Oedema in Graves' disease / by Arthur Maude.

  • Maude, Arthur.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Oedema in Graves' disease / by Arthur Maude. 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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    ease is, however, a comparatively rare accompaniment of this disorder, and the commoner cardiac lesion producing dropsy is dilatation with mitral insufficiency and feeble ventricular action (asystole). To this cause Marie) following Debove,1 ascribes the occurrence of dropsy in all cases. We must bear in mind, moreover, the fact that dilatation of the heart in Graves’ disease need not be a gradual process secondary to muscular enfeeblement of the walls, but may be a sudden active condition of nervous origin.2 And, as Dr. West points out, dilatation of this sort may account for those mysterious cases of sudden death in the disease which are not infrequent. Obviously oedema of cardiac origin may be progressive, become general, and extend to the serous cavities or the lungs. A case was reported years ago by Dr. Lauder Brunton, 3 in which rapid, almost sudden, death in Graves’ disease was found [post-mortem) to be due apparently to an insidious and rapid oedema of the lungs. IT. (Edema of nervous origin.—In a far more numerous class of cases we find a slight anasarca of the insteps and lower legs, which does not tend to increase. Though it may show itself from time to time for years, it is transient, appearing usually at the close of day, and disappearing with the main- tenance of the recumbent position. This condition may be found without any signs of cardiac dilatation ; in fact, when the heart is hypertrophied and acting with considerable force. If, however, the oedema tends to extend up the legs, the condition of the heart should be carefully investigated. For dropsy, which has been at first nervous in origin, the characteristic dropsy of Graves’ disease, may be perpetuated and extended by cardiac disability. III. Transitory oedema.—The rarest class is that of irregular, fugitive, unsymmetrical dropsies. Puffy swelling appears in various parts of the face, neck, arms, and hands; the cheeks 1 Les Acces d’Asystole dans le Gouts du Goitre exophthalmique, Soe. Med. des Hopitaux, June 1880. 2 Dr. S. West: St. Bartholomew’s Hospital Reports, 1881, xvii. p. 199. 3 St. Bartholomew’s Hospital Reports, 1874 x. p. 259.