On myxoedema and allied disorders : being the Bradshaw lecture delivered at the Royal College of Physicians, on November 10th, 1898 / by William M. Ord.

  • Ord, William M. (William Miller), 1834-1902.
Date:
[1898]
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Licence: Public Domain Mark

Credit: On myxoedema and allied disorders : being the Bradshaw lecture delivered at the Royal College of Physicians, on November 10th, 1898 / by William M. Ord. 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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    June 6th, 1897, that is to say seven years after the first appear- ance of symptoms connected with the thyroid. No autopsy was made so far as I am aware. It appears probable that the enlargement of the thyroid in such a case, as indeed, in ex- ophthalmic goitre generally, is due partly to hyperaeinia, and partly to changes in the gland, which are apt, in certain cases, to determine proliferation of the epithelium surrounding the cells, such proliferation ending in the replacement of the true glandular structure by fibrous materials and consequent destruction of the functions of the gland. The gland being thus destroyed, after a time undergoes a sort of cicatricial contraction, leading to atrophy comparable to that occurring in cirrhosis of the liver. I am inclined to think that the- succession of enlargement of the thyroid, with or without the typical signs of Graves’s disease, is much more commonly an antecedent of myxoedema with con- tracted thyroid than is generally supposed. In my own experience, and probably in that of many other ])hysicians, young women brought for treatment on account of aniemia and various nerve disorders, are found much more commonly now than formerly, to pre.sent some enlargement of the thyroid. Doubtless, with the phenomena of myxoedema and exophthalmic goitre brought more and more prominently before our notice, we have come to take more careful note than formerly of the state of the thyroid gland. It is certainly common to find a definite increase in the size of the gland present where neither the parents of the patient nor the patient herself were conscious of any tiling of the kind. I do not mean to say that in all these cases the enlargement of the thyroid is followed by atrophic change, but the great frequency of the occurrence of enlargement in adult women justifies the hypothesis that in a much larger number of cases than we know of at present, an enlargement of the thyroid has preceded the development of myxcedema. How this enlargement comes about is certainly not well understood as yet, but it must be remembered that, in the first place, myxcedema, like exoplithalmic goitre, is a disease affecting women in an exceedingly larger proportion than men. In fact, the title to Sir 'William Gull’s first paper brings this predominance into strong relief. The title of the paper was “ On a Cretinoid State supervening in Adult Life in Women.” Temporary increases and diminutions of the size of the thyroid body are certainly not ea,sy to recognise and determine, but certainly where a thyroid is