CHAPTER 7. Diseases Of The Blood And Ductless Glands

C--Hodgkin's Disease
G--Diseases of Suprarenal Bodies
         1--Addison's Disease
H--Diseases of Spleen
         1--Movable Spleen
         2--Rupture of the Spleen
I--Diseases of the Thyroid Gland
         2--Acute Thyroiditis
         4--Exophthalmic Goiter
J--Diseases of the Thymus Gland


   Definition.--Anemia means a deficiency in the volume of the blood albumin or hemoglobin. Pronounced anemia follows excessive loss of blood. Anemia may be local or general.

   Local Anemia.--Local anemia of the brain causes fainting. When the sluices of one large district are too wide open, others are left anemic. It is said that when the mesenteric channels are opened from any cause, all the blood of the body will be sent to the abdominal cavity, leaving all other parts of the body fatally anemic. Emotions strong enough to affect the nervous system, reflexes from pain, or reactions from shocks or blows upon the abdomen, may cause a fatal anemia of the brain. If not so severe, they may cause fainting. This condition can be brought about by tapping the abdomen and drawing off the fluid, removing large tumors, or emptying the fluid out of an ovarian cyst that is very large and which has overdistended the abdomen. By taking off the pressure, a reaction follows; the blood flows into the blood vessels of the abdomen too rapidly, causing fainting by emptying the brain. If the patient is very low, it may cause death.

   Local anemia affecting various organs is made possible by inheriting a predisposition. Irritation of the liver from overstimulation may cause hyperemia of the organ. If this condition is continued until there is a permanently enlarged state of the blood vessels, a sudden sickness, followed by fasting, may bring on an anemic state that will not be in keeping with any other part of the body. This may be true of any other of the organs of the body. Plethora of years' standing builds an enlarged state of the blood vessels. It takes time to readjust to a normal state.

   Reybaud's disease, which is an affection of the peripheral vessels, causes what is known as local syncope. This may occur in the viscera as well as in the extremities. Where it occurs in the brain it causes temporary aphasia.

   General Anemia.--This condition may be brought on from the continuous toxin poisoning produced by putrefaction in the intestines. Where a condition of this kind runs on for a very great length of time, patients become pale; the tongue is pale; the mucous membrane is bleached. The entire organism suffers more or less from oxygen starvation, and on this account there is more or less decomposition from a lack of oxygen in the system. When this is added to the original toxin poisoning, patients are put in line for building malignant diseases, especially sarcomas.

   Anemia from Hemorrhage.--This may either occur from a traumatic cause or it may be spontaneous. In injuries, if a large blood vessel is wounded, the bl eeding may be very rapid and end fatally in a very short time. If the blood vessel is small, the anemia will come on slowly. Fatal hemorrhage is favored by a condition of the blood in which it refuses to coagulate. When the blood is lacking the proper amount of fibrin, the tendency is for wounds to continue bleeding, or for spontaneous bleeding to take place, such as nose-bleeding or bleeding from the lungs. Hemorrhage from any part of the body may be continuous. There are people who are called bleeders. They belong to the class who are lacking in fibrin. The primary cause of a lack of this fibrin is undoubtedly toxin poisoning. Septic or pus poisoning also affects the blood in this way.

   After childbirth post-partum hemorrhage may be so severe as to cause death from this cause. Such diseases as alburninuria or Bright's disease favor hemorrhage. Gastric cancer kills the life of the blood, which is equivalent to the influence of a fatal hemorrhage. Lead, mercury, arsenic, and other mineral poisons cause anemia. All toxins produced by the action of bacterial fermentation on food end in anemia.

   Hyperpyrexia kills the life of the blood and produces anemia.

   Treatment.--In almost fatal hemorrhage from injuries it is considered good treatment to transfuse blood. My objection to this is that the blood transfused is not adapted to this particular case. Besides, it further shocks the patient to have blood thrown into the veins as suddenly as it has been lost, and the two shocks are more than the patient can stand. I remember having a patient who almost had a fatal hemorrhage from the bowels--a boy eleven years old, with typhoid. The first day he took his bed he bled to syncope. I was sent for. His pulse, as nearly as I could make out, ran about 180, He was apparently about as near death as it is possible to be. I had the pillows taken out from under his head, the foot of the bed raised, and insisted that no one should speak to him or make any noise. Occasionally the nurse was to put a teaspoonful of water to his lips--not in the mouth. Otherwise he was to be left entirely alone, without any nourishment whatever. In ten days his pulse was down to one hundred, and the feeding was begun. He made a splendid recovery.

