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Exophthalmic Goitre

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EXOPHTHALMIC GOITRE (known also as BASEDOW'S DISEASE, and as GRAVES' DISEASE).—Morbid protrusion of the eyeballs, with goitre, and disordered action of the heart. The disease was described in 1843 by a German physician, Basedow. and also by Graves, an Englishman. It usually appears in families where there is present a tendency to nervous diseases, and the hereditary element can often be directly traced. The affection is found more often in women than in men, and usually comes on during the early years of adult life. Its appearance is in many cases preceded by conditions which run down the system, by severe diseases, by subjection to intense mental excitement, and by over-exertion. The trouble begins with palpitation and a sense of internal unrest, and with tremors, debility, and weakness.

After a time the characteristic evidences of the disease appear : a moderate enlargement of the thyroid (goitre), and the forward displacement of the eyeballs (exophthalmos). It often happens that the disease is not recognised before it readies this point. A feeling of internal heat and immoderate perspiration now set in ; the sleep is interfered with ; and the appetite soon becomes poor. The patient usually becomes very thin, and a number of nervous and mental symptoms appear.

The subjects are irritable, their memory is poor, and this condition may even go on to melancholia and insanity. There is almost invariably rapid and irregular heart-action. The most marked sign, which is evident to the unpractised eye, is the protrusion of the eyeballs, so that the white of the eye seems very large (Plate XVIII., Fig. 1). The disease develops slowly and has a very chronic course, periods of improvement alternating with aggravated conditions. The sense of internal heat prompts the patients to

don very light clothing ; they prefer to keep cool, and like to sit at the open In the treatment of this condition, the patients must be protected from harmful influences, and should avoid all mental excitement. In most cases this advice can be followed only with difficulty. A life in the country, particularly in the mountains, is to be recommended ; or else a term of treatment in the proper kind of sanatorium. Care must be taken not to subject the patient to too many " cures." Among the remedial measures may be mentioned mild hydrotherapeutics, cool baths, half baths, the application of electricity to the neck, and simple but nourishing food, consisting mainly of milk and vegetables. In addition to these, medical treatment is necessary. The use of the thymus gland (not the thyroid) of sheep has been credited with success ; but the more modern treatment with specially prepared blood-serums from animals will probably be attended with a better outcome. In severe cases, where the goitre is very large, surgical interference, by which the gland is diminished in size, may be con sidered necessary ; but this should not be resorted to until all other of treatment have failed. It should he borne in mind that worry about the condition is one of the most frequent causes of the rapid, irregular heart action. If patients suffering from this disease would resolutely still their fears concerning themselves, they would aid the physician very materially in the treatment.