390 DISEASES OF THE HEART. 



appears in persons free from both menstrual disturbance and impov- 

 erishment of the blood. Men who are affected by this malady are 

 usually somewhat advanced in life, while among women it generally 

 appears during youth. 



The patients generally have long suffered from palpitation, with a 

 remarkable frequence of the pulse, which sometimes rises as high as 

 120 or 140 beats, when the patient and his friends become aware 

 that his eyes are more prominent than formerly, and that the neck is 

 enlarged. If the hand be laid upon the thyroid gland, or the steth- 

 oscope be applied to it, a remarkable rustling is perceptible both to 

 ear and touch. Sometimes a blowing sound is also heard at the heart 

 Generally these sounds are easily recognizable as " blood-murmurs," 

 as there is no secondary dilatation, nor hypertrophy of the organ, 

 without which it is impossible to ascribe a false murmur to valvular 

 derangement. At a more aggravated stage of the malady, the prom- 

 inence of the eye-balls increases to such an extent as to render the 

 eyelids incapable of covering the eyes completely. This inability to 

 close the eyes may have the most disastrous consequences. In some 

 instances, infiltration, abscess, and perforation of the cornea, and even 

 complete destruction of the eye, have been known to follow. Such acci- 

 dents are no doubt due in a great degree to a want of proper cover- 

 ing and lubrication of the bulb, although it would seem that the 

 graver degree of destruction does not occur until after the establish- 

 ment of a certain amount of anaesthesia of the cornea (attributable to 

 strain upon the ciliary nerves), rendering the eye incapable of protect- 

 ing itself properly. Sometimes the motion of the bulb is embarrassed, 

 probably in consequence of palsy of the ocular muscles, resulting from 

 stretching ; but, excepting the affections of the cornea above alluded 

 to, there is scarcely ever any other derangement of vision. Graefe 

 speaks of a spasmodic contraction of the levatores palpebrae superioris 

 as a very characteristic symptom which sometimes precedes the exoph- 

 thalmos. It becomes recognized by the hesitating and imperfect 

 manner in which the upper-lid is depressed when the eye is made to 

 look downward. In severe cases, the pulsation of the thyroid and 

 carotids is so marked as to be apparent to the eye even at a distance. 

 Most patients complain of oppression ; some of dizziness and headache, 

 and of other irregular symptoms. 



\Becker describes a spontaneous arterial pulsation in the retina 

 as a new symptom of Basedow's disease. 



Generally the disease drags on for months and years. Instances 

 when its course has been acute and rapid are exceptional. If the 

 result is to be unfavorable, it is generally on account of a gradual 

 dilatation of the heart with diminution of its functional power. The 



