30 



The Endocrine Organs 



remain open. The muscles are limp and weak. Deaf -mutism is common. 



Fig. 18. — Myxoedema of child (A) before and (B) after treatment with thyroid. 

 ( Byrom Bramwell. ) 



The highest functions of the nervous system remain undeveloped, the 



child becoming idiotic: this seems to 

 be due to an arrested development of 

 cells of the cortex cerebri. 



The above combination of symptoms 

 forms the condition known as cretinism. 

 This may be either sporadic or endemic. 

 The former is generally associated with 

 absence or early atrophy of the thyroid ; 

 the latter with goitrous degeneration. 

 Of endemic cretinism, according to 

 M'Carrison, there are in the Himalayan 

 valleys two types, the myxcedematous 

 and the nervous : the latter is presum- 

 ably associated with changes in the 

 parathyroids ; whilst in the former the 

 parathyroids are unaltered. This is 

 the type chiefly met with in Europe 

 (fig. 19). 



The symptoms do not show them- 

 selves until some little while after 

 birth, in spite of the absence of a thyroid. The absence appears to be 

 compensated, for a time at any rate, by autacoids conveyed from the 



Fig. 19. — Photograph of a case of endemic 

 cretinism. (E. Bircher.) The character- 

 istic depression of the root of the nose 

 is well seen. 



