796 THE ENDOCRINE ORGANS, OR DUCTLESS GLANDS 



recognize the disease. Besides being due to congenital absence of the 

 thyroid (sporadic type), cretinism may also occur as a result of goitrous 

 degeneration of the gland. This forms the so-called endemic variety of 

 the disease, and is more commonly seen in goitrous districts, being not 

 infrequently associated with disease of the parathyroid, in which case 

 the nervous symptoms are very prominent. 



The occurrence of thyroid deficiency in adults produces clinical mani- 



Fig. 196. Cretin, nineteen years old. The treatment with thyroid extract started too late to be of 

 benefit. (Patient of Dr. S. J. Webster.) 



festations allied to those of cretinism, but necessarily modified by the fact 

 that the patient has attained full stature and sexual maturity. Though 

 the skeletal changes are absent, the metabolic disturbances are if anything 

 more pronounced. This adult form of the disease, which is known as myxe- 

 dema, may occur spontaneously from atrophy of the gland, or follow the sur- 

 gical removal of the latter, when the term cachexia strumipriva or operative 

 myxedema is applied to the condition. The symptoms are very character- 

 istic (Fig. 197). The skin is dry and thick, with a deposition of connective 



