HYPOTHYKOIDISM 419 



remarkable rejuvenescence which, in certain individuals, occurs on proper 

 thyroid treatment. Perhaps it has been this moment which has caused 

 certain authors, particularly Horsley, to regard senility as a form of 

 hypothyroidism. For this view certain facts speak. The mentality is 

 deficient. The facial expression of the aged sometimes suggests senility. 

 The skin and hair are dry, the latter is lost. Obesity is present. The 

 nervous impulses are slow. The special senses, particularly hearing, are 

 affected and the sexual function weakens. It seems, however, to the 

 writer that in this consideration is perhaps overlooked the general sclerosis 

 of senility which affects all tissues and organs including the ductless 

 glands. It might be more advisable to regard senility as the result of a 

 multiglandular sclerosis in as much as all vital metabolic processes are 

 apparently carried out through their mediation. 



Association of Hypothyroidism with other Endocrinopathies may 

 occur. In view of the pathological lesions found at times in the other duct- 

 less glands in hypothyroid cases and the probability that the endocrin tis- 

 sues in common with all organs of the body require a normal supply of 

 thyroxin for nutrition, one may expect symptoms referable to the pitui- 

 tary glands, etc., to be found in association with hypothyroidism. (See 

 Figs. 1 and 2.) Such clinical syndromes do occur in certain instances. 

 Thus McCarrison draws attention to the prevalence of tetany in Hima- 

 layan women who also suffer from hypothyroidism and goiters. Due, 

 however, to the intimate relationship of the ductless glands, these puzzling 

 Plurigldndular Syndromes frequently show no predominant affection of 

 any single member of the endocrin system and have therefore received 

 special mention otherwise in the present work. 



Diagnosis 



The diagnosis of hypothyroidism in its typical expressions, cretinism 

 and myxedema, is obvious on inspection. Perhaps it is that the very 

 grotesqueness of the clinical pictures presented by such patients has fixed 

 the classical type so clearly in the minds of many physicians that the latent 

 or mild cases of subthyroidism are frequently passed by unnoticed. 

 Latent hypothyroidism in children, or myxedema fruste in adults, is, 

 however, much more common than the classical clinical syndromes as first 

 emphasized by Hertoghe followed by Kocher, F. Krause, Falta, Leonard 

 Williams and others. Recognition of these atypical cases may be difficult 

 and require most careful observation and consideration. With the hope 

 of aiding the discovery of more of these latent cases, most of which are 

 curable, the following remarks are added. 



The family history is important. Questioning may bring out salient 

 points such as history of early or uncontrollable obesity,, goiters, protu- 



