The effect of thyroid extract in exophthalmic goitre and in psoriasis / by A.G. Auld.

  • Auld, Alexander Gunn.
Date:
1894
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Licence: Public Domain Mark

Credit: The effect of thyroid extract in exophthalmic goitre and in psoriasis / by A.G. Auld. 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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    12 Medical Jocrxalj MEMORANDA. [July 7, 1894- A REPORT ON SOME RECENT CASES OF “MALIGNANT” INDIAN SYPHILIS TREATED WITH THYROID EXTRACT. By J. DUNCAN MENZIES, 31.B., Subgeon, R.N. [Communicated by the Dibectob-Gexebal R.N.] Dubixg the homeward voyage from Bombay in H.M.S. Euphrates I had an opportunity of studying the therapeutic action of thyroid extract in a few bad cases of syphilis. The patients were all invalids, lying in the military hospital, having been sent down from their respective stations for change to England. They were all in a very weak, sickly state, the disease being complicated by malarial fever, bowel complaints, etc. All mercurial and alterative treatment was suspended for the time, in order to watch the effect of the remedy. With the kind permission of Brigade-Surgeon- Lieutenant-Colonel F. Lyons, A.M.S., the senior medical officer in charge or troops, I was enabled to make the fol- lowing notes: Case i.—C. C., aged 23. Private. History.—Disease contracted at Allhabad, 1893. Symptoms.—Very severe type of syphilide, a rupial rash, with almost constant fever; swelling of the ends of the lsng bones and joints; marked cachexia and emaciation ; does not seem to be improving; will probably be a permanent cripple. I visited the patient on April 4th. He was then in a very weak condition, much disfigured by the eruption. Two large sores implicated the nose, and he had several similar ulcers on his body. The thyroid course was commenced this day. Thyroid tabloid (B. W. and Co.) (grs. 5) daily in water. April 6th. Desquamation noticeable on face. April Sth. Crusts on nose'dropped off. April 9th. Arms improving, slighUliyroidism present. He continued thus till April 14th, when the medicine had to be stopped on account of severe epistaxis and pyrexia. Ergot and turpentine were prescribed. Next day the treat- ment was resumed, and 10 grains were given. April 18th. Manifest im- provement of arms ; sores all cracking and drying up. April 22nd. Slight ague attack. Right leg much better ; ulcers healed, leaving pigmented scars. Joints less swollen. April 27th. Transferred to Royal Victoria Hospital, Netley. Remarks.—This patient was distinctly benefited by the new medicine. The serous crusts dried up and separated in a re- markable manner. Case ii.—A. P., aged 24, bombardier, Royal Artillery. History.—Admitted to hospital, May 22nd, 1893. Disease contracted at Allahabad. Invalided by medical board at that place, January 15th. 1894. Symptoms.—True primary lesion, severe secondary stage. By November, 1893, the patient had become extremely debilitated, anremic, and emaci- ated. The body was covered with a sloughy, rupial eruption ; the head and face being the part chiefly affected. Improvement nil: growing weaker; permanently unfit to serve as a soldier. Previous Treatment.—Mercury in all forms; iodides, nutritive and sup- porting diet, etc. When visited on April 4th, the patient was in a terrible state, his face, head, and body being a mass of irregularly shaped sores. He bad no pyrexia at first and his pulse was fairly good. One tabloid was given daily till April 8th. when the dose was increased to 10 grains a day. The beneficial effect of the new medicine soon showed itself. On April llth the rupial crusts exhibited white, circular, desquamating edges. April 16th. Dose 15 grains. April 21st. Ship at Malta coaling. Not so well; cough, coryza, and dyspnoea. Temperature, 104°: pulse, 120; respirations, 30. Symptoms aggravated by coal dust. The thyroid extract was omitted. He was ordered cough linctus, and linseed meal to chest. April 22nd. Temperature, 104°; pulse, 120; still very low. Arsenic and phenacetin ; port wine and extras. On April 23rd the temperature was 102.2D, the pulse 100, and he had passed a better night. At the evening visit the thermometer marked 104°. He was ordered quinine, gr. xv., at once, and on April 21 the temperature was 98°. and he was much better. One tabloid was given. He would take nourishment in small quantities only. On April 25th the large deep oval sores on the scalp were healing rapidly and satisfactorily. On April 27th he was disembarked to ambulance train. Remarks.—A serious and anxious case. The patient was in a desperate state on embarkation at Bombay. In spite of the high fever and unfavourable conditions of life on board ship in a crowded hospital, I think the man’s general condition was improved by the new remedy. Case iii.—M. R., aged 26, driver. Royal Artillery. History.— Admitted June 25th, 1893. Disease contracted at St. Thomas's Mount, Madras. Venereal complaints prevalent in the station. Typical sore. Secondary stage developed July 26th, 1893, before primary lesion had quite healed. A papular rash appeared, followed by a dull red, in- dolent, ulcerating syphilide. Previous Treatment.