406 NELSON W. JANNEY 



mental strain may fail to produce perspiration. The sudorific action of 

 pilocarpin m*y be absent (Falta). Electric conductivity is decreased. 

 Sebum is excreted in deficient amounts. Nevi and warts may be found. 

 Pigmentation is rare. The writer has observed large, coarse, thickened 

 and piirmented skin areas beset with hairs on the shoulders of adult hypo- 

 thyroid cases. In light cases merely the texture of the skin may be affected, 

 it, becoming rough and dry. 



The myxedematous swellings of the skin, mucous membrane and sub- 

 cutaneous tissues are characteristic of hypothyroidism. On account of 



Fi<r. 12. Snpraclavicular fat-padding in hypothyroidism. (Courtesy of Drs. Wm. 

 Enjiolbach and ,1. L. Tiornoy. ) 



the confusion brought about by using the appellation "myxedema" to adult 

 cases of hypothyroidism, physicians frequently regard such infiltration 

 as ;i peculiarity of the adult cases. Actually, however, it may be met with 

 in liyjH>tliyroi(l subjects of all ages although it is less common in cretins. 

 Cases of athyreosis are usually swollen with myxedema. Clinically this 

 condition is distinguished by its "solid" texture, an excellent term sug- 

 gested by Xellis 1>. Foster. Tt fails to pit on pressure. Rarely, in very 

 young subjects the whole body may be affected. Usually, however, and 

 regularly in adults the myxedematous infiltration is found confined to the 

 eyelids and brows, and cheeks, lips, nose, neck, supraclavicular fossae, 

 dorsa of hands and feet. Now and then myxedematous swellings appear, 

 at the ankles, or even the back or abdomen. 



Thyrogenic Obesity is one of the most early, striking and persistent 



