. The thyroid gland in health and disease. ristic 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 relatively slight. The patients mentality is muchdisordered
. The thyroid gland in health and disease. ristic 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 relatively slight. The patients mentality is muchdisordered ; there appears to be a loss of sensibility in the skin ;puberty is delayed and the sexual organs are ill-developed. Ahistory of convulsive seizures has in a few instances been obtained;a coarse nystagmus and internal strabismus have been notedin some cases. All degrees of this condition are seen, from aspastic paralysis of the lower limbs to a general rigidity ; in short,the condition is one of cretinous idiocy with associated cerebral. Fig. 62.—Cretin aged 10 years in whom nervous symptoms were very pronounced. diplegia and tetany. Fig. 57 affords a good illustration of thisclass of case. The subject is aged 24, is about 3| ft. in height,is obviously myxoedematous, and presents practically everyfeature of the type which I have just detailed. His sister is atypical myxoedematous cretin and she is very swollen. I have sought, in the course of my observations, 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
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