VII. DISEASES OF THE SUPRARENAL
can give no better definition than that given by Osler:
A constitutional affection
characterized by asthenia, muscular and vascular, irritability of the
stomach, and pigmentation of the skin--symptoms due, in all probability,
to loss of the internal secretion of the adrenal glands. Tuberculosis of
the adrenals is the common anatomical change.
Etiology.--Males are more
inclined to take this disease than females. The skin is of a yellowish-gray
tint. The disease is thought to originate in an injury to the abdomen or
to the spine--poverty of the adrenal enzymes.
languor, pronounced enervation and very enfeebled heart action,
irritability of the stomach, and the peculiar change in the color of the
skin. The first symptoms are those of weakness, weariness, and the
peculiar coloring of the skin.
Change in the Appearance of the
Skin.--This is usually the first thing to attract the attention
of the patient or his friends. The coloration ranges from a slight
yellowish to a deep brown or even black, The color is deeper on the
exposed parts of the body. The areolae of the nipples and genitals take on
a very much deeper hue. The stomach symptoms are those of nausea and
vomiting. As the disease advances, there is pain in the abdomen. Toward
the last there is complete loss of appetite. Diarrhea frequently
develops--due, of course, to lack of digestive power; for, as the disease
advances, the digestive secretions become less capable of preparing the
food for absorption.
The general constitutional
derangement is marked by a gradual decline in nutrition. The disease
usually ends by fainting. This, of course, is brought on by the continued
prostration, and becomes more and more profound. In some cases there are
tuberculous lesions. Osler describes two cases as having ended in a
delirium, with difficult breathing.
Treatment.--Never having had a
case, I cannot say very much about what can be done for the disease. It is
always safe, however, to feed properly and give the foods that will give
vitality and carry life into the system. Fresh fruits, raw vegetables,
milk, and eggs, I should say, ought to be about the limit; and then, if
the patient shows improvement, other foods may be given as indicated.
Those who believe in animal therapy declare that the suprarenal injections
have been used beneficially. Those who believe in drugs declare some
benefit may be derived from arsenic, strychnin, and other drugs.
DISEASES OF THE SPLEEN
of the spleen, such as has been referred to under other heads, occurs in
fevers, heart disease, hardening of the liver, and other diseases.
There is a wandering spleen, like
floating kidney. No doubt this condition may occur occasionally, but
certainly very rarely. There is no reason why the spleen should not sag
down below its normal position, from the same causes that allow the
stomach, transverse colon, and other organs in the abdominal viscera to
drop below their level. Great enervation, muscular relaxation, and
intra-abdominal pressure from gas, etc., may occasionally displace,
deform, and put out of their normal position any of these organs. This
condition of the spleen occurs so seldom that it is unfortunate to have
this reputation at all; for physicians who are always looking for the
unusual and grotesque will often be troubled with finding this condition
when it exists only in their minds. It is said that the wandering spleen
is found oftener in women than in men. In malarial countries, where the
spleen is frequently found enlarged, the wandering kidney may be found
also; for the weight of the enlarged spleen must necessarily pull very
heavily on attachments, and after the enlargement is overcome it would be
reasonable to expect to find the spleen, as well as the left kidney, below
its normal position on account of the stretched ligaments. This same
displacement may occur to every organ in the body.
necessary to correct the health of the patient should be done. If the
patient is complaining, and seeks the physician's advice for discomfort,
it will not be from wandering spleen; it will be due to indigestion, gas
in the bowels, which, if corrected by a proper diet, will remove all
symptoms that are driving the patient to seek relief.
Rupture of the Spleen
spleen has been known to become so enlarged from hyperemia, or engorgement
of blood, that it spontaneously ruptured. Then again the spleen may be
ruptured by a blow or fall. Fatal hemorrhage will follow this accident. It
is said that fatal hemorrhage has been known to follow puncture of the
spleen by a hypodermic needle. Abscess in the spleen has sometimes been
punctured, and the intense swelling has caused a rupture to take place at
the point of insertion of the needle. Of course, such accidents will prove
fatal very quickly. There is but one treatment, and that is to open the
abdomen and do whatever is necessary. It is strictly a surgical case.
DISEASES OF THE THYROID GLAND
symptoms belong to a syndrome. Where this state exists, there is toxin
absorption from decomposition in the bowels. The lymphatic glands are more
or less affected in the pelvis, causing hyperemia of the ovaries, a
tendency for painful menstruation, or an excessive flow; perhaps a
catarrhal condition of the uterus and hyperemia of the mammary glands. The
thyroid gland and the mammary glands in connection with the ovaries
develop this hyperemic state at the menstrual period. The catarrh in such
cases as this is a transient affair. The rule is that it never remains.