   Why should transfusion be given in such cases? Nature can make blood out of the tissues of the body as fast as it is necessary to be made; and that is the only legitimate, rational, and logical source of supply. Patients should be left entirely alone. They are shocked by being tormented with dressing and nurses. Where a patient is still living after having excessive hemorrhage, if he can be protected from shocks, such as noises, annoyances, handling, and the usual attention which patients receive, I believe that the majority would get well.

   Hemorrhage from the lungs and other parts of the body must be treated according to the needs of the case. Excessive bleeding at the nose is often an indication of high blood pressure and arteriosclerosis. The quickest and safest way to control the case is to proscribe food, and even water, for the first twenty-four hours. Keep the patient in a horizontal position, without any pillow under the head. Then, when the hemorrhage has ceased, no food is to be given for at least forty-eight hours after, and then only a very little. Such cases must be instructed to eat more moderately than ever before. If they will not heed, they may have apoplexy with paralysis following in the course of a year or two.

   Of course, each case must be treated according to its needs. Certainly these patients are to be controlled in regard to their eating. They are to be given the proper food. If they have no desire for it, they are to wait, and touch nothing at all, until an appetite comes for wholesome food. Such cases ought to be kept away from food for from seventy-two hours to one week. In that time nature will have taken up a great deal of the watery tissues, the blood will be more concentrated and vastly richer, and they will be started well on the road to full recovery. But they cannot be cured unless they stop their trashy eating. They should have the tensing exercise, and be kept away from company. They must be sent to bed early, should get up late, and should lie down after lunch each day. They are easily enough cured if the discipline is rigidly carried out.



   Definition.--A disease that is known by a persistent tendency for an increase in the white corpuscles. There are also enlargements of the spleen and lymphatic glands.

   Etiology.--Leading authorities declare that there is nothing known about the condition under which the disease arises. It can be safely said, however, that the exciting cause may be an injury; but without constitutional toxin poisoning, with lymphatic involvement, the disease cannot be developed.

   Symptoms.--The disease comes on gradually. The first thing to arouse attention will be a rather enlarged abdomen, with a growing pallor of the surface of the body. The doctor is usually consulted to give his opinion in regard to what causes the abdomen to enlarge. In these days of much operating for tumors, people are fearful of tumors, and if the abdomen shows any enlargement, the average individual is not happy about it until he gets an opinion of his case.

   Along with the enlargement of the abdomen there is a shortness of breath, or what might be better described as a feeling of precordial oppression, due to oxygen starvation. The more the blood becomes involved, the fewer blood corpuscles there are to carry the oxygen. Many cases are troubled with nose-bleeding. The primary cause being toxin infection, the cause of the toxin infection takes us back to intestinal putrefaction. Food decomposes in the alimentary canal, and there is enough irritation, inflammation, and ulceration in the stomach and duodenum to cause leukemia. The colon is affected with chronic inflammation and more or less ulceration. This state of the alimentary canal exists in many other chronic diseases; so the question naturally arises: Why does it develop in one person as leukemia, in another as Hodgkin's disease, and in another as chlorosis, etc., etc.? The reason for the development of these varying affections cannot be accounted for other than that heredity or diathesis governs types. Families have lived for a number of generations in a given manner, and the tendency has been to evolve a predisposition to take on special diseases. Those who have lived in a malarial country have evolved a diathesis which proves to be favorable for the development of leukemia.

   Before leukemia develops there is always a lymphatic derangement. The lymphatics in the groins and in different parts of the body enlarge, because they are the storehouses for the arrest and detention of toxins.

   Cases of chlorosis have been known to have fatal hemorrhage before the disease had advanced to the point where it could be diagnosed as leukemia. The pulse is usually rapid, soft, and compressible; and at the same time it will be full in volume. Toward the close of the disease dropsical effusions develop, which may end in general anasarca.

   Hemorrhages of different organs are of frequent occurrence. The disease known as purpura hemorrhagica is common.

