Myxedema

“ The nose is large and broad, and the skin of the eyelids and ears is enormously hypertrophied. The tongue is greatly hypertrophied. The disease is of long duration, and late in the history the bones of the spine and thorax may acquire great deformity. As we know little of the influences and sources governing nutrition, the pathology and etiology of acromegaly are obscure. Marie regards the disease as a systemic dystrophy analogous to myxedema, due to a morbid condition of the pituitary body, just as myxedema is due to disease of the thyroid. ”

“ Myxedema subjects show a loss of physical and mental energy which is proportional to the lack of thyroid. Deficiency in any of the organs of the kinetic chain causes alike loss of heat, loss of muscular and emotional action, of mental power, and of the power of combating infections—the negative evidence thus strongly supports the positive. By accumulating all the evidence we believe we are justified in associating the brain, the adrenals, the thyroid, the muscles, and the liver as vital links in the kinetic chain. Other organs play a role undoubtedly, though a minor one. ”

“ An animal engaged in battle or in a desperate effort to escape will be able to give a better account of itself if it have some means of accelerating the discharge of energy— some influence like that of pouring oil upon the kindling fire. There is evidence, though perhaps it is not conclusive, that such an influence is exerted by the thyroid gland. In myxedema, a condition characterized by a lack of thyroid secretion, there is dulness of the reflexes and of the intellect, a lowered muscular power, and generally a sluggish discharge of energy. ”

“ There is first that ubiquitous agent in the system, the thyroid. Chemical analysis of it has shown that the iodine content decreases with the age of the individual, and becomes specially low after forty. It is after the menopause in women that myxedema, the disease of complete degeneration of the thyroid, and of the physical and mental faculties, is most frequent. The thyroid of old people exhibits, in varying degrees, signs of a similar degeneration. Thyroid feeding, properly controlled, will clear up certain of the deteriorations of mind and body observable in the aged. ”

“ This is an abnormality, and is sometimes based upon pathologic changes in the thyroid gland analogous to myxedema. In men at about the same relative period an enormous gain in weight occasionally arises and is a serious annoyance and anxiety. ”

“ Conditions of excitement have also been reported in thyroidism, and, according to Falta, are not uncommon. Brunet has expressed the opinion that in such cases Basedow's disease acts only as a precipitating factor in an individual predisposed to a psychosis.
The English Myxedema Commission found the apathy characteristic of that disease present in all but three [208] of 109 cases. This condition develops early and may manifest itself in the form of a mild mental dulness. Intellectual activities are often markedly diminished and there is a slow, monotonous form of speech. ”

“ While the functions of this little organ are not yet very clearly understood, there is nothing more definitely known than its tremendous importance in the bodily economy. Without it there can be no such thing as healthy development. Thyroid deficiency in children gives rise to a form of idiocy, bodily malformation and degeneracy known as cretinism, while in adult life it is associated with a similar disorder known as myxedema. Goiter is the most common disorder of the thyroid gland ”

“ Thyroigenic obesity was reported by von Hertoghe in 1896. The isolation and chemical definition of adrenalin by Takamine in 1901 was a decided step in advance. Fröhlich in 1901 suggested that obesity, infantilism of the genitalia and myxedematous alterations of the skin pointed to tumors of the hypophysis. In the same year Neumann thoroughly reviewed the subject of growths in the epiphysis, submitting a study of twenty-two cases. The various types of dwarfism were first described by von Hansemann in 1902. Thyroplasia and myxedema were exhaustively studied by Pineles in 1910 and 1912. ”

“ A woman has had myxœdema for years, and has been told by many physicians that her condition is incurable, and she is indifferent and skeptical as to the value of the treatment proposed for her. In a few months it is with difficulty that she can be recognized as the same person. The swollen, pallid, stupid face is gone, and in its place are red cheeks and the pleasant expression of a healthy woman. She can walk several miles a day, sleep well, has a good appetite, and enjoys life.
Such is the history of myxœdema and how it came to be treated by the thyroid gland of animals. ”

“ The results of the treatment are very striking; the œdema rapidly disappears, leaving the skin soft, smooth, and moist; the
mental dullness gives way to cheerfulness and hope; strength is returned to the weakened muscles, and the patient becomes once more, to all appearances, a normal individual. A large number of cases of myxœdema have been recorded as cured by thyroid feeding, and these reports are usually accompanied with photographs of the patient as he appears before and after treatment, which present most striking contrasts. ”

“ MYXOEDEMA (or athyrea) , the medical term for a constitutional disease (see Metabolic Diseases) due to the degeneration of the thyroid gland, and occurring in adults; it may be contrasted with cretinism, which is a condition appearing in early childhood. There are two forms, myxoedema proper and operative myxoedema (cachexia strumipriva) . (1) Myxoedema has been termed “Gull’s Disease” from Sir William Gull’s observations in 1873. Women are more often the Victims than men, in a ratio of 6 to 1. ”

“ Even small doses, if beyond the patient’s power, may produce fever, excitement, headache, insomnia and vomiting. The administration must be persisted in throughout life, otherwise myxoedematous symptoms appear. The first most apparent results are those of growth, and this may supervene even in patients up to 25-30 years of age. Once started, 4 to 6 in. may be gained in stature in the first year’s treatment, though this is usually in inverse ratio to the age of the patient, and also diminishes in later stages of treatment. ”

“ In experimental myxœdema the degenerative processes have been found in the nerve-cells.
There are no symptoms referable to the heart or lungs, and if cirrhosis of the kidney and liver develop, their symptoms supervene upon and are secondary to those of myxœdema. High arterial tension has been noticed in the majority of the cases.
The COURSE of the disease is a chronic one, and is progressive. There are, however, intermissions in the severity of the symptoms in some cases. Recovery does not occur. ”

