286 THE DUCTLESS GLANDS 



tant to note that these nervous cases are considerably benefited 

 by treatment with sheep's thyroid. Cretinism is often classified 

 as a form of infantilism (q.v., p. 380). 



3. Myxoedema 



(a) Symptomology . In 1874 Sir William Gull communicated 

 to the Clinical Society of London a paper bearing the title, 

 " On a Cretinoid State supervening in Adult Life in Women." 

 This account was based upon five cases. In 1877 Ord proposed 

 the name " myxoedema," which has ever since been employed. 

 This writer describes changes in the thyroid. Curling and 

 Fagge had previously described atrophy of the gland in cretin- 

 ism. The early history of the subject may be completed by 

 referring to the work of Charcot, who called the disease 

 " cachexie pachydermique " ; Savill, who first described a case 

 in a male subject ; and Hadden, who first definitely ascer- 

 tained that atrophy of the thyroid is commonly associated with 

 myxcedema. 



The aetiology of myxoedema is obscure. Heredity, traumat- 

 ism, tubercular family history, alcohol, syphilis, and many 

 other factors have been alleged. The disease is chronic, and 

 the onset is very gradual. 



In most cases myxoedema shows itself in a gradual swelling 

 of the skin. This may be accompanied by nervous disorders, 

 neuralgia, convulsions, " tetany," mental disturbances, and 

 skin diseases. The swelling of the skin is at first most notice- 

 able on the face. The chin, eyelids, nose, lips, and cheeks swell 

 up, and the palpebral cleft is narrowed. A slowly increasing 

 languor is often felt in early stages, and a sensitiveness to cold 

 is frequently noticed. Headache is an early symptom in 

 some cases. 



The skin may become yellowish , and shows in fully developed 

 cases what is called " solid oedema." The swelling resembles 

 oedema or fat, but on palpation feels softer and more elastic 

 than fat, and unlike ordinary oedema, it does not pit on pres- 

 sure, nor does any fluid exude if the skin is pricked. The weight 

 of the patient is increased very considerably. The skin is 

 wrinkled in some regions, pendulous in others. The swelling 

 is fairly uniform over the trunk and limbs, but is most noticeable 

 in the hands and feet. The skin becomes dry and rough and 



