64 THE DISEASES OF THE THYROID GLAND 



eye-muscles which is observed in severe cases of Basedow's disease. Also 

 pareses and paralyses of the eye-muscles have been observed. Kappis 

 describes a case in which the beginning of the illness occurred eleven years 

 previously; with gradual increase in all symptoms there developed an exten- 

 sive paralysis of the eye-muscles and other cranial nerves. Kappis has 

 collected forty cases of eye-muscle paralysis in morbus Basedowi. 



Sometimes there occurs in Basedow's disease an excess of tears (Berger) ; 

 sometimes, however, an abnormal dryness of the eye. In high-grade pro- 

 trusion the cornea may ulcerate and erode, the lens may fall out, and the 

 panophthamtia that develops may lead to death. Patients with Basedow's 

 disease bear cataract operation badly (Mobius). In rare cases there is 

 observed atrophy of the optic nerves (also obtained experimentally through 

 administration of thyroid gland, Birch-Hirschfeld and Nonmbuo Ynvuye); 

 finally, mydriasis sometimes occurs on instillation of adrenalin (O. Lb'wi}. 

 The adrenalin mydriasis is also found in experimental hyperthyroidism 

 (Eppinger, Falta, and Rudinger). 



The eye symptoms belong to the classic form of the disease. In the 

 formes frustes they may be absent or only suggested. In the following 

 briefly sketched case they were wanting altogether: 



Observation III. S. Schm, fifty-six years, shoemaker. For about thirty years diffuse 

 enlargement of the thyroid, circumference of the neck 42 cm. Until six months ago, 

 perfectly healthy. Then occurred gradual increase in the size of the neck to 43 cm. and 

 then to 44 cm. Lassitude, sweatings, difficulty in breathing. His physician ordered for 

 him an iodine cure, which rapidly made matters worse. Severe dyspnea, cardiac pal- 

 pitations, marked tremor, profuse sweats, and profuse watery diarrheas, the bowels 

 moving ten to twelve times daily, loss of weight about 18 kg. 



Markedly emaciated, skin moist, eye symptoms not present. Both lobes of the 

 thyroid very much enlarged, the left somewhat larger, pulsation, vascular murmurs 

 weak. Perithyroidal lymph-glands palpable. Cardiac shadows widened to 13 cm. as 

 seen on X-ray examination, shadow of the aorta increased to 6 cm., tachycardia (110-130), 

 leucocytes 8500, of which only 33.3 per cent, are neutrophiles. Slight tremor, sweats 

 (Fig. 8). 



Of the alterations in the respiratory organs should be mentioned first 

 soundlessness of the voice (Trousseau}, sensation of scratching in the throat, 

 and tormenting, irritating cough (Nothafft). The irritating cough was first 

 described by Pierre Marie; he found it in twelve of fifteen cases. This 

 symptom may be very tormenting and may start in as an early symptom. 

 It is accompanied by little or no expectoration. Murray, however, observed 

 some cases in which there existed a profuse expectoration, a veritable bron- 

 chorrhea, which he brings into analogy with the profuse watery diarrheas 

 of the patients (paroxysmal condition of excitement of the autonomous 

 nerves). Further we should mention the increase in the frequency of res- 

 piration, the superficial breathing, and the air hunger, symptoms which 

 occur paroxysmally even as early symptoms, but which often last for a long 

 time. These symptoms are closely allied with the increased need for oxy- 



