408 



NELSON W. JANNEY 



pecia (Walsh), or by occipital loss of hair, the so-called "cassowary neck" 

 may be sugge^ed. Alopecia areata may be present. 



The eyebrows may fail to apear in marked cretins or, when present, 

 may be short, sparse and show defective pigment. Frequently the outer 

 third only is affected which may be quite absent, adding to the bizarre 

 appearance of the hypothyroid countenance. This eyebrow sign of Her- 

 toghe, who ably described latent hypothyroidism, is one of the most easily 



recognized and persistent stig- 

 mata of hypothyroidism. 

 Though it may be present in 

 otherwise normal individuals, 

 also in morbid conditions other 

 than thyroid deficiency, its pres- 

 ence should cause such a case to 

 be thoroughly investigated for 

 hypothyroidism. The writer has 

 observed it to be the only certain- 

 ly detectable physical sign in a 

 patient exhibiting, however, a 

 marked decrease in basal met- 

 abolism. The eyelashes are short, 

 weak and spaced or even absent 

 in severe cases. This is the 

 cause of the peculiar stare shown 

 by some hypothyroid individ- 

 uals. 



The nails suffer in at least 80 

 per cent of cases. ( Janney and 

 Henderson. ) The first changes 

 are simply increased softness 

 and brittleness so that patients 

 may complain of their nails 

 breaking or wearing down rapid- 

 ly to the quick or the finger tips becoming sensitive from lack of protec- 

 tion. In severer eases they may become paper thin or rarely be shed. The 

 Innulae are deficient and white spaces may appear 011 the matrix. Seaming 

 or cross furrows are occasionally present. At times hyperonychia de- 

 velops, particularly of the toes. Nail changes are by no> means confined 

 to hypothyroidism. The writer has observed all the pathology just enu- 

 merated in hypopituitarism and other endocrin diseases. Nail thinning 

 and seaming is met with in thyrotoxicosis. Such signs are, however, in 

 combinations with others extremely important. It is surprising how little 

 attention is generally paid to these a straws which show how the wind 

 is Mowing," to use a homely simile. 



]/>. Alopecia Arrata of hypothyroid 

 origin. (Courtesy of Drs. Win. Engelbach 

 and .1. L. Tieriiev. ) 



