120 THE DISEASES OF THE THYROID GLAND 



same size, of the same weight, and under the same living conditions would 

 rapidly lose in bodily weight under such conditions. The cause of endoge- 

 nous obesity is of very diverse nature (see also Chapter VI, on the hypophysis, 

 and the various forms of obesity, Chapter XIV). But it can hardly be 

 doubted that one of these causes is a slight grade of thyroid insufficiency. 

 The thyrogenous obesity may depend on inherited predisposition or may 

 follow infectious diseases (v. Noorden). Also it may be preceded by a Base- 

 dow's disease. I refer to the cases of Basedow's disease in which the initial 

 emaciation is followed by a progressive increase in weight. For the diagnosis 

 of thyrogenous obesity, important also are other symptoms such as phlegma 

 and constipation, especially if they have existed before the development of 

 obesity. Such cases belong in the domain of thyroid treatment; restriction 

 of calories in such cases can, especially in older persons, lead to a marked 

 exhaustion and cardiac collapse, without lessening the amount of fat, while 

 administration of thyroid gland reduces the body weight with amelioration 

 of the general condition (v. Noorden). 



The cause of the manifoldness of the hypothyroidal syndrome may be re- 

 garded, as in the hyperthyroidal syndrome, as differences in the constitutions 

 of the individuals affected. 



The course of myxedema in untreated cases may be progressive and give 

 rise to a cachexia; then intercurrent affections often occur, and lead to 

 death. Spontaneous improvement may also occur, not rarely with the 

 development of a goiter, in rare cases with hypertrophy of the accessory 

 thyroid glands. 



The treatment of myxedema will be considered after the description of 

 sporadic cretinism. 



2. Sporadic Cretinism 



Definition. In the preceding section we drew disease pictures that 

 originate in an organism already fully developed, when the thyroid becomes 

 insufficient or loses its function entirely. When the disturbance in thyroid 

 function develops in an organism as yet unfinished, there occur in addition 

 profound developmental disturbances that are the more intense the earlier 

 the disturbance begins. The conception of sporadic cretinism as hypo- 

 thyrosis or athyrosis of the youthful organism is decisively proved in the first 

 place by the sad experiences that were sometimes met with at a time when the 

 functions of the thyroid were not known, in strumectomies on children, and in 

 the second place by the fundamental researches on total extirpation of the 

 thyroid in animals (of Hofmeister and of v. Eiselsberg) . The thyroprivic 

 animals of v. Eiselsberg that were kept under the same conditions as the control 

 animals showed after a few weeks, as against the control animals of the same 

 brood, a considerable remaining behind in size and in body weight. The dis- 

 turbance in growth affected more the long bones than the trunk. The bones 