   Treatment.--The patient is fortunate if living in a warm country where he can stay out-of-doors all the time. The eating must be corrected: fresh fruit and vegetables principally; no meat, and a very limited supply of wholewheat bread and the decidedly starchy foods, such as navy beans, potatoes, corn bread, etc. These foods should not be given oftener than once a day, with a combination salad and cooked, non-starchy vegetables. The other two meals should be fruit.



   Definition.--This is a disease of the lymphatic glands. It starts on the side of the neck; the spleen enlarges, and there usually are formations of growths or nodules in the liver, spleen, lungs, and other organs. The lymphatic glands in different parts of the body become involved, feeling like nodules under the surface of the skin, on the arms, legs, and abdomen. These are very pronounced cases. The disease generally occurs in the first half of life, or in young people.

   Etiology.--This is one of the diseases of which the true nature of the real cause is not known. In all cases that I have been called upon to treat, however, I have found a gastro-intestinal derangement, and the bad habit of excessive eating and keeping up putrefaction in the intestine. Most authors declare that chronic tonsillitis may precede the onset. Chronic tonsillits is built from decomposition and putrefaction in the alimentary canal; so why should not these lighter forms of disease precede the chronic infections that come after resistance is broken down? The inguinal glands become involved and grow very rapidly. These are the first glands to show that there is putrefaction in the intestine. Of course, the lymphatic glands found on the surface and in the cavities of the abdomen and pelvis are always involved, playing an important part in developing catarrhal inflammation of the uterus, etc. In the early stages there is a slight fever. As the disease advances, the fever may go up in the afternoon every day. Sometimes a chill precedes the fever, and a sweating stage follows after the fever subsides. In fatal cases, pronounced emaciation ultimately sets in. This is about the time when the symptoms of dropsy begin to develop. Dropsy is usually seen in exhaustion. It means that the vital organs--heart and kidneys--are failing in their work through exhaustion brought on from toxin poisoning.

   Treatment.--The disease can be controlled, if taken in the early stages. Certainly I should not recommend an operation for the removal of the glands. This, however, is the common treatment, but it is positively unnecessary. A rational dietary, with proper care of the body, will overcome the disease. Authorities generally think that arsenic is the leading drug with which to treat this disease. Fasting for from one to two or three weeks is the proper thing--perhaps one week of fasting and then two weeks of fruit morning, noon, and night; after that, two meals of fruit, with a regulation dinner of meat one day, and a decidedly starchy food the alternate days, and at each dinner two cooked, non-starchy vegetables and a combination salad.


IV. PURPURA (Hemorrhage into the Skin)

   Description.-This is not a disease; it is a symptom, as it develops in many chronic diseases. It indicates a most pronounced toxin poisoning. It is not unusual for this symptom to present itself in pyemia, septicemia, heart diseases of all kinds, measles, scarlet fever, smallpox, cerebro-spinal fever, low forms of fevers, in cases of snakebite, and after the use of certain medicines. It has been known to develop quite extensively after the use of small doses of iodid of potassium.

   Treatment-No attention is to be paid to the purpuric symptom. The patient must be fed properly, proper care must be given to the body, and whatever manner of living has superinduced this symptom must be looked after and corrected as quickly as possible. If all people could be treated properly when they are first taken sick, such symptoms would never develop.



   Definition.--Chronic bleeding. The patients affected in this way are spoken of as "bleeders." When they are known, surgeons give them a wide berth. Women during their menstruation will have much loss of blood each month if they are inclined this way. Such cases will even continue to bleed for an indefinite length of time after a tooth is drawn. The slightest injury will cause great bleeding. The blood has lost its power to coagulate.

   Etiology.--Exactly the same condition obtains that is recognized in toxin poisoning. It may be that poisons may be taken in from the outside--such drugs as lead, arsenic, mercury, etc.; but the cause is usually decomposition manufactured in the alimentary canal and absorbed in the system. The reason why the blood is thrown into such a peculiar state that it will not coagulate is because this particular organ is the weakest one in the system--in the same way that the spleen becomes involved in leukemia because there is a predisposition to take on this affection. This affection, the same as any other, can develop only when the proper conditions are present. It is found in very young children. Why not? Parents live in such a way as to derange the mother's blood--lower its vital tone--and it would only be natural for the child to be born with a predisposition to take on affections similar to those of the mother. Besides, the child will nurse the mother, and, if it is fed, it will be fed the same way that the mother has eaten, which has brought her own blood deterioration upon her.

