Robert Graves Lecture 1975_Dr. Keith D. Buchanan

17/09/1975 in Royal College of Physicians of Ireland, 6, Kildare Street, Dublin 2

Keith D. Buchanan, Department of Medicine, Queen’s University, Belfast.

The Gut as an Endocrine Organ

Robert Graves was a distinguished Dublin physician. He must however, be best known for his description of the disease which is named after him (Figure 1). I find it comforting that this description was that of an endocrine disease. The description of the disease is outstandingly accurate, exemplifying the methods by which Graves taught clinical medicine to medical students. Graves at that time did not know that he was describing an endocrine disease, but it is obvious that he was impressed by this case history and I am sure therefore, he would also be impressed by the blossoming of present-day endocrinology. We know that the clinical observation of the patient is important, but there are few clinical syndromes which remain to b~ described and we now have to search somewhat below the surface in order to discover the cause of diseases. In this lecture I hope that I will uphold Graves’ tenets, but to some extent, will be using the rapid expansion of scientific medicine to help me on my way. Despite all these aids, it is unlikely that I will ever achieve what Graves did with so much less to help him.

R. J. Graves.

Figure 1

A lady aged twenty, became affected with some symptoms which were supposed to be hysterical. This occurred more than two years ago; her health previously had been good. After she had been in this nervous state about three months, it was observed that her pulse had become singularly rapid. This rapidity existed without any apparent cause and was constant, the pulse being never under 120 and often much higher. She next complained of weakness on exertion and began to look pale and thin. Thus she continued for a year, but during this time she manifestly lost ground on the whole, the rapidity of the heart’s action having never ceased. It was now observed that the eyes assumed a singular appearance, for the eyeballs were apparently enlarged, so 1hat when she slept or tried to shut her eyes, the lids were incapable of closing. When the eyes were open, the white sclerotic could be seen to a breadth of several lines all round the cornea. in a few months, the action of the heart continuing with unceasing violence, a tumour of a horse-shoe shape appeared on the front of the throat and exactly in the situation of the thyroid gland.

Irish J Med Sci. December 1976, 145:103

This being the fifteenth Graves Lecture since its beginnings in 1961.