HYPOTHYEOIDISM 415 



menorrhagia lasting twelve days with severe epistaxis. The condition 

 was cured by thyroidin. At the twelfth year the eyebrows began to fall 

 out. When thyroid preparations were omitted, hemorrhagic symptoms 

 of general nature appeared, subconjunctival hemorrhage, epistaxis, hemol- 

 ysis, epistaxis and purpura. Thyroid therapy arrested the hemor- 

 rhages. 



The Gastro-Intestinal System. The mouth tends to be large, the lips 

 coarse and cushioned, the mucous membrane pallid, the hard palate vaulted, 

 the soft, flabby. Earely the uvula may be edematous. In one case in my 

 series, uvular amputation became necessary. The appetite of cretins has 

 been the subject of comment. Their coarse habits of eating due to feeble- 

 mindedness have, it seems, led to the general impression that they devour 

 abnormally large quantities of food. In carrying out a large number 

 of metabolic experiments, the writer has, however, been brought to accept 

 the fact that the untreated hypothyroid case actually eats less than the 

 normal individual, this because a normal food intake cannot be fully 

 assimilated. (See section Metabolism.) Like other idiots, severe cases 

 of cretinism may deglutate various abnormal materials, even their own ex- 

 crement. Absence of thirst has been commented upon by various authors. 

 This may be caused both by decreased pulmonary aqueous loss and also by 

 diminution of nitrogenous and other end-products of metabolism requiring 

 urinary dilution for their excretion. 



Special studies of the digestive functions seem not to have been made. 

 Certain it is that various vague digestive disturbances are at times com- 

 plained of and often relieved by thyroid medication. Some cases of myx- 

 edema complain of a dragging sensation in the abdomen. Gastroptosis 

 is common. Obstipation due to deficient muscular action of the intestines 

 and abdominal walls is a classical symptom. The bowels move only at long 

 intervals in the untreated state. Even in light hypothyroidism, constipa- 

 tion is a frequent and early symptom. Cecal stasis and chronic colitis 

 are not infrequently met with. Without the aid of thyroid medication, 

 such conditions in subthyroid individuals are particularly refractive to 

 treatment. It should be remembered that a hypofunctional condition of 

 the digestive glands, liver pancreas, gastric and intestinal in common with 

 all organs and tissues is present in hypothyroid individuals. Hepatic en- 

 largement is reported by Argutinsky. 



The Genito-Urinary System. In view of the general reduction in 

 the chemical processes of the body, less urine with decreased amounts of 

 solids is passed in hypothyroid subjects. (See section Metabolism.) The 

 renal epithelium may suffer through the generally disturbed nutrition. 

 Albumin and tube casts are frequently reported in hypothyroid cases 

 though development of progressive nephritides seems, in spite of contrary 

 statements, rarely met with. According to Dock (c), albuminuria is pres- 

 ent in one-fifth of myxedema cases. Mucin may be found during treat- 



