Nervous and mental diseases . em is affected. This is most manifest inthe aortic branches, especially in the cervical arteries, and is seen in thetemporal and retinal arteries and veins. It is less well marked in theextremities, but Gerhardt ^ has noted it in the palmar arches and in thecrurals. He also calls attention to the presence of capillary pulsationin the spleen and liver and kidneys. In cases of long standing, vasculardilatation is produced and the veins themselves become fibrous andarterialized. The blood shows mainly the alterations of a simple anemia,but without increase of the tot
Nervous and mental diseases . em is affected. This is most manifest inthe aortic branches, especially in the cervical arteries, and is seen in thetemporal and retinal arteries and veins. It is less well marked in theextremities, but Gerhardt ^ has noted it in the palmar arches and in thecrurals. He also calls attention to the presence of capillary pulsationin the spleen and liver and kidneys. In cases of long standing, vasculardilatation is produced and the veins themselves become fibrous andarterialized. The blood shows mainly the alterations of a simple anemia,but without increase of the total number of white cells the lymphocytesfrequently are increased even to 60 or 70 per cent., and 30 per cent, isvery common (Kocher). The goiter may appear at any period of the disease or may. neverdevelop. In some instances it is of insidious growth, and the patientsattention is only incidentally called to it by tightness of the ordinary 1 *Riv. crit. di Clin. Med., Jan. 2, 1902. 2 * Centralblatt f. Chirurgie, Sept. 5, 532 NEUROSES. neckwear. In other instances it is of sndden development, or may ad-vance in size at intervals, or advance and recede repeatedly. In anycase it rarely attains very large proportions, and practically never inter«feres mechanically with respiration. It is nsually asymmetrical, the rightlobe commonly being most aifected. The swelling may be confined toone lobe, usually the right, or it may involve the isthmus alone. Thetumor usually otfers considerable resistance to palpation, and a pulsatilethrill is frequently to be detected. In some instances nodules, indic-ative of parenchymatous cllaugesj can be made out. Auscultation overthe enlarged thyroid readily detects in most cases abrait synchronous with the pulse, and the tumor canoften be seen to expand with every systolic manual compression it may often be greatly re-duced in size for the moment, and it has a tendencyto fluctuate in volume during the progress of the dis-ease, increas
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