CASE 6.-Patient male, age 45 years, had a severe infection of the middle finger on the left hand. He was treated by two eminent surgeons of New York City, with the result that after three weeks' treatment they informed him his finger would have to be operated again and possibly amputated. He was referred to the writer by a veterinary who is a most enthusiastic autotherapeutist from the marked successes he is having with this method of therapy in the treatment of animals, and by a patient whose brother had been given up by the attending surgeon to die of septic poisoning, but who was cured quickly by autotherapy. Patient was received at 10 a. m.. At 2 p. m. a hypodermic injection of the unmodified toxin complex was given. At 6 p. m. the pain stopped and the patient slept better that night than he had in three weeks. In twenty-four hours the pus had disappeared; in three days the patient had so far recovered that he was discharged in the custody of his wife, who is a trained nurse. Two months later this patient placed a series of reprints of my former articles dealing with the technic of autotherapy in its application to bronchial conditions and pus infections in the hands of the surgeon general of the French army. He showed. him his finger. He told him of the almost miraculous cure that was made by means of autotherapy. He was the object of much interest, as he was the first patient treated by Dr. Duncan himself the French surgeon general had ever seen, although he was familiar with autotherapy from an article that had appeared in the Paris Medical just previous to the outbreak of the war. He stated "autotherapy is being used successfully in many hospitals in France. So successfully, in fact, that accounts of the quick cures made by autotherapy were published in a number of the French daily papers."

BIBLIOGRAPHY.

1. "A New Method of Vaccine Treatment and Prevention of Sepsis" (Medical Record, September 16, 1911), Chas. H. Duncan.

2. "Autotherapy" (New York Medical Journal, December 14 and 21, 1912), Chas. H. Duncan.

3. "Autotherapy" (Veterinary Journal, London, October, 1912), D. J. Mangen.

4. "Autotherapy in the Prevention and Cure of Purulent Infections" (London, Practitioner, April, 1914).

5. "Prevention and Treatment of Septic Wounds in Warfare" (Indian Medical Gazette, November, 1914), F. W. Sumner.

6. “A Positive Method of Curing Purulent Infection"; An Appeal to the Army Surgeon (Interstate Medical Journal, October, 1915), Chas. H. Duncan.

7. "A Positive Method of Preventing and Curing Purulent Infection"; An Appeal to the Army Surgeon (American Medicine, October, 1915). 8. "Autotherapy Versus Operations" (The American Practitioner, July, 1913), Chas. H. Duncan.

9.

"Autotherapy in Surgery" (American Journal of Surgery, October, 1913), Chas. H. Duncan.

10. "Autotherapy" (Practical Medicine, Delhi, India, July, 1914), Chas. H. Duncan.

Treatment of Certain Types of Goitre With Quinine and Urea Injections.

BY L. F. WATSON, M. D., OKLAHOMA CITY.

Assuming that the symptoms of toxic goitre are caused by excessive activity of the thyroid function, many have attempted to limit this secretion by removing a portion of the gland, or ligating its arteries. Approaching the problem from another aspect, some have attempted to neutralize this hyperactivity by means of milk, blood, or serum of animals whose thyroids have been removed; still others have employed injections of different substances into the thyroid. Although these various methods are possessed of advantages and shortcomings, until a longer period of time has elapsed since any of them were instituted, it will be impossible to know just how much value they possessed. There is the question as to the future condition of the patient who has been treated by any of them.

Surgeons and internists agree that the best results follow the thyroid operation when it is performed before the disease has reached the more serious secondary stage-just as a smooth and comfortable recovery will follow the proper medical treatment when administered to beginning cases. If the surgeon is to operate on all favorable cases of beginning hyperthyroidism, surely much useless surgery will be done. Anyone with experience in the disease cannot doubt the value of thyroidectomy as a therapeutic procedure, and in many cases is the only treatment from which the patient may derive benefit. It is my opinion, however, that only in exceptional cases should it be the first step taken to effect a cure. The mortality is high; the recurrence is frequent; and until a greater number of patients have been cured by it, and until a longer period of time has elapsed since it came into use, there will always be the question as to whether the patient operated upon may not suffer at a later time from too little thyroid function. It is well known that thyroidectomy lowers a patient's resistance to disease and infection.

Plummer, from a study of several thousand cases of hyperplastic and colloid goitre, concludes that the disturbances are due to a change in the normal function. The stimulating effect is active

No. 1.-Human exopthalmic goiter after quinin and urea injection. Note beginning degeneration of epithelium and stroma.

No. 2.-Human exopthalmic goiter after quinin and urea in ection. Area of complete necrosis of epithelium and stroma. No connective tissue formation.

throughout the body, and the stimulating action is intra-cellular. These observations have been confirmed by the work of Kendall, who has isolated a crystalline substance containing 60 per cent iodine, and possessing the physiologic activities of the gland.

Bearing in mind these pathological changes which accompany exophthalmic goitre, it is obvious that medical treatment which stops short of destroying a portion of the enlarged and hyperactive gland, will at times fail to afford relief from the acute symptoms, and will also fail to prevent recurrence when the hypersensitive although quiescent goitre is subjected to severe psychic strain.

DISTURBANCES IN OTHER DUCTLESS GLANDS.

Too often toxic goitre is regarded as a disease of the thyroid gland alone, while in reality all the glands of internal secretion åre more or less involved. I have found glycosuria in 85 per cent

of the severe cases of hyperthyroidism. Dr. Sajous was the first to emphasize the close relationship and interaction existing between the ductless glands in health and disease.

Rautmann (3) who has recently reported the findings from autopsies on patients dying of exophthalmic goitre, states that an enlarged thymus very frequently accompanies hyperthroidism; the suprarenals and ovaries are involved in a majority of cases; the hypophysis, parathyroids and islands of Langerhans are less frequently affected. He states further, that the changes in the thyroid, parathyroid, thymus, and hypophysis are of a hypertrophic hyperplastic nature, while the changes observed in the suprarenals, ovaries, and islands of Langerhans are of a pronounced atrophic hypoplastic type.

TREATMENT.

Too frequently the hyperthyroid patient is not regarded as a sick person. Because his symptoms may not be severe enough to compel him to stay in bed, the physician is liable to be lax in insisting on close medical supervision. Surgeons and internists agree that any procedure for the treatment of hyperthyroidism must be based upon a period of rest, with medical, dietetic, and hygienic measures suited to the needs of the individual case.

The hyperthyroid patient will usually do best away from home, removed entirely from surroundings suggesting mental and physical exertion. Inquiry will frequently disclose some particular factor of work or worry that has contributed to the symptoms or perhaps caused the disease, and which should be corrected as far as possible. Sympathetic friends and relatives should be ex

cluded, thus giving the patient an opportunity for repose, as complete as can be, in a cheerful atmosphere.

ORGANOTHERAPY.

Organotherapy has an established place in the treatment of hyperthyroidism. It is necessary to make a careful study and examination of each patient to determine which ductless glands are contributing to the symptoms, and if their action is one of hypofunction or hyperfunction.

Hygienic.--A patient suffering from severe hyperthyroidism should have a rest of several weeks, on an open veranda or in a bright, cheerful room, carefully isolated from seriously ill or noisy patients. The more favorable the climatic conditions, the better for him.

Dietetic.--Body weight can be increased best by a simple nour