66 THE DISEASES OF THE THYROID GLAND 



the tremor. Kocher found it clearly manifested in sixty cases out of sixty- 

 three. Slight psychic emotions can make the tremor more evident. In- 

 tended movements do not ordinarily increase it. Fine coordinated move- 

 ments may, however, be disturbed or made impossible on account of strong 

 tremor. Very strong tremor may also assume a choreic character. In 

 fully developed cases the patients are often in an "etat de vibration per- 

 petuelle." The tremor may also affect the tongue, eyelids, lips, the lower 

 extremities, diaphragm, and respiratory muscles; the number of vibrations 

 reaching about 8 to 9.5 in the second, as many as in progressive paralysis and 

 alcoholism; while in senile tremor and paralysis agitans the number is less. 

 The tremor may be readily reproduced experimentally by the feeding of 

 thyroid gland. 



An exactly similar tremor is seen sometimes transitorily in hysteria and 

 neurasthenia, as the graphic registration has shown. 



A further symptom is muscular weakness, even paraparesis of the legs 

 has been observed (giving away of the legs). Stern regards this as hysterical. 

 Also transitory monoplegias and hemiplegias have been observed. Not 

 rarely occur drawing pains in the entire body, or only in the arms or legs, 

 or in the shoulders, and especially in the neck. Kocher found them in a 

 great number of his cases. Mdbius does not believe that they are in direct 

 connection with hyperthyrosis. That there is, however, such a connection 

 is made certain by the investigations of Falta, Newburgh, and Nobel, who 

 obtained the pains in numerous cases after the administration of thyroid 

 gland substance. The same is also true of the headache which is very 

 common in Basedow's disease; indeed it may be the initial symptom and is 

 very common in artificial thyroidism. Also the insomnia of the Basedow 

 patient may occur as the initial symptom; in many cases it occurs for 

 weeks, varying [in intensity], and may reduce the patient very much. 



Almost always occur alterations in the mental life, abnormal irritability, 

 unmotivated gaiety, hasty speech, rapid flow of thoughts, an indication of 

 flight of ideas, rapid change of mood, terrifying dreams; the character alters, 

 the patient becomes mistrustful, choleric, capricious, strikingly euphoric, or 

 often very much depressed. Mdbius happily compares this condition with a 

 very slight "Rausch" in which a maniacal mood may readily occur, and in 

 which a conversion into depression may readily follow. Attacks of laughing 

 and crying may occur, and combination with hysteria is not rare. Some- 

 times the condition terminates in delirium, confusion with hallucination, and 

 coma. 



The transition of these mental alterations into a true psychosis is not 

 rare. Often it is the maniacal conditions, often the depressions, that pre- 

 vail. Also the picture of melancholia may develop. According to Saltier, 

 out of one hundred and fifty cases in literature, more than seventy belong 

 to manic-depressive insanity. For the comprehension of these alterations in 



