. The thyroid gland in health and disease. n the Mother during Pregnancy.—Theseare the determining factors in as large a proportion of cases as20 per cent. The illnesses most commonly met v/ith are tetany (initself a sign of thyro-parathyroid defect), rheumatism, rheumatoidarthritis, malaria, and, less commonly, painful eye diseases andabscesses, but any of those mentioned previously (p. 47) mayact in this way. The following wdll serve as illustrative cases :— No. 177.—A goitrous mother suffered from rheumatism whileshe was pregnant Avith her second child. This child is cretinous 132 ENDEMIC C
. The thyroid gland in health and disease. n the Mother during Pregnancy.—Theseare the determining factors in as large a proportion of cases as20 per cent. The illnesses most commonly met v/ith are tetany (initself a sign of thyro-parathyroid defect), rheumatism, rheumatoidarthritis, malaria, and, less commonly, painful eye diseases andabscesses, but any of those mentioned previously (p. 47) mayact in this way. The following wdll serve as illustrative cases :— No. 177.—A goitrous mother suffered from rheumatism whileshe was pregnant Avith her second child. This child is cretinous 132 ENDEMIC CRETINISM to a very severe degree; it is non-goitrous. The first and thirdchildren are healthy. The fourth child is dead. No. 164.—The mother, a goitrous woman, developed severe bron-chitis before her sixth child was born. Her first five children arenormal. Her sixth is a cretin (fig. 58). No. 161.—The mother had a severe abscess of the jaw duringher third pregnancy. Her first two children are healthy. Herthird child is a Fig. 58.—Myxoedematous cretin. Aged 24. Height, 3 ft. 6 in. I believe that illnesses in the mother during pregngncy are ofmore frequent occurrence than I have noted ; it was not until Ihad collected seventy-eight cases of the disease that a fewhistories of such illnesses, which had been voluntarily offered,drew my attention to them. IV. Nutritional Factors.—The influence of these is verygreat. Their action may be ante-natal or post-natal. Thethyroid resources of sub-thyroidic children are often furtherimpaired by malnutrition and by such factors as cold andexposure. Cretinism, especially the nervous type of the disease,is much more common amongst the very poor of endemic areas. TYPES OF CRETINISM 133 V. Prolonged or Difficult Labour.—These may exert adetermining influence in a smsll proportion of cases (10 to 14per cent.). Such a history is common in association with other predis-posing factors, whether psychic, nutritional or infectiou
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