EXOPHTHALMIC GOITRE. 277 



shown, for example, that exophthalmia may be determined by injecting 

 injurious substances excreted by the kidney. MM. Ballet and Enriquez 

 exhibited at the Societe Medicale des Hopitaux a dog in which the 

 symptoms of exophthalmic goitre had been produced by long-continued 

 feeding on extract of thyroid gland. Toxic principles poured into, or 

 retained in the blood in excessive quantity act on the nervous centres, 

 and thus excite the complex disturbance recognised as exophthalmic 

 goitre. 



When clearly marked and accompanied by the essential symptoms 

 exophthalmic goitre cannot be mistaken for any other disease. No 

 other produces excessive prominence of the eyes, enlargement of the 

 thyroid gland, palpitation, and trembling movements. Nevertheless 

 in ill-defined or incomplete cases mistakes are easy. Even in man the 

 disease has sometimes been mistaken for slowly developing typhoid 

 fever, or for tuberculosis. Until recently its occurrence in animals 

 was not recognised ; it formed one of that group of unnamed diseases 

 the nature of which can only be discovered by clinical and anatomico- 

 pathological investigations. When recent it may be mistaken for true 

 palpitation, for " diaphragmatic chorea," or for heart disease. But 

 simple cardiac palpitation and spasm of the diaphragm are usually 

 temporary affections ; and even when they persist for a certain time 

 they at least diminish in intensity after a few days, while the other 

 symptoms of exophthalmic goitre fail to appear. Similarly in true 

 heart disease there is neither enlargement of the thyroid, protrusion 

 of the eyeballs, nor trembling. 



The prognosis is grave. In most cases, as I have said, the disease 

 steadily progresses, and leads to death after a varying period ; in others 

 it may become arrested. Sometimes it disappears almost completely; 

 sometimes cure is incomplete, enlargement of the thyroid and ex- 

 ophthalmia persisting in a modified degree. 



Treatment includes administration of drugs and surgical interven- 

 tion. Patients should receive nourishing food, should live in the open 

 air, and be rested or very moderately exercised. Electricity, especially 

 in the form of the continuous current, has been recommended, the 

 terminals being applied on either side of the heart. Hydrotherapy 

 also has its supporters. Medication is chiefly symptomatic, and com- 

 prises the administration of iodine, iodides, bromides, digitalis, valerian, 

 and arsenic. A new method of treatment, which has been attended 

 with improvement, and even with cure in some unlooked-for cases, 

 ■consists in administering thyroid extract, or tabellae of iodothyrin. 



Encouraging results have also followed surgical intervention in 



