THE CLINICAL USES OF THE PREPARATIONS FROM THE 
THYROID GLAND, PITUITARY BODY, SUPRARENAL 
CAPSULES, AND BONE-MARROW. 
BY 
RICHARD C. CABOT, M.D., 
OF BOSTON. 
FROM 
THE MEDICAL NEWS, 
Sept. 12, 1896. [Reprinted from The Medical News, September 12, 1896.] 
THE CLINICAL USES 0 F HE PREPARATIONS FROM THE THYROID GLAND, 
PITUITARY BODY, SUPRARENAL CAPSULES, AND BONE MARROW.a 
By RICHARD C. CABOT, M.D., 
OF BOSTON?*-~ 
To cover the ground with reasonable thorough- 
ness I have had to limit myself in two directions. 
First, I have kept strictly to the title of my paper 
and studied only the clinical ztses of these prepara- 
tions and not the theory of their nature, the modes 
of their preparation or action, nor the history of 
their introduction into medicine. Secondly, I 
have thought it best to say nothing at all of the 
uses of the preparations of the thyroid gland in 
myxedema, sporadic and endemic cretinism, and 
cachexia strumipriva. The usefulness of thyroid 
extract in these conditions is now so well estab- 
lished that any discussion of it would be tedious. 
Therefore, in speaking of the thyroid extract I 
shall confine myself to its uses in conditions other 
than those just mentioned. 
THYROID EXTRACT. 
Besides myxedema, cretinism, and the cachexia 
following thyroid extirpation, there is a long list 
of diseased conditions in which thyroid extract 
has been used, the most important of which are: 
(1) Simple goiter. (2) Exophthalmic goiter, or 
Graves' disease. (3) Obesity. (4) Psoriasis and 
other cutaneous diseases, including alopecia. (5) 
Tetany. (6) Insanity and various psychoses. (7) 
Retarded development in children. (8) Chlorosis. 
The thread that binds all these apparently heter- 
ogeneous conditions together is the fact that they 
all are, or maybe, associated with myxedema, and 
when so associated have been cured or amelio- 
rated by the thyroid treatment. Thus, some 
myxedematous patients are goitrous, many are 
fat and suffer from various cutaneous disorders; 
mental troubles are a very frequent symptom, and 
retarded development not uncommon. Many 
myxedematous patients get very anemic, and 
some, especially those whose myxedema is due to 
removal of the thyroid, show the spasms of tetany. 
Hence, it has occurred to physicians to use the 
thyroid treatment in each of these conditions 
when occurring without myxedema. 
Further, the thyroid preparations have been 
used in rickets probably from a general sense of 
its value in diseases of nutrition, and perhaps the 
same idea may have led to its use in diabetes and 
gout. It has been used in fibroid tumors of the 
uterus, and for hypertrophied scars-its marked 
powers of tissue metamorphosis probably recom- 
mending it. Favorable reports of its use in lupus 
led to its use in phthisis, and, finally, syphilis, 
cancer, and leprosy, have been experimented on. 
It is said to be good for piles. 
I will take up these various uses of the thyroid 
extract in what seems to be the order of their 
importance. 
THYROID EXTRACT FOR SIMPLE GOITER. 
Relief is sought in these cases either on account 
of the disfigurement and inconvenience of the tu- 
mor, or because of the pressure symptoms which 
it causes. Without treatment, tracheotomy is 
sometimes necessary to relieve the distress of 
breathing.19 
Out of a total of 322 published cases, 279, or 
eighty-seven per cent., are set down as improved, 
and only 43 as not improved. (See table.) These 
statistics are large enough to be convincing, I 
think, of the great value of thyroid extract in 
simple parenchymatous goiter. There have been, 
so far as I can ascertain, no wholly unfavorable 
reports-none where marked improvement has 
not appeared in a majority of all cases in which 
any one observer has tried it. Those who have 
tried the remedy, in large numbers of cases, agree 
that it is most effective in goiters that are of recent 
appearance and of moderate size, and especially 
in those occurring in young people, b 
Failures are mostly in cystic or colloid goiter, 
and in middle-aged people who have had the tu- 
mor a long time. It seems safe to say that every 
parenchymatous goiter of recent appearance in a 
young person can be considerably diminished by 
thyroid feeding. It is uncommon to see the tu- 
mor wholly disappear, only about ten per cent, of 
the cases having so resulted, but often there re- 
main only a few hard nodules not previously felt, 
which can be easily dissected out. 
a Read before the Massachusetts State Medical Society, June 9, 
1896. 
b The younger the better. Thomas 14 reports splendid results in 
sucklings with congenital goiter. 2 
CLINICAL USES OF THE THYROID GLAND. 
Thyroid Feeding in Goiter. 
Table No. I. 
Author 
No. of 
Cases. 
Cured 
Improved 
Not 
Improved 
Remarks. 
Bruns 1 
6o 
14 
29 
17 
Used the raw gland itself. "Thyroidism" in 1 case only. 3 re- 
lapsed after treatment omitted. Eailures=(a) cystic or colloid 
goiters ; (b) adult patients with tumors of long standing. 
Kocher2 
7 
0 
5 
2 
The failures were a goiter and a colloid tumor. 
Sene 3 
I 
0 
I 
O 
Alexjew4 
2 
I 
I 
O 
Epelbaum 5 
1 
0 
I 
O 
Ingals & Ohls« 8 
50 
2 
36 
II 
1 case not heard from. 2 of those not improved were under treat- 
ment less than a week. Cystic tumors were not excluded. 
Knopfelmacher 7 .... 
22 
5 
5 
The 5 obstinate cases were also unaffected by the iodin treatment, 
by ointment, and internally. 
Marie8 
I 
0 
I 
0 
Showed diminution in size within 5 days. 
Reinhold 9 
12 
0 
12 
0 
Insane patients-7 lost an average of 4 lbs. weight in 6 weeks. 2 
gained weight (3-9 lbs.). No change in mental symptoms. 
Angerer10 
78 
0 
72 
6 
Those not improved gave up treatment on account of "thyroidism;" 
most lost weight (6 lbs. in 5 weeks'-average), but gained it back 
later. 2 relapses in 5 and 7 months after omission of treatment. 
Prefers the raw gland. 
Stabel 11 
60 
4 
56 
0 
26 cases on raw gland did much better than 34 on tablets ; no " thy- 
roidism." 
Ewald 12 
19 
0 
19 
0 
Used English tablets and finds them much better than German. 
Putnam 13 
3 
0 
? 
I 
2 not heard from. 
Thomas14 
? 
? 
all 
0 
" Splendid results." All in young infants. 
Hennig16.. 
2 
0 
I 
I 
Using " thyrojodin " (Baumann18). 
Eschler18 
' ' many " 
" many " 
? 
? 
Does best in young people. 
