Two cases of exophthalmic goitre which appeared suddenly in soldiers after being in battle. In the one case, aged 30 years, the mother of the patient had been operated on for goitre. W. H. Har land (Brit. Med. Jour., Sept. 1, 1900).
There is probably a fright-centre as well as a speech-centre, and this may be congenitally weakened. A physical manifestation in the thyroid in a pre disposed person may assume a perma nent character from an inherent predis position. F. W. Higgins (Jour. Amer. Med. Assoc., Sept. 8, 1900).
Among the causes of this order are influences associated with pregnancy and childbirth. It has, to be sure, been thought that another explanation was nearer,—namely, that based on some special relationship between the func tions of the thyroid and those of the erative organs,—but as somewhat against this is the fact that there is no close cor relation between the special phases of the uterine disturbance and the thyroid dis ease. Both pregnancy and childbirth may excite or aggravate or, on the other hand, lessen the symptoms of exoph thalmic goitre.
Attention called to the very intimate relation which exists between the meno pause and pathological conditions of the uterus and Basedow's disease. In this relationship exophthalmic goitre placed in the position of an effect or conse quence, and not the cause, of the uterine condition. An improvement in the local condition is always followed by the ap pearance of the general disease. Jouin (Nouv. Arch. d'Obstet. et de Gynec., No. 6, '95).
How do emotional excitements and quasiphysiological strains and neuro pathic tendencies act in inducing Graves's disease? Are they to be classed as exciting or as predisposing causes; or is there no real difference, here, between excitation and predisposition in this con nection? The extreme advocates of the thyroid (toxic) theory assume that in all cases of relatively-sudden outbreak a certain degree of this special form of thyroid disease or at least of impaired power of resistance to disease was ready present, and that the causes men tioned act by increasing the instability of equilibrium of the nervous system and so making it react in such a way to the thyroidal poison as to increase in its turn the thyroid disease. The thyroid disease
could not, it is thought, be caused by a nervous influence, such as fright, even combined with that of neuropathic pre disposition. But the truth is that in exercising our ingenuity over explana tions of this sort, which involve tions that may or may not be true, we are apt to forget that the conditions may really be far more subtle than we con ceive them. For the present the impor tant thing to remember is the broad fact that nervous perturbations do at times bring on the signs of the disease in a remarkably-rapid manner, and that so far as one can tell it is not necessary in such cases that antecedent thyroidal dis ease should have been present. We are as ignorant of the real mode of action of the emotional cause as we are in the case of chorea or of paralysis agitans. We cannot deny that some special predis position may exist in a latent form in all these cases, and should admit that the discovery of its presence would simplify the problem, since otherwise it is not easy to see why an influence so common as that of emotional excitement should produce in different cases such diverse effects. I would only, in addition, fore shadow a theory which will be explained below at greater length : namely, that there is not only a relation of cause and effect between a special form of thyroid disease and the other signs and symptoms of exophthalmic goitre, but also a close correlation between the thyroid func tions and certain special nervous func tions in health. If this is so it is easier to understand how certain particular kinds of irritation should more fre quently act as causes for Graves's disease than other irritations apparently of equal severity.
The secretion of the thyroid is ex aggerated and probably altered. R. XV. Briggs (Edinburgh Med. Jour., Feb., '93).
Graves's disease considered a disease of the thyroid rather than of the nerv ous system. W. S. Greenfield (Brit. Med. Jour., Dcc. 9, '93).