David Drummond

Clinical Lecture on some of the Symptoms of Graves's Disease

you to examine, and shall refer briefly to the histories of some others, whose cases most of you will recollect. The first case is that of the young woman, a general servant, who was admitted into No. 12 Ward a few weeks ago. She is complaining of palpitation, shortness of breath, a swelling in the neck, and proptosis or exophthalmos. Her father and mother are living and well ; one sister had an attack of hemiplegia at the age of 2 years, and has since been subject to epileptic fits. Our patient has always had a comfortable home, and has been free from mental anxiety or want. In her work she has been much exposed to cold, and has often had wet feet, but has never suffered from rheumatism. In January, 1886, twelve months ago, she was struck by the prominence of her eyes, and about the same time she became affected with shortness of breath on exertion. She grew steadily worse until March, when some improvement was apparent. In April she took typhoid fever, from which she made a very tardy recovery, and her previous symptoms, taking advantage of her weakness, returned in a more exaggerated way, though it was not until October, 1886, that the palpitation forced itself upon her attention; so that, as far as her information is reliable, the order in which the cardinal symptoms of the disease ma(le their appearance was: enlarged thyroid, protrusion of the eyeballs, and palpitation, which, it is important to recollect, is not the most common sequence, for palpitation usually ushers in the symptoms, and this is followed by enlargement of the neck. However, I suspect that the dyspncea, which she described as one of the earliest symptoms, was cardiac, as it only took place on exertion. Throbbing of the carotids ;was next noticed, and later the swollen thyroid was seen to have acquired a pulse. The catamenia have been fairly regular, but the discharge scanty, and she asserts that the thyroid distinctly enlarges during the periods. As you may observe, the patien-t is somewhat anasmic. She is

A Case of Cirrhosis of the Liver, with Chronic Cerebral Symptoms Depending upon the Circulation in the Blood of Digestive Impurities

finger from thle perineaum indicates, by reason of the limited conliections of the growth, the expediency of attempting its complete removal, or if the mass is considerable, the suprapubic incision may with advantage be proceeded with. The value of thie perineal incision for drainage has already been demonstrated in several instances of this kind. Still, on the whole, the less intravesical malignant growths are inlterfered with the better, so far as concerns both the comfort and life of the patient. Of the curable forms of intravesical tumour of the bladder, the simple papilloma or villous growth furnishes us with an example, and this lhas undoubtedly within the present d(lecade been brought within the reach of surgery. In the cases of this kind wlhere I have operated, I have been able to accomplish all that I desired by a perineal incision. The following instances illustrate some of the difficulties connected with the diagnosis and treatment of tumours of the bladder. The first was that of a young man I saw in 1883, who was suffering from hlematuria. I opened his bladder from the perineum, and removed a villous growth, which seemed to occupy the orifice of the left ureter; he was temporarily relieved, but in the course of a month he died of exhaustion in consequence of repeated attacks of hlimaturia. After death, the left ureter was found( dilated; the pelvis of the left kidney was also dilated, and contanined a villous growth resembling that whlichl I hlad removed from the bladder. The other case was that of a middle-aged man, who presented _tll the symptoms of calculous pyelitis of the left kidney. The pain was so severe that I determined( to open and(l explore the kidney, whichl I did in the early part of December, 1887. I found the kidney not mulch larger than natural, but it was simply a bag of pus. I could find no stone or other cause for the renal obstruction. The bladder was examined, but nothing abnormal was detecte(ld. The patient hlad a good deal of h.mmaturia after the ,l)eration. lie got gradually weaker, and died about four weeks after the opEration. At a po.st-morte?n examination, a small epitlhelioma of the bladder was found, which had completely occluded the left ureter, and hlad thus led to the disorganisation of the corresponding kidney. Such are illustrations of some of the difficulties whlichl attend the diagnosis of tumours connected with the interior of the bladder; they certainly seem to indicate the great caution that is necessary in coming to a conclusion thllat their extirpation shlould be attempted. I have now completed the task which you, in your kindness, hlave imposed upon me. It only remains for me to thlank you for the patient and attentive hearing you have given me.

Tabes Dorsalis without Locomotor Ataxy

I believe I am able to draw another conclusion from these observations: namely, that hypermetropia ought Imore often to be considered as an arrest of development of the eye-since, in cases of anisometropia, with asymmetry of the cranium, hypermetropia is always found on the least developed side of the face In thus accounting for it, I believe I have also found the explanation of the inferiority of visual acuteness, which generally accompanies high degrees of hypermetropia; whilst I attribute the low, visual acuteness of the high degrees of myopia to the choroiditis, which is the cause of the lengthening of the globe.