Robert Graves Lecture 1996_Dr. Malachi J. McKenna
08/05/1996 in Royal College of Physicians of Ireland, 6, Kildare Street, Dublin 2
Osteoporosis Prevention: From Vitamin D to HRT
Dr. Malachi J. McKenna, Department of Endocrinology, St. Michael’s Hospital, Dun Laoghaire and St. Vincent’s Hospital, Elm Park, Dublin 4.
Robert Graves and Graves’ Disease:
Robert Graves (1796-1853) was the pre-eminent physician of his time. He is credited with introducing the bedside practice of medicine for teaching students and for supervising housestaff that was founded on clinical observation I. He also introduced the stethoscope to Ireland, was President of the Royal College of Physicians and wrote prolifically about medical topics. His most famous work, ” A System of Clinical Medicine”, was translated into French, German and Italian and was also published in North America. He made many original clinical observations. He achieved eponymous fame for a short clinical description which was published in an essay including six other clinical descriptions.
Although his original observation was short and purely clinical, his findings were prescient. He described 3 cases of thyroid enlargement in women which was associated with severe palpitations and nervousness. With hindsight, he observed the autoimmune nature of the disease incorporating a tendency towards remissions and relapses when he stated “… when the palpitations were violent the gland used to swell … the sudden manner in which the thyroid used to increase and again diminish in size, and the connection of this with the state of the heart’s actions or circumstances which may be considered an indication that the thyroid is slightly analogous to erectile tissue”.
He was reluctant to use the word goitre and thereby he inferred a distinction between his disease and multinodular goitre, which was described by Plummer about 70 yrs later(2), when he stated that “… the enlargement of the thyroid g!and seems to be entirely different from a goitre …. it is somewhat larger on the right than the left”. He was identifying the diffuse nature of the disease because the right lobe is usually larger than the left. Fortune favours the prepared mind: he learned about a fourth case some years after his original description from his friend William Stokes in which Graves described protrusion of the eyes “…. the eyes assumed a singular appearance, for the eyeballs were apparently enlarged, so that when she slept or tried to shut her eyes the lids were incapable of closing”.
In modern practice, it is possible to make a clinical diagnosis of Graves’ disease when a patient presents with classical signs and symptoms of hyperthyroidism, a diffuse goitre, and exophthalmos.
The Chairman of the Health Research Board presented the silver medal and thanked the speaker on an excellent lecture which was also warmly appreciated by a large attendance of Fellows, Members and guests.
This being the thirty-sixth Graves Lecture since its beginnings in 1961. The lecture being delivered in 1996 is the 200th anniversary of the birth of Robert Graves.