. 410 NELSON W. JANNEY 



backward children who become charges of the state and asylum inmates, 

 close examii^tion revealed 403 in 10,000 to be suffering from demon- 

 strable endocrin dystrophies (Max Schlapp and Paulsen). Of this 403, 

 79 were hypothyroid cases. It is well to remember that the physical signs 

 of many such cases are so trivial as to be easily overlooked and the mental 

 be very prominent. The psyche of the cretin is classically described as 

 heavy and listless. Though such cases are the most frequent, yet other types 

 of mental disturbances may occur. Certain hypothyroid children are 

 distinguished in the untreated state by their nervousness, crying and 

 screaming on slight provocation. This seems in fact a reaction to the 

 general feeling of malaise experienced by such small patients. It is a 

 significant fact that this nervous irritability frequently yields to proper 

 thyroid treatment. Such nervous hypothyroid children are to be distin- 

 guished from the "Nervous Cretinism" of McCarrison, endemic cases ex- 

 hibiting a spastic paraplegia. 



The mentality of older hypothyroid patients is nearly always affected 

 to some degree. Lack of the power of concentration, of memory and 

 will are early symptoms, sometimes the only ones complained of. The 

 disposition may change from the lively to the taciturn, from self-controlled 

 to the irritable. Frequently the patient is well aware of his lowered men- 

 tality and uses vain efforts to conceal the same. In severe cases the ten- 

 dency is usually toward apathy, dullness and depression which many 

 sink deeper into melancholia. 



It is a misconception to surmise that subthyroid patients are neces- 

 sarily incapable of much mental activity. A patient of my series had 

 suffered from marked symptoms of hypothyroidism since boyhood, weigh- 

 ing at puberty over two hundreds pounds and showing marked physical 

 incapacity. His condition remained undiscovered and untreated until 

 middle life. In spite of this, however, this gentleman became prominent 

 in social, civic and literary circles and was regarded among his friends as 

 a man of unusual mental attainments. Close examination, however, 

 elicited a number of peculiar psychic characteristics ascribable to hypothy- 

 roidism, mental instability and restlessness, vacillation, and disturbances 

 in the genital sphere. The basal metabolism was minus 30. in the un- 

 treated state. The physical signs were unmistakable. A practical cure 

 was obtained by thyroid therapy. 



Most cases of pronounced thyroid disease show anomalies in the sexual 

 psyche. These disturbances may or may not accompany physical genital 

 lesions such as impotence. In children, development of the sexual psyche 

 is retarded parallel with the lateness in which puberty appears. In severe 

 cases the sex instinct may fail to appear. Hypothyroid adults present 

 many curious anomalies, often of such vague character that they are with 

 difficulty traceable to their general condition. There may develop mys- 

 oirynv. Marital relations mav suffer and even lead to divorce. Certain 



