BASEDOW'S DISEASE IOI 



the results of internal therapy. A long period of awaiting is at all events 

 unsuitable if the cardiac manifestations are well pronounced, as operation 

 represents so much the less result the broader the cardiac dilatation and the 

 more advanced the degenerative alterations of the cardiac muscle and of the 

 other organs. On the other hand Kocher recommends a medical pretreat- 

 ment as preferable, as far as no indicatio vitalis does not make an immediate 

 operation necessary. 



Of late a lively discussion has arisen concerning the reliability or the value 

 of the irradiation of the thyroid gland with the X-rays. This was dis- 

 covered by Beck, first used in Germany by Gorl, and is warmly recommended 

 in Vienna by Holzknecht and G. Schwarz. Schwarz has reported 40 cases in 

 which after the irradiation the nervous symptoms always disappeared, and 

 the tachycardia almost always; in two-thirds of the cases there were gains 

 in weight, in about half the cases the exophthalmus retrogressed; only in one- 

 third was the struma decreased in size. The cases that Holzknecht later re- 

 ported showed a similar good result, v. Eiselsberg points out, however, 

 that in three of the cases that had been treated with X-rays and that 

 he operated on later, he found adhesions of the thyroid gland to the neigh- 

 boring parts; on account of this the operation was essentially more difficult. 

 Also Hochenegg reports three similar cases. It does not seem to me a priori 

 that such adhesions are to be referred exclusively to the X-ray therapy. 

 Kocher mentions especially that the operations of Basedow's strumas are 

 made especially difficult through an especial density of the peristrumal con- 

 nective tissues, by adherence of the external goiter capsule to the struma, 

 in short by alterations that are similar to those of a chronic inflam- 

 mation and are often found in strumas after a long treatment with 

 iodine salve; on the other hand it is to be expected that there are tissue 

 reactions to X-ray illumination that especially favor the development of 

 such adhesions and that the fragility of the blood-vessels constitute a 

 danger. In the discussion that followed Holzknecht 's presentation in the 

 Wiener Gesellschaft fur Arzte [Vienna Association of Physicians], v. Noorden 

 and v. Strumpell assumed an expectant attitude with regard to X-ray therapy, 

 while v. Wagner and Chvostek condemned it. In a number of cases that I 

 published from the first medical clinic since that time I have seen a right good 

 result as the consequence of X-ray therapy. 



I quote the following example: In one case the spontaneous glycosuria disappeared 

 from the day of the first irradiation, in another case the weight curve, which in spite of 

 week-long hospital treatment had continually sunk, began to rise only a few days after 

 the first irradiation, the diarrheas disappeared, and after a few weeks the patient could 

 again resume his studies as technician. 



As far as the internal treatment of Basedow's disease is concerned, it must 

 be sorrowfully said that all attempts to find a specific method of treatment 

 have up to the present not led to certain results. Ballet and Eniquez first 



