, 410 NELSON W. JANNEY 



nient. In the writer's own experience a youthful member of a hypothyroid 

 family developed, after an infection, a subacute nephritis followed by a 

 persistent albuminuria which cleared up on thyroid treatment. Functional 

 renal studies were negative in this case. A systematic study of renal func- 

 tion in hypothyroidism has not as yet been carried out. Bowen, Byron and 

 Boothby have reported, however, improvement in the functional picture in 

 adult cases after thyroid treatment, a distinguishing feature from ordinary 

 nephritis. 



The genitalia frequently suffer severely in young subjects. The parts 

 remain small. Puberty and secondary sex characters may set in late or, in 

 severe cases, fail to appear. Frequently the adult sexual organs, though 

 potent, are much diminished in size. In males, complete impotence is 

 the rule in cretins reaching adult age. Impotence may cease on thyroid 

 treatment to return when the treatment is neglected. This occurred in 

 a patient of Magnus-Levy at the age of 54. The writer can report a 

 similar observation in a man of 55 years. In Herz's case but two weeks 

 were required for a complete restoration of sexual function. Spermator- 

 rhea may occur according to Hertoghe. There seem no recent reports of 

 this anomaly. 



The female genitalia may be swollen and the labiae poorly developed, 

 failing to meet in the midline. The uterus may remain tiny and infantile 

 throughout life in the untreated state. Ovulation, menstruation and con- 

 ception do not occur in the severest cases. Premature menopause may occur 

 in the presence of degenerated and atrophic female genitalia (London and 

 others). Myxedema does not necessarily prevent conception as a number 

 of myxedematous multiparae are cited in the literature. In lighter 

 cases, amenorrhea is frequent, also menorrhagia and dysmenorrhea. In 

 functional menorrhagia and dysmenorrhea, the ovarieis and thy- 

 roid may be etiologically involved. Certain cases are cured by thyroid 

 medication. For careful studies of these relationships, see E. Novak. 

 Surgical removal of part of the thyroid does not prevent normal preg- 

 nancy. In Ilalsted's (a) experiments, the enormously hypertrophied thy- 

 roid glands of puppies born under these circumstances seemed to act com- 

 pensatorily. Attention has already been called to the disturbances "in the 

 psychic sexual sphere. 



Functional attircxis of cliildlwod of hypothyroid origin was described 

 by Leonard Williams who cured a number of cases by thyroid therapy. 

 It seems regrettable that, children are still disciplined for this apparent 

 laxity in their deportment without a proper examination as to the possible 

 presence* of a subthyroidal state. 



The Locomotor System. The limbs of cretins are short, stunted, 

 thnso of myxedematous subjects fat and flabby. The hands and, feet are 

 plump and coarsely shaped. The hand is usually described as spade-like 

 (Gull) with short pyramidal fingers usually lying open, due to defective 



