Exophthalmic goitre : its etiology, symptoms and treatment / by Casey A. Wood.

  • Wood, Casey A. (Casey Albert), 1856-1942.
Date:
[1901]
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Licence: In copyright

Credit: Exophthalmic goitre : its etiology, symptoms and treatment / by Casey A. Wood. 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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    exclusive, has never, so far as I know, been elevated to the dig-- nity of a theory either by evidence derived from experiments on the lower animals or by clinical observations of patients where paralysis of the nerve has occurred. Ag-ain, the pupillary reac- tions in Graves' disease are usually normal when they would inevitably be disturbed in disease of the sympathetic. These difficulties led Prof. Sattler (then of Erlang-en now of Leipzig) to advance a theory that to some extent removes them. He postulates a lesion of that portion of the central vasomotor neuron that presides over the vasomotor nerves of the thyroid, and of the post-ocular tissues within the orbit as well as an alteration in the cardio-inhibitory center of the pneuraogastric. In further support of Sattler's theory, Fitzgerald in 1883 pointed out that many cases of exophthalmic goitre are complicated with symptoms clearly cerebral, as for instance, glycosuria, paresis of the external recti muscles and paralysis of the associated move- ments of the globe. The chief objection, to my mind, that resides in the Sattler theory is that beyond Filehne's experiments on the restiform bodies (when division of these produced impaired function of the vagus, exophthalmus and vasomotor paresis in the ears, thyroid and anterior part of the neck) there are no post mortem findings to support it. Furthermore, it is necessary to suppose several circumscribed, isolated, invariable and unre- lated lesions which are without our experience in practical path- ology. The statement that acute iodism and exophthalmic goitre are practically the same condition has received the sanction of several observers. Jaunin and G. Gautier, both writing in the Revue niMicale de la Suisse Roniaine for 1899, describe cases in which the exhibition of iodine in considerable doses brought on all the symptoms of Graves' disease, except the marked prop- tosis. exciting causes, also, can have only a passing mention. Of some eleven cases observed, more or less closely by me, two only were in men,—one of twenty-four, the other twenty-two years of age. All the others were women of from nineteen to thirty-three years old. Graves' disease is in that sense a female' affection. There can be no doubt but that anemia and chlorosis are often present. Overwork, worry, fright, catching cold (thereby bringing on an acute or chronic thyroiditis) great mental excitement, excessive venery, insonmia, as well as many other causes have been assigned by both pliysician and patient