68 THE DISEASES OF THE THYROID GLAND 



Midler). The diarrheas are hardly influenced by medication. In rarer 

 cases, admixture with blood may be observed. Vomiting and diarrhea 

 may also be produced in animal experimentation by feeding with or injec- 

 tion of thyroid gland substance. In human beings, administration of thyroid 

 gland tablets continued over only a short period may suffice to produce 

 action on the bowels. In two cases, Folia, Newburgh, and Nobel observed 

 that on the third day of the thyroid medication the previously solid stools, 

 that occurred only once a day, had now become soft and failed to show 

 the impressions of the haustra, and that on the third day two soft stools 

 occurred. On withdrawal of the medication, the stools again showed their 

 former consistency. Kocher observed one case with obstinate constipation, 

 in which simultaneously with the appearances of the rather acute develop- 

 ment of Basedow's, diarrheas developed. The statement of Kocher, that 

 in none of the sixty-three cases of Basedow's described by him did consti- 

 pation exist, dare not be generalized. I have seen several cases of formes 

 frustes with constipation (see Observation V). Mobius regards the profuse 

 diarrhea of morbus Basedowi as the expression of the effort to cast out the 

 thyroid gland substance that is circulating in excess. From this standpoint 

 it would not be uninteresting to test the stools as to their iodine contents. It 

 is safe indeed to assume a marked increase in the secretion in the intestines. 

 This and the paroxysmal occurrence confirms the assumption of Mobius. 

 In the higher degrees, there is, in addition, apparently slight inflamma- 

 tory swelling of the intestinal mucous membrane; at least we may observe 

 this in experiments on animals in which, in the highest degrees of thyroid- 

 ism, hemorrhages into the mucous membrane may occur. We may assume 

 also an increased secretion of the pancreatic juice, in accordance with the 

 experiments of Balint and Molndr; these authors found in the watery evacu- 

 ations an abnormal quantity of tryptic and diastatic ferment. Whether we 

 may regard the profuse diarrheas as an expression of vagotony, as Eppinger 

 and Hess believe, appears to me questionable, for vagotony is inclined to 

 be associated with spastic obstipation. 



We should sharply distinguish from these profuse diarrheas the dis- 

 turbances of fat absorption that are sometimes found in morbus Basedowi. 

 Adolph Schmidt and H. Salomon have described one case apiece. I have 

 added seven cases, in which, as in Salomon's case, the fat-splitting was 

 relatively good, so that the disturbances lay especially in the absorption. 

 In the case very carefully investigated by me the dry substance contained 53 

 per cent, fat, of which 24.7 per cent, was neutral fat, 44.2 per cent, soaps, 

 and 31.1 per cent, fatty acids. Sometimes the fat stools are found only 

 on the overloading of the intestines with fat (v. Noorden). Of late Bittorf 

 has contributed a pertinent case. I here report two others: 



Observation V. Ad. K, thirty-three years, locomotive stoker, entered the first medical 

 clinic December, 1911. No hereditary taint, was always well until November, 1905. 



