14 PHYSIOLOGY CHAP. 



characteristic alteration of the countenance. The lower eyelids 

 are the first to present a sacculated semi-transparent swelling, 

 which is hard to the touch ; then the infiltration spreads to the 

 folds of the face, which become smoothed out ; to the nose which 

 gets rounded ; to the lips which swell, and bulge outwards, saliva 

 dribbling from them. The features are coarsened and expression- 

 less like those of a cretin. 



The mental functions accord with this appearance, since they 

 are blunted, so that the patients lose their memory, become deaf, 

 taciturn, melancholy, self-absorbed, and reply extremely slowly to 

 questions. They further complain of slight but perpetual head- 

 ache ; feel an almost constant sensation of cold, which is most 

 acute at the extremities ; at times they are seized with vertigo, 

 and may even lose consciousness. 



All these symptoms become still further aggravated. The 

 whole body may grow more bulky from the extension of the 

 swelling. The skin loses its elasticity, can only be picked up in 

 large folds, and becomes dry owing to defective capacity for 

 sweating. The epidermis desquamates in more or less extensive 

 lamellae, particularly on the hands and feet ; the hair turns grey, 

 falls out, and gets constantly thinner. 



The heart functions weakly, .but with ordinary rhythm ; the 

 pulse is small and thready. Examination of the blood shows 

 nothing constant; but there is often a more or less pronounced 

 and progressive oligocythaemia, which undoubtedly contributes to 

 the characteristic pallor of the skin, this being of the earthy, 

 yellow-spotted hue peculiar to cretins. 



The respiratory rhythm is almost always normal ; the digestive- 

 apparatus functions well, as also the urinary system. The spleen 

 is not enlarged. 



When thyroidectomy has been performed during adolescence, 

 one of the most serious effects is the arrest of development. A 

 boy on whom Sick operated at the age of ten, had at twenty-eight 

 become a cretin whose height was only 1*27 metres; a similar case 

 was described by Schmidt ; and the same phenomenon appeared 

 in a lesser degree on a third person, on whom Julliard operated at 

 the age of seventeen. 



This complex and characteristic syndrome of morbid pheno- 

 mena, as described by Kocher, is now generally known by the 

 name of cachexia tliyreo- or strumipriva, i.e. cachexia consequent 

 on complete ablation of the thyroid gland. 



In 1874 Sir William Gull presented to the Clinical Society of 

 London five cases of a disease which presented a morbid syndrome 

 closely resembling that of cachexia thyreopriva. In 1878 W. M. 

 Ord described five other cases of the same disease, to which he 

 gave the name of ' myxoedema, derived from the constant symptom 

 of thickening and swelling of the skin, as manifested especially in 



