Graves's disease / by Arthur Maude.

  • Maude, Arthur.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: Graves's disease / by Arthur Maude. 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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    I have never seen an instance of beri-beri, but the descriptions of the cedematous form of that disorder seem to bear a strong resemblance to the combination of paralysis and oedema which I describe in Graves’s disease ; and the pathological condition in beri-beri is known to be a peripheral neuritis.* This is a very imperfect sketch of a large range of nervous dis- turbances which affect every area and every level of the nervous system. I find great difficulty in ascribing any of the symptoms I have indicated to variations of blood supply, and we cannot fail, I think, to be struck by the resemblance of the clinical picture to the results of poisoning by alcohol, lead, and, perhaps, beri-beri. Pathologists have long sought to explain the phenomena of this disease by some focal lesion in the sympathetic or the medulla. But as our clinical knowledge grows, the more unsatisfying sucli explanations become. The old sympathetic theory died hard, killed by Filehne and Dr. Hale White, but will any lesion in the medulla do more than explain the cardiovascular symptoms ? I think not. We must regard the neurosis as a nerve poisoning, for the present; the brunt undoubtedly falls on the medulla, but it is felt from the cortex to the periphery. What that poison is we do not know. That there are probably secondary poisons I have indi- cated. But remember the one feature, so peculiar to the disease, the thyroid change. To my mind the universal goitre, the connection with myx- cedema the results of operations on the thyroid, point to that gland as the fountain-head of evil. This is only a provisional speculation as yet, but, failing surer ground, we must have provisional theories to direct our minds at the bedside. # Ross and Bury : ‘ Peripheral Neuritis,’ 1893, p. 316. Harrison and Sons, Printers in Ordinary to Her Majesty, St. Martin’s Lane.