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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    The Registrar-General, unfortunately, classifies all deaths from affections of the thyroid, except malignant and specific diseases, under the one head of “ Bronchocele,” hut his figures are instruc- tive, for they show that there has been a steady rise from 91 to 152 in the decade beginning with 1881.. The increase of deaths has been almost entirely female, the male mortality averaging 22^ and increasing from 21 steadily to 26. Now, simple goitre rarely kills, except by excessive thyroid enlargement, and such very large goitres are rare in England. The presumption is, therefore, that the increase in death rate is due to Graves’s disease, and this is supported by the increasing preponderance of female deaths. For there is no question that Graves’s disease far more largely affects women, and though women are more liable than men to all thyroid affections, I am not aware that there is any evidence that they are becoming increasingly so liable. Next, does Graves’s disease never occur in previously goitrous subjects P Two years ago M. Lasvenes* published in detail three such cases, in which the persons had been goitrous many years. They are the sole records I can find. I have myself met with seven instances. I have known them all for years, seen them fre- quently, and devoted great care to the diagnosis, as the question is, to my mind, of great importance. Case 1.—Married woman, aged 47. Goitrous since 18 years of age. Examined carefully and often in 1887—1888, and decided to be a case of simple goitre. Not till 1891 did she develop any real signs of Graves’s disease, and these were then accompanied by various paralytic conditions of great interest. I have twice published an account of her, and shall allude to some of her symptoms later. Case 2.—Married woman, 43. Goitre first noticed early in 1888, prob- ably due to constant use of water contaminated by cow-dung. A neigh- bour in the next cottage, using the same water, is also goitrous. Patient miscarried in November, 1891 ; immediately after she began to have severe palpitation, constant rapid pulse, and typical attacks of diarrhoea, while the goitre increased largely. Case 3.—Mrs. S , 51. Goitrous for 14 years. Has had, during the last two years, an attack of cystitis, probably secondary to slight cystocele, and two attacks of influenza. Eor six months she had rapid pulse, severe palpitation, flushing, sweats, and tremor, while for a year afterwards I noticed marked retraction of the eyelids, so great as to expose the upper margin of the corneae. b 2 # ‘ These de Paris,’ 1891.