Oedema in Graves' disease / by Arthur Maude.

  • Maude, Arthur
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Oedema in Graves' disease / by Arthur Maude. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and eyelids are favourite positions, while both limbs of one side of the body may be affected.1 This form of oedema is very transitory—in fact may only last a few hours. I have under observation a woman, aged forty, who has had Graves’ disease about three years. There is little and a very varying degree of goitre, and no exophthalmos; but the rapid pulse, tremor, gastro-intestinal crises, haemorrhages (chiefly pulmonary), and psychical conditions are well marked.2 The feet and ankles are frequently, but not constantly, swollen, the swelling sometimes extending to the knees. Her cheeks and lower eyelids are often swollen in the mornings, and the backs of both hands sometimes swell. The oedema in the upper extremities never lasts more than a few hours. The patient has old-standing tenosynovitis of the extensor sheaths of one wrist, and when oedema occurs in the hands these sheaths always swell. This is not the result of exertion, for she has been almost bedridden for a long time. I have O examined the urine repeatedly, and never found albumen. There is no evidence of valvular disease, and when the oedema first appeared there seemed no cardiac dilatation; latterly, however, dilatation has certainly come on, but at the same time she has become so feeble as to be confined entirely to bed, and there has lately been no oedema at all. On one occasion I gave her a subcutaneous injection of digitalin in one arm, which was followed by complete and absolute paralysis of all the muscles of that arm below the shoulder, and slight puffiness of the whole limb. This con- dition lasted only a few hours, and there were no signs of cellulitis. Her family is very neurotic. Rendu3 has described an cedematous swelling which appeared in both supra-clavicular hollows in several patients having Graves disease. It resembled a double hernia of the lung. II donne la sensation d’un empdtement diffus d’un oedeme dur et rSsistent, parfaitement indolent, non fluctuant, mat d la 'percussion, et sernble etre produit par un sorte de fluxion congestive du tissu 1 Cuffer ; France Medicate, 13Julyl878; case given in full by Millard, op. cit. 2 notes of this case appear iw-ySt. Bartholomew's Hospital Reports, 1892. 3 Nouvelle Diet. Encycl. des Sciences Med. ; article, “Goitre Exophthalmirpie/’ D D 2
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