MYXCBDEMA, CRETINISM, AND THE ADRENALS. 165 



MYXCEDEMA AND CKETINISM AND INSUFFICIENCY OF THE 

 ADRENALS. 



Removal of the thyroid gland, when it is followed by 

 death, gives rise to a characteristic train of symptoms in ani- 

 mals. The latter appear dull and apathetic; muscular inco- 

 ordination, shivers, precede spastic paralysis; the temperature 

 falls rapidly. The cause of the violent dyspnoea witnessed is 

 now apparent; and a casual remark of Wesley Mills's, 31 that the 

 thyroid gland "plays a special part in connection with oxida- 

 tion," indicates that we must be treading on the right path 

 when we include the adrenals in the process. While Albertoni 

 and Tizzoni 32 observed that the blood showed less power to 

 fix oxygen, Masoin 33 found that the relative quantity of oxy- 

 ha3moglobin in the blood was diminished in proportion as the 

 morbid results of thyroidectomy progressed. We can at least 

 assume, therefore, that the marked emaciation witnessed is 

 due to the imperfect nutrition which impaired oxidation of 

 the organism involves, that the tetanic convulsions point to 

 imperfect oxidation of waste-products, and that insufficiency 

 of the adrenals due to reduced thyroidal activity underlies all 

 the morbid phenomena that follow thyroidectomy. 



That imperfect, inadequate, or arrested thyroid secretion 

 can cause myxoedema has been established. In all cases in 

 which the diagnosis was unmistakable, the glandular elements 

 of the thyroid have been found markedly compromised. 

 Adami 34 found the specific cells replaced by fibrous tissues in 

 the majority of cases collected, and in less advanced cases the 

 degenerated remains of vesicular epithelium, along with areas 

 of the latter showing a tendency to compensatory hypertrophy. 

 In no case diagnosed as myxcedema did he find the gland nor- 

 mal or but little affected. In infantile myxoedema i.e., cretin- 

 ism either the thyroid is totally absent or there is more or 

 less deficiency of glandular elements and excess of connective 

 tissue with cellular debris. De Coulon 35 found that the colloid 



31 Wesley Mills: Canadian Practitioner, Oct., 1895. 



82 Albertoni and Tizzoni: Maragliano: Gaz. degli Ospedali, Oct. 20, 1894. 

 Masoin: Bulletin de I'Academie de M6d. de Belgique, No. 1. p. 88, 1895. 

 84 Adami: Trans. Congress of American Physicians and Surgeons, 1897. 

 86 De Coulon: Virchow's Archiv, vol. cxlii, p. 53. 



