Prof. H. Starck states that among 450 cases of Basedow’s disease
observed in the last few years sixty-nine were operated on by prominent
surgeons, nearly all of which had been seen by him before the operation.
From his observations he concludes: 1. Operation effected a cure (_i.
e._, complete physical and mental restoration) in approximately 30 per
cent, improvement in 35 to 40 per cent, while in the other cases it
proved ineffective or was followed by a change for the worse. 2. The
operative mortality was 9 per cent (6 deaths in sixty-nine cases).
Kocher had a mortality of only 3.1 per cent; according to others,
however, it is 12 per cent. 3. If the surgeon accepts the view that a
persistent thymus is responsible for a fatal outcome, although no
positive evidence is at hand, he must determine whether this gland be
present before resorting to resection of the struma; if it is, ligation
of the vessels or resection of the thymus is to be considered. 4. The
choice of the anesthetic is of great importance as to the outcome of the
operation. The Basedow’s type with predominating nervous, myasthenic and
psychic symptoms is best operated on under general anesthesia, the other
cases under local anesthesia. 5. Operation is contraindicated in status
lymphaticus; if it can not be avoided, a local anesthetic should be
employed. 6. In many cases the operation only lays the foundation for
successful internal treatment. 7. The most unfavorable time for
operation is that of increasing intensity of the disease; the most
favorable, the stage of latency, or arrest. 8. The most suitable cases
for operation are those in which there is a “goiter heart;” also some
cases with classical Basedow’s symptoms. Only slight success is to be
expected in the presence of a nervous-myasthenic-psychic symptom complex
with but moderate cardiovascular symptoms. 9. The size of the goiter as
determined by palpation is no criterion as regards the question of
operation. Small, soft goiters are often of greater significance than
large, firm ones. 10. The blood picture also is of no importance in
considering the operative treatment, since it is not materially
influenced by operation.—_The International Journal of Surgery._