nothing in her family history. Of her initial symptoms I have not a very good history, though as I recall it the first thing she noticed was her weakness followed by persistent nausea, vomiting and constipation. When she was sixteen years old she noticed a goitre which had not increased in size when I saw her. Her eyes were prominent and so remained while she was under observation, but are not now so prominent, which she attributed to a swelling of her upper lid. She was in bed when I first saw her and stayed there from February 22nd to the first of June, though she was under observation for only three weeks. Her treatment was hyoscine grain 1-100 three times a day, which was kept up till the middle of April, and an ice bag over her heart. She was fed per rectum.

It is my belief that the prolonged rest in bed and the hyoscine are what benefited the patient, though in a letter to me she says "that it was only through faith in the Lord that she became well." She has a fair degree of health, but is

very nervous.

DIET TREATMENT OF HEADACHE, EPILEPSY

AND MENTAL DEPRESSION.

Alexander Haig, M. A., M. D., Oxon, F. R. C. P., in "Brain," summer number, says: Those headaches associated with an excess of uric acid in the urine are treated by excluding from the diet all fishes, meat, eggs, tea, coffee, and cocoa, and giving milk, cheese, pulses, cereal foods, and fruit. From the change of diet the nutrition of the patient is lowered, so that the stored reserves of uric acid flood the blood, and, besides, many vegetable foods introduce more alkali and less acid into the body than do the animal foods interdicted, and thus increase the alkalinity of the blood, and flood it with uric acid. For these reasons an increase of headache occurs in the beginning of the treatment. To tide the patient over the period of excessive headache, a mixture of bromide of ammonium and salicylate of ammonium is given. However, this plan of diet is to be persevered in, for the increase of headache, in the beginning of the treatment, when the first rush of uric acid occurs, is to be regarded rather as a favorable than an unfavorable sign.

In mental depression the same diet is used, and, to conserve the patient's strength and energy, he is put to bed with most happy results.

In the treatment of epilepsy success was not so well marked; but a thorough trial of treatment is insisted upon before the plan is abandoned. Here, too, an increase in the number of convulsions may occur in the commencement, which, however, is not to be regarded as unfavorable.

The Roentgen rays are found to be of great value in the army and navy in the war with Spain. The bullets can be located with such accuracy as to be easily removed. The portable apparatus weighs about 70 pounds.

Death within twenty-four hours may be expected when the respiration and heart beats approximate.

A MONTHLY JOURNAL OF MEDICINE.

MEDICAL SENTINEL COMPANY Publishers

HENRY WALDO COE, M. D., Editor.

RUPERT BLUE, M. D., Associate Editor.

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WM. JONES, M.D.
R. NUNN, M.D.
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C. H. WHEELER, M.D.
A. J. GIESY, M.D.
A. E. MACKAY, M.D.
A. C. SMITH, M.D.
O. S. BINSWANGER, M.D.
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F. CAUTHORN, M.D.
W. F. AMOS, M.D.
J. F. DICKSON, M.D.

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RICHMOND KELLY, M.D.
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J. F. BELL, M.D.
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J. B. EAGLESON, M.D., Seattle.
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PORTLAND, OREGON, SEPTEMBER, 1898.

WASHINGTON STATE MEDICAL SOCIETY.

Elsewhere in this issue will be found a report of the Washington State Medical Society, which ought to be interesting reading to all the doctors of the great Pacific northwest. Dr. Eagleson, as president, and Dr. Coe, as secretary, backed by a good local committee, had determined upon a successful session, and what they predestined and foreordained they

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