86 THE DISEASES OF THE THYROID GLAND 



BamcJi. who experimented in a manner quite analogous to that of Lampe, 

 Liesegang, and Klose, and had similar results, does not agree with these 

 authors' interpretation. 



Much cited is the case of v. Nothajft, which I shall describe in detail on 

 account of the interest that it has attracted. It was that of a forty-five- 

 year-old man with a corpulency that had been increasing for several years. 

 In the course of about five weeks he took almost 1000 thyroid-gland tablets. 

 Inashort time there developed a complement of Basedow's symptomsof which 

 I will mention irritating cough, tachycardia, acceleration of respiration, 

 slight increase of temperature, bilateral exophthalmus, tremor of the whole 

 body, even of the tongue, increased strangury, glycosuria (up to i per cent.), 

 morose mood, excitement, and finally swelling of the thyroid gland. The 

 irritating cough disappeared eight days after the onset of the thyroid 

 glandular therapy, as did also the sugar, without alteration of the diet; the 

 tremor disappeared after four weeks; the struma, the exophthalmus, and the 

 rest of the eye signs lasted nearly one-half year and then retrogressed almost 

 entirely. Although here almost the entire symptom-complex of Basedow's 

 disease developed, the case is however not entirely convincing. We shall 

 see later that in many persons often relatively small amounts of iodine are 

 sufficient to occasion an enormous increase of the function of the thyroid 

 gland. Also in the case of v. Nothafft the amounts of iodine contained in the 

 administered thyroid gland material may have sufficed for the purpose, as 

 speaks also the transitory development of a struma. This objection might 

 very well be raised to an artificial hyper thyroidism, unless the thyroid gland 

 in the affected individual were absent. Now in myxedema after thyroid 

 operation we may indeed frequently observe an extraordinarily high toler- 

 ance for thyroid-gland substances, but on the other hand, symptoms of 

 hyperthyroidism may be elicited after the administration of enormous 

 amounts. At all events, we must not forget that we do not know anything 

 as to the amount of thyroid-gland secretion given off to the blood in Base- 

 dow's disease. Probably it is very large. We should further consider that 

 on the peroral administration of large amounts the absorption would soon 

 suffer harm. 



Although I therefore do not recognize the arguments advanced up to the 

 present time as convincing, I shall have to acknowledge that artificial 

 thyroidism has not as yet furnished complete evidence for the opinion 

 here advocated. The greater intensity of the symptoms in true Basedow's 

 always admits of the possibility that hyperthyroidism is only a partial phe- 

 nomenon of an alteration of the central nervous system and that the organism of 

 the Basedow's patient reacts to hyperthyroidism in a different manner than 

 the normal. The foundation for this can perhaps be seen in a constitutional 

 alteration, of which the cause lies in the associated involvement and perhaps 

 in a functional increase of other ductless glands. The final cause of all the 

 manifestations could well be regarded as lying in the central nervous system. 



