The pathology and treatment of Graves's disease / by W.H. Thomson.

  • Thomson, William Hanna, 1833-1918.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: The pathology and treatment of Graves's disease / by W.H. Thomson. 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.

    6/6 (page 606)
    wlio are generally very careless about cleanliness and sani- tary measures and much prejudiced against vaccination. In one of these countries (Puerto Rico) I have prac- ticed medicine for twenty-two years; there I made my first acquaintance with the disease, in the treatment of which I have had a rather extensive experience. I have also in my capacity of public vaccinator, which office I held there for many years, practiced vaccination extensively by direct inoculation with bovine and humanized ’vaccine virus, and from arm to arm, and can testify to the benefi- cial effects of this operation in the shortening of epidemics and rendering subsequent ones less severe, especially since the facilities for obtaining pure and reliable vaccine virus have been increased by the foundation of an institute for the cultivation of bovine vaccine virus to supply the country. I am sorry, Mr. President, not to he able to produce some statistics which would prove my assertion and make this paper interesting, but I could not procure them in the short time at my disposal to prepare this paper. I do not pretend to bring to your notice in this paper any new facts in connection with the disease, but simply to call your attention to the severity which its epidemics still have in many countries, especially the West Indies, and to make a plea to bacteriologists and workers in the field of infectious diseases in favor of research and investigation of the causes and pathogenesis of this disease, which has been little attended to, with the object of finding, if possi- ble, a more efficient measure to prevent its occurrence, either by devising other means of producing immunity from it or devising new means of treatment in man, or by improving the present measure of preventive inocula- tion, “ vaccination,” having more extensive and precise knowledge of the germ which causes it, and its habits and peculiarities, as is the case in other diseases of the kind. The history of small-pox dates from very far back. It is said to have existed as a scourge in China and Hindostan one thousand years before the birth of Christ, and to have made its way through Arabia and Egypt into Europe, where it was introduced by the crusaders. It was un- known on this continent before the arrival of the European conquerors and new settlers, who imported it into this and other newly discovered lands. It was a much-dreaded scourge all over the world until the wonderful discovery of Jenner in 1796 came to deprive it of a great deal of its hor- rible and deadly character in countries where this operation is regularly and persistently practiced. The discovery of Jenner was met by a great opposition at the beginning among a number of practitioners and lay people, and even at the present time organized anti-vaccination societies are in existence in England and other countries to attest what prejudice and ignorance can do even with the most useful and successful discoveries in our art. I will not tire you by giving a minute and elaborate de- scription of the disease, its clinical history, etc. I will simply make a hurried sketch of the disorder, its varieties, and different stages, making some remarks on its compli- cations, sequelae, and treatment, with reference to my ex- perience with it in the different epidemics which I have observed in Puerto Rico. Small-pox or variola is a contagious and infectious dis- ease of the blood, characterized by a peculiar eruption of the skin and inflammation of the mucous membranes of the body, accompanied by fever. According to the present views, like all other infectious diseases, it ought to be caused by the introduction into the body of some kind of microbe or germ which, by its pres- ence in the blood, produces the poison, toxalbumin or tox- ine, which gives rise to the grave symptoms and general dvserasia of the blood sometimes observed. But so far bac- teriologists have not found any special germ, and only the common pus coccus has been found in the pustules. The first cases of variola that appear in a locality can always he traced to contagion if properly investigated, and the disease has always a tendency to spread as an epidemic if not promptly checked by appropriate means. It is often preceded by other exanthemata, especially measles, and whether there is any relation between the agents causing these diseases or whether it is owing merely to the epoch of the year at which they occur being favora- ble for their development in the human system, I am not prepared to say. As to its primitive origin, some authorities believe that it first originated in the horse and cattle and from thence was acquired by man, and others hold the opposite view\ Variola is most conveniently divided, in regard to its severity, into benignant, malignant, and modi- fied ; as regards distribution of the eruption, into discrete, semi-confluent, confluent, and corymbose or clustered. The course of the disease is generally divided into five periods or stages, which indicate the different phases which the disease assumes before its termination, as follows : In- cubation., invasion or primary fever, eruption, secondary or suppurative fever, and incrustation and decrustation or des- quamation. In the modified variety all these stages are not perfectly developed, and so wTe will take a typical case of true variola for our description. The period of incubation includes the space of time which intervenes between exposure to the affection or contagion and invasion of the disease. This period may be shorter or longer according to the severity of the case to follow, but the limit generally assigned to it by most authorities is from five to twenty days. There are no appreciable symptoms in this stage. The period of invasion, or primary fever, is marked by symptoms which indicate serious constitutional disturbance. It commences with lassitude, chills, pains of the head, loins, and limbs, and hot skin. Conjunctive suffused ; rapid pulse and respiration. There are thirst and loss of appetite, with a white and coated tongue, dotted with red papillae, nausea, and often vomiting, constipation, pain and heat in the epigastrium, restlessness, and general prostration. To this may follow oppression of breathing, cough, lethargy, and in some cases delirium and coma. The tongue, which at the beginning of this stage was white, becomes red, the change beginning at the point and extending subsequently over its whole surface. In children convulsions frequently occur. There is an exacerbation of febrile symptoms to-