MYXCEDEMA, CRETINISM, AND THE ADRENALS. 169 



"startings." These represent the subacute phenomena of which 

 suprarenal spurts of activity are the source and of which 

 tetanus, epilepsy, rabies, and kindred disorders are the acute 

 expressions. 



Disorders of sensation become normal results when we 

 consider that the total loss of tone of the central vascular 

 trunks practically depletes the peripheral tissues of their blood 

 and that what blood does reach them is poor in oxygen. Sen- 

 sation is blunted especially where, as is the case with touch, 

 it is usually most delicate. When under the influence of thy- 

 roid extract the tumefaction disappears, the sensibility returns, 

 proving that the nervous and cutaneous structures were not 

 structurally impaired, but merely inactive through the absence 

 of their pabulum vilce. Perversions of the senses of smell and 

 taste; mental apathy, hallucinations, melancholia, vertigo, 

 marked reduction of the flow of urine, albuminuria, and glyco- 

 suria are also witnessed. Death occurs from exhaustion when, 

 as in exophthalmic goiter, an intercurrent acute disorder does 

 not, as is usually the case, carry the patient away before this 

 stage is reached. 



To emphasize the remarkable effects of thyroid extract 

 in myxcedema and cretinism is unnecessary. All the symptoms 

 enumerated sometimes disappear, and it is evident that this 

 wonderful result is obtained through enhanced oxidation in 

 all parts of the organism, and procured through the suprarenal 

 overactivity induced. 



Proof of all this is afforded by the fact that it is not only 

 in diseases in which the entire vital mechanism is held in 

 check by the absence of thyroid secretion that the effects of 

 the extract prevail. They are the same whenever, as in most 

 cases of myxcedema benefited by it, organic lesions of the 

 adrenals themselves or of any other vital structure are not 

 present to totally prevent the continuation of life. Probably 

 the nearest condition to uncomplicated myxcedema i.e., a 

 condition in which the human machine is simply in a state of 

 vital abeyance is catalepsy. In this disorder thyroid extract 

 should also prove efficacious if oxidation through induced 

 activity of the adrenals is the key to the process involved. The 

 experience of K. Hessler, of the Northern Indiana Hospital 



