BASEDOW'S DISEASE 57 



a. Morbus Basedowi [Basedow's Disease] Hyperthyrosis 



Synonyms. Graves' disease, Morbo di Flajani (Flajani's disease), goitre exophthal- 

 mique [exophthalmic goiter], [Parry's disease]. 



Historical. In the year 1840, v. Basedow first thoroughly described three 

 cases of the disease named after him. Of his precursors, is especially Graves 

 to be mentioned, who in 1835 described cases of the disease and brought it 

 into close relationship with hysteria. Since the time of v. Basedow, the 

 views as to this disease have undergone great changes. The French school 

 regarded it as a neurosis, while Mobius first in 1886 assumed an abnormally 

 increased activity of the thyroid gland as the cause, and pointed out the 

 opposition that exists between this disease and myxedema. 



Definition. By Basedow's disease we understand to-day a disease which 

 is brought about principally by the abnormally increased activity of the thyroid 

 gland. This is almost always accompanied by an enlargement and increased 

 vascular engorgement of the thyroid gland and leads eventually, through the 

 local symptoms conditioned by the enlargement, to a great number of very mani- 

 fold manifestations, of which especially the tachycardia, the well-known eye 

 symptoms, the tremor, and the increase in metabolic processes are the most 

 important. Most of the manifestations are to be explained by a heightened 

 condition of excitement of the vegetative nerves. Regular and very manifold 

 is the involvement of other glands of internal secretions, which for the most 

 part is secondary. The syndrome that results depends therefore not upon 

 the degree of hyperf unction, but on the constitution of the individual affected, 

 that is, on the reaction capability of the ductless glandular apparatus. The 

 cause of hyperthyrosis is not at present known. The possibility exists that it is 

 conditioned centrally, and that many symptoms of Basedow's are coordinate 

 with the hyper thyroidism. 



Occurrence. Basedow's disease is rather irregularly distributed. A 

 careful collection as to its occurrence has been made by Saltier. Most of 

 the investigations concerned with this subject, founded in part on a very 

 great observation material, agree that the classic form of Basedow's disease 

 is relatively of rare occurrence in regions where goiter is endemic. I men- 

 tion only the contributions of H. Bircher, Fr. Kraus, and W. Scholz. In 

 Germany, for example, typical cases of Basedow's disease are very much 

 commoner in the northern parts; they seem to be especially numerous in the 

 Russian Baltic provinces (Kroug). It is very much more common in 

 the female sex than in the male. In Sattler's compilation 3120 of the 3800 

 cases were females. It is not very common in childhood (according to Saltier, 

 out of 3477 cases only 184 were in children under fifteen years of age). Base- 

 dow's disease in sucklings appears to be very rare. While Clifford has re- 

 ported a case. The mother of the child had also previously given birth to a 

 child affected with symptoms of Basedow's. In the case described there 



