IgQ MYXEDEMA 



The patient, a woman aged fifty-five, has been known to me for six years; 

 the symptoms of the disease developed slowly and insidiously, and for a long 

 time they were so little characteristic that it was hardly possible to diSeren- 

 tiate the condition from the ordinary cachexia of old age. Bnt the- behavior 

 and appearance of the patient were, even at that time, so peculiar that I had 

 a photograph- of her taken which is here reproduced (see Fig. 1). Later 

 however, the typical symptoms appeared (see Fig. 2). They improved and 

 nearly disappeared under specific treatment (thyreoid extract), but returned 

 after some time, the patient having discontinued her treatment. Fig. 3 shows 

 the patient in this stage of her disease.^ 



ETIOLOGY 



Eegarding etiology, as little could be determined in my ease as in other 

 cases of myxedema. A tendency to nervous diseases and depressing influences 

 of a psychical nature are said to be conducive to the development of the dis- 

 ease. Whether alcohol, syphilis, and tuberculosis, those exterminators of the 

 human race, play their part in this disease is very questionable, although sev- 

 eral authorities (Pel, Greenfeld, and Byrom Bramwell) have called atten- 

 tion to the occurrence of tuberculosis in the families of myxedematous patients, 

 or in the patient himself. Several cases in the same family have also been 

 observed. 



The sex of my patient confirms the general experience that women are 

 attacked in the majority of instances, and Sir William Gull entitled his first 

 communication, " On a Cretinoid State Supervening in Adult Life in Women." 

 Full seven years after the first publication regarding myxedema, a male suffer- 

 ing from this affection was observed by Savage (1880). In 1894, ia a com- 

 pilation of 127 cases of myxedema, Heinsheimer found only 10 men, i.e., 

 7.8 per cent. ; and this proportion would about correspond to the ratio if we 

 tabulated all the cases that have been published up to, the present time. 



Typical myxedema is a disease of adults, occurring most frequently be- 

 tween the thirty-fifth and fiftieth years of life. It is, however, by no means 

 limited to these ages, but may occur earlier, as the so-called infantile myx- 

 edema, or even later (which is quite rare). 



SYMPTOMS 



The symptoms of myxedema consist of : 



1. Changes in the external integuments (skin, hair, nails), and the absence, 

 or, more strictly speaking, the degeneration of the thyreoid gland. 



2. Disturbances of the cerebral and nervous functions. 



3. Disturbances of nutrition (of metabolism) and of circulation. 



1 The literature up to 1896 is almost complete in C. A. Ewald's " The Diseases of 

 the Thyreoid Gland, Myxedema and Cretinism," in Nothnagel's " Special Pathology and 

 Therapy," xxii. Part I ; for later articles see Ewald's article " Organotherapy," in 

 Mendel's J ahreshericlit filr Neurologic und Psychiatrie. 



