THE SYMPATHETIC SYSTEM 79 



5. Moebius' Sign The eyes converge with difficulty, 

 due to paresis of the internal recti. 



6. Jellenick's Sign. Abnormal pigmentation of the 

 eyelids and of the skin of the orbit. 



4. TREMOR. The last of the important diagnostic 

 signs. It may be localized to the legs or generalized with 

 predominance of the hands and head. 



The following are its characteristics: 1. Fine tremor 

 of small amplitude. 2. Mixed tremor both spontaneous 

 and intentional, not modified by the will. 3. Tremor 

 increasing in intensity after fatigue and excitement. 



The tremor can be brought out in the following manner : 

 1. At the level of the head by a piece of paper on the 

 top of the head. 



2. Of the superior limbs by having the patient raise his 

 hand as if taking an oath; the tremor does not stay local- 

 ized to the fingers as do alcoholic tremors, but involves the 

 hand, the muscles of the forearm and even in some cases 

 the arm. 



3. At the level of the thorax, by placing a hand on each 

 shoulder a continuous vibration may be elicited. 



4. Of the inferior limbs, the patient sitting down, with 

 his feet resting, moves the tips of his toes (P. Marie). 



To these functional signs are added other symptoms 

 which have not the same constancy or the same clinical 

 value. The majority are indicative of a secretory dis- 

 turbance of the thyroid or of some other gland of internal 

 secretion. They vary with each patient and affect dif- 

 ferent systems. 



1. NERVOUS DISTURBANCES. 



a. Disturbances in motility. These consist of muscu- 

 lar cramps, particularly in the calves of the legs, contrac- 

 tures and even epileptiform attacks. 



