416 CASES OF EXOPHTHALMIC GOItEE. 



has been no return of the fits ; but the mother says that she 

 thinks one is now coming on, as she sees premonitory symp- 

 toms. 



Ordered — Potass, bromid, gr. xxr. ; spt. chloroform, nx xx. ; aquoe, 5 i. : ter 

 die sum. 



The next one was admitted into Mary "Ward, under the care 

 of Dr. Andrew, in June last. It is a most interesting case, 

 presenting in a typical manner most of tlie symptoms of exoph- 

 thalmic goitre, although neither the enlargement of the thyroid 

 nor the protrusion of the eyeballs is present to any great extent. 

 It is also remarkable in being complicated by diabetes, a dis- 

 ease which has been shown by the researches of Cyon, Eckhard, 

 Pavy, and others to be closely associated with the thii-d cervical 

 ganglion, and the nerves passing tlirough it ; the very part, in- 

 deed, to which the nervous disturbances in exophthalmic goitre 

 have already been attributed. 



Dr. Andrew has not only kindly placed this case at my dis- 

 posal for publication, but has afforded me every assistance and 

 facility for observing it myself. I have also to acknowledge my 

 obligations to Dr. Andrew's house-physician, Mr. Strugnell, to 

 whom I owe the observations with the ophthalmoscope, and to 

 Mr. Wharry, to whom I am indebted for the analysis of urea. 

 In recording the case here, I have inserted some observations 

 which were made some time after the patient's admission : e.g., 

 the ophthalmoscopic observations, which were made about the 

 end of August. Most of these, however, I have distinguished 

 by brackets from those made at the time of admission. 



S. P., aged 43, lady's maid. Patient is of the middle height, 

 and very thin and nervous-looking. Hair thin. 



History. — Her mother's family is very rheumatic, but they 

 are all long-lived. Father's family not so rheumatic, and they 

 live generally above middle age. There are none of either 

 family who have suffered from fits, nor is there any history of 

 either diabetes or phthisis. When 17 years of age, she had 

 rheumatic fever. At the age of 25 she became a lady's maid. • 

 About 10 years ago she had some family trouble, and some 

 more five or six years ago. About 13 years ago she went to a 



