Text-book of nervous diseases for physicians and students / by H. Oppenheim.
- Date:
- 1911
Licence: In copyright
Credit: Text-book of nervous diseases for physicians and students / by H. Oppenheim. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
1403/1480 page 1351
![The symptoms produced by a goitre pressing upon the sympathetic rule, unilateral. Attacks of breathlessness, hoarseness, dysphagia, dilatation of the pupils, etc., are also notable signs. It is not unusual for symptoms of exophthalmic goitre to supervene upon an old goitre (Mobius). Marie, indeed, would distinguish between the goitre Basedowifien and true exophthalmic goitre. Mikulicz and Reinbacli ^ also adopt this point of view ; they speak of the spontaneous th3^roidism of the goitre, and include slight tachycardia, tremor, vertigo, excitability, etc. As these symptoms form only a part of the symptoms of exophthalmic goitre, the condition cannot be regarded as being due to alteration in the thyroid gland. So-called goiirous-heart has been recently carefully studied by Minnich ( Das Kropfherz, etc., Leipzig, 1904) and Kraus ( Kongr. f. innere Med., 1906 ; D. m. W., 1906). Kraus dis- tinguishes two forms : 1. the cardiopathies caused by mechanical action of the goitre upon the nerves, trachea, and suijerior vena cava ; 2. the goitrous-heart, in the narrow sense of the word, which is caused by toxins arising from the thyroid. The relation of this condition to ex- ophthalmic goitre will be more fully discussed. I have seen a few cases in which I could not diagnose between exoph- thalmic goitre or goitre with symptoms of compression. The combina- tion of a simple goitre with nervous tachycardia may also confuse the diagnosis. Acute iodism may produce a syndrome allied to that of exophthalmic goitre. Breuer ^ has collected a number of cases in which treatment of goitre by iodine has given rise to the symptoms of Basedow's disease. Mobius ^ describes an enigmatical glandular disease, some of the symptoms of which correspond to exophthalmic goitre, but instead of the goitre there is swelling of glands. The disease runs a fatal course. The glands may, however, become swollen in exophthalmic goitre. Pathological Anatomy.—Nature of the Disease.—Examination of the nervous system has led to no uniform result. A case of Dinkier's, in which degenerative lesions were found in the brain, and changes in the roots of the cranial nerves were shown by the Marchi method, is too com- plicated to indicate the nature of the disease. Haemorrhages, softenings, and inflammations have been occasionally found (Naumann, Johnstone, Lamy, Gibson, Grainger Stewart, H. White, Klien*; the latter has col- lected the results), but in some cases the pathological character of the changes is doubtful; in others there were complications, and in the rest it was doubtful whether the changes represented the cause of the syndrome ; they were much more probably of a secondarj^ nature, and due to the poison of the disease (Klien). Degenerative changes have often been found in the sympathetic, but these are inconstant and not of real import- ance. Ehrich,^ who examined a sympathetic removed during life, found fatty infiltration of the ganglion cells, increase of the connective tissue between the cells, etc.; he regards these as secondary changes caused by the disturbance of circulation. Examination of the thyroid (Renaut, Soupault, etc.) showed cirrhotic processes, hyperplasia and obliteration of the lymph-spaces. Hanau-Haenig and Ehrich describe diffuse paren- chymatous hyperplasia with great structural changes of the cells and disappearance of the colloid. Ehrich also emphasises the great amount of blood and the dilatation of the vessels. Similar changes were found in 1 Mitt, cms d. Grenzgeb., vi. ^ j^i ]y^ iqqo. s j/. ^. iy_^ 1905. * Z. f. N., XXV. ■'' Beitr. z. klin. Chir., Bd. xxviii.](https://iiif.wellcomecollection.org/image/b21981590_1403.jp2/full/800%2C/0/default.jpg)
