Relations of diseases of the eye to general diseases : forming a supplementary volume to every manual and text-book of practical medicine and ophthalmology / by Max Knies ; edited by Henry D. Noyes.

Date:
1895
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Licence: Public Domain Mark

Credit: Relations of diseases of the eye to general diseases : forming a supplementary volume to every manual and text-book of practical medicine and ophthalmology / by Max Knies ; edited by Henry D. Noyes. 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.

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    rhages, multiple neuritis, etc. These occur in chronic toxaemias in general, and always exhibit a certain predilection for the region of the cerebral muscle nuclei and nerve roots. The principal symptoms are toxic phenomena, but these are preceded for a long time by gene- ral nutritive disturbances. I desire to call special attention to one point. The poisonous action of the noxious substances produced in the thyroid gland are noticeable, in the main, in the adjacent cervi- cal sympathetic. The oculo-pupillary fibres are chiefly affected; the upper fibres which pass to the vessels of the head are affected to a much less extent. This is easily understood in view of the fact that the cur- rent in the veins and lymphatics flows toward the heart. The gene- ral symptoms are those of a chronic toxsemia, the local toxic symp toms are those of a constant, sometimes a remittent or intermittent irritation of the sympathetic at the site of closest proximity to the diseased thyroid gland. It is also easy to understand that these local symptoms may be absent or vary in intensity, if only a certain portion of the gland is affected, and that the symptoms are more pronounced, as a rule, on the side on which the gland is more involved. Hence, the earliest possible enucleation of the larger part of the diseased gland is indicated so long as the principal symptoms are still local (goitre, palpitation, exophthalmus). But as the symptoms are rarely dangerous at this period, the operation is not performed, as a rule, until the chronic general toxaemia is too far advanced. Hence, the operative treatment has remained very unsatisfactory de- spite a few good results (Rehn, Berl. kl. Woch., 1884, No. 11). [See also Mannheim: “Der Morbus Gravesii,” Berlin, 1894. Most of the authorities advise against operation; see p. 124 et seq.—Ed.] Myxoedema. In many respects myxoedema (Ord, Lond. Clin. Soc., May 25th, 1888) is the direct antithesis of Basedow’s disease. A characteristic feature is the absence of the thyroid gland (cachexia strumipriva) or loss of its function. In the latter event the gland may even be enlarged. Myxoedema is characterized by a non-oedematous general swelling of the skin (no pitting on pressure), with pallor, coldness and cyan-