72 THE DISEASES OF THE THYROID GLAND 



tion Dec. 12, 1912. Apparently no hereditary nervous predisposition. Menses first ap- 

 peared in the eleventh year of life, flow abundant, regular, lasts for three days every four 

 weeks. Five normal births. Three years ago a miscarriage at the second month. Since 

 that time, development of Basedow's disease. Since that time, too, menses are accompanied 

 with severe pain, especially backache. The flow is less in amount. When the exophthal- 

 mus first developed, her face took on a terrified appearance, which her acquaintances 

 observed; she felt very well otherwise, and the ophthalmologist made the diagnosis, 

 Basedow's disease. Only several months afterward began to develop watery diarrheas, 

 cardiac palpitations, dyspnea, nose-bleeds, headaches, rheumatoid pains in the extremi- 

 ties, lassitude, sensation of dizziness, and extraordinary psychic irritability; the condition 

 gradually became worse, with a transitory period of amelioration during the summer before 

 I saw her. There occurred moreover insomnia, sweats, pains in the calves, pain in the 

 forehead and eyes on reading, also transitory marked flow of tears. The appetite very 

 changeable, at times voracious appetite, then again anorexia. 



Distinct protrusion, v. Grafe's symptoms plainly positive, Loivi's symptom plainly 

 positive. Tachycardia extremely variable, the pulse varying from 80 to 150. Subjec- 

 tively, rather marked oppressions; marked falling-out of hair, inclination to slight rises 

 of temperature. Marked sweats, very variable. Thyroid gland diffusely enlarged 

 (right lobe somewhat more than the left), soft, plainly pulsating, distinct palpable thrill,. 

 over it a diastolic vascular murmur. 



Alimentary glycosuria (200 gm. dextrose) negative. 



Blood-pressure Riva Rocci 130, Gartner 85; these differences were regularly found on 

 repeated examinations. 



At the beginning of the observation the above symptoms were present, except that 

 the tachycardia was very slight and the tremor of the hands scarcely demonstrable. 



The blood examination now shows: 



Leucocytes, 8000 of which: 



Polymorphonuclear neutrophiles, 70 per cent. 



Eosinophiles, 2 per cent. 



Lymphocytes, 21 per cent. 



Large mononuclears, 7 per cent. 



Later the condition became worse, the pulse rate rose to about 130, the tremor be- 

 came distinct, the blood examination now showed 9000 leucocytes, of which: 



Polymorphonuclear neutrophiles, 60 per cent. 



Eosinophiles, 2 per cent. 



Lymphocytes, 27 per cent. 



Large mononuclears, n per cent. 



Also the examination of the respiratory exchange of gases gave indeed always an 

 essential increase, but appreciable variations (Dr. Bernstein). 



Also the examination of the excretion of urine showed in the first period 0.45 and 0.37 

 gm. U. (on the 7th and 8th day of the purin free diet). 



