THE DUCTLESS GLANDS 1187 



by Schiff, the attention of physiologists and medical men was especially 

 directed to the importance of this organ by the observations of surgeons, 

 especially Kocher, on the untoward and even fatal effects following its 

 complete removal in man in operations for extirpation of goitre. In this 

 country attention had already been called to the connection of a disturbed 

 condition of metabolism known as myxcedema with atrophy of the thyroid. 

 A patient affected with myxoedema presents a gradually increasing blunting 

 of his or her mental activities ; speech is slow, cerebration delayed. With 

 this nervous defect are associated changes in the connective tissues, the 

 subcutaneous connective tissue becoming thickened, so that the face and 

 hands appear swollen and puffy, looking at first sight as if oedema were 

 present. The swelling is, however, due to newly formed connective tissue, 

 and not to the presence of an excess of interstitial fluid in the tissues. The 

 patient often presents a yellow, waxy appearance with a patch of colour on 

 the cheeks. The hair falls out, the pulse is slowed, and the temperature 

 tends to be subnormal owing to the diminution of the rate of metabolism in 

 the body. The intake of food and the excretion of urea are diminished. 

 If the atrophy of the thyroid occurs in early life during the period of growth, 

 e.g. in young children, the growth of the skeleton practically ceases. The 

 bones of the limbs may grow in thickness but not in length. There is 

 early synostosis of the bones of the skull and complete cessation of develop- 

 ment of mental powers. Children so affected may live for many years, but 

 when twenty-five or thirty present still a childish appearance (Fig. 547, c). 

 Stunted, pot-bellied, and ugly, they have the intelligence of a child of four 

 or five. They often present fatty tumours above each clavicle, and similar 

 subcutaneous tumours of fat or loose fibrous tissue are found in cases of 

 myxcedema in the adult. 



When the thyroid is extirpated in man the result is often the production 

 of typical myxcedema. In some cases, especially in young individuals, the 

 results are more severe, a condition of tetany being set up in which there are 

 tonic spasms of the muscles of the body, especially of the extremities. When 

 the thyroid gland is extirpated in animals the results more closely resemble 

 these acute cases. In certain cases a chronic condition of malnutrition is 

 set up, but a typical myxcedema with thickening of the subcutaneous tissues 

 by new growth of connective tissue has only been described* by Horsley in 

 monkeys. The effects are more pronounced in carnivora than in herbivora. 

 In the former a condition of tetany is produced accompanied with 

 muscular tremors and clonic convulsions which come on at intervals and 

 may be accompanied with severe dyspnoea leading to death within fourteen 

 days. In herbivora, wasting, diminution of respiratory exchange, and 

 disorders of nutrition are often the most prominent symptoms. These 

 results were ascribed by Munk to interference with the recurrent laryngeal 

 nerves during the operations, but the observations on man leave very 

 little doubt that they are due entirely to the removal of the chemical 

 influence of the thyroid gland. Many authorities were at first inclined to 

 ascribe these results in man and animals to the circulation in the blood of 



