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Hypothyroidism and the Contribution of Sir William Withey Gull (aka Jack the Ripper)

Posted in Uncategorized by ce399 on 28/12/2010

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One day, men will look back…and say I gave birth to the 20th century. – From Hell

J Neurol Neurosurg Psychiatry. 2006 May; 77(5): 639.doi: 10.1136/jnnp.2005.082198. PMCID: PMC2117466

Myxoedema and Sir William Withey Gull (1816–1890)

J M S Pearce

J M S Pearce, Department of Neurology, Hull Royal Infirmary, UK

Correspondence to: J M S Pearce
304 Beverley Road, Anlaby, East Yorks, HU10 7BG, UK; jmsp@freenet.co.uk

Received October 11, 2005; Revised November 7, 2005; Accepted November 22, 2005.

Other Sections▼

References

This is a brief history of hypothyroidism and the contribution of Sir William Withey Gull. Hypothyroidism and its complications provide many clinical puzzles for neurologists.

The thyroid had no known function until the end of the 19th century. In the wake of the term coined by Claude Bernard (1813–1878) in 1855, “internal secretion”, and his concept of the milieu interieur, Sir William Withey Gull in 1873 was one of the first to understand that the cause of myxoedema is atrophy of the thyroid gland.

Gull’s seminal paper1 related the changed appearance of a Miss B:

“after the cessation of the catamenial period, became insensibly more and more languid, with general increase of bulk… Her face altering from oval to round, …the tongue broad and thick, voice guttural, and the pronunciation as if the tongue were too large for the mouth (cretinoid)… In the cretinoid condition in adults which I have seen, the thyroid was not enlarged. …

There had been a distinct change in the mental state. The mind, which had previously been active and inquisitive, assumed a gentle, placid indifference, corresponding to the muscular languor, but the intellect was unimpaired… The change in the skin is remarkable. The texture being peculiarly smooth and fine, and the complexion fair, at a first hasty glance there might be supposed to be a general slight oedema of it… The beautiful delicate rose‐purple tint on the cheek is entirely different from what one sees in the bloated face of renal anasarca.”

Four years later, William Miller Ord (1834–1902)2 introduced the term myxoedema. Like Graves’ disease, it was generally considered an affliction of the nervous system, which shows how little was known of the thyroid. William Smith Greenfield (1846–1919) of Edinburgh, who examined pathologically one of Ord’s myxoedema patients observed that it was the antithesis to exophthalmic goitre. In his Bradshaw Lecture (1893):

‘In thus discussing Graves’ disease, even provisionally as a disease of the thyroid gland rather than of the nervous system, I am aware that I am opposed to nearly all English and American physicians of eminence.’

but Kocher even 10 years later observed:

“Surgeons had simply assumed that the thyroid gland has no function whatever…”;

And Jaques‐Louis Reverdin asked in 1882:

“Can it be that the thyroid body whose functions are still obscure plays a part in haematopoiesis so important that its ablation produces such profound trouble?”

George Redmayne Murray(1865–1939) of Newcastle, stimulated by his mentor Victor Horsley (1857–1916), introduced in Britain the successful treatment of myxoedema in 1891, with injections of sheep thyroid extract.3 A similar success in Lisbon reported in 1890,4 but reported in Portuguese, was overlooked.

The discovery of autoimmune thyroid disease5,6 had to await the 20th century.

Footnotes

Competing interests: none declared

J Neurol Neurosurg Psychiatry. 2006 May; 77(5): 639.doi: 10.1136/jnnp.2005.082198. PMCID: PMC2117466

Copyright © 2006 BMJ Publishing Group

Myxoedema and Sir William Withey Gull (1816–1890)

J M S Pearce

J M S Pearce, Department of Neurology, Hull Royal Infirmary, UK

Correspondence to: J M S Pearce
304 Beverley Road, Anlaby, East Yorks, HU10 7BG, UK; jmsp@freenet.co.uk

Received October 11, 2005; Revised November 7, 2005; Accepted November 22, 2005.

Other Sections▼

References

This is a brief history of hypothyroidism and the contribution of Sir William Withey Gull. Hypothyroidism and its complications provide many clinical puzzles for neurologists.

