GRAVES' DISEASE 79 



system appear disordered, exaggerated, and 

 fussily futile, and to the patient, if a woman 

 especially, the same adjectives may be applied. 

 To give a disease a name, and so to label it, is no 

 doubt for teaching purposes convenient, and 

 perhaps advantageous, but on the other hand it 

 is apt to confine our ideas and to put us off the 

 track of deeper investigation. When we talk of 

 Graves' disease we think of the great physician 

 who first described this enlargement of the thyroid. 

 When we talk of exophthalmic goitre we lay stress 

 on a prominent symptom. And yet the disease 

 may exist without either of these symptoms. 

 The cardinal signs are thyroid enlargement, 

 exophthalmos, tachycardia, and nervous tremor : 

 the first two may be absent, the last two are 

 always present. We must regard the disease as 

 one with a toxic origin, and apparently the first 

 affected organs are the endocrine glands, and 

 chiefly the thyroid and the suprarenal : through 

 these probably the great sympathetic ganglia are 

 disordered. We conclude that there is hyper- 

 thyroidism, i.e. an increased output of thyroxin, 

 because firstly we see the gland hi a state of ex- 

 citement and overgrowth, and secondly, because 

 much the same symptoms can be produced by 

 excessive thyroid feeding ; but this argument 



