BASEDOW'S DISEASE 8 1 



nation increases, a part of the phosphorus goes to the intestine with the 

 calcium. Investigations of Bolaffio, Tedesco and the author on fasting dogs 

 show that under the influence of thyroidin the N : ?2O5 quotient in the urine is 

 markedly increased, and that further, in agreement with Scholz, the elimina- 

 tion of phosphorus in the feces is very much increased and that the ab- 

 normal distribution of phosphorus to the kidneys and intestine is called 

 forth by an increase of the calcium elimination by way of the intestine. 



It should be mentioned further that in Basedow's disease Forschbach 

 found strikingly slight amounts of creatinin in the urine. Also the ex- 

 ogenous factor (addition of meat extract) seems to be very small. In many 

 a case of Basedow's disease there exists in addition a pronounced polyuria, 

 that cannot be explained alone by the greater gram molecular amount 

 [Molenmenge] of the urine on account of the increased metabolism. Here 

 there is well present an excitation of the nerves of the renal vessels. 



Later investigations, not as yet published, by Zehner and me as to the 

 uric acid metabolism in Basedow's disease have led to a very remarkable 

 result. We found in all the severe cases thus far investigated by us not only 

 that the endogenous factor of the U-elimination was strikingly small, but 

 that also the exogenous U-elimination was quite unusually small. I have 

 reported such an investigation in Observation VIII, and would express the 

 opinion that a portion of the uric acid is further decomposed under the 

 influence of the hyperthyroidism. 



There are found not rarely in Basedow's disease ephemeral increases in 

 temperature. These were first described by Bertoye. Already Charcot had 

 mentioned in opposition to Bertoye that they were very much less frequent 

 than Bertoye stated. Among his numerous cases, they were never seen by 

 Kocher. They have been seen however by Saltier. At all events, it is cer- 

 tain that in many cases of Basedow's disease the equilibrium of heat is very 

 labile, and that on slight provocations the regulation is broken through in 

 the sense of a hyperthemia. Frederick Muller saw regularly in one case 

 marked rises of temperature after the administration of quinine. Eppinger 

 and Hess saw them in cases after the injection of atropine. Moreover cases 

 of peracute Basedow's disease are described that previous to death showed 

 marked tachycardia with delirium, and a simultaneous rise of temperature 

 to 4o-4iC. (Friedr. Muller). Also Hirschlajj saw in a case a terminal 

 rise of temperature to 40. I have often seen in severe cases of Basedow's 

 disease transitory rises of temperature to 39, without finding a ground for 

 them in the examination. After goiter operations, as is known, there have 

 been observed marked rises of temperature that last for several days (Ber- 

 gert, Reinbach, Kocher, Lanz). Riedel found them also after the operation 

 for ordinary goiter, although those which occur after operations for 

 exophthalmic goiter are essentially higher. Kostlivy found in all cases after 

 operation pronounced neutrophilic hyperleucocytoses, but postoperative 



