104 THE DISEASES OF THE THYROID GLAND 



successful, in the latter it sometimes fails. While we must ascribe certain 

 of the important symptoms of endemic cretinism to thyroid insufficiency, 

 ma'ny facts speak for the separate position of this illness. 



I shall first describe those clinical pictures that develop through the failure 

 of the thyroid-gland function in the fully developed organism because here 

 the relations may be supervised more readily. 



i. Myxcedema Adultorum or Cachexia Thyreopriva Adultorum 



Definition. This condition, resulting from the absence or insufficiency of 

 the function of the thyroid gland in the adult organism, is characterized by 

 the diminution of all vital processes and by certain trophic manifestations. The 

 diminution affects the vegetative functions as well as the psychic life. There 

 is found slowing of the entire metabolism and diminution of the excitability of 

 the whole vegetative nervous system. The trophic disturbances affect especially 

 the ectodermal tissues, skin, hair, nails, and teeth, although almost all organs may 

 show regressive metamorphoses, especially the vascular system, which tends to 

 be the seat of a premature arteriosclerosis. 



Occurrence. Spontaneous myxedema of adults is a rare disease that is 

 found somewhat more commonly in England and Holland [than on the conti- 

 nent]. In goiter districts typical myxedema seems to be relatively rare. 

 Hereditary and familial occurrence is described by some authors (Maclll- 

 waine, Ewald, et al.). 



Symptomatology.- I begin with the description of the alterations in the 

 skin, the most important of which has furnished for the disease its name 

 myxedema. The myxedematous swelling may affect the skin of the entire 

 body; it shows, however, a predilection for certain sites, the cheeks, lids, 

 nose, supraclavicular fossae, neck, backs of the hands and feet. The cheeks 

 become yellowish in color, but on account of small venectases are colored 

 bluish-red in the middle. The nose and lips are also of this bluish-red 

 color. On account of the swelling of the eyelids the palpebral fissures are 

 much narrowed, and the deficient play of the features makes the expression 

 of the face rigid and sleepy. In the supraclavicular fossa? develop thick 

 cushions or pads that feel granular to palpation. The cushion-like swelling 

 of the backs of the hands and feet make the extremities appear claw-like. 



For the most part the swelling invades also the mucous membranes, the 

 mucous membrane of the mouth assuming a whitish color, while the par- 

 ticipation of the mucosa of the larynx leads to alterations of the voice; this 

 becomes harsh and, according to Magnus-Levy, singing becomes impossible. 

 The swelling of the uvula and the tonsils makes nasal breathing impossible; 

 the patients breathe with open mouth and snore at night. The Eustachian 

 tube and the tympanic cavity may also become involved by the swelling, 

 causing a diminution in hearing- ability; and finally the female genitalia 

 and the anus may become swollen. The tongue increases greatly in volume, 



