Milestones in European Thyroidology (MET)

Carl Adolph von Basedow (1799 – 1854)

Carl Adolph von Basedow Carl Adolph von Basedow was descended from a reputable family. His grandfather founded in 1774 the famous “Philanthropinum” in Dessau, the first of a kind of boarding schools which later expanded in Germany and in Switzerland and were based on models from Nature and the Enlightenment, inspired by the French philosopher J. J. Rousseau. Von Basedow’s father and his elder brother were presidents of the council of the principality of Anhalt. Carl von Basedow was born in 1799 in Dessau, the capital of Anhalt, which is located between Berlin and Leipzig. He studied medicine at the University of Halle (south of Dessau), where he received the doctorate in the name of the King of Prussia at the age of 22. The topic of his thesis (written in Latin) dealt with a new method of surgical amputations. After attending lectures at the famous hospitals Hòtel de Dieu and Charité at Paris he obtained a diploma (with the first grade) certifying him as general practitioner, surgeon, and obstetrician. The same year, in 1822, at the age of 23, he took over a GP practice in Merseburg, a district town of about 8000 inhabitants south of Halle.

In 1823, the young doctor married Louise Friederike Scheuffelhuth, daughter of the district notary. From their two elder daughters stemmed eleven grandchildren. Their son lived in France and had no children, and their youngest daughter died at 6 months. It is said that he was very close to his family and that he was an affectionate father. In spite of his many obligations he took the time to play music with his daughters, listen to concerts, hike and hunt. The soirées at the Basedows` were quite popular in the community.

Carl von Basedow had a reputation as an all-round, modern-thinking, and careful family doctor who had a foresight for future developments. Being engaged as a round-the-clock physician for “the town and the country” he was obviously quite socially-minded. It is reported that he often treated patients without payment. In 1831 he voluntarily helped to fight a cholera epidemic in Magdeburg. From today`s perspective it is astonishing to see how comprehensive the abilities of a general practitioner were at those times. Thus, Dr. Basedow even performed the post-mortem investigations of many of his patients. Being moved by the mysterious death of his youngest child he even performed the autopsy himself:

“The little girl, unfortunately my own baby daughter died . . . .At autopsy the heart was absolutely healthy and normal, however, in lungs, liver, spleen, and mesenterium there were multiple tubercles at the size of peas, some of them already being rather soft.” (Autopsy report from Dr. von Basedow)

In 1841 von Basedow was appointed Royal Medical Counsellor and in 1848, he was selected against eight other competitors as state physician (“Kreisphysikus”) for the district of Merseburg, being responsible also for the municipal hospital.

Typical for his engagement in the social aspects of medicine were his efforts to end the “unchristian breast-feeding by paid wet-nurses” and the surveillance of foster-mothers by a hygiene police in order to protect stepchildren. He introduced the testing of drinking water and he vehemently fought to ban paints containing arsenic.

After performing an autopsy in a death from unknown causes, Carl von Basedow came down with a fever and he died three days later on April 11, 1854. It must have involved a very contagious infection, as the dressing woman and the hearse driver also died.

Carl von Basedow had broad and varied scientific interests which have been documented in some 60 publications, 47 of which are considered important for that time(1). Most of his contributions dealt with topics related to surgery, internal medicine and gynaecology / obstetrics. However, there were also articles about diseases of ear, nose and throat, eye diseases, dermatology, neurology, and paediatrics. Very important at that time were his observations on the detrimental effects due to evaporations from paints containing arsenic (“Schweinfurther Grün”).

Most historically significant however, was the detection and first description of the “Basedow Disease” in March 1840. In fact he was the first to define the linkage of the three characteristic symptoms of exophthalmos, palpitations of the heart, and goitre(2). He had recognized this syndrome – the historical “Merseburger Triad” as it is called in textbooks – after observing four patients over periods of 11, 10, 5, and 2 years. However, he did not just describe the connection between these symptoms but he also tried to explain the pathophysiological mechanisms of this unusual combination of diseased organs. According to the title “Exophthalmos by Hypertrophia of the Tissue in the Orbita”, von Basedow had recognized that the exophthalmos was not due to any change in the eyeball but rather to the tissue behind it.

Carl Adolph von Basedow “. there appeared an eminent protrusion of the eye balls, which by the way were absolutely healthy and had a completely full sight. In spite of this the sick woman was sleeping with open eyes and had a frightening appearance.” (Dr. von Basedow`s report about Madame G.)