“ The processes of oxidation are diminished both in typical myxœdema and in advanced old age. There is a diminution of the blood-corpuscles and of hæmoglobin in both conditions.
After the initial obesity in early myxœdema and old age, there comes as a second stage a loss of fat, characteristic of the advanced stage of myxœdema (the cachectic stage) and advanced old age.
There is an increase of fatty tissue after extirpation of the thyroid gland, and later of connective tissue, just as in myxœdema and old age. This increase of connective tissue is typical of old age. ”

“ The number of deaths from myxœdema, especially since the discovery of thyroid extract, must be small indeed. Moreover, apart from Mr. Coleridge's fallacy of argument, it is impossible to see how he can really doubt the efficacy of the thyroid treatment, both in myxœdema and in sporadic cretinism.
Again, "Look at the diseases of the circulation," he says. "The doctors say that digitalis and nitrite of amyl act on the heart; and that the action of these drugs was discovered by the help of experiments on animals. Very good. The heart is concerned with the circulation. Very good. ”

“ Thus, in exophthalmic goiter menstruation is usually irregular and often disappears. In myxœdema there is atrophy of the ovaries and sterility. The above conditions in man often produce sterility.
In partial cases of myxœdema metrorrhagia is frequent. By giving thyroid extracts these uterine hæmorrhages may be stopped.
After having shown that old age can be caused with more or less certainty by degenerative changes in the sexual organs, we will now try to show that it can also be caused by various kinds of intoxication. ”

“ Oedema is local watery effusion, which may have various causes and significance. Anasarca must have a general causation, either connected with the state of the blood or with disorder of the heart, kidneys, or liver, or of more than one of those organs at once. Pitting on pressure is the sign of watery effusion. Soft crackling under the touch distinguishes emphysema. A firm enlargement of the surface of the face and upper part of the body occurs in myxoedema. ”

“ We do not now need to be told that the thyreoid gland plays a very important part in the economy, for we know that its surgical removal gives rise to a special disease known as myxoedema, which, in addition to its physical manifestations, is characterized by impairment of the mental powers. ”

“ Uncomplicated cases do not show fever and the occasional enlargement of lymphatic glands is probably connected with bacterial infections.
There are never visceral metastases in mycetoma as is true of the nearly related actinomycosis.
The process shows no tendency to heal naturally or under treatment but fortunately does not extend, the process being confined to a foot or a hand. The joints are rarely if ever invaded. Unless the sinus-riddled member is amputated the drain on the patient gradually exhausts him and death ensues in ten or fifteen years. ”

“ In 1891 George Murray published his Note on the Treatment of Myxoedema by Hypodermic Injections of an Extract of the Thyroid Gland of a Sheep. Later, the gland was administered in food. At the present time tabloids of thyroid extract are given. We could not have a better example how experiments on animals are necessary for the advancement of medicine. Now, with little bottles of tabloids, men and women are restored to health who had become degenerate in body and mind, disfigured and debased. The same treatment has given back mental and bodily growth to countless cases of sporadic cretinism. ”

“ MYCETOMA, OR MADURA FOOT.--Mycetoma is a chronic disease due to an organism resembling that of actinomycosis, but not identical with it. It is endemic in certain tropical countries, and is most frequently met with in India. Infection takes place through an abrasion of the skin, and the disease usually occurs on the feet of adult males who work barefooted in the fields. ”

“ For such, so to say, physiological purposes as we are required to give them, thyroid extracts should be administered in a quantity just sufficient to make up the amount of thyroid secretion which the body demands; the greater the age, the larger the dose; but we must not forget that, as in advanced cases of myxœdema, so also in advanced senility, we must not expect too great results from the treatment. ”

“ In more than 75% of cases of mycetoma the foot is the only part infected. More rarely there is involvement of hands, knees and buttocks.
The affected part shows nodules on the external surface which connect with the granulomatous lesions of the interior of the foot by sinuses. In advanced cases there may be a network of sinuses and cyst-like dilatations which are filled with a viscid fluid packed with the small fish-roe granules in the white variety or the gunpowder grains of the black mycetoma. ”

“ The changes which result from the thyroid treatment of cretins. owing to their stunted bodies and vacant minds, are even more astonishing than those described for myxœdema; for in cretins, not only do the œdema and other general symptoms disappear, but the dwarf begins to grow, and the idiot to show signs of intelligence. One patient who, at the beginning of treatment, was sixteen and a half years old and only thirty-three and a half inches in height, and in whom no growth had occurred in fourteen years, grew four and three quarters inches in six months ”

“ Morvan, Ord, and Combe found that myxœdema was frequently caused by numerous pregnancies, especially if associated with prolonged lactation.
This also explains why women become prematurely old so much more frequently than men, for their ovaries are much sooner exhausted, in consequence of their activity being much greater than that of the male sexual glands. There is a much greater demand not only on the female sexual glands, but also on the female thyroid, which enlarges every month in many women, and is greatly exhausted by each pregnancy. ”

“ Now, if a person suffering from complete myxœdema can obtain such a result by the use of thyroid extracts, should not a person suffering only from a partial form of the same disease be able to obtain similar results? It would be quite contrary to our physiological conceptions that a person in a bad condition of health and in physiologically inferior circumstances should benefit more, by exactly the same treatment, than another person who is in a much better condition of health. Therefore, the thyroid treatment of old age is justified. ”

“ There is a much more spectacular disease to be cited, —a relatively infrequent but well-understood condition called myxoedema, which occurs mainly in women and is also due to a deficiency in the thyroid secretion. As a result the patient, who may have been a bright, capable, energetic person, full of the eager purposes and emotions of life, gradually becomes dull, stupid, apathetic, without fear, anger, love, joy or sorrow, and without purpose or striving. ”