HYPOTHYEOIDISM 



427 



absorption by the lymphatics in the same manner as the normal secretion 

 is conveyed into the circulation from the healthy gland. The symptoms 

 of myxedema in the first case I treated in this manner rapidly disappeared, 

 thus proving that the thyroid gland is a true internal secretory gland, and 

 that the thyroid extract is a specific remedy for myxedema. The following 

 year it was shown by Howitz, of Copenhagen, and by Dr. Hector Macken- 

 zie and Dr. E. L. Fox, in England, that the same results could be obtained 

 by the simple method of giving thyroid extract or the raw gland itself by 

 the mouth." 



The effect of thyroid medication upon the symptoms of hypothyroidism 

 is a general tendency to return to the normal condition. In every tissue 

 and organ, the therapeutic effect may be manifest, so that the result may 



Fig. 16. The same myxedema patient before (left) and after (right) thyroid 

 treatment. (Courtesy of Drs. Wm. Engelbach and J. L, Tierney.) 



be positively startling in some instances. A decided change for the better, 

 especially in the mentality, may be noticeable within a few days, to be 

 followed in succession by improvement in the rapidly growing tissues such 

 as the skin, and finally in the internal organs, the skeleton and dentition. 

 In children growth and development is again resumed. Sometimes this 

 may be so rapid, according to Hertoghe, that kyphosis and scoliosis may 

 result. Bowing of the legs may be induced at first. The ability to grow 

 depends upon the epiphyses remaining open. Growth is usually difficult 

 to obtain after the twentieth year though it has occurred up to the thir- 

 tieth. There is usually very rapid increase in stature at the outset of treat- 

 ment, four or five inches being at times attained. Later there ensues a 

 gradual return to the normal growth curve. Severe cases of cretinism, 

 no matter how well treated, rarely attain normal size. Although not ana- 

 tomically, functionally perfect results may be obtained. Thus Hector 

 McKenzie's male cretin began treatment at the eleventh year and at the 

 twenty-fifth had become in every respect a normal individual except for 

 shortness of stature (5 ft. 4 in.). 



