Struma exopththalmica (vascular bronchocele and exophthalmos ) / by Professor Virchow ; translated, with notes and observations, by J. Warburton Begbie.

Date:
[1868]
Catalogue details

Licence: Public Domain Mark

Credit: Struma exopththalmica (vascular bronchocele and exophthalmos ) / by Professor Virchow ; translated, with notes and observations, by J. Warburton Begbie. Source: Wellcome Collection.

    14/16 (page 14)
    structure, and various kinds of degeneration, as, for example, the fibrous and cystic, have been detected in such goitres, there is no doubt whatever that the augmented activity and chronic enlarge¬ ment of the vessels, particularly the veins in them, is of chief im¬ portance. The central organ of the circulation invariably and, in point of time primarily, suffers. At first, however, and usually for a length¬ ened period, the heart is only functionally disturbed. Of this dis¬ turbance its greatly accelerated action is the prime, as it is the unmistakable, indication. After a time, structural change ensues, and that is, for the most part, of the nature of dilatation, or hyper¬ trophy with dilatation. The left ventricle is the chamber chiefly affected. Y alvular disease of the heart is certainly rare ; when it ex¬ ists, the imperfection is secondary, never primary. In other words, the increased size of the mitral and tricuspid orifices, discovered on the post-mortem examination of some cases of the disease, bore an intimate relationship to the greatly augmented capacity of both ventricles. This, the earlier result, was evidently the cause on which the insufficiency of the auriculo-ventricular valves depended.1 In the great majority of cases, a disturbed action of the heart, generally spoken of as palpitation, is the first symptom to attract attention. If, however, a very careful inquiry into the previous history of such patients be made, it will be found that for some time before the distressing action of the heart was noticed—possibly at a considerable period antecedent to the acknowledged existence of any departure from health—there had occurred a diarrhoea or lientery, a menorrhagia or leucorrhoea, an epistaxis, rather a fre¬ quently recurring loss of blood from the nose, or a hsemorrhage from piles ; and although, in many cases, none of these may have been sufficient to produce the more manifest indications of anaemia, it will, I firmly believe, be further found that impoverishment of blood—readily enough recognisable—exists. Virchow, like all recent observers of this disease, rejects the notion of the prominence of the eyes being due to u hydrophthal- mos.” He looks upon a change in the fatty tissue of the orbit—a view originally maintained by Heusinger—as being the essential morbid condition upon which the very strange aspect of the eyes depends. An hypertrophy of the fatty tissue, or its congestion, are the states more particularly indicated. Enlargement of the spleen is referred to by Virchow as having been noticed by some observers, but he truly remarks that the degree of importance to be attached to its occurrence has not been as yet accurately determined. There are then, it may be stated, four essential symptoms in this most interesting malady — namely, 1. Disturbance of the Heart’s action, prone to terminate in structural change ; 2. Enlargement— vascular in its nature—of the Thyroid gland ; 3. Prominence, with 1 See, for example, the case of J. K., as recorded by Dr Begbie, in “ Contri¬ butions to Practical Medicine,” pages 143, 148.