In conclusion, I must discuss the surgical treatment. An immediate operation is necessary if the thyroid gland compressed the trachea to such a degree that suffocation may be imminent ; such a condition sometimes occurs during pregnancy ; in order to save the patients life the pregnancy must be interrupted at once.

GOITRE and exophthalmic goitre are two conditions entirely different from each other; there ought to be no doubt in the diagnosis of same.

A goitre, i.e. an enlargement of the thyroid gland, may be a purely local disease, due either to a local inflammation or to a tumour ; on the other hand many cases of goitre prove to be symptoms of a constitutional disease.

All case of exophthalmic of a goitre originate in an increased function of the thyroid gland. there can be no doubt that this condition is connected with disorders of the nervous system.

The German physical Basedow, Merseburg, in 1848 for the first time gave an exact description of this disease. According to Basedow we are faced with three remarkable symptoms : (1) goggle- eye (Exophthalmus), (2) enlargement of the thyroid gland, and (3) disorders of the heart and of the blood vessels. To day we know that these symptoms, though essential, are not to be found in all case ; in many of them one or the other may well be not existing.

As to the symptoms to the heart and of the blood vessels, the most remarkable one is the rapidity of the pulse ; there may be about 200 pulse in a minute, especially after mental excitement to great physical strain.

1. Palpitation of the heart is usually the very first symptoms asking for the patients attention and for medical treatment. At first it only appears after severe strain, later on without any visible reason. When the disease progresses, the patient suffer from irregularity of the pulse, shortness of breath, even severe spasms of the heart ; the heart becomes enlarged and the cardiac sounds unclean.

The same applies to other parts of the vascular system and there may be remarkable dilatations and palpitation of the blood vessels. The small blood vessels of the skin enlarge, especially those after the slightest mental excitement. In serious cases profuse bleeding from nose, lungs, bowels of stomach occur.

As to the second symptoms. i.e. the enlargement of the thyroid gland, I should like to stress that in some cases no swelling will be found at all though the enlargement is noticeable in the majority of cases. Such an enlargement of the thyroid gland may be inborn, it may even appear during childhood, but usually it develops in a progressive stage of the disease. In very acute cases we see the swelling of the gland develop simultaneously with the other symptoms, and that within a few hours.

The tumor, due to the dilation and to the winding of the vessels, is characterized by pulsation and certain distinctly audible noises. By putting the fingers over the tumour we frequently feel a remarkable whirling ; later on the tumour is found to solidify owing to calcareous deposits. In some cases the big blood vessels.

The symptoms “goggle-eye” is the least essential of the three symptoms. mentioned by Basedow. Usually it appears simultaneously with the heart troubles, in some cases the goggle-eye from the very first symptoms of the disease. As a rule, both eyes are affected, very seldom it happens to the eye-balls, their mobility becomes limited.

The eyelids no longer cover the eyeballs entirely, which results in an inflammation of the cornea with all its consequences ; there may be ulceration, dimness and diminished strength of vision. The secretion of tears increases, often resulting in permanent weeping ; in some cases however, the contrary will be noticeable.

With regard to the digestive system, we have to mention very profuse diarrhoea any colic, characterized by periodicity and vomiting ; the appetite of the patients is increased, in some cases we are even confronted with jaundice.

As to the respiratory organs I mention the cough paroxysms, called “Larynx crises” ; there is only little expectoration, sometimes impediment in the patients speech. Other serious symptoms are formed by attacks of asthma, accelerated respiration; both often combined with bleeding.

In connection with the urinary organs, we must pay attention to the remarkable increase of the urine (polyuria), in some cases with deposits of sugar in the urine (glycosuria). As a rule the lymphatic glands, spleen and thymus are swollen.

As to symptoms of the skin, patients suffer from profuse sweats, especially at night, sometimes these sweats are accompanied by a feeling of heat. The skin is pallid, but flushes after the slightest excitement. Pigmentations of the skin are frequent ; the hair is getting gray prematurely and is falling out.

In the muscular system we often notice paralysis, either of some limbs or of some groups of muscles, in many cases combined with trembling of hands and fingers.

Finally the mental symptoms are to be mentioned : giddiness, sleeplessness, headache, grievousness, diminution of intelligence, great irritability, unnatural cheerfulness and carelessness with regard to their own condition, sprightliness alternating with deep depression, low spirits and indifference. These mental symptoms are usually accompanied by a remarkable anaemia, cachexy and high temperature.

Corresponding with the variety and multitude of the symptoms the homoeopathic treatment of exophthalmic goitre is a very difficult one. There can be no doubt that the drug picture which covers nearly all the symptoms of the disease is Iodine. It may be to some interest to know that Basedow himself used Iodine for treating his patients. In many cases, owing to the allopathic doses, this treatment proved a failure and resulted in a aggravation of the symptoms.

I am surprised, that in some homeopathic books, discussing the treatment of the disease, Iodine is not mentioned at all. Let us review the likeness of the symptoms of Basedow and Iodine : Both produce the same mental symptoms, i.e. irritability, excitability and unrest. Both shoe the same permanent feeling of heat, the same peculiar yellowish complexion, vomiting and diarrhoea. In addition both have the same heart symptoms, sleeplessness, sweat and anxiety, this worse when sitting down, improving when occupied and moving about.

