MYXEDEMA 105 



so that it becomes visible between the rows of teeth, and shows impressions 

 of the teeth. The increase in volume depends not only on the swelling of 

 the lingual mucosa but also on alterations in the more deeply lying parts. 

 Histological examination shows alterations of the muscle fibers and increase 

 in connective tissue; the latter contains numerous nuclei and numerous new 

 formed capillary vessels. The tongue papillae, too, become hypertrophic 

 (Maccone) . 



The myxedematous skin looks like alabaster. It feels elastic, pressure 

 with the finger evinces no pitting. It is dry and scales very much; the scales 

 are mostly clayey. Stevenson and Halliburton ascribe the clay-like texture 

 of the skin to the increased contents in mucin. They found the mucin- 

 contents also increased in the salivary glands and tendons. Halliburton 

 found in the blood and in the parotid of thyroprivic monkeys that the albu- 

 minous bodies precipitating to acetic acid amount to 3 per cent., while they 

 were not demonstrable in the blood of normal monkeys. Munk also 

 found mucin in the parotid secretion of a case of myxedema described by 

 Mendel. But other authors found that the mucin-contents of the myxede- 

 matous skin was not increased, while Bournemlle maintains that in the 

 investigations just mentioned it is not certain that the substance dealt 

 with was mucin, as in his investigations no reducing substance was yielded 

 by decomposition by means of acid. The microscopical investigation of the 

 myxedematous skin shows nuclear proliferation and new formation of 'con- 

 nective-tissue fibrils, especially around the sweat-glands and.sebaceous glands 

 and around the hair follicles (English Myxedema Commission, Virchow). 

 Unna found in skin of myxedemics substances that stained similarly to 

 mucin, while v. Wagner and Schlagenhaufer found them in the skins of 

 endemically cretinoid dogs and thyroprivic goats. A substance similar to 

 mucin could also be observed (Halliburton and Scholz) in other organs, such 

 as the kidney, the muscles, and the brain. That presence of this substance 

 similar to mucin was missed by certain authors has perhaps its explanation 

 in the fact that the accumulations of this substance are subject to much 

 variation, and in cases of long standing they sometimes disappear. The 

 skin then regains a flaccid lax texture and, in contradistinction to typical 

 myxedematous skin, can be moved about on the underlying tissue. 



Pigmentations of the skin occur relatively rarely. 



The hair of the head and beard, the eyebrows, the axillary and pubic 

 hairs become dry and brittle, and often, in part, fall out. On the skull 

 then develop large bald spots, that may lead to complete baldness. The 

 nails become dry and cracked, the teeth become carious and fall out, and 

 in the case to be described (Observation XII) the crowns of the teeth, in the 

 course of the year that the myxedema had existed, had ground off entirely. 

 The incisor teeth consisted of only short stumps provided with broad grind- 

 ing surfaces. 