Sanger17 
I 
0 
I 
0 
Some of the cases show distinct diminution in 
the size of the goiter after four or five days' treat- 
ment, and in several the tumor was entirely gone 
within a month. After from six to ten weeks' treat- 
ment the diminution has usually reached its limit, 
but some continue to improve for a longer period, 
and occasionally it is six weeks before any improve- 
ment begins. 
As most of the statistics are very recent, our 
knowledge as to the permanency of the cures is 
obviously very limited. Nine months after the 
cessation of treatment many of the cases have 
shown no relapse. On the other hand, Bruns1 
finds three-fourths of his sixty cases begin to re- 
lapse three months after cessation of treatment. 
The statements of observers are not sufficiently 
full on this point in most cases, and we cannot say 
at present how frequently the marked improve- 
ments above recorded are destined to be perma- 
nent, and whether, as in. myxedema, we must 
maintain the thyroid treatment through life to 
prevent relapse. Those cases which disappear 
most rapidly under thyroid treatment have shown, 
according to Stabel,11 the greatest tendency to 
relapse. Slight loss of weight'during the treat- 
ment is the rule, averaging five or six pounds in 
Angerer's 10 78 cases. Severe toxic symptoms are 
rare and can be prevented by care (Vide infra). 
THYROID TREATMENT IN OBESITY. 
The vast majority of observers are agreed that 
most obese persons, and many who are not so, 
lose weight rapidly during the first week of treat- 
ment with thyroid extract, the diet being unre- 
stricted. We can tell to a certain extent what 
type of obesity is most likely to be benefited. 
Leichtenstern,48 Buquin, 47 Kraus,49 and others 
have noticed that in young, robust, and vigorous, 
but obese persons, the treatment is not effective. 
It is especially successful where obesity is asso- 
ciated with pallor, and flabby, doughy tissues, 
and as such a condition is commoner in women, 
the remedy more often works well in women than 
in men. The loss of weight is most rapid during 
the first week of treatment, but continues more 
slowly for months in some cases. Among the 
most striking cases are those of J. J. Putnam, 50 
who was the first, so far as I can ascertain, to use 
thyroid extract in simple obesity. One of his 
cases lost forty-seven pounds under thyroid treat- 
ment. Ratjen35 reports a loss of fifty-seven 
pounds in three months' treatment. Rendu's21 
case lost sixty-six pounds in two months with no 
relapse up to date (one year). A loss of a pound 
a day for the first week is not at all uncommon. 
In most cases this loss of weight represents not 
simply a loss of fat (and water) from the tissues, 
but a drain on the lean as well. The excreta show 
that an increased amount of albuminoid matter is 
a Including cases reported in letters to the author. 
b Nearly. CLINICAL USES OF THE THYROID GLAND. 
3 
being burnt up in the body, so that muscle as well 
as fat is lost. V. Noorden25 says that thyroid ex- 
tract is the only known drug that increases the 
process of oxidation in the body without muscular 
or glandular exercise. He compares it to the 
blast from "a pair of bellows rousing the smol- 
dering fire of metabolism to fiercer flames." But 
as regards the albuminoids of the body, this is 
just what we want to avoid in our treatment of 
obesity, and, in fact, it can be avoided if a diet is 
so arranged that the loss of albuminoids is com- 
pensated by an increase in the proteid elements 
of the diet (Ewald44). 
The majority of observers agree that the weight 
is soon regained after the remedy is left off, unless 
exercise or careful dieting prevents it. This re- 
lapse does not always occur, and is often delayed 
some weeks, or even months, after the remedy is 
omitted, but in a larger number of cases the weight 
begins to increase again very quickly, and not in- 
frequently reaches its former figure within a 
month. Cases are recorded where patients have 
actually gained weight during the use of the 
remedy, but this is very rare. 
At the Congress for Internal Medicine, held at 
Wiesbaden just two months ago to-day, Ewald 
sums up a discussion on this topic with the con- 
clusion that we have in thyroid feeding a precious 
remedy in cases of obesity, and one whose ill 
effects can all be avoided. He recommends that 
we should never give this treatment to any patient 
whom we cannot watch closely, for its dangers, if 
not carefully watched, are considerable, b 61 In 
some cases he says the remedy entirely fails, the 
tendency of the organism to conserve its fat being 
very strong. Ewald compares such cases to those 
of pernicious anemia where the preservation of 
the fat layer up to death is so striking. 
Thyroid Treatment of Obesity. 
Table No. II. 
Author 
No. of 
Cases 
Loss of Weight. 
Duration 
Treatment 
Not 
Improved 
Relapsed 
Remarks. 
Leichtenstern and 
Wendelstadt20 
27 
3-19 lbs. 
4-6 weeks. 
2 
? 
Anemic, flabby cases do best. 
Rendu 21 
2 
66 lbs. in 1, "marvelous" 
in the other. 
2 months. 
O 
none so far 
1 year. 
Used tablets of dried extract. 
Dennig 22 
5 
6 lbs. av. 
10-27 days. 
I 
1 
Some show increase of albumin excretion, 
others do not. 
Buquin 23 
3 
a « 
3 
9 lbs ; 16 lbs ; ? lbs. 
3 weeks. 
V. Noorden25 
17 
" Considerable." 
? 
? 
" Most" 
Finds it useless unless supplemented by 
diet, but helps some where diet alone 
fails. 
Ingals 26 
MacKenzie27 
2 
5 lbs. in 1. 
? 
I 
1 case gained 5 lbs under treatment. 
I 
8% lbs. 
1 month. 
O 
Yes. 
Gained back gibs while still taking thyroid 
Smith 28 
I 
" Considerable." 
? 
O 
Schlesinger 29 
Jerzykowski 30 
I 
" Very successful." 
Tablets of beef thyroid had no effect. 
IO 
" Considerable." 
? 
? 
Effective only when combined with diet. 
Used Merck's tablets. 
Putnam 31 
6 
40 lb. in 1 ; 47 lb. in 1. 
Yes. 
Relapsed when thyroid was omitted. 
Other cases lost no weight. 
Bleibtreu 32 
I 
&/2 lbs. 
O 
Lost albuminoids in spite of increased 
protein diet. 
a eltzer 33 
1 
? 
O 
? 
Began to improve in 24 hours. 
Buschan 34 
1 
" much " 
? 
O 
? 
Ratjen 35 
1 
57 lbs. 
3 months. 
O 
? 
Barron 36 
5 
1 lost 28 lbs., others less. 
6 weeks. 
O 
Becker37 
2 
7 and 10 lbs. 
1 week 
Yes. 
Bourn ville 38 
6 
4, 5, 6, 8 and 12 lbs. 
8-10 weeks 
I 
Yes. 
Idiotic children all relapsed, some during 
treatment. 
Davies 33 
i 
" Considerable." 
■ 
O 
? 
In this case diet alone was useless, but with 
thyroids too, was very efficacious. 
Williams40 
7 
" Considerable," 36 in 1 
? 
I 
0 
Acne rosacea in 2 : markedly improved. 
Baldwin 41 
3 
1 lost 40 ; 1 lost 10 ; 1 lost 
several lbs. 
