334 ENDOCRINE GLANDS 



relationship of the sympathetic with the top of the pleura 

 and the mediastinal glands. We must remember that the 

 inferior cervical ganglion and the first thoracic ganglion, 

 whose rami communicantes contain the pupilo dilator 

 fibres, are in direct contact with the apex of the lung. 



Depending on whether the lesion affects a part, or all 

 the nerve branches, we notice simple inequality of the 

 pupil, inequality of the pupils associated with vaso-motor 

 changes, or the complete oculo pupillary syndrome. 



In apical pleurisy (Sergent), mydriasis characterizes the 

 first stage of pleural irritation and myosis the more exten- 

 sive involvement. 



Fibrous tuberculosis, inflammations of the superior 

 portion of the mediastinum (tuberculous or syphilitic), 

 are always accompanied by a hylum adenopathy. This 

 affects and then destroys the rami communicantes and 

 the sympathetic trunk, whence the appearance of vaso- 

 motor disturbances. When the inflammation, spreading 

 upwards, reaches the pupilo dilator fibres, their irritation 

 results in a pupillary dilatation. 



IV. FACIAL HEMIATROPHY. 



The facial trophic neurosis of Romberg is characterized 

 by the appearance of discolored spots on the face, a thin- 

 ning of the skin which becomes dry, scaly with an atrophy 

 of the adipose, and muscular tissue and even of the 

 skeleton. It can be caused by a lesion of the sympathetic, 

 or of the ganglia or of one of the centres. Its occurrence, 

 during the course of syringomyelia, is considered by 

 Dejerine and Mirallie to be due to a destruction of sympa- 

 thetic fibres in the cervical cord. L. Jacquet has observed 

 it during the course of a pleuro pulmonary tuberculosis, 

 affecting the inferior cervical ganglion. The co-existence 

 of the facial hemiatrophy, with oculo pupillary disturb- 





