Observations and experiments on the pathology of Graves's disease / by Walter Edmunds.

  • Edmunds, Walter.
Date:
[1895]
Catalogue details

Licence: Public Domain Mark

Credit: Observations and experiments on the pathology of Graves's disease / by Walter Edmunds. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    or amelioration of Graves's disease which now many times hag followed the removal of the whole or part of the enlarged thyroid. The last to review these cases is Dr. Oppenheimer, of Baltimore, who finds a total of sixty-eight on record: of these, eighteen are said to have completely recovered; twenty-six were more or less improved; in nine there was no change either way; in five there was immediate death; and in four death followed the operation within twenty-four hours. One case of improvement, amounting practically to cure, has come under my own observation. The case was seen almost from the commencement of the symptoms, and treated, but without suc- cess ; it gradually became worse, the patient at last being very iU, with the usual symptoms, including the paroxysmal attacks of palpitation and rapid breathing. The only course that seemed left was to operate on the goitre, but before undertaking this step a con- sultation was held with Dr. Hector Mackenzie. He agreed in the advisability of the operation, and also in considering the spasmodic attacks to be due to the effects of the disease itself, and not to the mechanical pressure of the goitre on the trachea. The attacks resembled those which occur in thyi-oidless dogs. A considerable portion (but not aU) of the goitre was removed; the patient was much benefited, and the symptoms gradually passed off, so that the patient was practically well, though the pulse, if counted, was found too fast, and a little exophthalmos might still have been detected on critical examination (at no time was it a prominent symptom). It is argued that the improvement must be due to the diminution of the thyi'oid secretion, following the removal of a portion of the thyroid, and that therefore the symptoms are due to that cause; but it must be remembered that for these cures to take place it is not apparently necessary that the whole or nearly the whole of the goitre should be removed; in some cases only one lobe has been excised, the remainder atrophying in time. This, too, is only what occurs in operations on ordinary goitre. In a case in which about half of a considerable goitre (which was compressing the trachea) was removed, the remaining portion gradually atrophied, so that in about a year the thyroid could not be detected, and the patient was well. These latter cases can only be explained by the breaking of some vicious circle, and the same exjilanation may apply in the cases of Graves's disease. Moreover the improvement, as we have seen, docs not always follow: Dr. Mackenzie informs me of a case