He does not draw any real distinction between cretinism and myxcedema, but divides cretins, in respect to their intel ligence, into the following three orders, beginning with the lowest order—the pure idiot: 1. Cretins. 2. Alieretins. 3. Cretinoid state.
1. The cretin proper is rhomme-plante (Roeseh); his sense of smell and taste is but little developed, and the sense of touch is much diminished; such cretins arc apt to die young of epilepsy or car diac weakness, but may live to be 70 or SO years old. They lead a purely vegetative life.
2. Micretins are on the intellectual' level of a chimpanzee, because the ani mal can do all that a micretin can. He is "Phomme-animal." (Boesch.) 3. The cretinoid state is simply char acterized by a retardation of intelligence, by a certain difficulty in comprehension, by a heaviness of mind; it corresponds to the abortive type of atrophic myxce dema.
Such classification may be helpful up to a certain point, but the classes cannot be kept rigidly distinct, the border-line between either two being invisible. WILLI OsLEn.] As in any other disease three orders may be recognized: (1) the very severe, (2) the less severe, and (3) the aborted, so to speak; they should not be rated, but shall all be classed under one main head and recognized as belonging to one entity. In no one case of cretin
ism shall we find all the possible symp toms present, and no two cases will ex actly resemble one another; but from the symptoms present we can say whether the case is a severe one or not.
[If the two classifications are carefully studied it will be seen that there is no essential difference between them; a pa tient with congenital myxcedema is a cretin: the mieretin is described by the condition of precocious infantile myxcc dema, and the eretinoid state is that of abortive, or "fruste," myxwdema. WILL IAM OSLER.] Differential Diagnosis. — Cretinism must be distinguished from achondro plasia: i.e., foetal or congenital rickets, idiocy, and infantilism or dwarfism; also lipomatosis universalis, and hydrminie anaemia.
[Koplik (N. Y. Med. Jour., vol. lxvi, No. JO), following the lead of Horsley and Barlow, believes that "sporadic cre tinism or infantile or congenital myxw derna should now also include those con genital cases formerly reported as con genital rickets." WILLIAM OSLER and BITPERT Nonvox.]