48 ENDOCRINE THERAPEUTICS 



be necessary from time to time. Without doubt 

 this thyroid feeding acts as a hormone to the 

 other endocrine glands, and so the whole tone of 

 the body is raised. It may almost be laid down 

 as an axiom that a one gland failure, existing for 

 some time, means a general gland failure, and 

 needs what is known as pluriglandular treatment. 

 In adults the same condition of hypothyroidism 

 is known as myxoedema. The external picture 

 is much the same, but the mental powers, having 

 been developed, only fail gradually ; there is a 

 general impairment of sensibility. There are a 

 few small signs which as a rule do not appear in 

 the cretin, such as an aching back, without 

 stiffness, and a tenderness on pressure ; and a 

 slight swelling about the ankles, not pitting and 

 not extending to the dorsum of the feet. The 

 puffiness of the lower eyelids is more noticeable 

 than in children, and the general swelling of the 

 skin of the face gives the almost immovable mask- 

 like aspect characteristic of the disease ; the 

 hair loses its gloss and falls easily. In almost all 

 cases the blood-pressure is raised so that the 

 breath is short and the heart's action hurried on 

 exertion. This high blood-pressure is probably 

 the result of thyroxin deficiency. The body 

 weight may increase in spite of a lessened food 



