98 THE DISEASES OF THE THYROID GLAND 



trary I cannot agree with Stern that "Basedowoid" cases never go over 

 into the classic form of Basedow's. It seems to me that the typical Base- 

 dow's on a degenerative foundation (Stern's degenerative Basedow's) can 

 hardly be anything else than a Basedow's with acute exacerbations. 



The diagnosis of the classic form is easy, differential diagnostic diffi- 

 culties presenting only in the formes frustes. Alcoholism and nicotinism 

 may produce tachycardia and tremor; the history or finally the demonstra- 

 tion of a central scotoma will set the diagnosis right (Chvostek). Fr. Muller 

 has pointed out the similarity of chronic lead poisoning to the formes frustes. 

 Here the lead line and the granular erythrocytes will set matters clear, 

 although I have seen a case of the combination of the two conditions [lead 

 poisoning and Basedow's]. Difficulties may also attend the decision of the 

 question whether such Basedow's symptoms as tachycardia, pigmentations, 

 lability of the vascular system which often accompany such trophoneurosis 

 of the vegetative nervous system as scleroderma, depend on a simultaneous 

 hyperthyrosis or the fundamental disease as such. Cassirer further points 

 out that a slight grade of exophthalmus is often simulated by the sclero- 

 dermic mask. The presence of a Basedow's struma in four such cases enables 

 us to speak with probability of a combination with Basedow's disease. 

 Most difficult is the differential diagnosis from the cardiovascular neurosis 

 of Chvostek in which occur tachycardia, dermographism, inclination for sweats 

 and fine-waved tremor. Great lability of the heart manifestations speak 

 for neurosis, enlargement of the thyroid gland and slight eye symptoms, 

 heightening of the [metabolic] exchange (v. Noorden) and especially a mono- 

 nucleosis speak for hyperthyroidism. In many cases, as Chvostek emphasizes, 

 a certain diagnosis can be first established from the course of the disease. 

 In persons that come to the physician with complaints as to slight emacia- 

 tion, nervousness, cardiac palpitations, and psychic excitation, light will 

 often be thrown on the matter by the fact that they have been using iodine. 

 For the judgment of the fat stools the evacuation of unsplit neutral fats and 

 the predominance of finely divided soap balls and fatty acid needles is decisive. 

 Evidence for the diagnosis of a complicating glycosuria is afforded by the 

 fact that the true thyrogenic glycosuria usually is of slight intensity and 

 that with the improvement or the retrogression of the Basedow's symp- 

 toms it not only disappears, but high or normal tolerance for carbohydrates 

 reappears very rapidly. 



Prognosis and Treatment. Since the beginning of the operative era in 

 the treatment of Basedow's disease the question of especial interest has been 

 whether surgical treatment should supersede the medical treatment. One 

 has but to consider the great variability in the course of Basedow's disease 

 to understand that this question can be solved only by great statistical 

 material. We must therefore bring up the question as to the prognosis 

 of the cases of Basedow's disease treated purely medically. The greatest 



