Pathology and treatment of Graves' disease / by James J. Putnam.

  • Putnam, James Jackson, 1846-1918.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: Pathology and treatment of Graves' disease / by James J. Putnam. 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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    other, but this fact should not be admitted as indicating more than it really does indicate. Many of the strictly nervous symptoms of Graves’ disease, such as the tremor, irritability, increased heart beat, and flushing of the skin, are me(t with in conditions of nervous excitement where no question of increase in the thyroid secretion comes in at all. As regards the differences in the condition of the skin, it is doubtful if there is any real contrast between the state induced by a relaxed vascular contraction and increased activity of the sweat glands, and that due to such manifest structural changes as are seen in myxoedema, where the diminution in perspiration is, for all we know, a secondary element. For- tunately, we have in the extracts of animal thyroids, now so largely in use for myxoedema and other states, a means of studying the action of the thyroid carefully and at leisure. To some extent this has already been done, and the results seem, in some, though not in all respects, confirma- tory of the thyroidal theory of the origin of Graves’ disease. These facts have been passed in review by Murray (Lancet, London, 1893), Greenfield, and others. An excess of thyroid extract seems to cause, quite regularly, even in healthy persons, to judge from the few experiments reported, an increase in the pulse-rate and temperature, and often diuresis with increased secretion of urea. Myxoedematous patients are sometimes very susceptible to this substance, and sometimes suffer from serious prostration, with angi- noid and neuralgic symptoms, as the result of a dose which other patients bear with ease.1 In such cases, howT- ever, important changes in the metabolism partly related to the previous myxoedematous state, are rapidly going on, attended with great loss of weight, and it may be that these changes, or possibly the absorption of toxic products, are in part the cause of the symptoms noted. Loss of weight is, indeed, apt to occur even with healthy persons who are taking thyroid preparations, and yet it is noteworthy that patients with Graves’ disease are not especially prone to emaciation as one might expect them to be if poisoned with OaM — 1 See, for example, Shattuck: Boston Medical and Surgical Journal, 1894/