   Treatment--There is nothing to be done except to build the patient up and stop all bad habits of eating.



   Definition.--The definition usually given is a constitutional disease characterized by pronounced enervation, with anemia and a spongy condition of the gums, which bleed on the slightest pressure or touch.

   Etiology.--This is one of the old affections, well known to the profession generally and to most of the intelligent laymen. Today it is called acidosis. It is pretty generally understood to mean a disease created from lack of green vegetables and fruit. It develops in its most profound type among sailors who are cast away from shore and lost at sea. The fact of the matter is that we have a great deal of scurvy, or acidosis, that is not recognized as such. Notwithstanding some of our best authorities declare that the disease is becoming very rare in the United States, the truth is that we have probably as much as we ever had, but of a form not recognized. It has always existed in the milder forms without recognition. Such affections as purpura hemorrhagica, many forms of ulceration, galloping consumption, tuberculosis of the lungs, and all conditions that have been recognized as of a scrofulous character, are so closely related to scurvy that they should come under the same head; for the cause must be the same, as nearly as causes can be the same.

   Symptoms.--The disease develops gradually. It is said that there is a gradual loss of weight. I find this true of only some of the victims of this disease. Some cases may be said to be obese, yet they can develop this disease. After the blood derangement becomes fatal, they have a loss of flesh. The gums become swollen and spongy, and bleed easily; the teeth loosen and fall out. When mercury is not the cause of pyorrhea, it must be due to scurvy, or acidosis.

   It is only when scurvy, or scorbutus, becomes constitutional that it is generally recognized as such. Very few recognize such local affections as pyorrhea, gastric ulceration, and stomatitis as scurvy; yet the truth of the matter is that these are local diseases brought on from identically the same cause or causes. Inasmuch as the cause of blood derangement, glandular derangement, etc., is the common toxin poisoning, these affections should be recognized as springing from the same source. In severe constitutional derangements of this character, hemorrhages beneath the mucous membrane of the mouth are common. The skin becomes dry and rough. Blue spots, like those caused by bruises, appear upon the legs, arms, and other parts of the body. The breath is always bad. The slightest injury often produces hemorrhage.

   A swelling on the order of dropsy in the ankles develops. As stated in previous articles, this is indicative of a very depraved condition of the system and pronounced enervation of the heart and kidneys. Hemorrhages from the lungs, stomach, and bowels are common. All the indications of general enervation may be expected. The heart, of course, is feeble and irregular in action. Small areas of the lungs will have hemorrhagic spots in them. Some of our leading authorities declare that it is very difficult to distinguish this disease from purpura. If they manage to get any distinction at all, it is a distinction without a difference; for they are one and the same thing.

   Treatment.--Raw fruit and raw vegetables until the disease is completely under control. Then add buttermilk to the diet. After buttermilk, fruit, and vegetables have been given for at least one week, some kind of starchy food, with combination salad, may be used for dinner. No meat should be given until full health is restored.

Infantile Scurvy

   The cause of this trouble is nursing mothers who have been living on food with an acid potentiality, to the neglect of fresh fruit and vegetables. This causes the milk to be deficient in the elements of the salts of soda. The milk is devitalized, lacking in vitamin or enzyme; and unless the child is taken from the mother's milk, and given the proper kind of milk and fruit juices, it will die. If the case is not very far advanced, by giving fruit and vegetable juices in conjunction with the mother's milk, and at the same time feeding the mother properly, it may not be necessary to wean the child.



   Definition.--I can give no better definition than that given by Osler:

   A constitutional affection characterized by asthenia, muscular and vascular, irritability of the stomach, and pigmentation of the skin--symptoms due, in all probability, to loss of the internal secretion of the adrenal glands. Tuberculosis of the adrenals is the common anatomical change.

   Etiology.--Males are more inclined to take this disease than females. The skin is of a yellowish-gray tint. The disease is thought to originate in an injury to the abdomen or to the spine--poverty of the adrenal enzymes.

   Symptoms.--Anemia, general languor, pronounced enervation and very enfeebled heart action, irritability of the stomach, and the peculiar change in the color of the skin. The first symptoms are those of weakness, weariness, and the peculiar coloring of the skin.

