The non-surgical treatment of exophthalmic goitre / by Solomon Solis Cohen.

  • Solomon Solis-Cohen
Date:
1912
Catalogue details

Licence: In copyright

Credit: The non-surgical treatment of exophthalmic goitre / 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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    and one should resort to it unhesitatingly, in any case in which cytolysis seems to be necessary. Rodagen, a preparation made from the milk of thyroidectomized goats, I have used in but a single instance; that of a woman who was steadily improving under rest and treatment with thymus gland and strophanthus, but who became impatient at the pro- longed restraint. There was immediate recurrence of subjective feebleness, anorexia, insomnia, and rapid action of the heart. The thyroid gland, which had been reduced, enlarged again, and con- siderably, in the course of a few days. The rodagen was stopped and the patient again improved. A month later it was again administered in smaller quantity, but with the same untoward result. The original treatment was resumed and the patient made complete recovery, which has now lasted for some seven years. This would appear to give color to the theory that in this case at least, the enlargement of the thyroid gland was a compensatory, defensive hypertrophy, the necessity for which vanished with the administration of the thymus preparation. Antithyroidin and thyroidectin have also failed in my hands, although neither has been given extended trial. The necessity to do so has not been evident when good results were obtained with- out them, and surgery has seemed preferable in the cases that did not seem suited for, or did not yield to, the medicinal and hygienic management that has been outlined. Summary. To sum up. Graves’ syndrome is a complex disorder, having many varieties, a multiple etiology, and an obscure path- ology. The goitre is an incident, and the disorder may exist without it. When goitre occurs, existing symptoms are usually aggravated and new symptoms added. Surgical treatment rarely becomes necessary in cases recognized early. In approximately 15 to 20 per cent, of cases, surgery is made necessary by failure or inability to institute prompt, or proper and persistent, non-surgical treatment. In about 5 per cent, of cases surgery may become necessary, despite early and skilful hygienic and medicinal management. The first element in treatment may, therefore, be stated as early diagnosis. Cases of which the true nature is not recognized are likely to be termed “neurasthenia,” “hysteria,” “nervousness,” “anomalous neurosis,” “nervous dyspepsia,” and the like. Ade- quate treatment may thus be not instituted until late; and some- times, too late. This is probably owing, in part at least, to the unfortunate title “exophthalmic goitre;” for both goitre and ex- ophthalmos are usually late signs. There is no specific; but certain useful measures may be organized into a form of special procedure. Non-surgical treatment is usually prolonged. Its keynote is individualization. It must be patient and persistent. Its principal
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