424 CASES OF EXOPHTHALMIC GOITEE 



of it, however, Claude Bernard lias found that protrusion of the 

 eyeball may be produced by irritating the branches connecting 

 the first and second dorsal ganglia with the spinal cord. 



Impaired Movement of the Eyelid. — The loss of consensus 

 between the movement of the eyeballs and the upper eyelid is 

 ascribed by Yon Griife to disturbed innervation of the lids, and 

 especially of the levator of the upper eyelid, which is partly 

 supplied by the sympathetic. 



Biahetes. — The diabetes in this case can hardly be due to 

 imperfect destruction of sugar in the body, as the temperature 

 was higher than normal. It must therefore be due to increased 

 formation. Increased formation depends, according to Bernard, 

 on dilatation of the hepatic vessels, and a quicker flow of blood 

 through the liver. According to Cyon, the vaso-motor nerves of 

 the liver pass from the vaso-motor centre in the medulla 

 through the cervical part of the spinal cord, pass out from it, 

 and proceed along the vertebral artery to the third cervical 

 ganglion, thence to the first dorsal, and along the gangliated 

 •cord and splanchnics to the liver. (See figure.) Division of 

 this nervous path causes the vessels to dilate, and produces 

 diabetes ; but it would appear that irritation of the cervical 

 ganglia, or at least of the first or the third, also causes diabetes, 

 which does not depend on paralysis, but on reflex inhibition of 

 the vascular nerves of the hepatic vessels. 



Patliology of Exoijlithcdmic Goitre. — All the symptoms seem 

 to point to an affection of the cervical sympathetic, and post- 

 mortem examination of a case by Peter showed that the lower 

 cervical ganglia, especially the right one, were thicker and 

 redder than normal ; that the connective tissue was increased, 

 as well as nuclei and spindle-shaped cells, while there were 

 very few ganglion cells. It seems, therefore, that the third 

 cervical ganglion, may be looked on as the seat of the disease. 

 So long as we know so little of the pathology, it is impossible 

 to treat the disease scientifically ; but the treatment which 

 seems in practice to have given the best results is the use of 

 digitalis and veratria, and Meyer states that he has obtained 

 great benefit from the application of galvanism to the neck. A 

 weak ascending current was passed through both sympathetics ; 