There is a possibility that this state of the thyroid gland may emerge
into a catarrh proper.
treatment should be obvious. Correct the digestion. Stop the improper
eating. The eating of candy and other foods between meals must be given up
entirely, and meals must be on time three times a day. During the
hyperemic state of these glands, one or two days should be spent on fruit
entirely: three fruit meals a day--morning, noon, and night. Then one
fruit meal may be dropped, and a regulation dinner of meat, salad, and
cooked, non-starchy vegetables taken every other day; and the alternate
days a starchy dinner, using some kind of decidedly starchy food in place
of the meat.
affection may be the sequel of typhoid fever, scarlet fever, pneumonia,
rheumatic fever, or mumps. The entire gland may be involved, or only one
lobe of it, and sometimes the isthmus. Where the inflammation ends in
suppuration the gland may be destroyed. It is said that exophthalmic
goiter has followed an acute thyroiditis, which in turn followed
of the thyroid gland. It may occur sporadically or in epidemic form.
There are three varieties of true
hypertrophy of the thyroid gland. The first is a follicular enlargement:
newformed tissue develops--gelatinous material accumulates in the
follicles. The second variety is vascular. In this variety the enlargement
is due entirely to enlargement of the blood vessels. This is the variety
that is so formidable when surgeons undertake to extirpate it. Bleeding is
tremendous, and I think the majority of surgeons go no farther in such
cases than to ligate the artery; which treatment may be somewhat
beneficial, but collateral circulation wilt be established and the gland
will continue to enlarge. We are having a great many operations of this
character, and they are of no special benefit. Why should they be? No
cause is even thought of, to say nothing about any attempt being made to
overcome the cause.
The third variety is cystic goiter.
This is characterized by a growth resembling cystic tumors. Occasionally
this variety will grow to enormous size--as large as a human head. We hear
occasionally of epidemics of goiter in different parts of the country. No
doubt suggestion has something to do with this disease as well as with
others, but there must be something atmospheric as well as dietary. There
are certain sections of the countries of Great Britain, France, and Italy
where the disease prevails. When the truth is known, it will be found that
the foods in such communities are deficient in certain elements, or the
style of eating of the people is such as to deprive the system of some of
the vital elements necessary to keep a well-balanced state of health.
Families and communities exchange ideas, patterning after each other in
their style of eating as well as of dressing, and it is not strange that
diseases of a certain character should develop in certain communities.
Symptoms.--An enlargement at
the base of the neck--easily discovered where the enlargement is of any
size--may be looked upon as a goiter. Just what kind of goiter is
presenting must be left to the diagnostic skill of the physician, and just
what can be done in any individual case must depend entirely upon the
causation. It is my opinion that the majority of cases of goiter of any
character have a primary cause of toxin poisoning--or a state of infection
due to intestinal absorption of putrefaction.
Treatment.--Correct the habits
or the life. See that the patient is fed properly. If there is a uterine
affection, it must be corrected. As a rule, there is a sensitiveness of
the mammary glands, and in too many cases the glands are removed because
of a suspicion that the disease is cancer or will develop into cancer. The
truth is that the uterine derangement, the mammary-gland enlargement, and
the goiter all are caused by the same basic lesion. Where there is a great
deal of fibroid development the disease is hard to overcome; but this
tissue can be caused to absorb, if the patient will be persistent in
disease characterized by an exophthalmose, an enlargement of the
thyroid, functional disturbance of the heart and vascular system
generally, and said to be caused by disturbances of the secretion of the
thyroid gland; or, to be specific, hyperthyroidism.
Etiology.--This is a disease
met with oftener among women than men, although some men develop a fatal
affection of this order. There is no question but that the cause is
enzymic shortage, allowing toxin poisoning; in this resembling alcoholism.
Constitutional poisoning by alcohol is pronouncedly a nervous and physical
trouble. Few cases, however, develop such a tumultuous action of the heart
as occurs in goiter. There are very good diagnosticians who believe that
it is a central lesion located in the base of the brain or in the medulla
oblongata. The symptoms said to be produced by the administration of
thyroid secretion are tachycardia, headache, sweating, and perspiration.
