BASEDOW'S DISEASE. 83 



dow's disease is the falling out of the hair, that sometimes may lead almost 

 to baldness. Also the nails are sometimes fissured. 



Alterations of the osseous system occur mostly if the Basedow's disease 

 has developed in an individual who is youthful. Holmgren has pointed out 

 that youthful Basedow's patients show an accelerated growth in height and 

 a somewhat premature closure of the epiphysial junctures. Very instructive 

 is a case of Schkarine in a four and one-half-year-old girl who showed an 

 abnormally rapid growth. Also Ballet reports a nineteen-year-old girl with 

 Basedow's disease and "gigantism." The skeleton of the patient with Base- 

 dow's is mostly slender; the end phalanges are mostly pointed (Revilliod). 

 v. Jaksch and Rotky describe in a case of Basedow's painful distentions at 

 the distal ends of the forearm bones, and later also of the ribs, shoulder- 

 blades, upper-arm, thighs, etc. Later the case developed kyphoscoliosis and 

 paraplegia. The simultaneous occurrence of Basedow's and rheumatoid 

 arthritis has been frequently described (Jones and others). 



The alterations in the genitalia are mostly more pronounced in men, and 

 in severe cases there may sometimes be decrease of libido and impotence. 

 In women there are usually alterations of menstruation sometimes cessa- 

 tion of menstruation is an early symptom. On longer duration of the disease 

 there may come about an atrophy of the entire genital apparatus (Cheadle, 

 Askanazy, et a/.). In the case of Kleinwachter there occurred, in addition to 

 a pronounced atrophy of the external and internal genitalia, even an atrophy 

 of the mammae. The relation between the genital sphere and the thyroid 

 gland is found also in the fact, known for so long, that there is an increase of 

 the volume of the thyroid at the time of puberty and during pregnancy. 

 There may also occur during the period of pregnancy a development of a 

 goiter (Lawson Tail) , which disappears after labor and recurs during the next 

 pregnancy. Vermorel refers the tachycardia and the cardiac palpitations 

 that sometimes occur at the time of puberty to a light grade of hyperthy- 

 roidism. At any rate it is noteworthy from this point of view that Base- 

 dow's disease is not at all rare. During pregnancy the Basedow's symptoms 

 mostly become exaggerated (Cholmogorojf and others'). As the tendency to 

 Basedow's disease is sometimes inherited and as in the decline of Basedow's 

 patient frequently other diseases neuroses of the vegetative nervous 

 diseases, diabetes, etc. occur, matrimony is to be advised against to 

 Basedow's patients, or in it conception is to be avoided (/. Novak). 



Basedow's disease can naturally be combined with many other diseases. 

 We should mention the not rare combination with the trophoneuroses, espe- 

 cially with scleroderma. Such a case was first reported by Leube. Since 

 that time numerous cases have been reported. An accurate compilation has 

 been made by Saltier. Basedow's disease may be added to an already exist- 

 ing scleroderma, or sclerodermic symptoms may develop in the course of a 

 Basedow's disease. Observers have often found that an improvement of the 



