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NELSON W. JANNEY 



faces. The complexion is pasty or grey. Their low intelligence is shown 

 bv their learning to sit, creep, stand and walk at a late age or not at all. 

 Hearing and sight may be defective, speech hoarse and slowly learned, 

 being often restricted to a few expressions of the simplest needs. 



The head is usually small and round and covered with scanty brittle 

 hair; the face is pale; the eyelashes and eyebrows scanty or absent. 

 The small eyes glare forth with an angry expression from between the 



Fig. 4. Cretinic Feet. Note 

 stubbiness and space between great 

 and second toe. Compare Illustra- 

 tion 1. (Courtesy of Drs. Lewellys 

 Barker and II. I. Goldstein.) 



Fig. 5. Hypothyroidism in a girl of 10 

 years. Notice Hertoghe's eyebrow sign, 

 myxedematous swollen eyelids, saddle nose and 

 spade-like hands. (Courtesy of Drs. Lewellys 

 Barker and H. I. Goldstein.) 



puffy lids. The ears are large, flaring, and the lobes often fused to the 

 head. Deafness is common. The nose and face is small and retracted, 

 as it were, under the protuberant forehead through the underdevelopment 

 of the base of the skull. The nose is small, of the saddle type, with large 

 open upturned nostrils from which nasal secretion issues. The cheeks 

 may show myxedematous swelling. The malar prominences are quite 

 marked. The mouth is large, lips thick and coarse and druelling saliva. 

 From the open mouth protrudes the large tongue. It is furrowed, tooth- 

 marked, and besprinkled with hypertrophied papillae. The chin is re- 

 ceding and often double through underdevelopment of the mandible and 



