.52 FIELDING H. GAKRISON 



of breathing, which was attended with a spitting of blood. She described herself also 

 as having frequent and violent stitches of pain about the lower part of the sternum. 

 "About thrle months after lying-in, while she was suckling her child, a lump of 

 about the size of a walnut was perceived on the right side of her neck. This continued 

 to enlarge till the period of my attendance, when it occupied both sides of her neck, 

 so as to have reached an enormous size, projecting forwards before the margin of the 

 lower jaw. The part swelled was the thyroid gland. The carotid arteries on each side 

 were greatly distended ; the eyes were protruded from their sockets, and the countenance 

 exhibited an appearance of agitation and distress, especially on any muscular exertion, 

 which I have rarely seen equalled. She suffered no pain in her head, but was fre- 

 quently affected with giddiness. [After outlining his scheme of treatment, Parry con- 

 cludes:] From this time no further application was made to me respecting this 

 patient, who probably soon paid her debt to nature." 



Between 1786 and 1815, Parry collected eight cases of this malady, 

 which were published after his death, in 1825. He undoubtedly is en- 

 titled to the credit of the original and classical account of the disease, 

 although he did not, as the French say, afficher, that is advertise his dis- 

 covery by attempting to label it. 



In 1802, Flajani published two cases of "bronchocele" or gozzo, in one 

 of which he recognized two of the cardinal symptoms, the goiter and the 

 cardiac palpitation. In discussing palpitation of the heart at the Meath 

 Hospital in 1835, Robert Graves, the Dublin clinician, published his clas- 

 sical description of exophthalmic goiter, in which the exophthalmic feature 

 was noted. He records that, in one patient, the beating of the heart could 

 be heard at least four feet from her chest. Stokes, one of the greatest in- 

 vestigators of heart diseases, actually believed that the goiter was secondary 

 to the cardiac affection. After the time of Graves and Basedow, many 

 similar observations were collected by clinicians, but it was not until the 

 year 1886 that the condition was attributed to an excessive outpouring of 

 the thyroidal secretion by the German neurologist, Mb'bius, who at the 

 same time described a number of related symptom groups, which he re- 

 garded as due to qualitative or quantitative changes in the secretion itself 

 ( u dysthyroidism"). The eye signs of exophthalmic goiter were localized 

 by Basedow (1848), Albrccht von Graefe (1864), Stellwag and Dalrymple 

 (I860), Mobius (1886) and others. The rapid emaciation attending the 

 disease in spite of liberal diet was not understood until Friedrich Miiller 

 demonstrated that the combustion and tissue waste are due to vastly in- 

 creased metabolism (1892). The value of iodin in the treatment of goiter, 

 already known to the surgeons of Salerno, was demonstrated by J. B. 

 Dumas and Charles Comlet in 1820. The following names have been pro- 

 posed for tlio disease (Dock (a), 1908): Glotzaugen (Basedow, 1840), 

 cachexie exophthalmujue (Charcot, 1856), morbus Basedowi (Hirsch, 

 S5S; Charoot, 1S.V.)), exophthalmic goiter, Graves' disease (Trousseau, 

 ISC.O), W orbo (H Flajani ( Pensutti, 1857), Parry's disease (Osier, 1898). 



In mimeetioii with the cretins observed by Paracelsus around Salz- 

 burg, it is of record that Curling, an English pathologist, first observed 

 hat absence of the thyroid body is accompanied by "symmetrical swell- 



