GOITER HEART 157 



stagnation in the lesser circulation may lead to enlargement of the thyroid 

 gland with greater or less manifestations of hyperthyroidism (Revilloid's 

 "goitre cardiaque"). 



Revilloid already mentioned that slight manifestations of hyperthyroid- 

 ism may occur with this "goitre cardiaque." This was later made intelligible 

 by the experiments of Blum which showed that ligation of the thyroid veins 

 leads to an eddying out of the thyroid-gland secretion and therewith to a 

 slight hyperthyrosis. Later, cirrhotic changes occur in such thyroids. 



Fr. Kraus first mentioned that there were numerous cases of cardiac dis- 

 turbances in goiter in which all stagnation is absent, and in which, therefore, 

 the mechanical factor as a cause does not come into consideration. In the 

 light forms of these are found tachycardia, often dicrotism of the pulse, slight 

 strengthening of the apex impulse, beating of the carotids, sometimes arrhyth- 

 mia, glittering eye, sometimes indeed a slight degree of exophthalmus, in- 

 clination to sweating, trembling, and eventually slight heightening of the 

 fundamental exchange, in short phenomena of a slight hyperthyrosis. In the 

 severer forms are found, in addition, hypertrophy and dilatation of the heart 

 and degenerative changes in the cardiac muscle. Also v. Mukulicz and 

 Reinbach found similar symptoms in a great percentage of the goitrous that 

 they examined. 



The fact that hypertrophy and premature degeneration of the cardiac 

 muscle is found so frequently in the goitrous with cardiac disturbances indi- 

 cates that we are here not dealing with the ordinary forms of hyperthyroid- 

 ism. Fr. Kraus first championed the greater nosological independence of this 

 form; the newer investigation, results of Minnich and E. Bircher seem fully 

 to corroborate his contention. The opinions of Minnich, in his significant 

 monograph, in so far as he regards these Basedow's manifestations as the 

 expression of a diminished thyroid-gland function, are not shared by the 

 author. Entirely new views, however, are opened by Minnich in his descrip- 

 tion of cardiac disturbances in relatively young strumous individuals of 

 )oth sexes, which mostly set in with new impulses in the growth of the goiter 

 and lead objectively to enlargement of the heart, eventually with the gradual 

 development of a protrusion of the precordium, and frequently also of 

 accidental murmurs and subjectively to pains in the cardiac region, pricking 

 pains, pressure, painful precordial points of tenderness, and cardiac palpita- 

 tions. Such cases may remain stationary a long time, or even become cured, 

 >r they may go over into tachycardia. This was the case in eleven of twenty 

 :ases. Here, therefore, we are dealing with a form of goiter heart in which, 

 it least in the beginning, hyperthyroidal symptoms were hardly present. 



The fundamental significance of these observations is supported by the 

 experiments of E. Bircher. Bircher saw enlargement of the heart almost 

 regularly in the animals in which he artificially induced struma by giving 

 them goiter water to drink. The weight of these hearts averaged one-third 



