Clinical notes on Graves' disease / by Grainger Stewart and G.A. Gibson.

  • Gibson George Alexander, 1854-1913.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes on Graves' disease / by Grainger Stewart and G.A. Gibson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    crises, and our experience justifies his descriptions. One of the most rapidly fatal cases of the malady, that described by Osier, showed remarkable symptoms of this kind. The patient, who had previously manifested no sign of Graves’ disease, except a slight degree of prominence of the eyes, was suddenly attacked by severe vomiting and diarrhoea with tachycardia, throbbing of vessels, exophthalmos, and swelling of the thyroid gland. Death occurred on the third day of the illness. One of the patients under our observation has suffered from diarrhoea from time to time during a period of three years. On several occasions it lias been so severe as to threaten death from exhaustion, while the onset of the attacks has often been alike sudden and unexplained. When we seek to explain these gastro-enteric symptoms we naturally think first of abnormal innervation ; and the acuter crises, with their frequently sudden onset, and occasion- ally abrupt termination, must undoubtedly be referred to this cause. The nervous system may operate through the vaso- motor functions, by modifying the processes of secretion and absorption, or by exciting the muscular fibre to increased peristaltic action; but we have certainly found evidence of extensive catarrh of the alimentary canal in two fatal cases, one of which is recorded in the sequel. The hccmopoictic system is almost constantly implicated, but to a very varied extent. The blood presents no constant condition. In many cases the amount of haemoglobin, and the relative number of red and white corpuscles, are within the limits of health ; but in a considerable proportion of patients exhibiting symptoms of Graves’ disease there are blood changes significant of varying degrees of amernia. The thyroid gland may be said to be almost invariably affected. Trousseau refers, howrever, to a case in which it was never involved, and various subsequent authors have con- firmed his observations. Amongst his 58 cases von Dusch found 3 in which there was no thyroid enlargement. The case of a lady who came under our notice with all the other cardinal symptoms of Graves’ disease (including tachycardia, exophthalmos, and tremor), afforded us lately an instance of the affection without any change in the thyroid gland. The