The effect of thyroid extract in exophthalmic goitre and in psoriasis / by A.G. Auld.

  • Auld, Alexander Gunn.
Date:
1894
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Licence: Public Domain Mark

Credit: The effect of thyroid extract in exophthalmic goitre and in psoriasis / by A.G. Auld. 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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    iis that E. J.’s wife was previously married, and had borne children by her first husband. Inasmuch as, in such circum- stances the wife has had impressed upon her certain features of her former husband, it is somewhat remarkable to find that all the children she has borne by her second husband inherit the malformation possessed by him. Note ox the Operatiox. By Dr. Ramsay Smith. The case was suitable for operation. The foot was becoming deformed, and walking was difficult and painful, on account of the boy’s efforts to keep the supernumerary toe off the ground, or from pressing on the sole of the boot. In choosing the method of amputation several things had to be consi- dered. In the first place, the fifth and sixth toes were united as far forwards as to the nails. This put the oval method of amputation out of account, unless I had made the incision on the outer aspect of the foot, a proceeding that had obvious disadvantages. In the second place the condition of the skin on parts of the supernumerary toe had to be con- sidered—parts were hard and horny, and otherwise undesir- able to have in a flap. On the whole I thought it best to use a Ashaped incision, and to preserve a flap from the outer part of the supernumerary toe. With this end in view I made the knife enter between the fifth and sixth toes, passed it backwards, keep- ing the edge well outwards, as far as the articulation with the metatarsal; then, having dislocated the bene, 1 turned the edge of the knife forwards, keeping it well inwards, and cut towards the front. By this method the tissues were dissected very perfectly from the phalanges of the toe I was removing, thus leaving as much tissue as possible on the outer aspect of the fifth toe and in the flap ; this at most was not much, but it included all the fibrous tissue of the part. I united the flap with the side of the foot by five catgut sutures placed deeply. The operation was done under strictly aseptic con- ditions, and the wound healed without any complication. The result of this method of operating is that the cicatrix has a course from behind forwards along the dorsal surface of the foot, then along the upper outer face of the fifth toe and •downwards to the under surface of that toe, whence it passes back a little way. This avoids having any part of th» cica- trix on the point of pressure on the sole of the foot, and leaves the contour of the foot exactly as if no supernumerary toe had ever existed. I did not interfere with the left foot; there was not the same urgent necessity. 1 had for several reasons to perform the first operation as expeditiously as possible; besides, the surroundings of the patient were very unfavourable to good results, and it seemed easier to keep one wound aseptic than two ; and, lastly, I wished to see the result of the first opera- tion in order to find out if the method could be improved upon in amputation of the toe of the other foot. The boy was able to walk in about a fortnight. A photo- graph taken nineteen days after the operation, and several days after the boy had been walking in boots, shows the ap- pearance of the cicatrix at that date. I have placed alongside °‘ tlie f°°t the amputated toe which, although somewhat altered by being preserved in spirit, gives an idea of its com- parative size. The left foot, which was almost identical with the right, is shown for the purpose of comparison. ON THE EFFECT OF THYROID EXTRACT IN EXOPHTHALMIC GOITRE AND IN PSORIASIS. By A. G. ATJLD, M.D., Assistant Physician to the Glasgow Royal Infirmary. The following brief notes of two cases seem worthy of pub- lication in view of the questions which are at present occu- pying attention, and awaiting more definite observations. Exophthalmic GoItre. H has been alleged that Graves’s disease is benefited by thyroid extract, though I have not come across any reliable data on the subject. A consideration of the facts and sug- gestions so ably propounded in the last Bradshawe Lecture by Professor Greenfield1 would tend to lead one to the oppo- site conclusion. To bring the matter to a practical test may be so far possible, although in cases of active Graves’s disease the difficulties and pitfalls encountered are self-evident. The following case, however, seemed peculiarly suited for this purpose, and at the suggestion of my friend Professor Charteris the treatment was begun by giving one of Burroughs and Wellcome’s tabloids every three days. Dr. Charteris also closely watched the case along with myself. The patient, a young woman aged 26, had been under my care for two years for Graves’s disease. For the first year the symptoms were typically developed, but the patient then got gradually better until latterly the disease seemed to be in a dormant or resting condition. At this time the thyroid gland itself was considerably enlarged throughout, but this enlargement was of a variable character, showing temporary fluctuations. A slight, but by no means obtrusive, degree of exophthalmos was present; the pulse-rate was from 90 to 100, and the temperature normal. As soon as the treatment was begun, the pulse and temperature were recorded twice daily. By the end of the first week, the exophthalmos had become much more pronounced, a symptom commented on by both the friends of the patient and by herself. The right eye was more affected than the left. The patient also com- plain°d of returning pulsation in the neck, which had become more swollen, and she felt weaker and out of sorts. After two weeks there was in addition diarrhoea, and the patient was paler and thinner. In the third week the dose was suddenly increased to two tabloids per day, continued for nine days, when sickness and perspi- ration ensued. The heart’s action rose from 99 to 138, and the temperature record for a fortnight was as follows : Morn- ing (before treatment) 98°, evening (after first tabloid) 100° ; morning 99°, evening 99° ; morning 100°, evening 100°; morning 99°, evening 100° ; morning 100°, evening 99° ; morn- ing 99°, evening 99° ; morning 100.6°, evening 99°; morning 100.6°, evening 100.8°; morning 100.4°, evening 99° ; morning 100°, evening 99° ; morning 100.6°, evening 101° ; morning 100°, evening 100.8°; morning 99°, evening 99°; morning 100°, evening 100°. The sudden increase in the dose did not affect the temperature. These facts speak for themselves. It seems to me that the effect of the thyroid extract was to rekindle the symptoms of the disease, and so support the view that Graves’s disease is caused by a hypersecretion on the part of the thyroid gland. Psoriasis. The papers of Dr. Byrom Bramwell, on the treatment of psoriasis by thyroid extract,2 induced me to make a trial in a case which came under my care at the Royal Infirmary, on May 4th. The patient was a young man, aged 19, thin, anaemic, and undergrown. The arms and legs were covered with angry-looking inflamed patches, while frequent patches also occurred on the trunk. He had been taking a mixture containing iron, quinine, and arsenic, with alleged benefit. The disease, the patient said, came out every year about February, and tended to get well towards the end of the summer; usually, however, a few patches were left over the knees. He was given one tabloid daily of the thyroid extract with no other treatment, and by the end of a week every trace of the disease had disappeared. 1 freely admit the remarkable character of this result, for even granting that the disease in this case had a natural ten- dency to disappear, it seems clear that the thyroid treatment had a marked, nay a specific, effect. I have’observed marked desquamation of the skin follow thyroid feeding in some cases of myxoedema, and it is probable some skins are more susceptible than others. It is advisable to continue the treatment for some time after the disappearance of the psoriasis to prevent a relapse. 1 British Medical Journal. December 9th, 1893. 2 British Medical Journal. October 23tli, 1893, and March 24th, 1894. The late Professor G. Brugnoli, of Bologna, has bequeathed the bulk of his estate, amounting to about £40,000, to the Ospedale Maggiore and the University of Bologna. Sub- stantial legacies are left to the Mutual Help Medical Society, to the Medico-Chirurgical Society of Bologna, and to the Royal Academy of Sciences.