ARTICLES 245 



picture is presented at whatever age the cretin may live to 

 be. On feeding with thyroid substance, development may be 

 induced to proceed normally, and the quiescence of months 

 or even years rectified in a short space of time. The treat- 

 ment, however, must be continued throughout life. Some 

 cretins are known to exhibit nervous symptoms collectively 

 described as " tetany." These cases McGarrison (1908) attri- 

 butes to involvement of the parathyroids. He showed that 

 cretinism may result from deficient thyroid secretion in the 

 mother, the maternal condition being produced by the action 

 of bacterial toxins absorbed from the intestinal tract. He 

 traced the infection to contaminated water-supplies^ and in 

 doing so, explained the endemic nature of cretinism. 



In the adult, toxins acting on the thyroid may also give 

 rise to hypothyroidism, or the causal condition may be a 

 tumour. The symptoms are not unlike those seen in cretinism, 

 but differ in that they supervene after the body is fully de- 

 veloped. Thus the integument is thickened and pseudo- 

 cedematous, especially that covering the face, hands and feet. 

 Increased deposition of fat adds to the appearance of thicken- 

 ing and stolidity. The surface is dry, and becomes rapidly 

 denuded of hair, baldness being usual, while perspiration is 

 much diminished. The body temperature is lowered on 

 account of diminished metabolic activity, less oxygen being 

 consumed and less nitrogen broken down and excreted. Sugar, 

 instead of being utilised, is largely stored as fat, and greater 

 quantities can be taken without causing glycosuria. Sexual 

 functions are in abeyance. Mentally, similar changes are pre- 

 sent. The sufferer is apathetic, and less able to exercise her 

 or his senses. In brief, hypothyroidism in the adult leads to 

 a lowering of all the body functions, with its attendant 

 sequelae. 



This condition was first described by Gull (1873) as a 

 " Cretinoid State supervening in Women." Some years later 

 Ord (1877) labelled it Myxoedema, and correlated it with the 

 thyroid ; and in 1 886, Hadden pointed out the atrophied state 

 of the gland. As in cretinism, the symptoms vary in severity 

 according to the degree of hypothyroidism present. This in 

 turn largely depends upon the condition of the gland. In 

 many cases there is a complete absence of thyroid tissue, 

 which would indicate an entire absence of secretion (athyroi- 

 dism). 



The treatment of hypothyroidism with thyroid juice was 

 first attempted by Murray (1891) in a case of myxoedema, and 

 with what success may be judged from the notes of the case, 

 which he has recently published. The patient recovered and 

 continued in good health for twenty-eight years, during which 



