The treatment of Graves' disease by thyroidectomy / by James J. Putnam.

  • James Jackson Putnam
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of Graves' disease by thyroidectomy / by James J. Putnam. 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.

    6/23 (page 804)
    I examined the tumor immediately after it was re- moved, and found it to be of a firm consistency and homo- geneous, somewhat granular in appearance. There were a few little cysts about the size of the head of a large pin or a little larger. A number of pieces were immediately placed in Muller’s fluid, and were afterwards examined by Prof. Councilman. He reported the structure to be adenomatous in character and not at all like that of the normal thyroid. The arborescent, follicular-looking tufts were covered with a high, cubical epithelium, quite different from the characteristic flat epithelium of the normal gland. There was no colloid to be seen. In two of Muller’s cases [1. c.] a similar condition was found. This observation is important in several respects. In the first place, it was noticed during the first two or three days after the operation that a gelatinous sort of sub- stance oozed out from the wound, which was supposed to come from the cut surface of the gland. It occurred to me at the time that the prostration and other nervous symptoms might have been due in part to the absorption of this material, though I finally abandoned the idea as improbable, for various reasons. I supposed at the time that this matter was colloid, and it is now an interesting subject for speculation what it may have been, and whether it did possess toxic properties. Certainly, where the large cut surface of a thyroid is exposed in this way in an open wound the best opportunity would seem to be furnished for poisoning from excess of thy- roid secretion, if such a thing is possible. With a view to test this point, I made a quantity of glycerine extract from the extirpated tumor and injected a large dose under the skin of a cat. This was followed by vomiting and perhaps some prostration, but nothing more serious occurred, and I was unable to pursue the investigation further. The change in histological structure is also interesting, no means well. The paralysis has almost disappeared, and the tigroid stump is smaller. The pulse has remained high until recently, but is now 108. The patient is very ansemic, but is gaining slowly.