Further observations on the histology and function of the mammalian sympathetic ganglia / by W. Hale White.

  • Hale-White, William, 1857-1949.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: Further observations on the histology and function of the mammalian sympathetic ganglia / by W. Hale White. 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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    The Nature of UxosJithahnio Goitre. Tho toxic syuiptoms observed in some cases of myxoodema treated by the ingestion of thyroid gland tissue recall so fore bfy certain troubles present in exophthalmic goitre that one is led to ask if hyperthyroidisation is not the true cause of Basedow's disease. Tachycardia, rise of temperature, insomnia, agitation, polyuria, alburninuria incomplete paraplegia, heat sensations, -^ifP^^^^f ^f- .^i' diarrhcea-these complications of the thyroid treatment are ■ verv suggestive of symptoms complained of by subjects ot exophthalmic goitre. While accepting the validity of this theory (therein agreeing with Professor Greenfield, whose recent Bradshaw lecture must be fresh in the mmds of your readers) of excess of function of the thyroid body as ex- plaining these phenomena in the. latter disease, M. Mane throws the onus of their production on derangement of the nervous system (1 tbe sympathetic). This nervous perturba- tion occasions an exaggerated secretion of thyroid juice and the clinical phenomena above mentioned declare them- selves For be it noted that an overdose of thyroid gland has never yet provoked the appearance of exophthalmos or of von Graefe's symptom. Moreover, in several cases of Basedow s dise?se treated by the removal of the thyroid body or by the ligature of the carotid arteries, the exophthalmos has persisted (three cases recorded by Dreesman, one case by Sprengel). On the other hand, thyroidectomy has brought about in other instances a disappearance of the protuberance of the globes of the eye. The nervous origin of exophthalmic, goitre is further proved by its sudden onset after a stiong moral shock. Bari6 and Joilroy have furthermore called attention to the remarkable frequency of Graves' disease in individuals suffering from locomotor ataxia. What seems certain is that some of the symptoms of Graves' disease are due to hypersecretion of thyroid juice, and that consequently the administration of thyroid extract, as recommended by some physicians in that disease, Is contraindicated. Horsley has already estab- lished the inutility of such treatment, and quite recently Canter of Lifege, in relating a case of myxoedema cured by thyroid tissue, states that he has observed an aggravation of several symptoms when the same method was applied in 1 Soci^t^ MMicale des H6pitaux, Feb. 23rd. 576 ThbLiAwcet,] MEDICA Basedow's disease. On the other hand, M. Marie pronounces strongly in favour of thyroidectomy. Professor Tillaux was the first to cu-re two exophthalmic cases by this means. Putnam has recently published statistics of forty-one cases treated by thyroidectomy; in thirty-four of these recovery or considerable improvement ensued, four ended fatally, one remained in statu qxio, and two patients had tetany. Such figures encourage the belief that the treatment of exoph- thalmic goitre should henceforth be conducted, not by the physician, but by the surgeon. I may mention, in conclusion, that in the 3Iedecine Moderne of Feb. 24th, Dr. Brissaud pub- lishes the details of a case treated by exothyropexia which ended fatally, the girl (aged twenty years) sinking rapidly in a state of coma. Professor Poncet of Lyons is the -author of this new operation. In it the thyroid gland is exposed by a longitudinal (or crucial, if the volume be very large) incision. The extruded gland is fixed between the lips of the wound and allowed to mummify. MM. Poncet and Jaboulay have successfully performed the operation in four- teen cases of goitre, four of which presented the tableau ^Unique of Graves' disease. Feb. 20tb.