? 
O 
3 
Weight regained because active exercise 
not kept up after stopping thyroid extract 
Grawitz 42 
2 
6 lbs. 
1-3 weeks 
O 
Using " thyrojodin." 
Hennig 43 
24 
2 ten lbs. per week. 
? 
O 
Using "thyrojodin" 1 lost 20 lbs. in 23 
days. 
Ewald 44 
11 
8 ten lbs. 
6 weeks. 
I 
" most " 
Using "thyrojodin." 
Eulenburg 45 
I 
17 
? 
? 
? 
Magnus-Lewy 46 
L 
8 lbs. 
Total 
145 
a Letter to Munich, med. Woch., April 23, 1895. 
b The danger signals will be briefly considered later on. 4 
CLINICAL USES OF THE THYROID GLAND. 
Drs. H. C. Baldwin and Harold Williams of 
Boston, have been good enough to let me mention 
the results of their experience in the thyroid treat- 
ment of obesity. Dr. Baldwin's three cases showed 
marked loss of weight, but relapsed because exer- 
cise was not kept up after the remedy was omitted. 
Some of Dr. Williams' seven cases have not re- 
lapsed and have been in all respects successful. 
In two an associated acne rosacea improved much 
during the treatment. 
Out of a total of 145 cases which I have been 
been able to collect, all but 6 got thinner under the 
treatment, so that, except for the question of re- 
lapse, the treatment was successful in over ninety- 
six per cent, of the recorded cases. How often 
and for how long relapse can be prevented, either 
by continuing the thyroid treatment, by exercise, 
by diet, or by a combination of these measures, 
we are not yet in a position to know. 
THYROID REEDING IN SKIN DISEASES. 
Here the results have been markedly poorer than 
in goiter and obesity. The remedy has been tried 
to a limited extent in a variety of diseases affect- 
ing the skin but especially in psoriasis. Here, out 
of 153 cases, only 62 improved during treatment, 
and of these only 43 had thyroid treatment without 
local remedies as well, so that only about one- 
fourth of the cases can be said to be really im- 
proved by the thyroid. Further, as the records 
of these cases are all very recent, and as very little 
is said as to the presence or absence of relapses, 
we may well hesitate to believe that the results 
are really due to the treatment and not to one 
of the spontaneous ameliorations so common in 
the course of the disease. Those most san- 
guine as to the merits of thyroid extract for 
psoriasis admit that there are many cases in which 
it has no effect, and some (about one-sixth) who 
are made worse by it. Byrom Bramwell56 thinks 
it a specific for certain types of the disease, but 
he has never attempted to point out any means of 
knowing beforehand whether a given-case will be 
made better or worse by it. Radcliffe Crocker 76 
of London, considers it very valuable in the "right 
cases." Crocker says that it "should never be 
given during the increasing stage of the disease," 
as sometimes scores of new spots rapidly develop 
under it. He finds it " very capricious in its ac- 
Thyroid Treatment of Psoriasis. 
Table III. 
Author. 
No. of 
Cases. 
Improved. 
Not 
Improved 
Worse. 
Relapse. 
Remarks. 
Abraham 52 
65 
18 (11 had local treat- 
ment, too). 
16 
15 
In 11 treatment had not continued long 
enough to judge of its results. 
Thibierge 53 
II 
8 
3 
0 
Average loss of weight 12 lbs in 6 weeks. 
Those who improved had local treat- 
ment too. 
Crary 54 
9 
2 
7 
0 
? 
Noticed peculiar "meaty " odor to skin. 
Busch 66 
24 
18 
6 
0 
? 
11 " cured." 
Bramwell 56 
6 
3 
3 
0 
1 very stubborn case cured in few weeks 
without local treatment ; 2 are well (6 
months, no relapse). 
Squire 57 
2 
0 
2 
Dill58 
4 
3 
O 
I 
1 " cured." 
Davies 59 
2 
2 
O 
0 
Hyde 60 
IO 
O 
IO 
Eschle61. 
2 
2 
O 
Fresh cases in young people. 
Brooks62 
5 
O 
I 
4 
Phillips 63 
2 
O 
2 
Putnam 64 
I 
O 
I 
Preese 66 
I 
I 
O 
0 
20 years' standing, resisted all kinds of 
treatment hitherto. "Cured." 
Wilson 66 
I 
I 
Cured-hair reappeared on scalp. 
Unna" 
I 
O 
I 
Auld 6B 
I 
I 
O 
0 
Stubborn hitherto. " Cured " in 1 week. 1 
tablet daily. 
Mosse 69 
I 
I 
O 
Stubborn case 1 year's standing. Prompt 
" cure." 
Jones70 
I 
O 
O 
I 
Glycosuria during treatment. 
Tschernogurow 71 . .. 
I 
I 
O 
0 
" Cured." 
Anderson 72 
I 
O 
I 
0 
Gordon 73 
I 
I 
O 
0 
Combe 74 
? 
Yes. 
Epelbaum75 
I 
I 
O 
0 
Total 
154 
63 
22 CLINICAL USES OF THE THYROID GLAND. 
5 
tion, failing in one attack after it has succeeded 
in a previous one. In children and sound young 
people it is often effectual." Thibierge believes 
in its utility but thinks it should be reserved for 
refractory cases where other remedies fail. It is 
in such cases that the treatment by thyroid feed- 
ing has scored its most striking successes. Age 
and sex seem to make little difference (Abraham52), 
although Eschle61 thought fresh cases in young 
persons were more amenable to this treatment. 
In eczema, of 22 reported cases, 77 18 79 80 81 9 
are set down as "cured," 3 as improved, 2 as 
unimproved, 1 as worse, and in 7 the result is 
not clearly stated. Out of 7 cases of ichthyosis, 
82 83 84 85 86 87 1 is called "cured," another "cured 
but relapsed when treatment stopped," 4 im- 
proved, and 1 unimproved. Of 4 cases of xero- 
dema, 88 89 1 showed improvement; the others 
none. Two cases of sclerodema 90 91 are reported; 
1 improved and 1 was "cured." Three cases of 
acne rosacea 92 93 gave 2 improved-Dr. Harold 
Williams' cases, one not improved. Success is 
mentioned in single cases of adenoma sebaceum,94 
pitunasis rubra,95 and exfoliative dermatitis,86 and 
failure in a case of vitiligo.97 Four chronic leg 
ulcers 98 99 showed no improvement. Two cases of 
alopecia 100101 are reported improved, but MacKen- 
zie102 claims to have tried it thoroughly and found 
it useless in this disease. The use of thyroid feed- 
ing in lupus seems to have been successful in the 
hands of Byrom Bramwell.103 Busch104 and Abra- 
ham105 reported 12 cases, all more or less im- 
proved. In 5 of these, however, local treatment 
was given at the same time. No complete cures 
are reported. 
THYROID TREATMENT IN PHTHISIS. 
