BASEDOW S DISEASE 59 



above the normal, while slight psychic emotions or physical movements 

 send it up unusually high. Moreover, there exist increased strength of 

 the heart action and cardiac palpitation. The patients feel the heart beat 

 "up to the throat." The cardiac impulse is then increased and broadened, 

 and the thoracic wall is strongly agitated. Very often broadening of the 

 cardiac dullness occurs, depending more commonly on cardiac dilatation 

 than on hypertrophy. Frequently there are accidental systolic murmurs. 

 All manifestations on the part of the heart show great variations that 

 parallel the remainder of the manifestations of the course of the disease. 



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&&& ^^^', l ^\:'g : . *:&'"" .m, .-.-;' 



..vv.^r'r-'^-;' ; i..' : v?^.v. .';....-.* O 1 ; " 



FIG. 5. Basedow struma. 



In the fully developed form of the disease the arteries of the gland often 

 pulsate very strongly, a phenomenon that gives these cases their own char- 

 acteristic feature. Especial cases may even go as far as a penetrating ve- 

 nous pulse in the thyroid gland or to a pulsatory shaking of the head (Mussel's 

 sign) or to choroid pulse (Becker). Also there have been observed marked 

 beating of the abdominal aorta, hepatic pulsation, and splenic pulsation 

 (C. Gerhardt). In opposition to increased heart action and the stormy pulsa- 

 tion in the neck, the radial pulse is often small and weak and the blood- 

 pressure not raised or even slightly diminished (Spietkojf, Donath}. Height- 

 ening of the blood-pressure is relatively rare. There occurs then an abnor- 



