484 EMIL GOETSCH 



Basal Metabolism Determinations in Thyroid Disorders 



Principles of Basal Metabolism. To Friedrich von Miiller (a) and 

 Magnus-Levy (a,) belongs the credit of first (1893-1895) pointing out that 

 one of the most characteristic phenomena of hyperthyroidism is an increase 

 in general metabolism, while in hypothyroidism there is a diminished 

 metabolism. They suggested, further, that these peculiarities depend on 

 the regulatory action of the thyroid secretion on metabolic processes. It 

 would seem, therefore, that the optimum conditions of body function are 

 dependent on a definite quantity of thyroid and synergistic secretions 

 which can vary only within narrow limits without producing more or 

 less serious disturbances. They noted further that in Basedow's disease 

 patients tended to become emaciated and that the metabolism was of a 

 labile character expressing itself characteristically in alternating periods 

 of emaciation and of increase in weight although a good appetite was 

 usually present. 



Magnus-Levy (a) (1895) was the first to make a systematic study of 

 the respiratory exchange in Basedow's disease and pointed out that along 

 with the emaciation, tachycardia and elevation of temperature, the 

 respiratory exchange and heat production per kilogram and minute 

 showed values far in excess of those of healthy persons of the same 

 size and weight. He further reports two cases of recoveries from Base- 

 dow's disease, in which the subjects showed normal respiratory rates. 

 In some instances of severe hyperthyroidism the respiratory exchange 

 reaches a point as much as 100 per cent above the normal. Between 

 this point and the normal there are all possible variations of respiratory 

 rates depending upon the severity of the thyroid intoxication (Du Bois, 

 191(5; Sandiford, 1920). 



In this country Du Bois was unquestionably the pioneer in the study 

 of metabolism in hyperthyroidism. His results and a review of the Ger- 

 man literature are given in his paper published in 1916. Du Bois was 

 the first to study metabolism in exophthalmic goiter by means of a respira- 

 tion apparatus, which was also a calorimeter. He believed that meas- 

 urement of the heat production gave the best index of the severity of the 

 disease and of the effect of treatment. Very severe cases showed an 

 increase of 75 per cent or more above the normal average, severe cases 

 50 per cent or more, and moderately severe and mild cases less than 50 

 ]>er cent, while a few mild and several atypical and postoperative cases 

 were found to bo within normal limits. 



Very soon after the discoveries of von Miiller and Magnus-Levy at- 

 tempts were made to measure the heat production and basal metabolism of 

 subjects under various conditions and with various diseases. By the 

 term "basal metabolism," or better, "basal metabolic rate/' of an organism 



