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regard as true examples of Graves' disease-where there was but little, if any, evidence of glandular enlargement.
The first case that I have to present was seen with me by Dr. J. B. Read, of this city, and is the fourth of my reported cases where recovery complete or approximate resulted from the use of electricity.
CASE I.—Mrs. E., aged 31, married, and the mother of two children, first observed an appreciable increase in the rapidity of the heart's action in the fall of 1878. About the same time, or soon after, as she was standing before the mirror one morning, her attention was called to an increased fulness about the neck; and, upon passing her hand over the part, she became aware of what she termed a "beating sensation," and a softer feeling. These symptoms increased somewhat rapidly, until they assumed the condition presented when the case came to me in Oct. 1879. At this time the heart was beating at the rate of 120 to 125 per minute, and on exercise, or under excitement, it went up to 150. The thyroid enlargement was marked, though not enormous, while the eyes were quite protuberant and bloodshot. Around the neck, over the thyroid gland, the measurement was fifteen inches. The patient was chlorotic, hysterical, and nervous to the last degree; and it was with the greatest difficulty that she could be induced to submit to the necessary examination and treatment. The spine was exceedingly sensitive to pressure all along its course, and especially between the scapula, where firm pressure invariably caused nausea; and on the occasion of her second visit, while running my fingers down the back, and lingering for a moment with a somewhat increased pressure over the more sensitive portion, she immediately rejected her breakfast which had been taken an hour before. It is to be remarked that these evidences of spinal irritation and extreme nervousness became manifest only after the appearance of symptoms indicating exophthalmic goitre. Previous to this time her health had been fair.
The only cause that seemed to bear any relation to the onset of the disease was the one that has been so frequently observed, viz., childbirth. A short time previously she had suffered from a long and tedious confinement, but had gotten up from it apparently quite well. I submitted her to the usual methods of galvanization of the sympathetic and central galvanization, and with some benefit.
The heart's action became somewhat more regular and less frequent; the goitre decreased a little in size, and the spine became less sensitive. Improvement, however, ceased at this point, and the case remaining stationary for nearly a month, I attempted general faradization. I have on several occasions pointed out the fact that general faradization is often most effective in lowering and increasing the strength of a pulse that is weak and rapid as a resultant of nervous irritability.
This effect upon the pulse-as experience shows and electrophysiology teaches-is most frequently observed in exophthalmic goitre after the use of the galvanic current. In this case, however, after galvanization had ceased to be effective, general faradization (from a Kidder faradic machine, which from long experience I have found to be the best apparatus for this form of application) was followed by a still greater diminution in the frequency of the pulse, by decrease in size of the thyroid enlargement, and a very marked improvement in the condition of the eyes. After twenty-five applications of general faradizationadministered in the course of two months-the measurement of the neck had decreased by two inches, leaving a slight but firm enlargement in place of the larger and softer tumor that was present at the beginning of treatment. The frequency of the pulse, decreased to about 85 per minute, was not particularly susceptible to sudden fluctuations under excitement or exertion, while the patient had gained immensely in nervous strength and self-control.
CASE II.-Miss C. H., aged 29, came to me in September, 1879, with an especially interesting and instructive history, since it illustrates how varying sometimes are the manifestations of a nervous diathesis. During childhood she had suffered long and severely from St. Vitus's dance, which did not entirely disappear until menstruation was established, at the age of fourteen. From the first this function was performed irregularly and painfully until the age of eighteen, when it suddenly ceased, and for some years she was afflicted with periodical hysterical seizures, together with a more or less constant jerking of the head, with a hesitancy of utterance, and an occasional partial loss of consciousness that would seem to have simulated attacks of hystero-epilepsy. At about the age of twenty-one menstruation again appeared, but irregularly, and at the same time her gene
ral health somewhat improved. In time the courses came on more and more regularly and less painfully, but at the age of twenty-four, after an attack of malarial fever, menstruation failed to reappear. It was at this time that she first began to be annoyed by an excessive palpitation of the heart, and soon her attention was called to a very decided enlargement of the thyroid. This enlargement gradually increased, and when I saw her it was very large, soft, and pulsating, and including the neck, measured sixteen and a quarter inches. The pulse beat at the rate of 110 per minute, while the exophthalmos was very great. After the patient had been subjected to the usual external treatment by the galvanic current, but without any special reference in its direction to the menstrual function-the courses appeared slightly for a day and then ceased, but on timing the pulse, I found that it had decreased in frequency to somewhat less than 100.
