100 THE INTERNAL SECRETIONS—1920 
occur in those either at, or past, the menopause and 
are the type encountered in the male. In this group the 
thyroid symptoms persist for a longer period before 
the development of the complete syndrome than do 
those in whom the ovarian symptoms are the initial 
ones. 
Four cases showing various phases of the thyroid 
type are detailed in the following paragraphs: 
Case I. Married female, aged 56 years, mother of 
eight children, all alive and well. Past and family his- 
tory negative except that two sisters, both older than 
the patient, are suffering from similar symptoms. For 
the past three years the patient has suffered from head- 
aches which occur in the early morning, usually awak- 
ening the patient about 4 A.M. These headaches are 
sometimes frontal, and other times occipital, and 
usually disappear about midday. She has had many 
attacks of vertigo, sometimes so severe as to cause her 
to fall over and associated with vomiting when severe. 
In the morning her feet are slightly swollen and during 
the day there are transient attacks of swelling of the 
lip. Her hands feel swollen and at times her wedding 
ring can be turned only with great difficulty. She has 
gained 46 lbs. in six years, though she describes her- 
self as “fa very small eater.” 
Physical examination shows a slight ocular error, 
which is properly corrected. There is a slight enlarge- 
ment of the heart to the left, with an accentuation of 
the second aortic sound. The blood pressure is 210 
mm. systolic and 100 diastolic. The abdomen is re- 
laxed, but otherwise negative, and the pelvis is normal 
except for a lacerated cervix and perineum. She is 51 
lbs. overweight, ana the skin is dry and feels boggy. 
Laboratory examinations: Urine, 2100 c.c. in 24 
hours, sp.gr., from 1008 to 1025; Mosenthal diet as a 
kidney function test shows no evidence of salt or nitro- 
