96 THE DISEASES OF THE THYROID GLAND 



ever, the tachycardia is evidently to be regarded as the cardinal symptom 

 of Basedow's disease; and, on the other hand, the sweats or the marked moist- 

 ening of the skin is so extraordinarily frequent that almost never can we 

 speak of a purely sympathetic type in the sense of Eppinger and Hess. In 

 my opinion everything speaks for the fact that in Basedow's disease the 

 entire nervous system is in a condition of overexcitement and that the pictures 

 presented by the vegetative nervous system are uncommonly manifold and 

 always changing. 



Very recently Stern has entered the list for the greater independence of 

 certain forms of Basedow's that he regards as Basedowoid. In a certain 

 sense there is in this a reversal to the views of Gautier and Buschan. Stern 

 divides the classic form into true and degenerative Basedow's disease, 

 according to whether the disease develops in a previously normal or in a 

 neuropathic individual. From the great group of formes frustes Stern 

 separates out Kraus's goiter heart; the remaining forms are based regularly 

 on an original degenerative neuropathic foundation. Basedowoid and 

 Basedow's according to this view are distinguished from each other essen- 

 tially by their beginning, course, and prognosis. According to Stern, they 

 never pass over into each other. Chvostek agrees with Stern on the whole, 

 except that he would regard as- formes frustes the relatively abortive cases 

 of true Basedow's that pursue a light course. Langelaan regards Stern's 

 Basedowoid as Basedow's on an asthenic basis. The practical significance of 

 a clinical differentiation of the individual formes is in themselves intelligible 

 if through them deductions as to the prognosis and therapy can be given. 

 On the other hand, I would point out with emphasis the danger that exists in 

 the fact that through the accentuation of the distinguishing features, the 

 painstakingly wrought-out conception of the pathogenetic unity, the hy- 

 per thyroidal syndrome, is relegated too much to the background. The 

 same is true as to the statement as to which symptoms must be present, if 

 we wish to establish the diagnosis of hyperthyrosis, that is, Basedow's disease 

 in a wider sense. It seems to me suitable to approach this question from 

 another direction, and to establish what symptom or what symptoms are con- 

 stant in artificial thyroidism and the earliest to appear. According to our 

 investigations on this subject it appears that without doubt the cardio- 

 vascular symptoms, especially the tachycardia, here predominate. To the 

 tachycardia may be added sweats, or mononucleosis, or psychic excitability, 

 or headaches, etc. The symptom that occurs twice as frequently is accord- 

 ing to our observation the greater moisture of the skin, which is absent only 

 in rare cases. If other symptoms are added to this, we obtain syndromes 

 such as tachycardia, sweats, headaches, or tachycardia, sweats, tremor, or 

 tachycardia, sweats, mononucleosis, etc. Hence by this route we come back 

 to the conception of Char cot and Mobius that just cardiac or vascular disturb- 

 ances are to be regarded as the cardinal symptom, to which is added in most 



