One of the most interesting features in this case is the result of the analysis of the blood, as to its corpuscular richness. Before thyroid treatment was commenced, the number of corpuscles was only 2,225,000 per cubic millimetre; after the cure by the thyroid juice, the number was more than doubled, being 4,774,000 per cubic millimetre. In Dr. Lewis Bruce's cases, to which I have already referred, the result was the reverse of that observed by M. Voisin; for in the eight uncomplicated cases recorded by Dr. Bruce, with one exception, there was in all of them a diminution in the number of red corpuscles.
At the discussion on Myxœdema, at the Edinburgh Medico-Chirurgical Society, to which I have already alluded, Dr. Alexander Bruce showed a case of myxœdema under the care of Professor Fraser, in the Royal Infirmary, in which, as the result of thyroid feeding, a condition of relative anæmia had been developed. The patient had no murmurs when admitted, but since the administration of thyroid preparations, basal and mitral systolic bruits had developed themselves. It is further stated that the blood corpuscles had fallen from 4,600,000 to 3,700,000, and hæmoglobin from 78 per cent. to 59 per cent.[45]
Further researches would therefore seem to be necessary, before we can arrive at a satisfactory conclusion as to what effect the thyroid treatment has upon the blood.
Possibly the dose of the thyroid preparation may be an important factor in the result, for Dr. Byrom Bramwell, in an important and exhaustive monograph upon this subject, says, that anæmia is apt to be produced by large doses of the remedy; and he mentions a case where the red blood corpuscles and the hæmoglobin underwent a marked diminution during the period of acute thyroidism, but rapidly increased under the subsequent administration of small doses of the remedy.[46]
The subject of blood analysis is most important, as tending to throw some light upon a matter at present but little understood, namely the physiological effect of thyroid preparations upon the blood.
Dr. Telford-Smith has reported four cases of Sporadic Cretinism treated by thyroid extract at the Royal Albert Asylum, Lancaster, when a well-marked improvement was noticed in each case. The clinical history of these cases is given with minute detail by Dr. Telford-Smith, and is well worthy of close study by those interested in this subject.[47]
Quite recently, at the Annual Meeting of the British Medical Association, held at Carlisle in August of the present year, communications were read on the Thyroid Treatment of Cretinism and Imbecility, by Dr. Rushton Parker, Dr. Telford-Smith, Dr. John Thomson, and others. An animated discussion ensued, the tendency of which pointed to the undoubted advantages both physically and mentally of the use of this remedy.
Although the physiological effects of thyroid feeding may not be definitely recognised and understood, there is overwhelming evidence to show that it produces marked psychical results, that it acts as a direct cerebral stimulant, and we have every reason to rely upon it as a valuable adjuvant to our treatment of idiocy; and it is not too much to say that the treatment of this infirmity, as well as of other mental defects, by thyroid extract or some other preparation of the thyroid gland, is one of the greatest triumphs of modern medicine; but much still remains to be learnt, as Professor Victor Horsley remarks, "So definite and pronounced is the cachexia thyroidectomica, that few subjects in the range of pathology offer a more fruitful and inviting field of research."[48]
Craniectomy.—The operation of Craniectomy (that is the cutting of strips of bone from the cranium) has been recommended and practised in cases of microcephalic idiocy, an operation suggested upon the theory of premature synostosis, or closure of the cranial sutures, thus causing an arrest in the development of the subjacent cerebral tissue. Although I could not omit a reference to this operation, it has not met with general acceptance, and one of the most recent writers on this subject, M. Bourneville, physician at Bicêtre, discourages it altogether; and from his examination of the skulls of a number of idiots, he affirms that "in the immense majority of cases, there was no premature synostosis, and that neither normal anatomy, pathological anatomy, or physiology, justified the operation of Craniectomy."[49] The late Sir George Humphry was of the same opinion, as, after an examination of 19 microcephalic skulls, he said, "There is nothing to suggest that the deficiency in the development of the skull was the leading feature in the deformity, or anything to give encouragement to the practice lately adopted in some instances of a removal of a part of the bony case, with the idea of affording more space and freedom for the growth of the brain."[50]
At a recent meeting of the New York State Medical Society, Professor Dana read a paper on Craniectomy for Idiocy and Imbecility, and he gave the following result of 81 cases:—In 35, there was improvement; in 22, no improvement; and death ensued in 24 cases. The conclusion at which Professor Dana arrives is that "it is largely through its pedagogic influence that an improvement takes place, and that the operation is allied in its effect to a severe piece of castigation!" Dr. Dana freely admits that this view of craniectomy for idiocy and imbecility lends itself readily to humour, and it would seem that he intended to kill the operation by ridicule.[51]