The radiogram of the hand shows all these facts in unique perfection. At the age of five or even ten years it presents the same findings as the hand of the new-born, corresponding to a backwardness in the skeletal development equal to that of an infant one year old (Fig. 122).
The tubular as well as the flat bones are thick and clumsy in advancing age and of great weight, owing to a genuine osteoselerosis as a sequel to undisturbed calcification in the presence of diminished physiological metabolism.
Abundance of lime, dense spongiosa, quiescent, narrow epiphyseal cartilage, absence of osteoid margins, distinguish the bone in thyreo aphisia from the lime-depleted, spongy bone, with exaggerated asteoid margins and considerably thickened epiphyseal cartilage, in raehitis. The primary fetal cartilaginous proliferations and ehanges, the premature synostoses of chondrotlystrophia or micromelia, never occur in thyreo aplasia, which, from arrest of skeletal development from infancy, is again distinguished from mongoloid idiocy, which not infrequently exhibits retarded, but also premature development of skeletal formation.
Dentition always suffers. The first teeth are delayed and rarely appear in the first year of life; usually not until after the twentieth month. They come isolated, in great intervals and quite irregular sequence, and are usually very small or inconstant and not infrequently undergo rapid decay from caries.
The second dentition is also much delayed and may not appear until the thirteenth year of age. A second complete set of teeth occurring at the normal period has been as little observed as a first set in thyreo aplasia. Occasioirally the second teeth certainly break through, part of the first set persisting, but often enough the first set has been lost for a long time before the second commences to appear in the third decade.
After these explanations it is clear that physical growth is consider ably interfered with in every- case.
I have had a patient who at the age of two and one-half years measured only 50 cm., Curling one of 631 cm. at the age of ten, and Tel ford Smith one measuring only- 75 cm. at the age of sixteen.
The static functions suffer correspondingly.
The considerable, though painless, articular relaxation, deficient development of the epiphyses, absent intellect, and consequently totally insufficient, muscular cotirdination prevent patients from walking for a considerable time. This does often not occur until late, although some
can walk with considerable imperfection at the age of five to eight. In the first years of life, however, and in the severe cases lasting until the third decade, there is inability to stand or even sit without support, the head itself not being properly balanced.
The mucous membranes participate in the myxcedernatous changes, as is shown by the tongue, the malar mucosa and the rough voice. The mucous membranes of the oral cavity- and tongue are thickened, the latter being already exceedingly enlarged from the abundant myxce dematous connective tissue between the muscular bundles. The tonsils are hypertrophie, the gums narrow, the tongue protrudes from the unshapely lips, respiration is grunting and snorting, the voice rough, unpleasant and unarticulated. The conjunctiva palpebrarurn is almost permanently and often obstinately inflamed. It is an undecided ques tion whether a mucosa! change is also a factor in constipation which is never absent in consequence of the' refusal to take solid food owing to the conditions of the oral cavity and teeth, and also in consequence of the weak abdominal muscles and the considerably distended stomach. The nasal mucosa. is likewise often involved and the scat of obstinate rhinitis. Pharyngitis granulosa is regularly present.
The blood-forming organs functionate badly, there is great pallor and the complexion is usually of a sallow hue. The Inemoglobin content is low, there are numerous forms of erythrocytes of varying ages, and the polynuelear leucocytes are increased.
The temperature, when accurately' measured, is usually found to be somewhat below normal, and perhaps this is the rule. Accordingly patients constantly have a sensation of cold.
There is no perspiration whatever even in the hottest summer, the skin is always dry, flabby and cool, easily desquamates, especially so at the cheeks, and wrinkles will often form at certain parts of the body, notably at the hands and feet, such as are normally only observed in the most advanced age.