   Change in the Appearance of the Skin.--This is usually the first thing to attract the attention of the patient or his friends. The coloration ranges from a slight yellowish to a deep brown or even black, The color is deeper on the exposed parts of the body. The areolae of the nipples and genitals take on a very much deeper hue. The stomach symptoms are those of nausea and vomiting. As the disease advances, there is pain in the abdomen. Toward the last there is complete loss of appetite. Diarrhea frequently develops--due, of course, to lack of digestive power; for, as the disease advances, the digestive secretions become less capable of preparing the food for absorption.

   The general constitutional derangement is marked by a gradual decline in nutrition. The disease usually ends by fainting. This, of course, is brought on by the continued prostration, and becomes more and more profound. In some cases there are tuberculous lesions. Osler describes two cases as having ended in a delirium, with difficult breathing.

   Treatment.--Never having had a case, I cannot say very much about what can be done for the disease. It is always safe, however, to feed properly and give the foods that will give vitality and carry life into the system. Fresh fruits, raw vegetables, milk, and eggs, I should say, ought to be about the limit; and then, if the patient shows improvement, other foods may be given as indicated. Those who believe in animal therapy declare that the suprarenal injections have been used beneficially. Those who believe in drugs declare some benefit may be derived from arsenic, strychnin, and other drugs.


(1) Movable Spleen

   Enlargement of the spleen, such as has been referred to under other heads, occurs in fevers, heart disease, hardening of the liver, and other diseases.

   There is a wandering spleen, like floating kidney. No doubt this condition may occur occasionally, but certainly very rarely. There is no reason why the spleen should not sag down below its normal position, from the same causes that allow the stomach, transverse colon, and other organs in the abdominal viscera to drop below their level. Great enervation, muscular relaxation, and intra-abdominal pressure from gas, etc., may occasionally displace, deform, and put out of their normal position any of these organs. This condition of the spleen occurs so seldom that it is unfortunate to have this reputation at all; for physicians who are always looking for the unusual and grotesque will often be troubled with finding this condition when it exists only in their minds. It is said that the wandering spleen is found oftener in women than in men. In malarial countries, where the spleen is frequently found enlarged, the wandering kidney may be found also; for the weight of the enlarged spleen must necessarily pull very heavily on attachments, and after the enlargement is overcome it would be reasonable to expect to find the spleen, as well as the left kidney, below its normal position on account of the stretched ligaments. This same displacement may occur to every organ in the body.

   Treatment.--Whatever is necessary to correct the health of the patient should be done. If the patient is complaining, and seeks the physician's advice for discomfort, it will not be from wandering spleen; it will be due to indigestion, gas in the bowels, which, if corrected by a proper diet, will remove all symptoms that are driving the patient to seek relief.

(2) Rupture of the Spleen

   The spleen has been known to become so enlarged from hyperemia, or engorgement of blood, that it spontaneously ruptured. Then again the spleen may be ruptured by a blow or fall. Fatal hemorrhage will follow this accident. It is said that fatal hemorrhage has been known to follow puncture of the spleen by a hypodermic needle. Abscess in the spleen has sometimes been punctured, and the intense swelling has caused a rupture to take place at the point of insertion of the needle. Of course, such accidents will prove fatal very quickly. There is but one treatment, and that is to open the abdomen and do whatever is necessary. It is strictly a surgical case.


(1) Hyperemia

   These symptoms belong to a syndrome. Where this state exists, there is toxin absorption from decomposition in the bowels. The lymphatic glands are more or less affected in the pelvis, causing hyperemia of the ovaries, a tendency for painful menstruation, or an excessive flow; perhaps a catarrhal condition of the uterus and hyperemia of the mammary glands. The thyroid gland and the mammary glands in connection with the ovaries develop this hyperemic state at the menstrual period. The catarrh in such cases as this is a transient affair. The rule is that it never remains. There is a possibility that this state of the thyroid gland may emerge into a catarrh proper.

