vary according to the organs primarily and chiefly affected; the condition could not be expected to follow a simple and predictable pattern. Myxoedema In 1873, Sir William Gull delivered a paper alongside his Anorexia nervosa work in which he demonstrated that the cause of myxoedema is atrophy of the thyroid gland. This paper, titled "On a cretinoid state supervening in adult life in women" was to be the better known of the two for many years. The background to Gull's work was research performed by Claude Bernard in 1855 around the concept of the Milieu intérieur and subsequently by Moritz Schiff in Bern in 1859, and who showed that thyroidectomy in dogs invariably proved fatal; Schiff later showed that grafts or injections of thyroid reversed the symptoms in both thyroidectomised animals and humans. He thought the thyroid liberated some important substance into the blood. Three years earlier, Charles Hilton Fagge, also of Guy's Hospital, had produced a paper on 'sporadic cretinism'. Gull's paper related the symptoms and changed appearance of a Miss B: After the cessation of the catamenial period, became insensibly more and more languid, with general increase of bulk ... Her face altering from oval to round ... the tongue broad and thick, voice guttural, and the pronunciation as if the tongue were too large for the mouth (cretinoid) ... In the cretinoid condition in adults which I have seen, the thyroid was not enlarged ... There had been a distinct change in the mental state. The mind, which had previously been active and inquisitive, assumed a gentle, placid indifference, corresponding to the muscular languor, but the intellect was unimpaired ... The change in the skin is remarkable. The texture being peculiarly smooth and fine, and the complexion fair, at a first hasty glance there might be supposed to be a general slight oedema of it ... The beautiful delicate rose-purple tint on the cheek is entirely different from what one sees in the bloated face of renal anasarca. A few years later, in 1888, this condition would be named myxoedema by W. M. Ord. Spinal Cord and Paraplegia Paraplegia is a condition usually resulting from injury to the spinal cord. This was a long-term interest of Gull's dating back at least to his three Goulstonian lectures of 1848, titled On the nervous system, Paraplegia and Cervical paraplegia – hemiplegia. Gull divided paraplegia into three groups: spinal, peripheral,