This is not a very common disorder. It was first publicly noticed by Dr. Graves, in his "Lectures," in 1835, and it is therefore sometimes called "Graves's Disease." It has since been more fully described by Dr. Stokes, and by Trousseau, and Dr. Cheadle has published an account of seven cases, in the "St. George's Hospital Reports."

This disorder is characterized by three particular symptoms: throbbing of the Heart and of the Carotid and Thyreoidal arteries, enlargement of the Thyreoid gland, and prominence of the eyeballs. This last symptom is generally so singular and so startling as to arrest attention at once, and it has given rise to the familiar name of the complaint, Exophthalmic Goitre.

The appearance presented by the prominent eyeballs is most striking and peculiar. Both of them are always affected. They seem to be enlarged, though in reality they are not so, but simply pushed forward. In extreme cases the bulging globes get beyond the enclosure of the eyelids, so that the eyes are never shut up. Even during sleep they look awake and staring. Trousseau mentions a case in which the margins of the eyelids got behind the largest circumference of the eyeball, which had to be pushed back before they could be got into place again. The projecting eyes are movable and lustrous, and the patient's look is wild and strange. It is a remarkable circumstance that vision, in this disease, is scarcely at all interfered with, and that the uncovered lining membrane of the eyelids does not become inflamed, as it is liable to do in facial palsy.

All three of the symptoms become more prominent under bodily exertion or mental excitement, and, in women, during the menstrual period.

The swelling never attains the enormous size, nor assumes the uncouth shapes, which are common in ordinary Bronchocele. The right lobe is usually the most enlarged. The arteries of the gland, especially its inferior arteries, as well as the carotids from which they spring, throb strongly; and the superficial veins are often visibly turgid and prominent. When the patient recovers, or the symptoms improve, the gland, though it gets less in bulk, does not generally recede quite into its natural dimensions, but becomes firmer from some interstitial deposit, the result of congestion long continued.

The Goitre, in these cases, is not dependent on any influences of soil or climate. Of the remaining symptom, the palpitation, though it is increased by bodily efforts and by mental emotion, still it is at all times present; and the heart's action, thus constantly forcible and frequent, is not necessarily associated with any organic disease of that organ. The glandular enlargement, and the protrusion of the eyeballs, taking place gradually, are not at first so liable to be noticed as the throbbing of the heart and arteries. Instances have been noticed in which one of the three symptoms have been absent; there may be palpitation and the affection of the eyes only, or there may be palpitation and Bronchocele only, but Bronchocele and the affection of the eyes do not occur together without palpitation. The throbbing is always the first symptom noticed by the patient.

Not only are the beats of the heart much more forcible, but they are also much more frequent than is natural, exceeding commonly 100 in a minute.

A vast majority of the patients are women, young women, between the ages of puberty and twenty-five years: women suffering some kind of derangement or other of their uterine functions. Yet the disease can have no necessary dependence upon uterine disorder, since it occurs occasionally, in an unequivocal form, in men; and in women who have survived the childbearing period. In one of Dr. Cheadle's cases, the complaint dated from the cessation of the menstrual discharge in a women aged fifty-two.

Neither is the complaint due to debility of the system, though sometimes connected with it, for several of the well marked cases occurred in strong, well-nourished, florid persons.

Besides the three symptoms which distinguish the disorder, there are others which are more or less observable in most instances: a change in the temper, which becomes capricious, irritable and peevish; a disposition to flush under slight emotion; a tendency to bleeding from the nose; a sense of heat in the parts supplied by the throbbing arteries, and profuse perspirations.

This is not in itself a fatal disease. Recoveries are often made.

Treatment

This must depend upon the state of the patient. Where there is debility of the system, and the menstrual discharges are out of order, the patient may try some of the preparations of Iron recommended under the head of Consumption; and at the same time she may apply the Iodine Liniment night and morning to the swelling. To quiet the throbbing of the heart and arteries she may take Digitalis, which has generally been found most effective, particularly in persons of a weak and delicate habit of body. The following mixture may be taken:

Tincture of Digitalis.....................Two Drams and a Half.

Tincture of Henbane.....................Three Drams.

Compound Tincture of Cardamoms... Six Drams.

Syrup........................................Half an Ounce.

Water sufficient to make................Half a Pint.

A tablespoonful three times a day.

At the same time the patient may take five grains of the Compound Rhubarb Pill every night at bedtime. And she may derive benefit from putting the feet and legs into hot water for ten minutes before stepping into bed: wrapping them up afterwards in flannel, or putting on a pair of warm woollen stockings to sleep in. If the rest is disturbed she may take five grains of Extract of Poppies, or ten grains of Bromide of Potash at bedtime.

The patient should avoid fatigue and exertion of every kind, should keep early hours, and her diet should be light and nourishing, without being stimulating.