MYXCEDEMA, CRETINISM, AND THE ADRENALS. 167 



abnormal condition present, including the mental torpor, seems 

 to gradually recede, until in many cases the change produced 

 is truly phenomenal, a fact readily understood when we con- 

 sider that the process enhanced by the thyroid is the one upon 

 which all vital functions depend: i.e., general oxidation. 



Myxcedema in the adult affords a picture varying from 

 that of cretinism in that the morbid phenomena are the result 

 of retrograde changes in normal tissues, whereas in infantile 

 myxcedema the cellular structures have never been brought to 

 their normal nutritional standard. The most striking differ- 

 ence shows itself in the superficial swelling, the result of per- 

 verted cutaneous and subcutaneous functions, which functions 

 have not been fairly developed in the cretin. If, for example, 

 the thyroid arsenic found by Gautier does play a role in this 

 connection, the skin, nails, and hair of the cretin may have 

 never received their normal supply, while those of the myx- 

 cedematous subject may have lost theirs through the thyroid 

 disorder. The other signs, however, are very similar: the 

 hypothermia is the same, the tip of the nose, the lips, and the 

 ears being sometimes bluish, and as cold as marble; the pallor 

 of the skin is also observed over all mucous surfaces; the nutri- 

 tion of all tissues is impaired witness the mental torpor, the 

 brittle teeth, the tumefied tissues, the lusterless hair, the alo- 

 pecia, the brittle nails, etc. 



The muscular impotence recalls that of the secondary 

 stage of exophthalmic goiter even to the paresis of the orbicu- 

 laris; the lids droop over the eyeball, and, if exophthalmos 

 does not occur, it is because the orbital vessels have not been 

 submitted to the centrifugal pressure of the first stage. The 

 copious lacrymation and nasal secretion is also observed in 

 the cretin. The patient is capable of spurts of strength, how- 

 ever, as shown by Charcot: an index that vital functions are 

 only in abeyance and that we are not dealing with structural 

 changes. The muscular exhaustion further shows itself by 

 the inability of the patient to stand normally, the quivering 

 of weakness, the ataxic gait observed at times (Hammond), and 

 the oft-noticed fibrillary tremor, ending in some cases with 

 paralysis. But again must we note the absence of tetany, that 

 condition brought about through accumulation of physiological 



