with difficulty that she can be recognized as the same person. The swollen, pallid, stupid face is gone, and in its place are red cheeks and the pleasant expression of a healthy woman. She can walk several miles a day, sleep well, has a good appetite, and enjoys life.
Such is the history of myxœdema and how it came to be treated by the thyroid gland of animals. Therapeutics can show no more brilliant results than these.
When myxœedema occurs in infancy or childhood it is called cretinism. The word "cretin" will recall to the minds of most of my readers visits to Switzerland or to the eastern parts of France, where these queer little dwarfs are so common. Goitre is also, curiously enough, frequent in these localities. But few are aware that we, here in America, possess cretins of our own. In the cretinous regions of Europe, where so many of the inhabitants are afflicted with the disease, it is called endemic or peculiar to the country. In America it occurs only occasionally, and not with any geographical regularity, and so such cretins are called sporadic. Now, sporadic cretinism with us is certainly a rare affection; but as the condition becomes more familiar to physicians, and as the inmates of our own idiot asylums are more carefully examined, it is possible that it will be found that cretinism, like myxœdema, is less rare than had been suspected.
The absence or disease of the thyroid gland produces much the same symptoms in the child as in the adult; the most striking difference is due to the fact that in the child development of the body and brain is interfered with, so that cretins are generally dwarfs, and the failure of mental development results in a condition closely allied to idiocy. These idiotic dwarfs are very repulsive to look at. They have large heads and necks and thick lips, through which protrudes the clumsy tongue. They have few or no teeth, and the swelling of the throat renders the voice indistinct. The nose is large and flat, and the swollen eyelids partly cover eyes which are frequently crossed. The limbs are swollen and often incapable of service; the skin which covers them is hard, rough, and thick. Cretins are always short, and may never grow taller than a normal child of two or three years. They never attain a high degree of intelligence, and most commonly are idiots with only the power to comprehend the simplest things of daily life, and with a vocabulary limited to a few words.
There are some differences between endemic and sporadic cretinism, and what follows applies only to sporadic cretins.
What has been said concerning the treatment of myxœdema by thyroid feeding may be repeated for sporadic cretinism. The changes which result from the thyroid treatment of cretins.
