64 ENDOCRINE GLANDS 



cheeks. The lips are thick and droop. The tongue is 

 enlarged, cyanotic and protrudes from the mouth, from 

 which saliva drools all the time. The facial deformity 

 gives an appearance of apathy and stupidity. The skin 

 is pale yellow, thick and coarse to the feel. 



The thorax seems crushed between the large head and 

 the prominent abdomen. The skin of the thorax show's the 

 same characteristic pallor and thickening; it forms rolls 

 and wrinkles in the flanks. 



The limbs seem enormous, especially at the level of 

 the hands and feet which are thickened cyanotic and 

 infiltrate with an indurated edema. 



The hairs are dry and break easily; the nails are striated 

 and badly formed; the voice is hoarse and nasal. 



The examination of these patients reveals a defective 

 nutrition and circulation ; the pulse is small, imperceptible ; 

 the respiration short ; the body temperature below normal : 

 35 or 36 degrees centigrade. 



Coming on at an age when the body is in process of 

 growth and when the intellect is not yet developed, 

 congenital myxedema causes a complete arrest of both 

 physical and mental development; whence the two im- 

 portant diagnostic signs : dwarftsm and idiocy. 



The height and weight are much inferior to the normal; 

 the first teeth appear late; the fontanels stay open until 

 an advanced age. 



Idiocy is absolute: the child cannot stand or walk; he 

 stays still in a chair and lets known by cries when he is 

 hungry or thirsty. He is not able to feed himself . He is a 

 plant, which simply breathes and digests. Very late he 

 finally learns to walk, but his movements are very slow. 

 He never is able to learn to talk or write; all attempts to 

 educate him are a failure. 



The evolution is very slow, without any spontaneous 



