Causes of Cretinism.—­This may exist at birth (congenital) or it may develop at puberty, and is due to the absence or loss of function of the thyroid gland.  Sporadic (here and there) cretinism may follow an acute infectious disease or it may be congenital.  Myxoedema may be hereditary and is most common in women.

Symptoms, (a) Cretinism.—­Mental and bodily development is slow.  There is extraordinary disproportion between the different parts of the body.  The condition is sometimes not recognized until the child is six or seven years old, then the slow development is noticed.  The tongue looks large and hangs out of the mouth.  The hair may be thin, the skin very dry.  Usually by the end of the first year and during the second year the signs of the cretinism become very marked and should be recognized.  The face looks large, looks bloated, the eyelids are puffy and swollen, the nose is flat and depressed and thick.  Teething is late, and the teeth that do appear decay.  The fontanelles are open.  The abdomen is swollen, the legs are short and thick, the hands and feet are not developed and look pudgy.  The face is pale and has a waxy, sallow tint.  The muscles are weak and the child cannot support itself.  Above the collar bone there are pads of fat.  The child does not develop mentally and there may be one of the grades of idiocy and imbecility (feeble-minded).

[Blood and ductless glands 261]

(b) Myxoedema, proper—­The skin is infiltrated, causing loss of the lines of the facial expression, skin is dry and harsh, much thickened, especially in the region above the collar bone.  The face is broad, with coarse features, the nose is broad and thick, the mouth is large, lips thick, hair scanty and coarse, slowness of motion and thought, weak memory, irritability, headache, suspiciousness, followed sometimes by hallucinations, delusion and dementia (insane).  The disease may progress for ten or fifteen years.  Death may occur early.

Operative type.—­This rarely develops except the thyroid glands have been entirely removed and then only if no extra glands are present.

Symptoms.—­Are the same as that of cretinism.

Treatment.—­An even, warm climate.  Thyroid extract, to be given by a physician, is the remedy.  After the recovery occasional small doses still may be necessary for some, or in cretinism for life.

DISEASES OF THE NERVOUS SYSTEM.

Neuralgia.—­Pain occurring in the course of the nerves and in their area of distribution.  The pain has remission and intermissions, and is due to some morbid affection of the nerves of sensation or their spinal or (brain) centers.