72 INTERNAL SECRETION 



epiphyses is extremely deficient, while the periosteal bone forma- 

 tion is undisturbed. But the changes are not in the skeleton only ; 

 the entire organism shows signs of arrested development. The most 

 marked of these is the infantilism of the sexual organs, in conse- 

 quence of which puberty is either very retarded, or is absent 

 altogether. Of the other organic changes, the most important is 

 the enlargement and degeneration of the hypophysis cerebri, first 

 described by Schonemann. The enlargement is easily seen in 

 life by means of skiagrams. In addition to the somatic changes, 

 there is a very marked arrestation of mental development. As 

 this shows itself in a decreased locomotion and an impaired 

 intelligence, the clinical picture presented by such thyroidless 

 children is very suggestive of that of cretinism. 



In adults, where the signs of arrested growth are absent, the 

 most conspicuous symptoms are those of nervous derangement. 

 There are fatigue and pains in the limbs, followed by pronounced 

 lethargy, and in spite of the fact that the muscular structure is 

 well developed, there is a remarkable deficiency in muscular power. 

 This is followed by a reduction in mental activity and power. 

 Of the somatic signs, the most important are the changes in the 

 skin, from which the disease myxcedema derives its name. The 

 skin is remarkably white and wax-like ; it is thickened and puffy, 

 yet at the same time dry. There is a peculiar cedematous swelling 

 which appears first in the face and afterwards in the extremities ; 

 it yields very slightly to pressure and gives a peculiar awkward- 

 ness to the body and a fixed expression to the face. The 

 circulation of the blood and the nourishment of the skin are both 

 much impaired. The coldness to the touch, and pallor of the 

 skin are objective signs, as the persistent sensation of chilliness 

 is the subjective sign, of the reduced cuticular circulation. The 

 dryness and scaling of the skin, the chronic eczema and secondary 

 pigmentation, and the blanching and loss of hair, are all signs 

 of trophic disturbance. The visible mucous membranes of the 

 tongue, the uvula and the nose, all show signs of cedematous 

 swelling. The changes in the function of the sexual organs are 

 very remarkable. In women, menorrhagia is an unfailing 

 accompaniment of athyrosis. Should pregnancy occur, as it 

 sometimes does, the signs of athyrosis will be greatly intensified. 

 Markedly cachectic men are sterile. The blood-changes consist 

 in a somewhat high degree of anaemia, a very great reduction 

 in the number of red corpuscles, accompanied by a proportionate 

 increase in the number of the leucocytes and, more especially, of 

 the mononuclear cells. 



In the absence of the thyroid gland it is possible, according 

 to Kocher, for man to live for seven years, though in a condition 

 of pronounced cachexia. Apart from the supervention of com- 

 plicating conditions, he may die as the result of the cachexia. 



Symptoms of suppression occur in 70 per cent, of the cases 



