THE THYROID APPARATUS 93 



followed by various symptoms of derangement, such as a sensation 

 of heat, increased perspiration, palpitation and, sometimes, by 

 glycosuria. The most remarkable are those cases where toxic 

 symptoms appear after a single large dose or the prolonged 

 administration of moderate doses. In isolated instances a single 

 large dose has failed to produce any evil effects ; such is the case 

 of a child of n, who swallowed 100 tabloids of 0.3 grm. each. 

 But Boinet and Ferranini found that the prolonged administration 

 of six to eight tabloids a day provoked serious symptoms of 

 intolerance. Conditions of psychic exaltation, sleeplessness, 

 violent trembling, extreme emaciation and anaemia, digestive dis- 

 turbances, extremely unpleasant subjective sensations, deranged 

 cardiac activity, and tachycardia, are all described as symptoms 

 of thyroid intolerance, v. Notthaft describes a case of artificially 

 produced Graves's disease. A man, aged 43, suffering from 

 obesity, who took nearly 1,000 thyroid tabloids in five weeks, 

 presented all the symptoms of true Graves's disease ; these 

 gradually disappeared, however, after the thyroid was suspended. 

 These cases suffice to show the enormous influence which the 

 thyroid substances exercise upon the organism. It is obvious that 

 their employment as therapeutic agents must be in rigid conformity 

 to the clinical indications, the pathological conditions, and the 

 idiosyncrasy of the subject. 



CONDITIONS WHICH MAY BE CLASSED AS THOSE 

 OF TRUE HYPERTHYROIDISM. 



Of the pathological conditions arising from a disturbance of 

 function of the thyroid gland, the most important is undoubtedly 

 Graves's disease or exophthalmic goitre. Karl v. Basedow, in 

 1840, first pointed out that the combination of exophthalmos, 

 goitre and tachycardia constituted the syndrome of a definite 

 clinical condition. To these three, other more or less characteristic 

 secondary symptoms have from time to time been added, and the 

 clinical definition of Graves's disease is now made to include the 

 so-called forme fruste and the condition lately described by Stern 

 as " Basedowoid." 



The nature of Graves's disease has formed the subject of 

 various conflicting hypotheses. The older neurogenic theory, 

 which regarded the condition as an affection either of the sym- 

 pathetic (more particularly the vago-sympathetic) nerve or of the 

 medulla, was based upon inconclusive experiments and isolated 

 and contradictory post-mortem findings. The thyrogenic theory, 

 as first propounded by Gautier and ably confirmed by Mobius, 

 produced a revolution in the point of view regarding the patho- 

 genesis of this condition, though individual authors still continued 

 to support the bulbar theory. Tedeski, for instance (1902), be* 



