Three cases of exophthalmic goitre in which hmmorrhages from practically all the mucous membranes occurred. In the one the bleeding from the mem branes associated with huge extravasa tions of blood into the skin. She gradu ally improved, and the hemorrhages finally ceased. In a second case, also a woman, during a thirty-five days' resi dence in the hospital she had six severe attacks, and was discharged unimproved. Popoff (Neurol. Centralb., Apr. 15. 1900).
The radial pulse may feel weak and thready when the carotids are beating strongly. The dilatations are due to in fluences acting ou the affected portions of the blood-vessels, and not to general increase of blood-pressure, which does not, in fact, occur. Arterial pulsation may be seen in the fundus of the eye, but this sign, as well as tortuosity of the veins near the disk, is often looked for in vain.
Local gangrene has occasionally been noted.
(Edemas occur, sometimes due to local ized circulatory changes, sometimes to cardiac weakness, sometimes, perhaps, to a myxcedematous tendency, and some times to unknown causes. The eyelids, one or both, are prone to this oedema, and may remain affected very obstinately.
Case of Graves's disease characterized by the presence of a rather rare symp tom: cedema of the eyelids. J. Arthur Booth (Jour. of Nervous and Mental Disease, Feb., '96).
Albuminuria, which is usually transi tory, may occur and should be watched for. General cedema, not due to cardiac weakness, may be a striking feature of early stages of the disease (Mackenzie). A non-pitting cedema of the legs or of the abdominal walls may occur, suggest ting myxcedematous cedema, but not influenced by thyroid treatment.
Slight mdema limited to the legs is not an infrequent accompaniment of exophthalmic goitre. This results from cardiac weakness, and is best met by the administration of cardiac tonics; a general cedema may be one of the main features of the early stage of the disease, and is not necessarily an un favorable sign; general oedema may supervene before death. Swelling of the eyelids may be an early symptom, or it may come on after some years. Sometimes a non-pitting swelling is met with, affecting the lower extremi ties and resembling the swelling of myx cedema. This kind of swelling is, how
ever, unaffected by thyroid treatment. H. Mackenzie (Edinburgh Med. Jour., 401-410, Apr., '97).
There are but four varieties of mdema of the limbs in thyreo-exophthalmic neurosis: (Edema of cardiac origin, dys cratic cedema, cedema coincident with albuminuria (this being independent of the well-known parenchymatous or glomerular lesions of the kidneys), and (edema of vasomotor origin. (Edema of cardiac origin may be paroxysmal. In well-established cases of cedema of the legs by asystole, when the impulse of the overtaxed heart is suddenly weakened and the tension of the radial pulse is suddenly lowered, digitalis excels; it is still more excellent when the oedema fol lows definite organic alterations of the muscle, of the cardiac valves, and of the aorta; apart from that, it should be banished from the treatment of exoph thalmic goitre.
By dyscratic cedema of the limbs in exophthalmic goitre is meant that which is coincident in many cases of the disease with chlorosis, or with anmia engendered by chronic metritis, with leucorrhcea, amenorrhoea, or dysmenor rhcea, or following pregnancy, nursing, or puerperal haemorrhages; in the two sexes, following sexual abuse, diarrhoea, or protracted illness, or privations. In the form of exophthalmic goitre due to these causes, in which the pulse does not usually exceed 100 or 110, and the pulsa tile goitre and the protrusion of the eyes are but moderately developed, in which the neurosis occurs with symp toms of torpor, soft mdema of the feet and of the lower part of the legs is com mon after walking and riding, or it be comes established for several weeks in the legs without the presence of albumin in the urine or dilatation of the heart. Infusions of pure bitters, milk, rare meats, and raw meat should be recom mended at first; if this is not sufficient, arsenic should be resorted to. Odema of the limbs is not observed whenever chemical analysis reveals the presence of albumin in the urine in exophthalmic goitre. It never exists when albumin, not very abundant, however, is not observed except during the digestive period. Liegeois (Jour. des Praticiens, Aug. 7, '97).