An unusual case of Graves' disease / by James Craig.

  • Craig, James.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: An unusual case of Graves' disease / by James Craig. 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.

    1/6 (page 589)
    CHRONIC OVARITIS, ITS ORIGIN AND TREATMENT. By W. J. BURLEIGH-ROBINSON, M.D.Durh. By chronic ovaritis, the title which heads this article, I wish to express the result of that slow and insidious process of inflammation which occurs in weakly women and strumous subjects, and not the better understood chronic interstitial ovaritis, the result of specific infec- tion and direct continuity of external inflammation. “ V'internitz,” in the Centralhlatt fiir Gymikologie, enumerates the causes of chronic oophorites as follows :— 1. Injuries during menstruation. 2. Puerperal troubles. 3. Gonorrhoea. 4. Masturbation. 5. Infection, due to external poisons. Leaving out gonorrhoea, take the above causes as those of that form of chronic ovaritis, of which I would treat, and to them I add leucorrhoea. In the great majority of cases, patients do not consult us until such time as they complain of pain, constant in character in one definite spot in the abdomen, a feeling of a lump, and a sen.sation as of something dragging and burning. It then becomes of the utmost import- ance to inquire into the previous history which is usually as follows :— Patient has been always “ delicate,” not necessarily ill, but that vague debility requiring cod-liver oil at an early age, and good living. 2. The menstrual history is irregular. 3. There may or may not have been early dysmenor- rhoea, 4. The irregularity in menstruating is shortly fol- lowed by the appearance of a discharge—leucorrhma —and it is from the date of the appearance of this dis- charge that the process producing chronic ovaritis may be said to start. We know that increased function in the vagina will produce function and growth in the mammce, uterus, and ovary, and the leucorrhoea by its mere presence, possessing as it does, the three attributes, heat, mois- ture, filth, will supply all the requirements for infec- tion by septic organisms, the patient thus being laid open to the chance of constantly recurring though .slight attacks of more or less septic vaginitis. Again, the chronicity and neglect of leucorrhoea is proverbial, and I have no doubt that a long-continued disordered func- tion, such as this discharge, will result in chronic changes in the ovaries, which, slight in themselves, place these organs at a great disadvantage from the point of view of recovery, should they at any time become the seat of any acute or subacute affection. It is thus of the utmost importance that with the appearance of the discharge treatment should begin, and not as is so often the case, the young patient left alone under the prevailing idea that “ as she gets older she will grow out of it.” With the exception of the discharge which most English women persistently ignore, no symptoms of any note occur until such time as through cold, damp, or puerperal troubles, an acute inflammation attacks the already chronically diseased ovary, then we get pain, fever, rigors, and in fact, all the symptoms of acute pelvic cellulitis followed by months of pain and discomfort. It is at this time we are generally consulted, and then we find the great importance of inijuiring closely into the previous history, to prevent “a mistake in dia- gnosis.” Whenever possible it is the duty of the practitioner to ascertain whether his patient suffers from a discharge, and if so, to ascertain its cause and source. Should it be leucorrhoea, tonics, cod-liver oil. and nutritious diet must be given, together with injec- tions of dilute boracic acid daily. Then, with fresh air—especially country air—from green fields, a re- covery will probably ensue. Should the symptom be due to a cervicitis, and the discharge be seen issuing from the os, great care must be taken in attacking it, for often the ovary has become irritated at the same time the cervicitis developed, and any free interference with suppositories, sounds or curette, is liable to and frequently does produce an acutes ovaritis of a dangerous character. In the latter stages when chronicity is apparent, local amesthesia should be applied to the abdomen. Leeches will be found useful as an occasional blister. But it is princi- pally essential that as much new blood as possible should be sent to the ovaries, and to aid this ferrugin- ous tonics should be administered. The patient should also rest on an inclined plane, the pelvis being raised at an angle of about 15 degrees, thus relaxing the broad ligament and allowing of a freer circulation. The disease is a chronic one, the treatment must necessarily be prolonged, and, in fact, the bedstead of a woman suffering from chronic ovaritis should never be allowed to assume the level plane. Gentle exercise, such as an hour or two in a bath chair daily, or carriage drive, when the jolting can be borne, is beneficial; the diet should be nourishing, and alcohol in any forni is directly contra-indicated owing to the great probability of the habit being formed. This treatment followed out thoroughly will give great relief, though slight relapses occur. The formidable operation of removing the ovaries should be our very last step in treatment, for owing to the numerous adhesions around the organs it is often extremely difficult and dangerous. In fact, the opera- tion should never be undertaken unless we see that all other efforts have failed, and that the patient’s nerve force and strength is being worn away, or we have reason to suspect pus in the vicinity. The wholesale “ spaying ” of women which of recent years has become so fashionable, is most serious in its results as to marital happiness, and dangerous to life, and excepting where life is in danger absolutely un- scientific. — ♦ AN UNUSUAL CASE OF GRAVES’ DISEASE, (a) By JAMES CRAIG, M.D., Univ. Dub., P.R.C P.I., Physician to the Meath Hospital and Co. Dublin Infirmary. The patient is a girl, who came under my care in the Meath Hospital on May 4th, 189.3. She was aet. 25, unmarried, and had been in employment as a general domestic servant until December, 1892. During the summer of that year she had suffered from ana?mia and palpitations and had noticed her neck becoming enlarged. Then in November menstruation ceased, and after a month of severe frontal neuralgia, the eyes became prominent. There was no history of fright or mental emotion, nor of any family neuroses. In January, 1893, she went to the South Dublin Union Hospital, where she fretted much, and after a time found her eyes become red and painful and very pro- minent. When she came under my care in the month of May her eyes were in a most alarming condition, of which the drawing and photograph give only a very imperfect picture. The eyeballs were markedly pro- minent, and the lower half of the bulbar and palpebral conjunctiva of each eye formed a red protruding mass which buried the edge of the lower lids completely beneath it. The lower portion of each cornea was ulcerated, there was no anterior chamber, and in the right eye a small mass, which appeared to be the lens, fa) Read before the Royal Academy of Medicine, May 11th, 1S91.