Hyperthyroidism and Basedow's disease / by August Schachner.

  • Schachner, August, 1865-1941.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Hyperthyroidism and Basedow's disease / by August Schachner. 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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    HYPERTHYROIDISM AND OW’S DISEASE.* By august SCHACHNER, M.D., LOUISVILLE, KY. IN 1786 Parry, who, according to Mo- bius, is really entitled to the credit of first writing upon this disease, de- scribed it as an enlargement of the thyroid gland with palpitation, cardiac hyper- trophy, exophthalmos, and a disturbance of the nervous system. In 1835, or about a half century after Parry, Graves described it as related to hysteria. The English gave it the name of Graves’ disease; but not until 1840, or more than half a century after Parry, did von Basedow’s writings make their ap- pearance. It is only, however, in recent years that it has attracted unusual atten- tion. This is due largely to our better knowledge of the disease, whereby we are able to recognize it not only in its earlier stages, but also in its more atypical forms. Where the clinical triad of vascular struma, exophthalmos and tachycardia with vascular changes are well marked, its recognition is unmistakable. There is a large class of atypical cases, such as formes frustes of Trousseau, where the diagnosis is not so easy, at least without some time for study and observation. These cases have frequently drifted from the internist to the neurologist or the ophthalmologist, until, through the lapse of time and the more perfect development of symptoms, their real nature becomes apparent. In addition to the three cardinal symp- toms already noted, may be mentioned tremor, restlessness, insomnia, psychic disturbances, muscular weakness, diarrhea and the loss of weight. In the skin we have excessive pigmentation, deficient pig- mentation, erythema, urticaria, perspira- tion, edema, and the loss of hair. In addi- tion to the acceleration of the heart, we have also dilatation of the right side, and later degeneration. Not only is the symp- tom-complex extensive in its scope, but al- most every symptom is capable of equally extensive variation in each individual case, which goes far towards explaining the diagnostic difficulties in atypical and early cases. Many are misled through the apparent lack of enlargement of the struma. A sufficiently clear distinction is not always made between changes in the thyroid gland and an enlarp-ement of the thyroid gland. The changes in the gland may not be attended by any apparent en- largement, and may only be appreciated by a microscopic section. By microscopic section, however, it is plain that we have changes that consist of an increased num- ber of cells and conditions pointing to an increasing activity of such cells without necessarily giving rise to more than a slight enlargement of the gland after it is exposed in an operative way. On the other hand, a considerably en- larged gland may be an underactive gland in that the type may be fetal in character, or the enlargement may be due to a col- loid condition, which is always a condition of inactivity because of its degenerated character. Notwitlistanding the attention it has re- ceived in recent years, there is yet much work ahead before its causation and path- ology are entirely settled. The most generally accepted view is tliat of Mobius, that it is a trophoneurosis due to a toxin dependent either upon an excessive amount of normal or abnormal secretion, or perhaps both. Many believe that the disease cannot be produced in its entirety by the administration of thyroid tablets, and therefore contend that an ex- cessive amount of the normal secretion alone is incapable of producing the dis- turbance. It is plain, however, that what- ever the toxin is, it is elective in its action, exerting its influence principally upon the heart, blood-vessels, central nervous sys- tem and skin. According to Mobius, the disease may * Read before the Tenth Annual Meeting of the Ohio Valley Medical Association French Lick, Ind., November 11-12, 1908.