INFANTILE MYXEDEMA (CRE- ' TINISM).
Definition.—Cretinism is a chronic disease of nutrition due to loss of, or im pairment of, function of the thyroid gland, and appears at any time between birth and puberty; after puberty it is known as myxcedema. It causes retar dation of development in the sensory, motor, and trophic nervous systems, leading to a retention of an infantile state, and to an extraordinary dispro portion between the different parts of the body—the brain, bones, skin, mu cous membranes, and generative organs suffering most.
Symptoms of cretinism are to be ex plained as the result of the myxmdema • tous process in the undeveloped tissues of an infant. A scientific application of the principles of heredity by such methods as have been used iu such sub jects as deaf-mutism, idiocy, and other nervous diseases will demonstrate simi lar relations and yield similar results in cretinism. William B. Noyes (N. Y. Med. Jour., Mar. 14, '96).
Symptoms. — These depend to a greater or less extent on the length of time the disease has lasted, and the age at which the affection has developed, but mainly on the degree of involvement of the functions of the thyroid gland. Girls are more often affected than boys, though the difference in proportion is not very large, but the symptoms, aside from the sexual organs, are in both sexes the same, and are characteristic in every pronounced ease. The disease may vary much in intensity, but even in the less marked cases diagnosis is seldom difficult, when all the symptoms of ab normal development are carefully sought and studied. Cretinism differs from most other diseases in that it is to be recognized by signs rather than by symp toms; the most prominent alterations concern the surface of the body, and are thus readily visible; so that the over sight of a case by a physician familiar with the disease is nearly impossible. When the disease has commenced a t birth or very early in infancy, it is sel dom recognized before the child is six months old, although it has been diag nosed as early as the sixth week. It may, however, develop in Idero. After the sixth month the symptoms begin f o 1)( come prominent; it is noticed 11;,,, child does not grow as rapidly a- ii should, that it is not as t ! as is usual, that its tongue is for its mouth, and lolls out hete he teeth. The tongue may be sp ,•1•_, as
to impede respiration when • lies on the back, and pieces of 1.11, an have even been excised through - diagnosis.
On further examination it is ,,,,• the skin all over the bndv o.• ing soft, and of normal swelled, dry, and scaly. \ ? only to the slightest degree, i po on pressure; it lacks the n look of oedema due to renal disea-e. In a very exceptional ease reported by rah, the oedema was not but affected certain parts alone of tile The desquamat ion may he furfo raceous, like that of measles, or it may more closely resendile that of scarier fever. The hair is apt to he thin anui coarse, and in olibir children may be lacking in parts \Shen` it i al e found under normal conditions, as in the ax Him and on the pubes. Even in infants it will be noticed that the eyebrows eyelashes are very scant, and perhaps al together lacking.
Thick hair has been noticed in some cases, but this is certainly exceptional. The face has a false look of old and sometimes has a distinct toad-like aspect. The eyelids are puffy and swelled, leaving but a narrow slit through which the eyes can be seen. The nose is depressed between the eyes, and the alm nasi are thick, thus making it seem still more flat, from the external width of the nostrils. The ears also suf fer from the same thickening, and stand out from the head. The lower lip, partly due to the lolling tongue, is everted and swelled. The teeth, if there are any, are irregular, ragged, and decayed; the second teeth often do not appear at all, or are much delayed in coming through, and are then, like the first, diseased, and of abnormal shape and size, although there is nothing distinctively character istic in their form. The abdomen is swelled, and there is often an umbilical hernia, though this is seldom of large size. The back is arched and there may be more or less curvature of the spine.