DISOKDERS IN RELATION TO 'THE EYE 789 



almost solid consistency, and progressed when the other symptoms of hyper- 

 thyroidism had been brought to a standstill. Removal of fat tissue of 

 the orbit has been found necessary in order to allow reduction of exoph- 

 thalmos and protective covering of the unduly exposed cornea by tar- 

 sorrhaphy. 



Hyperthyroidism. In a number of cases of hyperthyroidism Suker has 

 described a condition of deficient complementary fixation in lateral eye 

 rotation caused by dissociation of the sympathetic and oculomotor branches 

 to the extrinsic eye muscles after extreme abduction. The clinical mani- 

 festation consists in insufficiency of convergence or actual divergence of 

 the ocular axes on attempting to fix an object in the median plane at short 

 range, after extreme associated abduction to either side for even a brief 

 period. 



Optic atrophy, choked disc, and optic neuritis have been noted in 

 Graves' disease and after the experimental administration of thyroid ex- 

 tract to dogs, or its therapeutic use in myxedema and obesity in women. 



Hypothyroidism. Within the physiological limits we can imagine a 

 mild hypothyroidism which depends on a temporary overstimulatlon of 

 the gland or too great a demand on the hormone reserve. Such a relative 

 hypothyroidism might be expressed, in the sphere of immunity, by a sim- 

 ilarly temporary and passing tendency to infection, particularly to colds; 

 in the sphere of neurology, say, by a headache or by pain in the back ; in 

 the digestive sphere, by sudden loss of appetite or by sour stomach or 

 cramp; manifestations largely vagotonic. In connection with these sug- 

 gestions we must consider such actual observation of acute attacks of 

 gout, of gall-stones, and of renal colic after a sudden fit of anger or other 

 emotion, the sudden onset or. recrudescence of arthritis, lumbago, or 

 sciatica, after exposure to cold, a sleepless night, or exhaustion from over- 

 exertion. The thyroid reserve, as is well known, is depleted by various 

 factors such as repeated infections, emotional stress, and possibly by 

 certain drugs. 



Physiologically this drain is soon made good automatically by the or- 

 ganism itself. It appears that passive as well as active exercise, heat, 

 radiant energy, notably sunlight, aid in restoring the thyroid hormone 

 reserve, and that certain drugs, notably belladonna, iodin, and the' alka- 

 lines are valuable adjuvants. 



Hypothyroidism of a more decided and lasting character is noted as 

 a result of repeated functional disturbances, or organic changes in the thy- 

 roid as a result of disease, or possibly by marked overaction of antago- 

 nistic glands of internal secretion. 



The most marked and pathological forms are, however, found in those 

 conditions in which, as a result of operative removal or of grave disease, 

 congenital or acquired, the hormone action of the thyroid was completely 