This apparent success with cutaneous tu- 
berculosis led Morin 111 of Neuchatel, to try 
the remedy in pulmonary tuberculosis, and he 
has been followed by Kraus112 in Germany, and 
T. Smith 113 in England. All of these observers 
report generally favorable results but nothing 
very definite or permanent. Morin believes the 
goiter and tuberculosis are antagonistic. He 
noted the frequency of atrophied thyroid in 
phthisis, and out of 71 cases of myxedema found 
20 tubercular. Girard of Berne, noted that in the 
districts where goiters prevail, phthisis is more 
than twice as common in the non-goitrous as in 
those with goiters. Lt is a popular belief in these 
regions, he says, that goiter and tuberculosis are 
antagonistic. Morin also reports a phthisical pa- 
tient who improved markedly after acquiring 
goiter. In one very tubercular family he found 
every member phthisical except those whose thy- 
roid was enlarged. 
Kraus did not find that phthisical patients lost 
any weight under thyroid treatment, in fact, notes 
a gain in weight in one case, but he found no 
change in the signs in the lung. 
During the past ten days I have been giving 
thyroid extract to six phthisical patients. No 
particular change has been noted. 
THYROID TREATMENT IN SYPHILIS. 
This remedy has also been tried in syphilis. 
10. 108 109 no gjx favora5]e cases are reported, 5 of 
them said to be very severe, while in n cases no 
improvement has been seen. 
MISCELLANEOUS USES OF THYROID FEEDING. 
(1) Perhaps this is as good a place as any to 
speak of an interesting case of hypertrophied scar, 
reported by Dr. J. W. White, 114 in which, during 
thyroid feeding, a large unsightly mass, resem- 
bling keloid, shriveled away so as to leave only a 
linear scar. Dr. White had previously tried va- 
rious local treatments with no success. (2) The 
unsuccessful use of thyroid feeding in cancer115 
needs no further comment. (3) At the Wiesba- 
den Congress of last April, above-mentioned, 
where the whole subject of thyroid feeding was 
discussed, favorable results were reported in a 
variety of conditions; for example, in chlorosis,116 
rickets,11' gout,118 and diabetes.119 The cases are 
too few and the reports too meager for us to come 
to any conclusion about them. (4) A French ob- 
server (Jouin 12°) tried thyroid treatment in 5 cases 
of fibromyoma of the uterus, and noted marked 
diminution in the size of the tumors in 2 cases, 
and diminished hemorrhage in 3. 
The fact that in myxedematous children and 
cretinism the thyroid treatment is associated with 
notable growth in height has led some observers 
to try its effects in dwarfed children not myxede- 
matous, 121 122 to see if their development could 
not be helped. I have collected 10 such cases, 3 
in idiotic children, and 6 in whom the lack of de- 
velopment was mainly physical. A considerable 
increase in height was observed in all the cases, 
but the mental symptoms were not improved. 
This brings me to speak of insanity as treated 
with thyroid. About 60 cases are on record-25 
improved. Out of all who have tried the treat- 
ment, Bruce,124 an English writer, is apparently 
the only one who feels sanguine as to its use. 
Twenty-one out of the 25 improved cases are his. 
He considers it "a valuable addition to the alien- 
ist's armamentarium in certain cases,''and advises 
its use in cases of melancholia whose spontaneous CLINICAL USES OF THE THYROID GLAND. 
6 
improvement had come to a standstill; in mania- 
cal cases without signs of dementia and in stuper- 
ous cases in early stages. He finds that women 
do better under it than men, an observation par- 
allel to the results in obesity. It is contraindi- 
TETANY. 
The last use of thyroid feeding of which I 
shall speak is in tetany. Of twelve recorded 
cases, 169 160 161 162 163 164 165 106 167 only four showed 
improvement, but two of these were very ob- 
Thyroid in Insanity. 
Table IV. 
Author. 
No. of 
Cases. 
Improved 
Not 
Improved 
Remarks. 
Reinhold 123 
12 
o 
12 
Goitrous cases. 
Bruce 124 
3° 
21 
9 
14 quite well. 
McClaughry 125 
2 
I 
I 
Goitrous cases. 
Easterbrook 126 
I 
I 
0 
Several others benefited. 
E. P. Elliot127 
3 
O 
3 
Clarke 128 
" several' 'a 
? 
Stuporous cases. 
Scribner 129 
IO 
o 
IO 
Lost 5-17 lbs. weight. 
Total 
6o 
25 
35 
cated in emaciated patients, and those who eat 
poorly, and in cardiac disease. Bruce's experience 
related to 30 cases, 21 of which showed improve- 
ment, amounting to recovery in 14. Clarke,128 a 
Canadian writer, finds like Bruce, good results in 
cases of stupor-several benefited, one or two 
recovered, one relapsed. 
At the Danvers Asylum and the McLean Hos- 
pital for the Insane, the thyroid treatment has 
been tried to a limited extent without any benefi- 
cial effect on the mental symptoms. At the 
Worcester Insane Asylum, Dr. Scribner used it 
in 10 chronic cases without any effect except a 
decided loss of weight, amounting in 4 cases to 
over fifteen pounds. 
In epilepsy130 one author finds good effects and 
one bad effects from the treatment. 
Although starting without any strong bias 
against the possible utility of thyroid in exophthal- 
mic goiter, I have not been convinced by the liter- 
ature that a further trial should be given it. Out 
of 85 cases published, 22 improved, 40 did not, 
and 23 were worse. The size of the goiter has 
diminished in many of these cases, but without 
corresponding general improvement. The num- 
ber of those made worse is about equal to those 
benefited, and three-fourths show no improve- 
ment. Nevertheless, some actual cures are re- 
corded in obstinate cases, and there seems a 
possibility that in a certain type of the disease it 
may do good. In no other disease, however, 
does it so often do positive harm. On the whole, 
there is very little reason for hoping that it will 
do good in this condition. 
stinate and long standing cases, and have 
shown no relapse in a period of five months. 
Possibly, here, as in many other conditions, 
thyroid feeding may help to distinguish different 
types within each disease, according as they are 
or are not affected by the thyroid treatment. It 
Thyroid in Exophthalmic Goiter. 
Table V. 
Author 
No. of 
Cases 
Improved 
Not 
Improved 
Worse 
Bogrof131 
i4 
14 
0 
Bergmann 132 
7 
0 
0 
7 
Mendel133 
IO 
0 
IO 
0 
Stabel134.. 
IO 
0 
7 
3 
Leichtenstern 135 ... 
4 
0 
0 
4 
V. Jaksch 136 
6 
0 
6 
0 
Putnam 137 
6 
0 
6 
0 
Brissac 138 
I 
0 
0 
1 
Kraus 133 
3 
' I 
I 
I 
Voisin 140 
2 
2 
0 
0 
Schuster141 
all 
0 
0 
Senator 142 
"several 
0 
all 
0 
Beclere 143 
I 
0 
0 
I 
Silex 144 
I 
I 
0 
0 
Lemcke145 
I 
0 
0 
I 
V. Noorden158 
I 
0 
0 
Lanz 146 
I 
I 
0 
0 
Revilliod 147 
I 
0 
0 
I 
Ferguson148 
I 
I 
0 
0 
Casselbury 198 
I 
1 
0 
0 
Shurly 150 
" few "a 
0 
all 
0 
Joffroy151 .■ 
I 
0 
0 
I 
Ewald 152 
3 
0 
3 
0 
MacKenzie 163 
I 
0 
I 
0 
Sanger 154 
? 
