On some rarer factors in Graves's disease.

  • Maude, Arthur.
Date:
[1893]
Catalogue details

Licence: Public Domain Mark

Credit: On some rarer factors in Graves's disease. 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.

    6/10 (page 504)
    the right forearm. No muscles showed atrophy or hypertrophy. The knee-jerk was normal. No sensory symptoms, excepting a sense ot fatigue on exertion in the muscles of the lips and tongue as well as those of the forearm. On electrical examination the reaction of the nerves and of the muscles to both currents was normal. The sexual organs showed no visible signs of masturbation. Grasp on dyna- mometer, right hand 11 ; left hand 16. The above were the main facts elicited at the first examination made by Dr. Seguin in October, 1886. The boy remained under his care from that time for about two years, during which period he decidedly im- proved in motor power and skill, and his height increased by six inches. The treatment from the first, in the absence of any possible pathological diagnosis, consisted in the systematic, long-continued administration of tomes, such as the bichloride of mercury, phosphorus, arsenic and strychnia. At the same time, a mild faradic current was applied syste- matically every day. Also, from the first, a cold sponge bath was ordered on rising or at bed-time, followed by thorough dry rubbing and manipulation of all the muscles. Another part of the treatment consisted in gentle gymnastic movements of the hands, arms, trunk and legs. The case was lost sight of by the author from the close of the year 1888 until September of the present year (1893) when on inquiry, he received a letter from the boy’s father stating that his son is now in the junior class at college, that he stands well in his class, and excels in wrestling and other athletic sports. The treatment advised by Dr. Seguin had been faithfully carried out for nearly 3 years longer by the father, resulting in a gradual but continued improvement in the boy’s condi- tion. His weight at the present time is 166 pounds. His endurance is good, and he is able to raise from the ground an iron rail weighing 600 pounds. His grasp on the dynamometer at present is, right hand 72; left hand, 53. This, Dr. Seguin said, is the strongest grasp he has ever met with. Dr. B. Sachs said that in listening to the first part of Dr. Seguin’s paper—before it told of the boy’s remarkable recovery—the case reminded him of a primary muscular dystrophy, of the facial-scapular-humeral type, with perhaps some extension into the lower extremities. Such a case had recentlv come under his observation, with many symptoms very similar to those narrated by Dr. Seguin. In cases of progressive primary dystrophy, particularly in pseudo-hvpertrophic conditions, he had seen marked temporary improvement follow appropriate treatment, although he had never observed a complete cure. Again, in Dr. Se- guin’s case there might possibly have been some nuclear trouble, with a mingling of symptoms pointing to the spinal cord or medulla. If the case was one of primary muscular dystrophy, the question arises whether the cure will be a lasting one. He had seen a number of cases presenting a peculiar condition of pseudo-hypertrophy, in which the muscular tissue first enlarges, and then rapidly atrophies. Dr. George W. Jacoby suggested that Dr. Seguin’s case might have been one of poly-myositis ending in complete recovery, and followed by secondary hypertrophy of the muscles. Dr. J. F. Terriberry pointed out that it was against the laws of pa- thology to assume that an inflammatory process in the muscular tissue is followed by hypertrophy of the muscle, with increased force. Dr. E. D. Fisher said that taking into consideration the fact that the boy grew six inches taller while he was under Dr. Seguin’s care, the lesion was probably not a spinal one. Dr. Seguin, in closing the discussion, stated that the suggestion made by Dr. Sachs with reference to the possibility of curing a case of mus- cular dystrophy in its early stage was an interesting one; he was not prepared, however, to assert that the case he had related was an instance of that disease. Neither did it resemble a case of myositis. There was no pain : there was a general weakness, which was sometimes so pro- nounced that the boy was unable to hold objects in his hands, or he would lose all control over his muscles and fall to the ground. PARIS. ACADEMY OF MEDICINE. Tuesday, October iytb, 1893. The epidemic Diseases which call for Compulsory Notification. Dr. Le Roy de Mericourt.—I fail to see how the diagnosis of the cho- leriform affections is to be arrived at, as it is a generic term and does not represent a definite morbid entity. As a matter of fact cholera appears either in a sporadic or epidemic form but it is always the same disease, and it would be highly dangerous if other affections which possess more or less remote resemblances with it should be submitted to the same energetic treatment. Prof. Brouardel.—The question of the compulsory notification of certain epidemic diseases has long been under discussion among the medical profession and the Academy itself has already had occasion to call the attention of the public authorities to this important question. Moreover, to judge from the results obtained in Paris, public opinion is becoming rapidly reconciled to the intervention of the sanitary autho- rities whenever it is necessary to adopt certain measures of disinfec- tion, etc., with a view to prevent the propagation of infectious diseases. It is, therefore, only in respect of very few diseases that there will be any difference of opinion on this point. For my own part I have no objection to measles being struck off the list of diseases which call for compulsory notification but I cannot agree with Dr. Le Roy de Mericourt with reference to the choleriform affections. At the commencement of an epidemic of cholera, the existence of the disease is either not reco- gnised or only suspected. One hesitates to enunciate the diagnosis of cholera and yet it is of the greatest importance that the first cases should be notified to the authorities without delay. The difficulty is got rid of by permitting of these cases being notified under the designa- tion of choleriform affections. Lastly, 1 believe that the list of epidemic diseases lor compulsory no- tification should include not only small-pox but varioloid, seeing that it is often impossible to distinguish between these two affections in the early stage when prophylactic measures are likely to be most successful. Dr. Lereboullet.