DISEASES OF THE SYMPATHETIC NERVE Paralysis of the sympathetic nerve (contraction of the pupil, and of the palpebral fissure, sometimes retraction of the eye, redness and anidrosis of the affected laalf of the face), and irritation of the sympa thetic (dilatation of the pupil and of the palpebral fissure, sometimes exophthalmos, and hyperidrosis of the same half of the face) are but rarely observed in children either alone or in association with other nervous diseases. According to Oppenheim hereditary palsy and con genital weakness of the sympathetic nerve are possible. The condition may also be produced by the pressure of a tumor in the neck (thyroid gland, lymph-gland, etc.) or by operative traumatisms. The symp toms are variable and the clinical picture is the same in the child as in the adult.
Phenomena referable to lesions of the sympathetic are observed as secondary symptoms in diseases of the spinal cord and of the brachial plexus when the first dorsal root (and the eighth cervical root) which contain oculopupillary fibres passing from the spinal cord to the sym pathetic, are involved. Such a lesion produces so-called klumpke's palsy, characterized by paralysis of the small muscles of the hand and flexors of the forearm, loss of sensation in the distribution of the ulnar nerve on the one hand, and sometimes symptoms of paralysis of the sympathetic on the other hand. In palsies of the extremities due to injury of the inferior trunk of the brachial plexus, particularly in birth palsies, these oculopupillary symptoms are always present. Peters observed similar sympathetic symptoms in syphilitic pseudoparalysis, but his statements have so far not been confirmed.
Anomalies in the secretion of sweat are usually included among diseases of the sympathetic, although the pathologic connection is by no means clear.
It is well known that some persons perspire much inore freely when under the influence of heat, excitement and exertion than others, the difference being due to individual as well as familial peculiarities. The tendency to hyperidrosis may be compared to the tendency to blush, which is also very frequently hereditary. Under pathologic conditions disturbances of the sweat secretion may occur both as the symptoms of other diseases and as independent anoinaly. Usually there is hyper idrosis—which is much more common than aniclrosis or the absence of sweating—in circumscribed portions of the body surfaces.
General hyperidrosis occurs in certain neuroses (general neuras thenia, hysteria) in Basedow's disease, paralysis, in the course of epi lepsy, or as an "equivalent" of an epileptic attack. Localized hyperi drosis is seen in cerebral affections (hemiplegia), disease of the spinal corcl (poliomyelitis, syringotnyelitis, tabes), in injuries of the peripheral nervous system (nerve injuries, polyneuritis), and in diseases of the sympathetic.
Anomalies of the sweat secretion are regarded as idiopathic when no other disease of the nervous system is present and when the irritation which causes the sweating, or the localization of the secretion of sweat, or its intensity, or any or all of these factors are abnormal.
Localized eruptions of sweat in spots or involving one half of the face are frequently observed in children during the act of chewing acid, highly seasoned, or even normal food. The mere sight of such food may call forth the secretion. The corresponding part of the face becomes red, and perspiration appears in large drops on the surface of the skin. It appears that sometimes no more than a violent hyperamlia is proclueed. The latter phenomena, like most idiopathic anomalies of the sweat secretion, may be observed in several members of the same family-. Both the exciting stimulus and tile localization of the secretion are abnormal.
Another anomaly of the sweat secretion consists in so-called para doxical sweating. The subjects of this anomaly perspire under condi tions which ordinarily inhibit perspiration, such as cold, while heat arrests the secretion; hence in these cases the stimulus is abnormal. The localization of the sweat secretion may also be abnormal. In these cases of paradoxical sweating, certain portions of the body only be gin to sweat under the influence of cold, and in some cases perspiration appears only in parts of the body which generally are not prone to perspire, while the areas where sweating is normally most profuse, such as the palms of the hand, remain dry.
In another group of hyperidrosis we have so-called acrohyperi drosis, a condition in which, after a very slight psychic impression the tip of the nose, the forehead, and the hands or feet may break out in perspiration; in this condition both the stimulus and the degree of reaction must be regarded as abnormal.
Finally there is an anomaly which consists in unilateral layperi drosis occurring under the influence of heat, the warmth of the bed, or emotion. While the stimulus that produces perspiration is normal in this condition, the localization of the sweat secretion is abnormal.
With few exceptions these anomalies of the sweat secretion are permanent conditions: they are often very troublesome but do not materially affect the general health, although many of them may ser iously interfere with the subject's occupation and his social life. These forms of hyperidrosis may- be regarded as sudoral reflex neuroses, and it may be assumed that the reflex centres are situated in the spinal cord. The presence of sweat centres in the spinal cord has been definitely established.
The pathology sn-eat secretion both in the child and in the adult is in need of further study.