The treatment of Graves' disease by thyroidectomy / by James J. Putnam.

  • Putnam, James Jackson, 1846-1918.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of Graves' disease by thyroidectomy / by James J. Putnam. 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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    eyelids open wide, the eyes get a staring look, the pulse beats perhaps more slowly at first, then faster. If the .attention passes into fear, these phenomena may be inten- sified, and, in addition, the hand may be seen to tremble. If, instead of fear, shame or anger is present, the face may become suffused, and if I am not mistaken, the neck swells. Add to this the fact that emotions often cause a watery secretion in the bowels, and we have a tolerable picture of Graves' disease. I do not care to insist too much upon the pertinacity of this simile, and certainly not to claim originality for it, but I think it does give us a hint why it is that the vascular apparatus of the orbit an i the thyroid are liable .to suffer more than other parts of the vasco-motor system. It is especially to be remembered that emotional excite- ment may give rise to the symptoms of Graves' disease in an acute form, which then pass away under the influ- ence of rest. Gowers records a case of this sort, and my colleague, Dr. F. Coggeshall, has observed the case of a young girl who had acute Graves' disease in consequence •of a whipping, but recovered in a few weeks. It seems evident that the anatomical changes-—in the form in which we see them—are not the real cause of the symp- toms. Neither does the thyroidal cachexia theory fully stand criticism. It is therefore safest to study the dis- ease, provisionally, as a neurosis and to seek for its phy- siological analogies. In conclusion, it seems to me clear enough that we are not obliged to assume that the goitre is the cause of the -other symptoms in order to explain the favorable results of thyroidectomy. The thing which is needed for a cure in every case, and in every stage of the disease, is an ade- quate physiological rest for the disturbed nervous centres, and any influence may secure this which removes a good number of peripheral stimulations, or any influence which increases the stability of the central nervous sys- tem. That the diseased and engorged thyroid may be a centre for these abnormal stimuli cannot be doubted.