80 THE DISEASES OF THE THYROID GLAND 



ever, transitions, that is to say those cases in which the glycosuria occurs 

 under the use of thyroidin medication (Fried. Mutter). In such cases, just 

 as in the case of Ewald (myxedema in which diabetes developed on the 

 continued use of thyroidin medication and persisted after its withdrawal) 

 there might very well be supposed also a disease of the insular apparatus, 

 which up to the time had been latent, and which had been made manifest 

 through the thyroidin medication. 



For the understanding of many of the characteristics of the metabolism 

 in Basedow's patients we must note that the action of thyroidin depends 

 on the constitution of the affected individual. As was mentioned previously, 

 in normal individuals the action of thyroidin on the gas exchange, the protein 

 and the carbohydrate metabolism is often intensive, while other indi- 

 viduals are entirely refractory to the same dose of thyroidin. The consti- 

 tutional differences probably lie in the different degrees of excitability of 

 the vegetative nervous system, and this has perhaps its deeper foundation 

 in the different reaction capability of the ductless glandular system. Now 

 it seems that in Basedow's patients alterations of constitution occur in 

 the course of the disease. So, for example, -o. Wagner mentions a case of 

 Basedow's disease, in which the initial rapid emaciation was followed by the 

 development of an obesity, that had the characteristics of an essential obesity. 

 Not so very rarely, too, are observed cases of Basedow's disease in which the 

 initial rapid emaciation changes to a condition in which the patients not only 

 recover what they have lost, but when placed on a little superfluous diet, 

 they become fat in spite of the fact that they may still show symptoms of 

 hyperthyroidism. Magnus-Levy reports a case of Basedow's that after 

 subjective and objective amelioration received daily for four and one-half 

 weeks two or three thyroidin tablets, without there occurring an aggrava- 

 tion of the Basedow's symptoms or an increase of the exchange of gases. 

 A similar case was observed by the author. It was that of a forme fruste 

 with distinct Basedow's symptoms (without eye symptoms) and glycosuria. 

 After X-ray irradiation of the thyroid gland all symptoms disappeared; 

 and high tolerance for carbohydrates soon came on. When the patient 

 again presented himself after several months, thyroidin medication for 

 three days (nine tablets a day) could be administered without an appear- 

 ance of increase of the pulse rate or of alimentary glycosuria. 



The thyroid-gland secretion has an enormous influence on the salt met- 

 abolism. As W. Scholz first pointed out, it increases the elimination of phos- 

 phorus, especially through the intestine. The increase [of the phosphorus] 

 in the feces may reach as much as 25 per cent. Older observations of v. 

 Noorden and the later ones of Oeri have shown that the distribution of 

 phosphorus to the kidney and intestine is exclusively dependent on the elimi- 

 nation of calcium ; of calcium only a very slight part is to be found in the urine, 

 by far the greater part is to be found in the feces. When the calcium elimi- 



