Recent advances in endocrinology / by A.T. Cameron.

  • Alexander Thomas Cameron
Date:
1935
Catalogue details

Licence: In copyright

Credit: Recent advances in endocrinology / by A.T. Cameron. Source: Wellcome Collection.

    89/444 page 75
    study of over 4,000 cases, exophthalmos absent in 12 per cent., thyroid enlargement absent in about 20 per cent., and both absent in 9 per cent. The basal metabolic rate prior to operation was stated to be low in about 0-5 per cent. The dissociation of exophthalmos from the hyperthyroidism of Graves’ disease is exemplified by the appearance of the former after operation in a number of definitely authenticated cases (345). The interval of time between operation and this development varied from three to twelve months, and the condition, once developed, showed no subsequent improve¬ ment. Illustrative proof that this subsequent development cannot be ascribed to a recurrence of the Graves’ disease is the finding that in several of these cases the basal metabolic rate was below normal, while one exhibited definite myxoedema.1 It has long been recognized that achlorhydria frequently accompanies hvperthyroid conditions. It has recently been shown that it is a true achlorhydria. Two-thirds of fifty hyperthyroid patients remained achlorhydric after histamine; the incidence was the same in Graves’ disease and in toxic adenoma. Of 42 eases examined six months after thyroid¬ ectomy 31 showed normal gastric acidity (26). 1 According to Kunde (183) all the symptoms of Graves’ disease can be induced in laboratory animals by artificial hyperthyroidism, but exophthalmos cannot be induced in the dog, although mild exoph¬ thalmos can result in the rabbit ; rabbits thyroidectomized at an early age develop marked proptosis. However, Whitnall (336) has recently published a critical review, from the anatomical point of view, of theories concerning the causation of exophthalmos, which suggests that, as far as this symptom is concerned, conclusions from experiments on animals are not applicable to man. Of the involuntary musculature of the orbit the Palpebral is responsible for the eye-lid signs, but only for these. The Orbitalis muscle cannot produce protrusion of the eyeball in man, since “it is a mere vestige tucked away deep in the infra-orbital fissure,” but it can do so in the lower animals, where it “ exists as a broad sheet of fibres filling the wide gap in the bony lateral orbital wall.” In man “ the Perivascular fibres suggest the possibility that dilatation of the vessels or paralysis of their walls favours increased exudate which may be the main factor in proptosis.” Marine’s views on the production of exophthalmos are quoted in Chapter VII of this volume. Naffz.iger (243) has studied histologically, and has described successful surgical treatment of cases of progressive exophthalmos following operation.
    No text description is available for this image
    No text description is available for this image
    No text description is available for this image