The administration of thymus in exophthalmic goitre / by R.H. Cunningham.

  • Cunningham, R.H.
Date:
1895
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Licence: Public Domain Mark

Credit: The administration of thymus in exophthalmic goitre / by R.H. Cunningham. 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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    taken it broiled very slightly. At this date the heart was 120 and regular, the respirations 20 per minute. She says she has slept a little better, but no change ex- cept that noted above is perceptible. October 20th.—-I saw her for the last time, as she and her mother were unexpectedly compelled to return to her home in a neighboring State. She stated she had slept very well for the past few nights (no trional or other hypnotic had been taken since the 10th) and had taken the thymus uncooked for the past three days without nausea. The pulse was 100, the respirations 18. Since October 20th her mother has written to me a number of times to inform me that her daughter has steadily improved, and in the last letter written by Miss B , on March 10th, she writes that she feels as well as she ever did, that the swelling in the neck has disappeared, and that she can take a considerable amount of exercise without getting fatigued. Her pulse is about 72 and she sleeps as well as she did before her trouble commenced. Her mother tells her that her eyes are no longer prominent and that the color has returned to her cheeks. Case II. has, unfortunately, not followed the treat- ment very regularly ; sometimes neglecting to take the glands for several days at a time, but he has neverthe- less considerably improved in many respects. Briefly summarized, the most prominent symptoms presented by him were a general diminution of energy, severe in- somnia, palpitation of the heart, fatigue and moderate dyspnoea on the least exertion, prominent eyes with lagging of the upper lids on looking downward, and a slight horizontal nystagmus on rapid convergence, a slight increase in the size of the thyroid, pulse from 100 to no, and a well-marked, fine-waved tremor of the hands. The above symptoms had been becoming pro- gressively more prominent during the past four years. After an irregular administration of slightly cooked lamb’s thymus for two weeks the pulse-rate had fallen to 78 per minute and was perfectly regular. He slept very much better, and was feeling stronger. His eyes had become much less prominent, and only after a very searching examination was a slight degree of Von Graefe’s symptom found to be still present. When I last saw him his eyes were apparently normal, his pulse was 76, his capacity for hard work had greatly in- creased, and the tremor of the hands had entirely dis- appeared. In a third case that presented the usual symptoms of exophthalmic goitre the thymus gland tabloids of Messrs. Burroughs, Wellcome & Co. have been administered at the rate of twelve to fifteen 5-grain tabloids per day and have been followed by improvement, especially as re- gards the ocular symptoms. In this case after a week’s treatment with the tabloids in the above dose a very considerable decrease in the enlarged thyroid occurred. This diminution still continues to slowly progress. Two and a half weeks after the tabloids were begun, the pulse- rate, which in the beginning averaged about 124 per minute, had become 96, though it would readily mount to 120 after moderate exertion or excitement. She feels, however, much stronger, and has been able to re- sume her work. Possibly had a larger number of the tablets been given a more rapid and marked effect would have fol- lowed. At present she is taking the fresh thymus gland and the results of this procedure the writer will give in detail in a later paper on this subject. If the results following the administration of thymus in these cases be compared with those published by Owen,1 I think one may reasonably exclude the factor of mere coincidence, for though cases of Graves’s dis- ease do get well sometimes without any treatment what- soever, Owen shows the suppressed symptoms began to return when the administration of the thymus was dis- continued. The remarkable and rapid diminution of the increased heart-action and the progressive abatement of the other symptoms would certainly lead one to believe that by administering the thymus via the gastro-intestinal tract some substance that influences the deranged metabo- lism in a peculiar and striking way has been added to the blood. The present state of the knowledge of the physiolog- ical chemistry of the thymus gland certainly does not help one to form a definite idea as to what this sub- stance may be. It is true that Schindler has shown that a high percentage of adenine, a base derived from nuclein (Halliburton3), exists in the fresh and in the dried thymus of the calf; but whether the extractives or the nuclein (Kossel6) or the derivative base, ade- nine, of the thymus are the chemical bodies or not which act in exophthalmic goitre in a manner analo- gous to that attributed by Goulay7 to the nucleo-al- bumin of the thyroid body when the latter is given in myxoedema, one has not sufficient evidence for posi- tively stating. A brief look through some of the scanty literature of the experimental results obtained from depriving young animals of the thymus would lead one to believe that the presence of the thymus gland in the lower animals is not a necessity for the well-being of those animals, provided we are ready to accept the results of those observers as finally conclusive. Though Langenhaus and Saveliew8 got negative results in the dogs and rab- bits that survived after extirpating the thymus, it is difficult to reconcile such results with the apparent physiological activity of the said gland in certain or- ders of young animals. The deaths of many of their animals resulted, according to the authors, from gas- tro-intestinal disturbance consequent to “ too much green food ” in the case of the rabbits, and in the dog worms were found in the intestine. No definite syste- matic information, however, is given regarding the char- acter of the diet from first to last, and this, in my opin- ion, is an important omission when one takes into consideration the difference between the large, well- developed thymus of a calf or of a lamb that has been brought up on milk, and the small, atrophied thymus of a calf of equal age that has been weaned early and fed on grass. Further details on this score will be sub- mitted, however, in another paper. In 1893 Macalister9 called attention to the remark- able metabolic effects that occurred during a diet of thymus in a case of pseudo-hypertrophic paralysis, and his results would tend, to say the least, to substantiate one of the ideas of some of the older writers,11 that the thymus stands in relationship with the state of devel- opment of the muscular system. In exophthalmic goi- tre also many symptoms are manifested by the muscu- lar system that possibly arise from the action of the pathologically altered product of the thyroid which Lemke13 states is a specific muscle-poison that sepa- rates the normal tonus into many small contractions. But does the thymus add to the blood a special sub- stance that has an “oppositeness ” of action to the hy- persecretion of the thyroid, or to some poisonous sub- stance occurring in the blood consequent to the quali- tative alteration of function of the thyroid ? Possibly, as Owen suggests, though I do not unite with him in bringing forward the “oppositeness” of action that is claimed by Zanda,11 on repeating Bardeleben’s (1841) ex- periments, to exist between the spleen and the thyroid, as a reason to strengthen the probability of this possi- bility, for Fano 10 was unable to corroborate Zanda's statements, and the writer on repeating Zanda’s ex- periments, using young and middle-aged dogs, finds also that the consequences of total thyroidectomy, after previously extirpating the spleen, are the same as in animals who possess the spleen intact. As Breisacher first pointed out, when thyroidectomized dogs are fed on meat that has been thoroughly ex- tracted by boiling, the appearance of the cachexia is much delayed ; if, however, the dogs are fed on the