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

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1893
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Licence: Public Domain Mark

Credit: Clinical notes on Graves' disease / by Professor Grainger Stewart and G.A. Gibson. 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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    which would prechide any such diagnosis, and in these cases it appears to be produced solely by some functional disturb- ance of the nervous system. Such nervous dyspnoea is described by Germain See, Pain in the precordial region, referred to also by the same author, will be seen to have been aprominent symptom in one of the cases (Case 7) described in the sequel. Symptoms of dropsy are found only, for the most j)art, as the result of enfeebled cardiac activity. In this condition there may not only be a considerable amount of oedema of the lower extremities, but also so large a quantity of serous fluid in the pleural sacs and peritoneal cavity as to necessitate aspiration. It will be seen that such a train of symptoms was present in Case 7. Tachycardia has been absent in no case under our notice and in at least one well-marked instance, already referred to, this symptom, although attended by exophthalmos and tremor, was not associated with thyroid enlargement. Tachycardia is usually accompanied by palpitation, but the subjective phe- nomena often fail to attract the patient's notice. In some rare cases referred to by Eulenburg there has been neither tachycardia nor palpitation. Germain See will not allow that increased frequency of the pulse may be absent, and our observations are in accord with his opinion. At times the frequency of the pulse is easily controlled by rest and drugs, but in many cases the tachycardia resists treatment. Extreme irregularity of the pulse occiu-red in one of the cases described in the sequel. Although exceptional, the condition is well recognised, having been described in con- nection with this disease by Eendu and others. Hypertrophy of the heart in Graves' disease was originally described by Stokes, and most of the subsequent authorities have coincided with him in this respect. Cardiac hypertrophy has been a frequent accompaniment of our cases; showing itself not only by outward displacement of the apex and increased force of its beat during life, but also by considerable increase of weight on post-mortem examhiation, as in Case 7. Dilatation, however, has been much more frequent, especially