As pointed out by Georg Hennemann(3), Carl von Basedow did not only detect the thyroid associated exophthalmos – the term Graves` ophthalmopathy was introduced by later generations – but he was already correct in thinking of a cause mediated via the circulation when he hypothesized that “dyscrasia of the blood” (i.e. inadequate mixture of the blood) would cause the tissue swelling in the orbita and the thyroid. During the following hundred years there were more than 50 publications with various, partly rather peculiar proposals concerning the aetiology, as demonstrated in the extensive historical review by Hennemann(3) . The uncertainty would last until the year 1956, when finally Adams & Purves discovered the antibody-mediated origin (i.e. via circulation)(4).

It is amazing to read the exact and meticulous clinical descriptions from those days. Von Basedow described most of the signs and symptoms of hyperthyroidism which remain valid, although some of those longstanding, extreme alterations are scarcely to be seen nowadays, at least in Western Europe. Thus the male patient of his series (“Herr M.”) finally lost his eyesight after his extremely exophthalmic eyes (“prominent like a crayfish`s eyes”) were gradually destroyed by infections, leaving residual craters. Von Basedow described explicitly pretibial myxoedema in two patients, although he declined the term “oedema”, because the thickened lower legs (not the feet) consisted of a “plastic brawn”, not being impressible and not releasing fluid by puncture. The phenomenon of an amelioration in Basedow`s hyperthyroidism during pregnancy was described in all of his three female patients, as well as its post-partum deterioration.

It seems striking that severely thyrotoxic subjects often do not realize their own bad condition. This observation was also made in all the four of von Basedow’s severely ill patients. Regarding the two ladies, who were observed for the longest time, this peculiar behaviour even led to the rumour in town that they were mad, since in spite of their frightening appearance with extreme weight loss, swelling of the eyes and breathlessness, they showed an unnatural gaiety and carelessness, and even during cold periods they would wear open or light clothing. One of them (“Madame F.”) was even put into a lunatic asylum, although Dr. von Basedow asserts that she never had any ill intensions or “abnormal expressions of will”. All four patients were extremely thin (obviously accompanied by frequent diarrhoea). That is why von Basedow – not knowing that the newly recognized disorder would get his name – proposed in his second publication to name the disease “goggle eye cachexia” (5).

It is noticeable that among the various treatment methods from that time, von Basedow reported that iodine (given because of goitre, and obviously at high dosages) and digitalis would give improvement to hyperthyroidism, the best cure being pregnancy, however.

In conclusion, Carl von Basedow not only discovered the Merseburger Triad (exophthalmos, tachycardia, goitre) but also described most of the other main characteristics of immune hyperthyroidism. Additionally, he pondered logical pathophysiological causes of the disorder. Certainly such an outstanding achievement deserves that the disease (except in English-speaking countries) is called “Morbus Basedow” or “Basedow`s Disease”. In March 1990, this outstanding contribution was the focus at an international convention called “150 Years of Morbus Basedow” at Halle and at Merseburg. At this event the only still existing original painting of Carl von Basedow (see above), which was painted by his cousin the painter Franz Krüger, was donated to the Carl-von-Basedow-Klinikum in Merseburg, where it now hangs in the hall. At this meeting, leading thyroid experts were invited to an impressive ceremony at the tombstone of Carl von Basedow at Merseburg`s cemetery, where the organizers, the late Wieland Meng, and Aldo Pinchera (ETA president) gave short speeches honouring Carl von Basedow.

Prof. Dr. med. Klaus-Werner Wenzel
Humboldt University Berlin
Fellow of the Royal College of Physicians Edinburgh



References

1. Broghammer, H. Sanitätsrat Dr. Karl Adolf von Basedow: Kreisphysikus von Merseburg. In: Lebensläufe-Lebensgeschichten; 3., Herbert Broghammer - Herbolzheim, Centaurus Verlag, 2000 (Stadtarchiv Merseburg)
2. Basedow, von C. A. Exophthalmos durch Hypertrophie des Zellgewebes in der Augenhöhle, Wochenschr. für die ges. Heilkunde 1840, 13:197
3. Hennemann, G. Historical aspects, about the development of our knowledge of morbus Basedow. J. Endocrinol. Invest. 1991, 14:61
4. Adams D.D & Purves H.D. Abnormal responses in the assay of thyrotropin. Proc. Univ. Otago Med. School 1956, 34:11
5. Basedow, von C.A. Die Glotzaugen. Wochenschr. für die ges. Heilkunde 1848, 49:770




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