IOO THE DISEASES OF THE THYROID GLAND 



5 were improved and 5 remained uninfluenced. The latest statistics of 

 Kocher include 376 of his own cases, of which 76 per cent, were cured (in one- 

 fourth of these the exophthalmus was retained). The mortality was 3.9 per 

 cent., the rest was improved or not cured; one-third of these cases were oper- 

 ated on more than once before the desired result was obtained. Leischner 

 and Marburg report 45 cases (without compression symptoms) from v. 

 Eiselberg's clinic, of which there were 6 cases of death (3 of the first 4 cases 

 operated on died), 18 cured, 8 improved. Mayo has 4.75 per cent, mortality 

 in 405 cases and 70 per cent, cures; Schultze (Riedef) reports among 50 cases 

 72 per cent, cured, 12 per cent, improved, 2 per cent, poor results, 12 per 

 cent, deaths. Landstrb'm reports among 38 cases 52.6 per cent, cured, 18.4 

 per cent, improvement, 29 per cent, poor result, among which 5.5 per cent, 

 death. I shall not enter into the older compilations, they are less valuable, 

 as the methods of operation have improved since their time and also the 

 indications for operation have changed somewhat. [See the tabulated list of 

 operative results in the addendum to this chapter.] 



If we consider that among the cases operated on just the mild cases seem 

 to be rare from the better situated classes, that therefore the surgical statistics 

 contain the especially severe cases, there is no doubt that all the surgical 

 treatment in general surpasses the medical. To this should be added that 

 after the operation the tachycardia usually diminishes; in a relatively short 

 time, the body weight rapidly increases, even without hospital care, and 

 working capability is rapidly attained. The difficult point of the question 

 to-day is concerned with the indications for operation. Mild cases among the 

 better situated classes should indeed not be recommended operation, nor 

 should the chronic formes frustes on a degenerative-neuropathic basis (Stem's 

 Basedowoid). Also Kocher points out that the results in these cases are less 

 satisfactory. Operation is indicated in cases with compression symptoms. 

 In the cases of pure Basedow's the social status should be decisive, because, 

 as already mentioned, without doubt, operation leads more rapidly and 

 certainly to working capability. A certain risk is always associated with 

 operation, especially if a status thymico-lymphaticus is present. According 

 to the statistics of Capelle, already mentioned, nearly 100 per cent, of the cases 

 of Basedow's disease that died at operation had a hyperplastic thymus. 

 Hotz therefore proposed to avoid operation if the X-ray transillumination 

 shows a shadow [indicating an enlarged thymus gland]. The demonstra- 

 tion of an enlarged thymus gland by means of the Rb'ntgen procedure is 

 however very uncertain. Kostlivy believes that the operation is especially 

 dangerous in the cases without mononucleosis. This does not however meet 

 with my view, because mononucleosis in the one and the same case may vary 

 greatly (vide ante). All these questions have not as yet been worked 

 out fully. 



Another question is as to whether one should operate early, or should await 



