290 THE DUCTLESS GLANDS 



Kocher's term was " cachexia strumipriva." " Cachexia 

 thyreopriva " is a more correct term, but is less usually 

 employed. 



It is important to note carefully the symptoms recorded 

 when the thyroid is totally removed from the human subject. 

 The cachexia comes on at a very variable period after the opera- 

 tion from six to eight days up to months or years. Patients 

 advanced in years suffer less than young people under twenty. 

 The patients first complain of fatigue, weakness, and heaviness 

 in the limbs, sometimes associated with pains, tremblings, and 

 sensations of cold. There is a diminution of mental activity, 

 loss of memory, slowness of thought, speech, and movements. 

 Then one notices fugitive swellings of the face, hands, and feet, 

 which gradually become stationary and lead to a coarseness 

 and puffiness of the whole body. The skin loses its suppleness, 

 and becomes infiltrated, dry, and scaly. The hairs of the head 

 fall out. 



There are also nervous symptoms, such as are observed in 

 myxoedema. The symptoms, in fact, as they were described by 

 Kocher and Reverdin, are very much like those of myxoedema, 

 except, perhaps, that not so much stress is laid on the "solid 

 oedema." 



The majority of writers since the year 1896 have assumed 

 that the precise nature of the symptoms depends on the amount 

 of injury inflicted upon the parathyroid bodies in other words, 

 that myxoedema properly so called is due to the absence of 

 thyroid functions, while the nervous symptoms (tetany) are 

 due to injury to the parathyroids. This matter will be referred 

 to again when extirpation experiments on animals are dealt 

 with. 



5. Graves 9 s Disease (Exophthalmic Goitre, Basedow's Disease) 



The three cardinal symptoms of this disease are tachycardia, 

 exophthalmos, and increase in size of the thyroid gland. Some 

 authors consider that certain nervous symptoms are equal in 

 importance with those here mentioned. 



In addition to protrusion of the eyeballs the more impor- 

 tant eye signs are (1) a widening of the palpebral clefts or 

 Dalrymple's sign ; (2) dissociation of the movements of the 

 eyeball and the upper lid (v. Graefe's sign) ; (3) inability 

 to maintain convergence of the eyes (Moebius' sign). 



