74 INTERNAL SECRETION 



interstitial connective tissue. We are still, even at this date, 

 entirely in the dark in regard to the etiology of this slow, pro- 

 gressive atrophy of the thyroid tissue. We only know that women 

 are far more frequently affected than men (80 per cent.) ; that 

 the disease is frequently associated with disturbance of sexual 

 function, and occasionally with acute infective conditions; and 

 that it occurs with much greater frequency in countries where 

 goitre is not endemic (Great Britain, Belgium). 



The abortive forms of true myxoedema, to which Hertoghe 

 gave the name of Hypothyroidie benigne chronique, resemble the 

 myxcedema postoperativum frustrum which appears after partial 

 thyroidectomy. 



These cases, which have latterly received a good deal of 

 attention, generally show only isolated, though characteristic, 

 secondary symptoms of myxcedema ; such are trophic and 

 vasomotor disturbance of the skin, absence of perspiration, falling 

 of the hair, and, occasionally, oedema. Functional disturbances of 

 the sexual organs, such as menorrhagia, also occur. The manner 

 in \vhich these cases respond to treatment with thyroid extract 

 shows that the condition arises from a reduced thyroid activity, or 

 hypothyreosis. 



Another clinical condition which ought to be included in 

 this group is Adiposis dolorosa, or Dercum's disease, but its 

 pathogenetic relationship to the thyroid gland is by no means 

 fully established. In 1888, the American neurologist, Dercum, 

 described a condition in many respects resembling myxcedema, 

 but characterized by the appearance in the connective tissue at 

 different parts of the body, of circumscribed and very painful 

 fatty tumours. In addition to the localized fatty tumours, there 

 are also diffuse fatty deposits and, at times, a remarkably obese 

 bodily habit. Side by side with this, there is usually pronounced 

 muscular weakness, the patients performing only the most 

 necessary voluntary movements on account of the pain induced 

 by muscular action. The will-power is generally unimpaired, 

 though there is sometimes an apathy reminiscent of that of 

 myxcedema, and more rarely a condition of psychic exaltation. No 

 information concerning the metabolism of the condition is forth- 

 coming ; in some cases glycosuria has been observed. A 

 remarkable feature of the condition is the absence of eosinophile 

 leucocytes from the blood. Six cases have come under post- 

 mortem examination, and of these five showed more or less far- 

 reaching pathological changes of the thyroid gland. In one case, 

 described by Dercum and MacCarthy, the thyroid was normal, but 

 there was adeno-carcinoma of the hypophysis cerebri. 



The pathological anatomical findings appear to point to the 

 thyroid as the originating cause in adiposis dolorosa. But the 

 hypophysis undoubtedly plays a part in the genesis of this con- 

 dition, and it is probable that the sexual glands also are concerned, 

 as in such cases they are frequently atrophied. 