0 
all 
0 
Auld156 
I 
0 
0 
1 
Cantu 156 
I 
0 
0 
I 
Nasse157 
I 
0 
0 
I 
Total 
85 
22 
40 
23 
a Counted as 2 in totals. 
a Counted as two cases in total. CLINICAL USES OF THE THYROID GLAND. 
7 
may be that there are the thyroidal and non- 
thyroidal types of obesity, psoriasis, tetany, in- 
sanity, etc. In the case of obesity, we seem to be 
already in possession of some criteria by which 
we can tell beforehand whether or not a given 
case is likely to be benefited. In the other con- 
ditions, such criteria are very scanty, but there 
seems to be some ground for hope that thyroid 
treatment may enable us to split up several sup- 
posed entities of disease, as we have split up 
jaundice and asthma, and show them to be simply 
symptomatic of a number of different underlying 
conditions. 
To sum up the impression gained from the 
study of the literature of thyroid feeding, it seems 
to be: (i) Of great value in simple parenchy- 
matous goiter, especially in young people. (2) 
Of considerable value to reduce weight in obesity, 
especially in the anemic, flabby types, and pro- 
vided the relapse is prevented by diet and exer- 
cise. (3) It seems to deserve a further trial in 
obstinate cases of psoriasis, sclerodema, and 
lupus; also in tetany, certain phases of insanity, 
and retarded development in children. (4) In 
exophthalmic goiter it rarely does good and often 
harm. (5) In chlorosis, rickets, diabetes, and 
tuberculosis, the evidence is not sufficient to 
warrant inference. 
A few words as to the form in which the thyroid 
is to be given. Many of the most successful re- 
cent results in Germany have been with the fresh 
gland, raw or fried.1 10 11 168 There is little doubt 
that this is superior to the German dried extracts. 
Whether or not it is superior to English and 
American extracts, we have no sufficient evidence 
to show. The fresh gland is very unpalatable, 
but may be given by the rectum. 
Attempts have been made in Germany to ex- 
tract the active principle of the gland, and 
Fraenkel's " Thyreoantitoxin, " 169 and Baur- 
mann's " Thyrojodin," 170 are now being experi- 
mented with in Germany. The latter preparation 
is an iodin compound, and considerable success 
in the use of it was reported by Ewald and others 
at the Wiesbaden Congress, two months ago to- 
day. The dosage is exact, and it is free from 
some of the unpleasant toxic qualities of the 
dried preparations of the gland. 
I have alluded to some dangers attending the 
use of thyroid preparations. Bad symptoms 
caused by it are probably of two kinds,171 (1) the 
physiological action of an overdose of the gland 
itself, and (2) ptomain poisoning due to products 
of decomposition included in the dried prepara- 
tions of the gland. Their two chains of symp- 
toms are often lumped together under the name 
of " Thyroidism." 
"Thyroidism" is first shown by rapid pulse 
and palpitation; cardiac oppression and angina, 
even fatal in a few cases, may occur. Anorexia, 
nausea and vomiting, diarrhea, lassitude, malaise, 
faintness, vertigo, headache, and pain in back 
and extremities, are not uncommon; hysterical 
manifestations and, rarely, aphasia, monoplegia, 
convulsions, and even coma occur. With some 
preparations urticaria, erythema, and eczema 
are produced. 172 173 174 An odor to the skin and 
perspiration is sometimes noted. I have had two 
patients speak of this. 
In those predisposed to diabetes by inheritance 
a temporary glycosuria 174 may occur, <?, and 
Noorden 175 hopes that we may in the future be 
enabled to make an early diagnosis of diabetes. 
In giving thyroid preparations, the best guide 
is the pulse. Any considerable quickening or palpi- 
tation should lead us to discontinue the drug until the 
cardiac action is again normal. There are no dan- 
gers in the use of the drug, provided we begin 
with small doses, one to two grains of American 
extracts, and gradually increase, watching the 
pulse. It should never be given to a patient who 
cannot be closely watched. 
SUPRARENAL EXTRACT IN ADDISON'S DISEASE. 
Since Rollesboue's remarkable Goulstonian 
lectures on the suprarenal bodies, in which he 
recommends a trial of the extract of these glands 
for Addison's disease, a certain number of cases 
have been reported. I have been able to collect 
only twenty cases, out of which nine have been 
considerably improved. The use of the prepara- 
tion is still in its infancy, and these cases repre- 
sent trials of watery, alcoholic, and glycerin 
extracts, as well as of the gland itself, raw or 
dried, so that it is misleading to lump them all 
together and judge of the results. The various 
fluid extracts are evidently very inferior to the 
gland itself, dry or raw. One case, under the 
care of Dr. F. C. Shattuck, at the Massachusetts 
General Hospital, I had an opportunty to ob- 
serve. Dr. Shattuck felt no doubt of the 
diagnosis, and no improvement occurred until 
after the use of the dried extract of suprarenal 
body. The patient is now, to all appearances, 
well, and has been so for four months. An ab- 
solute diagnosis of Addison's disease is, I believe, 
impossible without an autopsy, so that a certain 
amount of doubt is thrown on the apparent bene- 
fit derived from this mode of treatment in genuine 
a V. Jaksch (Fourteenth Congress, Wiesbaden) doubts whether 
the reduction of copper in these cases is always due to sugar. 8 
CLINICAL USES OF THE THYROID GLAND. 
Suprarenal Extract in Addison's Disease. 
Table VI. 
Author. 
No. of 
Cases. 
Result. 
Remarks. 
Parkinson 177 
I 
Worse. 
Died soon after. 
Turney 178 
I 
Worse. 
Died soon after. 
Ringer and Phear179 
1 
Temporarily better. 
Died soon after. 
Pitres 180 
2 
Worse. 
Subcutaneous use. 
Spellman181 
3 
2 no effect. I greatly better 
but relapsed. 
Using alcoholic extract. 
Stockton 182 
I 
Nearly well. 
Bronzing gone. 
Osler 183 
I 
Much better. 
No relapse (3 months). 
Sansom 184 
2 
Temporarily much better. 
Relapsed and died. 
Jones 185 
I 
"Cured." 
Oliver 186 
2 
i "practically well," i greatly 
better. 
t diagnosed by Pye-Smith. 
Maragliano187 
7 
Good results. 
Glycerin extracts. 
Shoemaker 188 
I 
Improved. 
Stewart189 
I 
Not better. 
Epelbaum 190 
2 
Much better. 
Fresh raw gland. 
