In 1835 Graves, a Dublin physician, described an affection characterized by exophthalmos, swelling of the thyroid gland, and tachycardia. In 1840 Basedow, in Germany, more fully described this affection. It is now generally known either as Grave's disease, Basedow's disease, or exophthalmic goiter. Its underlying disorder seems to be an overaction of the thyroid gland.

In addition to the above-mentioned syndrome patients usually present more or less marked tremor, excessive perspiration, especially of the hands and feet, and they often complain of palpitation and shortness of breath which is made worse by exertion or excitement. In advanced cases there is more or less cachexia.

This affection is of psychiatric interest because the mental condition of those afflicted with it is, as a rule, far from normal. The characteristic mental manifestations are: restlessness; a state of being "on edge," i.e., easily startled, excited, angered, or brought to tears; anxiety; sleeplessness. Very severe cases are sometimes complicated with delirium.

1 Bourneville. Progres medical, 1897.

2 Ibid., 1890.

The disease varies in degree. Some cases run a rapid course toward a fatal termination. Others are characterized only by an incomplete syndrome, such as moderate tachycardia (pulse 100-110 per minute at rest) with slight tremor and sweating of palms, but without exophthalmos and without noticeable enlargement of the thyroid gland. Obviously it would hardly be proper to speak of such cases as exophthalmic goiter. Accordingly they are generally spoken of as hyperthyroidism. But they may, under certain conditions, develop into the complete syndrome. Other cases, again, are still milder, being latent under ordinary conditions, but developing characteristic manifestations of hyperthyroidism when exposed to severe and prolonged stress.

All forms of hyperthyroidism are said to be more common in women than in men; but recruiting experiences in the World War have shown that it was more common than had been suspected in men of military age in degrees sufficient to disqualify for military service.

Treatment

Persons liable to develop hyperthyroidism on exertion should select a sedentary occupation and lead, as far as possible, a life free from excitement or strain.

When symptoms of hyperthyroidism develop, the following measures of treatment, mentioned in the order of their importance and efficacy, should be tried: rest in bed, including mental rest, i.e., freedom from worry or excitement; the administration of belladonna in ascending doses; possibly sodium bromide or trional Cases which do not recover sufficiently under the above treatment to be able to resume at least light work should be treated surgically. Partial extirpation of the thyroid gland often results in permanent relief. In competent hands and in cases which have not been allowed to become too far advanced the operation is attended with but little danger.1

1C. H. Mayo. Surgery of the Thyroid. Observations on Five Thousand Operations. Journ. Amer. Med. Assn., July 5, 1913.