THE SYMPATHETIC SYSTEM 67 



thyroidectomy only causes mild and very transitory 

 symptoms). The clinical picture is identical to that of 

 acquired myxedema of the adult ; infiltration, anemia, loss 

 of hairs, asthenia, with slowness and awkwardness, sleepi- 

 ness, deterioration of mentality and low body temperature. 



In children the symptoms are more marked than in 

 adults. The thyroidectomy brings on a complete stoppage 

 in mental and physical growth, being the more marked as 

 the subject has been operated on early in life. 



3. ENDEMIC MYXEDEMA OR CRETINISM. Cretinism 

 is found in certain mountainous countries (Valois, Alps, 

 Pyrenees) in children drinking water from certain springs, 

 and is characterized by a physical and mental deterioration. 

 This condition is so similar to the myxedematous idiocy 

 that the only way it can be differentiated from it, is by 

 the presence of a goitre. The latter develops as a rule 

 around puberty and becomes enormous. It forms some- 

 times a hard tumor, containing cartilagenous centres, at 

 other times, soft or cystic tumors. In spite of the presence 

 of the goitre the function of the thyroid is abolished. 

 According to their mental state these cases are classified 

 as complete cretins, in which walking can only be accom- 

 plished on all fours and speech is replaced by noises 

 and semi cretins and cretinoids in which speech is slow 

 but who, however, are able to perform a few simple tasks. 



4. ABORTIVE MYXEDEMA. CHRONIC MILD HYPO- 



THYROIDISM. SLIGHT THYROID INSUFFICIENCY. 



When lesions of the thyroid disturb, without abolishing 

 the function of the gland, myxedema reveals itself in a series 

 of types showing various grades of thyroid insufficiency. 



A. IN CHILDREN. 



Following an infectious disease, the child shows a 

 retardation in development. The skin becomes thicker, 



