754 THE ENDOCRINE ORGANS, OR DUCTLESS GLANDS 



and puffy. (4) An abnormal development of the connective tissues 

 causing a shapeless condition of the surface; the abdomen is always 

 swollen, the hands and feet are shapeless, and the nose depressed. (5) 

 The nervous system also fails to develop properly, so that at the age of 

 puberty or over, the child remains like an infant in his mental behavior, 

 idiotism being common. Indeed, the whole clinical picture is so char- 

 acteristic that once having seen a case no one can fail afterward to 



Fig. 194. Cretin, nineteen years old. The treatment with thyroid extract started too late to be ot 

 benefit. (Patient of Dr. S. J. Webster.) 



recognize the disease. Besides being due to congenital absence of the 

 thyroid (sporadic type), cretinism may also occur as a result of goitrous 

 degeneration of the gland. This forms the so-called endemic variety of 

 the disease, and is more commonly seen in goitrous districts, being not 

 infrequently associated with disease of the parathyroid, in which case 

 the nervous symptoms are very prominent. 

 Atrophy of the thyroid in adults causes the clinical condition known 