The same method was repeated for some three weeks longer, when I had the pleasure of showing the case to Dr. P. B. Porter. At this time the pulse was about 90, while the tumor had decreased only about one inch. The exophthalmos had been only slightly influenced. Deciding to change the method of treatment, I placed one electrode (the anode) directly behind the angle of the lower jaw, pressing back the sterno-cleido mastoid muscle, and the other on the back of the neck, a little to one side of the sixth cervical vertebra. Instead, now, of treating by means of a steady continuous current, I brought into the circuit. a simple water rheostat, and by this means, somewhat rapidly, but without shock, increased and decreased the strength of the current through a seance of not more than two or three minutes in duration.
The results of this method of treatment were before long manifested in a further reduction of the pulse, and a gradual diminution of the severity of the other symptoms, until, after twentyfive of these applications, recovery was far advanced. The pulse was 75, the eyes resumed their natural position and appearance, while the neck, although somewhat fuller than normal, measured but thirteen and three-quarter inches, a decrease of two and a half inches.
CASE III.-Miss M., aged 22, was seen, with Dr. E. B. Belden, October 18, 1879. Menstruation began at the age of seventeen,
but for two years it was scanty and irregular, after which for a while it appeared normally. At the age of twenty, menstruation again became irregular, and attended also with cramps and considerable pain. At this time the first signs of exophthalmic goitre became manifest, and when I saw her two years subsequently, the three cardinal symptoms of the disease were quite pronounced, although moderate in degree compared to the foregoing. The pulse averaged about 88 per minute. The eyes were slightly protuberant, while the neck measurement over the enlarged gland was fifteen inches. Opportunity was afforded of seeing this patient but a comparatively short time, but in the few applications that were given, the circumference of the neck over the gland was reduced to fourteen and a quarter inches. The pulse, however, became markedly modified, decreasing to the normal standard of 72 per minute. As I am recording this case the patient again calls at my office. It is now five months since the treatment was discontinued, and the pulse is found to be 72, the same as recorded at that time.
The neck is found to measure fourteen and a half inches, show. ing an increase during the interval, although smaller by half an inch than it was originally.
An interesting fact connected with this case is its relation to the menstrual function. The disease first began to show itself as menstruation became scanty and irregular. Two years subsequently the slight diminution in the goitre and decrease in the frequency of the pulse were simultaneous with a more regular and better performance of the menstrual function. After the cessation of treatment she remained better until a short time before the last visit to which I have just alluded, when there was a retention of the menses, followed by some increase in the size of the thyroid and an increased action of the heart. Through the administration of remedies, menstruation was established in about a week, resulting in a modification of the circulation.
CASE IV. Mrs. C. was seen with Dr. Frank Wilmuth, of East Orange, N. J. The enlargement of the thyroid was considerable, but the eyes were not at all affected. The pulse was rapid, beating ordinarily at 125 a minute, but reaching 160 when under excitement. When asleep, it was but 95. The patient was the mother of two children, and although her last labor, four years ago, was somewhat severe, it could hardly have entered as a fac
tor in the causation of the disease, since the first evidence of cardiac disturbance appeared three years subsequently. The symptoms were coincident with exhaustion following hard work in house cleaning. The patient submitted to considerable treatment, but coming so far her visits were necessarily rather infre quent. It is by no means clear to my mind that the necessity of riding so far, both before and after each visit, did not interfere somewhat with the efficiency of the treatment. At all events, no impression was made upon the disease other than some diminution in the rapidity of the pulse.
CASE V.-Miss aged 34, came to me but a few weeks ago from Dr. James Collard, of Westfield, Mass., with a goitre of considerable size, but with very little protuberance of the eyes. The pulse was 112, menstruation was normal, but the patient was extremely nervous and depressed. Her mother has a very large goitre, which began to develop thirty years ago. A brother and sister died of hasty consumption, and four years ago the patient herself had a slight hemorrhage.
The pulse was found to intermit some eight times a minute. I saw the patient but three weeks, when she was compelled to leave the city, but with the intention of continuing the same course elsewhere. Under the short treatment that she received the pulse lost its intermittent character and became entirely regular. At the same time the patient became much less nervous. Aside from this, little was accomplished except some diminution in the frequency of the pulse and a very slight decrease in the size of the goitre. The case is, however, especially worthy of record because of the very interesting temporary results that followed various applications. On counting the pulse during the first galvanic application, no intermittence was detected. A few moments after the removal of the electrodes it intermitted as usual eight beats a minute. The same results followed a second application, with the exception that after the removal of the electrodes the pulse began to intermit but three or four times a minute, and after the fourth application it became permanently rhythmical. At one time during the treatment the pulse fell to sixty-seven, and stayed there for some time.