Recent observations on the functions of the thyroid gland, and the relation of its enlargment to Graves's disease : also remarks on the therapeutic use of sheep's thyroids and of other organic extracts / by James J. Putnam.

  • Putnam, James Jackson, 1846-1918.
Date:
[1893?]
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Credit: Recent observations on the functions of the thyroid gland, and the relation of its enlargment to Graves's disease : also remarks on the therapeutic use of sheep's thyroids and of other organic extracts / 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.

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    Original Slrticleg. ^ RECENT OBSERVATIONS ON THE FUNCTIONS OF THE THYROID GLAND; AND THE RE- LATION OF ITS ENLARGEMENT TO GRAVES’S DISEASE; ALSO REMARKS ON THE THERAPEUTIC USE OF SHEEP’S THY- ROIDS AND OF OTHER ORGANIC EXTRACTS.1 BY JAMES J. PUTNAM, M.D., Professor of Diseases of the Nervous System, Harvard Medical School. The object of this paper is to call attention to the present state of our knowledge as to some of the func- tions of the thyroid gland, and certain disturbances of nutrition due to its atrophy; and as to the relation of goitre to the nervous symptoms met with in Graves’s disease and analogous states. I shall also speak of the therapeutic action of thyroid extracts in conditions other than myxcedema, and as to the use of some other organic extracts as therapeutic agents. The dramatic history of the discovery of the relation of thyroid disease to myxcedema, cachexia strumiprivi, cretinism, and the so-called foetal rickets, is now, in its broad outlines, familiar to every physician, so thor- oughly has public attention been aroused by the de- velopments of the past few years. As long ago as 1856, Schiff had noticed the fatal effect of thyroidect- omy in dogs; and even earlier than this Sir Astley Cooper and one or two other physiologists had made a few experiments in the same line, with varying results. In 1856 Curling described a few cases of sporadic cre- tinism as occurring in England; and in 1871 Dr. Hilton Fagge described others, and noted that they were characterized by atrophy of the thyroid. In 1874 Sir William Gull read his paper on “The Creti- noid State in Women ”; and two years later, Dr. Ord gave a full description of myxoedema, and christened the symptom complex with its present name. He also remarked on the clinical relationship between these cases and those which had been described by Curling and Fagge, and noted that the atrophy of the thyroid made a pathological bond between them. In 1884 came the remarkable observations of Rever- din, of Geneva, and Kocher, of Berne, who found that the thyroidectomy with which their experience in the goitrous districts of Switzerland had made them famil- iar, was often followed by a strange cachexia. Kocher at first thought this to be due to laryngeal asphyxia, but Reverdiu a few months later recognized it as essentially identical with myxoedema. The flood-gates of physiological research were then opened, and a mass of observations began to pour in, which I have no space even to summarize.2 Dr. Felix Semon, rec- ogniziug the extreme interest of the new discoveries, at once proposed the appointment of a commission of inquiry from the Clinical Society of London, the re- port of whose labors, finally published as a separate volume in 1888, will always be referred to as a treasure- house of facts upon this subject. Even before the publication of this report, came the scarcely less valuable review by our own colleagues, Drs. Hun and Prudden, based on one hundred and fifty cases, and giving the details of two thorough and important autopsies. Finally, in the winter of 1891- 1 Read before the Section for Clinical Medicine, Pathology and Hygiene of the Suffolk District Medical Society at the meeting, December 20tb. 2 See a review, with original observations, by Dr. F. P. Kinnicutt, New York Medical Record, xliv, p. 449. 1892, Mr. Horsley, of London, whose name is identified with the best original research with regard to this matter, published in Virchow’s DenJcschrift and in the British Medical Journal (January, 1892), a compre- hensive and masterly analysis of all the facts which were at our disposal up to that time, relating to the physiology of the thyroid. Most of Horsley’s conclusions have been confirmed by subsequent research ; and it is now accepted by every one that the thyroid is an organ of immense im- portance for nutrition. A few of his views will, how- ever, now bear revision ; and a few important discov- eries are to be added. The history of the therapeutics of myxoedema was sketched anew by Dr. F. C. Shattuck at a recent meeting of the Medical Improvement Society ; and I have nothing to add to his interesting remarks except to call attention to the fact that many cases of cretin- ism have been greatly benefited by thyroid feeding, even those where the disease had existed up to adult life. Two or three of these cases have been under the care of Dr. Osier,8 of Baltimore, to whom we also owe an investigation into the frequency of sporadic cretinism in America, showing that it is a disease of rare occurrence among us. It is probable that the thyroid is not, as Horsley thought it was, a haemapoietic organ of real significance (Gibson 4 and others, and among recent observers, De Quervain 6 ). It is practically certain that the functions of the thyroid are not related to those of the spleen (De Quervain 6 ). Later observations have indeed made it more and more probable that it is not safe to regard secondary enlargement of an organ following thyroid- ectomy as a sign of compensatory activity. This is especially important as regards the pituitary body, since this is probably or possibly related to the thyroid in function. It does frequently enlarge after removal of the thyroid and so does the thyroid sometimes en- large after removal of the pituitary body ; but Vassale and Sacchi,7 who have been most successful experi- menters with regard to the pituitary body, do not believe that the enlargement or the increase of colloid which accompanies it, necessarily means an increase of functional activity. The interesting experiments by Breisacher [v. Hors- ley] with regard to the action of animal food in in- creasing the cachexia from removal of the thyroid have been confirmed, with slight modifications, by De Quer- vain,8 in a very recent research. This latter observer was unable to confirm the state- ment of Rogowitsch, Capobianco, and others9 that constant demonstrable changes occur in the central nervous system after thyroidectomy. It is not impossible that a repetition of the fatigue experiments of Professor Hodge, of Clarke University, would show that anatomical changes could be more easily induced in animals suffering from cachexia than in normal animals, and that, for this reason, anatomical changes would sometimes be present which at other times were not found. Piseuti10 has recently observed 3 Transactions of the Association of American Physicians, 1893. 4 British Medical Journal, 1893, i, p. 14. 5 Virchow’s Archiv, 1893, Bd. 133, Heft 3. c See also Gley and other authors cited by him in the Arch, de Phys. n. et p., 1894, p. 207. 7 Arch. Ital. de Biol., 1893, t. xviii, p. 385. 8 Virchow’s Archiv, 1893, Bd. 133, Heft 3. 9 See a paper by the writer, on cases of myxoedema, etc., in the American Journal of Medical Sciences for September, 1893. 10 Cited by Gley, Arcb. de Phys. n. et p., 1894, p. 187.