S YMPTOMA TOLOG Y 



1287 



1. The pseudo-myxoedematous form. 



2. The myxcedematous form. 



3. The cardiac form. 



4. The nervous form. 



5. The chronic form with acute or subacute exacerbations. 



1. The Pseudo-Myxcedematoits Form. — In this subvariety of the 

 chronic stage there is usually hypertrophy of the lateral lobes of 

 the thyroid gland, more rarely a globular enlargement of the central 

 lobe. This hypertrophy is usually well marked in quite young 

 children, but is by no means evident in older children. In young 

 children the face is thin and the skin of a pecuhar light bronze colour, 

 said to be quite different from the pallor of an anaemia. In older 

 children the skin colour is violet-bronze. These colourations are 

 beheved to be associated with a parasitic invasion of the suprarenal 

 capsule. 



There is enlargement of the lymphatic glands in the neck, axillae, 

 and groins, while the parotid gland is also often hypertrophied. 



In young children the liver and spleen may be found to be 

 enlarged, but in older cases the abdominal signs are not well marked. 



With regard to the circulatory sj^stem, there may be tachy- 

 cardia, sinus irregularities, and an extra systole, and the blood- 

 pressure may be lower. Convulsions have been noted, and at times 

 slight fever, while the occurrence of conjunctivitis is also recorded. 



2. The Myxcedematous Form. — In this form the thj^roid gland is 

 atrophied, and associated with the usual symptoms of myxoedema, 

 such as the rough skin, loss of hair, and the presence of a firm 

 oedema not pitting on pressure, together with an arrest of mental 

 development in young children, or a mental degeneration in older 

 persons. The lymphatic glands of various regions are enlarged, 

 and there may be inflammatory eye affections. 



3. The Cardiac Form. — In the cardiac form there is disturbance 

 of the heart's action associated with arrhythmia, allarrhythmia, extra 

 systole, or sinus irregularities. The greater number of the cases 

 would be classed under Mackenzie's ' Rhythmus nodalis.' 



4. The Nervous Form. — Various brain and spinal cord symptoms 

 are seen in this disease — e.g., spastic paralysis in the legs, athetosis in 

 the arms, aphasia, pseudo-bulbar paralysis, or suprabulbar paralysis. 

 They are associated with the other symptoms of the disease. 



5. Acute or Subacute Exacerbations. — ^The principal feature of 

 this form is the preponderance of fever, and this may be due to 

 exacerbations of an old infection or to new infections. This form 

 is the cause of much mortality, and is separated from the acute 

 form by the rarity of the parasites in the blood, and by the history 

 of the long duration of the illness. As a rule it occurs in patients 

 who show marked hypertrophy of the thyroid gland, and there may 

 also be signs of suprarenal insufficiency. 



Blood.' — -The haematology has been investigated by Dias, who finds that 

 the haemoleucocytic formula has a great similarity to that found in African 