Consequently, when prescribing Iodine for exophthalmic goitre, we have to restrict ourselves to high potencies. I used to give single doses Iodine 200x once a month.

Instead of pure Iodine, we may prescribe plants which contain it : I mention Spongia, Badiaga, Fucus, Hedera helix.

Spongia 6x in indicated in cases of exophthalmus and swelling of the thyroid gland, combined with biting pains in the heart, in the eyes, weeping, etc.

Badiaga 6x : palpitation of the heart due to joyful excitement, general weakness, pains in the fore head radiating towards the eyes ; condition worse in the afternoon.

Fucus 4x suitable in cases of enlarged and indurated thyroid gland.

Hedera helix 3x, suitable in cases of large, indurated goitre combination with pains in the heart, stiffness in all joints, condition better in fresh air.

Thyroidin is another important drug containing Iodine. The key symptoms are sleeplessness, giddiness, headache, exophthalmus, depression, irritability of the heart, pulse accelerated and very weak ; patients is unable to lie down, urine increased, often with deposits of albumen and sugar. Like Iodine we have to prescribe Thyroidin only in very high potencies. In cases where the symptoms of the disease are entirely like the drug picture, I give a single dose of Thyroidin 1,000x, repeating the dose not earlier than two or three months afterwards.

Finally we may prescribe Iodine in the shape of chemical compounds as there are Arsenicum iodatum 6x, Aurum iodatum 6x, or Barium iodatum 6x, according to the modalities of the cases.

Apart from these medicaments just mentioned, there are a great number a short review of those which in my own experience proved to be effective.

In case characterized by their heart troubles, I usually start treatment with Lycopus virginicus 6x and Ferrum sulfuric 4x, each drug to be taken twice daily ; these drug not only relieve the heat symptoms in a short time, but also improve the general condition of the patient. Key symptoms of these drug are : better by cold, rest and laying down, worse by moving about and during the night.

Calcarea phosphorica 12x, alternating with Jaborandum 6x : great weakness. due to profuse sweats.

Cactus grandiflorus 2x : pains in the heart, feeling of compression of the heart.

Kalmia 2x : palpitation of the heart, rheumatic pains. feeling of deafness and weakness.

Adonis vernalis 4x : heart symptoms, depression. pains radiating towards the left hand, irregularity of the pulse. Obstipation alternating with diarrhoea, restlessness.

Convallaria majalis 4x : great weakness of the heart, anguish, burning sensation over the whole body ; sweats.

Strophanthus 6x : severe pains behind the breastbone, pulse much accelerated, continuous palpitation of the heart intense anguish.

Asarum europaeum 3x alternating with Nasturtium 2x : nervous excitement, headache, irritability of the heart.

Belladonna 12x : enlargement of the pupils, face very hot, reddened and flushed, sweats, worse at night, palpitation of the heart, better by rest, pulse very rapid, jumping eyelids very dry.

Glonoin 30x : irregularity and palpitation of the heart, severe headache, worse by sunshine, better when moving about.

Natrum muriaticum 12x : patients undernourished, livid complexion, melancholy, hopelessness, permanent whining, sleeplessness, pulse accelerated.

Ephedra 3x : metabolism accelerated, exophthalmus, severe headache, apathy, pulse very slow.

Yohimbin 30x : single dose suitable in cases of exophthalmus.

Of course the potencies of the drugs just reviewed are not at all unalterable ; we have to keep in mind that the Basedow patient may be extremely sensible not only to Iodine and Thyroidin but also to each other drug, provided this drug is the simillimum for the patients own symptoms.

Furthermore, it would be a great mistake to restrict ourselves to the homoeopathic treatment ; we should rather combine it with an energetically and carefully any prove of decisive influence with regard to the progress of the disease. This has been made clear by relapses of the disease, owing to the patients non- attention to the doctors prescriptions. As to the dietetic treatment, I usually give a vegetarian diet, in some cases uncooked food.

When the patients condition has improved, he may eat meat, such as veal, chicken, pigeon, and fresh-water fish ; whereas mutton, pork, goose, duck, game, sea fish, picked fish and tinned meats are prohibited. Liquid food ought to be restricted. As a matter of course, spirits, coffee, tea, tobacco, and strong spice are to be discontinued. Instead of these stimulants I recommend the Adinolan Tea. Its chief constituents are Gnaphalium, Juniper, Betuline, and Scilla ; its pleasant taste and prophylactic effect against accumulation of toxic end- products of metabolism make it suitable as a daily beverage instead of coffee and tea.

Again and again, we have to stress the importance of psychical treatment and of bodily repose ; in light cases we may restrict ourselves to the prohibition of overwork. In serious cases we have to insist upon confinement to bed, at least for several hours of the day.

In serious cases, especially in patients suffering from intense palpitation of the heart and accelerated pulse, I add the application of leeches to the homoeopathic treatment. Usually once a week I put three or four leeches on the heart region or the throat.

In conclusion, I must discuss the surgical treatment. An immediate operation is necessary if the thyroid gland compressed the trachea to such a degree that suffocation may be imminent ; such a condition sometimes occurs during pregnancy ; in order to save the patients life the pregnancy must be interrupted at once. Furthermore, we have to communicate with the surgeon in cases where, in spite of the most careful homoeopathic treatment, the condition of the patient did not show any sign of improvement but even became more serious still.

W. Karo