Some remarks on the nature and treatment of pulsating thyroid gland, with exophthalmos ("Graves' disease") / by William Moore, M.D.

  • Moore, William, M.D.
Date:
1865
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Licence: Public Domain Mark

Credit: Some remarks on the nature and treatment of pulsating thyroid gland, with exophthalmos ("Graves' disease") / by William Moore, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    tlie force of the heart. The double pulsation of the arteries of the neck, and those alone, he considers another evidence of local vascular excitement. Both Henoch and Stokes agree that this condition is not attended with fever, nor w^ith physical signs or general symptoms of cardiac inflammation. Now, although many of the most prominent symptoms of this affection, as palpitation, menstrual suppression, and mental anxiety are compatible with anemia, still I am not prepared to admit such to be the exciting cause of this disease. In four of the cases I have adduced the appearance of the patients was not spanemic; on the contrary, three of them might be called florid and well developed, and when ferrugineous preparations were exhibited they proved ineffectual. In this view of the question I am not singular; for whilst Withusen admits that in a great proportion of cases there was well marked anemia, with suppression of the menses, and cardiac symptoms such as Avould suggest the inference that this moi'bid condition stands in direct relation to the phenomena of Graves' disease; still, he goes on to say—if this blood disease had always evinced itself in a gi-eater or less degree we should have progressed in our knowledge of this affection; but such is by no means the case, as numerous instances could be shown where not a trace of anemia was present; on the contrary, the patients Avere blooming, active, and plethoric, and where the remedies usually employed in anemia were found absolutely useless. Nor does Henoch regard anemia as an indispensable element in the development of the disease. For my own part I consider the origin of this afiection to be essentially nei'vous, in which the vaso-motor system plays the most conspicuous part. When we consider that the motor fibrils of the heart are derived from the sympathetic as well as from the spinal nerves; and as Professor Moleschott has shown that the heart is animated by four very excitable nerves—two vagi and two sympathetic, having a peculiar consensus, so that the state of irritation or over-excitement which is produced in one of the nerves is transmitted to the other three; again, branches from the inferior cervical sympathetic supply the thyroid body and larynx; such being the nervous distribution we may easily reconcile palpitation, pulsation of the carotids and thyroid body, with any vaso-motor irritation along this important region. Then comes the question of exophthalmia, dilated and restless pupils, &c. It is now an admitted fact that there are two antagonistic set of fibres in the