A contribution to the clinical study of exophthalmic goitre / by William Pepper.

  • Pepper William, 1843-1898.
Date:
[1879]
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the clinical study of exophthalmic goitre / by William Pepper. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    without either blood or pseudo-membrane. There has been very frequent complaint of pain at the lower part of the abdomen. In addition to the above symptoms, there have been for several years quite frequent and copious hemorrhages from the nose. Menstrua- tion has always been scanty and irregular, and lately has been ab- sent entirely for a number of months; it occurred twice in 1817? and three times in 1878. During the summer of 1878, oedema of the ankles frequently appeared towards evening. On examination in August, 1878, her condition appeared very alarming. She was extremely emaciated and feeble. The immense protrusion of the eyeballs, and the enormous enlargement of the thyroid gland gave her a shocking appearance. She was unable to cover the corneae, but no inflammation had occurred. Emaciation was extreme; her weight did not reach seventy pounds, and the skin and mucous membranes were bloodless and slightly sallow. The tongue was tremulous, red, and smooth. Appetite was capri- cious and somewhat abnormal. The bowels were moved frequently, from four to eight times in twenty-four hours, the character as above given. Respirations were frequent and increased markedly by the slightest exertion. The pulse was very small, weak, and frequent; in the sitting posture, it averaged 140. Exertion brought on severe palpitation. The heart sounds were sharp and feeble, with strong hsemic murmurs at the base, and along the pulmonary artery. The carotids throbbed excessively, and the thyroid wras the seat of strong diffused pulsation and thrill, with loud humming murmur on auscul- tation. No venous hum could be heard on ausculting the temples. There had been frequent epistaxis of late. The feet and ankles were oedematous. The urine was pale, of low sp. gr. 1009-1010, but con- tained no albumen. She had already used iron, tonics, bismuth, and ergot. I now directed her to use an exclusive diet of milk and arrowroot, to have absolute rest, and to take a pill of nitrate of silver, gr. I, with powdered opium gr. ] thrice daily. She went directly to the sea-shore, but the climate did not suit her; and although she had gained somewhat when I next saw her in September, the diarrhoea and attacks of epistaxis continued. She was then directed to remain in bed for several weeks, the diet was restricted to light broths, milk and water, and arrowroot, and pills of sugar of lead and opium were given. The diarrhoea was soon checked; she was thoroughly anointed daily with oil, and her diet was cautiously enlarged. In consequence of febrile symptoms with a tendenc}^ to night sweats, she took for a time six grains of quinia sulphate daily in divided doses. On September 25th, there was such marked im-