BASEDOW'S DISEASE 8$ 



be called forth by the heightening of the metabolic processes that ensues in 

 consequence of the administration of the thyroid. 



Oswald, Minnie h, and others assume that in Basedow's disease the thyroid 

 furnishes a less active secretion (hypothyrosis or dysthyrosis) ; Mobius 

 believes, as already mentioned, in the increased secretion of a substance that 

 is qualitatively altered; while most authors, especially Fr. Kraus, advocate 

 the mere increase of the thyroid function without qualitative alteration 

 (hyperthyroidism). For this supposition, which I also advocate, speaks: 



1. The opposition in the symptom picture of Basedow's disease and 

 myxedema. 



2. The fact that on exothyropexy (conduction of the secretion of the 

 thyroid gland to the exterior) the thyroid gland in Basedow's disease fur- 

 nishes more secretion than the thyroid of the ordinary strumas. 



3. The results of surgical treatment (diminution of the secreting 

 parenchyma). 



4. The aggravation of Basedow's disease on the administration of 

 thyroid glandular substances and finally, 



5. Artificial thyroidism. 



Against these points many objections have been raised of which I shall 

 mention only the most important. Against point 5 has been objected 

 that while it is true that most of the symptoms of Basedow's disease may 

 be produced on the administration of thyroid gland, they remain much be- 

 hind those of true Basedow's disease in intensity, and some of them, for 

 instance the eye symptoms, are not produced in artificial thyroidism at all. 

 As far as the eye symptoms are concerned, I must again mention that Kraus 

 and Friedenthal observed exophthalmus after the injection into the blood 

 of rabbits of the thyroid glandular juice contained in the serum, as did 

 Heinecke on long-continued treatment with large amounts of thyroid glandu- 

 lar substance. In addition to-day exophthalmus can be produced in dogs 

 on the use of juice expressed from human strumas (Lampe, Liesegang, and 

 Klose, Baruch}. 



Lampe, Liesegang, and Klose, on the intravenous -injection into certain 

 breeds of dogs of fresh juice expressed from Basedow strumas, have found 

 marked increase of the temperature and pulse rate, exophthalmus, glyco- 

 suria and albuminurta. Death occurred in convulsions. Expressed juices 

 that were obtained from normal thyroid glands or ordinary strumas had no 

 effect, or very little effect. The authors regard these experiments as evidence 

 that in Basedow's disease there exists no hyperthyroidism but a dysthyroid- 

 ism. The experiments are very significant, but I do not regard them as 

 furnishing evidence for a dysthyroidism. It will not do to leave altogether 

 unconsidered the long-known fact that, as stated above, through the feed- 

 ing with normal thyroid glandular substances all the symptoms of Base- 

 dow's can be produced in a more or less well-pronounced manner. Also 



