The value of diminished electrical resistance of the human body as a symptom in Graves' disease / by H.W.D. Cardew.

  • Cardew, H.W.D.
Date:
1891
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Licence: Public Domain Mark

Credit: The value of diminished electrical resistance of the human body as a symptom in Graves' disease / by H.W.D. Cardew. 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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    anonkey s and demonstrated the rhythm of the tremor to be from •eight to ten per second, which coincides with that of Graves’s ■disease, given by Marie as from eight to nine per second. Von , Eisselberg found identical symptoms in man after total extir- I pation of the thyroid. In fact, such symptoms constitute the I “neurotic” stage of Horsley’s experiments, and this would indicate that the change in the gland (if there is any) in Graves’s disease is in the direction of arrest or profound altera- I tion of secretion. Much has been made of the contrast between this affection and myxcedema ; but here, again, the same ex- I periments prove that the ‘ ‘ myxoedematous ’ ’ condition is but a more advanced stage of the “neurotic” and is clinically I -supported by the fact that the symptoms of Graves’s disease I •may give place to those of myxcedema. Recent opinion ' .poin.ts to the secretion of the thyroid gland as “preventing the development of some toxic product in the blood which poisons the system if the gland is removed.” It is probable that some change takes place in the nervous system in Graves’s disease, giving rise to the characteristic disturbances. In ■ one other condition we meet also with such symptoms—viz , •the climacteric period in women. There may be the same •emotional state, some amount of fine tremor on occasions, and •hot flushings and sweating, and Kisch has called attention to the “rapid heart” of the grand climacteric. One is not 'infrequently struck with the resemblance of the nervous •disorders in both conditions; they are of the “general sort that accompany depressed nervous force in dependence •upon a general innutrition ” and are referable to some change Nihat has stamped its impress upon the nervous system. Cardiff. A NOTE ON POST-PARTUM HAEMORRHAGE. By JOHN COCHRANE, L.R.C.P. & L.R.C.S. Edin., JUBDICAL OFFICER OF THE P.ARISH OF LOCHGOILHE.AD AND KILMORICH, AND DISTRICT MEDIC4L OFFICER OF HEALTH, ARGYLL COUNTY COUNCIL. That post-partum hsemorrhage is a dreaded complication 'likely to be encountered at any time is, unfortunately, well known to all, and the following cases which have occurred cn my practice illustrate the value of the well-known pro- cedures of compressing and kneading the uterus in this form ■of haemorrhage. A stout young woman was in labour in her first pregnancy. She was of small stature, and when she called upon me previously to her confinement I was struck with the large size • of her abdomen, which suggested twins to me ; and on seeing •her frequently afterwards her whole appearance justified the belief that I might expect some difficulties at labour. She ^ad marks of scrofulous sores on her neck. When summoned to her one evening between 10 and 11 p.m , I found that she had been ill with pains for two evenings previously to 'her sending for me, but that they had passed off before iMming. On naaking a vaginal examination I discovered that the os uteri was dilated to about the size of a half-crown, •that the membranes were ruptured, and the waters drained •away. The presentation, which was that of the head, appeared •to be normal, but there was a difficulty in ascertaining exactly actual position, owing to the high presentation. I found there was pelvic contraction, which accounted for the amount of abdominal protuberance, the child being prevented from making the usual descent into the pelvis. I waited for ■several hours, and as the pains increased in great frequency a^ strength I examined again I then found that although the head of the child had descended a little it had become ^pacted in the pelvis, and that no further progress was being made. As the patient was becoming extremely restless ;aud exhausted, and the pains had much increased in '^verity, I resolved to apply forceps and expedite the labour. Owing to the large size of the head and he contracted pelvis it required a considerable amount of traction to ■deliver ; some trouble was also occasioned by the body of the child, which was a very large one. The head was elon- (gated to an extraordinary degree by the great pressure exerted on it during its passage. The child when bom showed no ■signs of life, but recovered under artificial respiration. I had no efficient nurse and so had to rely entirely on my own -efforts. After allowing the patient a rest of about twenty minu^s I proceeded to remove the placenta, which was de- tached, but on introducing my hand into the uterus I found maur-glass contraction. With my hand within the part where the placenta, which was a large one, was lying encysted, I had no difficulty in removing it in its entirety. Although I had my other hand outside, grasping the uterus in order to steady and stimulate it, there was immediately a tremendous gush of blood. I continued to grasp and knead the womb until it began to contract well, but at first whenever I relinquished these efforts the hiemorrhage recurred alarm- ingly. At length, when it ceased and I had bandaged the patient and raised the pelvis, I administered a large dose of ergot. The patient was extremely exhausted and pale, but the kneading process proved quite sufficient to check the flow and thus saved the woman’s life. In two other cases which I have seen these processes have been equally efficacious. One was the case of a woman in Skye who had been in labour for three days, and whose attendant, a midwife, was very averse to my being called in. On reaching her I found her in an extremely critical condition and, apply- ing forceps, extracted a living child. I then found a second child present, which I also delivered alive after turning. Shortly after removal of the placenta post- partum htemorrhage supervened, but in the end kneading, &c , proved successful in arresting it. The other case was a primipara I ascertained some months previously to the time of delivery, on making an external examination of the abdomen, that there was a tumour attached to the wall of the uterus. At term her labour was quite normal up till the third stage, but upon endeavouring to remove the placenta I found, as in the case just narrated, the condition of hour-glass contraction present, and on introducing my hand into the encysted portion of the uterus, where the placenta was, found also an adherent placenta. I detached it carefully bit by bit, for it was in a diseased state ; in spite of my care, however, hmmorrhage soon set in so severely and persistently that I was forced to retain my right hand in the uteius for hours, with the left hand externally compressing ard grasping the organ before I could induce proper cot trac- tion. At last my efforts were rewarded, when the patient rallied wonderfully from her collapsed condition, which required the administration throughout of a considerable quantity of brandy. She afterwards made a good recovery. In this case I am satisfied that the tumour interfered with the proper contraction of the womb, was evidently the cause of the prolonged continuance of the hmmorrhage, and may possibly have had some effect in causing the tetanic spasm of the uterus. With perfectly clean hands washed in a reliable antiseptic solution I have never found any harm to follow their intro- duction into the cavity of the uterus, while the fatal results which have now and again followed the injection of such solutions as that of perchloride of iron, even in the hands of careful and experienced obstetricians, must make us chary of employing such methods to arrest hmmorrhage. Lochgoilhead, Greenock. Climcd Botes: MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL. HARPOON WOUND OF THE LIVER ; RECOVERY. By T. Gann, M.R.C.S. Eng., J P., DISTRICT SURGEON, CORAZAL, BRITISH HONDURAS. On Feb. 21st a strongly built man about twenty-eight years of age was admitted into the Corazal District Hospital with the following history. On the previous day he was out in his dorey spearing fish on the Rio Nuevo. The harpoon was fastened to its shaft and pointing upwards. He was standing up in the boat when she gave a sudden lurch, throwing him forwards on to the point of the harpoon, which penetrated his abdomen. On admission about twenty- eight hours after the accident he was much collapsed and complained of great pain all round the wound; about one inch of the harpoon (which afterwards proved to be seven inches in length) was seen protruding from a jagged wound immediately below the tip of the ensiform cartilage. Chloro- form was administered and an incision six inches in length was made from the harpoon shaft through the abdominal parietes ; the peritoneum was opened, and it was then found that the