BASEDOW'S DISEASE 89 



will be found a compilation of such cases. The observation that a fully 

 developed Basedow's may gradually go over into a myxedema has nothing 

 striking about it, for an overfunctionating thyroid may degenerate and 

 become functionally insufficient. Such a case was first described by Jojfroy 

 and A chard. In a twenty- three-year-old woman there first developed a 

 typical Basedow's disease, then great weakness, swelling of the feet, legs, 

 trunk, the upper extremities and the face, apathy, great fatigability. Au- 

 topsy showed a sarcoma of the pleura and disappearance of the thyroid 

 parenchyma, in the place of which was found connective tissue. Confer 

 also the case of Gauthier. 



Concerning the cases with simultaneous occurrence of Basedow's disease 

 and myxedema, I would remark that in many of these cases the diagnosis 

 myxedema seems to me very doubtful indeed. I call to mind the above- 

 mentioned case of v. Schrotter, which microscopical examination showed to be 

 lipomatosis. Perhaps something analogous is to be seen in the case of 

 Hirschl, in which the skin of the ankle-joint was entirely normal and the 

 swelling of the leg ended in a sharp ring. In this case, too, the swelling of 

 the face was limited to a pad-like thickening on the lower border of the 

 lower jar. The circumstance that the skin was dry is no evidence for myx- 

 edema; otherwise there was a typical Basedow's disease. Also in both of 

 Loeiv's cases otherwise typical cases of Basedow's disease there existed 

 a thickening of the extremities that involved the backs of the feet little 

 if at all. Thyroid medication had no influence on this thickening. 



It seems to me further noteworthy that almost all the cases that Saltier 

 quotes show peculiar complications. In two cases (cases of Mobius and of 

 Hirschl) there existed at the same time osteomalacia. In the case of S oilier, 

 the myxedematous swellings occurred especially at the time of menstruation, 

 in the case of Ulrich there were choreiform twitchings, in the case of Kow- 

 alewsky epilepsy since youth, in the case of Holub there was marked Chvo- 

 stek's sign, and in Osier's case there later occurred under thyroid medica- 

 tion marked glycosuria. Moreover, I consider it possible that cases that 

 stand on the border-line of thyroid glandular insufficiency would under cer- 

 tain conditions show lowered tolerance for thyroid-gland preparations. 

 As example I cite the following case: 



Observation X. Mrs. B., forty-eight years, has nad five confinements. After the last 

 confinement there was a gradual taking on of body weight, until she weighed about 125 kg. 

 About twenty years ago she underwent a reduction cure, in the course of which she rapidly 

 lost 14 kg. At the time, also, thyroid-gland tablets were administered. After the treat- 

 ment marked excitability, cardiac oppressions, diarrheas, sweats, and tremor occurred. 

 These symptoms lasted a long time. Then they retrogressed and the body weight again 

 increased. Three years ago after inunction of an iodine salve, there was a gradual in- 

 crease of the Basedow's symptoms. The thyroid gland had formerly been large, and now 

 enlarged still more. Two years ago the right lobe of the thyroid gland was extirpated. 

 After the operation there was gradual increase of body weight, about 12 kg., sensation of 



