BASEDOW S DISEASE 79 



Saltier has collected forty cases from the literature. In twenty-six cases the 

 Basedow's disease was present before the diabetes, in eight cases the dis- 

 eases appeared about the same time, in the rest the Basedow's occurred in 

 the course of the diabetes. 



In many individuals the hyperthyroidism determines a predisposition 

 for glycosuria. The disturbance may be occult, that is, glycosuria appears 

 only on the administration of large amounts of pure grape-sugar. The ali- 

 mentary glycosuria in Basedow's disease was first described by Kraus and 

 Ludwig, and by Chvostek. It seems to have its complete experimental corre- 

 late in the alimentary glycosuria which may be elicited on the abundant ad- 

 ministration of thyroid-gland tablets in many normal individuals and in 

 animal experiment (Ewald, J. Dale, Dennig, v. Noorden, Bettmann, Georgjew- 

 sky, Strauss, and others). The disturbance in the carbohydrate metabolism 

 may, however, also be manifest, that is glycosuria is found on mixed diet. 

 Such cases of spontaneous glycosuria do not appear to be common (Lewin, 

 v. Nothafft, A. Kocher, Falta). Also Observation VII, reported previously, 

 belongs to this group. The glycosuria is characterized as thyrogenic by the 

 fact that it comes on with the development of Basedow's disease, and disappears 

 again with its amelioration, and that after the cure of the Basedow's also the 

 overloading tests show entirely normal relations. It is to be distinguished 

 from the alimentary glycosuria of Basedow's in degree only, as the alimentary 

 glycosurias also disappear on the spontaneous or therapeutically induced 

 improvement of the Basedow's. This is observed especially after X-ray 

 irradiation of the thyroid (Schwarz, Hirschl, Falta). The thyrogenic gly- 

 cosuria seems chiefly to occur in traumatic Basedow's, and, as had been 

 mentioned previously, is frequently combined with disturbances of fat 

 absorption. 



In the combination of Basedow's with true diabetes there may well be 

 assumed, in addition to the disease of the thyroid gland, an independent 

 lesion of the insular apparatus of the pancreas. On the other hand I would 

 regard that in the true thyrogenic glycosuria the hyperthyroidism brings 

 with it a marked additional loading of the internal secretory activity of 

 the pancreas, with the implication that the internal secretory activity of the 

 pancreas is weakened, whether by the thyroid secretion or by other factors 

 is not known. If, however, the pancreas is not equal to the necessary breadth 

 of function, especially if an alimentary overloading is added, glycosuria makes 

 its appearance. This hypothesis seems to be explained in an unforced 

 manner: i. by the fact that hyperthyroidism does not lead to glycosuria in 

 all individuals; 2. that the glycosuria disappears with the retrogression of 

 the hyperthyroidism, and that after this retrogression alimentary overload- 

 ing does not lead to glycosuria. Distinction of the pancreatogenic from the 

 thyrogenic glycosuria is not attended with any difficulty; but there are, how- 



