Clinical notes on Graves' disease / by Professor Grainger Stewart and G.A. Gibson.

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes on Graves' disease / by Professor Grainger Stewart and G.A. Gibson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    In the male sex, Trousseau, as we mentioned, has observed some interference with the generative functions, and a serious state of affairs of this kind has been disclosed in connection with a case previously referred to. Anaemia and failure of nervous energy incident to the disease probably afford the explanation of these symptoms. The nervous system manifests symptoms which are multi- farious and characteristic. A great liability to considerable fluctuations of temperature may be said to be eminently significant. In many cases a slight local hyperfemia is quite sufficient to induce high degrees of temperature, and not infrequently we have seen pronounced oscillations of the temperature curve without any ascertainable local cause. Among sensory phenomena subjective symptoms are com- mon ; and these are not confined to the ordinary sensibility, for the special are involved as well as the ordinary sense- paths. Galezowski has described subjective luminous pheno- mena, and in several of our cases subjective auditory symptoms have been remarked. The ordinary as well as the special sensibility is, when tested, found to be increased, and hyper- sesthesia is as universal in the sensory as tremor in the motor nervous mechanism. The protrusion of the ocular globes is almost always bilateral; but it is extremely common to find one eye more prominent than the other. Occasionally the exophthalmos is confined to one side entirely. It is in rare cases alto- gether wanting, as in 4 out of 58 referred to by von Dusch. Changes in the nutrition of the eyeball are rare; but inflammation and ulceration of the conjunctiva and cornea have been described by Basedow and subsequent authors. The pupil is said, as a rule, to show no marked departure from the ordinary condition; but some observers, as Geigel and Friedreich, have noticed changes mostly in the direction of dilatation. By von Graefe this was not seen once in two hundred cases. We cannot understand how this can have been, for our own experience leads us to believe that dilatation is by no means uncommon.