BASEDOW'S DISEASE 99 



difficulty lies in the fact that the internist publishes only the severest, be- 

 cause interesting, cases, and that further, this material comes especially 

 from clinics and dispensaries, hence from the poorer classes of the popula- 

 tion; and yet v. Noorden mentions the fact that the course of Basedow's disease 

 is to a great extent dependent on whether the patient for a long time can 

 be placed under favorable living conditions until he has had time to regain 

 his health. The material of the individual statistics is therefore very 

 dissimilar. All statements by the internists agree on the one point that 

 in mild forms of Basedow's disease, recovery is the rule, as far as the 

 patients can spare time for a proper treatment (v. Noorden, Oppenheim, 

 Pribram, Chvostek, Mackenzie, Murray, Quine, and many others). Special 

 statements as to the curability of severe cases are not at hand. The state- 

 ments as to curability are concerned only with the slight and severe forms 

 together. I mention A. Kocher's statistics (internal cases) 18 per cent., 

 Syllaba's 26 per cent., Stern's (of 19 cases, 9 almost cured), Mackenzie's 50 

 per cent, (very good result), Quine's 60-70 per cent., Klemm's 25 recoveries 

 among 32 cases. Just as difficult is any idea as to the mortality (death from 

 Basedow's disease itself, not from intercurrent affections). Saltier has col- 

 lected the literature that is not too one-sided, and arrives at n per cent., 

 Kocher states 22 per cent., Leischer and Marburg, 12-25 P er cent., Mackenzie 

 estimates the mortality in the acute cases as at 30 per cent., in cases in which 

 icterus develops, the prognosis is extremely grave. Between these two ex- 

 tremes recovery and death- lie the chronic and more or less improved cases, 

 concerning the relationship of which to each other the figures again vary 

 widely. Thus Kocher states 33 per cent, uncured, 27 per cent, improved; 

 Syllaba 36 per cent, improved, Stern, of 19 cases of classic morbus Basedowi, 

 6 with slight improvement, 3 uncured. Stern mentions that the improve- 

 ment may set in even after years. Stern's work is of great practical impor- 

 tance in so far as it shows that cases on a degenerative-neuropathic basis 

 progress to full height, rarely die of Basedow's disease itself, and on the 

 contrary, very rarely recover entirely. 



In spite of the quantity of the material, its dissimilarity, as previously men- 

 tioned, gives no certain result, at least not until according to v. Noorden' s 

 proposition there are separate statistics as to the disease in the well-to-do 

 and the poor classes. Before I go into the question of internal treatment I 

 would like to make a few remarks as to the results of operation. Concern- 

 ing the method of operation, it should be mentioned that the ligation of 

 arteries of the thyroid gland has to-day for the most part been discarded, be- 

 cause unsafe, and that enucleation methods are mostly practised, and some- 

 times excision and ligation are combined. The resection of the sympathetic, 

 introduced by Jaboulay, practised especially by Jonnescu and by Abadie, has 

 found but little vogue. Lately Berard has stated that among 40 operations, 

 there were 8 complete cures, 5 died at operation, 16 retained a small goiter, 



