. Diseases of children. mentaland physical exertions are difficult. The habits are uncleanly, andthe disposition is usually pleasant, but may be vicious. The tem-perature is subnormal. The appetite is good but there is apt to be adislike for meat. Constipation is usually met w^th, is obstinate, and 512 DISEASES OF THE DUCTLESS GLANDS may persist for a long time. Blood examination reveals an anemiawith marked diminution in red cells and hemoglobin. The thyroidgland is not palpable. The arrest in mental and physical developmentvaries according to the age at which the deficiency of thyroid secret
. Diseases of children. mentaland physical exertions are difficult. The habits are uncleanly, andthe disposition is usually pleasant, but may be vicious. The tem-perature is subnormal. The appetite is good but there is apt to be adislike for meat. Constipation is usually met w^th, is obstinate, and 512 DISEASES OF THE DUCTLESS GLANDS may persist for a long time. Blood examination reveals an anemiawith marked diminution in red cells and hemoglobin. The thyroidgland is not palpable. The arrest in mental and physical developmentvaries according to the age at which the deficiency of thyroid secretionbecame effective. Diagnosis.—The diagnosis of a typical case, well advanced, is easilymade, but early diagnosis, which is so extremely important, may bevery difficult in infancy. The coarse, dry skin, short stubby extremities,subnormal temperature, and slow mental responses form a combina-tion which points strongly to cretinism. It must be differentiatedfrom rachitis, Mongolian idiocy, achondroplasia, and Fig. 49.—A cretin, eighteen years old. Rickets.—The mentality in rickets is normal, and the characteristicbony changes are easily demonstrated by the skiagraph. Dwarfism.—Even if associated with idioc}, dwarfism may bedifferentiated by the absence of the facial expression of the cretinand the skin changes. The body of the dwarf shows symmetry, whichthe cretin lacks. Mongolian Idiocy.—Mongolian idiots present the characteristicslanting eyes, but lack the peculiar faces of the cretin. The bodyis more symmetrical, and instead of the apathy of the cretin unduerestlessness is the rule. CRETINISM 513 Achrondroplasla.—This disease may be differentiated from cretinismby the fairly well-developed intellect, and the more marked shortnessof the extremities. The size of the thyroid gland may be of service inclearing up a puzzling case, and a trial administration of thyroidextract will show definitely whether cretinism be present or not. Prognosis.—The prognosis
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