Nervous and mental diseases . s rounded andshowing jelly-like trembling on slight jarring. The whole appear-ance is one of hebetude and stupidity. The skin of the trunk andextremities is likewise infiltrated. In the axillae and subclaviculardepressions lipomatous-like masses are often encountered. The hands TROPHONEUROSES. 495 and feet are enlarged with cushion-like swellings on their dorsal surfaces;the digits are thick and clumsy. The scrotum is often much thick-ened. The epidermal structures are greatly affected. The skin is dry,harsh, and branny. The hair becomes dry and scanty on all port
Nervous and mental diseases . s rounded andshowing jelly-like trembling on slight jarring. The whole appear-ance is one of hebetude and stupidity. The skin of the trunk andextremities is likewise infiltrated. In the axillae and subclaviculardepressions lipomatous-like masses are often encountered. The hands TROPHONEUROSES. 495 and feet are enlarged with cushion-like swellings on their dorsal surfaces;the digits are thick and clumsy. The scrotum is often much thick-ened. The epidermal structures are greatly affected. The skin is dry,harsh, and branny. The hair becomes dry and scanty on all portionsof the head and body. The nails are dry, fragile, striated, and sebaceous secretions are defective. The mucous mem-branes, wherever visible, are tumefied, pale, dry, and elastic. Mucouspolypi in the nasopharynx are not uncommon. The tongue is thickenedand, with the infiltrated condition of the buccal, pharyngeal, and laryn-geal mucous membranes, explains the muffled voice and difficulty Fig. 217.—A case of myxedema before and after two(Dr. John Woodmau). iths treatment by thyroids The intellectual state in myxedema is uniformly marked by apatheticenfeeblement, and cerebral torpor shows itself in sluggish mentation,defective memory, slow speech, and lethargic movements. Myxedemicpatients are usually indolent both mentally and physically, and areirritable and somnolent. Some cases show nocturnal insomnia and aretroubled bv disturbing dreams. The sluggishness of movement andthe clumsiness of the hands and feet are due to the cerebral torpor andthe local thickenings. These patients have no muscular energy and arepromptly fatigued on the slightest continuous effort, but there is nopalsy. The thyroid in the great majority of eases can not be detected bypalpation. There may be a history of its former presence or actualenlargement, and even a goitrous condition may persist. In some in- 496 NEUE0SE8. stances exophthalmic goiter has preceded myx
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