IIO THE DISEASES OF THE THYROID GLAND 



edemics infusion of jaborandi did not bring about secretion of sweat. I, 

 too, observed, in the above-mentioned cases, after pilocarpine injection 

 only slight salivation and no or only minimal sweating. In myxedema there 

 is also a diminution of the function of the sebaceous glands (deficient oiling 

 of the skin and hair) . I have not been able to find in the literature statements 

 as to the secretion of gastric juice or pancreatic juice. 



To a slight tonus of the autonomous nerves points the high-grade atony 

 of the intestines that is the cause of the well-known obstipation of myxedema 

 patients. Defecation in well-developed cases, if purgatives be not employed, 

 may not occur for two or three weeks. 



Almost constantly do alterations of the psychic functions accompany 

 myxedema. The English Myxedema Commission found the apathy char- 

 acteristic of myxedema absent in only three of one hundred and nine cases. 

 This may develop relatively early, and in the light cases may consist only 

 in a sluggishness of the previously mentally and bodily active patients, 

 in a retardation of the psychic functions, in an inability to form rapid conclu- 

 sions and in a slowing and monotony of the speech. According to Magnus- 

 Levy, in light cases the "capability of reacting to strong stimuli" is for the 

 most part not lost. In more well-developed cases there is a complete dullness, 

 the patients brood, and there exists marked desire for sleep. The speech 

 may be markedly slowed "als ob die Sprachwerkzeuge eingefroren waren" 

 [as if the speech-mechanism were frozen in] (Meltzer). Char cot compares 

 such patients to hibernating animals. In such individuals, too, the intellect 

 tends to deteriorate and the memory, especially that for recent occurrences, 

 is lost. 



In such high-grade cases there are rarely lacking, in addition to this 

 decided apathy, signs of a more deeply seated mental disturbance. Already 

 at the beginning of the myxedematous disease or in the formes frustes are 

 hallucinations commonly present, concerning which, as Murray says, the 

 patient does not willingly speak. 



The English Myxedema Commission found among the myxedema patients 

 investigated by them illusions 18 times, hallucinations 16 times, and a 

 frank psychosis 16 times. The psychoses belong to various types, although 

 the melancholoid conditions predominate; and may of course consist only of 

 a combination with myxedema. Very commonly, however, they stand in an 

 intimate relation with myxedema in this respect that through the myxedema 

 a previously existing predisposition becomes manifest. In these cases the 

 symptoms of the psychosis develop simultaneously with those of the myxe- 

 dema and vanish after thyroid therapy has been instituted, to reappear 

 again when the therapy is discontinued. Such a case has been described by 

 Pilcz. In many cases, especially at the beginning, the inhibition is suddenly 

 interrupted, and the condition may transitorily go as far as excitation. 

 Horsley distinguished between a neurotic stage that occurs at first, and a 



