Among the psychoses observed are oversensitive notion of duty and inco herence of ideas. A. Maude (Brit. Med. Jour., Oct. 21, '93).
Changed mental state in cases of Craves's disease noted, especially motor restlessness, which sometimes almost imitates a chorea, and which is present in subacute mania and neurasthenia. Its value is that it expresses their men tal attitude as well. They are subject to fright—often have hallucina tions of sight and sometimes of hearing. The memory is usually much impaired. Their mental processes are fragmentary.
They have no fixity of attention, and often present a distinct tendency to melancholia. Hysteria and the psy chical changes of hysteria are frequently present among them, and in rare cases the disease is marked by the develop ment of acute mania. Maude (Med. Press, Sept. 4, '95).
Polydipsia, excessive thirst, ravenous desire for food, and other morbid sensa tions of this complex sort are classifiable here. The sexual feelings are often be low the normal.
Epilepsy, hysteria, chorea, and paraly sis agitans may complicate Graves's dis ease, and in the case of the former two affections, especially of epilepsy, the con nection seems particularly close, so close that epileptic attacks are thought by some observers to belong to the specific symptomatology.
[A patient with Graves's disease under my own care, a lady of 30, has had seri ous attacks for many years, some of which have seemed positively epileptic, others at least in great part hysterical. The diagnosis of hysteria has seemed strengthened by the fact that the seiz ures usually come on when she hears music, so that she has given up the piano altogether, although previously devoted to it, and shuns hearing others play. JAMES J. PUTNAM.] Hysteria and its hallucinations form the material out of which ideas of per secution are created in exophthalmie goitre. Ballet (Jour. of Nervous and Mental Dis., July, '90).
It would be premature to assume that the toxic agent at work directly excites the convulsions. This is possible, but it is more probable that the epilepsy is as sociated with Graves's disease just as it may be associated with migraine or with tabes. A tissue-poison of some sort, not necessarily that which is found in the thyroid, may act as the exciting cause.
Local cramps and muscular spasms are of occasional occurrence. It is not known whether they are of central or of periph eral origin.
Tremor is almost, though not abso lutely, universally present. It is fine and rapid, and usually involves the hands alone, though sometimes also the head and other parts.
The tremor of Graves's disease is most marked in the hands, and may be con _ fined to them. Other muscles most often affected are the pectorals, ser rates magnus, and erector spinet. If the tremor is well marked in any group of muscles, it is sure to be general over the whole body to some degree. Placing the hands on the patient's shoulders when he is standing will detect even very slight tremor. Maude (Brain, Autumn, Winter, '92).
Choreiform twitchings are also com mon, suggesting the fine, jerky move ments of many young girls of nervous temperament.
The voice in Graves's disease is occa sionally stridulous, weak, high pitched, and tremulous, but one should not too hastily refer this to localized lesions causing paresis of the vocal cords. This, too, may occur, but the peculiar change of voice is, perhaps, a phenomenon of more subtle character.
Localized paralyses and atrophies be long to the rarer signs. The paralyses are analogous in general characters to those met with in tabes. In both cases there may be either transitory or rela tively permanent loss of power in the muscles supplied by cranial nerves, cially the eye-muscles, and those of the face and the larynx; while the sudden, functional paraplegics of tabes are, per haps, analogous to the "giving way of the legs" in Graves's disease.
The following symptoms may occur besides the classical trio: Elevation of temperature of one or two degrees (the urine presenting no febrile character); muscular trembling constant, uniform, uninfluenced by voluntary movements (the myograph shows eight or nine oscillations a second, the most rapid type of trembling known) ; sensation of warmth; giving way of the legs (mild paraplegia) without spasmodic phe nomena or lancinating pains. Ghareot (Le Bull. Mod., Feb. 3, 'S9).