Zuco and Foa 191 
? 
No improvement. 
Used watery extract. 
Shattuck 192 
1 
Apparently well. 
T otal 
2t 
Addison's disease; but when we have such benefit 
recorded in cases diagnosed by such clinicians as 
Pye-Smith, Osler, and F. C. Shattuck, we cannot 
help feeling hopeful about the treatment, especi- 
ally as on physiological grounds, there seems to 
be reason to expect that it would work well. 
Experiments with suprarenal extract have 
shown it to have the property of increasing 
blood-pressure by stimulation of the vagus and 
cardiac muscle, and also of contracting the caliber 
of the periphery arteries.186 Acting on this sug- 
gestion, Bates 195 has used it as a local astringent 
and hemostatic in operations on the eye, and also 
in glaucoma and conjunctivitis. Oliver186 and 
Clark 194 have used it with benefit in a case of 
diabetes insipidus, and its use has also been 
praised in three cases of diabetes mellitus, and in 
hysteria, and neurasthenia, with loss of vasomotor 
tone, and in certain forms of anemia.186 
It is evidently a powerful medicinal agent, and 
severe toxic symptoms have been recorded in 
connection with its use, 196 180 but on the whole, 
there seems to be reason to feel hopeful about its 
result. Certainly, it deserves a farther trial in a 
disease for which no other treatment has hitherto 
availed anything. 
EXTRACT OF PITUITARY BODY IN ACROMEGALIA. 
The records of this subject are very scanty. I 
have been able to collect only nine cases of its 
use. 199 200 Five of these appear to be more or less 
improved. Three of these are reported by 
Marinesco,196 an Italian. The headache and other 
pains improved, the general condition was better, 
and the extremities smaller. One case was able 
to move the hands better and walk with less 
fatigue than before. One favorable case comes 
from England, under Bramwell's197 care, and an- 
other from Germany. In these two, thyroid ex- 
tract has previously been tried without success. 
In the German case reported by Mendel,198 the 
knee-jerk, which had been absent, returned, and 
the condition of the teeth and gums improved. 
Thyroid treatment has also been tried for 
acromegalia in ten cases, six of which have im- 
proved, and four not improved. 201 209 As both the 
thyroid glands and pituitary body are sometimes 
found diseased at autopsy in acromegalia, it may 
be that the simultaneous use of both extracts will 
be found useful. 
BONE-MARROW. 
Since ordinary forms of anemia yield readily to 
treatment by other drugs, it is chiefly in pernicious 
anemia and leucemia that we have hoped for help 
from bone-marrow. But I have been unable to 
find accounts of a single case of undoubted per- 
nicious anemia which has shown any permanent 
improvement. The case of Danforth's,210 which 
attracted so much attention at the time it was 
reported in October, 1894, has since211 relapsed 
and died, and there is no reason to suppose that 
the temporary improvement had any connection 
with the treatment. The cases of Frazer212 and 
Bigger213 both lack a satisfactory blood examina- 
tion, and their subsequent progress after the first 
few months is not recorded. The other cases 
reported as improved (nine in number) are de- 
fective, either as to diagnosis or as to the subse- 
quent progress of the case. Temporary improve- CLINICAL USES OF THE THYROID GLAND. 
9 
meats are so common in pernicious anemia with 
any treatment, as well as without any, that no 
case can be called cured unless the improvement 
has persisted at least two years (Cabot). There 
are no records of improvement in leucemia and 
and four not improved. 
In secondary anemia and chlorosis we have a 
considerable number of favorable reports. Fifteen 
cases of chlorosis and chlor-anemia, are all said 
to have improved, and in two of these, Blaud's 
pills are said to have had no effect. 
Seventeen cases of secondary anemia, including 
four of rickets, are also recorded as improved. 
But these anemias are easy to cure, as a rule, and 
as marrow contains iron, it is not remarkable that 
improvement was noticed. 
Two cases of anemia infantum, pseudo-leu- 
cemia, are reported by Combe, a French obser- 
ver, as cured by bone-marrow, but there is reason 
to doubt the diagnosis. 
On the whole, there seems to me to be less 
reason to expect good results from the use of 
bone-marrow than from any of the other animal 
extracts I have mentioned. 
CONCLUSIONS. 
1. Thyroid extract is certainly valuable. 
2. Suprarenal extract we have reason to hope 
will be proved so. 
3. Pituitary extract we cannot judge of as yet. 
4. Bone-marrow is in all probability useless. 
Articles Referred To: 
goiter. 
1 Bruns, Beitrage z. klin. Chirurg., 1895, xiii, 1. 
Deut. med. Woch., October 11, 1894. 
2 Kocher, Schweitz. Corresponded., 1895, January 1st. 
3 Sene, Jour. d. med. et de chirurg. fract., May 25, 1895. 
4 Alexjew, La med. Moderne, June 25, 1895. 
5 Epelbaum, " Organotherapie, " Paris, 1895, H. Jouve. 
6 Ingals and Ohls, NewYork Med. Journal, September 7, 1895. 
7 Knopfelmacher, Wien. klin. Woch., October 10, 1895, 
8 Marie, Semaine Medicale, November 13, 1895. 
9 Reinhold, Munch, med. Woch., December 24, 1895. 
10 Angerer, Munch, med. Woch., No. 4, 1896. 
11 Stabel, Berlin, klin. Woch., February 3, 1896. 
12 Ewald, loc. cit. 
13 Putnam, Personal Communication. 
14 Thomas, Fourteenth Cong. f. Int. Med., Wiesbaden, April 
10, 1896. 
15 Hennig, Munch, med. Woch., April 7, 1896. 
16 Eschler, Therap. Monatsch., January, 1896. 
17 Sanger, Mercredi Medicale, December 11, 1895. 
18 Baurmann, Munch, med. Woch., April 7, 1896. 
19 Bruns, Beitrage z. klin. Chirurg., 1895, xiii, 1. 
OBESITY. 
20 Leichtenstern and Wendelstadt. 
21 Rendu, Mercredi Med., November 13, 1895. 
22 Dennig, Munch, med. Woch., 1895, No. 17 and 20. 
23 Buquin, Journ. d. med. de Paris, 1895, p. 485. 
24 Letter to Munch, med. Woch., April 23, 1895. 
25 V. Noorden, Zeit. f. Prakt., January 1, 1896. 
26 Ingals, New York Med. Journal, September 7, 1895. 
27 MacKenzie, Brit. Med. Journal, July 14, 1894. 
28 Smith, Brit. Med. Journal, July 21, 1894. 
29 Schlesinger, Gaz. Hebdom., 1896, p. 252. 
30 Jerzykowski, Wratch, 1896, No. 7. 
31 Putnam, Personal Communication. 
32 Bleibtreu, Deut. med. Woch., 1895, No. 22 and 23. 
33 Meltzer, Nezv York Med. Journal, May 25, 1895. 
34 Buschan, Deut. med. Woch., October 31, 1895, No. 22 and 23. 
38 Ratjen, Munch, med. Woch., No. 48, 1895. 
36 Barron, Ref. in Tranact. of Assn. American Physicians, 
1893, P- 8. 
