338 0. P. HOWAKD 



series of ftrty-three patients. Thompson states that "it is of the septic 

 type, oftenest remittent, but sometimes intermittent and always irregular 

 and occasionally remaining elevated three or four degrees for several 

 consecutive days. The duration of the fever varied from a few days to 

 several weeks. Often it lasted for ten days or a fortnight, in one case 

 for forty days and in another thirty-eight days." 



Mackenzie believes that such pyrexia is due to some complication. 

 Even though the temperature be normal, a subjective feeling of heat is 

 the rule, especially at night, and even in cold weather. Further, the 

 patients enjoy cold weather and are very intolerant of hot. 



Leopold-Levi in a recent communication on hyperthermia in thyroid 

 disturbances calls attention to the following clinical observations. The 

 subject is always too warm and sometimes suffers from a true "thermo- 

 phobia." The sensation of heat is localized and is either continuous or 

 intermittent but the temperature is hardly ever above 37 C. The tem- 

 perature is regularly a few tenths of a degree centigrade above normal 

 or there may exist a mild subfebrile state which is exaggerated by such 

 accessory factors as fatigue, emotion or menstruation. Lastly there 

 may be prolonged fever with remissions. 



Protein Metabolism. The protein metabolism is definitely increased 

 and the nitrogen equilibrium is maintained with difficulty; in the severe 

 cases there is a well defined loss of nitrogen. According to Magnus- 

 Levy (e), Lustig was the first to call attention to the increase of nitrogenous 

 metabolism in Graves' disease, but it was Friedrich Mueller who first 

 published convincing data. During the worst periods of the disease a 

 nitrogen-loss is by no means always the rule. In Magnus-Levy's opinion 

 the loss is not due to a relative subelimination but to the "toxic protein 

 disintegration." Janney (&) found that the nitrogen balance is a rather 

 delicate measure of the action of the thyroid hormone or Kendall's thy- 

 roxin. Janney noted a gain, not a loss, of nitrogen as the result of the 

 therapeutic action of the thyroid extract and concluded that loss of 

 nitrogen is due to a toxic action of the gland. 



Forschbach noted that only small amounts of creatinin, both en- 

 dogenous and exogenous, are excreted in the urine in Graves' disease: his 

 observations have not yet been confirmed. 



Carbohydrate Metabolism. This may also be disordered to a greater 

 or less degree. Accordingly we will consider (1) alimentary glycosuria, 

 (2) transitory spontaneous glycosuria, and (3) associated diabetes mellitus. 



Alimentary (llyrosuria. In many cases of Graves' disease alimentary 

 glycosuria can be excited by the administration of a carbohydrate-rich 

 meal, or better still of one hundred grains of pure glucose to the fasting 

 patient. Transitory glycosuria, especially of the alimentary type, was 

 noted by Clivostek in (><) per cent of his cases. In marked contrast is 



