330 ENDOCRINE GLANDS 



in 1858 and observed clinically by Homer in 1869). It is 

 characterized by the following symptoms : 



1. Slight non-paralytic ptosis, due to a narrowing of 

 the palpebral fissure. 



2. Myosis with integrity of the pupillary reflexes. 



3 . Enophthalmos . 



4. Muscular hypotonia. 



5. Vaso-motor disturbances (erythema), thermic dis- 

 turbances (excess of heat), secretory disturbances (sweats) 

 and trophic disturbances of the face and the arm on the 

 same side. Andre Thomas has shown recently in wounds 

 of the cervical sympathetic a weakening of the vascular 

 tone at the level of the corresponding upper extremity, 

 for instance the vaso-motor reactions during a hot bath are 

 less pronounced on the affected than on the healthy side. 

 Oelsnitz and Cornil have made similar reports by means of 

 the study of the oscillary amplitude with the apparatus 

 of Pachon. 



ETIOLOGY. 



These two syndromes of stimulation or paralysis can be 

 caused by lesions of the cervical sympathetic at various 

 levels. We can consider, from an anatomical point of 

 view, a bulbar centre and a medullary centre (cilio-spinal 

 centre of Budge), localized in the column of Clarke in 

 the first segment of the dorsal spinal cord. The nerve 

 fibres starting from the cord by the rami communicantes 

 of the anterior roots of the first dorsal pairs, reach the 

 cervical sympathetic by means of the subclavian loop. 



(a) LESION OF THE BULBAR CENTRES. These cause: 

 either a typical Claude Bernard syndrome or an alternate 

 bulbar paralysis, characterized by a crossed hemiplegia 

 with hemianesthesia, and the syndrome of Claude 

 Bernard with hemiasynergy and lateropulsion on the 

 side of the lesion (syndrome of Babinski-Nageotte). 