37 Becker, Deut. med. Woch., 1895, No. 37. 
38 Bournville, Comp. Rend. d. 1. Soc. de Biol., January 24, 1895. 
39 Davies, Brit. Med. Journal, 1894, No. 1749. 
40 Williams, Personal Communication. 
41 Baldwin, Personal Communication. 
42 Grawitz, Munch, med. Woch., April 7, 1896. 
43 Hennig, loc. cit. 
44 Ewald, Fourteenth Cong. f. Int. Med., Wiesbaden, 1896. 
45 Eulenburg, Deut. med. Woch., August 15, 1895. 
46 Magnus-Lewy, Fourteenth Cong. f. Int. Med., Wiesbaden, 
1896. 
47 Buquin, Paris, Thesis, 1895. 
48 Leichtenstern, loc. cit. 
49 Kraus, Therap. Woch., January 26, 1896. 
60 Putnam, Transact. Assn. Am. Phys., 1893. 
51 Eulenburg, loc. cit. 
SKIN DISEASES. 
(a) Psoriasis. 
52 Abraham, Lancet, 1894, p. 94. 
83 Thibierge, Semaine med., August 17, 1895. 
84 Crary, Nezv York Med. Record, 1894, vol. xlvi, p. 427. 
88 Busch, Dermat. Zeit., September, 1895. 
86 Bramwell, Brit. Med. Journal, 1894, No. 1734. 
57 Squire, Brit. Med. Journal, 1894, No. 1723. 
58 Dill, Lancet, January 6, 1894. 
89 Davies, Brit. Med. Journal, 1893, T. 257. 
60 Hyde, Jour. Cut. Gen. Urin. Diseases, October, 1894. 
61 Eschle, Therap. Monatsch., January, 1896. 
62 Brooks, Brit. Med. Journal, January 14, 1894. 
63 Phillips, Brit. Med. Journal, 1893, ii, 1152. 
64 Putnam, Personal Communication. 
68 Preece, Brit. Med. Journal, March 30, 1895. 
66 Wilson, Brit. Med. Journal, p. 365, 1895. 
67 Unna, Munch, med. Woch., 1895, No. 48. 
68 Auld, Brit. Med. Journal, 1894, p. 1749. 
69 Mosse, Mercredi med., September 11, 1895. 
70 Jones, Internal. Med. Annual, 1896, p. 526. 
71 Tschernogurow, Verhandl. d. Mosk. Dermat. Gesellsch., 
1896, vol. iii. 
72 Anderson, Lancet, 1894, T. 94. 
73 Gordon, Brit. Med. Journal, 1894, T. 186. 
74 Combe, Rev. d. I. Suisse Row., 1895, xv, No. 5. 
78 Epelbaum, loc. cit. 
66 Crocker, "Twentieth Cent. Prac. of Med.," vol. v, p. 175. 
(b) Eczema. 
77 Bursch, loc. cit. 
78 Menzies, Brit. Med. Journal, 1894, No. 1734. 
79 Phillips, Brit. Med. Journal, 1893, ii, 1152. 
80 Daves, Hunterian Soc., November 28, 1894. 
81 Kingford, loc. cit. 
(c) Ichthyosis. 
82 Bursch, loc. cit. 
83 Walker, Internal. Med. Assn., 1896, p. 526. 
84 Nobbs, Brit. Med. Journal, March 30, 1895. 
88 J erzykowski, loc. cit. 
86 Jackson, Jour. Cut. & Gen. Urin. Diseases, October, 1894. 
87 Davis, loc. cit. 
(d) Xeroderma. 
88 Jackson, loc. cit. 
89 Phillips, loc. cit. 
(e) Scleroderma. 
90 Arning, Mercredi med., December n, 1895. 
91 Unna, loc. cit. 10 
CLINICAL USES OF THE THYROID GLAND. 
(/) Acne Rosacea. 
92 Dill, loc. cit. 
93 Harold Williams, Personal Communication. 
Miscellaneous Skin Diseases. 
94 Walker, loc. cit. 
95 Scratchard, Semaine med., 1895, Ixx. 
96 Jackson, loc. cit. 
97 Mosse, Mercredi med., September 11, 1895. 
»8 
DU 
190 Beevor, Brit. Med. Journal, July 13, 1895. 
101 Abraham, loc. cit. 
102 MacKenzie, Brit. Med. Journal, July 13, 1895. 
103 Bramwell, Brit. Med. Journal, 1894, No. 1737. 
104 Bursch, loc. cit. 
105 Abraham, loc. cit. 
100 Walker, loc. cit. 
SYPHILIS. 
107 Menzies, Brit. Med. Journal, 1894, No. 1749. 
108 Gordon, Brz'Z. Med. Journal, 1894, No. 1726. 
199 Bramwell, Ann. Dermat. &• Syph., 1895, 8 and 9. 
110 Gouladse, Ref. in Med. Moderne, April 1, 1895. 
PHTHISIS. 
111 Morin, Ref. in Therap. Monatsch., 1895, No. 11. 
112 
113 Smith, Ref. in Proc, of Hunterian Soc., No. 78, 1894. 
114 J. W. White, Un. Med. Mag., August, 1895. 
115 Ewald, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
119 Roos, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
117 Heubner, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
118 Combe, loc. cit. 
119 Blackstein, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
V. Noorden, Fourteenth Cong. f. Inter. Med., Wiesbaden, 
1896. 
Hansemann, Fourteenth Cong. f. Inter. Med., Wiesbaden, 
1896. 
Rosenfeld, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
120 Jouin, Mercredi Med., July 31, 1895. 
121 Schmidt, Fourteenth Cong. f. Inter. Med., 1896. 
122 Comp. Rend. d. 1. Soc. d. Biol., January 24, 1896. 
INSANITY. 
123 Reinhold, loc. cit. 
124 Bruce, Lancet, October 13, 1894, and October 5, 1895. 
123 McClaughry, Journal Mental Sciences, 1894, p. 635. 
126 Easterbrook, Brit. Med. Journal, March 30. 1895. 
127 Elliot, Personal Communication. 
128 Clarke, Proc. Canadian Med. Assn., August 17, 1895. 
129 Scribner, Personal Communication. 
130 Kraus, Therap. Woch., January 26, 1895. 
EXOPHTHALMIC GOITER. 
131 Bogrof, Ref. in Mercredi Med., August 21, 1895. 
132 Bergmann, Ref. in V. Noorden, Berlin, klin. Woch., 1895, 
p. 790. 
