Graves's disease, Raynaud's disease, and some of the allied forms of vasomotor disorder (vasomotor ataxia) / by Solomon Solis Cohen.

  • Solis-Cohen, Solomon, 1857-1948.
Date:
[1909?]
Catalogue details

Licence: In copyright

Credit: Graves's disease, Raynaud's disease, and some of the allied forms of vasomotor disorder (vasomotor ataxia) / by Solomon Solis Cohen. 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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    secretion, are termed in general “ hypothyroidism; ” while Graves’s disease and certain disorders akin thereto, but not exhibiting its complete picture, are attributed to excessive thyroid activity and termed “ hyperthyroidism.” This is but a small comer of the vast domain of the pathology of the internal secretions, and indeed but a portion of the field of perverted thyroidism. Yet even this is too large a topic to be handled in a single clinical lecture. I shall show you three cases, two of Graves’s disease and another of an allied disorder, and shall point out certain features therein which lead me to doubt the current doctrine of their original and exclusive dependence upon thyroid disturbance. That they are associated with thyroid disturbance and that many of the later symptoms are thus to be explained is indubitable, and in various papers published during the last fifteen years I have given atten- tion to that fact; but to me the principal element in these very various symptom-complexes is the vascular disorder that they manifest; and I am tempted to seek their proximal explanation in a failure <3f the cardiovascular regulatory mechanism. That the cause and intimate nature of this underlying failure in vaso- motor taxis is still to seek must be admitted. That some very close relation exists between the sympathetic, or, to use Gaskell’s better term, the visceral, nervous system and the internal secretions, not alone of the thyroid gland, but also of the adrenal gland, the pituitary gland, and very probably the thymus gland and the para- thyroid bodies, is evident. But in the present state of knowledge we are not justified in asserting that the thyroid disturbance is the starting point of the disorders under study, and especially we are not justified—and here I come to a highly practical question— in looking to surgery upon the thyroid gland as the only or the best method of treatment. When long-continued thyroid disorder has given rise to pronounced morbid changes in the gland, there may, indeed, be not only justification but urgent necessity for operative interference; either because of mechanical danger from pressure of the goitre upon the windpipe or upon the nerves and vessels, or because the excessive or perverted secretion of the dis- eased gland is giving rise to dangerous intoxication. This, how- . ever, is a late stage of the disorder, and, if T may reason from a moderately large personal experience, is one that ought not to