The thyroid had no known function until the end of the 19th century. In the wake of the term coined by Claude Bernard (1813–1878) in 1855, “internal secretion”, and his concept of the milieu interieur, Sir William Withey Gull in 1873 was one of the first to understand that the cause of myxoedema is atrophy of the thyroid gland.

Gull’s seminal paper1 related the changed appearance of a Miss B:

“after the cessation of the catamenial period, became insensibly more and more languid, with general increase of bulk… Her face altering from oval to round, …the tongue broad and thick, voice guttural, and the pronunciation as if the tongue were too large for the mouth (cretinoid)… In the cretinoid condition in adults which I have seen, the thyroid was not enlarged. …

There had been a distinct change in the mental state. The mind, which had previously been active and inquisitive, assumed a gentle, placid indifference, corresponding to the muscular languor, but the intellect was unimpaired… The change in the skin is remarkable. The texture being peculiarly smooth and fine, and the complexion fair, at a first hasty glance there might be supposed to be a general slight oedema of it… The beautiful delicate rose‐purple tint on the cheek is entirely different from what one sees in the bloated face of renal anasarca.”

Four years later, William Miller Ord (1834–1902)2 introduced the term myxoedema. Like Graves’ disease, it was generally considered an affliction of the nervous system, which shows how little was known of the thyroid. William Smith Greenfield (1846–1919) of Edinburgh, who examined pathologically one of Ord’s myxoedema patients observed that it was the antithesis to exophthalmic goitre. In his Bradshaw Lecture (1893):

‘In thus discussing Graves’ disease, even provisionally as a disease of the thyroid gland rather than of the nervous system, I am aware that I am opposed to nearly all English and American physicians of eminence.’

but Kocher even 10 years later observed:

“Surgeons had simply assumed that the thyroid gland has no function whatever…”;

And Jaques‐Louis Reverdin asked in 1882:

“Can it be that the thyroid body whose functions are still obscure plays a part in haematopoiesis so important that its ablation produces such profound trouble?”

George Redmayne Murray(1865–1939) of Newcastle, stimulated by his mentor Victor Horsley (1857–1916), introduced in Britain the successful treatment of myxoedema in 1891, with injections of sheep thyroid extract.3 A similar success in Lisbon reported in 1890,4 but reported in Portuguese, was overlooked.

The discovery of autoimmune thyroid disease5,6 had to await the 20th century.

Footnotes

Competing interests: none declared

Other Sections▼

References

References

1. Gull W W. On a cretinoid state supervening in adult life in women. Trans Clin Soc Lond. 1873– 1874. 7180–185.

2. Ord W M. Report of a committee of the Clinical Society of London nominated December 14, 1883, to investigate the subject of myxoedema. Trans Clin Soc Lond 1888. 21 (supp)

3. Murray G R. Note on the treatment of myxoedema by hypodermic injections of an extract of the thyroid gland of a sheep. Brit Med J 1891. 2796.

4. Un cas de myxoedème traité par la greffe hypodermique du corps thyroïde d’un mouton. Sem Medicale 1890. 10294.

5. Weetman A. Autoimmune thyroiditis: predisposition and pathogenesis. Clin Endocrinol 1992. 36307–323.

6. Vaidya B, Kendall‐Taylor P, Pearce S H S. The genetics of autoimmune thyroid disease. J Clin Endocrinol Metab 2002. 875385–5397. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of

BMJ Group Other Sections▼

References

References

1. Gull W W. On a cretinoid state supervening in adult life in women. Trans Clin Soc Lond. 1873– 1874. 7180–185.

2. Ord W M. Report of a committee of the Clinical Society of London nominated December 14, 1883, to investigate the subject of myxoedema. Trans Clin Soc Lond 1888. 21 (supp)

3. Murray G R. Note on the treatment of myxoedema by hypodermic injections of an extract of the thyroid gland of a sheep. Brit Med J 1891. 2796.

