THE SYMPATHETIC SYSTEM 325 



diarrhea, gastro intestinal crisis, simulating tabes, etc., or 

 to stimulation of the sympathetic; tachycardia, tremor, 

 cutaneous pigmentation, glycosuria, etc. 



We must remember that Basedow's disease can be 

 present without any goitre. This can only be explained 

 by the irritation of the cervical sympathetic for, experi- 

 mentally, the stimulation of this nerve causes a vaso-con- 

 striction of the body of the thyroid. 



The research work undertaken by the Vienna school and 

 that at Sainton, in France, permits us to distinguish two 

 types of Basedow's disease. 



Some are vagotonic. They have only a slight tachy- 

 cardia, but intense subjective cardiac disturbances. Von 

 Graefe's sign is very pronounced (a spasmotic retraction 

 of the upper eyelid). On the contrary, Moebius's sign is 

 absent. There is only a slight exopthalmos. There 

 is considerable perspiration, a gastric hyperacidity, a pro- 

 fuse diarrhea, disturbances in the cardiac rhythm and the 

 absence of an alimentary glycosuria. These patients have 

 an exaggerated oculo-cardiac reflex and react violently to 

 pilocarpin. The others are sympathicotonic. As op- 

 posed to the last type, they have a tachycardia. Van 

 Graefe's sign is absent, Moebius's sign is present and exo- 

 phthalmos is very pronounced. The lacrymal secretions 

 are weak, the skin dry and alimentary glycosuria is often 

 positive. These patients have an absent or reversed 

 oculo-cardiac reflex and react severely to adrenalin. 



The exclusively vagotonic or sympathicotonic type is 

 very rare; in the majority of cases the patients suffering 

 from Basedow's disease show evidence of irritability of the 

 two systems. (Sainton, Laignel-Lavastine) . 



Clinically the syndrome of Basedow's disease appears as 

 an endocrine-sympathetic syndrome, for we have syn- 

 dromes of Basedow's disease of thyroid origin; the toxic 



