The limbs are short and stunted; so that the thick skin lies in folds on the arms and legs and on the face (forehead) as well. The hands and feet are unde veloped, pudgy, and look like those of a pachyderm; fingers and toes are immo bile, with a tendency to stand apart, as a result of the morbid condition of the 'skin. The nails are short, brittle, often striated, either longitudinally or ver tically; they lack the normal glossy ap pearance. The child is distinctly pale, although there may be some suffusion of the cheeks. The fontanelles remain patent long beyond the normal term. All the muscles of the body are weak; the child cannot support itself, and the overlarge head droops forward, so that the chin may rest on the chest. Goitre, which is common in the endemic form, is only occasionally seen in the sporadic cases, though usually the thyroid gland cannot be palpated. In the supraclav icular regions large masses of fat are sometimes seen, which with the thick, wrinkled skin may form a sort of collar; so that the head seems to be supported, as artificially done in high cervical caries, with a Thomas collar.
The mental condition of the child is as ill developed as the physical; the patient is apathetic, sits about with apparently no interest in any person, not even recog nizing his parents or objects about him. If the child attempts to walk, the move ments are slow; there is more or less in co-ordination, owing to the general paresis of the muscles; but there is no paralysis; the deep reflexes are present but commonly weak. The face is im mobile, there is dullness of expression and action; the child makes no attempts to walk, talk, read or write, and does not answer questions readily.
The child exhibits no desires except, perhaps, for food, and manifests its hun ger or thirst by inarticulate cries. There is often a distaste for meat, but the ap petite may be voracious. Constipation is usually present. Abnormal sensations are not common, and there is usually retardation in the sense of pain; head ache is not complained of. The cretin is usually good tempered and does not cry. The child has to be fed with a spoon and almost altogether with fluid or semifluid food, for the mucous mem branes from the mouth to the rectum are apt to be swelled; these undergo changes similar to those of the skin.
Memory is deficient, and speech is slow, thick, and hoarse. Although idiots, their idiocy is not such as one sees in cerebellar sclerosis: they have no tics, no epileptoid movements; they do not make faces; do not grit their teeth, and do not masturbate. Infants and young children, as in so many other affections, often suffer from convulsions, but these are in no way pathognomonic.
There is no sweating, and no secretion from the sebaceous glands, but there is constant drooling from the wide-open mouth, and there is a secretion of tears. Their temperature is invariably subnor mal, and they are always anaemic. They suffer from cold and are subject to sores and ulcers, which do not heal readily. The genital organs are also involved, and show signs of lack of development; the testes and ovaries are small and atro phied. Girls may, however, menstruate, and this profusely, and there is occasion ally a tendency to severe hemorrhage from the uterus, or in both sexes from the nose and gums. The heart, lungs, liver, spleen, and other abdominal organs do not appear to be involved; the kid neys act naturally, though the amount of urine passed. and the percentage of urea and uric acid excreted, may be a little less than normal; a trace of albumin and hyaline casts have been noted in some cases, but these are not persistent and point to no radical organic alterations in the kidneys, but the brain, skin, mu cous membranes and bones are invariably affected, usually all of them in about equal degree, though in many cases the body is apparently more diseased than the brain, at any rate as far as can be judged from a study of the mental facul ties.
[Combe (Revue Mesd. de la Suisse Romande, Anuo xvii, Nos. 2 to 6) divides myxcedema in children into three classes, which may be easily recognized by spe cial groupings of the symptoms noted above: 1. Congenital myxcedema with com plete nanism and absolute idiocy.
2. (a) Precocious infantile myxcedema with incomplete nanism and imbecility, the child showing some rays of intelli gence. (b) Late infantile myxcedema: merely a backward child, neither idiot nor imbecile, but the intelligence merely less developed than in other children of same age.
3. Abortive ("I rmqe") myxcedema, where there is nanism, swelling of in teguments, cyanosis, and coldness of limbs, but mobility is preserved, intelli gence is almost normal, and there is very slight cachexia.
The same author says further on: from a clinical point of view or a pathological one these two diseases (myxcedematous idiocy and congenital myxcedema) ought to be united, the one resembling myxcedematous troubles in the formed subject—myxcedema of the adult; the other representing the same symptoms in the as-yet-undeveloped or ganism of the child—congenital or in fantile myxcedema." In this statement we fully concur.