THE THYROID GLAND IN MEDICINE. 483 



as to their own appearance and to the attention which it attracts, 

 and consequently shun society ; and for this reason partly, and 

 partly because of their muscular weakness and subnormal tem- 

 perature, they like nothing so well as staying quietly in the 

 house. The onset of the disease is gradual and its progress is 

 slow, ordinarily extending over a period of several years. It 

 most frequently occurs in women of middle age. Altogether 

 myxoedema, although not a direct menace to life, makes the vic- 

 tim of it very uncomfortable and unhappy. 



The appearance of a person suffering from advanced myxoe- 

 dema is so characteristic that when one has seen a case there 

 is usually no difficulty in recognizing another. In the earlier 

 stages, however, when the disease is beginning, its diagnosis may 

 be difficult or temporarily impossible. 



Myxoedema is not a common disease in this country, and 

 until five years ago was regarded as incurable. But as physi- 

 cians become more familiar with the condition, which after all 

 has only been recognized for about twenty years, and more espe- 

 cially as the possibility of curing it becomes more widely known, 

 it is altogether probable that we shall find the disease less rare 

 than we have been led to suppose. 



The series of experiments which led to the employment in this 

 disease of the thyroid glands of animals resulted in discoveries 

 so complete and definite that it became possible to predict that 

 the thyroid treatment of myxoedema would be a success. Be- 

 fore Sir William Gull described the affection and claimed for it 

 a place of its own among the list of distinct diseases, it had been 

 regarded as a variety of Bright's disease. But to the trained eye 

 the resemblance of myxoedema to Bright's disease was too super- 

 ficial to be satisfying; and, furthermore, when these patients 

 died their kidneys, which would have shown disease changes if 

 they had been responsible for the symptoms observed in life, 

 were found to be normal. So the first step forward in our knowl- 

 edge of the disease was the establishment of the fact that the seat 

 of the trouble was not in the kidneys ; it was not discovered until 

 later that it was in the thyroid gland. This discovery came 

 about from several sources. 



It was observed by physiologists that animals from which the 

 thyroid gland had been removed developed a condition of oede- 

 ma and stupidity; and several surgeons reported that patients 

 from whom the thyroid gland had been removed by operation 

 for various causes developed symptoms almost identical with 

 those of the cases which had been regarded as examples of 

 Bright's disease, but in whom the kidneys were found nearly 

 normal. 



This experimental evidence was amplified by the work of 



