Exophthalmic goitre : its etiology, symptoms and treatment / by Casey A. Wood.

  • Wood, Casey A. (Casey Albert), 1856-1942.
Date:
[1901]
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Licence: In copyright

Credit: Exophthalmic goitre : its etiology, symptoms and treatment / by Casey A. Wood. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    symptoms of the disease. Our forefathers regarded it as a result of the exophthahnus. We know, on the contrary, that the prop- tosis seems more pronounced on account of the wide open Hds. Continual palpebral retraction to an extent that exposes the white sclera between lid edg-es and cornea, above and below, is practically always a sign of disease. It is almost invariably a symptom of Basedow's disease, although the staring eye or glotzauge, as our German friends call it, is occasionally seen in certain forms of mania, in tetanus, in hysteria and other afTec- tions. Infrequent ivinking is also an important and constant sign of exophthalmic goitre. This is known as Stellwag's sign, although most authorities persist in confounding or including with it the sign of Dalrymple. The truth is, so far as I have been able to trace it, that in 1869, Stellvvag first described the sign that bears his name and drew attention to the retraction of the lids as the most noticeable cause of the glotzauge. But Dalrymple, had years before {London Lancet, May 26, 1849,) published a definite description of this same phenomenon. Graefes sign is a most valuable one. It occurs early, is quite constant, and although it may be present in Thomsen's disease and sometimes fails altogether, it should always be searched for in doubtful cases. It consists in an impairment of the consen- sual movements of the upper lid in association with the eyeball. In a normal eye, when the globe is rotated downward, the upper lid-edge follows it, covers a portion of the upper cornea and preserves about the same distance from the sclero-corneal junc- tion throughout the whole excursion. Much of this diagnostic value, which is great, depends its mode of application. It is better to cover one eye and ask the patient, with his head in the primary position and at ease, to fix the point of a pencil held eighteen inches from his face and on a level with the forehead. The pencil end is now slowly lowered, the head all the while in the primary position, and the pencil kept eighteen inches from the body, until it reaches a point opposite the ensiform cartilage. In exophthalmic goitre the upper lid, during this excursion, will be noticed to lag behind and even to expose a zone of white sclera between it and the cornea. Insufficiency of convergence, or the sign of Mobius, depends upon the fact that the stretched internal recti muscles are unable to move the bulging eyes inward to the same extent and with the same facility that they can normally situated globes. It is