HEALTH COLUMN.

Otago Witness, Issue 2059, 10 August 1893, Page 49

HEALTH COLUMN.

A NEW DEPARTURE IN. MEDICAL TREATMENT.

Very little Is to be found in most works on medicine with regard to that structure in the neck called the thyroid gland, except that its enlargement constitutes the familiar disease called goitre, and that the strange condition Called cretinism is in some way related to goitre. Till recently the function of this organ was quite unknown. But within the last few years certain obscure forms of disease have been shown to be closely related to the thyroid gland, and the work done in connection with them has led to nich a remarkable new departure in their treatment, and to so substantial an advance in scientific knowledge with regard to this organ, that a short account of the present position of the subject, and the steps by which it has been attained, may not prove uninteresting. The thyroid gland in man is situated in the neck, a little below "Adam's apple," which marks the top of the windpipe. It Is of a deep red colour, and is so freely supplied with blood, that its arteries are together just about as large as those which pass to the whole of the b v ato. The disease called goitre, which is due to an enlargement of this gland, is very frequently found in various mountainous districts, fcuch as the Alps, the Pyrenees, the Himalayas, &c ; and though not common in Britain, it is found in Derbyshire occasionally, and is there known as the " Derbyshire neck." The other disease mentioned—cretinism—is found in the same mountainous districts above mentioned, and the name is derived from "cretin," which is applied to a certain dwarfed, thick-skinned class of human beings found in the Alpine valleys. They have broad faces, thickened features, thick coarse hair, and a wrinkled, shrivelled skin, which gives them the appearance of old age. Their mental development, like their bodies, is dwarfed and stunted, but not to the same degree in all case*. Similar Individuals are occasionally, but very rarely, met with in this country, and are known as sporadic cretins. In 1873 Sir W. Gull read a paper on what he called a cretinoid state supervening in adult life in women. In 1877 Dr Ord more fully described the same disease, and proposed for it the name, now universally adopted, of Myxcedema. This disease is rare, but presents such distinctive features that a well-marked case is quite unmistakable. It generally comes on during middle life, and affects women much more frequently than men. Superficially, it presents but little resemblance to cretinism; the stunted growth and shrivelled ekln are con*

spicuous by their absence; and it is not a little remarkable that Sir W. Gull should so long ago have divined the close relationship of the two diseases. The face is much swollen and broad ; the features heavy and expressionless ; the hair coarse and scanty ; the hands thick and clumsy; the skin everywhere thickened, scaly, and destitute of perspiration, the whole body enlarged, heavy, and awkward. The mental features of the disease are equally characteristic ; the perceptions are dulled, speech and movements slow, and there is a great loss of energy and of ability for exertion. The bodily temperature is much [reduced, 'and. the patients are very easily influenced by cold, and always worse during cold weather. At the first glance the disease might be mistaken for a form of dropsy ; bat the swelling is felt to be firm, and does not retain the impression of the fingers, as in that case it would. In one of Dr Ord's cases, where a post mortem examination was performed, the swollen skin was found to contain a much larger quantity of nuoin than is normally present; in consequence of which he gave the name Myxcedema, or mucous swelling. He observed, moreover, that the thyroid gland was in a state of degeneration. A number of cases were soon reported by other observers, so that no doubt could be entertained that this was a distinct and hitherto unrecognised disease. Some cases were benefited by treatment to a certain extent; but on the whole, till 1891,Myxoadema, though very slow in its progress, had proved one of the most intractable and hopeless of diseases. Meantime, however, light had been thrown upon the meaning of the disease from 'an unexpected quarter. In many of the valleys of Switzerland, visitors cannot have failed to observe that a large proportion of the population have swellings on the front of the neck, some of them of a very large size. This is goitre. In the great majority of cases these goitres produce no deleterious effect upon the health, and no inconvenience, except from their size. In some districts, indeed, they are regarded a3 decidedly ornamental. Occasionally, however, they cause pressure upon the windpipe, and threaten to stop the passage of air through it altogether; and it is on this account that their removal has usually been performed. In Switzerland, therefore, where goitre is common, it was natural th&t relief from its occasional discomforts and dangers should most often be sought; and it was there, accordingly, that surgeons had most experience of its removal. In 1882-83, Raverdin and Kocher, two Swiss surgeons, described a peculiar train of symptoms which had come on some time after complete removal of the thyroid gland in some of their patients. These symptoms were lassitude, loss of activity, slowness of thought, speech, and movement, thickening of the features, and general swelling of the body. Their descriptions were published in ignorance of the accounts of Myxoaclema which had bean given in this country. The singular correspondence between the two conditions was not long in being noticed ; and when it was first pointed out in this country by Dr Felix Semon, at the Clinical Society of London In 1883, it was regarded as of such importance that a committee of the society was appointed to make inquiry into the whole subject. The results of its elaborate investigations were published in a substantial volume in 1888. In connection with the work of this com* mittee, Professor Victor Horriey undertook a series of experiments on animals, in whioh he obtained very remarkable results. He confirmed the observations of others who had found that dogs die very soon after removal of the thyroid gland with muscular tremors and other symptoms, due to disturbance of the nervous system. 'But in monkeys he showed that the operation is longer survived, and that the symptoms foundlowering of temperature, thickening of features, loss of hair, &c. — closely correspond to those seen in man both after removal of the thyroid gland and in the spontaneous disease called Myxcedema. It was these experiments which first definitely warranted the conclusion that the cause of the symptoms of Myxcedema I& loss of function of the thyroid gland. (To be continued.) ,

— Doctor : "There is something yon have which I have not been able to get at. ' When I do, I think I can get away with it* in a very little while." Patient (lugubriously): "It must be my bank account."