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Karl Adolph von Basedow was born on March 28, 1799, in Dessau, Germany, a town located between Berlin and Leipzig (Fig. 1). He was the son of an aristocratic family. His grandfather, Johann Bernhard Basedow, was a German educational reformer, teacher, and writer. In 1774, he founded the “Philanthropinum” in Dessau, a short-lived but influential progressive school inspired by the French philosopher J. J. Rousseau. Von Basedow’s father held a prominent position as president of the council of the principality of Anhalt [1].

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Karl Adolph von Basedow.

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Map of Germany, indicating Dessau, von Basedow’s hometown, and Merseburg, the town where he practiced as a family physician and was laid to rest

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Little is known about von Basedow’s youth. He had two sisters and one brother [1]. Basedow went to school in Dessau and then studied medicine at the University of Halle (south of Dessau), where he received his doctorate of medicine and surgery in January 1821 at the age of 22. His thesis, which was written in Latin, addressed a new method of lower leg amputation. After spending 2 years on the surgical services at two famous hospitals in Paris, Hòtel de Dieu and Charité, von Basedow obtained his license certifying him as a general practitioner, surgeon, and obstetrician in June 1822. In the summer of 1822, at the age of 23, Basedow settled in Merseburg (Fig. 1), a district town of about 8000 inhabitants, and began practicing as a general physician.

On April 23, 1823, von Basedow married Louise Friederike Scheuffelhuth, the daughter of a district notary. They had three daughters and one son; their youngest daughter died at 6 months of age from tuberculosis [1]. Von Basedow was described as an affectionate father, taking time to play music with his daughters. He loved not only listening to music and concerts but also hiking, was an avid hunter and fisherman, and enjoyed socializing [2]. The evening soirées at the von Basedow’s were quite popular in the community.

In 1841, von Basedow was appointed Royal Medical Counselor, and in 1848, he was selected from among eight other candidates as state physician/chief medical officer (“Kreisphysikus”) for the district of Merseburg, a position he held until his untimely death. After pricking his finger while performing an autopsy on a patient who died of typhus or spotted fever, von Basedow developed a fever and died 3 days later of sepsis on April 11, 1854, at the age of 55 [2, 3]. Von Basedow was buried in the Sixtus Cemetery in Merseburg on Good Friday, April 14, 1854.

As a physician, von Basedow had a reputation as a kind, talented, and skilled family doctor with extensive knowledge of all aspects of medical practice who also possessed a social conscience [2]. He was the “round-the-clock” physician for “the town and country,” caring for not only aristocrats but also the poorest, sometimes without seeking payment. In 1831, he voluntarily helped to fight the cholera epidemic in Magdeburg; an invaluable experience that he would later draw from when cholera afflicted Merseburg. He performed the autopsies of many of his patients, including his youngest child. The comprehensive care provided by von Basedow as a general practitioner during these times is truly remarkable.

Von Basedow was not only an astute and dedicated physician but he was also extremely dedicated to public health issues. He sought to end the “unchristian breast-feeding by paid wet nurses,” introduced testing of drinking water, and, after observing the detrimental effects of arsenic-containing paints (“Schweinfurter Grün,” “poison green”), vehemently fought to ban paints containing arsenic [1, 2].

From a scientific standpoint, von Basedow became a member of the Medical Society of Leipzig in 1838 and was recognized as a very accomplished scholar with excellent insight and foresight. Similar to his clinical practice, he had extensive, broad, and diverse scientific interests, which were documented in approximately 60 publications. The majority of his contributions addressed topics related to surgery, internal medicine, and obstetrics and gynecology. However, articles also focused on diseases of the eye, ear, nose, and throat, dermatology, neurology, and pediatrics, reflecting von Basedow’s extensive and different scientific interests [4].

