888 WALTER TIMME 



. j 



thyroids; thyroid, testicles, hypophysis and suprarenals; thymus, supra- 

 renals, hypophysis ; and so on almost indefinitely. 



Symptomatology. The syndrome develops between the ages of 25 

 and 30 years and is more frequently seen in males than in females. Up 

 to this age sexual and genital development are apparently normal or only 

 moderately delayed. Indeed, some of the patients may have already 

 married and borne children. After the particular etiological factor has 

 arisen, the patient begins to suffer from fatiguability after exertion which 

 theretofore never produced fatigue. This occurs both in the muscular 

 and the mental spheres. Or else, one of the tissues such as the hair shows 

 the atrophic process and begins to fall out. In still other cases, the sexual 

 appetite diminishes and impotency arises. Again, the symptoms arrange 

 themselves about the gastro-intestinal tract and we see nausea, vomiting, 

 anorexia, with loss of weight, some discoloration of the skin with thick- 

 ening of the epidermis. This condition may last for years. The patient 

 shows a face free of hair, pale, dry and of a yellowish brown color. Occa- 

 sionally there is a myxedematous condition of the lower lip which looks 

 puffy and thick and becomes more or less protruded. The skin of the body 

 is generally thick, dry and scaly, but usually whitish and translucent in 

 contrast with the pigmentation of the face. The genitals are small, the 

 scrotal sac is without tone and the testicles are extremely small. The 

 thyroid gland is regularly small. The limbs are flail-like and the rounded 

 muscle contour gone. There are no acromegalic features in this syndrome 

 though the epiphyses are united. With the weakness, a certain degree of 

 lassitude and apathy are manifested. The patient cannot bear cold and 

 has the constant subjective sensation of cold. Mentally the picture is one 

 of instability irritability and anger arising from the merest trifles and 

 ideas of reference developing occasionally. A lack of inhibition is mani- 

 fest. In those cases in which the syndrome arises soon after puberty, the 

 voice becomes high-pitched. Polyuria and polydipsia are frequently met 

 with. Diarrhea and progressive gastro-intestmal disturbances occur. The 

 pulse becomes slow and the blood pressure low. Spasticity of the blood 

 vessels occurs with resulting acroparesthesia and erythromelalgia 

 (Murri). Here the syndrome frequently merges into the Raynaud type. 

 The teeth frequently fall out and those that perchance remain are carious 

 (Sourdel). Headaches and neuralgic pains in the extremities and else- 

 where are common. Frequently they are so intense as to prevent sleep. 

 While no actual muscle atrophy is seen, yet tetanoid muscle spasms are 

 met with. The reflexes are unaltered with the exception of the cremasteric 

 which is diminished. Hyperacusis and tinnitus also occur. Nasal hydror- 

 rhea has been noted. Smell is usually diminished and frequently van- 

 ishes. Physical and psychical impotence are important observations. 

 Blood examination frequently shows a leukocytosis and an eosinophilia. 



