BASEDOW'S DISEASE 95 



gland. Mobius distinguished primary and secondary Basedow's disease 

 according as to whether the alteration of function developed in a previously 

 normal or in a goitrously degenerated thyroid gland. Secondary Basedow's 

 disease ordinarily pursues a chronic course and is often incomplete; the 

 primary is often acute and rich in symptoms. The secondary form corre- 

 sponds to the goitre basedowifie (Revilliod and Pierre Marie] . Mobius does 

 not however ascribe so very great a significance to this distinction, as he regards 

 the alteration of function of the thyroid gland as the central figure. "The 

 cardinal symptom is just the tachycardia." Th. Kocher distinguishes between 

 the fully developed forms and the so-called hyperthyrotoxic equivalents. 



Fr. Kraus has separated out the so-called goiter heart as an especial 

 independent form. Apart from those cardiac disturbances which come about 

 through mechanical obstruction to the circulation or respiration, there exists 

 additionally in goiters, according to Kraus, a cardiac disturbance associated 

 with other hyperthyroidal symptoms, which cardiac disturbance is produced 

 by the thyroidal secretion acting at a distance. 



Eppinger and Hess distinguish between sympathicotonic and vagotonic 

 forms, according to whether the symptoms of excitation predominate on the 

 part of the autonomous or of the sympathetic nerves. Characteristic 

 for the vagotonic cases would be "a relatively slight degree of tachycardia, 

 with, however, markedly pronounced heart oppressions, distinctly marked 

 v. Grdfe, and wide palpebral fissures, absent Mobius, slight protrusion of 

 eyeballs, the marked secretion of tears, outbreaks of sweats, diarrheas, dis- 

 tresses that are to be referred to hyperacidity, eventually eosinophilia, and 

 disturbances of the rhythm and mechanism of respiration, absent alimentary 

 glycosuria;" in the sympathicotonic cases, Eppinger and Hess found "marked 

 protrusion of the eye-balls, greatly increased cardiac activity with slight ac- 

 centuation of the subjective disturbances, absence of sweats and diarrheas, 

 marked falling out of the hair, inclination to increase of fever, absence of 

 eosinophilia, no disturbances of respiration, alimentary glycosuria." 



The position of many of these symptoms as sympathicotonic or vagotonic 

 is as yet quite insecure. Thus, for example, the interpretation of the sweats 

 as vagotonic is not sufficiently founded, because as yet we have known noth- 

 ing as to the course of autonomous nerves of the skin. The significance of 

 the individual phenomena is rendered the more difficult because there exist 

 both sympathetic accelerator [fordernde] and inhibitor and autonomous ac- 

 celerator and inhibitor fibers. I cannot look upon the alimentary glycosuria 

 as sympathicotonic, as according to our investigations the alimentary factor 

 is to be sharply separated from the nervous factor, and for the former the 

 functional breadth of the pancreas is the determining factor. Moreover, 

 there are undoubtedly cases, as Eppinger and Hess and recently v. Noorden, 

 Jr., bring out, in the course of which at times the sympathicotonic, at times 

 the autonomotonic, symptoms predominate. Before everything else, how- 



