82 THE DISEASES OF THE THYROID GLAND 



hyperthermia only in cases with thyrotoxic symptoms or in true Basedow's. 

 Kochcr, Lanz, v. Bruns, and Schultze explain this hyperthermia as an absorp- 

 tion fever, as in operations on the throat there are present especially favor- 

 able conditions for the formation of hematomata. More probable is the 

 explanation that in consequence of the manipulation of the gland more thy- 

 roid secretion is absorbed and perhaps also the cervical sympathetic is irri- 

 tated mechanically. The objection of Schultze that the injection of extracts 

 from such strumas calls forth no essential rises of temperature in other people 

 does not seem to me tenable, as normal individuals do not possess the lability 

 of thermal equilibrium that exists in the Basedow's patients. 



The skin in Basedow's disease is usually delicate, pliable, moist, readily 

 reddened, showing well a lively play of the vasomotors. Increased sweat 

 secretion is almost constant and is mostly present from the beginning of the 

 disease. As is the case with all the symptoms of Basedow's disease, the 

 sweats undergo great variations; sometimes they occur only at night, and 

 often they are influenced greatly by psychic excitations. In rare cases, the 

 sweats have an odor (v. Basedow's, Dauscher, Observation V, previously re- 

 ported). Many of the patients sweat more on one side. In consequence of 

 the abnormal moisture of the skin due to the sweats there is found in most 

 Basedow's patients a reduction of the resistance to the passage of an electrical 

 current; this was first described by F. Chvostek and Vigouroux and was more 

 exactly studied by O. Kahler. On account of the marked excretion of sweat, 

 miliaria sometimes occur; the formation of larger vesicles with elevation 

 of the epidermis, as in Case K. (Observation V), seems to be a very rare 

 occurrence. 



Pigmentations are found in about half of all cases, and indeed on the eye- 

 lids, lips, throat, on the lines of constriction of the corset laces, on the 

 nipples, in the axillae, on the linea alba, exceptionally on the mucous mem- 

 branes, and also on the genitalia. In rare cases is found a diffuse brown 

 coloration of the skin of the extremities, indeed even a bronzing. In many 

 cases occur edematous swellings, especially of the eye-lids, but also on the 

 extremities; they are firm and do not pit on pressure. They probably differ 

 in nature. Trophedemas are apparently not very rare in Basedow's disease. 

 In many cases it seems as though we were dealing with a kind of lipodystrophy , 

 as for example in the case reported by v. Schrotter, in which simultaneously 

 with the emaciation of the upper half of the body there developed a con- 

 siderable swelling of the lower half of the body, looking just like myxedema. 

 Microscopical examination showed a lipomatosis with extraordinary large 

 fat lobules. In this case there was found also a quite extraordinary pigmen- 

 tation of the skin in the form of sharply circumscribed surfaces. I shall 

 refer later, in the discussion of the pathogenesis, to the myxedematous swell- 

 ings in this disease. There may be found also in certain cases hemorrhages 

 into the skin and the mucous membranes. A common symptom in Base- 