4. Un cas de myxoedème traité par la greffe hypodermique du corps thyroïde d’un mouton. Sem Medicale 1890. 10294.

5. Weetman A. Autoimmune thyroiditis: predisposition and pathogenesis. Clin Endocrinol 1992. 36307–323.

6. Vaidya B, Kendall‐Taylor P, Pearce S H S. The genetics of autoimmune thyroid disease. J Clin Endocrinol Metab 2002. 875385–5397. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of

BMJ Group

J Neurol Neurosurg Psychiatry. 2006 May; 77(5): 639.doi: 10.1136/jnnp.2005.082198. PMCID: PMC2117466

Copyright © 2006 BMJ Publishing Group

Myxoedema and Sir William Withey Gull (1816–1890)

J M S Pearce

J M S Pearce, Department of Neurology, Hull Royal Infirmary, UK

Correspondence to: J M S Pearce
304 Beverley Road, Anlaby, East Yorks, HU10 7BG, UK; jmsp@freenet.co.uk

Received October 11, 2005; Revised November 7, 2005; Accepted November 22, 2005.

Other Sections▼

References

This is a brief history of hypothyroidism and the contribution of Sir William Withey Gull. Hypothyroidism and its complications provide many clinical puzzles for neurologists.

The thyroid had no known function until the end of the 19th century. In the wake of the term coined by Claude Bernard (1813–1878) in 1855, “internal secretion”, and his concept of the milieu interieur, Sir William Withey Gull in 1873 was one of the first to understand that the cause of myxoedema is atrophy of the thyroid gland.

Gull’s seminal paper1 related the changed appearance of a Miss B:

“after the cessation of the catamenial period, became insensibly more and more languid, with general increase of bulk… Her face altering from oval to round, …the tongue broad and thick, voice guttural, and the pronunciation as if the tongue were too large for the mouth (cretinoid)… In the cretinoid condition in adults which I have seen, the thyroid was not enlarged. …

There had been a distinct change in the mental state. The mind, which had previously been active and inquisitive, assumed a gentle, placid indifference, corresponding to the muscular languor, but the intellect was unimpaired… The change in the skin is remarkable. The texture being peculiarly smooth and fine, and the complexion fair, at a first hasty glance there might be supposed to be a general slight oedema of it… The beautiful delicate rose‐purple tint on the cheek is entirely different from what one sees in the bloated face of renal anasarca.”

Four years later, William Miller Ord (1834–1902)2 introduced the term myxoedema. Like Graves’ disease, it was generally considered an affliction of the nervous system, which shows how little was known of the thyroid. William Smith Greenfield (1846–1919) of Edinburgh, who examined pathologically one of Ord’s myxoedema patients observed that it was the antithesis to exophthalmic goitre. In his Bradshaw Lecture (1893):

‘In thus discussing Graves’ disease, even provisionally as a disease of the thyroid gland rather than of the nervous system, I am aware that I am opposed to nearly all English and American physicians of eminence.’

but Kocher even 10 years later observed:

“Surgeons had simply assumed that the thyroid gland has no function whatever…”;

And Jaques‐Louis Reverdin asked in 1882:

“Can it be that the thyroid body whose functions are still obscure plays a part in haematopoiesis so important that its ablation produces such profound trouble?”

George Redmayne Murray(1865–1939) of Newcastle, stimulated by his mentor Victor Horsley (1857–1916), introduced in Britain the successful treatment of myxoedema in 1891, with injections of sheep thyroid extract.3 A similar success in Lisbon reported in 1890,4 but reported in Portuguese, was overlooked.

The discovery of autoimmune thyroid disease5,6 had to await the 20th century.

Footnotes

Competing interests: none declared

Other Sections▼

References

References

1. Gull W W. On a cretinoid state supervening in adult life in women. Trans Clin Soc Lond. 1873– 1874. 7180–185.

2. Ord W M. Report of a committee of the Clinical Society of London nominated December 14, 1883, to investigate the subject of myxoedema. Trans Clin Soc Lond 1888. 21 (supp)

3. Murray G R. Note on the treatment of myxoedema by hypodermic injections of an extract of the thyroid gland of a sheep. Brit Med J 1891. 2796.

