HYPOTHYROIDISM 411 



patients masturbate. In one adult case this habit ceased for good two 

 weeks after treatment was instituted. The writer has observed masturba- 

 tion in even very young subthyroid children. 



The relation of the thyroid gland to insanity requires, like so many 

 border-line subjects, a thorough re-investigation with modern methods. It 

 presents a rather inviting field for research. There have, however, already 

 appeared a number of observations which suggest hypothyroidism as the 

 underlying cause in certain grave psychoses. The English Myxedema 

 Commission reported in their series 16 cases of definite psychoses aside 

 from a like number of individuals showing hallucinations and delusions. 

 According to Murray, the hallucinations may be visual and auditory, such 

 as hearing voices; the ringing of bells, photic phenomena or the ap- 

 paritions of animals. Such delusions and hallucinations clear up 

 when the missing thyroid function is restored through glandular admin- 

 istration. Phillips observed goiter in 12 per cent of patients suffering 

 from psychoses. Seventeen of these patients or 70 per cent were afflicted 

 with manic-depressive insanity or melancholia. The remaining cases were 

 paranoiacs or dementia precox. Certain authors have found thyroid anom- 

 alies in the insane to be even more frequent. In one hundred insane cases 

 studied by Kojima the thyroid gland was found to be decreased in size. 

 In 12 per cent of the male and 18 per cent of the female cases hypothy- 

 roidism had developed, the gland in each case being small. A type of hypo- 

 thyroid insanity occurring in women about menopause has been described 

 by Mott together with histopathologic studies. (See Pathology of Hypo- 

 thyroidism.) Symptoms present are mental confusion, loss of memory, 

 delusions of persecution and hallucinations. Finally a state of dementia 

 intervenes. 



An interesting case of myxedematous psychosis with autopsy is recently 

 reported by Uyematsu. In addition to the usual symptoms, drowsiness, 

 vertigo and incoordination were present. Autopsy showed an extremely 

 atrophic fibrous thyroid gland. In the little glandular tissue remaining, 

 lymphatic infiltration had occurred. The case was complicated by ovarian 

 atrophy. The brain and cerebellum showed arteriosclerosis, changes sug- 

 gesting senility and an edematous condition of the cells. The cerebellum 

 was atrophic, thus explaining the peculiar symptoms. Odin has reported 

 cases with cerebellar symptoms which disappeared under thyroid therapy. 



A remarkable family showing a strange mingling of hypothyroid stig- 

 mata and neurologic disorders has been recently reported by Barrett. 

 Sixty-one members of six generations were studied. A large number 

 showed dystrophies of nails and hair. In extreme cases merely a lanugo- 

 like covering of the scalp was present. Two individuals had definitely 

 developed hypothyroidism, one patient improving on thyroid medication. 

 The neuropsychiatric abnormalities included four cases of feebleminded- 

 ness, one epilepsy, one nocturnal enuresis. Three cases died at an early 



