The Bryson symptom in exophthalmic goître : with a report of forty cases / by Hugh T. Patrick.

  • Patrick, Hugh T. (Hugh Talbot), 1860-1939.
Date:
1895
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Licence: Public Domain Mark

Credit: The Bryson symptom in exophthalmic goître : with a report of forty cases / by Hugh T. Patrick. 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 BRYSON SYMPTOM IN EXOPHTHALMIC GOITRE * WITH A REPORT OF FORTY CASES. By HUGH T. PATRICK, M.D., PROFESSOR OF NEUROLOGY IN THE CHICAGO POLYCLINIC. Five years ago Dr. Louise Fiske Bryson f first called attention to a condition in Graves’s disease that lias since been called the Bryson symptom—viz., diminished chest expansion or vital capacity. She cites it as one of the “ distinctive, fixed conditions ” prevailing in this disease which “ afford the only rational basis for prognosis.” Other fixed conditions are not specified and no measure- ments or cases are given. Dr. Graeme M. Hammond J con- siders it “ of the greatest importance in regard to the prognosis ” and “ also of assistance in locating the seat of the lesion.” He says further: “ Dr. Bryson states that where the expansion is found to be reduced to half an inch or less the termination of the case is invariably fatal.” He fouud the symptom present in the eight cases reported in his paper, and as recovery took place the expansion in- creased. Dr. A. B. Pope * has reported a case of exoph- thalmic goitre in a man with chest expansion of an inch and a half, and in the discussion Dr. E. Le Fevre said the symptom was “ owing to some nervous influence similar to that which gave rise to the rapid heart action.” Three years after her first paper Dr. Bryson || resumes the theme, giving particular prominence to the respiratory symptoms, and emphasizing especially diminished chest ex- pansion, but she seems to have receded somewhat from her former positive position as to its patlioguomonic impor- tance, as of twenty cases the Bryson symptom was present in only thirteen. She considers the disease, however, to be “a disorder of nutrition respiratory in its first manifesta- tions,A and even makes this assumption the foundation of * Read before the Chicago Medical Society, October 1, 1894. •)• A Preliminary Note on the Study of Exophthalmic Goitre. N. Y. Med. Jour., December 14, 1889. f A Contribution to the Study of Exophthalmic Goitre. N. Y. Med. Jour., January 25, 1890. # N. Y. Med. Jour., April 19, 1890. || Exophthalmic Goitre: A View of Thirty Cases. The Post-gradu- ate, July, 1892. A Italics mine. a therapy consisting of a series of respiratory gymnastics executed by means of Taylor’s respirator. These views have been quoted at home and abroad,* and the Bryson symptom would seem to be about to take its place among the important signs of Graves’s disease as bearing upon the diagnosis, prognosis, pathology, and treatment. Ham- mond,f indeed, distinctly calls it the fourth cardinal symp- tom, a distinction, by the way, which belongs to Marie’s symptom—tremor. At the time when Dr. Bryson’s first article appeared I had under observation a case of exophthalmic goitre which I measured several times, finding the chest expansion not materially diminished. After this I measured a number of cases, finding the expansion sometimes diminished and sometimes about normal, and I presently noticed that di- minished expansion seemed to go with a diminution in general vitality and muscular strength. I finally, then, began comparing the chest expansion with the hand grasp as recorded by the dynamometer, this affording the most convenient, if only approximately accurate, index of the general muscular condition. It is the result of these meas- urements that I wish to present. 1 may premise tliat only well-developed, in a measure typical, cases are comprised in this report, no formes frustes being included, and that the diagnosis was in every instance confirmed by some well- known neurologist. I have therefore deemed it unneces- sary to lengthen my paper by giving the symptoms of each case in detail. With the exception just noted, the cases have not been selected, but embrace all that I was able to measure from November 1, 1892, to May 1, 1894. The patients were all women, and it may be worthy of not-'' that of come sixty cases seen since 1891 only two were in men. * Frank S. Johnson, Trans. III. State Med. Soc., 1893, p. 193 ; J. Madison Taylor, Med. News, 1893, pp. 613, 111 ; William Oliver Moore, Internat. Clinics, 1893, i, p. 92 ; Edmund Lee Tompkins, Amer. Jour, of Obstet., November, 1893 ; W. II. Thomson, N. Y. Med. Jour., June 3, 1893; William A. Hammond, Pis. of the Nerv. Syst., 1891, p. 190; Landon Carter Gray, Treat, on Nerv. and Ment. Pis., p. 551 ; Mann- heim, Per Morbus Gravesii, Berlin, 1894, p. 33 ; Oppenheim, Lehrb. der Nervenk., Berlin, 1894, p. 829 ; Grasset et Rauzier, Mai. du syst. nerv., Montpellier and Paris, 1894, ii, p. 309; Debove et Achard, Manuel de med., Paris, 1894, art. by Letienne, vol iv, p. 391; Blocq, Etudes sur les mal. nerv., Paris, 1894, p. 113. f Grteme M. Hammond, loc. cit. Table I.—GRAVES’S DISEASE. No. Age. Duration of disease. Date of examination. Chest ex- Average. DYNAMOMETER. Remarks. pansiou. R. L. Average. Centimetres. I 29 4| years. Nov. 1, 1892. H 40 30 Following flight. Dec. 8, 1892. H 47 40 Feb. 25, 1893. 4 46 37 Mar. 2, 1893. 44 4-31 50 45 41-8 2 30 2 years. Nov. 1, 1892. 54 55 45 Feb. 11, 1893. 4 4‘75 60 57 54-2 3 32 4 years. Nov. 30, 1892. If 24 24 -ici i i'th examicat'/on sue had been two Dec. 14, 1892. If 12 16 weeks confined to bed, following mental Dec. 21, 1892. 2i 26 16 worry. May 17th, much better; had Jan. 28, 1893. H gained over twenty pounds. Mav 11, 1893. 2 1-8 16 16 io-7 4 37 1 year. Nov. 9, 1892. 3 37 47 is right-handed, but has always been stronger Nov. 30, 1892. H 3-25 40 50 43-5 n> left. 5 31 Probably Oct. 15, 1892. 1 67 47 Much yctse since a confinement nine week? 4 years. Dee. 2, 1892. 54 6-25 49 48 52’15 ago.