On the Simultaneous Occurrence and Interrelation of Basedow's Disease and Tabes
Boston Medical and Surgical Journal
Is there one among us who has not been struck, if not puzzled, by the curious distribution of edema, especially in cases obviously of mechanical obstruction to the circulation? We see, for instance, two cases of mitral disease with failure of the myocardial compensation. The physical signs and symptoms taken altogether indicate lesions similar in kind, as well as degree, and also an approximately equal myocardial weakness. The parallelism between the two eases may be accentuated by an equal
... ted by an equal rapidity and degree of improvement under, for all practical purposes, identical treatment. The sequence of events is mechanically impeded circulation, dilatation of the right heart annulling compensatory hypertrophy, over-plus of blood in the venous system, stasis, dropsy. A difference in the degree of the dropsy in the two cases may be readily accounted for by differences in the lesion, valvular, myocardial, or both, which elude any means now in our powers to estimate. But it would seem that the distribution of the edema should be essentially the same. It is, however, notoriously not so. In one case we see dropsy chiefly or only in dependent parts, especially the legs; in another the great serous sacs are markedly involved with a varying degree of stasis in the lungs, liver, and kidneys and little or no anasarca; in still another stasis shows itself mainly in an enlarged liver; in short, seemingly similar mechanical conditions show results which vary far more widely than one would, off-hand, expect.