62 ENDOCRINE GLANDS 



are thick, sausage shaped and cyanotic, and the patients 

 have some difficulty in moving their limbs or performing 

 delicate movements with their fingers. 



The skin is not only infiltrated but dry and coarse 

 (whence the name of pachydermic cachexia suggested by 

 Charcot). Sweating is abolished. The hairs become dry, 

 break off and fall out in the temporal occipital regions. 

 There is often a falling out of the eyebrows, eyelashes 

 and hairs of the arm pit and pubis. The nails become 

 fragile and striated longitudinally. 



Similar changes take place in the mucosa. The tongue 

 thickens and moves with difficulty; the teeth loosen up in 

 the tumefied gums; the voice becomes weak, due to the 

 infiltration of the laryngeal mucosa. 



2. ATROPHY OF THE THYROID. At the beginning it is 

 possible to notice a transitory swelling of the thyroid 

 preceding the atrophy. This occurs as a rule after a 

 certain time. The infiltration of the tissues renders the 

 palpation of the gland very difficult. 



3. MENTAL CHANGES. The patient with myxedema 

 is in a state of stupor and apathy; he stays motionless 

 and isolated, indifferent to all that is going on ; he avoids 

 moving and walks very slowly. He is incapable of keeping 

 his attention on anything or to exercise his memory. 

 He looks stupid and answers questions in a slow and 

 monotonous voice. Some cases have an unconquerable 

 desire to sleep and do so anywhere. 



4. SECONDARY SYMPTOMS. These patients complain 

 all the time of being cold; in winter they stay near the 

 fire covered with blankets and their feet on hot water 

 bottles; in summer they wear an excessive amount of 

 clothes and stay in the sun all the time. Their body 

 temperature is lowered and can be below 36 centigrade. 



The heart sounds are muffled; the pulse is small and 



