CLINICAL SYNDROMES 329 



whatever be the cause, a very considerable percentage of cases of Graves' 

 disease will reveal at some time or. another, during their course, an in- 

 crease in the systolic blood pressure. 



Vasomotor Phenomena. These are almost invariable and are best ex- 

 emplified by flushing of the face or neck, transient erythemas of the 

 upper chest, purpura, dermatographia, urticaria, pruritus, and subjective 

 feelings of heat. These will be further considered under the cutaneous 

 symptoms. Anginoid precordial pain has already been referred to. 



The Cutaneous Symptoms. The skin is strikingly pale, thin, soft 

 and satiny to the touch. It is always moist and at times bathed in a 

 profuse sweat which is always extremely annoying to the patient. The 

 sweating, which is especially marked under excitement, while usually 

 generalized, may be unilateral or even localized in its distribution. Du 

 Castel refers to a case reported by Williams with profuse sweating of 

 only the right leg below the knee. Moist hands and feet are almost 

 invariable accompaniments of hyperthyroidism. Increased perspiration 

 was present to some degree in 76 and to a marked degree in 55 patients 

 of Murray's series of 120 cases. Apart from the sweating there is always 

 a feeling of subjective warmth and a tendency to feel more comfortable 

 during the cold weather. 



Vigoroux Sign. The variation in the electrical resistance of tissues 

 was first described by Vigouroux in 1879 with an especial reference to 

 hysteria in which it was found increased. Charcot (&) in 1885 spoke of 

 the lowered resistance of the skin to the galvanic current noted in the 

 cases of Graves' disease studied in his clinic by Vigouroux. Two years 

 later Wolfenden, of England, found from a study of 25 cases of Graves' 

 disease that the electrical resistance of the skin may be very low (200 

 to 300 ohms) even in the early stage of the malady, in contrast to 

 the normal resistance (4000 to 5000 ohms) of simple goiter. In a later 

 paper Vigouroux (a) (1887) found it much reduced even in the larval 

 cases or "les formes frustes" of Graves' disease. 



The method of examination is briefly as follows. One requires a 

 constant cell battery, a resistance coil of 100 ohms, a galvanometer gradu- 

 ated in milliamperes and a pair of electrodes. One should always apply 

 the latter to the same portion of the body, namely the nape of the neck 

 and the top of the sternum. The body resistance to the passage of a 

 moderate current of fifteen volts will vary between 4000 and 5000 ohms. 



According to both Wolfenden and Vigouroux the decreased resistance 

 is not due to the increased moisture of the skin so common in exophthalmic 

 goiter, for it occurs whether or not the skin be wiped dry and dusted 

 with starch powder before the electrodes, also almost dry, be applied. It 

 is not due to errors from the variation in the size of the electrodes, or 

 in the variation in the strength of the current used, for both of these can 

 be controlled. The raison d'etre is not clear, but in Wolfenden's opinion 



