116 The Unity of the Organism 



torpid, sometimes rigid, often exhibiting muscular tremors, 

 and are incapable of carrying out any delicate manual acts 

 of precision. At first the swelling is variable ; it is more 

 pronounced in the morning than in the evening, but steadily 

 increases until it becomes permanent. It is not ordinary 

 cedema, in which percussion with the fingers leaves a depres- 

 sion ; it Js a hard and elastic swelling. It is specially local- 

 ized in the hands, feet and face, where it produces a char- 

 acteristic alteration of the countenance. The lower eyelids 

 are the first to present a sacculated, semi-transparent swell- 

 ing, which is hard to the touch ; then the infiltration spreads 

 to the folds of the face, w r hich become smoothed out ; to the 

 nose, which gets rounded ; to the lips which swell, and 

 bulge outward, saliva dribbling from them. The features 

 are coarsened and expressionless like those of a cretin. 



"The mental functions accord with this appearance, since 

 they are blunted, so that the patients lose their memory, 

 become deaf, taciturn, melancholy, self-absorbed, and reply 

 extremely slowly to questions. They further complain of 

 slight but perpetual headache ; feel an almost constant sen- 

 sation of cold, which is most acute at the extremities ; at 

 times they are seized with vertigo, and may even lose con- 

 sciousness. 



"All the symptoms become still further aggravated. The 

 whole body may grow more bulky from the extension of the 

 swelling. The skin loses its elasticity, can only be picked 

 up in large folds, and becomes dry owing to defective 

 capacity for sweating. The epidermis desquamates in more 

 or less extensive lamellae, particularly on the hands and feet ; 

 the hair turns grey, falls out, and gets constantly thinner. 



"The heart functions weakly, but with ordinary rhythm ; 

 the pulse is small and thready. Examination of the blood 

 shows nothing constant ; but there is often a more or less 

 pronounced and progressive oligocythaemia, which undoubt- 

 edly contributes to the characteristic pallor of the skin, 



