CRETINISM.
The indications for treatment are identical with those of myxcedema, and the sooner thyroid feeding is commenced the better as regards both the mental and physical development of the child. There is some difficulty in determining the correct dose, but any case may be commenced in the infant with a dose daily of i min. of the liquor or gr. of the dry gland; if much increase of pulse-rate, or if the loss of weight becomes very marked, the dose may be lessened. The thyroid may be increased in any case till the low temperature conies up to the normal and keeps there, and till the body weight comes to and remains normal; generally speaking, 5 mins. daily or i gr. of the extract need not be exceeded.
Improvement may be effected even in cretins of twenty years of age; growth to the extent of 6 inches in height in a year has been observed. 'the dry skin desquainatcs, and the new skin retains its moistness, and in a few months the features become altered; their thick, coarse texture changes, and they become sharp, and the expression lively and pleasant.
The improvement in the mental condition is equally surprising as the cretin gradually rises to a higher moral, intellectual, and physical level, but it is too much to expect that the mental development will proceed equally with the physical when the remedy has not been commenced till the child has already reached the age of puberty. The thyroid feeding must be continued all through life, and Murray calculates that i dr. of the old B.P. liquor or io grs. of the dry powder are sufficient for the weekly intake of thyroid in adult individuals to supply the absence of the normal gland; these doses should he evenly spread over the days of the week.