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JAMA. 1904;XLII(5):291-294. doi:10.1001/jama.1904.92490500011001c.
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The departure from the normal in the cervical sympathetic may be classed under two heads, namely, irritation and paralysis.

1. The symptoms of irritation are: (a) mydriasis, due to spasm of the dilator pupillæ; (b) exophthalmus, said to be due to contraction of the smooth muscular fibers of the orbit (Müller's); (c) widening of the palpebral fissure by tonic contraction of Müller's muscle; (d) contraction of the walls of the vessels of the head, face and neck, including pallor of the skin, frequently with an increase in the amount of perspiration; (e) acceleration of the heart beat.

According to Nicati,1 paralysis of the cervical sympathetic may be divided into two stages:

First Stage.  —(a) Contraction of the pupil, (b) narrowing of the palpebral fissure (ptosis), (c) decrease of the tension of the globe, (d) increased lachrymation, (e) injection of the ocular conjunctiva, and, in many cases, (f) slight exophthalmus.


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