THE SYMPATHETIC SYSTEM 133 



The diagnostic value of this sign has been contested by 

 L. Bernard and by Massary, who considers it as a vaso 

 motor phenomenon, which may appear in a variety of 

 conditions. It is possible that when found alone the white 

 line is simply a nervous disturbance, showing itself by a 

 vaso motor instability. Furthermore, the white line does 

 not exist in all cases of hypotension. According to 

 Castaigne it shows a vascular collapse, a decrease of the 

 angiotonic function, while hypotension indicates insuffi- 

 ciency of the cardio tonic function. When this white line 

 is found associated with hypotension and a certain degree 

 of asthenia, then it has a real diagnostic value. 



To these three main diagnostic signs are added other 

 clinical manifestations : 



1. CIRCULATORY CHANGES. Closely related to hypo- 

 tension. Some are subjective; the patient complains of 

 palpitations and precordial pain; the slightest effort may 

 be followed by syncope. The others are objective; the 

 pulse is small, often rapid, weak, easily compressed and 

 very unstable; the heart is accelerated. The slightest 

 fatigue is susceptible of causing an attack of tachycardia 

 with arythmia. 



2. DIGESTIVE DISTURBANCES. They are nearly always 

 constant. Anorexia is the rule, at first in the morning 

 and resembles that of alcoholics. Later it may come 

 on at any time after the ingestion of food. Sometimes 

 it is incoercible, particularly in children, and prevents 

 all ingestion of food. Constipation is the rule in 

 the slowly evoluting cases; in the acute forms there is a 

 diarrhea. It is associated with abdominal pains and 

 together with vomiting simulates poisoning. 



3. THE PAINS. These are usually localized either in 

 the lumbar region, or the epigastrium, or the hypochon- 



