The Bryson symptom in exophthalmic goître : with a report of forty cases / by Hugh T. Patrick.

  • Patrick, Hugh T. (Hugh Talbot), 1860-1939.
Date:
1895
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Licence: Public Domain Mark

Credit: The Bryson symptom in exophthalmic goître : with a report of forty cases / by Hugh T. Patrick. 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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    various ailments, selecting those whose troubles would not, in my opinion, affect the result. These are presented in Table II. Table II.—For Comparison. General condition. Chest DYNAMOMETER. No. Age. Affection. expan- sion. E. L. Aver- age. 1 52 Tabes. Fair. Ctm. 4 30 25 27-5 2 24 Hysteria. U Yerv good. 7 80 70 75 3 31 Good. 5 45 45 45 4 51 Chronic rheumatism. Fair. 4 40 25 32-5 5 41 Incipient tabes. Good. 51 55 55 55 6 29 Cerebro spinal syphi- Good ; very 5 100 75 87-5 7 30 lis; dement, paral. (?) Epilepsy. muscular. Good. 3i 50 50 50 8 46 Ophthalmoplegia. U 7 47 47 47 9 23 Brach. neuralgia. Very good. 4^ 80 70 75 10 43 U U Fair. 6 72 70 71 11 39 Chronic rheumatism. Verv fair. 51 60 40 50 12 18 Sciatica. Fair. 4J 55 50 52 • 5 13 26 Neurasthenia. Verv fair. 3| 65 50 57 5 14 38 Hvsteria and Fair. 58 42 50 15 17 neuralgic pains. Hystero-epilepsy. Good. 5 55 47 51 16 28 Lumbago. Very good. 6 95 95 95 17 36 Hvsteria. Fair. 4 30 30 30 18 22 U Good. 4| 46 46 46 19 34 Hvsteria and neu- <4 6 75 70 72-5 20 22 ralgia. Hysteria and organic Fair. 4£ 37 50 43-5 21 30 heart disease. Headache. Anaemic. 4 75 70 72-5 22 30 Tabes. Very good. H 80 67 73-5 23 15 Hysteria. Good ; well 4^ 45 35 40 24 19 Valvular heart developed. Anaemic. 41 51 55 53 25 27 disease. Headache. 41 50 40 45 26 41 Hysteria. Good. 4* 61 54 57 5 27 23 Hysteria and lumbago. Very good. 4 47 47 47 28 26 Sciatica. Good. 6 77 75 76 4-8 1 •• 1 '' 56-36 I am well aware also of the varying results given by the dynamometer, and I do not allege absolute accuracy for my figures or wisb to make too sweeping deductions from them, but all measurements were taken by myself in as nearly a uniform manner as possible, and sources of error excluded as well as might be. It will be seen that the average chest expansion in the forty cases of exophthalmic goitre is 4'3 centimetres and the hand grasp 43‘75 kilogrammes; in the twenty eight other cases, 4'8 centimetres and 56-36 kilogrammes respec- tively—that is, the expansion in Graves’s disease is dimin- ished half a centimetre, or ten and a half per cent., the hand grasp 12-61 kilogrammes, or twenty-two and two fifths per cent. In other words, the grasp is diminished more than twice as much as the expansion. It may be contended that the average expansion of the twenty eight women used for comparison is not up to the normal, and I think this may possibly be true, but I also think they make a far bet- ter basis for comparison than statistics of measurements taken by some one else whose methods would doubtless differ in some degree from mine, and consequently whose re- sults, other things being equal, would differ from mine. Further, these measurements were made in the same dis pensary which furnished the majority of the cases of Graves’s disease,* and the subjects are fairly representa- tive of the class of patients furnishing the material for this report, and, as before mentioned, the pathological conditions in these women were not such as to mate- rially affect chest expansion or hand grasp. But even supposing that the expansion of the twenty-eight might be materially below the normal, we could not suppose in all these various cases a condition which would affect chest expansion to the exclusion of other muscular action, in- cluding hand grasp, and as we find that the hand grasp in Graves’s disease is diminished twenty-two and two fifths per cent, and the expansion only ten and a half per cent, the natural conclusion would be that if one of these two is pathognomonic of this malady it would be the weakened grasp and not the diminished chest expansion, an assump- tion I would not for a moment entertain. Again, we find of the forty cases twenty-six with an expansion below the average of the twenty-eight, while thirty show a diminished grasp. Could we take accurate dynamometric measurements of the lower extremities and of the pelvic muscles, I have no doubt we should find an equal falling off. Many of these patients complain of a sudden “ giving way of the legs,” and placed in the recumbent posture show- their muscular weakness in the manner of rising. A woman now under observation, not included in this re- port, is a case in point. It is not what could be called a very severe case; she does her own housework, gets about very well, hand grasp and chest expansion only slightly diminished and yet she rises from the supine position much like a patient with idiopathic muscular atrophy; that is, she first raises the trunk by means of the arms till she rests on her elbows; then, again by help of the arms and with a peculiar wriggle or writh- ing movement to bring accessory muscles into play, she brings the trunk to the perpendicular; the erect position is then at- tained, with manifest effort, by turning round and pushing her- self up with her hands first on the floor and then on her thighs or adjacent objects. I think the diminished power of convergence often ob- served, as well as the occasional affection of the laryngeal muscles, is quite analogous to these other findings, and is simply a part of a general myasthenia, sometimes affecting one set of muscles more, sometimes another. I find, further, that many of these cases show a rapid and marked falling-off in both chest expansion and hand grasp on repeated effort. Thus either may diminish one half after three or four trials in rapid succession, and in a general way the decrease affects 1 th and is proportional to the debility. The idea that the diminished ch est exrmsion is simply part of a diminished vitality or ener.°7is borne out by the history of individual cases. I have generally found that as the patient improves in general tone the expansion in- creases (and vice vena), although not necessarily in the same ratio, and that the grasp goes with it hand in hand. But as the diminished hand grasp shows the larger per- centage in the table, so here it is apt to show the larger fluc- tuations, which would stem again to indicate that it is the more delicate index of the two. These facts are well illus- trated by Case III. The rule, howler, is not absolute, and * Professor Mendel’s Poliklinik, Berlin.