—Antisyphilitic; mercury hypodermically, etcl On April 4th 5 grains of extract were ordered. On April 6th the skin was improving, acting freely; desquamation commencing. April 12tli. Dose increased to 10 grains ;’ eruption not so dusky; pink granulations under scabs. On April l lth the dose was increased to 15 grains, and on April 17th to 25 grains, which was well borne. On April 18th two large ulcers on the left shoulder were rapidly drying up. A bedsore on the left hip was much better. No thyroidism was noticed. The pulse was 96 and regular. Warm permanganate fomentations ordered to facilitate desquamation. Wine and extras. On April 20th the face was still very red, but the unhealthy cachectic look of the man was fast disappearing. All the larger sores were granulating. On April 22nd there had been a further advance, and the general health was much improved. Remarks.—This man was in an advanced stage of syphilitic cachexia when received at Bombay from the depot atDeolali, and had been over ten months in hospital. Case iv.—T. H. S., aged 21, private. History.—Admitted from the station at Bareilly December 8th, 1893. Disease contracted on station October, 1993. Symptoms.—Extreme debility, cachexia, emaciation, pains in long bones ; copious rupial rash on trunk, scalp, and extremities. Previous Treatment— Mercury, arsenic, nervine tonics, general sup- port ; improved slightly in hospital. A medical board at Moradabad recommended change to England, January 22nd, 1894. The patient, when placed under my care on April 4th, was in a miserable corrupt state, his body being covered with foul, discharg- ing, malodorous sores. On April 10th desquamation was noticed after 10-grain doses of extract. The old scars were actually peeling, and his general condition began to improve. The crusts over the ulcers be- came detached, leaving flat, pigmented, healthy granulation areas. On April 14th a large ulcer on the left hip was closing. On April 17th the dose was increased to 20 grains. Pulse 96; no untoward symptoms. On April 20th the face was desquamating freely; an ulcerated patch involv- ing the right upper eyelid showed pink granulations. The sores were dressed with simple ointment. On April 22nd the dose was reduced to 15 grains, as there had been slight diarrhoea on the previous day. The patient continued to gain strength, and was disembarked on April 27th. Remarks.—This was my best case. No recun-ence of the eruption took place. Old cicatrices took on a healthy action, and the pigmentation in a great degree disappeared. I should like to draw attention to the following considerations : 1. The exceptional virulence of the poison. 2. The undeni- able value of thyroid extract given alone, without any mercurial preparations. 3. The hygroscopic and absorbent properties of the powdered extract. I have found it useful for insufflation and dusting purposes. “Tabloids” are very susceptible to moisture. Three other cases came under my notice : (a) Rupial ulcers of face and arms. (6) Ozsena, with ulceration of nasal passages. (c) Hereditary syphilitic patient with a broken down gumma of calf. These men also decidedly progressed under the new treatment. I am inclined to regard the remedy as a powerful skin tonic and adjuvant to the mercurial and alterative treatment of syphilis. MEMORANDA; MEDICAL, SURGICAL, OBSTETRICAL, THERA- PEUTICAL, PATHOLOGICAL, Etc. URTICARIA FOLLOWING THE ADMINISTRATION OF IODIDE OF POTASSIUM. Mbs. L., a middle-aged healthy looking woman was taken on May 28th, 1894, with a somewhat severe attack of general urticaria. She complained of prostration, pain in the head, nausea, and general febrile symptoms. The attack could not be traced to any irritating ingesta in her diet; it lasted about four days, during which time she was obliged to keep to her bed. At my last visit, she showed me a prescription she had commenced taking on May 26th, which she had been ordered for rheumatism. I found it con- tained potassium iodide, and she was of opinion that the medicine had not suited her; as she felt her “eyes water” and seemed to sneeze a good deal after taking the first dose. From May 26th to 28th she had taken in all 25 grains in divided doses of 5 grains. As urticaria is a somewhat exceptional eruption after iodide of potassium I thought the foregoing case not altogether devoid of interest. Geo. W. Sequeiba, M.R.C.S.Exg., L.S.A. Jewry Street, Aldgate. SCARLET RASH AFTER ENEMATA. De. Suckling, in his contribution of June 2nd, points to the possibility of a rash resembling scarlet fever being due to an aperient enema. Mr. Staveley, on June 30th, states that a similar skin condition may be met with after the use of brisk aperients in chronic constipation, and also in later stages of acute intestinal catarrh when peristalsis of the paralysed gut is established. In all these cases he points out that indican is present in the urine. It seems to me that a kindred phenomenon may be found