Licence: Public Domain Mark
Credit: Graves's 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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![Case 4.—Mrs. P—-=-, 54. Goitre since marriage at 29 years old. In the last two years it has increased largely, though the water supply she uses is excellent. At the same time, she has developed frequent distress- ing palpitation, and a rapid and irregular heart. She has some dilatation of the heart; this, however, may be due, as may the other cardiac signs, to emphysema, which is present. But she presents, also, marked and typical tremor of hands and trunk. Case 5.—Mrs. W. K , 23, is the daughter of the last patient. One other sister is also goitrous ; patient has had a large goitre since child- hood ; for about two years has been subject to distressing palpitation, especially when startled, which she is very easily. Soon after marriage, last autumn, she suddenly developed a form of rhythmic spasms, which I shall describe briefly later on, and on watching her closely for some time I noted extreme palpitation and rapid pulse. Case 6.—Mrs. A. S——, 52. Goitrous 15 years. For about two years her menses, previously natural, became irregular, prolonged, and profuse, with no objective cause discoverable. During this time she has become increasingly subject to severe palpitation and irregular rapid heart. She also presents marked retraction of the lids. Case 7.—E. J , unmarried, 37. Mother myxoedematous patient of weak intellect. Goitre has existed since puberty. I have known her nearly seven years, and found no sign of Graves’s disease till the autumn of 1892. Since then she has developed every sign of that disorder in an aggravated form. I may say boldly, here, that in my opinion the value of the eye- lid symptoms in Graves’s disease has been much over-rated ; that I find them common in many people in good health, and particularly common in neurotic subjects. Next, the disease is said, on all hands, not to occur in districts where bronchocele is common, nor in the subjects of previous bronchocele. I can find, however, nothing like statistics on either point. In wading through the vast bibliography of this disease, I am struck by the large number of cases reported in certain Western American States, possibly because the medical press is so prolific there; but in 1878 an Illinois physician* (Mr. Earle) asserted that it was very common in that State. Mr. Burton, of Cambridge,']' thought it also very common in that county, where bronchocele is compara- tively unknown, but where rheumatism and anaemia (the result of malaria) are very rife. Again, though it is known in India among natives (we have Sir * ‘ Brit. Med. Jour.’, 1893. II. Epitome—21 (95). Tachycardia, f Earle: ‘Trans. Illinois Med. Soc.\ 1878.](https://iiif.wellcomecollection.org/image/b22328865_0006.jp2/full/800%2C/0/default.jpg)
