In January, 1921, we instituted a study of fifty unselected cases of fully developed exophthalmic goiter.1 No specific therapeutic measures were employed "in order to determine the natural history (spontaneous course) of the disease,"2 and to establish an "index for the evaluation of therapeutic procedures."3 From the group were excluded (a) patients who had thyroid enlargement without other manifestations of exophthalmic goiter,4 and (b) those who, with or without thyroid enlargement, presented sympathomimetic symptoms, without significant elevation of the basal metabolism (autonomic imbalance).5 In the group studied, we included (1) patients with a significant elevation of metabolism on repeated readings; (2) patients whose illness was sufficiently severe to warrant residence in a hospital where beds are at a great premium (two exceptions), and (3) patients from the poorest sections of the city, who were subjected to constant economic strain (one exception).
The patients were first
HYMAN HT, KESSEL L. STUDIES OF EXOPHTHALMIC GOITER AND THE INVOLUNTARY NERVOUS SYSTEM: X. THE COURSE OF THE SUBJECTIVE AND OBJECTIVE MANIFESTATIONS IN FIFTY UNSELECTED PATIENTS OBSERVED OVER A PERIOD OF TWO YEARS, IN WHOM NO SPECIFIC THERAPEUTIC MEASURES WERE INSTITUTED ("SPONTANEOUS COURSE"). Arch Surg. 1924;8(1):149–164. doi:10.1001/archsurg.1924.01120040160007
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