—Compulsory notification being only justifiable in respect of such diseases as are obviously dangerous and preventible by the adoption of sanitary measures by the public authorities in the inter- est of the public health, I should suggest that measles be struck off the list drawn up by Dr. Vallin, as measles are an affection which does not belong, at any rate for the time being, to the class of diseases the pro- pagation of which can be easily prevented. What will the sanitary authorities do on being notified of the occurrence of a case of measles ? Will all the children who have come into contact with the patient be Quarantined for from twenty to twenty-five days ? And unless this is one, I fail to see how infection can be avoided. When more efficient means of preventing contagion than those at present at our disposal are discovered, the time will come for measles to be added to the list of epidemic diseases for compulsory notification. 1 may also suggest that the words cholera and choleriform diseases be substituted for cholera and choleriform affections in the list. The term “diseases” seems to me to be preferable to “affections.” For example, antimony cholera, arsenic cholera, etc., i.e., the various forms of metallic poisoning are choleriform affections, not diseases. Prof. Grancher.—Like Dr. Lereboullet 1 consider that measles should not be included among the infectious diseases the notification of which should be made compulsory. Measles are most contagious during the incubation period, that is to say, before the disease can be diagnosed. Under such circumstances, the principal object of notification would not be attained seeing that the patient could not be isolated sufficiently early in the case to prevent infection. In respect of disinfection it is universally admitted by medical men in charge of hospitals for children that it is absolutely inefficient in preventing tne propagation of measles. Dr. Vallin.—I am prepared to admit that measles is especially con- tagious during the pre-eruption stage, but 1 consider that it should be maintained on the list because cases of late infection are not unfre- quently met with. Moreover, it seems to me that, as only in July last the Academy insisted on the necessity of a fortnight’s isolation in the case of school children suffering from measles, it would be some- what inconsistent to score this disease off the list of those which should be notified to the authorities. Dr. Cadet de Gassicourt.—I agree with Prof. Grancher on the ineffi- cacy of isolation and disinfection in preventing the spread of measles; but disinfection is useful as a prophylactic measure against the compli- cations of measles especially broncho-pneumonia. Dr. Hallopeau.—There is a contagious disease which is not included in Dr. Vallin’s list in which it ought to occupy a foremost place should it prove dangerous to the public health; I am referring to leprosy. But as leprosy has never been shown to be directly transmissible in France, I quite admit that its inclusion in the list is not indicated for the present. Dr. Chauvel.—I move that the term ophthalmia neonatorum pure and simple be substituted for that of purulent ophthalmia, for the following reasons : purulent ophthalmia does not develop in the space of a few hours: as a matter of fact it usually appears from the third to the fifth day after birth and the first symptoms are so slight that they usually escape detection. It is only when the secretion has become purulent and the conjunctiva is extensively infiltrated, that is to say, when the case is already far advanced, that the midwife becomes aware of the danger. To secure the desired result, i.e., to save the child’s life and at the same time to protect those around it from infection, the duty of the midwife should be so clearly laid down as not to allow of any hesita- tion on her part. . Dr. Kelsch.—I suggest that the term “ epidemic ’ ’ as applied to dysen- tery in the report of the Commission should be deleted from the list. Dysentery, whether sporadic or epidemic, is but one and the same affection. All epidemics of dysentery are preceded by a few sporadic cases. There is, therefore, in my opinion, no reason why the word dysentery should not be used without any epithet whatever in the list of diseases which call for compulsory notification. Prof Brouardel.—I wish to point out that professional secrecy is not abolished by the law regulating the practice of medicine in France, so that it seems to me that there is no need for restricting the compulsory notification of puerperal infections by the words “ unless the physician be requested by the parties concerned to keep the diagnosis a secret,” as suggested by Dr. Vallin. 1 move, therefore, that these words be deleted. Each of the diseases mentioned in Dr. Vallin’s report was then put to the vote with the amendments introduced in the course of the discussion. . r The following is the list ot diseases proposed by the Academy tor compulsory notification: „ , .. Cholera and choleriform affections, yellow fever, plague, small-pox and varioloid, scarlatina, sweating sickness, diphtheria, typhoid fever, tvphus fever, dysentery, puerperal infections, ophthalmia neonatorum. CHIRURGICAL SOCIETY. IVednesday, October 11th, 1893. Anuria consequent on Compression of the Ureters by a Uterine Fibroid; Abdominal Hysterectomy; Recovery. Dr. Tufiier.—The observation I am about to relate is that of a woman on whom I operated two years ago and who has since completely reco- vered from the grave manifestations which she presented at the time