Clinical notes on Graves' disease / by Professor Grainger Stewart and G.A. Gibson.

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1893
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Licence: Public Domain Mark

Credit: Clinical notes on Graves' disease / by Professor Grainger Stewart and G.A. Gibson. 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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    enlargement of the gland, although usually bilateral, is very rarely symmetrical. In one or two cases we have found only one lobe to be affected. From our own observations we should be inclined to conclude that the left is more commonly the earliest and chief seat of enlargement, but from the time of Parry and Graves the majority of authors have found the right to take precedence. There can be no doubt that, as Graves and Stokes noticed, and other observers have corrobor- ated, the size of the gland varies from time to time with the state of the circulation, and from other circumstances. As to the nature of the morbid process it has been held to be due, in the early stages, to a simple hypersemia, and in the later to a hypertrophy of the connective tissue. It will be seen, however, in the sequel that, from the result of post- mortem investigation in two of our cases, Dr. Eobert Muir has found a glandular hyperplasia with catarrhal changes in some of the acini, a disappearance of the colloid material of the spaces, and some cellular proliferation of the interstitial tissue. We can only recall one case of Graves' disease attended by enlargement of the spleen. This organ is described as the seat of an enlargement by other authors, and, in view of the frequency of ansemia in this disease, it might be expected to undergo an increase in size; but, even in cases which have been attended by pyrexia for some time, we have found, as a rule, no evidence of such a change, either in the living or the dead subject. The only exception to this statement occurred in a patient who had for a considerable time been in India, where he had suffered from malaria. His case will be found in the sequel (Case 6). The circulatory system not infrequently shows subjective symptoms. Even in the early stages of the affection, attacks of faint- ness are extremely common without structural changes in the circulatory apparatus. The subjective sensations of palpitation form one of the most frequent symptoms of the disease, and are linked with the objective phenomena of tachycardia. Severe cardiac dyspnoea, while most typically arising in cases of failure of the heart, has been present also in conditions