Development of the disease requires two factors: first, a functional anomaly of the thyroid gland, and, second, a neuropathic condition, either hereditary or developed through fright or trouble. Muller (University Medical Magazine, Sept., '93).
Group of cases showing the complexity of relationship between ordinary goitre and Graves's disease, and likewise as an example of family tendency. A mother and three daughters were afflicted as fol low: The mother had goitre, with diffi culty of breathing; the oldest daughter had goitre without nervous symptoms; the next daughter had complete Graves's disease, following strong emotion and beginning with an attack of cardiac de ficiency; the third daughter had a mild form of typical Graves's disease without apparent cause. Soltas (France Med., Aug. 14, '96).
Neurotic heredity and emotional ex citement considered the most important of the predisposing causes. Valencon (Gaz. des Hop., June 19, '97).
There can be no doubt but that Graves's disease is more common in neu ropathic families and among neuro pathic persons than in connection with sound health, and it is equally certain that it often develops rapidly after ex posure to fright, prolonged anxiety or excitement, profound grief, or after phys iological strains such as draw strongly on the resources of the nervous system.
Neurosis is the only satisfactory con ception of the disease. Leflaive (Gaz. des HAIL, Jan. 12, '89).
Fright seems to be an etiological fac tor. The disease is a widely-distributed derangement of the emotional nervous system, but alteration in function of the thyroid has much to do with many of the secondary symptoms. H. W. G. Mackenzie (Lancet. Sept. 20, '90).
Exoplithalmic goitre considered a branch of the neuropathic and closely related to the arthritic family. Char cot (Schmidt's Jahrbficher, Feb., '91).
The approximate cause of Graves's disease is probably abnormal action of the thyroid gland. The conditions favor ing the development are: female sex, neuropathic state, climatic conditions, all causes diminishing the resistance of the organism, and especially mental shock. Mobius (Med. Chronicle, July,
'92).
Exophthalmic goitre considered a gen eral neurosis, having at times spinal, bulbar, and cerebral symptoms. It can precede, follow, alternate with, or ac company other manifestations of mental degeneration. The psychical troubles of exophthalmic goitre do not form an in tegral part of the affection. Their asso ciation with this affection is the result of the hereditary condition from which they both arise. Exophthalmie goitre is a pons-medullar neurosis, consisting in the exaggeration and permanence of the physiological phenomena of emotion. Raymond and Serieux (La Semaine Mod., Aug. 10, '92).
Only an organic lesion of the central nervous system can explain all symp toms. P. Mannheim (Schmidt's Jahr bticher, Feb. 15, '94).
Strong emotional disturbances arc the most common causes of this disease. These affect the brain in such a way that vascular disturbances result. Sooner or later substances are set free in the blood, perhaps largely from the enlarged and overnourished thyroid, and • these cause a principal part of the other symp toms, as, for example, the nervous ones. So it is easy to understand how removal of the gland frequently causes improve ment, evidently without removing the disease, nor is it likely that organic changes can be found in the brain in a disease of this kind. C. Gerhardt (Mit thellung,en aus den Grenzgebciten der Med. u. Chir., B. 1, H. 2).
The majority of the symptoms are traceable to some lesion of the sympa thetic nervous system. Some are the result of irritation along the sympa thetic, while others are due to paralysis of the sympathetic. William C. Krauss (Buffalo Med. Jour., May, '96).
Case of a woman, aged 33 years, who, through a fall in a stairway, was badly frightened. Symptoms of exophthalmic goitre immediately followed. Within two months, however, the palpitation lessened, and my:co:edematous swelling of the face and of the lower extremities occurred. The goitre became fibrous, the uterus passed into a stage of atrophy, and the skin was dry. J. A. Kirschi (Wiener klin. Woch., July 5. 1000).