The pathology and treatment of Graves's disease / by W.H. Thomson.
- William Hanna Thomson
- Date:
- 1893
Licence: Public Domain Mark
Credit: The pathology and treatment of Graves's disease / by W.H. Thomson. 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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![respect has been based wholly upon empirical grounds. In such an instance as this, however, it is difficult not to infer a causal relation between the food taken and the resultant symptoms. The meat diet seemed to be not only a con- tributing but a direct cause of diarrhoea, tremor, and rapid heart action—as direct as we find in any other seemingly immediate connection. That we have now more than empirical grounds for inferences about the relation of auto-infection to the gene- sis of many of the derangements of functional nervous dis- eases is as well settled as any of the recent advances of pathology. In the processes of normal intestinal digestion it is claimed, on apparently well-ascertained facts, that the healthy system is constantly producing organic poisons, which are as capable of causing injury as any of the prod- ucts of retrogressive metabolism in the body at large. We may therefore have specific disturbances occur from these organic poisons in either of two ways: First, by their ex- cessive generation, or, secondly, by a failure in the normal functions of the body which are protective against them, from deficiency in the protecting functions of the organs them- selves, or from a greater virulence in the poison generated than they can counteract. An effect from diet, therefore, in nerv- ous disorders, one way or the other, would be explicable on chemical principles rather than on nervous textural changes, and, from my experience in the treatment of functional nervous diseases, I am becoming more and more persuaded that we have in this direction greater promise of progress, both in theory and in practice, than in hypotheses of irri- tative nervous lesions as the source of many functional dis- orders, Graves’s disease included. On this point Dr. Fagge well remarks: “ Some writers have endeavored to account for all the phenomena of the [Graves’s] disease on a theory of irritation. But it is a sufficient objection to such a view that a primary irritation of a nerve center, lasting for months or years unchanged, is as yet unknown to pathology.” On the other hand we may say that, while a structural lesion in the medulla which would account for the phe- nomena of Graves’s disease is almost inconceivable without its sooner or later involving all the vital functions of that seat of life, yet particular functional derangements pro- duced by toxic agents are just what might be expected, for nothing is more characteristic than the narrowly selective operation of functional nervous poisons, which may go on for years, as in the case of opium, affecting certain functions without producing either progressive changes in them or extension to other functions. The chief hindrance to committing ourselves to the toxic in distinction from the structural aetiology of such diseases is the considerable change which it involves in our views of the pathology of functional nervous diseases in general. It seems to offer too tempting, because too easy, a solution of many of the most obscure problems of prac- tical medicine. That its advocates are often carried away by its far-reaching conclusions is undeniable, and many of their deductions are open to criticism on the score both of haste and of hobby-riding. But just the same may be said of bacteriology—namely, that it is too much like a blazing comet passing through the medical sky, with a nucleus of fact surrounded by a cloud of seemingly mere gas, carry- ing a tail of still more tenuous inferences stretching out to infinity. We need not, however, surrender our nucleus of facts, nor legitimate inferences based upon them, because everything can not be demonstrated at once in a newly dis- covered field. Certainly there is one fact in Graves’s disease which points much more distinctly to a digestive disorder than to a structural nervous lesion, and that is its occurrence in women about ten times as often as in men. We can hardly imagine that this difference is due to a difference in the medulla between the two sexes. That the digestive appa- ratus in women, however, is subject to special disorders is notorious. Many years ago I published in the Transactions of the Medical Society of the State of New York the case of a girl who, after a suppression of the menses from a wetting in a thunder shower, had first an obstinate constipation, which was attributed by the late Dr. White, Professor of Obstetrics in Buffalo, and for a time also in Bellevue Hos- pital Medical College, to intestinal obstruction, as she had developed stercoraceous vomiting. In the further progress of her case, however, her bowels were made to act, but the dejecta showed a total absence of coloring matter. She then had sudden suppression of urine, which was soon fol- lowed by profuse salivation and lacrymation, but which stopped after five days, when the kidneys started secretion again, and this alternation between the flow from the blad- der and from the mouth continued at intervals till her death, about three months after the beginning of her affec- tion. Such a case, however, only illustrates in an extreme way what derangements in the secretions and in the chem- istry of the products of the blood-making and of the blood- purifying glands can take place from nervous disorders in the splanchnic system of women, and hence renders the sur- mise probable that if auto-infection from the intestine can take place at all, it may be looked for in women with spe- cial frequency. I may mention, therefore, in this connec- tion, that I have not yet seen a case of severe Graves’s dis- ease in which diarrhoea was not sooner or later a prominent symptom. On the other hand, it may be asked, if the symptoms of Graves’s disease are to be ascribed to toxic infection of the blood by intestinal poisons, what relation has that fact to the common implication of the thyreoid in this affection ? To this it may be replied that the facts of both sporadic myxoedema and the cachexia following thyreoidectomy, in both man and in animals, point much more to a metabolic function of the thyreoid than to a secreting one. It may be questioned whether such be not the main function of the ductless blood glands—that is, that they produce changes in the blood passing through them that may free the blood of otherwise toxic products, rather than that they add par- ticular secretions of their own to it. The interesting ex- periments of Grutzner seem to support this conclusion as regards the thyreoid, for he found that the blood of an ani- mal from which the thyreoid had been removed, when in- jected into the veins of another animal, caused symptoms in it similar to those observed by Kocher in operative myxoe- dema in man.](https://iiif.wellcomecollection.org/image/b22325347_0006.jp2/full/800%2C/0/default.jpg)
