354 C. P. HOWAKD 



sions, astagia-abasia and contraction of the fields of vision. Many of the 

 cases of so-called epilepsy are rather examples of major hysteria or hystero- 

 epilepsy. 



Epilepsy may occur as a coincident disease or as a complication. In 

 the latter case Ballet suggests that it is due to changes in the cerebral. cir- 

 culation dependent upon the damaged action of the heart. 



Paralysis agitans has been found as a rare association of Graves' 

 disease, according to Moebius and Gordon (quoted by Dock). 



Tetany. "Idiopathic tetany" seems to be a very rare complication 

 though it has been mentioned in the literature. In one case in our own 

 series typical tetany seizures were observed on several occasions in a 

 young woman with a moderately severe form of Graves', disease ; while no 

 Trousseau phenomenon could be elicited there was a distinct increase in 

 the mechanical and electrical irritability of the nerves. 



"Post-operative tetany" must have been relatively common in the early 

 development of the surgical treatment of the disease. Judd, of the Mayo 

 Clinic, has observed only seven or eight instances of temporary tetany, 

 apparently resulting from trauma to the parathyroids during therapeutic 

 strumectomy; in one instance it followed the ligation of both inferior 

 thyroid vessels at one operation and was the most severe case. While it 

 persisted for seven weeks it was controlled by calcium lactate. 



Tabes dorsalis is often a complication, in Dock's opinion; though we 

 must confess never to have seen it ourselves, there is not infrequent 

 reference to it in the medical literature, especially of France. It is of 

 interest because its presence would suggest the possibility of the syphilitic 

 origin of the thyropathy in such a case. 



Thomsen's disease has also been reported as a complication. 



Cerebral Nerve Paralyses. Sattler and Kappis have collected all the 

 cases from the literature up to the year 1911. Heuer, five years later, 

 was able to find eighty cases and added one of his own. It is probably a 

 rare complication in spite of the number in the literature, as on account 

 of its rarity the majority have no doubt been reported. A review of the 

 literature shows that almost every cerebral nerve has been involved either 

 alone or in combination with other nerves. The most interesting is a 

 group with the picture of "bulbar paralysis" as seen in Heuer's case and 

 in ten others in the literature. The spinal accessory appears to be the 

 only cranial nervo to have escaped involvement in exophthalmic goiter; 

 thus 1 leuer found isolated palsies of the first, second, third, fourth, sixth, 

 seventh and ninth nerves quite commonly and combined lesions of the 

 motor fifth, eighth, tenth and twelfth nerves in the bulbar cases not in- 

 frequently. The third or oculomotor nerve has been the most frequently 

 involved and next to it the sixth or abducens. Ballet concluded from a 

 consideration of his five cases that the ocular palsies may occur alone or in 

 conjunction with other phenomena of hysteria and regards them as of 



