100 THE INTERNAL SECRETIONS 1920 



occur in those either at, or past, the menopause and 

 are the type encountered in the male. In this group the 

 thyroid symptoms persist for a longer period before 

 the development of the complete syndrome than do 

 those in whom the ovarian symptoms are the initial 

 ones. 



Four cases showing various phases of the thyroid 

 type are detailed in the following paragraphs: 



Case I. Married female, aged 56 years, mother of 

 eight children, all alive a'nd well. Past and family his- 

 tory negative except that two sisters, both older than 

 the patient, are suffering from similar symptoms. For 

 the past three years the patient has suffered from head- 

 aches which occur in the early morning, usually awak- 

 ening the patient about 4 A.M. These headaches are 

 sometimes frontal, and other times occipital, and 

 usually disappear about midday. She has had many 

 attacks of vertigo, sometimes so severe as to cause her 

 to fall over and associated with vomiting when severe. 

 In the morning her feet are slightly swollen and during 

 the day there are transient attacks of swelling of the 

 lip. Her hands feel swollen and at times her wedding 

 ring can be turned only with great difficulty. She has 

 gained 46 Ibs. in six years, though she describes her- 

 self as "a very small eater." 



Physical examination shows a slight ocular error, 

 which is properly corrected. There is a slight enlarge- 

 ment of the heart to the left, with an accentuation of 

 the second aortic sound. The blood pressure is 210 

 mm. systolic and 100 diastolic. The abdomen is re- 

 laxed, but otherwise negative, and the pelvis is normal 

 except for a lacerated cervix and perineum. She is 51 

 Ibs. overweight, and the skin is dry and feels boggy. 



Laboratory examinations: Urine, 2100 c.c. in 24 

 hours, sp.gr., from 1008 to 1025; Mosenthal diet as a 

 kidney function test shows no evidence of salt or nitro- 



