BASEDOW'S DISEASK 69 



Then struck by a locomotive, fell on the left side, for three weeks hematuria and fever. At 

 the beginning also unconsciousness, then severe headache, vertigo, nausea. Imme- 

 diately after the accident began tremors, palpitation, anxiety, insomnia, and twitchings 

 in the lower extremities. Eight days after the accident, the patient noticed an enlarge- 

 ment of the right lobe of the thyroid gland. Soon afterward marked pulsating in the 

 vessels of the neck and oppressive feeling of heat, and burning of the skin of the throat 

 and neck. This condition continued from this time on without essential alteration. 

 The patient states that he has become peevish and irritable and afraid of people. His 

 muscular strength has diminished, he tires easily, and often has drawing pains, also 

 headaches, vertigo, and sometimes vomiting, also very heavy sweats. Ordinarily slight 

 constipation, from time to time a period in which three or four broth-like evacuations of a 

 gray color occur daily. 



Rather thin; the face especially, but also the skin of the throat and upper part of 

 the breast a burning red. On disrobing and on excitement the redness increases. Pro- 

 nounced dermographism. On stroking the skin with the handle of the percussion 

 hammer there are elicited streaks the breadth of which is that of a finger. 



The right lobe of the thyroid is enlarged, about the size of an apple. Surface smooth, 

 elastic, but not hard in consistence, evident pulsation, vascular murmurs. In the neigh- 

 borhood, enlarged lymph-glands. Points of exit of the trigeminal nerves tender to 

 pressure. Slight paralysis of the sympathetic on the right. All eye symptoms negative. 

 To Rontgen examination slight widening of the shadow of the aorta to 6 cm., and of 

 the heart to 12^ cm. Pulse 120-140. 



Blood pressure, according to Riva-Rocci, taken on the arm 140. On the left middle 

 finger (Gartner) 85. 



Later measurements: 

 Riva-Rocci, 130-120; 

 Gartner, 70. 

 After two weeks: 

 Riva-Rocci, 120-110; 

 Gartner, 55. 



Blood: Erythrocytes, 5,000,000. 

 Leucocytes 9200, of which: 

 Polynuclear neutrophiles, 55 per cent. 

 Lymphocytes, 32 per cent. 

 Large mononuclears, 14 per cent. 

 Eosinophiles, i per cent. 



Several later blood examinations gave similar results. 

 Alimentary glycosuria (100 gm. dextrose) 4.24 gm. of sugar. 



The stools frequently show the luster of fat and a gray color. After 250 gm. of oat- 

 meal and 300 gm. butter, typical fat stools. The microscopical examination shows little 

 neutral fat, but many soap balls and fat needles. 



Profuse sweats, in which the bedclothes are soaked through. On the soles of the 

 feet exist pea- to bean-sized vesicles filled wjth serous fluid, which burst, and leave the 

 cutis exposed. 



Marked tremor of the hands, intensified on movements. 

 Examination of the fundamental exchange (Dr. Bernstein}. 



CQi Oj RQ Per kilogram body weight 



237.6 289.0 0.804 I 



220.2 293.0 0.741 ' 



230.1 296.5 0.776 1 3 ' 2;> *" 



