THE SYMPATHETIC SYSTEM 85 



Finally, exophthalmic goitre can exist with a number of 

 diseases, the glandular origin of which is suspected but not 

 proved; diabetes- (severe diabetes with abundant gly- 

 cosuria), Dercum's disease, paralysis agitans, sclerodermia, 

 Raynaud's disease, osteomalacia, tetany, myasthenia, etc. 



DIAGNOSIS. 1 



1. The diagnosis of typical Basedow's disease is made; 

 when the four cardinal symptoms have been observed; 

 this is found only in this disease. If the exophthalmos is 

 very mild and if the ocular symptoms consist simply in a 

 certain fixity and peculiarity of the eye, bulbar tabes can 

 simulate the syndrome of Basedow's disease by ophthal- 

 moplegia and tachycardia. The examination of the 

 patient reveals, however, the presence of symptoms of 

 tabes foreign to Basedow's disease. A co-existence of the 

 two diseases is however possible. 



2. In mild or abortive form the diagnosis is difficult. 

 In these cases the tachycardia predominates and the 

 other symptoms are practically absent. Certain cases 

 of Basedow's disease appear clinically to simulate tuber- 

 culosis, cardiac diseases, or nervousness. 



a. Pseudo tuberculosis, because they have a dry 

 cough, a rapid pulse, diarrhea, sometimes fever and they 

 lose weight. 



b. Pseudo cardiac, because they complain of palpi- 

 tations, and they have extra cardiac murmurs. Some have 

 pain which simulates angina pectoris, others have 

 paroxysms of tachycardia and palpitation resembling 

 paroxysmal tachycardia. 



c. Pseudo nervous, because they complain of a variety 



GOETCH TEST FOR HYPERTHYROIDISM. 



1 The subcutaneous injection of % c.c. of 1-1000 adrenalin solution will cause a rise 

 of blood pressure of over 10 mm. or an increase of pulse rate of over ten beats 

 a minute 



