



MYXEDEMA 1 07 



patient had a large neck, and of late years this has increased, producing difficulty in swal- 

 lowing, difficulty in breathing, and indeed attacks of suffocation, on which account the 

 patient was operated on in June, 1909. Nine days after the operation the patient was 

 entirely well. In March, 1910, the hands and feet began to swell, the condition being 

 taken for rheumatism. In the summer of 1910, myxedema was diagnosed, and an order 

 given for thyroid tablets. Under this treatment the swellings retrogressed, but the 

 patient became thin (loss of weight of 9 kg. in five weeks) and developed a marked tremor. 



At present are seen swellings of the backs of the hands and feet, of the supraclavicular 

 fossae, and also of the face, especially in the vicinity of the eyes. The pulse is about 70. 

 The skin is dry to the touch. 



o.oi gm. pilocarpine subcutaneously; after one-half hour slight flow of saliva, no 

 sweat. 



100 gm. grape-sugar, no dextrose in the urine. 



150 gm. grape-sugar, no dextrose in the urine. 



Leucocytes, 6200, of which: 



Polymorphonuclear neutrophiles, 62.6 per cent. 



Eosinophiles, 5 per cent. 



Lymphocytes and large mononuclears, 32.4 per cent. 



After the instillation of homatropine into the eye, mydriasis occurs after about forty- 

 eight hours. 



A fully normal sella turcica to Rontgen examination. 



In addition to the myxedematous manifestations are present slight signs of a primary 

 chronic articular rheumatism (dry form). 



Moderate constipation. 



Observation XII. Schw. F., thirty-eight years, entered September, 1910. First men- 

 struated at twelve years of age. The flow was always regular and abundant. Two 

 labors; since the last (eight years ago), which was followed by a hemorrhage, the menses 

 have ceased. Since this time very poor appetite, patient always constipated. For one 

 year the hands and feet often seem as if asleep, sensation of cold, formication in hands 

 and feet. Speech has become slower. Often vertigo. Status: Skin pale, thickened and 

 dry to the touch, hands cool, hairs thinned out and dry. Teeth small and loose, the 

 chewing surfaces much worn down, so that the teeth are reduced to about one-half 

 their length. In the axillae and on the pubis the hairs are entirely absent. The facial 

 expression is slightly catatonic, both lobes of the thyroid are palpable, internal genitalia 

 atrophic, blood-pressure very low (between 60 and 70, Gartner), o.ooi gm. 1 adrenalin 

 subcutaneously; no glycosuria, no increase in blood-pressure. 



100 gm. dextrose by mouth and at the same time 0.002 gm. 1 adrenalin subcutaneously; 

 no glycosuria. 



o.oi gm. pilocarpine; no salivation, sweating very slight. Slight increase in blood- 

 pressure. 



Erythrocytes, 3,500,000. 



Hemoglobin, 70 per cent. 



Leucocytes 7000, of which: 



Polymorphonuclear neutrophile, 52 per cent. 



Lymphocytes and large mononuclears, 42 per cent. 



Eosinophiles, 6 per cent. 



After the instillation of homatropine, mydriasis occurs after about thirty-six hours. 



From the middle of October, thyroid tablets. At the beginning of November swelling 

 of the face has disappeared, the skin about the eyes and on the clavicles very loose, 

 facial expression very much livelier, hands now warm and less cyanotic. 



1 German edition states mg. [ = milligram]; evidently gm. is intended. Editor. 



