IDIOCY. — Children suffering from idiocy, when not due to disturbance of the thyroid function, do not suffer, as a rule, from retardation of physical growth. Their heads are apt to be smaller, much smaller than those of cre tins, except in cases of hydrocephaly, and the fontanelles and sutures have usually closed prematurely. Here, again, the lack of any alteration in the skin would be almost enough to distinguish the two diseases at first sight. But from the type known as the Mongol idiot the marks of distinction are not so readily recognized.
[The Mongol type of idiot resembles the cretin more closely than any other. Telford Smith, in speaking of this form, says: "Idiots belonging to the so-called Mongol type are those who most nearly resemble the cretin, both in physical aspect and in mental character. In idiots of this type we get the stunted growth, the dull, heavy expression, with open mouth and thick lips; the slow, deliberate movement, and hoarse, gut tural. and monosyllabic speech; the mental apathy, and lack of spontaneity; the sluggish circulation, and sensitive ness to cold. A thickened condition of subcutaneous tissue is often found, with dull cutaneous sensibility. The skin is coarse and dry, the hair short and thin. First and second dentition are delayed. As far as palpation enables one to judge, the thyroid gland is subnormal in size. Pseudolipomata I have not found." He has tried the effect of thyroid extract with some benefit, but there is not the same remarkable change as in the cre tins. I cannot altogether concur with Dr. Telford Smith's statement as to the slow, deliberate movements and mental apathy of Mongolian idiots. It was a form in which Dr. Kerlin, of Elwyn, was particularly interested, and with him I had many opportunities of seeing cases. They rather impressed me as vivacious, often very sprightly and mis chievous. In no instance was there any condition of the subcutaneous tissues suggestive of myxmdema. WILLIAM OSLE11.1 To distinguish infantilism from cre tinism is in many instances extremely difficult, and there is much confusion in the papers on this subject.
[Brissaud (Nouvelle Icon. de la Anno x, No. 4, pp. 240-262) believes that infantilism is nothing more nor less than myxmdematous idiocy, and that the differences in degree of fantilism result from two conditions versely associated: (1) the intensity of the atrophic thyroid lesion; (2) the age at which the suppression of the thyroid function produced arrest of development. Tie says "many cases of infantilism should better be called cases of plasia'; they have nothing to do with disturbances of the thyroid. Such are the eases first described by Lorain; they are not eases of arrest of development, but rather arrest of growth as a partial result of premature epiphyseal tion; there is nothing infantile about them, except the figure; these are eases of small adults." Or, in other words, fantilism is a "morphological syndrome characterized by the preservation in the adult of the exterior form of infancy with the non-appearance of the secondary sexual characters" (Osier, Trans. gress Amer. Phys. and Surge., vol. iv, '97). There arc many cases reported (Wunderlich, Brit. Med. Jou•., ii, 1420, '97; Dukes, Brit. Sled. Jour i, 618, '9S; and others) where the symptoms of tinism or myxmdema are almost gether lacking, and where the evidences of infantilism exist, but which improve markedly under thyroid treatment, thus showing that they should be classed as eases of cretinism, and not infantilism. It is such cases as these which have led to the confusion on the subject; but in future the differential diagnosis will be made readily if in no other way than by the effects of thyroid treatment; for undoubtedly a condition of infantilism does exist, non-dependent on the condi tion of the thyroid gland. WILLIAM OSLER.] Lipomatosis universalis is a form of partial idiocy, with enormous fat accu mulation; growth is not stunted, and the condition of the skin is quite differ ent from that of cretinism.