308 0. P. HOWARD 



Halsted ha,s suggested infection as a probable explanation for the thyroid 

 hyperplasia noted by him following partial thyroidectomy in dogs ; when 

 his assistant used most rigorous aseptic ' procedures not a single animal 

 showed the usual post-operative hyperplasia. 



Tumors of the thyroid may be followed by signs of hyperthyroidism, 

 though not usually. 



Syphilis, especially in the secondary stage, is a frequent cause of a 

 strumitis, according to Engel-Reimers, and is occasionally associated with 

 symptoms of hyperthyroidism, viz., tremor, tachycardia and insufficiency 

 of convergence. Schulmann has also reported some cases of hyperthyroid- 

 ism due to a thyroiditis of both the secondary and tertiary stages of 

 syphilis : he considers the secondary cases amenable to antiluetic measures 

 (but not the tertiary). Clark's case of exophthalmic goiter was believed 

 to be due to congenital syphilis. It was that of a young woman with skeletal 

 signs of hereditary, syphilis and a strongly positive Wassermann reaction, 

 who developed very acute symptoms of exophthalmic goiter, which re- 

 sponded promptly to antiluetic medication. In Swan's series of fifty 

 cases of exophthalmic goiter there was a history of lues, and that ques- 

 tionable in only one case. Yet Castex in 1919 wrote : "The most frequent 

 cause among us (i. e., Argentinians) of disturbances of thyroid function 

 is syphilitic infection either acquired or inherited." In spite of the 

 above abstracts from the literature, we must confess that proof is still 

 lacking that syphilis plays any but a minor role in the etiology of exoph- 

 thalmic goiter. 



Tuberculosis. The frequency of hyperthyroidism in tuberculous 

 patients was first noted by Stanton, Dumas and Hufnagel. Levy found 13 

 cases of Graves' disease among 170 tuberculous patients. Mackenzie (b) 

 believes that such an experience must be quite exceptional, as he has 

 seen only one mild case of Graves' disease in a tuberculous patient. 



Pregnancy and Lactation. These factors play an important but by 

 no means a consistent role. Thus sometimes the symptoms of exophthalmic 

 goiter begin during pregnancy or the puerperium, while on the other hand 

 many patients with Graves' disease improve during pregnancy and do 

 not afterwards relapse, according to the observations of Charcot (&) and, 

 more recently, of Dock (>). It has not been definitely shown that disease 

 of the gonads, or orchitis, and oophoritis have a definite bearing upon the 

 etiology of hyperthyroidism, though Hoennicke, who noted the relation- 

 ship between osteomalacia and Graves' disease, suggested an ovarian source 

 because of a supposed connection between osteomalacia and ovarian dis- 

 ease; however true this may be it is, needless to say, an exceedingly rare 

 coincidence. 



Nasal disease has been emphasized by many, some even suggesting 

 that swelling of the nasal mucosa can reflexly produce the syndrome and 

 that cauterization of the nose will cure the disease ! 



