362 GENERAL DISESSES. 



of the administration of the extract of the gland in cases of myxoedema 

 and in cretins make clear their great importance. Whether directly 

 toxic substances are formed in the thyroid or not, it seems proper to con- 

 sider the cachexia struinipriva as due directly or indirectly to auto-intox- 

 ication. 



EXOPHTHALMIC GOITRE. (Basedow's Disease, Graves' Disease.) 



The characteristic lesions of this disease are unilateral or bilateral 

 enlargement, largely hyperaemic, of the thyroid gland and protrusion of 

 the eyeballs exophthalmos. These lesions are apt to be associated with 

 functional disturbance of the heart. ' There is reason to believe that_this 

 condition may be due to hvpersecretion of the thyroid gland, and that 

 its functional characteristics may he properly regarded as indications of 

 an auto-intoxication. 



s* ~~ 



JEA8E. 



This name is applied to a disease especially characterized morpholog- 

 ically by a peculiar pigmentation of the skin and by certain changes, 

 morphological 07- functional, in the adrenals. The patients suffer from 

 cerebral symptoms, great prostration, syncope, and derangements of the 

 functions of the stomach and intestines. 



The pigmentation of the skin is the symptom which has especially at- 

 tracted attention. The change in color usually begins and becomes most 

 marked in those parts of the skin which are f covered by the clothing 

 of are naturally of darker color. The rest of the skin afterward changes 

 color, but not uniformly, white patches being left. The color is at first 

 a light yellow or brown ; this becomes darker until it is of a dark green- 

 ish, grayish, or blackish-brown. The mucous membrane of the tongue, 

 lips, and gums may be similarly piginented. 



Under the name of Addison's disease different observers have de- 

 scribed cases in which the symptoms and bronzedskji^gxisted without 

 disease of the adrenals ; cases in which the bronzed skin was the only 

 lesion; and cases in which the adrenals were diseased without symptoms 

 or bronzed skin. 



The Skin. The discoloration of the skin is due to deposit of yellowish - 

 brown pigment in the deeper layers of the epidermis, especially in the 

 layer covering the papilla?, and less constantly in the connective tissue 

 of the cutis. 



The Brain. Pigmentation of the gray matter, acute meningitis. 

 chronic meningitis, and distentiou of the ventricles with serum have been 

 observed. 



The Sympathetic Nerves, especially those which are in contactLjvithjtiie 

 admaalvjnay showLajvariety of changesjapparently due to chronic in- 



1 On the relationship between the thyroid and Basedow's disease, consult Eulenberg, 

 Deutsche med. Wochensch., October 4th, 1894; also Edmunds, Jour, of Pathology and 

 Bacteriology, vol. iii., p. 488, 1896; Farner, Virchow's Archiv, Bd. cxliii., p. 509, 1896, 

 bibliography. 



