70 THE DISEASES OF THE THYROID GLAND 



The fundamental exchange is therefore somewhat increased. 



Result: Forme fruste of Basedow's after trauma with all important symptoms 

 (tachycardia, sweats, tremor, increase of the fundamental exchange, mononucleosis) 

 with exception of the eye symptoms. In addition, fat stools and alimentary glycosuria. 



Observation VI. A. Schr., woman aged thirty-three years. First entered clinic Jan. 9, 

 1913. Father was very nervous and easily excited. Menstruation, which began at the 

 age of fourteen years, occurs regularly every four weeks, lasts four to eight days, not 

 painful. Seven years ago, luetic infection, after which unilateral headache, for one year 

 diplopia. Two children, that are very nervous, two miscarriages, the one before the in- 

 fection, the other after it. For three months menstruation very sparse. 



The present illness began three months ago. At first insomnia and severe headaches, 

 then marked palpitations. Dyspnea, profuse sweats, severe tremors in the hands and 

 feet. Conditions of excitement, sometimes vomiting. During the last three months has 

 lost about 10 kg., the throat is enlarged, for six weeks the eyes protrude. During the first 

 week five to six stools daily, of normal consistence, but of a white-grayish color. 



Exophthalmus distinct, but not marked. Thyroid enlarged, diffusely, distinct 

 tremor, marked tachycardia. 



Blood-pressure. Gartner, 95. Riva-Rocci, 135. 



Leucocytes 5500 (of which 55 per cent, polymorphonuclear neutrophiles and i per 

 cent, eosinophiles) . 



Alimentary glycosuria positive (with 100 gm. dextrose 0.57 gm., with 50 gm. dextrose 

 2.4 per cent, with 30 gm. dextrose, negative). 



Overloading with fat at present does not lead to fat stools. No diarrhea now. 



The cases with fat stools all seem to show certain characteristics. Al- 

 most always they are formes frustes with absent or slightly developed eye 

 symptoms. In addition all cases up to the present have shown latent dis- 

 turbances in the carbohydrate metabolism. In three cases, the disease 

 developed after a trauma. For a close relationship between thyrogenic 

 glycosuria and fat stools speaks also the observation that both disturbances 

 retrogress simultaneously, either spontaneously or after therapeutic pro- 

 cedures (exposure to Rontgen rays). It is not unlikely that both come 

 about through an inhibition of the internal secretory activity of the pan- 

 creas. At least there must also be assumed a direct action of the excessively 

 produced thyroid-gland secretion on the intestinal mucous membrane, for 

 in diabetes mellitus the absorption capacity of fat is perfectly normal. 

 I do not speak here of the fat stools in cases of diabetes mellitus with closure 

 of the pancreatic ducts, as in these it is known that the disturbance in the 

 splitting of neutral fat is prominent. The observations of Balint and Molndr, 

 that I have already mentioned, do not speak, as these authors believe, 

 against my assumption, for they are dealing with watery diarrheas that have 

 nothing to do with fat stools and that mostly occur in the other forms of 

 Basedow's disease. Up to the present I have seen only one case with fat 

 stools in which formerly profuse diarrheas had existed. 



The examination of the blood in Basedow's disease usually gives normal 

 figures for the red blood cells and the hemoglobin. In cases where a diminu- 

 tion is present, the iron-content is, according to the investigations of 



