MYXEDEMA III 



myxedematous or cretinoid stage, although this distinction may have 

 been influenced by the tetanoid manifestations after thyroid-gland extirpa- 

 tion which at that time were ascribed to the absence of the thyroid. 



Other coarse disturbances that are routinely looked for on the investiga- 

 tion of the nervous status are not as a rule found. The reflexes are for the 

 most part normal, only rarely are they increased or diminished. Not 

 rarely the patients complain of paresthesias and of rheumatic pains. The 

 test for sensibility for the most part normal, at the most it has been 

 stated that slowing of conduction is present, although this finding is by no 

 means constant. It has been recognized that testing of sensation is hard to 

 carry out in heavily apathetic patients. The same holds good for tests of 

 the smell, taste, and hearing. Most common of these disturbances are those 

 of hearing. These were found by the English Commission in almost half of 

 the cases it investigated. The cause for them has not as yet been certainly 

 ascertained. Wagner v. Jauregg assumes that they are produced by myxe- 

 dematous swelling of the mucous membrane of the tympanic cavity and the 

 tube. It is, however, often very hard to determine what part the lessened 

 power of apprehension of the central apparatus and the lacking appercep- 

 tion plays in this; in any case it is significant that the disturbances of hearing 

 react promptly to thyroid medication. 



The conductivity of the skin for the electric current is diminished on 

 account of the high degree of dryness. Authorities also state that in many 

 cases there is diminution of the electrical excitability of the nerves and 

 muscles. In one case Erb found it normal. Rudinger and myself found 

 an appreciable diminution of the galvanic excitability of the nerves in 

 thyroidless dogs. The investigation was conducted three months to one and 

 one-half years after extirpation of the thyroid. Instead of the normal value 

 of 1.2-1.5 milliamperes we needed 2-3 milliamperes in order to produce (test 

 of the sciatic nerve) a cathodal closing contraction. In one case of myxedema 

 Erb found a slow twitching of the muscle to mechanical irritation. The 

 motor processes, too, are conducted slowly. The movements are extremely 

 slowed, the gait heavy, slow, and slightly staggering. One of the early 

 symptoms is a rapid tiring, only on the longer duration of the disease is the 

 motor power diminished. The cause of all alterations in function of the 

 central and vegetative nervous system lies in nutritive disturbances. Walter, 

 and Marinesco and Minea found in thyroidless dogs a slowing of degeneration 

 and regeneration of the nerves. 



There is not much known concerning alterations in the osseous system 

 in myxedema. Stubenrauch describes in a case symmetrical changes of 

 the bones and joints of the feet. Both first interphalangeal joints were 

 destroyed, the middle and end phalanges showed in part abnormal transpar- 

 ence and in certain places direct loss of substance. In the absence of further 



