The treatment of exophthalmic goitre : based on forty-five consecutive cases / by A.D. Rockwell.

  • Rockwell, A. D. (Alphonso David), 1840-1925.
Date:
1893
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Licence: Public Domain Mark

Credit: The treatment of exophthalmic goitre : based on forty-five consecutive cases / by A.D. Rockwell. 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 has been, excellent for years, and she can engage without restraint in all the ordinary pleasures and ac- tivities of life. Case VIII.—Miss D , aged twenty-nine, was re- ferred to me by Dr. Stephen Wickes, of Orange, N. J., March, 1885, with the three cardinal symptoms of the dis- ease well developed, the exophthalmus, however, being much less marked than the other two. The pulse when ordinarily tranquil was 125, sometimes considerably higher, and on one occasion under excitement it beat at the alarming rate of 175 per minute. The heart was slightly enlarged, and the systolic murmur, which is so frequently present in these cases, was unusually loud and could be distinctly heard, even when the ear did not touch the chest. The disease was not of recent origin, for some four years before, when nursing a sick relative and subject to much physical and mental strain, she first observed symptoms of disturbed heart action, and shortly after the throat and eyes both became affected. The patient was under observation and treatment until April, 1886, a little more than a year, and in that time re- ceived eighty-five applications of electricity, with the re- sult of a gradual but steady improvement not only in the condition of her general nervous system, but in the special symptoms characteristic of the disease. The systolic murmur entirely disappeared, the pulse sank to a per- manent rate of about 80, and the eyes resumed their natural appearance. Her general health is excellent. Case IX.—Miss R , aged twenty, was brought to me on November 16, 1887, by Dr. F. Myers, of Fort Worth, Tex. The thyroid was only slightly enlarged, but the eyes protruded to a degree that greatly altered her expres- sion, and was the source of much annoyance. The heart pulsated at the rate of 120 per minute, but on occasions of excitement and physical fatigue I have counted it as high as 150. These symptoms had existed some three years, but all her bodily functions were normal, and, contrary to what is usually observed, her general health and strength first-class. This was one of the few cases that have come under my observation when digitalis seemed to do harm. Whenever it was given in any considerable dose, either alone or in combination, the excitability of the heart was undoubtedly increased, and this effect I attributed to the fact that, associated with the over-excited cardiac contrac- tility there was absolutely no enfeeblement of the heart muscles. Strophanthus proved equally unpleasant in its effects, while veratrum viride was found to exercise the most salutary influence. No other drug was given for its direct effect upon the heart, and the treatment was prac- tically confined to electricity alone and extended over a period of fourteen months. From November 16, 1887, to March 23, 1888, she received sixty-six applications, with an interval of rest until October 17, 1888, when she received forty-seven additional treatments between that date and January, 1889. During the first two months of treatment there were but slight evidences of improvement, but during the following two months the eyes became less prominent and the goitre perceptibly decreased in size. In March, when she temporarily discontinued treatment, the pulse had not only fallen to 100 beats per minute, but was not readily susceptible to ordinary emotional or phys- ical causes. Seven months after, when she returned, I found her in about the same condition as when she left. Resuming treatment on October 17th, she perceptibly gained during the next three months, and was finally dis- charged as approximately cured, the pulse seldom rising above ninety, with but slight evidences of exophthalmus or thyroid enlargement. The patient has since married. Case X.—Mr. B , aged about thirty-five, was re- ferred to me by Dr. E. Hochheimer, of New York, Janu- ary 5, 1888, with comparatively slight but persistent evi- dences of the disease. The pulse was 100, with slight swelling of the thyroid. There existed neurasthenia with extreme melancholy, and while there was hardly any ex- ophthalmus, there was present the somewhat rare symp- tom of obstinate oedema of the eyelids. The patient fully recovered after forty applications of electricity, extending over a period of three months. Case XI.—Mrs. M , a widow aged thirty-one, consulted me January 9, 1888, with the following history : Five years before, her first child was born after a pro- longed and unusually severe labor. She convalesced slowly, and in a few months more or less began to notice an undue activity of the heart, with shortness of breath, whenever she ascended the stairs or walked more rapidly than usual. These symptoms did not greatly increase ijntil about two years ago, when the heart began to give her more trouble, and she first noticed a “ a strange ap- pearance about the eyes and a fulness in the neck. ’ ’ The eyes were now very prominent, the thyroid about as large as a small hen’s egg, and the pulse-beat from 128 to 135 per minute. She was markedly anaemic and extremely nervous. The patient was under treatment from January 9th to April 7th, and then again from June 8th to July 29th, receiving in all some fifty-live applications of elec- tricity. Recovery has been approximate and permanent. The eyes are perhaps slightly more prominent than natural, but not to a degree to excite comment. There are only traces of the enlarged thyroid, while the heart pulsates at a uni- form frequency of between 80 and 90 per minute. Her general nervous condition also improved to such a degree that she now counts herself a well woman. Case XII.—Mrs. E , aged thirty-four, was seen with Dr. J. H. Gunning, of New York, April 21, 1888. Four years before, she had miscarried, and subsequently had worried much over domestic troubles. Three years before, her heart began to trouble her, and soon after she observed a slight protrusion of the eyes and some enlarge- ment of the thyroid. When Dr. Gunning and I first saw her the eyes were prominent, but the gland was only slightly though perceptibly enlarged. The pulse ranged in frequency from 115 to 135, and on one occasion we counted it at 165. The patient has lost much flesh, men- struation was irregular and profuse, and with a generally nervous condition was associated a very decided muscular tremor whenever she attempted to move the hands, simu- lating in marked degree the tremor of paralysis agitans. The patient was under treatment, with some intervals of rest, for seven months. During this time she received seventy-three applications of electricity and was discharged approximately cured. The pulse never rose above 100 and was usually at 85, the tremor had entirely disappeared, and the eyes were quite normal. Case XIII.—Miss S , aged twenty-five, came to me August 6, 1890, through the kindness of Dr. W. T. Giddings, of Gardiner, Me., with well developed evi- dences of Graves’s disease. The eyes were slightly though distinctly protuberent. The thyroid gland was enlarged to the size of a very large almond, while the pulse beat at the uniform rate of 120, running up, however, on slight exertion, much higher. All exercise was exhausting, and ascending the stairs especially so. That the disease was not of recent origin was evidenced by the history given. As far back as 1885, while a pupil at Wellesley College, the act of recitation would cause her hands to tremble and perspire, her heart to beat tumultuously. When the cause of excitement was over, the heart would resume its normal action; but she noted, as time went on, that this instability of the heart-beat became more frequent and prolonged, until finally it “went wrong” always, as she expressed it. It should be stated that the patient was somewhat anaemic, and since the age of fourteen has suf- fered from myopia and astigmatism. In 1887, and then again in 1889, she had slight attacks of the grippe, which occasioned a decided increase in the severity of her symp- toms. The symptoms, however, that were most distress- ing, if not the most serious, were the frequent and terrific headaches from which she suffered. These were associated with intense nausea, lasting some twenty-four hours and recurring almost every week. The