ADDENDUM 145 



tained on incision. In the majority of cases, such energetic treatment will 

 not be necessary. The application of cold to the neck in this case is a means 

 of physical treatment that must not be forgotten or dispensed with. 



The question of dysfunction in the cases of Basedow's disease has by no 

 means been disposed of, and in America has attracted no less an authority 

 than Halsted, who has been much impressed with recent experiments of, 

 among others, Klose, Lampe, and Liesegang. Lampe has been active in 

 applying to the sera of Basedow's patients the Abderhalden reaction, with 

 various organs as the objects to be acted on, with the result that he finds 

 present in the sera ferments against ovaries, thyroid, thymus, and no other 

 organs. Deutsch has also experimented along these lines and has found that 

 thymus gland tissue is split up also by normal serum. The significance of 

 these experiments would seem to point to some defect of thyroid secretions; 

 whether or not the positive results of the experiments mentioned above would 

 tend to rule out simply a mere excess of thyroid secretion is not known to the 

 editor. 



The fact that the sera act on ovaries in the Abderhalden test would point 

 to some defect in ovarian action. It is well known that Basedow's disease is 

 often associated with, in addition to the menstrual disturbances that seem to 

 be a part of the disease itself, pelvic disturbances, and that the disease is often 

 considerably ameliorated, if not cured, with the remedying of these pelvic 

 conditions. This fact has been repeatedly pointed out, and is mentioned 

 among others by Porter. According to Lampe, dysfunction of the branchio- 

 genic organs leads to dysfunction of the sexual glands. In some women, 

 there is no doubt that the pelvic or the sexual trouble has led to marital un- 

 happiness, this even when there is no gross gynecological lesion. According 

 to Thomas, who in speaking of the subjects of exophthalmic goiter states that 

 "nearly every married woman with whom I have discussed the matter has 

 admitted some sort of incompatibility with her husband, and since it almost 

 always appears during the active sexual life, I strongly suspect a distinct 

 relationship." 



The transition into the sexual sphere leads us once more into the confines 

 of the Freudian hypothesis. Scarcely any of the most ardent of the advo- 

 cates of Freud would venture the assertion that Basedow's disease is the re- 

 sult of a suppressed sexual experience of childhood, yet such a Freudian dis- 

 ciple might find evidence for it in a case of Basedow's in a child fifteen years 

 old, that I saw at the St. Agnes Hospital, Philadelphia. This child had been 

 the victim of an attempt at rape, immediately after which it developed the 

 classical symptoms of Basedow's disease (I am not certain as to the pres- 

 ence of an enlarged thyroid) and almost utter inability to speak, which 

 symptoms had persisted for some months. I am not certain as to the ulti- 

 mate fate of the child, as she had been referred to the hospital from a country 

 district, and paid only one visit to the hospital. 



