BASEDOW'S DISEASE 67 



the psychic life the observation is important that in individual cases similar 

 conditions may occur after the administration of thyroid-gland tablets. 

 Conditions of excitement are not uncommon in thyroidism. Cases of 

 thyroidin intoxication insanity have also been observed (Boinet, Parhan and 

 Marbe). The authors last mentioned observed two cases, in whom after the 

 ingestion of great amounts of tablets there set in complete confusion and 

 hallucination. The manifestations disappeared with the withdrawal of the 

 administration of thyroid. The following case (Falla, Newburgh, and 

 Nobel) is instructive : 



Observation IV. Woman, aged fifty, who for a half a year had suffered loss of weight, 

 headaches, insomnia, associated with psychic depression and thoughts of suicide. There 

 was also present glycosuria. The condition gradually ameliorated and after some weeks' 

 stay at the clinic the patient felt very well. Then the patient took thyroid tablets for 

 three days, upon which the psychic depression and thoughts of suicide recurred. On 

 the withdrawal of the drug these disappeared. 



Already Brunei mentioned that Basedow's disease is not associated with 

 any special psychosis ; when a true psychosis occurs in it, we may well assume 

 that a psychopathic predisposition already existed and that the hyper- 

 thyrosis constituted the determining factor. 



Of the symptoms affecting the digestive tract we shall mention first in- 

 creased flow of saliva. This symptom often occurs paroxysmally, and even 

 initially; more rarely there is a dryness of the mouth. When the flow of 

 saliva is increased, there is an increased tonus of the nerves of the salivary 

 glands ; when the flow is diminished there is an increased tonus of the sympa- 

 thetic nerves of the salivary glands (formation of a thickly flowing secretion) 

 or irritation of the sympathetic nerves of the salivary glands (Eckhardi) ; 

 also the noticeably increased diuresis may exercise an influence here. The 

 slight degree of acidity of the gastric juice, that is usually observed in rare 

 cases of Basedow's disease (Eppinger and -Hess), points also toward an in- 

 creased gastric tonus. Sometimes crises of hyperacidity are observed 

 (Maranon). Ordinarily, however, subacidity is present (Wolpe). Especially 

 important symptoms are vomiting and diarrhea (Pierre Marie} , because they 

 greatly reduce the patient. Vomiting is found, according to Saltier, in 15 

 per cent, of all cases. Ordinarily it occurs paroxysmally, for the most 

 part without any relation to ingestion of food, often without any nausea. 

 When there has been no ingestion of food it is usually thin; the paroxysm 

 may last for a whole day, in which case the vomiting may occur thirty times 

 during the day and be uncontrollable. For the most part it is unaffected 

 by medication ; it may disappear as rapidly as it came, and may be followed 

 by a period of increased ingestion of food. More common are the profuse 

 watery diarrheas (according to Saltier in 30 per cent, of all cases). For the 

 most part they are painless. Twenty to thirty stools a day may occur. 

 They may lead to scaphoidal retraction of the abdomen as in cholera (Fr. v. 



