Exophthalmic goitre / by Samuel E. Earp.

  • Earp, Samuel E.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Exophthalmic goitre / by Samuel E. Earp. 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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    Reprinted from “ The Medical CouncilPhiladelphia, March, 1909 Exophthalmic Goitre. By Samuel E. Earp, M.S., M.D. . Indianapolis, Ind. Professor Clinical Medicine, Indiana University School of Medicine. The following illustrates an instructive method of examination given at a clinic at the Indianapolis City Hospital February 5, 1909. The patient before you, J. W., is a mu- latto, 38 years old, whose parents were oc- togenarians when they died, and here the history stopped. The patient had the or- dinary diseases of childhood, eight attacks of gonorrhea and lues fifteen years ago; otherwise he states that his health has been good until a year ago, when he had an at- tack of difficult breathing, weakness of the knees, and diarrhea; he could not sleep at night, his eyes were red and inflamed and gave him some pain, and sweating was pro- fuse. He said he was in a hospital for a time and apparently recovered with the ex- ception of a rapid heart. This information is very vague. You notice he is a well-developed man, quite muscular and weighs 180 pounds. I placed a bandage over his eyes, and hence we shall commence at the feet in examination and come to this as a finale. The feet and ankles are edematous, be- tween the knee and ankle there are some yellow scars that are probably luetic. As I lay my hand upon his outstretched hand there seems to be a tremor; the nails are corrugated and there is evidence of pulsa- tion of the blood vessels. Expansion of the chest is one-half inch. Picking up a fold of skin I notice some slight edema. Dur- ing palpation we notice a tremor, thrill, tachycardia, and systolic murmur. You can see the evidence of dyspnea. There is a mitral regurgitation. The vascular condi- tion of the carotids and other vessels is well defined. As we now place the patient in an upright position you will note a slight ; enlargement of the thyroid gland which could not be seen before. And as I remove the bandage from the eyes you see the bulging of the eyeballs, which completes the drama. You will observe two signs which occur in some cases of this character: one, ihe lagging behind of the upper eyelid, known as the GraePs sign, and the increase in the width in the palpebral fissure, known as Stellwag’s sign. You have thus far ob- tained sufficient information to determine this to be a case of exophthalmic goiter. Possibly the cause may be a disturbed in- nervation, a diseased medulla or a lesion of the central nervous system; and it is surely evident that there is a toxemia. It is ad- mitted by all that there is a perversion of the function of the thyroid gland, and I have given you in detail the presumable effects of hyper-secretion of the thyroid and the possible ways by which it may produce a defect of metabolism. Furthermore, the same may be said of the role played by the pituitary body as suggested by Sajous. This disease may be preceded by emotional disturbances, mental strain or any of the infectious diseases, particularly rheumatism, or a hyperacidity of the thyroid body. The changes in the gland are a hyperplasia with tubular proliferation, the follicles being filled with colloid material. The etiology and pathology of the subject are interesting and comprehensive and may be taken up at another time. The treatment that we shall inaugurate will be rest in bed, an ice bag to relieve the tachycardia and bromide of sodium to over- come the insomnia. It may be necessary to use trional or perhaps morphia; the latter we should do without, if possible. A cap- sule containing 2 grs. of ergotine and 1-30 gr. of strychnia will be given three times a day, and 5 gr. doses of bromide of quinine four times a day. Iron and arsenic are un- called for unless there is sufficient anemia