_Class of 1900, Macon, Mo._
Karl B. is the son of sturdy parents, both of whom were born and reared
in the Swiss Tyrol. He had never developed like the other children—was,
in fact, much smaller at five and a half years than the
fourteen-months-old baby. He was dull, placid, taking no note of his
surroundings, sitting or lying just where he was left, and never evinced
any disposition to play or converse with the other children. I saw this
child on the 4th day of January, 1908, in a purely accidental manner.
The parents had been told by their attendant that the child had either
rickets or was an idiot, and they in consequence had kept the child in
the background for two or three years, being very much chagrined and
mortified at the prospect of bearing through life the burden of hopeless
idiocy. The child had such classical symptoms of cretinism that I asked
permission of the family to treat him for awhile, though it required
some persuasion, because of the fact that they felt it was time and
money wasted. On the 5th day of January, 1908, the child was five years
and a half old, twenty-eight inches in height, circumference of chest
twenty-one, abdomen twenty-three. He was given one and one-half grains
of thyroid extract twice daily, the dose being gradually increased until
he showed signs of irritability, with accelerated pulse. The child's
extremities soon warmed up, the circulation became better, the hair
began to grow, the child for the first time in its life walked and
talked, began to take note of surroundings and to play with the other
children.
Just one year after the beginning of the treatment—January 5, 1909—the
child was thirty-five and three-quarter inches in height, chest
twenty-three, abdomen twenty-three.
This disease, sometimes known as cretinoid or myxoedematous idiocy, was
first described by Fagg in 1871. Since then a number of cases have been
published, both in England, on the Continent and in America, showing
that the disease is not confined to any one country. While the disease
is comparatively rare, cretins are more common than was formerly
supposed. The disease seems to be in reality a pachydermatous cachexia,
and it is now, I believe, well established that it is caused by
congenital absence of the thyroid gland or to the presence of something
which abolishes its functions. Little is known as to the causes of its
destruction or abolishment of function. As a rule only one case occurs
in a family, the other members presenting nothing abnormal in their
mental or physical development, hence the term sporadic. It has been
more frequently reported in the Tyrol, in Switzerland, a coincidence
which makes this child's case all the more interesting, in that both its
parents are physically and mentally well up to par and the other
children possess even more than the average intelligence.
_Symptoms_—The symptoms are practically identical with those of the
myxoedema which follows the removal of the thyroid gland in adults. The
symptoms of cretinism in most cases in infants make their appearance
during the first year, occasionally, however, not until the child is
three or four years of age. The appearance of the cretin is very
striking, and so characteristic that when once seen the disease can
hardly fail to be recognized. The child is much dwarfed, the fingers and
toes are short and stumpy, the cutaneous tissues seem to be thick and
boggy, but do not pit on pressure, as in ordinary oedema. The facies is
extremely characteristic. The head seems large for the body, the
fontanel is open until the eighth or tenth year, the forehead is low and
the base of the nose broad, so that the eyes seem unusually wide apart.
The lips are thick, the mouth half open and the tongue protrudes
slightly, the cheeks are baggy and the hair is coarse, short and
straight, and the skin has the peculiar leathery feel of elephant skin.
The abdomen is pendulous, large, streaked with prominent veins, and
reminds one of rickets. The skin is dry, the voice husky and rough.
There is but one word which describes the peculiar clumsy manner of
walking—that word is waddle. The child actually waddles like a duck. The
temperature is always subnormal, and one of the things the mother will
always call to your attention is the fact that the child has such cold
hands and feet and requires so much more cover than the other children.
Cretins are dull, placid and good natured, never quarrelsome.
_Treatment_—There is no tendency toward spontaneous improvement. These
cases have until the last few years been considered hopeless and
condemned to a life of idiocy. Really, in the treatment of cretinism in
the adult marvelous results have been got from the administration of the
dried and dessicated extract of the thyroid gland of the sheep. This has
led to its use in the myxoedema of infancy. The results are astounding.
The child grows mentally and physically, takes note of surroundings to
which it formerly paid no attention whatever, and can be taught almost
as well as a perfectly normal child. In all cases the thyroid extract
must be kept up indefinitely, the dose being gradually increased,
otherwise the improvement ceases at once.