. The thyroid gland in health and disease. rvations, to find in thehistories of these cases some etiological reason for dissociatingthe obvious cretinoid condition from the no less obvious nervoussymptoms. I have not been able to find that cretins of this typeare more frequent among the small class in whom the onset of the 144 ENDEMIC CRETINISM cretinism is coincident with some accident or trauma. Nor hasa history of prolonged labour, of infectious diseases, of convulsionsor of any other affections of childhood afforded any grounds forthe dissociation of the nervous from the cretinoid symptoms
. The thyroid gland in health and disease. rvations, to find in thehistories of these cases some etiological reason for dissociatingthe obvious cretinoid condition from the no less obvious nervoussymptoms. I have not been able to find that cretins of this typeare more frequent among the small class in whom the onset of the 144 ENDEMIC CRETINISM cretinism is coincident with some accident or trauma. Nor hasa history of prolonged labour, of infectious diseases, of convulsionsor of any other affections of childhood afforded any grounds forthe dissociation of the nervous from the cretinoid factors which give rise to the nervous symptoms are ante-natal in their action ; and I believe that this type of the disease,like the myxoedematous, is due to the congenital defect of thethyroid mechanism. The symptoms which are characteristic of nervous cretinism are very similar to those which occur in animals afterthe complete removal of the thyroid and parathyroid , as these symptoms are described by Murray, they are. Fig. 63.—Nervous cretinism. Case is of mixed type and shows markedmyxoedematous as well as nervous symptoms. practically identical—a fact which affords some ground for thebelief which I have expressed. I have, however, obtained resultsin three cases by means of the therapeutic test of thyroid feeding,and by detailed post-mortem examination of the glands in afourth, which to my mind amount to actual proof that the nervoussymptoms are due to defect of the whole thyroid apparatus. Without giving full details of these cases, it may be said thatthe administration of the fresh and dried extracts of sheeps thy-roid produced a striking improvement in the nervous spasm disappeared; in one case (fig. 62) the double internalstrabismus, with the associated coarse nystagmus, almost entirely NERVOUS CRETINISM 145 disappeared. Another—a child (fig. 63) who could only rise toits feet by means of a support, and who could take but a fewstumb
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