418 NELSON W. JA1STNEY 





underdevelopment of the skull, thinning and rarefaction in the long hones, 

 hypoglycemia, delayed blood glucose curve, creatinuria, etc. Von Werdt's 

 (b) case of progressive muscular dystrophy had a colloid struma. Pin- 

 cherle has recently described a remarkable patient whose condition would 

 certainly suggest hypothyroidism to be the underlying etiological factor at 

 least in this instance. A boy of eleven years exhibited the classical signs 

 of congenital hypothyroidism from early years. Gradually progressive 

 muscular dystrophy of pseudohypertrophic type developed. Thyroid 

 medication caused improvement both of the hypothyroid symptoms and 

 the dystrophic condition of the musculature. Further studies of this 

 myopathy with aid of basal metabolic rate determinations are indicated 

 and may be productive of development of organotherapy in certain types 

 of case. 



The Lymphatic System. Swelling of the lymphatic glands is com- 

 mon in subthyroid children. The occurrence of adenoids has been alluded 

 to. Tonsillar hypertrophy may be extreme. It is surprising how often 

 hypothyroid individuals give a history of unsuccessful tonsillectomies and 

 adenoidectomies in as much as the tonsils, etc., have a tendency to grow 

 again. Before hypothyroidism was recognized, one of my patients gave 

 the history of having undergone three tonsillectomy operations by careful 

 operators but still showed remnants of tonsillar tissue in his throat. Grant 

 Self ridge has called attention to the frequency of an endocrin factor in 

 such cases, in many of which the thyroid is functionally deficient. It is 

 sometimes remarkable that in conjunction with the general improvement 

 of these cases on thyroid treatment the hypertrophied tonsils and adenoids 

 decrease in size. We have here excellent grounds against the indiscriminate 

 practice of nose and throat operations without a general medical revision 

 of the case. 



The Temperature. As a result of the inhibition of all metabolic 

 processes and the circulatory weakness, there is a generally low caloric 

 production. This is evinced by the cool clay-like feel of the skin particu- 

 larly of the extremities. Hypothyroid individuals frequently complain 

 of the cold and go about, in winter bundled in heavy clothing. Nearly all 

 feel better during hot weather. The decrease in perspiration noted in 

 such subjects is probably due, aside from degeneration of the sebaceous 

 follicles, to the lowered requirement for reduction of the body tempera- 

 ture by sweat evaporation. 



The body temperatures encountered may be very low, 06 F., or even 

 still more abnormal. The low temperature together with slow pulse and 

 respirations represent some of the most characteristic manifestations of 

 the hypothyroid condition. Fever during attacks of infectious diseases is 

 likely to be lower than in normal individuals. 



Hypothyroidism and Senility. Any careful observer will note the 

 prematurely aged appearance of an advanced ease of myxedema also the 