133 Mendel, Berlin, klin. Woch., February 3, 1896. 
134 Stabel, loc. cit. 
133 Leichtenstern, Deut. med. Woch., December 13, 1894. 
136 V. Jaksch, Fourteenth Cong. f. Inter. Med.,Wiesbaden, 1896. 
137 Putnam, Personal Communication. 
138 Brissac. 
139 Kraus, Therap. Woch., January 26, 1896. 
140 Voisin, Soc. des Hosp., October, 1894, also Semaine Med., 
i895> P- 33°- 
141 Schuster, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
142 Senator, Berlin, klin. Woch., February 3, 1896. 
143 Beclere, Soc. des Hosp., October, 1804. 
144 Silex, Berlin, klin. Woch., February 8, 1896, p. 130. 
146 Lenecke, Hosp.-Telfalde, 1895, 4 R. iii, 17. 
146 Lauz, Correspondence f. Schweitz. Aert., 1895, 25, 2. 
147 Revilliod. 
148 Ferguson, Brit. Med. Journal, 1894, vol. ii. 
149 Casselburg, New York Med. Journal, August 24, 1895. 
150 Shurly, New York Med. Journal, August 24, 1895. 
151 Joffroy, Mercredi Med., August 21, 1895. 
152 Ewald, Berlin, klin. Woch., February 3, 1896. 
163 MacKenzie, loc. cit. 
164 Sanger, Munch, med. Woch., 1895, No. 48. 
155 Auld, Brit. Med. Journal, 1894, No. 1749. 
156 Cantu, Annales d. I. Soc. med. Chirurg. d. Lieges, 1894. 
157 Nasse. 
158 V. Noorden, Fourteenth Cong. f. Inter. Med., Wiesbaden, 
1896. 
TETANY. 
159 Frankel, Wien. med. Bl., 1895, p. 755. 
190 Kraus, Therap. Woch., January 26, 1896. 
161 Schultze, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
162 Marschener, Deut. Arch.f klin. Med., March 26, 1896. 
163 Bramwell, Brit. Med. Journal, June 1, 1895. 
164 Levy-Dorn, Therap. Monatsch., February, 1896. 
165 V. Jaksch, Fourteenth Cong. f. Inter. Med., Wiesbaden, 
1896. 
166 Schultze, Zeit. f. Nervenheil, 1895, p. 416. 
167 Gottstein, Zeit.f. Nervenheil, 1895, p. 177. 
168 Lepine, Semaine Med., February 12, 1896. 
1,19 Fraenkel, Wien. med. Bl., 1895, p. 755. 
170 Baumann, Munch, med. Woch., April 7, 1896. 
Grawitz, loc. cit. 
Gottlieb, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
Rehn, loc. cit. 
Hennig, Munch, med. Woch., April 7, 1896. 
" THYROIDISM." 
171 Lang, Deut. med. Woch., September 12, 1895. 
172 Beclere, Soc. Med. des Hosp., January 18, 1895. 
473 Ewald, Fourteenth Cong. f. Inter. Med., Wiesbaden, 1896. 
174 Bettmann, Fortschritt des Med., 1894, p. 750. 
175 V. Noorden, Zeit. f. Prakt. Aert., January 1, 1896. 
176 Hennig, loc. cit. 
Stabel, loc. cit. 
Ewald, Berlin, klin. Woch., 1895, No. 2 and 3. 
Dennig, loc. cit. 
Jones, Internal. Med. Ann,, 1896, p. 526. 
SUPRARENAL EXTRACT. 
177 Parkinson, Ref. in La Med. Moderne, February 28, 1896. 
178 Turney, loc. cit. 
179 Ringer and Phear, loc. cit. 
180 Pitrest, Mercredi Med., September 4, 1895. 
181 Spellman, Rev. Med. de I'Est., January 15, 1896. 
182 Stockton, Medical News, November 16, 1896. 
183 Osler, Internal. Med. Mag., February, 1896. 
184 Sansom, Brit. Med. Journal, November 16, 1895. 
183 Jones, Brit. Med. Journal, August 24, 1895. 
186 Oliver, Brit. Med. Journal, September 14, 1895. 
187 Maragliano, Riforma Med., 1890, 280. 
188 Shoemaker, University Med. Mag., 1895, vol. viii, No. 5, 
p. 309. 
189 Stewart, Ref. by Duckworth's " Twentieth Cent. Practice of 
Med.," vol. ii, p. 22. 
19(1 Epelbaum, " Organotherapie," Paris, 1895, H. Jouve. 
191 Zuco and Foa, Ref. by Maragliano, loc. cit. 
192 Shattuck, Personal Communication. 
193 Bates, New York Med. Journal, May 16, 1896. 
194 Clark, Brit. Med. Journal, May 18, 1896. 
196 Glay, Semaine Med., January 11, 1896. 
PITUITARY EXTRACT. 
196 Marinesco, Semaine Med., Nov. 13, 1895. 
197 Bramwell, " Atlas of Clinical Med.," vol. ii, p. 3. 
198 Mendel, Berlin, klin. Woch., 1895, No. 48. 
199 Rollestone, Lancet, April 25, 1896. 
200 Ransom, Brit. Med. Journal, June 8, 1895. 
THYROID EXTRACT IN ACROMEGALIA. 
201 Putnam, loc. cit. 
202 Mosse, Mercredi Med., September 11, 1895. CLINICAL USES OF THE THYROID GLAND. 
11 
203 Murray, Brit. Med. Journal, February 9, 1895. 
204 Benson, Brit. Med. Journal, 1895, p. 949. 
205 Eschle, Therap. Monatsch., January, 1896. 
208 Unna, Munch, med. Woch., December 3, 1895. 
207 Mendel, loc. cit. 
208 Schultze, Fourteenth Cong., etc., Wiesbaden, 1896. 
209 Joffroy, Mereredi Med., August 21, 1895. 
BONE-MARROW. 
210 Danforth, Chicago Clin. Rev., October, 1894. 
211 Danforth, New York Med. Rec., May 9, 1896. 
212 Frazer, Brit. Med. Journal, June 2, 1894. 
213 B'gger, Lancet, September 22, 1894. 
214 Patton, Internal. Clin., April, 1896. 
218 Billings, Johns Hopkins Bull., November, 1894. 
218 Pease, TV. K State Hosp. Bull., 1896, No. 1, p. 133. 
217 Salford, Lancet, December 7, 1895. 
218 Mann, Lancet, March 10, 1894. 
219 Watkins, American Med. and Surg. Bull., May 7, 1896. 
220 Hun, New York Med. Journal, January 17, 1895. 
221 Lawrie, Brit. Med. Journal, 1895, p. 1238. 
222 Hamilton, New York Med. Journal, January 12, 1895. 
223 Hanford, Lancet, February 23, 1895. 
224 Pepper and Stenzel, "American Year-book of Med. and 
Surg.," 1896, p. 80. 
225 Drummond and Cameron, Brit. Med. Journal, May 18, 1895. 
228 Bars, Brit. Med. Journal, May 16, 1896. 
227 Nammack, New York Med. Rec., December 14, 1895. 
228 Combe, Semaine Med., May 4, 1895. 
229 Kraus, Therap. Monatsch., January 26, 1896. The Medical News. 
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