   Treatment.--The treatment should be obvious. Correct the digestion. Stop the improper eating. The eating of candy and other foods between meals must be given up entirely, and meals must be on time three times a day. During the hyperemic state of these glands, one or two days should be spent on fruit entirely: three fruit meals a day--morning, noon, and night. Then one fruit meal may be dropped, and a regulation dinner of meat, salad, and cooked, non-starchy vegetables taken every other day; and the alternate days a starchy dinner, using some kind of decidedly starchy food in place of the meat.

(2) Acute Thyroiditis

   This affection may be the sequel of typhoid fever, scarlet fever, pneumonia, rheumatic fever, or mumps. The entire gland may be involved, or only one lobe of it, and sometimes the isthmus. Where the inflammation ends in suppuration the gland may be destroyed. It is said that exophthalmic goiter has followed an acute thyroiditis, which in turn followed infectious fevers.

(3) Goiter

   Definition.--Enlargement of the thyroid gland. It may occur sporadically or in epidemic form.

   There are three varieties of true hypertrophy of the thyroid gland. The first is a follicular enlargement: newformed tissue develops--gelatinous material accumulates in the follicles. The second variety is vascular. In this variety the enlargement is due entirely to enlargement of the blood vessels. This is the variety that is so formidable when surgeons undertake to extirpate it. Bleeding is tremendous, and I think the majority of surgeons go no farther in such cases than to ligate the artery; which treatment may be somewhat beneficial, but collateral circulation wilt be established and the gland will continue to enlarge. We are having a great many operations of this character, and they are of no special benefit. Why should they be? No cause is even thought of, to say nothing about any attempt being made to overcome the cause.

   The third variety is cystic goiter. This is characterized by a growth resembling cystic tumors. Occasionally this variety will grow to enormous size--as large as a human head. We hear occasionally of epidemics of goiter in different parts of the country. No doubt suggestion has something to do with this disease as well as with others, but there must be something atmospheric as well as dietary. There are certain sections of the countries of Great Britain, France, and Italy where the disease prevails. When the truth is known, it will be found that the foods in such communities are deficient in certain elements, or the style of eating of the people is such as to deprive the system of some of the vital elements necessary to keep a well-balanced state of health. Families and communities exchange ideas, patterning after each other in their style of eating as well as of dressing, and it is not strange that diseases of a certain character should develop in certain communities.

   Symptoms.--An enlargement at the base of the neck--easily discovered where the enlargement is of any size--may be looked upon as a goiter. Just what kind of goiter is presenting must be left to the diagnostic skill of the physician, and just what can be done in any individual case must depend entirely upon the causation. It is my opinion that the majority of cases of goiter of any character have a primary cause of toxin poisoning--or a state of infection due to intestinal absorption of putrefaction.

   Treatment.--Correct the habits or the life. See that the patient is fed properly. If there is a uterine affection, it must be corrected. As a rule, there is a sensitiveness of the mammary glands, and in too many cases the glands are removed because of a suspicion that the disease is cancer or will develop into cancer. The truth is that the uterine derangement, the mammary-gland enlargement, and the goiter all are caused by the same basic lesion. Where there is a great deal of fibroid development the disease is hard to overcome; but this tissue can be caused to absorb, if the patient will be persistent in living correctly.

(4) Exophthalmic Goiter

   Definition.--A disease characterized by an exophthalmose, an enlargement of the thyroid, functional disturbance of the heart and vascular system generally, and said to be caused by disturbances of the secretion of the thyroid gland; or, to be specific, hyperthyroidism.

   Etiology.--This is a disease met with oftener among women than men, although some men develop a fatal affection of this order. There is no question but that the cause is enzymic shortage, allowing toxin poisoning; in this resembling alcoholism. Constitutional poisoning by alcohol is pronouncedly a nervous and physical trouble. Few cases, however, develop such a tumultuous action of the heart as occurs in goiter. There are very good diagnosticians who believe that it is a central lesion located in the base of the brain or in the medulla oblongata. The symptoms said to be produced by the administration of thyroid secretion are tachycardia, headache, sweating, and perspiration. These symptoms are very similar to those found in extreme cases of Graves' disease.

