. The thyroid gland in health and disease. of the lower limbs (fig. 61), or they maybe widely separated (fig. 62). The patient exhibits a completeor partial inability to stand upright. When supported on hisfeet he usually rests on his toes (fig. 57), and the knees may be I Since my original account of nervous cretinism was published in 1908 [4],reports of similar cases have appeared from time to time in the literature, indicatingthat the condition is to be found in England as well as in the Himalayas.—R. McC. 141 142 ENDEMIC CRETINISM close together or actually crossed, or the lower extremitie
. The thyroid gland in health and disease. of the lower limbs (fig. 61), or they maybe widely separated (fig. 62). The patient exhibits a completeor partial inability to stand upright. When supported on hisfeet he usually rests on his toes (fig. 57), and the knees may be I Since my original account of nervous cretinism was published in 1908 [4],reports of similar cases have appeared from time to time in the literature, indicatingthat the condition is to be found in England as well as in the Himalayas.—R. McC. 141 142 ENDEMIC CRETINISM close together or actually crossed, or the lower extremities mayremain in a position of rigid extension. There is an increasedknee-jerk and there may be marked flexion of the toes on the those cases in which the cretins are capable of walking thereis a peculiar stiffness of gait, and they may walk on their toes ;as each foot reaches the ground there is a certain amount of give at the knees and ankles, which produces a sort ofbobbing motion. There is sometimes flat-foot. The upper limbs. Fig. 61.— Nervous cretins with slight myxcBclematous symptoms, swelling offace, of the wrists and ankles, and in the armpits. The right-hand figure is thatreferred to in the text. A section of his thyroid gland is shown in fig. 64. assume a position of right-angled flexion ; the thumb may bedrawn into the palm and the fingers closed over it, whilst thewrist is flexed. Spasmodic movements of the upper limbs arecommon. These are features characteristic of tetany. Thespastic rigidity is always worse in the lower limbs. The head maybe turned slowly from side to side, and in several of the worstcases I have seen, grimaces occurred. The face is character-istically cretinoid. The degree of swelling varies considerably—itmay be marked or slight, and confined to the face, hands, wrists NERVOUS CRETINISM 143 and ankles. The abdomen is, as a rule, swollen and is always considerable stunting in growth, which may beextreme or relative
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