Case of a child who presented a typ ically cretinoid appearance when first seen in February, 1S90, then 5 years old. Mentally deficient. Given one 5-grain tabloid of thyroid extract (Burroughs, Wellcome & Co.) daily, which raised the temperature to 102° F.; dose reduced to one-half. Gradual improvement. Weight fell at first to twenty pounds, and then slowly increased, the cretinoid aspect disappeared, and the intelligence steadily improved. Continued to take smaller quantities of the extract, and has de veloped into a healthy child, weighing thirty-seven pounds, and measuring thirty-seven and one-half inches in height. No thyroid gland could be de tected on palpation. W. Carr (Brit. Med. Jour., Nov. 13, '97).
Probably cretins never develop phys ically so as to become the equals of nor mal children of their own age, but they are no longer dwarfs. This development of stature is the single permanent gain of treatment, since there is relapse of all the other features of cretinism if treat ment is not persisted in. The change of the myxcedematous state of the skin is as remarkable as that of growth; the wrinkles disappear, also the oedema, and from being harsh, dry, and scaly, it be comes soft, moist, and smooth. The hair also shows great improvement, it grows normally where it had been lacking be fore, and becomes fine and thick, sup planting the coarse, thin hair character istic of cretinism.
It is the brain, however, which, as the more delicate organ, suffers most in this condition; it responds more slowly than the body to the effects of treatment, and seldom if ever recovers a normal tone. Children who have suffered from cretin ism are not so intelligent, as a rule, as other healthy children. As Koplik (N. Y. Med. J our., vol. lxvi, No. 10) says: "Though the thyroid treatment rescues these unfortunates from a state of per petual idiocy, it does not restore fully the psychical state, which has become dwarfed for a greater or less period be fore the therapy was initiated. Though bright, the children are not the equals of children of normal condition of their own age, but are very slow in appropri ating ideas and in perfecting their speech-vocabulary." However, there are exceptions to this rule, and where the degree of cretinism is not marked, where the body seems to be more affected than the brain, children may be quite as in telligent and bright as those unaffected.
There are a few cases reported where, though the physical symptoms were very much ameliorated, yet there was almost no improvement in the mental condition.
[Such cases have been reported by d'Andrea and Pieraccini. It is probable that in such instances there is a bad neurotic family history, or that the children themselves, before the onset of cretinism, have suffered from some neu rosis (for example, convulsions, epilepsy, etc.). WILLIAM OSLER and RUPERT NORTON.] Effect of thyroid treatment is In creased metabolism, shown by (1) eleva tion of temperature; (2) increased ap petite, with more complete absorption of nitrogenous foods; (3) loss of weight, with nitrogen excreted in excess of that taken in the food; (4) growth of skele ton in the very young; (5) marked im provements in body-nutrition generally; (6) increased activity of mucous mem branes, skin, and kidneys. The rheu matic symptoms and the anmmia arc not only not relieved, but are most fre quently aggravated. G. N. Crary (St. Louis Med. and Surg. Jour., July, '95).
[Increase of anmrnia and aggravation of rheumatic symptoms observed in case of goitre complicated with rheumatism in which thyroid tablets were given. The tablets were discontinued and salic ylates and iron substituted with good effect. C. S. WITHERSTINE, Assoc. Ed., Annual, '96.] Without treatment cretins may live to an advanced old age, even to 70 or SO years, though death is more common be tween the second and third decade or fore 35. They are liable to very slight ailments, and usually die of some current affection, since cretinism seldom of itself causes death. We know of no difference as regards prognosis whether the child has a goitre, or shows atrophy or absence of the thyroid gland. In some cases even the goitre itself may be cured. Combe (Revue Med. de la Suisse Romande, Anno xvii, Nos. 2 to 6) says: "Goitres may be cured by thyroid treat ment; the younger the patient, the more efficacious is the treatment. Cystic goitres arc not amenable, nor old colloid ones where there is much new growth of connective tissue, with a colloid de generation of the vascular walls and in terstitial tissue." The remedy is a powerful one, and, where used carelessly, a dangerous one; patients have been killed by injudicious use of the thyroid gland.