COMMENCEMENT OF ILLNESS. 417 



family where one of the members was fidgety, and gave her a 

 good deal to do. She remained in this situation for ten years. 

 About five years ago she began to lose flesh, but she grew 

 stronger again. Three years ago she went to a situation where 

 the ladies were very kind, but were often out at balls, so that 

 she was often kept up at night. AVhen she did not get sleep at 

 night, she lost it altogether ; for she never could sleep in the 

 day. About two years ago she noticed a pulsation in the epi- 

 gastrium. About that time she had a severe fall on the back of 

 the head. She was unconscious for some minutes, and did not 

 recover from its effects for several hours. About this time, also, 

 she began to notice that her stools became occasionally very 

 pale. They continued so for about five weeks at a time, and a 

 similar attack has come on every three months since. About 

 six months ago she became very thirsty, felt pain in the back, 

 and began to lose flesh. Two months ago she had diarrhoea 

 and sickness. About three weeks ago one of the ladies whom 

 she served noticed that her right eye was looking strange, and 

 asked if she had a cold in it. Before that time it was natural. 



On Admission. — The patient is very thin, There is some 

 oedema of the feet and ankles. The thyroid gland is more pro- 

 minent than usual : the right lobe is larger than the left. The 

 patient nev'er noticed the enlargement of the gland until it was 

 pointed out to her in the hospital. 



Eyes. — Both eyes somewhat prominent ; the right eye more 

 prominent than the left. [On pressure, the eyes retreat in the 

 sockets. There is very slight tenderness to pressure on the 

 right eye, more on the left. There is a brown patch on the right 

 side of the right conjunctiva. This has been there ever since 

 she remembers. On making the patient look up and down, the 

 right upper eyelid does not follow^ the movements of the eye as 

 quickly as normal ; so that on looking down, the conjunctiva is 

 exposed, forming a white ring above the cornea. The patient 

 states that she feels as if the right eyelid caught. The left eye- 

 lid moves normally. 



The pupils are normal in size. The right pupil does not act 

 quite so readily as the left. She is presbyopic, focus being 16 

 inches. She has noticed that she required to hold objects 



2 E 



