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"Want you to meet my wife, doctor Carrie, make you 'quainted with Dr. Calibree," said Kennicott. Calibree bowed quietly and shook her hand, but before he had finished shaking it he was concentrating upon Kennicott with, "Nice to see you, doctor. Say, don't let me forget to ask you about what you did in that exopthalmic goiter case that Bohemian woman at Wahkeenyan."
If the brain cannot endure the strain, then neurasthenia, nerve exhaustion, or even insanity follows. If the thyroid cannot endure the strain, it undergoes hyperplasia, which in turn may result in a colloid goiter or in exophthalmic goiter. If the adrenals cannot endure the strain, cardiovascular disease may develop.
In excess they produce such diseases as exophthalmic goiter, and goiter is concerned with the enlargement of the glands and surrounding tissues beyond anything like natural size. Then, too, a defect in the glands causes the disease known as myxedema in adults and cretinism in children. Most of all, the gland seems to tell on the germ plasm of the body, especially in women."
Of this number 2483 were born of healthy and sane fathers; 2285 from healthy mothers; 961 from goitrous fathers; 1267 from goitrous mothers; 49 from cretin fathers; 41 from cretin mothers; 106 from cretin fathers with goiter; 66 from cretin mothers with goiter; 438 fathers and 405 mothers were not specified.
The presence of a colloid goiter is a suitable soil for the development of Graves' disease, and I fully recognize also the evidence that infection or auto-intoxication may be contributing factors and must be assigned their role.
The face markings, those on the arms, the stomach, and elsewhere on the body, are believed to be purely aesthetic. The people compare their tattoo with the figures of an American's shirt or coat, saying they both look pretty. Often a cross-hatched marking is put over goiter, varicose veins, and other permanent swellings or enlargements.
Next about the goiter: "THEY talk about goiter! I haven't seen a goiter in this whole canton that I couldn't put in a hat." He had growled at everything, but I judged it would puzzle him to find anything the matter with this majestic glacier. I intimated as much; but he was ready, and said with surly discontent: "You ought to see them in the Protestant cantons." This irritated me.
I have never known a case of Graves' disease to be caused by success or happiness alone, or by hard physical labor unattended by psychic strain, or to be the result of energy voluntarily discharged. Some cases seem to have had their origin in overdosage with thyroid extract in too vigorous an attempt to cure a colloid goiter.
The accompanying illustration pictures an extreme ease of cystic goiter shown by Warren. A strange feature of tumors of the thyroid is that pressure-atrophy and flattening of the trachea do not take place in proportion to the size of the tumor.
If the depressing action of bromids on the heart is counteracted by the coincident administration of digitalis, they will act only for good by quieting the nervous system and more or less inhibiting the secretion of the thyroid gland. If a patient has exophthalmic goiter fully developed, absolute rest in bed, with the treatment outlined above, should soon cause improvement.
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