On exophthalmic goitre / by A. Maude.

  • Maude, Arthur.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: On exophthalmic goitre / by A. Maude. 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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    conditions, M. Joffroy will not commit himself definitely, but he inclines to the belief that the coincidence is not accidental, but that in such cases (which are now not rarely known) an early catarrhal, or proliferation stage, in the thyroid, which is accom- panied by the symptoms of Graves’ disease, is gradually succeeded by progressive filroid degeneration of the gland, which, of course, produces myxoedema. We fail to see how this view can be dis- puted. In his myxoedematous patient the thyroid had undergone complete fibrosis, a few small cellular masses representing all that was left of the vesicles. The examination of the nervous system in all these cases was exhaustive, and disclosed these points. Case 1.—Nervous system showed no changes. Case 2.—The only change found was some Wallerian degene- ration of the left vagus. Case 3.—Syringomyelia. Case 4.—Typical tabes dorsalis.—We review this case in detail later on. Case 5.—The cervical spinal cord showed some sclerosis of Goll’s columns, and columns of Burdach. There was no lesion in the restiform bodies. Cases 1 and 4 both showed degeneration in several peripheral nerve trunks. We wish to draw attention to this as confirming our own observation that clinical symptoms of peripheral neur- itis are by no means rare in Graves’ disease.11 Greenfield also observed changes scattered all over the nervous system, which (from their nature and distribution) resemble those produced in tetanus and hydrophobia, and suggest their dependence on an irritative toxic action. 0. Hezel12 gives a full and minute account of a post-mortem examination of a typical case, a woman aged 45. The microscopic examination was full, and all the details of staining are given, so that we are able to say that the best methods were used. The medulla, sympathetic trunks and ganglia, the vagi, the greater number of cerebral nerves, the thyroid and muscular substance of the heart were all carefully investigated. No changes were dis- covered in the restiform bodies or solitary bundles. The changes in the cervical sympathetic ganglia were marked, and though limited in extent, affected portions of both sides. The main changes were :—- (1) Infiltration by round cells of the walls of the small vessels, with occasionally narrowing of their lumen. (2) Small haemorrhages. (3) Nuclear proliferation of the connective tissue capsules of