Page:On the pathology of exophthalmic goître.djvu/1



pathology of exophthalmic goître has attracted attention, and has been a subject for discussion since the disease was first described by Graves. The importance of the subject is evident, for future advances in our methods of treating the disease will largely depend upon a clear explanation of its pathology. It will, therefore, be useful to consider the subject in the light of recent experimental research and clinical observation in order to obtain a clear expression of opinion upon the main points which require further explanation.

When we examine a typical case of exophthalmic goître we find that the most prominent symptoms are the goître, the exophthalmos, the tachycardia, the various nervous symptoms, and the condition of the skin. As a natural consequence the heart, the nervous system, and the thyroid gland have each in turn been considered to be primarily at fault, and different theories based upon some observed or suspected morbid change in one or other of these organs have from time to time been advanced in order to explain the phenomena of the disease.

Few, if any, now maintain that exophthalmic goître is primarily a disease of the heart, for it is generally allowed that the cardiac symptoms are secondary to disease of either the nervous system or thyroid gland. We thus are left to consider whether the disease is really due in the first instance to morbid changes in the nervous system or in the thyroid gland.

Many symptoms which occur clearly indicate that the normal functions of the nervous system are deranged, but this is not evidence of the existence of definite changes in the structure of any part of the nervous system, as all these symptoms may well be the result of the action of some toxic agent or of some altered state of nutrition upon the nerve centres. When we examine the records of cases in which the nervous system has been thoroughly examined, we are at once struck by the fact that in many cases no lesion has been found. On comparing the accounts of those cases in which a definite lesion has been found we find that the lesions described vary considerably in different cases, though each one may be definite enough in itself.