BASEDOW'S DISEASE. 339 



takes place, the prominence of the eyes subsides as completely as do 

 the thyroid enlargement and the disturbance of circulation. 



That this ifc not a mere coincidence of morbid conditions, and that 

 it is fully entitled to be regarded as a separate and distinct disease, is 

 evident from the circumstance already alluded to, that the changes in 

 the thyroid and eyes, not only appear simultaneously with the derange- 

 ment of the circulation, but that they also subside together. 



In seeking for a common source to which the individual symptoms 

 of Easedoufs disease may be attributed, the idea of a derangement of 

 innervation of the vascular walls naturally suggests itself. Palsy of 

 the vaso-motor nerves fully accounts for the dilatation and increased 

 pulsation of the carotids and thyroid arteries, as well as for the oedem- 

 atous swelling of the thyroid gland and intra-orbital fat. The sub- 

 ject of the innervation of the heart, indeed, is by no means satisfac- 

 torily understood, in spite of the labor expended upon the subject; yet 

 it is perfectly supposable that variation in the degree of fulness of 

 the blood-vessels, which traverse the substance of this organ, may have 

 an important influence upon its function ; and that palsy of the vaso- 

 motor nerves of the cardiac vessels will cause them to dilate, thus aug- 

 menting the supply of blood to the cardiac muscles, and producing 

 essential modification of the heart's action. We have no hesitation in 

 declaring our belief that the probable cause of the symptoms of IBase- 

 doufs disease consists in a subparalytic state of the vessels of the mus- 

 cles of the heart. At the same time we deem it rash, or at least pre- 

 mature, to ascribe such palsy of the vascular walls to coarse structural 

 changes of the cervical ganglia of the sympathetic nerve. Apart 

 from the fact that the lesions of the ganglia in some cases are entirely 

 different from those found in others, and that in other instances again, 

 in spite of the most careful search, no lesion whatever has been found 

 in the ganglia, it is improbable that the nervous disorder of the vas- 

 cular wall should depend upon coarse and palpable alterations of tex- 

 ture of the nerve-fibres and ganglion-cells, simply because such nervous 

 derangement often subsides entirely. 



Basedow*s disease is far more common among women than among 

 men ; menstrual disorder, or perhaps the lack of red corpuscles in the 

 blood, which so often accompanies such disorder, also seems to have 

 some part in its production ; but it is altogether inadmissible to regard 

 such disease of the vaso-motor nerves as a mere part of that wide- 

 spread disorder of innervation, which occurs in hysteria, and to attrib- 

 ute the relaxed state of the vessels to faulty nutrition, either of the 

 vessels or of their nerves, proceeding from the want of red corpuscles 

 in the blood. Indeed, JBasedow's disease is not especially prevalent in 

 cases of severe hysteria or intense chlorosis, and in some cases eveo 



