Anaemia and its consequences: enlargement of the thyroid gland and eyeballs / [James Begbie].

  • James Begbie
Date:
1849
Catalogue details

Licence: Public Domain Mark

Credit: Anaemia and its consequences: enlargement of the thyroid gland and eyeballs / [James Begbie]. Source: Wellcome Collection.

    10/22 (page 6)
    a lady aged thirty, married, and the mother of two children. The commencement of her illness was marked by long-continued and frequent hemorrhage from internal piles, often for weeks together, to the amount of 5 or 6 oz. daily, and extending over a period of be¬ tween three and four years, during a long period of which she had been subjected to much anxiety and distress of mind. The hemorr¬ hage at last ceased on the occurrence of an abscess near the anus, and never returned; but it left her reduced in strength and exsan¬ guine. She had too long disregarded the repeated loss of blood, and only became alive to her situation when the violent palpitation of the heart, with throbbing and giddiness of the head, arrested her atten¬ tion, which occurred almost immediately on the cessation of the he¬ morrhage. The catamenia continued regular. On my first visit, twelve months after the appearance of these symptoms, the large and prominent eyeball, which I cannot well describe, but which once seen cannot be readily forgotten, the dark discoloured eyelid, and the pallid complexion which bespeaks poverty of blood, induced me to examine the thyroid gland before listening to the heart’s action, or feeling the pulse at the wrist. It was tumid and hyper¬ trophied, especially the lateral lobes, which were enlarged to four or five times their normal bulk, and had long resisted the use of iodine, which had been administered in large measure, and, according to the experience of the patient, with manifest disadvantage. The tumour, as in the former case, was subject to remarkable variations, accord¬ ing to the state of the circulation, augmenting and decreasing as excitement or rest prevailed. She felt very sensitively the marked change in her expression, from what she termed the protruding- eyes, and experienced at same time great discomfort from the sense of pressure, as if the eyeball were too large for the orbit. I need not repeat a description of the symptoms—the throbbing of the head, the ceaseless impulse of the heart, the anaemic murmur of the ventricle, the continuous rushing sounds in the veins of the neck and in the thyroid swelling, the whiff of the carotids, or the jerking of the pulse at the wrist. One set of symptoms I may notice in the words of the patient herself,—u A very painful sensation was experienced on leaving the horizontal posture, vio¬ lent cough came on, causing retching and an agonizing pain in the head, seemingly caused by an extreme rush of blood to the brain, with a sense of bursting. This was relieved on resuming the horizontal posture, and taking food. As a preventive, I was forced for some months to breakfast immediately on awaking from sleep, lying perfectly still in the posture in which I awoke, as even a slight raising of the head would occasion distressing pain. After eating I could rise with impunity.” These are manifestations of the enfeebled brain, and part of the train of symptoms induced by impoverished blood. Every symptom was referable to this state; the murmur of the heart, and arteries, and veins, proclaimed its presence, and nothing remained but