WILLIAM OSLER and Rm'ERT NORTON.] Of other pathological conditions found in cretinism we know little or nothing.
At an autopsy on a 6-month-old child who had died suddenly, having shown during life some evidences of myxcedema, the site of the thyroid gland was found occupied by some small, gland-like bodies, while at the root of the tongue there was a body which on microscopical ex amination was seen to be composed of epithelial space containing colloid ma terial, and which had probably had a vicarious thyroid function. Asehoff (Deut. med. Woch., p. 263, '99).
Thyroidin on infantalism and arrested growth. The normal hypertrophy of the thyroid gland at puberty antedates the development of the sexual organs. The thyroid secretion is increased in virtue of this hypertrophy, and the surplus is used for the growth of the genital appa ratus, of which it is only a corollary. The initial cause of infantilism is dys thyroid in nature, and complete myx cedema is the extreme degree of thyroid degeneration. Hertoghe (Gaz. des Mal. Infant., vol. ii, No. 7, 1900).
Prognosis.—This has entirely changed since the introduction of the thyroid treatment; previous to this discovery little could be done to improve the tinoid condition. To-day the outlook for cretins, more especially the sporadic cases, is bright; as regards the endemic cretins we cannot entertain such a ful view, though the chances of their improvement are much greater than they were. Cretinism is never of itself a fatal disease.
Treatment.—The use of the thyroid gland in one form or another has tionized the treatment of cretinism. Be fore this discovery we could do but little to improve the condition of patients fering from this disease; pilocarpine seemed to be of some service through its action as a sudorific, and a mild winter climate also helped in slight degree to keep the patients from going down hill as fast as they otherwise might.
In the thyroid gland there seems to have been found a specific, and no other remedy appears necessary with which to treat the disease. The remedy, though a specific, is not all-powerful, since the permanency of its action depends on its constant use. Even with its use we can not promise a cure in any given case, for unless treatment be continued indefi nitely a relapse will surely occur. The
treatment seems to be of more avail in sporadic than in endemic cretinism; but this is not an established fact, and it seems probable that if treatment is begun as early as possible in cases of endemic cretinism we may hope for the same good results as are seen in children with sporadic cretinism. But to attain this mothers with goitre or those who have given birth to cretins or other de generates should take the thyroid treat ment during pregnancy. One satisfac tory result of treatment is "that one thing appears to be proved by our obser vations, which corresponds to the findings of other observers, and which is not only theoretically interesting and practically important, but also consoling for the pa tient, and that is that under no condi tions will the disease (which has been treated with thyroid, and then treatment stopped) develop again in its primary in tensity." (Foerster, Dent. med. Woch., Nos. 12, 13, and 16, '97.) The later in life the condition of cre tinism develops, the greater is the prob ability of almost perfect mental recovery under treatment, since mental degener acy is never so prominent in adults as in children; the adult does not become an idiot as the child does from cretin ism; whereas if the condition has de veloped early in life and been left un treated, the chance of normal mental development is seriously diminished. In both instances the return to a normal physical state is almost certain, as the body-symptoms react sooner to treat ment, and they are the first to recur if treatment is interrupted.
The increase in height and the im provement in the condition of the skin under thyroid treatment are the two features which make the prognosis so favorable. Children show a most as tonishing rapidity of growth during the first months or a year of treatment—a gain of eight inches in a year has been seen, and in a number of cases the in crease was an inch or more a month for several consecutive months. After hav ing thus attained a nearly normal stat ure, growth proceeds gradually, as in healthy children.