BASEDOW'S DISEASE 97 



cases the increase in metabolism; with somewhat longer action of the hyper- 

 thyroidism, tachycardia, mononucleosis, and tremor may well be regarded 

 as cardinal symptoms. From these symptoms to pronounced exophthalmus 

 is indeed a wide stride; probably there is added an enormous flooding of 

 the blood with thyroid secretion; and perhaps other constitutional factors 

 whose nature is unknown to us. In the fully developed cases we have always 

 before us a marked condition of excitation of almost the entire vegetative nervous 

 system. This way of looking at the subject brings us back to Mobius's 

 view that all the syndromes of Basedow's disease have a common nucleus. 

 The classic form of Basedow's is characterized only by the more pronounced 

 accentuation of the eye symptoms, by a more considerable increase of the 

 metabolic processes, and by its rapid origin, while Stern's Basedowoid ordi- 

 narily shows from the beginning an insidious course. 



From both these forms the classic form and the forme fruste is to be 

 delimited sharply only the Kraus-Minnich goiter heart. The newer in- 

 vestigations show that here the cardiac disturbances are not of pure hy- 

 perthyroidal origin, but that the goiter noxus is involved in their coming 

 about. I shall therefore speak of this form under cretinic degeneration. 



Course.- The classic forms of Basedow's disease as well as the formes 

 f rustes show the greatest variability in their course. The classic form may de- 

 velop in the midst of complete health, often in a peracute manner, for ex- 

 ample, during swimming (Pribram) or a few hours after a tonsillotomy 

 (Patterson); the condition may again return to normal, with a disappearance 

 of the eye symptoms, or may lead to death under stormy manifestations (de- 

 lirium, premortal increase of temperature), or may go over into a chronic form 

 with remissions and renewals. It can, however, after several years show a 

 surprising turn toward amelioration, and may eventually heal with the re- 

 tention of the exophthalmus, which has now become definite; relapses of 

 this form are frequent; in other cases it leads to severe irreparable cachexia. 

 The classical form may also begin gradually both in previously normal and 

 in neuropathically affected individuals, or may show quite the picture of a 

 forme fruste, and only later develop fully under any determining factor or 

 without ascertainable cause. 



Among the formes frustes are slight abortive cases of sudden onset. 

 The cases with fat stools and glycosuria are mostly cases of abortive formes 

 frustes (without eye symptoms). Many of the cases that I observed set in 

 after trauma, but in the great majority of formes frustes a quite gradual 

 beginning is the rule; especially in those forms existing on a neuropathic 

 basis, the forms that Stern designated as Basedowoid, the beginning goes as 

 far back as youth, and decades may lapse before the disease is to any degree 

 distinct. In such characteristic cases the trophic disturbances are mark- 

 edly prominent. It is Stern's great service to have shown that in these 

 cases there is quoad sanationem a very favorable prognosis. On the con- 

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