The Common Vein Copyright 2010
Introduction
Diagnosis of body disorder in early civilization was easiest performed on superficial structures. It is thought for example that dental disease was recognized and surgically treated in civilizations as early as Indus Valley Civilization of Pakistan as far back as 7000 BC (Coppa). The thyroid is a superficial structure but not normally seen nor felt. However goiter has been and is a very common entity in many parts of the world particularly in mountainous areas where soil erosion has washed iodine from the soil and as a result, people who live in the mountains and subsist on their own agriculture are at risk for this entity. Not only has it been a problem for the people of the mountains but also for the fetuses that depended on maternal intake for the iodine. Hence cretinism went hand in hand with goiter disease of the mountain people.
Diminished iodine intake results in increased size of the gland by hyperplasia as it attempts to maintain a normal level of thyroxine in the blood. This disease thus creates a prominent and sometimes huge and deforming thyroid mass, defined by some ancients as “elephant of the throat”. The goiter was easily recognized and diagnosed as abnormal and the unsightly appearance necessitated attempts at solving the problem.
The Chinese emperor Shen Nung prescribed the use of seaweed for the treatment of goiter as early as 2700BC. It is remarkable that this civilization was aware of a real therapeutic advantage of seaweed which we now know, like many products of the sea, are high in iodine content. It is one of the first diseases that not only was recognized as the treatment had an effective biochemical component. This is truly remarkable.
Thyroid Goiter |
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The drawing reveals a mountain person from China who subsists off the land of the region. The soil erosion depletes the soil of iodine resulting in unsightly goiters particularly in females whose needs increase during pregnancy. It is therefore not surprising that the entity was recognized in ancient times due to its easy visibility, and unsightly appearance. However what is surprising was the ability of the Chinese to identify use seaweed in therapy. We now know that seaweed is rich in iodine. Courtesy Ashley Davidoff MD Copyright 2011 99670.8s |
2000BC
Arthova Veda an ancient Hindu collection of incantations contains exorcisms for goiter
1400BC
Ayur Vedic medicine native to India came into existence in 1400BC and is translated as the “science of living” Goiters were mentioned by the designation “galaganda” and were seen as “two encapsulated small or big swellings in the anterior angle of the neck, which hang like the scrotum”.
331BC -156BC Alexandrian School
Goiter was attributed to the drinking of snow water
15AD
Celsus first described a bronchoceole (a tumour of the neck). He identified cystic types of goiters that were able to be drained
In this same period Pliny recognized the entity of goiters in the mountains, believed that goiter was due to dirty water and also used burnt seaweed in treatment
85AD
Tshui ChinThi a Chinese physician distinguished between incurable solid tumors and mobile benign curable masses.
150 AD
Galen, referred to ‘spongia usta’ (burnt sponge) for the treatment of goiter. He suggested that the function of the thyroid was to lubricate the larynx. He linked aphonia following neck surgery with injury to the laryngeal nerves.
340 AD
Ko Hung a Chinese alchemist recommended alcoholic extract of seaweed.
650 AD,
Sun Ssu-Mo advanced Chinese treatment of goiters by adding dried powdered mollusc shells and chopped up thyroid gland to seaweed.
990AD
Ali-ibn-Abbas of Persia was the first to discuss surgery as a treatment for goiters. Al Zahrawi (aka Albucasis)( (936 -1013) the great Andalusian surgeon discussed ” “the elephant of the throat” which likely represented thyroid goiter
1110 AD
Jurzani a Persian doctor observed in ‘Treasure of Medicine’ the association of exopthalmos, with goiter.
1271
Marco Polo – both father and son wrote of the people of the Karkan in Turkestan that had tumors of the throat caused by the poor quality of the water that they drank.
1475 AD
Wang Hei was a Chinese physician whose work entitled I Lin Chi Yao described the anatomy of the thyroid gland. He observed that the thyroid lay in front of the larynx and looked like a lump of flesh about the size of a date (“jubube” is a Chinese date). He described it as “flattish and of a pink colour”. His prescription for goiter was to use dried thyroid from 50 pigs, and adding the resulting powder to cold wine for the treatment of goiter .
1525
da Vinci sketched a bilobed structure in the neck which may have represented the thyroid
1543
Vesalius illustrated two “glandulae larynges” in “De Fabrica Humani Corporis” which he suggested lubricated the larynx.
