Another case is that of Miss Y., aged 13 years in June, 1908. Of a highly neurotic stock ; had a large goitre, neck 15in., weight 7st.; she had been treated for Graves' disease. Her history during the two past years. has been that her nervousness continues, she easily gets tachycardia (up to 140), menstruation has been rather irregular ; but on the whole she has gained in self-control, has increased in weight to 7st. 9lbs., shows no muscular tremors.

I cannot label either of these cases ; one man would say “Graves’,” another would say “ordinary Bronchocele.” I offer merely as a tentative opinion the suggestion that they are mixed cases-that is, that the thyroid secretion is partly depressed and partly exalted, and I think this opinion can only be defended on the grounds that the secretion is a complex one, and that pathologically it may show irregularities of several kinds.

Finally, I cite a case which seems to show that passive goitre may be converted into the active form. Mrs. S., aged 39, mother of seven children, aged from 11 months to 15 years, consulted me in January, 1910. Eight years ago, when a child was born, she developed a goitre, which gave her no trouble. The town she lived in was, she said, full of people with just such throats (I may say that the medical man practising in that district reported, "Goitre uncommon and only sporadic"), and she had not consulted anyone about it.

In December, 1909, while away for a holiday, her mother and one of her children who was with her became very ill, and she had a few weeks of excessive strain and worry. When I saw her in January, she had the typical appearance of active goitre—Tachycardia, emaciation, tremors, dance of arteries, pigmentation of neck, face and abdomen-exophthalmos and goitre.

In conclusion, it seems to me that the first business of the profession, in connection with the various forms of goitre, is to get accurate knowledge of their etiology.