402 



NELSON W. JANNEY 



that the patient is scarcely aware of the same. Men holding good positions 

 in life may lose the same because of inefficiency. Women cease to take 

 interest in social life as the veil of illness gradually parts them from the 

 normal activities of their sex. They complain of being no longer liked by 

 their friends and of many vague symptoms which often mislead the phy- 

 sician into carrying out unavailing treatment of various kinds. 



As the disease progresses, the facial expression becomes altered. It 

 may assume the peculiar trance4ike appearance of the sleep-walker. Im- 



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v 1 1 



1 1 



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pear jVk, j*QHPHk 



Fig. 7. The stature of cretins compared with normal individuals of the same 

 age. (Courtesy of Drs. Win. Engelbach and J. L. Tierney.) 



mobilization of the eyelids and cheeks through myxedematous swellings 

 are the chief causes of this condition. The face grows pale, the cheeks 

 often flabby, the forehead traversed by wrinkles. The features take on 

 a peculiar coarseness, the lips and cars thicken. At times, weariness 

 or premature senility predominate the impression afforded the observer 

 by sufferers from this strange malady. The various symptoms described 

 in detail below now slowly put in their appearance, the hair of the body 

 is partially lost, the gait and body movements become slow and atactic, 

 the musculature flabby, the digestion impaired. 



Symptoms and Signs Referrable to the Thyroid Gland. The changes 

 in the thyroid inland may be hypertrophic or atrophic nature. Often- 

 times, the earliest abnormality, and certainly the most frequent, is a 

 slight symmetrical hypertrophy of the thyroid gland. (For the grounds 

 for regarding thyroid hypertrophy as due to a subfunctioning condition 



