BASEDOW'S DISEASE 93 



observations met with in Paris by the fact that only certain forms of struma, 

 as those for example in Geneva or Vienna, reacted to the administration of 

 iodine in this manner. The regional difference in the sensitiveness toward 

 iodine can be elicited from the large series of experiments of Fleischmann. 

 Fleischmann after the administration of iodine to the persons under inves- 

 tigation in Basel saw acceleration of the pulse in 68 per cent., in Berne in 23 

 per cent., in Berlin in only 3.7 per cent. In Heidelberg, the use of iodine 

 was warned against by Krehl. According to the statement of Breuer, 

 Kocher, Mobius, Ortner, Goldflam (the last on the injection of iodipin into a 

 person with tabes), there even a typical morbus Basedowi may develop, even 

 in cases in which no struma existed before the treatment with iodine; or in 

 cases of cured Basedow's there may occur a severe relapse with a new 

 enlargement of the thyroid gland. Case B. (Observation X), previously 

 reported, furnishes a good example of this; or an existing Basedow's dis- 

 ease may be considerably aggravated by iodine therapy (compare case S. 

 Schm). In Vienna, according to my observations, conditions are such that 

 one must directly warn young persons with diffuse soft strumas against the 

 use of iodine. Pineles has seen especially frequently, after the use of iodine, 

 the occurrence of the manifestations of thyroidism in goitrous individuals in 

 families in which Basedow's disease or diabetes has occurred or in which a 

 neuropathic disposition has existed. This was the case even when the 

 iodine was given in very small quantities. 



It would really be correct to separate the cases of simple iodothyroidism 

 from those of iodine Basedow's, although there are transitions between the two 

 groups. In the first group of cases administration of iodine brings about a 

 rapid melting down of thyroid-gland tissue and hence the manifestations of 

 thyroidism. After the discontinuation of the iodine medication the mani- 

 festations for the most part rapidly retrogress, the thyroid gland remaining 

 the same in size or becoming smaller. In the cases of iodine Basedow, on 

 the contrary, the thyroid gland increases in volume, and the Basedow's 

 manifestations can long outlast the iodine medication. 



As to the etiology of Basedow's disease we do not know anything definite. 

 The goiter noxus can play only a subordinate role, as just the fully developed 

 forms of Basedow's disease are rare in goiter districts. Neuropathic pre- 

 disposition is to be regarded at the most as a predisposing factor; psychic 

 and bodily traumata as well as iodine and thyroid glandular medication are 

 to be regarded as determining factors. Frequently Basedow's disease de- 

 velops at the close of acute infectious diseases (acute articular rheuma- 

 tism, angina, typhoid fever, scarlet fever, etc.). In some cases an idio- 

 pathic thyroiditis passes over into it. Finally, Kahn and myself in several 

 cases of declining tetany saw occurrence of thyroid glandular swelling and 

 distinct Basedow's symptoms. As furthermore the true Basedow's struma 

 shows accumulations of lymphocytes and as the parathyroid glands in such 