   Symptoms.--The disease is divided into an acute and a chronic stage. The acute disease arises very rapidly. The patient will become exceedingly nervous, the pulse running from 120 to 160. The heart is tremendously tumultuous, and there is a feeling of precordial oppression, approaching that of smothering in severe cases. The eyes have a protruding appearance. Patients are often suddenly seized with vomiting, and sometimes diarrhea. The thyroid gland is found very much enlarged and soft. The gastro-intestinal symptoms are pronounced. The rapid heart action is one of the most pronounced symptoms. The exophthalmos may be unilateral; that is, one eye may be more pronouncedly projecting than the other. In extreme cases it is impossible for the eyelids to close. The protrusion has been known to be so extreme as to dislocate the eye from its socket. This appears rare and exaggerated; yet the projection is at times more than one could imagine to be possible. In the foregoing I have given the usual etiology and symptoms. I shall now give my opinion and impressions in regard to the disease.

   It is a pronounced case of toxin poisoning. The patients affected with this disease have been eating beyond their digestive limitations for perhaps months, and possibly years, keeping up a continuous putrefaction in the large intestine. In nearly all the cases I have seen there has been colitis. The absorption of toxins from the putrefaction, running over a long period of time, has brought on pronounced enervation and an excitable state of the heart and arteries. The arterial pressure is high, and the heart is tremendously overworked. As stated before, there is a decided similarity between this disease and alcoholic neuritis or delirium tremens. Both are caused from toxins--one from alcoholics plus the toxins from putrefaction in the bowels, and the other from simple toxin from putrefaction.

   In Graves' disease or the disease under consideration, there is almost invariably a history of sex neurosis. The patient early in life has begun to practice self-abuse. Then, when maturity is reached, the excess in venereal excitement has been continued. The truth of the matter is that exophthalmic goiter is the culmination of several years of sensualism.

   The fact that the thyroid gland becomes involved in the syndrome to such an extent that it appears to be causative is probably due to enzymic shortage in the gland, allowing a local toxin poisoning.

   Treatment--This disease can be cured, if taken in time. Some of our best medical authorities declare that the seriousness of the symptoms warrants strong measures being carried out; hence they recommend ice to quiet the heart. The ice-pack is to be placed over this organ, and the application is to be continued through day and night until the heart is controlled. Then drugs are given to control the action of the heart. Serum therapy is recommended; also surgical treatment for the removal of part of the thyroid gland. I certainly would not recommend any of these remedies. A patient should be put to bed, and kept there perfectly quiet, away from all friends and family. No one is to come into his presence except the nurse. Water may be given as freely as there is demand--which will not be very often after the first day or two.

   The bowels are to be washed out with copious enemas. If the weather is cold, and there is a tendency for the hands and feet to be cold, hot applications are to be placed to the extremities; but the patient is to be kept in bed, perfectly quiet, and nothing is to go into the stomach except water until the pulse-rate is brought down to ninety or below. By that time the tumultuous heart will have quieted down, there will be less bulging of the eyes, and the whole aspect of the patient will be that of a decided improvement. It may require a week or two, but no hesitancy should be felt in carrying out the instructions to the letter. It is far better to trust the patient in the arms of nature than to trust to remedies questionable in their character and certainly doubtful in their efficacy.

   As soon as the patient is able to eat (and eating certainly should not be started until the symptoms are absolutely under control), several days should be spent on fruit--any kind of fresh fruit that the patient can enjoy--say, three days. Then three days more on fruit morning and night, with an ordinary meal at noon of meat or meat broth and salad, with a cooked, non-starchy vegetable or two, every other day; and the alternate days some form of starchy food in place of the meat or broth, with vegetables and salad. After that a reasonable amount of eating on the order of fruit for breakfast, starch and fruit for the noon meal, and the regulation dinner in the evening.



   This is one of the ductless glands situated behind the sternum. In normal people it is extinct by the time of puberty. 'The only thing that makes this gland of interest is that sometimes it remains and takes on hypertrophy, producing a tumor in the mediastinum. I have met with but one case. The disease started to develop in the young man at about sixteen to seventeen years of age. It grew so, rapidly that it displaced the heart several inches downward and to the left. The patient suffered a great deal, and died at the end of two, years after the tumor had started to grow.

   Treatment.--No treatment seemed to be of any avail; in fact, as in the case of many other tumors situated in the vital parts of the body, nothing can be done after they have once started. The time to cure such derangements is before they have started to grow. I knew this boy when he was an infant at the breast. He was as healthy and normal as other boys, and would have remained so if he had been properly taken care of and his eating had been of the right sort.