388 NELSON W. JANNEY 



proliferation which can indeed progress until complete disappear- 

 ance of all glandular structure has taken place, (von Eiselsberg.) 

 A complete fatty degeneration may ensue (Stilling). Hadden very 

 aptly compares the changes to those of chronic diffuse nephritis and 

 cirrhosis of the liver; Thomas to non-tuberculous Addison's disease. 

 For this resemblance there seems good reason as such organic diseases are 

 probably induced by infections similar to those leading to thyroid atrophy. 

 A difference of opinion exists as to whether the acute thyroiditites observed 

 in infectious fevers can lead to the above mentioned extremely chronic 

 cirrhotic atrophy of this ductless gland. Such degenerative processes 

 do not seem to occur as a direct sequence but one cannot exclude thereby the 

 possibility of cause and latent effect. . \ 



The histo-pathological changes of the subfunctioning thyroid of myx- 

 edema are carefully described by Marine and Ldnhart (/) as follows: "The 

 colloid is practically absent. The epithelial cells have lost their regular 

 and uniform columnar type characteristic of the early stage of active 

 hyperplasia and are irregular in size and shape. There is perhaps some 

 piling up of the epithelial cells and desquamation of the partially de- 

 generated cells. The nuclei are in general large, often hyperchromatic 

 and irregular in size and outline. Nuclear figures are still observed, but 

 the new formation of cells is not sufficient to offset the cell-death and 

 the follicles become smaller, though still preserving the infoldings of 

 the well-developed hyperplasia. The surrounding fibrous stroma is rela- 

 tively, perhaps absolutely, increased, as the follicles become smaller from 

 the death of their secreting cells the fibrous bands appear wider, and 

 finally give the appearance of a generalized cirrhosis in which are nests 

 of compressed epithelial cells with or without the outlines of follicles. 

 This interstitial cirrhosis is secondary to and consequent, to the death of 

 the epithelial elements. Lymphoid foci are scattered here and there 

 throughout the stroma. This is the simplest picture of the anatomical 

 changes in the thyroid in myxedema, and those occurring in the cretin 

 thyroid are similar. ]\Iost cases, either of myxedema or of cretinism, in 

 man do not present so simple an anatomical picture for the reason that 

 other processes as cyst formation, hemorrhage, calcification, adenoma, 

 groups of enlarged follicles filled with desiccated colloid, etc., may all 

 be crowded into the same gland. 



"Summing up, then, the type of atrophy supervening on active hyper- 

 plasias arid clinically associated with myxedema or cretinism is a. cell- 

 death due to exhaustion from overwork and malnutrition. The process 

 is simple, but the anatomical changes in such glands, especially in long- 

 standing cases, are often highly complex." 



The Systemic Effects of Hypothyroidism. On account of the control 

 of cellular nutrition, repair, regeneration and growth exercised by the 

 thyroid gland, every tissue and organ in the body is liable to show the 