Von Basedow’s most significant contribution to medicine was the first description of “Basedow disease” in the German language on March 28, 1840, entitled “Exophthalmos due to hypertrophy of the cellular tissue in the orbit” [5]. In this seminal article, von Basedow describes “…there appeared an eminent protrusion of the eyeballs, 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.” This initial publication was followed by several others and the phrase “glotzaugen-cachexie” or “google eyes cachexia” was coined [6, 7]. These publications represent von Basedow’s observations of four patients over periods ranging from 2 to 11 years. In his 1840 publication, von Basedow masterfully described the relationship between three characteristic symptoms: exophthalmos, palpitations, and goiter [5]. In 1851, these three cardinal symptoms characterizing the disease became known as “Merseburg triad.”

Von Basedow had impressive observation skills and depicted this illness meticulously, vividly, and accurately, describing a frequent pulse that was irregular and sometimes accelerated, a swollen thyroid gland, and eyeballs that could not be pushed back with movements that were hindered such that the patients slept with their eyes open [2]. He also remarkably described the symptoms of heat intolerance (during cold weather, women would wear open or light clothing), profound sweating, diarrhea, and weight loss in the presence of increased appetite, as well as weakness, tremor, pretibial myxedema, and temperament change [2]. His two most severely thyrotoxic female patients displayed an “unnatural gaiety and carelessness,” and one, Madame F, was even placed in a lunatic asylum, although she never had any ill intentions or “abnormal expressions of will.”

Although the long-standing and extreme alterations of untreated disease are scarcely seen today, von Basedow clearly describes these processes such as observed in Herr M who lost his eyesight after his “prominent like a crayfish’s eyes” were gradually destroyed by infections, leaving residual craters [1]. In his female patients, he also reported on the amelioration of hyperthyroidism during pregnancy, as well as deterioration of disease in the postpartum period [2]. Regarding treatment, von Basedow reported that mineral waters that contained iodine and bromide and digitalis would improve the symptoms of hyperthyroidism [1].

There has been a long dispute over who first described these diagnostic features as these symptoms had been previously reported by Irish physician Robert James Graves in 1835 [8], Italians Antonio Giuseppe Testa in 1810 [9] and Giuseppe Flajani in 1802 [10], and British Caleb Hilier Parry in 1825 [11]. However, none of these other descriptions were as extensive and complete as von Basedow’s, and von Basedow was the first to associate the large and complex symptomatology to a single underlying disease process. Since 1858, this disease has been most commonly referred to as “Morbus Basedow” or Basedow’s disease in Europe and Graves’ disease in English-speaking countries [3].

Von Basedow not only described the relationship between these symptoms but also attempted to explain the pathophysiology of this unusual combination of symptoms and involved organs. He recognized that the exophthalmos was not due to any change in the eyeball but rather to hypertrophy of the surrounding tissues of the eye [5]. In addition, von Basedow was correct in postulating that the etiology of this disease was mediated via the circulation when he hypothesized that “dyscrasia” (inadequate mixture) of the blood was responsible for the orbital swelling and goiter [12]. He proposed that the disease was due to a wrong mixing of the blood resulting in cell tissue congestion and glandular vegetation in the affected organs [2].

During the next 100 years, over 50 publications proposed various etiologies for this disease process, but it was not until the late 1950s, when Adams and Purves discovered the antibody-mediated origin of this disease [13, 14]. It is now well accepted that Basedow’s disease is an organ-specific autoimmune process that differs from all other autoimmune diseases since it is associated with target organ hyperfunction and not organ destruction [15]. If we accept that “dyscrasia” describes circulating antibodies and immune imbalance and “cell tissue congestion and glandular vegetations” depict the cellular infiltration seen with autoimmune orbitopathy and thyroiditis, we can contemplate whether much progress has been made since von Basedow’s astute observations [2]. In March 1990, von Basedow’s outstanding contributions to this disease process were the focus of an international convention, “150 Years of Morbus Basedow,” which was held in Halle and Merseburg, Germany.

Today, 160 years after the death of its describer, the exact etiology for autoantibody production resulting in the triad of symptoms known as Basedow’s disease and Graves’ disease remains to be determined. However, to this day, we are indebted to Dr. Karl von Basedow for his remarkable clinical observations and description of this disease process, as well as its potential pathophysiology, management, and treatment. In this modern era of technology and science, we should not forget the power of observation, the gift of astute reasoning, and the genius of Karl von Basedow .