Licence: Public Domain Mark
Credit: An unusual case of Graves' disease / by James Craig. 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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![10. Melancholic delusions are more often m et with We next come to consider the beneficial effects of partial thyroidectomy. Steirlin collected 29 cases in ■which a portion of the gland was removed, and in 22 of them complete recovery ensued. Wette collected 26 of what he considered undoubted cases in which removal of portion of the gland was followed by con- siderable improvement and often by a distinct cure, in fact he says that the altered gland is the cause of the disease, and that operation is the only satisfactory treatment. Putnam, of Boston, has found removal successful in curing the disease, but .says, that while there is little risk of death there is great risk of considerable temporary prostration and laryngeal paresis. Erieberg, of Cincinnati, recommends it in severe cases that will not yield to medical treatment. Booth and Newton, of New York, have also re- corded satisfactory result.s from operation. There is not much to be said either for the benefi- cial effects of medical treatment directed towards re- ducing the size of the gland, or to the fact that the introduction of thyroid juice into the system in health produces certain effects similar to symptoms of ex. goitre. Certainly pressure, ice, and the inunctions of red iodide of mercury externally and the administration of belladonna and ergot internally, all of which may be said to aid in reducing the size of the swelling or in diminishing the secretion have been credited with at least as good results as any other therapeutic agents. The administration of the juice in health has been followed by relaxation of the arterioles, rapid heart action, diuresis, slight rise of temperature, and an overdose in myxoedema has produced flushing, exces- sive perspiration, muscular spasm, tremor, tumultuous heart action, rapid pulse, and death from cardiac failure. Now while all these arguments seem more or less to favour what I may call the “ glandular theory,” and to prove that the goitre is the cause of the other symptoms lest anyone should be led to adopt this view from the plausible nature of the arguments set forth and to consider that we should at once hand over our cases to the surgeon for the purpose of curing them, I will touch briefly on the other side of the question. In a number of cases of ex. goitre a complete cure has followed the removal of a na?al polypus or the cauterisation of a thickened nasal mucous membrane, while some instances of complete recovery are recorded in which practically no treatment at all has been adopted. Guttman about twelve years ago practised thyroidectomjf ■nuthout any result. Kocher, of Berne, had a case which died the night after operation, and four cases in w’hich no result was notified, and he says the patients have as little chance from operation as if they suffered from malignant goitre. Striimpell, in one case, partially removed the gland and the patient died. While Mannheim as the result not only of great personal observation but also of extensive research in the literature of the subject considers that unless for urgent dyspnoea operation should not be undertaken, and he a.sserts that only twelve of Wette’s cases were genuine Graves’ disease, and of these three were un- successfully operated on, two were moderately suc- cessful, and the others were doubtful. Four of his own forty-one cases w’ere operated on and only one seems to have received partial benefit. He says the most successful treatment is a dietetic and hygienic one which ensures physical and mental rest in the widest sense, and that experience shows electricity to be useful, but the utmost that therapeutics can effect is jierceptible improvement, whilst a complete cure is beyond it. In conclusion, it may be of interest to mention that this disease has been observed in animals. Two cases are reported from St. Petersburg, the first that of a four year old thoroughbred horse, which after a long gallop exhibited abnormally strong and frequent arterial pulsations, cardiac palpitations, and progres- sive weakness, the thyroid body was found tumefied, and sixteen days after marked double exophthalmos appeared, and after a month’s illness the colt died. The second case was that of a small pet bitch, seven years old, in which the cardinal symptoms were fresent, but were cured with iodine in three months, n the Veterinary Reports for the Kingdom of Saxony, 1890, Roder cites the case of a cow in which palpita- tions, arterial pulsations, enlarged thyroid and intense double exophthalmos had existed for four years. Finally a somewhat doubtful case has been reported by Professor Cadiot, of Paris, in which a gelding ex- hibited cardiac palpitations, a bounding pulse, great hypertrophy of the thyroid gland, but no exophthal- mos. A reference to these interesting cases -will be found in the Lancet, of Aug. 20th, 1892. »- §clcctcb |)rescnptions anb therapeutic cl^otes. 145.—For Whooping-Cough li Sulphonal, gr. j ; Creasoti, Hp ij ; Syr. tolutani ; Aquaj, aa .^ij. M. Two teaspoonfuls to be given every two hours. The Practitioner. 146.-—For Bronchitic Asthma K Extract; stramonii, gr. J ; Potassii iodidi, gr. v ; Ammonii carbonatis, gr. iv ; Tincture lobeliae setherea?, 11\^v ; Aq. chloroformi, ad. jjss. M. A tablespoonful every four or six hours. I'he Practitioner 147.—Colourless Iodine Ointment:— It lodi, gr. XX ; Potassii iodi, gr. iv ; Sodii sulphitis, gr. xl ; A(p qs. ^I. Rub the salts with the water until the solution becomes colourless, then add Adipis benzoati, AtlanUi Clinic. 148.—For Neuralgia ;— It Li«]. arsenicalis, Hl^iij ; Tinct. gelsemii, Iffx ; Liq. strychniie, HUU ; Glycerini, Iff ; Aq. destill, ad |jj. M. For one dose. To be repeated three times a day after meals. 149.—To Assuage the Thirst in Diabetes ; — U Pilocarp. nitratis, gr. vij ; Sp. vin. rectificati, .Ij ; A(p destill, ,“)ij. il. The tongue to be moistened with five or six drops of this mixture four or five times a day. La Jfedicine Mmlerne. There will shortly be a vacancy for a medical super- intendent at the Earlswood Asylum for Idiots. The salary is Ai'Xi, with furnished residence, ecc. Full particulars can be obtained of the Secretary, 96 King William Street, London, E.C.](https://iiif.wellcomecollection.org/image/b22325207_0006.jp2/full/800%2C/0/default.jpg)
