84 THE DISEASES OF THE THYROID GLAND 



Basedow's disease is associated with an improvement of the scleroderma. 

 There are, however, cases that take another course. Also complications of 

 Basedow's disease with tetany have often been observed (see Chapter IV). 



Pathogenesis. Before I enter into the consideration of the individual 

 forms of Basedow's disease, I should like to make a few remarks as to the 

 theory. The observation of File/me and of Dourdoufi and Bienfait that in 

 animals after the transection of the corpora restiformia there occur tachy- 

 cardia, exophthalmus, and hyperemia of the thyroid gland (unilateral opera- 

 tions are attended with these phenomena on one side only), for a long time 

 attracted many adherents to the bulbar theory, which attributed all the 

 Basedow's symptoms to alterations in the brain stem. Actually many 

 symptoms point to a bulbar origin, as for instance the glycosuria that some- 

 times occurs, the alterations of the voice, and eventually the pareses of the 

 various cranial nerves (Saltier} . It is indeed true that in certain cases altera- 

 tions are found in the medulla oblongata (Mendel and others), but in the 

 majority of cases these findings are absent. The French school, especially 

 Charcot, Trousseau and Gauthier, and in Germany Gerhardt and Buschan, 

 have regarded Basedow's disease as a neurosis, assuming that the entire 

 nervous system is diseased. Then Mo'bius, as has already been mentioned 

 in the beginning, placed the thyroid gland as the central figure in the patho- 

 genesis, assumed a poisoning of the body by the copious production of a 

 harmful secretion, and expressed the thought that all forms of Basedow's 

 disease (goiters that have become associated with Basedow's symptoms, 

 formes frustes, and the fully developed Basedow's disease) all depend on a 

 uniform basis. Mobius first pointed out the opposition between the symp- 

 tom picture of Basedow's disease and the disease condition that ensues 

 after extirpation of the thyroid gland. Mobius's teaching gained ground 

 rapidly, the predominant place of the thyroid gland in the pathogenesis of 

 Basedow's disease finding general recognition; but on the contrary the views 

 as to the kind of functional disturbance diverged greatly. The view first 

 advocated by Notki and later by Blum, that certain poisons existing in the 

 body were rendered nontoxic (i.e., detoxicated) in the thyroid gland and that 

 in Basedow's disease this detoxication is incomplete, may to-day be regarded 

 as untenable. It was displaced by the secretion theory, which maintained 

 that from the thyroid gland a specific active secretion is given off to the 

 blood path that is necessary for the retention of certain body functions, or, 

 according to the supposition of others, to the paralyzing of certain poisons 

 circulating in the body. The detoxication theory, although in an essentially 

 modified form, again greets us in the view last-mentioned. In this form, 

 however, there is as little evidence for it as in its older form. The known 

 experiment of Reid Hunt, according to which the resistances of animals to 

 methyl cyanide is somewhat raised, is not evidence for the detoxication 

 theory as, as Reid Hunt himself emphasizes, the heightening of resistance can 



