66 ENDOCRINE GLANDS 



The symptoms are the same as those of the congenital 

 type, but less severe. The physical development is bet- 

 ter and the mentality more advanced; dwarfism is less 

 marked and the idiocy less absolute. As a general rule, 

 the symptoms of myxedema are proportionally less pro- 

 nounced as the disease occurs later in life. 



The skin is still thickened and infiltrated, but much less 

 dry. The first teeth come out at the normal time, but 

 the second crop does not appear or the teeth are badly 

 developed. Growth is delayed, the height is below the 

 normal for the age. Ossification is not completed. 



The mentality is not retarded as much and these 

 individuals can be educated to a certain extent; motion 

 is very slow and awkward, but they can make themselves 

 understood and can obey a few simple commands. The 

 low body temperature, the sensitiveness to cold are as 

 appreciable as in the previous type. These children when 

 untreated usually die early. 



3. POST OPERATIVE MYXEDEMA. 



In 1882 J. Reverdin showed that the affection described 

 by Gull in adults and by Bourneville in children, could 

 occur in either case after a thyroidectomy for goitre. 

 This was a very important discovery which led to the path- 

 ogenic treatment of myxedema; thyroid organo therapy. 



The total extirpation of goitres or a total thyroid- 

 ectomy causes in man, as well as in animals, two kinds 

 of phenomena. 



1- ACUTE SYMPTOMS which were studied under the 

 name of acute post operative myxedema. These were in 

 reality cases of tetany due to the simultaneous extirpation 

 of the thyroid and parathyroids. 



2- CHRONIC SYMPTOMS. These occur usually three 

 or four months after the complete thyroidectomy (partial 



