EXOPIITHALMIC GOITIM.—This disease may precede myxoedema, and its symp toms may therefore appear along with those of the latter malady. Individually, however, exophthalmic goitre differs so markedly from myxccdema as to render an error unwarranted.
NEPHRITIS.—The oedema of this tion is most marked in the face and pendent parts. There is pitting on ure, which is not the case in myxcedema. The skin is not scaly and dry and the nutrition of the hair is normal. In nephritis the patient is normal mentally. In myxcedema the swelling affects the forehead, the upper as well as the lower eyelid, the bridge of the nose, the lips, and tongue, differing from acute phritis; it is most intense over the mas seters and in the supraelavieular spaces. which are rarely affected in nephritis In granular kidney the (edema only al feets the ankles and legs after standing, and is not very well rnarked. In myxw dema there is usually depression of tem perature, which is rare in nephritis and other diseases; this is also accompanied by a subjective feeling of cold. Al. Allen Starr (Med. Nem s, Dec. 15, 22, '94).
The character of the (edema is entirely different from that encountered in ne phritis; it does not pit on pressure, and cannot be removed by massage. Espe cially characteristic of ni!,rxcedenia is the swelling in the supraclavicular region noted by Hilton Fagg in cretins. The stupid cretinoid appearance of patients with myxcedema is characteristic. S. J. Meltzer (Med. Age, Mar. 10, '96).
[As pointed out by Osier, too much stress should not be laid upon the supra clavicular swellings, since fatty enlarge ments are sometimes observed in this situation in healthy individuals: the pseudolipomata of Verneuil. CHARLES E. DE M. SAJOUS.] There are instances in which the diag nosis is by no means easy. Case of a married woman, aged 44 years, with 10 children, who had always had excellent health. Ever since puberty she had a tendency to swelling of the feet, particu larly at night. For a year or more she had been getting pale and heavier, the face a little swelled and flabby, and the eyelids (edematous in the morning. Pale
yellow, very muddy complexion; skin dry; but the broad features character istic of the myxredematous facies absent. No folds of skin on the forehead; neck not swelled; no large supraclavicular pads; the thyroid gland could be felt. Legs swelled, particularly below the calves. No pitting as in ordinary (edema. No change in voiee. Very despondent and low-spirited. Pulse, 70; no inerease in tension. Temperature, 08.5°. Amount of urine normal; color also; specific gravity, 1017; trace of albumin; no tithe-casts. Case regarded as one of 13right's disease, but sliggrvi ive nf inyx oedema. Under thyroid extract marked improvement. lf she omits it for a few eeks the swelling returns. Her dispnsi I .tt lizttlintl Itgain. anti —atm 0,1t.r Mod dom., Feb., '971.
Etiology.- \I \ WZ1F, at first be Li, N• .1 1.t (0 WOIllen, hilt the 41( Clinical Society Com r„,-,.-.11 odd, d to those of Hun have ..11,,k+ :I that it {NI1S al,o prevalent among rv-u to the i..tent of about 25 per cent. I %, rolde( lion of women to the disease d bv the latter author to the ',,.1 tbat the tlivroid. being, functionally 1., I. :I, live, is more liable to degenera r \ • • I :•1. 't Among the 95 women re . or 1. 1 in his statistics. ti4 were married I.ad had 300 children and 29 abor 7., I Di,orders of menstruation at bv copious. repeated hr.emor rIi.-,t, !lay act as predisposing factors.
old and damp seem to predispose the r_