Graves's disease / by Arthur Maude.

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

Licence: Public Domain Mark

Credit: Graves's disease / by Arthur 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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    say here, that when I wrote on this subject a year ago,* I had never seen it in the muscles of the face, but, led by an observa- tion of Dr. Sansom’s, I have since found it affecting the masseters. This is important, as it negatives the theory that the tremor might be produced by spinal change. The points on which I would lay stress in reference to this tremor are— 1. That it is almost universal in exophthalmic goitre. 2. That it exactly resembles the tremor produced in animals after removal of the thyroid: it is in fact a thyroid tremor. 3. That its character is much more uniform than that of hyste- rical tremor, for which it might otherwise be taken. I cannot discuss here the diagnostic differences between this tremor and that due to alcoholism, paralysis agitans, disseminated sclerosis, and various metallic poisonings, but here are some tracings illustrating these distinctions. Dr. Judson Bury informs me that he has once found marked fibrillation of the interosseus muscles of the hand, in addition to the ordinary tremor, but this he was inclined to ascribe to a peripheral neuritis. My allusion to a pseudo-epileptic state brings up the question of eclamptic convulsions. To this M. Balletf devoted attention in 1883. He collected many cases, and showed that though the main cardiac signs may supervene in chronic epileptics, in another series of patients the convulsions had a direct relation to the increased heart action and were, perhaps, induced by it. Clonic spasms of one side of the face, convulsive tic, is described in one instance by Eulenburg, and in another by Dr. Hughlings Jackson, who attributed the convulsion to discharge of facial centres in the pores. Similar spasms have been seen affecting the muscles of one shoulder and the side of the neck. Cliorea% is undoubtedly a frequent concomitant, but I dismiss it as probably purely secondary to vasomotor disturbance. * ‘ Brain/ LIX and LX, p. 424. t ‘Rev. de Medecine/ 1883, p. 254; Kovalivski: ‘Arch, de Neurologie/ xviii, p. 422 ; ‘ St. Barth. Hosp. Rep.’, 1874, p. 254 ; R. Reynolds : ‘ Lancet/ 1890, i, p. 1057. £ L. G-ros : ‘ Soc. Med. de la Seine/ August 19, 1864; Gagnon : ‘ Gay. Hrbd.de Med. et de Chir.’, 1876; Kelly: ‘Med. Press and Circular/ 1878; Ghoymski, 1880; Jacobi: ‘Med. Rese/ New York, 1879; Patel Gros; These de Paris/ 1884; S. West: ‘Trans. Opbth. Soc.’, 1886; Gueneau de Mussy :