The changes which have been noted produce a striking facial appearance, not to be mistaken when the disease is advanced. This is well seen in Plate II. The disease lasts for many years, and death usually is due to the occur rence of some low type of bronchitis, pneu monia, or influenza.
Treatment is now very successfully conducted by the use of fresh thyroid glands, or thyroid extract or tabloids, but should he under medical supervision. Plate II. shows the remarkable change such treatment may produce in a short time in all the symptoms.
Cretinism is a form of idiocy associated with a peculiar condition of the body. It is mentioned here because it is associated with goitre, and seems to be due to the same cause. Cretins are usually affected with goitre, and are numerous in districts where goitre prevails. Moreover, cretinous children are usually the offspring of goitrous parents. Cretins are ill grown and stunted, with swollen bellies. The skin is coarse, head large, flat at the top and expanded at the side, the nose sunken and flattened at the bridge, the lips thick, chin pro truding, mouth wide and gaping, the tongue large. The countenance is dull and heavy ; there is general muscular weakness and slow ness of sensibility. Associated with these are feebleness or want of intellect, and sometimes deafness and dumbness, perhaps squinting and blindness.
Treatment of cretins is more moral than any thing else. Careful training may do much for
them, along with good food, cleanliness, exer cise, &c. The disease does not appear to be hereditary, and goitrous people who have re moved from the tainted district do not beget cretinous children. It also appears that cretins who have removed from the district where goitre prevails, and live in a healthy place, may beget children free from both goitre and cretinism.
Cretins are liable occasionally to violent out. bursts of temper, which, however, proper train ing and moral control can do much to prevent. As a rule, however, they are quiet and harmless. An establishment for the care of cretins has been founded at Abendberg, near Interlaken, in Switzerland, by Dr. GuggenbUld.
Treatment by thyroid feeding has frequently yielded remarkable results. It must be directed by a physician.
Acromegaly is another disease associated with a blood gland, and first fully identified by a French physician, Marie, in 1885. It seems related to the pituitary gland, as myxoedema is to the thyroid, being associated with changes in that gland due to disease.
The chief symptoms are great enlargement of the hands and feet, hence the name applied to the disease, which means large extremities. The bones as well as the soft parts are en larged, and the soft enlargement is not dropsi cal, for it does not pit on pressure. The hands become spade-shaped.