The administration of thymus in exophthalmic goitre / by R.H. Cunningham.

  • Cunningham, R.H.
Date:
1895
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Licence: Public Domain Mark

Credit: The administration of thymus in exophthalmic goitre / by R.H. Cunningham. 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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    The shock is less, and there is not so much abdominal distention nor pain at the umbilicus. In fact, these latter may not be present at all. Again, the tumor, especially if outside the external ring, is apt to be harder and more solid to the touch, and if the seat of torsion is below the ring, the swelling would not extend into the canal, and the finger passed through the ring would, in this case, be able to clear up any doubts. Still, as we have seen, a correct diag- nosis may at times be extremely difficult and impos- sible before making an exploratory incision, especially where we also have a hernia present. Abscess from an inflamed appendix, as also gonorrhoeal and traumat- ic inflammation of the testis and epididymis, should not be forgotten. Treatment.—If left alone there would probably be either one of two results—atrophy or gangrene. In this connection Chaveau’s experiments on goats are interesting. He found that after a subcutaneous tor- sion of the cord the testis would atrophy, and that gangrene only occurred in cases where he had pre- viously introduced substances into the circulatory sys- tem which had undergone putrefactive changes. Atro- phy is not a very infrequent result following the subcutaneous operation for varicocele, and it is well known that the surgeon Delpech was killed by a pa- tient on whom he had operated for double varix, and who afterward had atrophy of both testes. As Nash says, “ It will probably not happen very often that sur- geons will be fortunate enough to see cases at their commencement, but now that the accident and its causes are becoming generally known, they will at least be prepared for it, and some will undoubtedly be recognized in time to be untwisted.” In all cases where castration has been performed there has been a good recovery, and this would be much earlier resorted to where we have a testis in the inguinal canal, as it ’ well known that they are apt to become sarcomatous if left in this situation. In eight cases the testis was not removed. Two of these were untwisted without opera- tion, followed by atrophy in one. In three the testis sloughed away during healing. In two, there was sub- sequent atrophy ; and in one, five months after opera- tion, there was no change except that it was harder than normal, and fixed by adhesions at the root of the penis. I record still four cases * which, without doubt, were results of this accident, but where the torsion was not discovered ; and I am especially indebted to the papers on the subject by Lauenstein and Lexer. 36 West Thirty-ninth Street. THE ADMINISTRATION OF THYMUS IN EX- OPHTHALMIC GOITRE. By R. H. CUNNINGHAM, M.D., ASSISTANT DEMONSTRATOR OF PHYSIOLOGY, COLUMBIA COLLEGE, NEW YORK. Apropos of a report by David Owen, in the British Medical Jourjial of February 16, 1895, of a case of ex- ophthalmic goitre that was successfully treated by the accidental administration of the thymus gland, a sur- vey of the benefits derived from the administration of minced thymus in the following cases of that disease will additionally tend to show that in certain cases, at least, of exophthalmic goitre a diet of thymus may be followed by results that are surprising, gratifying, and very suggestive. The first of these cases, whose history I give in full detail from my private case-book, was under my per- sonal observation for eighteen days only. She has, *1. H. H. Johnson : Boston Medical and Surgical Journal, 1888. ■2. Bramm : Langenbeck's Archiv, 1890, p. 163. 3. Erichson : 8th edi- tion, vol. ii., p. 813. 4. Volktnann : Berliner klinische Wochenschrift, No. S3, 1887. however, reported her progress to me by letter a num- ber of times since I saw her. Since treating her, sev- eral other cases have come under my observation, two * in the Department for Nervous Diseases at the Van- derbilt Clinic, and the others in private practice, and all have been treated either with the fresh gland or with thymus tabloids. These cases are still under treatment with the thymus ; nevertheless from the im- provement that has occurred in one or more of the symptoms, even in a few weeks’ time, I feel justified in adding them to this report. Case I.—Miss B , aged twenty, consulted me, October 2, 1894, stating that several physicians whom she had consulted had told her she had Basedow’s dis- ease. She consults me now to get something to make her sleep, as she has been unable to sleep for the past two nights, and also because she has felt so extraor- dinarily weak for the past few days. Her hereditary history is noteworthy. Her de- ceased father had prominent eyes, was a sufferer from insomnia, and had died of pneumonia two years ago. Her paternal aunt had prominent eyes, and also a slight swelling in the neck. She had frequently com- plained of palpitation of the heart and of general weakness. The patient’s mother says the doctor who attended her stated that her death was due to “ heart trouble.” Miss B—’s brother, aged twenty-five, has a tendency to prominent eyes, but is strong and active. Except for an attack of measles at fourteen years of age, Miss B had had good health until two years ago. A short time after her father’s death, at which she was very deeply grieved, she began to suffer from palpitation of the heart on the least exertion. From that time her eyes have gradually become more promi- nent, though she has been seriously troubled with in- somnia for the past year only. In addition to the above she compl^i^of a loss of energy, mental de- pression, excessive swemTTTg on the ri^ht side at- night, sensations of “ flushing,” trembling of the hands, and occasional head*aches, but has had no aural disturb- ance. Her appetite is poor, and her bowels are usu- ally constipated. The examination showed a fair amount of exoph- thalmos, both Von Graefe’s and Stellwag’s symptoms being present. The inco-ordination on convergence was slight. The apex-beat of the heart was strong, 124 per minute, regular, and was not displaced, nor was there much evidence of hypertrophy. The lungs were apparently normal, and no abnormality could be made out in the region of the thymus. The thyroid was moderately enlarged, soft, and compressible, but no enlarged accessory thyroids or lymph glands were present. A moderate bruit existed over the thyroid. She appeared slightly anaemic, and the result of the examination of the blood was as follows : Red cor- puscles, about four million six hundred thousand per cubic millimetre ; white corpuscles (not counted) ; haemoglobin, sixty per cent. (Von Fleischl's haernom). Microscopically nothing worthy of remark was no- ticed. The urine was 1.022 specific gravity, and nega- tive. She was put on the thyroid tablets, one tablet (gr. v.) t.i.d., and, in addition, trional was prescribed for the insomnia. October 4th.—She states she feels worse and has slept no better than before. The heart-beats had increased to 136 per minute, and were also irregular at times. The respiration was 28. The thyroid tablets were discon- tinued, and later in the day arrangements were made with a butcher to supply her daily with a fresh thymus from a healthy lamb that had been brought up on milk. This was to be minced fine and taken raw if possible. October 10th.—She returned and stated she had been unable to take it raw as it made her sick at her stom- ach and she could not retain it. Therefore she had * For the privilege of referring to these in this report the writer is indebted to Dr. Frederick Peterson, Chief of Clinic, Department of Neurology, at the Vanderbilt Clinic.
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