146 THE DISEASES OF THE THYROID GLAND 



It is evident that in the above case the sexual element if present at all was 

 subordinate to that of the factor of fright, which was present also in the 

 present case, seen by me at the St. Agnes Hospital. It was that of a highly 

 religious, intelligent married woman, M. H., aged twenty-nine years, who 

 during the strain of nursing a sick father, sustained a fright, during which 

 she found that a burglar had entered her store. A few weeks later her 

 father died. Since the time of his death she suffers from obsession of 

 a religious and " immoral" nature, in the course of which she dares God to 

 do his worst by her, and wishes harm to people. Sometimes the obses- 

 sions are of a sexual nature, and objects in her environment suggest to her 

 thoughts that she is ashamed of. The patient dreams very much, but 

 none of the dreams have a sexual content, at least so far as she states. 

 Her mental and physical conditions have improved somewhat recently, in 

 consequence of a stay at a sanitarium. She has been happily married for 

 five years, shows a moderate amount of libido (it increased very little during 

 the earlier stages of her illness), but has had no children, not because she uses 

 means to prevent conception, but because according to a doctor her "womb 

 is turned/' There is some evidence of hyperthyrosis, fine tremor, pulse 112, 

 rather large thyroid, suggestion of exophthalmos, leucopenia of 2000 and 

 various accessory signs (tendency to looseness of bowels rather than con- 

 stipation, hair has become finer and more luxuriant). 



The factor of fright in the etiology of Basedow's disease has been empha- 

 sized by Crile, whose name is important in the ductless glandular diseases in 

 general, not only because of the fact that he has developed an ingenious theory 

 for the explanation of certain of these diseases (especially Basedow's disease), 

 but also because of his theory and practice of treatment in operating on Base- 

 dow's disease and in general (principle of anoci-association). Crile agrees 

 with the author that Basedow's disease is conditioned by a state affecting the 

 central nervous system; in the course of this the nerve cells of the cerebral 

 cortex become chromatolytic, at the same time that the cells of the liver and 

 the suprarenals become less granular. These organs together with the thy- 

 roid gland, and the muscular elements constitute the kinetic system, the pur- 

 pose of which in the organism is the conversion of potential energy into 

 kinetic energy. The above changes, if I understand Crile rightly, are more or 

 less theoretical for Basedow's disease, but have been obtained by him in a 

 number of conditions such as the various forms of traumatic, emotional, and 

 toxic, foreign proteid, and anaphylactic shock, as well as in various forms of 

 drug poisoning and anemia. As has been stated, Crile has formulated on the 

 basis of theory his principle of anoci-association upon which is founded a 

 method of operating in which the deleterious effects of shock are minimized 

 by a combination of local and general anesthesia. The method has been 

 applied especially to operations on the thyroid gland. Whether or not the 

 good results attest to the truth of the theory, or whether the combination of 