Eustachian described the thyroid gland as a single entity but was the first to name the isthmus that connected the two lobes.
1567
Paracelsus, a German Swiss alchemist suggested that mineral impurities in the water were related to goiter formation. In 1567 Paracelsus associated cretinism with goiter.
1656
Thomas Wharton an English physician published his work in Adenographia and is responsible for naming the gland “thyreoidea”, meaning oblong shield in Greek, and reminiscent of a shield commonly used in ancient Greece. It appears that he was really describing the shape of the thyroid cartilage onto which the thyroid is attached. The thyroid to many has a shield like appearance as well.
1656
The entity of cretinism was first described by Felix Plater a professor of medicine in Basel Switzerland
1750
Frederick Reysch of Leiden in the Netherlands described the microscopic appearance of the thyroid
1754
The term cretin was described in Diderot’s encyclopedia as an “imbecile who was deaf and dumb with a goiter hanging down to the waist”
1791
In 1791 during the French revolution Pierre Joseph Dusault performed a partial thyroidectomy and in 1808 the first total thyroidectomy performed by Dupuytren. Unfortunately the patient died 36 hours later due to hemorrhage and infection.
Surgery of the thyroid was considered hazardous in these early years with a mortality of up to 40% and consequently the French Academy of medicine banned thyroid surgery in 1850. Subsequently thyroidectomy was only indicated when there was respiratory obstruction.
18400’s
In 1848 the following was Philadelphia surgeon Samuel Gross’s take on thyroid surgery
“Can the thyroid gland when in a state of enlargement be removed?
If a surgeon should be so foolhardy as to undertake it….every step he takes will be environed with difficulty, every stroke of his knife will be followed by a torrent of blood and lucky it would be for him if his victim lives long enough to enable him to finish his horrid butchery. No honest and sensible surgeon would ever engage in it.”
1811
Bernard Courtois from Paris, France discovered iodine in the burnt ashes of seaweed
This was the seminal concept that linked iodine as the common denominator used in the treatment of goiter. The chemical secret of seaweed was thus discovered 5,000 years after its first known use.
1821
William Prout a British chemist and physiologist was the first to recommend iodine in the treatment of goiter.
1835
Robert James Graves an Irish doctor published his accounts on exophthalmic goiter associated with palpitations and the entity now called Grave’s disease was established .
1873
Sir William Gull physician to Queen Victoria noted that atrophy of the thyroid was associated with an underactive thyroid in the already described clinical condition of myxedema
1880
Ludwig Rehn a German a physician was the first to perform a thyroidectomy for exophthalmic goiter
Theodor Kocher performed over 2000 thyroidectomies, and initially did not supplement his patients with thyroid hormone. Subsequently he realized that patients required supplementation and he administered “half a sheep’s thyroid lightly fried and taken with current jelly once a week”. Kocher was awarded the Nobel Prize for Medicine in 1909.
1914
Edward Calvin Kendall isolated “thyroxine” as the active principle of the thyroid gland.
Thyroxine became available in the 1920’s. Three tons of animal thyroid yielded 33 grams of thyroxin and it was thus an expensive but necessary drug.
1912
Hashimoto Hakaru published a report on struma lymphomatosoma now recognized as the most common cause of hypothyroidism – Hashimoto’s thyroiditis.
1926
Sir Charles Harrington a British scientist was able to synthesize thyroxine
1945
Hiroshima “Little Boy” August 6 1945 and “Fat Man”Nagasaki August 1945 resulted in exposure of large populations to radiation and resulted in an increase in papillary carcinoma and frequency depended on age at exposure and distance from the radiation source.
1952
Rosalind Pitt-Rivers worked under Sir Charles Harington. She subsequently went on to work with her Canadian post doctoral fellow Jack Gross and synthesized tri-iodothyronine which was biologically more active than thyroxine.
1986 April 26th
Chernobyl is small town located in the Ukraine region of the former Soviet Union where the worst nuclear accident occurred when a reactor exploded and released radiation into the atmosphere which by some estimates were 100 greater than Hiroshima The radiation and particulalrly radioactive iodine became incorporated into the plants and water and people were contaminated by ingestion particularly of milk
One of the main consequences was an increase in thyroid carcinoma in children some of whom were not yet born estimates as a 10 x increase