Henrot attributed myxcedema to hy pertrophy of the pituitary body and of the pineal gland involving secondarily the sympathetic, this theory being based upon Tiedemann's view that the pitui tary body affords an anastomosis be tween the two main neighboring ganglia of the sympathetic, and upon the fact that in reptiles and fishes, in which mu cous tissue abounds, the pineal gland and pituitary body are markedly developed. The cutaneous infiltration with mucin \vas thus explained. This is, to a de gree, sustained by the cases of J. Stew art, alluded to by Adarni, in which autopsy disclosed a large cancerous tumor of the pituitary, the thyroid be ing normal. But the only manifestation of the disease seems to have been a myxcedernatous swelling of the hands and of other regions to a. less extent. Goodhart accounted for all the nervous and mental manifestations by suppos ing the existence of a cerebral lesion, the nervous elements undergoing changes corresponding to those observed else where in the organism. Charcot gave the disease the name of cacke.rie paehy dennique, under the belief that it bore a certain kinship with elephantiasis due to impaired nutrition of the nervous system. All these conceptions found many able supporters.
The most prominent and perhaps the only dissentors from the prevailing views in respect to the physiolog,ical effects of athyroidism are Professor Munk, of Berlin,. and R. 11. Cunningham.
Munk (Virchow's Archives; Then Gaz., Jan. 15, '98) absolutely denies that the removal of the thyroid in animals either necessarily (1111SCH dOritil Or inevi tably' leads to inyxcedeina, haring never seen myxcedema develop in animals. He contends that the feeding of thyroid or the ingrafling of the removed gland into another part of the body never lessens the dangers of thyroidectoiny, hieli al ways remains a serious opentlion.
kept a number of animals alive after the operation, and has been sueeessfol in the case of apes that have stir\ ived, and are in good health nearly year liner lhe careful, complele, hut, thoroughly a fiel) tic, removal of the supposedly absolutely essential thyroid. This view coincides with that of Lanz (Boston Med. and I. ur 11,1 17. '95 , Ito saw in 14-4, ty,o 01111,011ent Ca tiSt'S : I ) I sit if g frim absorption of putrid mil. 2 a specific effect of the rt g An I lit, utt gl in Jour. of Exper.
p. 1.17. '9S) after a careful review t'te litt rat ure and a series of experi - no tr.:los that tlw symptoms of in fts roidisin are manifestations of into‘ication resulting, from the in decomposed thyroid material. 1 he so tall( d experimental thyroidism is t. lie contends. specific for tlie thyroid r the ingestion of many sub st ani s rived from animal tissues tlit r than the thyroid g,land may pro diwe an intoxication strikingly similar in &wiry respect to that of experimental tbyroidisin.
'While the toxic effects noted might furnish some ground for Cunningham's lett s. he will find it difficult to explain how this decomposed thyroid material can. administered therapeutically, cause the disappearance of morbid conditions an.I all the symptoms attending myx itileina. CHARLES E. DE M. SAJotls.] In all cast.s in which the diagnosis of ii,vx,Judema was unmistakable, and in the thyroid. or what remained ,,f it, was histologically examined, its fineti‘ iv- were found markedly compro mi.7ed 1,y local morbid processes of vari los kinds. Adami, in a study of the 1.terature of the subject, ascertained that in the majority of cases the atrophy was "pi.culiarly extensive, the specific cells of the gland being replaced by fibrous t1S ^11.".- some, less advanced, there were n-t ( nly degenerated remains of vesicular epithelium, "but of vesicles which by the s%ii-(rabi,nelant proliferation of their epi tl el'urn would seem to be undergoing a pompensatory hypertrophy,"—an effort t,, restore a function exemplified in other directions.
Case of a woman, 20 years old. who had thickening of the skin. falling of hair, atrophy of the thyroid gland and other organs peculiar to mmedenta.
hile simultaneously there was a very rapid pulse, difficult breathing, exoph thalmos, and the sweating peculiar to exoplithalmie goitre. The typical symp toms of both diseases being present, the thyroid theory of the origin of myx °Aetna seems to be unlikely. Jolly (Jour. Amer. Med. Assoc., Apr. 15, '99).
Among the disorders to which atrophy of the thyroid have been traced, accord ing to Combe, are acute articular rheu matism (IIadden), erysipelas (Mendel), syphilis (Koehler, Pospieloff), and ac tinomycosis (Koehler). To this list may be added malignant neoplasms, several instances of which have been recorded.
Acute inflammation of the thyroid may induce infantile myxcedema, followed in turn by more or less complete atrophy of the gland. It is therefore probable that a certain proportion of myxoedema in the adult could be traced to this cause.
Myxcedema is a symptom or combina tion of symptoms of loss of the function of the thyroid gland. in the idiopathic form it is a symptotn of eltronic inter stitial thyroiditis, just as anasarea may be a symptom of renal disease or ascites of hepatic disease. G. R. Murray (Brit. Med. Jour., Feb. 8, '96).
[It is possible that the thyroid en largement reported as preceding myx cedema in some cases would be found to have been dne to a thyroiditis occurring in arthritic individuals. As stated under ETIOLOGY, a. proportion ot cases of myx (edema show an ancestral histOry of rheUmatism, asthma, etc., and other manifestations of arthritism. CHARLES