CLINICAL SYNDROMES 353 



synchronously in the same patient. In such an event surely the term 

 "Dysthyroidism" seems justified. 



The other diseases of the ductless glands as diabetes mellitus, acro- 

 megaly, and Addison's disease, have been discussed. 



In Locomotor System. Sattler collected from the literature in 1880 

 thirteen cases of exophthalmic goiter associated with osteomalacia. Some 

 years later Koeppen made a post-mortem diagnosis of osteomalacia in a 

 patient with Graves' disease associated with kyphoscoliosis ; he saw another 

 patient with kyphoscoliosis and dental caries. It was not until 1919 

 that another case was added by Hitzenberger, who suggests a possible 

 etiological relation between the two conditions and that osteomalacia may 

 be due to an internal secretory dyscrasia. We agree with the suggestion 

 of Hofstaetter that the complication may be assigned to the hypophysis. 



Revilliod speaks of the pointed fingers as well as of the exaggerated 

 flexibility of the inter phalangeal joints in patients with Graves' disease. 

 Holmgren (a) noted that in eighty-nine cases of Graves' disease occurring 

 before the fourteenth year there was an unusual growth in the long 

 bones with early ossification ; he emphasizes the contrast of this increased 

 growth in young exophthalmic goiter patients with the dwarfism of 

 cretinism and assigns it to a hyperfunction of the thyroid gland. In a 

 later paper he reported one hundred and twenty-seven cases of hyper- 

 thyroidism in youthful patients with an increase in length of body in 

 seventy-five per cent. 



Trophic Changes. Decubitus ulcers have been reported in rare cases 

 according to Moebius. 



Arthropathologic Conditions. Chronic arthritis and intermittent hy- 

 drarthrosis are occasional complications. 



Angiosclerotic Changes. Gangrene of one or both legs has been re- 

 ported according to Moebius (6). This is probably senile in origin and 

 merely hastened by the coexisting Graves' disease. 



Hematopoietic System^ Chlorosis is sometimes observed in the 

 young female suffering from Graves' disease or in a case running a very 

 acute course. 



Pernicious anemia and Graves' disease have been reported occurring 

 in the same patient by Neusser (quoted by Dock (b) ) ; in this case atrophy 

 of the liver was found post mortem. Jaccoud reported another case with 

 icterus, purpura and fatty degeneration of the liver. In the case reported 

 by Stockton and Woehnert there was a thrombosis of the superior vena 

 cava and innominate veins, which developed in the course of acute .Graves' 

 disease complicated by cardiac insufficiency. 



Nervous System. Complete paraplegia and hemiplegia of an organic 

 nature have been observed in a few cases. 



Hysteria occurs in 25 to 34 per cent of cases in Murray's experience, 

 and is manifested by alteration in sensation, paresis, paralysis, convul- 



