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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    Case XXXVII is a striking exception in the first two ex- aminations. The only one of my patients (Case III) who ever showed an expansion as low as half an inch (D25 ctm.), indicating, according to Dr. Bryson, an absolutely fatal termination, had, four months later, gained over twenty pounds in weight, and was better than at any time during the six months she was under observation. I think, then, we may conclude that the Bryson symp- tom, although present in many cases of exophthalmic goitre, is in no wise pathognomonic of this affection, or even an important sign; that it has no special significance in relation to the prognosis, pathology, seat of the lesion, or treatment, and should be relegated back to the compara- tive obscurity of an individual in a large community of manifestations which all depend alike upon the general' state; a state which makes the French designation of the disease, exophthalmic cachexia, quite as appropriate as any other.* Venetian Building. THE VALUE OF GUDE’S PEPTO-MANGAN IN THE TREATMENT OF ANAEMIA. By HUGO SUMMA, A. M., M. D., ST. LOUIS, PROFESSOR OF PATHOLOGY, PATHOLOGICAL ANATOMY, AND BACTERIOLOGY, MARION-SIMS COLLEGE OF MEDICINE ; PHYSICIAN TO THE EVANGELICAL DEACONESS HOSPITAL ; PATHOLOGIST TO THE REBEKAH HOSPITAL. The year 1893, with the publication of the results of very careful chemical investigations of the conditions of the blood in various diseases, especially those of the blood itself by Professor von Jaksch (1), the well-known author of the Handbook on Clinical Diagnosis, marks a new era in our understanding of the various anaemic processes. Our former vague knowledge of these conditions was molded into definite shape and form chiefly by his successful effort to elucidate all the characteristic features common to the various forms of anaemia. lie was thereby enabled as the first one to give a definition of this, up to this time, so pli- able and undoubtedly much-abused term, anaemia. Anaemia, in the broadest sense of the word, includes all those processes characterize!1 by a decrease in the amount of albumin and by an increase of the liquid part of the blood ; in other words,- hypalbuminaemia and hy- draemia are conditions present in all forms of anaemia, and this holds good not only in cases of primary anaemia, like leucaemia and chlorosis i also in all so-called secondary anaemia. This discovery enables us to i ndeistan I the hitherto empirical fact that the treatment of anemia requires not only or exclusively the administration of iron, but that all the metabolic processes, especially the introduction and assimilation of albuminous substances, must be increased, should the treatment be followed bj success. But just * I wish to express my ,-rreat gratitude to Professor Meudel, Pro- fessor Jolly, Professor Oppenliuim, Professor Bernhardt, Professor Eu- lenbui-o- and Dr. Goldseheider of Berlin, R-ofessor Brissaud of Paris, and Dr. J. Huglilings Jackson of Lond>n, for permission to examine cases entering into this repoit. this part of the treatment is exceedingly difficult, since one of the most constant symptoms which we meet with in the various forms of antenna is a more or less high degree of anorexia. This anorexia completes the “ circulus vitiosus ” so frequently observed in clinical pathology—a circulus vitiosus which must be understood in each individual case in order to be amenable to successful treatment. For it is evident that a continuous anorexia will lead to insufficient nutrition, to subnutrition, thereby constantly increasing the condition of hypalbuminaemia. The anorexia is, however, a natural sequelae of this ab- normal condition of the blood, in consequence of which, at least in the greater number of cases, the secretion of hydro- chloric acid is decidedly diminished (2). In the treatment of these cases, therefore, we must constantly bear in mind the condition—hypalbuminaemia. In order to facilitate the increase of albumin in the blood, notwithstanding the anorexia already existent, its adminis- tration in the form of easily assimilated peptones would be most rational. Prompted by this thought, I began in the spring of 1893 to make use of Dr. Gude’s preparation, known as pepto-mangan, in most all cases of anaemia that came un- der my observation, with the exception of those accom- panying or following chronic infectious diseases, such as tuberculosis, or of malignant tumors, such as cancer, etc. I collected from my clinical record thirty-four cases. The greater number of these were closely observed, not only as to the influence of the remedy upon the subjective symp- toms, but also as to its effects upon the blood by careful examinations which I carried out with the aid of Gartner’s hsematokrit (3). This excellent instrument, which requires the use of Professor Gartner’s Kreisel (spinning top) centrifugal ma- chine, enables, in a very accurate manner, a determination of the volume percentage of the red blood-cells within about ten minutes. I prefer this method of determining the efficacy of a remedy against anaemia to the old method of counting the red blood-corpuscles. Although, generally speaking, the number of the red blood-corpuscles bear a certain proportion to the volume percentage, yet it would be wrong to identify both. I n blood diseases especially, the knowledge of the volume per- centage is undoubtedly of great importance. During the above-mentioned period I observed neither cases of leucaemia nor of pernicious progressive anaemia. The thirty-four cases I treated with pepto-mangan were partly cases of chlorosis and partly secondary anaemia, oc- curring chiefly after subacute malaria and typhoid fevers. Of these I select six as paradigmata, as it were. Two of these were cases of chlorosis and four cases were secondary anaemia: Case I.—Miss A. S., aged eighteen years; chlorosis rubra; oligocythaemia and oligochromaemia; palpitation of the heart; frequent pulse; coated tongue; feetor ex ore ; constipation ; ir- regularity in menstruation; easily fatigued; muscular weakness. At the beginning of treatment, thirty-per-cent, volume; eight days later, thirty-eight per cent.; at the end of the fourth i