These symptoms are very similar to those found in extreme cases of Graves'
is divided into an acute and a chronic stage. The acute disease arises
very rapidly. The patient will become exceedingly nervous, the pulse
running from 120 to 160. The heart is tremendously tumultuous, and there
is a feeling of precordial oppression, approaching that of smothering in
severe cases. The eyes have a protruding appearance. Patients are often
suddenly seized with vomiting, and sometimes diarrhea. The thyroid gland
is found very much enlarged and soft. The gastro-intestinal symptoms are
pronounced. The rapid heart action is one of the most pronounced symptoms.
The exophthalmos may be unilateral; that is, one eye may be more
pronouncedly projecting than the other. In extreme cases it is impossible
for the eyelids to close. The protrusion has been known to be so extreme
as to dislocate the eye from its socket. This appears rare and
exaggerated; yet the projection is at times more than one could imagine to
be possible. In the foregoing I have given the usual etiology and
symptoms. I shall now give my opinion and impressions in regard to the
It is a pronounced case of toxin
poisoning. The patients affected with this disease have been eating beyond
their digestive limitations for perhaps months, and possibly years,
keeping up a continuous putrefaction in the large intestine. In nearly all
the cases I have seen there has been colitis. The absorption of toxins
from the putrefaction, running over a long period of time, has brought on
pronounced enervation and an excitable state of the heart and arteries.
The arterial pressure is high, and the heart is tremendously overworked.
As stated before, there is a decided similarity between this disease and
alcoholic neuritis or delirium tremens. Both are caused from toxins--one
from alcoholics plus the toxins from putrefaction in the bowels, and the
other from simple toxin from putrefaction.
In Graves' disease or the disease
under consideration, there is almost invariably a history of sex neurosis.
The patient early in life has begun to practice self-abuse. Then, when
maturity is reached, the excess in venereal excitement has been continued.
The truth of the matter is that exophthalmic goiter is the culmination of
several years of sensualism.
The fact that the thyroid gland
becomes involved in the syndrome to such an extent that it appears to be
causative is probably due to enzymic shortage in the gland, allowing a
local toxin poisoning.
can be cured, if taken in time. Some of our best medical authorities
declare that the seriousness of the symptoms warrants strong measures
being carried out; hence they recommend ice to quiet the heart. The
ice-pack is to be placed over this organ, and the application is to be
continued through day and night until the heart is controlled. Then drugs
are given to control the action of the heart. Serum therapy is
recommended; also surgical treatment for the removal of part of the
thyroid gland. I certainly would not recommend any of these remedies. A
patient should be put to bed, and kept there perfectly quiet, away from
all friends and family. No one is to come into his presence except the
nurse. Water may be given as freely as there is demand--which will not be
very often after the first day or two.
The bowels are to be washed out with
copious enemas. If the weather is cold, and there is a tendency for the
hands and feet to be cold, hot applications are to be placed to the
extremities; but the patient is to be kept in bed, perfectly quiet, and
nothing is to go into the stomach except water until the pulse-rate is
brought down to ninety or below. By that time the tumultuous heart will
have quieted down, there will be less bulging of the eyes, and the whole
aspect of the patient will be that of a decided improvement. It may
require a week or two, but no hesitancy should be felt in carrying out the
instructions to the letter. It is far better to trust the patient in the
arms of nature than to trust to remedies questionable in their character
and certainly doubtful in their efficacy.
As soon as the patient is able to eat
(and eating certainly should not be started until the symptoms are
absolutely under control), several days should be spent on fruit--any kind
of fresh fruit that the patient can enjoy--say, three days. Then three
days more on fruit morning and night, with an ordinary meal at noon of
meat or meat broth and salad, with a cooked, non-starchy vegetable or two,
every other day; and the alternate days some form of starchy food in place
of the meat or broth, with vegetables and salad. After that a reasonable
amount of eating on the order of fruit for breakfast, starch and fruit for
the noon meal, and the regulation dinner in the evening.
DISEASES OF THE THYMUS GLAND
is one of the ductless glands situated behind the sternum. In normal
people it is extinct by the time of puberty. 'The only thing that makes
this gland of interest is that sometimes it remains and takes on
hypertrophy, producing a tumor in the mediastinum. I have met with but one
case. The disease started to develop in the young man at about sixteen to
seventeen years of age. It grew so, rapidly that it displaced the heart
several inches downward and to the left. The patient suffered a great
deal, and died at the end of two, years after the tumor had started to
treatment seemed to be of any avail; in fact, as in the case of many other
tumors situated in the vital parts of the body, nothing can be done after
they have once started. The time to cure such derangements is before they
have started to grow. I knew this boy when he was an infant at the breast.
He was as healthy and normal as other boys, and would have remained so if
he had been properly taken care of and his eating had been of the right