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April 10, 1886

EXOPHTHALMIC GOITRE; DYSPEPSIA; PROGRESSIVE MUSCULAR ATROPHY; CHRONIC DIARRHŒA.A Clinical Lecture Delivered in Jefferson College Hospital on February 25,

JAMA. 1886;VI(15):393-396. doi:10.1001/jama.1886.04250040029001

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The first case, gentlemen, that I will bring before you to day, is one that will well illustrate the method of therapeutics as based upon a physiological basis, about which I have already spoken to you on several occasions. Exophthalmic goitre, as you no doubt are aware, is a disease characterized, so to speak, by four sets of symptoms: we have an implication of the eyes, they are prominent and protruding; we have an implication of the thyroid gland, which is hypertrophied; we have a dilated condition of the blood-vessels generally; and we have the heart affected, in so far as its action is increased in frequency and in force. We have, then, this complexus of symptoms in typical cases, but of course it is not in every case that we have all of them present. In this case, for example, there is no protrusion of the eyes, though the

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