94 THE DISEASES OF THE THYROID GLAND 



cases are swollen, many authors have thought of an infectious etiology of 

 Basedow's disease. This assumption is not however satisfactory, as many 

 cases of Basedow's disease develop in complete health and are entirely fever- 

 free. Hence the acute infection is regarded by Mobius, de Quervain and 

 others only as the connecting link. As I have already mentioned, the 

 assumption of a thymogenic Basedow's disease seems to-day to have but 

 little foundation. Even those who refer all the symptoms of Basedow's 

 disease to an increase of function of the thyroid gland must recognize that 

 the cause proper of this increase of function is as yet unknown. As the 

 secretion of the thyroid gland is regulated by the central nervous system, 

 lately nervous centers have again been assumed (Wiener), constituting, in'j'a 

 manner, a revival of the bulbar theory of Char cot and Geigel (Oppenheim). 

 According to this theory many of the Basedow's symptoms, above all the 

 eye symptoms which are so hard to produce by artificial thyroidism, are 

 coordinated with those of the thyroid glandular swelling. This theory would 

 at least explain the rare observation that the exophthalmus may occur 

 unilaterally (Fr. Muller, Roasenda, Kocher, and others). 



The statements as to the theory and etiology of hyperthyrosis bring to 

 recognition the fact that the cause of Basedow's disease is not as yet explained. 

 Most of the symptoms can be referred to the hyper thyroidism; the cause of the 

 hyperthyroidism is possibly conditioned centrally, and thus perhaps a series 

 of symptoms and alterations in the function of other ductless glands are coordinate 

 with the hyperthyroidism. Finally, we should point out that the not unusual 

 combination of the trophoneuroses (scleroderma) with symptoms similar 

 to those of Basedow's disease or even typical hyperthyrosis obtain some 

 value in this connection (see Chapter I). 



Forms of Basedow's Disease. In consequence of the great variability 

 which Basedow's disease presents in its manifestations and in its course, 

 there has existed from former years the attempt to bring forward certain 

 symptoms as cardinal symptoms and to lend to certain apparently more re- 

 mote symptoms a greater nosological independence. Originally the symptoms 

 of the so-called Merseburg triad exophthalmus, goiter, and tachycardia 

 were taken as the cardinal symptoms. However, exophthalmus is wanting 

 in a not inconsiderable part of the cases of this condition and, moreover, 

 Pierre Marie added a new cardinal symptom the tremor. The fact that the 

 exophthalmus is often permanently absent led Pierre Marie to the establish- 

 ment of the formes frustes, the effaced, or better, the incomplete forms, while 

 formerly Charcot understood by forme fruste the residual condition after 

 improvement of the classic form. Gautier and Buschan distinguished true 

 Basedow's disease and the pseudo- or secondary Basedow's disease, regard- 

 ing the former as a general neurosis with the predominance of the psychic 

 and vasomotor sphere, while the latter is brought about by other changes 

 in the organism among others also a disturbance of function of the thyroid 