4. Un cas de myxoedème traité par la greffe hypodermique du corps thyroïde d’un mouton. Sem Medicale 1890. 10294.

5. Weetman A. Autoimmune thyroiditis: predisposition and pathogenesis. Clin Endocrinol 1992. 36307–323.

6. Vaidya B, Kendall‐Taylor P, Pearce S H S. The genetics of autoimmune thyroid disease. J Clin Endocrinol Metab 2002. 875385–5397. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of

BMJ Group

J Neurol Neurosurg Psychiatry. 2006 May; 77(5): 639.doi: 10.1136/jnnp.2005.082198. PMCID: PMC2117466

Copyright © 2006 BMJ Publishing Group

Myxoedema and Sir William Withey Gull (1816–1890)

J M S Pearce

J M S Pearce, Department of Neurology, Hull Royal Infirmary, UK

Correspondence to: J M S Pearce
304 Beverley Road, Anlaby, East Yorks, HU10 7BG, UK; jmsp@freenet.co.uk

Received October 11, 2005; Revised November 7, 2005; Accepted November 22, 2005.

Other Sections▼

References

This is a brief history of hypothyroidism and the contribution of Sir William Withey Gull. Hypothyroidism and its complications provide many clinical puzzles for neurologists.

The thyroid had no known function until the end of the 19th century. In the wake of the term coined by Claude Bernard (1813–1878) in 1855, “internal secretion”, and his concept of the milieu interieur, Sir William Withey Gull in 1873 was one of the first to understand that the cause of myxoedema is atrophy of the thyroid gland.

Gull’s seminal paper1 related the changed appearance of a Miss B:

“after the cessation of the catamenial period, became insensibly more and more languid, with general increase of bulk… Her face altering from oval to round, …the tongue broad and thick, voice guttural, and the pronunciation as if the tongue were too large for the mouth (cretinoid)… In the cretinoid condition in adults which I have seen, the thyroid was not enlarged. …

There had been a distinct change in the mental state. The mind, which had previously been active and inquisitive, assumed a gentle, placid indifference, corresponding to the muscular languor, but the intellect was unimpaired… The change in the skin is remarkable. The texture being peculiarly smooth and fine, and the complexion fair, at a first hasty glance there might be supposed to be a general slight oedema of it… The beautiful delicate rose‐purple tint on the cheek is entirely different from what one sees in the bloated face of renal anasarca.”

Four years later, William Miller Ord (1834–1902)2 introduced the term myxoedema. Like Graves’ disease, it was generally considered an affliction of the nervous system, which shows how little was known of the thyroid. William Smith Greenfield (1846–1919) of Edinburgh, who examined pathologically one of Ord’s myxoedema patients observed that it was the antithesis to exophthalmic goitre. In his Bradshaw Lecture (1893):

‘In thus discussing Graves’ disease, even provisionally as a disease of the thyroid gland rather than of the nervous system, I am aware that I am opposed to nearly all English and American physicians of eminence.’

but Kocher even 10 years later observed:

“Surgeons had simply assumed that the thyroid gland has no function whatever…”;

And Jaques‐Louis Reverdin asked in 1882:

“Can it be that the thyroid body whose functions are still obscure plays a part in haematopoiesis so important that its ablation produces such profound trouble?”

George Redmayne Murray(1865–1939) of Newcastle, stimulated by his mentor Victor Horsley (1857–1916), introduced in Britain the successful treatment of myxoedema in 1891, with injections of sheep thyroid extract.3 A similar success in Lisbon reported in 1890,4 but reported in Portuguese, was overlooked.

The discovery of autoimmune thyroid disease5,6 had to await the 20th century.

Footnotes

Competing interests: none declared

Other Sections▼

References

References

1. Gull W W. On a cretinoid state supervening in adult life in women. Trans Clin Soc Lond. 1873– 1874. 7180–185.

2. Ord W M. Report of a committee of the Clinical Society of London nominated December 14, 1883, to investigate the subject of myxoedema. Trans Clin Soc Lond 1888. 21 (supp)

3. Murray G R. Note on the treatment of myxoedema by hypodermic injections of an extract of the thyroid gland of a sheep. Brit Med J 1891. 2796.

4. Un cas de myxoedème traité par la greffe hypodermique du corps thyroïde d’un mouton. Sem Medicale 1890. 10294.

5. Weetman A. Autoimmune thyroiditis: predisposition and pathogenesis. Clin Endocrinol 1992. 36307–323.

6. Vaidya B, Kendall‐Taylor P, Pearce S H S. The genetics of autoimmune thyroid disease. J Clin Endocrinol Metab 2002. 875385–5397. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of

BMJ Group

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