THE SYMPATHETIC SYSTEM 83 



tuberculosis are reduced to skeletons. Some become 

 cachectic in a few weeks without diarrhea and die 

 of marasmus. 



3. CARDIAC DISTURBANCES. Certain cases of exoph- 

 thalmic goitre have a marked paroxysmal tachycardia. 

 Others, as a result of fatigue, have an acute dilatation of 

 the heart, an extreme dyspnea and die of asphyxia. In 

 others, cardiac insufficiency develops slowly: edema, 

 oliguria, and albuminuria and symptoms of dilatation of 

 the right heart with foci of pulmonary apoplexy showing 

 the typical picture of progressive asystole. This has 

 usually a valvular lesion as a starting point, resulting 

 from a previous attack of rheumatism (Barie). 



CLINICAL FORMS. 



Exophthalmic goitre shows certain peculiarities. 



1. IN CHILDREN. The condition can be hereditary or 

 familial. It is mostly found in girls. The symptoms 

 are mild; the goitre is not very big; the exophthalmos 

 not very pronounced or absent; the tremor less marked 

 and sometimes resembles chorea. A cure is possible, but a 

 recurrence must be watched for when the patient grows up. 



2. IN MAN. When Basedow's disease occurs in man, 

 the nervous symptoms and in particular the psychic 

 symptoms are very marked and appear long before any 

 of the important diagnostic signs. The evolution is more 

 rapid and the prognosis is bad (Pic and Bonnamour). 



3. IN PREGNANT WOMEN. Pregnancy is rare in this 

 condition, as exophthalmic goitre is often accompanied 

 with atrophy or insufficiency of the ovary. 



Some cases, however, are able to have several pregnancies 

 without any trouble. Furthermore, it may be a cause for 

 improvement. In other cases, however, pregnancy 

 occurring during the course of Basedow's disease has very 



