SPORADIC CRETINISM 123 



of the median rudiment of the thyroid gland, analogous indifferent rests with 

 traces of thyroid-gland tissue, which not infrequently give occasion to tumor 

 formation. The cases described affect children who have reached the elev- 

 enth year of life at most. The girls were far in the majority; they were all 

 well developed at birth. Only in the second half of the first year of life 

 did there gradually occur a standstill in the development. Among the 

 numerous cases of sporadic cretinism described in the literature a large 

 number certainly belong to thyroaplasia. Diederle counts, among others, also 

 the two cases of Kocher and the known case of Bourneville (Pacha de Bicetre) . 

 Also two cases of Magnus -Levy belong to this group. The above-mentioned 

 case of Bourneville attained an age of thirty-six years. As I have said be- 

 fore, I would rather not take up the question whether pure cases of thyro- 

 aplasia can reach so old an age, especially if they have not been previously 

 treated. In any case it is established that also in complete absence of the 

 thyroid gland, life and a certain degree of development is possible. 



Symptomatology. I shall now describe the clinical picture of sporadic 

 cretinism without regard to the etiology of special cases. We must in every 

 respect consider that only those cases which show the fully developed clinical 

 picture can belong to the thyroaplastic form, while in the incomplete forms 

 there is only a relative insufficiency of the thyroid function which must have 

 begun later in life. 



I would like to describe three cases of sporadic cretinism that Herr Hofrat 

 Wagner v. Janeregg kindly allowed me to examine. 



Observation XIV. Margerete H., two and one-half years. Entered the psychiatric 

 clinic (of Wagner) Nov. 4, 1909. Father has a goiter, avowedly from blowing the bugle- 

 horn. Otherwise no goiter in the family. Her mother's mother was insane. Parents 

 have never been away from Vienna. A five-year-old child of the parents is entirely 

 normal. The birth of the patient was normal; she was nursed by the mother until 

 the end of the second year. From birth lusty and lively; large, well developed; from 

 the eighth month on the parents first remarked that the child did not take on more 

 weight and since that time has remained at a standstill. The child has had an umbilical 

 hernia since birth. It has never spoken. 



Height 62 cm. 



Circumference of skull, 42 cm. 



Breadth of shoulders, 45 cm. 



Circumference of breast, 45 cm. 



Pulse, 1 20. 



Rectal temperature, 36. 



Panniculus adiposus soft, lax; myxedematous texture of the skin; walking and stand- 

 ing impossible. Forehead arched forward, root of the nose somewhat sunken in; no teeth 

 as yet. Eyelids enormously swollen, tongue thick, abdomen markedly arched forward; 

 umbilical hernia. Body weight 7.1 kg. From Dec. 2, 1909, on, thyroidin tablet every 

 third day. 



Nov. 10, 1910. 71 cm. long, weighs 9.1 kg. Treatment discontinued. 



Entrance into the first medical clinic on Oct. 15. Can only stand when it holds fast 

 on a support, cannot speak, is, however, otherwise lively and busies itself. All fontanelles 

 closed. 



