CLINICAL SYNDROMES 339 



the experience of Naunyn who, in his large series of cases at Strassburg, 

 noted only one case of alimentary glycosuria. Stern, too, noted it only 

 once in a small series of eight cases of exophthalmic goiter. However, 

 Stern admits that alimentary glycosuria occurred in 22 per cent of 

 Mendel's and 36 per cent of Strauss 7 series. Schulze noted it in 25 per 

 cent of his series, though of a varying degree; he believes it is much 

 less frequent than the adrenalin glycosuria which he found in 80 per 

 cent of his series. Williamson believes that alimentary glycosuria is 

 common and states that it may be induced in some cases by 20 to 30 

 grams of glucose, while in others 100 grams are required. 



Transitory spontaneous glycosuria is not common, though it occurs 

 occasionally in the course of Graves' disease. In Stern's opinion these, 

 with few exceptions, were instances of a diabetic glycosuria considered 

 under the third group. He, however, reports a case of his own and 

 refers to some reported by Chvostek, Kraus and Ludwig. Contrary to 

 the experience of Naunyn, who never saw a case of spontaneous glyco- 

 suria in Graves' disease, Williamson states that there is frequently a 

 temporary or intermittent glycosuria, but gives no figures. 



Stern further calls attention to the glycosuria produced by thyroid 

 medication in a certain percentage of patients not so far as known sub- 

 jects of hyperthyroidism ; he believes such may occur in those with latent 

 diabetes but also in more or less normal individuals. 



Associated Diabetes Mellitus. A true diabetes seems to occur in 

 Graves' disease somewhat more frequently than does simple glyco- 

 suria. The coincidence of these conditions, writes Stern, may be three- 

 fold, that is, exophthalmic goiter may arise during the course of 

 diabetes mellitus or it may be contemporaneously produced or the ap- 

 pearance of the diabetic phenomena may be subsequent to that of 

 Graves' disease. Stern found twenty-three such cases in the literature 

 'up to the year 1902 and reported two more of his own. Thompson, a 

 few years later, reported three such instances in his series of eighty cases 

 of Graves' disease. Finally, Williamson notes that both exophthalmic 

 goiter and diabetes mellitus may develop after a sudden mental shock 

 or great mental anxiety, and that a family history of diabetes is not 

 uncommon in Graves' disease (which was true in seven of his own 

 series), both of which facts are further evidence of the relationship be- 

 tween Graves' disease and diabetes mellitus. 



Hyperglycemia. Flesch in 1912 noted a complete absence of spon- 

 taneous hyperglycemia in Graves' disease, while 60.7 per cent of the same 

 cases showed an "alimentary hyperglycemia" one hour after the inges- 

 tion of 100 grams of glucose. Geyelin could not confirm the findings 

 of Flesch and criticizes the latter because he studied only nine fasting 

 cases and because of his use of an old, unwieldy method for the determi- 



